I got an email from CRC Health Group, "a national behavioral health care company. CRC recently created a graphic which I believe helps to illustrate "almost" anorexia. I thought I would send this over to you in case you felt your readers would benefit from it. A copy of the graphic is embedded which you are free to publish as you see fit. Thanks for your time and all that you do to educate your readers about eating disorders."

Well. This is kind of cool. The information is coming to ME, now.

While Anorexia has not been part of my own journey or Binge Eating experience, I'm obviously pretty aware of the complexities of eating disorders, and even how some symptoms and behaviours can have cross-over between the official diagnoses. In fact, I've already written about the prevalence of "almost" disorders, because when those are factored in, it makes one ask "is disordered eating the new normal?"

This graphic is based on a book by Jenni Schaefer, called Almost Anorexic.

From the CRC Health website:
We created the above infographic to generate awareness about a phenomenon that recently came to our attention called “almost anorexic.” There are a lot of gray areas around the diagnosis and treatment of anorexia(and all eating disorders), and these disorders are becoming more prevalent in the United States (and around the world).

While only 1 in 200 adults meet the clinical diagnosis of anorexia, 1 in 20 people meet the criteria to be considered almost anorexic. The percentage is much higher for teen girls.  Since eating disorders are among the deadliest of all mental disorders, our treatment community is urgently reaching out to improve awareness about the symptoms and warning signs of anorexia.

Awareness and information is crucial and can save lives. It's not just the librarian in me saying that. If you see yourself or a loved one in these descriptions, check out crchealth.com for suggestions on how to find help.

Baloney is putting it mildly. BMI is a load of bull. And the misuse of the Body Mass Index as a measurement tool muddies the waters when we talk about obesity, and contributes to systemic fat shaming.

BMI = weight(kg)/height(m)2

Now, I'm not mathy. Numbers are not my strong suit. But even I can see that it's a relatively arbitrary formula that does not take into account all the variables which measure health. BMI doesn’t differentiate between muscle and fat, it just takes your weight and height into account. It doesn't measure your overall body fat. Leaving aside the "muscle weighs more than fat" argument, which is mainly applicable for elite athletes, more than the general population, the formula is especially flawed because it doesn't take into account where the fat is stored. And that does make a difference. Belly fat and visceral fat is far worse for your health than the blubber on your butt or under your arms. It's the waist that matters - it's what I mean when I refer to "my gut." So, even if BMI did accurately measure body fat (and it doesn't: it only measures body weight), it still wouldn't tell us accurately how healthy a population or an individual is.

So, why use it? BMI was never really meant to measure an individual’s weight or health, or to put individuals into categories. It was developed over 200 years ago, and was meant to be used as a tool to measure the overall "health" (or average weight) of a population. "The BMI was introduced in the early 19th century by a Belgian named Lambert Adolphe Jacques Quetelet. He was a mathematician, not a physician. He produced the formula to give a quick and easy way to measure the degree of obesity of the general population to assist the government in allocating resources." We do need ways to track populations and general trends, so that health care decisions and policies can be made, and using BMI in that way makes some sense ... IF you understand what is being measured. When we use BMI, we learn obesity rates. What worries me is how much obesity is being correlated to health. There are a lot of assumptions that go with the term "obesity." A better measure of a population's health would be body fat percentages, but BMI only measures overall weight.

Where it becomes really problematic is when statistics show sharp increases in obesity, and words like "epidemic" and "crisis" start getting thrown around. It's how we've arrived at a point of declaring war on obesity, how fat shaming children has become acceptable, and how screening programs in schools and workplaces seem like a good idea to administrators. What is discussed far less is that BMI category cut-offs got lowered over 10 years ago, so people woke up one day without changing one bit, only to all of a sudden be labelled overweight or obese when the day before they had been normal. This also partly accounts for the sudden increase in “overweight” people, leading to all the hysteria about the Obesity Epidemic (like fatness is somehow contagious). While lifestyles are changing and are more sedentary, when stats are used to back up the “Obesity Crisis” it’s usually traceable back to when they changed the category numbers, making it look like there was a huge spike in fatness.

What's needed is better science, and clarity in statistical analysis. How obese the population is doesn't really tell us how healthy it is, yet decisions are made based on our collective fatness. If the stats helped hospitals to purchase more beds and equipment that fit the morbidly obese, or if the stats helped city planners to include more bike lanes and sidewalks and to limit the number of fast food restaurants in areas around schools, or if the stats supported insurance companies to cover claims which currently are paid out-of-pocket, then I wouldn't be as outraged by the continuous mis-use of the BMI. That's not the case. Instead, the stats are used for headlines to hype up a crisis of epidemic proportions, which people are expected to address on an individual level. Therein lies the blame and shame.

On that individual level, don't worry about your BMI. Worry about your HEALTH. If your doctor or fitness professional uses the BMI and nothing else to determine your weight category, call them out on it. There are far better ways to determine whether you need to lose weight, and how much. Or whether it's affecting your health. "A more reliable, but still relatively simple, assessment of fatness would rely on a skin-fold score based on measurements taken with a caliper at several areas (in men, the thigh, midchest and abdomen, and in women, the thigh, triceps and area above the hip bone) that reflects the amount of fat under the skin. Or, since abdominal fat is more hazardous, simply take a tape measure around the widest part of the abdomen and another at the hips and calculate the waist-to-hip ratio. For men it should be no higher than 0.90, and for women no higher than 0.83." In addition to your waist circumference and body fat percentage, any medical professional should be assessing blood pressure, blood glucose levels, cholesterol, and heart rates.

We simply can't leave our health to an outdated, ineffective formula.

Because, as I keep trying to remind myself, you can't tell how healthy someone is or isn't just by the size of their body.

More arguments about BMI and why it's not as clear-cut as we are led to believe:

• Obesity rates: is the BMI a good measurement? (CBC News)
• Nevermind your BMI: to measure your health, it's all about the waist (The Globe and Mail)
• Weight Index doesn't tell the whole truth (The New  York Times)
• Top 10 Reasons why the BMI is bogus (NPR)
• The Duh Truck rides again (Shapely Prose / Kate Harding)
• Yes, Virginia, the BMI is BS (Dances with Fat / Ragen Chastain)
• Don't expect government to win the war on obesity (The Globe and Mail)

Health is all about mindset. In order to focus on being as healthy as possible, you have to remove a lot of the associated emotions, assumptions, and attitudes that go with it. Dr. Yoni Freedhoff wrote an article last week, published in the Globe and Mail, which introduced an informal term: Post-Traumatic Dieting Disorder. It's a phrase that sums up "it's not a diet, it's a lifestyle change!" that is becoming more popular.

In theory, I know that to be true. What I find hard to come to terms with is that lifestyle change still feels like a diet, it's just a diet that is intended to be long term. You change your habits, but that just makes you an habitual dieter. Lifestyle change means that you're not following someone else's specific rules, you're following your own, and occasionally you can break them, but there are still rules. There are still restrictions, on amounts (portion control), on when you eat certain things (nutrient timing), on what you eliminate from your options on a regular basis (bread, pasta, icing; sugar, dairy, alcohol, gluten) - regardless of your reasoning why. Whether you tell yourself "no" because you are trying to lose weight, or because you are trying to be healthy, if you deny yourself something that you really really want, it's still a diet. If you force yourself to eat things you don't enjoy "because it's good for you" then it's still a diet.

A lifestyle should be something you not only want, but that you enjoy. Which is ultimately exactly what he says: "live the healthiest life you can honestly enjoy." My problem? I want both. I literally want to have my cake and eat it, too. I want the skinny. I want the strong. I want the icing.

So, I struggle back and forth in my head, between the better option. Is it better to keep trying for weight loss, including food denial (whether you call it "dieting" or "lifestyle change" it emotionally amounts to the same thing for me), in the hopes that the end result of some fat loss will be worth the mental anguish? Or do I focus more on body acceptance, to find a way to be okay with how I look and just appreciate how I feel and what I can do? I believe it's one or the other, frankly. And because I flip flop between which path to take, I end up going in circles, starting and stopping dieting, which is the definition of yo-yo'ing.

I don't love the term "post-traumatic dieting disorder" because I think it undermines and belittles the severity of the real thing, Post-Traumatic Stress Disorder. But there's no denying that for those of us who have lifelong struggles with weight fluctuations, obesity, and maintenance, some kind of acknowledgement of the toll it takes - mentally and physically - is needed. As he outlines below, it's no small thing, either.

Here, the article in its entirety: Aim for the healthiest life you can enjoy, not just tolerate

And some of the most poignant, impactful quotes:

• Dieting is predicated on suffering and humans aren’t built to suffer in perpetuity.
• Why, despite knowing better, do we blame ourselves when the nonsense fails? Could it be a case of suffering from post-traumatic dieting disorder (PTDD)? Because, really, what are modern-day diets, if not traumas? They’re generally some combination of undereating, overexercising or blind restriction. People on diets are trying to live the healthiest lives they can tolerate, rather than the healthiest lives they can enjoy.
• PTDD is not a formal diagnosis, but rather a shared constellation of symptoms: recurrent dieting has led to feelings of failure, shame, hopelessness, insecurity and sometimes even deep and abiding depression. Their body images are often worse than when they started dieting in the first place and their relationships with food are anything but healthy – in many cases they feel threatened by the very foods they love most. They can also become socially withdrawn and their personalities can change, which in turn can negatively impact their closest relationships and lead some to believe themselves unworthy of love, marriage, intimacy, health or a normal lifestyle.
• The triggers of PTDD lie not just with a person’s chosen diets, but with society as a whole and the hateful weight bias that permeates it. Whether it’s shows such as NBC’s The Biggest Loser, which teaches that scales measure not just pounds, but also success and self-worth, or whether it’s well-intentioned health professionals suggesting that unless a person reaches a particular weight their health is doomed. Celebrities’ weights are endlessly critiqued, with popular magazines shaming women, mostly, when they “pack on the pounds.”
• Society’s overarching message is that thinness is attainable if a person wants it badly enough; failure is simply a reflection of personal weakness and laziness.
• Rather than deny imperfections, we need to embrace them, and in turn dieters, instead of trying to live the healthiest lives they can tolerate, need to start cultivating the healthiest lives they can enjoy.

And if there's a chance at free training sessions, you bet your patootie I'll be doing it through My Fitness Pal. I'll
overlook the fact that it makes it easier for Mat to check what I'm eating than my giant binder with photos that I'd bring him each month. Prizes! Free stuff! I'm in.

And, hopefully, I will also soon be back on track.

Tosca Reno is singin' my song, in a recent Huffington Post article called "The Pornographication of Fitness needs to stop." Reno is the queen of Clean Eating, and is currently promoting a sugar detox with a Strike Sugar Challenge. But this article speaks to a much more balanced approach to fitness than what she has experienced from the belly of the beast. (Pun intended). She has been a "bikini girl, clad in what was essentially panties and bra, standing on a fitness booth, hawking fitness gear and the lifestyle, exposing my well-toned thighs and abdomen to the general public." And from her inside vantage point, fitness was far more about sex than it was about strength or health.

Mat and I have disagreed about how motivating or negative "fitspiration" can be. I see it as using highly sexualized images of women to promote fitness, often with quotes attached which seem motivating until you deconstruct what they're really saying. He sees it from the body builder's perspective, because he knows how hard the people in the photos have worked to get themselves to fitness-model levels of preparedness. Tosca Reno's argument about how fitness is portrayed in the media covers both angles, addressing head-on the issue of making fitness into something sexual. 

Gazing at images of caricatured breasts, buttocks and biceps gives you the impression this is how a fit body should look, that every fit body needs to be shaped in the same vein. Fitness magazines use exactly these images to "inspire" women to look this way. Yet most of us can't identify with what we are looking at because we don't believe ordinary us could ever be them.

What we don't realize is that when we are looking at the faces and bodies of women in these physique magazines, is that most of them have dieted for months to look that way. Or most of them are just days prior to a contest where they have put themselves through rigorous training and dieting to get lean enough.  Or they have just competed and won't look the same in a few days time.

In other words, she is acknowledging both Mat's view and mine: those bodies were hard-earned. They are not fake, they are real people. AND they are simultaneously not realistic expectations, even for the women who live in those bodies, because they represent one very specific moment in time. A moment which is often well lit, professionally photographed, perfectly posed and positioned, and oiled to highlight every bulge and fibre line. When those women take off the high heels, go home and relax hours later, do they even look as fit or as buff as they do in the photos? Yet these are the images that are ubiquitously used for inspiration.

Perhaps from my vantage point of 55 years of age, one willingly accepts that there is more to fitness than pornography. Somehow the butt-baring image just doesn't work after a time. So what then is the new direction of fitness? If you ask me, the key to fitness is being able to move your body in the way it was meant to move.

It means you can run, jump, swim, play, bend, walk and lift with all parts of your body from joints, muscles and bones to hands and feet, all body parts working in unison. It means that if you had to run 5K to get away from danger, if you had to swim for 20 minutes to save yourself in a flood, if you had to lift a heavy weight out of the way to free yourself, something or someone else, you could do it. 

The new fitness trend is not about prostituting yourself but about doing the hard work measured in reps, sets and sweat to create a body, an entire organism engineered to sustain itself in this brave new world. It means you can help yourself -- not be dependent on someone else. It means you train differently, think intelligently, respect powerfully, sensing a new strength in yourself that comes not from the desire to have a cutie booty but a strong one that can move when it has to, along with the rest of the magnificent machine called YOU. 

Being fit in a functional rather than sexual way means you are entirely capable of being powerful no matter what your height, bust size, shoe size or hair color. You are empowered from the depths of your DNA because you did the work, you earned your place and you walk confidently because of it. A functionally fit You welcomes all sizes, shapes and colors, your boobs and butt are incidental.  What we really need to build in the gym is a sense of self and what we are capable of. Believe it!

She concludes that the pursuit of sexiness stops being important. Her definition of fitness - something functional, based on what your body can do - is in line with what I'm trying hard to believe 100% of the time. I believe it about 85% ... but when I am surrounded by so many images of sexiness, it's hard not to aspire to look like them. It's the 15% of me that still buys in to fitness-as-synonym-for-sex that stands up and applauds Tosca Reno for voicing her philosophy so eloquently.

I've been mulling over how to write about the dichotomy between finding balance and losing weight. What I've been stuck on is the angle from which to approach the topic. Can I re-lose the weight I've put back on, and continue to lose, while still aiming for a balanced approach to health?

It doesn't feel like it. And I wasn't sure why. But I think it's because for binge eaters, there IS no balance. Just as an alcoholic can't have "just one drink", there are some foods which I can't have just a little of. There is no such thing as "just one bite" when you're not able to stop, so cheat meals or occasional indulgences don't work the way they do for most people. Which, y'know, could be fine except that I can't stop eating altogether and go "dry" to sober up.

But maybe I'm not as alone as I thought. Diet talk is everywhere. Mixed messages are everywhere. Confusion is, well, everywhere. An article I've been holding on to brought the point to the forefront: Diet talk has become inescapable. "Many of the behaviors that today’s diet books and food trends promote are straight out of the DSM Diagnostic Criteria for Eating Disorders. Preoccupation with food and eating, making excuses for not eating, elimination of large categories of food, rigid food rules and rituals, guilt and shame associated with food and eating, avoidance of social activities because of anxiety about food, isolating oneself from friends and loved ones because of dietary ideology, the list goes on. These are not normal or healthy behaviors, they are hallmarks of disordered eating, and they are PROMOTED in diet books and blogs and between friends, with distressing and escalating regularity."
She concludes that we are, as a culture, developing a collective eating disorder. What started as a desire to improve the quality of our diets has turned into a national obsession.

It makes it pretty difficult to distinguish between truly disordered eating habits, and healthy habits. Where do you draw the line? How do we recognize in ourselves or others when it has become a problem? Another recent article attempts to shed light on "the most common eating disorder you've never heard of." The problem is that they've taken the designation of Other Specified Feeding or Eating Disorder - which is a catch-all category used to diagnose anything other than anorexia, bulimia, and binge eating disorder - and called it "the most common." That part doesn't make sense, but what is striking from the article are the statistics. It sheds light on how many people fall on the eating disorder spectrum. Most often, the focus is only on those who are at the farthest end.

Consider some of these statistics:

• One in 68 adults will develop clinical anorexia, bulimia, or binge eating disorder, but at least one in 20 have demonstrated symptoms of these disorders.
• 74.5 percent of women said concerns related to shape and weight interfered with their happiness.
• In one study on adolescent boys and young men, 17.9 percent reported becoming “extremely concerned” with their weight and physique by adulthood.
• One in 20 adults exhibits symptoms of an eating disorder, and the prevalence of dieting and disordered eating behaviors among male and female young adults is particularly high.
• Among women ages 25 to 45 without a history of anorexia nervosa or binge eating, 31 percent reported having purged as a means of weight control.

Dieting and poor body image don't mean you have an eating disorder. But your behaviour doesn't have to be extreme in order to have one, either. The best way to consider whether there's a problem to address is to ask whether your relationship with food, shape, and weight is truly interfering with your life. Ultimately “the main feature that cuts across all eating disorders… is feeling like your shape and weight is one of the most important factors that determines how worthwhile you are as a person,” Dr. Thomas says.

When I lived out west, I met the clinical criteria for Binge Eating Disorder: "eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating; a sense of lack of control over eating during the episode; at least two days a week for six months."

I no longer meet that criteria. The work I've been doing, on my own, with Mat, with doctors, by blogging, has helped tremendously. But I will probably always call myself a binge eater. I don't know what "recovery" looks like, or if there is such a thing. I really do think of it in terms of an alcoholic. It's always going to be there, under the surface. As evidenced by this weekend's near-binge, moments of relapse can happen without warning, at times that aren't obvious. That's kind of scary to me.

Which brings me back to my conundrum. All-or-nothing thinking is a big part of the problem that got me into this mess in the first place. If I can't be perfect at eating all the time, why bother? If I mess up a diet, then I give in and go overboard the other way. If I'm not good at an activity right away, then I must not be able to do it at all. You see where I'm going with this? All-or-Nothing is the hallmark of a lot of eating disorders. That's why I'm striving for balance. And, yet, I'm not sure that balance is really, truly, possible when it comes to eating. There ARE whole categories of foods I have to mentally eliminate and take off the table. I DO need to track what I'm eating and weigh myself and account for it all. There still is fear, for me, around food: there's something "bad" about everything, so nothing feels "safe"! And certain foods will likely always be triggers. Not exactly the definition of balanced.

It tells me that there's still a long way to go. But also that it's possible and there is hope, even if that hope is to inch along the spectrum back towards the middle. I think I believed that I could jump from one end to the other - all-or-nothing - and that it could be like flicking a switch. Make the lifestyle changes, lose weight, get into shape, you're done, move on. It's not like that, at all. I don't know why I thought it would be. Like much of the population, I'm living in the grey areas, the always moving grey areas between the ends of the disordered eating spectrum.

When 1 out of 20 are also living there, at least I know I'm in good company.

Warning: rant ahead.

People need to learn to keep unsolicited opinions to themselves. Mutually-agreed-upon diet talk among friends is one thing, and even then should be kept to a minimum. But it's been awhile since I've had relative strangers make comments and assumptions about my body, and I forgot just how much it sucks.

When you work with the public, you never know what they're gonna say. I usually take it in stride, even when it's personal, because they don't really know me. Except for when they do. Some of our regulars DO know me a little bit. One lady brings the kids she babysits to my weekly story times and always wants to diet talk, usually right as I'm setting up and in front of the kids. I do my best to shut her down. She shames other staff who don't actively diet or exercise, and tells them all about what she does, but because I am able to say "why yes, I do work out" and she could see that I had lost weight, I just got the chitter chatter, I didn't get the shame.

Until today.

I was walking on my rounds, and she saw me, waved me over, started yammering about nothing that I cared about. I was trying to politely extract myself from the conversation because I was on my lunch break, and she was going on and on about which kind of bagels and bread her kids will eat, and how she prepares her spaghetti sauce, and how many calories in her brand of yogurt, when she looks at my belly and says, "so, you've quit the diet and exercise, eh?"

My jaw clenched.
Pretty sure my face went beet red.
"No," I snapped. "Still going to the gym. Every day. Bitch."
Okay, the "bitch" was silent, in my head, but I really wanted to say it.

Because body shame sucks, and it should never be okay to comment on people's bodies, and only assholes assume things about people, and unsolicited diet talk is never ever acceptable. If I hadn't been at work, if I didn't only know this lady in a professional capacity, I'd have likely launched into a "you can be fit and fat, you know" tirade or try to school her on why my weight loss has stalled and gone back up, or why it's none of her fucking business anyway. But I didn't. I clenched my smile, said, "well, I have to keep going" and got the hell out of there.

The worst of it is, I let her. I let her get away with it, and I let her get to me.
I'm sitting at my desk, staring at my lunch. My healthy, vegetables-and-chicken whole-foods lunch.

And I can't eat it.

Because I know how hard I work.
I know what I eat, and don't eat, and what I have given up, and what I feel deprived of.
And it's not enough. It may never be enough.

Those words, those unsolicited words based on one glance at my body and an assumption, those unsolicited words undid a few months' worth of work.

I know she's wrong.
I know she's wrong.
I know she's wrong.

But I am still staring at my lunch sitting on my desk.

Nerd Fitness posted a fantastic blog dissecting various fad diets and exercise programs. Offering a balanced approach ('cuz, y'know, nerds are like that: do your research and weigh the pros and cons), he acknowledges the good and the bad in each one.

Not surprisingly, the end result is that the only tried-and-true method for health, fitness, and weight loss is ... <drum roll please> ... diet and exercise.

Folks, we have a winner.

Check it out: What you need to know about P90X, Insanity, Weight Watchers, Shakeology, Cleanses, and Nutrisystem