Hungry: A Food Writer Wrestles With Her Daughter's Anorexia

Sheila Himmel, an award-winning food writer and restaurant reviewer for the San Jose Mercury News, loved to eat. Then her daughter became anorexic, forever changing Himmel's relationship with food and her identity as a journalist. In Hungry: A Mother and Daughter Fight Anorexia, Himmel and her daughter Lisa examine how their family coped with Lisa's serious eating disorder.

Himmel recently wrote an illuminating ReportingonHealth primer for journalists interested in covering eating disorders. You can also check out her ReportingonHealth member profile here. She recently took time out from her book tour with her daughter to chat with me about media coverage of eating disorders and how journalists can do justice to this complex and emotionally-charged topic. This interview has been edited for length and clarity. A disclosure: I worked with Sheila at the San Jose Mercury News.

Q: You probably reviewed a lot of writing about eating disorders when you and your daughter wrote your book. What do journalists get right about this topic, and what do they get wrong?

A: If you haven't personally experienced it, or somebody in your orbit hasn't, there's still a tinge of "just get over it, why don't you just eat?" I think there still is that bias that when everything is called a disorder, we mock that. But this is real. And I think we still get it wrong when we report on new research. We don't go back and see how many patients were actually involved, what the drop-out rate was. We'll take any new study and run with it. We often get the information directly from whoever has a financial interest, or even if it's a nonprofit, or a press release. And a lot of the eating disorder reporting is sensational and celebrity-based, like Michael Jackson "clearly had some kind of anorexia."

Q. What good work have you seen lately?

A: Dr. Perri Klass wrote in the New York Times about body image and weight - how she as a pediatrician is not a classically thin woman and yet she's giving advice. It was about her conflict in giving parents advice about how to make sure kids eat right and she doesn't look the part. It was very honest, yet informative.

Q: How did experiencing an eating disorder in your family affect your work as a journalist and your identity as a journalist? Did you want to branch out into other topics besides food?

A: I was an editor for most of my career (at the Mercury News' Sunday magazine and Sunday opinion section), and before that, a copy editor (before becoming a food writer). At first, I didn't want to write this story at all. When the idea first came up, my thinking was that we don't write about ourselves. But I don't have that much trouble writing personal essays. I also kind of came of age in the time of the new journalism, when you could put yourself into a story. The fact that you were a person in the room became ok.

But even given that, I did have a hard time. I got over that part (being in the story myself) easier than I did about writing about my child. And your child who is struggling, that was huge. The whole experience has given me a lot more confidence. It was really hard. And the fact we were able to do it - there was something maturing about it. I'm not afraid to ask anybody anything anymore. If they don't react well, it's ok.

Now I'm interested in the intersection of eating disorders and food - just the way we eat normally. I don't have a plan for a next book, but I can see pursuing this. Eating disorders aren't going away. I just came across a JAMA study of hospitalization for eating disorders. We tend to think it's an affliction of teenagers and young adults, but the biggest increase was in boys and girls under 12 and patients aged 45 to 65.

Q: Did being a patient advocate for your daughter change your journalism - or vice versa?

A: There were times when I was more one than the other, and times when the book was clearly on the back burner. The most important thing was our daughter's health. Being a journalist - it helps in any medical situation because you're not afraid to ask questions, afraid to question authority, and you know where to go for information.

Q: How do you keep your emotions in the right place when writing about such a charged topic? You don't want to withdraw into complete objectivity, yet it must be difficult to not go to the other extreme, too.

A: It's happening now, when we give readings. People come and they're desperate for help because their child or grandchild is suffering and they don't know what to do. People will come and tell their story and expect that we can help them, and we're not doctors. We hooked up with the (San Jose, Calif.-based) Eating Disorders Resource Center and they sent a physician to each reading.

It's actually been harder for Lisa. She's dealing with that now - how to not take on the other people's pain. These are horrible, sad stories and you're dealing with an often life-and-death situation. Our book is just our story. But I tried to keep in mind what to include and what not to include, that it was our story but we were writing for these people who come to the readings. They may have been sideswiped by this just like we were and don't know where to turn. We can just tell them a few things we learned along the way and where to go for help.

I imagine it's the same dynamic with diseases like cancer - you're talking to people who may die. It's very hard. With eating disorders, the other trick is that there's all this shame connected with it. To get someone to talk in the first place can be tough. A lot of it, esp. with bulimia was hidden. Why do they want to tell their story? You have to find some good outcome in it for them. There is: that you can get through this (desire) to hide it. It's like cancer used to be - you just didn't talk about it.

Q: What are some under covered stories in this area?

A: What I keep hearing is that brain biochemistry could have something to do with eating disorders. That's something I find really fascinating. Is there some genetic twist that predisposes people to eating disorders?

Eating disorders are psychiatric disorders in the DSM. With all insurance coverage - it's covered if you're deathly ill and need to go to the hospital. It's not if you want to do talk therapy. That's what helped Lisa, but it wasn't covered. When she was in the hospital, it was horrible. She just got worse and was taking all kinds of medication, but that was covered.

One of the issues that are hard to measure is the effectiveness of nonmedical intervention - talking therapy for eating disorders. There's cognitive behavioral therapy and all the other philosophies. I'd also like to see an expose of some of these treatment centers, because they cost a fortune. Like any (drug) rehab place - you get back in the real world and then that's it for your recovery. They have frequent fliers who are back all the time. I'd like to see someone follow the money for these treatment centers. Who owns them? They cost a fortune. Where does that money go?

Q: How did you deal with patient confidentiality concerns when reporting on eating disorders?

A: When I went to the adolescent inpatient unit at Stanford University Medical Center, I didn't take notes at all, or talk to any of the patients. The staff led me around. I talked to the doctor. At an eating disorders support group, I disguised people and didn't use their names. There was no reason for them to identify themselves. They're not public people. I didn't want my presence to take over the group. I just wanted to be a fly on the wall and I participated in this group as a parent. Some people get nervous, others put on a show when a reporter's in the room. I just wanted to see what this was like for real people.

Q: How do you write about a topic like this without exploiting - or appearing to exploit - your subject?

A: I'm not sure that it's that different from covering any other medical issue. Somebody has to agree to talk to you. Staying away from the celebrity coverage is what I'm thinking of, of who's too thin and too fat. Our book editor said, "Do whatever's best for Lisa." She said all the right things. Having written about Lisa for the Mercury News helped. The reaction to that was so positive. We knew that there was a need out there (for information). And that people responded to it in the way we intended, not "how can you expose your family?" That's also part of the problem with eating disorders: the shame and the loneliness. That's the ability that journalists have. The best thing we do is put into words how other people feel - you know how you're reading something and say 'that's it!' That's what we're trying to do in our book.