Weight Stigma Awareness Week, September 22-26, 2014

Stigma is nothing new. Throughout the centuries people have been stigmatized for everything from the color of their skin and country of origin to their age and religion.

A hundred years ago, people were not stigmatized for weight; yet today, people are routinely and pervasively abused for being anything outside of our thin “ideal.” And, it starts early in life. Research reveals that even pre-school children, age three to four, view obese peers as mean, ugly and stupid. In elementary school, the likelihood of being bullied is 63% higher for an obese child. Obese youth are stereotyped as lazy, unfriendly, dishonest. Adolescents are teased more for being overweight than anything else.

Prejudice extends far into adulthood; even medical professionals (especially medical professionals, sadly) are guilty of weight bias, often perceiving  overweight or obese patients as less disciplined and non-compliant, or even viewing them as annoying or problem patients. Sadly, as body mass index (BMI) increases, so does a doctor’s intolerance of these individuals.

Medical education consistently promotes the falsehood that BMI is an end-all, be-all measure of health. Many healthy people such as professional athletes have BMI’s in a range that would be labeled overweight or obese. Very few of us would consider LeBron James unhealthy (physically, anyways!) despite a BMI that makes him obese.

The stigma and abuse of people of size is pervasive in the media and advertising as well. The popularity of TV shows such as the Biggest Loser indicates just how obsessed we are in America with thinness and extreme dieting or exercise. Sustainable health lives in the middle. People can be healthy at a whole wide range of sizes and shapes.

I wonder what it will take for us to start looking at and valuing more accurate measures of health such as blood pressure, exercise tolerance, and blood sugar instead of BMI? I wonder what it will take to shake us from our obsession with the health food and diet industry that exploits our fear of fat to the tune of billions of dollars a year? Does anybody know a person who has been able to sustain a healthy weight by going on a diet? Or taking a pill?

This is what Weight Stigma Awareness Week is all about. It is a chance for everyone to take a moment and consider how they view those who are overweight or obese, and if any negativity is attached, possibly reconsider this type of value judgment.

 

 

 

Lost Time

In our culture, we are taught that certain things happen at certain ages – you get your driver’s license at 16, retire at 65. This idea also extends to certain decades. The 20s are geared to finishing up college, starting a career, and securing a spouse. If the spouse doesn’t materialize in the 20s, surely marriage and children should occur early in the following decade. If not, you could end up single forever, growing old alone, unless of course, you count your pets. This is just the way life is “supposed” to unfold–the “normal” life trajectory.

This idea of what should happen by certain ages causes a tremendous amount of undue stress, turmoil and strife for many women who have struggled with an addiction, eating disorder or mental illness. They feel that they have “lost time” due to spending years in their illness that might have been spent otherwise. What’s more, these women believe they will never be able to make up the lost time; they have fallen off track with little hope of ever catching up or getting back into the stream of life. They tell themselves they will never get married or have a family because “the time” for that has passed.

I know how these women feel because I spent many years in early recovery living with those beliefs.

Even though I followed the career script by completing college, medical school and residency in my 20s, I departed from the social plan in the grips of a full-blown eating disorder and alcoholism that would take me years to recover from. The latter half of my third decade of life was dedicated to searching for and finally finding sustainable recovery.

By my mid-30s I became aware of something my diseases robbed from me: I had not found a mate nor started a family. I thought my only option was to accept it, grieve the loss, buy a dog and go on. Because, of course, there is only ONE decade when people can get married…and have babies, right? That was my distorted belief, and many women think likewise. I see them in recovery meetings, in professional circles, and in groups at TK. Their misery, though very real, is misguided. There is a real absurdity about our culture’s timetable. It does not take into account the unique plan that a loving God, or higher power, has for each and every one of our lives.

I remember when I was afraid to hope, to live life fully, to go after what I wanted, to trust it would be there for me, too. To actually dare to believe that God is kind and merciful, that even in my late 30s I had plenty of time to make up for lost time.

So I took a chance … followed my heart. I got married to someone I love on a soul level. Together, we are having a baby.

Just as I hope for women to discard the world’s adoration of unrealistic thinness and beauty, I hope for them to disregard artificial timetables. I have lived long enough to see women meet and marry the “love of their life” at every age, and have the family they always wanted, or elect not to. I have seen talented women launch successful careers, in their 20s, 30s, 40s and 50s. Life is dynamic and full of possibilities; it rarely runs according to a societal dictate.

In my life, things may still go terribly wrong at some point; that’s a risk we all take when we are in the game. Even if it does, I will be grateful for everything: the journey … the experience … for living.

 

 

 

Suicide: The Public Exploitation of a Private Tragedy

Earlier this year, I wrote about a personal experience that my family and I went through; it involved suicide. Losing someone you love is always horrible; but death by suicide usually adds a host of other complex emotions to the already considerable grief.

Even if a loved one has what is thought to be a terminal disease, there is still hope — advancements in medicine, a miracle of healing … something.

When a loved one completes suicide, hope evaporates entirely.

On Monday, the world lost Robin Williams, a beloved artist. But, what is so often overlooked by the media in particular is that right now one family is utterly devastated, suffering unimaginable pain. This family lost a husband, a father, a brother, a friend.

These family members may be reliving final interactions with him, repeatedly asking themselves what they might have done differently in order to prevent their current reality.

I know I did.

I endlessly asked myself how this could have happened; were there signs I had missed? If I had been closer to my nephew, spent more time with him, could this life have been saved?

I experienced many emotions after he died: guilt, sadness, pain and anger as well as profound gratitude for who he was. Only through the love I am shown by family and friends was I able to resolve this issue in my heart, soul and spirit. And only with the understanding that he is in the hands of God, now, do I find peace with how his life ended.

I can’t imagine going through that period of my life, my family’s life, with stories of my nephew’s death and life publicly displayed on every news channel, radio station, website or newspaper.

In this current situation, I pray for two things: first, for this family to be surrounded by a compassionate and supportive circle of true friends; and second, for another event to transpire in the world in order for the media to move on, thus ending the hoopla and exploitation of this tragedy.

Cocktails and Playdates: A Worrisome Combination

It used to be that a child’s playdate was just that: kids would get together and run around a park, swim in a pool, maybe just play in the backyard. Today, many playdates offer a new component; one that isn’t entirely centered on the children, but geared more toward the mothers. This added component is alcohol.

Mothers meet up, often at someone’s home, and as the children play, the mothers enjoy each other’s company, as they sip on a glass of wine, a cocktail, or sometimes several cocktails.

For those of us in the treatment field, children and alcohol in the same sentence and the same physical environment has certain implications. “Cocktail playdates” are growing in popularity throughout the country. Is it surprising?

Consuming alcohol is so socially accepted, integrating it into every event can seem reasonable. Even if one mom felt a minor hesitation, seeing everyone else engage in alcohol consumption in the context of a playdate could alleviate any apprehension. However, it’s important for us to remember – alcohol is a central nervous system depressant, which means it slows brain function, which can impair an individual on many levels. The children playing on the swing set or engaging in a game of tag in the back yard deserve responsible monitoring; this means, an adult will tell them when they are swinging too high, or will step in if one child is getting too rough. The more any mother drinks, the more her awareness of what is taking place around her is dampened.

Intrinsic, and even more worrisome, to the concept of a date is that there is a beginning and an end. Unless all involved live in the same neighborhood, driving home is required. Getting behind the wheel in any state of intoxication is dangerous, with higher stakes due to the presence of a child in the car.

Above and beyond the moment, what impact does a mother’s drinking have on a child? Although many mothers who consume alcohol – those who drink recreationally all the way down the continuum to those with severe substance use disorders – often don’t realize the effect on kids, especially if the kids are preverbal or too young for explicit memory.

Children know intuitively, on a body and soul level, when their mother starts dissolving away in alcohol. This is particularly true with extra sensitive kids, even when it is just a few drinks. They are hyperaware of the subtle changes that their mothers experience with even just one drink. This becomes problematic if they have no language for what they are perceiving; or if they do give voice to what they feel and the mother invalidates it.

We are as sick as our secrets, whether they are secrets we live alone with, secrets we are engaging in “socially,” or whether we are aware of them or not, the secrets we keep from ourselves. When we are mothers, this gets passed onto those dependent on us. The good news is so does our recovery, our wellness, and our abundant living.

Efforts to Combat Prescription Opioid Abuse

Prescription opioid abuse is now epidemic in our country. The statistics regarding addiction and death are staggering.

The rate of death due to overdose of prescription opioids more than quadrupled between 1999 and 2010. This far exceeds the combined death toll from cocaine and heroin overdoses. In 2010 alone, prescription opioids were involved in 16,651 overdose deaths, whereas heroin was implicated in 3036. A full 82% of the deaths due to prescription opioids and 92% of those due to heroin were classified as unintentional.

Rates of emergency department visits and substance abuse treatment admissions related to prescription opioids have also escalated dramatically. In 2007, prescription-opioid abuse cost insurers an estimated $72.5 billion – a substantial increase over previous years. Although these costs are similar to those associated with diseases such as asthma and HIV infection, a dramatically lower amount of health care dollars are spent to treat substance use disorders.

Responding to the prescription pill addiction epidemic, The Department of Health and Human Services (HHS) is implementing a widespread effort to address the key risks involved in prescription drug abuse, particularly opioid-related overdoses and deaths. This focuses on four main objectives: providing prescribers with the knowledge to improve their prescribing decisions and the ability to identify patients’ problems related to opioid abuse, reducing inappropriate access to opioids, increasing access to effective overdose treatment, and providing substance abuse treatment to persons addicted to opioids.

Basically, these objectives could be reduced to two words: knowledge and treatment. Physicians need increased education about opioids and heightened awareness about addiction. Prescriptions are written too flagrantly, far too often and with too little information about the patient’s substance use history. These dangerous and addictive drugs are simply too easy to obtain today.

For those with opioid addiction, we need a greater availability of treatment using evidence based therapies, including medication-assisted therapies (MATs) such as naltrexone and buprenorhine. When prescribed and monitored properly, MATs are safe, cost-effective, reduce risk of overdose and generally help patients recover. Yet, these drugs are underutilized due to barriers such as insurance coverage, too few qualified prescribers and negative attitudes and misunderstandings about medications among treatment professionals, recovering people, and lay people alike. Too many people continue to erroneously believe that MATs replace one addiction with another.

So, we return to the need for increased education. If physicians and the public alike had an improved understanding of substance use disorder, especially in the area of opiate addiction, patients would be helped rather than shamed. In place of lives continuing to be wrecked and lost by this disease (both addicts and their loved ones), we may see scores more added to the ranks of those who are saved, recovered and restored to health.

A Jumbo Mistake

Numbers are the bane of many women. Often, this negativity involves the numbers found on a scale, but also extends to the sizes of clothes. How many girls and women have I seen in treatment who would literally starve themselves to death if only they could be a size 00?

Therefore, I generally applaud attempts by manufacturers to defuse the size issue, but not here.

Recently, a Japanese clothing company (interestingly called FATYO) unveiled a new wardrobe line with not a single number; however, the “new” approach was obviously not designed to promote anyone’s self-esteem. A shopper might ask for a shirt or pair of pants in a “titch, skinny, fat, or jumbo.” I suppose it is possible that whoever was hired for translation purposes may have had it in for the company!

Really…jumbo?

It remains to be seen how well FATYO will fare in the marketplace, but I’m thinking the outcome will be poor in the U.S. It is regrettable that in their noble effort to get away from numbers, this company went the wrong way altogether with their language.

Wouldn’t it be nice if someone came out with a line of clothing — jeans or otherwise — whose sizes were: gorgeous, awesome, beautiful, and extra beautiful? Now that would be a store I would shop at!

An interesting side note to this story is what lawmakers in Japan have implemented regarding size. In 2009, the government set maximum waistline sizes for citizens over 40, they were: 33.5 inches for men and 35.4 inches for women. In order to receive Japanese health coverage, employees must get their waistlines checked annually; if deemed overweight, they are sent to health counseling.

This brings weight stigma to a whole new level. What about the concept of size diversity? What about the concept of health at every size? What about using more accurate markers of health than waist size, such as blood pressure, blood sugar levels, cholesterol levels? All of which are much better predictors of health risk than waist size.  And, what about the relevance of exercise to health?

 

To Med or Not to Med…That is the Question

According to the World Health Organization, depression is on the rise and is expected to be one of the biggest health problems we face by the year 2020. Millions of people take antidepressants every day; a significant number of them are women. We know that depression is far more common in women than in men and that the highest prevalence occurs during child bearing ages (mid-twenties to mid-forties). And, depression doesn’t disappear when a woman becomes pregnant. It is estimated that between 10% and 25% of pregnant women suffer with major depression.

So, while many commonly used antidepressants have been shown to be safe during pregnancy, countless numbers of women are plagued by the decision of whether to continue to take medication during their pregnancy, or stop. Nearly every woman is committed to do everything in her power to nurture and protect the baby growing in her womb. Frequently, those women who don’t or can’t have a serious mental illness, physical illness or addiction that interferes with their ability to care for themselves.

Far too often, women with depression or anxiety decide to discontinue their medications during pregnancy, and they base this decision on myth, fear, stigma and shame rather than scientific evidence of the actual risks and benefits of being on antidepressants during pregnancy.

It is important to remember that most women take these medications for a reason, often because depression has profoundly and quite negatively impacted their lives. Many women and healthcare practitioners fail to take into account the risks for a woman and her baby when stopping her antidepressant. Most healthcare providers are quick to relay the risks of staying on antidepressants, the biggest of which substantiated by the scientific literature, is neonatal withdrawal syndrome, which lasts two to three days after birth and is characterized by irritability and poor feeding. The scientific literature is largely mixed about other hazards of being on antidepressants while pregnant, but the largest study in 2013 showed no increased risk of malformations, miscarriage, stillbirth or pulmonary hypertension in the newborn.

What people spend far less time thinking about and talking about are the risks of untreated depression during pregnancy. Discontinuing antidepressants can have harmful consequences to the mother and her baby, which include:

  • increased use of cigarettes, alcohol or other substances
  • deteriorating social function, emotional withdrawal, worry related to pregnancy and excessive concern about their future ability to parent
  • impaired ability to attend regular obstetric visits and comply with prenatal advice;
  • malnutrition which can lead to low birth weight
  • increase in risky behavior and impaired capacity to avoid dangerous behavior
  • heightened risk of self-injurious, psychotic, impulsive, and harmful behaviors
  • increased risk of postpartum depression or PPD
  • difficulty carrying out maternal duties and bonding with their children

Whether to continue taking any medication during pregnancy comes down to individual choice. But, far better it be an informed, evidence-based decision, than one based on societal pressure, shame or fear. The risks and benefits will depend on the person, her history of depression, severity of depression, length of time on and response to antidepressants, and whether or not non-pharmacologic therapies have been effective in treating her depression. Whatever you decide, it is important to remain connected to people who can help you, support you and recognize signs of depression interfering with your abundant life.

 

Recovery Nugget

Last week, I shared about my experience at the university eating disorders awareness walk. I left all of you with a little cliff hanger. A few have emailed or texted me asking me to spill the beans – to which I responded, “You will just have to wait for next week’s blog!”

So here it is. The best thing I shared about my experience, strength and hope in recovery at that walk, probably the coolest thing that has ever happened to me, and something I was pretty sure would never, ever happen in my life, has been added to the long list of abundant gifts from God in recovery.

About three months ago, after a very short time of trying, I found out that my husband and I are with child!

There are many reasons why I told myself that would/could never happen to me. These reasons, all products of “disease thinking,” included: I was sick for too long and messed up my body; I pissed away my 20s; I’m somehow subhuman and don’t have the same rights and privileges as all parents my age in the world; I’m too old; I can’t possibly deserve this gift … and life is already too good, way better than I ever imagined possible.

Here is an absolute truth about disease thinking: it only produces lies.

I have always been in awe of the power of our bodies to heal themselves. And now, I’m especially in awe of the power of my body to support, nurture and nourish a growing baby boy.

I have heard his heart beat on several occasions…from within my body…just wild! I have seen ultrasound pictures, both of which brought tears of real joy to my eyes, with my husband, David, by my side, holding my hand, tearing up as well.

David thinks our baby is the luckiest creature in the whole world, having the time of his life. “He gets to spend his days with you, he gets to eat well, meditate with you, go to recovery meetings and learn the value of living a spiritual life. He gets to go to work with you and help women save their lives, drive with you as you go from full-time doctor at TK to amazing wife and mom at home. He gets to eat yummy late-night snacks, and on top of it all, he gets to do his own form of fitness every day, all day (he was quite active last time in the ultrasound!). He gets to have you as his home right now and his mom for the rest of his life.”

Does it get any better, more abundant than this? This I would not want to miss out on. This would not be possible in a life of drinking, restricting, bingeing and purging.

 

 

 

Reflections on College

BUWALKphoto

This past weekend I was blessed with the opportunity to represent TK at the first New England University Eating Disorders Awareness walk at Boston University. And to boot, I had the gift of bringing my step son along. Some of you have seen him with me at the Chicago NEDA walks…never too early to get them involved in the cause!

The Boston event was profound for a number of reasons. The three other speakers were inspiring and wonderful company to be among. Doris Meltzer and her husband spoke about their daughter who died of bulimia at the age of 19. Their message is always heartfelt and an incredibly powerful reminder that eating disorders kill — and that the need for expert care, and adequate amounts of care, are critical, both for sufferers and their families.

College is a time that most people associate with freedom, independence, socializing, “partying” and maybe even a little bit of learning. I had such aspirations when I set off to attend the University of Chicago.

But my bulimia started my freshman year in college, and sadly, my whole college experience was affected by this terrible illness. I maintained all A’s, competed as a college athlete on the softball and basketball teams, and even  got accepted into one of eight  spots in medical school offered each year through the early acceptance program.

My bulimia was a deep, dark, terrible secret. The few attempts I made at student counseling to get help for it were futile. “It’s not that bad, yet.” Or, “We can’t really help you with that, since you get six visits and that’s all.”

Not until my third year of medical school did I finally find a treatment team who knew how to help me (not only with my anorexia and bulimia, but the alcoholism, trauma, depression and anxiety that went along with it). By the time I found this help, I had resigned myself to dying of my bulimia, fairly certain that I was a lost cause and beyond help.

Now fast forward 14 years into the future. I’m standing on a stage at BU, first and foremost as a woman recovered from her eating disorder, speaking to college students, advocates and professionals about hope and recovery. Also, I am standing up there as a wife, married to the love of my life, step-mom (or step-monster as my kids like to joke), daughter, sister, friend, doctor, and CEO/Medical Director of the best residential treatment center in the world for women.

If someone would have told me 14 years ago that this day would happen, I would have tried to have them committed!

Unbelievable grace and abundant gifts have come my way in recovery.

Next week, I will blog about the biggest one yet!

 

 

Celebrate International No Diet Day May 6, 2014

International No Diet Day is celebrated each year by those who recognize the absurdity, futility and dangers of diets.

At Timberline Knolls, we applaud those who created this day. Diets exist for one reason and one reason only: to make money. This is a multi-billion dollar industry. Although diets are supposedly equal opportunity in nature, they are definitely targeted toward women and designed to capitalize on female insecurities linked with the culturally held delusion that thin is beautiful, powerful, loveable and ideal.

Diets hurt women because they discover that they can’t starve themselves consistently; they take that to mean that they are lazy, stupid, fat or just plain bad people. Those who diet and actually lose weight may initially feel good, in control, even beautiful. This is a temporary state (real beauty is an INSIDE job!). When they inevitably fall off the wagon and possibly gain more weight from the point that they started, they feel terrible, depressed, and even suicidal.

Diets are usually rife with strict rules, rigid do’s and don’ts, restrictive amounts and types of foods; they are often short lived, and frequently associated with rebound bingeing, weight gain and the development of eating disorders. Conversely, mindful eating teaches people to experience a wide variety of food choices, flexibility in amount and types of food, pleasure in the process of eating, attention to body hunger/satiety cues, freedom from the good/bad food dichotomy, and an absence of morality in attitudes towards eating.

Unfortunately, our culture continues to buy into the false belief that thinness translates into power, beauty and success. What’s more, the body type most women strive to emulate is far from their natural, beautiful, God-given body type.

International No Diet Day is a good start. Let’s work toward a time that we collectively celebrate No Diet Year, hopefully followed in quick succession by No Diets Forever! This “new normal” must be sprinkled with a healthy serving of weight diversity, intuitive eating, and health at every size!