A GUIDE to AccompAny thE hBo® DocUmEntARy FILm THIN

recognizing And deAling with eAting diSorderS

10 SignS of An eAting diSorder

1. Drasticweightloss

2. Preoccupationwithcountingcalories

3. Theneedtoweighyourselfseveraltimesaday

4. Excessiveexercise

5. Bingeeatingorpurging

6. Foodrituals,liketakingtinybites,skippingfoodgroupsorre-arrangingfoodontheplate

7. Avoidingmealsoronlywantingtoeatalone

8. Takinglaxativesordiuretics

9. Smokingtocurbappetite

10. Persistentviewofyourselfasfatthat

worsensdespiteweightloss

ANOREXIA NERVOSA ischaracterizedbyself-starvationandexcessiveweightloss.

Symptomsinclude:

• Refusaltomaintainbodyweightatoraboveaminimallynormal

weightforheight,bodytype,age,andactivitylevel

• Intensefearofweightgainorbeing“fat”

• Feeling“fat”oroverweightdespitedramaticweightloss

• Lossofmenstrualperiods

• Extremeconcernwithbodyweightandshape

BULIMIA NERVOSA ischaracterizedbyasecretivecycleofbingeeatingfollowed

bypurging.Bulimiaincludeseatinglargeamountsoffood—more

thanmostpeoplewouldeatinonemeal—inshortperiodsof

time,thengettingridofthefoodandcaloriesthroughvomiting,

laxativeabuse,orover-exercising.

Symptomsinclude:

• Repeatedepisodesofbingeingandpurging

• Feelingoutofcontrolduringabingeandeatingbeyondthepoint

ofcomfortablefullness

• Purgingafterabinge(typicallybyself-inducedvomiting,abuseof

laxatives,dietpillsand/ordiuretics,excessiveexercise,orfasting)

• Frequentdieting

• Extremeconcernwithbodyweightandshape

Source: National Eating Disorders Association, 2005

Eatingdisorderssuchasanorexia,bulimia,andbingeeatingdisorder

includeextremeemotions,attitudes,andbehaviorssurroundingweight

andfoodissues.Theyareseriousemotionalandphysicalproblems

thatcanhavelife-threateningconsequencesforfemalesandmales.

whAt iS An eAting diSorder?

how to help A friend

Rememberthatyoucannotforcesomeonetoseekhelp,changetheirhabits,or

adjusttheirattitudes.Youwillmakeimportantprogressinhonestlysharingyourconcerns,

providingsupport,andknowingwheretogoformoreinformation!Peoplestrugglingwith

anorexianervosa,bulimianervosa,orbingeeatingdisorderdoneedprofessionalhelp.

Ifyouareconcernedabouttheeatinghabits,weight,orbodyimageofsomeoneyoucare

about,letusassureyouthatyouaredoingagreatthingbylookingformoreinformation.

Thislistmaynottellyoueverythingyouneedtoknowaboutwhattodoinyourspecific

situation,butitwillgiveyousomehelpfulideasonwhattodotohelpafriendorlovedone.

• LEARNasmuchasyoucanabouteatingdisorders.

Readbooks,articles,andbrochures,andutilize

helpfulonlineresources(seebackpage).

• KNOw thE dIffERENcESbetweenfactsand

mythsaboutweight,nutrition,andexercise.Knowing

thefactswillhelpyoureasonagainstanyinaccurate

ideasthatyourfriendmaybeusingasexcusesto

maintaintheirdisorderedeatingpatterns.

• BE hONESt.Talkopenlyandhonestlyaboutyour

concernswiththepersonwhoisstrugglingwitheatingor

bodyimageproblems.Avoidingitorignoringitwon’thelp.

• BE cARINg, BUt BE fIRM.Caringaboutyour

frienddoesnotmeanbeingmanipulatedbythem.

Yourfriendmustberesponsiblefortheiractionsand

theconsequencesofthoseactions.Avoidmakingrules,

promises,orexpectationsthatyoucannotorwillnot

uphold.Forexample,“Ipromisenottotellanyone.”Or,

“IfyoudothisonemoretimeI’llnevertalktoyouagain.”

• cOMpLIMENtyourfriend’spersonality,successes,or

accomplishments.Remindyourfriendthat“truebeauty”

isnotsimplyskindeep.

• BE A gOOd ROLE MOdELinregardtosensibleeating,

exercise,andself-acceptance.

• tELL SOMEONE.Itmayseemdifficulttoknowwhen,if

atall,totellsomeoneelseaboutyourconcerns—aguidance

counselor,doctor,parentorfriend.Addressingbodyimage

oreatingproblemsintheirbeginningstagesoffersyour

friendorlovedonethebestchanceforworkingthrough

theseissuesandbecominghealthyagain.Don’twaituntil

thesituationissoseverethattheirlifeisindanger.

Source: National Eating Disorders Association, 2005

how to help A friend

Onelistcannottransformnegativebodythoughtsintoapositive

bodyimage,butitcanhelpyouthinkaboutnewwaysoflooking

morehealthfullyandhappilyatyourselfandyourbody.

10 StepS to A poSitive body imAge

1. AppREcIAtEallthatyourbodycando.Celebratealloftheamazingthingsyourbodydoesforyou—running,dancing,breathing,laughing,dreaming,etc.

2. KEEp A tOp-10 LIStofthingsyoulikeaboutyourself—thingsthataren’trelatedtohowmuchyouweighorwhatyoulooklike.Readyourlistoften.Addtoitasyoubecomeawareofmorethingstolikeaboutyou.

3. REMINd yOURSELfthat“truebeauty”isnotsimplyskin-deep.Whenyoufeelgoodaboutyourselfandwhoyouare,youcarryyourselfwithasenseofconfidence,self-acceptance,andopennessthatmakesyoubeautifulregardlessofwhetheryouphysicallylooklikeasupermodel.Beautyisastateofmind,notastateofyourbody.

4. LOOK At yOURSELfasawholeperson.Whenyouseeyourselfinamirrororinyourmind,choosenottofocusonspecificbodyparts.Seeyourselfasyouwantotherstoseeyou—asawholeperson.

5. SURROUNd yOURSELfwithpositivepeople.Itiseasiertofeelgoodaboutyourselfandyourbodywhenyouarearoundotherswhoaresupportiveandwhorecognizetheimportanceoflikingyourselfjustasyounaturallyare.

6. ShUt dOwN thOSE VOIcES IN yOUR hEAdthattellyouyourbodyisnot“right”orthatyouarea“bad”person.Youcanoverpowerthosenegativethoughtswithpositiveones.Thenexttimeyoustarttotearyourselfdown,buildyourselfbackupwithafewquickaffirmationsthatworkforyou.

7. wEAR cLOthES thAt ARE cOMfORtABLEandthatmakeyoufeelgoodaboutyourbody.Workwithyourbody,notagainstit.

8. BEcOME A cRItIcAL VIEwERofsocialandmediamessages.Payattentiontoimages,slogans,orattitudesthatmakeyoufeelbadaboutyourselforyourbody.Protestthesemessages:writealettertotheadvertiserortalkbacktotheimageormessage.

9. dO SOMEthINg NIcE fOR yOURSELf—somethingthatletsyourbodyknowyouappreciateit.Takeabubblebath,maketimeforanap,findapeacefulplaceoutsidetorelax.

10. USE thE tIME ANd ENERgythatyoumighthavespentworryingaboutfood,calories,andyourweighttodosomethingtohelpothers.Sometimesreachingouttootherpeoplecanhelpyoufeelbetteraboutyourselfandcanmakeapositivechangeinourworld.

Source: National Eating Disorders Association, 2005

10 StepS to A poSitive body imAge

Seeking treAtment

Eatingdisordersareserioushealthconditionsthatcanbeboth

physicallyandemotionallydestructive.

Peoplewitheatingdisordersneedtoseekprofessionalhelp.Ifnot

identifiedortreatedintheirearlystages,eatingdisorderscan

becomechronic,debilitating,andevenlife-threateningconditions.

whAt dOES tREAtMENt INVOLVE?

Themosteffectiveandlong-lastingtreatmentforaneatingdisorderissome

formofpsychotherapyorpsychologicalcounseling,coupledwithcareful

attentiontomedicalandnutritionalneeds.Ideally,thistreatmentshouldbe

tailoredtotheindividualandwillvaryaccordingtoboththeseverityofthe

disorderandthepatient’sparticularproblems,needs,andstrengths.

• Psychologicalcounselingmustaddressboththeeatingdisordered

symptomsandtheunderlyingpsychological,interpersonal,andcultural

forcesthatcontributedtotheeatingdisorder.Typically,careisprovided

byalicensedhealthprofessional,includingbutnotlimitedtoapsychologist,

psychiatrist,socialworker,nutritionist,and/ormedicaldoctor.Careshould

becoordinatedandprovidedbyahealthprofessionalwithexpertiseand

experienceindealingwitheatingdisorders.

• Manypeoplewitheatingdisordersrespondtooutpatienttherapy,

includingindividual,group,orfamilytherapyandmedicalmanagement

bytheirprimarycareprovider.Supportgroups,nutritionalcounseling,

andpsychiatricmedicationsundercarefulmedicalsupervisionhave

alsoprovenhelpfulforsomeindividuals.

• HospitalBasedCare(includinginpatient,partialhospitalization,intensive

outpatient,and/orresidentialcareinaneatingdisordersspecialtyunit

orfacility)isnecessarywhenaneatingdisorderhasledtophysical

problemsthatmaybelife-threatening,orwhenitisassociatedwith

severepsychologicalorbehavioralproblems.

• Theexacttreatmentneedsofeachindividualwillvary.Itisimportantfor

individualsstrugglingwithaneatingdisordertofindahealthprofessional

theytrusttohelpcoordinateandoverseetheircare. Source: National Eating Disorders Association, 2005

Seeking treAtment

1. cONSIdERyourthoughts,attitudes,andbehaviorstowardyourownbodyandthewaythatthesebeliefshavebeenshapedbytheforcesofweightismandsexism.Theneducateyourchildrenabout:(a)thegeneticbasisforthenaturaldiversityofhumanbodyshapesandsizes,and(b)thenatureanduglinessofprejudice.

Makeanefforttomaintainpositive,healthyattitudesandbehaviors.Childrenlearnfromthethingsyousayanddo!

2. EXAMINE closelyyourdreamsandgoalsforyourchildrenandotherlovedones.Areyouoverempha-sizingbeautyandbodyshape,particularlyforgirls?•Avoidconveyinganattitudewhichsays,in

effect,“Iwilllikeyoumoreifyouloseweight,don’teatsomuch,lookmoreliketheslendermodelsinads,fitintosmallerclothes,etc.”

•Decidewhatyoucandoandwhatyoucanstopdoingtoreducetheteasing,criticism,blaming,staring,etc.,thatreinforcetheideathatlargerorfatteris“bad”andsmallerorthinneris“good.”

3. LEARN ABOUt ANd dIScUSS withyoursonsanddaughters:(a)thedangersoftryingtoalterone’sbodyshapethroughdieting,(b)thevalueofmoderateexerciseforhealth,and(c)theimpor-tanceofeatingavarietyoffoodsinwell-balancedmealsconsumedatleastthreetimesaday.•Avoidcategorizingfoodsinto“good/safe/no-fat

orlow-fat”vs.“bad/dangerous/fattening.” •Beagoodrolemodelinregardtosensibleeating,

exercise,andself-acceptance.

4. MAKE A cOMMItMENt NOt tO AVOId ActIVItIES(suchasswimming,sunbathing,dancing,etc.)simplybecausetheycallattentiontoyourweightandshape.Refusetowearclothesthatareuncomfortableorthatyoudon’tlikebutwearsimplybecausetheydivertattentionfromyourweightorshape.

5. MAKE A cOMMItMENt tO EXERcISEforthejoyoffeelingyourbodymoveandgrowstronger,nottopurgefatfromyourbodyortocompensateforcalorieseaten.

6. pRActIcEtakingpeopleseriouslyforwhattheysay,feel,anddo,notforhowslenderor“wellputtogether”theyappear.

7. hELpchildrenappreciateandresistthewaysinwhichtelevision,magazines,andothermediadistortthetruediversityofhumanbodytypesandimplythataslenderbodymeanspower,excitement,popularity,orperfection.

8. EdUcAtEboysandgirlsaboutvariousformsofprejudice,includingweightism,andhelpthemunderstandtheirresponsibilitiesforpreventingthem.

9. ENcOURAgEyourchildrentobeactiveandtoenjoywhattheirbodiescandoandfeellike.Donotlimittheircaloricintakeunlessaphysicianrequeststhatyoudothisbecauseofamedicalproblem.

10. dO whAtEVER yOU cANtopromotetheself-esteemandself-respectofallofyourchildreninintellectual,athletic,andsocialendeavors.Giveboysandgirlsthesameopportunitiesandencouragement.Becarefulnottosuggestthatfemalesarelessimportantthanmales,e.g.,byexemptingmalesfromhouseworkorchildcare.Awell-roundedsenseofselfandsolidself-esteemareperhapsthebestantidotestodietinganddisorderedeating.Source: National Eating Disorders Association, 2005

10 thingS pArentS cAn do to prevent eAting diSorderS

ByMichaelLevine,Ph.D.,andLindaSmolak,Ph.D.

Thequestionsbelowareintendedtobeusedinconjunction

withtheHBOdocumentaryfilmthin.Thisguidecanbeused

byteachers,communitygroups,families,orindividualswho

areinterestedinexploringthevariousissuesraisedbythefilm.

1. Whatfactorscontributetopositivebodyimageandhealthyself-esteem?

2. Doyouthinkthereissuchthingasaperfectbody?

3. Alisadrewanoutlineofwhatsheperceivestobeherbodyimage.How

doyouseeyourownbody?Doesyourperceptionchangedependingon

yourmood?Doothersseeyouthewayyouseeyourself?

4. Wheredoesthestandardforwhatisattractivecomefrominoursociety?

5. Whydoyouthinkpeoplecomparethemselvestootherpeople,friends

orclassmates?Howdoesitmakeyoufeeltocompareyourselftoothers?

6. Howarecontemporaryfemalebodiestypicallyrepresentedinadvertise-

ments,television,movies,andprintmedia?Howdotheserepresentations

influencethewaygirlsfeelabouttheirbodiesandthewaytheydress?

7. Whoinsocietybenefitsfrompeoplebeingunhappywiththeirbodies?

8. PollyandBrittanydiscusstheirparents’attitudestowarddieting.

Thinkaboutyourownparents/guardians.Dotheydiet,countcalories,

exercise?Howhastheirattitudeaboutweightaffectedyou?

9. Shellyhasatwinsister.Howdosiblingsand/orpeersinfluencetheway

youngboysandgirlsact,look,andthinkaboutthemselvesandothers?

10. Theindividualswhoarefeaturedinthefilmareallwomen.Menalso

strugglewitheatingdisorders,butwhydoyouthinkanorexiaand

bulimiaoverwhelminglyaffectyoungfemalesmorethanyoungmales?

diScUSSion QUeStionS for the hbo docUmentAry film thIN

PremieresTuesday,Nov.14at9pm/8ConOr see it anytime on HBO On Demand®

Companion book available from

Companion DVD available at HBO.COM

A downloadable PDF of this guide is available at THINDOCUMENTARY.COM or HBO.COM/DOCS

Ifyouorsomeoneyouknowissufferingfromaneatingdisorder,itisimportanttoseekhelpimmediately.

RESOURCES

NationalEatingDisordersAssociation(NEDA)www.nationaleatingdisorders.orgTollfreelivehelpline:800-931-2237Monday–Friday,8:30a.m.–4:30p.m.(PST)

EatingDisordersCoalitionforResearch,PolicyandAction(EDC)www.eatingdisorderscoalition.org202-543-9570

AcademyforEatingDisorders(AED)www.aedweb.org847-498-4274

NationalWomen’sHealthInformationCenter(NWHIC)www.womenshealth.gov900-994-9662

EatingDisorderReferralandInformationCenter(EDRIC)www.edreferral.com

SomethingFishywww.something-fishy.org

GürzeBookswww.bulimia.com

AmericanDieteticAssociationEatingDisorderFactSheetwww.eatright.org

EmpoweredParentswww.empoweredparents.com

ThinDocumentaryWebsitewww.thindocumentary.com

Inclusiononthislistisinnowayanendorsementofthesesites.HBOisnotresponsiblefortheinformationalcontentofthesesites.

NEDAisanindependentorganizationnotaffiliatedwithHomeBoxOffice,Inc.orthedocumentary“Thin.”NEDAmaterialsareusedunderlicense.

Text ©2005 National Eating Disorders Association.

©2006 Lauren Greenfield/VII

DirecteD by Lauren GreenfieLD executive ProDucers r.J. cutLer Lauren GreenfieLD

ProDucers r.J. cutLer Lauren GreenfieLD amanDa micheLi teD skiLLman Director of PhotoGraPhy amanDa micheLi

outreach shannon Puckett eDiteD by kate amenD, a.c.e.

for hbo: suPervisinG ProDucer Lisa heLLer executive ProDucer sheiLa nevins©2006 Home Box Office, Inc. All rights reserved.

HBO®, HBO On Demand® and HBO Documentary FilmsSM are service marks of Home Box Office, Inc.