By Diane R. Girardot, MA, LPC
Let them eat cake! I'm not referring to Marie Antoinette's famous remark as starving peasants demanded sustenance. These four words are the hindsight of a mother devastated by her daughter's eating disorder, permission for adolescents to grow, and a whimsical slogan for eating without shame.
Harriet Brown recalled being jubilant that her sixth grade daughter opting for more healthy eating by giving up cake as suggested by her health teacher in a standard classroom lecture on nutrition. But that new habit was a very bad omen and soon turned deadly. Her joy became a fear for her child's life no parent should have to face.
Brown's book, Brave Girl Eating, chronicles the path the eating disorder took and the impact on the family. Her daughter is a survivor and now a thriving college student worried about her GPA and not her weight.
CHOP Medical Director and Director of Research & Quality, Eating Disorder Services Dr. Rebecka Peebles, shared the podium with Ms. Brown during the recent Renfrew Center Foundation Eating Disordors Conference in Philadelphia. Dr. Peebles cited school health/nutrition classes and BMI screenings can be as influential to eating disorder development as media and on-line social networks. And yes, the message there is an epidemic of obesity is certainly a player and mistakes can be made in diagnosis and treatment because of it.
If one 14-yr-old girl who is 260 pounds loses 40 pounds in three months using diet pills, purging, restriction and excessive exercising, she is congratulated for successfully losing weight. Another girl, same age, height, and loss methodology sheds 40 pounds from her 125 pound starting point and she referred for inpatient treatment.
Both girls have eating disorders. According to Dr. Peebles, it took 16 months to get the first girl screened and treated for an eating disorder after she dropped to 110 pounds. By that time, the child had become so "entrenched that there was an increase risk for complications," she said.
Dr. Peebles added medical and educational professionals have been trained to attack elevated BMI immediately, prompting unnecessary distortions and worry in many cases. "Children have to grow out to grow up." she explained. "It is not normal not to grow."
The urgency for an adolescent to reduce BMI can backfire. The field needs to build in attention to a high BMI child losing weight that includes questions about food intake and purging, exercise, and thoughts about food and self so pediatricians, nutritionists and school personnel can differentiate between normal growth/loss and an eating disorder.
Identifying what is "normal eating" isn't that easy when more than half of people seem to be on diets. Just as many eat mindlessly when they are bored or skip meals periodically. How many people really do follow the "three meals a day and two snack" rubric?
Nutritionist Sondra Kronberg and Dr. Judith Brisman both of Long Island, NY, led a conference session that found clinicians in attendance don't follow the rubric themselves, much less the general public. "Like sex in the 50s, what we eat is not really talked about because of shame," said Kronberg, who is also the founder and nutritional director of the Eating Disorder Treatment Collaborative.
Normal eating can best be described as eating when you are hungry and stopping when you are full, she explained, while being at ease with the social, emotional and physical components of food and eating. Disordered eating disrupts that flow by inserting body image, fear, rituals, and self-abuse taking on a disproportionate role in the person's life.
Relaxed eating satisfies hunger and allows for pleasure without remorse; an extension of self-care and body acceptance.
"It is a playground for eating maturity," Kronberg quipped. No shame necessary.
"If I ate the way I thought I should, I wouldn't have the energy to work," spoke out a woman in the second row. From across the room, another woman gleefully shared she ate leftover "wedding cake for four days" and didn't think twice.
Dr. Brisman, founding director of the Eating Disorder Research Center, who admitted to having a preference for structured eating, agreed in the need to toss food "shame" to the wind.
"We water plants or paint the house and we don't ask if it is good for the plant or if the house needs it," she said. "Why ask if eating is good for us?"