Friday, May 1, 2009


I am currently finishing up my pediatrics rotation. While I absolutely love working with kids, the constant focus on The Obesity Epidemic has been infuriating and exhausting. I gave a presentation to the department today, and while I usually talk directly about HAES in these contexts, I just couldn't cope with that kind of hostility after over a month of it. So I spoke about a related topic -- treatment of Anorexia Nervosa.

I spoke about Family Based Treatment, and how it is the only treatment for AN that has reasonable evidence behind it. I discussed how FBT works. I talked about the absence of evidence that families of teens with AN are themselves pathologic. Many of the audience members had a big problem with this. The argument that most families have pathology, particularly if you put a big microscope under them, so you shouldn't use anecdotal evidence to villify families of teens with AN was not convincing apparently. Plus, you know, the lack of evidence.

Anyways, that was all fine. I can deal with that. But then, just as I'm finishing, one of the pediatricians says, "You know, I bet that this behavioural approach would work really well for obesity as well. You schedule meals at particular times, you watch the kids, and you force them to normalize their eating." An argument followed where I stated that there is no evidence that kids who are fat eat worse than their thin peers. The pediatrician and several others were simply like, "You're wrong." Fine. Even that I can deal with!

But just before the pediatrician left, I was making the point that there is a huge difference between AN -- a severe mental illness with a high mortality and even higher morbidity -- and obesity -- a supposed risk factor for illness that describes one end of the normal spectrum of human variation. And the pediatrician said, very confidently, that he didn't think AN was worse than obesity in the long run. Nobody else seemed to understand how profoundly offensive, never mind ridiculous, that statement is.

Sigh. There are so many days where I feel like I'm living in a parallel world, and I start wondering whether I really am the crazy one. I'm ready for pediatrics to end.