Thursday, November 24, 2011

Hunger, Eating Disorders, and Family Ties

When I began reading Hungry, A Mother and Daughter Fight Anorexia by Sheila and Lisa Himmel, the complexity of eating disorders really began to sink in. Food-related addictions are like any other addiction, except for the fact that is it impossible to avoid coming into contact with the object of the obsession.

Characterized by an obsessive fear of gaining weight and refusal to maintain a healthy body weight due to a distorted self-image, anorexia is all about obsession, and in fact, has a high incidence of comorbidity with obsessive compulsive personality disorder. It also has the highest mortality rate of any psychiatric disorder. According to a study by the National Association of Anorexia Nervosa and Associated Disorders, 5 - 10% of anorexics die within 10 years after contracting the disease; 18-20% of anorexics will be dead after 20 years and only 30 - 40% ever fully recover. The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of ALL causes of death for females 15 - 24 years old. The South Carolina Department of Mental Health shares these staggering statistics. It is estimated that 8 million Americans have an eating disorder - seven million women and one million men. One in 200 American women suffers from anorexia Two to three in 100 American women suffers from bulimia Nearly half of all Americans personally know someone with an eating disorder (Note: One in five Americans suffers from mental illnesses.) An estimated 10 - 15% of people with anorexia or bulimia are males.

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Unhealthy diets and physical inactivity are to blame for hundreds of thousands deaths each year, with approximately 100 million Americans categorized as obese. Still, 8 million people suffering from an eating disorder is a significant number too. Unlike other addictions, recovery from an eating disorder cannot happen in a vacuum. As Sheila points out in the book's introduction, "you can't just say no to food. At work, at home, on the street, America is a twenty-four hour buffet." To make things worse, "society prizes thinness for women" at the same time as it promotes fast convenience foods at every turn. With the growing national angst over obesity, the plot thickens along with the waistlines.

It is this conflict, like the push/pull in a great novel, that makes this nonfiction book so compelling, and so disturbing. Published last August, the account of a young woman's battle with anorexia and bulimia brings to our attention the many conflicting messages that we give and receive in our family relationships. While feeding our children is how we nurture them from the time they are born; as they grow older, we have less and less control over what, when, how, where, and why they eat. Throughout most childhoods, food is alternately used as nourishment, reward, comfort, bribe, love, punishment, and ritual. In Lisa's family, with her mother's job as a food writer and her father's love of gourmet, food was even a bigger part of the conversation. Whether this was a contributing factor, or just a coincidence, it's impossible to know.

As the Himmel's found when they searched for explanations for Lisa's eating disorder, there are certain "causes or triggers" that showed up on almost every list of factors: society's worship of ultra-thinness, anorexic mother or sister, parents highly focused on appearance, trauma, perfectionist personality, genetic predisposition to the disorder. The genetic predisposition is a biggie. According to Wikipedia, inheritance rates range are estimated between 56-84%.

I have had long looks into the kitchens and dining rooms of two of my closest friends, who have alluded to dark periods as young women when they flirted with eating disorders. One of them fought it off with such gusto, she now refuses to impose any limits on junk food in her home. She resented even the attempts of some parents to ban soda machines from her children's school. The other is incapable of shaking the feeling that with one wrong bite, obesity will not be just her own destiny, but her husband and children's as well.

How much of the heritable factor is due to the environment created and maintained by a parent and how much is due to the genes directly inherited from that parent? And does it matter? Just as it is ludicrous to assume that the patient has control over the disorder, it seems equally so to expect the parent with a similar history to be able to change her own skewed perspective.

There are no easy answers. One friend, a pediatrician, scoffs at the idea of tip-toeing around the topic of dieting with overweight teens. At the same time, many girls and women who have fallen prey to an eating disorder, say they can identify the exact phrase that started them down that torturous path.

Beyond exploring just the personal and social roots of Lisa's anorexia, Sheila looks at the historical roots as well. She compares the current views of eating disorders to past views of diseases like cancer, and tuberculosis. The mystery and shame that surrounded these illnesses causes the same sense of self-blame in patients with eating disorders. There is the notion, as with most mental health issues, that "the patients have brought it on themselves," and that they should just "get over it."

The Himmels' memoir is an important and valuable tool for all of us, whether we or someone we love is suffering from an eating disorder... or not. Developing an awareness of our society's tendency towards obsession about food, appearance, and health is a critical step in the journey to regaining moderation and balance in our own lives and the lives of others.

Hunger, Eating Disorders, and Family Ties

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