BRAVE GIRL EATING: A FAMILY’S STRUGGLE WITH ANOREXIA

A READING GUIDE

(Ch. 1)

1. What are some of the myths that surround Anorexia Nervosa (AN)? What can school nurses and other professionals do to help dispel these?

2. It is believed that eating disorders are a result of both emotional/social as well as biological/pathological factors. Discuss these multi-factors, then describe the stigma attached to the first set of factors and what might be done to increase awareness by nurses of the second set.

3. Discuss the first indicators/behaviors or “red flags” that Kitty exhibited. How can school nurses and other professionals work with families to catch these earlier and speed treatment?

(Ch. 2)

4. Why did the author describe AN as “battling a many-headed monster in the dark)? Is there often guilt attached to this diagnoses by parents/families?

5. What was the author’s reasoning for declining inpatient units or residential clinics for Kitty’s treatment? Was this reasonable? Explain.

6. Does the term “encapsulated psychosis” help explain the mental illness component of AN? Does this relate to the “demon-like voice” that Kitty often used? And can this symptom actually be helpful in helping parents understand AN better and in their quest for positive treatment?

(Ch. 3)

7. How does the culture we live in affect how we eat? How can school nurses and other professionals impact these long-held beliefs?

8. Describe Family Based Treatment (FBT-LeGrange), also known as the Maudsley approach. Why is this type of treatment so appealing to Brown? How does FBT differ from more traditional and dated therapies such as In-patient and residential treatment options as well as those suggested by Minuchin and Bruch?

9. What are the long-term benefits of FBT from a physiological point of view? Discuss the three stages of this therapy and which stage Kitty fell into when beginning FBT.

10. Explain the physiology that occurs in the body when Kitty begins increasing her intake after so many months of starvation. Why does she begin by losing weight?

(Ch. 4)

11. Discuss the DSMIV’s definition of AN as a choice or lifestyle. Does this affect public perception of this disorder? How can school nurses help with understanding of AN?

12. How has the medical and psychological thinking surrounding AN evolved historically? What does this author believe is the answer or solution?

13. What are some of the side effects of re-feeding? Which type of calorie is the most important to include when beginning the slow process of healing from starvation? Why? Why is this so difficult for Kitty? What might be the nurse’s role during this stage?

14. Briefly discuss the role of neurotransmitters in the brain and why they are helpful in understanding AN. (Ch. 5)

15. Discuss the Minnesota Experiment of 1944. How did this starvation study help us to better understand AN?

16. Discuss the genetics theory and also State vs. Trait. How are these helpful in understanding AN?

17. Does neurobiology play a role in AN? If so, how?

18. Discuss why the psychologist Shan Guisinger relates AN to historical strategies for surviving famine. What factors support her theory? Why did this author relate to her theory?

19. For AN, is it yet possible to provide best practice, evidence-based treatment and up-to-date research/clinical practice? Why is this author so frustrated when trying to find what would be commonplace for every other area of medicine?

(Ch. 6)

20. Was there a school plan in place for Kitty as she transitioned back to school in the fall? Was Kitty’s plan enough? What type of plan might be helpful to students struggling with anorexia? How can the school nurse and other professionals be involved?

21. Brown relates that “the demon” returned when they began re-feeding Kitty. Discuss how the demon is a “measure of effectiveness.”

22. What percent of girls and women develop Anorexia? Does the risk increase or decrease, and by how much, if one sibling in the family has the disease? Is there anything that can be done to decrease this risk?

23. Discuss the pros and cons of including antidepressant medications, such as fluoxetine and Zyprexa, for those suffering from eating disorders. What side effects did Kitty experience?

24. Through all of Kitty’s treatment and care, who has seemed to be the most supportive and significant provider for this family? What elements of care were most helpful? What elements can be harmful?

25. Discuss the idea that anorexia is related to our culture. How does this disease affect everyone around the sufferer?

26. During re-feeding why is Kitty seemingly no longer able to feel hunger or appetite?

(Ch.7)

27. The professional opinion is that approximately 2/3 of all cases of anorexia will face recovery as a life-long challenge/struggle, even after with recovery. Discuss how hormones/chemicals in the body play a role in this.

28. Discuss the role the gymnastics team (and other teams like this) played in Kitty’s disease. Why would coaches or school officials hesitate to bring their concerns to the parent? How is the issue of returning to gymnastics resolved?

29. Discuss the terms “mental health” and behavioral health” in terms of insurance providers. What were the insurance issues Kitty’s family was faced with?

(Ch.8)

30. Chapter 8 discusses “who” has the responsibility for Kitty’s eating (re-feeding). Why is it so important to Kitty that her parents assume this role?

31. How does growth play a key role in the re-feeding process?

(Ch.9)

32. Discuss five examples of why competitiveness is such a hallmark of this illness and can be such a problem in eating disorder groups? How do the differing therapies utilized affect this?

33. Discuss the pervasive cultural assumption that there’s “something wrong with wanting to eat.” Does this acculturation/thought actually cause anorexia?

(Ch.10)

34. Why are residential care therapies usually ineffective in treating anorexia?

35. Discuss why “calories in; calories out” theories do not work well as identified in both the Starvation Study and Sims Experiment (inducing obesity)?

36. Why was it so hard for Kitty to gain weight toward the end (nearly two months’ plateau) even eating 4000 calories per day? How did her parents know she was not yet recovered even though BMI was “normal”?

37. Why is recovery so elusive to achieve and the term “weight restored” so misleading with eating disorders?

38. What was Harriet Brown’s family’s “happy ending”?

BODY OF TRUTH: HOW SCIENCE, HISTORY, AND CULTURE DRIVE OUR OBSESSION WITH WEIGHT—AND WHAT WE CAN DO ABOUT IT

A READING GUIDE

1. Do you believe weight is a major issue for women (and, increasingly, men) in this culture? Has weight been an issue in your life? In what ways?

2. What surprised you most in the book?

3. Do you agree with Brown that the real epidemic in America isn’t obesity—it’s our obsession with obesity?

4. Brown writes that one of our most deeply engrained assumptions is that fat is unhealthy (p. 9). What does she mean by this? Do you agree?

5. In the first chapter, Brown describes four “big fat lies” and explores the evidence that does or doesn’t support each of them. Which of her arguments do you find convincing? Which do you disagree with?

6. BMI, or Body Mass Index, is widely used today to describe people’s health based on which category they fall into. Given the history of the BMI (p. 10), do you think it’s a reliable measure? Why or why not?

7. In Chapter Two, Brown suggests dieting to lose weight makes most people fatter and less healthy in the long run. Do your personal experiences support this? How about the experiences of friends and family members?

8. Some experts suggest fat-shaming is a good way to inspire people to lose weight and keep it off (pp. 52-54). Do you agree? What do you think of campaigns like Strong4Life, which are aimed at childhood obesity?

9. Brown describes a mother who brought a seven-month-old to a therapist because she moaned with pleasure whenever she ate (p. 75). Can you identify with that mom? Why or why not?

10. In Chapter Three, Brown describes a dichotomy we’ve created between “good food” and “bad food.” Have you seen this in your own relationships with food? Are there foods you avoid because they’re “bad”?

11. Weight loss is a $60 billion industry, and the book explores the different stakeholders who have a vested interest in the business of weight loss. Does this change the way you think or feel about dieting personally? On a broader scale?

12. What do you think of the American Medical Association’s decision to categorize obesity as a disease (p. 104)? How might this affect people who are obese?

13. Brown cites research showing that doctors and other medical professionals are strongly biased against fat and fat people (p. 115). Did this surprise you? How could such bias affect both fat people and those who are “normal” weight?

14. Children are strongly affected by our cultural attitudes around fat, thinness, beauty, and health. Brown lists a number of reasons we should be worried about how these attitudes affect children (p. 145 and elsewhere). Do you agree we should be worried? How do you think we might encourage health in children and teens without shaming or harming them?

15. Have you ever engaged in “fat talk” (p. 154)? How does it make you feel? Does doing more or less of it change your behaviors around food or weight?

16. The book makes a case for thinking of health in terms of behaviors rather than as a number on the scale. Do you see advantages in thinking about weight and health separately like this? Disadvantages?

17. Did the book shift the way you think about weight, health, and beauty? How so? Might you do anything differently in your own life after having read it?