MEN AND WOMEN WITH EATING DISORDERS AT MIDLIFE STILL SUFFERING IN SILENCE

By CRISTIN RUNFOLA
Originally published on January 23, 2014 at UNC Exchanges

Midlife eating disorders continue to fly under the radar, and it’s a problem! A poor assessment, minimization of symptoms, or failure to refer for treatment after disclosure is still all too common and can have devastating consequences for women and men in midlife suffering from these disorders. A number of articles – >8 in the last year alone – have focused attention on this issue, but the myth that eating disorders only affect teenage girls is hard to erase and continues to plague those with these disorders. Sadly, even today, we hear stories from our more mature patients about negative experiences with the healthcare system, and the adverse effects these experiences had on their eating disorder recovery.

This post highlights just one of those stories. In the form of a written letter to a primary care physician, a woman with midlife onset anorexia nervosa illustrates a disclosure gone awry and educates about eating disorders in women her age. She states that she wants people to know that “eating disorders are devastating, and people at midlife can and do develop them.”

With permission to post her letter here, we have the unique opportunity to learn from her story. “Although I can’t take back what happened to me, by sharing my story, I hope to help prevent this from happening in others down the line,” says this woman who remains actively engaged in outpatient treatment for anorexia. The letter detailing her story is posted below.

Dear [physician]:

Several years have passed, but I will never forget the day that I came to see you for a physical exam. Please bear with me as I tell my story as an example of the importance of primary care in the early detection and treatment of eating disorders among people of all ages.

In 2006 and early 2007, I had lost some 40 percent of my body weight and began seeing a new psychologist for treatment of depression. She immediately diagnosed me with anorexia nervosa, was concerned about my health and urged me to have a physical. A friend referred me to you, and I made an appointment right away. I was 42 at the time, and you told me that it was impossible for me to have anorexia nervosa because I did not have it when I was a teenage girl. Instead, perhaps because I’d worked and traveled in developing countries, you ordered a parasite test. When it came back negative, you did not suggest any follow up.

I did not know what, if anything, was wrong with me, but I became convinced I must not have anorexia. I continued to see the psychologist, but I usually dismissed her concerns about my weight and my physical health because I believed that you would know best. My health (physical and mental) declined, and I was soon hospitalized for depression. After weeks of little progress, the doctor insisted that I go to an inpatient eating disorders program. I turned back to your office to have a hospital-required pre-admission ECG, but while you offered to provide the earlier results, you would not perform the new ECG. I took that as an indication you did not want me for a patient and so I never returned.

Since then, I have been in continuous treatment – inpatient and partial hospitalization on three occasions, but mainly outpatient with a team including a psychologist, registered dietitian, psychiatrist and primary care specialist. Treatment gives hope that I can avoid leaving my 13-year-old daughter motherless, as I was at age 14.

Although it is pointless to spend time thinking about where I would be now had I known I had an eating disorder earlier on, I do know that, according to the National Eating Disorders Association, “early treatment can lead to faster recovery, prevent symptoms from becoming chronic and reduce the likelihood of a fatal outcome.”

I tell you this story not to find fault. I truly believe you are a good doctor, or my trusted friend would not have recommended you. And you were certainly not the only medical professional who, at least in my mind, gave me permission to deny the eating disorder for nearly two years. (My first psychiatrist and therapist largely ignored the weight loss issue, instead focusing solely on the depression that had brought me to them.)

Clearly, there are misconceptions about eating disorders, and I hope that, if you still hold the belief you expressed when I saw you in 2007, you will at least consider anorexia and bulimia as among the many possible diagnoses in older people who have lost significant weight or engage in over exercise, purging or laxative abuse. In recent years, as rising numbers of men and women have developed eating disorders in midlife, an explosion of related research and media coverage have made the phenomenon widely known. But if you haven’t been aware, I encourage you to read the 2013 research report I’ve enclosed. [Included below, Ackard, 2013]. I would feel guilty if I did not bring this to your attention, now that I know about the importance of early detection and treatment and about the widespread nature of these disorders among all types of people at all ages.

Thank you for reading this, and if you have any questions or comments, by all means feel free to contact me, or better yet, a specialist eating disorders program near you. And I wish you all the best as you continue to make a difference in the lives of men and women in our community through your important practice of primary care.

Sincerely,

[name removed to protect confidentiality]

Striving daily for recovery, the writer of this letter is an inspiration. A wife and loving mother of two, science and technology writer, and wickedly skilled crochet enthusiast who finds joy in making blankets, baskets, bags, and more for others, this woman (like so many who fall prey to eating disorders) is a compassionate, caring, and talented woman with extensive wisdom to share. Yet, eating disorders prevent individuals like her from being able to engage in life to the fullest as it takes much time and energy to battle daily the negative thoughts, feelings, and physical sensations that come with the disease.

It’s true that we cannot go back and erase what’s happened to her but we can use her story to educate others about eating disorders to prevent a similar occurrence in the future.  As she so importantly notes, “The life-threatening reality of these disorders makes this issue of awareness so, so important — families, friends, patients and medical professionals need to know that these disorders break the stereotypical bounds, and that there is help out there from compassionate specialists and from support groups. And there is hope.” She adds, “While there is no sure cure, people can and do recover.” She is right! With individual and (now) couple-based treatment available to adults with eating disorders, professional treatment is improving and people are recovering.

We urge you to share this story with others to spread the word that eating disorders strike at all ages and to ensure appropriate assessment, timely treatment, and adequate care is given to women and men of all ages suffering from these disorders.

A few resources on eating disorders in midlife are below for your reference:

Book for professionals, family members, and individuals in midlife affected by eating disorders: Midlife Eating Disorders: Your Journey to Recovery by Cynthia Bulik, PhD.

TIPS FOR STAYING ON THE EATING DISORDER RECOVERY TRACK THROUGHOUT THE HOLIDAY

By CRISTIN RUNFOLA
Originally published November 25, 2013 at UNC Exchanges

For individuals recovering from eating disorders, an all too familiar, yet unwelcome fear can arise as thoughts about holiday eating, weight, and social gatherings near. Recollections of past holidays that were fraught with triggers and slips, can also bring up painful memories and worries about staying healthy while sharing precious time with friends and family. These very thoughts may result in feelings of isolation, anxiety, defeat, and even despair. As one individual wrote, “You are forced to sit and face distressing thoughts and emotions [while] surrounded by people who can enjoy the food and company without a second thought. Not only are you struggling with the disordered thoughts, but you’re then struggling with struggling.”

Yet, I have the pleasure of knowing many remarkable men and women who have made it through the holidays successfully while recovering from an eating disorder. Most of these individuals learned what worked for them through trial and error, helpful professional guidance along the way. Recovery is never linear, but knowing that others have navigated the holidays successfully, provides those still suffering with renewed hope that they too can overcome the obsessive thoughts and worries that complicate this time of year. Drawing from the experiences of others, I have compiled a list of tips for maintaining recovery during the holidays while staying focused on the things in life that are most important to you.

1) Keep doing what you’re doing: Stick to what works!

One of the most important pieces of advice we can give is to continue following your meal plan.

  • “Having a game plan of what I was going to eat ahead of time was really important,” says a member of Embody Carolina who recently recovered from an eating disorder. She went on to state, “It helped me feel less overwhelmed by all of the food because I knew exactly what I needed to eat. It also helped keep me accountable [to] make sure that I ate everything I needed.”
  • Another tip, “Holidays can be unscheduled chaos and I found it best to stick to my meal plan and its snacks as closely as possible, which in turn helped keep my hunger/fullness cues on track.” -McCall Dempsey, Founder of Southern Smash

Maintaining a consistent eating schedule that has worked for you will help keep you on track. Make sure to eat all of your meals and snacks, without skipping any “in preparation for” a later anxiety-provoking meal or “to make up for” a previous snack or meal. Doing so may set you up for a binge, making it more challenging to stop eating the next time you’re faced with food. Switch it up by alternating between food situations that are “safe” and ones that are “challenging.” For example, if you are going to your grandma’s house for dessert, a “challenging” snack that evokes anxiety, consume a typical dinner beforehand that is within your meal plan and feels familiar and “safe.” Depending on your place in recovery, prepare in advance for how you’ll manage the incorporation of new foods or experiences into your day, such as having dinner in someone else’s home. Develop a realistic plan that has a high likelihood of working for you. And, remember, balance, structure, and flexibility are key!

For more tips on healthy eating during the holidays, read below posts by CEED dietitians, Elysse Thebner and Laurie Conteh:

2) Don’t do it on your own: Reach out for support.  

Start conversations early! Before you leave for the holidays, spend some time talking with a supportive loved one or friend about how you’re feeling. Develop a plan for how the people around you can support you when you’re struggling, and enlist their help in brainstorming strategies for managing distressing thoughts and feelings during holidays. Some of the most brilliant ideas come from our loved ones, who have a vested interest in keeping us healthy and can provide an objective view on the situation. Here are some other ways that people in recovery have relied on their support systems during the holidays:

  • “I talked through emotions and anxiety in private with my husband. This allowed him to know how to best support me when we were in the midst of family chaos. And usually that support just meant standing by my side. Sometimes just knowing someone is by your side is all the support you need.” –McCall Dempsey
  • “Reaching out to allies ahead of time was one of the best things I did for myself. I let the people closest to me know why the holiday was hard, and gave them ideas ahead of time (when I was in a good mental state) about what strategies were helpful to me. Last year, I was surprised by a text message from a friend saying simply, “I know Thanksgiving can be hard: Know that I love you.” It meant the world.”  -Colleen Daly
  • “My partner knew that I would have urges to exercise over break, so he put a post-it note on our treadmill that said, “Step away from the treadmill.” It worked.” –Anonymous male
  • “Our family has buffet-style Thanksgiving dinners, which is hard for me because I’m tempted to binge. I asked my cousin, whom I am really close with, to prepare my plate and eat with me in a room away from the food. He was happy to do so, and I was able to get through the meal okay.” –Anonymous female
  • “When I was feeling anxious, I asked my partner to go on a walk with me.” –Anonymous female
  • “I took my most body-confident, fashion-forward friend with me shopping for a new holiday outfit. I hated trying on new clothes, but her enthusiasm and love for designing outfits had been infectious in the past. We changed together and, in the dressing room, she stripped down easily and flaunted new outfits, owning her body and modeling for me a confidence that I hoped to achieve. She was also an incredible story-teller, and helped get my mind off things when needed.” –Anonymous female

One of the most powerful motivators in recovery can be your family and friends. They usually want to be there for you, but just don’t know how. Pick and choose whom you talk to and the role they play in your recovery wisely. Then, take a leap of faith and let them in. Knowing that it’s not just you fighting against the eating disorder can provide you with the strength you need to move forward when things get tough.

3) Direct the conversation! Handle unwelcomed comments.

No matter how brilliant our family and friends, we live in a weight-obsessed world, where dieting and appearance are topics that easily seep into daily conversation. Comments about appearance are usually the first we hear after reuniting with someone who we haven’t seen in awhile.  “Wow, you look great! Have you lost weight?” “Have you been working out?” “You’re looking healthier.” “What do you do to stay so skinny?” “You’ve really been eating more, huh!?” “You’re like me, when you gain weight, you can see it in your face.” Then there are the comments about food and dieting. “I’ve been eating really clean the last week so I can gorge on Thanksgiving food.” “Ugh, I shouldn’t have eaten that second slice of pumpkin pie, I’m already fat.” “After break, I’m going to eat super healthy and lean down; you should have seen my muscles before, I had a six pack.” These comments can be unsettling for many, but for those with an eating disorder, they can be especially distressing. There are three things you can do to navigate these comments: 1) prevent them, 2) divert conversation, and 3) call them out.

  • Prevent them! Talk with the people you’ll be around in advance and let them know what these types of comments are unhelpful. Ask them kindly to refrain from making triggering comments when they are around you in order to help support your recovery. Not sure what to say? Here is an example:
    • “Hey mom! I’ve been working really hard on recovery, and I’m feeling a little anxious about heading home for the holidays. To help me continue eating well, it would be really helpful for us not to talk about dieting when we’re eating. Instead, can you help me think about something else, maybe tell me about your new work project? What do you think?”
  • Divert conversation! When a comment is made, strategically change the topic of conversation. Develop a list of conversation starters beforehand so you’re prepared and not caught off guard. An example:
    • Friend says, “You’re so lucky, your legs are so thin!”
    • Your response, “Oh…I completely forgot to tell you about this TV show that I just started watching and love, and think you will too! I know you’re all about powerful, independent women so we have to watch it together. Have you seen Scandal?”
  • Call them out! If someone makes a comment that’s triggering or not in line with recovery-oriented goals, feel free to call them out on it. Comments can be made unconsciously, and bringing awareness to them may be all you need to make them stop. Here are some suggestions for what to say, which will depend on your personality and relationship with the person:
    •  “Wow, we just spent 5 minutes talking about dieting. I am feeling like that conversation is pulling me into eating disorder thoughts. We better change the topic ASAP.”
    • “It is upsetting for me to hear that you feel guilty after eating. That’s something I’m working on not feeling, especially as I’ve learned that there really are no “bad” foods. Can we help each other not say these things? ”
    • “Are you really calling yourself fat? You know I have an eating disorder – that’s really not helpful for my recovery.”
    • Or if all polite and respectful attempts fail and you’re just not getting through, “Dude, STOP! I’m not engaging in this conversation with you!” And get to higher ground with another conversation partner!

In a previous blog post, Dr. Cynthia Bulik wrote, ‘“The important thing is that you navigate the waters to have conversations with each other that are productive and enjoyable and don’t immediately catapult you back into the old roles that you had before you left home. This is not automatic. It takes practice and some trial and error to develop new and more mature communication styles.”

4)      Remember your values and live them fully

Take a few minutes to identify your personal values. Tweet them, text them, and write them down in big bold letters on a piece of paper to take with you wherever you go during the holidays. Develop a plan for living these values daily throughout the holiday break. This scheduling will provide structure to your day and make certain you take time for the good stuff. For example, if you value family, you might decide to protect an hour in your day to spend time enjoying conversation over tea with a family member. Or, if you value generosity, you may wish to spend some time each day engaging in a generous act, like driving your brother to his soccer game, buying a stranger coffee, or donating to a local charity. Filling your schedule with positive activities that warm your heart will leave less room for eating disorder thoughts and behaviors to creep in.

If the eating disorder presents, take some time to consider whether the eating disorder behaviors are in line with your values. Usually they are not. With this knowledge, in the moment, when an eating disorder thought pops up, you can take a moment to step back and think of a value-driven behavior. For example, if you are eating lunch with a friend who you haven’t seen in 3 years, and start having anxious thoughts about the food, remind yourself of an important value, such as attentiveness, and change your behavior to be in line with this value (e.g., listen attentively to your friend talking). By engaging in value-based behaviors, you can redirect thoughts away from the eating disorder and focus on things that are most important to you.

  • Colleen Daly, eating disorder advocate, with a personal history of an eating disorder, did just this during her recovery. She says, “Before I ate, I took a deep breath, entered a mindful state, and became thankful for the gifts I had – including a strong system of support, nourishing my mind, body and spirit, and recovery.”

5) Be compassionate with yourself and others.  

Holidays can be a stressful time for everyone. Most of us are trying to do the best that we can at a time of the year that can feel chaotic. It is an important time to practice compassion for yourself and those around you. Some important recovery tips to remember:

  • Practice acceptance! McCall Dempsey says, “No matter where you are on your recovery journey, holidays can often bring up anxiety and sad memories. Accept that these feelings and thoughts [might be] there.  Do not try to shove them away because ‘you should not feel this or that’…Saying we should not feel a certain way only causes the anxiety to go up, up, up.  I find that accepting my feelings, being in the moment and being gentle with myself are a few of recovery’s greatest gifts.” Well said!
  • Expect a rocky journey, with twists and turns. No recovery is straight forward, so expect that your plan might not go perfectly. Have compassion for yourself after slips. Rather than beating yourself up over them, embrace the digressions as learning experiences and focus on helping yourself get back on track.
  • Schedule ‘me’ time. Taking time for yourself is a must. One patient states, “Setting aside some quiet time for myself throughout the day was really helpful. Making sure to take care of myself and give myself some time to recharge helps kept me from becoming overwhelmed and exhausted and let me focus more on enjoying time with my friends and family.”
  • Give others a break. If someone says or does something that’s out of line or unhelpful, consider giving them a break too.
  • Notice the good stuff! Focus on the things that have gone well, and reward yourself for the small steps forward. Make a point to acknowledge and thank your friends and family when their support is effective. Focusing on all your successes will remind you and your loved ones of what’s going well, which will increase everyone’s motivation to push forward.

Holidays are a time for honoring and spending time with the family members and friends most important to us. The eating disorder can be an unwanted guest, inserting itself into situations when you least expect. Preparing ahead of time for how you can manage the eating disorder may help keep it at bay. We encourage those of you in recovery to take some time before the holidays to reflect on your recovery goals, the important things in your life, and a to develop a realistic plan to stay healthy and happy. We at CEED wish you all safe travels and a lovely holiday break.

Below are related blog posts that you may find helpful as well:

WHAT TO BELIEVE? MIXED MESSAGES ON FOSTERING HEALTH IN KIDS

By CRISTIN RUNFOLA
Originally Published on July 30, 2013 at UNC Exchanges

Part 1

Perhaps now more than ever, parents are plagued with contradictory advice and doubt about how to maintain their children’s health. While research is advising parents not to focus on their children’s weight, media messages and many public health campaigns are pushing for just the opposite.

A recent article published in JAMA Pediatrics found that when it comes to talking about eating with kids, weight-based discussions (as opposed to health-based ones) may increase children’s risk for binge eating, unhealthy dieting, and extreme weight control behaviors, regardless of the child’s BMI. (A more in-depth article summary can be found HERE). This article received widespread media coverage, generating excellent public discussions on the topics it raised –read more HERE.

However, recent “anti-obesity” campaigns, such as the Strong4Life campaign initiated by Children’s Healthcare of Atlanta and Dubai’s “Your Weight in Gold” initiative, which target individuals who are overweight or obese and promote weight loss as an end goal, either continue today or have had lingering effects. Who can forget the Georgia print ad featuring a sad, angry-looking girl that read “WARNING…IT’S HARD TO BE A LITTLE GIRL IF YOU’RE NOT. Stop childhood obesity,” for example? Such images evoke strong emotional responses and leave imprints on our brains.

These campaigns cause great unease (and even uproar) among eating disorders professionals. In press statements or blogs, the Academy for Eating Disorders, Binge Eating Disorder Association (BEDA), and Association for Size Diversity and Health have presented our concerns HERE, HERE, and HERE, citing the potential damage that weight-based discrimination and targeting only weight (instead of behaviors) can have on eating patterns, body image, and self-esteem.

As Boston Children’s Hospital Chief of Endocrinology Dr. Joseph Majzoub notes, however, “The history of obesity for many, many years has been one of blaming people for lack of self control” (The New York Times, 2013). Genes are often excluded from conversation, despite their significant role in determining our weight and size. People are left feeling ashamed for their assumed lack of willpower and inability to make their body change. These tactics can backfire. Read BEDA’s take on this issue HERE.

It’s no wonder that parents are confused about how to broach this topic with their kids. It is well known that parents can play a crucial role in the development of healthy eating and weight for children, but clear, sound, evidence-informed advice for parents on how to do this can be hard to find. And the media do not always present a complete or accurate picture.

Excellent books (such as those by Ellyn Satter) and websites do exist (e.g., http://www.ellynsatterinstitute.org/).  Some of the blogs referenced above provide excellent health promoting strategies and tips for talking about weight with your child. (The hyperlinks should make it easy for you to take a few minutes to peruse them easily.) However, additional outlets across the Internet must be made available to ensure that such information is disseminated to parents from all walks of life.

We encourage healthcare educators to spend some time creating accurate non-stigmatizing resources on this topic that can be made available to parents free of charge. We’ll do our part too! A list of conversational “dos” and “don’ts” for discussing the sensitive topics of weight, health, and body image will follow shortly. Stay tuned…

[Thanks to Emily Bulik-Sullivan for edits]

DOES BODY ACCEPTANCE AFFECT HEALTH?

Originally published August 15th, 2011 on UNC Exchanges.

No, but this became a question for Jess Weiner, author, self-esteem expert, and leading activist in the body acceptance movement after a “weigh-in” (no pun intended) with her doc.  In a recent article in the September issue of Glamour magazine, Jess Weiner bravely shared the results of her medical “weigh in” that left her questioning whether loving her body was affecting her health.

After struggling with an eating disorder, Jess, like many individuals in recovery from an eating disorder, replaced the scale with other more important factors to measure her self-worth. She fully embraced the body acceptance movement, loving her size 18 body and successfully advocating for others to do the same. However, during a talk, after an audience member questioned, “How can you be healthy looking like that?” she realized that in addition to avoiding the scale, she had been avoiding the doc’s office and all medical markers of health and wellness (e.g., cholesterol, blood pressure). She had no idea how healthy she really was!

Our own Cynthia Bulik, Ph.D. weighed in on the issue regarding underlying motivations for avoiding the doc. She discussed the issues of provider bias and stereotyping of heavier women that occurs in the medical setting and can lead to “simplistic thinking” regarding women’s health and an immediate response of “you need to lose weight.” Check out what else she had to say at:  http://www.glamour.com/health-fitness/2011/08/jess-weiners-weight-struggle-loving-my-body-almost-killed-me.

The article discusses how a trip to the doctor’s office informed Jess that her physical health was not great and that she was close to the pre-diabetic danger zone. With a family history of heart disease and diabetes, this propelled her to make lifestyle changes in order to achieve not just mental, but physical health. Simultaneously, she began to question whether accepting and loving her body was putting her at risk physically (hence the provocative title, “Loving my body almost killed me”).

Through the course of this journey, Jess found that it was not body acceptance that was leading her down a potentially dangerous health path, but some extreme thinking that might have put blinders on her. In the cognitive-behavioral world, she (like many of us) fell prey to what we call all or nothing thinking and generalization. Her body acceptance generalized beyond not focusing on weight to the point where she was eschewing basic health care behaviors such as visiting the doctor and monitoring her health—not her weight.

Even our great leaders and thought provokers today fall into “thinking traps.” It is those who share their experiences and admit their “errors” that evoke the type of discussion and self-reflection that propels our field forward.

Jess’s messages came across even more clearly in follow-up interviews with NBC and Kate Harding. She emphasized that weight loss and body acceptance can co-existand that loving your body means treating it well on the inside and out. During her appearance on NBC, she stated, “I didn’t just set out to lose weight…it was a part of my health awakening, but not my sole purpose…it was about how I wanted to feel.” She learned that for her weight loss did not equal bad or represent acceptance of society’s thin ideal, but that it was a means to an end in line with over-arching core values of health and full physical functionality, not appearance. She needed to clarify what body acceptance and loving her body meant to her.

While there are some controversial points brought up in the Glamour article, there were important messages and questions worthy of consideration and reflection for all.A couple that stood out to me: One, accepting and loving our body does not mean disregarding our health; in fact quite the opposite. Two, weight loss and gain may be secondary to engaging in health-oriented behaviors that are appropriate for sustaining optimal health and physical function. Three, living our value-driven life feels best – it is important for us to step back and reflect on whether our current behaviors are in line with our core values in life. Four, challenging ourselves by asking questions is important to move ourselves and our field forward. Lastly, and most importantly, if Jess got each of all to have a hard think about what acceptance and loving your body means to us, and helped us to appreciate that it might mean different things to different people, then her courageous article was a success!

My definition of body acceptance: viewing my body and the bodies of others in a non-judgmental and non-critical way, while also accepting the changes that may need to occur externally in order to maintain health, wellness, and optimal physical functionality.

Loving my body means: engaging in behaviors that show respect, kindness, and acceptance for my body, including providing my body with the nourishment, rest, and care it needs to function and treat me well. It means considering all aspects of health that affect my body including physical, psychological, and mental health.

You can view the NBC interview at: http://today.msnbc.msn.com/id/3041426/vp/44088947/

By: Cristin Runfola, M.S.

LETTER TO THE EDITORS OF NEW YORK TIMES REGARDING FEBRUARY 19, 2011 ARTICLE, “TODAY’S LAB RATS OF OBESITY: FURRY COUCH POTATOES”

The Binge Eating Disorder Association (BEDA) Objects to Language and Inaccuracy of Statements Perpetuating Stereotypes of the Obese in the New York Times February 19, 2011 Article.

“Today’s Lab Rats of Obesity: Furry Couch Potatos“

2.20.2011 originally published in UNC Exchanges.

To the Editors of NY Times,

I am writing in response to an article published in the NY Times on February 19th, 2011 entitled, “Today’s Lab Rats of Obesity: Furry Couch Potatoes” by Andrew Pollack. I have two major concerns with the article: (1) terminology used that perpetuate negative stereotypes of individuals with obesity, and (2) inaccuracy of statements that are not based on empirically-based research.

Regarding the first concern, the terminology – couch potatoes – is pejorative, offensive, and not scientifically sound. This type of language perpetuates the negative stereotype that all obese individuals are lazy, inactive, and blameworthy for their excess weight. Obesity research shows that there are genetic, biological, and environmental factors implicated in the etiology of obesity. In fact, research suggests that 40-80% of weight is due to genetic factors (Herrera & Lindgren, 2010; Lee, 2009), suggesting strong genetic underpinnings and a predisposition to obesity. By describing obese monkeys as “couch potatoes,” the New York Times is maintaining the stereotype that behavioral characteristics are solely to blame for excess weight, discounting the role of biology. I am shocked that the “obese resource” director at the Oregon National Primate Research Center used the “couch-potato” term himself – whether implicit or explicit prejudice, this shows just how pervasive these negative stereotypes are today. Research does not support that “many [people] these days….sit around too much, eating rich, fatty foods and sipping sugary drinks,” as implied by the author.

Such stigmatizing attitudes and bias against obese individuals may lead to weight-based discrimination in the educational, employment, and health care setting, and may negatively impact interpersonal relationships (Teixeira & Budd, 2010; Brownell & Puhl, 2003). These stereotypes make individuals with “greater than average” weight vulnerable to social injustice, unfair treatment, and impaired mental health and quality of life (Puhl & Heuer, 2009). I urge you to be mindful of the language you use when discussing weight-related problems, and to refer to the scientific literature for accuracy in reported statements; these faulty descriptors have major implications in the lives of many of your friends, family members, peers, and colleagues.

The above touches on my second concern regarding statements made that are not based on empirical research.  In the article, humans are accused of “fudging their daily calorie or carbohydrate counts” when questioned and go on to state that nonhumans “‘don’t lie to you.”‘ While research does suggest that dietary recall is not the most accurate assessment of actual food intake, we cannot say whether this is due to blatant lying (as implied in the article), memory disturbances, difficulty with estimating portion sizes or other factors. Such over- or underreporting may be unintentional. Further, as with non-human samples, other measurements exist for use in humans to increase accuracy with dietary assessment. If we do lie on dietary recall, it is likely partly a result of the negative messages (such as those in the article) that tell us we lack self-control and are to blame for any weight-related issues. This may lead to guilt and shame and render some hesitant to fully disclose health behaviors. Even if people are honest, would they be trusted by those who hold these stereotypes in the first place? And do those who hold these stereotypes respond in such a way that make these individuals feel unsafe to disclose anything personally sensitive?

I feel it important to write you about these concerns because language can significantly impact societal perceptions about individuals with obesity. As weight is not necessarily an indicator of health, it is important for us to dispel the myth that individuals with “above-average weight” are lazy, inactive, and lack self-control. I appreciate your coverage on the current research in obesity, but strongly advocate for greater sensitivity to the language used in describing such research. I also urge for a more critical review of the research to prevent misinterpretation of data and ensure evidenced-informed statements.

Sincerely,

Cristin Runfola

____

Cristin Runfola, M.S.

Eating Disorders Psychology Intern

Eating Disorders Program, Dept of Psychiatry

University of North Carolina School of Medicine

 

Doctoral Candidate, Clinical Psychology

Palo Alto University

Pacific Graduate School of Psychology