Talk is cheap

Honestly, when I posted about prevention I expected to get very negative feedback. But by email and in the comments I see that not only did I strike a raw nerve but that there are people who actually agree with me. This is really welcome news, and a great relief. Blogging is odd because the impulse to speak up is not done with the expectation that I'll be heard or agreed with. I say it because it itches, and I want to shout.

So, but, then... what to do about this issue? As nice as it is to know I'm not alone I still feel quite helpless in the tide of things going in the other direction. The AED conference in Miami last week, which is arguably the biggest collection of experts on EDs, featured plenty of prevention talk (less than the other more consumer and therapy-oriented events). I mostly fight it by refusing to join it, but that doesn't bring change. Prevention talk is cheap. So is anti-prevention talk. What about action? I honestly don't know what to do about it. Aside from getting it straight in my head, and speaking up when spoken to, and not participating in it -- is there something more I can do?

I honestly feel that the "prevention" tide is a new version of the older ideas, more palatably and better marketed recycling of the idea that eating disorders are about being victimized by someone or something. While it is less common these days to cite parents as that "someone" the new "somethings" are media and a social pressure to be thin.

A while back an author asked me why I did not review and talk to parents about her book for parents - one that talks so much about many of the same things I do. (I try to stick to positive reviews of things I think are helpful to parents and stay silent on the ones I do not) I explained that the section on prevention, in a book for parents whose loved ones already have eating disorders, was a back-handed way of saying "these are the things you did wrong or failed to stop." As positive as it sounds to say "Mom, don't diet" and "Give your daughter's praise for their accomplishments, not their looks," the corollary is that your daughter's eating disorder came about because you didn't. This is not to say that we should NOT be doing those good things or that failing to do them helps, but if those things prevent an eating disorder (and I know of no evidence to say they do) then yes, we would need to hold ourselves responsible for helping cause the eating disorder. If that was true then yes, we do need to change those things in order for our loved ones to recover. And apologize. Profusely.

Listen: I dieted as I got older and pregnancies changed my shape. I talked about healthy foods. I bought into every foolishness out there, and even remember whining in front of a mirror in front of my daughter. That was stupid. I regret it, deeply. It hurts me to think of. But I don't believe it caused my daughter's eating disorder and not having done all that or had those attitudes would not have prevented it. Doing penance for it would not have treated it either. I did change, and thank goodness - for my own sake and for my family and friends (who think I'm a nut for criticizing dieting and refusing to join in the "you're so pretty and I'm so fat" parties.

But this prevention talk is a witch hunt searching for easy targets. Our whole society is off on an pro-dieting tear, and pressures to be thin and gorgeous and young and upper class and virtuous and have small feet.... these are ubiquitous. If we went on another tear in another direction - and we will - it will have effects on mental health as well. But soap commercials don't cause OCD. Banning death won't prevent depression. Anxiety disorders aren't a sign of something dark and hidden in someone's past. And I worry that what we're preventing is a genuine understanding of eating disorders.


  1. It's hard to prevent a disease when the cause isn't really known. For example, the scientific understanding relationship of atherosclerosis to specific foods has changed many times-for example, margarine was once thought to be the answer to butter and now it is thought of as a toxic substance!!!! And so I think it will be the same with eating disorders.

    We see these things go around and come around many times with lots of diseases because there can be a statistical association between two factors but that doesn't mean one caused the other. Proving disease causation is a rigorous process that is often overlooked and I think the situation with eating disorders is the same.

    However, saying that, I think that people should have no qualms about doing the right thing even if their reasons for this are erroneous. So IMO cultural changes that lead us to a more balanced and NATURAL healthy society will be good, even if they don't decrease the incidence of eating disorders. Let's think about this in terms of more than looks and dieting too-that's just a small part of everyone's life--most of our lives aren't just about our appearance-we work, have families, etc. All of these things create stress and anxiety and probably make things worse for people with anxiety disorders--I think this modern lifestyle needs to be on the chopping block too!!!! But whether that would prevent eds, well, heck I don't know!


  2. Laura, I agree with you whole heartedly. I STRONGLY agree that while if we knew are children had Ed, and were educated to understand how best to effectively assist and and cope, then it would be an issue BUT, I don't think it has any validity in prevention as you can't erase a genetic predisposition before you know it exists. For example, I have discovered that I had a pre disposition to graves disease triggered by an autoimmune response to a drug therapy for a different drug induced autoimmune response.. My sister developed graves as well from a different drug induced auto response. Neither one of us knew we had this pre disposition, as no one I know in my family has the disease. One cannot prevent something that they don't know exists.

    A much more productive course would be early recognition and appropriate effective evidenced based intervention as a most important way to attack this disease. This should be the focus of the Ed community. Educating those in the field of exposure, ie
    School nurses and guidance counselors
    Therapist , psychiatrists, nutritionists
    Coaches, even maybe middle school health Ed
    Here is where i believe we can truly change statistics..

  3. I worry that what we're preventing is a genuine understanding of eating disorders.

    Me too

  4. My concerns about prevention is that they are often targeted too narrowly.

    One of the looking at those families that had meals several times a week. My family used to do this. After this stopped, there was little regulation or monitoring on food intake.

    Interventions on body confidence or self esteem would have been helpful for the adults around me who encouraged me not to gain weight or offered to pay me to lose weight. I never had those ideas until my family put them into my head.

    Now, I am in a position to train families. The identified patient automatically becomes the family when it comes to weight issues. The family eats together and exhibits the ability to enjoy treats in moderation. Dieting is out. This may be an "intervention," but it is still primary prevention for disordered eating. Families also are recommended to do activities together. Surprisingly, if they follow this plan, they grow closer and weight is no longer a problem.

    Relationships heal.

  5. I wrote a lot on your previous post Laura, so I won't repeat the same things again. However, two things I will say are as follows:

    1. The idea of 'ED prevention' is appealing because we all know that once established, EDs are often very difficult to treat. However, it would be FAR more effective if the focus was switched away from prevention to EARLY RECOGNITION of ED symptoms and signs - by family and friends.

    2. There is research money available for 'ED prevention'. Research is very often grant-led, and so if money has been put aside to investigate a specific topic or field, then that's the direction the work goes.

    In terms of the current 'prevention programmes', which focus on improving 'body image', then absolutely NONE of these would have prevented my decline into AN as a child.

    Furthermore, this type of thing (, which some have hailed as 'ED prevention', bores the pants off me.

  6. My experience (from several years ago):

    I had a hard time getting medical professionals to (at first) take seriously my concern that there was a problem, something wrong, with my daughter's behavior when she first started losing weight. My attempts at early intervention were essentially rebuffed--maybe that is too strong a word, but all my observations and knowing my daughter were discounted. One place said to my daughter (and this was by a young therapist who, as it turned out, had had an ED herself when younger), "You didn't look or act like someone with an ED". So much for early intervention. And, they complain about parents sticking their heads in the sand! My experience was the exact opposite.

    Prevention: I tried like the devil early on when 2-3 years PRIOR to the development of an ED when I first saw signs of worries about food and anxiety. Got her into counseling. Saw a nutritionist. Got her help with time mgmt. She wasn't too thrilled, but went along with it, at least for a time. It did not prevent the ED.

    Maybe there are ways to do it, but based on my experience of 1 child, 'taint easy.


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