September 30, 2008

Carnival of Eating Disorders

Welcome to the 20th Carnival of Eating Disorders, generally ably hosted by Isabella Mori at Change Therapy. As I am a guest host, Isabella being the true Ringmaster, I shall happily take the role of Carnival Barker to announce the attractions!

Step right up ladies and gentlemen, and enter the tent.

To intrigue and draw you in, we present the question of whether eating disorders are chronic illnesses, courtesy of Dr. O’Toole at Kartini, and whether to use the term recovered or ‘in remission.’ Please do not fight in the aisles - it distresses the elephants..

For a balancing act to rival the great Chinese acrobats, Cowcakes describes what Intuitive Eating really is.

In the Haunted House attraction, the Coping With Life blog talks about research linking a history of child sexual abuse with bulimia (though not anorexia):

Taming the wild beast of modern food choices is the New Matilda, with whip and chair, in a review of the Michael Pollan book, “In Defense of food” in a post titled “The Simple Life is Not So Simple”.

Under the Big Top are three rings, and on the theme of circles we can announce the solo show: “Sitting In Circles With Rich White Girls: Memoirs Of A Bulimic Black Boy” brought to us by the Virtual World.

And now a spotlight on the next ring, where long overdue discussion of race and culture tries to tame the lions of both body image and racism at Amptoons.

Third ring: we examine closely the clowns, and then consider the models: where Carrie discusses some of the ongoing concern for models and their health and their effect on the audience. Shield your eyes if you are sensitive.

Isabella sends in Sister Meg Funk, with refreshments: “Eating too little or eating too much is equally harmful “ she asserts in an eponymous blog.

While William Bay works the strobe lights with a message on the Cyclical Nature of Fast Food and Depression at Fast Food Confessional.

On the fairway, don’t forget to stop by the house of mirrors for Female Body Image’s post on Eating Disorders, for no extra charge as the two are often a package deal. And a truly optimistic moment on Mirrors in the House.

You may notice we don’t have the usual Fat Lady on display at this carnival – but since we don’t label people by their weight we couldn’t find any. Nor will you hear any chiding of children for their bodies or food, because the management thinks yammering about weight doesn’t work and even in our Freak Show we can’t find evidence of an Obesity Epidemic.

We have decided, however, to keep in the sawing a man in half trick – but in this case we’re sawing the guy who decided to make Boy Scouts obsess on their weight. And we may not put him back together.

And if you seek a fortune teller, the future may be told in a hopeful light by Here and Now 4 Angel in her post title: Health and Happiness.

That’s the Carnival for September, and as we bring down the tent we remind you to read previous 2008 Carnivals: (September 1, July 31, May 31, February 29, and January 1) and check in again at Change Therapy for the next Carnival on October 31, and your entries are welcomed for that Carnival: Submit to the Carnival of Eating Disorders.

(Thank you, Isabella, for this opportunity to host the Carnival!)

September 29, 2008

The sound of silence

Carrie Arnold recently asked: "Seriously, when you don't engage in talk about food/weight/shape, what DO you talk about?"

And I really considered it. What if, starting right now, it simply was not an option to talk about food choices, weight, shape and appearance.

Well, a marvelous silence would blanket the land, certainly. There'd be a lot more eye contact, I think. The TV and radio channels would be silent much of the day and night without talk shows and news spots and commercials selling dieting and the necessity of altering our appearance. Parties would be odd for a while, but we'd adjust. Class reunions... well, no one would go any more because the whole point was to compare notes on aging and diets.

Mealtimes would be companionably silent for a while. The sounds of clinking and chewing and "mmmm" would eventually lead to conversations about other enjoyable things. Food would taste much better.

Supermarkets and food manufacturers would save lots of ink on "FAT FREE!" and "GUILTLESS" labelling. And since we wouldn't all be flailing each other with the virtues of one food over another we might lose the whole section of the supermarket devoted to Foods Replacing the Foods You Really Wanted.

School would be silent for a day, but kids adjust quickly: they'll find creative new ways to insult one another.

The Internet will go dead for a while, absolutely. Without dieting sites and sites staring at celebrities' bodies and fat jokes.... we'd have to go back to using the Internet for science or something.

September 28, 2008

Eighty-five per cent of what?

Setting target weight is, in my opinion, fundamental to eating disorder recovery. Set too low, it consigns a patient to permanent illness as the brain marinates in stress hormones and not enough nutrients. Set and not adjusted as height and maturity progress is a recipe for relapse. Set and not adjusted after patient is recovered and finds a metabolic level that is naturally maintained: a tightrope of torture. Set too high.... well, that never happens. (The irrational terror of an anorexic or bulimic about an average weight is only slightly greater than that of those around him or her - it is sad.)

Another issue is psychological: if you set a range, most people will choose the lowest number - even people without an eating disorder history. But the body has its own ideas: the body has its own natural metabolic rate and it healthily and beautifully changes over the day, over the month, over years. In our family we call that the boa constrictor effect: the illness cinches in more securely every time you exhale.

And after malnutrition we know that there is a natural progression of caution, then wild cravings, and up to a year of settling down to intuitive eating. Brain chemistry and metabolism take far longer to recover than simple body weight, but of course the body composition has to normalize first.

Most maddening, to me, is that we define the illness with the 'less than 85%' term but we have no real definition of RECOVERY. Of HEALTH. I wish we didn't settle for anything less than 100%, and I rail at the idea that those between 85.01% and 99.99% are 'not in danger.' That's ridiculous. That is exactly when most of the distress, and the bingeing and purging, require the most attention.

It is a myth that there is one common standard, a scientific way to set weight goals that everyone is using. "There is considerable variance across studies in the determination of the AN weight cut-off."

Eighty-five per cent of what?

"The citation of the 85% criterion creates a sense of false consensus."

If you want some better information, check out:

September 27, 2008

IEDs are everywhere

OK, this study is interesting on its own. But I have to marvel at the sad poetry of calling eating disorder patients "IEDs," an acronym more commonly used to mean Improvised Explosive Device. And indeed, anorexia and bulimia send emotional shrapnel in every direction, maiming and destroying without discrimination.

I guess we can make up acronyms as we please (especially when the Internet can help us figure them out). In a field where SCOFF and EAT help diagnose the illness, I guess we can expect both irony and poetry in the making of new terms. (I'm guessing in the original German this acronym was different.)

Back to the study, Are individuals with an eating disorder less sensitive to aesthetic flaws than healthy controls?, I think it is useful for parents to know that patients really do not see what the rest of us see - literally. And therefore their interpretation and actions are different as well. This is why logic and anger with our loved ones don't work and don't help. Just knowing that it isn't a matter of intelligence or will or vanity can help de-escalate our own reactions and fears. Recovery - FULL recovery - is of course the goal, but knowing where they are coming from can really help.

"CONCLUSION: IEDs are less capable of recognizing flaws in the appearance of others...Evaluating the appearance of others more positively in contrast to one's own appearance could lead to poor self-evaluation, thus reinforcing body dissatisfaction and contributing toward the maintenance of the disorder."

One More Bite

I am so very glad to point parents to a new blog, one with truly helpful and intelligent thinking on eating disorders. Dr. Joy Jacobs, a member of the F.E.A.S.T. Advisory Panel, is the author:

One More Bite

September 26, 2008

I guess they are pretty smart in the Ivy League

It is easy to find things to complain about, but so much more pleasant to sometimes enjoy the beating back of the tide of a-scientific hysteria:

Harvard removes calorie info, cites eating disorders

Let's eat. Let's let our bodies and a reconnection with pleasure and our appetites and satisfaction guide us instead of the numbers.

September 25, 2008

Two "must-see" videos

Hands down, the two best video clips on the current science in eating disorders, interviews with two of my favorite scientists done by Jane Cawley at Maudsley Parents:

Fighting Stigma with Science

Brain Imaging and Eating Disorders

September 24, 2008

A belated introduction...

It is time for a belated introduction. Of me... to me

Laura, meet Laura:

Laura Collins is my pseudonym, which I used to write my book in 2004. Laura Lyster-Mensh is the name I use in my daily life and the rest of my writing career. Collins is a family name of my dear grandmother. The reason for the pseudonym was to preserve my daughter's privacy as she grew up (she was 16 when I wrote the book).

As a very wise physician told me back then: "Don't make your daughter into a professional anorexic."

And as it turned out, this worked well. She got to grow up without a whole lot of scrutiny from strangers, and I was very healed by the ability to get out and fight in a very public way for better treatment and against the legacy of blaming families for eating disorders. She has always supported my work, even comes to ED events and has spoken publicly, but had little interest in getting more involved herself - her job has been being healthy, growing up and leading a life not held in place by a book and on TV.

But there have been unintended consequences. LC has become a one-note Sally without a real life. And LLM's real life has a peculiarly empty resume the past few years.

So, in concert with the theme of the recent NEDA conference, "Break the Silence," I begin the process of becoming one person again personally and professionally. Hello, me. Hello, you.

September 22, 2008

Yes, I am asking YOU, today, to call

OK, I know you read these type of messages and it is like Pledge Drive week - you figure someone else will do it. But really, this message is for YOU. I got blisters walking all over Congress actually visiting my Congresspeople. I wrote a letter to the editor at my local paper. All YOU have to do is pick up the phone. It really is simple, easy, feels great, low-fat (that's a JOKE, people). Please do it. Santa knows if you're naughty or nice and *I* will know it was you who didn't call if it doesn't pass. Because if you ALL did, it would pass.


Dear EDC and FAC members -

As we continue to move forward on parity with the goal of passing this historical legislation this session, we need your voice! The addiction and mental health parity bill, now named the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, will be considered in the House early this week under suspension of the rules. Democratic leadership hope to bring the bill up on Tuesday.

House leadership made the decision to move the bill forward separately in addition to the extenders package in the Senate out of fear that the extenders bill will get bogged down in partisan politics and thereby prevent parity from being enacted.


Use the toll-free Parity Hotline to Call your Representative:

1-866-parity4 (1-866-727-4894) to call their Members of Congress. (The Parity Hotline reaches the U.S. Capitol switchboard, which can connect callers to the offices of their members.) To determine your representative go to and put in your zip code.
Message: "I'm calling to ask that Representative X vote YES on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This legislation must pass before Congress adjourns."

If you need more information or assistance:
One of our advocacy partners on Capitol Hill, Faces and Voices of Recovery has set up a capwiz tool for this action alert and is generously sharing it with the Coalition. Here is the link:

As you'll see on the site, by punching in their zip code, you will get the name of your Member of Congress, a phone number for the Member and a script for the call. Background information about the bill is also available.

Thank you for making a call that makes a difference!
Jeanine Cogan, Ph.D., Policy Director
Eating Disorders Coalition
(202) 352-3208

We'll always have Austin....

My preliminary conference report, with pictures:


September 20, 2008

Dueling bloggers

I write this from the atrium of the hotel at NEDA in Austin.

Carrie is blogging from a nearby computer and I'm trying to beat her to the post....

Guest posts:

F.E.A.S.T. made a very strong, powerful appearance at N.E.D.A. and the message that family involvement in treatment is essential was heard loud and clear. Parents and families DO NOT cause eating disorder but are an ESSENTIAL component for RECOVERY!!!!! Stephanie!

Hi you all. I just met the Feast group and was so welcomed and appreciated all the sharing. Talking to other parents is so helpful in understanding this disease and what our children are going through. Shelly

It has been a great honor,privilege and humbling experience not only to meet Laura in person, help at the FEAST table and meet many wonderful parents. I wish that every parent could have this experience........Denise

Wow... what an experience! How could I have known on Monday, that by Saturday I would gain a wealth of new friendships, drastically increase my working knowledge of eating disorders and strengthen my resolve to continue helping families. (Thank you to whoever had the idea of placing the F.E.A.S.T. booth across the isle from our UCSD booth!) Christi

Pictures and thoughts when I've had more than 4 hours of sleep... Laura

p.s. Carrie beat me! Have I mentioned how happy I am to know Carrie?

September 17, 2008

Packing my gratitude along with the brochures

I'm flying to Austin this morning for the NEDA conference. I leave with gratitude to so many people:
  • To the family who donated too much, made me cry, and prompted the creation of FEAST
  • To Malia, Lydia, and Bridget for moderating the forum
  • To the two anonymous donors of $1300US to pay for the exhibitor’s table at 2008 NEDA conference
  • To our Advisory Panel member, Dr. Bulik, for getting public access to important research findings for six months
  • To Lydia for the FAQs, the photos, the networking, and spreading links to FEAST throughout the ED world
  • To the Parent Council for getting up too early, or staying up too late, or giving up an hour of work, or missing their child’s return from school in order to make the meeting international
  • To our Advisory Panel for keeping us informed, connected, and on track
  • To the Parent Council members and other parents who volunteered to help with Stanford’s online research
  • To the parents who are writing FAQs for the Around the Dinner Table Forum
  • To the families who have donated $1800 US for FEAST and the ATDT forum since September 2007
  • To the community of wise parents on the ATDT forum
  • To Libbie for transcriptions
  • To the ATDT “Mentors” who give their time and wisdom to newer families
  • To all who have done audio interviews for the Recovery Page
  • To the FEAST Speaker’s Bureau for responding to my call for New York Times interviewees
  • To those who volunteered to help with the FEAST recipe book
  • To the Media Outreach Committee for making the Internet a safer place to be a parent
  • To Therese for introducing us to our UK advisor
  • To the Parent Council for meeting every 3 weeks
  • To Chris for creating an amazing binder of resources for the NEDA conference and arranging for networking
  • To the parents attending the NEDA conference and helping out at the table
  • To Piedmont Press for the FEAST brochure
  • To Siobhan for months of hard work – during hard times - on the Provider database
  • To Carrie for being our Science Blogger
  • To Sandy for organizing and designing the Feast Family Recipe book
  • To Carolin for thinking of FEAST business even after the recent loss of her mother
  • To my mother-in-law for her math-challenged but compassion-filled over-estimates of costs
  • To my husband and son for their support and patience
  • To Olympia, always, for her SELF and for her rich life and her generosity

September 16, 2008

Culture and blaming

There really seems to be a difference between the guilt/blame dynamic in different cultures.

The struggle to understand eating disorders seems to be similar everywhere: shock, confusion, fear. And the "why, why, why" seems universal. It is a life-changing crisis no matter where it happens.

But it splits, it seems, when it comes to the guilt part. I'm not enough of a scholar of cross-cultural differences to explain it, but we Americans seem to do a lot more blaming and guilt.

Is this the the underbelly of "self-determination?" Of the American spirit of unlimited potential?

Freud didn't take off anywhere as well as it did here in the US. Though European, Sigmund and his friends found nurturing waters here. And perhaps that is a clue. Not that Freud messed us up - causing us to blame ourselves and each other for our temperaments and brain functioning - but that we were a willing environment for that sense that 'you can do anything' but 'you are responsible for everything' as well.

My interest in getting parents to stop the guilt and blaming isn't just palliative: these responses are also the most effective way to keep people from being effective in a crisis. If parents were kept outside the room and out of the loop and told 'not to worry' when a young person has leukemia we'd be poor supports to our children. Eating disorders are no different.

September 15, 2008

Clinics and Clinicians: list your practice at the FEAST website

Finding good eating disorder specialists to work with our families is neither simple nor straightforward. Parents never dream they will need such services, and have little idea how to go about finding or deciding between options.

F.E.A.S.T. wants to help. We are compiling a list of eating disorder specialists who practice in accordance with our stated principles. If you are a clinician, please let us know if you would like to be on our list.

We have a simple form for submitting your listing:

F.E.A.S.T. Eating Disorder Specialist Submission

If you are a parent or client and want to let us know about a clinician not on our list, please fill out the form and we will contact the clinician to get more details.

September 14, 2008

Our place

How much do time do you spend researching the purchase of a new car or home? How much time is reasonable to spend comparing prices and features for a new phone package, cable TV, lastest music player?

It would be nice if there was a shortcut when your kid gets ill. If you could just visit a consultant who would sort out the options for you, print out a chart. If there was an "Idiot's Guide to Being a Parent of an Eating Disorder Patient."

There isn't, sadly. (Though don't be surprised if you are treated like an idiot.) And I wish every parent was given the mission, the time, and the permission to research the options with as much energy and taking as much time as we would buying a house. But parents are often held back by a fear of seeming too enmeshed, or of being distrustful, or a fear of not "knowing their place."

Our place is on the phone, on the Internet, in the bookstore, at the library. Our place is at a series of waiting rooms with a notebook and a pen and a list of questions. Our place is taking as much care in the decisions of who, where, and how our children will get treatment as we would the most important decision of our lives - it may well be. They're worth it.

September 13, 2008

The Pregnant Couch Potato

I wish we had more people examining the science and interpretation of science in psychiatry and psychology like Peter Kramer:

The Pregnant Couch Potato, or, How Rumors Get Started

The implications here in terms of body image and nutrition and eating disorders abound, but this is valuable stuff on a lot of levels.

September 12, 2008

recovery, relapse, remission

Caring is good. Thinking is also good. I am grateful for those in the ED world who think and care deeply.

Dr. O'Toole at Kartini is one of those thinkers. She takes her experience and her training and intellectual drive and is willing to form and speak opinions where many either just keep doing the same thing - or complaining.

O'Toole's recent blog post, Is Anorexia Nervosa a Chronic Illness? will undoubtedly alarm some people, cause some to nod in agreement, change some minds, and fail to move others. For myself, someone who hears from countless people who feel cheated or heartbroken or self-doubting when a loved one relapses, this post touches on many things that resonate. My own daughter relapsed after an initial recovery. And recovered - no, I believe I will now adopt O'Toole's language - my daughter's anorexia is successfully in remission.

Some parents are afraid of the word "chronic" and think that means remains ill all the time - that is not the meaning as I read it. Chronic here means can come back under certain circumstances - some mysterious.

And that brings me to something we discuss too little: vigilance. For many years our daughter had us to remain vigilant to signs that her eating disorder might reassert itself in times of stress or low nutrition. Now she is both capable and competent at remaining vigilant herself.

That, actually, gives me even more admiration and wonderment at my precious daughter. Gaining remission was hard, maintaining it is heroic. Instead of fearing the illness, I now concentrate on admiring my dear daughter's healthy full life, and vigilance.

September 11, 2008

are AN, BN and BED different diseases?

I must apologize for the bias I often show in discussing anorexia more than I do bulimia. There are reasons, if not excuses, for this bias. One is that my daughter had anorexia, not bulimia. Another is that most of the recommendations for one are similar for the other, especially those I care about most (nutritional rehab, behavioral stabilization, separating the illness from the person, no blaming, and parental engagement).

It is my understanding that researchers focus on AN not out of a lack of concern about BN but because anorexia has a clearer diagnosis category in the form of weight in a field with limited research resources.

And of course, anorexia is glamorized more, and bulimia stigmatized more, in the popular imagination.

It is clear that a lot of treatment out there DOES treat eating disorders as if they are similar or the same in origin - same facilities, same clinicians, same page of the DSM. In fact, a lot of treatment purports to treat the cause of these/this illness(es) despite consensus on what, exactly it/they is/are.

But it really is a question to be asked: what is the relationship between anorexia, bulimia AND binge eating disorder? Is it a spectrum? Different manifestations of a common illness?

I don't know. Although some are asking, I don't hear coherence in the field on this. But this I know: bulimia isn't a less dangerous or less important illness - ask the Smeltzers or others who weren't even allowed to have bulimia included on their daughter's death certificate. We need FAR more attention to the issue, and to treatment.

September 10, 2008

US readers: call Congress TODAY

An important message from the US Eating Disorders Coalition:

Call-in day for passing mental health parity is TODAY.

Call your Members of Congress!

Action: On Wednesday, September 10th, you should call your U.S. Representative and Senators by using the toll-free Parity Hotline: 1-866-parity4 (1-866-727-4894). The Parity Hotline reaches the U.S. Capitol switchboard which can connect callers to the offices of their members. If you don’t know who your Senator is, you can simply tell them your state and they will connect you. For your Representatives, go to and then enter your zip code – this will identify who your Representative is.
Targets: All members of the Senate and House.

Message: "I'm calling to ask that the Senator/Representative urge the congressional leadership to pass mental health and addiction parity legislation this month before Congress adjourns."

Background: The House and Senate committees of jurisdiction reached an agreement on the language of a good parity bill that will be brought to the floor of the House and Senate (H.R. 1424 and S. 558). First, however, they must agree on the source of $3.8 billion in offsets ("pay-fors" over 10 years) required under the Budget Act.

September 9, 2008

RSVP for FEAST get-together Austin next week

Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.) will be welcoming members, Advisors, and friends at a “Get to Know Us” opportunity at the NEDA conference in Austin next week. If you will be at the conference, please join us:

Thursday, September 18
the Rogers Room
Austin Renaissance Hotel

We have arranged with the hotel to supply specially made box dinners. Please let us know if you are planning to join us so we can arrange for your meal ($28, RSVP by Friday September 12).

Please come meet the parents of F.E.A.S.T. and our advisors!

P.S. If you have other dinner plans, please plan to stop by anyway to say hello.

Too little too late is expensive

Families know already the emotional toll of a chronically-ill patient who was treated too late or without sufficient resources.

And families living in parts of the world without a financial safety net know the financial costs of ongoing medical care, therapy, lost employment, and lost educational opportunities.

But here's another way to quantify a small part of the economic scope of inadequate treatment: £7m bill as anorexia destroys job hopes

September 8, 2008

anti-Maudsley prejudice

If you ask this question of the researchers and leading clinicians, the answer is clear: the Family-Based Maudsley approach to eating disorder recovery is the only approach with evidence to support its use in adolescent anorexia, and is recommended as the first line of treatment in professional guidelines all over the world.

But we have a lot of work to do to do when it comes to public understanding of the illness.
"No, the family dysfunction in eating disorders must be emphasized, not downplayed." got 25%.
"What is the Maudsley Method" got even more: 29%.

September 7, 2008

Debunking the myths in order to pile on a few more

In 2005, I was interviewed for a piece in Newsweek called "No one to Blame" about anorexia. It was a well-researched piece that is still one of the best explanations for the public on biology, about genetics, and the importance of dispelling myths about this killer disorder.

But in 2008, it seems, we go about Debunking the Myths of Anorexia in Newsweek by simply applying the old myths to new populations.

No wonder parents, and the public, are confused and skeptical of everything they hear about this illness. Why don't myths stay debunked?

September 6, 2008

Do the thinking for both of us

"suicide is an irrational act, but people engage in discussions about people who are temporarily suicidal as though they were making rational decisions and choices..."from: Suicide Barriers are Effective

One of the biggest misunderstandings in eating disorder treatment, in my opinion, is that the thoughts and behaviors are rational and part of free will.

Easy to be confused about that, since it SEEMS rational to worry about food and to use food as a cosmetic device and to have all sorts of magical thinking about eating - in a society that has made those things seem the height of virtue.

But the thoughts and behaviors of anorexia and bulimia are NOT rational. And until the last stages of recovery, patients really cannot be expected to be.

Until then, it's our job.

September 4, 2008

The gift of being driven

Dr. O'Toole over at Kartini has a wonderful blog post up on what parents can do to support recovering/recovered kids who are at college. She gets it right on this, and every parent with a kid near college age will cheer.

Several of the Around the Dinner Table forum community just sent recovered kids off to college for the first time, and my daughter is off again as well, and I'm thinking a lot about the drive for achievement.

"She's a gifted dancer.""He's driven to succeed." "She lives to run." "We don't have to remind him to hit the books - he won't leave them alone."

It has been a while since I could hear things like the above without cringing. I used to think of them as bragging rights. Now I hear them as warning signs.

It is subtle, but parents learn to listen for the difference between "loves to" and "lives to." Between "wants" and "has to."

An eating disorder can bestow an unnatural focus - this focus can translate into high grades, high jumps, and blue ribbons. We can be seduced by these successes - we can grow dependent on seeing our children as over-achievers and star athletes.

Don't let them tell you that parents cause eating disorders with our high expectations or our pride in our child's achievements. Yet let's recognize the luxuries of supporting our child through the normal stuff... like failing freshman chemistry and sleeping through 8a.m. lectures. Not that I know anything about those things...

September 3, 2008


Accurate Parental Classification of Overweight Adolescents' Weight Status: Does It Matter?

I'm going to leave aside the thorny issue of how to determine "overweight" and what the health effects are.

The take-home here is: encouraging dieting doesn't reduce weight.
Yet our entire society is engaged in a massive campaign to encourage dieting in children. My son's elementary school staff, pediatrician, boy scouts, public and commercial TV, cereal boxes, movies, casual strangers, friends, family - they all talk like nascent anorexics about good and bad foods and no fat and the obesity crisis.

You probably think I'm oversensitive about this topic because my child suffered from "the other side of the coin." I don't think so. I think the other side of the coin helped me identify the currency, and it is bogus.

Dieting doesn't "work." Dieting to lose weight is like holding your breath to save oxygen. And yammering at people about their weight - on either side of the coin - is beside the point. If weight was a choice in anorexia or BED or even for anyone then let's discuss it. But it isn't, beyond a small margin. Do we badger people about their choice of height? Skin color?

If someone is ill, and one of the symptoms is weight gain or loss, then concentrate on the illness and not the symptom.

We have got to get off this appearance as proxy for virtue kick. It's hurting people. It is hurting our kids.

September 2, 2008

Should you stay or should you go?

Should you try to repair and improve a soured relationship with a clinician - or move on?

Obviously, this depends on both parties. Is the family - alone - truly more competent than the doctor, therapist, and nutritionist? Have you tried to openly address your concerns? Do you have a better option in place?

A lot of times families just don't have a lot of options. You may live in an isolated area. You may have a national health service. Your insurance may be limited. And there aren't that many clinicians to go around. Add to that the fact that eating disorder expertise is hard for a parent to judge (is it number of patients, number of years of experience, type of training, or the professional company they keep). Eating disorders are treated in as many ways as there are treaters: how do you know you have the best fit?

Just like marriage, sometimes things are so obviously out of whack that the decision is easy. Sometimes you need to date others a bit before the Dear John call. And sometimes a relationship is a fixer-upper - where all parties are respectful and humble enough to accept uncertainty and good will.

We never found a perfect situation - ideological match, training, distance, insurance, coordinated team - but we did find along the way a handful of skilled wonderful brilliant clinicians who added the perfect piece to the puzzle of my daughter's recovery. They were worth the search, and one thing I notice is that our family - even our ill daughter - knew within moments of entering the room who they were. I have such gratitude for those people - you know who you are - and so do the rest of your patients.