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Science Talk

Lying in Weight: The Hidden Epidemic of Eating Disorders in Adult Women (And A Few Men)

In this episode, molecular biologist and journalist Trisha Gura discusses her new book, Lying In Weight, about eating disorders in adult, even elderly, women, as well as a small percentage of men. Plus we'll test your knowledge of some recent science in the news. Websites mentioned on this episode include www.trishagura.com; www.sciam.com/podcast

Welcome to Science Talk, the weekly podcast of Scientific American for the seven days starting May 23rd. I am Steve Mirsky. This week on the podcast, we'll talk about eating disorders with Trisha Gura, author of the new book, Lying in Weight.The subtitle of the book explains how the information here is different from your usual morning-news-show-anorexia-report and that subtitle is the "Hidden Epidemic of Eating Disorders in Adult Women"—and in fact men are not immune to eating disorders too, and we'll talk about that. Plus we'll test your knowledge about some recent science in the news.

First up, Trisha Gura: After getting her PhD in molecular biology, Gura became a science journalist. She has written for Scientific American and was a Knight science journalism fellow at M.I.T. as well as a visiting scholar at Brandeis University. We spoke in the library at Scientific American.

Steve: Hi Trisha. How are you?

Gura: Hi Steve.

Steve: Good to see you. Tell me—first of all, the book is called Lying in Weight, w-e-i-g-h-t.

Gura: That's correct.

Steve: What does the title mean?

Gura: The "weight" part of course is because the book is about eating disorders, but the "lying in weight" refers to the fact that eating disorders often don't go away—they are not cured.And when a person has an eating disorder—say when younger—some remnant of the eating disorder lasts and stays lying in wait until some stressful event happens, and then it pushes it over the edge again, much like alcoholism. You can be a dry drunk, but you are always an alcoholic.

Steve: And there is also some mendacity involved, maybe self-delusion or lying to other people about the fact that this disorder is still apparent.

Gura: That's part of the pun. Women often lie to themselves and often lie to others. Eating disorders are very secretive diseases.

Steve: You are very honest in the book—in the first chapter you talk about your own experiences with an eating disorder. Why did you decide to be public about that and tell us something about it and how it motivated you to write the book?

Gura: Well! The book inception came out of a conversation with one of my fellow Knight fellows, who had bulimia and as a teenager and [it] recurred when she was pregnant, and she asked me what happened to women with eating disorders—when they got older did the eating disorders go away?

Steve: Because everybody thinks of eating disorders as being the province of teenage girls or young women.

Gura: Exactly! And I had suffered from anorexia nervosa and felt that I hadn't had an eating disorder in a long time, but as we talked more and more, I realized that yes, there was in that something that was a remnant. And I went looking for information out there for eating disorders in older women and there just wasn't anything out there.

Steve: You also talk in the book about your grandmother, who you suspect also had an eating disorder, as an elderly woman.

Gura: My grandma died at 87 probably from complications of bulimia.She vomited and aspirated her vomit and died and we knew that something was going on, but we figured out she's just old, you know and the throwing up was diverticulosis, so no one really investigated.

Steve: Let's go to your background a little more—not your history with anorexia—but you have a doctorate in molecular biology. So that when you started to investigate this issue of eating disorders in adult women you came at it with a scientist's viewpoint and you found that the data really didn't exist all that much?

Gura: Exactly! The science and the medical journalism background—I've been doing medical journalism for 15 years. And when I went scouring through the medical literature, there was[were] hundreds of articles that I went through; most of them are geared toward teenage girls—which was all the more frustrating—and then I began talking to hundreds of experts and again the data had to do with young girls and teenagers, sometimes for practical reasons, because you got a cohort of individuals who are at high school level or college—well that's where the expert's offices are located—at colleges—so that's why you get that contingent of girls.And so there were articles that dealt with things like marriage or pregnancy, or parenting or midlife with eating disorders, but they were sparse and it took some digging; and the book is more or less connecting the dots on these desperate areas of research.

Steve: Right! In the book you kind of go through the lifespan of a collective woman through the various stages of their life and how eating disorders may be associated with a particular stage?

Gura: There are no other eating disorders books that do that—that look at the life stage—and again since I am dealing with older women, I was wondering what sorts of issues were precipitating these eating disorders; and as we talked about the "lying in wait" or the latent part of the eating disorder, the question is what makes them emerge and the answer is these stresses—life stresses, like the big transitions, like marriage, pregnancy, parenting, mid- and late-life—and it seems that when anybody is stressed out, they fall backon their old vices, so if food and body has been your vice, that's what you fall back upon it when times are tough.

Steve: You also talk in the book about how much or how many individual cases of eating disorders in the country are kind of sub clinical. They are not really full-blown cases, but they are—again—they are lying in wait.

Gura: That's correct. The statistics say that up to 30 million individuals in United States have diagnosable eating disorders. You fit a set criteria and that criteria is listed in the DSM-IV which is a—more or less a—bible for mental illness. There are millions more women who have eating problems that involve dieting or vomiting or binging.

Steve: Or exercise.

Gura: Or over-exercise. Exercise is a form of purging [for people] who do not have a diagnosable eating disorder, but they have food issues or body issues, nonetheless. These people are not counted and there is[are] tens of millions more in the United States and probably tens of millions more throughout the world.

Steve: What's the breakdown? It's mostly female, but there are some male cases.

Gura: Right now about 10 percent of eating disorders cases—anorexia and bulimia—are men, but binge-eating disorder—it's quite interesting—a lot more men, almost 50% of the number of women who have binging disorder, men represent about 50% of the number of women [people] who have eating disorders.

Steve: Real quick: Anorexia, bulimia and binge eating—give us a quick explanation.

Gura: Anorexia:self-starvation. You drop down to about 80 percent of your normal body weight—and for women who are not post-menopausal, you lose your periods for three consecutive months. Bulimia is you binge and you purge. There are two different kinds of bulimia:The purging can be vomiting, but it can also be exercise. Binge-eating disorder is quite interesting and eclipses the two other eating disorders. In other words, there are more cases of binge-eating disorder than anorexia and bulimia combined. Binging disorder is a lot like bulimia, but there is no purge step involved, so these individuals tend to be overweight and obese.

Steve: The definition in the book talks about binging [a]is consuming between 2,000 and 10,000 calories in a two-hour period?

Gura: That is something to do with it. We could all say, Well Thanksgiving, you know—Don't I binge, you know, when I have to unbuckle my belt and sit on the couch? That's not a binge. Binge[ing] is eating a large amount of food in a discrete period of time, much more—definitively much more—than what most people would eat. But there is a second component that makes it a binge, and that's the emotional component. You feel out of control to stop, perhaps out of body.So binging would be more like: I am stressed out, I am having a really bad day, I walk in my house, I open up the refrigerator and I just start eating and I am not thinking about anything except my stressful day, I am cramming food in my mouth and suddenly I realize the refrigerator is half empty. I am uncomfortably full. I couldn't have stopped if I wanted to, and now I feel incredibly guilty because of what I have just done. That's binging.

Steve: And maybe even still hungry?

Gura: Binging isn't always about hunger. People claim that they are not hungry when they binge. It's more about emotions, its anesthetizing uncomfortable emotions using food.

Steve: Right! I should've said, and maybe even still wanting to eat more.

Gura: Yes! The only thing that seems to stop people is the discomfort of your stomach being stuffed full of food.

Steve: So obviously there is huge psychological component to this, but you talk in the book about this experiment that I had never seen before, "the Minnesota Men's Starvation Experiment".This was done all with men back in the 1940s.

Gura: That's correct.

Steve: And it's really fascinating. Why don't you talk about that experiment and what happened to these guys and what that show[s] us about the mind-body interplay in this whole area?

Gura: Back in 1944, a researcher by the name of Ancel Keys got together a group of conscientious objectors, and he wanted to study what starvation in the prisoner camps would do. So these men agreed to eat about 50 percent of their normal caloric intake for a period of time. After about 3 months, these men of course all lost weight—significant amounts of weight—and then they were allowed to eat again, and of course as you would expect, these men started binging. They were hungry, they had been starved. But what was really interesting is after they had returned to normal weight, the men still continued to binge. They were hoarding food. They were hiding food like they weren't going to get enough—and then [these] men—in the 1944—were complaining about their thighs were too fat, their butts were too fat, they didn't like their bodies, they felt that they were fat. So something about the food and the food changes affected their minds, so that psychologically they had a distorted body image, showing you that eating disorders are biological as much as they are cultural.

Steve: It's really amazing, especially because we hardly ever think of men in this situation. And you've talked about—what was it—10 percent of the eating disorders are male; and in here you have [as] one of the really fundamental studies in the field as the study involving men.

Gura: Exactly! There's a related study involving rats. There was a woman by the name of Mary Boggiano who could get rats to binge. It was very interesting how she did it. She starved the rats, allowed them to re-feed, and then what she did is she shocked their feet. The combination of a diet and stress—i.e., a footshock—caused the rats to binge eat. If she did it for three cycles, and it got so bad that the rats would forego their regular rat chow and go down a maze of footshocks just to get two Oreo cookies or potato chips. In other words, they didn't want to binge on regular food, they wanted to binge on junk food—and they would go through a gamut of footshocks to get that food, that's how bad it was. And rats have nothing to do with culture. They are not thinking, "Oh my Gosh! My thighs are fat", which tells you there is something about eating disorders that are indeed biological, because you can get rats to binge eat.

Steve: More from Trisha Gura—author of Lying in Weight—in a moment. But now it's time to play TOTALL.......Y BOGUS. Here are four science stories; only three are true. See if you know which story is TOTALL.......Y BOGUS.

Story number 1: Air pollution regulations in England are reversing the century's long buildup of black soot on the tower of London, slowly revealing the rosy marble of the tower for the first time in some 700 years.

Story number 2: If you hear one person express the same opinion repeatedly, it can persuade you almost as much as hearing many people express that opinion.

Story number 3: Sharks have joined the list of known animals that can reproduce without sex and …

Story number 4: Finger length is a good predictor of the British SATs, which test seven-year-old kids.

We'll be back with the answer, but now we return to the second part of the interview with Trisha Gura.

Steve: Before we talked, I was at a magazine stand, and just as an exercise, I looked at the covers of a lot of the women's magazines and a lot of fitness magazines. I don't know if it was half, but it was probably between a third and 40 percent had something about, you know, getting thin now, getting your body looking nicer; and it was all related to losing weight and being really thin. What does all that stuff accomplish or influence out there?

Gura: To have an eating disorder, more or less, you need two components—genes and environment. So genes load the gun, environment pulls the trigger. So a certain kind of an individual is born with a genetic predisposition. We can describe it as being overly anxious or in the case of bulimia—impulsive. This is a very highly sensitive individual. You put this individual in the context of our world with all those fashion magazines and perhaps some psychological factors at home—things like family things—and suddenly the eating disorder provides a way to cope, so the thinness is the gateway to the dieting and the other behaviors. Once we get into those dieting and binging behaviors, biologically, something sticks in this individual and they go to a full-blown eating disorder. Now, as you get older and hear about caloric restriction and how great it is and—let's say I am 45 or 50 years old,—I want to live longer, and I want to be healthy. I am going to go on a diet. So I am also going to work out because "Hey! That's healthy." In that particular individual, doing that—[excercising]—it becomes obsessive. So you have obsessive dieting, obsessive exercise, and then the eating disorder takes on a life of it's own as it does in the rats, and it becomes a serious, serious problem and it could begin even in mid or late life. And there are cases in the book where that has happened—for the first time, a woman at 68 gets an eating disorder.

Steve: So what can people do, you know, if they want to obviously exercise and eating healthfully—those are great things! So what you do to do those things but make sure it doesn't get out of hand?

Gura: There are several resources that I give in the book and also on my Web site—trishagura.com—that talk about that. There is a self-test: "Do I over exercise or not?." One of the questions is, "Do you exercise if you are hurt, injured or exhausted?". So if you are exercising obsessively, you cannot take a day off, even if you are hurt, injured or sick. You are restricting your calories on the days that you don't exercise, you are forgoing all your social events just to get you work out, and these are red flags. So exercise in moderation means to watch out for these red flags. Eating is similar. Advocates of eating-disorders-treatment do not promote diets in any form. Diets lead to binging and it's not good. And so people think they are losing weight by dieting but studies show actually they gain weight by dieting.

Steve: In the long run?

Gura: In the long run.

Steve: Right! There was just a metastudy that showed that all diets fail for most people if you wait long enough, and long enough is not 20 years—it's usually just a couple of years.

Gura: The only exception that I have read is Weight Watchers, which really isn't a diet—it's more a lifestyle change. What ends up happening is people diet, slow down their metabolism, blow their diet—now they are operating on a lesser caloric output—and then end up gaining weights, and then they feel bad and they diet all over again. And then you see the cycle and then you end up with the obesity problem that we now experience in this country.

Steve: Another thing you are talking about in the book is the destructive kind of media story about—for example— one of the Olsen twins goes to a rehab center for six weeks and comes out announcing, "I am cured."

Gura: That's the myth of recovery about eating disorders—one that I believed, actually, when I was sick, and when I started the book—which is that you get an eating disorder when you are a teenager, you go and you get treatment, it could last well—however long it will last, three months, couple of years, whatever; you get better, your symptoms stop, and you are cured. And then you go on with life and you are fine. And that's not the case. Two-thirds of the women with eating disorders do not fully recover. Half of that group stays completely ill all their lives, the other half partially recovers getting one of the sub-clinical illnesses that we talked about or they just relapse get better, relapse get better, relapse get better not understanding that eating disorders are dangerous. They are latent and they stay and if you're not careful, and you do the wrong things—you go back to these habits and you start dieting and exercising again—you could force yourself into a relapse.

Steve: So where is this whole field right now in terms of a knowledge base, and, you know, where is it going over the next five, ten years?

Gura: There are two major arms to the field. One is biology. Genes and biology, as we spoke about—what is causing—what sorts of molecules are involved in causing us to overeat versus those that causes [us] to eat. What precipitate[s] a binge, what throws a person into dieting so far that they get anorexia? So that's a big arm of the research. The second area is binge-eating disorder, which only recently has come out as a diagnosis. Right now, in the DSM-IV, binge-eating disorder is not yet an official diagnosis. But Harvard affiliated researchers are pushing for that, noting that the incidence of binge-eating disorder is more than bulimia and anorexia combined, and it's probably behind the epidemic of obesity; so a lot of research is going into why it comes about and how to treat these individuals who are suffering.

Steve: And on the anorexia front?

Gura: Anorexia—we are looking for treatments. Right now, there is not an evidence-based treatment that works to cure anorexia. That is not to say that treatments don't work and they can't be helpful. We just don't know which ones will work best, so we need to do a lot more research into recovery and healing from anorexia.

Steve: Have you heard of a diagnosis called orthorexia? Did we talk about that may be a couple of years ago?

Gura: Yes! Yes.

Steve: Yeah!

Gura: Orthorexia—well, there is this body dysmorphia or body-dysmorphic disorder. That's an individual who obsesses about a flaw, a mole or freckle or a body part to the point of absolute compulsion, trying to either change it or just worrying about it. Orthorexia is an obsession with health food.

Steve: Right!

Gura: So you restrict your food choices down so far and you are very anxious and very worried if you are not eating, say all organic food. These are other forms of eating disorders. There are other unnamed sorts of eating disorders and researchers lump them all under a category called Eating Disorders Not Otherwise Specified. It turns out EDNOS is the most prevalent of all the eating disorders; this mishmash category contains the largest number of individuals and it's just the bin where we throw all the eating disorders that we don't know how to name. This is just a hodge-podge of these sort[s] of food behaviors.

Steve: The book is Lying in Weight: The Hidden Epidemic of Eating Disorders in Adult Women.Trisha Gura—hanks very much.

Gura: Thank you Steve.

Steve: For more info about the book, eating disorders in general, and to hear other podcasts on the subject, go to www.trishagura.com. That's t-r-i-s-h-a-g-u-r-a.com. You'll also find a schedule of bookstore and public appearances there. We will be right back.

Male voice: Science Video News, now at sciam.com—easy to view and updated three times a day. Video news, just a click away at www.sciam.com/video.

Steve: Now it's time to see which story was TOTALL.......Y BOGUS. Let's review the four stories.

Story number 1: Tower of London original rose marble color being revealed due to air pollution controls.

Story number 2:One person's repeated opinion is almost as persuasive as hearing many people voice that opinion.

Story number 3:Sharks can reproduce without having sex and ...

Story number 4:Finger length is a good predictor of British SAT scores.

Time is up.

Story number 4 is true. The results of math and reading tests in seven-year-old's could be predicted by measuring the relative lengths of their index and ring fingers—that's according to research published in the British Journal of Psychology.Scientists conjuncture that the relationship stems from levels of testosterone and estrogen in the womb which affect both brain development and finger length. On the other hand, sorry, maybe it's the[that] finger length is just a function of how well the kids can manipulate a number two pencil.

Story number 3 is true. A female hammerhead shark was found to give birth without mating with a male, and the little shark has no paternal DNA. The case study—published in the journal Biology Letters—is the first report of parthenogenesis in sharks. Mammals are the only major vertebrate groups in which asexual reproduction has not been found.

Story number 2 is true. If you hear one person express the same opinion repeatedly it can persuade you almost as much as hearing many people express that opinion. That's according to a study in the current issue of the Journal of Personality and Social Psychology. That's the bottom line from a series of six experiments done with over a thousand college students. The studies found that people assume that an opinion is a majority opinion when they hear it from multiple people, but hearing one person express the same opinion over and over and over and over was almost as persuasive—which should be of particular interest to talk radio show listeners and their beleaguered friends.

All of which means that story number 1—about the tower of London turning rosy because of air pollution regulations—is TOTALL.......Y BOGUS. Because what is true is that, although carbon soot from coal smoke has been blackening the Tower of London for centuries, today's coal has lower sulfur dioxide content, and sulfur dioxide kills micro organisms so the gunk that does build up on the tower now can better support microbial life on the walls, according to research in the June 15th issue of Environmental Science and Technology. The microbe's metabolic processes result in yellowish gunk building up, so the tower is actually now slowly turning yellow like Austin Powers' teeth.

Well that's it for this edition of the weekly Scientific American podcast. You can write to us at podcast@sciam.com, check out news articles at our Web site, www.sciam.com, the daily Sciam podcast 60-Second Science is at the Web site and at I-tunes. If you are looking for anything older than the last 60 episodes of either the weekly or the daily, you can't find them at the iTunes site. You have to go to our Web site—sciam.com—hit the podcast link, and go through the archives if you're looking for anything ancient in our podcast directory. For Science Talk, the weekly podcast of Scientific American, I am Steve Mirsky. Thanks for clicking on us.

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