Obsessed: America's Food Addiction--and My Own Part 4

Today Michael is a motivational speaker, talking about an addiction he feels was created and nurtured by the "Big Food" makers. "Studies have doc.u.mented a biochemical sensitivity to hyperpalatable foods, usually processed foods, that promote the phenomenon of cravings and cause people to act unreasonably and irrationally with food, trying to solve other problems," he explains. "If you take out the word food and you put in alcohol or you put in cocaine, the concept of addiction is not controversial."

Michael's story and his behavior as a food junkie is all too real to me. If we had a medical diagnosis called food addict, I'm convinced I would qualify. Most people a.s.sume that all food addicts are fat, but I'm here to tell you they are not. Just because I have a healthy body weight doesn't necessarily mean I have a healthy relationship with food.

Most people don't know that I still fight my cravings for "bad food" every day. Even my Morning Joe partner, Joe Scarborough, thought I was a highly controlled eater-overly controlled, I think he would say. Joe and my executive producer, Chris Licht, were always pushing me to eat more when we were out on the road together. They thought my diet was far too restrictive, and they were very concerned about me.

And then they became witnesses to a breakdown in my highly disciplined diet. It happened in a big way on one of our road trips, and became an inside joke on Morning Joe, although it wasn't all that funny to me. Joe told the story to Diane when she interviewed him.

"We were in Dallas at a Bob Schieffer journalism symposium at Texas Christian University, and we had been going from five in the morning to about ten-thirty at night. We had not had time for dinner, so our producer Louis ordered Mexican food for us to take in the car on our way to the airport.

"I swear to G.o.d, I heard in the backseat of the Suburban what sounded like racc.o.o.ns going through the ten plates of Mexican enchiladas. Mika had devoured a meal that was intended for, like, four or five people. She'd eaten the entire thing and she had this sauce all over her face and going down the front of her shirt.

"I said, 'What in the h.e.l.l are you doing?'

"And she snapped out of her trance and said, 'Oh, my G.o.d. Oh, my G.o.d.'"

Joe said that was the first time he truly realized just how extreme a battle I sometimes fought with food.

Ashley Gearhardt's interest in food addiction is rooted in part in her own weakness for some of these foods. She recalls how, during a time crunch, she stopped at a vending machine in the bas.e.m.e.nt of the psychology department and bought an ancient package of Oreos. She said the cookies tasted like cardboard, but that didn't stop her from eating every one.

"I ate the whole package because my body's responding to this jolt of sugar, jolt of fat that I'm getting, even though it really didn't taste that great," she recalls. "Most foods have been changed and altered in a way that really resembles how we've created drugs of abuse."

Gearhardt developed the Yale Food Addiction Scale to identify people who are most likely to show a dependency on high-fat, high-sugar foods. The scale evaluates cla.s.sic signs of addiction, such as tolerance and consumption, by asking people to indicate how frequently they engage in certain behaviors, such as these: *I find that when I start eating certain foods, I end up eating much more than planned.

*I find myself continuing to consume certain foods even though I am no longer hungry.

*I eat to the point where I feel physically ill.

*Over time, I have found that I need to eat more and more to get the feeling I want, such as reduced negative emotions or increased pleasure.

She offered me a compelling portrait of the food addict. "You need more and more of the substance to get the same effect that you once did. You used to eat a couple of cookies, and that was enough for you. Now you find yourself eating the whole pack and wanting more."

Like drug addicts, food addicts also show signs of withdrawal, like anxiety, agitation, headaches, and disrupted sleep, when they try to cut down or stop eating addictive food. Another similarity is that they often know their behavior is causing them physical and emotional problems, and hurting their personal relationships, but they find themselves unable to change it.

Food addicts also devote considerable time to the pursuit of food. "There's a lot of time spent purchasing the substance, using the substance, recovering from the effects of the substance," Gearhardt told me. "So rather than going out and socializing or going on a walk, your life starts to revolve around the substance."

It may sound a lot like a cocaine addiction or alcoholism, but we're talking here about the "ultraprocessed" foods available to us at every turn.

New York Times reporter Brian Stelter is someone else who relates personally to the concept of food addiction. His cravings lingered long after he lost that hundred pounds. "I increasingly felt it myself when I would pa.s.s by McDonald's or Burger King or Cinnabon, and I never felt that tug walking by the grocery store where there were fresh fruits and vegetables."

It's a tug he came to resent. "Let's a.s.sume that there's some element of weakness there. Maybe it's 25 percent, 50 percent, 75 percent, but I also a.s.sume there's some piece of it that's addicting. I began to actually resent it. I would still eat at McDonald's-I love their salads. But I didn't like the tug I felt toward the other food when I was there. I wish I hadn't ever tried it.

"It's funny to say those words because it sounds like a drug. I felt it even more after I'd lost the weight. I don't know if that's because my body became so used to whatever chemicals and additives are in fast food. I guess that my body is missing and craving those substances, whatever they are.

"That's what's so frustrating about this moment in the culture: that there's so much we don't know about what this food does to us."

Most overweight people are not food addicts, so dealing with food addiction won't address the entire obesity challenge, but it's certainly part of it. Researcher Ashley Gearhardt studied a population of people who had been diagnosed with disordered eating and found that about half of disordered eating individuals met the addiction threshold. Around 10 percent of college students met the threshold.6 But the more we learn about our response to highly processed foods, the more likely it seems that there's something biochemical going on in our bodies. You don't have to be an addict to find your determination breaking down in the face of foods rich in sugar, fat, and salt. You just have to be pulled in by their sensory power.

Lisa Powell calls some of our food "anti-nourishing, if not downright toxic." We're being fed, she says, but we're not being nourished. "And I think that plays a huge role, both physically and psychologically. I think you don't reach that sense of satiety. It has nothing to do with how many calories are in the foods you ate, it has to do with the experience of eating, with the flavor and the roundedness of the experience that we've lost. It's all this intense flavor that just goes in a hurry and we aren't mindful."

In his book The End of Overeating, former FDA (US Food and Drug Administration) commissioner David A. Kessler, MD, hearkens back to the comparison between a banana and candy. A handful of M&Ms, he says, has what the food industry calls "better mouth feel. You have to chew less, and they do just 'melt in your mouth.'" That means the sugar and fat hit your system faster and set off a pleasurable reaction. Add to that the constant barrage of advertising and marketing urging you to go out and buy these foods and their ready availability-a combination that Kessler dubs a "food carnival"-and weight gain is the entirely predictable outcome.

"If I give you a pack of sugar, and I say, 'Go have a good time,' you're going to look at me and say, 'What are you talking about?' Now I add to that fat and temperature and texture and mouth feel and color, and I'm going to put it on every corner, and I'm going to say you can do it with your friends, you can do it at the end of the day when you want to relax. Besides making food more irresistible, we made it socially acceptable to eat at any time. What did we expect to happen?"

David Kirchhoff of Weight Watchers describes the effect in a darker way, not as a carnival but as "the equivalent of water-boarding people with food, where eventually you'll break down and you'll start eating." Like so many other people involved in the struggle to bring America's weight down, Kirchhoff fought his own battle, taking nine years to lose forty-five pounds and keep them off.

He writes about brain research in his book Weight Loss Boss, and when we interviewed him, he described what happens to many of us at the sight of one of our favorite foods. "A functional MRI can show your brain lighting up like a Christmas tree." The higher functions of the brain may stay in control initially, "telling you not to eat whatever the trigger food is-ice cream, chocolate, whatever might be the case. You can avoid that food for a period of time, but then something called decision fatigue sets in, and eventually you break down and you'll start to eat it."

When we put this biochemical response together with the food industry's drive to sell its products, the real problems set in. If eating high-fat, high-sugar food prompts people to eat more and more of it, that's what the industry is going to manufacture.

"If you bathe taste buds all the time in excesses of sugar and salt, which is what the typical American diet does, people tend to like products with lots of sugar and lots of salt, and the wrong kinds of fat, and artificial flavorings," explains Yale's David Katz. "Then, if you ask food companies to make products that are much lower in sugar and salt, those products do very badly. n.o.body buys them. And then the food companies say, 'Hey, we tried, but we're not going to go out of business to make the public health types happy, so forget about it.' And we get stuck there."

I asked Zeke Emanuel whether he thought food companies were manipulating consumers by creating foods we can't resist. He answered me cautiously. "As an ethicist I'm very careful about the words I use and try to be careful about manipulation; it tends to be one of the squishier words. But I would say they adjust, modify, test, and reformulate the products to increase their palatability," he said. "After all, they want to increase sales. That's how they make their money. They're trying to make us happy with what they're giving us."

Sugar is a particularly significant culprit in the obesity epidemic, and it is everywhere in the food supply. Some experts say that recommendations to eat a low-fat diet fostered the problem. In the late 1970s, the US Department of Agriculture, the American Medical a.s.sociation, and the American Heart a.s.sociation began urging people to reduce their fat intake. Countless Americans heard that message and in many cases began replacing fats with carbs; but instead of getting those carbs primarily from whole grains, fruits, and vegetables, they upped their consumption of bread, pasta, and potatoes.

At the same time, food companies began tinkering with their recipes, according to Robert l.u.s.tig, MD, a pediatric endocrinologist at the University of California, San Francis...o...b..nioff Children's Hospital "The food industry was remanded to change its processes. It was basically told 'we have to go low fat,'" says l.u.s.tig, who also directs the university's Weight a.s.sessment for Teen and Child Health program. "The problem is that low-fat food tasted like cardboard and the food industry knew that."

To compensate for the loss of flavor, the industry began replacing fat with carbohydrate, especially sugar. And the cheapest sugar available was high-fructose corn syrup, which it now uses in vast amounts. Not only is high-fructose corn syrup cheap, it helps foods last longer on supermarket shelves. "What happened was the 'Great Subst.i.tution,'" says l.u.s.tig.

"Which is worse for you, the fat or the carbohydrate?" he asks. "When you compare, on balance, the answer is that carbohydrate is worse, because the carbohydrate drives insulin, and insulin drives metabolic disease." Not only do sugars contribute to the obesity epidemic because of their calories, but l.u.s.tig is even more concerned about their direct health impact. "Sugar is the factor that takes you from obesity to metabolic syndrome." Metabolic syndrome, which is strongly connected with obesity, is a risk factor for type 2 diabetes, high blood pressure, cholesterol problems, heart disease, and fatty liver disease. And l.u.s.tig cautions, "There are implications for cancer and dementia, as well."

Sugar is the factor that takes you from obesity to metabolic syndrome.-Robert l.u.s.tig No wonder he has labeled sugar "toxic" and is heading a movement against it.

Some people seem to be listening. l.u.s.tig's ninety-minute lecture "Sugar: The Bitter Truth" has been viewed more than 3 million times on You Tube since it was posted in July 2009. Listening, perhaps, but not yet acting on the information. It is shocking to me that Americans now consume an average of twenty-two teaspoons of sugar a day. That's 450 calories right there. Compare that to American Heart a.s.sociation recommendations that men consume no more than nine teaspoons a day and women no more than six teaspoons, amounts that Dr. l.u.s.tig says are reasonable, and probably safe.

Why is sugar so bad for us?

In limited quant.i.ties, our bodies can handle it, explains Dr. l.u.s.tig. Take fructose. Traditionally, it was found mostly in fruit and honey. We can metabolize a certain amount of it, especially if it contains fiber, which delays its absorption in the intestine, and gives the liver a chance to spread out the time it takes to metabolize the food. Exercise also helps, because it speeds up energy metabolism within the liver, allowing the fructose to be turned into energy rather than liver fat. But the much wider use of high-fructose corn syrup puts our health at risk.

"If you overwhelm your liver's capacity to metabolize fructose, then it's a poison," l.u.s.tig warns. "A calorie is a calorie in terms of the number of pounds of weight you put on. But that doesn't mean that a calorie is a calorie in terms of the metabolic consequences. If you put those calories in your subcutaneous fat, you just get fat. If you put those calories in your visceral fat or in your muscle or in your liver, then not only are you going to get fat, but you're going to get sick, too."

Studies of how sugary drinks affect the body, conducted by Kimber Stanhope, a nutritional biologist at the University of CaliforniaDavis, suggest that l.u.s.tig's fears are justified. Her subjects were young, healthy people in a hospital setting where it was possible to measure every calorie they consumed. Within two weeks, those who consumed drinks sweetened with high-fructose corn syrup had higher levels of LDL cholesterol in their blood and other risk factors for heart disease, while the subjects who consumed drinks sweetened with glucose did not. LDL cholesterol, also known as the "bad" cholesterol, collects in the walls of blood vessels, causing blockages and increasing the risk for a heart attack from a sudden blood clot in a compromised artery.

Stanhope explains that all fructose and glucose molecules get delivered directly from the digestive system to the liver. Most of the glucose molecules bypa.s.s the liver, because glucose use by the liver is controlled by an enzyme which shuts down when the liver does not need energy. (Glucose, a simple sugar that the body makes when it digests carbohydrates, provides our primary source of fuel.) Therefore, most of the glucose in the drinks sweetened with glucose ended up being used by muscle, brain, and body fat for energy. In contrast, most of the fructose in the drinks sweetened with fructose ended up in the liver. That's because, says Stanhope, "the enzyme that controls fructose use by the liver never shuts down. It efficiently starts processing all the available fructose molecules, which allows the liver to keep bringing more fructose molecules in. The liver has to do something with all this fructose, so it starts turning some of it into fat for later use. Some of this fat gets sent out in the blood where it increases risk factors for cardiovascular disease."

Lewis Cantley, a Harvard professor and head of the Cancer Center at Beth Israel Deaconess Medical Center in Boston, is another scientist very worried about sugar, especially its potential link to cancer. His theory is that when we eat or drink sugar, it causes insulin to spike, which may help fuel the growth of certain cancers, including breast and colon cancer. Dr. Cantley is so convinced of the connection that he has practically eliminated sugar from his diet. "I can remember when I was a kid the thought of eating bars and bars of candy was just absolutely fantastic. And now, if somebody offers me something sweet, I might take a bite of it to be polite but I would never finish it.

"I think the problem is a lot of people get addicted to sugar," he adds. Indeed, he thinks the dependency may be strong enough that people need to move slowly to break the hold. "If you take sugar out of your diet, maybe it has to be done gradually."

So we've got a weight problem in this country, and the same foods that are making us fat are also causing serious diseases. What are the solutions? I think it's safe to say that some combination of personal responsibility, education, and changing the food environment in this country offers our best hope. "At the end of the day, what each of us does with our feet and our forks is up to us, and so we do have to share in the responsibility for the solution," said David Katz. "Most of us who manage to be thin are working really hard to make it so, and have a skill set that the rest of the world doesn't have."

I totally agree with that. I've found an incredible amount of inspiration, smart advice, and new skills from the friends, colleagues, nutritionists, scientists, and other experts dealing with food issues whom Diane and I spoke with as we were writing this book. But making the commitment to get to a healthy thin is a lot harder if we don't know what's in our food. So one very important public health step is to require more informative food labels in both supermarket and restaurant foods, including a clear indication of how much sugar is added.

As an ill.u.s.tration, Stanhope points to the label on a yogurt container. "I think the time has come for the companies to have to say 'added sugar' versus 'total sugar' on the container, so we can differentiate between the sugar that is in the fruit or the milk, and the sugar that is added in the processing," she says.

That's just one example of the big-picture solutions Diane and I discuss later in this book. We can't hope to get on the right track as individuals until we get on the right track as a nation. We need smarter policies and healthier communities if we are going to really solve our problems with food and weight.

CHAPTER FIVE.

FIGHTING THE FOOD DEMONS.

MY STORY, WITH JOE SCARBOROUGH,.

DR. NANCY SNYDERMAN, FRANK BRUNI.

With Americans living in a food carnival and eating foods that may have addictive properties, it shouldn't be a surprise that so many of us have eating disorders. Many of these disorders lead to obesity, while others help us keep our weight down, but not in a healthy way, as I know all too well.

When I set out to write this book, I thought I was writing about problems that were in the past. In recent years, I have managed to maintain my tight grip of control most of the time. But now, at Diane's insistence, I am trying to release a little bit of that control and settle at a slightly higher weight. My goal is to develop a more relaxed att.i.tude toward food so that I do not have to live at two extremes: feeling hungry most of the time and bingeing occasionally. It's hard, and the truth is that acknowledging my struggles with food has uncovered some bad influences and feelings that leave me on the edge of reverting to old, unhealthy behaviors.

Joe Scarborough tells another story about me, and it's one that I hate, because it's so embarra.s.sing. But I'm in "tell-all mode" here, so I won't hide it. This one happened when we were traveling. We do that a lot, broadcasting the show from around the country. We tend to have especially long days when we are out of town. Generally it means getting up even earlier than usual, in another time zone, and staying up late to attend events and meet people.

Joe says, "We were at a luncheon for about five hundred people in California, and I took one bite of the meal and thought, that's not worth the calories. I looked over at Mika, and this skinny woman who I had a.s.sumed just didn't like food, had in thirty seconds devoured the entire plate-the chicken cordon bleu, the sauce, the fries, everything. She probably inhaled about thirty-five hundred to four thousand calories in thirty seconds."

Joe watched in amazement as I pressed my fingers onto the plate trying to get the last of the crumbs. Moments later, we were onstage in front of five hundred people! Later, he said to me, "I can't believe you ate that." I was horrified, too, but it really helped Joe understand why I work so hard to hold myself back. "It hit me that she was struggling every single day of her life to not do what I would do, which is eat when I was hungry. She lived hungry all the time. Every six months or so when she was just exhausted and her defenses were completely knocked down, she would, without thinking, just start eating like the rest of us, except even more ravenously."

It hit me that she was struggling every single day of her life . . . She lived hungry all the time.

-Joe Scarborough Another story still shocks both me and my husband. I had taken an Ambien one night to get to sleep. With my crazy schedule, I need to do that sometimes. The drug can increase the likelihood of sleepwalking, and that's what I did-down two flights of steep stairs from the bedroom and right into the kitchen. Jim told me what happened next. He thought I was coming down to get a snack because I couldn't sleep. I said hi to him, and then I went into the pantry and opened this big jar of Nutella.

Nutella is made from hazelnuts, skim milk, and cocoa, and it's meant to be spread on bread. I love, love, love it. Really, it's my favorite thing in the world. Never mind that a couple of tablespoons have as many calories, fat, and sugar as a Three Musketeers bar. Never mind that consumers have filed a cla.s.s action suit against the manufacturer, saying they were misled into thinking Nutella was a healthy breakfast for their kids to spread on toast. I wasn't thinking about any of that when I reached into a drawer and grabbed a spoon. In the next moment, I began devouring it as if I was the hungriest person on earth.

Then I seemed to say "the h.e.l.l with that," as I put down the spoon and reached into the jar with my hand, scooping out the Nutella again and again, then licking it off my fingers. Pretty soon, the stuff was all over my face. I dipped in one hand, then both, again and again. As the Nutella spread up my arm, I licked it off there, too. After I finished the entire contents of the jar I calmly went back upstairs to bed.

The next morning I woke up, took a shower, and went to work, with no memory of the Nutella raid. When I got home that evening and saw Jim, he was like "whoa" and I'm like "what?" And he says, "Nutella?" and when I looked totally confused he said, "Oh my, you must have been eating on Ambien." Then I kind of remembered. I thought I had just been dreaming about eating Nutella, but I had actually done this in the kitchen in front of Jim!

To me, Ambien is almost like a truth serum. It frees you of inhibitions, allowing you to give in to temptations you are usually able to resist. The Nutella night revealed the intensity of my ongoing eating issues.

That kind of behavior is obviously unhealthy, and I pray that my daughters will not be as consumed by food as I have been. Throughout my school years and the early days of my career, I was aware that other people also had food issues. But frankly, I didn't talk to them about their issues, or about my own. It took me a long time to see my own eating disorder as part of a larger picture, one experienced by many other successful people. As I became more aware of that, I recognized how important it is for all of us to share stories about our own battles with food demons, so we can help one another replace shame with support.

Maybe because Diane and I decided to go public with our struggles, a lot of well-known people have been willing to talk very candidly to us about theirs. While we were researching this book, we were both amazed to learn how common many of those stories really are. Sometimes, they are linked to coping with a terribly traumatic event. Dr. Nancy Snyderman understands that as well as anyone.

Nancy weighed 135 pounds when she entered college, just as Diane did. It was a reasonable weight for women at their height, which was about five feet eight inches. Not skinny, but healthy. She told us what happened to her near the end of her freshman year at Indiana University. "My roommate was working late on a really hard calculus problem, and she was getting help from the residential advisor. I remember saying, 'I'm going to bed, but I'll leave the door unlocked.'

"An itinerant was hanging around the dorm. He slipped in the front door behind a student who wasn't paying attention when she came in. Then he went down the hall turning doork.n.o.bs. And mine was unlocked. He raped me, and the next thing you know, I'm wandering around campus in the wee hours of morning totally disoriented."

It was 1971, and rape was mostly hidden from view. The campus police took Nancy back to her dorm room, where she took a shower, got dressed, and went to cla.s.s. "There was no counseling, no talking about it, no nothing, so I turned to food. Food was my savior. I suspect that if you talk to a lot of women who have some kind of traumatic event in their lives, you'll find they turned to food for comfort. I found great solace in it."

I suspect that if you talk to a lot of women who have some kind of traumatic event in their lives, you'll find they turned to food for comfort.

-Dr. Nancy Snyderman It didn't take long for Nancy to put on fifty pounds, her way of trying to disappear from view. It took her a lot longer, almost twenty years, to lose the weight. "Learning to like me was the same path as learning to be healthy; it was the same path as rediscovering my self-esteem," she says. "Going off to fat camp didn't help; depriving me of food didn't help. All it did was make me put food under my bed. I would order salad when I was out in public, and I would sneak the potato chips afterwards.

"Every person who has a food issue figures out how to game the system. I don't care if you're anorexic, you're bulimic, you're a h.o.a.rder-it doesn't matter if that's what you want to do. But the only person you hurt when it comes to food is you."

Frank Bruni, now an op-ed columnist for the New York Times, is another person who initially kept his history of eating disorders secret, later making them public in his memoir, Born Round: The Secret History of a Full-Time Eater. Before becoming a columnist, Frank was the newspaper's chief restaurant critic for five years. Being a "professional eater" was a curious job for a man who acknowledged to Diane and me that he was a "baby bulimic."

In a telephone interview (ironically, conducted while his refrigerator was being repaired), Frank talked about his earliest experiences with food. "It was really more about how huge my appet.i.te was. I was about two years old, and my mother wouldn't give me a third hamburger. I got so upset that I threw up." Frank told that story for two reasons: to ill.u.s.trate his belief that some people are hardwired to be big eaters and "because it is a kind of odd, quirky bit of foreshadowing, since when I was in college there was a period when I was an actual bulimic." Like Diane, Frank tried "pretty much every diet you can imagine, including juice fasts and eating nothing but fruit for days at a time."

He, too, tried the Atkins Diet time after time, but it rarely helped him lose any weight. "It was a chronic dieter's behavior, where you ignore evidence and keep engaging in 'magical thinking.' It would do nothing for me, because I think for that diet to really work, it's betting on you becoming so bored with the monochromatic eating regimen that you won't consume that many calories," Frank explained. The diet does not require calorie counting, allowing you to eat as much of the acceptable foods as you want. "I love meat and eggs, and ate so much of them that it didn't work for me."

Frank turned to bulimia in college in a desperate attempt to be thin without feeling deprived. "One of the things I found so seductive about bulimia was that I didn't have the same sense of panic or sacrifice at the beginning of every meal," he recalls. "I thought, if my willpower fails me, I have this safety valve of throwing up what I ate and the calories won't stick with me."

Frank's reliance on bulimia didn't last long, but his struggle for weight control certainly did. One of his hardest times came when he was covering George W. Bush's race to the White House. He was surrounded by food on the campaign trail, and very little of it was nutritious. "Every single meal was some sort of buffet or a bunch of stuff being thrown at us on the campaign plane," he recalls. "Some days it was just a constant level of fairly abundant eating, and then some days it was stress-induced binge eating after a really, really grueling day. I would feel almost like a drug addict's desire for a blast of pleasure and a release. I would sit down in front of my hotel minibar and eat the peanuts, then the Oreos and then the Pringles. Before you knew it, I'd eaten every stupid snack in that minibar."

Frank tipped the scales at 275 pounds. In those days, he recalls, he would allow himself to overeat "because I would tell myself the lie that tomorrow I was going to go on a diet, or the next day I was going to fast. I would end up giving myself permission in the moment to overeat."

I would tell myself the lie that tomorrow I was going to go on a diet, or the next day I was going to fast. I would end up giving myself permission in the moment to overeat.-Frank Bruni Eventually, Frank learned the secrets to good eating that helped him break the constant cycle of dieting and weight gain. He lost eighty pounds, in part by redefining appropriate portion sizes, and he has kept that weight off. Gaining control over his schedule was key for him, because it gave him time to cook healthier foods and to exercise rigorously.

When the Times offered him the job as restaurant critic, Frank thought long and hard before accepting it, concerned about the potential impact on his weight. Ultimately, he decided he would be able to eat with enough restraint when he was not working that he could stay "on the straight and narrow." Ironically, he actually gained some weight after his stint as critic ended.

Like me, Frank has not entirely conquered his food demons. "I still have a somewhat compulsive relationship with eating. I mean, the desire to overeat comes along with some frequency. I'm not a slave to it, as I once was, but I still have to struggle with it, and sometimes I lose the struggle."

The link between eating disorders and obesity is getting more attention from scientists. For a long time they were considered distinct. Conditions like bulimia and anorexia were viewed primarily as psychological issues, while overweight and obesity were viewed as either genetic or metabolic problems, or as failure to take personal responsibility. But now we are starting to understand that there is a lot of overlap, characterized by an all-consuming focus on weight and food.

This is where my story of food obsession and Diane's tale of fighting fat converge. Both of us spend an incredible amount of time focused on food. In Diane's case, she has lost weight, gained it back, and started all over again, virtually her entire life. In my case, I have been so terrified of that loss of control that I have resisted even weight gain that would be good for me. I would be healthier and more at peace if I weighed 135 pounds instead of 125, but I'm afraid that I won't stop there and the weight will keep on climbing. So I sacrifice and I suffer and I'm hungry a lot. What a waste of mental and physical energy for both of us. "At least your obsession with food helps you keep the weight off-mine doesn't," Diane told me with frustration. She may be right, but it is still not healthy. One problem is that being so thin really gets rewarded. When I'm at my thinnest, I have everyone in the world telling me how great I look. Companies send me clothes to wear, and I can't believe how attractive they are. I feel like a model. Women say to me, "You're amazing, look how good you look!"

That kind of praise drives me to keep my weight way down. It's hard not to enjoy so much reinforcement from the outside world. Culture is a very powerful force. Ever since I was a kid, I studied the landscape and I saw how things went for women-prettier and thinner equals success. Diane gets really annoyed when I say this. She thinks I am too willing to accept a culture where women are valued most for their looks. I agree with her that it shouldn't be that way, but it is, and that's a fact.

But I am finally realizing that trying to be extremely thin is like trying to collect water in a sieve. It just doesn't work. I have to come to terms with that. And when I hit the scales at 118, or even 125, that is just not healthy for me. I have more work to do if I am going to reach 135 pounds and still feel good about myself.

CHAPTER SIX.

MIKA AND DIANE: MAKING PROGRESS, STILL STRUGGLING.

OUR STORY, WITH DR. MARGO MAINE,.

LISA POWELL, SUE GEBO, D'MARIO SOWAH, ANDY DEVITO, DR. THOMAS LANE.

By the time we reached the halfway point in writing this book, Diane had lost forty pounds. Meanwhile, I was still driving myself crazy with thoughts of food and desperate to find enough piece of mind to achieve, and stop at, a ten-pound weight gain. I was still living hungry most of the time.

As I began confiding more about my eating habits and obsessions to Diane, she began pushing me harder to deal with my att.i.tudes toward food and weight. She thought I was masking some of my emotional issues, instead of dealing with them directly. Finally, I agreed to talk with clinical psychologist Dr. Margo Maine, a nationally known specialist in eating disorders. Margo is also co-founder of the Maine & Weinstein Specialty Group in West Hartford, Connecticut.

Margo presented me with a completely different way of thinking about my eating patterns when she surprised me with a diagnosis of orth.o.r.exia nervosa. The doctor who originated the term, Steve Bratman, explained that "orth.o.r.exia nervosa indicates an unhealthy obsession with eating healthy food." The term derives from the Greek word orthos, which means "right," or "correct," and orexia, meaning "appet.i.te," and is intended to sound like a relative of anorexia nervosa.