This is a handout I got in my Medical Family Therapy class. The copyright at the bottom says “(c) 2005 National Eating Disorders Association. Permission is granted to copy and reprint materials for educational purposes only. National Eating Disorders Association must be cited and web address listed. www.NationalEatingDisorders.org Information and Referral Helpline: 800.931.2237.” I think that covers me. I’m willing to take the risk, anyway, because eating disorders are a huge problem. The most conservative estimates, using the most strict definitions, are that six million people in the US struggle with disordered eating. Estimates using less strict definitions (including Eating Disorder Not Otherwise Specified in the DSM-IV-TR), but still very realistic, are at about 20 million. And eating disorders are the most deadly mental disorder. If not treated, 20-25% of those with serious eating disorders die from them. You won’t find that statistic in many official sources, though, because for some very strange reason, coroners will not list Anorexia or Bulimia Nervosa as a cause of death. They prefer “Cause of death unknown” in those cases. Plus, eating disorders are learned behavior. Don’t let your kids learn the values that encourage disordered eating from you!
OK, here it is. It’s by Michael Levine, PhD:
1. Consider your thoughts, attitudes, and behaviors toward your own body and the way that these beliefs have been shaped by the forces of weightism and sexism. Then educate your children about (a) the genetic basis for the natural diversity of human body shapes and sizes and (b) the nature and ugliness of prejudice.
*Make an effort to maintain positive attitudes and health behaviors. Children learn from the things you say and do!
2. Examine closely your dreams and goals for your children and other loved ones. Are you overemphasizing beauty and body shape, particularly for girls?
*Avoid conveying an attitude which says in effect, “I will like you more if you lose weight, don’t eat so much, look more like the slender models in ads, fit into smaller clothes, etc.”
*Decide what you can do and what you can stop doing to reduce the teasing, criticism, blaming, staring, etc. that reinforce the idea that larger or fatter is “bad” and smaller or thinner is “good.”
3. Learn about and discuss with your sons and daughters (a) the dangers of trying to alter one’s body shape through dieting, (b) the value of moderate exercise for health, and (c) the importance of eating a variety of foods in well-balanced meals consumed at least three times a day.
*Avoid categorizing and labeling foods (e.g. good/bad or safe/dangerous). All foods can be eaten in moderation.
*Be a good role model in regard to sensible eating, exercise, and self-acceptance.
4. Make a commitment not to avoid activities (such as swimming, sunbathing, dancing, etc.) simply because they call attention to your weight and shape. Refuse to wear clothes that are uncomfortable or that you don’t like but wear simply because they divert attention from your weight or shape.
5. Make a commitment to exercise for the joy of feeling your body move and grow stronger, not to purge fat from you body or to compensate for calories, power, excitement, popularity, or perfection.
6. Practice taking people seriously for what they say, feel, and do, not for how slender or “well put together” they appear.
7. Help children appreciate and resist the ways in which television, magazines, and other media distort the true diversity of human body types and imply that a slender body means power, excitement, popularity, or perfection.
8. Educate boys and girls about various forms of prejudice, including weightism, and help them understand their responsibilities for preventing them.
9. Encourage your children to be active and to enjoy what their bodies can do and feel like. Do not limit their caloric intake unless a physician requests that you do this because of a medical problem.
10. Do whatever you can to promote the self-esteem and self- respect of all of your children in intellectual, athletic , and social endeavors. Give boys and girls the same opportunities and encouragement. Be careful not to suggest that females are less important than males, e.g., by exempting males form housework or childcare. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to dieting and disordered eating.
Nathen's Miraculous Escape 
March 16, 2010 at 7:03 pm
Alright,
So this is quite the topic.
First I would like to know some real statistics involving death in regards to eating disorders. Perhaps in the future we can work towards expanding the odd standards of morticians.
Here is something that I will submit for your consideration:
It seems to me that the most sinister menace to humanity is the various collection of diseases that are called metabolic disease. Those, along with hearth disease, as far as I can tell, make up the basic majority of human mortality… eventually at least. So here’s my thought/question: are mild eating disorders what clinicians claim them to be or some relevant biological intervention in the prevention of the aforementioned diseases? In other words, the organism that is suffering through its own demise could potentially be manufacturing a crude antidote by way of eating disorders. This could be true on a personal level, or even a cultural level if you take into account the horrid social ridicule that that overweight individuals are exposed to.
March 16, 2010 at 8:28 pm
Hi Ben,
Thanks for the comment. The 20-25% mortality rate _is_ based on research, not just guessing, but I haven’t seen the actual paper yet. I’ll get it and send it to you.
I think I get what you’re saying, and I imagine that the bulk of the people you take to the emergency room _are_ suffering from metabolic conditions, as you describe. As I understand them, though, eating disorders are another thing entirely, more like obsessive-compulsive disorder, a fixation on control often coupled with a distorted body image. It may be that obesity will be considered a kind of eating disorder in the future, and it may well be that the extreme anxiety about food that people struggling with eating disorders is related to our societal fear of food that comes from so many people dying from obesity-related conditions. It’s not a good trade-off though, not a protective mechanism. An untreated eating disorder will kill someone younger than obesity will.
And good point about the social ridicule of obese people. The opposite tends to be the case for (early stage at least) eating disorders because thin is beautiful in America. People with anorexia tend to get compliments on looking thin, at least for a while.
March 19, 2010 at 3:14 pm
Hi again, Ben.
After looking for the source myself, I emailed my prof and this is what she emailed back. I’ll let you know when I know more:
Hi Nathen, I don’t have it handy and I am not able to easily find the whole reference without doing some digging (which I cannot take the time to do right now, sorry). This website might be helpful although they don’t list references
http://www.mirasolteen.com/eating-disorders/information/eating-disorder-statistics.php
And what might be even more helpful is the recent study I mentioned in class by Scott Crow where he found high rates of mortality for people with EDNOS (5.2%) and higher than expected rates for BN. Follow this link for the info:
http://ajp.psychiatryonline.org/cgi/content/abstract/166/12/1342
I like the statistic by Wright because it catches peoples attention but it is problematic. The statement says 20-25% of those with SERIOUS eating disorders will die….how do they even measure that? the point though is that EDs are serious and life threatening. :-)
March 20, 2010 at 12:42 pm
I think next time I want to say something I will just have Ely write it for me. Ya’ll are just so damn eloquent.
After reading all of the replies to this post and thinking about it for a while, I do have a greater appreciation for the seriousness of EDs.
I’ve been reading your post and the replies, though, and wondering why I have such an emotional response to it. I think that I have finally tacked it down. It may be egotistical of me to assume that most people think like I do, but I can say that my impression of people–certainly myself included–is that weight-ism is what keeps the majority of us from becoming obese or morbidly obese. It doesn’t seem to be related to health concerns or wanting to feel better. Simply the desire to avoid being ‘fat’ might be the thread that is holding back the nation from reaching 100% obesity.
Of course, that’s a pretty big assumption. I just worry that entirely eliminating that cultural stigma about weight may make things much worse for people. Short of completely changing the way that people think about and interact with food and the food system, which would be preferable, I think that cultural taboos could be the most effective deterrent against our country’s increasing obesity.
I guess what I’m saying is that I think that you’re right to be concerned with eating disorders, and to champion their treatment. I’m just concerned that the information that is presented there for the prevention of ED’s could contribute to what I see as being a more frightening problem.
March 21, 2010 at 4:13 pm
Hi Ben,
Thanks for commenting! I’ve been a little self-conscious about having a debate with Ely about this, when we are both such thin guys. It’s nice to have someone with a more informed opinion here.
Do you wish that Mom had limited your calories as a kid? Or made you more afraid about food? Or broke any of the guidelines listed above?
I remember thinking that you younger brothers got more leeway with food than Ely and I did. Not that there was any fear of food or fatness that I recall, but we were not allowed to open the refrigerator! We ate meals with the family and snacks that Mom made, and that’s it.
Nathen
March 16, 2010 at 9:39 pm
are you saying there aren’t over-eating eating disorders listed in the DSM? i thought there was one called “binge eating” and one called “compulsive eating.”
i always figured it would take about as much unhealthy mental patterns to consume enough calories to get to the morbidly obese range as it would to restrict enough calories to get to the morbidly underweight range. maybe i’m wrong about that. i guess i’m curious about how much obesity is caused by stuff like thyroid conditions and how much is caused by lack of education about nutrition, and how much is caused by psychological stuff. i reckon it’s often a combination of the three.
March 17, 2010 at 4:38 pm
Hi Maya,
Anorexia has a “restricting type” and a “binge-eating/purging type,” and Bulemia has a purging type and a nonpurging type, so both can binge and both can purge. The main difference seems to be that with Anorexia, people get very thin and, if female, lose their periods. There is a kind of catch-all category, called “Eating Disorder Not Otherwise Specified,” which you can diagnose someone who doesn’t fit AN or BN. “Binge-eating disorder” is one of their suggestions for this category. There is no “compulsive eating disorder,” though.
Maybe I’ll post the criteria for the disorders next.
I have seen an estimate that 20% of people who qualify as obese have eating disorders.
Nathen
March 18, 2010 at 1:08 pm
It seems good to shield any young, learning animal from harsh treatment, but then how do we deal with a biology formed in a food scarce environment that now exists in a food rich world? The natural check on consumption that scarcity provided is gone, while the stigma associated with gluttony (probably with us since humans first shared food)is not. So what could be the real root of these unhealthy behaviors? Symbolically, someone who eats too much is someone who has had more than their share of a precious resource and is not cooperating in the group. I still remember the hateful looks I received after eating a broken piece of key lime pie that the waitresses had also been eying in the walk in refrigerator at the Chart house. Absolutely withering! Most overly thin or heavy people would likely laugh at the ideas above: that all it would take is some positive reinforcement and suddenly being any weight or shape would be equally well looked on in the social sphere. What we are missing is a stable food culture, and the above seems to discourage an important aspect of such: prohibitions and social taboos that moderate our biological appetites. Rather, it seems to say that stigma is the problem rather then self destructive behavior.
March 18, 2010 at 5:04 pm
Hi Ely,
Thanks for the thoughtful comment. Food is such a emotion-laden, controversial topic, isn’t it?
It sounds like you are afraid that if parents followed these guidelines more kids would be obese. Is that right? It seemed like Ben had a similar idea, that some of the stuff is advice against a healthy amount of fear of being overweight–kind of an overreaction to the unfortunate circumstances of people with disordered eating. Am I getting you?
One of the things along those lines I’ve thought of about this list is that not restricting kids’ caloric intake might be a problem if it is in the form of highly seductive foods, like key lime pie. I doubt the authors are suggesting you make sure your kids get to eat as much dessert as they want. I think it’s more about the moralizing: some foods/body shapes are good and some are evil/shameful and you must have CONTROL! That’s the kind of thinking that primes kids for eating disorders.
What do you think?
Nathen
March 19, 2010 at 5:11 pm
“Moralizing” is a bad frame here. Is that what led experts to create an environment of stigma for smokers? No, It was to discourage deadly behavior out of concern for individual and public health. It seems established that it is social stigma and not higher prices that have reduced smoking. The guidelines above are aimed at preventing another dangerous behavior, but we need to keep this in perspective. 1 in 5 Americans have Metabolic Disease and 64% are overweight or obese. Limiting caloric intake in kids can’t be good as a rule (could you or I have been taller?), but some limits in the form those calories take seems sensible for parents in this brave new world food environment. I would agree with any approach that reduces fear and builds desire for self actualization. There’s so much to this, of course. Terrible sexual double standards for body shape (see almost all sitcom spouses) and psychological aspects of control and power, food as a reward or withholding as punishment, etc. Interestingly, if I imagine a world of equality between men and women, I wonder if more women would say what I’ve heard guys say in private, that they consider a low bmi a necessary “given” in a mate. The point being: Is it just that the patriarchy is demanding an unreasonable standard of women, or that women have insufficient power to insist on the same high standard in their men?
March 21, 2010 at 4:05 pm
Interesting points, Ely. I honestly don’t know enough about the subject to make a really satisfying reply. I’ll just tell you a couple things that come to mind and see what you think.
First, a low bmi looking healthy is an obvious cultural construct. Other cultures have had really different versions of what desirable looked like. In my mind it is largely a coincidence that those slender bodies we like happen to look like people who aren’t suffering from metabolic disease etc. If we lived 50 years ago in a Polynesian culture, for example, we would still insist that fat is beautiful, and that it’s too bad that it means not being as healthy, like foot-binding, circumcision, high-heeled shoes, or any number of strange appearance-fixations.
Second, food is qualitatively different from smoking in that you can’t stop eating. There is no small amount of cigarette smoke that is better for you than not smoking, that we know of, anyway. That may seem like a small point, but I think it changes the psychology of the interaction in a way that is probably important.
Third, social stigma does not seem to be working in the case of obesity. Maybe it is with smoking, but it seems that obesity is on the rise in spite of the incredible social pressure to be thin and to be in control of our bodies that is generating these eating disorders.
Fourth, I think the point of the “10 Things” list is something like this: Eating disorders are the result of a highly ambivalent or even hateful relationship kids develop with their bodies, part of which they learn from you, their parents. Kids who love, cherish and respect their bodies do not get eating disorders. I think that chances are they are less likely to become obese, too. Treating food like a harmful substance to be feared is similar, I think, and I bet that obese have this thought pattern as firmly implanted as those with eating disorders do.
OK, I thought I had a couple more ideas but I’m running out of steam. What do you think?
Nathen
March 23, 2010 at 2:11 pm
I agree with your analysis of the author’s points and everything in your last paragraph. I get it-the more widespread and pressing issue of OVER nutrition is not what the above guidelines are meant to address! The issue just triggers me on the subject of consumption. There is no better example of Aristotle’s “limited vs. unlimited good” concept than food. Some is essential, too much is harmful.
I do believe that body shape preferences reflect more than a social construct, however. Those coming from the biological perspective point out the inverse correlation between bmi and fertility (to be fair, underweight is even more harmful to fertility in women). There seems to be a sweet spot. Supposedly scientists have identified shape preferences that extend across all cultures and throughout human history-a code of symbols and spacial relationships that advertise crucial biological information. Besides basic symmetry, it is the distribution of body fat and or muscle-for a woman, the hips should be greater than the waist, and for men a chest and shoulders that are greater than the waist-that seems to matter (see paleolithic fertility sculptures, Byonce’, and Justin Timberlake respectively). The hallmark of the western lifestyle, a body that is thickest at the middle, is nowhere to be found as a beauty standard (the East-Asian Buddha is an interesting exception). This gives a biological explanation for an aesthetic standard (cultural construct)that yes, even Raphael followed.
What I’ve read about the Polynesians is that their efficient metabolisms served them perfectly as seafarers until they encountered the western diet and diseases. Those in the Cook expedition as well as others had much to say about the beauty of the people they encountered, and seemed to measure it against the standard to which they were accustomed.
On your third point about stigma, there is another way to see this. I heard about research on body weight and peer group indicating that a person is statistically likely to synchronize with their immediate community-gain or lose weight. The hypothesis was that subconscious cues are exchanged about feast or famine socially.
by the way, chef Jamie Oliver has an interesting new show where he tries to reform American public school cafeterias-he’s indirectly taking on government policy and agribiz (Fri. ABC)!
March 20, 2010 at 9:47 am
“Anything worth doing is worth overdoing” (Steve Lester sr.)
da
March 23, 2010 at 5:20 pm
I would like to see a study done on diets of kids now VS diets of kids in my generation and before. Fat children were the exception in my school. If you were to say, “That fat kid…..” Everyone knew who you were talking about because there were so few of them. It was considered an oddity. Today I look around and it seems like most kids are overweight. Now that’s dramatic! What happened? I don’t know that our diets were that much better. Less processed foods because they hadn’t been invented yet, I guess. But, to my mom, if we drank several glasses, up to a gallon, of milk a day, she felt we were getting good nutrition. And dessert after every meal was the norm. (This is what every family that I knew did.) But the main thing I would look at immediately is that in my generation, after school every kid on the block was outside. I remember spending whole days outside, only coming in for meals. TV was a new thing back then. I had no restrictions on TV watching, yet I spent most of my time playing. We didn’t have computers. We didn’t have video games. That’s my suspicion. Everyone sits around on their butts all day instead of running and jumping and twisting and galloping and crawling and rolling and swinging and all that stuff kids naturally do. Or did.
March 26, 2010 at 6:55 pm
I’d like to see that study too, Mom. If kids really are getting less exercise these days, that might account for it.
Another possible angle: Reanna just told me about a study where scientists fed rats an equal number of calories, but some with sugar and some with corn syrup, and the corn-syrup rats gained way more weight. It could be the kind of foods we’re eating, too.