Thursday, January 04, 2007

"Force-feeding" and anorexia

Recently I've been asked to speak about the Maudsley approach to healing anorexia on several radio shows. In every interview there is a question or comment about "force-feeding" anorexics, and it's always offered in a tone of mingled horror and contempt, as if there could be nothing worse than coercing someone into eating.

To which I usually respond something like, "Actually, there's nothing worse than watching someone compulsively starve herself to death."

Now an interesting paper published in the American Journal of Psychiatry takes on both the moral and legal issues around the idea of what the authors call coerced care for eating disorders. I love the analogy its author, Dr. Arnold Andersen, uses for how dieting can lead into anorexia: "The situation resembles that of a person boarding a canoe headed for Niagara Falls on a journey that begins voluntarily but ineluctably transforms into a nonvoluntary propulsion toward the Falls, with the person at times not recognizing that the upcoming Falls even exist."

That describes it so very well. Someone who is deep in anorexia cannot see the falls or even know they exist. They need the strong hand extended from the shore to pull them out of the current.

Far worse to watch the boat go merrily over the falls.

Tuesday, January 02, 2007

More on culture and eating disorders

A new study released by the University of Minnesota shows that teenagers who read lots of magazine articles about dieting are five times as likely to practice "extreme dieting measures"--including fasting and intentional vomiting--than teens who don't.

According to an article in the Chicago Tribune, Harvard Med School researcher Alison Field commented, "The articles may be offering advice such as cutting out trans fats and soda, and those are good ideas for everybody. But the underlying messages these articles send are, `You should be concerned about your weight and you should be doing something.'"

This study will come as no surprise to any parent of an eating-disordered child. It describes perfectly the nexus between culture and eating disorders, which is not black and white, either/or. Do magazine articles cause anorexia and bulimia? No, but they clearly, clearly play a role in triggering adolescents who are vulnerable.

And it's not just teen magazines, either. Not long ago on an online forum for parents who are re-feeding their anorexic children, someone started a thread on what triggered each child's descent into anorexia. I was shocked by how many parents mentioned a school health class. And in fact, a 6th-grade "health" class that focused on the dangers of obesity and the virtue of cutting out fats, carbs, and other "bad" foods was the catalyst that led to my own daughter's full-blown anorexia a year and a half later.

As parents, we're used to thinking about all sorts of potentially risky behaviors: drugs, early sexual behavior, alcohol, etc. Now we can add another one to the list.

Monday, January 01, 2007

And yet another Leaden Fork award goes to . . .

Reader's Digest, for its well-meaning but shamefully one-sided advice on how to avoid compulsive overeating. In fact, this could be a primer for how to induce an eating disorder.

Blog reader Deborah Lee brought this to my attention, and points out a couple of items on this top 10 list that really bugged her:

"3. Never, ever buy a snack at gas stations, drugstores, or discount chains.

4. Never, ever stop at a food store just to buy a snack."

Writes Lee, "While I understand the sentiment in these statements, and it may be sound advice in principle, this sort of black-and-white, all-or-nothing thinking is what eating disorders thrive on, and is completely unnecessary."

I'm with you on this, Deborah. Of course Reader's Digest is just one of many media outlets that get this way wrong. Especially in this season, when the default assumption is that we're all trying to lose weight and need "tips" like these. Open just about any women's magazine right now and you'll see headlines like "How to Stick to Your Diet,""Want to lose weight? Be sure not to skip breakfast," and a host of other ridiculous headlines.

I'm looking forward to a year that started without a lot of advice on how to lose weight--and focused instead on creating a healthy and joyful relationship with food, exercise, love, work, and all the other pleasures of being a human being.

How about it?