Fat-Hating and Eating Disorders

Somehow I was not one of the tens of thousands of people who have reacted to Maura Kelly's anti-fat-person blog entry on Marie Claire. The magazine has received 28,000 e-mails about the piece; the initial post itself has garnered 3,000 comments. It's in the Daily News, HuffPo, washingtonpost.com, etc.

Basically, she wrote a hateful post about how it's "aesthetically displeasing to watch a very, very fat person simply walk across a room"--yes, that is a direct quote--and how even though she has a few friends who could be called plump, she would be "grossed out if I had to watch [fat people] doing anything." It's not hard to see why the fatosphere freaked out. There was even a protest staged in front of the offices on Friday, in which fat people were supposed to gather and make out, or something. (The post was prompted by Maura's editor asking about her reactions to Mike and Molly, a CBS show about two obese people in love. It's ridiculous that this idea in and of itself is a premise, incidentally.)

What's striking me is her apology, made after the post proved explosive. Here's where I should say that I've worked with Maura and have never found her to be anything less than honest, kind, and sincere. (I've also written for Marie Claire and haven't found their party line to be any more anti-fat than any women's magazine, though I wasn't writing about body issues.) When I read the apology, I could hear the words coming out of her mouth; they were in line with the person I know.

The post itself was anything but. I kept reading, waiting for a disclaimer better than "some of my best friends are fat!" and never got one; I kept waiting for the big reveal to this obviously farcical post (right? right???) and was left hanging. But as her apology makes clear, this woman has been in the grip of an eating disorder. It's behind her now--that is, she is no longer engaging in eating-disordered behavior--but manalive, do those mind-sets ever stick.

I'm sympathetic to how this grossly myopic view of fat people might be a symptom of an eating disorder. I don't want to believe that Maura's actual feelings are anywhere near as hateful as her words. So then I asked myself: Do I, deep down--as someone who's had an eating disorder--have the same reaction to seeing morbidly obese people? The answer was a swift, decisive no. I felt relieved to answer this honestly--rather, to come to that answer honestly--and vaguely righteous, suspicious that maybe Maura's post wasn't about her eating disorder at all but about something closer to bigotry.

But then I remember my mother and the mustard cape.

There was no plus-size store within driving distance of the South Dakota town where I grew up, so when I was a kid the only time my morbidly obese mother purchased clothes was during our annual summer visits to my grandparents in Dallas. These visits were as shrouded in mystery as her annual visit to the gynecologist: I knew it was something adult women did, specifically something my mother did, and it had something to do with something I wanted no part of. I pictured these stores--we didn't have words like "plus-size" back then; my father referred to it as the "big woman" store, and my mother didn't refer to it at all--as somehow dark, dank, with lighting that was harsh and low at the same time. I pictured eerily large dressing rooms with mean, ugly mirrors; I pictured elephantine, kindly saleswomen who were all very careful not to mention the fact that this was a "big woman" store. I pictured women filing out of there not delighted with their purchases, nor even relieved at having gotten it done, but furtive, ashamed. I absorbed so much shame from the very idea of the store that the thought of going there with her seemed like a punishment devised especially for me, designed to make me see my fate as a woman.

We eventually moved to an actual city, one with "big woman" stores of its own. My mother's shopping trips went from an annual basis to an as-needed one. It became a bit of a treat, actually--the best store (possibly only, even in the early '90s) was at a mall an hour's drive away; every so often after school she'd pick me up and announce we were going to that mall. I would go into Claire's and pick out cheap earrings, and would meet her back at the store. The first time she suggested this I felt squeamish, literally sick to my stomach at the thought of going into that store with her; she may as well have suggested we go to a sex-toy shop as a mother-daughter team. But it made the most sense, and I acquiesced; imagine my surprise when I saw that the store was just like any other, just with added digits on the clothing tags. If anything, they were preferable to the cheap, gaudy places that catered to teenagers like me. I read the simple, sunny decor and the saleswomen's perky attitudes as disguising shame. Perhaps it was simply maturity.

On one of her trips--one without me--she purchased a mustard-yellow cape. Why, I have no idea. She wasn't a dramatic dresser--the flashiest she gets even now is a red blouse instead of a black or forest green one--nor did she and my father go out to the sort of places where a cape would be appropriate. I suspect she just saw it and was in a good mood; the saleswoman probably told her it looked good on her. I can hear it now: Most people can't wear that color--but you! with that red hair! those hazel eyes! you owe it to yourself!

And the thing is, it did look good on her. I can see that now. At the time, though, all I remember was my mother showing off her purchase, twirling around the living room in a cape, and being horribly, horribly embarrassed. Embarrassed for her, that she was taking delight in an outlandish garment when she hadn't earned the right to do so by being thin. Embarrassed for myself, for being her daughter. Embarrassed that capes meant for big women even existed; embarrassed that there were fat women walking around out there right at this very minute wearing mustard capes and thinking they looked fabulous.

It became crucial to not allow my mother to wear her mustard yellow cape. Words I used include ridiculous, weird, how could you, terrible. Words I did not use include fat, fear, and I. I was 15. It was the same year I stopped eating breakfast, and lunch. Yes, fat people made me very, very uncomfortable.

I wish I could tell you that my mother heard her petulant 15-year-old daughter protesting her fashion choices and catalogued it along with her other sins, sins like making me use coupons if I went into the grocery store for her and calling parents of friends just to make sure that yes, a responsible adult would be there for the Friday night sleepover. Instead, she took off the cape, put it in its bag, and stuffed it into her closet, where it stayed until they moved out of the house.

I tried once, post-college, to try to get her to wear it. By then I could see my mother for who she was: a flame-haired, hazel-eyed woman with just the slightest hint of Texas twang whose charm lay partially in the fact that she didn't know she had any. I knew by then that the mustard cape would bring out that flame, highlight that hazel, and maybe send her a quiet alert about her own charisma. I took it out of its bag and brought it out casually. "You really should wear this, Mom," I said. "I know I made a big deal out of it when you got it, but" [it's not about fat, it's not about weight, it's not about you] "I was a teenager and anything out of the usual was mortifying. But try it on--I know it'll look great."

She laughed. "I don't know what I was thinking when I got that thing," she said. "Who am I to try to wear a cape?"



Maura, Maura, how could you not have seen? How could you not have known your own history so? How could you have looked at your own reaction--and for the record, while I find your reaction sad and even abhorrent, it's also an authentic reaction and I'm not going to ask you to deny that--and stopped at its face value? How could you not have put it together that a revulsion of fat people might not be about fat people at all, but about your own relationship with your body? You're a smart writer and a smarter lady, and this wasn't your best. It wasn't even your worst. It was your sickest. I have no idea where you're at in your recovery, only that you write about your eating disorder history as being in the past. And the eating may be, but the disorder lingers.

Binge Eating Disorder: It Officially Exists!

The American Psychiatric Association recently announced their officially proposed updates to the DSM-5. The mental health professional community had already let it be known that the addition of binge eating disorder would likely be among the changes--it's the APA's rationale that's news to me. (In the DSM-4, BED was listed as a variant of eating disorder-not otherwise specified; this change would make it a discrete diagnosis.)

*BED tends to run in families yet is not a simple familial variation of obesity.

*BED has a greater likelihood of male cases and a later age of onset than other eating disorders.

*Compared with obesity, BED sufferers have greater concerns about shape and weight and a higher likelihood of mood and anxiety disorders.

*BED is associated with a lower quality of life than obesity.

*BED has a greater likelihood of medical comorbidities than either other eating disorders or obesity.

*BED has a lower level of diagnostic stability and a greater likelihood of remission.

*Individuals with BED have a more positive response to specialty treatments than to generic behavioral weight loss treatments.

I’m hoping that BED’s inclusion helps with the last two items in this list. If mental health providers are more aware of BED and know that it is a treatable condition, it makes sense that patients will get care more swiftly--and that the care will be more effective--than they would were they to follow standard medical advice given to those whose primary issue is that they’re overweight, not that they suffer from BED. I wonder if the “later age of onset” for BED is actually “later age of diagnosis.” Of BED sufferers whose personal histories I know, their behaviors began in childhood, even if they didn’t reach clinical frequency until adulthood.

The proposed change is important for another reason: It would lessen the frequency of ED-NOS diagnoses. Right now, ED-NOS is the most fatal eating disorder, yet is the least-known—and, because of its breadth, perhaps the least understood. Given that BED has a greater likelihood of medical comorbidities than other eating disorders, this could shed some light on the actual risks of ED-NOS. Right now, ED-NOS is a sort of catch-all diagnosis; it’s actually the most common diagnosis at the Renfrew Center, a leading treatment facility. An ED-NOS diagnosis can mean anything from a binge-starve cycle, to chewing and spitting, to food rituals that disrupt one’s life, to purging disorders (purging without bingeing). It can also mean anorexic, bulimic, or binge eating behaviors that do not meet the criteria for frequency or severity: for example, someone who binges and purges twice a month as opposed to twice a week (required by DSM for a diagnosis of bulimia), or someone who restricts her food, has an intense fear of gaining weight, and has body dysmorphia but has not dipped below the 85% of appropriate body weight, as specified by DSM for a diagnosis of anorexia. (It’s noteworthy that another proposed DSM change removes the requirement for amenorrhea for being diagnosed with anorexia; this criterion “disqualified” a lot of anorexics from being diagnosed as such, and I’m glad to see it removed.)

I would love to see more research into ED-NOS, for a variety of reasons. Because of its breadth, it can be more difficult for sufferers to recognize themselves and seek help. (What I listed above—someone who restricts her food, has an intense fear of gaining weight, and has body dysmorphia without going below 85% of her appropriate body weight—applies to a lot of women who wouldn’t think of themselves as having eating disorders.) I’m still wrestling with the question of biology, and whether eating disorders are on a sliding scale or on an on/off mode—like, is a woman who perpetually diets actually a woman with a mild (or not mild) case of ED-NOS, or is there another factor--possibly a biological one--missing from the plain old dieter that she’d need to be considered an ED patient? (Carrie Arnold wrote about this much more clearly here.) And is ED-NOS actually, depending on the symptoms, a “touch” of anorexia or bulimia? (I don’t think that’s the case, but if the sliding-scale theory is correct, that’s a logical conclusion.)

What the DSM-5 proposed changes do for BED is begin to legitimize it. I’m sure that eventually the fat-haters will laugh at the diagnosis (“Put down the potato chips, honey, that’s your prescription!”) but I’m confident that it will encourage more sufferers to recognize that they can seek appropriate treatment, and that with time even some of the haters would see that treating BED as a psychiatric diagnosis instead of as mere obesity (all the better if more non-overweight BED sufferers speak up) is a better cure for both the symptom and the cause. I hope that eventually these changes will lead to the same for ED-NOS as well.