Tagged Eating Disorders

Eating Disorder Symptoms Have Spiked During Covid

Anxiety, disrupted routines and loneliness are fueling people’s food issues as they hunker down during the Covid-19 crisis.

Malinda Ann Hill decided to resume treatment for her eating disorder almost as soon as she shifted to working remotely in March 2020. She knew even before the pandemic that isolation at home would be detrimental to her ongoing recovery from anorexia nervosa. “I had made a really distinct decision not to work from home, so that sent me into a tailspin,” said Ms. Hill, 49, who lives with her daughter in Wynnewood, Pa., and works as an art therapist and bereavement coordinator for a local hospital.

The community and structure of her workplace were helpful for someone who had struggled with disordered eating since her early teens. Sudden loneliness, mounting fears about the unfolding pandemic and a new lack of boundaries between work and home all helped tip off a relapse that Ms. Hill said had already been brewing.

“I thought maybe I should get back into treatment now,” she said. “Because this is going to be bad. And this is going to set off a lot of other people, too.”

Indeed, some doctors, therapists and dietitians who treat eating disorders, such as anorexia, bulimia and binge eating disorder, are reporting an overwhelming spike in the need for their services, with waiting lists growing at many practices and treatment centers across the country.

The National Eating Disorders Association reported a 41 percent increase in messages to its telephone and online help lines in January 2021 compared with January 2020. And in a study of about 1,000 American and Dutch people with eating disorders published last July, more than one-third of subjects reported that they were restricting their diet and increasing “compensatory behaviors,” like purging and exercise. Among the Americans, 23 percent also said they would regularly binge-eat stockpiled food.

“I’m seeing more clients, and I’m getting clients who are sicker when they come to me, because we cannot get them access to a higher level of treatment,” said Whitney Trotter, a registered dietitian and nurse in Memphis who provides one-on-one nutritional counseling for adolescents and adults of color with eating disorders. She noted that many in-patient treatment centers are fully booked due to the heightened demand.

The uptick in her practice stems from a mix of relapse cases, like Ms. Hill’s, and disorders that have newly taken hold in the past year. “I’m treating more teenagers, and also more teachers, doctors, nurses and other first responders and essential personnel,” Ms. Trotter said. “An eating disorder can manifest as a trauma response. Our nervous systems were not meant to deal with a long-term pandemic.”

How food scarcity can stoke eating disorders

Early on in the pandemic, fears around grocery store shortages and food access re-triggered some people’s disordered eating. “I found myself lying awake at 3 a.m., thinking, ‘What if there is no more baby food at the store?’” said Aneidys Reyes, 33, a stay-at-home father in Madison, Wis., who had been in eating disorder recovery for more than six years before the pandemic.

Mx. Reyes, who was raised as a girl, said that their eating disorder originally began as a coping strategy for the gender dysphoria they experienced as a teenager. Now that they identify as transgender, the urge to restrict food is less connected to body image anxieties. “It’s weird for me, because it’s not the same old eating disorder,” they said. “But once I’m at a certain level of anxiety, then my brain is like, ‘Do you remember these neuropathways? What if it’s what you’re eating? What if your clothes don’t fit tomorrow?’ All these old, familiar thoughts come back.”

Even after grocery store shortages eased, patients who were being treated for eating disorders struggled with how pandemic rules required them to navigate eating with less professional support. “For a patient who would previously have spent the day at a treatment center having all their meals provided for them, a virtual program requires so much more autonomy than they would have previously had,” said Lauren Muhlheim, a psychologist in private practice in Los Angeles.

Ms. Hill deliberately chose an in-person treatment program, even during the early days of social distancing, because she knew she needed hands-on help making decisions around what and how much to eat. When her program switched to virtual support, she had to think about meal planning again. “Suddenly I had to be in charge of the food,” she said. “They wanted me to have more variety, but I didn’t want to go back to the grocery store. I started having panic attacks.”

Our societal tendency, on social media especially, to demonize quarantine comfort eating and pandemic-related weight gain hasn’t helped. “The pressure to have used the pandemic time to have gotten or kept in shape is a big theme,” said Dr. Muhlheim. Ms. Hill said that “diet culture noise” had felt louder to her in the past year.

Why treating eating disorders over Zoom is harder

The majority of residential eating disorder treatment programs have stayed in-person, but they are typically reserved for patients who need the highest level of care due to the severity of their eating disorder behaviors or related medical complications. The next step down is known as a “partial hospitalization program,” where patients live at home and manage some meals themselves, but attend a mix of individual and group therapy meetings, plus meal support sessions (where eating is monitored so patients cannot restrict food or purge afterward), for anywhere from six to 11 hours a day.

Many such programs, as well as individual outpatient services (where patients have daily or weekly check-ins with a therapist or dietitian), have shifted to a virtual treatment model. In addition to leaving patients to navigate food shopping and meal preparation alone, the virtual model makes meal support sessions trickier. “You can’t tell as well from a camera how much someone is eating,” Dr. Muhlheim said.

Dr. Muhlheim said that she is also concerned about the loss of casual interactions that normally take place between participants in group treatment. “You can only have one conversation at a time on Zoom,” she said. “You can’t just pull someone over to chat, so you lose a lot of that connection.” In fact, in a recent survey of 63 eating disorder patients, 68 percent said they would not choose to continue with online therapy once in-person services resumed.

But some therapists said they are thrilled that virtual services have increased access for patients who would otherwise not be able to travel for treatment. “For my teacher clients, especially, virtual therapy is much more accessible because they can do a session on a planning period or right at the end of the school day,” noted Ms. Trotter, the dietitian. Virtual care can also be more affordable than residential treatment programs.

Sometimes it’s even free. In March of 2020, Diane Summers, a nutrition therapist in Seattle, asked her colleagues if anyone had time to offer no-cost meal support via Instagram Live. “I was kind of hoping for maybe two or three people a day to go live,” she said. “But we were just flooded with willingness to be a part of the project.” Therapists and dietitians signed up in every time zone, enabling the account (@covid19eatingsupport) to offer live meal support 24 hours a day for several months of the pandemic.

When teens fixate on restrictive eating

Teenagers have been particularly vulnerable to developing eating disorders during the pandemic, both because adolescence is already the most common time for such struggles to emerge and because of the added pressures they face now. “It’s a combination of the loss of structure, the loss of peer connections and the loss of their usual activities,” Dr. Muhlheim said. “They have all this time and they decide to focus on an exercise program, or maybe it feels like running is the only thing they can really still do. But we know exercise is a huge trigger.”

That’s how it started for Lily, a 16-year-old high school sophomore in Los Angeles who said that body image anxieties weren’t a big part of her life until the pandemic. “I don’t think weight loss was ever on my mind at all,” she said. “It was more of, ‘I love running, I have all this time, so why not push myself and see how far I can run?’” She began working out every day to fill the time previously occupied by school and team sports. “Lily is super book smart and school comes easily to her, so she’s had a lot of extra time,” with the switch to remote learning, her mom, Nikki, explained. (The family asked to use only their first names to protect Lily’s privacy.)

After a few weeks of intensive exercise, Nikki noticed that Lily was eating less at family meals, too. “I wasn’t necessarily skipping meals, but I was trying to eat less meat and dessert and more vegetables,” Lily said. “I thought I was being healthy.” But she also became more fixated on her weight and further curbed her eating.

In those who are vulnerable to eating disorders, even unintentionally dipping into a negative energy balance, which happens when you expend more energy than you consume in calories, can trigger the rigid, restrictive mindset that is the hallmark of most eating disorders, said Dr. Kenisha Campbell, director of adolescent medicine outpatient clinical services at the Children’s Hospital of Philadelphia.

“Eating disorders are brain disorders because the brain cannot function without appropriate nutrition. So once the ‘eating disorder brain’ is in control, they can’t make any decisions around eating,” explained Dr. Campbell, who specializes in eating disorder treatment. “We have to feed the brain, so the brain can fight the eating disorder.”

By December, Lily often felt dizzy and had developed a resting heart rate of 40 beats per minute, which was dangerously low for her. She was put on bed rest by her family doctor, and a psychologist prescribed an intensive family-based treatment in which her parents planned meals and monitored everything she ate. On tough days, it felt like the whole family was trapped in the house with her eating disorder, Nikki said.

Lily knows that once going out for dinner or getting ice cream with friends is again an option, she’ll be presented with more challenges than she currently has when eating in the safety of her own home. “It doesn’t feel like I have to miss out on things because of my eating disorder,” she said. “I’m missing out on everything because of the pandemic.”


Virginia Sole-Smith is the author of “The Eating Instinct: Food Culture, Body Image and Guilt in America,” and writes the newsletter Burnt Toast.

When I Lost My Sense of Taste to Covid, Anorexia Stepped In

Voices

When I Lost My Sense of Taste to Covid, Anorexia Stepped In

With flavor gone, my old eating disorder came roaring back.

Credit…Nathalie Lees

  • March 3, 2021, 11:22 a.m. ET

The day after my family and I were diagnosed with Covid-19 last September, I made myself a cup of coffee. I had been awake most of the night with chills and hoped I’d find comfort in its familiar aroma and warmth.

I lowered my face to the surface of my mug and inhaled. Nothing. I started searching for smell wherever I could. In the bathroom, I untwisted the cap on one of my perfume bottles and couldn’t detect its jasmine fragrance. I brought a candle up to my nose, but it was scentless.

When I sipped my coffee, all I could sense was its warmth. I started to make breakfast for my 4-year-old daughter and my 3-year-old son ­— maybe there I could find something with taste. I put a strawberry in my mouth and could feel its seeds but couldn’t detect its sweetness. I bit down on an almond-butter granola bar, sinking my teeth into the sadness of a reality I didn’t want to face.

I was diagnosed with anorexia at age 12, the year after my mom died. She’d been sick with metastatic breast cancer for three years, and even when it spread to her bone marrow, her liver and her brain, I was still convinced she’d get better. It’s what my family had told me, and so I believed it to be true. Until it wasn’t.

When she died, I felt as though life had become out of control. Pretty quickly, I realized that I could not impose order on the larger world, but I could control something that had always been in my life and always would be: food. And so began a three-year stretch of multiple hospitalizations and a 17-month-long stay at a residential treatment facility.

Now, at 35, after 20 years in recovery, I’m far better than I’d ever thought I’d be. But some days, my mind still flirts with anorexia. The disorder secretly seduces me, satisfying my affinity for control and order. It always lurks in the background and I have to make a concerted effort to keep it cornered.

Without taste, I was triggered. Anorexia beckoned me, reminding me that I could shed even more weight off my already slender frame if I skimped here and slacked there. When I would make my breakfast in the mornings after losing my taste, I’d forgo frothed milk in my coffee, opting to drink it black instead. I’d put one and a half slices of cheese on my grilled cheese sandwich instead of two and a half. I’d start to place granola on top of my yogurt, but uncomfortably familiar questions would stop me.

Do you really need to eat that? Why waste the calories?

Without taste, food became a formality. It was merely sustenance, and so I settled for the bland, bare minimum. Chewing felt like a chore, and every bite took effort I didn’t want to expend.

I was craving comfort. After days of not eating enough, I decided to seek it in a food that I used to love eating with my mom: ice cream. I ordered a pint of Ben and Jerry’s Glampfire Trail Mix and as soon as it arrived I dug my spoon into satisfying chunks of pretzel, chewy marshmallows and crunchy fudge-covered almonds. I couldn’t taste a thing, but I detected texture. I liked the act of digging my teeth into something that took work to chew. I liked hearing the crunch of the almonds, and swirling the softness of marshmallow in my mouth.

I found myself relating to one of Ben & Jerry’s founders, Ben Cohen, who has very little sense of taste and no sense of smell. When he and his partner, Jerry Greenfield, were developing their signature ice cream in the 1970s, anosmia-stricken Ben advocated for chunks. He became the texture taster, the one who would determine if teeth could be satisfied even when the tongue could not. After three small spoonfuls, I put the ice cream back in the freezer, not allowing myself to have any more.

There are often competing forces at play in my recovery; the healthy side of me that recognizes I need to eat more and wants to indulge in foods I enjoy, and the old eating disorder that tells me I shouldn’t.

The next day, family friends dropped off a homemade broccoli and cheese casserole, coloring books for my kids and a dozen bags of groceries filled with food we like to eat: cinnamon raisin bagels, red grapes, smoothie mixes and more. I wanted nothing more than to enjoy the home-cooked meal, which looked like something my mom would have made. I ate some of it, but not enough.

As our symptoms subsided and our two-week quarantine ended, I started to see the effects of eating too little. I could see it in my slightly sunken-in cheeks, could feel it in the contours of my hip bone, could hear it in my stomach, which groaned in the dark of night. I took a photo of myself and recognized I was too thin. My husband noticed, too. He reassured me that my taste would come back, and he reminded me of how much traction I’d lose if I let myself get stuck in the setback.

Over the years, I’ve had to change my perspective on what it means to be in recovery. I used to strive for “full recovery” — a life without slip-ups or setbacks — and would always feel like I had failed whenever I faltered. Now I frame my thinking around what I call “the middle place,” that sticky space between sickness and full recovery. I make it my goal to continuously progress through that space — for myself, for my family. Recovery is about recognizing that I’m in control of my choices, even when anorexia comes knocking, pleading for another chance. During Covid, I opened the door a crack, but eventually closed it.

My sense of taste was gone for about five weeks, and once it came back I started to regain my footing and, eventually, the pounds I had lost. Taste first showed up one morning when I was eating a banana; soon more flavors re-emerged.

And then one Sunday afternoon, I ate creamy tomato bisque and felt and smelled and tasted every single spoonful. There was the warmth, the savory tomatoes, the bliss of basil.

I finished the soup and was still hungry. So I got myself a generous side of crackers and Gouda cheese, which I ate with unfettered enjoyment. For the first time in five weeks, I finished that meal feeling full.

If you need help with an eating disorder, the National Eating Disorders Association helpline can be reached at 800-931-2237. For crisis situations, text “NEDA” to 741741 to be connected with a trained volunteer at Crisis Textline.


Mallary Tenore Tarpley teaches journalism at the University of Texas at Austin, where she is the associate director of the Knight Center for Journalism in the Americas. She is writing a memoir about her childhood experiences with anorexia.

Exercise vs. Diet? What Children of the Amazon Can Teach Us About Weight Gain

A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.
A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.Credit…Samuel S. Urlacher, Ph.D.

Phys Ed

Exercise vs. Diet? What Children of the Amazon Can Teach Us About Weight Gain

What we eat may be more important than how much we move when it comes to fighting obesity.

A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.Credit…Samuel S. Urlacher, Ph.D.

Gretchen Reynolds

  • Feb. 24, 2021, 5:00 a.m. ET

When children gain excess weight, the culprit is more likely to be eating too much than moving too little, according to a fascinating new study of children in Ecuador. The study compared the lifestyles, diets and body compositions of Amazonian children who live in rural, foraging communities with those of other Indigenous children living in nearby towns, and the results have implications for the rising rates of obesity in both children and adults worldwide.

The in-depth study found that the rural children, who run, play and forage for hours, are leaner and more active than their urban counterparts. But they do not burn more calories day-to-day, a surprising finding that implicates the urban children’s modernized diets in their weight gain. The findings also raise provocative questions about the interplay of physical activity and metabolism and why exercise helps so little with weight loss, not only in children but the rest of us, too.

The issue of childhood obesity is of pressing global interest, since the incidence keeps rising, including in communities where it once was uncommon. Researchers variously point to increasing childhood inactivity and junk food diets as drivers of youthful weight gain. But which of those concerns might be more important — inactivity or overeating — remains murky and matters, as obesity researchers point out, because we cannot effectively respond to a health crisis unless we know its causes.

That question drew the interest of Sam Urlacher, an assistant professor of anthropology at Baylor University in Waco, Texas, who for some time has been working among and studying the Shuar people. An Indigenous population in Amazonian Ecuador, the traditional Shuar live primarily by foraging, hunting, fishing and subsistence farming. Their days are hardscrabble and physically demanding, their diets heavy on bananas, plantains and similar starches, and their bodies slight. The Shuar, especially the children, are rarely overweight. They also are not often malnourished.

But were their wiry frames a result mostly of their active lives, Dr. Urlacher wondered? As a postgraduate student, he had worked with Herman Pontzer, an associate professor of evolutionary anthropology at Duke University, whose research focuses on how evolution may have shaped our metabolisms and vice versa.

In Dr. Pontzer’s pioneering research with the Hadza, a tribe of hunter-gatherers in Tanzania, he found that, although the tribespeople moved frequently during the day, hunting, digging, dragging, carrying and cooking, they burned about the same number of total calories daily as much-more-sedentary Westerners.

Dr. Pontzer concluded that, during evolution, we humans must have developed an innate, unconscious ability to reallocate our body’s energy usage. If we burn lots of calories with, for instance, physical activity, we burn fewer with some other biological system, such as reproduction or immune responses. The result is that our average, daily energy expenditure remains within a narrow band of total calories, helpful for avoiding starvation among active hunter-gatherers, but disheartening for those of us in the modern world who find that more exercise does not equate to much, if any, weight loss. (Dr. Pontzer’s highly readable new book on this topic, “Burn,” will be published on March 2. )

A young Shuar boy fills a water gourd in the river.
A young Shuar boy fills a water gourd in the river.Credit…Samuel S. Urlacher, Ph.D.

Dr. Pontzer’s work focuses primarily on Hadza adults, but Dr. Urlacher wondered if similar metabolic trade-offs might also exist in children, including among the traditional Shuar. So, for a 2019 study, he precisely measured energy expenditure in some of the young Shuar and compared the total number of calories they incinerated with existing data about the daily calories burned by relatively sedentary (and much heavier) children in the United States and Britain. And the totals matched. Although the young Shuar were far more active, they did not burn more calories, over all.

Young Shuar differ from most Western children in so many ways, though, including their genetics, that interpreting that study’s findings was challenging, Dr. Urlacher knew. But he also was aware of a more-comparable group of children only a longish canoe ride away, among Shuar families that had moved to a nearby market town. Their children regularly attended school and ate purchased foods but remained Shuar.

So, for the newest study, which was published in January in The Journal of Nutrition, he and his colleagues gained permission from Shuar families, both rural and relatively urban, to precisely measure the body compositions and energy expenditure of 77 of their children between the ages of 4 and 12, while also tracking their activities with accelerometers and gathering data about what they ate.

The urban Shuar children proved to be considerably heavier than their rural counterparts. About a third were overweight by World Health Organization criteria. None of the rural children were. The urban kids also generally were more sedentary. But all of the children, rural or urban, active or not, burned about the same number of calories every day.

What differed most were their diets. The children in the market town ate far more meat and dairy products than the rural children, along with new starches, like white rice, and highly processed foods, like candy. In general, they ate more and in a more-modern way than the rural children, and it was this diet, Dr. Urlacher and his colleagues conclude, that contributed most to their higher weight.

These findings should not romanticize the forager or hunter-gatherer lifestyle, Dr. Urlacher cautions. Rural, traditional Shuar children face frequent parasitic and other infections, as well as stunted growth, in large part because their bodies seem to shunt available calories to other vital functions and away from growing, Dr. Urlacher believes.

But the results do indicate that how much children eat influences their body weight more than how much they move, he says, an insight that should start to guide any efforts to confront childhood obesity.

“Exercise is still very important for children, for all sorts of reasons,” Dr. Urlacher says. “But keeping physical activity up may not be enough to deal with childhood obesity.”

Modern Love: I Wanted to Love Her, Not Save Her

Modern Love

I Wanted to Love Her, Not Save Her

The first time we spoke, she was so weak she had collapsed. Why did that not alarm me?

Credit…Brian Rea

  • Feb. 19, 2021, 12:00 a.m. ET

When Darla and I had our first real conversation, she was so delirious from hunger that she had passed out behind the self-help section where she had been pretending to shelve books. I found her lying on the dingy store carpeting, propped up on one pencil-thin arm, eyelids fluttering, trying to focus on me.

Months later, she would tell me that she hadn’t been able, in the moment, to distinguish between me and one of our co-workers, an acne-covered teenager who might have vaguely resembled me, I guess, in the eyes of someone as starved as she was. I was neither acne-covered nor a teenager but a 22-year-old aspiring writer who was working at a chain bookstore in Minneapolis for lack of any better ideas.

“Are you all right?” I asked.

She nodded and took my hand. Hers felt so cold I had an impulse to rub some warmth into it.

“Did anyone see me fall down?”

I shook my head no. “What happened?”

“I haven’t eaten in days. I’m anorexic.” She said this in such a matter of fact, unashamed way that I accepted it as if she were telling me her birth sign.

“Do you want me to get you something to eat?” I asked.

She smiled, maybe recognizing me for the first time in the conversation. Although we had worked together for a few months, we barely knew each other.

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“It doesn’t work like that,” she said. “Just sit here with me until I get my strength back.”

So I did.

After that, we talked a lot. I told her about my plans to drive my old Chevy Malibu to Kansas City, where I was planning to crash on the sofa of a friend of a friend, once I had saved enough money. She told me about the poetry she was writing and the crush she harbored on our assistant manager. We discovered that we shared a love of Jack Kerouac. I told her that my Kansas City adventure was supposed to be my “On the Road” moment.

“Did you know that the Walker Museum has a Beat Generation exhibit right now?” she said. “You can see Kerouac’s typewriter with the actual scroll of ‘On the Road.’”

We went to the exhibit and saw the scroll. She talked about all the places she hadn’t been, and I told her how badly I wanted to see the world, to have an adventure.

“Maybe you’re having an adventure now,” she said, taking my hand. Hers was warmer this time.

Soon she stopped talking about the assistant manager, but she didn’t stop starving herself.

I didn’t try to help her with that. I’m not sure why. It’s as if I accepted her struggle as a given, as a fact of her. I was struggling myself after a recent heartbreak and was trying to teach myself how to do basic things again: to think for myself, to walk properly, to hold myself upright, to sleep and to breathe.

To see her struggle to force down solid food, to watch as she spread a thin layer of butter on a saltine that she would chew to a paste before it would go down (this was her only meal some days) seemed not natural, of course, but also somehow unremarkable to me. I watched her starve and held her while she did it.

Some people might call that enabling. I called it love.

Maybe I wasn’t so wrong. A few years ago, I read about a study in which the researchers suggested that kissing may counteract anorexia. I’m sure there’s a healthy and deserved skepticism about such claims, but wouldn’t it be nice if it were true, that love could cure a dangerous illness? Anyway, what a scientific experiment that must have been!

When Darla and I kissed for the first time, it didn’t cure her of anything, but it did cure me of my dream of going to Kansas City. I still have never been there, all these years later. I have no desire to go.

To anyone observing us then, with Darla being so dangerously thin, I must have looked like a bystander who had come upon an accident victim in a burning car and asked her about her favorite music instead of pulling her from the flames.

It’s not that I didn’t want to risk burning my hands. It’s more that my instinct was to burn along with her. A better person, I realize, would have driven her to the nearest rehab center, but doing so never even occurred to me.

Instead, Darla and I engaged in our own private version of the kissing cure. What were the results? It would take a long time to find out.

Those first few months were our adventure. We quit our jobs at the bookstore. Instead of driving alone to Kansas City, I sold my Chevy Malibu and used the money to buy us tickets on an Amtrak train headed west.

As we stared at the map of America at the station, she said, “Where will we go?”

I told her to pick the most romantic-sounding name along the Empire Builder line, which led to us buying two tickets on a sleeper car to West Glacier, Mont.

For participants in the kissing cure, I would recommend a berth on an Amtrak sleeper car, where you can seal yourself away from the world, rattling through the night and swaying together under the blanket with each curve of the tracks. At every station, we would put on our glasses (we had the same prescription and sometimes would wear each other’s) and look out the window at the smokers on the station platforms hurrying to get in their last inhales before the “All aboard!” sounded.

Before the train pulled into West Glacier, the sleeper car attendant had convinced us not to get off. “This is a summer resort town, my dears,” he had said, “and it’s November. Unless you want to sleep at the station, you had better stay on until Whitefish.”

It was good advice. We hadn’t booked anyplace to stay in West Glacier, thinking we would just find a hostel when we got off. The truth is we likely would have fought, cried, frozen and headed back home, with our adventure prematurely ended.

Thanks to the attendant, though, we stayed on until Whitefish, spent a week taking in the mountain views and then, longing for our sleeper car, boarded the Empire Builder again, this time for Seattle, where we spent another week at a hostel before taking the Coast Starlight to Sacramento. From there, we took a bus to San Francisco and then to Flagstaff, Ariz., where we used the last of our remaining savings to rent a trailer in a trailer park where we had our first Christmas together.

Darla was eating a little more by then. Not much, but a little. She seemed to have more energy. We stayed for a few months, supporting ourselves with temp work, driving a $500 car the owner of the trailer had sold us — until it stopped running.

When our money ran out, we ran back home to the Midwest and got married soon after. Recently we celebrated our 23rd anniversary. Last year, our son turned 18.

For those interested in the kissing cure, I will say this in support: Darla has gained enough weight over the years that she was actually thinking about going on a diet until the pandemic lockdown trimmed us both down (many people put on pounds during this time, but our instinct was to limit trips to the grocery store, which had a slimming effect).

We have been together long enough now that those early versions of ourselves seem like children. In snapshots from those times, I see her in overalls and T-shirt, skeletally thin but beaming with the happiness of new love and the promise of adventure.

Our married life has not been without conflicts. I have taken her for granted, put my needs ahead of hers, indulged my weaknesses. But I never have regretted the fact that I did the possibly irresponsible thing back then by not acting alarmed about her anorexia, by not pressuring her to do anything about it, and instead just loving her for who she was. She never wanted heroic intervention from me or from anyone else. She triumphed over her issues with food on her own terms and is happy for me to be sharing our story now.

This is the confession of an enabler, I suppose. Or maybe I simply don’t know the difference between enabling and loving. What I do know is that I never would have wanted to be a participant in any experiment other than the one Darla and I unwittingly enrolled in all those years ago.

Adam Barrows teaches in the English department at Carleton University in Ottawa, Ontario.

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Modern Love Podcast: With the Help of Strangers

Modern Love Podcast: With the Help of Strangers

Two women find allies to survive difficult times.

Hosted by Daniel Jones and Miya Lee, produced by Hans Buetow and Kelly Prime, and edited by Sara Sarasohn and Wendy Dorr; music by Dan Powell; read by Julia Whelan and Eliza Rudalevige

Dec. 9, 2020, 4:01 p.m. ET

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[New York Times subscribers are invited to join the hosts Daniel Jones and Miya Lee on Dec. 15 for an evening of performances and special guests, celebrating the new “Tiny Love Stories” book. RSVP here.]

‘‘In trying to persuade me to file charges, my father said, ‘What would you tell your little sisters to do?’”

Credit…Brian Rea

This episode contains descriptions of domestic violence.

In 2013, Courtney Queeney published “The View From the Victim Room,” an essay about surviving domestic violence and the legal proceedings that followed. “I couldn’t sit or lean against anything comfortably because my head was still a battered, crusty mess,” she wrote.

In the essay, she described going to a courthouse every two weeks to renew her emergency protection order against her ex. It was during this period that she found “scattered bright spots” — things to laugh about when everything seemed unfunny. She found comfort in the woman who shared her court schedule; her lawyer, whom she revered; and the judge who made her crack up.

Today, we hear about how Courtney has worked through the experience and aftermath of her abuse — and where is she now.

Today’s stories

The View From the Victim Room,” by Courtney Queeney

Courtney’s essay ended with her walking “out of court into so much sunshine.” But as she explained to Daniel Jones in this podcast episode, the seven years since her essay was published have not been easy. “I just want to get somewhere back to whatever my normal was,” she said.

One of the things that have helped her is her recent decision to become a court advocate. Reflecting on the many people who have supported her, from lawyers to therapists, Courtney said, “I’ll never be able to adequately thank all of them for what they did for me.”

“I’m a stranger to a lot of them,” she continued, “but what I can do is be that person to somebody else who needs a person.”

Held by String,” by Eliza Rudalevige

In her Tiny Love Story, Eliza writes about a woman named Shelly, whom she met in an eating disorder recovery program when she was 11. Eliza was the youngest in the program, while Shelly, in her 60s, was the oldest.

When Eliza was released from the program after 100 days, Shelly gave her a handmade bracelet, which Eliza still has seven years later. “Looking at the beads nestled in the tough leather, I think of the young girl in the veteran’s arms,” Eliza wrote.

Shelly became a protector of sorts for Eliza, encouraging counselors to “tone down their harshness” toward her and making her feel less alone. When Miya, a host of the podcast, asked Eliza what she would say to Shelly if she were to see her again, she said, “I don’t think I ever said thank you to her. So I think I’d say thank you.”

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If you or someone you know is being abused, support and help are available around the clock. Visit the National Domestic Violence Hotline’s website or call 1-800-799-SAFE (7233).

Hosted by: Daniel Jones and Miya Lee
Produced by: Kelly Prime and Hans Buetow
Edited by: Wendy Dorr
Music by: Dan Powell
Held by String,” written and read by Eliza Rudalevige
The View From the Victim Room,” narration by Julia Whelan, produced by Ryan Wegner and Kelly Rogers at Audm
Executive Producer, NYT Audio: Lisa Tobin
Assistant Managing Editor, NYT: Sam Dolnick

Special thanks: Nora Keller, Mahima Chablani, Julia Simon, Laura Kim, Bonnie Wertheim, Anya Strzemien, Joanna Nikas and Choire Sicha.

Want more from Modern Love? Watch the TV series and sign up for the newsletter. We also have swag at the NYT Store and two books, “Modern Love: True Stories of Love, Loss, and Redemption” and “Tiny Love Stories: True Tales of Love in 100 Words or Less.”

The Urgency in Fighting Childhood Obesity

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Credit Paul Rogers

Life-threatening ailments like heart disease, cancer, stroke and Type 2 diabetes most often afflict adults. But they are often consequences of childhood obesity.

Two new studies, conducted among more than half a million children in Denmark who were followed for many years, linked a high body mass index in children to an increased risk of developing colon cancer and suffering an early stroke as adults. The studies, presented at the European Obesity Summit in Gothenburg, Sweden, this spring, underscore the importance of preventing and reversing undue weight gain in young children and teenagers.

One study, of more than 257,623 people, by Dr. Britt Wang Jensen and colleagues at the Institute of Preventive Medicine, in Bispebjerg, Denmark, and Frederiksberg Hospital in Copenhagen, grouped children according to standard deviations from a mean B.M.I., adjusted for a child’s age and sex.

They found that each unit of increase in being overweight at age 13, generally corresponding to a two- to three-point increase in B.M.I., increased the risk of developing colon cancer by 9 percent and rectal cancer by 11 percent.

The second study, involving 307,677 Danish people born from 1930 to 1987, used a similar grouping of B.M.I. The risk of developing a clot-related stroke in early adult life increased by 26 percent in women and 21 percent in men for each unit of increase in being overweight at all stages of childhood, but especially at age 13.

Although neither study proves that excess weight in childhood itself, as opposed to being overweight as an adult, is responsible for the higher rates of cancer and stroke, overweight children are much more likely to become overweight adults — unless they adopt and maintain healthier patterns of eating and exercise.

According to the American Academy of Child and Adolescent Psychiatry, obesity most often develops from ages 5 to 6 or during the teen years, and “studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.”

In a study published in 2014 in The New England Journal of Medicine, Solveig A. Cunningham and colleagues at Emory University found that “overweight 5-year-olds were four times as likely as normal-weight children to become obese by age 14.” The study, which involved a representative sample of 7,738 kindergartners, found that the risk of becoming obese did not differ by socioeconomic status, race or ethnic group, or birth weight. Rather, it showed that excess weight gain early in life is a risk factor for obesity later in childhood across the entire population.

Children are generally considered obese when their B.M.I. is at or above the 95th percentile for others of the same age and sex. Currently, about one-third of American children are overweight or obese. By 2012, the Centers for Disease Control and Prevention reports, 18 percent of children and 21 percent of adolescents were obese.

The adverse effects of excess weight in childhood and adolescence don’t necessarily wait to show up later in life. In a review of complications resulting from youthful obesity, Dr. Stephen R. Daniels, a pediatrician at the University of Colorado School of Medicine and the Children’s Hospital in Denver, found that problems in many organ systems were often apparent long before adulthood. They include high blood pressure; insulin resistance and Type 2 diabetes; high blood levels of heart-damaging triglycerides and low levels of protective high-density lipoprotein (HDL) cholesterol; nonalcoholic fatty liver disease; obstructive sleep apnea; asthma; and excess stress on the musculoskeletal system resulting in abnormal bone development, knee and hip pain, and difficulty walking.

Problems of youthful obesity go beyond physical ones. Obese adolescents have higher rates of depression, which in itself may foster poor eating and exercise patterns that add to their weight problem and result in a poor quality of life that persists into adulthood.

In a study conducted in Singapore, researchers reported that “individuals who were obese in childhood are more likely to have poor body image and low self-esteem and confidence, even more so than those with adult onset obesity.”

Another study by Dr. Jeffrey B. Schwimmer of the University of California, San Diego, and colleagues found that obese children and adolescents reported a diminished quality of life that was comparable to that of children with cancer.

Taken together, the data speak to the critical importance of preventing undue weight gain in young children, a task that depends largely on parents, who are responsible for what and how much children eat and how much physical activity they engage in. As researchers from the University Medical Center Groningen in the Netherlands put it, “Early recognition of overweight or obesity in children by their parents is of utmost importance, allowing interventions to start at a young age.” Yet, they found in a study of the parents of 2,203 5-year-olds, “parents underestimated their overweight child in 85 percent of the cases.”

Though it seems logical that parents who think their children are overweight would make a special effort to assure they would “grow into” their weight as they get older, research has shown the opposite. Such children tend to get even fatter, according to findings from the Longitudinal Study of Australian Children reported in April in the journal Pediatrics by Eric Robinson of the University of Liverpool and Angelina R. Sutin of Florida State University College of Medicine.

Even being labeled overweight can itself be damaging and make it harder for children to avoid bad habits, the authors suggested. A 2014 study of girls aged 10 to 19 found that “regardless of actual weight, adolescents who reported having been labeled ‘too fat’ by a family member or peer were more likely to become obese nearly a decade later.”

“I encourage parents to change the environment at home,” Dr. Daniels of the University of Colorado said in an interview. “Without being authoritarian, they should limit high-calorie-dense foods, keep sugar-sweetened beverages out of the house and assure that kids eat the right amount of fruits and vegetables and fewer calorie-dense snacks. Parents also need to be tuned into opportunities for physical activity and set hard-and-fast rules about television and time spent on electronics.”

Following the “5210” daily program endorsed by the American Academy of Pediatrics can help: Aim for five fruits and vegetables a day; keep recreational screen time to two hours or less; include at least one hour of active play: and skip sugar-sweetened beverages and drink water.

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Parents Should Avoid Comments on a Child’s Weight

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Credit Stuart Bradford

Should parents talk to an overweight child about weight? Or should they just keep their mouths shut?

Parents in this situation are understandably torn. Say something, and they risk shaming a child or worse, triggering an eating disorder. Say nothing, and they worry they’re missing an opportunity to help their child with what could become a serious long-term health problem.

Now a new study offers some guidance: Don’t make comments about a child’s weight.

The study, published in the journal Eating & Weight Disorders, is one of many finding that parents’ careless — though usually well-meaning — comments about a child’s weight are often predictors of unhealthy dieting behaviors, binge eating and other eating disorders, and may inadvertently reinforce negative stereotypes about weight that children internalize. A parent’s comments on a daughter’s weight can have repercussions for years afterward, contributing to a young woman’s chronic dissatisfaction with her body – even if she is not overweight.

“Parents who have a child who’s identified as having obesity may be worried, but the way those concerns are discussed and communicated can be really damaging,” said Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut. “The longitudinal research shows it can have a lasting impact.”

The impact on girls may be especially destructive, she said, because “girls are exposed to so many messages about thinness and body weight, and oftentimes women’s value is closely linked to their appearance. If parents don’t challenge those messages, they can be internalized.”

The new study included over 500 women in their 20s and early 30s who were asked questions about their body image and also asked to recall how often their parents commented about their weight. Whether the young women were overweight or not, those who recalled parents’ comments were much more likely to think they needed to lose 10 or 20 pounds, even when they weren’t overweight.

The study’s lead author, Dr. Brian Wansink, a professor and the director of Cornell University’s Food and Brand Lab, characterized the parents’ critical comments as having a “scarring influence.”

“We asked the women to recall how frequently parents commented, but the telling thing was that if they recalled it happening at all, it had as bad an influence as if it happened all the time,” said Dr. Wansink, author of the book “Slim by Design.” “A few comments were the same as commenting all the time. It seems to make a profound impression.”

Some studies have actually linked parents’ critical comments to an increased risk of obesity. One large government-funded study that followed thousands of 10-year-old girls found that, at the start of the study, nearly 60 percent of the girls said someone — a parent, sibling, teacher or peer – had told them they were “too fat.” By age 19, those who had been labeled “too fat” were more likely to be obese, regardless of whether they were heavy at age 10 or not.

Comments made by family members had even stronger effects than comments made by unrelated people.

Several studies have found that when parents encourage overweight teenagers to diet, the teenagers are at higher risk of lower self-esteem and depression and of being overweight five years later.

Research by Dianne Neumark-Sztainer, a professor at the University of Minnesota, found that when parents talked to their teens about losing weight, teenagers were more likely to diet, use unhealthy weight-control behaviors and binge eat. Those behaviors are less likely to develop when conversations with parents focused on healthy eating behaviors, rather than weight per se.

Harsh comments about weight can send the message that parents are “tying weight to some kind of perception about how the child is valued,” Dr. Puhl said, and that can trigger negative feelings. “The children are internalizing that, and thinking they’re not O.K. as a person. And that is what’s leading to other outcomes, like disordered eating.”

So what’s a parent to do? Do they just stand by while their child gains weight?

Dr. Neumark-Sztainer was besieged by parents asking her this question, and wondering, “How do I prevent them from getting overweight and still feel good about themselves?”

In her book, called “I’m, Like, SO Fat: Helping Your Teen Make Health Choices About Eating and Exercise in a Weight-Obsessed World,” she notes that parents can influence a child’s eating habits without talking about them. “I try to promote the idea of talking less and doing more — doing more to make your home a place where it’s easy to make healthy eating and physical activity choices, and talking less about weight.”

For parents, that means keeping healthy food in the house and not buying soda. It means sitting down to enjoy family dinners together, and also setting an example by being physically active and rallying the family to go for walks or bike rides together. Modeling also means not carping about your own weight. “Those actions speak louder than words,” Dr. Puhl said.

While your children are young, “there doesn’t need to be a conversation at all – it really is just about what’s being done at home,” Dr. Neumark-Sztainer said.

If an older child is overweight, “wait for your child to bring it up, and be there to support them when they do,” she said. “Say, ‘Look, I love you no matter what size you are, but if you would like, I will support you. I suggest we focus not so much on your weight but on your eating patterns and behaviors. What would be helpful for you?’”

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An Eating Disorder in People With Diabetes

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Credit Luba Lukova

The first time she skipped an insulin dose, the 22-year-old said, it wasn’t planned. She was visiting her grandparents over a summer break from college and indulged in bags of potato chips and fistfuls of candy, but forgot to take the extra insulin that people with Type 1 diabetes, like her, require to keep their blood sugar levels in a normal range.

She was already underweight after months of extreme dieting, but when she stepped on the scale the next day, she saw she had dropped several pounds overnight. “I put two and two together,” said the young woman, who lives in Boston and wished to remain anonymous.

She soon developed a dangerous habit that she used to drive her weight down: She would binge, often consuming an entire pint of Ben & Jerry’s peanut butter cup ice cream, and then would deliberately skip the insulin supplements she needed.

People with Type 1 diabetes, who don’t produce their own insulin, require continuous treatments with the hormone in order to get glucose from the bloodstream into the cells. When they skip or restrict their insulin, either by failing to take shots or manipulating an insulin pump, it causes sugars — and calories — to spill into the urine, causing rapid weight loss.

But the consequences can be fatal. “I knew I was playing with fire, but I wasn’t thinking about my life, just my weight,” said the young woman, who was treated at The Renfrew Center of Boston, which specializes in treating eating disorders, and is in recovery. “I got used to my blood sugars running high all the time. I would get so nauseous I would throw up, which I knew was a serious sign that I should go to the hospital. It was very scary.”

The eating disorder the young woman developed is unique to people with Type 1 diabetes and has been called diabulimia, though it is not a recognized medical condition. (People with Type 2 diabetes who take insulin do not have the same rapid response to insulin restriction.) It occurs when patients manipulate their insulin in order to purge calories, much as someone with bulimia might induce vomiting to lose weight.

Insulin restriction can lead to diabetic ketoacidosis, a potentially fatal condition that develops when the body lacks insulin and starts to break down fat, producing ketones that can poison the body. It also increases the risk of serious long-term complications of diabetes, including kidney disease, blindness, nerve damage, amputations and heart disease.

“It’s a Faustian bargain,” said Dr. Henry Cheng, the Northeast regional medical director for The Renfrew Center.

Young women with Type 1 diabetes, which is often diagnosed in the pre-teenage years, when girls may be preoccupied with weight and body image, are at 2.4 times the risk of developing an eating disorder than other young women without diabetes, research suggests. Weight loss is often the first symptom of Type 1 diabetes, but once the condition is diagnosed and patients start insulin treatment, they tend to gain weight.

The combination of Type 1 diabetes and an eating disorder is “very dangerous,” said Ann Goebel-Fabbri, a psychologist in Brookline, Mass., who specializes in treating people with diabetes who have eating disorders. “Anorexia is the most lethal psychiatric diagnosis that exists, and the risk of mortality is so much more heightened when Type 1 diabetes is added.”

Research suggests insulin manipulation is not uncommon. A recent study in Germany found that among patients ages 11 to 21 who were being treated with insulin for Type 1 diabetes, one in three girls and one in six boys had reported either disordered eating, insulin restriction or both.

Another study from the Joslin Diabetes Center in Boston that followed 234 adult women with Type 1 diabetes for 11 years found that 30 percent reported engaging in insulin restriction behaviors. Those who restricted insulin died at an average age of 45, compared with 58 for those who didn’t restrict insulin.

Treatment for diabulimia is especially challenging because approaches to managing eating disorders and diabetes are at odds with one another, said Trish Lieberman, the director of nutrition at Renfrew. “The treatment for diabetes includes very intense focus on reading labels, counting calories and carbohydrates, and limiting sodium and fat,” she said. “All these things that are very effective for treating diabetes are actually contraindicated for eating disorders, where we try to take a more intuitive approach, saying there aren’t good or bad foods.”

Indeed, Dr. Goebel-Fabbri said, the meticulous focus on food in diabetes “can mimic an eating disorders mind-set.”

An added danger occurs when diabetic patients disengage from their medical care, she said. That’s what happened to the Boston college student, who put off going to the doctor for months at a time, hoping the delays would give her time to change her behavior and improve her blood glucose test results. She was alarmingly underweight, and her friends and family were concerned.

Last spring, with severe pain racking her body and fearful she had damaged her kidneys (she had not), she finally enrolled in an intensive five-week day treatment program at Renfrew, followed by a slightly less intensive six-week program.

“At that point, it wasn’t so much for me,” she said. “I almost felt like if I were to die, I would deserve it. I was thinking more of my mom. I couldn’t do that to my mother.”

Though she still suffers from obsessive thoughts about food, she said, “I’m in a much better place. My weight is at a healthy range. I’m more comfortable about reaching out when I need help.”

Experts say both physicians and family members should be on the lookout for eating disorders in Type 1 diabetes patients who have repeated episodes of ketoacidosis, or consistently poor blood sugar control that doesn’t improve. While eating disorders usually develop during the preteen and teenage years, they may emerge later, during college or early adulthood, in those with Type 1 diabetes, experts say.

Once patients get help and start recovering, they can regain their health and stave off long-term complications, Dr. Goebel-Fabbri said. “What’s so positive, and what people need to hear, is that healing can occur, once blood sugar gets to a healthier range.”

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