When I first came clean about my various health woes back in January, I promised this wouldn’t become a sad sack sick girl blog… and I’d say making you wait almost five months for an update achieves that goal.

So here’s the word: Tomorrow morning, Horace and all his little cyst friends are getting cut out.

I’ve been consulting with a fancy gynecologist who specializes in hard-to-treat ladyparts like mine for the past several months. We’ve tried the Pill — a low-estrogen version that isn’t supposed to interfere with my migraines. Horace is unmoved and continues to flare up with waves of stabbing pelvic pain and 12-hour migraines several times a month. The rest of the time, he wakes me up in the middle of the night, hurts when I pee, spasms when I do certain yoga poses and is generally annoying.

So I’ve also had several ultrasounds and they all say the same thing: Horace is an endometrioma, or endometrial cyst, which is a sign of endometriosis.

For the uninitiated, endometriosis is a currently incurable medical condition where your endometrial lining (that’s the bloody part of your period, sorry for squeamish types) grows outside of your uterus, in places where it’s not supposed to be. It can build up into lesions, adhesions (where it sticks bits of your insides together like really icky, painful Velcro) or cysts. I now have at least three of those: Horace is actually “complex,” meaning he’s two cysts stuck together, plus he has a buddy on my right side.

For some reason — I guess they way they look all dark and smooth on the sonograms? — endometrial cysts are also known as “chocolate cysts” in the medical community. I think this is proof that A) the medical community has a crappy sense of humor and B) has never seen or tasted chocolate.

To be clear: At the moment, the only official way to diagnose someone with endometriosis is to cut them open and take a look-see. So I’m “presumed endometriosis,” until my gyno cuts me open tomorrow and peeks inside. Endometriosis does bring with it some big, scary implications like the Cleveland Clinic’s helpful assertion that 30 to 40 percent of women with the condition are infertile, making it one of the top three causes of infertility in the United States. I have a lot of feelings about that. But right now, we’re mostly focused on Mission Make the Pain Stop. 

This surgery won’t cure said endometriosis — my body could decide to make some new Horaces whenever it wants — but it’s the best shot we’ve got at Mission Accomplished, for at least a few months, maybe a few years, and maybe longer.

So right now, I’m excited. Cautiously so; I’ve been excited before about treatments for both Horace and his migraine friends and then brutally disappointed when they didn’t pan out. (Things that have disappointed me even though other people swore they were The Best Ever: Acupuncture, chiropractors, physical therapy, lots and lots of supplements, even more drugs and so on.) And this, for sure, is the most aggressive step I’ve taken to get this situation under control, so it’s going to be uber-frustrating if I end up back on the heating pad, screaming into a pillow, in three months’ time.

But it’s nice — empowering even — to feel like I’m a little closer to understanding this whole situation. It always seemed obvious to me that there had to be a major hormonal component to my migraines, but nobody was really dealing with that aspect. Now, some dots have been connected.

And this brings me to my bigger point: Why am I over-sharing all of this with the world wide web? Not because I expect this to help lots of other women diagnose their own endometriosis — although the disease does take forever to get diagnosed correctly. I’m not a doctor or an expert on this condition by any means so I’m not qualified to have that sort of input on anybody.

I’m sharing all of this because I think part of having a good body image is understanding your body — and it’s crazy to me how poorly we understood women’s health issues like migraines, cysts and endometriosis and how many myths and misconceptions circulate about these conditions and the type of people that get them.

I’ve worried a lot that writing about chronic illness would hurt me professionally — no one wants to hire the flaky sick freelance writer — or personally — no one really wants to get drinks with the flaky sick girl either. But the fact of the matter is, dealing with chronic pain hasn’t made me flaky. It’s made me more focused, both in terms of the work I want to be doing and how I want to spend my time (and who I want to spend it with) when I am feeling good. It has also meant realizing I can’t control everything, paring down, saying no when I would have preferred to say yes, forgiving myself for not answering every email on time and hoping the world will forgive me too — but I’m not so sure these are such terrible lessons.

Unfortunately, flaky is just the beginning of the not-so-nice associations with these sorts of “female troubles.” There’s also hysterical, unstable and just plain making-it-up (see: The doctor who told me I “couldn’t possibly be in as much pain as all that.” Yeah. We loved her). On a case by case basis, I get where these stigmas come from — people being driven crazy by pain can seem, well, crazy. I find myself doing this uncontrollable-tears thing on the phone with my gyno’s secretary about twice a month which, I’m sure, totally makes her day. Plus even well-meaning medical professionals just get frustrated because it’s hard to feel successful with a patient who doesn’t get better. My gynecologist is nationally ranked and working at one of the country’s best hospitals — he shouldn’t be shrugging helplessly and describing endometriosis as “mysterious” when I ask him how likely this surgery is to fix anything.

But big picture: The reason women like me seem crazy is because we’re having to live with sh*t that nobody can accurately explain or fix. And the reason my doctors are so stymied is because these conditions have been dismissed forever and ever — by doctors, researchers, pharmaceutical companies, employers, men, other women, society. Enter the vicious cycle.

One in three women will experience migraines during her lifetime; 8.5 million American women have endometriosis. And millions more have other kinds of cysts, fibroids, or the myriad of other “female troubles” that fall under this umbrella. So we’re not talking about freaky symptoms of the odd hysterical female. These issues are the reality of having a body for a large number of women. 

So on the one hand, I hate Horace. I hate my migraines. And I hate all the ways they f*ck with my life — the fact that I can’t travel for an assignment without packing an artillery of painkillers and a heating pad; the way every weekend is a crap shoot as to whether I’ll get to enjoy myself or have to spend the day in bed; the low-grade way it all vacuums up my energy day-in, day-out because I’m always getting sick, being sick, or getting over being sick; the uncertainties about what’s coming next for me.

And I’m excited and cautiously optimistic that this surgery will represent a turning point for the better — no more Horace will mean nothing to trigger crazy hormonal flare-ups and migraines, at least for awhile.

But I’m not sorry for how this experience has taught me how desperately we need more education, research and awareness about women’s bodies. Because we’re never going to get out in front on this body image business — let alone choice and the rest of body politics — if we don’t take women’s health more seriously. That means asking questions about why this stuff happens and what we can do about it. That means treating these issues — and the women who have them — with respect, not skepticism.

And for me, at least, that means not being afraid to talk and write about what’s happening over here.

Oh and if someone could just figure out how to give Rush Limbaugh or maybe the Arizona State Senate an ovarian cyst or five, we might make some real progress.

PS. If you’re looking for more specific information about any of this stuff, here are some resources that I’ve found helpful:

• Tori of Anytime Yoga (who has been dealing with sh*t for way longer than me and with far more grace) posted a fact about endometriosis every day during March (Endometriosis Awareness Month) and I learned so much.
• The Society of Menstrual Research’s fabulous Re:Cycling blog – tremendous resource on all things lady parts.
• The Endometriosis Foundation of America — also, who knew Padma Lakshi was an endo sufferer? See what I mean how this stuff impacts so many women?
• The American Migraine Foundation and Migraine.com — info in spades especially because June is Migraine Awareness Month.

[Creepy endometriosis vs. regular uterus picture from here – not a site I'm endorsing as a medical reference, btw, just thought it was a handy illustration.]

I’m so thrilled to be participating in my girl Ragen’s iVillage slideshow of Diet Quitters. 

A) Because it’s really fun to be back over in iVillage Never Say Diet land for a visit.

B) Because I’ll be so stoked if we inspire even one woman to break up with an unhealthy diet/weight cycling pattern. And with 33 awesome women featured, I think those odds are good.

And maybe there is a C: Because I actually needed a tad of this inspiration myself this week. If you follow me on Twitter, you might have noticed that I’ve been in LA — and pretty often, in rooms where I was the person least likely to qualify for “Most Beauty Standards Achieved.” At least compared to when I’m in work-from-home mode, and my only competition for such titles are the cats. (Even though my cats are eye. candy.) Not seeking pity, just reporting facts. For the most part, I was pretty proud of how much this did not faze me — I do believe, in my bones now, that there are lots of different kinds of pretty in this world and I’m rocking my own thing over here and you can do your thing and we’re all good with each other. And more crucially, that pretty is well and good — but we all bring so much more to the table.

But I’d be lying if I didn’t admit that towards the end of the week, I caught a glimpse of my stomach rolls in a full-length mirror and thought “I can’t seriously be walking around like this.” Because there are a lot of different kinds of pretty — but you have to keep exposing yourself to alll of them. Or the Beauty Myth eats its way back into your brain so fast.

Enter Ragen, with her sensible explanation of why dieting isn’t worth it because there’s no science to prove that it works and my 31 new best friends with their inspiring stories of getting all those “you’re not good enough” voices out of your head — so you can listen to what your body really needs to be healthy.

Ragen and I did a much longer Q&A while she was reporting this story and because I’m chatty, she couldn’t possibly fit it all into my slide, so I thought I’d copy and paste that conversation here, in case you guys are interested in the longer take on me and diet quittage.

PS. For the record: This is NOT to say that everybody in LA is beauty-obsessed or all about being pretty in the Beauty Myth way. Far from it! I had many lovely body positive conversations and moments this week with lots of beautiful (in all ways) people. The stomach rolls moment is as much about my own insecurities and how I’m a work-in-progress on this stuff as it is about being in a Beauty Myth-dominant setting. So we’re all clear. Onward!

RAGEN: What was the last diet you were on?

I know, I know. This blog has been a little… quiet… as of late. Does it help to know that I’m thinking about you guys a lot more than I’m actually writing posts? Probably not, and there’s nothing more irritating than those blog posts that are really just “ahhh! soo busy!” excuses, so let’s not even go there. I am tweeting and Facebooking a bunch, and you knowing I’m Pinterest-ing, and hey, I’m even on Instagram now… so at least we’re all keeping up in all of those places.

I’m dropping in now to tell you about one of the things that is keeping me so busy (in an awesome way): The Economic Hardship Reporting Project, which is an exciting new journalism nonprofit founded by best-selling investigative journalist Barbara Ehrenreich and the Institute for Policy Studies. Its mission, per the About page, is this:

to force this country’s crisis of poverty and economic insecurity to  the center of the national  conversation. Unemployed, underemployed, and anxiously employed Americans need to know that they are not alone, that the current economic crisis is not their fault and that they are not always getting the information they need to find solutions.  Just telling compelling stories of individuals and families isn’t enough. We want to link such stories to the large picture, as we explore extreme — and deepening — inequality and the decline of the middle class.

And here’s me, over on the contributor page, with a little hint for you about what I’m working on…

I was invited to contribute primarily because of my work with The Nation Institute’s Investigative Fund — but those of you who know me through my writing about body image might be all “what does this chick who talks about loving your body know about economic hardship?”

Well, I’ll be the first to admit: Not so much. Although EHRP does state that part of its mission is to work with “unemployed or underemployed journalists,” (which is awesome!) I’m not currently in either camp. (Knock wood. This industry is madness.)

But when we talk about beauty myths, body image and size discrimination, we can actually get into conversations that are really about race and socioeconomic class pretty darn fast as I often discovered during the Beauty Schooled project. Then at the beginning of May, I attended the Beyond Hunger Conference, organized by the amazing Witnesses to Hunger and Philadelphia’s Center for Hunger-Free Communities and learned — from women who have been there, or are there, and do know this firsthand — that the war on obesity in this country all too often ends up being a war on poor people.

So those are some broad strokes for now, but trust me: There is overlap. In ways that I’m still learning and thinking about as I’m reporting my first story with EHRP… and because I love dissecting these issues with you guys, I’ll do my best to keep popping in to share what I’m learning/thinking about and ask you what you think.

In the meantime, definitely add the Economic Hardship Reporting Project’s blog to your feeds — Barbara, co-editor Gary Rivlin (author of Broke USA) and the rest of the team are posting some great stuff. And you can also follow them on Twitter, like them on Facebook, donate to support their work, you know the drill.

Longtime readers of this blog will know that I am usually a pretty big Michelle Obama fan. I’ve defended her right to wear un-American fashion designers, because she’s the First Lady, not First Barbie Doll. I had a whole lot of feelings when Rush Limbaugh called her fat. And there is a lot about her MyPlate program and the whole Let’s Move campaign that is just great. 

But then, last month, Michelle Obama went on The Biggest Loser. And that’s where she lost me.

Because TBL is a show that glorifies pretty much everything we’re doing wrong about obesity in this country. It’s about getting thin at any cost. It’s about no pain, no gain. It’s about public humiliation. It’s definitely not about health, no matter what the coaches scream as “motivation.” 

My friend Ragen Chastain, the amazing fat dancer and activist, has written a wonderful piece explaining exactly why Obama’s decision to appear on TBL was a mistake. I’m reprinting it here with her permission because she’s had trouble getting traditional media outlets to publish it (they’re afraid of pissing off the White House — really, guys? First Amendment, anyone?) and we need to get the word out. Just because a show glorifies weight loss doesn’t mean it’s good for your health. 

Here’s Ragen: 

When I heard that Michelle Obama was going on The Biggest Loser to congratulate the participants on being role models I knew that I had to do something.  So I e-mailed my friend Darryl Roberts, filmmaker of America the Beautiful 2: The Thin Commandments. We wrote a well-researched article pointing out the problems with Mrs. Obama endorsing the contestants as role models.  That article is below.

It wasn’t meant for this blog, but it’s now been turned down by three major media outlets.  Not because they disagreed with us, in fact all three said that they agreed with the article.  It was denied in all three cases because the White House wouldn’t like, they were worried about damaging their working relationship with the White House, and it it made the First Lady look bad and out of touch.  That confused me since I think the problem is that the First Lady IS out of touch, not that I’m pointing it out. And why does the media believe that, in America, we should be scared to question our government?

So I’m using my little forum here to get this out.  But before I do, I want to make an invitation:

Michelle Obama – have lunch with me.  I believe that you are a good person and that your intentions to improve kids’ health are good, and I don’t believe that you intend for the media to be too scared to publish pieces that are critical of you.  I’m a champion athlete, a trained researcher, and a real live obese woman and I think that a good place to start is for us to have a conversation.  Tell me where and when you’d like to have lunch and I’m buying.

In the meantime, here’s the piece that the media was too scared to publish:

Michelle Obama’s “Biggest” Mistake

By Darryl Roberts and Ragen Chastain

DARRYL: I have had the opportunity to get to know Health at Every Size proponent Ragen Chastain after interviewing her for my documentary America the Beautiful 2: The Thin Commandments.  I was coming home from a screening of the movie when I received an email from Ragen alerting me to the fact that our first lady Michelle Obama was going on The Biggest Loser to proclaim the contestants as role models.

I will admit that initially I didn’t quite believe this. The Biggest Loser is a show that’s exploits a very dangerous aspect of American life, the unhealthy ways in which we attempt to lose weight. Surely the First Lady had to know this. But it turned out to be true and, knowing what we know about health and weight, Ragen and I decided that we had to respond.

Mrs. Obama, we know you love our youth as much as we all do and that you want to see them healthy, but we would ask you why you chose a game show like The Biggest Loser as a platform to promote “getting healthy,” and why you continue to push weight loss even though it doesn’t meet the criteria of evidence based medicine.

Have you vetted what happens to some the contestants one of two years after the show?

The New York Times did some digging and this is what they found:

“The Biggest Loser has produced some amazing results for its obese contestants, but at what cost? Many see the pounds come right back, and it’s likely because they engage in dangerous, damaging behavior in the first place in order to win the weight-loss reality show, the New York Times has learned. Season one’s winner, who’s almost back to his original weight of 330 pounds, dehydrated himself to the point of urinating blood. “I’m just waiting for the first person to have a heart attack,” says a doctor.

This season’s first episode resulted in two hospitalizations, which is scary given the content of a release form obtained by the Times. It reads: “No warranty, representation or guarantee has been made as to the qualifications or credentials of the medical professionals [on the show].”

Shockingly, contestants who talk about being completely inactive sometimes for years have to attest that they are “in excellent physical health”. And while the Times got some tidbits — contestants apparently work out in as much clothing as possible when the cameras are off — few were willing to talk. After the paper started digging around, former contestants were emailed a reminder of the serious consequences that come with unauthorized interviews: fines of $100,000 to $1 million.”

A lot of our youth actually start off exercising and eating better. But when they don’t see the “desired result” on the scale, they stop because they mistakenly think that if their healthy habits don’t lead to weight loss then they can’t lead to health.

From my travels with the film and Ragen’s work as an expert speaker on Health at Every Size, we can produce health professionals from Harvard, Princeton, Michigan State, the University of Denver, UCLA, who will tell you exactly what we’re telling you.

RAGEN:  This is an illustration of good intentions gone horribly awry. Calling these contestants good examples of health and fitness is deeply problematic. There are already firsthand accounts of Biggest Loser contestants being encouraged to engage in incredibly unhealthy behaviors, including working out against doctor’s orders, and manipulating their weight through dehydration.

According to Golda Poretsky’s interview with former contestant Kai Hibbard:

“They start teaching you that because you are overweight you are sub-human …There was a registered dietician that was supposed to be helping … but every time she tried to give us advice … the crew or production would step in and tell us that we were not to listen to anybody except our trainers.  The doctors had ordered us to take [a solution to re-balance our electrolytes] and the trainers were like, “Throw it out, right now.”  So I got to a point where I was only eating about 1,000 calories a day and I was working out between five and eight hours a day …   And my hair started to fall out.  I was covered in bruises.  I had dark circles under my eyes … My period stopped altogether and I was only sleeping three hours a night.  I tried to tell the TV show about it and I was told, “Save it for the camera.”

Exactly what’s wrong with the “lose weight” to be healthy approach?

RAGEN: Teaching kids about healthy eating and helping them develop a lifelong love of movement are excellent intentions.  Focusing on the weight of kids in order to do that is simply horrible execution.

The National Institutes of Health (NIH) stated recently that a program that shames kids carries  “a great risk of increasing stigma for those children who are overweight or obese which, in turn, can reinforce unhealthy behaviors (e.g., overeating),” and also said:

“Studies suggest that overweight children who are teased about their appearance are more likely to binge-eat or use unhealthy weight-control practices, and weight-based victimization has been correlated with lower levels of physical activity. Not surprisingly, stigmatization of obese individuals, particularly adolescents, poses risks to their psychological health.”

Hospitalizations for eating disorders in children younger than 12 years old rose by 119% from 1999 to 2006 according to a report issued by the American Academy of Pediatrics (AAP) published in the journal Pediatrics.

It’s not just that focusing on kid’s weight might hurt them, it’s also that it doesn’t help.  According to research from the University of Minnesota “None of the behaviors being used by adolescents (in 1999) for weight-control purposes predicted weight loss[in 2006]…Of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors, including significant weight gain.”

Meanwhile there is not a single study that shows that weight loss works for more than a small fraction (about 5 percent) of people.  The cold hard truth is that there is absolutely no evidence that supports the idea that the majority of fat people can become thin through diet and exercise.

Is There a Solution?

RAGEN:  Absolutely.  The fact that I’m a healthy fat athlete isn’t a surprise or a paradox, there are lots of us.  A great deal of evidence (Matheson et. al., Wei et. al, the Cooper Institute etc.) points to the conclusion that healthy habits make healthy bodies in a wide variety of sizes.

Matheson et. al. People who participated in four healthy habits had essentially the same hazard ratio regardless of their weight. Obese people who participated in four healthy habits had a dramatically lower hazard ratio than thin people who did not participate in healthy habits.

The worst thing is that all this focus on the weight of individuals is distracting us from the systemic issue of lack of access.  Many people do not have access to the healthy foods that they would choose to eat -including foods that are not genetically modified or full of hormones or government subsidized high fructose corn syrup.  Many people do not have access to safe movement options that they enjoy, or to affordable evidence-based health care.  But as long as we focus on little Johnny’s BMI, we don’t have to address the real problems here and we can just keep shaming and blaming fat kids and adults and misinforming them and everyone else about the odds of becoming permanently thin.

We admire Michelle Obama and we believe that she is a strong woman.  In fact, we believe that she is strong enough to step up to a microphone and say “I truly believed that I was doing the best thing for kids’ health.  I now realize that I was wrong, and I am going to lead the charge in fixing it.  We are going to start focusing on supporting the development of healthy behaviors, and access to healthy safe movement options, and affordable evidence-based healthcare for kids of all sizes, and we are going to stop focusing on the weight of any kids at all.”

We look forward to seeing it.

++++++

So that’s the article that was “too controversial” for three major media outlets.  I’ll end the way I started. Mrs. Obama, I’d like to take you to lunch. No need to spend government money – I’ll come to Washington DC at my own expense, we’ll go to lunch and I’m buying.  I think that we both believe in giving our citizens the opportunity to achieve their health goals and I think that if you are trying to eradicate obese people, it is worth talking to one and seeing if we can learn from each other.  What do you say?

I’ve got a story up on Cultivate.com asking one of life’s more confounding questions: Should you have open shelving or closed cabinets in your kitchen? 

I know. It’s a head-scratcher. But we roped in Sherry Petersik of the absurdly addictive Young House Love to push her open shelving agenda give her take and I think you’ll walk away with a much clearer head. (Hint: It’s all good! You can have both!)

Fun fact: I have that same gray penny tile from Sherry’s kitchen wall (above) on my bathroom floor. And yes, it’s delightful.

You guys may have seen this news last week: California toxicologists tested a bunch of those supposedly “toxin-free” nail polishes… and found out that they’re actually toxin-full, as I’m reporting on Slate’s xxFactor blog today.

Hmm, what does this remind us of? If you said Brazilian Blowout (or lead in lipstick or carcinogens in baby shampoo or…) give yourself a high five.

The bottom line: Unhealthy chemicals keep appearing in beauty and personal care products where they ought not to be — even those that are labeled otherwise. This is why we need chemical policy reform in this country. This is especially why the beauty industry needs tighter regulations. And this is most definitely why the beauty industry cannot be allowed to police itself — which is how the current system works (or rather, doesn’t) and what the industry is pushing for now with a new bill in Congress that is just a whole bunch of lip service.

As most of you know, I got my start on this whole beauty critique beat with a story on the terrible working conditions in nail salons, which ran in The Nation in 2007. At the time, it felt like such a victory that activists had persuaded OPI, Essie and other big brands to reformulate their products. And when San Francisco passed its Healthy Nail Salon Recognition ordinance, I thought we were really getting somewhere. 

But as long as beauty brands are allowed to put products on salon shelves without pre-market safety testing, full disclosure of their ingredient list or even honest product labels, salon workers and consumers are going to be at risk.

Full story over on Slate’s xxFactor. As always, I’d love to hear your thoughts. And if you’d like to get involved in the fight for safer cosmetics laws, the Campaign for Safe Cosmetics would love you to write to the House’s Energy and Commerce Health Subcommittee, which is currently reviewing the new legislation.

Guys, be sure to check out Whole Living‘s Blue Issue (April 2012) — it’s on newsstands now and it features my cover story, 50 Ways to Save Water (that’s the PDF, if you hate those, it’s also on their website here).

Now, excuse me while I nerd out for a minute, because I learned a ton reporting this piece. Like the fact that it takes 2,900 gallons of water to produce a single pair of blue jeans, and that it takes way more water (1,857 gallons) to produce a pound of beef than a pound of chicken (409 gallons); yes, yes, vegetarians, a plant-based diet wins again. Though interestingly, soy milk is just about tied with cow’s milk: 49 gallons of water to make one glass vs. 53 gallons of water per glass. So that’s good because soy milk is kinda icky.

And all of this is important because 884 million people lack access to clean water around the world, and like most environmental stories, the plot is only getting thicker.

The good news is there is a lot you can do. 50 things, actually! I have been trying to incorporate some myself — using leftover ice cubes to water houseplants, planning out a new irrigation system for my garden that gets water to the plants without too much waste. (Soaker hoses = good; wildly spraying your yard like you’re at a carwash = not so great.) Probably our biggest impact change has been getting a SodaStream; y’all know I don’t do product reviews, but it has seriously changed my life! And no more buying several two-liter bottles of seltzer and soda every week, which each require around 132 gallons of water a pop. You’re welcome, planet!

However, my husband would be appalled if I didn’t confess the key ways in which I am still wasting water wildly and therefore a complete fraud. They are:

1) We often leave faucets dripping because our cats like to drink from the sink and eschew bowls (and the water fountain we purchased for them — yes, we are those people).

2) I refuse to let yellow mellow. Because of the gross.

3) My showers. Oh man. They are not short. I love water.

There’s not much I can do about the first two (I don’t want dehydrated cats and again, gross) but I am working on this last one. I’m going to get this Water Pebble (again, not product placement — I’m buying it with my own dollars!) which is supposed to help by flashing lights when it’s time to get the hell out. I know: Carbon footprint of buying a gadget vs. improved water footprint if I actually shorten my showers… a girl can’t win. But we all do what we can.

So check out the story. I’d love to hear your thoughts. Anyone else have any genius water-saving tips to add to my list? Or want to make an impassioned case for mellowing yellow?

Last month, in Why Fit is the New Thin, I explored how the “fitspiration” phenomenon can be uncomfortably reminiscent of the “thinspiration” phenomenon. They aren’t entirely identical; thinspiration is pretty much always about collecting pictures that glorify an unhealthy and unattainable standard of beauty (skinny). Fitspiration can be about motivating and empowering yourself to try rock climbing, do a handstand, run a marathon or reach some other kick-ass physical fitness goal. But it can also be about glorifying an unhealthy and unattainable standard of beauty… and because it all gets dressed up as “fitness,” the unhealthy parts can be a lot harder to pick out. I offered some guidelines that help me separate the “this makes me want to run outside and be sweaty and awesome!” stuff from the “this makes me feel like dog poo if  I can only go to the gym for 35 minutes instead of 45 minutes today.”

You guys had a lot of thoughts about this. Which I dig. Because I get it. Fitspiration is incredibly compelling — I mean, that’s its whole raison d’etat. (As I noted in that post, a lot of it is advertising, which means Nike, Lululemon and the rest have paid huge sums of money to talented mad men and women specifically to ensure you’d find these images highly appealing.) And again, there are plenty of examples of positive fitspiration out there, doing good things.

But then one comment came in, from Concerned Fitness Pro, which I’ve decided to respond to in post form. Because there’s a lot happening here. And it’s not just about fitspiration but also about how we distinguish between inspiration and judgment when we’re looking at other people’s bodies. Which, let’s face it, we all really, really like to do.

So here we go. (Just to be clear, the paragraphs in italics are Concerned Fitness Pro’s comments; the bold and regular stuff is me.)

1. But fitness models are so healthy! 

I disagree tremendously with the general health view points of this article. I will also address some of the other comments as well. First, it is nearly impossible to maintain being a fitness model and having an eating disorder. The amount of muscle required to become a true fitness model requires a VERY healthy diet and exact fitness prescription distinct to each individual.

Actually, it’s pretty possible. Research shows that as many as 31 percent of young female athletes in “thin-build sports” have eating disorders (and as many as 62 percent participate in disordered eating behaviors), compared with just five to nine percent of the general population. (Those stats straight from an American College of Sports Medicine 2011 position paper on the issue.) “Thin-build sports” are physical activities where a lean physique is an asset — think running, gymnastics, and oh yeah, fitness modeling.

You’re assuming that everyone with an eating disorder has wasted away to nothing and wouldn’t be able to lift a free weight, or is morbidly obese from binge eating. But the eating disorder spectrum is far more nuanced than that; patients come in all shapes and sizes and some of them may look very physically fit. Compulsive exercise (also called obligatory exercise and anorexia athletica) can go hand in hand with an eating disorder or be a mental health problem in its own right. And the reason the ACSM is tracking eating disorder stats among female athletes so closely is because they’re worried about Female Athlete Triad, a triple threat condition where young, female athletes with some form of disordered eating fail to take in enough nutrition to support their sport — and wind up with amenorrhea (loss of period) and osteoporosis.

2. I mean, they’re not like those runway models… 

 I have known several models who are not fitness models and that I feel there a much better depiction for your argument. Many of the models on runways etc are not “ripped” due to their appearance in clothing, and its effects on selling the product. They fast and maintain very unhealthy diet in many of their circumstances to stay that skinny (Liquid diets before shows, not eating at all before shows, do research and you’ll be mortified). Victoria Secret models are not fitness models. Their habits and lifestyles should not be compared similarly.

True, Victoria Secret models are not fitness models. They’re working to achieve a different aesthetic. But we can absolutely compare their habits and lifestyles. In both cases, these women are training to meet their industry’s specific standard of beauty. Yes, the fitness model’s standard of beauty is also — allegedly — about health, whereas the Victoria Secret model’s standard of beauty is about sex appeal. But in both cases, they’re working tremendously hard to maintain an impossible standard. As the data shows, athletes are not exempt from eating disorders. They’re actually getting more of them than the average population. They may look more “ripped” than Gisele and co, but I’d argue these two groups have more in common than we realize. And by subscribing to a narrow idea of what an eating disorder looks like and what healthy looks like, we’re doing a big disservice to people who may need help — but are harder to spot.

3. It’s okay to intervene when someone is fat, for their health’s sake.

Now, I am not familiar with any of these images, nor do I judge someone for their ability to be fit. However, if I see someone who is overweight and they are close to me, I will say something. Its the same thing as an alcoholic intervention etc. If someone is endangering their health, I will let them know it for their sake. Many believe it is enough exercise every once in a while, but if they do not maintain a healthy level of body fat, which for women is under 30%, then they are at a much greater risk for CVD.

Concerned Fitness Pro and I already covered the “not familiar with any of these images” part. (He/she went back and familiarized and stands by his/her comments. Moving right along.)

Now let’s talk about why you wouldn’t “judge someone for their ability to be fit,” but you would feel free to say something to an overweight loved one. That, my concerned friend, is hypocrisy plain and simple. Because it’s not the same as an alcoholic intervention. If you see someone regularly missing work and letting down loved ones because of drinking, yes, fine, intervene. If you look at someone’s waist size? Keep your mouth shut. You don’t have enough information yet.

We know that being overweight correlates to certain health issues, but we do not know that the weight itself causes the problems — science is far from conclusive on this question. Studies show that at least one in five obese people have no health issues at all, and overweight women actually live longer than normal or underweight women. (To my regular readers: Sorry, I know I keep trotting out the same stats there. There’s plenty more research like this and I’m working on a longer post where I’ll get it all nicely synthesized for you.)

If you know your overweight loved one also eats an unhealthy diet, smokes, and never exercises, well, maybe then you’d want to have a respectful conversation about healthy lifestyle choices and what you can do to support them. But you should want to have the same conversation with your thin friend who has a similarly unhealthy lifestyle — because science does show that these specific lifestyle habits cause health problems. And in both cases, you can actually have this whole talk without ever bringing body size into things. Not judging them by their muffin top (or “skinny fat”) will go a long way towards making the respectful part happen.

Because you’re concerned about their health, right? Not how good they look in a bikini?

4. Eating bad foods is bad. 

Rewarding yourself with food in moderation is okay, however, just because you go on a run does not mean you can pig out on a huge bowl of ice cream or have a heavy night of drinking. Especially sugar, to some is considered by many health experts as a drug or a poison due to its addicting effects of releasing dopamine in the brain. I myself do indulge on certain pleasure on occasion such as alcohol and bad foods, but I feel guilty about it. I should feel guilty about it. These things shorten your life. You cannot be sensitive to your health.

Hoo boy. Concerned Fitness Pro, your world has a lot of rules. And guilt! That doesn’t sound like much fun — but hey, that’s your diet. I respect your right to feel guilty after you eat ice cream. Personally, I’m working on shedding my food guilt and listening to my body instead of following a bunch of external rules. That’s because I’ve found that guilt is just my way of apologizing for doing what I wanted to do anyway… and since I’m a grown up person, I don’t owe anyone an apology for making my own decisions, as long as they don’t hurt anyone.

So I know what you’re going to say: But I AM hurting someone — myself! — when I eat that ice cream! See above re: Sugar and poison. I’ve been following this research too (here’s an article I wrote for Fitness Magazine last year about it) and it’s fascinating stuff. But it’s also pretty controversial and (like the whole causation/correlation question around obesity) far from definitive. So right now, I don’t see a need to treat sugar like heroin — though I’m open to being wrong about this if the science becomes more conclusive.

[Breaking news update: Dr. Nora Volkow, director of the National Institute on Drug Abuse, just gave a lecture saying yes, food can be addictive — but also that this idea is still super controversial. Time's Healthland has a helpful breakdown of her talk and the counter-arguments.]

I do see plenty of reasons to increase regulations on how the food industry is allowed to market sugary foods to kids, and I’d love to see clearer labels on packaged foods that helped people understand when they’re buying something without much nutritional value. Because right now, food companies do pretty much everything they can to convince us than everything they sell is healthy and that’s misleading and confusing.

But I want us to be better informed to help us make our own choices. What those choices are — well, that’s up to every individual. (With occasional, respectful input from the people who love them and want them to live a long time.) Applying morality to food and health, as you do when you talk about “bad food” and “guilt,” implies that there are always clear right and wrong choices and anyone who makes the wrong choice should be condemned. Health, however, is not some sort of prime directive. We eat food for so many reasons (joy, community, comfort, artistry) that aren’t about health and yet they are equally valid. And so, there are plenty of situations, happy and sad, where health doesn’t have to be (and some where it absolutely should not be) our top priority in a food decision.

5. The pros outweigh the cons (even if you stop menstruating). 

Some fitness models, specifically women, are between 14-20% body fat. Although this can have some adverse effects with menstrual cycles etc, the pros out-weight the cons. To get to this toned level, it takes a lot of hard work and dedication in being healthy. I’m not saying you need to look like these fitness models, either. I just don’t think maintaining average health is good enough. Images of these models inspire people to get in shape. Better shape = live longer and happier. People are way too sensitive, and need to get over it.

Last week’s Dara-Lynn Weiss debacle reminded me of one of the biggest problems with this whole, endless is weight health? debate: When we focus relentlessly on weight and beauty, we teach girls that their entire value comes from their weight and/or beauty. Just ask all those teenage girls posting YouTube videos about it. This is why I push to separate conversations about health from conversations about size. In our culture, right now, the latter is just too tangled up in the Beauty Myth — start talking about weight or BMI as a non-judgmental health marker and you’ll all too quickly veer into fat-shaming territory with all its moralizing rhetoric. When we don’t even know for sure that it’s the actual excess weight causing the problems, why go there? Let’s talk about enjoying nutritious foods, finding fun ways to stay active and other healthy lifestyle choices that can be taught in a less judgmental fashion.

But it’s not enough to get the Fat Talk out of our health conversations. Girls are hit with the Holy Trinity of Pretty/Pink/Princess from infancy (for a more thorough explanation of how that happens, check out this post on Peggy Orenstein‘s Cinderella Ate My Daughter). So even if you can teach them that these things have nothing to do with health (a major victory in and of itself), they’re learning that they have everything to do with making friends and being popular, liked by boys, successful, and so on. Pretty/Pink/Princess may not sound so evil on the surface, and to be clear: I’m writing this as a former girl who ardently loved all things pretty/pink/princess and I hope to one day have a daughter and I will certainly enjoy the heck out of it if/when she goes through the PPP phase.

But when we narrow our girls’ options down to nothing but Pretty/Pink/Princess, we’ve got trouble. Because that’s when they start thinking the “Am I pretty or ugly?” question is the most important thing ever, that’s when it gets more difficult to unpick Pretty from other valued character traits, that’s when the cycle continues.

All of this is a long way of telling you about a fun baby present that I put together for my friend Amy, who is expecting a baby girl in June. I have no doubt that Amy is going to teach her daughter that the world is wide open and full of possibilities in addition to Pretty/Pink/Princess. (Because this isn’t about eradicating the PPP — I probably can’t make that clear enough. It’s about presenting plenty of other options, so the PPP stays in its place and doesn’t become the all-powerful narrative of a girl’s life.)

Awhile back, Amy had mentioned wanting suggestions of books to read to the baby  so I put together a collection of all of my favorite books from childhood featuring brave (non-princess-y) girls as the main characters. My mom (who is awesome and responsible for making sure I read most of these in the first place!) and sister (also a prolific reader who now works in education) brainstormed with me to pull together the ultimate list. Then I winnowed it down to my favorites, which was delightfully difficult. There really are a huge number of amazing books with strong heroines out there — despite how many times you had to read The Red Badge of Courage in school (blergh).

So here’s my list, pictured above and Amazon-linked below. Appropriate for ages 3 (or however young you can push Madeline on ‘em?) to 18 (and really, well beyond), with nary a princess in sight. Okay, there’s one but she’s very ordinary. There’s also one garishly pink cover (thanks publishing industry!) and some of these girls happen to be pretty, but that’s really not the point.

And I can guarantee that none of them ever so much as mentions their weight.

Madeline by Ludwig Bemelmans 

Eloise: The Ultimate Edition by Kay Thompson

Mary Poppins by PJ Travers

The Ordinary Princess by M.M. Kaye

Ramona Quimby, Age 8 by Beverly Cleary

Pippi Longstocking by Astrid Lindgren

Ballet Shoes by Noel Streatfield

Harriet The Spy

Emma by Jane Austen

Jane Eyre

And if you want to see the full list that we brainstormed, Amy posted it on her blog today. (A lot of these went off theme and are just awesome kids’ books… but they still steer well clear of the PPP, making them great choices for girls of all ages.)

Thoughts? Any ideas on how else to promote this “the PPP is not everything” message with girls? Any other must-read titles that you think we missed? I’d love to keep adding to the collection. 

PS. Peggy Orenstein’s Fight Fun with Fun! Resource List is even more exhaustive and super helpful on this front.

I admit, when this whole Vogue Mom story broke, I had to take some serious deep breaths. (In case you’ve been under a rock all week: Socialite Dara-Lynn Weiss wrote an essay in the April Vogue — the “shape” issue, ha! — about her obsessive efforts to get her seven-year-old to lose 16 pounds.) And when Ms. Weiss then announced that her fun anecdotes about screaming in Starbucks and forbiding her daughter to eat cupcakes (before sneaking two herself) resulted in a book deal… I had to take a lot of deep breaths. Because that is a thing. That is happening. Yeah.

Anyway. I’m calmer now. And I’m also over on Slate’s XXfactor blog again, making some of my favorite points about this whole mess (not the book deal part, that’s just gross): We’ve got health and beauty all tangled up in a big ball of confusion. The Vogue Mom is batsh*t, yes, but while we’re finger-wagging, let’s also look at our own complicity in this mess. And you can’t tell much about a person by their size — other than their size.

It’s generating all SORTS of feelings in the comments. So go check it out, weigh in there or come back and we’ll talk about it here.

But bottom line: Have we learned nothing from those Georgia billboards (the counter-campaign is UP, btw!) and my awesome cousin Kate? Fat-shaming isn’t good for anybody’s health. Especially not when you’re seven.