tag:trishagura.com,2008:/blog//1 2008-07-17T19:48:42Z Movable Type 3.35 tag:trishagura.com,2008:/blog//1.35 2008-07-17T19:11:30Z 2008-07-17T19:48:42Z

It was a ghastly image: up to 600-pound mothers-to-be in unprepared maternity wards.

Trisha Gura http://trishagura.com New York Times Magazine article about pregnant women who are morbidly obese. It is a ghastly image: up to 600-pound mothers-to-be in unprepared maternity wards. Beyond the demand for bigger scales, extra-wide operating tables and longer surgical instruments (obese women are twice as likely as normal-weight women to require Caesarian Sections), the situation is dangerous. Newly-minted “bariatric obstetricians” are desperately try to manage the risks:]]> animal studies demonstrate that an obese mother during her pregnancy can predispose her offspring to become susceptible to obesity later in life – and this susceptibility is independent of genes or post birth diet.) The Times article brings to mind an equally-frightening scenario on the other side of the scale. In Lying in Weight, I wrote about below 90-pound mothers-to-be with anorexia or bulimia. Again there’s a litany of risks. •To mother: miscarriage, hyperemesis gravidarum •To baby: birth defects, premature birth, and low birthweight (Of note: same thing on the animal studies. Pups born to undernourished female rats later developed obesity, hypertension and high insulin levels -- as well as propensity to overeat. The idea is that being starved in the womb teaches embryos to overconserve calories. Later in the life, the offspring balloon out with the smallest intake of food.) Given all this -- not to mention the costs of all the tests, procedures and equipment to manage pregnancies in women with weight issues -- we might be quick to judge, saying, "My gosh, these women should be anything but pregnant." But I want to move away from the sensationalism and chastisement. I draw upon my experience as a mother with a history of anorexia. In a woman's passage into adulthood, weight is a metaphor for responsibility. When people say, she is “taking on the weight of the world," they mean that she is assuming the role and responsibilities of an adult. With pregnancy, a woman stretches her definition of herself. As she reads her “What-to-Expect” books and decorates the nursery, internally she is preparing for the day that she will become a “mom.” A healthy woman can make the stretch. Literally. Her belly will pop out and so will her new identity. It’s a powerful transition. But it can go awry when a mother is physically challenged by an eating disorder or extreme weight issue. The outcome, of course, depends upon the mother, her willingness to address her problem and the support that she receives along the way. For this reason, no woman should be the denied the experience of pregnancy, birth and motherhood. It is a transformative one. However, a woman with extreme shape and weight concerns can--and some say should—get help with her problem before pregnancy. With a therapist or a healer as a guide and support, such a woman can better prepare herself to make the transition to motherhood -- with less of a risk to herself and her child. Isn’t that what we really want? I’m sure the “bariatric obstetricians” would want that too.]]> tag:trishagura.com,2008:/blog//1.34 2008-06-16T17:42:40Z 2008-06-16T17:47:57Z

Our active girls as they kick their goals or lob their jump shots are, in essence, playing with an evolutionary kill-switch that controls survival of the species...ghrelin

Trisha Gura http://trishagura.com After another weekend of carpooling my 12-year daughter to soccer, I came across a timely study on the theme of athletes and menstruation. There’s been an alarming trend in teenage female athletes: As many as 25 percent of our daughters who participate in athletics stop menstruating -- compared with 2 to 5 percent in the general population. leptin, an appetite suppressor made in fat cells and luteinizing hormone that pulses to jump start monthly cycles. The idea is that these and other hormones signal the body when it is experiencing an energy deficit. The body, in turn, shuts down its monthly cycles. The body knows: a woman shouldn’t be having a baby when she is starving. And so our active girls as they kick their goals or lob their jump shots are, in essence, playing with an evolutionary kill-switch that controls survival of the species. Maybe. While the causes of athletic amenorrhea are unclear, the consequences are certain. Lack of periods leads to frightening bone loss at an age where girls need to build their bones to ward off osteoporosis late in life. The phenomenon, known as “female athlete triad,” refers to three problems that go hand-in-hand: low energy availability, menstrual disorders, and weak bones. The Harvard researchers, led by pediatric endocrinologist Madhusmita Misra, MD, at Massachusetts General Hospital, Boston had another idea on how to tackle the problem. They focused on a new player in the world of endocrinology and reproduction: a stomach-secreted hormone called ghrelin, known to spur appetite. Researchers have found that if they give ghrelin to animals and humans, not only stirs hunger; it also blunts the production of hormones that regulate ovarian and menstrual function. Another factoid: ghrelin levels are elevated in people with anorexia nervosa, which may be why they feel a voracious appetite, constantly think about food, even dream about it. Tragically, people with anorexia will not let themselves eat the food, however. That in mind, Misra and her colleges studied 21 teenage athletes with amenorrhea, 19 normally menstruating athletes and 18 nonathletic girls. Not surprising, body mass index, a measure of body fat, was lower in the amenorrheic girls than in the other two groups. Still, these athletes were not underweight in the range of anorexia, less than 85 percent of the ideal body weight for their ages. So why did some of the girls lose their periods while other did not? The answer may be ghrelin. The levels of that hormone were higher in athletes that were not menstruating than in either of the other two groups. The data also showed that athletes with higher ghrelin levels had lower levels of the sex hormones estrogen and testosterone. So those, too, could be feeding into menstrual shutdown. Whatever the mechanisms, “These findings suggest that hormonal disorders may explain why amenorrhea occurs in some but not all adolescent athletes,” Misra said. “In addition, ghrelin may be an important link between an energy deficit state and the hormones that regulate menstrual function.” Indeed. We would welcome the information. Maybe down the road, ghrelin supplements could restore menstrual function to these young girls at risk. It’s worth a shot. Our girls should be free to pursue their athletic dreams. At the same time, we should encourage them to eat healthy while being active. For those who lose their periods, bone loss is a debilitating consequence that could plague them in years to come. For my daughter’s sake, and my own, having experienced amenorrhea until the age of 33, I applaud these studies and hope for more. The results were presented today, June 16, 2008, at the Endocrine Society’s 90th Annual Meeting in San Francisco. ]]> tag:trishagura.com,2008:/blog//1.33 2008-05-19T14:03:37Z 2008-05-20T14:49:49Z

Willpower is voice in your head that barks, “don’t eat this and that or you’ll get fat.” Brain researchers think of willpower in an entirely different way.

Trisha Gura http://trishagura.com Anyone who’s tried dieting has been lambasted with the concept of “willpower.” It’s a voice in your head that barks, “don’t eat this and that or you’ll get fat.” In the case of eating disorders, willpower also translates to willing yourself not to binge or purge or restrict. That may sound like the right approach to healing. But if you think about willpower this way, healing is submitting to a punitive, parental force that tells you “don’t” when some other child-like part of you says "do." Maybe not such a good healing tactic. Brain researchers think of willpower in an entirely different way. Willpower, in science-speak, is about choices and decision-making. Your mind makes a plan to act and then (here’s the willpower part) you choose whether or not you will carry out your plan. That’s the hard part. But you are in charge. You get to choose. Scientists at Case Western Reserve are studying why the execution part of the plan is such a tough thing. It turns out that the brain resource you need to draw from in order to follow through on your best intentions is limited. It’s a kind of mental gas tank that can be overtapped. Scientists know this because they recruited volunteers to do an impossible-to-solve puzzle. At the same time, the volunteers were also asked to eat radishes, a bitter but “good-for-you” food. Of course, no one really wanted to eat the radishes. And to make the distaste even stronger, the researchers presented other volunteers working the puzzles nearby chocolate chip cookies. This is the worst nah-nah-you-can’t-have-it temptation. Not surprisingly, the radish eaters gave up more quickly on the puzzle -- eight minutes sooner and nearly half as quickly as the cookie eaters. The conclusion: your willpower runs out sooner if you have to spread over two challenging tasks. In recovery, the translation might be if you are trying to stop bingeing, for example, you shouldn’t file for divorce or go back to school to change careers – at the same time. However, a common theme of recovery is that once a person starts to move forward, many aspects of his or her life start changing at once. You can use this reality to your advantage. If you time these changes things right after the other, rather than on top of each other, you actually can strengthen your willpower. The Case Researchers found that when volunteers did several unrelated tough tasks in a row, they were more effective having learned “I can do this” on a previous task. “Willpower” is a brain muscle that thrives on training. So, according to this research, a good way to plan to curb unhealthy behaviors is to clean your plate of as many other stressors as you can -- before you start. Then take on one life change at a time. If you can. Willpower, not self-punishment.]]> tag:trishagura.com,2008:/blog//1.32 2008-05-09T12:58:41Z 2008-05-09T13:14:47Z

This tragic dynamic and others have prompted psychologist Cynthia M. Bulik, PhD, Director of the University of North Carolina Eating Disorders Program, and her colleagues to begin a pilot study of and intervention for couples

Trisha Gura http://trishagura.com osteichthyes, no bigger than a bloated paper clip. But some goby fish see slimming down as survival. ]]> Lying in Weight: the Hidden Epidemic of Eating Disorders in Adult Women. “Who partners up with a woman weighing 85 pounds?” I asked. The answer: any one of five categories of men (or women if the male is the one with the eating disorder or the relationship is same-sex). The so-called, “Macho Man, Control and Conquer,” is like the superior goby acting in concert with his inferior, anorexic wife/girlfriend. The husband/boyfriend could be an executive, doctor, attorney, military officer, or minister. He’s the man used to managing other people, assigning duties, and being aggressively IN CHARGE. He chooses a partner with an eating disorder because she will accept his alpha position, and by extension, her subordinate one. She starves to shrink into her Stepford role. As a bonus, she’s slender and trophy-like in appearance. All the more reason for him to stay with her. This tragic dynamic and others have prompted psychologist Cynthia M. Bulik, PhD, Director of the University of North Carolina Eating Disorders Program, and her colleagues to pilot an intervention for couples in which one member is suffering from anorexia nervosa. Called, Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN), the intervention starts with the premise that adults develop anorexia, too. And when they do, they are often in relationships. Intimacy is tough and tougher still when one partner has an eating disorder. Both partners feel the effects. Therefore, both might benefit from treatment, in this case cognitive-behavioral couple-based interventions that have been successfully employed for the treatment of depression, anxiety disorders, smoking cessation, and cancer. Will it work? We do have measured success stories with family-based therapy, traditionally with child, parents and siblings. So there is great hope for family therapy in marriages or partnerships. The time has never been riper. Bulik’s group, in conjunction with Self Magazine, just published a survey of 4,000 American women aged 25 to 45. Nearly two-thirds (65 percent) of the women reported disordered eating behaviors, and 10 percent report symptoms of eating disorders such as anorexia and bulimia nervosa or binge eating disorder. That’s a frightening number of adults, the majority involved in partnerships. Couples intervention might be a sorely needed option for those who are struggling. Back to the fish. Gobies find power imbalance in relationships the key to maintaining a stable, noncompetitive society. However, fish are fish and they can maintain smaller sizes without becoming mentally ill. Humans are a different story. Take one common scenario: a woman in this situation shrinks down to “feel loved.” But she eventually realizes -- and admits -- that her partner does not love her for her. He loves her for what she can do for him. And as his dominance continues, she regresses into self-loathing. She does more of the eating- disordered behaviors such as starving, vomiting and/or exercising to excess. Finally, she becomes so sick that she is hospitalized and/or unable to fulfill her duties to him. He, then, dumps her for someone better able to do the job. Another scenario -- and one I like so much better: the woman reaches her breaking point. She taps that strength buried inside her and fights back, not with food, but her voice. She swells up in her body, as well as personality. And the couple renegotiates their relationship. Or she, healthier, leaves him to look for a better partner. She has figured it out. There are more fish in the sea. ]]> tag:trishagura.com,2008:/blog//1.31 2008-04-14T16:45:33Z 2008-04-14T20:44:12Z

Is chocolate addicting? Common wisdom would say, yes.

Trisha Gura http://trishagura.com Godiva, melting on their tongue, undeniably engenders an uncontrollable craving for more. But is this craving an addiction? And, by the way, what’s the difference between craving and addiction anyway?]]> Lying in Weight. “No, chocolate is not truly addicting,” Boggiano says, “but it can sure as heck feel that way for some.” Technically, chocolate does not induce a drug-like effect on the brain – at least not in the same way that, say, cocaine and heroin do. If you doubt, know this: scientists have even taken apart the ingredients of chocolate i.e. cocoa, cocoa butter etc. and found that no subjects craved the components when they were presented in different food sources. The sum of a candy bar is definitely better than its parts. There’s more. Historically, doctors have used the word, “addiction” to refer to a recurring compulsion by an individual to engage in some specific activity. He or she does this despite harmful consequences to health, mental state or social life. Addictive substances or behaviors (i.e. gambling) breed a tolerance, meaning that greater dosages are needed to produce an identical effect over time. And taking away the addictive substance evokes noticeable, if not extreme, physical withdrawal symptoms. Chocolate does not produce the classic responses that defines real addiction. “It's not like you need more and more chocolate each time,” Boggiano says. “And any feeling of "withdrawal" is probably more psychological (a habit) vs. physiological.” Speaking of physiology, there’s a slew of medical research on what happens in the brain in response to addictive drugs. Simplifying the research, an addictive substance is one that produces a specific effect on a specific neurotransmitter (dopamine) in a specific region of the brain called the nucleus accumbens, a seat of reward -- and ironically, fear. Chocolate does not do this. Or it at least it does not do it in the same way as cocaine and heroin. Studies show that drugs of abuse stimulate the production of dopamine in the nucleus accumbens. These drugs also keep the stimulation going when the brain is repeatedly exposed to them. Chocolate, too, stimulates dopamine. But the brain eventually down-regulates this dopamine response after repeated exposure to chocolate. So, what looks like a duck, isn’t a duck – that is, if it's a chocolate duck. However, no one can deny the pure pleasure and pick-me-up feeling of a nice hunk of a Dove Bar. If this is not addiction, than what is it? Researchers suggest that chocolate induces a delicious mood state that is so vastly different from the PMS-depressed-like mood state you were in when you bought the Dove Bar in the supermarket. Thus, it is this contrast in states of mind (blah versus ahh) that provides the 'hook' or belief that chocolate is addictive. Of course, there is the caveat that when an eating disorder involving bingeing is present, this dopamine response in the brain can go awry. But that’s a whole different story; a study by British researchers showed that for those who consider their intake of chocolate excessive, any pleasure experienced is short-lived and accompanied by deep feelings of guilt. Indeed, chocolate is bittersweet.]]> tag:trishagura.com,2008:/blog//1.30 2008-04-07T20:19:21Z 2008-04-07T20:22:14Z

Desperation for thinness is a spectrum, with life-threatening diabulimia on the severe end and simple longings to be skinny at the opposite

Trisha Gura http://trishagura.com Boston Globe ran an article about diabulimia, a practice in which individuals with diabetes skip or underdose their insulin in a misguided attempt to stay thin. The article cited in the work of psychologist Ann Goebel-Fabbri, at the Joslin Diabetes center in Boston. She published a shocking study last year showing that diabulimia tripled the risk of death from diabetes or its complications. Those who restricted their insulin died on average 13 years younger -- at 45, compared to 58.]]> Internet PSA about diabulimia. The graphics illustrate the reality: when you practice diabulimia, you stare death in the mirror. I could stop there, with a dismissive, “well, diabulimia, however tragic, is rare.” And as someone who has struggled with an eating disorder, I could say, “well least, I haven’t done that.” But upon reflection, I realize that by having engaged in anorexia, I, too, flirted with mortality. Just at a slower pace than my diabulimic sisters. Starving while overexercising for decades certainly took its toll on my body. I have no idea if I have cut my life short in my sorry pursuit of thinness. I do know that if I click my tongue at “desperate people who do desperate acts for thinness,” or believe that those who practice diabulimia should pay the price for their own demise, I’ve lost the sight of the truth. Desperation for thinness is a spectrum, with life-threatening diabulimia on the severe end and simple longings to be skinny at the opposite. I sit somewhere on that spectrum. And every day I work hard to move toward the life-affirming pole. How about you? Where do you fall? How far have you gone for want of thinness? And what are you willing to give up in order to head in the other direction—toward healing?]]> tag:trishagura.com,2008:/blog//1.29 2008-03-26T18:04:51Z 2008-03-26T18:10:03Z

Adolescents who regularly skip breakfast end up heavier than their counterparts, who spoon their cereal and nibble their toast regularly.

Trisha Gura http://trishagura.com a study published this month in Pediatrics, Dianne Neumark-Sztainer’s group at the University of Minnesota reported that adolescents who regularly skip breakfast end up heavier than their counterparts, who spoon their cereal and nibble their toast regularly. Because the skippers tended to be trying to --or thinking about trying to -- lose weight, the authors concluded that breakfast-skipping may be a misguided attempt at weight loss. ]]> 5-15 percent of anorexia and bulimia cases and at least 35 percent of binge eating disorder cases occur in males. The message here is not just to think about breakfast as a tool for obesity prevention. But also about how our growing teens, both males and females, are gradually formulating unhealthy perceptions and habits related to eating. Since those can be the gateway to the eating disorders hole, let’s think more broadly than just how to keep teens from getting fat. ]]> tag:trishagura.com,2008:/blog//1.28 2008-03-11T17:28:01Z 2008-03-11T17:37:57Z

There’s long been a consensus that what you eat influences how you sleep. But can how you sleep dictate how you eat?

Trisha Gura http://trishagura.com There’s long been a consensus that what you eat influences how you sleep. But can how you sleep dictate how you eat? The answer is yes. At least at the extreme. narcolepsy, a sleep disorder. Half reported runaway cravings for food and binge eating. More extreme, almost a quarter (23.3 percent) met the criteria for a clinical eating disorder. The findings are stunning, first in their numbers. •Of the 60 narcolepsy patients surveyed, 67 percent reported an irresistible and persistent craving for food -- versus only 5 percent of the 120 controls. •A whopping 55 percent of narcoleptics engaged in binge eating --versus a scant 1 percent of controls. While it’s clear that there is a connection between sleep and appetite, questions remain. What exactly is it? And what can the rest of us non-narcoleptics take home as a message? On a molecular level, the link between sleeping and eating uncontrollably is all about a neurotransmitter called orexin (a.k.a. hypocretin), discovered in 1998. While trying to find a good target for an obesity drug, researchers stumbled upon orexin (and its receptor) – both located in a region of the brain called the hypothalamus, which controls appetite. Dogs and mice that bear mutations in their orexin receptors eat less, showing that the molecule plays a role in stimulating appetite. But the mutant animals also develop a bizarre form of narcolepsy, characterized by floppy “sleep attacks,” called cataplexy, that come on unbidden. (Check out Skeeter “the narcoleptic poodle” to see what narcolepsy looks like. In humans, narcolepsy is a bit different, characterized by a huge variation in symptoms, everything from sleepiness all day long to dropping over like a rag doll at unpredictable moments. If that isn’t enough angst, there is something more. Narcolepsy patients tend to be overweight, “some heavily overweight,” says Droogleever Fortuyn. “Sometimes they have candy with them -- and offer me some. It wasn’t very difficult to think that there might be a connection.” Indeed, he found one. And now Droogleever-Fortuyn is advocating for more attention to eating disorders in the treatment of patients with narcolepsy. They are already slogging through inconceivable setbacks from severe their sleep disturbances. How much worse to shamefully—and thus quietly—suffer from the symptoms of an untreated eating disorder? While physicians and therapists can keep this in mind when treating patients with narcolepsy, there is a larger message for the vast majority of us who do not suffer from the sleep disorder. Eating and sleeping are intimately, molecularly connected. The narcolepsy patients were not binging to find pleasure through food in the midst of suffering a debilitating disease. Instead, the bingeing stemmed from biological roots. The same molecular pathway that influences sleep patterns and muscle tone also affects appetite. If you don’t believe this, just take a lesson from people’s experiences with the sleep drug, Ambien. Many of the drug’s users began sleepwalking into their kitchens and stuffing down thousands of calories of food. Why? The drug targets a still-mysterious circuit in the brain that links the primal acts of eating and sleeping. We can all take a lesson from the extremes. While binge eating disorder and narcolepsy represent the severe end of the disordered eating and sleeping spectrum, they both point to a biological connection worthy of further study. To wit, we all aspire to sound sleep and healthy eating. ]]> tag:trishagura.com,2008:/blog//1.27 2008-03-05T14:52:55Z 2008-03-11T17:40:51Z

s the spring holidays fast approach, we begin to think again about eating as a family...there may be a troubling fly in this family-style soup.

Trisha Gura http://trishagura.com As the spring holidays fast approach, we begin to think again about eating as a family. There’s growing evidence that family meals play an important role in the health and well being of adolescent girls, not to mention in blunting eating disorders. But there may be a troubling fly in this family-style soup. recent study, conducted by the University of Minnesota School of Public Health, surveyed a group of 2516 adolescents at two time periods in their lives: 13 and 16 years of age, on average. When asked about body mass index, eating behaviors and family relationships during the second round of surveys, girls who regularly ate meals with their families were less likely to engage in extreme measures to control weight, such as use of laxatives, diet pills and smoking. The older, family-meal-eating teens were also less likely to fast, eat food substitutes, binge eat or chronically diet. Such evidence has led to an outpouring of consumer advice both promoting an Ozzie and Harriet-style of family togetherness and giving tips of how to achieve that in today’s fast-paced, fast-food world. However, the University of Minnesota study has a caveat -- and it’s a big one. The decrease in disordered eating was only seen in girls. Boys were not protected. In fact, more frequent family meals increased boys’ extreme weight control measures, mainly skipping meals and dieting. So what’s really going on? The research team, led by renowned eating disorders expert Diane Neumark-Sztainer, can’t cite the reason for the sex disparity. But the team speculates that boys might perceive the rituals around mealtimes differently, or that girls may be more sensitive to interpersonal relationships that play out over a platter of family-style pasta. If this is so, then it’s not so important that everybody sits around the table together. Instead, it’s the dynamics that matter. There are studies to confirm this premise: • Researchers videotaped mothers with and without eating disorders interacting with their toddlers at mealtimes and play. In both situations, mothers with eating disorders tended to “overcontrol” their children, leading to more conflict. Later studies showed that when the same toddlers reached the age of 10, they themselves showed more disturbed eating habits and attitudes. • Women with bulimia reported experiencing more negative childhood mealtime and food-related occurrences as compared to controls. The women with bulimia said they felt high levels of stress and conflict during meals, experienced food as a tool for punishment or manipulation, and fell prey to parents who emphasized dieting and weight. Here’s the kicker: the women with bulimia said that mealtimes tended to be the only time the family spent together. It seems that healthy family interaction, not family meals per se, are the protecting influence on teens. I don’t doubt the studies that show regular family mealtimes can help guide our children away from risky behaviors. But simply having more meals together is not going to solve poor body image, eating disorders or the myriad of other adolescent troubles now plaguing our kids. Beyond the food or meal participation, the attitudes and banter bandied about the dinner table also make a difference. As evidence, British researchers have found that kids who hear negative comments about weight and shape run a higher risk of developing binge eating disorders. What better fodder for a budding eating disorder than regular, nasty commentary about body size or fat content every night at 6 p.m.? Let’s not jump the gun and reduce the prevention of eating disorders, in specific, and teen delinquency, in general, to simple nostalgic solutions. Disordered eating and eating disorders are complex problems with many causes, biological, psychological and social. Understanding the reality of these complexities is the first step in prevention. And, if you’re moving toward that goal, pay attention to the complicated ways you behave as a family. Hannah Cohen-Cline contributed to this blog. ]]> tag:trishagura.com,2008:/blog//1.26 2008-02-21T15:30:19Z 2008-03-11T17:39:14Z

I wrote about chewing and spitting in previous blog. It's when you eat food, chew it and then spit it out without swallowing. The idea is to lose weight because you are not consuming the calories. While many commentators have...

Trisha Gura http://trishagura.com previous blog. It's when you eat food, chew it and then spit it out without swallowing. The idea is to lose weight because you are not consuming the calories. While many commentators have since posted and emailed me personally about how the practice is devastating their lives (there's issues of dentures, ulcers, lost hair and huge grocery bills), there are others who say they think C & S is a safer form of bulimia. I'd love to hear more comments on the issue. Leave them on this post or, better yet, on the train of posts in the original blog. There's not much out there on this topic. Let's find out together...]]> tag:trishagura.com,2008:/blog//1.25 2008-01-29T13:14:21Z 2008-03-11T17:39:32Z

Diabulimia. "Chewing and spitting." Drunkorexia. People are engaging in secret, shameful behaviors all for the sake of getting or staying thin.

Trisha Gura http://trishagura.com They do it because they’re desperate. People are engaging in secret, shameful behaviors all for the sake of getting or staying thin. Shortly after giving birth, Lauren, 35, would tell her husband that she was going to the grocery store late at night. There, she would buy bags of junk food, gorge in her car, and then make herself throw up in the parking lot. Her goal was to reach her pre-pregnancy weight. At all costs. The “cost” to Lauren was her relationship with her new baby, which she says she lost during the two years that her bulimia raged untreated. "How tragic,” we say. But her story just scratches the surface. chewing and spitting.” She puts food her mouth, tastes, chews and then spits out the masticated glob without swallowing. She thought she was operating on the sly, getting some enjoyment out of food, without suffering the weight-gain consequences. But Kaitlin suffers other consequences. The corrosive acid, from letting the chewed food sit in her mouth, then the spitting, has deteriorated her teeth below the gum line, a condition that is virtually impossible to repair. At the ripe age of 23, Kaitlin wears dentures. Had enough? It gets worse. Arguably,diabulimia is the most dangerous "stealth" anti-caloric practice anyone can do. It’s performed by individuals with type 1 diabetes, who don’t make enough insulin. As they have to take the hormone daily, some diabetics have figured out that by skipping doses, their bodies can shed pounds. Medically speaking, without insulin, cells cannot metabolize sugar. Instead, they flush it out through nearly constant urination. The practice is akin to bulimia, except that it is sugar, not food, that's being purged from the cells -- and body. While “sugar out” means “calories out,” diabulimia can also lead to “lights out.” A recent study reported that when anorexia or a related eating disorder was present alongside diabetes, the 10-year mortality rate rises from 2 percent of diabetics without anorexia and 7 percent of anorexics without diabetes to 35 percent for those with both diseases. Not surprisingly, eating disorder experts are alarmed. According to Brenda Woods, M.D., director of medical services at Remuda East, an eating disorders treatment center in Milford, VA., most of Remuda’s diabetic patients “underdose” their insulin in a misguided attempt to slim down. We can argue that these behaviors, however tragic, are rare. But let’s move onto the anything goes realm of college campuses. There, students skip meals in order to save their “calorie quote” for binge drinking. While the practice is not new, its moniker, “drunkorexia,” is. No one has firm statistics about how many drunkorexics are frequenting frat parties and university pubs. But studies do show that at least a third of alcoholics also have eating problems. For my book, “Lying in Weight: the Hidden Epidemic of Eating Disorders in Adult Women," I interviewed Tracy, 43, who for decades vacillated between alcoholism and bulimia, recently settling on a mild version of the latter. And Janet, 56, who started in her late teens, still both drinks and binge eats, simultaneously. Followed by purging. Finally, there is the simple craving to be really thin. “Wannarexia” has popularized itself into Wikipedia, defined as “a label applied to someone who claims to have anorexia nervosa, or wishes they did.” Do we click our tongues at desperate people who do desperate acts for thinness? Do we dismiss them, saying they should pay the price for their own demise? Or do we turn our appetites for the sensational into an honest bit of soul searching. Desperation for thinness is a spectrum, with life-threatening diabulimia on the severe end and simple longings to be skinny at the opposite pole. How far are you willing to go? And why is thinner important to you? Is being skinny, to you, the means to feel attractive, á la fashion model Kate Moss? Is “fabulously thin” a Fountain of Youth, to place you in the market after a midlife divorce? Is getting thinner the way you try to hang onto an errant spouse? Desperate people, wanting basic love and admiration, do desperate acts. While the concept is age old, the stakes today are higher as cosmetic technology flirts with genomics, promising yet newer ways to sculpt our bodies -- at the molecular level. ]]> tag:trishagura.com,2008:/blog//1.24 2008-01-09T15:11:33Z 2008-01-09T15:25:41Z

Forget weight loss and body sculpting. My New Year’s resolution is to learn how to eat normally.

Trisha Gura http://trishagura.com New Year’s Day, the first of the weight loss advertisements arrived: a press release for a new diet plan. Then came a flood of emailed anti-fat strategies; coupons for local health clubs; Google ads flashing “Lose 30 pounds in Weeks – No Diet.” And I haven’t even turned on the TV yet, where commercials for elliptical trainers, diet pills, and low-carb shake schemes will hold me hostage until I press the remote. Forget weight loss and body sculpting. My New Year’s resolution is to learn how to eat normally. I’m not sure what exactly that is. Along with everyone else, I’ve been so indoctrinated with dieting and exercise tips, I’ve lost sight of health. But I'm not to be deterred. National Association for Eating Disorders: •46% of 9-11 year-olds are “sometimes” or “very often” on diets, as are 82 percent of their families. •91 percent of girls on a college campus had dieted. •95 percent of all dieters will regain their lost weight in 1-5 years and those who diet frequently are 12 times as likely to binge as those who don’t diet. Dieting is not normal eating. And because I am recovering from anorexia nervosa, dieting certainly is unhealthy for me. What is Normal Eating? Dietician Ellen Satter takes a stab at the question in her book, "Secrets of Feeding a Healthy Family." Normal eating is: •Being able to eat when hungry and continue eating until satisfied. . •Leaving some cookies on the plate because you know you can have them again tomorrow. •Aiming for happiness rather than thinness. For me, normal means making tapioca pudding because I like it and I haven’t allowed myself to eat it in 12 years. Normal is eating three meals every day, because I usually eat only one, dinner, thinking I should save my calorie quota just like, when a preteen, I used to save a my chocolate candy bar, nibbling a bit each day, making it last two weeks. This year, I’ve eaten until I feel stuffed, just to know that I can tolerate that feeling. I’ve let my daughter cook me macaroni and cheese, and eaten it with relish -- because her meal making is an act of love that I am now choosing to receive. I’ve refused to accept entertain the self-destructive idea that the number on the scale measures my worth. For you, "normal" will be just as personal. You know your habits. Terry Bravender, M.D., director of Duke University’s Eating Disorders program, tells me that, at it’s core, eating normally means breaking a moral code as in: I should eat only “good” foods like spinach and stop eating “bad” foods like Haagen Dazs Double Chocolate. All foods are good, sometimes, in the right proportions for you. We know how to do this. As toddlers, we never thought to say, “I was so bad today,” because we ate two chocolate brownies. We knew instinctively how to eat, based on our body’s cues for hunger and fullness. But then, we grew up into a culture of “Losing 10 Pounds: the Gateway to a New You.” Most of us tried the diet and exercise schemes. Some of us went overboard. And we lost the best relationship, the one between our plates and ourselves. But we can find normal again, like an old friend. A good start is to tune out the advertisements and tune into our own bodies. They will bring us true happiness. But only if we’re willing to listen. ]]> tag:trishagura.com,2007:/blog//1.23 2007-11-16T00:51:38Z 2007-11-16T00:59:41Z

Could it be that there’s a backlash against all the nipping, tucking and Photoshopping to create impossible beauty ideals?

Trisha Gura http://trishagura.com They don’t do it -- because they’ve had enough. Some women in midlife are not coloring their hair, dieting religiously, and struggling to achieve unrealistic standards of physical beauty. While the statistics continue to startle us -- $8.2 billion worth of beauty products sold in 2006, a $55.4 billion annual weight loss industry, and 2.7 million women aged 51-64 who underwent cosmetic surgery in 2005 -- there appears to be a subset within this demographic that is letting go of measuring self-worth based on appearances. Could it be that there’s a backlash against all the nipping, tucking and Photoshopping to create impossible beauty ideals? survey of 322 women, aged 20 to 84, Tiggemann found that women’s body dissatisfaction did not increase as they aged. “Everyone says, ‘I’d rather be thinner’ or ‘I’d like to have a body that looks like this,’” Tiggemann says, in a personal interview. “But it matters less to a woman when she gets older.” In other words, the average middle-aged woman has grown smarter. As she grays, wrinkles, and thickens, she increasingly dreads the changes to her hair, skin, and shape. But she is no longer willing to endanger her health or simply go to all the expense and trouble to try to meet contemporary culture’s idealization of women. Some women are letting go. Makers of the Dove Campaign for Real Beauty have tapped this vein. Their latest campaign, “Onslaught,” is all the rage. In it, a fresh-faced adolescent is depicted on the brink of life. Next follows a barrage of destructive beauty ads, videos, even the acts of bulimia nervosa. And the message, “Talk to your daughter before the beauty industry does.” Another data point: actor-cum-photographer Leonard Nimoy, of Star Trek fame, has come out with a provocative photography exhibit entitled, the Full Body Project. It depicts women from the "Fat Bottom Revue," a burlesque presentation meant to promote “fat liberation.” The women are indeed full-bodied, some would say obese and, therefore, repulsive. Nimoy sees the women differently. “The cruelest part … is that these women are being told, ‘You don’t look right,’” Nimoy says in a recent New York Times article And the beauty industry has hooked a number of these women in to buying clothing and accessories that slim, beauty aids, plastic surgery, diet pills and programs, therapy and the basic premise that you can look like a fashion model. And you should. But there is a brave cadre that wants a different message. Perhaps it is one about a life-well-lived. If you are spending a great proportion of your waking hours obsessing about food and flab, you are taking away from quality time. At midlife, we wake up to the reality that we have fewer birthdays ahead than behind. And time becomes more precious than any diet or exercise goal achieved. Yes, exercise and healthy dieting can prolong life. And true, it feels marvelous to take off a few pounds after indulging in a glut of holiday feasting. But if body-sculpting endeavors diminish mental and physical health, are they worth it? The Dove women in their underwear say no. ]]> tag:trishagura.com,2007:/blog//1.22 2007-10-09T14:36:06Z 2007-10-09T14:54:50Z

“Anna Rexia,” a chance for the everywoman to dress like a “slut” with an eating disorder...Bionic Woman, super strong but the size of a sapling.

Trisha Gura http://trishagura.com Anna Rexia," a chance for the everywoman to dress like a “slut” with an eating disorder. The designers are stuffing a busty babe into a skeleton costume. Now that’s about as ironic as resurrecting the Bionic Woman, super strong but the size of a sapling. (And a gothic to boot). I’m guessing this is about the ultimate fantasy, having it both ways, semi-starved and strong, skeletal and busty. To wit, Miss “Anna Rexia” is available in a plus size, offering curvier women the chance to dress-up as our current runway model ideal. ]]> I'd say the costume is so over the top, it’s doing us a favor. Unlike the new Bionic Woman, who looks relatively normal-sized (for TV celebrities that is) and was created by TV writers to seduce us with dark themes of killing and maiming, "Anna Rexia" makes us realize the silliness of our mixed cultural ideals. No one woman can be meet them all, unless of course she’s half robot or pretend. Halloween with its skeletons, witches, and ghosts does glorify the mentally afflicted. And so does our contemporary blurring of science fiction and reality. What's next? Bionorexia? Bustorexia? Let’s keep this Halloween theme to one day, please. Anorexia is ghoulish disease, worthy only of compassion not worship. tag:trishagura.com,2007:/blog//1.21 2007-09-28T19:20:02Z 2008-03-11T17:39:49Z

They do it for shock value. The fashion moguls are playing the "shock and awe" game again. This time with an ad campaign for Nolita, featuring an emaciated nude woman. Not just thin a la Kate Moss. Not heroin addict...

Trisha Gura http://trishagura.com Kate Moss. Not heroin addict chic, heroin chic as promoted by Calvin Klein in the 90’s. No, thin, as in a concentration camp survivor thin. She’s in newspapers, on billboards, on TV, and all over the Internet. See for yourself. Warning: this isn't pretty. It’s anorexia nervosa, stark and real. ]]> Benetton ad campaign. He wants, “to show the reality of this sickness to all through this naked body, a sickness that in most cases is caused by stereotypes imposed on women by the fashion world.” Wow. At first glance, Flash&Partners is doing a great public service, warning models of the pitfalls of going too far on the skinny side. The poor starving waif in the Nolita ad must be a former model who went over the edge of the runway and fell to the basement. Somewhere on the group’s website, we’ll find her sad story. Or, at least exhortations from the sponsor about avoiding anorexia. Maybe there are a few links to the appropriate eating disorder organizations. And advice from a few treatment centers. Guess again. The emaciated woman is Isabelle Caro. She's 27, and according to her blog, she's a theatrical comedian who's suffered from anorexia since the age of 13. She blames her disease on a difficult childhood, not the fashion industry. So this isn’t the story of a fallen model. Rather, F&P is apparently using Caro as a symbol of what could happen to wayward runway models and a remonstration to the culture for goading young girls into unhealthy ideals. If there were some follow up content, I could buy this message. But there isn't any. The group's Website includes a press release, an email feedback link, and a photo gallery that features close-ups of Caro's nearly-skeletal body parts and her coyly smiling face, culminating with a fluorescent pink “NO.” The screen says, “No,” but her smile says, “Yes.” Yes to what? "Yes, I am a person, a female inside this body.” “Yes, I am the best anorexic – at 5'4," 68 pounds." "Yes, I've got your attention now." Only she knows what’s she was thinking. And we are left disturbed, haunted, intrigued, and perhaps manipulated. Whatever our personal reaction, we can’t help but look at this image, a representation of classic anorexia. And that’s the whole point of shock ads. So much for just saying "no." While there isn't additional content relating to Caro or the “No Anorexia” campaign on the Nolita site, there's lots of other eye candy for your viewing pleasure. Like the thumping Flash movie featuring a model (not Caro), reclining. This person looks much healthier and is fully-garbed in skin tight pants and leather boots. She rolls to and fro as she demos the Nolita line. By comparison to Caro, the clothed model is fleshy! Well not really. But she's still probably thinner than 97 percent of the rest of the women in the world. In any case, it's quite a show. And sadly, the show is what this is all about. Isabelle Caro -- in the raw -- is merely a ploy to get people to click onto a high-end clothing site. Bait and switch. Titillate and sell. If F&P really wanted to help cure a disease greatly exacerbated by the industry from which it profits, it might have consulted the medical community first. Some experts say that many women, particularly those most desperate for thinness, are likely to respond to the ad, not with caution, but rather, with a competitive drive: I want to be like her, the best anorexic. Remember that coy smile. So the ad campaign can actually worsen the fall from the runway into eating disorders. Fabiola De Clercq, the president of Italy’s Association for the Study of Anorexia, summed it up bluntly, telling The Times, U.K., that the image was “pointless and damaging” and Reuters that the woman used for the photo should be in the hospital -- not up on a billboard. Indeed, there’s more harm than help in using Caro this way. In the Nolita ad, she’s merely a prop -- just as all the runway models are objects, living hangers, draped with clothing. Will we remember Caro’s face? Or her story? Will we say, "What an act of courage by this woman to allow her starved, naked body to be exposed, raw and real?" Probably not. But for sure, we’ll remember Nolita. And not for the company's humanitarian largess. Rather, we’ll remember Nolita for its shrewd branding as we did Calvin Klein for its ad campaign using children in provocative poses. Speaking of children, you ought to check out the children’s section of the website, “Nolita Pocket.” If your kids were visiting, they would need to click past Caro’s image before entering an anime world of cute characters, activities, and, of course, Nolita’s children’s line. The photographers and fashion designers are doing what they do best: Making bodies and clothing into art – or spectacles. Either way, they sell. And we buy. And keep on buying, even if it means disease. ]]>