Take Care Tuesday – National Eating Disorder Awareness Week

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This week is National Eating Disorder Awareness week. And honestly, that is some serious stuff. Important stuff. Life or death stuff. So this is going to be a serious post, but it is a serious issue. Eating disorders hit mostly teenage to early-twenties girls, but more and more this is a gender-free disease that is ravaging our youth and leaving them with a lifetime of health and mental issues. The reality is this: even as we struggle with increased levels of obesity, anorexia and bulimia and other eating disorders remain a huge and growing problem.

“Eating Disorders Awareness Week is February 23rd through March 1, 2014 and we are asking our supporters to Be a VOICE, not an echo! VOICE your own strengths, talents and standard of beauty, STOP echoing back the mass media’s unrealistic standards. You can help ANAD spread the message of eating disorders awareness!”

I have written before about how I have an ‘unhealthy relationship’ with food and definitely suffer from ‘disordered thinking’ and ‘body image dysmorphia’. But I am an adult, and so have a different outlook and ability to put things in context and perspective.

The purpose of this week is to draw attention to the struggle of those who have eating disorders, with the goal of helping them out – and helping them to GET help. Personally I also want to help people realize that because food is part of life, people with eating disorders have a lifelong struggle – while they might be ‘recovered’ now, the truth of ‘one day at a time’ was never so real.

I have written about this elsewhere in the past, so what I will do is quote myself a bit, and also a few important points elsewhere. I invite everyone to comment and share to keep the conversation going.

A Little Background
Let’s start with some scary stats from ThinkProgress:

According to the National Eating Disorder Association, an estimated 20 million U.S. women and an additional 10 million U.S. men will struggle with a “clinically significant” eating disorder at some point in their life. Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, or what’s defined as an “other specified feeding or eating disorder” (OSFED). Although many Americans incorrectly assume that it’s easy to spot an eating disorder, the people who struggle with this condition can actually come in all types of shapes and sizes, and are typically adept at hiding their symptoms.

They also note how eating disorders is the most fatal mental illess, and that a “2003 study found that people with anorexia are 56 times more likely to take their own lives than people who don’t suffer from an eating disorder.”

The Obsessive Pursuit of ‘Healthy’

We have all seen or heard about someone whose dedication to exercising several hours per day and being very controlled in what they are eating sounds like it has gone a bit too far – when you read what they write or listen to them talk it is a bit scary. Well, over at the Independent they look at how a slanted and absolute view of ‘healthy’ and ‘unhealthy’ can feed into someone who already has an eating or body image disorder:

“There appears to be no concept of moderation – going to the gym is considered ‘healthy’, no matter how obsessive or time-consuming the habit becomes. Eating any type of sugary or fatty food is universally dubbed ‘unhealthy’, no matter how much mental anguish and social exclusion the act of refusing that food might cause.

In school canteens, I now routinely hear teenagers claiming to be ‘allergic’ to wheat, dairy, gluten and sugar, or to be embarking on ‘raw, vegan’ diets they have seen espoused by celebrities in the pages of glossy magazines. “

Because there is such an emphasis on the obesity epidemic, it allows teens to mask obsessive behavior as a healthy pursuit. But make no mistake – there is a line between seeking to push ourselves and hit peak fitness and health … and disordered thinking.

What NOT to Say

Most of us who have experienced tragedy of some type have had people with no idea WHAT to say but a compulsion to say SOMETHING – and not surprisingly in the case of someone with an eating disorder, the things you say to HELP could actually be a trigger that makes things WORSE for the other person.

There are many more, but there are discussions of what NOT to say here, here, here and here, including:

“— DON’T COMMENT ON THE PERSON’S WEIGHT / APPEARANCE. This one should be obvious, but even well intentioned people have a tendency to say things like, “oh, you look so much healthier now!” For a person with an ED, “healthy” can very well mean “fat.” The ED person needs to learn to focus on the much larger world beyond food and weight, and constantly being reminded of zir own appearance is highly detrimental to that. Instead of talking about zir weight, ask the ED person how ze FEELS. “

Pro tip – when you have no idea what to say, try something basic such as “I’m sorry, and have no idea what to say, but I’m here for you”.

The T-Rex Runner

Danielle over at the T-Rex Runner did a very brave thing just over a year ago – she laid our her entire life with eating disorders.

Disclaimer: This is a series of posts about my experiences with anorexia and bulimia. Many of the things I discuss could be extremely triggering if you are dealing with an eating disorder, so please read at your own risk. I am not an doctor or a therapist. I am simply telling you my story.

If you follow her posts, you will know that in recent years she needed stomach surgery due to issues caused from acid erosion from bulimia, has chronic heart issues she’ll never get past that came from her eating disorders, and has terrible back issues that have recently side-lined her from running more than a couple of miles … you guessed it, that stem from her disorder.

She is an incredibly funny and warm and genuine person who has struggled terribly with this disease and at a very young age has chronic and serious health effects that will be with her forever. If we can prevent this from happening to one person it will be a victory.

Pinterest and Instagram Struggle With ‘Thinspo’

Just over a year ago I stumbled upon an article at Buzzfeed that talked about online diet programs that targeted anorexic teens, using popular hashtags and search terms. This is what I wrote at the time:

I didn’t think myself naive when I started my first real engineering job nearly a quarter century ago, yet I was quickly introduced to several new terms by a fellow engineer a couple years older than me. I learned the term ‘MILF’ and the expression ‘mind the gap’ which referred to the space between a woman’s upper thighs indicating she was thin and had proportionally wide hips. Neither or these were particularly respectful terms nor anything I would ever find myself using, but sadly they were two of the kindest expressions that I recall hearing from this engineer (misogynist and sexist don’t begin to cover it). Anyway, that was my context for ‘mind the gap’ …

Over the holiday break I encountered an article talking about difficulties at image sharing sites such as Pinterest dealing with eating disorder relating groups. As someone who lost nearly 100 pounds in the last year the term ‘thinspiration’ sounded great to me … until I saw the images associated with it! The terms ‘Pro Ana’ (for anorexia) were terribly shocking … but nothing in writing prepares you for the ghastly pictures of these young women (because it IS a predominantly female problem) who have starved themselves beyond recognition. Apparently ‘mind the gap’ now involves becoming underweight to the point of maximizing the gap between your thighs regardless of your hips of body type.

It isn’t just Pinterest, they were just the last to adopt new content rules prohibiting Pro Ana groups. Other sites such as Tumblr already have such rules in place, or like Instagram have warnings in place for when you search certain tags.

In the last couple of days the topic has come up again at HelloGiggles and more disturbingly at BuzzFeed. Each points to the rampant increase in the content in spite of the rules from the sites, with HelloGiggles noting:

Instagram, the popular social media photo-sharing app, has recently brought a very serious issue to light. It seems that some people (mostly teenaged females) have been using the photo service to share ideas and images that are pro anorexia. [snip] Once you click “see images”, a sea of images bombards you. Over 306,000 and counting for #Ana alone.

Over at BuzzFeed they look at how weight loss programs and sellers are specifically TARGETING these Pro-Ana keywords on social sites in order to push their goods. Here is some of what they have to say:

Tumblr (and Pinterest) have grappled with how to handle its pro-ana community, and both ban the content, deleting it when it’s brought to their attention. But ads for FatLossFactor.com, a site that sells a weight loss program, continue to be posted by stock accounts against targeted keywords (tags) associated with pro-ana content, like “thinspo” and “starve,” so they appear beside images of extremely thin young women.

Looking at the program (FatLossFactor), BuzzFeed finds that it really doesn’t stand out in too many ways from the other myriad weight loss schemes – they push their service through a variety of advertising methods, bombard social media, and even (like the infamous MyPadMedia) associate positive reviews with web searches for ‘FatLossFactor scam’. The site uses affiliate marketing methods who are incented to drive traffic regardless of the methods.

The other truly disturbing thing is the association of ‘cutting’ with the Pro-Ana groups. It is (unfortunately) not surprising, as both of these things are more related to control than anything else … but it is tremendously sad to think of beautiful young women doing such damage to themselves. Both of my high school aged boys know girls who either had eating disorders or who have engaged in cutting or other self-destructive behavior. It is horrible for them to have watched these friends in such terrible states, and I can only imagine the impact on the girls and their families.

These groups have been around longer than the internet, and those looking for them will eventually find them. But with social media and visual social media in particular, the ability for these ideas and images to propagate quickly is easier than ever. And … more dangerous. If you have kids, even in elementary school, it isn’t too early to start talking to them about body image and reinforcing that beauty comes from within, not according to a scale or (Photoshopped) magazine image. Healthy comes in all shapes and sizes.

It is very interesting what I have seen, read and learned in the meantime. It has helped me understand my own struggles and patterns, and also those in others. It has helped me realize that eating disorders are not some one-dimensional problem, there is no universal solution, and once you start dealing with one you will be struggling in one way or other for the rest of your life.

Food Is Fuel

I was surprised when I started reading in early 2013 just how much of a problem eating disorders are for runners. Of course, we discuss it openly here and many of you have shared your own thoughts and feelings – and struggles – and have just been amazing. And that brought me back to the one contrast with those dealing with drug and alcohol addiction: people with eating disorders need to cope with their problem while simultaneously having to use the object of their difficulty multiple times a day. The reason is simple – food is for fuel and is essential to life.

Here is a bit of what I said at the time, using my own story as fodder:

While HOW I started running – being a 375 pound guy who decided to start running and immediately kept it up 4-5 days a week – is not exactly standard, WHY I did it – to lose weight – is very common. In fact, it was the reason I picked up running again last year after 5 sporadic years. But as I frequently say, this time I went from being someone who ran for weight control to being an actual runner who was always training and pushing to run better, longer and faster. I eat better than ever, run faster and further than ever before, and as a result I am in the best shape of my life. Also, I eat LOADS of food, but I have completely rebalanced what I eat and when.

When your goal is simply weight loss and maintenance, exercise is often a ‘diet augmentation’ – in other words, you are not training, not really seeking to hit any exercise goals unrelated to weight loss, and very often heavy workouts are a part or excuse to a reward system based on … yep, food. And generally our ‘rewards’ are not proper recovery food, but instead ‘junk food’ we feel we have ‘earned’. I know that for many years my running allowed me to eat a pint of ice cream as part of lunch, have a bag of M&Ms in my desk, and so on.

What I never really thought about was the content of my diet – because I never stopped living in ‘weight loss mode’, so food was always both the enemy and the ultimate reward for me. In other words, I never saw food as simply ‘fuel for living’.

I am certainly not alone in that regard, as evidenced by the spiraling obesity statistics in our country. Rather than looking at food as fuel to be eaten in certain amounts at specific times for maximum effect, how do we use food?
– For pleasure
– For comfort
– As a painkiller when we’re sad, depressed, or hurt
– As a social tool
– As a sexual tool/toy
– A reward
– Just something to do when we’re bored
– As Gifts

Food is equated to health, it can become an obsession, and an addiction that can ruin lives. Our economy has many billion-dollar food-related industries that are constantly trying to sell us something quick, easy and highly profitable for the company that is really not great for our bodies. Through the years, it has become harder to know what is REAL and what is a ‘lab recreation’. We hear about how so many ‘multi-grain’ foods are actually highly processed grains reconstituted with added components and nutrients to meet labeling standards. We know that very often the cheapest foods are the least nutritious, as they are filled with chemicals that deliver taste and shelf-life without actually delivering the full nutrition of ‘real’ foods such as natural yogurts or fruit.

My story of learning the importance of ‘food as fuel’ has been told before, but looking back when it was fresh it is more interesting – and more scary! I had no idea what I was doing – and it could have had disastrous results:

It was mid-August 2012, and I was already under 200 lbs, having dropped more than 75 pounds in about four months. I was running 8-10 miles a day 5-6 days per week, most weeks easily exceeding 50 miles per week – and I really didn’t know that was a lot at the time. I had signed up for a half-marathon, but I really had no clue how to prepare my nutrition or anything about ‘tapering’. In fact, all I did the day before was to ‘take it easy’ with a 6 mile run the day before. But I had run 12 miles in a single go before and wasn’t overly worried about the distance – and I knew I would need something during the run, so I had bought a few Gu packets. I had a small breakfast a while before the run, but at that point all I was having was yogurt and fruit.

Boy was I ever in for a surprise! On race day, I forgot my GPS watch so had to go on feel, which I was still developing. As a result I went out fast – WAY too fast. That pace was tough, but I kept it for the first half, and when I came to the turn-around point I had a Gu with water. Yes, water, because I didn’t want all of those extra calories, which was the same reason I only used one Gu packet. Soon enough I felt myself starting to slow down. I didn’t fight it too hard, as I knew I’d gone out too fast.

But later in the race I was getting exhausted, and by mile 11 I was seriously concerned that I couldn’t finish the race. I was afraid that if I stopped to walk I wouldn’t be able to start again, so I kept running. My joke is that I ran a 8 minute mile for the first half and an 11 minute mile for the last half to end up with my 9:24 overall pace. But how I felt crossing the finish line was no joke – I didn’t feel good. I had run out of fuel long before the end of the race, and my body felt like it was tearing itself apart to give me energy to keep going.

It took running a full marathon and another half marathon in the following months for me to understand just HOW BAD I felt, and it was not good. I didn’t want to be touched, had a hard time eating anything, felt muscles tightening, so I didn’t stop wandering around. Of course, I did my best to just shake it all off and get into the car to head home after a short time, my family still concerned at how I was feeling but assuming since it was my fastest pace yet that I was just spent.

Bottom line: I went to run a half-marathon in the midst of a restrictive diet that wasn’t balanced for my running needs, and neglected to remember to fuel up as part of my training plan. I learned a lot that weekend, and put it all into practice in later races and ever since. Now when I eat, I approach it from a totally different perspective: fueling heavily in the morning, sustaining mid-day and using more vegetables in my dinner fare.

I keep coming back to Setting Goals as a cornerstone: as I have said, many people who exercise at a gym or pick up running or go on a diet have a goal of ‘weight loss’, but that is a bit vague, and it results in looking at food as the enemy to be minimized and avoided, rather than as an essential part of the REAL goal which is ‘healthier living’.

The Take-Away

In that half-marathon I just described I learned about ‘food as fuel’, something I knew instinctively but clearly didnt’ understand. But I learned something else – I learned I had an unhealthy relationship with food, that I suffered disordered thinking … and that I would struggle with it forever.

I have also learned that I have a terrible body image, and even this morning I saw myself in the background of a picture my son posted on Tumblr … and was surprised at how thin I looked (naturally I could find ‘fat zones’, but was overall surprised).

At the same time – I am lucky. My issues are self-contained. I don’t feel the pressure to look like someone else, don’t get external pressure from my wife or kids or friends or family to be something I am not. At this point in my life I am fully surrounded by the positivity of unquestioning love and acceptance.

But for millions of young women and men – and very likely at least a few who will read this – it is a different story. For millions, each meal is a struggle every trip in front of the mirror is an ordeal, and every social situation is additionally stressful due to the fear of judgment and feelings of inadequacy.

So this week, reach out to those around you – let them know that they are OK just the way they are, that you love them, and that you are there for them no matter what. As is true for so many things, people with eating disorders need to decide for themselves when they need help … all we can do is let them know that we are there for them without judgment, only with love.

Let’s take this week and focus our efforts, and try to make eating disorders a thing of the past.

14 thoughts on “Take Care Tuesday – National Eating Disorder Awareness Week

  1. This is a great post – and so many important points. I wonder if we all don’t have some dysmorphic body images, especially those of use who has lost a ton of weight. I think we have to stop supporting and promoting the idea of physical perfection – and I need to do that now, starting with me!

    • I totally agree – it is all about setting up unrealistic mental images about our bodies, and then letting those go to be more healthy. Seems it should be simple or happen naturally over time … but it isn’t, and it doesn’t ever seem to totally happen. But like you say, it is a work in progress, and we all need to make a concerted effort.

  2. Fantastic and touching post. I admire how you share so much of your own experience and relate it – in an objective and non-judgmental way – to the stories and struggles of others. Keep up the good work – on yourself, on the blog, and on motivating others!

  3. I’m so glad you wrote this post today. I grew up with a very bad relationship with food and terrible body image and I can agree with so much of what you’ve said here. I’m so much better now than I ever have been in my life…I am thin and I can actually recognize myself as being thin which I never did before even at under 100 pounds. But in some way I am always going to be dealing with it. Especially food related things. I have to talk myself down off some serious ledges from time to time.

    Excellent excellent post. So thoughtful as usual.

    • Thanks – glad it is ‘thoughtful’ rather than just ‘hellaciously long!’ 🙂

      And I think it is important to recognize as you say that “I am always going to be dealing with it”. It might not be the same as before, but in some way or other, those ‘ledges’ we deal with will always be there. We just have to work to ensure we’re never staring over the edge of one again!

  4. A very interesting post. There’s such a fine line between thinking it’s good to require nutritional labeling, banning soft drinks from school vending machines, encouraging the use of pedometers and standing desks, and disallowing massive sized sodas in NYC, all positive to combat the obesity crisis, but all potentially even more dangerous for those with eating disorders, making it easier to become obsessive, etc.

    It’s also interesting for me to think that many of my running idols would seem to fit the definition of having a disorder, as they exercise for hours a day and are very controlled in their eating (I’m thinking of elite marathoners, Olympians, even many of the top local runners), but I suppose the difference is the goal? Wanting to qualify for the trials, or break 2:30, or whatever.

    For me, the only body image pressure I feel, oddly enough, is at work — being known as “the runner”, as in the crazy girl who runs to work sometimes, who runs marathons on the weekends, who’s always training for something, who’s always encouraging others to walk or run or take the stairs. I feel it’s become part of my office identity, but you’re right, it’s much easier to handle as an adult. If I stopped running and/or gained a lot of weight, my office identity might change to be “the traveler” or “the one who tries to teach everyone Italian” or whatever, and I recognize that that would be fine too.

    • Thanks Carina – I think like so many other things none of these decisions exists in a vacuum; we try to help people but some others might end up negatively impacted.

      I’m not sure about elites … because while they are training heavily and on a very controlled diet, it is also their job and they are in it with a team.

      It is funny about how you gain certain identities in different areas of your life – I was very much ‘the runner’ on my last project, because it was largely in Kentucky and that is what I did in my spare time … and asked about trails and so on.

  5. Really great post Mike! I love how you approached it all! This is such an important topic to bring up and I think most people have dealt with it in some way even if very small or by knowing someone who has dealt with an eating disorder!

  6. Eloquently put as always! I get very suspicious anymore of all the restrictive “healthy” diets out there and at the same time get overwhelmed by the information available to us now. I know we’ve both had our struggles and I think we’re both on a good path now!

    • Thanks Laura! Hopefully we can stay on the good path! I totally agree on the suspicions – when something is promising miracles with no effort I worry! And yes on the information – so many factors to consider!

  7. Just got back from Japan and saw this. I am so touched and you did an amazing job writing about your experiences while incorporating some really important information. Thank you so much for including me!!

    • Loved the initial Japan post – such great pictures (as always). So sorry you couldn’t do the marathon – though I think it was the right choice.

      And thank YOU for the incredibly powerful ‘Life with ED’ series … it really is great and moving and important stuff.

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