July 25, 2009


And while I'm in a goofy mood, and about to put on my tap shoes:


I'm absolutely positive that snarkiness and suspicion should be my response to the Love My Life email I got yesterday. It is, after all, a commercial enterprise and a conscious attempt to 'go viral' via the social media's capricious winds, and not entirely original. As a rule, I don't do cute or bumper stickers, don't forward jokes, never send greeting cards.

But it has been That Kind Of Week and, frankly, people sell me cynicism and the false cool of cold every day. When things are good, or even when things are tough, there are times when #LML really is the right response. I'm a very fortunate person with so much to be thankful for.

LML. There, I said it: LML.

July 24, 2009

A theory on why reporting on eating disorders is improving

I had lunch with this reporter a few years ago, and enjoy seeing her byline again on a good piece on eating disorders.

A theory on why anorexics spurn food

I note a definite trend in mainstream reporting around EDs: the science is percolating to the surface. The 'narrative' is changing**, and in a good way. I really believe parents are now far more likely to get good, authoritative information than the hopeless, disheartening, victim-blaming stories of the past.

The illness is still just as hard, and getting good treatment is still almost as hard, but at least the starting point is changing.

** Just the accompanying photograph says volumes. It is a man, it is painful, and it doesn't involve a mirror.

July 22, 2009

Psychologists Investigate Cognitive Failings

"Failings?" Failings?!

I can really only think of one response to this title to an otherwise interesting article: Psychologists Investigate Cognitive Failings Of Eating Disorder Sufferers.


Is low blood sugar a 'failing?' Coma? Heart attack? This is appalling use of words - though as a writer I know that headlines are written by editors and the writer may never see the title until it goes to press (or bytes). This sort of, well, failing as a journalistic device perpetuates not just the idea that eating disorders are a problem but that they are an error. A mistake. A lack of something to one's character.

I find eating disorder patients to be undergoing a massive brain experience largely out of their control - not a failing at all. All efforts at insight or recovery under these circumstances are heroic and require extraordinary bravery. The "failing" goes on with the rest of us when we misunderstand, underestimate, and fail to act.

Failing, indeed.

Seeking Maudsley practitioners for a project in Heidelberg

I am posting this on behalf of Annette Mehl at the Psychiatric Clinic in Prague:

Maudsley experienced or trained therapist/psychologist wanted!

The 1st Psychiatric Clinic in Prague and the Center of Psychotherapy Research in Heidelberg is looking for a Maudsley trained psychologist or therapist who would be interested in taking part in our international chat-project: "Get-Connected" for primary caregivers of patients with an Eating Disorder.

What do you need to do?

Guide 1-2 chat-groups for primary caregivers (weekly 1.5 hours per group over 6 months)

Advantages for you?

Free flight to Prague to meet all therapists/psychologists (the meeting will take place at the 1st Psychiatric Clinic in Prague at the end of September 2009). Being part of an international team of therapists/psychologists working with Maudsley.

For further information please visit our website:

If you are interested, please contact us:

Dipl.-Psych. Annette Mehl
Adress: 1st Psychiatric Clinic, Ke Karlovu 11, Prague 2

The evolution of our gut

My husband has an instinct for when something he sends me will inspire a blog post. I'd like not to be so predictable, but, he's right:

Microbes ‘R’ Us

I have a strong feeling (or is it a "gut reaction?") that my readers will be interested!

July 21, 2009

New insights

Some of the best minds in eating disorder research AND treatment are at it again:

Review Provides New Insights into the Causes of Anorexia

I wish every parent could get information like this early on. It would make such a big difference in how they regard the food, the thoughts, and the context.

I wish every parent could also hear the thing one stops hearing much when a kid has an eating disorder: something nice about our beloved child! There are positives and strengths and assets in the makeup of people vulnerable to this condition - and recovery is the way to allow our child and his or her talents to emerge and thrive.

"Keys had never intended for the BMI to be used in this way"

Why are doctors still measuring obesity with the body mass index

July 18, 2009

"Harm reduction"

"Hi,I am recovering from anorexia and regularly read your blog. I live in the UK and as I was reading earlier I wondered what you would make of the treatment of eating disorders over here. In hospital, people over 18 who suffer from eating disorders are given a choice between full recovery to a BMI of 20-21 and what they call 'harm reduction'. This entails teaching the anorexic to maintain a BMI of around 15, high enough to keep them out of hospital but not so high that they can't cope with the weight gain.

Personally I am not a fan of this approach, I think that anything that makes the anorexia happy is not something which is going to end in health and happiness. The people who go down this route are still going to end up with drastically restricted lives and health problems such as osteoporosis - but they won't be draining money from the NHS because here, anorexics are only hospitalised once their BMI goes under 13.5. It's incredibly sad that people are written off in this way, because given a choice, what anorexic wouldn't choose this far less scary option?Anyway, you have a lot of other important topics to discuss on your blog but I thought it you might be interested in this."

I am interested in this. I think it is beyond sad, and very wrong. We need to stop treating anorexia as a choice and understand this is a "can't" and not a "won't." Policies that offer a "choice" to stay unconscious are cruel and misunderstand the nature of the brain condition. The way you put it: "written off in this way" is exactly right.

We need policies that aim for real recovery, not "harm reduction." I am saddened and angered by the lives thrown away by a lack of will on society's part to do what needs to be done. Policies like the one you describe would not be acceptable if what we were talking about was oxygen levels or blood sugar levels. We can at least set the standards at levels with a possibility of sustaining a recovery.

Easy? Hell, no. But why would we settle for less?

July 16, 2009

The Meaning of Longer Life

I'm too busy this week for original thoughts, so here's some rational thought on "Calorie Restriction" and long life, from The Meaning of Life in the New York Times and from one of my favorite bloggers, Szwarc at Junkfood Science.

July 14, 2009

The missing link - FINALLY - on planning meals

The biggest complaint among parents attempting to successfully implement the Family-Based Maudsley approach at home is meal planning.
I was terrible at it. I knew what I had to do, I understood the concepts, but I had been an intuitive eater and an intuitive feeder - I had no idea what I was doing when it came to planning and serving family meals suitable for my daughter's re-feeding.

I hear this all the time: "But what do I make?" "What about vitamins?" "Should I count calories?" "Is this healthy?"
So it is with glee and enormous relief that I introduce a book that I've watched develop and have looked forward to being able to recommend to parents: Feeding Your Anorexic Adolescent, by Claire P. Norton, MS RD. Among the things parents will love: practical advice that "is about the food," Dr. James Lock's quote on the back, the wonderful and empowering epigraphs throughout the book, the chapter summaries, the straightforward and wholesome and energy-dense recipes.

For those who follow the eating disorder world and the Family-Based Maudsley debates, you will enjoy the complete lack of nonsense. This book includes so much that a parent needs to hear, and leaves out all the stuff they don't.

I've met Claire in person, I'm happy to say. I've eaten in her kitchen - delicious scones. I've cooked some of the recipes to the approval of my children. I'm proud to have this book in my kitchen, and on my list of recommended books.**

**It has been a good year for Maudsley books, hasn't it? And more to come, by the way...

July 13, 2009

F.E.A.S.T. Advisor on Rachael Ray show

Dr. Cynthia Bulik, my friend and a F.E.A.S.T. advisor, was on the Rachael Ray Show today talking about "orthorexia."

I'm of the thinking that orthorexia is a term that describes everything from very unhappy relationships with food all the way to people with undiagnosed anorexia. The difference: anorexia is a brain-based mental illness driving thoughts and behaviors, while unhappy relationships with food are unhealthy thoughts and behaviors that society aids and abets.

Your thoughts?

July 11, 2009

"It embarrasses"

Every once in a while I attempt, against the tide of public gloating and self-loathing, to speak up against our society's weight problem.

Not a problem of weighing too much, mind you, the problem of weighing too heavily the issue of heavy.

One sign of my success in at the very least getting my friends and family on message is that everyone I know sent me this: Top 10 Reasons Why The BMI Is Bogus.

One friend said "I knew you would have seen it already. It was about BMI and was on NPR -- all your favorite initials."

July 10, 2009

"Chats for Primary Caregivers"

Is it just me, or is it really getting to be a better world for caregivers seeking help?

Get-Connected: Fighting Symptoms of Anorexia or any other Eating Disorder with Chats for Primary Caregivers

SO wonderful to see resources (in this case in Germany and in Poland) spreading around the world.

July 9, 2009

Get trained to be a Family-Based Maudsley Treatment provider

A heads-up for therapists and professionals interested in being trained in the Family-Based Maudsley approach to eating disorder treatment:

A two-day training in Chicago in September:

"First step in the certification toward becoming a FBT therapist"

July 6, 2009

The book I want you to read first (not mine)

Imagine this:
  • A book to clearly describe the history and concepts of the Family-Based Maudsley approach.

  • A book with a range of real, detailed, and telling family stories.

  • A book that is accessible, well-written and focused.

  • A book that does not shy away from the very hard and frightening issues, yet isn't scary.

  • A book free of the myths of the past.

  • A book with no agenda or dogma.

  • An indictment of poor treatment seen in contrast to the incredible potential of good treatment.

  • A celebration of effective clinicians and loving families.

  • A work of optimism and belief in the concept of family.
That book is now available in Australia, and in the UK. It will be available next month in the US. June Alexander has written the book I would like to see any family facing this illness given on the first day of diagnosis. "My Kid is Back" is a dream come true.

** And no, I don't get a commission or a prize and I don't endorse books unless I really believe in them. I wouldn't do that to fellow parents. If you don't believe me, let me send you the list of people who I've really annoyed by declining to write about his or her book. No one asked me to talk about this book. It stands on its own as a very much needed tool for parents and it has shot to the top of my recommendations.

Who needs food?

I'm mildly amused to report that I have been diagnosed with a nutritional deficiency. Ironically, in this case it isn't "about the food," because Vitamin D is really more about sun exposure. My understanding is that I would have trouble at my age getting enough Vitamin D from the sun unless I wish to move farther south and take up nudism. (The moving thing is not out of the question, I suppose.) Dietary Vitamin D is tough to get enough of, so I'm on little white pills.

A self-proclaimed "food is medicine" nut gets sick from the only nutrient you get without eating, huh?


July 5, 2009

Larger than Life

This line of research seems to me to be significant in body dysmorphia of all kinds: Nonverbal Status Cues Alter Perceived Size.

I remember the "aha" moment I experienced as I first read about body dysmorphia and body schema. For the first time I realized that what we all perceive as our body - the size and dimensions and outside appearance - is made up by our brain. None of it is objective, and all of it is probably manipulable by brain function - diet, hormones, stress, personal history, the people around us, art, even temperature and time of day.

It was both a frightening and a freeing realization. I let go of a lot of stuff that day about my own body and self-consciousness. I let go of appearance as something to discuss at all - it became meaningless and silly. I've never been much of a mirror person, but I stopped thinking the mirror was going to tell me anything of much importance beyond whether I had spinach between my teeth and my shirt was evenly tucked in.

And now I think I'll reconsider whether S.K. and K.M. were, indeed, as tall as I remember them in elementary school. Maybe they just made me FEEL small.

July 4, 2009

Biology of Mind

I know: the biology of mental illness makes your head explode. Too geeky, too much talk of nature VS. nurture. Over-promising and underperforming false starts in finding mental disorder's homes on the genome. The tiresome sense that either biology or psychology has to "win."

Maybe it takes a Nobel brain to explain why studying genes isn't futile, isn't a fight between nature and nurture, and why the Biology of Mind is a boon to psychotherapy.

July 3, 2009

Rhymes with 'barbarian'

Skim this piece really quick:

Food First - TIME

Now go back and look at the year it was published.

I know! I know!**

** Say this in the inflection of Prunella Scales from Fawlty Towers when on the phone to her sister, for best effect. To my husband's growing dismay, I do!

THE ORIGINAL PAPER: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2026117&blobtype=pdf

July 2, 2009

Eat up, mom

OK, this is fascinating on so many levels, and I'm looking forward to reading the whole paper, but I am perversely tickled at one unexpected protective factor against anorexia:

Higher maternal weight.

Childhood Risk Factors for Lifetime Anorexia Nervosa

"Childhood Risk Factors for Lifetime Anorexia Nervosa by Age 30 Years in a National Birth Cohort.

OBJECTIVE:: To examine whether previously identified childhood risk factors for anorexia nervosa (AN) predict self-reported lifetime AN by age 30 years in a prospective birth cohort. METHOD:: Using data from the 1970 British Cohort Study, at birth, 5, 10, and 30 years, we examined associations between suggested childhood risk factors and self-reported lifetime AN at 30 years, adjusted for sex and socioeconomic status. RESULTS:: Anorexia nervosa was independently predicted by female sex (odds ratio [OR] 22.1), infant feeding problems (OR 2.6), maternal depressive symptoms (OR 1.8), and a history of undereating (OR 2.7). High self-esteem (OR 0.3) and higher maternal body mass index (OR 0.91) were protective. CONCLUSIONS:: Of 22 suggested risk factors for AN, only four risk and two protective factors were confirmed in this prospective cohort study. We did not identify a role for perinatal factors, parenting, childhood body mass index, childhood emotional or sleep problems, academic ability, or exercise."

July 1, 2009

"dying to hear more voices"

Oh, Carrie - this is priceless. PRICELESS!**

"Schizophrenia is not dying to hear more voices, and depression isn't dying to be sad. Diabetes isn't dying for higher blood sugar, and cancer isn't dying for a larger tumor. An anorexic isn't starving for perfection and they're not dying to fit in. They're just starving and dying. And the sooner we can strip away this false meaning, the better we can get aggressive treatment and nutrition for the people who need it the most."

Dear journalists: please try harder

**Notice I didn't say "perfection." I would, but it might sound pathologically hyperbolic!