Calling the Sugar Plum Fairy Fat and Other Ways To End Up on the Naughty List!

Back in the mid 1990's I first began getting interested in public health. One of my first areas of interest was around eating disorders, especially among female athletes. Many of you may remember the book that sparked my interest, "Little Girls in Pretty Boxes".

This book focused on body weight/image pressures among female athletes in elite gymnastics and figure skating. The book is heartbreaking, following several athletes along paths of injury and disordered eating...many of which lead to permanent injury or death. Even though the book is almost 15 years old, I sometimes wonder if we've even learned anything from those stories.

On NBC's Today Show this morning, Jenifer Ringer was a guest. She is a New York City Ballet principal dancer, currently playing the Sugar Plum Fairy in The Nutcracker. Her name has been all over the blogosphere in the past week after a critic for The New York Times Dance Section wrote that "she looked as if she'd eaten one sugar plum too many".

In response to the outrage over his comments, the critic (Alastair Macaulay) published a second editorial five days later called "Judging the Bodies in Ballet". His primary argument- judging the body is fair game in ballet. "If you want to make your body irrelevant to criticism, do not choose ballet as a career". And I would assume that he would argue that the same goes for gymnastics or figure skating, where the body is actually part of the art form. But if that is true, how does the cycle of pressure and expectation ever get broken? Are you asking for criticism if you choose to participate in one of these sports?

In public health, we often make much more headway by changing laws/policies versus changing any one individual's opinion. In that spirit, there have been some systemic changes that have made these types of sports safer for young female athletes. For example, a minimum age limit for Olympic competition was enforced (even though some countries have cheated), hoping that it will help with wear and tear on young bodies that can not yet handle the intense training. Changes have been made to make the equipment safer. For example, after many serious injuries occurred on the women's vault in gymnastics, their pommel horse was replaced with a "vaulting table" that was more appropriately sized and padded.

So minimum ages and safer equipment are wonderful, but what will help with the unrealistic body image problem? In her Today Show interview, Jenifer shared that the New York City Ballet has all types of bodies on the roster, including hers that is more "womanly". I guess that's a good start. If ballet companies can model variety and acceptance and strength for their audiences (including aspiring ballerinas), that can begin to change perceptions of what is "normal". And the outrage shown by readers of the critic's comments. I guess that's a good start too.

Shame on you Mr. Macaulay for picking on the Sugar Plum Fairy.

A Pop Health Book Review of “Unbearable Lightness”

Welcome back readers! After a holiday, bronchitis, and work travel hiatus- Pop Health is back with a new feature- reviews of books which examine public health and popular culture issues.

Over the weekend I finished reading “Unbearable Lightness- A Story of Loss and Gain”, by Portia De Rossi. I actually mentioned this book back in a November post when it first came out. The story chronicles Portia’s struggle with both Anorexia and Bulimia from approximately age 12 to the present. The strength of the book is in its ability to portray the absolute complexity of an eating disorder. Sometimes these disorders (and other mental or physical health issues) are over simplified. For example, the commonly held belief that someone is Anorexic simply because she/he needs to “have control over something”. However, in Portia’s case, she wove an incredible story that examined causes at multiple levels. And in public health, this multilevel thinking is essential for the development of effective interventions. I have decided to begin with the causes most closely associated with Portia herself and work my way out.

Intrapersonal:

Portia endured a complete lack of healthy coping mechanisms. She dealt with a lot of sorrow and changes in a short amount of time as an adolescent growing up in Australia. Her father passed away and she changed to a more affluent school district. She worked to cope with these challenges by identifying a way to be “special” and “stand out”. She chose modeling because models are special. She also changed her name when she was 15. There was another girl her age with the same name (Amanda Rogers), so she changed it to Portia De Rossi to be more unique.

Portia also felt intense guilt and shame over being gay. Although she realized her sexual orientation early on, she kept this secret until her late 20s. Much of her self hatred focused on feeling as if she was disappointing her family and would ultimately ruin her chances to have a successful career and “normal” life.

Interpersonal:

Portia’s relationship with her mother is examined in quite a bit of detail. Throughout her modeling career as a teenager, her mother was definitely her accomplice in yo-yo dieting. Her mother taught her “dieting tricks” to lose the weight quickly for jobs, but also rewarded her with McDonald's after auditions. However, her mother’s strongest influence seemed to be over the guilt and shame she felt over being gay. After she came out to her mother, the response was “let’s just keep this to ourselves”. Portia was told to keep it from the family and from employers/co-workers.

Besides 1-2 friends and her brother, Portia is very isolated. In addition, her relationships with co-workers on Ally McBeal and other colleagues in the industry seem to have contributed to her eating disorder as well. For example, two of her co-stars (Calista Flockhart and Courtney Thorne-Smith) were famously accused of being Anorexic and underweight throughout the show’s run. So Portia was constantly working with and compared to an unrealistic ideal. In addition, many people who could have and should have recognized the problem and intervened- stayed silent. For example, as Portia dropped from a healthy 130 lbs to sub-100s, her costume designer told her she looked fantastic and asked for her secrets to weight loss. Portia also sought the help of a professional nutritionist. Even though she confided to binging and purging on the first visit, she was still given a food scale and a diet to help her lose weight. The nutritionist did not try to intervene until Portia was almost down to 82 lbs.

Community/Society:

Portia’s existence in several “communities” contributed to her struggle with eating disorders. Her first professional affiliation in the modeling community in Australia is where she developed a strong knowledge of dieting, purging, and excessive exercise. The “older girls” taught her this. It was the norm in that group to be unhealthy in order to get ready for a job.

From Australia, Portia traveled to the United States and the “Hollywood Industry”. Unfortunately, it was a smooth transition from the unrealistic expectations of the modeling to the acting industry. She describes a particularly gut-wrenching fitting that she endured when a photo shoot had to be rescheduled after the client realized that she was in fact a size 8- so no selected clothes would fit her.

In addition to body size, she also felt Hollywood was not accepting of a homosexual lead actress. Several times she spoke of the paralyzing fear she felt after seeing how quickly Ellen DeGeneres’ show was canceled after she came out in the late 1990s.

This is just a brief overview of these complex contributors to Portia’s eating disorder- I could easily go on for many more pages. Overall, I think the book is a fascinating read…for those of us interested in public health, eating disorders, and/or Hollywood. It portrays Portia’s struggle, self hatred, and self destruction with brutal honesty- so be prepared.

A closing word of caution: this book may not be appropriate for someone with a current or recently recovered eating disorder, since it outlines her eating, binging, and exercise rituals in incredible detail.