Childhood Eating Disorders Blog

Dear Readers,

A new study of eating disorders among high school students is getting alot of press. Researchers in a study (published in the International Journal of Eating Disorders this month, April 2008) found a small “clustering effect” in female students. This means that girls who live in the same county with girls who either starve, diet, over-exercise, binge, or use diet pills are 4 percent to 10 percent more likely to engage in eating disordered behaviors than if they lived in counties where these behaviors are rare.  These results are leading some to conclude that eating disorders are contagious.  I worry that too much focus on “contagion” could lead to isolation and discrimination against girls with serious eating disorders. 

Let’s not forget that it is well proven in a number of  studies that genetics are the strongest factor in causing eating disorders. I am not the first clinician to conclude that genetics “loads the gun;” family issues and social influences can “pull the trigger.”  

I suspect that this new study is picking up on girls who are experimenting with eating disordered behaviors because researchers did not look at how many girls in the study actually had clinically significant disorders. As risky as it can be to play around with eating disordered behaviors, most girls who experiment with these behaviors won’t develop an eating disorder unless they are genetically susceptible.

To test whether eating disorders are contagious, this week I asked each of my teenaged patients whether they “caught their eating disorder from someone else.” Each and everyone of them, said absolutely not! I’d like to share some of the points these girls made:

• “My eating disorder was caused by some really serious problems at home, not from peer pressure.”  • “My eating disorder was too personal to be a ‘group thing.’”  • “My school had strong cliques, I remember thinking that  being thin would make me more popular.”  • “I admired older girls in my school who had eating disorders, but they never talked about or shared what their ‘techniques’ were.”   • “I got my eating disorder really young and I still struggle in college. It was really hard for me when other parents would blame me for causing their kid’s eating disorder. I remember that I wasn’t allowed to play with some girls for fear that I would “infect them.” I also remember how sad this made me feel.”     The researchers of this new study argue that prevention and treatment efforts should be targeted not at individuals but at schools and other geographic communities. I urge us all to treat girls with eating disorders as individuals. Each of these girls has a personal story and their own particular pain. Each of them deserves individual attention and a treatment program tailored to their particular situation.Peace, Marcia 

Dear Readers,

This week has had interesting reports from Europe. First, France is considering legislation that would make promoting eating disorders a crime punishable by fines and imprisonment. Though it is hard to imagine how one could prove that this website or that diet caused an eating disorder, but nevertheless, it is a good sign that the French are beginning to take eating disorders seriously.

Today, I read that Britain’s former deputy prime minister has secretly struggled with bulimia for decades. What amazed me the most was how well this 69 year-old man described his bulimia. He said that his binge eating became a tactic for coping with stress from overwork. CNN at http://edition.cnn.com/2008/WORLD/europe/04/20/prescott.bulimia.ap/index.html quotes Mr. Prescott as saying “It became my main pleasure, having access to my comfort food. So what I did was stuff my face with anything around….there would be a weird kind of pleasure in vomiting and feeling relieved.”

Since eating disorders are as big of a problem in most of Western Europe as in the United States, it is a good sign when they are openly discussed by people involved in politics.

Peace, Marcia

Dear Readers,

I just finished a new book that many of you will want to know about, Unlocking the Mysteries of Eating Disorders: A Life-Saving Guide to Your Child’s Treatment and Recovery (McGraw Hill, 2008). It is written by David B. Herzog, M.D., a Harvard psychiatry professor and head of The Harris Center at Massachusetts General Hospital; Debra L. Franko, Ph.D., a Northeastern University psychology professor and Harris Center associate director, and Pat Cable, R.N., the Harris Center’s director of publications.

Marcia and I know Dr. Herzog to be one of the most compassionate and expert professionals in the eating disorders field. He and his colleagues have written an eminently sound guide. You hear the voices of lots of parents and their kids who are struggling with eating disorders, both boys and girls. I especially liked the section on setting up a treatment team for your child, which is broken down into important issues and questions that should be asked, as well as the section on the use of antidepressants in treating both bulimia and anorexia. 

One common denominator the authors find among their patients is the feeling, “I’m not good enough.” They note that eating-disordered kids come from a wide variety of backgrounds: some report idyllic and happy childhoods, some have a history of trauma or abuse. “The paths that lead to ‘I’m not good enough,’ differ from one person to another,” they write.

A good piece of advice is to counsel your perfectionistic child  to strive for “excellence, not perfection.” The authors explain, “Excellence is achievable; perfection isn’t.”There is also a very helpful section on how to appeal a denial of coverage from your insurance company.  

In short, this is a book well worth reading.

Take care,

Nancy

Last weekend, I received a call from Andrea, a former patient who is away at college. Andrea called me from a hospital emergency room in tears because a doctor had just told her that she didn’t look anorexic. Andrea had been rushed to the local hospital by her college health service because her heart function was abnormal. At the hospital, Andrea was asked about her medical history. She told them that she had several hospitalization for anorexia and that she has had similar heart problems whenever her weight drops below 140#. Andrea is 5′7″ and since Christmas has lost 10 pounds through severe dietary restriction and over exercise. Andrea called me because she knew she needed alot of support not to restrict her eating even more severely by falling into the trap of “I’ll show them who has anorexia.”  The good news is that Andrea’s heart scare jump-started her return to a healthy diet, but I’d like every professional to guard against making triggering statements like “You don’t look anorexic!”

Peace, Marcia

Dear Readers,

I just had a good exchange with Lily Cuadra from the Broward County, FL chapter of ANAD (National Association of Anorexia and Associated Disorders). ANAD is devoted to helping individuals and their families find eating disorders resources and provide referrals to professionals. There are over 350 ANAD-affiliated support groups through the U.S. and in 18 other countries, all of them free of charge.

I learned that for your group to represent ANAD, you need to find a professional sponsor. Lily joined up with two friends, one of whom was Nikki Kramer, a primary therapist at the Renfrew Center in Coconut Creek, FL. Nikki was able to serve as the group’s professional sponsor. Only 16 months after launching, their group has over 100 people on its mailing list, and anywhere from 12 to 20 people attend their bi-weekly meetings! It’s inspiring to hear about grassroots support groups like this springing up and bringing hope to people in the region who may not have had anywhere to turn to before. Good luck to you and your group, Lily!

Take care,

Nancy

This past February 2008, a new British website was launched which has  parents rightfully worried. Miss Bimbo.com lets young girls play a virtual fashion game using diet pills, dieting, breast implants, and plastic surgery to create the “hottest, coolest, most famous bimbo in the whole world.” Find out more @ http://edition.cnn.com/2008/WORLD/europe/03/25/miss.bimbo/

Peace, Marcia

Dear Readers,

In our book, Marcia and I discuss the importance of media literacy, and educating your children on how to be a critical consumer of mass media. I was reminded of what can happen to those who haven’t been given this kind of education recently when I attended a very good public forum on body image and fashion in Cambridge, MA.

Titled “Redefining Perfection: Beauty, Fashion and Body Image,” the forum was sponsored by The Harris Center, formerly known as The Harvard Eating Disorders Center (which is headed, incidentally, by the excellent Dr. David Herzog, whose new book I will write about next). Speakers included Kirsten Haglun, Miss America 2008; Paige Adams-Geller, a former Miss California and founder of Paige Premium Denim, and Bradley Bayou, former creative director for Halston, who now dresses Oprah, Halle Berry and Deborah Messing, among others.

All three panelists have personal ties to the issue of eating disorders. Haglund and Adams-Geller are both former anorexics. Haglund has made eating disorders education her “platform,” or main topic as she criss-crosses the country speaking. Adams-Geller, once an anorexic model and USC student who survived days on end eating only rice cakes, transformed herself into a successful “fit” model for jeans, then parlayed her expertise in jeans fitting into her own $100 million company. Paige Premium Denim makes the importance of maintaining a healthy body weight and healthy body image an integral part of its message. Bayou woke up to the issue of eating disorders when his own daughter was diagnosed with bulimia four years ago when she was 25.

Bayou recounted how the saddest day of his life was when he learned of his daughter’s diagnosis, and recalled how, as a child, she had tried so hard to fit into his own line’s sample sizes an an effort to get his attention. Then he launched into an attack on the fashion industry, especially fashion editors, for failing to take responsibility for the negative message they are sending to young Americans. By only publishing pictures of anorexic-looking models, said Bayou, they are setting the standards  by which top designers, models, and modeling agents have to live. 

Bayou also placed some blame on the CFDA (Council of Fashion Designers of America) for being “unwilling to stick its neck out” and legislate stricter rules against underweight models. Spain and Italy, Bayou noted, have both instituted such rules, and in those countries 30 percent of the models who worked the runways last year were too thin to work this year’s shows. 

Adams-Geller talked about how it was nearly impossible to get normal sized models for her denim fashion shows. She prefers models who are around size six (still hardly an accurate reflection of the average American woman) but no modeling agent represents models bigger than size 0 or 2.

The forum was a good reminder that since the fashion industry, including the fashion magazines that create consumer demand, are not changing their ways, it’s still up to parents and educators to teach children that the female (and male) “glamour” figures they see in magazines, movies, on tv and in music videos do not reflect reality. Instead, let’s teach our kids to look elsewhere for role models: to scientists, writers, activists, musicians, educators, or artists — people who are celebrated for what they do, not how they look. 

Take care,

Nancy

A new twist on anorexia is “Orthorexia,” a compulsive and obsessive preoccupation with healthy eating. Orthorexia is NOT an official diagnosis, but it is very similar and as life-threatening as anorexia nervosa.
Steven Bratman, MD is given credit for recognizing and coining Orthorexia Nervosa in his 2001 book, Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating. Having myself been a vegetarian and natural food purveyor, I recognized that Bratman was capturing a modern variant of anorexia. Health Food Junkies describes Bratman’s own near fatal experience with orthorexia. His obsession with healthy eating crowded out other activities and interests, impaired relationships, and became physically dangerous. People with orthorexia usually avoid fat, white sugar, white floor, and all processed food. They fast often and for extended periods. They may eat only raw foods, take many herbs and supplements, and eat too many fruits and vegetables. It is not surprising that often the orthorexic loses a dangerous amount of weight. At least several people have died of orthorexia in the past few years. See Bratman’s website  http://www.orthorexia.com/ for information. The real danger of orthorexia is that it  masquerades as healthy eating so that a developing eating disorder goes unnoticed.

Peace, Marcia