The evidence is clear, that young girls who have self-esteem and body image issues, are more vulnerable, and may engage in unhealthy and addictive behavior as adults.
To read the article go to: www.time.com/time/health/article/0,8599,1847340,00.html
To read a more comprehensive piece about this study, go to: www.nytimes.com/2008/10/14/health/14well.html
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Girls' Self-Image May Affect Future Weight
(AP) - Where a teenage girl sees herself on her school's social ladder may sway her future weight, a study of more than 4,000 girls finds.
Those who believed they were unpopular gained more weight over a two-year period than girls who viewed themselves as more popular. Researchers said the study showed how a girl's view of her social status has broader health consequences.
The girls in the study were still growing -- their average age was 15 -- and all of them gained some weight. However, those who rated themselves low in popularity were 69 percent more likely than other girls to increase their body mass index by two units, the equivalent of gaining about 11 excess pounds. (The body mass index, or BMI, is a calculation based on height and weight.)
Girls who put themselves on the higher rungs of popularity also gained some excess weight, but less -- about 6 pounds.
Both groups, on average, fell within ranges considered normal. But a gain of two BMI units over two years is more than the typical weight gain for adolescent girls, the researchers said.
"How girls feel about themselves should be part of all obesity-prevention strategies," said the study's lead author, Adina Lemeshow, who began the study as a Harvard School of Public Health graduate student. She now works at the New York City Department of Health and Mental Hygiene.
The research, appearing in January's Archives of Pediatrics & Adolescent Medicine, used data from an ongoing study used frequently by scientists studying childhood obesity.
Weight and height data were reported by the girls themselves rather than getting weighed and measured by doctors; that's a weakness in the study that the researchers acknowledged.
The researchers took into account the girls' weight and BMI at the start of the study, along with their diet, household income, race/ethnicity and whether they'd reached puberty -- and still found the link.
In the study, perceived popularity was measured in 1999 by how the girls reacted to a question next to a picture of a 10-rung ladder: "At the top of the ladder are the people in your school with the most respect and the highest standing. At the bottom are the people who no one respects and no one wants to hang around with. Where would you place yourself on the ladder?"
The researchers put the girls into two groups: the 4,264 who said they were on rung 5 or above, and the 182 who said they were on rung 4 or below. The weight gain link was based on those two groups.
Clea McNeely of Johns Hopkins Bloomberg School of Public Health called the study strong. She said she wanted to know more about the 4 percent of girls who rated themselves below average in popularity, particularly whether they already were gaining weight faster before they rated themselves as unpopular.
"The reason this paper is so important is it has broader implications beyond weight gain," said McNeely, who was not involved in the research but wrote an accompanying editorial. "Subjective social status is not just an uncomfortable experience you grow out of, but can have important health consequences."
Experts know little about how to intervene in teenagers' peer groups to improve health, McNeely said, but when adults set standards in schools, students treat one another with more respect.
Teenagers may give grown-ups "bored looks," she said, but "adults are still the most important influential figures in their lives."
The study was supported by a grant from the National Institutes of Health.
Starving Themselves, Cocktail in Hand
By SARAH KERSHAW
Published: March 2, 2008
The New York Times
Manorexia, Orthorexia, Diabulimia, Binge Eating Disorder.
All are dangerous variations on the eating disorders anorexia and bulimia, and have become buzzwords that are popping up on Web sites and blogs, on television and in newspaper articles. As celebrity magazines chronicle the glamorous and the suffering, therapists and a growing number of researchers are trying to treat and understand the conditions.
The latest entry in the lexicon of food-related ills is drunkorexia, shorthand for a disturbing blend of behaviors: self-imposed starvation or bingeing and purging, combined with alcohol abuse.
Drunkorexia is not an official medical term. But it hints at a troubling phenomenon in addiction and eating disorders. Among those who are described as drunkorexics are college-age binge drinkers, typically women, who starve all day to offset the calories in the alcohol they consume. The term is also associated with serious eating disorders, particularly bulimia, which often involve behavior like bingeing on food — and alcohol — and then purging.
Anorexics, because they severely restrict their calorie intake, tend to avoid alcohol. But some drink to calm down before eating or to ease the anxiety of having indulged in a meal. Others consume alcohol as their only sustenance. Still others use drugs like cocaine and methamphetamine to suppress their appetites.
“There are women who are afraid to put a grape in their mouth but have no problem drinking a beer,” said Douglas Bunnell, the director of outpatient clinical services for the Renfrew Center, based in Philadelphia.
The center, like a small but growing number of eating-disorder and addiction-treatment facilities, most on the West Coast, offers a dual focus on substance abuse and eating disorders.
Dr. Bunnell, the past president of the National Eating Disorders Association, said the obsession with being skinny and the social acceptance of drinking and using drugs — along with the sense, lately, that among celebrities, checking into rehab is almost a given, if not downright chic — are partly to blame.
“Both disorders are behaviors that are glorified and reinforced,” Dr. Bunnell said. “Binge drinking is almost cool and hip, and losing weight and being thin is a cultural imperative for young women in America. Mixing both is not surprising, and it has reached a tipping point in terms of public awareness.”
Psychologists say that eating disorders, like other addictions, are often rooted in the need to numb emotional pain with substances or the rush provided by bingeing and purging. The disorders are often driven by childhood trauma like sexual abuse, neglect and other sources of mental anguish.
Manorexia is the male version of anorexia. Orthorexia is an obsession with what is perceived as healthy food — eliminating fats and preservatives, for example. But people with this condition can dangerously deprive themselves of needed nutrients.
Diabulimia refers to diabetics who avoid taking insulin, which can cause weight gain, in order to control their weight. Despite the name, the disorder does not typically involve purging.
Binge Eating Disorder refers to obsessive overeating, especially of foods high in salt and sugar, that does not involve excessive exercise or purging to compensate for the high caloric intake.
Judy Van De Veen, 36, who lives in Gillette, N.J., became anorexic at 24. She said she starved herself, meting out small bites of low-calorie food for two months. Then she began bingeing and purging, throwing up entire boxes of cereal, whole pizzas and fast food from drive-throughs that sometimes cost her $80 a day.
She went into treatment, both inpatient and outpatient, for her eating disorder for several years in the late 1990s, with mixed results. In 2001, still struggling with bulimia, she took up drinking. If she ate while drinking, she said, she would purge, but then consume more alcohol to make up for the loss, because she wanted to remain drunk.
Many bulimics who drink use alcohol to vomit, experts on eating disorders say, because liquid is easier to purge. They also tend to vomit because they often drink on empty stomachs.
“In the beginning of my eating disorder I wouldn’t touch alcohol because it is so high in calories,” said Ms. Van De Veen, who later found herself regularly hospitalized for dehydration. “But I have the disease of more: I just want more no matter what it is.”
Two years into her drinking problem, she joined a 12-step program. She spent the next two years in and out of six residential rehab programs, spending about $25,000 of her own money because she didn’t have health insurance. But none of the programs were equipped to address eating disorders, so she binged and purged and her eating disorder raged.
Ms. Van De Veen said she has been sober for three years, but is still struggling with bulimia. She now has a 14-month-old daughter, Cheyenne, and she said that her pregnancy and support groups had helped her make progress on her eating disorder.
“I had an excuse to eat,” she said of being pregnant. “I didn’t care and I loved it.”
But she said the temptation to binge and purge is haunting her again.
Trish, 27, who has had an eating disorder for the last 10 years, recently checked into Renfrew, her fifth stint in a treatment center or hospital.
Like Ms. Van De Veen, Trish, who agreed to be interviewed on the condition that only her first name be used to protect her privacy, struggled with anorexia first and then found alcohol. Before she was admitted to Renfrew, she said she was blacking out from lack of food and suffering from excruciating stomach pain.
Trish, a nurse who lives in Ohio and works with cardiac patients, said she would starve herself through her 8- or 12-hour shifts, staring at the clock and fixating on when she could have her first drink. Drinking, she said, relaxed her when she had to eat in front of other people, a huge source of stress.
“Drinking helped me be less anxious,” she said. “It helped me be more of Trish. The two go together: If I drink more, I’m more into my eating disorder and vice versa.”
Studies show that binge drinking and alcohol abuse are on the rise among women, who are also more prone than men to eating disorders.
About 25 to 33 percent of bulimics also struggle with alcohol or drugs, according to a study published last year in the journal Biological Psychiatry. Between 20 and 25 percent of anorexics have substance abuse problems, the study found.
A growing number of researchers are examining the psychological and neurological links between eating disorders and substance abuse: Does eating a chocolate bar, or bingeing and purging, stimulate the same pleasure centers in the brain as drugs or alcohol?
Suzette M. Evans, a professor of clinical neuroscience at Columbia, recently began a study of the connection between bulimia and substance abuse, a field she said has been neglected.
“People are finally beginning to realize that food can function in the same way as drugs and alcohol,” Dr. Evans said.
As more patients seek treatment for both eating disorders and substance abuse, a complicated set of mixed messages can arise. The response to addiction is abstinence; but quitting food is not an option.
“We’re trying to get our patients to find effective behaviors and life skills,” said Dr. Kevin Wandler, the vice president for medical services at Remuda Ranch, which addresses both eating disorders and addiction at its facilities in Arizona and Virginia.
"Eating normally would be an effective behavior, but it’s easier to give up alcohol and drugs because you never need it again,” Dr. Wandler said. “If your drug is food, that’s a challenge.”
Trish left Renfrew on Feb. 22, after her second time in treatment there. She was determined, she said, to break her obsessions with weight, food and alcohol. Before she checked in, “I didn’t even have the energy to laugh,” she said. But as she prepared to go home, she had more hope than she has had in years.
“I will not live my life like this,” she said. “I’ve learned this time not to be ashamed. I want to love myself and I want to forgive myself.”
www.nationaleatingdisorders.org
The Voices of Eating Disorders
By Tara Parker-Pope
And their faces
In a country where many people struggle with eating too much, it can be hard to understand a disorder in which people basically starve themselves. In the latest Patient Voices, my colleague Karen Barrow explores the daily challenges of men and women battling anorexia, bulimia and other eating disorders.
You’ll meet Gillian Craig, a 17-year-old from Shaker Heights, Ohio, who still struggles with anorexia.
“People so don’t understand this disease,” she said. “As much as it seems like a choice, it’s not conscious. This is not something I’ve chosen. This is something I’ve been dealt.”
Her mother, Lauren Craig, also talks about the challenges of mothering an anorexic.
“It has been totally devastating,” she said. “It’s all consuming. Even when things are going well, you’re really concerned. When things are bad, everything revolves around it.’
Click here to listen to the voices of eight men and women struggling with eating disorders, including Kirsten Haglund, 19, who was named Miss America for 2008 and hopes to use her position to raise awareness of the problem.
Pictures by: Barney Taxel for The New York Times, Darren Hauck/New York Times, Jeremy M. Lange for The New York Times, Ruth Fremson/The New York Times, Stuart Isett for The New York Times, Brendan Smialowski for The New York Times
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