Happy Horny Skinny —

Trigger warning: Graphic discussion of eating disorders and fat shaming.

Back in 1999, Dr. Drew Pinsky, the popular addiction specialist turned TV and radio host, did something unconscionable that only caught up with him in 2012:

A Boston judge on Thursday approved a record $3 billion guilty plea by British drugmaker GlaxoSmithKline, which paid the “Celebrity Rehab” doctor — known as Dr. Drew — $275,000 to tout Wellbutrin, approved by the FDA to treat depression, as a drug to treat other conditions including obesity, addictions and sexual dysfunction.

Dr. Drew infamously told “Loveline” listeners that Wellbutrin “could explain a woman suddenly having 60 orgasms in one night.” Dr. Drew was part of “Operation Hustle” (I am not making this up), Glaxo’s campaign to illegally promote the off-label benefits of its antidepressant. Sales reps wanted to promote the wonderdrug as the “the happy, horny, skinny pill.”

Dr. Drew’s “non-branded campaign” (as he called it in his public response to the charges) is the kind of conflict of interest that makes many of our readers wary of anti-obesity research, like bariatric surgeons who publish glowing research on weight loss surgery. But in a country waging a War on Fat, society tends to dismiss the means of getting thin, so long as the ends are impressive (see: Biggest Loser).

This kind of all-or-nothing approach to weight loss and (supposedly) health is nothing new, but it seems as though the impact that such a weight-focused approach can have on individuals is now affecting Dr. Drew in a way he might not have anticipated.

As a way of drawing attention to National Eating Disorder Awareness Week (NEDAW), Dr. Drew’s daughter, Paulina, publicly disclosed her seven-year battle with anorexia and bulimia. Last November, she first published a harrowing account in the Columbia Spectator about confronting her mother over her ED on a ride home from a nice restaurant. Her mom kept talking about some friends who owned a gym and their tricks for staying thin. The subject became too much for her:

My ability to listen to my mother talk about her gym owners had disappeared when I had hit rock bottom four months prior and had put myself into therapy. Purging eight times in one day to cope with the emotional stress of being home during spring break had finally scared me enough to take action. And here I was again, stuck in a car with her.

Without even thinking, the words erupted from my mouth.

“Well I’d rather have an over-eating disorder than an under-eating disorder.”

She said, “You don’t mean that,” to which I replied, “Yes I do. I’ve already had an under-eating one.”

Without missing a beat, she responded, “No, you haven’t.”

I paused, but before I knew it, the words were out of my mouth. “Yes, I have. I’ve been throwing up since the seventh grade.”

All of the air was sucked out of the space we both shared. This was not the way I wanted to tell her; this was not what I had planned. I had imagined a triumphant moment that involved eating a whole cake with my hands without breaking eye contact and saying, “YES, I HAVE BEEN A BULIMIC AND ANOREXIC FOR SEVEN YEARS. BUT NOW I AM BETTER. I AM EATING THIS CAKE BECAUSE I WANT IT AND I’M HUNGRY. AND GODDAMN IT TASTES GOOD.” But the words flew out of my mouth before I had a chance to take them back. The following moment was the longest and most painful silence of my life; I felt like my stomach was going to fall out and that I was going to projectile-vomit onto the windshield. After a silence that lasted far too long, she responded.

“Well, get your teeth checked.”

It’s a disturbing response, and one that the media has immediately picked up on as proof that the ED was her mother’s “fault.” And indeed, parents can definitely trigger EDs in people (my wife being one example I know intimately), but Paulina goes on to explain how her whole world centered around getting and staying thin:

My 13-year-long figure skating career fostered my eating disorder, which was normalized by the people around me. Both inside and outside the world of figure skating I was repeatedly praised for my “perfection.” Everyone constantly inquired about my thinness, asking how I did it and how they could emulate it. My hunger didn’t matter, I was told, because it was merely a means to an end. A friend’s mother told me that if I went to bed hungry, I would lose weight. And it was true. I began to realize that people liked me better thin. I had boyfriends who never failed to comment on how “amazing” and “beautiful” I looked; my friends and their mothers asked me what I ate and how I worked out. Thinness became my entire identity. Everyone needed me to be thin and, even worse, I needed myself to be thin. [emphasis mine]

Paulina makes the case that it takes a village to normalize an eating disorder, but admits that within her nuclear family, “‘diet and exercise’ is our religion.”

Paulina with her father and mother.

As a parent, I’m painfully aware that I will eventually do something or say something that may make a deep and lasting impression on how my children perceive themselves and their role in society. Parents screwing up their kids is inevitable (although there are varying degrees of effect), which is why, despite my initial disgust with Paulina’s mom, Susan, I read more about how she reacted in the long-term to her daughter’s ED. And from what I’ve read, Susan has been very supportive in the two years since her “get your teeth checked” comment.

And then I found this post in Susan’s blog regarding Paulina’s ED and that comment specifically:

I was terrified and speechless. I had no idea how to respond, since I have no formal training in this subject.  In a defeated voice I muttered my response, not to hurt her, to advise her as a mother would. Maybe I was angry because she hid this from me. As a mother, I’m frustrated and confused, even talking about it now. I feel like I failed as a mother and I sink into a deflated self. My baby girl was suffering from an eating disorder. How could I have not known? Her periods were normal, she was always at a good weight, and I never saw her vomit. No one knew.

Was it the best response? No. But people are complicated and their reactions, particularly to their children, can be unpredictable. But most importantly, Susan seems to have learned how to support Paulina. Even better, Paulina was strong enough to move forward and overcome her ED and she is now an fierce advocate for Body Acceptance. She’s leading events at Columbia University this week for NEDAW, including this awesome photo session promoting body positivity.

This is an excellent “lemons into lemonade” moment; the kind of moment you hope will come from such tragic circumstances. But I think her father still needs a wake-up call on how his attitude toward fat people may influence not only her daughter’s perception, but the public’s perception of weight and health.

Paulina shares an anecdote in this Bodies Endangered blog post that highlights his pragmatic problem:

When I was last home from school in June, I brought up Kim Kardashian during a family dinner. I hadn’t even completed my thought about how disgusting I found the media’s emphasis on her weight gain during her pregnancy, before my mother interrupted me: “Yeah. She got really fat.” I paused and looked at my father, hoping that he would start a riot on my behalf; he just mumbled his medical opinion under his breath, saying, “You know, it’s very unhealthy for the baby to gain that much weight. Could be Eclampsia, which is very serious.”

It’s the kind of comment you would expect from 9 out of 10 doctors, who are just as susceptible to the panic surrounding obesity as anyone else. But later, Paulina says something quite revealing: “From a young age I was told to crave hunger, to strive for it. If I went to bed satisfied, I felt that I had failed. This left me physically and emotionally starved.” Recall the bolded comments on hunger above. The emphasis on hunger played a significant role in Paulina’s ED, and we get a glimpse of where it came from in some of Dr. Drew’s podcasts.

Dudebro and the Doc (1996)

If you weren’t aware, Dr. Drew frequently partners with an unrepentant douchebag named Adam Carolla, who is best known for his racist, sexist, homophobic and transphobic rants. Like his cowardly progenitor, Tom Leykis, Carolla’s public relevance is tied directly to the stagnant supply of perpetually-threatened dudebros who need constant reassurance that they are the kings of their domain (“their domain” being mom’s basement).

The dynamic is that Dr. Drew is the yin to Carolla’s yang… Carolla is the abrasive “straight-shooter,” while Dr. Drew legitimizes whatever the fuck Carolla spews out by polishing it up with his benign, clinical manner, thus softening the dudebro message for a broader audience.

I haven’t seen the Dynamic Duo in action since the ’90s, so I thought I’d see what they have to say about fat people and I was shocked — SHOCKED! — to discover that Carolla is an equally colossal douche on that subject as well. I stumbled upon this podcast from exactly one year ago, during which Dr. Drew talks about his diet.

“How’s your diet work?” Carolla asks.

“I don’t eat,” Dr. Drew says. “Here’s how I know I’m okay: I’m hungry. And then I try to eat so much that I don’t get full. I eat good, balanced, low fat, high protein, but I try not to get full so that I’m like hungry an hour later. That tells me that my body’s using its resources. So I’m hungry all the f’ing time and it aggravates me.”

Sound familiar?

This is the kind of thing Paulina was taught throughout her life: hunger is the goal, hunger is something you should crave, something you should strive for. It’s a kinder, gentler version of “Nothing tastes as good as skinny feels.” And it’s not just the advice he gives his daughter, it’s the advice he still lives by to this day. My question is, if cultivating hunger is such an effective and sustainable weight loss strategy, why does Dr. Drew have to keep starting new diets?

Right on schedule, Carolla gives the standard dumbass dudebro diet template that he thinks people have somehow forgotten. “I’ve found that most people say this and the number 1 ‘Hey, you used to be fat, why are you not fat any more?’ — stop drinking soda and started walking is usually the number 1 answer.” I’ve got news for Carolla: I don’t drink soda regularly and I walk all the damn time. Why am I not skinny, yet? “It’s insane that there probably have been more books written about dieting than there have been about World War 2, World War 1 and Vietnam.”

“Oh sure, all wars combined,” Dr. Drew responds.

Ignoring why there are so many books about dieting, Dr. Drew goes on to explain his theory on the “obesity epidemic” by claiming that “people are so unregulated emotionally that they use food to regulate their emotions and then they can’t contain — they have no frontal lobe function — they can’t contain their desires.” Again, recall Paulina’s comment about how the emphasis on staying hungry left her “physically and emotionally starved.”

[Sidenote: Regarding the popular claim that obese people are brain-damaged or, as Dr. Drew says, "they have no frontal lobe function." The prefrontal cortex (PFC) controls executive function, which includes working memory, reasoning, task flexibility, and problem solving. Basically, the line of reasoning goes that either getting fat damages your PFC or a damaged PFC makes you fat. The most frequently-cited study on the topic compared the PFCs of ten lean, nine obese, and eight formerly-obese women and found that obese women had the least active PFCs.

Of course, this doesn't explain why the lean women with a BMI of 26 had greater PFC function than formerly-obese women with a BMI of 28. If PFC were affected by weight alone, you would expect that function to be more comparable. But if you dig a little deeper, you learn that leptin-deficient people have lower functioning PFC as well, and when they receive leptin injections, their PFC improves. Leptin reduces their constant hunger. Fat people tend to be leptin resistant, so their body doesn't process the leptin as well. Could this affect PFC function? And does weight cycling affect PFC function, such that extreme cyclers have lower PFC function than non-cycler? And, as always, how does fitness affect PFC function? All unanswered questions, but, yeah, let's just run with fat people are brain damaged.]

Carolla goes on to talk about his recent experience at Disneyland, complaining about all the fat people in scooters and how scooters should be for people who are too physically frail to ride the Matterhorn, which is like “being gang-raped dry.” Dr. Drew laughs about this and joins in the rape jokes, which is problematic on a whole other level.

Anyway, Carolla wants the audience to know that Disneyland is full of horrible, horrible fat people and he goes on a rant that tells you exactly what you need to know about where his concerns for their health and well-being:

When you see the 63-year-old chick walking around and [she's] got the extra 30 pounds on her or 50 pounds pounds her, okay. But when you see the 19-year-olds — lots of ‘em, lots of ‘em — and I always notice especially the women… guys can go ahead and play nose guard for the football team or still occasionally get laid or even if they have to, just buy a prostitute. But the fat chicks, socially — and I also started doing a map, so a couple things: a) many of the employees over at Disney are not husky and not fat, but morbidly obese. You’re talking about women that are — and men, but I always say I notice the women because it impacts their life socially more greatly. [emphasis mine]

Dr. Drew chimes in with, “You feel bad for them.”

Gee… why is it that fat women are more socially impacted than fat men again? Let me scratch my big, dumb, hairy chin a minute and think…

So, Carolla goes on to lament the fact that he only sees the fat female Disneyland workers paired up on to work the rides with other fat females. “What they should really do, honestly,” Carolla ponders, “they should put the thin ones with the fat ones so that the fat ones have something to look at —”

“Some motivation,” Dr. Drew says.

“Other than themselves,” Carolla responds.

“For health reasons.”

Yes, clearly Carolla’s concern for these “fat chicks” is their health. And his reasons for making fun of fat women is because he’s concerned for their health. Carolla goes on to talk about how when his writing partner is on a diet and they go out to eat together, he tends to eat better, which is something Dr. Drew calls “social motivation.”

Carolla goes on to lament the sad PUA fact (and PUA is nothing if not sad) that “when you’re out on the hunt,” he has to deal with fat chicks. I’m including this rant because this is the kind of shit that Dr. Drew contributes to on what is half his show:

There was always the chick who was a little chunky, but not fat, just a little chunky, do you know what I mean? And had a little extra bosom on her, which was a plus, but a little extra ass on her, which was not a plus, unless you’re a black guy, and you were like — but there was always that chick. There was the chick — there were hot chicks, there were chicks that looked great in their bikinis and then there was that chick that was cute in the face, but she was just like 15, 20 pounds away from being hot, you know? And it was kind of understood. It was almost a shame. She had beautiful eyes, but kind of a big ass, you know? And that chick wasn’t 100 pounds overweight. That chick was 10, 15 pounds overweight. She’d be smokin’ at 125, 130, but she was more 140, and therefore blowjobs only and everyone felt sorry for her. That chick who was 10, 15 pounds overweight and could never really get past that mark, you know what I mean? Every once in a while she’d drop a couple pounds, but she’d quickly get up to that fighting weight. So cute, but always a little extra meat on her, just enough to get her off the desirable chart for most of the guys.

This is the kind of mentality that drives young women to a perpetual dieting or, worse, eating disorders because they are taught think of their bodies in this way by our culture. Most of that cultural influence comes in the form of ubiquitous subtlety: Adam Carolla’s dream woman in every magazine, movie, TV show and pop music act. This teaches women and dudebros alike that 140 pounds is something to be ashamed of, something that makes a woman completely undesirable. And now Carolla is scandalized by women who weigh over 200 pounds. Dudes who weigh that much? That’s fine. They can be noseguards and still get laid.

But remember: it’s all about health.

So Dr. Drew tries to reason with Carolla about changing social standards, saying, “Is it possible,  you know, women really set the tone for what’s attractive, you know what I mean? Is it possible things are changing and guys are sort of into that? Because there are those guys who are into it. And those are the ones that are into are into it.”

“I agree, but until Sports Illustrated or Victoria’s Secret has one of these chicks show up on the beach —” Carolla retorts.

“Okay, enough said,” Dr. Drew says. “Touché.”

“Because that’s who decides.”

Exactly.

And here we see the biggest problem with Dr. Drew: when faced with Carolla’s toxic misogyny and tireless douchebaggry, Dr. Drew rolls over completely. He wants to be the voice of reason, but he can’t help but join in on the joke because otherwise Carolla mocks him for being spineless. This willingness to yield to Carolla’s brute opinions takes a particularly ugly turn when the conversation turns to hunger in America and how cheap food has gotten. Carolla compares the price of gas at the start of Obama’s term to now (which is incredibly misleading, since gas prices spiked throughout the Bush era wars, but dropped just before the 2008 election) and how the price of tacos has barely moved.

“Well, kids go to bed hungry every night, Adam,” Dr. Drew says, sarcastically. “They’re starving. There’s hungry kids everywhere.”

Carolla laughs derisively and says, “They are not.”

Dr. Drew then explains how people can simply panhandle in a subway for 50 cents and get a whole meal from Del Taco, adding that people can “do it every day with no end in sight.” Carolla reminisces on the good ol’ days of poverty when you’d beg for money all day just so you could afford a loaf of bread and a can of beans.

“That’s the point: are we starving or are we obese?” Dr. Drew says. “Especially when I hear hunger commercials, I get confused. I don’t understand. How could a third of children go to bed hungry and be obese? Maybe that’s the problem.”

Carolla talks about how he goes to bed hungry all the time. I mean, what’s the big deal, guys?

“And by the way,” Dr. Drew adds, “when I’m not hungry, I’m gaining weight. I need to be hungry or else I’m in trouble. I’m hungry right now.” Again, we see the Pinsky’s Cult of Hunger on display.

Carolla returns to the subject of fat girls at Disneyland and says that he thinks there are more fat women than men, which is “that’s something that’s new and weird and sad, which it used to be a 23-year-old chick was like, ‘Hey man, I gotta look good because I gotta get myself a man to marry me in the next five years.’”

Again, we see the facade of health laid bare. This isn’t about whether fat people are healthy, but about whether fat women are motivated enough by Carolla’s pin-dick to lose weight. But Dr. Drew puts a “positive spin” on it by reminding us that women get fat because they are fucked up.

“But what we’re seeing is ‘I’ve gotta keep this big thing around me to protect me from people so I don’t get abused the way I was as a kid,’ which we know — you and I know — that’s the majority of this shit.” Okay, so far we’ve learned that fat people are brain damaged and the majority of fat women have been abused. Great analysis, Doc!

As if this weren’t bad enough, Carolla then endorses stigma as the best way to motivate fat people. “There’s nothing that keeps people in line like ‘I don’t want to fuck you fatty.’” Dr. Drew laughs and laughs at this hilarious observation, completely ignoring the fact that if weight stigma actually produced results, then obesity rates would not have risen between 1980 and 1999, when mocking fat people was par for the course.

Carolla continues, “I will not hang out with you, I don’t want to be your boyfriend or your girlfriend, I don’t want to be engaged to you, I don’t want to start a family with you because you’re unattractive to me and you’re unhealthy. Now that is the ultimate ‘Get in line, straighten your shit out.’” As you read about Adam Carolla’s concern for health, bear in mind that this is the man Dr. Drew himself said is “almost an alcoholic.”

As with most of this shit, Carolla is pulling success of motivational stigma out of his ass, since researchers have studied stigma extensively and know how ineffective it is in motivating people, particularly weight stigma. Dr. Drew is an addiction specialist, so does he believe that stigmatizing drug addicts will help them get clean? If not, then why does he let Carolla spew this unfounded bullshit day in and day out on his show?

It’s because Dr. Drew has no fucking clue what the fuck he’s talking about. Recently on CNN, Dr. Drew answered viewer questions and when asked about exercise bulimia, he responded, “I got a whiff of exercise bulimia. You sort of exercise too much, and if you miss it you freak out. You have to constantly exercise.  I don’t feel right if I don’t do it.  But, you know, a little whiff of mental health issue never hurt anybody.” Really, Dr. Drew? You think getting “a little whiff” of a mental health problem doesn’t hurt anybody? Perhaps that’s why you think Carolla has a little whiff of alcoholism? And have you asked your daughter what that “whiff” can do?

I found another Carolla/Drew podcast from November, shortly before Paulina published her article on her ED. Once again, both Carolla and Dr. Drew mock the idea that poor people can’t feed their kids, and again, Dr. Drew says “You can eat for a dollar a day in this country, easily.” He then follows this up by saying, “I’m anti-obese, I’m pro-hunger.”

Dr. Drew listens as Carolla proposes yanking everybody off food stamps and performing a kind of tough love experiment that forces families to take responsibility for themselves and he speculates on how many people would really starve. “Ten million? Five million? Two million?” All of this, Dr. Drew listens to and responds to positively and reinforces Carolla’s message, as though this Cro-Magnon, knuckle-dragging fuck-face has all the world’s problem’s solved, if we’d just snatch food stamps away from hungry kids because they don’t understand how you can be poor and fat.

Dr. Drew promotes a two-dimensional view of these enormously complicated issues: fat is bad, thin is good; the poor should eat fast food and not get fat; and hunger is always, always good. You can’t take shortcuts when it comes to health messaging. A doctor can’t promote drugs for off-label purposes for a quarter-million dollars and say it’s what he would have said anyway. A parent can’t teach their kids that hunger is a virtue and be surprised when one of them develops an eating disorder. A celebrity can’t suggest that perhaps poor kids would be better off going to bed hungry and not sound like a monster.

I am glad that Paulina has recovered from her eating disorder and that her relationship with her mother has improved. But her father is still promoting misinformation and a collaborating with a man whose definition of health is how fuckable she is, defined by whether she’s a 140 pound lard-ass or a 125-pound babe. Dr. Drew is part of the cultural problem that emphasizes looks as a proxy for health, which is critical trigger for eating disorders in young women.

Paulina may have escaped the harm of eating disorders, but nearly 30,000 women are hospitalized each year for ED-related health issues (PDF). Isn’t it about time that Dr. Drew takes an ethical stand for them as well? Isn’t about time Dr. Drew told Adam Carolla to shut the fuck up?