Most of you have probably noticed by now that it's Eating Disorders Awareness Week. For the first few days this week, my Facebook feed was inundated with message about loving your body and talking back to the media, and so on. It was like being at a high school pep rally, only about not wearing lipstick! and accepting our natural beauty! and loving our bodies!

I don't really like pep rallies, if for no other reason than I really don't do peppy all that well.

Rallying people and getting them motivated are great. Most of these war cries have to do with preventing eating disorders: that if we label digitally altered advertisements, we will decrease eating disorders. Or that people need to accept their natural sizes, which would eliminate eating disorders. They're nice thoughts, and they seem like really good ideas. It's why they have so much traction. People without eating disorders can relate to not liking how they look. They can relate to looking at beauty magazines and then feeling seriously ugly. They understand about dieting and wanting to be a Size Negative Eleventy Billion but not being able to lose those last XX pounds. Cindy Bulik calls this the "I just wanna look like a model" model of eating disorders.

The problem is that eating disorders aren't just extreme diets and treating them as such gets us nowhere. Writes Autumn Whitefield-Madrano, a recovering (?) eating disorder patient:

I just know that by the time I was discharged from Renfrew, I’d finally begun to learn that my dissatisfaction with my body wasn’t causing my eating disorder; it was merely a symptom of my disease, like restricting my food intake or binge eating...I’d begun to understand that loving my body wasn’t the point. The point wasn’t even to like it. The point was to learn how to eat.

I personally find body image--how the brain figures out what we look like--a fascinating neuroscientific and philosophical issue. My own body image issues long predated my eating disorder, but they didn't have anything to do with lipstick or models.My brain had a hiccup in figuring out what size I really was, likely due to problems in the insula and somatosensory cortex. Ridiculously altered images don't help, but they weren't a cause.

Others take a different approach towards eating disorders prevention. If we can educate people about how dangerous and pointless eating disorders are, then maybe people won't start. It's an attitude I had myself for a while, and the well-meaning philosophy feeds into tell-all newspaper articles and discussions about just how few lettuce leaves you survived on at your worst.

I never ceases to astound me just how many people give a shit about that sort of thing.

Except that this type of thinking essentially posits that eating disorders are choices, or voluntary behaviors. Perhaps that first step can be, I don't know. The problem is that most people who take that first step don't think they're going to develop an eating disorder as a result. So telling them that eating disorders are dangerous is kind of pointless, since they're not going to get an eating disorder from adding a little bit to their athletic training or cutting out junk food or whatever. By the time they have an eating disorder, it's too late.

To wit: a recent study on weight history in bulimia was just published, and researchers found that women suffering from bulimia ultimately gained weight as the result of their disorder. The Atlantic magazine wrote:

"Most patients lose a lot of weight as part of developing this disorder, and all dedicate significant effort, including the use of extreme behaviors, to prevent weight gain," said researcher Jena Shaw. "In spite of this, we found that most women also regain a lot of weight while they have bulimia," she continues. Maybe tell that to those kids with their pro-bulimia "ana-mia" Tumblrs?

{{Emphasis mine.}}

Nice thought, but it probably won't work to actually prevent an eating disorder. It's like telling someone who's sad to cheer up lest they get depression, or working to prevent bad moods everywhere! (Like pep rallies, unbridled optimism also makes me stabby, so I'm not sure I could tolerate this world for long...)

I'm not against the prevention of eating disorders, I'm just not sure that we have any clue how to do it yet.

Men get eating disorders, too. A British organization by the same name has a website and Twitter account by the same name. Eating disorders information can be found at the website for the National Institute of Mental Health, and also on the website for information on women's health. It implies that eating disorders are just a women's issue.

As the Kartini Clinic blog pointed out last week, one of the very first medical descriptions of anorexia was of an adolescent male. In 1689, believe it or not. So the idea that eating disorders are "just" women's issues is actually quite wrong.

The problem is that after Richard Morton first described anorexia in 1688, later medical doctors lumped anorexia in with "hysteria." Hysteria is derived from the Greek word for the uterus (which is why you get a hysterectomy), which means that men automatically can't be "hysterical" in the nineteenth century, technical usage of the word. Which is where we started to go wrong.

Later conceptualizations of eating disorders continued to exclude men, because eating disorders were seen as a female over-concern with one's looks, or a diet gone wrong. Men, it seemed, didn't face these pressures and/or were too smart to fetishize the size of their asses. Since men didn't face the body image pressures that women did, men couldn't get eating disorders.

It's bollocks, by the way. If you're human, you can get an eating disorder.

I'm blogging about this not just because I've been reading stuff about eating disorders in males, but also because I got a press release emailed to me this morning about a symposium on male eating disorders at the 2012 IAEDP conference this spring.  The tag line was:

Our latest news shares the sad and startling fact that one in three men are willing to shorten their lifespan just for the sake of better meeting society's image of the "ideal" man.

Huh?

I mean, there are just so many things wrong with this. First of all, eating disorders have existed long before current body ideals evolved, so that can't be the cause. Second, an eating disorder isn't being "willing to shorten your lifespan." That's like saying someone is willing to develop cancer so they can lose weight from chemo. Eating disorders aren't choices. They aren't about vanity or looks. They're a real biologically-based illness that kills, not because vain and vapid people of all sexes and genders are too self-absorbed to stop harming themselves, but because they have an illness that we generally suck at treating.

Also, I'm not sure of the scientific validity of a hypothetical "would you rather" question in assessing body image issues or eating disorders in any population. Nor are people with eating disorders actually making these decisions. Like I said, it's an illness, you idiots.

Of course, what I got was a press release and promo information. I don't know exactly what the presentation is going to contain. The email I got did say that they were also premiering a male-specific eating disorders assessment, which could be a very good thing. I haven't seen it, so I can't say for sure.

It's just that perpetuating these myths about what causes eating disorders doesn't do anyone any good in the long run. Yes, issues of eating disorders in males does need more attention, but could we at least get the facts right first?

So this whole life-size Barbie doll created a spark of discussion not just on my blog, but also on the Today show.  Take a look at a clip from this morning's show via Hulu:



Did you notice that one word was absent from this discussion of eating disorders? One aspect of the discussion that is so frequently ignored, here and elsewhere?

Biology.

I'm not trying to ignore culture and the ins and outs of people's lives that can have a significant effect on the development of an eating disorder. I'm not trying to say that an eating disorder is "just" biology, because the idea that anything is either biological or cultural is pretty ludicrous.

But biology is pretty much absent from our discussions about eating disorders in the mass media. Sure, people will mention that genetics influence eating disorders, but the discussion stops there. Of course, biology is being mentioned, which it wasn't just a few short years ago. Still, the notion that eating disorders are rooted in biology and have an actual neurological basis is rarely mentioned in most stories about eating disorders.

So often, media stories file eating disorders under one or two major causes: unrealistic beauty images and control issues. There might be lip service to ideas about neuroscience and genetics and biology, but it doesn't get much discussion. And that bugs me. I don't want a slew of cookie cutter stories on eating disorders, blathering on and on about DNA and nothing else. Eating disorders are very complicated and biology is one aspect of the story.

But it's a big aspect. It explains so much about why people get sick and why they have such a hard time getting better. And we (as a community, as a culture) basically ignore it.

It's something that continues to baffle me.  We talk about biology in lots of other contexts--why are eating disorders so different?  Why are we so resistant to bringing up the biology factor?

As much as my inner feminist hates to admit it, I had a Barbie doll when I was younger. I had several of them, in fact. And I even had the Ferrari. And a token Ken doll.

The point of this post isn't to wax nostalgic about toys gone by. It has to do with a recent blog in the Huffington Post about using a life-size Barbie to help raise awareness about eating disorders and body image issues.

Forgive me, but I'm not exactly sure I see the connection between a mental illness and Barbie. We don't connect Baby Cries A Lot and major depression. Or Furbies and animal hoarding. It's a plastic toy. And let's remember that eating disorders and even body image issues existed long before Barbie hit the scene in the 1950's.

I get that Barbie is probably not the best role model for pretty much anything other than reinforcing gender stereotypes.  I get that she is an exaggeration of what some people feel is the "ideal body type."  That being said, so was the Venus of Willendorf, and my body doesn't look a thing like either Venus OR Barbie.  Most women don't.

Our culture has some seriously warped ideas about beauty, especially feminine beauty.  Most of us buy into them, in one form or another.  Most of us don't have eating disorders.


I find blaming Barbie and the like (models, etc) for eating disorders pedantic and not just a little offensive.  I wasn't unable to eat and at death's door because I was over-idealizing a plastic doll with blonde hair.  I was unable to eat because my brain was broken and it needed to be fixed.  The suggestion that I nearly died because I was somehow society's dupe strikes me as a little bizarre.

I'm not saying that cultural body image stuff is irrelevant or totally unrelated.  It isn't.  It forms a backdrop against which eating disorders form and emerge.  Many in the fashion industry have frank eating disorders themselves, so there's definitely some overlap.  But it's not a cause, and I kind of resent it being made to look that way.

A college girl who learns that Barbie has an unrealistic body will be more informed and hopefully a better consumer of media and its messages.  The problem is that knowing these things--that models are Photoshopped, that eating disorders are dangerous, that Barbie is a total fake (the bitch!)--don't prevent eating disorders.  EDs aren't decisions.  They aren't under conscious control--if they were, they wouldn't be an actual mental illness.  I knew plenty about anorexia and Barbie dolls before I got sick, and here's the kicker: I still got sick.

I think stuff like this--however well-intentioned and well-executed it might be--almost trivializes eating disorders.  It makes me feel like a supercilious brat, when that's not the case at all.  Lots of things influenced my eating disorder, and I'm happy to take a good, hard look at any of them.  But, please, leave Barbie out of this one.

Earlier this week, Pepsico announced a makeover for its Diet Pepsi.  The problem wasn't the taste of the soda, or the colors of the can.  No, the problem was the shape of the can.  Now, instead of being short and squat just like all of the other soda cans, Diet Pepsi is going to be tall and sleek and skinny.  And, so the ad campaign would like us to think, we can be too if only we chug cans of Diet Pepsi.

I find the whole thing offensive and annoying.  Yes, yes, I know the big wigs on Madison Avenue would like us all to think that thin is better, but um, can you guys be a little more creative with your message?

Not surprisingly, eating disorder groups have been up in arms about the can and the message that it sends.  In one article, a NEDA spokesperson said that the ad campaign was "thoughtless and irresponsible."  In a more in-depth interview with the Wall Street Journal, NEDA CEO Lynn Grefe said:

“I could care less about the shape of the can,” Lynn Grefe, head of NEDA, tells the Health Blog. “They could make it doughnut-shaped for all I care.”


It’s the Diet Pepsi media campaign that’s the problem, she says. The campaign celebrates being skinny and suggests that strong, confident women must be so. That the Skinny Can campaign is being paired with Fashion Week, an event put on by an industry that has had to address eating disorders among its model ranks, is particularly problematic, says Grefe.


This campaign won’t cause anyone to develop an eating disorder, but could trigger someone who is already vulnerable to negative body-image issues to start dieting or become more extreme in their dieting, which could eventually lead to disordered eating, says Grefe.


...And recent evidence shows that hospitalizations for eating disorders are on the rise, calling attention to the messages that are being perpetuated about thinness and dieting. “It is exactly that kind of thinking that has truly caused the increase in people feeling bad about themselves,” says Grefe.

But there's quite a leap in logic there.  No one's quite sure what is causing the increase in eating disorder hospitalizations.  It's likely that EDs are on the rise in younger adolescents, yes.  At the same time, most young people feel bad about themselves in some respect or another.  Yet very few develop eating disorders.

All of Grefe's statements were technically correct.  Yet I'm not convinced of the direct link between skinny can --> body image issues --> eating disorder.  I had body image issues my whole life, yet I only developed anorexia after I was depressed and thought that eating better and exercising more would make me feel better. Okay, yes, I wanted to lose 5 pounds, but that wasn't the real motivator.  Nor do I know that my body image issues wouldn't have been there in a non-diet-oriented culture.  More and more studies are linking body image disorders with deficits in neurological functioning.

These efforts sound good on paper, and I don't think protesting the skinny can is bad in and of itself.  Like I said, it's rather obnoxious.  Frankly, if I'm going to buy one of your products, I'd like to be respected a bit lot more.  I'm just not sure about the fact that so many people take for granted that there must be a connection between skinny things (jeans, cans, models) and eating disorders.  I do think that these messages are definitely a part of the cultural milieu in which eating disorders exist.  But eating disorders have existed long before the advent of Size Zero supermodels and (apparently) Size Zero diet soda cans.  I'm guessing that if all of this skinny model nonsense went away, another cultural issue would fill the void and be used as a scapegoat for eating disorders.

This "prevention" work sounds good. It's hard to oppose it and not sound like some sort of misogynistic skeleton-lover. It's not that I like these images, approve of them, or even think they're healthy. They're not. I'm just wishing more people would question the connection between these messed-up ads and their impact on eating disorders.

In the end, Laura said it best:

Somewhere in here, in the headlong and well-intentioned efforts, is also a confusion of ideas: disordered eating and eating disorder; and body image distress and Body Dysmorphic Disorder. There is an assumption that preventing body image distress will prevent BDD, and that preventing disordered eating will prevent eating disorders. That assumption needs to be questioned as well: do we really know that these are true? If so, how strong is the effect? One kid in 20? One in 1,000? One in 100,000? Not that one in a million isn't a good thing, but is that where our efforts should go? Or is preventing eating disorders the only reason for these efforts?

Several weeks ago, there was a massive to-do over a horrifically Photoshopped image of a Ralph Lauren model. Boing Boing said it best: "Dude, her head is bigger than her pelvis!" And in the image, indeed it was. Ralph Lauren later fired the model, Filippa Hamilton, for being too fat, even though she's a size 4. Last week, documentary filmmaker Darryl Roberts (he directed the movie "America the Beautiful") was supposed to have appeared on Larry King Live until the people at Ralph Lauren allegedly had the segment pulled. Now, the America the Beautiful Action Group has created a Facebook page encouraging people to boycott Ralph Lauren.

I have not joined this Facebook group for a variety of reasons, one being the fact that I never bought any of his stuff anyway, so my boycott of the company would have precisely zero effect on their bottom line. The other major reason is that I really, really, truly dislike how negative ads like Ralph Lauren's are conflated with causing eating disorders.

In an open letter to Ralph Lauren, Roberts writes that:

I’ve had the pleasure of meeting tens of thousands of young girls while promoting my documentary “America the Beautiful.” To look in the eyes of over 100,000 college women and hear their pain (body image, self-esteem) has been an experience that I will never forget. I’ve also heard from over 80,000 parents that are in pain because they have to hear from their sons and daughters in pain. It does truly become a generational cycle.

I’m sure that you’re fully aware that a lot of the American population feels that the unhealthy ads in magazines are damaging to women. The damage comes in various forms; body image problems, low self-esteem and for some of the women, they get a full blown eating disorder like your niece Jenny.

{snip}

Believe it or not, [adults and parents] get hurt as much as the young girls that read the magazines and look at the ads. “How? You wonder.” When a young girl reads these ridiculous fashion magazines and gets triggered into a full blown eating disorder, who do you think gets left holding the bag for the $30,000 a month treatment? I’ve met parents that have had their entire savings wiped out and some have taken out second mortgages on their homes to pay for the treatment of their young daughters.

Although Roberts says that he was told by an ED expert that 50-80% of the risk for developing an eating disorder is genetic, the message here is clear.

I'm all in favor of supporting a boycott for Ralph Lauren because he's engaging in false advertising (which is what I think the dramatically altered images really are), for being denigrating towards women, or for just being a douchebag. All of these are quite possibly true.

All of these have NOTHING to do with eating disorders.

Yes, our thin-is-in culture plays a role in triggering eating disorders, but the holy-is-in culture played a role in triggering eating disorders during the Middle Ages. I'm not saying that we should support or participate in this culture (it's damaging even if you exclude any triggered eating disorders), but we can also oppose it for reasons that have nothing to do with EDs.

Writes Sue Sierralupe of the Oregon Natural Health Examiner:

The National Organization for Women (NOW) is one of the many organization demanding a change in advertising policies that encourage eating disorders. NOW has prioritized encouraging women's self esteem with Body awareness education, "Love your Body Day" and a posting of ads offensive to women and ads that are supportive of women. NOW has asked Ralph Lauren to apologize encouraging unrealistic body images that lead to eating disorders.

...Most cases of anorexia and bulimia are symptoms of unhealthy self esteem. According to the Women's Center for Healthy Living (WCHL), "Anorexia and bulimia are characterized in part by a refusal to eat and repeated attempts at dieting. Even if individuals suffering from anorexia or bulimia are a normal weight, their body images are distorted, causing them to continually attempt weight loss. The thought process of those suffering from anorexia or bulimia is that if they only weighed a certain number, life would be "good" and they would feel good about themselves. The truth is that weight cannot and does not determine your self-esteem or self-worth."

Which is pretty much bass-ackwards. I don't oppose NOW for trying to promote women's health by ads that aren't sexist and offensive. I rather think that's a good idea. But EDs aren't just a feminist "up yours" to the patriarchy done in a nice feminine way. They're an illness.

Many people with EDs have a history of low self-esteem because they also suffered from perfectionism, and nothing saps your self-esteem like the feeling that you are never good "enough." Yet the one thing that absolutely wrecked my self-esteem was my eating disorder. The truly pitiful self-esteem happened after; it wasn't great before, but it wasn't literally and metaphorically in the toilet, either. EDs aren't about the vapid pursuit of an ever-decreasing weight. They're about scrambled neurotransmitters, about how ED symptoms can help mediate feelings of anxiety and depression, they're about genetics, and a vicious cycle that doesn't seem to stop. Furthermore, the symptoms of body dysmorophia and "feeling fat" are a relatively recent phenomenon- they weren't consistently present before the 1800s, and didn't comprise a majority of AN cases until into the 1900s.

Ultimately, Sarah Ravin said it best: this focus on EDs as just really extreme body image dissatisfaction "trivializes the anguish that eating disordered people experience."

Most of you know by now that a few weeks ago, Kate Moss said that "nothing tastes as good as skinny feels." Moss got spanked by many in the press--and rightly so--for this comment. I didn't blog about it initially, because a statement of a person in the fashion industry that advocates weight loss isn't especially newsworthy to me. There's the occasional zinger, but mostly I ignore it.

The fallout over the Kate Moss comment has been considerable, and it was annoying me a little bit. Kind of like the itch directly in the center of your back that you can't reach very well. And all you want to do is scratch. Well, I figured out what was bothering me, and this post is the equivalent of scratching an itch.

That the media reported on a famous person saying something that made them look like a goon really didn't bother me. It was a really stupid statement, she said it in an interview (which Moss would have well known is "on the record"), and she doesn't have the best reputation for promoting healthy body image anyway. I rolled my eyes and sighed when I read the quote (remember, I worked in an office where a similar phrase was posted all over), but I was neither surprised nor particularly outraged. Annoyed and irritated, yes, but I have grown almost to expect it in some arenas.

What irritated me was the coverage that had headlines like "British model Kate Moss accused of encouraging anorexia and bulimia with 'skinny' comment" and "Kate Moss accused of encouraging anorexia among teens." Certainly her comments were vexing and troubling, and do NOT make recovery from an eating disorder any easier. When so many other people have a disordered eating mindset, you have to ask: whose disorder is it anyway? And these comments do nothing to dispel the serious nature of eating disorders. But these comments, while stupid and idiotic and just flat-out WRONG, don't really encourage anorexia.

People have been saying "cleanliness is next to godliness" for centuries. There are celebrities who market their own line of non-toxic cleaners so you don't poison your family by using the "regular" stuff. Um, hello OCD. I have struggled with both compulsive hand-washing and compulsive cleaning, but I was never encouraged to boycott Purell or a line of cleaning products because they promoted unhealthy images of cleanliness. Did navigating our germ-phobic society make challenging my OCD thoughts any easier? Nope. Did it have anything to do with my OCD? Not at all.

Yet we also know that no matter how much a celebrity says that several showers a day makes them feel "good," it's not going to lead to a spike in OCD cases. Or that uncovering the illegal wiretapping from the Bush administration is going to cause a spike in schizophrenia cases because the people paranoid about others' listening in on their thoughts could actually be right. We get that distinction between our messed-up environment and a biologically-based mental illness for many other things, but we don't get it for eating disorders. Instead, we have quotes from Kate Moss' publicist saying "For the record, Kate does not support this as a lifestyle choice."

Lifestyle choice?!? That's almost more harmful than the initial comment.

Part of the problem stems from how our society admires the symptoms of anorexia, namely the weight loss. Considering that anorexia is egosyntonic, many sufferers don't initially recognize that they are suffering from an actual disorder instead of being really good at losing weight. Since sufferers don't usually recognize the ED thoughts as being unwelcome or intrusive (at least at first), it's easy to see how sufferers can use statements like Moss' to justify their actions. It is incredibly sad that it is so easy to justify the behaviors of a mental illness because our culture is just that screwed up.

Because the "nothing tastes as good as thin feels" line is commonly used in the pro-anorexia world, I can see how Moss' comment might be taken to be an endorsement of this. However, most of the "pro-ana" slogans have actually been adopted from generalized dieting mottoes. Our culture gave it to them, not the other way around. If this comment is used to justify ED behaviors, it's not really any different than people hiding behind the latest diet or food trend that's been hyped. Of course we would be better off if we didn't fetishize the anorexic body, and if we were able to get rid of the inaccurate equation that thin = happy. Her comment was neither accurate nor helpful.

And, for the record, I've tasted "skinny" when I was anorexic. It's called ketosis, and if you can imagine the constant taste of rotting and fermenting apples in your mouth, then you'll know what I mean. Skinny feels uncomfortable. You're always cold, you can't sit down because your ass is too bony, and your fingernails are blue. There's plenty of food that tastes better than this.

I got invited to join a Facebook group of this name late last night, and I spent part of the day contemplating my response. I hesitated in writing for several reasons, not the least of which were that I don't have time right now to be responding to a lot of potentially irritated people, and also because I wanted to frame my thoughts properly. After a while, I figured what the hell- I'll bite. I decided to blog my thoughts here and post a link to the group so I didn't have to check two places for comments.

I searched through my blog archives and was astonished to discover that I had never answered this question head-on, in its own post. So, here it is.

To me, the question of "Does media play a role in eating disorders?" is usually asked in a sense of "Does media play a role in causing eating disorders?" And that answer, I would have to say, is pretty minimal. Media provides lots of context, and more than enough triggers, but to say that people with eating disorders are "dying to be thin" minimizes the seriousness of the illness and does everyone a disservice.

I was flipping through a copy of The Handbook of Treatment for Eating Disorders and I stumbled across an article that looked at the Three Ps of eating disorder onset: Predisposing factors (ie, genetics and other neurobiological factors), Precipitating factors (ie, culture, dieting, "healthy eating," etc), and Perpetuating factors (ie, what keeps the illness going). The role of the media certainly fits in the category of "precipitating factors," but although these factors are important, they seem more incidental than causative. Predisposing factors are largely homogeneous; precipitating factors can vary widely.

Finding yourself afraid to eat is a rather bizarre phenomenon. Our brains need to explain it somehow--so we turn to the vocabulary we know. I did blog about this almost two years ago now, rather briefly, and I think I shall plagiarize myself a bit:

Could eating disorders be women and men trying to be perfect? To live up to society's expectations? To look like models? I doubt it. That's part of it. It's the cultural context of the illness. In the Middle Ages, women (most of the recorded cases were in females) who starved themselves were considered saints. They fasted to get closer to God. Some, like Catherine of Siena, got hooked. It felt good. Her explanation was of faith. Ask a sufferer today, and a lot of it seems to be 'healthy eating' and images of supermodels and the idea that you can Have It All. It's no more a reason than faith. But it is a context. It does explain the triggers, the psychological environment from which an eating disorder develops.

One of my OCD fears was that I was going to catch AIDS from someone, or that I already had AIDS and was going to give it to someone else. Regardless, it was OCD. But if I was about 15 years older (the OCD AIDS stuff started in about 1993-1994, when I was 13-14), AIDS wouldn't have been on the radar. It might have been another disease. It might have been something else entirely. A person with schizophrenia would not have feared the CIA listening in on phone calls 100 years ago. First off, they probably wouldn't have had a phone, nor would there have been wire taps, and lastly- there was no CIA. Diseases have a context. But that doesn't mean that AIDS fear mongering caused my OCD, nor that the CIA causes schizophrenia.

Or, for that matter, that the media caused my eating disorder.

Much of the debate about media and eating disorders boils down to this: do eating disorders exist along a continuum with more normalized eating (that is, are eating disorders an extreme version of a diet and common body image issues?), or are eating disorders a separate entity. The answers aren't all in, and I won't pretend to understand all the answers that we do have (but I'll pretend enough to do a more in-depth blog tomorrow- stay tuned!), but I believe that eating disorders are a distinct entity separate but similar to our obsession with dieting and thinness.

Let's compare eating disorders to depression. Saying eating disorders are just a really whacked out diet is like saying depression is just a really bad mood. Most people with depression are in a really bad mood--that's kind of the definition of depression, really. And many people with eating disorders appear to be dieting and have body image distortion. But depression isn't a really bad mood that won't go away. When the weather sucks or the store is out of eggs or the car won't start, people will often say, "Ugh- I'm so depressed!" Not really. You're pissed off, sad, annoyed, whatever, but that's not depression. Both eating disorders and depression frequently pass through stages of seeming like just another diet or a really bad mood that lasts for-freaking-ever, but they then take on a life of their own. They stop becoming a choice and become an illness.

I thought for a long time that the thinness ideal had a lot to do with eating disorders, and I've since changed my mind, especially in light of the emerging research that suggests that up to 82% of eating disorder risk is genetic.* Eating disorders existed long before supermodels and they'll probably exist long after. And I think we are missing so many opportunities for prevention and education by focusing on the media aspect and leaving so many other areas out in the cold.

*A, this wasn't the study that I was referring to in a previous post (the study is too new), but it does confirm the numbers in the talk that I scribbled down.

I saw an update on Twitter this morning, linking to an article about how the German magazine Brigitte is going to cease using models in favor of "real women." (those two words are used in the deck headline in the Telegraph news article).

This got me thinking: what is a real woman, anyway? Are models, however starved and Photoshopped they might be, not real? Does that mean that models are fake women?

When I read that, I think of this past election when "real Virginia" didn't include any of the DC suburbs where I lived. I may have been a fairly new Virginian, but the state sure took my taxes! Northern Virginia might be more urban and liberal, on average, than the rest of the state, and it might not be what people traditionally thought of as "Virginia" (government stiffs instead of slackjaw yokels, if you really want to dig into stereotypes), but last time I checked, I was a Virginia resident. I was real. My vote counted as much as anyone else's.

So what makes a woman real? Is it like the Skin Horse in the Velveteen Rabbit? Is it the presence of breasts? A uterus? A monthly craving for chocolate? That seems awfully limited. A mastectomy or hysterectomy doesn't dissolve your womanhood- you're still real and you still count. A transgendered person (male-to-female) is a real person, in my eyes. They're not "fake."

What, then, is different about professional models? Their size? I worked with many TB patients who were almost as skinny as I was in the worst of the AN, but for them, it was a microorganism stripping the flesh from their bones rather than a brain disease. They were still women, despite their jutting bones and androgynous figures shrouded by sheets and paper hospital gowns.

Neither my TB patients nor many professional models look like the "average" American woman. And I think it's cool that the magazine is transitioning away from using professional models and using women you're much more likely to encounter on a 3am emergency trip to CVS to buy Midol, Tampax, and a pint of Chubby Hubby. (Not that I have any experience with this...) But even if I didn't encounter some svelte six-foot supermodel at CVS--though luck would have it that I likely would--that doesn't mean she's fake. Just rare.

Our idolization of her shape and size is our problem, not hers. We criticize these models, yet still buy the products they're advertising. It's probably impossible to avoid buying anything advertised by too thin men and women, but we can cut down. And who's to say that Brigitte will use women who look like "average" German women? They probably won't be the ones with zits and excessive facial hair.

I don't know that I have an answer to the question who is a "real" woman. I don't know that there is a single answer (one of the many reasons I avoided philosophy), but I do think that these semantics matter. Professional models aren't a foreign species, and all might not have arrived by their current figures through nature alone. That might make their bodies fake, but it hardly makes them fake.

A new proposal by French lawmakers would require that airbrushed photos are labeled as such. Similar laws have been proposed in the UK (two news stories on the subject can be found here and here), on the grounds that these ads can be "very damaging." Eating disorders are usually cited as one of these damages, along with more general body image woes.

Rachel at The F Word blogged about the subject here, and compared the issue of labeling airbrushed ads with the warnings on cigarettes. And to some extent, I agree with this line of thinking. These ads are damaging. Younger and younger girls are dieting. People think that they can actually look like the models in the ads. Body dissatisfaction is eerily normal.

All of these things are very bad. Even without mentioning eating disorders, I think we need to take a long, hard look at what our ads are teaching. A label, even just to identify that these images have been digitally altered, is a place to start. More and more people find smoking distasteful, less associated with the virile Marlboro Man and more associated with stink and lung cancer.

What I object to is having this legislation linked directly to eating disorders. The French proposal is headed by an eating disorders expert and is part of an ongoing campaign against eating disorders. An Australian article on the subject said that

"[French Parliamentarian Valerie] Boyer said being confronted with unrealistic standards of female beauty could lead to various kinds of psychological problems, in particular eating disorders...

"These images can make people believe in a reality that often does not exist," Ms Boyer said, adding that the law should apply to press photographs, political campaigns, art photography and images on packaging as well as advertisements."

I agree that this false reality (that all so-called "beautiful" people are thin, etc.) is troublesome and plays right into eating disordered thinking. I mean, two days before I was admitted to the hospital, I had people asking me for diet tips! Plenty of people without eating disorders have similar delusions that I do.

However, these delusions are the result of an eating disorder, not a cause.

I'm not naive enough to think that Size Zero and airbrushed models have nothing to do with eating disorders. They're part of the cultural backdrop against which eating disorders are expressed. In the Middle Ages, the obsession was with fasting and holiness. This didn't cause eating disorders, either, though it did alter the meanings people ascribed to their symptoms. Learning how to live in this fundamentally effed-up environment is one of my major tasks in recovery. I try to participate as little as possible, but short of turning hermetic, there's going to be Cosmo on the newsstands and I'm going to see pictures of "scary skinny celebrities" and celebrity weight gain. I intend to fight it, but in the meantime, I have to live among it.

Our culture has a damaging obsession with food and weight and appearance. This needs to stop, even if it doesn't prevent a single eating disorder.

When I saw an article called "The Daisy Duke Diet" in my newsfeed, I elected not to read it, figuring it was the standard drivel. However, I was wrong. What was that I said about assuming making an ass out of "u" and me?

Thanks to Tiptoe, I decided to read the article and was pleasantly surprised to the point of astonishment. Not only did it thoroughly debunk the idea of models causing eating disorders, it included some of the latest research explained rather well.

If it isn’t skinny models, what’s the cause? In the last dozen years or so, scientists have linked anorexia to many different physiological conditions: high levels of estrogen in the womb; low levels of serotonin in the brain; a genetic mutation; overactivity by dopamine receptors; a general tendency toward anxiety and obsessionality; high age at menarche; elevated amounts of a mysterious peptide called CART; autism (which is underdiagnosed in girls, perhaps because it sometimes manifests itself in the form of eating disorders); premature birth or other birth complications; irregular activity in the insular cortex of the brain; post-traumatic stress disorder; an autoimmune disorder affecting the hypothalamus and pituitary gland; variations in the structure of the anterior ventral striatum (the brain region responsible for emotional responses); and even being born in June (seriously — one theory is that a winter-type disease in the mother at a certain vulnerable point during the pregnancy is responsible). Some of these causes may overlap with one another, but biomedical researchers are virtually unanimous that anorexia has physical roots, though the mechanism remains poorly understood.

Writer Fred Schwartz concludes that

Anorexia is a dreadful disease, and still poorly understood. If the growing scientific knowledge about it can be pieced together, we may eventually learn to identify, prevent, treat, and even cure it. But political activists do not help its sufferers when they oversimplify a complicated condition and blame it on their stock assortment of evil forces in American society.

Keep in mind that the National Review is a conservative magazine. I don't think big business and the beauty industry are pure innocent things being targeted by evil people trying to pin the blame for eating disorders. I do think their messages are harmful. I do think we need to do something about it.

I just don't think they cause eating disorders.

Part I: A Zero-Sum Problem

I've shied away from speaking directly about models and the whole "size-zero" phenomenon. Partly because I think it gets away from the ultimate cause of eating disorders: genetics, biology, neurochemistry. Eating disorders date back hundreds of years- long before fashion models. Even in the 1600s, where the ideal body type was far more realistic to what Nature had intended, people had anorexia. Women. And men.

This happened without fashion models, without a diet culture.

And yet.

Yet at the same time, disordered eating is essentially more prevalant than a relaxed attitude around food and body weight. It's The Media, we say. Hollywood. The Fashion Industry. The Patriarchy. All of these are true, in a sense. It certainly normalizes these food and body obsessions of ours. It allows eating disorders to fester and hide.

And, given that dieting is the "gateway drug" to eating disorders, this obsession can trigger (but not cause) EDs.

A lot of the impetus on banning Size Zero models is that it will prevent eating disorders. Or help to prevent them. Which is all well and good, and I certainly don't think it will hurt, but I'm not sure this will do a whole lot to prevent eating disorders on a large scale. It will send a message, and that's the important part. It is a start to ending this body obsession of ours.

Part II: A model of what?

Maybe what we need to be asking ourselves first is: what is a model, anyway? Are they supposed to be models of "good behavior"? Of what clothes to wear and how to look in them? Of what a young child should aspire to one day? Of something else entirely?

It's no secret that eating disorders are rampant in the fashion industry. Most of those body weights are unnatural. I won't go as far to say "all" models are starving, because I really just don't know. But the weights are unrealistic for basically all young men and women out there.

Study after study (the most famous of which was the Minnesota Starvation Study by Ancel Keys) has shown that restricting your diet and forcing your weight below its natural setpoint makes you, in less scientific terms, utterly batshit crazy. Your hair falls out. Your nails stop growing. Your skin gets scaly. You have so many bruises it looks like someone hammered you with a baseball bat.* Your period stops. You can't think of anything but food.

This isn't healthy.

The personal antics and behaviors of those in the fashion industry aside (Kate Moss, anyone?), the ideal woman in this society is fundamentally unhealthy. This is a model? Something that's held up as the highest form of beauty and flattery and achievement?

And if models are supposed to be displaying how clothes are "supposed" to look on people, why are they using people who don't look like almost anyone else in the population? I'm not willowy and 5 foot 9; I'm about 5 foot 5 and muscular and athletic.

On the other hand, what about the models?

Part III: The Fashion Police

Here is the one, over-arching reason I think there should be a regulation of models' body weights: for their own health and safety.

I've read comments on newspaper articles about this issue (most recently in Fashion Week in Madrid), who say that this type of regulation is overly paternalistic. Intrusive.

Yet I had an N-95 mask given to me when I worked at the health department to prevent me from breathing in germs during an outbreak. The lawnmower guy my dad hired last summer had ear plugs. Welders use goggles. These are required by law.

Why? Most companies aren't willing to shell out the money to protect their workers. So the government had to step in and make sure that companies were doing what they were supposed to be doing.

It's the same thing here. We think of models as these independent entities, figures strutting on catwalks, images on magazines. Most of them are employees- of a modeling agency, of a clothing company. If eating disorders are an inherent danger in the industry (as infectious disease is in public health), then there need to be measures to protect the workers.

The public is apt to blame the models. "Stupid girls, being such an unhealthy model for my little girl." Or, "They should just stop."

And that last reason adds fuel to the need for these regulations. People with eating disorders, people whose cognitive abilities are comprimised by starvation, don't realize they're sick. It's called anogosnia- a lack of insight into disease, which is common in many neurological disorders, such as brain injury and stroke. Semantics aside, eating disorders, strokes, and Alzheimers are all brain diseases. Pancreatic cancer and diabetes are diseases of the pancreas. Totally different cause and etiology, yet they are not treated as two totally different entities with totally different insurance coverage.**

Are models victims? Well I don't know.

Are they in need of protection? You better believe it.

*It took me about 8 doctors to figure out that I wasn't bruised up because of medication or klutziness (though I'm sure that didn't help). I took Vitamin C supplements, which helped somewhat. Then my psychiatrist took one look at my battered legs and told me I had a Vitamin K deficiency. Vitamin K is a fat-soluble vitamin and is crucial to helping blood clot. So my fat intake was upped and within a week, the bruises were essentially gone.

**Don't. Start. Me. On. This.

According to the TV show America's Next Top Model, a size 8 is now "plus sized."

So much for that theory of vanity sizing, huh?

This is one of the most messed up things about our society's views on size and shape. Theoretically, we're fatter than ever. And our models are thinner.

Sarah Hartshorne, the contestant on ANTM, stands 5'10" and weighs in at 150 lbs, for a BMI of 21.5. Though she's quite a bit taller than me, she's roughly my size. This means that I'm a plus-sized model.

Um, hello.

What is a model? You can make model airplanes, or design a computer model to simulate things like global warming. These things are paradigms, the penultimate version of what we're supposed to be and do.
Yet if you look at TV, we can't be anything remotely resembling one of the models. The obvious solution is: get realistic models. You know, men and women that look like, um, us.

But that would make all of these multi-billion dollar corporations lose money. It's much more profitable to sell us an endless like of crap to make us feel just a little bit more like one of the models.

Here's what I don't get. Most of the women I talk to agree that models have very unrealistic body sizes and shapes. They would like to see more normal looking women showing off the clothes that they're going to be wearing. Which is all well and good, except for the small, tiny, itsy-bitsy detail that models are still as thin as ever.

I wish a designer would be willing to take a chance on designing for the any-woman so that she could feel like wonder-woman. All women deserve to feel beautiful. It's not a privilege or a payoff for starving yourself half to death. Here's the sick part: I was at 75% ideal body weight and people were asking me for weight loss tips. My heart was failing and people wanted to know how I did it.

Ludicrous.

Some part of me feels as if I should be grateful that ANTM has a plus-sized model.

Wait a minute, though. That's what they should be doing. If women come in all shapes and sizes, then shouldn't models? Why should I feel grateful? Especially when she's probably a token effort (like the obligatory minority or disabled contestant at a beauty pageant).

She's a beautiful girl, and I hope she wins. Not just because she's plus sized or would be sending a strong message to young girls (though that doesn't hurt). But also because she's a good model.

No, I've never had delusions of grandeur and wanted to be a model. For one, I'm too short. For the other, I'm a klutz.

However, everyone can now be a model. Seriously! Check this video out.



The Hole - video powered by Metacafe

And turn up the volume. That really makes the video.

Everything isn't always what it seems. Go Photoshop!

It struck me, as I walked around the aisles of the grocery store today, just now "normal" it was to diet. Yes, this has occurred to me before, but there's almost an unwritten assumption that you're trying to lose weight. Marshmallows have these big labels saying "Naturally Fat Free!" As anything that is 100% sugar typically is. All sorts of sweets and snacks are somehow supposed to be good for you (or at least cause less guilt) because they have "whole grains."

Yes, your diet- meaning typical daily intake of food- is intricately related to health. Absolutely. The consumption of omega-3 fatty acids can help with depression. When I don't eat enough fats, I can't absorb Vitamin K, a clotting factor, and I have these disgusting bruises all up and down my shins. And so on. This isn't exactly newsbreaking. What is bizarre is the almost complete lack of emphasis on the dangers of dieting.

The whole model/anorexia debate, as played out, ironically enough, on the cover of People magazine, is good in that it draws attention to the dangers of anorexia and bulimia, but not always so good in that all the chips aren't on the table. Models, modelling, and looking at models do not cause anorexia or bulimia. Eating disorders are not a diet gone a little too far. The link isn't causal.

The dangers of ultra-skinny models go beyond just triggering eating disorders. It makes the tell-tale behaviors (eating low fat, no fat, no cal foods, binge eating, overexercising, purging) seem quite standard and ordinary. If a young teen says that he or she is going on a diet, no one will likely bat an eyelash. It might even be written off as an obsession over Kate Moss. In my office, everyone is dieting. Together. It is more odd that I am not than that I am. A young teenage girl is much more likely to be at a more advanced stage of her eating disorder upon diagnosis because it all seems so freaking normal.

I was lucky. My rapid weight loss was so absurd, so seemingly unprovoked, that my mom picked up on it quickly. By then, of course, I had already dropped 10 pounds and malnutrition had thoroughly set in. Even then, it gave Ed much more ammunition to use to lull me and my loved ones into thinking that everything was normal, everything was fine.

Duh. Doesn't everyone want to lose weight? I'm on a diet, I'm just eating healthy, exercise makes me feel great (in the 100 degree Atlanta heat in the middle of the day for an hour and a half). No one noticed. In fact, I was solicited for advice. Two days before I was found to have a pulse of 44 and a blood pressure that was completely undetectable.

So this whole model thing goes quite beyond just triggering eating disorders. It can then sustain them. Normalize them. Make anorexia (at least on a moderate level) seem somehow enviable.

It's hard not to look for the low fat options. I feel guilty when I don't buy them, when I have to ask for a larger size in the dressing room. Tell me that these standards are unhealthy all you want, but they're still standards. They're ingrained upon me. I have to make a conscious effort, every hour of every day, in order to fight these things.

There's a part of me that would like to run out and change the world, but all I want to do anymore is live in it and be accepted no matter how large and untoned my butt is, or how odd my tastes in clothes, books, and music might be.

Really that's all.

I have hemmed and hawed about whether or not to get up on my soapbox about this one: the recent deaths of models from anorexia. Certainly, they are tragic. No doubt about it.

Yet there are two aspects to this debtate:
1) Do ultra-thin models cause eating disorders?
2) What do ultra-thin models say about our society?

The answer to the first one is (fairly) obvious: no model or industry or whatever can cause an eating disorder. Flat-out. Wonderful research has been demonstrating the genetic link in both anorexia and bulimia. However, people don't pop out of the womb restricting their food intake or binge eating and purging. There is always an environmental factor in any sort of disorder. Remember that whole Nature vs. Nurture debate from high school biology? Same thing here. I don't think that the models are at fault. It's the notion that looking like that (bones popping out everywhere) is healthy. It's combining those images with the obesity fears promulgated in schools everywhere. There has to be a middle ground.

It doesn't take a rocket scientist to figure out that in kids all across the US and elsewhere who are told to be frightened about becoming fat, they start worrying and are told to restrict their food. Or to eat "healthy." Or exercise more. If you're hardwired for anorexia or bulimia...well, you get the point.

This basically brings me to the second point: what are models, well, modeling? That this is how women should aspire to look? Hate to break it to ya Calvin Klein, but most women don't have a chance. I'm 5'5" and I have to wear pants that are proportioned short. That's not quite right, considering the average American woman is 5'4". When young, impressionable children and adolescents (hell, young adults and women) see magazine images, it's easy to be lured into the idea that this is "normal." Or in being deluded into the idea that the latest Hollywood starlet's diet is healthy.

No go, kiddies. No go.

I never read fashion magazines. I never followed gossip columns and the like. But if you read pretty much anything these days, every bulge on your body is God forbid a reason for anxiety. Don't eat 80 servings of broccoli a day? Sorry buddy- you're screwed. Ditto for not spending every spare minute at the gym. So in college, what with the Freshman 15 paranoia going around, I decided to skip desserts and start exercising.

Whooops! Someone forgot to tell me where that might end up.

I don't blame anyone or anything for my anorexia- just my DNA. But there are other factors affecting eating disorders, and we'd be blind to overlook them.

(I was going to say that was just my 2 cents, but considering the length and the rate of inflation, that's got to be at least a couple of bucks.)