We knew this, we just didn’t always do it, although we didn’t do it in a different way with each child. For a while we counted each spoonful of rice cereal Jacob swallowed, not the ones that ended up on his face and hands. We watched Lisa eat too many cookies and tried not to say anything. We did offer nourishing meals.
Now I can see that what we did do—fret—didn’t help and what we didn’t do enough was to intervene. We should have picked up on Lisa’s comforting herself with food, and tried harder to get her into nourishing activities, or find another adult who could help her, before she became so susceptible to social pressure to be thin.
The trigger to eating disorders often releases very slowly, over years, so you hardly notice: Nine-year-old José won’t eat spinach. Not to worry, many kids don’t like spinach, and there are plenty of other leafy green vegetables that provide iron and vitamins A and C, without the mineral taste of spinach. Maybe it’s not the flavor, but the slimy mouth-feel of cooked spinach that José finds revolting. So the parent turns to broccoli flowerets, which are crunchy unless overcooked and can be entertaining. They look like little trees! It could end there. He’s just One of Many Who Don’t Eat Spinach. Or, he gets over his spinach thing and moves to sweet potatoes, another font of nutrition, or he escalates to rejecting all green foods.
And who knows, when José gets a little older he may reverse himself and go green altogether, becoming the One Who Doesn’t Eat Meat. Many teenagers do. With increasing interest in health and the environment, the vegetarian diet makes a lot of sense. But teenagers tend to see their choices as full-speed ahead or reverse, and they easily slide off track. Lisa didn’t eat meat, then fried foods, then desserts, then carbohydrates after 6:00 p.m., then no carbohydrates at all, until food itself had become the enemy and she had a life-threatening disease.
Vegetarianism has been associated with bulimia, especially for adolescents. Many anorexics started by just saying no to red meat or by developing a repugnance to animal flesh. Eliminating certain foods is a ritual and a way to control your life, the need or hunger that often drives eating disorders. Researchers for the American Dietetic Association found vegetarians “more likely to feel extremely guilty after eating, have a preoccupation with a desire to be thinner, have a tendency to eat diet food, and like the feeling of an empty stomach. In addition, the vegetarians were more likely not to enjoy trying new, rich foods. Also, the vegetarian participants had a greater tendency to feel that food controls their lives, [they] give too much time and thought to food, and [they] have the impulse to vomit after meals compared with nonvegetarians.”
When Lisa was in high school, our family internist was the first to diagnose her anorexia. The clinic now makes it easier, with an extensive website that often features eating issues. Recently it linked to a story about Steven Bratman, MD, who coined the term
orthorexia nervosa
, the obsession with quality rather than quantity of food. This focus can be benign or even beneficial when it’s about improving health, treating an illness, or losing weight, but people with orthorexia can’t stop the train. Bratman provides a list of warning signs:
1. Spending more than three hours a day thinking about healthy food
2. Planning tomorrow’s menu today
3. Feeling virtuous about what they eat, but not enjoying it much
4. Continually limiting the number of foods they eat
5. Experiencing a reduced quality of life or social isolation (because their diet makes it difficult for them to eat anywhere but at home)
6. Feeling critical of others who do not eat as well as they do
7. Skipping foods they once enjoyed in order to eat the “right” foods
8. Feeling guilt or self-loathing when they stray from their diet
9. Feeling in “total” control when they eat the correct diet
Orthorexics, like anorexics, become different people, defining themselves by what they don’t eat.
Whenever I teach a food-writing class or give a guest lecture, I like to ask people to name the foods they don’t eat. Everybody has something. At a local high school, students quickly named cottage cheese, applesauce, bananas, and lima beans because of their mushiness—a texture they most likely loved when they were younger and possibly associated with immaturity. But how do you acquire an aversion to honey cough drops, olives, or dried fruit? One girl said red licorice made her nose bleed. I wasn’t the only one in the room to have a thing against honeydew melon, although to call it an allergy would be a stretch. It gives me a scratchy throat, even if it’s just touching the watermelon in a fruit salad. Still, I avoid it.
Anybody know what vegans
do
eat? Beyond beans, vegetables, and fruit, I start to go blank. There must be some kind of emulsifying egg substitute in vegan pastries. But unless you are a vegan or live with one, all you really need to know is what they don’t eat: animal products.
Even with religious dietary laws, practitioners as well as spectators tend to be more familiar with what is forbidden than with what is allowed. My father’s parents kept a kosher house and didn’t eat pork or shellfish ever, but they did eat in non-kosher restaurants. In Stockton, California, there weren’t any other kind. My father didn’t eat pork or shellfish, but once he left home and tasted a cheeseburger, there went the proscription against mixing a calf with its mother’s milk. One of his favorite restaurants, Emil Villa’s Hick’ry Pit, specialized in barbecued spare ribs. He never had the ribs, always the chicken. It was okay for me and my sister to have the ribs, however—as long as we weren’t dining with anybody who might be offended. Once Nancy forgot this, and ordered the ribs, in the company of Nana George, who opined at the table that pork would make Nancy sick. Mom, whose family didn’t go out of their way for pork but didn’t shun it, either, put in that really, the cleanliness of pork was as good as any for beef these days. Nancy went home and threw up.
As with Jews and keeping kosher, American Muslims’ observance of halal varies widely. “Some Muslims just say a prayer before eating,” says Safaa Ibrahim, executive director of the Council on American-Islamic Relations, based in Santa Clara. Another school of thought is that buying meat raised and slaughtered by other “people of the Book” (Christians and Jews) is fine. “I grew up eating kosher meat,” says Shahed Amanullah, who founded
www.zabihah.com
, a nationwide guide to halal restaurants, markets, and stores. “Some say only meat hand-slaughtered by a Muslim. I try not to get too political.”
Some halal rules are similar to those for kosher foods. However, halal is certified not by a central authority but by word of mouth. “You just trust the owner of the store,” says Tahir Anwar, imam of the South Bay Islamic Association. In restaurants “as long as food we’re being served is halal, it’s fine to eat somewhere that isn’t totally halal. Kosher is also permissible. If we can’t find halal meats, we are allowed to have kosher. The method of slaughter is quite similar.”
The word
kosher
means proper, and
halal
means permitted or lawful, as in this verse from the Koran: “Eat of that which Allah hath bestowed on you as food lawful and good.” But in tune with the food negativity of our times, halal and kosher are commonly known for what they forbid, not what they allow. Both religions have specific words for the opposites of halal and kosher. Pork, alcohol, and products made with non-halal animal content, such as gelatin or a cheese made with rennet, are
haram
. Pork, shellfish, and eating meat with milk are
treif
.
Religious practices, allergies, and vegetarianism are a person’s own business. It’s when we get all self-righteous about what others are eating, when we disdain each others’ choices, when we obsess and fetishize food, that problems arise. The food revolution that rode into town flying the flag “You are what you eat” has taken a forbidding U-turn.
Besides “I don’t eat,” the other popular foot-stomping about food is “I don’t cook.” This, too, is said with pride. It is who I am, as in, “I work so hard, my commitments are vast, I’m just so darn important. There’s no time to cook.” Surely there’s a restaurant to grab takeout on the way home, or one that delivers. In an economic downturn, there may be more time to cook, but restaurants have parried with markdowns and cheaper menu items.
Supermarkets used to be all about raw ingredients, which you imported and assembled at home. Now they devote valuable real estate to delis, pizza ovens, sushi, noodle bars, even creperies.
Whole Foods has set a frenzied pace in what the industry calls “meal replacement.” As a teenager exclaimed one night at the new Whole Foods store in our area, “I’ve never seen so much food in my life!” Whoa, a market with the ability to astonish a teenager! Our relatively modest Whole Foods store has a Prepared Foods section with Singaporean barbecued meats on a stick, grilled panini sandwiches, a retro cafeteria line with steam-table all-stars like turkey Tetrazzini and tamale pie, a very good beef brisket near the soup station, and a fabulous salad bar. Across the store from Prepared Foods is another soup station in the seafood department, and all the ready-to-eat fish dishes. Non-cooks of many persuasions feel right at home at Whole Foods.
My own unscientific observation is that fewer shoppers go to the world’s largest retailer of organic and natural foods with a shopping list. They browse. They likely spend way too much time browsing, aisle after aisle of exquisite produce and new packaging. It’s just so exciting, like a Toys R Us or a casino for foodies.
As at a casino, it’s hard to find your way out of Whole Foods without spending money. The high-beam lights and zigzag floor plans can be disorienting. While I was admiring the red army of perfect cherry tomatoes at the salad bar, a man cried into his cell phone: “I’m in the food court area. Where are you?”
But even foodies, who congregate at Whole Foods, farmers’ markets, and specialty cheese shops, tie ourselves up in refusing and restricting. We turn up our noses at foods that are out of compliance with our local, seasonal, organic mantra. People who take this to the extreme have been coined
locavores
and
localvores
, proudly by themselves, derisively by others. In San Francisco, a restaurant called Fish & Farm opened in the fall of 2007, featuring a majority of food from less than one hundred miles away (plus an herb garden on the roof, recycled marble countertops, and a bottle crusher for recycling on-site). In December 2007, San Francisco got a self-described “neighborly Cal-Italian eatery” called Local Kitchen & Wine Merchant. Motto: “Drink Global, Eat Local.” My town, Palo Alto, offers a series of seven three-hour classes on cooking with California native plants.
As with religion and vegetarianism, there is a continuum of belief and practice among people who consider themselves serious about food, down to the basics of bread and butter. Foodies serve artisan bread, it goes without saying. But, horrors, we come upon restaurants serving salted butter. Worse, our friend Joanne is a fabulous cook, yet puts out a tub of margarine. She doesn’t eat it, but her husband, an Australian immigrant, likes its spreadability. Back when cholesterol was found to be evil, my parents converted to margarine and we never saw butter again. In more recent years, my father invested in plastic vats of I Can’t Believe It’s Not Butter!
Ned and I are Plugra people. Plugra is a modestly priced, European-style unsalted butter from Kansas. We don’t splurge on Kerrygold from Ireland and never churn our own. We are butter snobs, but reasonable and correct, just like everyone else who vehemently doesn’t eat something. Just like everyone who drives a car, we know that we are reasonable and correct; it’s the others who are jerks.
We live in Restriction Nation, where Lisa developed her own brand of “I don’t eat.” The seeds were planted in middle school, stayed underground through about half of high school, then grew into something awful.
eight
Roots of Anorexia Lisa’s Early Days and a Bit of History
On a warm evening in June 1999, we parents are planted in plastic folding chairs on the blacktop, our backs to the setting sun. Out on the grass, Lisa’s fellow middle school graduates squint, the sun in their faces. Maybe this slight discomfort will be the final trial of three turbulent years. The ceremony, unlike the years, is short and sweet, unlike other graduations the parents have attended. Preschool and elementary school promotion ceremonies can be way too much ado, to the point that it scares the graduates out of participating. And once you’ve had to sit though a high school or college marathon recital of unfamiliar names, you know to bring something to read. But Jane Lathrop Stanford Middle School captures just the right tone: Congratulations, let’s move on. Rambunctious kids have practiced the procession from auditorium to soccer field at least three times. Trussed in their serious clothes, with families and teachers assembled, they somehow get the gravity of the occasion.