Fighting Anorexia: No One to Blame

unrealistic and absurd images of what "beauty" is, and what women are supposed to look like, a culture that worships thinness as though it were sanctified, etc. etc.,

Thank you.

http://msnbc.msn.com/id/10219756/site/newsweek/page/4/

Children predisposed to eating disorders are uniquely sensitive to media messages about dieting and health. And their interpretation can be starkly literal. When Ignatius Lau of Portland, Ore., was 11 years old, he decided that 140 pounds was too much for his 5-foot-2 frame. He had heard that oils and carbohydrates were fattening, so he became obsessed with food labels, cutting out all fats and almost all carbs. He lost 32 pounds in six months and ended up in a local hospital. "I told myself I was eating healthier," Ignatius says. He recovered, but for the next three years suffered frequent relapses. "I'd lose weight again and it would trigger some of my old behaviors, like reading food labels," he says. These days he knows what healthy feels like. Ignatius, now 17, is 5 feet 11, 180 pounds, and plays basketball.

That's one part of a big story. Apparently you think you can pull one piece of the puzzle out and believe that's the whole explanation.

exactly what reason does the article say that the age of onset is decreasing? Do they mention all the weird hormones added to food? That would be another group to blame.

"Seven years ago "the idea of seeing a 9- or 10-year-old anorexic would have been shocking and prompted frantic calls to my colleagues. Now we're seeing kids this age all the time," Rosen says."

Or maybe you didn't really read the article at all.

something in the environment is responsible.

Here's another quote from the article:

In other words, many kids are affected by pressure-cooker school environments and a culture of thinness promoted by magazines and music videos, but most of them don't secretly scrape their dinner into the garbage. The environment "pulls the trigger," says Cynthia Bulik, director of the eating-disorder program at the University of North Carolina at Chapel Hill. But it's a child's latent vulnerabilities that "load the gun."

So the illness is caused by genes + environment. The article also says the illness is dramatically increasing in younger children, so either:
a) the environment is "pulling the trigger" more often, or
b) there are more children with those genes - which means something in the environment is selecting for that gene. For example, maybe the parents were influenced by the media in selecting their mates.

Ever heard of something called evolution? Nevermind the reality of better diagnosis. That has nothing to do with it, I'm sure.

You are focused on of many possible parts of the issue. Staying with that focus is easy to do, as long as you select quotes that address that single focus.

Maybe you better explain it to me - explain the evolutionary process by which there has been an explosion of 9 and 10 year olds with anorexia. Is there an evolutionary advantage causing more people to carry it, or has there been an environmental change causing the carriers to become ill?

Do you really think "better diagnosis" explains this:
Seven years ago "the idea of seeing a 9- or 10-year-old anorexic would have been shocking and prompted frantic calls to my colleagues. Now we're seeing kids this age all the time," Rosen says.

The reason I'm focusing on this is because you objected to niyad's post,
telling her to "read the piece", and I pointed out that it's mentioned several times in the article, with direct quotes showing I did "read the piece". Have you read the piece? Why are you pretending that there are no environmental influences? (cultural and/or physical environment) Are you in the media industry and don't want to be blamed?

Much less anything that resembles the complexity of evolution, or even the follow-up pieces I posted. No wonder you are confused.

Really can't blame it all on today's media images.

Related to the rise of Attention Deficit Disorder I wonder . . .

an etiology tied to anxiety disorders, including OCD, may be a very real part of the puzzle.

Research shows the comorbidity with ADHD as no more than the general population, however.

Everybody I ever knew who was anorexic acted just like a person with OCD, just with the compulsion related to food, among other things. My best friend developed anorexia in junior high and at the same time became an obsessed clean freak. The anorexia was treated and, thankfully, went away completely, along with the clean freak stuff, which remitted at exactly the same rate as the anorexia.

:shrug:

Cognitive therapy for OCD can actually change brain chemistry as well as medication.

http://www.healthyplace.com/Communities/ocd/sandra/treatment.htm

Perhaps that is correct, if "one" refers to a single individual.
What is social conformity? What is peer pressure?

"Anorexia is probably hard-wired....."

Anorexia is probably as "hard-wired" as the human survival instinct. In our current media-driven culture, perceived survival may depend on physical attributes and perhaps little else. Obviously honesty, character, and independent intellect have lost all meaning and value in our "modern, new and improved" culture, so what's left? Spin.

"Spin" is the current term for creating an image of what you want the viewer to think they see. Reality is irrelevant. Image is everything.

Now, consider a child who's life depends on parental acceptance. The child picks up clues as to what will please the parent. The younger the child, the more dependent they are on this parental acceptance. For a toddler, abandonment equals death.

The fact that the common age for the young anorexia patients has "slipped to 9 years old" seems more like a report card for our culture.

We should be asking why knowledge, understanding, competence, innovation, and natural talent, have lost their meaning in our culture.

I'm not sure what's more disturbing--the utter callousness of people who would describe those who have correctly identified a documented correlation between continued media obsession with anorexic-thinness and anorexia in young people as people looking only to "blame" something, or the stupidity of those who believe we should basically eliminate the media factor and ascribe the anorexia epidemic to genetics based on the "findings" discussed in one article.

If you ask me, all the misogynists, those who have prejudice against fat people, and the parents (including some on this board) who don't want to take responsibility for their failures as role models and caregivers are the people looking to assign blame. Disgusting.

about what's actually been found in regard to this disease.

Your need to blame the media outweighs your ability to look at the picture holistically, which doesn't help anyone suffering from this disease. Your callous response is disturbing, as you have allowed emotions to overtake you. That leads to nothing but dangerous conclusions.

Do you think it helps me recover when I see a magazine in the grocery store telling me that I should want to lose 10 pounds and gives me a meal plan for 1200 calories? Do you think it helps me recover when I am reading the newspaper and see an article for a weight loss product along with pictures and testimonials where previously mildly overweight women lose weight and are now borderline underweight and are now so much happier with themselves? Do you think it helps me recover when the checkout clerk looks at the size of the clothes that I am buying and says that she wishes that she were that size (After all, many attractive stars are that size as are models, who are probably smaller.)? Do you think that it helps me recover when stars who are portrayed as very attractive are the same size or smaller than me in some ways (even if they are heavier in other areas)? Do you think that it helps me recover when stars who are at a healthy weight, a weight that I used to be, are called fat and unattractive in magazines? Do you think that it helps me recover when all our young female heros seem to fit an ideal body type?
As I understand it, eating disorders have increased from almost no cases to significant in third world countries once American television became popular.
My eating disorder support group recommends avoiding television and many magazines to help in recovery.
Yes, myself and other sufferers have a genetic tendency to develop this disease. People also have a genetic tendency to develop alcoholism, diabetes, heart disease, and cancer. Despite this, for example, the media tells us that being obese is the cause of type II diabetes and that is why children are now getting it. We need to continue to look at what environmental factors trigger anorexia and look at preventing it in the ways that we can. It is possible that some people would get it anyway, just like some people get type II diabetes without being even overweight, but if it can be prevented in a significant number of individuals we need to look at that. Writing it off as genticallly inevitable doesn't do anyone any good either.

However, the focus on the media has been a great way for many therapists to keep people focused on therapy that did little to nothing for them for years on end. It kept new treatment ideas and research from moving forward, which is why the treatment community has only begun to see a change for the positive in recovery rates and a decrease in relapse rates and severity. The poster above dismissed everything that has changed about treatment of AN, and has offered improved results. It's not perfect. There is much to learn. But to dismiss the piece I posted and the research I posted out of hand, and to say that I have no shame, is simply sick, in my opinion.

No research based treatment that understands triggers is going to offer any other type of recommendation than what you have been given in regard to media. As for the genetic compnent, no, it does not mean inevitability, just as it does not mean inevitability for someone who has a "genetic propensity" for depression, bipolar disorder or schizophrenia. But knowing that patients I have worked with come from a variety of backgrounds, including backgrounds where television and pop media are not in the home, your point about there being many possible environmental triggers is very true.

I do thank you for your very thoughtful and meaningful posts, and for having the courage to share your personal story.

Salud!

My child has clinically diagnosed OCD and I know she has anxiety. Obviously she's more prone to a disorder such as this (according to the article.) HOWEVER, as her parent I can't change our entire culture. I can shelter her a bit, and educate her, but we need to examine our collective social responsibility as well. Images of perfection for girls start with Barbie dolls at about age 3. It's a constant battle.

We should be asking why knowledge, understanding, competence, innovation, and natural talent, have lost their meaning in our culture.

No one to blame, my ass.

Thanks.

Until we meet someone with the problem.

Or become educated in some other way. Thanks.

I work with them every day, and, still there are days when my emotional brain spins in confusion at what I see and hear.

and age of onset is dropping. same with autoimmune disease. i have a kid with each. there is some evidence that the shift in our food supply, especially the change in the fat profile of most of what we are eating, may be a big piece of the puzzle. this would also explain heart disease increases.
it is a tangled knot. and blame is a useless exercise, for sure.

and the nation is too prozac upped to really see much less care

It seems everything reienforces itself. Recovering from anorexia, I try to make sense of all this. The less that I ate and less frequent that I ate, the less that I wanted to eat. When I feel stress, I don't want to eat. I think that these tendencies are stronger in some individuals than others.
The negative self talk comes from somewhere though. If it were considered good to be overweight, we wouldn't be having negative thoughts about having some fat on our bodies. If it were a positive thing to eat large amounts of food, we wouldn't think negative thoughts about eating too much.
Instead every person exposed to normal media hears things like this: (parentes are how my mind has twisted it) "Fat bad." "Thin good." (One can never be too thin.) "Americans are too fat" (I'm an American, therefore I must be too fat.) "It is bad to eat a lot of fat and carbohydrates." (It must be even better not to eat any fat and/or carbohydrates.)
I am in an eating disorder support group. Everyone of those women is a perfectionist, usually a fallen perfectionist, and cares or has cared more about others needs than her own. Almost all of us have some type of anxiety disorder too. Perhaps this is related to the genetics of it (Anorexia could have been an adaptation to feed ones children, who were less able to survive, in times of famine by going without food oneself.), but I think that a lot of this is an expression of stress and feelings. We want to be perfect, but have been unable to be perfect at the things that we wanted to be perfect at so we seek to be perfect at something that we seem to have a naturual talent at. We feel that others, important people in our lives, will not accept us if we are not perfect so we become perfect in the way that we can, either quite innocently or even vengfully "Maybe, you don't really want me to be perfect, do you?" . Feeling that others are more important or that you are expected to defer to others can be expressed as an eating disorder too. "I am not important enough to waste food on." "I want to take up as little space as posssible or even just disappear so that I don't hurt or inconvience anyone." "I don't need anything at all." or the vengeful reverse psychology "You won't let me meet my needs. I won't meet my need for food. I'll show you what happens when my needs aren't met."
I do think culture is responsible in that thin=good and that there actually seems to be more black/white thinking. None of the women in my eating disorder support group are what I'd term "glamour girls" though. Some probably are, but probably even less than in the general population.
As for thoughts why it might be appearing at a younger age, it could be environmental. Children are picking up on the thin=good message at younger ages and are exposed to it more often. They are dieting as a group at younger ages, including many who never develop eating disorders. Children also seem to be under more pressure for success, of all types, than they were in the past. Biologically, children go through puberty at earlier ages and this disease might be related to that change in many young people.

I'm a recovering anorexic. My sister too. Ten years ago, I weighed 92 lbs. My sister landed her butt in the hospital when she was a teenager, she weighed 85 lbs.

My problem was learning to deal with my life, and it was the same for my sister too.

I do think now, it's a combination of things. Media, for sure (models, magazines, barbie dolls ect..) they are teaching children that this is the ideal body type, but what they fail to explain is that every person is different, and that pictures in magazines are airbrushed to make these people look "perfect". The other factor, is that as parents have less time, many kids don't understand how to deal with life's problems. They are not taught by anyone how to deal with stress, losses, depression, anxiety ect...(which was my problem)

The best thing (I think) that parents, teachers could do, if eating disorders are occurring more often in young children, is to try and see what is "eating" away at the child. Maybe schools should start teaching programs on how to deal with stress and anxiety, include it within the health curriculum.


BTW, I'm at a healthy 120 now, and holding steady.

Shame on you.

After noting your post above, you've no idea how much that says.

Heads in the sand help no one.

and hairspray

just makes things worse.

observed in younger individuals. Obesity was the first commented upon, now anexoria...

What the article doesn't examine is how much of it is now being diagnosed that was not previously? Reference the mention in the article of the man whose child has been diagnosed as anorexic and whose 18 year old sister died of 'unknown causes' (while she was maintaining a very strict nutritional diary).

Another factor not investigated: while numerical quantities of currently diagnosed sufferers is given, what is not mentioned is the percentage of the population under the age of 13 now compared to the same percentage in previous 'eras' - (for the sake of comparison, I would use the year of the death of the gentleman whose sister died as the index.)

I am, by no means, an expert on eating disorders. However, while I accept that each eating disorder needs to be addressed in a unique fashion, I think that the decrease in the age of the onset of all forms of eating disorders is just too coincidental to be 100% independent of each other.

In fact, I would go so far as to say there is a difinite coefficient factor here.

With obesity, it is assumed that decreased activity combined with the availability of high fat foods is the sole culprit. While I admit in most cases this may be true, I am also willing to contend that there are as many cases of low age onset obesity caused by chemical imbalances as there are cases of low age onset anorexia. The difference is that while the overweight child may not be in immediate imminent danger of death, they will, in many cases, suffer from depression and/or a loss in self esteem. Particularly if they are in a situation where they are constantly told they are at fault for being overweight.

I think low age eating disorder onset needs to be consecutively studied from a more general standpoint (inclusion of all types) and less in a narrow, specific targeted population (obesity, anorexia, OR bullimia). Perhaps the studies are out there, but I haven't come across these generalized studies, just the more single issue types. With a more general study readily available, assigning a root cause, or causes, with any degree of accuracy becomes much more probable. (To be honest, said study may be out there, I just haven't encountered it in mainstream media.)


EDIT: For some inexplicable reason, my fingers appear to be afflicted with a stutter this morning.

various entertainment for kids. For example, magazines target young children, music videos are very sexually charged and focus more on beauty than talent etc. young men are now being objectified in the manner that women have been for centuries. yada yada.

Just my .02

I agree with the premise that there are cultural and biological factors, but we can't change our biology at this point, so we should try and do something about our freaking culture.

Kate Winslet commented once that looks in America were more important for actors/actresses to possess than actual talent. In Europe you may actually find frumpy actors who are artists. Imagine that?

the reason given for the younger age of onset is parents being more aware of the disease, and accepting anorexia as a possibility for what they are seeing in their kids.

I don't doubt for a minute that the media is playing a part, but only a part. Remember we are talking about 8-10 year olds here. At that age kids are still heavily into cartoons which don't exactly portray realistic bodies but usually the characters have enormous heads on small bodies.

SOME kind of attention? However I did read the possibility you note in the article, I am just a bit skeptical.

You and I may subject our kids to bubble headed cartoon characters at that age, but many 8-10 year olds are far beyond the cartoon phase and have moved into the MTV craze.

And, now that you mention it, I wouldn't doubt that we'll see a demand for plastic surgery "head enlargement" in the future? Then again, perhaps Barbie will keep that particular craze at bay. ;)

I know there's more than cartoons out there. (and I thought about the plastic sugery angle you mentioned :) ) My son is nine and besides cartoons watches mostly discovery and the history channel now. We are hopelessly un-cool. :)

banning the channel, thus making a huge issue of it, or cringing and casually discussing anything questionable at a later time. I thank goodness she's not into the MTV thing yet cause I'd ban that in a second.

:hi:

PS it's great that your son has such good taste in what he watches. That's a great way to use TV.

For whatever reason, the person feels out of control in some aspect of their life, so they compensate by eating either too much or not at all. In children that young, I would first look to the parents, or possibly even siblings, before blaming advertising or no one at all. Besides, assuming there is only one cause is an oversimplification of reality and probably false to begin with.

which makes one more prone to such a disorder. I agree that parents possibly have a "role" but so does our society and brain chemistry. Kids who are not prone to such a disorder won't develop one with or without controlling parents, the media and/or other influences.

...as a single cause.

For whatever reason, the person feels out of control in some aspect of their life, so they compensate by eating either too much or not at all. In children that young, I would first look to the parents,

I think the article wishes to address the issues surrounding the disorder, and attempts to get away from the "blame the parents" mindset.

That said, I do think parents are far too controlling when it comes to food intake. I don't force my child to eat anything she isn't interested in eating.

Also, I wasn't merely referring to parents being controlling about food issues. People with eating disorders often have control issues outside of the realm of food, whether it is over-protective or domineering parents, a series of calamatous events, or some form of abuse or victimization. In these cases, where the victim feels they cannot control their life, they seek to control what and how they eat. In young children, I would first look to the parents as the source as they are the ones most likely to be controlling that child's life, or would be in a better position to understand what is making the child feel out of control if it isn't them. That isn't "blaming the parents," it's deductive reasoning.

I believe it is destructive reasoning to look at parenting first. I used to feel this way before I having a child with a neurological disorder so I understand where your coming from. The article attempts to clear up the "blame the parents" attitude about this particular issue. I do think that other ED's can perhaps be attributed to the environment, however?

I'm not "blaming the parents," and you're not an expert just because you have a personal experience on which to base your opinion. I'm not claiming to be an expert, either, I'm merely stating my reasoned opinion based on my own personal experience. This article is explaining another angle of the issue, which I keep stating is complex and not solely the result of a single factor, though you keep choosing to ignore this fact, presumably because you are taking it personally and feeling defensive. If you bother to re-read what I've written, perhaps without the chip on your shoulder, you'll see that I have never claimed to be speaking of all people with eating disorders, nor have I said the parents are definitely or solely to blame.

And, I don't have a personal experience with anorexia in my child. What I do have are the neurological conditions that might make her more susceptible, regardless of my actions. Knowing she is susceptible can however arm me in a way to try and prevent such a thing by informing myself as best I can. So yes I have a role to an extent. But, not all parents would have to be as vigilant as I.

I am simply trying to get away from the "blame the parents" thinking on this. Parents were blamed for autism, tourette syndrome, adhd along with many other genetic neurological conditions for years. I'm advocating away from that mentality is all. I don't have a chip on my shoulder, and I tried to indicate that when I said I used to look to parenting first also.

I don't disagree that there are many factors involved (including parents) but I don't think they are the primary factor.

Peace :hi:

If anorexics are suffering from TOO MUCH serotonin in their brains, then do they suffer MORE from being put on antidepressants? It seems logical that if they have too much serotonin, a serotonin re-uptake inhibitor (if I got that right) would only make things worse. I'm asking because friends have been put on Prozac etc. and they never seemed to get better. Maybe this is why?

I was put on SSRI's (selective serotonin re-uptake inhibitors). Tried Prozac (ugh, horrible) and Zoloft and some other one that I forget the name. Zoloft made me feel less suicidal but I became more weight loss obsessed. It was in a different way though. Without the drug, I always felt fat and depressed and that I must lose weight. On the drug, I felt elated with each pound and more pumped up to lose more weight. Does that even make sense? All I know is that I felt somewhat better but it did nothing for my obsession with weight.

If you have too much serotonin, and eating very little reduces the serotonin and make you feel less anxious, then you add MORE serotonin and eating less makes you feel sort of - I guess you are feeling more manic on more serotonin and eating less sort of levels you out? And when they boost the serotonin higher, you are manic, so less depressed but more determined to achieve your weight loss goals, which actually will level out your brain chemistry. Wow, is that really it? Because I am thinking of all the antidepressants my girlfriend has been on, and the suicidal periods, and the drugs that didn't help.

That was confusing! And I don't mean that as an insult - it is just so complex. Eating less on SSRI's didn't level me out. Actually, just compounded the problem. I felt MORE manic. Just thinking about how I felt (feel) is confusing. For me, over-the-counter diet drugs (dexatrim back when it was "good" not stripped down, & ephedrine) mixed with Zoloft, a diet of pickles, apples, and crackers, and (on many nights because I was depressed) alcohol had my chemistry so screwed up that I couldn't really tell you what was going on. I know I somehow made it through college with damn near straight A's but I couldn't tell you how.

I have followed the literature for years, as a layman. I think this article really describes major breakthroughs. I really wonder if the whole class of anorexics has suffered under inadvertent malpractice. I think they've been prescribed precisely the opposite of what they needed.

I also wondered how a special diet might impact levels of serotonin and amino acids etc?

And would probably still be considered anorexic by many -- I prefer to think positive and not say "once an anorexic, always an anorexic". I ended up in the hospital a few times and was sent to different eating disorder specialists. I met other anorexics/bulimics. There are a million different reasons for/causes of/factors leading to (take your pick) anorexia. Me? It started out being about control mixed with wanting to suppress anything that made me (having been raped) "feel sexual"-- breasts, menstruation, etc. It is all very complex. Of course being thin played into that, but that became more of an obsession later on. For some people it is about attention. For some it is about losing weight and then becomes an obsession. It varies greatly.

No, I didn't read the article. I've read enough of them and every one says something different. Like I was told by the doctors I saw, there are no "experts" because it is so complex. You can really only get help if you want help. I didn't want help for years -- then I would have lost control.

or maybe you already did - there is new information about a genetic predisposition and too-high levels of serotonin in the brain.

Did you have OCD-ish tendencies and anxiety? This article points to neurological issues that can play a role as well.

I read this article very carefully, and while it gives good information about the latest brain research, it doesn't explain why this is hitting kids younger.

Now... I'm no scientist, but I have noticed that the age for "sexual eligibility" is also going down. Kids' clothes are sexually alluring at a much younger age than they used to be, and kids get "boyfriends" and "girlfriends" at an earlier age. There is a definite de-sexualization process going on with anorexic kids: no boobs, no period, no turning into fat old mom.

Yeah, I'm sure it's hardwired, but it's not that simple. It could be that it starts from many different social/psychological triggers, and then once the starvation process kicks in, becomes biological. Or it could be that anorexics are just canaries in a cultural coal mine: they're generically more senstive to social messages.

I had a little bout with this as a younger woman -- have grown up to have all kinds of anxiety-related problems. But had I grown up in a different family/country/era, it would have been different -- hard to explain how different (maybe worse, maybe better( but different)).

early onset of puberty and the sexualization of pre-teen girls due to excessive hormones in the food supply - I wonder if that could be a factor? Puberty is occurring earlier.

Now... I'm no scientist, but I have noticed that the age for "sexual eligibility" is also going down. Kids' clothes are sexually alluring at a much younger age than they used to be, and kids get "boyfriends" and "girlfriends" at an earlier age. There is a definite de-sexualization process going on with anorexic kids: no boobs, no period, no turning into fat old mom.

Agreed.

I believe a combination of factors contribute, and one who has a neurological predisposition is obviously going to be more susceptible. They say girls are more likely to have OCD than boys, and that might be part of the equation as well? Especially when coupled with the societal demands placed on women to be thin/sexual - and as you said from a very young age.

Seems like the point is to get people off of blaming parents - who need to be part of the treatment. It does seem possible, however, that the children as well as the parents are partially caught up in a culture of "perfectionism"/stress that has taken them away from sit-down meals, among other things. A routine that might more important than people realize.

That is not to say that genetics, environmental toxins, cultural images/advertising don't also have a role.

clips:

"With stakes this high, how do you treat a malnourished third grader who is so ill she insists five Cheerios make a meal? First, say a growing number of doctors and patients, you have to let parents back into the treatment process. For more than a hundred years, parents have been regarded as an anorexic's biggest problem, and in 1978, in her book "Golden Cage," psychoanalyst Hilde Bruch suggested that narcissistic, cold and unloving parents (or, alternatively, hypercritical, overambitious and overinvolved ones) actually caused the disease by discouraging their children's natural maturation to adulthood. Thirty years ago standard treatment involved helping the starving and often delusional adolescents or young women to separate psychologically—and sometimes physically—from their toxic parents. "We used to talk about performing a parental-ectomy," says Dr. Ellen Rome, head of adolescent medicine at the Cleveland Clinic.

....Although parents are no longer overtly blamed for their child's condition, says Marlene Schwartz, codirector of the Yale eating-disorder clinic, doctors and therapists "give parents the impression that eating disorders are something the parents did that the doctors are now going to fix.

...These days, family-centered therapy works like this: A team of doctors, therapists and nutritionists meets with parents and the child. The team explains that while the causes of anorexia are unclear, it is a severe, life-threatening disease like cancer or diabetes. Food, the family is told, is the medicine that will help the child get better. Like oncologists prescribing chemotherapy, the team provides parents with a schedule of calories, lipids, carbohydrates and fiber that the patient must eat every day and instructs them on how to monitor the child's intake. It coaches siblings and other family members on how to become a sympathetic support team. After a few practice meals in the hospital or doctor's office, the whole family is sent home for a meal.

...Critics point out that the Maudsley approach won't work well for adults who won't submit to other people's making their food choices. And they charge that in some children, parental oversight can do more harm than good. Young anorexics and their parents are already locked in a battle for control, says Dr. Alexander Lucas, an eating-disorder specialist and professor emeritus at the Mayo Clinic in Minnesota. The Maudsley approach, he says, "may backfire" by making meals into a battleground. "The focus on weight gain," he says, "has to be between the physician and the child." Even proponents say that family-centered treatment isn't right for everyone: families where there is violence, sexual abuse, alcoholism or drug addiction aren't good candidates. But several studies both in clinics at the Maudsley Hospital and at the University of Chicago show promising results: five years after treatment, more than 70 percent of patients recover using the family-centered method, compared with 50 percent who recover by themselves or using the old approaches."