Athletes and Disordered Eating

Knowing when we have taken a healthy behavior too far can be hard to judge. In the March issue of Runner’s World, Caleb Daniloff writes about how his attention to nutrition, while training for his first marathon, drifted into bad eating habits. Believing that losing weight would help him train better and run faster, he ended up restricting his eating, drastically cutting calories, becoming preoccupied with his weight and body, and avoiding foods that he formerly ate with abandon. He caught himself before developing a full-fledged eating disorder, but the article describes several elite athletes who didn’t.

Disordered eating — that is, eating behavior that doesn’t meet the medical definition of an eating disorder, but can be injurious nonetheless — is widespread. Three-fourths of American women between 25 and 45 display some disordered eating, according to a study cited in Daniloff’s article.

How do you know whether your eating is disordered? The most common sign, according to Leslie Bonci, a nutritionist quoted in the story, is this: “Food choices become about what not to eat.”

The article includes some common food rules people adopt that can signal disordered eating. The magazine’s list of danger signs is directed at athletes, but it’s useful for everyone. Here’s a paraphrase:

1. Eating energy bars as meals rather than eating real foods.
2. Avoiding fat, or carbs, or a particular basic food group.
3. Rigidly scheduling mealtimes rather than eating according to feeling hungry.
4. Logging calories precisely.
5. Avoiding eating with others if it doesn’t fit with your food rules.
6. Skipping fuel on long runs.

When you’ve taken all the pleasure out of food for yourself — when food rules take precedence over friends and family, when it’s all about what you’re taking away from yourself, rather than what you’re giving to yourself — you’ve crossed over from moderation to disordered behavior. Athletes and non-athletes alike would benefit from shifting their focus from food as an obstacle to weight loss to food as a means of fueling and replenishing one’s body.

The Fat Trap

Just in time for New Year’s and New Year’s resolutions, Tara Parker-Pope has written a sobering article about weight and weight loss. In "The Fat Trap," published in the January 1 issue of The New York Times Magazine, she describes research on the difficulty of maintaining weight loss. Some key points: the body can go into “defense” mode to defend a higher weight, which is why lost weight can be so hard to maintain. In addition, weight loss is much more than simply a matter of willpower -- people lose and gain weight differently, based on body type, genetics and biology.

From the viewpoint of an individual wanting to lose weight, the article is discouraging, because it details how much work it takes to maintain significant weight loss (including daily exercise and careful monitoring of diet). The article, however, also strongly makes the case that being overweight or failing to lose weight is not a personal failing, but a result of a complex interplay of factors, some of which are beyond a person’s control. As Parker-Pope writes:

It is true that people who are overweight, including myself, get that way because they eat too many calories relative to what their bodies need. But a number of biological and genetic factors can play a role in determining exactly how much food is too much for any given individual. Clearly, weight loss is an intense struggle, one in which we are not fighting simply hunger or cravings for sweets, but our own bodies.

In my practice, I have found that many of my clients with weight-related issues.have harshly judged themselves for their inability to lose weight, or have been harshly judged by others. We are far too comfortable criticizing others’ weight or making value judgments about it. I hope this article contributes to more acceptance of different weights and sizes.

Can you be too fat to be President?

There’s a new wrinkle in the 2012 presidential race: The idea that you can be too fat to be president.

The issue has gotten a lot of attention in recent weeks alongside discussion that New Jersey governor Chris Christie could be a viable candidate for the Republican presidential nomination. As speculation grows that he could enter the race, pundits are writing about his weight, and asserting that Christie is too fat to be president.

New York Times columnist Frank Bruni did his best Sunday to challenge the weight prejudice directed against Christie (who doesn’t talk about how much he weighs, but has referred to his long-running “struggle” with his weight).

We treat weight as if it is simply a matter of willpower, and equate thinness with virtue and weight with gluttony and slothfulness. Despite all the evidence that weight is much more complex than simple willpower, and is affected by many factors, including genetics, we continue to denigrate the overweight and to value thinness above all else. We act as if being thin is a sign of self-control, and being fat is a sign of no self-discipline. Bruni -- a former food critic for the Times and the author of Born Round, an excellent memoir revolving around eating -- writes that his thinness in college didn’t reflect self-control: “It reflected bulimia and laxatives,” he says.

Ironically, this focus on Christie’s weight occurred during the first Weight Stigma Awareness Week, an effort by the Binge Eating Disorder Association to make people aware of the stigma and discrimination that the overweight face. It’s a reminder of the importance of not making judgments about behavior based on weight.

Therapists in Therapy?

Is being in therapy a mark of personal defect? Or is it an indicator of strength? Dr. Steven Reidbord, a California psychiatrist, explores this question in a recent blog post on Psychologytoday.com. Reidbord describes a patient who asked him whether he had been in therapy himself. Behind that question was the patient’s feeling that if his doctor had been in therapy it would mark him as deficient, since the patient himself felt deficient because he was in therapy with Reidbord.

Many people share this feeling. They believe that they must be defective if they are in treatment and can’t just deal with their problems on their own. If they are coming to therapy twice a week, instead of once, well then they must be twice as defective. I think about it the opposite way. Why struggle alone with something when you can get help with it and possibly master it? Dr. Reidbord writes that chefs go to restaurants where meals are cooked by other chefs. Lawyers often have their own lawyers. What is the problem with shrinks having their own shrinks?

I myself often compare the person who believes it’s better to solve a problem on his or her own to an injured runner who feels a sharp pain in his ankle but believes that no sports medicine specialist can help him. He continues to run or devises his own cure for the injury, figuring out a way to work around the problem. Often, though, he’ll end up re-injuring himself. And when he finally does go to the doctor, the problem is worse. I feel the same way about psychological pain that I do about a sports injury: Rather than suffer alone, I think it’s better to seek help in reducing pain and suffering. And it makes sense to me that a psychotherapist who feels that therapy helps his patients would recognize its value in his own life.

I found Dr. Reidbord’s words refreshing as he tries to destigmatize therapy and mental illness. Does acknowledging that there is a behavior or emotion that is troubling you and that you need help managing mean you’re defective? Hardly. It means you’re human.

Roots of Depression

If you’re looking for the roots of depression, you may have to look further back in the past than you might think.

That’s an interesting takeaway from a recent study of 100 people who experienced depressive episodes as adults. As reported in The Atlantic, researchers found among those adults, people who had undergone trauma early in their lives were less resilient than people who had not. The people who had suffered early trauma (such as the loss of a parent) were more vulnerable to depression following later events involving interpersonal loss. And when they fell into depression as an adults, those episodes tended to be triggered by events that were less severe than those inducing depression in adults who hadn’t been hit by trauma in their youth.

The Atlantic reported these results as if one should be surprised that people’s lives as adults are affected by their early experiences. But in fact, researchers and practicing psychologists have long known about the importance of a person’s early experience in understanding their adult emotional life. Putting it bluntly, you don’t have to be Sigmund Freud to figure out that our childhood leaves an imprint on how we behave when we’re grown up. When people experience loss as children, the experience is often overwhelming; they commonly haven’t yet developed the emotional strength to overcome it. When another crisis comes along years later, it can be like having a new wound before the old one has entirely healed; people are more vulnerable to the next injury. Moreover, they may rely on whatever imperfect or faulty coping mechanisms they used as children -- behaviors that are no more effective than they were the first time around.

And yet, many people who experienced major emotional setbacks as children berate themselves, if, as adults, they are tipped into a depressive episode by a minor problem. They blame themselves for their emotional weakness. Their difficulties can be exacerbated by psychotherapists who minimize the significance of their past; while some psychologists (myself included) consider the past to be an important element (but by no means the only factor) in understanding people’s present behavior, others see little value in exploring the past. Perhaps more research like this will increase awareness about the past’s importance, enabling people to use it to address present-day issues more effectively.

Craving Fatty Foods

A recent study at the University of California, Irvine may shed light on how deeply humans are attached to fatty foods.

In the study, reports The New York Times, rats that were given diets high in fat had an immediate reaction in their gut: They began producing chemicals similar to those produced by marijuana use, creating for the rats a further craving for additional fatty foods. When the rats were injected with a drug that blocked absorption of the marijuana-related chemicals, however, the animals lost their interest in fatty foods.

The experiment — which also found that rats didn’t have such a chemically triggered craving for sugar or protein — suggests that people, too, have a strong biological attraction to fatty foods. A similar chemical reaction in humans may affect how easily we can moderate our desire for, and consumption of, fatty foods.

We don’t know whether humans have exactly the same reaction to fat, but the experiment does encourage thinking about how people may be susceptible to eating certain kinds of food and why they might feel deprived by giving it up. The experiment also makes one wonder about the degree to which people might have different biologically based cravings for fatty foods. It’s very easy to judge other people on the basis of willpower, telling yourself that you can restrain your eating, so why can’t they? It’s equally easy to beat yourself up for finding it hard to change eating habits. Perhaps further research along the lines of this experiment will encourage a little less judgment of people’s character based on their weight and their eating habits.

Learning about Suicide Prevention

When a person commits suicide, it’s common for loved ones to be left feeling a mixture of bewilderment and guilt. Why had she lost all hope? they ask. How come I wasn't able to stop her? What did I do wrong?

These are the questions that Jill Bialosky asks in her new memoir, History of a Suicide. The suicide at the heart of the book is that of her younger sister Kim, who took her life two decades ago at the age of 21. Bialosky, a poet and writer, embarks on a quest to investigate what led her sister to kill herself, and to understand how Kim, as she puts it “had arrived at the moment of resignation.” Jill also wants to alleviate some of her own guilt about not having been able to prevent it. It’s a very moving story.

The sisters, who grew up in the prosperous Cleveland suburb of Shaker Heights, had a painful childhood. Jill’s father died when she was three years old, leaving her mother, who herself suffered chronic depression, to raise her three daughters alone. Remarrying some years later, Jill’s mother gave birth to Kim when Jill was 10. But Kim’s father soon abandoned the family, leaving his wife for another woman.

Over the following years, the girls’ mother struggled to support the family through a series of low-paying jobs. Kim’s father reappeared only sporadically in his daughter’s life. And when he did, he could be cruel to Kim, telling her that she would never amount to anything in life.

In hindsight, Jill sees several points where it was clear that Kim was suffering deeply. One was when Kim, desperately unhappy and homesick at sleepaway camp one summer, ran away from camp and found a house where she called her mother and begged her to pick her up. Another pivotal moment when Kim, during her senior year in high school, had an abortion and soon afterward left school to get a GED. It’s hard not to read about these events without wondering about missed opportunities to help her.

Through her research about her sister’s life, through participating in a group for suicide survivors, and with the help of Edwin Schneidman, a psychologist who specializes in the study of suicide, Jill comes to accept that there was little she could have done to save Kim, who the family knew was depressed, but had no indication was suicidal. Her father’s abandonment, Schneidman says, left a wound and fragility in Kim that neither Jill nor others could heal.

That conclusion shouldn’t be interpreted as saying there is nothing one can do if, unlike the case with Kim, one is aware that a person is suicidal. As Bialosky points out in her book, people who feel like killing themselves may feel that way for only a short period of time. In her book, she questions Dr. Schneidman:

“Do you think she could have gotten through it had she gotten past that moment when she wanted to die and had felt hopeless? If she had maybe found a passion, finished school? If she had gone into therapy?” Those were the questions that had been eating away at me. “A lot of things had to happen,” he said. “But I wouldn’t be doing the work I do if I didn’t think it were possible.”“What should you do if you fear someone is suicidal?” I said.
“Dare to ask,”he said.

That, perhaps, is the book’s most important lesson.