Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia

By Kelly D. Brownell; John P. Foreyt | Go to book overview

FOREWORD

A Tribute to Hilde Bruch

Hilde Bruch was to have written the other foreword to this volume. Her recent death, in an old age filled with honors, has deprived us of this commentary, and of so much else. I know of no one who could have commented more wisely on this rich and varied volume. For she could bring to the task the perspective of half a century of work in the eating disorders. And she did more than simply watch the field evolve; more than anyone else, Hilde Bruch was responsible for its creation.

It is often difficult to look back in time and recognize what were the significant contributions to the development of a discipline, to understand what things made the difference, what changed the paradigms. Two sources of change are certainly new ideas and new observations, and Hilde Bruch contributed significantly to both. Her concept of "preferred weight" foreshadowed currently popular notions of a body weight set point, and her description of the problems of reduced obese persons— "thin fat people"—astutely recognized the physiological pressures resulting from weight loss in some persons—perhaps those who reduce below a body weight set point. She soon recognized the heterogeneity of obesity and her early attempts at a clinical classification of the disorder preceded later (and still continuing) efforts to this end. It was Bruch who described the "family frame" of children with obesity and set the stage for the development of family therapy.

But new ideas and new observations play only a part in the creation of new paradigms—in this case, in our understanding of the eating disorders. More important is the questioning of the old ways. As long as we look at things in the old ways, it is often difficult to see what is in front of us. Once the blinders are removed, it is often striking how much we can see. Hilde Bruch's main contribution may well have been to remove the blinders.

I remember a gourmet meal that she cooked for me in the summer of 1953 when I was embarking on full-time research on obesity, and the impression that she made at the time. I had been listening to other experts' bland assurances that we knew just about everything that could be learned about obesity. No doubt there were a few rough edges that could be

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