Our most basic connection is to family. Family ties link us to a genetic, as well as a cultural, past. Through marriage, work, and play, one family interacts with others, forming the network of society. Each thread in this fabric affects, and is in turn affected by, the others.

How, exactly, do families contribute to eating disorders? Researchers use different criteria. Some look at how members communicate. Do they use facts or emotions? Do they express emotions openly or in a disguised way? What about problem-solving: Does the family take a creative approach, or is it stuck with rigid, unworkable solutions? And leadership: Who’s in charge?

Alas, no formula can capture the complex interactions of any family, let alone a family coping with an eating disorder.

Is an eating disorder hereditary? Studies of identical twins, who share the same genetic traits, found that when one of a pair of twins has anorexia, her sister has a better than 50 percent chance of developing the disorder. The correlation is pretty high, but is it proof? Not really – remember that both twins are reared in the same family environment and experience the same social and psychological pressures. What we need are studies of identical twins who have been brought up in different homes. If both twins develop a disorder, then the evidence for a genetic predisposition would be strong.

Michael Strober, a psychologist at UCLA, recently found that anorexia nervosa was eight times as common among close relatives of anorexic patients as in the general population. He writes: “At least some cases of the illness arise from a familiarly transmitted liability, although the manner in which genetic and environmental factors combine to produce illness remains uncertain.”

The stereotype holds that eating-disordered people are white and come from upper-middle-class backgrounds, but patients actually come from many different races and all levels of society. The parents of eating-disordered children tend to be older, but the same holds true of many psychiatric illnesses. Nor is birth order significant—being born first, second, or twelfth doesn’t make any difference. And proportionally, as many eating-disordered individuals come from broken homes as they do from intact ones.

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“Five pounds of sugar is heavy,” says Pat, a 41-year-old resident of Huntingtown, Maryland. “When I think that I lost the equivalent of five of those bags, it’s easy for me to resist temptation.”

Pat found the extra 25 pounds after giving birth to twins in 1992. Three months later, she found the motivation to get rid of them when she saw a family photo. “I stood out in the photo, but not because of my outfit,” she recalls.

A size 14 and only 5 foot 4, Pat knew that she had to make a change. She joined Weight Watchers in October and was down to a size 8 at her twins’ christening the following February.

Pat has successfully kept off her weight, but not without temptation. She has that bag of sugar as a reminder of what she used to weigh. “I remember coming back from the grocery store one day and lifting that 5-pound bag of sugar to put it in the pantry,” she says. “I thought, ‘I lost five times that much!’

That realization has rescued Pat from many a sticky dietary situation over the years. She recalls one incident in 1998, when she was § feeling particularly frazzled. “The kids hadn’t eaten, and they had to be at T-ball and soccer practice on the opposite sides of town,” she says. “I figured that the easiest thing was just to stop at McDonald’s on the way.” As she reached for her keys, she remembered the sugar.

“I’d taken off five bags of sugar, and I didn’t want to add one back on,” Pat says. She put down the keys and went to the kitchen to prepare a quick meal of chicken and vegetables.

WINNING ACTION

Pick up a bag of sugar. Find a symbol of your weight loss—a 5-pound bag of sugar, a can of Crisco, or a slab of bacon. When somebody says McDonald’s, think about your symbol. Pick it up to remind yourself of how far you’ve come and how much additional weight you’d have to carry around if you gained it back.

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