World Wide “ED?” That’s short for “World Wide Eating Disorder” epidemic. It’s a horrifying trend and is growing at an alarming rate; conservatively, it involves hundreds of millions of individuals.

I did a quick skim of the medical literature and found eating disorders and body image problems cropping up in Great Britain, Australia, and New Zealand; Croatia, Sweden, and Israel; Mexico, Brazil, China, Japan, Ghana, and South Africa. Even Fiji.

Fiji? It’s a Polynesian island that has been meandering along under balmy blue skies for 3,000 years – with only one recorded case of an eating disorder. Yet, Fiji is now part of the global epidemic.

How did that happen?

In the HBO documentary, “Thin,” a fly-on-the-wall look at four patients checked into an eating-disorder clinic, one of them, Brittany, 15, tells her secret ritual: chewing and spitting. She and her mother would buy bags of candy, chew it, taste it and spit it out before swallowing. To Brittany, these episodes were nostalgic mother-daughter moments. The teen was bonding to her mother, who, not surprisingly, also has an eating disorder.

Brittany is by no means alone.

Who isn’t stressed out?

Some people claim stress causes them to lose their appetites. Others, the vast majority, find that long-term stress does just the opposite: causing them to overeat or binge and pack on pounds around their bellies.

Scientists are finding that there are at least two neurotransmitters in the brain that act to cause weight gain in the face of adversity. The molecules, called neurotransmitter Y (NPY) and PYY, are part of our ancestral heritage, built when famine (a form of stress) meant a death sentence.

But today, in times of plenty, the “Y” molecules are unwanted friends crashing our holiday parties, again and again.

Even Goby fish do it.

Dieting, that is.

Why, you may ask? You’d think that dieting would be a death sentence for a tiny osteichthyes, no bigger than a bloated paper clip. But some goby fish see slimming down as survival.

In essence, gobies, lower on the ladder of piscine hierarchy, starve themselves to minimize their threat to plumper, more powerful leaders. Starving is a way out of imminent confrontation.

This fish story doesn't just have import for our marine friends; it bears on human behavior as well and brings] to mind several of the marriages I profiled in Lying in
Weight: the Hidden Epidemic of Eating Disorders in Adult Women.

During an interview for Oprah and Friends XM Satellite Radio, host Dr. Mehmet Oz, M.D., asked me, “So, are you on a diet?”

My response was knee-jerk. “Oh, no,” I answered. “Diets are so dangerous for me.”

The reason came out in follow-up question by Dr. Oz: “How did your eating disorder begin?” he asked.

I was surprised to learn that the most common search terms that are bringing people to my site are "chewing and spitting" -- or variants of the two words. I'm astonished because I didn't realize how many individuals are trying this tactic in order to ward off fat. I also thought --mistakenly-- that chewing and spitting out food was new, something about which girls are swapping tips, just as we, back in the 1980s, whispered secrets about bingeing and vomiting.

Apparently not. My friend Joe, 61, told me the following story:

My dad was doing this in his fifties, when I occasionally visited home from college. In retrospect, I think he'd just moved from the public to the private sector, and was frantically trying to lose weight so he could get into his suits without a corset.

They do it even in remote island villages.

In my last blog, several people who posed comments asked if the U.S. was the only country suffering eating disorders.

Here's my answer:

In Sigatoka, Fiji, eating disorders have emerged from, literally, nothing.

According to anthropologist Anne Becker, before 1995, no eating disorders existed on the island, excepting one murky case of anorexia. The Polynesian island meandered along under balmy eating-disorder-clear skies for 3,000 years, as villagers proudly displayed their large brown bodies, built to a size we would label obese. But in Fiji, the bigger the body, the more the love.

Then, in 1995, it all changed. The village chief permitted television.

They do it because their brains are wired to.

Girls with anorexia nervosa starve due to neural processing problems -- much like those associated with Asperger’s disorder, a mild form of autism.

That’s the latest theory of eating disorders, proffered in The Times (U.K.) by Janet Treasure, head of the Eating Disorders Unit at the South London and Maudsley Hospital NHS Trust. In essence, faulty circuitry in the brain causes the restrictive, repetitive and obsessive behaviors of both disorders. Those with anorexia target the abnormal patterning toward food. Those with Asperger’s focus intensely on other areas of interest.

Treasure’s controversial thesis is based, in part, on commonalities that the two disorders share.

"Thin," a documentary about contemporary eating disorders, just came out on DVD in July 2007. In the film, director and photographer Lauren Greenfield lets the camera roll on four women at The Renfrew Center's Coconut Creek, Florida residential treatment facility for eating disorders. Her fly-on-the wall approach is unmatched in unveiling the untold horror of anorexia and bulimia nervosa --and how they seduce their victims with promises of thinness.

Still, the film leaves the reader longing for something more satisfying.

The four stories roll on, occasionally intersecting, but more often following their own trajectories. The lack of a cohesive narrative leaves the average viewer rightfully shocked but nonetheless adrift in a sea of seemingly meaningless suffering.

First in Italy and Spain, and now in Britain, super skinny models are buzzing through headlines once again. The talk is about whether or not to ban models with frighteningly low Body Mass Indexes (BMI) from participating in London Fashion Week 2008.

So far, skeletal gets to stay -- as long as a doctor signs off, that is. Based on “The Model Health Inquiry,” commissioned by the British Fashion Council, models need only provide "good health" certificates from eating disorder specialists. And then it’s business as usual.

Apart from what this move signifies about our current ideals of beauty, I’m most skeptical about logistics.

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 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.

Ready for the ultimate Halloween costume?

Here it is: "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.

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?

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.

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 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...