Childhood Eating Disorders Blog

I’m just back from a great conference, which I’ll be telling you more about. But first let me tell you about Jane Fonda’s keynote speech. Fonda brought many eating disorder professionals, including me, to tears with the story of her recovery from an eating disorder during her keynote presentation at the Renfrew Center Foundation Conference for Professionals last week in Philadelphia.

At times reading from her candid 2006 memoir My Life So Far, Fonda told us that as a school girl she had learned to binge/purge from a friend in boarding school. The reason she kept on bingeing and purging, she said, was the belief that she had to be perfect and thin to be loved by her father. She pointed out that she didn’t think her father meant to cause her harm but that generations of Fonda men had openly preferred really thin women. Jane’s open, non-apologetic description of how she fell into a life dominated by an eating disorder was heart wrenching.

Fonda ended up suffering for over 30 years with a “half-crippling” eating disorder that became a “real addiction.” She compared her periods of anorexia as being a “dry drunk,” meaning that she wasn’t bingeing or purging but she had all the other aspects of an eating disorder. She finally realized that she was either going to die — maybe not physically because she hadn’t needed to be hospitalized, but spiritually– if she did not stop her eating disordered behaviors cold turkey. She later did counseling, noting that it is much harder for adults to recover from eating disorders than teenagers. She reminded her audience that as hard as recovery is to achieve, it is accompanied by profound growth.

When asked by an audience member about Hollywood’s contribution to eating disorder, Fonda said that she felt that the media’s scrutiny of the bodies of female celebrities contributes to eating disorders among women and young girls.

Marcia Herrin and Nancy Matsumoto, authors of The Parent’s Guide to Eating Disorders, 2007

Dear Readers,

                Since one of us grew up there, we feel we have the right to say that California is a strange place. It’s on the cutting edge when it comes to environmental and energy issues, and is the hotbed of the so-called liberal elite. But it is also the state that elected both Ronald Reagan and Arnold Schwarzenegger, and just passed a ballot proposition reversing the legality of same-sex marriage. The latest salvo in the food and nutrition wars also comes from the kooky left-coast state, in the form of the outlawing of the school bake sale.

                In the recent New York Times article, Bake Sales Fall Victim to Push for Healthier Foods, Patricia Leigh Brown reports that the school bake sale is “fast becoming obsolete” as a result of strict nutrition standards governing public schools that restrict the percentages of sugar, fat and saturated fat in foods sold on campus during the school day. California may have started this trend by passing this strict nutrition law in 2005 and putting it into effect in July 2007, but nationwide, more and more school districts are adopting similar nutrition standards, some even tougher than California’s.

                The movement, of course, is fueled by concern over obesity rates in America. As we have noted in our post, Should College Dining Halls Post Calorie Counts?, the goals of well-intentioned anti-obesity crusaders can sometimes conflict with those of people suffering from eating disorders. This is especially clear in the Times’s account of an Oakland, CA elementary school teacher who taught her students about “good foods” versus “bad foods,” and offered them healthy snacks.

                We’re all for healthy snacks, but telling kids that they shouldn’t eat certain foods makes these foods more enticing to some and makes others kids feel guilty for enjoying these foods. A very good predictor of risk for developing an eating disorder, in fact, is when one begins to categorize foods as “good” and “bad.” We need to teach kids to enjoy balanced meals including dessert and moderately sized snacks. It’s consuming too many calories that causes obesity, not eating so-called “bad” foods.

Demonizing and banning certain foods, we fear, will lead to an increase in both eating disorders and obesity.

                Labeling foods as “good” or “healthy,” may seem pretty benign, but it can be as harmful as demonizing foods containing high percentages of sugar or saturated fat.  We have seen kids who feel that as long as a food is good for them they can eat unlimited quantities, a practice that can result in a variety of physiological problems, including bulimia, binge eating disorder and obesity.

                The bottom line: these schools are making a big mistake by banning bake sales and preaching the gospel of good versus bad foods.  Several recent studies even suggest that schools may not play as big of a role in the way kids eat as most people believe. Check out this recent New York Times story, Are Schools Really to Blame for Poor Eating?  to read more about these studies, which seem to indicate that no matter what the school’s nutrition policies, the biggest unwanted weight gain among students occurs during the summer, when school is not in session. Hear that, parents?

Take care,

Marcia and Nancy

The holidays are nearly here again, and for families where over- or undereating is an issue, these food-oriented festivities, which kick off with Thanksgiving, can be fraught. Here, we offer a few tips on how to handle this challenging time of year. They are applicable to families dealing with an eating disorder or for anyone who wants to eat healthily during the holidays

·         Try making your family’s holiday traditions more about relationships and activities than about food.

·         Don’t skip meals or plan to undereat or diet the day following a family holiday.

·         Do what you can to keep the variety of dishes reasonable and minimize food that is left out for grabbing and snacking.

·         Talk to other family members in advance about not pushing food or commenting on diets, calories, or weight loss. Even too much emphasis on trying to make healthy choices at holiday meals can add to the stress.

·         It is particularly important if your child is recovering from a serious eating disorder to have pre-warned family members about the kind of talk and attention that is appropriate. I suggest that parents develop a kind of code or signal that tells family members or other guests, “change the subject, and fast!”

·          Because meal schedules may be altered and more snack foods and desserts are served during the holidays, it’s important that parents of an eating-disordered child be extra-solicitous and vigilant. If circumstances conspire to create a level of stress that interferes with your child’s recovery, you and your child should sit down and prioritize the extras in your lives. Remember that the first item on your list of important things to accomplish – even during the holidays — should be your child’s recovery.

My patient Jane’s treatment was in its early stages when she faced her first family Thanksgiving meal. As much as her parents wanted her to be able to fully participate in the traditional meal, it was clear that Jane was far from ready. Jane, her parents, and I decided that the best approach was to carefully plan in advance what Jane would eat, focusing on taking care of the basic food groups: protein, carbs, calcium, fat, veggies, and what we call “fun foods,” or treats eaten purely for enjoyment. We agreed that Jane could eat some turkey for protein, a slice of bread and butter for carbs and fat, a glass of milk, and green beans. We decided Jane could bring a fun food from home that felt “safe.”

Holiday meals can also be a time for progress. Sarah, a freshman in college and a patient of mine recovering from anorexia, is excited about participating fully in her family’s Thanksgiving for the first time in years. Sarah knows that her grandmother will start the family festivities by serving a traditional Italian meal in the early afternoon. A few hours later, out will come a full Thanksgiving meal with all the trimmings. Sarah knows that she needs to have her usual good breakfast, to think of the Italian meal as lunch and the traditional Thanksgiving meal as dinner. Sarah’s parents are ready to negotiate serving sizes and other choices if she needs help.

We hope that these tips will help you all enjoy the spirit, the meaning, the fun and the foods of the holiday season!

Marcia and Nancy

Dear Readers,

We recently received this comment from a reader, Karen F. Chambre:

“I am very interested in the mental health parity law. A law has already passed in California. A main problem is that some of the insurance companies have is they find loopholes and do not offer parity for parity diagnoses. Is this new law different?”

I’ve written about the mental health parity law a few times on this blog since the law includes eating disorders and has been a major focus of eating-disorder advocates. Here is an answer to Karen’s question and an update on the legislation.  I found this good document on the Web site of the Mental Health Association in California, which explains the impact that the new federal legislation will have in California. The new law won’t take effect until January 1, 2010. 

 A spokesperson for U.S. Rep. Patrick Kennedy’s (D-RI) office offered these further explanations on how the new mental health parity law will close loopholes found in the existing 1996 law:

·         The current law merely prohibits health plans from offering lower annual or lifetime benefits for mental health coverage than for physical health coverage.  Most plans get around this requirement by imposing additional treatment limits or cost-sharing (higher co-pays) for mental health care, both of which are allowed. The legislation just passed closes this massive loophole by no longer allowing most health plans that cover mental health to require patients to pay, say, 50% coinsurance for mental health outpatient services when other outpatient services require only 20% in cost sharing. Nor does the new law allow health plans to cap psychiatric inpatient stays at 30 days if they allow unlimited stays for treatment of other conditions.

·         While many states have parity laws on the books, ERISA (non-governmental pension and benefit) plans are not covered under these laws. The new federal legislation brings ERISA plans into the fold, vastly increasing the number of Americans the law applies to.

      ·          State mental health parity laws that are less stringent than the new federal parity law will be overridden      by the new law. 

If you would like to read a good summary of the bill, which was pushed through as part of the federal government’s notorious $700 billion bailout package, check out this page of the Bazelon Center for Mental Health Law’s site.

Take care,

Nancy

One of our readers, Shane, asked a great question about the difference between being an “abstinent” eating disorder sufferer and being fully recovered. Marcia responds, “This question reminds me of a college student I work with who has not had an episode of bingeing and purging for almost six months. She knows she isn’t recovered, though, because she still thinks obsessively of food and counts calories. She’s working with me so that she will be able to enjoy food without worry.”

            Harvard’s Dr. David Herzog has done the most work on defining what it means to be recovered from an eating disorder. He wrote a seminal academic paper in 1999 in which he defined recovery as a substantial enough improvement that the formerly eating-disordered person is able to lead a productive life without medical or psychiatric impairment. So if you at one time needed intensive counseling and/or occasional hospitalization and can now live a normal life with only occasional nutritional, medical or psychological support, you could be considered “recovered.”   

            For the anorexic this means maintaining a healthy weight, normal menstrual function, and much-reduced obsession with weight. For the bulimic, it means refraining from bingeing and purging. To answer Shane’s question directly, we would say that abstinence implies maintaining health and not engaging in eating-disordered behaviors, but holding on to the obsession with weight and other eating-disordered thoughts. In other words, you may still be obsessed with food, weight and have poor body image, but you don’t act on those thoughts and feelings.

            We hope this answers your question, Shane.

Take care,

Marcia and Nancy