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Doesn't everyone worry about food?

THE BALTIMORE SUN

"UM, SO DO you have an eating disorder?" asked a woman who had known me for five years.

"Um, so do you have an eating disorder?" asked a colleague who had known me for 11.

"So, um, do you have an eating disorder?" asked my sister who has known me all my life, 41 years and counting.

The source of these queries was not my stunningly svelte figure, I regret to say. All three were responding to a piece of fiction I had written. And while they were sophisticated readers who were not quick to read fiction as autobiography, the authenticity of detail I provided about anorexia, bulimia and compulsive overeating seemed to convince them that I must have gone beyond normal research tools.

How else, they reasoned, would I know that eroded tooth enamel is often an early warning sign of a bulimic who uses vomiting as her "compensatory measure," as the professionals would have it. How could a layperson know about lanugo, a condition seen in severe anorexics, whose bodies begin to grow hair? Where did I find the stunning catalog of the damage that eating disorders do to the heart and the reproductive system?

I was dumbfounded. Didn't everyone know such things? To me, eating disorders were part of a cultural landscape, a knowledge as inescapable as "Survivor" -- you didn't have to watch the final episode to know Richard Hatch won the $1 million. But after my sister quizzed me, I began to realize that my generation, women who headed off to college in the mid-tolate 1970s, owned bulimia in a way. It is a language we can all speak, even if we've never traveled in that country.

Back then, we literally didn't have a name for it. Anorexia nervosa is described in medical literature in the late 17th century and the term was coined in the 19th, according to Dr. Harry Brandt of the Center for Eating Disorders at St. Joseph's Medical Center. Bulimia was not recognized until the late 1970s.

For years, doctors had observed patients who starved themselves, and flip-flopped endlessly on its cause -- physiological or psychological? (Brandt believes it's a combination of the two.) But they had not yet observed the binge-purge syndrome, in which people of normal body weight took extreme measures to rid their bodies of excess calories.

By the late 1970s, my friends knew all about anorexia. I don't know how many times I heard the joke: "I'd like to get anorexia just until I got thin, and then I'd stop." Fasting was a popular dieting tool in the dormitories at Northwestern University, but we didn't think of this as an eating disorder, just a quick way to drop a few pounds. We made the connection that smokers were thinner because they had a noncaloric oral fixation; if we had known that smoking boosted metabolism, more of us might have taken up the habit.

But we didn't link other, odder behaviors to any single syndrome. Yes, we knew which girl in our dining hall excused herself in mid-meal, threw up what she had eaten, and then returned for another course. We laughed about our friend, a high school homecoming queen, who took laxatives on spring break in Florida, but we assumed it was an experiment that would not be repeated. We gossiped about the stunning sorority beauty who seemed to have a bit of kleptomania problem; it was only years later that I realized her strange bouts of thievery often involved food. Did she steal the cheese plate from the refrigerator because she had a compulsion to steal, or because she had been reduced to gorging in secret?

It was about this time that medicine found a name for what we were seeing, but refusing to see: bulimia. Bulimia comes from the Greek word "boulimia," which denotes great hunger. But the fact is, bulimics don't eat out of hunger. They don't even know what hunger is; they literally may not recognize the physical sensation of wanting to eat, because that's not the reason they eat. They are not addicted to food, even in a psychological sense. They are slaves to a compulsive behavior that involves consuming unthinkable quantities of food, then trying to get rid of it.

I used to joke I was a failed bulimic: I could binge, but I couldn't purge. I routinely ate past the point of hunger and I noticed there were certain foods around which I had no self-control. I understood when a friend observed: "If I were an alcoholic, I could stop drinking. But I have to eat, so how do I learn to control it?"

Yet my weight stayed in normal zones and I fell short of the kind of binges that mark the true bulimic or compulsive overeater, who might eat as many as 6,000 calories in a single session. (Bear in mind, a healthy adult needs perhaps 2,000 calories a day. )

In my mid-20s, I worked in a newsroom where one of my co-workers retreated to the bathroom every day and threw up. Plumbing problems were the least of our concerns, and several of us asked the bosses if they would do an intervention. The male editors winced; they had no idea how to confront such a problem.

The writer Anne Fadiman once noted that most serious bibliophiles have a shelf of books that don't fit with the rest of their collection. Hers was Arctic exploration; mine was a series of psychological texts, novels and memoirs about eating disorders. By the time I was in my 30s, I had built quite a collection -- Susie Orbach's "Fat Is a Feminist Issue," "Eve's Apple," by Jonathan Rosen, "Wasted," by Marya Hornbacher.

And for all this, I never thought of myself as a person with an eating disorder -- until my nearest and dearest started quizzing me.

So, although I wanted to laugh off the constant questions, I decided to check it out. On the Internet, I found the site for St. Joseph's, which includes a do-it-yourself test of 15 questions, designed to help you identify if you have a problem. (Another excellent Web site resource is "Something-Fishy.org," run by a woman in recovery for eating disorders, or EDs, as the affected call them. I used this while researching my novel.) I took the test once, and failed pretty resoundingly. I decided to take it again -- and, again, had far more "yes" answers than was considered healthy.

But doesn't everyone worry about gaining weight? (Question No. 1) Doesn't everyone feel bad if they gain weight? (Question No. 5) Doesn't everyone label foods "good" or "bad"? (Question No. 7) Doesn't everyone use food for comfort? (Question No. 8) And isn't everyone dissatisfied with his or her body shape? (Question No. 14)

The quiz is not scientific, Dr. Brandt assured me. It's just a tool to help the Internet surfer do a little self-examination. Most bulimics and compulsive overeaters know they have a problem, but they don't want help. Many of the patients Brandt sees consider him the enemy: He wants them to get well, they believe he just wants to make them fat.

Are there preventive measures one can take to make the development of an eating disorder less likely? Brandt offered these suggestions:

"Dieting is a disaster and doesn't work ... It is the greatest single risk factor." We have to accept that our weight, not unlike our height, is largely a matter of genetics.

"Eat normally." Many people deprive themselves of food during the day, setting themselves up for binges later.

"Legalize food." That means dropping the idea of "good" and "bad" foods. The body needs everything -- carbohydrates, protein and fat.

As knowledge of eating disorders increases, some stereotypes are beginning to break down, Brandt said. For example, it is not a problem that affects only middle- and upper-class women. More men are being treated for anorexia and bulimia; doctors like Brandt worry that they may not be getting help precisely because they think of eating disorders as a "women's disease." The problem is not exclusive to white populations, another popular myth.

Anorexia, while recognized first, probably affects the smallest number of people -- about 0.5 percent to 2 percent of the population. Bulimia is estimated at 3 percent to 4 percent, while binge-eating may be as high as 8 percent to 12 percent, although Brandt expresses some doubt about that final figure.

The fact is, my friend, my colleague and my sister probably know someone with an eating disorder. They just don't realize who it is. Because it could be a woman or a man, someone in your family or workplace or gym, who is of normal weight and seems to have normal appetites.

Laura Lippman, a reporter for The Sun's Baltimore County staff, writes about eating disorders in her latest novel, "The Sugar House."

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