Some of you may have heard about the t- shirt that Urban Outfitters recently pulled from their online catalogue after much hate mail was received. The shirt said 'Eat Less' and was featured on a waif-y model. It is hard to believe that they actually went there! But they did, and while it may have been to generate some publicity (tacky, much?), enough people protested that they thankfully took it off of their website. I also heard that the shirt has been pulled from stores--so hopefully that is true!

A couple of my therapist friends who I got to know while doing some contract work at the Carolina House brought an awesome article to my attention that I just have to share. Below is this article that was published in Durham's Independent Weekly newspaper and written by Rebekah L. Cowell (follow this link to see the article) about some local women who are in recovery and working towards exposing myths about eating disorders that this t-shirt's message was perpetuating.

Amy Lambert used to tell herself what Urban Outfitters is telling millions of other young women: Eat Less.

It wasn't unusual for Lambert, who had an eating disorder for more than eight years, to consume little more than one container of yogurt in a day. Now recovering, Lambert led a protest last week outside of Urban Outfitters at Southpoint mall in Durham.

Last week, Urban Outfitters placed in their online catalogue a gray V-neck T-shirt worn by a rail-like young woman. On the front, in script, the words "Eat Less."

"Urban Outfitters targets a young demographic, and they are reinforcing the idea that eating disorders are a choice, not an illness," she said.

Four other women from a Durham Eating Disorder Support Group joined the peaceful protest, brandishing signs that read, "Messages Can Re-Enforce Deadly Beliefs" and distributing fliers titled "Messages in Media: 'Eat Less' is Humor That's Not Funny."

Mall security shut down the protest 30 minutes later.

"We want to make it a friendly family environment," said Public Safety Officer Sellers, who refused to disclose her first name. "We can't just have people here doing that [protesting and handing out literature]."

Urban Outfitters did not return the Indy's calls or e-mails regarding the ad campaign, but after national outcry the T-shirt was removed from the chain's website, though the shirts that have already been shipped will be in stores. When the Indy visited the store and asked for the T-shirt, it was not on the sales floor. An employee who didn't want to be named called the slogan "harsh."

At least 24 million Americans suffer from eating disorders, which have the highest mortality rate of any mental illness. Twenty percent of people with an eating disorder will die prematurely from complications related to their disease. Telling an individual with an eating disorder to "eat less" aggravates emotional, psychological and physical issues. And for those still stuck in dangerous patterns, it is a message of validation, says Chase Bannister, clinical director for Carolina House.

In fact, the T-shirt has been posted on "pro-anorexia" sites as a source of "thinspiration."

"The banner-statement 'Eat Less' can be a stinging trigger for women and men with anorexia, bulimia or binge-eating disorder," Bannister added, "ultimately providing reinforcement for the distorted belief our patients work so hard to stamp out: 'I will never be okay unless I'm thin.'

The women said by holding the protest, they sought to empower themselves and spread a message of acceptance for a healthy body. Sandy Yarnall had anorexia for more than half of her life. She finally received treatment in 2008. "I struggle every day with wanting to go back to a very unhealthy size, and where I was before recovery, and seeing that message did distress me."

Rebecca Clemins has had an eating disorder for 25 years. "Urban Outfitters put this tee on a waif-like model, which enforces the idea that being waif-like is preferred, and they are encouraging a lifestyle that is killing young women," she said.

"I can't imagine endorsing something that creates so much misery," said Carson Hadley, who developed her eating disorder in eighth grade. She had to drop out of high school during her senior year to get in-patient treatment at Carolina House. "That shirt reminded of what I can't be if I want to live."

I am so proud of the women who participated in this protest, shared their stories, fought to raise awareness and exposed myths about eating disorders. This can certainly be an inspiring act for those with eating disorders who are working towards health to see- that not only is recovery very possible, but that it can also be empowering to take a stand and work towards educating people about the truth about eating disorders.

Athletes and Eating Disorders- Part 2

If you missed part 1 of Athletes and Eating Disorders, you can scroll down a little to read it, or you can click here! I had the honor of interviewing Nancy Matsumoto (co-author of The Parent's Guide to Eating Disorders and a free-lance writer in NYC--follow this link for more on Nancy!), who is working on completing Toolkits for NEDA (National Eating Disorders Association) that are geared towards coaches and trainers. Both disordered eating and eating disorders impact many athletes, and one of the ways to promote health amongst athletes is to educate coaches and trainers, who are in unique positions of influence to point athletes towards the proper treatment and care of their bodies. Nancy, in my previous post, mentioned a phenomenon called the Female Athlete Triad, that I wanted to expand on (courtesy of NEDA).

Below is NEDA's description of this term/phenomenon:

The Female Athlete Triad includes 1) disordered eating, 2) loss of menstrual periods and 3) osteoporosis (loss of calcium resulting in weak bones). The lack of nutrition resulting from disordered eating can cause the loss of several or more consecutive periods. This in turn leads to calcium and bone loss, putting the athlete at greatly increased risk for stress fractures of the bones. Each of these conditions is a medical concern. Together they create serious health risks that may be life-threatening. While any female athlete can develop the triad, adolescent girls are most at risk because of the active biological changes and growth spurts, peer and social pressures, and rapidly changing life circumstances that go along with the teenage years. Males may develop similar syndromes.

The Female Athlete Triad puts female athletes at risk, and also inhibits their athletic performance. I am glad Nancy mentioned this because it is something that not many people know about (even in the field of eating disorders!). Below are the last few questions/answers of my interview with Nancy- I hope that you will find this informative (like I have)!

Me: What are some things that you have been struck by or learned about eating disorders and athletes through this process?

Nancy: One thing I’ve learned about athletics and eating disorders is that for the coach, the line between encouraging athletes to achieve peak performance levels and promoting unhealthy eating and training behaviors is blurred. For this reason, when coaches and trainers, are told they need to be more vigilant in spotting and addressing dangerous behaviors it can sound to them like their ability to do their jobs is being questioned and curtailed. They want to create winning athletes, and the traits that create champions—perfectionism, the desire to please coaches, and strong drive to succeed—are those often associated with eating disorders. They may fear that in order to encourage healthier behaviors among their athletes, they will have to discourage the very traits that make their athletes excel. What we hope the Toolkit will do is show that the better nourished and healthier the athlete is, the better her or his performance will be, and that although eating-disordered behaviors may seem to improve performance in the short run, in the long run they do not support athletic excellence.
Me: For many elite athletes who are competing at world class levels (whether collegiately, professionally, in the Olympics, etc), particularly in sports that may encourage (implicitly or explicitly) a high degree of scrutiny over body composition and weight for performance purposes (gymnastics, ice skating, running, wrestling, etc), eating disorders and disordered eating are increasing. Do you have any thoughts about how we might work towards helping athletes approach their performance and bodies from a more healthy standpoint?

Nancy: Yes, education and support for both athletes and coaches is very important. Some coaches are still not fully aware of the risks for and dangers of eating disorders among their athletes. We hope that once they do understand the facts, they will be open to discussing these risks with the team, stop making negative comments about weight or size, establish a zero tolerance policy for eating disordered behaviors, and foster a climate in which an athlete feels she or he can discuss these issues without fear of reprisal. For athletes, it’s great to have a sports nutritionist speak to the team about the importance of adequate fueling and hydration in their sport, to go over the warning signs for problem eating and exercise behaviors, and to encourage them to seek help at the earliest signs of a problem.

A lot of these strategies are about de-stigmatizing eating disorders, making athletes understand that disordered eating and eating disorders are a common problem among athletes, and that they can and should be discussed. Athletes should also know where there is help available, and that these problems can be solved with the right professional treatment. In many athletic settings, lack of knowledge about eating problems creates a climate of fear among eating-disordered athletes that makes it very difficult for them to admit to this problem. This causes a lot of suffering in silence. All the recovered athletes I spoke to talked about the tremendous stress of having to perform while also sustaining their disorder in secret.

When the Toolkits are completed and available, I will be sure to post a link so that any of you who may be interested in passing this information on to a coach you know, an athlete that you know, or if you are a coach/athlete yourself that desires this information, that you will be able to access it! By raising more awareness and promoting education for coaches and trainers, we can hopefully provide more care and restore health to those who are suffering from eating disorders and disordered eating. For more information on eating disorders, follow this link to access the National Eating Disorders Association site.

Busting an Eating Disorder Myth..

We've all heard the saying "Don't judge a book by it's cover." When it comes to weight and eating disorders, I don't know if we have really operated this way. What I mean by this is represented in a commonly held myth about eating disorders-- which is that you can usually tell when someone has an eating disorder because of their size. Yes, when someone is very underweight, that is typically an obvious indicator that someone is anorexic. However, someone who struggles with either bulimia or an eating disorder not otherwise specified (also known as EDNOS- the third and only other current eating disorder (aside from anorexia and bulimia) recognized in the Diagnostic and Statistical Manual of Mental Disorders) is typically of average weight or overweight. In fact, you might be surprised to learn that you can't tell by looking at someone if they struggle with bulimia or not.

A recent article published on Newsweek.com addressed this myth. The article, entitled Finding A Healthy Medium: Eating Disorders Don't Discriminate Based on Size, by Kate Dailey, is one worth reading. It is so important to be aware of the facts and to know that eating disorders affect people of all shapes and sizes. This article also addresses BED (binge eating disorder). Follow this link to read the article.

Someday Melissa

There has been quite a bit of media coverage over the last two or three days on the story of Melissa Avrin, a 19 year old girl who lost her battle with bulimia last year. (The cause? A heart attack.) Her mother, Judy, was on the Today show last week and there have been a few articles published recently, all aimed at raising awareness about eating disorders, but also honoring and remembering Melissa's life. Judy has become an advocate and will be lobbying tomorrow April 26, and April 27 in Washington DC to support the FREED Act (Federal Response to Eliminate Eating Disorders Act). To find out more about the advocacy work that you can take part in, follow this link which will take you to the Eating Disorders Coalition site.

But back to Melissa's story- I would really, really encourage you to check out this article, which was published in the New York Times on April 21st. Judy has been raising awareness and speaking out about losing her daughter to an eating disorder over the course of this past year and she is also finishing up a documentary on her life (called Someday Melissa), which she is hoping to have completed by June. Sharing Melissa's story may help to dispel myths about bulimia, as well as connect a face and a story with an illness that is so commonly misunderstood. Melissa was young- 19 years old- and did not survive her battle with bulimia. Her eating disorder took her life, and it is a really heartbreaking story. What is so tragic is that she represents so many who struggle; while many do overcome this battle, there are still some who are like Melissa and are losing their fight. The more that we all can do to raise awareness, provide education, and advocate for more accessible treatment is a step towards saving lives.

To view a trailer of Judy's documentary on Melissa's life, follow this link. It is definitely worth checking out. It is a short, five minute video that is really powerful. Judy found Melissa's journal after she passed away, and after reading through it, was inspired to make a movie that would change peoples lives- as that was one of Melissa's goals that she had journaled about wanting to accomplish someday. Judy is using her grief to advocate, raise awareness and instill hope in the lives of others who are struggling with an eating disorder. If you or someone that you know is struggling with an eating disorder, I hope that Melissa's story may inspire you towards health. You are not alone, and it is possible to beat this disorder with the right treatment! To read different stories of hope and freedom from eating disorders, courtesy of the National Association of Eating Disorders (NEDA), follow this link.

When Is It Time To Speak Up?

Nancy Matsumoto (a freelance journalist who has contributed to the New York Times, Newsweek, Time, etc..) and Marcia Herrin (a nutritionist specializing in eating disorders who founded the Dartmouth College Eating Disorders Prevention, Education and Treatment Program), have co-authored a great book called The Parent's Guide to Eating Disorders. They also have a blog called Eating Disorders and Nutritional News. To read a little more about Nancy and Marcia, follow this link! I wanted to share a recent blog post written by Nancy because I think it is a very authentic post that addresses a topic that people often ask and wonder about. The title of the post is 'Knowing When to Express Concern About a Friend's Eating Disorder.' Follow this link to read it, or you can read it below (copy and pasted).

In other fun news, I had the opportunity to ask both Nancy and Marcia some questions recently about some different eating disorder topics which I am excited to share with you soon! :) :) Follow this link to check out their website.

Knowing when to express concern about a friend's eating disorder

A recent experience reminded me that even when we know what the right thing to do is, it’s still hard to know when to do it. Over the course of the past year, I have become friends with a woman, I’ll call her Jane, in my Japanese language class. I recognized the telltale signs of anorexia in her right away: the hollow cheeks, the clothes hanging off her skeletal frame, the way she liked to bring food for others, but didn’t want to eat much herself.

Later, Jane told me that she did not see herself as too thin, she thought she looked normal, maybe even a little bit heavier than she wanted to be. This, too, is a classic symptom of the body dysmorphic disorder that often accompanies anorexia.

I wondered if I should say something, to express concern and find out if Jane was in treatment. Had I been just half as emaciated as Jane was, I would not have been able to think straight; I would have felt dizzy and probably fuzzy-headed from malnourishment. But Jane’s mind was razor sharp. She was an encyclopedia of kanjicharacters, devoured the finer points of grammar that made my eyes glaze over, and read the appendix of our dry text book for fun.

Although she was always the most prepared person in our class, Jane was also always late to class. I thought she had a job that she couldn’t leave early. Later, she told me that she had no job; the digestive problems caused by her anorexia meant that she simply had to wait until she felt well enough to leave her apartment. Often, she didn’t arrive until the last 20 or 30 minutes of our two-hour class.

Then Jane went away to Florida on vacation. It was sunny and warm there, but she returned with a wretched cold and looked thinner than ever. She looked terrible. “Feel my hands,” she told me and another classmate. Even though our classroom was overheated as usual, her hands were icy cold. Suddenly, she had entered crisis mode. Being in Florida surrounded by friends who were healthy, fit, and enjoyed active, outdoor lives had suddenly made her want those things for herself. She looked in the mirror and for a moment saw how different she looked, how starved and unhealthy the woman who stared back at her was. It was a moment of clarity that lasted long enough for Jane to realize she needed help.

For the first time, Jane also opened up to me and a few others in our class about her eating disorder. She was desperately seeking a treatment center, she told me. Even though all the doctors she spoke to felt she should be hospitalized, she hoped to stay at home and find outpatient treatment. I was scared for her life, and I could tell she was, too. I berated myself for not saying anything earlier. Maybe I could have prevented this sudden and horrible downturn. I knew what was happening to her and I didn’t say anything.

I thought that she would think me too pushy, or a know-it-all. I worried that I would be intruding. After Jane spoke openly about her worries, I was able to refer Jane to Marcia, who then recommended a good psychologist in New York for her to see. When I saw Jane at class yesterday, she told me she liked her therapist but was worried that she would not be able to afford many more treatments. She couldn’t afford to spend the $5,000 out-of-pocket minimum her insurance plan required before it would cover 50 percent of the therapist’s bills. Even paying for half of the treatments would be a stretch.

When I asked Jane today whether it would have offended her if I had spoken up, she told me, “I wouldn’t have reacted negatively, because I know what’s going on with me. I’m not sure that I would have done anything about it; you have to be ready.”

The kind of epiphany she had recently, when she recognized what she looked like and how sick she was, Jane told me, has happened before, although it never lasts. “I want to do something, and then I’ll go into hibernation again,” she said. Two weeks ago she had a phone interview with the Renfrew Center in Pennsylvania, but then decided not to go.

Jane said she wanted so much to be healthy and active but added, “I don’t know how to be active, to sleep and to squeeze food in. I can’t eat because it makes me feel bad, and I’m afraid I will get sick. I’m like a child; I want to be taught to eat again.” Then, she added, “I don’t know if I’m going to make it. If this can help someone else, please write about it.”

I asked Marcia if she thought I had done the wrong thing by waiting to voice my concerns to Jane. Marcia responded, “You have to trust your instincts on when to speak up, and it sounds like you did. I have reminded other concerned friends in similar situations that you can trust your instincts if your motives are pure. We all need to remember that we can't force another adult to take action (without taking legal action first). What Jane needs now is encouragement to hang in there long enough to benefit from treatment. Sometimes this is a good time to suggest or lend a book. Maybe Life Without Ed byJenni Schaefer or, Gaining: The Truth About Life After Eating Disorders, byAimee Liu. Good books can lead to good discussions, too. “

As a nutritionist who often sees eating disorders patients who cannot afford professional treatment and/or have difficulties with insurance issues, Marcia told me, “I have lots of thoughts about this.” The first is that Jane’s dilemma is typical of our insurance system, which slaps large deductibles on eating disorders treatment and follows with inadequate reimbursements. The patient goes without treatment and, in the worst cases, ends up hospitalized in an intensive care unit at upwards of $1,000 a day.

Marcia’s second thought was that it is often hard for patients make recovery their number one priority in life; everything else should be secondary. This is not easy in cases where the patient doesn’t have the complete support of loved ones, however.

Jane’s comment about feeling like a child who needs to learn how to eat again, Marcia noted, is a perfect description of what a good nutritionist can help an eating-disordered patient do, and why seeing a nutritionist or dietitian who specializes in eating disorders is so important.

“Another thing that can be inspiring,” Marcia said, “is to help the other person see that her life is important to others—children, spouses, families, friends, even pets, and to you!”

I will tell Jane that she is important to me, and to our class. I hope that if you are concerned about a loved who is in despair over an eating disorder, you will do the same thing.

Take care,

Nancy

Marcia Herrin and Nancy Matsumoto, co-authors, The Parent’s Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com).