For some people, food is fuel. They eat when they’re hungry, stop when they’re full and rarely gorge themselves on donuts, candy bars or other sweet, fatty treats. What’s the point? It’s unhealthy.
Not so for others. For them, food is much more than fuel. It’s warmth, it’s comfort, it’s refuge from abuse, neglect and loneliness. For people — especially children — starved for attention and emotional nourishment, food can become love. And some can’t get enough of it.
Such was the case with a young Irish-American girl from Boston who grew up to become a physician and nationally recognized epidemiologist at Fred Hutchinson Cancer Research Center. Dr. Anne McTiernan has spent the last 25 years researching, writing and lecturing about the effects of diet, exercise, and weight loss on cancer and health. She’s also just published a gripping memoir about her impoverished Catholic childhood and how the cruelty she suffered as a young girl greatly complicated her relationship with food and with her own health.
“Starved: A Nutrition Doctor’s Journey from Empty to Full” is a courageous and insightful book. It’s also a page-turner. McTiernan’s mother all but abandoned her only child for the first few years of her life, farming her out to a series of group homes and boarding schools, bleak institutional environments where food, attention and compassion were sparse. As a result, she nearly starved to death at the age of 4. A doctor finally intervened, forcing McTiernan’s mother to bring her daughter home. More than a decade of physical and emotional abuse followed — as did a host of body image, weight, and food issues — as the future scientist desperately tried to fill the void where a parent's love should have been.
McTiernan writes unflinchingly of these difficult years, effectively capturing the pain she suffered growing up without a father (her parents separated before she was born); the anguish, hostility, and guilt she had about her mother’s mistreatment; and her struggles first with near-starvation, then obesity and obsessive dieting. Perseverance, grit, and scholarship eventually helped her escape a dysfunctional family and future and go on to use her hard-won wisdom and experience to help others. As she puts it in the book, “I didn’t have a plan to focus on diet or obesity; I wasn’t a fitness freak. I didn’t even study nutrition in college … But I was in training for this career my entire life.”
Poignant and peppered with intelligence and sly wit, “Starved” is a hero’s journey — replete with humor, heart, self-actualization and, of course, science. Fred Hutch News Service writer Diane Mapes sat down with McTiernan before her Northwest book tour to discuss her story.
Tell me about how this book came about. Have you always wanted to write about your childhood?
I’d always loved to read. I didn’t know that I would do creative writing, but when I read "Angela’s Ashes," which was about Frank McCourt’s miserable Irish Catholic childhood, I thought to myself, “I had a miserable Irish American childhood. I could write a book.”
Physicians have a saying, “See One. Do One. Teach One.” We learn things very quickly and, as a result, we think we can do almost anything quickly. I was soon disavowed of this when I started to write. I learned writing is not something you learn by just reading. You really have to learn how to do it and you have to practice. I took a certificate in memoir writing at the University of Washington, worked with a writing group and with two different editors. It’s a big effort to try to put something down on paper and then craft it into a story with a story arc. In science, things are written in a formulaic way. Often the language is stilted, it’s written in passive tense and it’s more structured. There are certain things you have to cover and there’s less freedom.
In creative writing, you’re not thinking in terms of a formula per se. It’s more about how it flows. It’s about story. And physicians deal with story all the time. When we present a case to our attending [physician] in medical school, we present it in story form, orally. It’s almost like a narrative arc of the patient’s history. That reminded me a little of the creative writing process.
A big focus of your research has been on diet and obesity and its impact on health, including cancer. Was this a conscious choice?
Some of it was just by chance, like the initial Women’s Health Initiative diet study that I became involved with when I first came to Fred Hutch. But some of it was deliberate.
I feel like I really understand what a lot of our study participants are trying to do. I know what these people are dealing with when they talk about not wanting to give up a food or a pattern of eating. I absolutely empathize with them. It’s very difficult to change your diet or change your lifestyle habits. These things became quite entrenched. And food is not just a lifestyle —you’re confronted with food choices all day long. Then there’s the issue of comfort food, which so many people have issues with. You can try to get someone to change their diet and reduce sugar and fat, but that’s what’s making them happy and comfortable.
Growing up, your weight and diet fluctuated dramatically. First, you were malnourished. Then, as you got older, you gorged yourself on candy bars and peanut butter and Marshmallow Fluff sandwiches. Later, in high school, you starved yourself thin again. Can you talk about how your attitude toward food has changed?
They say inside every person with obesity, there’s a small person crying out. In me, I’m in the normal weight range but I want to eat enough to make me obese. I’ve always had issues with food. In times of stress, I reach for chocolate or high-calorie food.
But I am pre-diabetic — something I inherited from the father I didn’t really know — and I have to be really careful. I keep my carb intake quite low and try to keep my weight down in the normal range and that works. I’m very lucky that way.
As for my eating habits as a child, I just showed what kids will do if they have free reign. Kids need guidance, especially in a situation where there’s so much food available. My daughters make sure their kids have excellent nutrition available to them. And their kids have limits. They can have desserts but not very much. Every bite they put in their mouths has to be high nutrition. Otherwise, how are they going to grow? That’s what you need to do with kids. Being home alone as a child was very difficult for me. If it was nowadays, with even more junk food available, I would have been even heavier.
You were a tough little kid. How did you power through?
I think from early on, I learned I had to be tough. I was sent to a group home starting when I was 3 months old. And then I went to a Catholic boarding school when I was 4. I’d have trouble if someone sent me to something like that now — away from family, with no power. I guess I had to develop toughness in order to be able to survive.
I think persistence helped me get through my childhood and medical school and through years of research. I just didn’t give up. But it wasn’t all on my own. When I was small, I did have people in my life who were helpful. My aunt Margie was crazy as a bunch of beans, but she loved me. I also had a grand uncle and neighbors who were good to me. Sometimes people that are in children’s lives don’t realize what kind of effect they can have on them.
In your book, you also delved a bit into body image and body dysmorphia, where people don’t have an accurate sense of their own appearance. As a scientist, what’s that about?
That just shows that the brain doesn’t really understand reality sometimes, especially in someone who’s developed anorexia or another eating disorder as a way of dealing with life. It’s not a reality-based connection.
When I experienced that, I was a teenager in the late ‘60s and there was just starting to be an issue with the media showing models in magazines. It’s not as bad as it is now where everyone is “photo-shopped” to look perfect, but it was still unrealistic. There was no way that mere mortals could look like these people. So you end up feeling like there’s something wrong with you.
I know childhood obesity is a complex issue. Can abuse contribute to it at all?
I haven’t done any research on this, but others have. Children who are abused in various ways — physically, sexually, emotionally — have a higher risk for obesity. At least that’s true in our culture where there’s access to food. In others cultures where there isn’t, they deal with it in different ways. In our culture, though, it’s a risk and it continues into adulthood — especially for women. It can have lifelong effects.
One meta-analysis [published in Psychosomatic Medicine in January 2016] showed that a history of child abuse increased risk for eating disorders in adulthood. For example, a history of physical abuse tripled the risk for a binge-eating disorder. Another paper [published in Pediatrics in 2008], showed a significant association between a history of child abuse and risk for adulthood obesity.
Holidays are stressful and they’re also a time when we’re surrounded by tons of fattening food and pressure to partake. Do you have any advice for people like me who have trouble staying away from the holiday goodies?
I think if you can distract yourself from food, it helps. One thing about physical activity [beyond burning calories], if you’re taking a walk, or pedaling on a stationary bike or doing an elliptical machine, you’re not stuffing your face with food or high-calorie drinks. Some people might want to do meditation; others might want to go to church. Anything you can do to distract yourself is helpful.
We’ve seen in our studies that when someone is on a [diet], and they’re also assigned to an exercise program, they lose a little more weight. Part of that is burning more calories. Some of it is metabolism, but not a huge amount. I think distraction is a big part of it.
Also, write down everything you eat — and your physical activity. Writing everything down forces you to realize what you’re putting in your mouth and it helps you count calories. It also keeps you accountable.
As someone with food issues and my own dysfunctional childhood, your book totally spoke to me. What kind of feedback have you received from others?
Others have said it really spoke to them, too, because they’ve dealt with something similar and they hadn’t seen that subject written about. They liked having it written about, especially in a way that shows you can deal with it and survive it.
Book launch party: Join McTiernan at 7 p.m. Monday, Jan. 23 at University Bookstore in Seattle for a book launch party. McTiernan will also appear at Ravenna Third Place Books at 7 p.m. Thursday, Feb 16. "Starved: A Nutrition Doctor’s Journey from Empty to Full” can be purchased at bookstores and online. Click here to purchase the book through Amazon Smile (with a percentage going to Fred Hutch).
Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied. Email her at dmapes@fredhutch.org.
