Advertisers commonly alter photographs to enhance the appearance of models’ bodies, and such alterations can contribute to unrealistic expectations of appropriate body image – especially among impressionable children and adolescents. A large body of literature links exposure to media-propagated images of unrealistic body image to eating disorders and other child and adolescent health problems. The AMA adopted new policy to encourage advertising associations to work with public and private sector organizations concerned with child and adolescent health to develop guidelines for advertisements, especially those appearing in teen-oriented publications, that would discourage the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image.

Its important to note that eating disorders are biological illnesses with a myriad of  genetic, hormonal and neurobiological factors.  Just as parents do not cause eating disorders, nor do airbrushed magazine ads. (In fact, Carrie Arnold over at Psychology Today’s Body of Evidence does a great job of examining this aspect of the AMA’s statement).  But our hope is that this new policy is not just focused on removing a risk factor for those who may be genetically more susceptible to the “thin ideal”.  A society saturated with computer-generated images portrayed as real bodies is unhealthy and harmful whether it contributes to an eating disorder or not.   Its harmful to females and males.  Its harmful to kids and adults.  Its harmful for anyone that struggles with negative self-esteem or body image.  In this way, the issue of photoshop and media ethics is more than an eating disorder prevention issue but one that addresses self-esteem and body image on a societal level.

While some will say the policy doesn’t accomplish enough, its encouraging to see a well-respected, national organization like the AMA acknowledging the issue and prompting further attention to it. What’s most encouraging is that this recent action by the AMA, seems to be part of a larger momentum of change including the Girl Scouts’ announcement of its’ project, Healthy MEdia: Commission for Positive Images of Women and Girls which is being co-launched by the National Association of Broadcasters (NAB), the National Cable & Telecommunications Association (NCTA), and The Creative Coalition.

The new policy also arrives amidst several specific wins in the fight against harmful media practices surrounding weight, food, beauty ideals and sexualization.  Most recently, the Federal Trade Commission (FTC) won a settlement against Beiersdorf, Inc. (parent company of Nivea) Inc. that prohibits them from making continued false claims that its Nivea My Silhouette! skin cream can reduce consumers’ body size.  In June, the National Eating Disorders Association (NEDA) publicly applauded Yoplait for agreeing to pull a troubling ad campaign after being warned by NEDA that it normalized dangerously disordered thoughts around food and weight.  And thanks to international body image advocates Sharon Haywood, Melinda Tankard Reist and more than 5,000 signatures on a petition at Change.org, major networks MTV and VH1 both agreed to ban a violent and misogynistic music video starring Kanye West and other high profile music stars.

Lots of individuals and organizations are pushing back against the tide of false bodies, diet myths, weight prejudice and general negativity in the media.  They’re making great strides in the promotion of positive body image, self-esteem and overall health (vs. weight).  In addition to those we mentioned above, here are just a few more organizations and individuals that are doing good and speaking out for change:

• Endangered Species
• Adios Barbie – The Body Image Site for Every Body
• The Health at Every Size (HAES) Community
• Pigtail Pals - Redefine Girly: Let’s Change the Way We Think About our Girls
• Jean Kilbourne (and her extensive list of media literacy resources)
• Center on Media & Child Health

When it comes to body image and media literacy, what other successful campaigns and positive social changes have you noticed lately? 

Join the discussion and check us out on Facebook & Twitter.

When author and recovery advocate Johanna S. Kandel was speaking here at CED in February 2011, she talked about this struggle as it related to her own ballet career and her identity as a dancer.  Now recovered after 10 years of struggling with periods of anorexia, bulimia and binge eating disorder, Johanna remembers thinking that removing ballet from her life would also remove the ED.

Click here to view the embedded video.

In the clip, Johanna shares so bravely about a story which so many others can relate to – being in a very scary place for a long time, feeling like there isn’t much to cling to other than the ED.  The longer one identifies solely with their ED, the harder it can be to envision oneself without it.  Fortunately, while there is no magic wand, there are skilled treatment professionals, evidence-based therapies, ongoing support groups and various treatment options for those who are struggling with all types of eating disorders.  It is never too late to hope.  It is never too late to seek treatment and to begin the journey to recovery.

Do you find yourself hoping one change will erase the ED from your life?  Does it prevent or delay you from seeking meaningful help?  If you find yourself feeling like your eating disorder is your only identify, try this exercise:  Draw a picture of a sun with many different rays of light coming out.  On each ray, write down an important role that you play in life or important elements of who you are.  For example:

Daughter, College Student, Nanny/Babysitter, aspiring Writer, Employee, Colleague, Tutor, Sister…

OR…

Brother, Friend, Fiance, Son, Employee, Hospital Volunteer, Uncle, Artist, Band Member, Pet Owner…

Early on in recovery, the eating disorder may have an important place around your sun as well.  As Johanna mentioned in the clip, it can often feel like the ED becomes your only identity.  Reminding yourself that you are so much more than your ED can help to make it a little bit easier to loosen your grip on the ED.   Gradually, through treatment, the ED becomes a less important part of who you are, and you can spend more time focusing on the true rays of light in your life.

*          *         *

This was the second of several recovery blogs inspired by the February 2011 presentation by Johanna Kandel at The Center for Eating Disorders at Sheppard Pratt. Follow CED on  Facebook to stay tuned as we continue to post additional recovery-focused blogs and video clips .  Johanna shares more about her own recovery journey in her highly influential book, Life Beyond Your Eating Disorder,  and continues to support others through her role as the Executive Director of The Alliance for Eating Disorders Awareness, a non-profit organization based in Florida. You can learn more about Johanna and her incredible book in these previous blogs as well:

• “There is Hope” for Eating Disorder Recovery (video clip)
• Life Beyond Your Eating Disorder: Q&A with Johanna S. Kandel ~ Part 1
• Life Beyond Your Eating Disorder: Q&A with Johanna S. Kandel ~ Part 2

Check out these two ads for almonds found in Men’s Health - a men’s fitness magazine.   Despite the magazine’s title and efforts at health-focused articles, most readers would agree, the general tone of the magazine is usually just as image-focused as any women’s fashion magazine.   Focus on health often seems secondary to the focus on rock-hard abs and a heavy dose of scantily-clad women.  However, we found the following almond ads were somewhat effective at marketing the product in a healthful and holistic way without focusing on the body. What do you think?

“A Handful of Good News…because they’re packed with great stories to tell. Like how just a handful a day gives you 6g protein, 3.5g fiber and can even help you maintain healthy cholesterol levels.”

“A handful of jet fuel. Grab a snack that’ll give you a boost anytime, anywhere. A handful of heart-smart, nutrient-rich California Almonds with 6 grams of protein power can be just the lift you need. It can even help you maintain healthy cholesterol.”

To be honest, we were fairly surprised to see an ad for anything in this men’s fitness magazine that didn’t include a photoshopped close-up of a chiseled body.  But we were  pleasantly surprised to see these ads focusing on health vs. weight and even highlighting the utility of the body vs. how it looks.  Eating for nourishment and strength to do the things that we enjoy – for example, playing with your kids – is a healthful concept that we fully support and one that is also important throughout the eating disorder recovery process.

We were fully prepared to give this company an A+  for their marketing messages until we found the ads’ female counterparts in Real Simple, a women’s magazine that generally delivers a better-than-average display of body/size diversity and emphasizes physical and mental well-being.  Notice the difference in the  marketing  of the same exact product when it is targeted towards women?

“A handful of chocolate-covered permission. Looking to maximize goodness and minimize guilt? Satisfy more than just your sweet tooth with the antioxidant-rich duo of dark chocolate and California Almonds.”

“A handful of no regrets…Want a simple snack without the guilty aftertaste? Make sure your heart-smart, nutrient-rich California almonds are always within reach. Just a handful a day can help you maintain healthy cholesterol levels.”

Internal feelings of “guilt” and “regret” are introduced to the female consumer where previously existed “good news” and “fuel”.  A very different message gets portrayed – one that implies women should rely on external permission to have a snack instead of their own body’s internal hunger cues and legitimate need for nourishment and strength.  These ads also suggest that women should feel guilty or experience regret if they eat certain foods.  These are not uncommon experiences for individuals who struggle with disordered eating*, and it is often this very cycle of eating and the subsequent guilt/regret that perpetuates chronic dieting and many of the symptoms involved with anorexia, bulimia and binge eating disorders.  While extreme dieting and eating disorders are a growing problem for both females and males, this marketing campaign clearly capitalizes on the female experience.

Ads such as these do not cause negative body image or disordered eating by themselves.  However, they help to perpetuate unhealthy beliefs within a culture that is already saturated with mixed message about food, weight and an obsession with unrealistic beauty ideals.  Most interesting in this example may be the clear distinction between the two genders.   It’s essential to educate youth and adults about media literacy so we can collectively begin to protect ourselves and our families from the repercussions.  It’s also important to remember that sometimes the very subtle messages about how we “should” relate to food are even more invasive than those with obvious intentions to mislead us.

Be a critical viewer of the media.  Question the images and the advertisements you come across.  Compare ads that are targeted to different genders, ethnicities and ages.   Ask yourself what messages they are sending and what effect they might have.

Do you consider yourself to be media literate?  How do you resist subtle messages like the ones discussed above? Leave a comment below or join the conversation on our Facebook Page and follow us on Twitter.

*Disordered Eating: A significant deviation from normalized eating patterns that may include dieting, fasting, bingeing, or skipping meals. Disordered eating disregards internal regulation of hunger and fullness and provides the body with much more or much less than the body needs to function properly.  Instead of feeling good after a meal, someone who has disordered eating will often experience feelings of guilt, shame, discomfort, fear or discontent.

The end of a calendar year brings with it endless conversations of new year’s resolutions.  Setting these notoriously lofty goals is often an attempt to pull oneself out of the seasonal funk that can settle in with shorter days, colder weather and a barrage of holiday stressors.  When people make resolutions, it is often done with the intent to completely overhaul their life.  They look to make a sweeping change that will fix all that is wrong, and get them back on the “right track”.  Unfortunately, this particular type of goal setting usually backfires – as evidenced by the fact that most people end up making the same exact resolutions year after year.

New year’s resolutions also send a message that today doesn’t count – it gives us permission to stay unhappy or unhealthy ”just a little bit longer” until January 1st rolls around. This could mean different things for different people depending on whether you are working towards recovery from an eating disorder, still struggle with chronic yo-yo dieting or are trying to quit smoking.  So, how do you pull yourself out of the winter blues without jumping on the resolution bandwagon?  Here are a few ideas to get you started…

1.  Don’t wait.  Start making small adjustments today that have nothing to do with food, eating, or your weight. Creating small but positive disruptions in your daily routine can help you stay grounded and may even help to break a cycle of negative thoughts or eating disorder symptoms that are associated with certain places or a time of day.

• Try taking a different route to work or school.  This small change could open up new possibilities, even if its just observing the new scenery or discovering a park along the way that you never knew existed!  Who knows, you may even find out that your new detour involves less traffic or fewer lights.
• Do some interior designing.  Consider rearranging some furniture or updating a picture wall inside your house or apartment.  Visible changes such as these can offer a sense of renewal without the obligation or pressure.
• These are just a few examples…you can come up with your own ideas for “minor adjustments” and share them on our Facebook page.

2. Setting goals is a great thing but not if the goal is unrealistic, unhealthy, too vague, or involves intense pressure to succeed.  All of these characteristics can make it very difficult to follow through with a resolution.  Instead, focus on taking small, concrete steps forward in the direction of balanced living.

• If you tend to make resolutions that are unrealistic and unhealthy…“I have to get myself to the gym.  I’m going to purchase a membership and force myself to go everyday, no matter what.”
  • Try this instead: “I will commit to going to one or two community yoga classes by the end of the month and work on developing a positive and supportive relationship with my body.”
• If you tend to make resolutions that are vague and counterproductive… “I need to lose weight by the summer so I’m really going to stick to my diet this year!”
  • Try this instead: “I give myself permission to stop dieting and to trust my body. If I need the help of a professional nutritionist to do this, I will seek one out.”
• If you tend to make resolutions that leave no room for error and put a lot of pressure on you to succeed…“As of January 1st, I am never going to act on my eating disorder symptoms again.”
  • Try this instead: “Before the week is over, I will call and schedule an appointment to begin seeing a therapist.” This is an example of a small but very meaningful task that can result in long-term change.  If you already see a therapist, consider this instead: “In the next week, I will use at least one new support or coping skill that I’ve never tried before.” Examples include: attending a support group, journaling, or enrolling in art therapy.

3. Now that you’ve resolved NOT to make a resolution, how are you going to cope with everybody else who feels inclined to talk about resolutions, weight loss and diets all of the time?

• Be the bearer of accurate news.  When your friends start discussing the new diet they will begin on January 1st, inform them about why diets don’t work and be sure to let them know that 98% of the people who go on diets gain all of the weight back and that half of them gain back more than they lost.
• Try out the “shock and awe” technique. As others start to bemoan their hips and curse their thighs while resolving to change their bodies in the new year, employ the element of surprise – say something  NICE about yourself and your body. Body bashing has become such an accepted form of conversation (especially around the holidays) that when someone (You!) is able to reflect positively on their own body, people are seriously caught off guard and may think twice about their own statements.  Try one of the comments below or come up with a few of your own!
  • “I am so grateful for all of the things my body allows me to accomplish.”
  • “I’m much more concerned about feeling strong and healthy than I am about fitting into a particular size.”
  • Even if you are not at a point in your life, or in recovery, where you actually believe these statements, say them anyway.  Saying them out loud helps move you in the right direction toward real change.  You will not only have helped yourself, but you will steer the conversation away from a negative place and become a role model for positive body image.  This is particularly important if children and adolescents are within earshot of the conversation.

Here’s to a hopeful 2011 full of balance and mindfulness!

If you have any questions about eating disorders, please call our admissions coordinators at (410) 938-5252 to speak confidentially about your concerns and treatment options.  Additionally, you can visit our website at www.eatingdisorder.org for more information, including an interactive on-line quiz that can help determine whether you, or someone you care about, might have an eating disorder that requires professional treatment.

We are incredibly excited to welcome Johanna as our 2011 NEDAW Keynote Speaker!  In addition to the kick-off event, this particular week in February will be filled with recovery and support opportunities, family workshops and positive body image promotion, including Maryland’s 5th annual ‘Love Your Tree’ Art Exhibit.

Don’t forget to follow CED on Facebook for daily updates and reminders about the Feb. 20th kick-off event with Johanna Kandel where she will be speaking about the recovery process, answering questions from the audience and signing books.If you’d like to attend “Life Beyond Your Eating Disorder” you can reserve a seat by emailing RSVP@sheppardpratt.org or by calling (410) 938-3157.

More About Johanna…

Johanna Kandel, who recovered after a ten-year-long battle with various eating disorders, is the founder and executive director of the Alliance for Eating Disorders Awareness, based in West Palm Beach, Florida. Since its inception in 2000, the Alliance has brought information and awareness about eating disorders to more than 120,000 middle school, high school and college students nationally. In addition, Johanna runs free weekly support groups, mentors women with eating disorders through their treatment and recovery, helps thousands of people to gain information and find the help they need, and advocates for legislation on local, state and national levels.

She is a member of the Eating Disorders Coalition Junior Board, Florida co-team leader for the National Eating Disorders Association’s STAR program, and board member/Expert Advisory Committee member for Girl Future, a website dedicated to educating and empowering girls ages nine to fifteen. She is an active participant in National Eating Disorders Awareness Week, has received many awards for her ongoing support and advocacy work—including the Jefferson Award for Public Service, the Giraffe Award and Harlequin Enterprises’ More Than Words Award—and she has appeared on national television programs including NBC Nightly News and Today.

More About her Book…

Now fully recovered after many years of struggling, Johanna Kandel knows firsthand how difficult the healing process can be.  Life Beyond Your Eating Disorder is a collection of information, hands-on tools, and a compassionate, encouraging chronicle in which Johanna and others share their individual stories of recovery.

The book provides a candid and comprehensive look at the ups and downs of recovery while cultivating hope, insight and practical tools  for addressing the everyday challenges involved with overcoming an eating disorder.  Among the recovery topics Johanna covers in the book are:

• Helpful hints to avoid self-sabotage
• Sidestepping triggers
• Quieting the eating-disordered voice and strengthening the healthy, positive voice
• Practical tools to help you get through the moment – or the meal
• Letting go of all-or-nothing thinking
• Overcoming fear and embracing change
• Staying motivated and moving forward
• How to find your core identity beyond your eating disorder

What People are Saying About the Book…

Finally, a refreshing new voice speaks out about full recovery from eating disorders! I am proud to be on the same team as Johanna Kandel. If your life has been touched by an eating disorder in anyway, you must read Life Beyond Your Eating Disorder.  ~ Jenni Schaefer, Author, Life Without Ed and Goodbye Ed,Hello Me

Whether you are struggling, in recovery, recovered, or helping a family member or friend through this difficult time, this is an amazing resource for you.  Johanna’s story gives each of us hope that not only can we recover from these illnesses, but each of us can help someone who may be struggling to find their way back to health and happiness. ~ Allison Kreiger Walsh, President and Founder, HOPE, Inc.

This book is an excellent navigational tool for the journey toward recovery from eating disorders.  With fierce enthusiasm, numerous insights and boundless encouragement, Johanna carries the recovery torch high, illuminating pathways so others can find life beyond their eating disorder. ~ Anita Johnston, PhD, Author, Eating in the Light of the Moon

If you have questions about NEDAWeek or the upcoming events, please call CED’s Community Outreach Coordinator at (410) 427-3886.

The Center for Eating Disorders’ Past NEDAWeek Events from the Blog Archives:

• Awareness Meets Action – National Eating Disorders Awareness Week 2010
• What’s All The Buzz About Eating Disorder Prevention? Rosalind Wiseman Speaks About Raising Confident & Competent Children (2010)
  
• The Center for Eating Disorders celebrates the 23rd annual National Eating Disorders Awareness Week! (2009)
  
• CED Welcomes Darryl Roberts, Director of the Widely-Acclaimed Documentary, America The Beautiful (2009)
  
• Recovery (2008) – by Jess Weiner, author, advice columnist, and self-esteem expert who knows first hand about recovery from eating disorders. This year, she celebrated 17 years of recovery and loving her imperfect life.

Q &A with Evelyn Tribole, MS, RD (Part I)

What is Intuitive Eating, and what are some of the general benefits for individuals?  For families?

Intuitive Eating is an approach that teaches you how to create a healthy relationship with your food, mind, and body–where you ultimately become the expert of your own body.   You learn how to distinguish between physical and emotional feelings, and gain a sense of body wisdom.  It’s a process of making peace with food–so you no longer have constant “food worry” thoughts.  This means that meals are not a moral dilemma resulting in feelings of guilt and shame, but rather a place to practice tuning into one’s inner needs and fulfilling those needs in a healthy, nurturing way. While there are many ways of incorporating the process of Intuitive Eating, there are three core characteristics:

• Unconditional permission to eat.
• Reliance on internal hunger and satiety cues.
• Eating for physical, rather than emotional reasons.

There are many benefits for individuals and families who eat intuitively. Unfortunately, one of the myths or misconceptions about intuitive eating is that it is unhealthy because people often fear that if you allow yourself to eat whatever you want, you’ll just a eat lot of “junk food” and you won’t be able to stop.  The truth is, there are studies that show Intuitive Eaters are actually healthier, both physically and mentally.  Here are two that illustrate these conclusions:

In 2006, Dr. Stephen Hawk, from Brigham Young University evaluated 343 college students and found that Intuitive Eating does not lead to poor nutritional food choices.  To the contrary, he found that Intuitive Eaters consume a greater diversity of foods, take greater pleasure in eating and have healthy body weights.

A larger study on nearly 1300 college women by Tracy Tylka*, from Ohio State University, found that Intuitive Eaters are more optimistic, have better self-esteem, and a lower body mass index (BMI), but without internalizing culture’s unrealistic thin ideal.  (That part is important, because if you desire or value an unrealistically thin body, it increases your risk for eating disorders).

How does Intuitive Eating compare to our current societal norms and cultural messages around food/eating?

The pleasure of eating has become a lost art in the USA. Instead, eating is commonly viewed as something that will kill you, cure you, or make you fat. This is where we can take a lesson in the pleasure principle from France. An international study found that Americans worry the most about their health and enjoy eating the least. In contrast, the French are the most food-pleasure-oriented and least food-health-oriented. [1] Notably, France has nearly half the obesity rate compared to the USA, for both adults and children [2].

When food restrictions are placed on a chronic dieter, or on a person who chronically feels guilty about eating, it increases the “forbidden food” burden. Consequently, rigid food rules interfere with the individual’s ability to “hear” or be attuned to the eating experience of his or her body.

Can you briefly explain the “diet mentality” you refer to in your book?  From a nutrition perspective, how do diets affect weight and health?

Many times, “healthy eating” or “better nutrition” is code for dieting. Consequently, if you focus solely on these factors, without considering your internal body cues or what would best satisfy hunger, you can easily feel deprived. This in turn may increase cravings and thoughts of food, overeating, dieting, and heighten anxiety around snacks and meals.

There are compelling studies, which indicate that dieting actually predicts weight gain (and often binge eating). While most people know that diets don’t work, not many are aware of the weight-gain hazard. For example, a team of UCLA scientists reviewed 31 long term studies on dieting and concluded that [1]:

• Dieting is a consistent predictor of weight gain.
• Up to two-thirds of the people regained more weight than they lost.
• Diets do not lead to sustained weight loss or health benefits for the majority of people.

A prospective study on nearly 17,000 kids ages 9-14 years old, found that dieting predicted binge eating behavior and concluded that, “…in the long term, dieting to control weight is not only ineffective, it may actually promote weight gain” [2]. Recently, a five-year study on teens, found that dieters had twice the risk of becoming overweight, compared to non-dieting teens [3]. (Notably, at baseline, the dieters did not weigh more than their non-dieting peers.)

I consider dieting a form of “nutritional trauma”. It might sound a bit dramatic, but once your body experiences the biological and psychological deprivation from dieting, your body gets smarter. Consequently, it gets harder to stick with each new diet, because your cells know what to do. When dieting, hunger becomes a feared sensation, rather than a natural process that gears up and down, depending on when, and how much you ate. And if you eat just until the hunger goes away, you will likely be hungry sooner, which sets up a cycle of constantly thinking about food and what to eat. This is a big part of the “diet mentality”. Conversely, if you learn to eat intuitively and feed your body on a regular, consistent basis, by honoring your hunger, it will help build “body-trust”.

…part 2 is now available here:  “Body Image, Eating Disorders & Intuitive Eating”…A Special Pre-Event Q&A with Evelyn Tribole, MS, RD

In Part II of this Q & A, Evelyn answers questions about body image and eating disorders as they relate to Intuitive Eating.  Follow CED on Facebook for additional updates about our blog and upcoming events.  You can also visit our Events Page for more details on how to register for the Intuitive Eating event on November 21, 2010.

In addition to co-authoring the groundbreaking bestseller, Intuitive Eating, Evelyn is also an award-winning registered dietitian in private practice in California and a nationally recognized nutrition consultant;  She has appeared on hundreds of interviews, including: CNN, Today Show, MSNBC, Fox News, USA Today and the Wall St. Journal.  For more info about Evelyn Tribole, click on her picture above or visit her website at www.evelyntribole.com.

The historic Gatehouse at the entrance to the Sheppard Pratt Campus

***

Since 1989, the Center for Eating Disorders at Sheppard Pratt has been committed to the pursuit of emotional and physical wellness for children, adolescents and adults with eating disorders. Services are provided by an interdisciplinary team of professionals across a full continuum of care which includes a 26-bed Inpatient Program, 12-hour/day Partial Hospital Program, an evening Intensive Outpatient Program, outpatient therapies and support groups.

The Center combines a behavioral program to assist in the management of eating disorder impulses with an evidence-based, multi-modal therapy program. Individual and group therapies include cognitive-behavioral therapy, dialectic behavior therapy, interpersonal therapy, body image therapy, art therapy, movement therapy, occupational therapy, and nutritional counseling. Family therapy at The Center is guided by a Family-Based Treatment approach (Maudsley model) and family systems theory.

The Center is located on a beautifully landscaped suburban campus in Baltimore and participates with most insurance plans. Recovery occurs with the achievement of medical, nutritional and psychological stabilization. The Center supports the development of healthy coping mechanisms as a replacement for eating disorder behaviors. Specialized treatment tracks are available for individuals struggling with trauma disorders or substance abuse in addition to their eating disorder.  Prevention, education and outreach services are also available.

***

In case you want more than 200 words….you can take a virtual tour of the program and listen to video interviews from our staff here.   Additional information & details about admission are available by calling (410)938-5252, or emailing EatingDisorderInfo@sheppardpratt.org.

You can also visit our website at www.EatingDisorder.org and follow CED on Facebook for program updates and motivational, recovery-focused status updates.

With two of the most influential annual body image campaigns about a week behind us, the seeds for change have been planted once again.  As proposed in our previous post,  Fat Talk Free Week is Over – Now What?, it becomes important for each of us to think about how we can maintain the national momentum of positive body image on a long-term basis in our own lives.  Yesterday, we shared a few startling statistics that show just how pervasive negative body image is in our country;  whether you’re three years-old or thirty-years old, it is something that can have profound effects on self-esteem and overall quality of life.  So in an effort to help fuel the positive energy triggered by Fat Talk Free Week and Love Your Body Day, we wanted to share several easy ideas for body image building all year long.

1. Plan ahead. It’s always okay to schedule a positive body image session for a later date.  Page through your daily planner (or scroll into the future on your iPhone calendar) and jump ahead a few weeks or months.  Insert positive body image statements on random days or write down empowering statements on birthdays and special events that will help you remember and commit to appreciating your body and being “fat talk free”.
2. Don’t forget to share. Have you seen this Tri Delta Fat Talk Free Video from the 2008 campaign?  This is powerful stuff!  Post it on your Facebook page or share it with co-workers any day of the year.  Spread the word so that you can begin building a support system of body positive people around you who also choose not to engage in “fat talk”.
3. Speaking of Facebook…check out the Center for Eating Disorders FB page and become a fan to receive positive body image status updates, motivational quotes, and links to helpful resources and events.
4. Reconsider monthly magazine subscriptions.  Research has shown that even just 3 minutes of looking at fashion/women’s magazines can have a significantly negative impact on our self-esteem and body image.  Similar effects can be attributed to men’s health/fitness magazines which have been shown to encourage body dissatisfaction and unhealthy weight control behaviors among males.  Consider switching subscriptions or signing up for a positive affirmation email so you get a reliable dose of confidence in your inbox instead of a monthly blow to your self esteem.
5. Celebrate the seasons. As the season changes and autumn is here, feel the brisk air as you breathe, notice the colors of the leaves you can see, taking in all that nature can offer and remember that it is your body that allows you to have these experiences.   Start to focus on your body’s functionality more often.  In each season there are opportunities to reflect on what the body can do and its ability to maintain balance even as things change around us.
6. Break it down. For individuals with eating disorders or severe body image distortion even just one day of “loving” your body may seem like an insurmountable or overwhelming task.  Setting goals is good but when we set goals too high too quickly we set ourselves up for failure.  If  loving your body doesn’t sound do-able at this time in your life, remember that body image is not an “all or nothing” concept.   Any changes, even small ones, that can be made to help you realize how special, unique and beautiful your body truly is can be seen as an important step forward in recovery that often leads to further acceptance of self and health.  Start with something small like giving yourself permission to accept a compliment instead of immediately trying to disprove it.  Or, you can work with a therapist to come up with a specific body image goal that’s right for you.

• Body Image in a Bathroom
• Adding Up, Weighing In and Counting Down: 5 Ways to Cope with the Numbers Game of Pregnancy
• Confidence is Making a Comeback
• Appreciate Your Ankles
• Pre-Baby Body Love: Nurturing Your Body Image Foundation
  

Written by Kate Clemmer, CED Outreach Coordinator and  Amy Scott, CED Admissions Coordinator

Above photos courtesy of  blogs.targetx.com and www.youtube.com

The Center for Eating Disorders at Sheppard Pratt is excited to welcome Dr. James Lock to Baltimore on September 25, 2010 as one of six featured speakers at our annual professional symposium, Eating Disorders: State of the Art Treatment.

James Lock, MD, Ph.D. is a Professor of Child Psychiatry and Pediatrics in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine where he also serves as Director of the Eating Disorder Program for Children and Adolescents. Dr. Lock is the co-author of the only evidenced-based treatment manual for anorexia nervosa, and one of his newest publications is a treatment manual for adolescent bulimia entitled: Treating Bulimia in Adolescents: A Family-Based Approach. Dr. Lock has lectured extensively across the U.S., Canada, Europe, South America, Asia and Australia. More recently, Dr. Lock has been involved in research regarding a form of treatment called Cognitive Remediation Therapy (CRT) for individuals with eating disorders. Prior to his presentation in Baltimore on September 25th, we were eager to hear what Dr. Lock had to say about CRT and what attendees could expect to learn from his upcoming talk, “Cognitive Process and Remediation in Anorexia Nervosa”. Read Dr. Lock’s responses below and register for the upcoming professional symposium in Baltimore to hear more.

Q & A with James Lock, MD:

What is CRT and how did it originate?

JL: Cognitive Remediation Therapy (CRT) is a therapy designed to improve brain processing inefficiencies such as difficulty focusing, staying on task, and processing speed. CRT was originally devised for remediating thinking processes in people with brain injuries. It has subsequently been used in schizophrenia and obsessive-compulsive disorders. Most recently it was refined for use with adults with anorexia nervosa to specifically address difficulties in flexibility in thinking and over focus on details to the neglect of the big picture.

What sets CRT apart from other therapeutic approaches such as cognitive behavior therapy (CBT) or dialectic behavior therapy (DBT)?

JL: CRT does not focus on eating disorder symptoms, but rather on thinking style. CBT focuses on thoughts, behaviors, and beliefs that putatively maintain the eating disorder. DBT focuses on thoughts and emotional processes using skill-based learning and groups focused on eating disorder symptoms or general emotional and cognitive functioning. In other words, CRT does not aim to address the specific problems related to the eating or psychiatric disorders per se, but rather focuses on a problematic thinking style that may contribute to the development and maintenance of symptoms.

What general benefits could CRT offer individuals with eating disorders? Are there specific individuals who are particularly well-suited for CRT?

JL: The main benefit of CRT for individuals with eating disorders is that they could learn how their particular thinking style effects their thinking processes. In addition, they can learn ways to change some aspects of this thinking style using cognitive exercises. This in turn could help them understand how this relates to decisions they make about eating, exercise, and related behaviors. It is unknown if there are specific individuals who would make particularly good candidates for CRT. It should be stressed that CRT is a very new treatment in the context of eating disorders and its benefits remain largely unknown.

The title of your Sept. 25^thpresentation is “Cognitive Process and Remediation in Anorexia Nervosa” what do you hope attendees will take away from this talk?

JL: I hope attendees learn what CRT is (and isn’t) and to understand how it may be useful in the context of other eating disorder specific treatments to enhance therapeutic alliance and increase motivation.

Where can professionals go to read more about the use of CRT in the treatment of individuals with eating disorders?

JL: There are a number of articles that have been published on CRT by Kate Tchanturia, Ph.D and colleagues from the Maudsley Hospital in London. Reading these would be a good place to start.

We are greatly appreciative to Dr. Lock for his responses and look forward to hearing more about this intriguing new treatment approach on September 25th. To register for the symposium (7 cme/ceu credits) please download the program brochure (pdf) or visit our Events page. Don’t delay, space is limited and discounts expire soon! For more information about Dr. Lock’s publications, please click on the images of the books below:

Kathryn Zerbe, M.D. is a Professor of Psychiatry and Obstetrics & Gynecology at Oregon Health & Science University.  She also serves as the Director of the Oregon Psychoanalytic Institute and has authored over 60 clinical papers and four books including, Integrated Treatment for Eating Disorders: Beyond the Body Betrayed.  Dr. Zerbe is a Distinguished Fellow of the American Psychiatric Association and a Fellow of the Academy of Eating Disorders. She has been repeatedly selected as one of “America’s Top Doctors” and is a highly sought after speaker both in the united states and internationally.

Find out more about Dr. Zerbe’s work and her upcoming presentation in Baltimore by reading her insightful and thought provoking responses to our questions below.  And don’t miss your chance to attend all six expert presentations on September 25th, 2010. (This event has been approved for 7 CME/CEUs). REGISTER soon!  Space is limited. 

Q & A with Kathryn Zerbe, M.D.

The title of your upcoming talk in Baltimore is “Resiliency, Vulnerability and Growth: Utilizing Transference and Countertransference Reactions to deepen the Treatment of Eating Disorders”.  What specific role does vulnerability play in this process?

KZ: Bewilderment, boundaries, and burnout — these are just a few of the concerns that clinicians are liable to struggle with when treating patients with an eating disorder.  Recognizing that in our quest to be helpful to our patients, we also face a potential undertow because the work to preserve life is taxing in the short run and often takes a commitment of time, energy, and sacrifice in the long run.  Clinicians ‘in the trenches’ know these facts, but what do we do to help ourselves to deal with the hurt feelings that arise when tenacious negative transferences arise, or when we are in a seemingly unwinnable battle with 3^rd parties, or experience powerlessness when the patient refutes our counsel?  Awareness to these vulnerabilities, and others, are the first line of defense in staying attuned, steadfast, and nimble in robust clinical practice.

What would you say is the biggest barrier clinicians may face in trying to implement improved strategies for utilizing transference and countertransference in the clinical setting?

KZ: “To know thyself’ and “To be true to thyself’ have been laudable goals since the time of Socrates and Shakespeare, respectively, but such ideals are easier to write about in the abstract than to achieve in real time.  With the daily challenge of managing a lively practice and tending to one’s busy personal life, it is easy to put one’s own needs on the back burner.  Taking a small amount of time weekly to think about the impact of clients is enormously helpful.  In this way, one works on the feelings and clinical formulation one has about each specific person in practice but is simultaneously humbled by what each person teaches us by sharing their unique history and viewpoints.

What are the potential consequences of ignoring or ineffectively addressing transference and countertransference issues in the therapeutic process?

KZ: Like most clinicians, I feel extraordinarily blessed to be working in this field where one has the opportunity to witness individuals grow and change over time.  However, burnout is a formidable foe to contend with because change is often difficult, slow, and painful for the patient.  Sensitive clinicians pick up on, or in technical parlance, “contain,” these feelings.  To avoid burnout and to keep the work fresh, invigorating, and growth promoting, the therapist  who ‘knows himself or herself’ best is in a better position to assist the patient, and this is a ‘work in progress’  that is never done until one retires from practice altogether.

In your upcoming presentation, you will discuss strategies for managing “cultural countertransference”. Can you briefly define this term in the context of treating individuals with eating disorders?

KZ: Therapists as well as patients are prone to having conscious and unconscious reactions to media stereotypes, idealized body images, and culture norms as a whole.  We clinicians are in a better position to help our patients by becoming more aware of these potential ‘blind spots’ to  the  prevailing cultural  in ourselves and thinking them through.  Recovery can be enhanced by a timely discussion and critique of noxious cultural norms in therapy.  Both patient and clinician can make use of reading, media, movies, self-scrutiny, and ongoing dialogues with peers or consultants to become more cognizant of our largely unconscious idealization and overvaluation of beauty.   However, as Dr. Catherine Steiner Adair of Harvard University pointed out when she defined the term ‘cultural countertransference,’ in the early 1990s, we must also be wary that too much focus on the culture can be a defense to deepening the patient’s treatment.

Overall, what do you hope symposium attendees will take away from your presentation at The Center for Eating Disorders on September 25^th?

KZ: If participants emerge from my talk (which will use art history slides to demonstrate concepts and to provide encouragement for each therapist to bring his/her unique creativity and tenacity to the therapy hour) with permission to ‘take care of yourself’ as you take care of the patient, I will be very happy, indeed.  Perhaps there will be an idea or two that will be new to the ear, but more likely the listener will simply take more seriously the need for ‘time outs’ and the pragmatic and psychodynamic reasons that undergird that need and recommendation.  One of my heroines, Eleanor Roosevelt, said “Do something that is scary everyday!”  I keep that saying on my desk as a reminder that our daily work as clinicians presents us with mysteries and a summons for personal growth that we can’t predict when we get to the office in the morning.  The more tools that we have in our therapeutic hip pocket, the better!  So, I’m looking forward to gaining wisdom from the other speakers who come first and hearing the comments and questions from the audience to, very selfishly, enhance my individual practice!

Our enduring thanks to Dr. Zerbe for taking time out of a busy schedule to provide such thorough answers. Be sure to join us on September 25th for what is sure to be an engaging and enlightening presentation.  Download the Eating Disorders: State of the Art Treatment PROGRAM BROCHURE (pdf) for registration details and deadlines.

If you’d like to order or find out more about Dr. Zerbe’s publications, please click on the links below.  These titles will also be available for purchase at the upcoming symposium.

• Integrated Treatment for Eating Disorders: Beyond the Body Betrayed (2008)
• The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment (1993)