A WEIGHTY SUBJECT Do you or someone you know, such as a daughter or son, eat too much or too little because of anxiety or other stress? Barbra Streisand and other famous performers battle with eating to relax, especially before a live performance. Her limousine is like a delicatessen so she can eat herself into relaxing. Maybe you eat to relax before going to a meeting or speaking in public. Princess Diana had the same problem: bulimia, apparently from TMS stress reasons. Others almost starve themselves because they want to be thin for one reason or another, an eating disorder known as anorexia. Eating too much or too little can be a sign that a person needs to recognize they have TMS and that a repressed emotion may be the cause of their weighty problem. Princess Diana had an over-eating problem, diagnosed as bulimia. It sounds very much like the problem was TMS-caused, because she sure had her marital anxieties which may very well have caused her to turn to food as the answer to the emptiness she felt in her marriage. Due to Diana’s openness and willingness to communicate, we have a better understanding of the eating disorder, bulimia. Diet and health researchers said there are lessons to be learned from her public admissions that she had problems with eating and food. This is what they learned about bulimia: Bulimia can be the response to great pressure in one’s life, especially for those with perfectionist tendencies and expectations (sound like TMS?). Bulimia is often a cry for help or a plea for attention. A person often needs people to understand them, but does know how to attract their attention in a positive way, not over-eat to solve their emotional problem. Low self esteem or self-bullying can bring on bulimia or other eating disorder. These emotional problems can cause a person to do things to injure themselves, such as bingeing on food and then purging it later. Overeating, or bingeing, can provide a sense of comfort when a person feels alone or helpless. Guilt and shame that follows often causes the person to try to get rid of the extra calories through vomiting, using laxatives or water pills, or excessive exercise. When Diana spoke about her bulimia, she wanted people to know that those with eating disorders are often misunderstood. While the media led people to believe that her bulimia was the problem, she asserted that bulimia was only a symptom, and that the true problem was the emptiness she felt in her marriage. She was using food as a way to fill her emptiness, and her eating disorder as an escape mechanism. The flip side of the weighty problem is anorexia nervosa. The Mayo Clinic says it is an eating disorder that causes people to obsess about their weight and the kinds of foods they eat. They try to maintain a weight that is far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively. I used to date a beautiful school teacher who began to lose weight on purpose and stuck to a diet mainly eating grains and beans. She became so thin, her arms and legs like broomsticks, that her friends, I included, urged her to see a doctor, but she didn’t. I went to one of her backyard cookouts and looked at the plate of food she served me. It was just a pile of bulgur, a cereal food made from the groats of several different wheat species, most often from durum wheat. I tasted a little of the food on my plate, but it had no taste or aroma. Not a spice in the pile. When my hostess wasn’t looking, I lowered the plate and offered it to my dog, Chelsea, a big black Lab. She took one sniff and turned away. My friend taught elementary school and may have been under stress from her job, and teachers know how true that can be. She may have had romantic problems none of us knew about. She moved away after a while and I don’t know if she overcame her anorexia. Eating such a strict diet of bulgur was a fad back then, in the 1980s, when people thought it was healthy to eat such a limited diet and weigh so little. But in more recent years, dieticians at the Mayo Clinic and others who may not even know about TMS agree that anorexia nervosa isn’t really about food. It’s an unhealthy way to try to cope with emotional problems. When you have anorexia nervosa, you often equate thinness with self-worth. Anorexia can be difficult to overcome, but the Mayo Clinic says that with treatment, you can gain a better sense of who you are, returning to healthier eating habits, and reverse some of the eating disorder’s serious complications. The Clinic does not mention Dr. Sarno or TMS directly, but it is apparent to we who do believe in it that both anorexia and bulimia can be overcome by learning and repressed emotions that caused them. Symptoms of anorexia are if you lose weight mainly through severely restricting how much you eat. You may also try to lose weight by exercising excessively. Exercise, while healthy when done properly, can become addictive and be too much. Others with anorexia binge eat and then purge the food from them, similar to bulimia. Others control calorie intake by vomiting after eating or by misusing laxatives, diuretics, or enemas. No matter how weight loss is achieved, anorexia has a number of physical, emotional and behavioral signs and symptoms. Physical signs of anorexia are extreme weight loss, thin appearance, abnormal blood counts, fatigue, insomnia, dizziness or fainting, a bluish discoloration of the fingers, hair that thins or falls out, absence of menstruation, constipation, dry skin, intolerance of cold, irregular heart rhythms, low blood pressure, dehydration, osteoporosis, swelling of arms or legs. But don’t think that any one or more of these symptoms mean you are anorexic. Get a doctor’s examination if you have more of the symptoms. Symptoms of emotional and behavioral anorexia include refusal to eat, denial of hunger, afraid of gaining weight, lying about how much food has been eaten, excessive exercise, lack of emotion, social withdrawal, irritability, preoccupation with food, reduced interest in sex, depressed mood, possible use of laxatives, diet aids, or herbal products. Anorexia, like bulimia or other eating disorders, can take over your life. You may think about food all the time, spend hours agonizing over options in the grocery store and exercise to exhaustion. You also may have a host of physical problems that make you feel generally miserable, such as dizziness, constipation, fatigue and frequently feeling cold. You may feel irritable, angry, moody, sad, anxious and hopeless. You might visit pro-anorexia websites, refer to the disease as your "friend," cover up in layers of heavy clothing, and try to get by on a menu of lettuce, carrots, popcorn and diet soda. If you're experiencing any of these problems, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a confidant you can talk to about what's going on. If you're concerned that a loved one may have anorexia, watch for these possible red flags: skipping meals, making excuses for not eating, eating only a few “safe” foods that are low in fat and calories, adopting rigid meal or eating rituals such as cutting food into tiny pieces or spitting foods out after chewing, cooking elaborate meals for others but refusing to eat what you prepare, repeatedly weighing themselves, frequently looking in a mirror to see if you’ve lost weight, complaining about being fat, not wanting to eat in public. Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor. There are several commonly recognized causes of anorexia nervosa, but its exact cause is unknown. It could be a combination of biological, psychological, and environmental factors. Those of us who believe in TMS consider it to be psychological, from one or more repressed emotions such as low self-worth, anxiety, stress, guilt, etc. Some people have a tendency toward perfectionism, sensitivity, and perseverance, all traits associated with anorexia that also are TMS-related. Also, young women may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food even if they are hungry. They may have an extreme drive for perfectionism, which means they may never think they’re thin enough. Some may think their boyfriend or husband prefers a thin woman. Or if she has bulimia, she may think the man she loves prefers a more full-bodied woman. “Some like ‘em hot.” Movies and television may influence men as well as women because they emphasize thinness by showing thin actors and models. Success and worth are also often associated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls. If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control. If you decide to see a doctor, do a little journaling first. Write down any symptoms you’re experiencing and when they began. Write down important personal information such as major stresses or recent life changes. Makes a list of medications, vitamins, and supplements you’re taking. Write down questions to ask your doctor. Ask a family member or friend to come with you to the doctor’s appointment. Some cases of anorexia are much more severe than others. Less severe cases may take less time for treatment and recovery. One of the biggest challenges in treating anorexia is that people may not want treatment, may think they don't need it or may be concerned about weight gain. And, some people with anorexia don't see it as an illness, but instead promote it as a lifestyle choice. Although alternative medicine hasn't been well studied as a treatment for people with eating disorders, some alternative treatments can help reduce anxiety. And, such treatments may help people with eating disorders by increasing a sense of well-being and promoting relaxation. Alternative treatments that have been shown to reduce anxiety include meditation, yoga, and to those of us who suggest the eating disorder may be caused by TMS repressed emotions, try recovery techniques such as meditation and journaling to learn what those emotions are. Identify problem situations that are likely to trigger eating too much or too little. If bulimia or anorexia is a problem for you or anyone you know, consider using TMSWiki.org/forum as a support group to learn how to deal with and overcome the problem. I recently read an article by Abby Ellin on the subject called “Fat and Thin Find Common Ground.” She said that unlike people with anorexia or bulimia, who tend to be excessively thin, many binge eaters are overweight or obese. And much of the focus of anti-obesity efforts — listing calories at restaurants, banning cupcakes in schools, sending students home with body mass index “report cards” — are decried by eating disorder activists, who say such measures can encourage anorexia or bulimia. She wrote that when binge eating disorder gained legitimacy as a full-fledged mental condition in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders in May, many people in the eating disorders and obesity communities wondered: Will this inspire us to finally get along? It was a good question, since historically, the two groups have been at odds. Anti-obesity activists, in turn, worry that the eating disorder community minimizes the medical risks of obesity, which the American Medical Association classified as a disease in June, and plays down the discrimination many obese people face. “They come out of different traditions,” said Kelly Brownell, dean of the Sanford School of Public Policy at Duke University. “Obesity was mainly dealt with in medical professions, and eating disorders were dealt with more in psychology professions.” But binge eating disorder, which symptoms include consuming enormous amounts of food in a two-hour window without purging at least once a week for three months, could bridge the gap between the two worlds, while also reducing the stereotype that only thin people suffer from eating disorders. “We cannot address obesity and not eating disorders,” said Chevese Turner, 45, founder of the Binge Eating Disorder Association. Last fall, clinicians, researchers and advocates who work in the eating disorders and obesity communities, or have struggled with the food and weight issues themselves, held a Congressional briefing in Washington, D.C. to focus attention on the intersection of obesity and eating disorders. “Part of what drives me crazy is that the obesity community and policymakers dismiss eating disorders as a small group of people, when in fact it is 30 million and growing – with more and more evidence that the focus on obesity and restriction, and growing weight stigma in the culture, is contributing to this rise,” said Ms. Turner, who spoke at the event. Susan Rappaport knows all about this. At 26 and a petite 5-foot-4, she weighed nearly 200 pounds — the result, she maintains, of years of dieting. She would starve herself during the day and then get out of bed in the middle of the night to binge. When she told her doctor that she thought she had an eating disorder, he brushed it off, said Ms. Rappaport, 50, who now weighs about 120 pounds and runs the NuYu Revolution Fitness Studio on the Upper West Side of Manhattan. “It was like, ‘You’re not skinny enough to have an eating disorder.’ But I was a fat eating disordered person.” A study in pediatrics last fall found that nearly half of adolescents with eating disorders had a history of obesity, but because of their higher weight their symptoms often went unrecognized and untreated. Other studies found that among those with a present or past history of binge eating disorder, about 20 percent were of normal weight, 40 percent were overweight, and 40 percent were obese. Although not directly saying eating disorders are caused by TMS repressed emotions, specialists in the subject have “shared psychological components, commonalities and underpinnings,” said Dr. Scott Kahan, director of the Strategies to Overcome and Prevent (STOP) Obesity Alliance at the George Washington University School of Public Health and Health Services, a nonprofit obesity policy organization. “Low self-esteem is extremely common in both, as is body dissatisfaction. Both place excessive emphasis on appearance and body size. In the same way, many of the same psychological underpinnings play into both.” Another area where the two fields converge is weight stigma, said Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity at Yale University. A study in July of this year found that the more people feel stigmatized or bullied about their weight, the greater their risk for obesity. “It makes no sense to separate people based on their size,” said Dr. Susan McClanahan, founder of Insight Behavioral Health in Chicago. She is aware of the inherent conflict. “You’re telling one group ‘You have to eat’ and the other ‘It’s O.K. not to eat everything on your plate,” she said. “But I think it’s been a real relief for the anorexics to see someone who is overweight and have them realize, ‘They’re just a person, it’s nothing to be afraid of.’ And the overweight folks can say, ‘Just because you’re skinny doesn’t mean you’re going to be happy.’ You can be absolutely miserable when you’re thin.” One thing nearly all eating disorder specialists agree on is that the cultural conversation around food and body size must shift, along with media messages promoting images of thin models and an estimated $61 billion a year weight loss industry, in which the vast majority of dieters regain their weight within five years. “The focus should be on behaviors, not weight,” said Dianne Neumark-Sztainer, a professor in the School of Public Health at the University of Minnesota. [Sounds like TMS to me.] “We know from our research that talking about weight and diets is not effective, and for many leads to weight gain over time,” said Dr. Sztainer, the author of I’m, Like, So Fat! “We really want to focus on providing a community that makes it easy to engage in healthy eating and physical activity.” Dr. Brownell believes that the two communities could work together as a powerful political force, sharing a goal of better food- and health-related messages and policies. “Better access to healthy, locally grown foods might be such an example,” he said. “The extreme presence in our society of unhealthy, highly processed foods are a problem for both of these camps. Some people respond by eating too much, and others respond by extreme control so it becomes an eating disorder. A healthy food environment would be a benefit in both worlds.” Amen, I say. And again I say, Think TMS.