Fat Shaming in its Purest Form

In the past week, an abusive campaign was started–and thankfully stopped–on Facebook as well as Instagram.

Project Harpoon was launched supposedly to put an end to “skinny shaming,” claiming that: ”In current societal fashion, a recent trending surge of ‘pro-obesity’ and ‘fat acceptance’ have paved the way for many people to renounce exercise and personal healthcare in general.”

The alleged goal of this movement was to show people’s “thinner beauty.” Of course, to prove their point, they photo-shopped images of plus-size women to make them look skinnier. As if that was not offensive enough, beneath each post appeared an insulting, mean-spirited caption.

This is nothing but fat shaming in its purest form.

The irony is that the campaign itself was launched on the premise that size shaming, regardless of which end of the spectrum, is damaging and hostile to the parties who are targeted. And yet they engage in fat shaming and size shaming in their campaign against it for “skinny” people.

Fat shaming is real and extremely prevalent. Whether it’s celebrities on the red carpet who have not gotten rid of their baby weight fast enough, or young girls in high school who do not weigh 100 pounds, people, females primarily, are stigmatized, criticized and bullied every single day throughout our country due to their size.

Skinny shaming, on the other hand, if it does exist, exists as an extreme exception to the rule and on a small, skinny if you will, scale (pun intended). Skinny IS the ideal. It is what our culture pressures all women to be. It is what our society indicates is the answer to all issues. Want to be popular? Lose weight. Want to attract a husband, be successful at work, and be happy all the time? Wear a size zero. Want to be good? Go on a diet.

People are no more shamed for being skinny than for being wealthy. How many people are made fun of because they drive a top-of-the-line car, or wear a $5,000 watch? It just doesn’t happen.

In this project’s artificial zeal to encourage “skinny acceptance” through their campaign, they said: ”No shaming please. No hate speech please.”

The truth is if they had read their own words, Project Harpoon would have gone the way of similar detrimental ideas and never seen the light of day.

 

 

 

Treating Anorexia: Is Cannabis A Cure?

A recent issue of Cosmopolitan magazine included a lengthy article on the use of medical marijuana for those who struggle with anorexia. By and large, the article was positive regarding such usage and it provided several salient and supportive facts. These included such statistics as; medical marijuana is now legal in 23 states as well as the District of Columbia and a record 53 percent of Americans now favor the legalization of marijuana.

Through case examples, the article revealed that cannabis helped reduce anxiety and irrational thinking while facilitating food acceptance and consumption in those who used the drug. In other words, it helped women eat.

Here’s the problem. Anyone who has spent any appreciable time treating women with anorexia knows one simple truth: anorexia is not about eating. If it was, then effective treatment would be as easy as forcing a person to ingest X amount of calories each day. There would be no need to understand the “whys” behind the disorder, what purpose it serves in the individual’s life, how the family is involved, etc.

The truth is, anorexia is a highly complex psychiatric disorder, and as such, certain therapeutic interventions are necessary to help a person truly heal. If we do not examine and alter the underlying emotional and cognitive issues, the person is quite likely to eventually succumb to relapse or develop another self-destructive coping mechanism, very possibly addiction. We know that up to 50 percent of those with eating disorders also have substance use disorders.

Another issue that was frequently alluded to in the article related to perception. Several of those interviewed spoke of their dislike of pharmaceutical medication—they rebelled against taking pills. However, this antipathy did not extend to marijuana. The usual expressions, “it’s from the earth,” and “weed is natural,” were heavily relied on. The problem is, marijuana, even if it comes from the earth, is a drug; and in many markets today, it is not a well-regulated drug.

Are psychotropic drugs often used in the treatment of anorexia? Yes, but every physician knows, when using medications, certain general principles apply, such as choosing the drug that provides the greatest benefit with the least harmful side effects. When used chronically, marijuana has been shown to increase risk of depression; also it is neurotoxic, which means it kills brain cells. This makes it a less than ideal “medicine.”

One of the more disturbing aspects of this article was the reference to marijuana as a “cure” for anorexia; this reference was made by a physician. The only cure for anorexia is recovery. In fact, that is the ultimate goal of treatment. Recovery is synonymous with freedom. Freedom from being bound to a substance or a behavior to make your way through life. Being able to find and remain connected to the wisdom within, the Higher Power within that provides a sustainable power source to live abundantly.

This is true freedom. This is recovery.

Say No to the “J” Word

Ellen Leanse, Apple and Google alum, recently posted a commentary on the word “just.” She illustrated how often, and in what contexts, women utilize and rely on this word. Not only do women use the “J” word far more than men, but by and large, they do so in a deferential or apologetic fashion. “I was just wondering if …” or “I just needed a minute of your time …”

It seems that women still feel the need to continually provide justification for their existence and ask permission for their presence in the world.

I, and many of my female colleagues, found her post to be personally revelatory. Like untold thousands of other women who read the message, we are now monitoring the “the “J” word in our day to day texts, emails and conversations.

Yet, I could not help but take this concept to another level – the world of treatment and recovery.

How many women and girls come to us every single day because they have been told by parents, peers, advertisers, the media, that they are “just” not good enough. They are not pretty enough, smart enough, popular enough, and let us never forget, definitely not skinny enough. Then how many hours, days, even months do we work to convince them that they deserve to take up space in the world, to live BIG, that they are more than good enough, that each one of us has profound value and worth; that each individual is meant to be her unique self, not an “idea” of herself, the female she will finally be once she gets inflated lips, breast implants, and loses enough weight.

I encourage you to read this post, then consider dropping the “J” word from your interactions.

This is one example of a little word with big psychological implications. Be aware of what we say, how we say it and what that says about our sense of self. Make a change and drop the “J “word, or at the very least be conscious about using it. Little steps can and do lead to big changes.

 

My Story is Your Story

Motherhood immediately changed my perception of many previously held beliefs. For example, I quickly learned that sleep has far more value than money, showering every other day is reasonable, and wearing the same outfit two days in a row is more than acceptable.

But, it is in the months following childbirth that profound and life-changing truth is actually revealed, such as the intricate beauty and vastness of love.

Like most women, I have given and received love throughout my life. In recent years, my husband, step-kids and dog have been the primary recipients of my affection. David, William, Suzanna and especially, Lily, have returned that love in their own special ways.

I genuinely thought I had a solid grasp of what love embodied and entailed. Then my son entered my life, ushering in a whole new level and knowledge of love.

Often, Samuel naps on my chest. The simple sound of his breathing, the squishy weight and warmth of his body, the softness of his perfect skin all conspire to catapult my love into the 4th dimension. I feel such an overwhelming and fierce love for him that my heart actually burns. I love this child, not due to anything he has done or ever will do. I love him simply because he is him.

In these moments I often reflect on the love of my parent in Heaven. God loves me as I love my son, probably far more, which is beyond my capacity to fully comprehend. And God does so due to nothing I have done. God’s love is not for sale–it cannot be bought or earned. God loves because that is who God is and that is what God does.

This vast love serves as a message of extraordinary hope to every woman in recovery. I spent years severely abusing my body through alcohol and eating disorder behaviors. I hated my body—the feelings it held and the memories it stored. By any reasonable estimation, the harm I exacted on my physical being should have been profound and permanent. And yet, it is this very same body that offered safety, security and shelter to my son for nine months, and now continues to nourish him long after his birth.

For every woman who is in recovery, or moving toward it, please remember this: my story is your story. Whatever you have done in the past regarding your body, behaviors or choices in NO way defines you today. Those chapters are written, those pages are permanently turned. Our bodies and souls were created with a tremendous capacity to be born anew, to be fully restored to wellness.

In recovery, we are living a whole new chapter, with many more to come. Each of us has the ability to author the remainder of our story with power and positivity. Life can be abundantly good.

Treating Co-occurring Disorders Together: It’s Time for Change

A tragic story was reported in the news earlier this month; it centered on a young man’s effort to obtain treatment for alcoholism and bulimia. After getting bounced around from clinic to clinic in Arizona and California, Brandon Jacques ultimately died of sudden cardiac arrest. He was the victim of negligent treatment and multiple flaws in the health care systems from which he sought help.

These flaws involved clinical ignorance in the area of assessment and treatment of dangerous co-occurring disorders, such as eating disorders along with substance use disorders. Additionally, he was on the receiving end of shockingly unethical admission procedures, rooted far more in making money than helping people.

Although Brandon died four years ago, the story only came to light recently due to the settling of a law suit by his parents. They won a substantial judgment for their son’s wrongful death.

I believe this tragedy underscores the absolute and dire necessity to treat co-occurring disorders simultaneously. We know a strikingly high rate of co-occurrence exists between eating disorders and substance use disorders. Despite this knowledge there is a paucity of training programs to equip clinicians with the tools to identify and treat both. As a result, very few treatment centers offer the expertise required to truly recognize and effectively treat both disorders. Add to this already grim picture the fact that those with anorexia nervosa have the highest premature mortality rate of any mental illness, and of that population, those most at risk of sudden death are those with binge-purge behaviors who also abuse substances, and the stage is set for more tragedies.

Eating disorders and substance abuse are both addictions, and as such, similar therapeutic approaches can be utilized to achieve recovery. Addressing them together not only makes sense, but research studies indicate that this strategy yields better long term outcomes for patients.

Honestly, why would a program help an adolescent beat an addiction to cocaine, only to return home still an anorexic? Why would a facility treat a man with binge eating disorder without addressing his addiction to alcohol? In each of these examples, treatment is simply inadequate.

Even more important than incomplete care is the need to have a treatment team that understands the complex medical, physical, psychological and spiritual issues inherent to each illness as well as the entire package of illnesses. In the case of this 20-year-old man, he died from ramifications of bulimia (low potassium levels and other electrolyte imbalances) while receiving treatment for alcoholism in a substance abuse clinic where the focus was detox. No doubt, those providing “care” were unaware of Brandon’s co-occurring eating disorder, which essentially resulted in his death.

Those with more than one addiction or disorder deserve quality care and thorough treatment, and quite literally, their lives depend on it. It is time for simultaneous treatment of co-occurring eating and substance use disorders to serve as the rule throughout our country, rather than the exception.

 

 

 

Power, Productivity and Pills: A Dangerous Triad

Adderall is the prescription drug that just keeps on giving, regrettably continuing to give treatment centers like Timberline Knolls more profoundly addicted people to treat.

Adderall is an amphetamine. It’s legitimately used to treat narcolepsy and Attention Deficit Hyperactivity Disorder (ADHD). For years, this drug was typically misused by college students to facilitate studying. Then, it moved on to busy moms, who had too much to do, too little time, and existed daily under the unforgiving superwoman myth.

Now, Adderall, and similar stimulant medications, have permeated many areas of the work force.

According to a recent article in the New York Times, stimulant abuse, addiction and overdose is escalating at an alarming rate. A 2013 report by the federal Substance Abuse and Mental Health Services Administration found that emergency room visits related to nonmedical use of prescription stimulants among adults 18 to 34 tripled from 2005 to 2011, to almost 23,000.

Those taking stimulants claim they use them to increase work performance and productivity; many believe these drugs are imperative to succeeding in today’s competitive work force. The thought process goes like this: “If my counterpart is possibly using a stimulant to maximize her productivity, or even just because she actually has ADHD, I better get some for myself to level the playing field.” Obtaining a prescription is as easy as visiting a doctor and reciting a laundry list of ADHD symptoms (easily found on the Internet).

The numbers alone indicate that the ploy works. About 2.6 million American adults received ADHD medication in 2012; this is a rise of 53 percent in only four years. Use among adults 26 to 34 almost doubled. It is unlikely that the prevalence of ADHD legitimately escalated that rapidly in the general population.

The truth is many individuals are addicted to perfectionism, competition and winning in the workplace. They will go to any lengths to get that, including putting their lives at risk. And, they are applauded for doing so. They are viewed as a dedicated, productive and efficient employee.

What employer would NOT love someone who works that hard?

Stimulant abuse can fuel work addiction. Underneath it all is a lie: you are not good enough as you are; you are only worthy if you perform better than anyone else and work at breakneck speed; you only have value if you achieve a certain salary, position or title.

These success imperatives are born of shame and based on lies that someone or society tells you about yourself.

At the end of the day, the question always remains: what is the price of success? If it is jeopardizing a person’s immediate and long-term health, then the price is clearly too high.

The French Government Has Got My Vote

People talk endlessly about fashion models – how they are far too skinny and serve as an unrealistic example of what women should look like, which of course, is all true.

But, now the French government is actually trying to do something about it. They are working to pass legislation that would require models to present a doctor’s certificate indicating that they are at a healthy enough weight to work. This would be predicated on the model’s body mass index, or BMI. All models would have to fall into the normal weight, not the underweight range in order to work.

Evidently, the famous Paris fashion houses are not speaking out one way or another on this proposal. Conversely, the union of modeling agencies is fervently opposed to this law, claiming it is very unfair and inaccurate. This objection may be less about the law and more about the consequences. It seems that anyone employing models without such certificates would be penalized, both financially and potentially with six months in jail.
The government is not confining legislation to the modeling industry. They are also seeking to outlaw Internet sites that promote the practice of anorexia. Additionally, they want to require any computer-generated alteration of photos to be acknowledged. So, if a models waistline is reduced or her legs are lengthened through artificial means, it must be stated.

As far as I am concerned, this pending legislation is overwhelmingly positive on every possible level. Runway models epitomize the “sick” ideal that is also reinforced daily in fashion magazines throughout the United States. The concept that pro eating disorder websites would cease to exist is beyond wonderful. And imagine living in a world where there was real truth in advertising? If a photo was “improved” by someone wielding a mouse, we would know it. The great hope would be that no longer would insecure women and girls look at a model with a 15-inch waistline and wonder why they could not achieve that goal. Even better, now that the proverbial cat was out of the bag, perhaps the advertising industry would stop doing it altogether.

We applaud the positive action taken by the French government; if successful, perhaps American legislators will consider doing likewise. It’s time for all of us to partner together to end the eating disorder epidemic.

Vyvanse: An Inappropriate Medication in the Treatment of BED

In my previous blog, I wrote about Vyvanse, a type of amphetamine, that recently received swift approval from the FDA to treat binge eating disorder (BED).

No doubt, Vyvanse helps people who are accurately diagnosed with attention deficit hyperactivity disorder (ADHD). However, there are other treatments that help with ADHD as well, many of which you hear nothing about because they lack a pharmaceutical company-backed marketing campaign. (CBT is one example).

There are also non-stimulant medications for ADHD, which are utilized when there is a good clinical reason NOT to use a potentially addictive and appetite suppressing medication, such as if someone has a heart rhythm disorder, a substance use disorder or eating disorder. Last time I checked, BED IS an eating disorder.

Most clinically sound treatment approaches for BED, and any eating disorder, have at least some focus on helping the person accept their body’s natural size and shape (rather than struggle endlessly to achieve a societally sanctioned and sick thin ideal).

Another focus of clinically sound eating disorder treatment is helping patients learn to recognize and honor their natural appetites, hunger and satiety cues. Stimulants suppress this aspect of a person’s being. Therefore, such learning is limited for those who take medications like Vyvanse.

With an eating disorder, a person might binge, restrict, or practice other unhealthy food-related behaviors. We know this is not “the” problem, rather it is an overt symptom of the core emotional, spiritual, and physical pain the person is experiencing. Effective treatment necessitates getting to that core and discovering what is actually driving the disorder. Once the origin of the pain is unearthed, it can be addressed in a therapeutic environment.

We want the person to see that her method of hurting and controlling her body was born out of necessity and became an unhealthy strategy to cope with loss, anger, or trauma that once overwhelmed her ability to manage.

Since all eating disorders involve food, we also strive to help sufferers reconnect to their bodies and normalized eating patterns. We want them to understand the positive role food plays in health, enjoyment and functioning, as well as learn to honor satiety and hunger cues. Ultimately, we hope they will accept and value the natural, God-given size and shape of their own bodies.

For any clinician who values such approaches to eating disorder treatment, Vyvanse is an inappropriate medication choice for those who suffer from BED. A drug such as this serves to disconnect a woman from her body by shutting off hunger cues, which will result in weight loss.

Unfortunately, the trauma associated with a rape, the rejection she experienced from her mother, the spiritual chasm that developed because God seemingly let her down when she needed Him most—whatever emotional turmoil she has been living with is still there. It does not miraculously disappear with appetite suppression or weight loss.

Treating an obese person who struggles with BED with Vyvanse is not much different than considering weight restoration from tube feeding for a person with anorexia. A weight-related goal will be achieved. However, once the medication is curtailed, or the feeding tube is removed, the eating disorder will return. Or, she will substitute it with another equally harmful coping technique, such as chemical addiction or self-harm.

She will do this because she remains a wounded and hurting individual—a woman still in need of healing.

Those who promote market or prescribe Vyvanse to treat BED without highlighting the aforementioned risks are doing the public, and especially those with BED, an extreme disservice. For some, the return is at best temporary, and in the worst scenario, deadly.

The Perils of Consumer-Directed Medication Marketing

How often does it come to our attention that things are not exactly what they seem?

Let’s consider the recent launching of a nationwide media campaign to shed light on binge eating disorder (BED). Using well-known and probably well paid spokespeople, such as international tennis star Monica Seles, these public service advertisements are supposedly designed to increase awareness of BED, provide much needed education and help people get the treatment they require.

An informative website has even been established to assist in this effort. Keeping in mind that BED is the fastest growing eating disorder in the United States today, how could this campaign be anything but very positive?

Now, let’s consider the recent and very rapid approval of lisdexamfetamine dimesylate, which goes under the brand name of Vyvanse, to treat BED by the United States Food and Drug Administration (FDA). It is important to note that this drug, a product of Shire, is not new. Historically, it has been used to treat attention deficit hyperactivity disorder (ADHD). In this capacity, it has proved highly lucrative. In 2014 alone, sales of Vyvanse reached 1.5 billion dollars.

Another interesting occurrence is that within days of approval, Monica Seles began visiting medical centers and patient advocacy groups. Allegedly this was to increase awareness of the condition, but in all likelihood based on who is paying her, it was to strongly promote using Vyvanse in the treatment of BED.

Now, let’s look at the relationship between the media campaign and the drug approval. Not only is Shire paying Monica Seles, and other celebrities, but by and large, they are funding the campaign. They are even donating money to popular non-profit eating disorder organizations to get them to jump on the drug bandwagon. The mission of these organizations is to increase awareness and prevention of eating disorders, NOT to promote Shire’s pharmaceutical products.

This is a calculated strategy that the drug company has used in the past, namely with ADHD. First the drug manufacturer embarked on a campaign designed to “help” people who struggled with ADHD by creating awareness, de-stigmatizing the illness and assisting them to get the medication they needed.

Isn’t it intriguing that the medication they would seek and ultimately receive was either Vyvanse or Adderall, a pharmaceutical drug produced by Shire? And what a success this strategy has proven to be. Sales of Adderall remain in the billions.

Shire has been cited and fined by federal officials for inappropriately marketing their products; clearly this hasn’t slowed them down in the least, since this is the strategy currently being used to market Vyvanse. The steps are as follows: awareness of the disorder is created through a widespread media campaign, the drug achieves approval, a consumer direct marketing campaign is launched, and people flock to doctors for a prescription. Additional sales of Vyvanse are expected to reach between 200 and 300 million dollars.

But here is the problem: all obese people do not struggle with BED. In fact, of those who are seeking treatment for obesity, only 7 to 10% meet the clinical criteria for BED. But now, due to the “helpful” website, it is likely that more obese people will get the prescription. This is because they know what to say to receive an appetite-suppressing medication (phen-phen anyone?) Included on the site are the correct questions to ask, and symptoms to discuss, in order to garner the diagnosis of BED. In the time it takes to reach for a prescription pad, the deal is sealed and Vyvanse is on board.

The truth is, drug seeking is not confined to pain killers, benzodiazepines such as Xanax and Ativan, and opiates. Imagine the hardship of being an obese person today, with all the struggles and abuses that go along with living in our culture, which is sick with the thin ideal: health problems, employment discrimination, and societal intolerance. Many frustrated obese people have tried every possible weight loss focused therapies and diet plans without success.

But now, here is this drug, being touted as the first of its kind ever to treat BED. Of course, the reality is that similar to Adderall, phen-phen, and even cocaine, it is actually an appetite suppressant.

This legitimate pharmaceutical will undoubtedly be supported by physicians with little to no eating disorder or addiction training, and little to no success helping obese patients lose weight.

Vyvanse can help people achieve that desired, albeit short-sighted and often unhealthy, treatment outcome. What treatment-seeking obese person would “not” want it? The desire is completely understandable.

What they don’t know is that Vyvanse won’t help them with the emotional and spiritual underpinnings of their eating disorder. And what they probably will not be told by their physician is that it is a stimulant, which carries a significant abuse potential.

The story is not a new one. The drug is taken, it “works,” tolerance and dependence develop, more is taken, and eventually abuse and addiction can result.

Pharmaceuticals can often be a critical component of a treatment plan built to support sustainable recovery. However when drug companies promote products in this fashion, when the exclusive intent is to make huge profits, when the risks and dangers of addictive medications are not communicated, the outcome for patients using the drug can be very poor.

It is no wonder that many Americans hold corporations which operate in this manner in utter contempt. And also why many academic centers, non-profits and treatment centers alike steer clear of receiving monies from big pharmaceutical companies under the auspices of helping to promote disease awareness.

Reject Predictability

The holiday season has come and gone; it does so every year with great predictability. Thanksgiving leads to Christmas, which leads to New Years. It all goes according to plan, and by and large, it is good.

Equally predictable, and far less positive, is what happens the very minute America steps into a new year. With the turn of a single calendar page, we are catapulted back into the world of diet obsession and weight-loss fanaticism. This happens every single year without fail.

Today, stand in line at a grocery store. Magazine headlines announce the latest celebrity fitness or diet craze for 2015. Flip on the television or radio. Every other ad is touting a new weight-loss supplement or ab–toning device; chain fitness centers offer every imaginable deal to get you to purchase an annual membership. The implication is that you clearly lost all control during the holidays, ate everything in sight, and are now shockingly fat. In our culture that immediately translates into failure, weakness and the understanding that you are no longer worthy of love, happiness or success.

The truth is that holiday weight gain is minimal at best.

Research indicates that people gain an average of one or two pounds during this season. And yet, year after year, absurd numbers of people buy into this post-holiday hysteria and willingly throw more money at the diet and weight-loss industry. They buy the supplement or ab gizmo; they purchase the gym membership. In time, the supplement fails, the gizmo gathers dust and the membership only depletes the bank account month after month. It is time for this cycle of predictability to stop.

Instead of allowing the multi-billion dollar diet industry to continually lead us around by the collective nose, how about we react to their tactics in a whole new way? Instead of embarking on this New Year ensconced in guilt, shame and a negative body image, why not look forward to what 2015 might contain?

This new set of 12 months could offer a variety of new experiences and adventures, personal growth, and even new people to know and love. Be unpredictable. Be joyful. Be you!

By not responding to the diet industry in the expected fashion, maybe the advent of a new year will prove a little less predictable and a lot more positive.