I follow Laura Collin’s blog almost all of the time—but some personal medical issues have kept me from reading lately, until today.  I scanned her recent entries and saw this.??

Good God.  But it does raise a few questions/issues; in fact, way more than a few.??

1. Parents don’t cause eating disorders. Since we founded the Kartini Clinic we have been saying loudly, unequivocally and clearly:  Parents don’t cause eating disorders and children don’t choose to have them.  Do we say this to ingratiate ourselves with parents?  Hardly.  Do we put it like this because we are “black and white thinkers” and “dogmatic”?  Well, if you think the statement “the world is not flat” is black and white and dogmatic, then maybe.  We proclaimed this initially, in the 1990’s, based on our overwhelming clinical experience and we continue to say it based on the evidence, both genetic, clinical and now, neurobiological.??You see, not only do parents not cause eating disorders they couldn’t cause them if they wanted to.  ??Why would anyone want to cause an eating disorder in their child, you ask?  Well, the article quoted by Laura—if true on the face of it—shares the story of a sad little girl and an obsessed, neurotic, misguided woman who apparently believes it is better to be dead than fat.  Certainly she must think it is better to be anxious and unhappy than fat.  Whatever fat is, in this context. ??I have recently seen two cases of what I feel may be Munchhausen by proxy—where a parent is vested in their child’s having an illness (in this case an eating disorder) to the extent that the parent will fabricate symptoms and even starve the child while claiming “he won’t eat”.  Nasogastric tubes get placed, unnecessary medical procedures are performed, etc.  It is incredibly sad, in fact, criminal.  And yet, even these parents, by anyone’s standard disturbed, have not been able to cause anorexia nervosa in their child.?? 
2. Epigenetics as subtext? I have begun to wonder whether or not the fashionable focus on “epigenetics” in the mental health world is not partially a back door way to place blame for causality on parents and families.  I’m just going to toss that one out there and invite comment. ?? 
3. The Obesity “Epidemic”. The whole obesity thing makes me want to stand on a very high peak and shout “Cease this madness!”  Presumably in previous eras “we” were not as fat as we are now.  And yet we ate cupcakes.  We even ate Twinkies.  But our mothers did cook at home—a difference between “now” and “then” that doctors are reluctant to discuss.  It is far easier to blame children and insist they “learn to make healthy food choices” than it is to talk painfully and frankly with parents who will do almost anything to avoid preparing and sharing family dinners.   OK.  Comment invited here too.?? 
4. Paging the Doctor! And then this Vogue article about the seven year old child who lost 16 pounds—did her pediatrician finally then wake up?  That is terrible weight loss in a young child (even though it still doesn’t mean she has an eating disorder).  It reminds me of something a family physician friend of mine once told me, and which many of you have heard me quote:  “Julie,” he said, “if you want to be shot out of a cannon into a bed of granola there is always some doctor out there who will willingly oblige.”