Letter to my Fat Son

In What I’d Say to My Fat Son, Joshua Max writes movingly about his experience as a fat kid.

He began as a chubby kid with a belly who didn’t hate himself or his body, and grew into a bulimic teenager and adult--a man who may have been of normal weight, but who was filled with shame and body hatred.

It took years--plus $5,000 worth of dental work to fix teeth damaged by stomach acid from repeated regurgitation--but Max has come to a place of peace and body acceptance. What helps him? Making peace with his body and with other people. Surrounding himself with supportive friends. Focusing on small ways to help others when he starts to feel badly about his appearance.

Max’s plan for his potential future son: encourage him to be active, teach him about healthy eating, and help him not to focus too much on his weight. Finally, Max hopes to help his son avoid making value judgments about weight. “If someone hurts his feelings about his size,” writes Max, “we’ll talk about how people are uncomfortable with fat people because they see them as lazy, stupid, incompetent and ugly, but that fat people are none of those things inherently and some skinny people are also those things.” These are wise words from which we all could learn.

Boys' Body Image Worries

Eating disorders are usually considered the realm of women and girls. Boys, however, make up a growing share of those with body image concerns and eating disorders.

A recent study of adolescent boys, described at The Atlantic, concludes that boys, in contrast to girls, are usually less worried about thinness and are more worried about being muscular, leading them to fell pressure to gain weight.

Boys are increasingly susceptible to media images of men’s bodies. Like girls, they increasingly seek to emulate unachievable body types; but instead of trying to look like a supermodel, they’re trying to look like a superhero. Their ideal is to be like the Batman or Superman toy from their childhood, but only 1 or 2 percent of men naturally have the body type that is typically represented in action figures, according to Raymond Lemberg, a psychologist specializing in male eating disorders.

So rather than focus on thinness, boys are more likely to try to bulk up with steroids and protein powders, and through overexercise. But just as parents and professionals should be on the alert for signs of eating disorders among girls, they need to do the same with boys—looking for overconcern about weight and shape, as well as high-risk behaviors such as using steroids.

This development among males is disappointing. When people hope for equality of the sexes, I don’t think that the phenomenon of boys and men grappling with unrealistic body image standards is what they have in mind. 

What You Lose When You're a Perfectionist

When people think about perfectionism, they usually do so in relation to psychology; they look at it as a personality trait and see it as a reflection of someone’s character. In contrast, “The Agony of Perfectionism,” an article recently posted on TheAtlantic.com, explores perfectionism through the lens of economics. But despite the different approach, the economic takeaways arrive at the same conclusions as the psychological ones.

Economists once believed in the existence of the rational consumer. In theory, when a person had to make a purchasing decision, he or she would collect all available information about that potential purchase, weigh all the options, and in the end make a reasoned, well-informed choice about what to buy.

Anyone who has tried to buy a camera on Amazon or book a hotel on TripAdvisor, however, knows this is not possible. You face a vast number of choices and a wide range of passionate opinions. At a certain point you have to cut off your research and make a decision.

So some economists have divided consumers into two groups. One comprises people who strive to make their decisions in a rational way, seeking out as much information as they can get before they make their pick. These folks, called “maximizers,” want to examine all possible choices and to feel that they have made the best choice. Maximizers, in other words, are economic perfectionists. In contrast, the other group of consumers, called “satisficers,” aren’t perfectionists; they tend to settle for something they consider “good enough.”

So who’s happier with their purchase? The people who exhaustively research their purchases to find the best possible choice? Or the ones who put much less thought before they pull the trigger and buy? The satisficers, oddly enough. Despite all their research, maximizers are more likely to be filled with regret. Because the amount of information they can collect is limitless, they are always left wondering whether they made a mistake by not looking for more information, or by paying attention to the wrong information. There is always room for them to wonder whether they could have made a better choice.

Maximizers are also more susceptible to looking at others’ Facebook and Instagram posts and feeling badly about themselves and their choices. In the past, you were limited by your imagination in thinking that others were doing all sorts of cool stuff that you weren’t doing. Now, however, you can see actual photos of what they’re up to. You can Google them, easily learn about their achievements, and fuel your dissatisfaction and feeling of not measuring up.

In summarizing the research, the author makes the sad point that the maximizers/perfectionists work harder and perform better, but are also more likely to feel depressed and regretful. Whether you look at them from the psychological or economic point of view, the article encapsulates the challenge of striving to achieve and make good choices without pushing yourself to the point of dissatisfaction with all your choices.

My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind

After reading this excerpt in The Atlantic, I had to read the book itself. My Age ofAnxiety: Fear, Hope, Dread and the Search for Peace of Mind, by Scott Stossel, is an exhaustive look at the author’s experience with debilitating anxiety. He is trying to understand why he is so anxious and also how best to treat it. He has every reason to be anxious: his genes, his parents, and his own temperament. He describes some harrowing early experiences with separation anxiety and the less–than-sensitive ways his parents dealt with it. But in another chapter, he describes how his own kids, despite a much different family environment, exhibit some of the same phobias. So after a thorough examination of the research, he sees his anxious self as a product of both nature and nurture.

The book seems more positive about treatment than the magazine article. Stossel has been treated by a bunch of different therapists and psychiatrists over the years. Some of the therapeutic choices seem questionable. For example, Stossel’s father, when he needed a therapist, started seeing his son’s longtime psychiatrist. (It’s nearly always a bad idea for people that close to one another to be separate clients of the same psychotherapist.) The author is most positive about his current therapist, a psychologist who has tried to help him understand the sources and meaning of his anxiety, to provide him with concrete skills to reduce and cope with his anxiety, and who is supportive of medication.  This doctor also makes a point of helping the author to look at his strengths and what he has overcome, rather than simply focusing on his deficits.

This book is filled with information about anxiety and its sufferers—I did not know that Charles Darwin suffered from so much anxiety or that Matt Lauer was phobic about vomiting. There is also much about the history of anxiety and how our definitions and diagnoses have shifted based on research and medication; some disorders, such as social phobia, were popularized after medications were developed. But the most interesting parts are the author’s descriptions of his own struggles. It was terrifying for him to feel so much fear at such a young age. It’s impressive that he has been able to accomplish so much despite it.

Surviving Anxiety: One Man's Story

This month’s Atlantic Magazine features its editor Scott Stossel’s brave discussion of his longstanding and crippling anxiety. What makes it brave? His willingness to graphically describe some of his most shame-filled moments, such as clogging the toilet (loose bowels being one unfortunate symptom of his anxiety) while at the Kennedy compound in Hyannisport researching a book on Sargent Shriver.  I was feeling his pain as he described the experience and his awkward efforts to deal with it.

Where did all this anxiety come from? The author describes himself as something of a perfect storm for anxiety and depression.  There’s a family history of anxiety on both sides of his family going as far back as great-grandparents --including a set of grandparents who fled the Nazis and hid their Jewishness after they were safely in the United States. More immediately, the author’s mother had a host of her own set of fears and phobias, stemming in part from two miscarriages and other difficulties getting pregnant before he was born. In addition, he had a hard-drinking father with little empathy for his son’s emotions. It’s not difficult to see how both the genetic links and the environmental effects might produce an anxious person.  

He describes a host of treatments beginning at age 10 for medication and 11 for therapy. According to the author, nothing has worked. The article certainly gives you a sense of the great variety of treatments for anxiety and also the complexity of helping someone with such a number of symptoms and issues. His article also has you hoping that there is a less dangerous solution out there for a fear of public speaking than Stossel’s own remedy of Xanax, Inderol and scotch and vodka. One thing that struck me in his treatment descriptions was that his therapists and psychiatrists seemed to be very either/or in their approaches—either therapy or medication—so it didn’t seem that there was too much coordination between them.  It seemed he almost needed to hide one from the other.

On a bright note, this man, despite his severe anxiety, has managed to marry and become the editor of the Atlantic. It’s impressive, given the struggles he describes. He describes himself as a duck: “To some people , I may seem calm. But if you could peer beneath the surface, you would see that I’m like a duck—paddling, paddling, paddling.” How brave to let others see how hard you have to paddle.

Fat Talk and Body Dissatisfaction

Have you ever said, “I really shouldn’t eat that dessert”? Have you ever deflected a compliment about your appearance by saying, “Oh, I’m nowhere near as thin as you”? This casual banter can be more harmful than you think.

That’s the conclusion of arecent paper, “Is Fat Talking a Causal Risk Factor for Body Dissatisfaction?” “Fat talking” is an expression used to describe the very common dialogue among women (and some men) about how their bodies compare to others, why they shouldn’t eat what they’re eating, and how fearful they are of gaining weight. For this article,  the authors looked at 23 years of studies that measured fat talking. They were trying to understand the link between fat talk and body dissatisfaction. Is it that people who are dissatisfied with their bodies are more likely to engage in fat talking? Or does engaging in fat talking increase the risk people will be dissatisfied with their body? In that case, if you decreased fat talking, you could decrease body dissatisfaction--a worthy goal, since body dissatisfaction is linked to problems such as eating disorders and low self-esteem.

So what did the results show? Fat talking was most strongly correlated with body dissatisfaction for adolescents and adults, as opposed to for younger children. There was some indication of a cause-and-effect relationship between fat talking and unhappiness with one’s own appearance--that fat talking precedes changes in body dissatisfaction. In the one study that directly assessed this, exposure to others’ fat talking led to an immediate increase in body dissatisfaction. In other words, the more you do things such as compare your eating and exercise habits to other people and the more you evaluate other people’s appearance, the more likely you are to be unhappy with your own body. Now, people might know this intuitively. But the article is still a good motivator to be mindful about fat talking and to be conscious of its possible impact on yourself and others.

Overweight and Underweight: What they have in Common

When people are obese, they are often told by their doctor to diet and lose weight. But when  treated for an eating disorder--whether it’s binge eating, anorexia or bulimia--patients are told not to diet. What is the overweight person who binge eats supposed to do? Abby Ellin writes about this conundrum and of the effort of professionals to incorporate knowledge about eating disorders into treatment for obesity. 

Whether they are underweight or overweight, both groups tend to go back and forth between severely restricting their food intake and overeating or bingeing. The treatment for binge eating is geared towards avoiding dieting, not focusing on weight, and on regularizing eating in order to break the restriction-binge cycle. At the same time, a common approach to obesity has been the diet--focus on calories, portion sizes, weight loss. This makes for mixed messages  for the overweight person who also binge eats. Recent changes in the upcoming Diagnostic and Statistical Manual of Mental Disorders includes the diagnosis of Binge Eating Disorder and will hopefully allow for more common ground in the treatment of eating disorders and obesity, according to Ellin’s article.

So where is the common ground? For both underweight and overweight people with eating disorders, low self esteem and body dissatisfaction is common. Both place excessive emphasis on appearance and body size, says one expert quoted in the article. Both groups also suffer from weight stigma and bias. Shifting the focus away from weight and dieting is helpful treatment for both groups.  “The focus should be on behaviors, not weight,” said Dianne Neumark-Sztainer in the article. She is a professor in the School of Public Health at the University of Minnesota. “We know from our research that talking about weight and diets is not effective, and for many leads to weight gain over time.” 

On a societal level, it would help to reduce weight stigma and to lessen cultural pressure to be thin. On an individual level, it helps to resist checking the number on the scale and to focus on changing individual behaviors:eating regularly, learning to respond to feelings of hunger and fullness, and coming up with non-food-related strategies to cope with troubling emotions will help.