A couple of weeks ago, a reader comment on a discussion about hyper-palatable foods (HPF) brought to mind an issue I’ve heard before, one which highlights a key misunderstanding about our approach at Kartini Clinic that I fear may be widespread. So I wanted to dedicate a blog post to addressing this misconception.

The misunderstanding is essentially this: that limiting HPFs is about preventing the patient from “becoming fat,” and it therefore reinforces the idea that their disordered fear of food and weight gain was valid.

There are two separate issues here: “I won’t let you get fat” and “hyperpalatable foods ”. They are not connected. The proscription against these HPFs is not, emphatically not, because eating them will cause someone to become fat. The over-shooting of weight, seen by Ancel Keys when his subjects ate and over-ate on HPFs after deprivation, resolved with time—about a year and a half. His subjects did not have anorexia nervosa or other eating disorders and therefore processed bodily information in a fundamentally different way from those who do. They were (in retrospect) somewhat amused by becoming overweight (or “fat” as one of them put it), something that not only would not amuse our vulnerable young patients, but would terrify them. They would not be able to think rationally about it or take the long view, and hence would be prone to engage in compensatory (eating disordered) behaviors in order to allay their anxiety. The torment of feeling compulsed to engage in these compensatory behaviors (restricting intake further, over-exercising, purging, etc.) is what we are primarily trying to avoid by steering clear of HPF for about a year. Not forever. And emphatically not because we think HPFs are evil. They are “hyper palatable” because they are delicious and hit our pleasure receptors, our reward system, hard.

There are many misunderstandings about how the subjects in the Minnesota Semi-starvation Study were fed and then re-fed, often because information has not been taken directly from the study but rather from popular press summaries of it. How much each subject ate in the study was carefully calibrated to either maintain their normal weight (the control phase) or to reduce it a certain percentage (the starvation phase). Their exposure to HPFs was later, after the 12 week controlled re-feeding was over and they were allowed to eat whatever they wanted. That was when many of them reported bingeing on desserts and treats on their own. During the study Keys himself fed them the diet known to prevail in wartime Europe: largely potatoes, cabbage and similar cheap starches.

I agree with Dr. Rebekah Peebles when she says “we cannot be afraid of what the eating disorder is afraid of”.  We are not afraid of food at the Kartini Clinic. We have three chefs on staff who prepare and cook all meals for our kids as well as several times a week for our staff (in other words, we eat our own cooking!). All meals are made from scratch using whole grains, full fat ingredients, whenever possible organic, farm to table, real food, eaten together in a spirit of joy. We never use institutional ingredients from Sysco that you’d find at many other programs. And Kartini Clinic has piloted being focused on complete weight restoration for every child and guiding that restoration by the patient’s own biology, not by some insurance table of weights or out of date formulas.

At Kartini Clinic we advocate health at every size, but bear in mind : not every lean person is healthy and not every fat person is either. So we love the person regardless of their size or condition, realizing, however, that platitudes can blind us to real health concerns. Although you can be healthy at every size, it does not necessarily mean that you are.

Kartini Clinic sees young patients with binge eating disorder as well as those with obesity and type two diabetes. We love those kids the same as all the others. Regardless of their weight, we refuse, and always have, to diet them or restrict their caloric intake below that required  by their own body for growth and development. We go to great lengths to understand their individual biology and metabolic needs. We teach them to fight back against fat shaming and prejudice. We talk openly about it and about their personal experiences.  

I have written about the fallacy of BMI many times in my blogs. Kartini Clinic has always questioned all the rules– including the use ofBMI as a measurement of health. We advocate getting rid of BMI determinations altogether and point to the absurdity of shifting the goalposts for “normal,” “overweight,” “obese,” because of a few minor shifts in an individual’s BMI measures.

In fact, over the years we’ve been subject to a lot of criticism for not following rules or treatment conventions common across the eating disorder treatment world. For example, we were one of the first to maintain that anorexia nervosa is largely a heritable brain disorder, something for which we were pilloried by our colleagues, until the scientific evidence caught up with this notion. At Kartini Clinic we don’t follow “the rules”– ever– unless we know and agree with the rationale for those rules. As you can imagine, this attitude gets me personally in a lot of trouble. But it’s not about me, is it? It’s about the kids.