Eating Disorders at Home

Historically, the relationship between food calories, energy expenditure, and fat was not thoroughly investigated or catalogued. But even before the reign of the enormous British monarch Henry VIII, it was understood that eating a lot made people grow large. Rather than a cause for criticism, obesity was social currency, proof that a breadwinner was indeed prosperous enough to overfeed himself and his family. Such people were looked up to as role models. Now, we know better, but don’t always do better.

In an essay about the societal ramifications of eating disorders, eating disorder therapist Kate Sutton wrote,

Social interactions play a significant role in the development and maintenance of eating disorders through various mechanisms…

Then she went on to give examples. At any type of gathering, there are others to whom a person can make self-comparisons. Even for kids with a restricted upbringing, whose only contacts are made in homes and at church, and maybe not even at school, there is still plenty of opportunity for comparison and judgment. Those factors of course lead inevitably to self-judgment, and from there, to seeking a way to change the self in order to be more acceptable to the majority.

Adults of course play a huge role, particularly with regard to children and youth. The relentless pressure of influence is out in the open, because of the presumption that grownups are supposed to be teaching, through every possible means, at every moment. With adult peer pressure, the methods and effects are more sly and insidious. Among a group of young people, peer pressure can go either way, advocating either conformity or non-conformity.

… Or else!

At any age, the pressure is felt in various forms. Some people can give you a look that just makes you want to sink through the floor. Others may talk about you, or to you. The message is delivered loud and clear: You are inadequate and you need to change, before the situation reaches the point where no one wants anything to do with you. Peers and random strangers are bad enough, but when a family member starts picking on you, even with alleged best intentions, it’s the worst. There is no escape. You live in the same house with this person whose eyes critically weigh you every day, and who keeps track of every bite you put into your mouth.

Obviously, in recent decades inescapable media influence has changed the culture immensely, with magazines, advertisements, television, movies, and the internet relentlessly illustrating exactly how thin human beings are “supposed to be.” The cultural pressure from those multiple sources has been documented extensively.

But even before media saturation, even before that influx of visual overload, some segments of the population were relentlessly pressured about excess weight because of professional requirements. As Sutton wrote,

In certain sports and professions where appearance and weight are emphasized, such as ballet, gymnastics, modeling, swimming, and wrestling, there is a heightened risk of developing eating disorders due to the pressure to maintain a specific body type.

The insidious factor, as “Counselor Kate” reminds readers, is that the family is where an environment is easily created that normalizes disordered eating behaviors, ranging from mild to severe, for no good reason (as ballet training, for instance, might be excused as), but just because.

As we have seen, entertainer Marc Maron describes his mother as a former obese child and a “functioning anorexic” who reacted with panic to the presence of overweight people, and whose main mission in life was to keep her own weight below 120 pounds. He in turn was indoctrinated to be phobic about butter, cheese, and double chins.

This type of upbringing is a constant reminder, “There’s good enough, and there’s not good enough, and you are very close to the edge.” Relentlessly delivered day after day, a message of this sort can be extremely damaging. In this respect, a person with the career of professional comedian is very fortunate, because there is somewhere to “put” the trauma.

Your responses and feedback are welcome!

Source: “Understanding How Eating Disorders Affect Friends and Social Circles,”
CounselOrkate.com, undated
Image by Pixabay/Free for use under the Pixabay Content License

The Rise of Bulimia

A recent post asked the question, “When did bulimia become “a thing”? The short answer is, more recently than anorexia.

Back in the Middle Ages, the phenomena that we today identify as eating disorders had religious overtones. People who refused food as a form of spiritual discipline, known as ascetics, were sometimes revered and sometimes persecuted. A condition known then as “wasting disease” probably encompassed what later came to be known as anorexia. The term “anorexia nervosa” was coined in 1874 and “bulimia nervosa” was named more than a hundred years later.

In the earlier part of the 20th century, anorexia was an upper-class disease, but in the 1970s it became more democratic. It has been called the most deadly of any psychiatric disorder because even though it may take years, many of the victims do succeed in eventually starving themselves to death.

Over the years, knowledge about anorexia and bulimia grew hand-in-hand. For Psychology Today, Emily Deans, M.D., wrote,

Bulimia (binging and then purging via exercise, vomiting, or laxatives) is first reliably described among some of the wealthy in the Middle Ages, who would vomit during meals so they could consume more. Apparently this behavior did not happen in ancient Rome despite a common conception otherwise.

Plain old binge eating disorder does not include purging or indeed any other effort to avoid obesity. Of the obese individuals who look for medical help today, about one-third of them are binge eaters. Quite recently, purging disorder has also been recognized as a separate entity.

Dr. Emily Deans also wrote,

The eating disorders also appear to be genetic, perhaps related to inherited differences in serotonin receptors. Much of the natural progression of anorexia can be explained by disordered thinking about body image combined with the process of starvation itself.

Anorexia afflicts about 0.5% of women and 0.1% of men. Bulimia around 1-3% of women (also 0.1% of men), and binge eating disorder 3.3% of women and 0.8% of men.

Now to back up a little, Britt Berg, M.S., compiled for the Eating Recovery Center a comprehensive history of eating disorders that fills in more details. Binge eating used to be called Night Eating Syndrome until psychiatrist Albert Stunkard clarified that it can occur at any time of day, changing the name of it to the more familiar Binge Eating Disorder, shortened to BED.

Anorexia nervosa, over time, underwent a transition from signifying “a pursuit of spiritual perfection to a pursuit of bodily perfection,” to identification as a distinct disease. Also, in due course, the medical profession realized that women were not the only sufferers of any of the disorders, because men are also affected. An interesting detail about the evolving state of the art is:

“Parentectomy” was considered an appropriate treatment for anorexia nervosa well into the 20th century. Essentially, a person with an eating disorder would be separated from their parents as a “cure.”

In the 1970s, in the United States, England, France, and Germany, eating disorders of every kind increased dramatically. Over the years, as successive editions of the Diagnostic and Statistical Manual of Mental Disorders were published, descriptions of the various conditions became more detailed and differentiated. Just over 10 years ago recognition of BED as a distinct entity allowed victims to obtain insurance coverage for treatment.

Berg notes that now, the available treatment for eating disorders includes a range of care levels including inpatient, residential, partial hospitalization programs, intensive outpatient programs, and virtual intensive outpatient programs. Consequently many therapeutic approaches are employed, including:

Acceptance and commitment therapy (ACT)
Cognitive behavioral therapy (CBT)
Dialectical behavior therapy (DBT)
Exposure and response prevention (ERP)
Emotion-focused family therapy (EFFT)
Family-based treatment approaches (FBT)

Next: More questions and answers.

Your responses and feedback are welcome!

Source: “A History of Eating Disorders,” PsychologyToday.com, 12/11/11
Source: “Bulimia Nervosa/Purging Disorder,” NCBI.NLM.NIH.gov, April 2017
Source: “Let’s Get Real About the History of Eating Disorders,” EatingRecoveryCenter.com, 07/13/23
Image by Alexa/Pixabay

The Obesity-Related Addiction That Isn’t Even Fun

People with bulimia have a lot going on. It’s not simply that they can’t see themselves accurately. Visual hallucinations are only one aspect of an entire array of sensual experiences. An anorexic person can eat a teaspoonful of rice and feel full. Looking bloated is not the worst nightmare; feeling bloated is.

Just like other types of enthusiasts, some folks who cherish and cultivate their eating disorders have favorite slogans that they live by. A person may be horrified by the concept of foreign matter being inside her or his body, even if that intrusive substance is food. They don’t like excess fat on their communication, either. Why say “Emptiness is freedom” when “Empty is free” conveys the message so eloquently?

The quest for emptiness becomes grotesque and horrifying. An 80-pound person wrote:

i purge for 45 mins to 2 hours flushing over and over again
i am bloated (not as bloated as i was before purging my binge), and i feel like things are still inside me
i never feel empty, even when i restrict or when i get hunger pains after my b/p session

Another appreciates precision in distinguishing similar but not identical phenomena: “I frequently get the hunger feeling after purging, but never the truly ’empty’ feeling. I consider those two distinct sensations.” But wait, it gets worse, in the next entry:

Well yes, I do get the empty feeling. I purge down to my morning weight or less… When I get to the point that I taste literally just bile and it burns coming up, I feel pretty empty… When I push [on my stomach], it feels like there’s nothing in there at all. It’s not every time because I just don’t have the willpower to stand there all night and push it all out, but it does happen.

In looking forward to the day when they can live in their own place and make up the rules, a person might fantasize about “keeping the refrigerator and cupboards empty, and free of food.” (There’s that “f” word again.) Again and again, respondents mention the adjectives light, fresh, thin, empty, and free. One person says,

I get so frustrated seeing my parents bring a bunch of junk into the house. It’s very triggering having it just there… When I’m on my own I finally won’t have to worry about binging… And no one will be there to pressure me to eat.

People with these feelings may not even be able to define exactly what the emptiness represents freedom from, or what it replicates — but isn’t part of the ideal of freedom, the concept of not needing to explain your dream or its conditions to others? Shouldn’t it be a basic rule of human conduct, that each person is allowed the leeway to chase their own particular definition of the ideal life? The philosophical ramifications are deep and wide.

If someone wants to be very skinny, why should they not be allowed to pursue their vision of fulfillment (which paradoxically, in this case, is emptiness) — just like the person who aspires to drive a race car or climb a mountain? Those are, after all, life-threatening modes of existence, and the lucky drivers and mountaineers who make it through might win piles of money and acclaim.

Okay, maybe this line of thought goes a bit too far into the territory of the absurd. But people who are mentally or emotionally disturbed do not know that. They may deeply believe in their right to self-destruct, borrowing the reasoning of patriots and freedom-lovers everywhere, to rationalize their lifestyle to themselves and justify it to others.

But the person who binges and purges, what do they get in return for all that risk? Disapproval, scorn, and possibly torture (unwanted treatment) in a place with locked doors. This quotation illustrates the common tendency to regard doctors and other medical personnel as the enemy:

I got out of hospital today for refeeding syndrome (ironically not ED related) I have physical issues that cause malnutrition but also some food body issues that no one really knows about other than I have low self esteem/can’t see myself as others do. They haven’t connected those two, luckily.

Other respondents are eager to share thoughts like these:

I also have no interest in gaining back to a healthy bmi…
I know I would feel that way no matter how low it went so it’s completely illogical and unsustainable…
I have felt more confident in myself since being underweight. Even if I’ll never feel beautiful or thin I can rationalise the thoughts… So in a way I have a peace of mind…
just feel sad and lost and stuck…

So many questions arise, like, when did bulimia become a “thing?” Do the afflicted people discover the behavior by themselves, or learn it from peers or older relatives? Did people binge and purge during the two world wars? Did the disorder even exist then? During the Depression? Did bulimics rejoice that cupboards were bare and no one had enough to eat? Did banquet guests in ancient Rome really vomit on purpose just so they could gobble down more food?

Currently, is binging and purging an American phenomenon, or does it span the globe? If not for the cultural trend toward fat-phobia and fat-hate, would people choose to live this way?

Your responses and feedback are welcome!
Source: “ED Support Forum, EDSsupportForum.com, 06/06/20
Source: “ED Support Forum,” EDSsupportForum.com, 02/24/17
Source: “ED Support Forum,” EDSsupportForum.com, 11/01/22
Image by Gerd Altmann/Pixabay

Matters Worth Pondering

Unfortunately, there is more to say about bulimia, binging and purging, and the connection (or not) between severe, life-threatening eating disorders and the obesity epidemic that has, over the past few decades, inexorably overtaken large segments of humanity.

We have seen how individuals who are into binging and purging, or binging without purging, or purging only, have all kinds of unusual traits (such as being unable to see their mirror reflections accurately) and unconventional ideas (like a longing for non-existence.)

They quote slogans like “Why am I not dead yet” (without a question mark, which makes it sound more like a declaration of intent.)

In this realm of knowledge, it seems as if every answer spawns more questions:

— Why do many eating disorder victims declare themselves as having a very real death wish?
— Is that self-hatred related to the culture’s disgust in regard to obesity?
— Does the effort to end childhood obesity drive the tendency toward anorexia and bulimia?
— Does the same impulse to self-harm which drives the kids who starve themselves, also motivate the kids who seem determined to eat themselves into an early grave?
— Do both of those conditions stem from the same root cause?
— Do people in both those camps see themselves as doing these aberrant behaviors for the same reasons, even though the end results are radically different?
— Do they perceive themselves as doing for different reasons the harmful behaviors that culminate in identical results?

Here is a tough one: In light of the widespread concern over both childhood and adult obesity, what are we to make of the fact that services and institutions are much more likely to cater to severely underweight anorexics than any other type of eating-disordered patient? Anorexia accounts for only less than 10% of eating disorder sufferers, and even among anorexics, the majority are not in the life-threatened category.

Is it the glamour? Perhaps coaxing a person of waif-like thinness to partake of nourishment is aesthetically more appealing than convincing a tub-of-lard-proportioned individual to stop eating so much.

As for victims of the unglamorous disorder known as binge eating, the writer Róisín points out that due to societal fatphobia and other factors, it seems that the medical profession “does not view them as worthy of resources.” There are pragmatic and political aspects. Róisín goes on to say,

Whilst crime is treated as the problem in and of itself, instead of as a result of poverty and state abandonment, eating disorders are similarly seen as the primary issue to solve, instead of a symptom of a wider problem… By applying a universal approach to a complex mental illness, treatment perpetuates the very problem it professes to be solving… We cannot rely on getting rid of an eating disorder whilst coping with the same circumstances that enabled the illness to develop in the first place…

The issue has been contemplated from even more doctrinaire points of view. Alice Weinreb writes of how “second-wave feminists… analyzed anorexia and bulimia as a way to articulate the dangers posed by postwar consumer capitalism for girls and women”:

The analysis hinged upon the paradoxical meaning of consumption in postwar capitalism, which was the cause of and symbolized by the deadly self-denial of the anorexic and the irrational gorging and purging of the bulimic. Eating disorders thus expressed the gendered and destructive impacts of late-modern capitalism on the female body, combining the demand for unbridled consumption and individual empowerment with expectations of female self-denial and physical smallness.

So, there is a lot going on. As previously noted, one trait that people who binge tend to share is a total lack of discrimination. Food preferences have nothing to do with it. They will consume whatever happens to be available, regardless of quality; and whether they like it, or even hate it, is irrelevant. Basically, no food is off-limits, When the urge to stuff themselves hits, all bets are off. Of what help, then, is any advice to identify “problem foods” and describe strategies to avoid them — when literally any food is a problem food to these individuals?

Here is a matter that parents would prefer not to think about. It harks back to Tom Jones, an entertainment film made more than 60 years ago, which included a “lusty dining scene” that attracted considerable attention and comment at the time. One reviewer referenced the “lascivious meal, a lusty marriage of food and sex.”

Critic Wook Kim wrote, “The dinner begins innocently enough, but their furtive glances soon turn into almost incandescent gazing: even a village fool can see where this is going.”

The question is… but what has this to do with the contemporary child who consumes a whole package of cookies in one sitting?

Your responses and feedback are welcome!

Source: “Tom Jones (1963) – Lusty Dining,” YouTube.com, undated
Source: “Of Lust, Ladies, And Lobsters,” NPR.org, 08/06/09
Source: “Top Ten Memorable Movie Eating Scenes,” TIME.com, 01/05/12
Image by Jean Louis Mazieres/Attribution-NonCommercial-ShareAlike 2.0 Generic

Why Am I Not Dead Yet

As previously suggested, the ED Support Forum and other websites of its kind might constitute either a blessing or a curse. We reviewed a few of the various suggestions offered to eating disorder sufferers involved with refeeding, and worse yet, with refeeding syndrome. That condition may lead to consequences as severe as seizures.

One young woman reported in a post that she had suffered three of them, but told no one “because then they would find out about my ED, lol.” Laugh out loud, indeed. A paranoid mind might suspect that the forum exists, literally, to support eating disorders themselves, rather than the overcoming of them.

The contradictions and restrictions involved in maintaining binge eating disorder are exhausting. Keeping up with all the rules is like a full-time job, and the prospect of suffering the equally self-imposed penalties is dreaded.

A phrase seems to turn up frequently in the forum questions and answers about the hellscape known as disordered eating: “Why am I not dead yet” — without a question mark, which seems to remove it from the realm of the ordinary interrogatory. Put that way, the tone is not questioning, but resigned. Seemingly, the only thing a victim hates more than the eating disorder is the prospect of release from it.

That lying mirror

A peculiarity of pathologically emaciated individuals is the inability to actually see themselves in mirrors, photos, or the flesh. To themselves, they look repulsively fat, always. A forum participant known as Hiraeth_, a bulimia patient who accumulated more than 5,000 posts on the site, reminisced about the time when she had made herself so ill the question was legitimate — “Why am I not dead yet?” In one post, she named her ultimate goal as “being so […] thin that even I can see it.”

To maintain her “ideal” weight of 50 kilograms (110 pounds) she binged and purged almost every day, and took laxatives multiple times per day. A court ordered her into a hospital, where despite observation and strict rules, she still managed somehow to almost kill herself. That episode was followed by a year of being “in and out of hospital so many times I lost count, literally.” She writes,

After that horrible year, it surprisingly went better. I didn’t get hospitalized for 14 months. Until last week, lol. I hope this rollercoaster won’t start over again. Because this time, I bet I can’t be saved.

The gender factor

For whatever reasons, few eating disorder studies include males, but, surprise!

Despite the stereotype that eating disorders only occur in women, about one in three people struggling with an eating disorder is male, and subclinical disordered eating behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women.

One might think that this refers to gay men, but one would be mistaken. Despite the shortage of reliable and wide-ranging statistics, it is suspected that males binge almost as often as females, although females are more likely to purge. Furthermore, it appears that women are more likely to purge in reaction to “normal” consumption patterns, and in the absence of binge eating.

Back to the ED Support Forum, one individual reported that she or he had been binging and purging for nearly five years, yet their blood work remained “completely normal,” which is “a bummer” because “I’m kinda hoping this kills me but it might take longer than I intended.”

The whole mess raises philosophical questions that can probably not be answered, such as: What does this have to do with the worldwide epidemic of childhood obesity? In a sense, it is almost as if the BP (binge and purge) people are some strange order of penitents doomed to suffer their ailment to compensate for all the planet-smothering obesity.

Like religious zealots who parade through the streets flogging themselves with whips, it is their destiny to take upon themselves the world’s sins of overindulgence, and somehow restore balance to the cosmic order. The one thing they cannot abide is the sin of obesity.

Your responses and feedback are welcome!

Source: “Search results for query: refeeding,” EDSupportForum.com, 2023
Source: “Bulimia Discussions,” EDSupportForum.com, June 2016
Source: “Eating Disorders in Men and Boys,” NationalEatingDisorders.org, undated
Source: “Bulimia Discussions,” EDSupportForum.com, 2016
Image by Gareth Williams/Attribution 2.0 Generic

Mutual Aid for Eating Disorders

One dangerous aspect of the World Wide Web is that young people can go there to be coached on exactly how to slim down in hazardous ways, by experts, i.e. other kids — or worse yet, adults — who are only too happy to indoctrinate them. The uninhibited spread of dangerous knowledge has been an ongoing problem ever since online forums were invented.

The one consulted here is ED Support Forum, a useful font of information on these topics, for better or worse. It apparently intends to help people escape from problem conditions, but in the course of helping, of course, readers will unavoidably find out a lot about how to acquire and maintain dangerous conditions.

The site is a huge resource, sorted into categories, where even those with unusual and arcane issues can find kindred souls. For instance, they ask each other about refeeding syndrome — a frequent consequence of malnutrition, whatever the cause, and not a challenge for amateurs to be handling on their own. Refeeding is the process of reconditioning the patient’s body to accept food without going all haywire from electrolyte imbalance and other complications. Refeeding syndrome is when it goes all haywire anyway.

The looming hazard posed by refeeding syndrome is a major reason for wanting to make sure that misguided young people do not become involved with any of the pathological and often grotesque efforts to lose weight in unsafe ways. Asking advice from people in the same boat is not a great choice but it’s as far as many people will go. They’re giving each other advice about how to manage refeeding syndrome at home, on their own. One poster asks,

Has anyone ever been thru refeeding at home? Went 8 days fasting with very little liquid. Then tried consuming the last 3 days. Every time I try, I break out in sweats head to toe. Then nausea. My lower legs and feet and ankles are swollen and even after hours of elevation don’t go down much. I have passed out a few times. My blood pressure is low. Last check was 86/58.

This person goes on to say that they have social anxiety, and rarely leave home, so of course going to a hospital “isn’t an option.” So they request not to be offered any advice like calling 911 or visiting a doctor or the emergency room. But then their next post says they “did end up at ER sunday.” The poster wrote:

Because of malnutrition/starvation/dehydration my body is trying to hold on to fluid nutrients or whatever it can. Fluid in chest/abdominal wall is what is causing the pain… I’m weaker now than I was Sunday. Still swollen. Wt up 8 lbs from swelling. My stomach has been removed and I’ve had 3 bowel resections.

This really sounds like hell on earth, and another member of the forum confirms that “refeed edema is super painful… Stick to whole foods, avoid processed since processed has high levels of sodium,” and goes on to give other advice gleaned from research papers. Another amateur counselor notes that the mental health toll an eating disorder imposes can be devastating. Implementing “damage control” is exhaustingly time-consuming, and the whole process is something “you can really beat yourself up over.” They write,

You will have to challenge your perfectionism which the ED is tightly bound around, so that’ll freak it out. Unfortunately, challenging perfectionism a little might be what keeps you mentally and physically safer during your ED.

Another person, and just for ease of communication we’re going to assume this is a female, confides that her “ED brain” looks in the mirror and sees a big, fat blob that absolutely needs to continue losing weight. Even if her calorie count is tiny, the ED brain gets angry. When the number on the scale goes up by even one pound, the ED brain tells her she is a failure, and is only happy when the number decreases. The person writes:

Then my little bit of sanity I have left sees the real me in the mirror and thinks I look disgusting… That this is the one body I’ll ever get and I’m ruining it… Also stop losing before I get put in forced recovery.

“Dark Seas” contributes information about how prickly and defensive her ED brain is, because when someone advises her not to vomit, or offers some other helpful advice, the ED brain hisses, “Of course they’d say that, because they don’t want me to be skinny.” So even a helpfully-intended intervention is received as an insult and a challenge.

Your responses and feedback are welcome!

Source: “Refeeding at Home,” EdSupportForum.com, 05/22/24
Source: “How to avoid/lessen binging,” EdSupportForum.com, 01/25/24
Source: “ed brain vs rational mind,” EdSupportForum.com, 06/11/22
Source: “ED Brain,” EdSupportForum.com, 03/08/22
Image by Edvard Munch/CC BY 4.0 rawpixel.com

Oprah Through the Years, Part 21

Courtesy of the Oprah Winfrey Network, March of 2011 brought the TV audience a new reality show, “Addicted to Food.” It was recorded on location at the Shades of Hope Treatment Center, a facility specializing in eating disorders and addiction. Shades of Hope founder and CEO Tennie McCarty has found that addicts come from homes affected by dysfunction, abuse, addiction, or some combination of all three. The work that must be done is “to delve deep within and confront not only the outward behaviors of addiction, but also the secrets, pain, self-loathing, and blame that lie beneath.”

How long does that take? At minimum, 42 days, which is the length of the Intensive Residential Program. This has been shown to be enough time to dig into the psychological issues, learn the tools of recovery, and achieve a solid state of abstinence. The process is not easy, and the rules are strict, for good reason. No alcohol, no smoking, no other types of addictive substances are allowed, because to run a program meant to end one sort of addiction while allowing other addictive substance to be used is just plain silly.

While a client’s weight may be tracked, it is not revealed. The point is to get away from the idea that “it is always about the numbers and the connection of worth/control/success to the number on the scale.”

And that’s not all…

Oh — and no TV, or books or magazines are allowed either, because people need to be thinking about their own issues, not about the larger world or some imaginary characters. McCarty explains that the goal is to allow all the negative feelings to emerge and “slap the client in the face.” Hopefully, that blow will metaphorically knock the mask right off, exposing the anger and all the other stuff. When this happens, the client is said to be “showing up.”

The Intensive period includes Family Week, and then another week in which to process whatever transpired during that time, and to figure out what’s next — which might be a transitional period, either still at the Shades of Hope, or at another facility. Or perhaps it is time to return home, and get back to school, work, or whatever.

But… and this is a big but…

None of these stages can be regarded as an end point, because this is not a race where a person breaks through a ribbon at the end of the course. Nope, says McCarty. It’s all about a lifelong commitment, during which the individual must be constantly on guard because that inner void still cries out to be filled, and “switching” addictions is definitely a real possibility, to be avoided at all costs. Day by day and minute by minute, the commitment — to use new attitudes and new tools to change old patterns — must be scrupulously kept.

McCarty offers five helpful “tips” for recovery, more thoroughly described on her page, and worth looking into:

1. Be conscious of what you eat.
2. Eat with intention.
3. Maintain a healthy meal plan.
4. Eat by the clock.
5. Recovery is not a diet, but a way of life.

The show made at this “extremely difficult rehab center” involved eight clients, and it must have been edifying for Oprah to recognize which one (or ones) she most closely identified with. Seven years later, InTouchWeekly.com made an attempt to follow up on the participants, which proved to be rather half-hearted and largely unsuccessful. But their website also contains the trailer for the original show, which is pretty interesting. SocialWorkersSpeak.org also took note of the series and made some comments.

In the next chapter of Oprah Winfrey’s life of up-and-down weight shifts, we will see things take off in a whole different direction.

Your responses and feedback are welcome!

Source: “Addicted to Food Q&A: Tennie McCarty and Tough Love,” Oprah.com Source: “Remember Oprah’s Reality Show ‘Addicted to Food’? Here’s What the Cast Is up to in 2018,” InTouchWeekly.com, 03/01/18
Source: “Oprah Winfrey Network’s ‘Addicted to Food’ Tackles Emotions Behind Eating Disorders,” SocialWorkersSpeak.org, 05/12/11
Image by Pat Hartman

Oprah Through the Years, Part 20

We left off last time by mentioning how the rules change. This is one of life’s little jokes. As soon as you get used to one condition or set of circumstances, it will probably be necessary, before too long, to readjust to something else. For humans, the primary survival trait is adaptability, and the young are better at it. This is one reason why, when correctly applied, being like a little child is a very desirable state.

Youth is when many people are easily able to swallow and assimilate anything without suffering a physical penalty. As the body ages, it becomes less tolerant and… the rules change. When something else is going on at the same time, this fact might be easy to ignore. In the case of Oprah Winfrey, trainer and friend Bob Greene pointed out that her thyroid issue was an easy excuse to fall back on, and that she had “absolutely” done so on more than one occasion.

People are usually pretty good at generating excuses for not achieving their dreams. Just like a regular human, the global influencer and star had a particular and individual issue to deal with. In her case, it was a medical condition that required expert management, as well as patient compliance.

At the same time, like billions of regular people, Oprah was getting older every minute. As time goes on, and even with dedicated effort, it becomes more and more difficult to stave off weight gain.

In human history, this has rarely been the case. For obesity to become a significant problem, a society has to reach the stage of having food surplus to its needs. The civilization advances to where it can afford to have some members unable to defend themselves, and dependent on others for their continued well-being. When the society has abundant food, and physical fitness is not a priority requirement, people can become obese.

The Bob Greene worldview

Greene theorized that no one, be they an anonymous teenager or a world-famous star, would ever be able to completely overcome food addiction; that the problem would never completely disappear, and would always need conscious and diligent management. He also suggested that no one could properly start the recovery journey without squarely facing five crucial questions:

What are you hungry for?
Why are you overweight?
Why have you been unable to maintain weight loss in the past?
What in your life is not working?
Why do you want to lose weight?

The last query is a particular challenge, because the seeker is quite likely to come up with the wrong answer. “Then I’ll be happy” is not the right one, because it encompasses only two possible outcomes, neither of which can satisfy, as Greene explains:

You never reach that size or weight and you’re never happy. And even worse, you reach that size and weight and realize it has nothing to do with your happiness.

The following year, 2010, was when Oprah famously stated for publication that she was not fond of the term “food addict,” but…

I realize that I really have been one. And believe me, I — like so many of you — have punished myself for that. But I know that I’m not alone, and I know that the battle hasn’t ended.

This admission seems to cover two bases: First, it pleads guilty to the same fat-hate that dwells in the heart of even the most compassionate person. Also, it appears to confirm that the last person anyone is ever able to forgive is their own self.

Your responses and feedback are welcome!

Source: “Oprah’s Weight Loss Confession,” Oprah.com, undated
Image by Oprah.com/Fair Use

Oprah Through the Years, Part 19

As we learned, during a decade or so of time the weight issue was not a major problem for Oprah. She had found a large amount of inner peace in not hating any part of herself, not even the pockets of cellulite. But old mental habits die hard, and there are contradictions involved in embracing the self, no matter how calorically challenged, while also carrying out public activities (on national television, for instance) that might be regarded by the cynically minded as the very embodiment of fat-hate.

Imagine this scenario: The problem you overcame, and so triumphantly buried with a great deal of ceremony (and publicity), has clawed its way out of the grave, hitched a ride on a garbage truck, and is now demolishing your front door. What could be more disheartening? Oprah Winfrey, after a lot of emotional ups and downs, had reached a pretty good emotional equilibrium and, if there was any justice, ought to have been able to coast.

Instead, after being advised to “learn to embrace hunger,” she gradually gained back 40 pounds. Some of the difficulty was simply due to nature taking its course. As a human body ages, multiple processes are responsible for making it less resilient. It does not mend itself like it used to, and pain occurs in parts you never even knew you had. The entire organism might suddenly begin to demonstrate an uncanny propensity to grow.

O, the publication

At the beginning of 2009, the cover of Oprah’s very own slick magazine showed her current self next to an earlier, much slimmer version, and the words “How did I let this happen again?”… all of which looked like a pretty clear case of fat-hate. The inside pages held her musings on that subject, including a strong suspicion that the ultimate cause was a life out of balance, “with too much work and not enough play, not enough time to calm down… I let the well run dry.”

The conclusion seemed to point in a productive direction:

I don’t have a weight problem — I have a self-care problem that manifests through weight.

In that same year, a segment of the immensely popular “The Oprah Winfrey Show” featured 16 teens participating in “a grueling eight-hour intervention where they confront the reasons why they’re overweight.” Author Natalie Flynn described it as “humanizing” and as a way for booth the participants and the audience to grasp “what living with obesity truly entails.”

A recent Salon.com article looked back over that time with a congratulatory pronouncement:

[W]hat Winfrey has largely consistently managed to get right is her approach to childhood obesity. In her recent special and in old episodes […] Winfrey allows children to speak candidly about their weight, often showing in raw detail how obesity takes a toll on them mentally, socially and physically.

Cynics might have identified it as just another, though perhaps superficially compassionate, demonstration of how obsessed society is with maintaining a standard of fat-hate, while at the same time blaming the victims for “abusing food.” That in itself is a tricky phrase, which could logically encompass chaining up food in a basement and striking it with a belt.

Meanwhile, Bob Greene was also in the public eye, providing for the official website “Oprah’s Weight Loss Confession.” Some of the problems in the media star’s case, not relevant to most teenagers, were the concurrent challenges presented by worldwide success. Oprah had met and overcome so many obstacles, he theorized, that it was difficult for her to grasp the inevitable challenge of aging, which means “the rules change.”

Your responses and feedback are welcome!

Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” EOnline.com, 03/24/24
Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Source: “Oprah’s Weight Loss Confession,” Oprah.com, 01/05/09
Image by aphrodite-in-nyc/Attribution 2.0 Generic

Oprah Through the Years, Part 18

We have discussed the concept of displacement and its various manifestations. In the most primitive sense, displacement is an escape valve for the mental energy generated by a threatening situation. In the most elemental case, the choices might be limited to “fight” or “flight.”

In the simplest terms, someone with a threatening food addiction might opt to fight, by getting into a program of some kind; or to flee by ignoring the threat and by putting all that mental energy into (for instance) online gaming, a very sedentary occupation that offers a lot of opportunity for snacking.

But we humans are more complicated than that, and sometimes our wires get crossed. A previous post offered the example of the so-called “fitness freak,” who trades in their doughnut habit for an obsession with working out, losing fat, and gaining muscle — to a degree that bystanders might call obsessive. But as long as a displacement activity keeps the person away from their drug of choice, while at the same time doing no harm, and while actually achieving good results, why not just accept it and move on?

The fly in the ointment

For Oprah Winfrey, however, no amount of activity could displace her craving for bread and potatoes and a whole lot of other edibles. For decades, she was a whirlwind of energy, constantly involved with professional obligations and thoroughly invested in charitable efforts.

Going back to the most elementary definition of displacement behavior, she focused on helping people flee or fight; to escape or defeat obesity. One of her 1995 TV episodes on “fattertainment” was optimistically described like this: “By providing solutions, rather than showcasing problems, the show hopes to use the power of broadcasting in a positive manner.”

Three young girls had written to the host about their uncomfortable feelings and experiences around excess weight. Oprah’s crews filmed their families and the girls and their mothers appeared on the show to talk about the “emotional roadblocks” that contribute to obesity among the young.

On the personal level

In 1995, at age 47, Oprah started to work with trainer Bob Greene, because like any sane person, she realized that having an intellectual realization is not the same thing as living the newly revealed truth. Still, it took a few more years and some unnerving heart palpitations to really jolt her into high gear. Eventually, it occurred her that “taking care of my heart, the life force of my body, had never been my priority” — and then proceeded to organize life differently with an eye toward shrinking the influence of the three ominous O’s — “Overeating. Overstressing. Overdoing.”

Furthermore — and this appears to be a vital element of the whole equation — to quote Oprah, “I no longer hated any part of myself, including the cellulite.” Ten years later, the cover of O magazine feature a toned 160-pound Oprah. By this time, she thought the actual battle with excess weight had been won. Looking back later, she said,

I’d conquered it. I was so sure, I was even cocky. I had the nerve to say to friends who were struggling, ‘All you have to do is work out harder and eat less! Get your 10,000 steps in! None of that starchy stuff!’

Not long afterwards, puzzled medical professionals diagnosed her first with hyperthyroidism, then with hypothyroidism, and what with one thing and another, exercise began to seem less of a priority, and she was warned by a doctor that it would be necessary to “learn to embrace hunger,” which she was in no way prepared to do.

Your responses and feedback are welcome!

Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Source: “Making Peace With My Body,” Oprah.com, 08/01/02
Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” MSN.com, 03/24/24
Image by aphrodite-in-nyc/Attribution 2.0 Generic

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources