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.

It's nice to think about preventing eating disorders.  I'm not saying we can't do it or we shouldn't try.  But I'm wondering how teaching kids about "loving your body" and the dangers of eating disorders is actually going to help.

In a recent Huffington Post article, therapist Judith Brisman writes:

•Talk about eating disorders and how dangerous they are. Talk about it in the same way you talk about lung cancer and smoking -- or death and drunk driving. It's that dangerous. It can't be ignored.


•Help your kids pay attention to their inner life. What are they feeling inside when they turn to the third batch of cookies, or when they are skipping breakfast and lunch? Be genuinely curious about their fears, thoughts and worries about their body. And educate them! They may not know that skipping breakfast and lunch disrupts metabolism.

•Help your kids be responsible for what they are eating. Allow them snacks. For example, it's okay to eat cake -- but how many times a day? And what should portion size look like? Talk, be curious, instruct and pay attention. Kids need to know that if they get too skinny or become anorexic, they won't be able to be in the school play or on the hockey team. Kids should be as scared of anorexia, binge eating and bulimia as they are of smoking and drunk driving. They also should know that there are many things that can be done to help if they worry they are in trouble with food.

I don't think that these things are bad.  Open lines of communication between parent and child are very important.  And I do think that kids should be taught about eating disorders the same way they are taught about smoking, drunk driving and cancer.

My question is this: do we know that this will actually prevent eating disorders?

I'm guessing that most people who develop an eating disorder today probably know what one is.  I knew eating disorders were dangerous before I got sick, and it didn't really stop me.  One, I thought it would never happen to me. Two, I didn't realize I had anorexia until I was already stuck. 

I wish more kids (and adults!) were taught about the dangers of dieting and that "healthy eating" can go too far.  I want more people to know about exercise--too much and not enough.  I can believe that these things might help.

But explaining to someone how dangerous eating disorders are isn't going to prevent someone from getting sick.  It's like telling someone that cancer can kill you and expecting that this will make cancer rates go down.  It's a nice thought, but that's not how cancer works.  And that's not how eating disorders work, either.

Eating disorders are baffling and scary, and it's probably nice to think that if we just don't complain about our butts and if we tell little Susie and Sammy that EDs can kill, then surely they won't be stupid enough to get sick.  After all, my mother once told me (in all seriousness) that she never thought I would develop an eating disorder because I was smarter than that.  As in, I knew it was dangerous so why would I "dabble" in anorexia?

Because I didn't know I was dabbling in anorexia when I first got sick.  I just wanted to eat "better."  I was actually trying not to get anorexia.  It happened all the same because an eating disorder isn't a choice.  It's not logical.  It's an illness. 

Part of the goal of National Eating Disorders Awareness Week is what's known as "awareness-raising." People want to raise awareness of what eating disorders are, what causes them, and how they can be treated. This is not necessarily a bad thing. However, the information that is spread, and the topics covered by the media, don't necessarily reflect that latest scientific understanding of eating disorders.

So many stories discuss the need to look "perfect," and society's pressures to be thin. I'm not going to deny that these factors are true, but I think the blame is a little misplaced. These things can trigger eating disorders and allow them to flourish, but that's a far cry from looking at them as a cause.

Some of the people I know who are desperately trying to prevent eating disorders--a noble cause regardless!--are looking at things like discontinuing the use of emaciated models, changing the way women are used in advertising, and promoting gender equality. Again, these are all things that I support. I just have to question their impact on preventing eating disorders. It's easy to zero in on these things because sufferers tend to be inexplicably drawn to thin models and fashion magazines during their illness.

There's also some intuitive sense there: many women want to look like the models in magazines, even if it's just on a subconscious level. And some of these women may go on diets or exercise to look just a little more like that (though it is typically covered in improving "health"), but most don't develop eating disorders.

I do think our culture is more than a little toxic, but if that were the case, more people would have eating disorders. I absolutely think we should stop using emaciated models- for their sake and also for ours. But there's a difference between doing that and trying to prevent eating disorders. A few studies have found that challenging the thin ideal can help lower the risk of eating disorders short term, but I remain skeptical.

I think our obsession with dieting and freakish fears of obesity are far more damaging. Why? Diets (which are really just socially sanctioned forms of malnutrition) become normal and EDs love to hide behind things like "diets" and "healthy eating." And we stop getting worried. Most people are afraid of fat, and we buy into what people with eating disorders say.

So maybe it's time to let Barbie off the hook, and instead look at little closer at what our own "health" industries are promoting.

As researchers make more and more progress into what causes various mental illnesses, they're getting a clearer picture of what happens before the onset of clinical illness. And knowing what happens before illness onset can mean figuring out a way to start preventative treatment.

Although we're quite a long way off from discovering this in eating disorders, there was an interesting study on how people with schizophrenia do not respond to "bizarre" faces (photos were altered in Photoshop for the experiment). Not only do normal people respond visually, their brains set off a sort of alarm when they see these abnormal faces.

“The visual areas of the brain are highly connected to other areas, including the prefrontal cortex and the amygdala, but in schizophrenic patients, there is a diminished connection between the various parts, leading to disturbed integration of information — and thus to distorted experiences," Prof. Talma Hendler says.

The key to the findings is this: emotional understanding and processing begins early- very early. Given that schizophrenia is strongly rooted in genetics, it is likely that this abnormal emotional processing begins early, too. So a screening test could be developed for high-risk children to determine if they have these characteristics, too.

Of course, we don't know if antipsychotics work as a prophylactic treatment, nor do we know if this abnormal processing is predictive of future schizophrenia. For instance, brain functioning was altered in those people closely related to OCD sufferers, even though they didn't have any symptoms themselves. But we know the genetics, and perhaps being able to keep a watchful eye on those most likely to suffer may be just as good. Still, every tool should be evaluated and this could prove very interesting and useful

EDITED: Laura just posted about a potential test for predicting postpartum depression.

This past weekend was the Stand Up 2 Cancer event, where celebrities raised money to try and "eliminate" cancer. I believe the catchphrase was "This is where the end of cancer begins."

As I biochemist, I find the idea of "eliminating" cancer quite absurd. Cancer is simply a byproduct of evolution. If genes couldn't mutate, we would still be pond scum, or living near the vents at the bottom of the ocean. But genes can mutate, and if you have a mutation in the wrong genes, then you have cancer. You can no more "eliminate" cancer than you can gravity. You just...can't.

I'm not saying we shouldn't do what we can to prevent the illnesses we can. I'm not cold-hearted (well, not all the time).

It's quite the same with eating disorders.

Call me cynical, but I think we're going to find it hard to prevent all eating disorders. It's a biologically-based mental illness; the genes that cause anorexia (which may have been evolutionarily useful to early humans in withstanding famine) and bulimia and binge eating disorder aren't going to "purge" themselves from the human race. Ergo, there will still be cases of eating disorders no matter how hard we try.

And I have some issue with a lot of the prevention efforts out there. Raising the self-esteem of girls is a good thing. So is media literacy. And building better body image. After all, our culture isn't exactly the most healthy.

But is this really going to prevent eating disorders?

Why not focus on the dangers of some of the "healthy eating" and "wellness" initiatives out there? Why not focus on the importance of full nutrition- the need for fats, the dangers of dieting, the benefits of eating when you're hungry and stopping when you're full? Why not focus on not skipping meals? Or the dangers of over-exercise? The futility of dieting? The dangers of perfectionism?

A lot of the people I know with an eating disorder started off by trying to "eat healthy" or "get fit" or even just "lose five pounds." An eating disorder evolves then, takes on a life of its own.

I never gave a hoot about models and magazines until I was sick. And then I was frighteningly drawn to them, must look must look. I fixated on skinny people. To an extent, I still do. I thought that if I ate the right foods, looked the right way, then I could calm the chaos in my head.

Would hearing messages that I looked just fine the way I was have helped? Perhaps. But likely, given my perfectionistic personality, I would have ignored them anyway. My parents did and said all of the right things. They never told me to diet. They never pressured me to get all A's in school.

What will prevent so much suffering is emphasizing the importance of early aggressive treatment. The importance of eating properly. But the oddities of current models? Not so much.

Most of the articles I read on childhood obesity leave me swearing in frustration and/or shaking my head in disgust.

Not so with this fabulous article:

Singapore to scrap anti-obesity program

Why? Apparently it caused some kids to be singled out and teased about their weight loss. The director and creator of the "Trim and Fit" program says, "If you want to focus on just overweight children, then no matter what you call it, there will be a stigma associated."

Gee, I'm surprised at that one. Actually, I am surprised that someone would a) notice that, b)admit it, and c) then DO something about it. Amazing.

People told me I was fat (chubby, hefty, big-boned, curvy...you get the idea) when I was younger. And I was about 85% weight-for-age on the growth curves. But I was also 90% height-for-age. Duh. But schoolkids neither know the difference nor care. If I wasn't a target because of my weight, I would have been for something else (smart, quiet, loved books, etc).

The irony with all of these anti-obesity programs is that none of them work. Even the Centers for Disease Control and Prevention published a study that said the same thing- within whose vaulted halls many such anti-obesity propaganda has sprung. In a 2005 report, they said that only one of the studies targeted at middle school students showed even minor decreases in weight. Most hilariously, if you read the first part of the report, it says that overweight (a BMI between 25.0 and 30.0) was not associated with excess deaths. Underweight (BMI less than 18.5) was associated with excess deaths- though you never hear about that. The only other group whose weight was associated with excess deaths were those people with a BMI greater than 35.0- which is approximately 8% of the population.

Why aren't more reports being issued about the dangers of underweight? Though I hesitate to implicate the big bad media in the causation of eating disorders, I will argue that the promulgation of the thin ideal causes weight loss to go unnoticed or un-worried-about. Our threshold for determining a healthy weight has been lowered. Right before I was hospitalized for anorexia at a life-threatening BMI, people were asking me for diet tips. That's just messed up. Creating all of these fears of obesity and how fat is going to kill you just you wait and see, when really it's only 8% of the population that has an increased risk of death and illness? As well, many of the so-called morbidly obese may well have a chemical imbalance that causes an inability to feel full.

So can we get some sanity here? Please? For all our sake's, and especially our children's. An effort to end one problem may be creating an even larger one.

No pun intended.