Nothing is more stressful for a student who is in recovery from their eating disorder than trying to negotiate eating on campus. College living is full of obstacles to eating consistently and mindfully: buffets in the dining halls; eating between classes and on the go; staying up until 4 AM; social events involving food; and limited access to the grocery store or a working kitchen. While many students in treatment are given guidelines as to how to eat in a healthy manner, it is often difficult to implement those strategies in a campus setting but it is possible.  A great resource for this task is the book, Mindful Eating 101: A Guide to Healthy Eating in College and Beyond by Dr. Susan Albers which we will reference throughout this post.

Mindfulness is an old concept that has, more recently become somewhat of a cultural catch phrase. Standing at a coffee shop bulletin board, you may notice advertisements for mindful meditation classes or yoga classes that promise skill development in the art of mindfulness or even magazine covers that stress the importance of mindful living. So, what is mindfulness?  Mindfulness refers to the ability to bring one’s awareness completely to the present moment. In contrast, mindlessness, refers to behaving or doing things without much attention.

Consider that you are eating dinner in your dorm in front of the TV during your favorite night of television. As you laugh along with the show and get intrigued by products during the commercials, you occasionally pick up your phone and make plans for the evening and attempt to skim a chapter in your text book for tomorrow’s quiz.  All the while, you also continue to go through the motions of eating your dinner…mindlessly. In this situation, your attention is likely focused on the characters and themes in the TV show and not on your food or your body’s response to the food.  When this happens, it is common for people to eat more than they normally would because they aren’t really enjoying their food, and they aren’t in touch with the mechanisms in the body that tell us when we want to stop eating. In contrast, when you choose a meal from the dining hall and sit at a table to enjoy it with a friend but without other distractions, you may find that you eat more slowly, you savor the tastes of the food, and you have an increased awareness of your hunger/satiety cues, which allow you to stop when you feel full. This style of eating would be considered mindful eating.

Individuals who’ve struggled with an eating disorder or have chronically dieted often lose touch with their body’s natural ability to regulate food and eating processes.  Sometimes they may need help establishing normal eating patterns again and re-connecting to their bodies.  In eating disorder treatment, mindfulness is a concept that is used frequently in helping people to develop awareness of their thoughts, emotions, patterns, triggers, and hunger/fullness cues.

Eating mindfully is an important skill because it allows you to eat exactly what your body wants in just the right amounts. Restricting your food intake or dieting is not mindful because it denies your body of the food that it needs for fuel and nourishment.  Bingeing is also not mindful eating because it exceeds the amount of food that your body wants or needs and may cause you to feel uncomfortably full or even pained.  Mindfulness involves trusting your body to maintain a balance.  Learning to eat mindfully can take time, so be gentle with yourself as you practice the steps that will allow you to eat intuitively in response to your own body’s needs.

Dr. Albers outlines the seven habits of mindful eaters in her book.  These habits are the key components of learning to eat mindfully.

1. Awareness: Use your senses to gather information about the world. By using sight, sound, hearing, touch and taste, you can become attuned to what is going on around you at any moment. Turning this inward, you can better recognize your hunger, fullness and thirst cues to help guide your eating choices.
2. Observation: Simply notice your thoughts and feelings as an impartial observer. The key is to do this without judgment. For example, if you have the thought “I am fat,” simply notice that it is there, label it as a negative thought, and move on.
3. Shifting out of autopilot: Some of our routines become so mundane that it is difficult to pay close attention to the details. These routines sometimes enable mindless eating or skipping meals completely, and so you may want to change the routine or bring awareness to it in order to be more mindful. Try waking up a few minutes earlier to fit in breakfast or consider meeting a classmate someplace for lunch that you’ve never been before.
4. Finding the gray area: Black and White thinking refers to thinking in extremes. Food is good or bad. Someone is fat or skinny. Clearly, life is not that simple. To be mindful, one must be flexible and avoid operating in extremes. An example of this is someone who is on a diet that forbids bread; even if a person wants bread they will deprive themselves of it because of the diet. Sometimes, this deprivation can lead to the person bingeing on bread. In contrast, a mindful eater would recognize the particular craving and allow herself to have an appropriate serving of bread at the time when she wants it.
5. Be in the moment:  As a college student, you may find yourself frequently eating in class, while cramming for a test, or even while walking or driving across campus. Multi-tasking like this is not considered mindful because you cannot use your senses to enjoy the food or to stay aware of your hunger and fullness cues. Ideally, a mindful eater would sit with their meal on a plate at a table and devote their full attention to eating. However, this is not always a realistic goal for a college student.  Try making small changes that help you stay present during meals, such as always sitting down to eat and turning off your phone to remind yourself to stop texting and posting on Facebook until you finish your lunch.
6. Non judgmental: Notice judgmental thoughts and proceed with compassion instead of criticism. Often at the campus dining halls, various stations offer different types and categories of food. If you notice yourself judging a particular food station ( “I can’t order from that section, everything is full of fat.”) notice the criticism attached to the food and label it (“there I go thinking of foods in good and bad categories again.”) Practice compassion and focus on truthful statements (“this food may have fat in it, but I need some fat to help me protect my organs”).  Try to incorporate different foods from each of the various food stations at the dining hall throughout the course of the week.
7. Acceptance: Accept things for how they are as opposed to how you think they should be. Dr. Albers gives a great example in her book of accepting your shoe size, even if you wish it were different, because there really is nothing that you can do about it. As much as you may wish to have smaller or larger feet, eventually you must let go and accept that your feet are the size that they are.

If you’ve struggled with disordered eating, it may be easier to practice mindfulness at first with something that is not related to food. Try this simple exercise to practice the aforementioned skills. Close your eyes and simply count how many sounds you can hear in the room. When you think you have counted the sounds in the room, push yourself to try to hear beyond the room. Can you hear sounds from outside? In the hallway? What about the sounds closest to you…can you hear your own breathing? The sounds that you hear are happening in the here and now; congratulations…you have been successful at being mindful of the present moment! Now you might want to try doing a similar exercise with your food, using your senses to guide your eating.

Stay tuned for “Part 2″ about Mindful Eating on Campus with some more helpful hints. You can also see all of the previous posts in this blog series at, Battling Body Image Concerns and Disordered Eating on Campus.

For more information about Dr. Albers and her Mindful Eating series, visit her website at www.mindfuleatingcafe.com.

Written by Jennifer Moran, PsyD, College Liaison at The Center for Eating Disorders at Sheppard Pratt

Michelle Obama had this to say about the usability of the new icon, “When mom or dad comes home from a long day of work, we’re already asked to be a chef, a referee, a cleaning crew. So it’s tough to be a nutritionist, too. But we do have time to take a look at our kids’ plates. As long as they’re half full of fruits and vegetables, and paired with lean proteins, whole grains and low-fat dairy, we’re golden. That’s how easy it is.”   Easy as it may seem, we still have some reservations about the new icon, particularly the dietary suggestions and some of the interactive tools that accompany it.

• Blanket Assumptions. MyPlate’s overall recommendation is: “Enjoy your food, but eat less”.  This statement operates under the basic assumption that all Americans overeat which is simply not true.  What if the consumer already eats appropriate portions, or perhaps doesn’t eat enough to fuel their body?  “Eat less” sounds a lot like a universal prescription for restriction and leaves little room for honoring internal cues for hunger/fullness.

• Is this just another diet? The reigning factor in MyPlate seems to be focused on control; control your diet and portions within the confines of the plate, and avoid too many of what MyPlate defines as “empty calories” (more on this term later).  Healthy, normalized eating involves trusting your own body’s hunger, fullness, and taste cues to help give you everything you need. The My Plate icon could be a helpful reminder of the importance of a balanced diet.  However, working overtime to make every meal fit precisely into MyPlate could be more harmful than helpful in establishing a peaceful relationship with food.  Furthermore, many of the associated online tools on the USDA website, including “analyze my diet”, food tracking and calorie counters seem to foster an unnecessary focus on precise counting/measuring of foods.

• Essentially Missing. Fats and oils are not visually represented anywhere on MyPlate despite the fact that fats and oils are necessary for energy, transportation and absorption of vitamins, satiety, taste and texture, heart health, and cholesterol.  They are an essential nutrient, and a major component of all brain and nerve cells. The MyPlate website does state that “oils are not a food group, but are essential.”  If the goal is healthy and balanced eating, such an essential part of the human diet needs to be represented on this easy-to-read graphic as it was with the last two government food models. Showing healthy ways to incorporate dietary fat and oils into meals could help educate consumers on appropriate amounts of dietary fats and oils as opposed to just instilling a fear of them by ignoring them altogether in the icon.

• Labeling Foods. Labeling foods as good/bad or healthy/unhealthy is a way of thinking that isn’t making Americans any healthier and can actually promote disordered eating.  Yet the USDA website where MyPlate lives continues to assign the  “empty calories” label to a long list of  foods.  A calorie is a measure of energy, equal to the amount of heat that is contained in food and released upon breakdown in the body.  All food provides energy to our body – glucose to fuel our cells, protein to build, repair, and maintain body tissues, and fat for healthy cell membranes and brain development. Remember that by incorporating different choices from all food groups, you will naturally be achieving an appropriate balance of calories – thus leaving room for the treats and extras that are physiologically and psychologically satisfying.  Removing labels on food, such as “empty calories”, and working to make all foods neutral lends itself to a healthier relationship with food, and helps with food habituation – when you’ve had a food item a multitude of times and can decide freely whether you’ll truly enjoy and taste the food when you have it.

• Logic. The plate pictures protein, grains, fruits and vegetables with a side of dairy as an ideal meal. How would an average consumer translate this message? Perhaps strawberries just don’t make sense with your Chinese food meal.   Does this picture create the notion that every food group must be consumed at every meal? (i.e. veggies with your cereal?)  That feels like a lot of pressure.  And what about lasagna or casseroles when almost all of the food groups may be combined into one dish – where does that fit into the MyPlate icon?  Looking at an overall weekly balance of nutrients and food choices would be more appropriate than feeling as if the eating must be perfect on every plate at every meal.

• Does it promote overeating? Does the plate send the message that someone should push past their satiety point just to incorporate that fruit or dairy serving? Not honoring the fullness cue could trigger feelings of shame and guilt (not to mention physical discomfort), which can lead to emotional eating or compensatory restricting.

So, the next time you sit down to a meal, take a look at your plate. Not in an effort to follow the MyPlate guidelines exactly, but more so to be mindful.  Are you choosing a variety of foods from each food group throughout the day or week? Do the food choices make sense and complement each other?  Are you able to stop when you feel full?  Choosing foods that nurture the body and the mind are all steps on your road to health, and a healthy relationship with food.

Do you have questions about MyPlate or other nutritional guidelines?  Ask our Registered Dietitians and we’ll post the questions and answers on our blog!  Submit questions by emailing kclemmer@sheppardpratt.org anytime before August 10^th.  Add “ask the dietitian” in the subject line.

Submitted by Courtney Perkins, RD with contributions by CED’s team of Registered Dietitians

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.

Join us on Thursday February 24th, 2011  to hear from a panel of parents who’ve been through the treatment process in various forms with their own children.  Listen to their stories and join the conversation during a special Q/A with the panel members and several treatment specialists from CED. You can read more about the event and meet our panel members below, then download the Event Flyer or visit our website to register for this free event.

*   *    *

For someone with an eating disorder, the positive role of the family in the recovery process cannot be underestimated.  Parents, spouses, siblings and close support people can make a world of difference for someone who is struggling with an eating disorder, especially as they work towards recovery.  But its not easy.  It takes a lot of patience and presents many challenges for parents and support people who have never before been forced to learn about the complexities of an eating disorder or navigate the world of treatment. Just as the individual with the disorder experiences intense fears, personal hardships, and emotional angst throughout the illness and recovery, so too do those who support them.  It can be torturous to have an eating disorder but in many ways, it can be just as difficult to care deeply for someone who does.

Parents in particular, despite the age of their son or daughter with an eating disorder, can be met with incredible fear, stress and frustration as they try to weed through a completely new landscape of physical and mental health complications, what to say and what not to say to someone in treatment, and how to respond to irritability, refusal to get treatment, or general isolation from the rest of the family.  And while each family has their own unique experience, two things are very common when approaching the recovery process with a loved one:  1) you will have a lot of questions, and 2) you may feel very alone.  That being said, it can be very beneficial to talk with other families who understand what you’re going through and can offer knowledgeable, experienced support.

This year, in honor of National Eating Disorders Awareness Week, The Center for Eating Disorders at Sheppard Pratt will be hosting a Panel Presentation and Q/A event featuring parents who’ve experienced the difficult job of supporting a loved one with an eating disorder.  This free event is designed to create a safe place for families and support people to gather, ask questions and seek feedback from those who’ve been in the trenches themselves.  The panel will also include specialists from the Center for Eating Disorders who will answer questions about the treatment process, types of therapy, health and medical concerns,  nutrition issues, and all things affecting recovery.

All of the parent panel members come to the table with different experiences, different strengths and different outcomes but they all have an important story to tell and a hopeful message to share.   If you have questions about supporting a loved one, or you would just like to listen and know that you are not alone, please join us for this special event in Baltimore on Thursday February 24th at 7:00 pm.

~  MEET The PANEL ~

PARENT & FAMILY Panel Members:

Jane Cawley – Jane and her family helped her daughter, then age fourteen, recover from anorexia nervosa with family-based treatment in 2004. Ever since, she’s worked tirelessly as an advocate for eating disorders, actively helping parents find and better understand information on eating disorders and the treatments available.  She co-chairs Maudsley Parents and serves on the steering committee of NEDA’s Parent, Family, and Friends Network.  She was also recently interviewed for a PsychCentral blog entitled, What Parents Need to Know About Eating Disorders: Q&A with Jane Cawley

Katherine Bloom – Katherine is the loving mother of Kira Bloom, who lost her struggle with bulimia nervosa on May 21, 2009 at age twenty-five.  Katherine now speaks out to honor her daughter’s memory, the importance of treatment and to share what she has learned in hopes of sparing another family a similar tragedy.

Jean R. – Jean and her family learned to navigate the world of eating disorders when their daughter was diagnosed with anorexia nervosa in 2000.  Through their daughter’s journey they became acquainted with an ANAD support group, and in the spring of 2007, she volunteered to be on the Eating Disorder Network of Maryland board.  Jean has also been involved with Supporting Each Other, a support group for family members and friends of those who have loved ones struggling with disordered eating.  As an educator, Jean sees the importance of education to spread awareness and understanding about this dangerous disease.

TREATMENT SPECIALIST Panel Members:

Steven Crawford, MD – Dr. Steven Crawford is a board certified psychiatrist and Associate Director of The Center for Eating Disorders.  Dr. Crawford has spent over 20 years devoted to the treatment of individuals and families impacted by eating disorders.  He remains committed to providing the best possible treatment for every patient at CED, ensuring a comprehensive continuum of care, state-of-the-art programs and a staff of highly qualified, specialty trained practitioners.  Dr. Crawford also serves on the faculty at the University of Maryland where he trains medical students on prevention, identification, early intervention and evidence-based treatment for eating disorders.

Dina Wientge, LCSW-C – Dina Wientge has been a part of the CED staff for more than 14 years. She received her Masters in social work from the University of Maryland and trained at Johns Hopkins University .  Dina provides family therapy for patients in CED’s inpatient program and oversees all aspects of the Center’s family therapy programming.   She is one of a select group of clinicians from across the country who have been specially trained and certified to provide Family Based Treatment (FBT) for eating disorders.

Debbi Jacobs, LCSW-C – Debbi Jacobs earned her MSW from the University of Maryland, Baltimore, School of Social Work in 1999.  Prior to joining the team at The Center for Eating Disorders, she provided individual, couples and family therapy at the Jewish Family Services in Baltimore with a particular interest in trauma and loss.  Debbi currently provides individual and family therapy at CED’s outpatient department with a concentration in providing support for families engaged in the Maudsley method of re-feeding.

Samantha Lewandowski, MS, RD, LDN – Samantha Lewandowski received her BS in Nutrition from the University of Delaware and her Masters in Health Promotion Management from The American University.  Samantha, a Registered Dietitian, joined the CED staff in 2006, and her main role is working on nutritional goals with patients and their families in the outpatient setting.  As Nutritional Care Coordinator, she also supervises the outpatient nutrition staff, coordinates nutrition programs and provides community workshops and professional trainings on the prevention and treatment of eating disorders.

All family members, support people and health/mental health professionals are welcome to attend.  Download the Event Flyer or visit our Events Page to pre-register and reserve a seat.

If you have questions about this panel or any of our other NEDAWeek events, please call The Center for Eating Disorders’ Outreach Coordinator at (410) 427-3886.

]]> http://eatingdisorder.org/blog/2011/01/support-for-parents-families-navigating-the-world-of-eating-disorder-treatment-recovery/feed/ 0 http://eatingdisorder.org/blog/2010/12/the-resolution-solution/ http://eatingdisorder.org/blog/2010/12/the-resolution-solution/#comments Wed, 29 Dec 2010 21:16:04 +0000 Kate Clemmer http://eatingdisorder.org/blog/?p=1503

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.

Q & A with Evelyn Tribole, MS, RD (Part 2)

In your book, you have a chapter entitled “Respect Your Body” – what kind of role does body image play in becoming an intuitive eater?

Body image is often at the core of people’s struggle with eating and weight because their initial desire to lose weight or change their body in some way may have been the catalyst for their first diet.  Unfortunately the first diet often leads to more diets, and a long relationship with dieting and weight fluctuations can wreak havoc on a person’s metabolism, their relationship with food and their overall self-esteem.  As mentioned above, diets have also been shown to result in increased weight gain (rather than the intended weight loss) which can perpetuate further body dissatisfaction. In other words, as stated in the book, “body vigilance begets body worry, which begets food worry which fuels the cycle of dieting”.

That being said, in order to move towards becoming an intuitive eater you really have to learn to respect your body.  Respecting your body doesn’t necessarily mean immediately liking every aspect of your body.  Respecting your body means treating it with dignity, and meeting its basic needs.  It means accepting your genetic blueprint, getting realistic about what is a healthy weight for you and letting go of the unrealistic and unhealthy weight expectations you’ve set for yourself along the way. Chapter 12 in my book and my presentation in Baltimore on November 21^st will delve into some more specific steps involved in this process.

Can someone who has had an eating disorder become an Intuitive Eater?

Yes they can, however, timing and readiness are key factors that must be considered in order to do so safely and in a way that does not create risks for relapse.  When an individual is in the throes of an eating disorder, he or she is not capable of accurately hearing biological cues of hunger and fullness.  In this situation, their “satiety meter” is broken, a consequence of complex interactions of mind-body biology and malnutrition.  In the beginning of treatment, nutrition rehabilitation usually requires some sort of eating plan (often under the direction of a nutrition therapist). With proper treatment and input from their providers, individuals with eating disorders can determine the best timing and their readiness to begin transitioning from a structured eating plan to more intuitive eating. Ultimately, when a person recovers from an eating disorder, she trusts her inner body wisdom. She/he is at peace with mind and body, and finally, enjoys the pleasures of eating according to natural hunger and fullness cues and without guilt or moral decree.

In your experience, what are some of the most frequent reactions or responses people have had after learning about and incorporating intuitive eating into their lives?

One of the most common reactions from people who make the shift into Intuitive Eating, is that they marvel at their new sense of freedom and peace—freedom from:

• Worrying about every single morsel they put into their mouths.
• Judgment from their incessant food-police critic.
• Worrying about what other people think about their food choices.
• Pre-occupation about eating the “right” or “wrong” food.
• Counting—calories, carbs, or points.
• Guilt, judgment, and self-worth related to food and body.

Consequently, their anxiety is markedly decreased, and they can participate in life—on what’s happening — right now, in the moment.  No more distraction.  When someone is constantly worried about what they eat—it’s akin to talking on the phone to a person who is simultaneously emailing or surfing the net.  The distracted person is saying the right words, but the connection is missing.

I never tire of hearing the genuine surprise of “taste discovery”, when someone finally gives herself unconditional permission to eat.   It’s not unusual for some to discover that they really don’t like a particular food that they have lusted after, and felt guilty while eating it.  When you have unconditional permission to eat—you really get to taste and experience the food, without judgment.

When someone embraces Intuitive Eating (and “gets it”), it is very empowering—because ultimately, the individual becomes self-attuned, and the expert of his or her own body.

Who could benefit from attending your workshop on November 21^st, 2010 at The Center for Eating Disorders at Sheppard Pratt?

This will be a great opportunity for individuals who’ve struggled in anyway with their relationship with food or weight including those who struggle with yo-yo dieting, compulsive overeating, weight fluctuations, restrictive diets, disordered eating or any type of general anxiety about food and weight.  This will also be a helpful presentation for parents or caregivers who are looking for ways to help their families develop an emotionally and physically healthy relationship with food.  Professionals who work with individuals around eating and weight can also benefit from learning more about Intuitive Eating.

In addition to attending your workshop on Nov. 21^st and reading your book, Intuitive Eating: A Revolutionary Program That Works, can you recommend any other supportive resources or additional strategies for individuals or families who are interested in intuitive eating?

On my website I have an entire collection of articles, interviews, research, trainings, and supportive resources related to Intuitive Eating. I would suggest starting there. You can also sign-up for my e-newsletter to receive ongoing news and research about intuitive eating.

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If you missed Part 1 of this special Q & A with Evelyn Tribole, we suggest you take a moment to go back and read it here.   Part 1 is important to understanding what Intuitive Eating is all about and provides links to additional research supporting the intuitive eating principles set forth by Evelyn Tribole, MS, RD and her Intuitive Eating co-author Elyse Resch, MS, RD, FADA.

You may also be interested in some of these past entries from The Center for Eating Disorders at Sheppard Pratt Blog:

• Thanksgiving with an Eating Disorder: 10 Tips to Help You Get Through the Holiday
• Tips for Overcoming Holiday Stress and Anxiety – Part I: The Food
• Tips for Overcoming Holiday Stress & Anxiety – Part II: The Stress
• Why Diets Don’t Work
• Baby Steps in the Wrong Direction? Increased Anxiety About Weight in the Very Young Child
• Should People With Binge Eating Disorder Try to Lose Weight?
• Updates & Evidence-Based Nutrition Guidelines in the Treatment of Eating Disorders, with Marcia Herrin, EdD, MPH, RD, LD

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.

Marcia Herrin, EdD, MPH, RD, is the founder of Dartmouth Colleges nationally renowned nutrition programs and has served as a nutrition consultant to a variety of universities and school systems, including the school of the American Ballet Theatre. Currently, Dr. Herrin conducts a busy private practice in Lebanon, New Hampshire where she specializes in children and adults with weight issues and eating disorders. Dr. Herrin is the author of several books including, Nutrition Counseling in the Treatment of Eating Disorders, a detailed treatment manual for professionals. On September 25th, Dr. Herrin will provide a training entitled, “Updates and Evidence-Based Nutrition Guidelines in the Treatment of Eating Disorders” which will be of great interest to novice and veteran treatment providers alike. In advance of her presentation, we asked Dr. Herrin about the significance of nutrition therapy, important indications for the treatment team and a little preview of her upcoming presentation! Dr. Herrin’s answers follow:

Q & A with Marcia Herrin, EdD, MPH, RD LD

Can you provide a brief description of the impact of nutritional deficits on cognitive and/or emotional functioning?

MH: Research shows that many nutrients, such as vitamin B12 and iron, are essential to human brain function and that deficiencies in these nutrients and others can lead to impaired cognitive function and impaired memory and concentration. Nutritional deficits are also directly related to impaired emotional functioning, i.e., irritability; apathy; withdrawn behavior; decreased ability to focus, to listen, and process information; and to fatigue. Deficits in nutrients and calories lead to preoccupation with food. We also know that nutrition deficiencies affect cognitive function and can be associated with anxiety, depression, and obsessive-compulsive disorder.

What are the overarching goals of nutritional counseling for patients and families affected by eating disorders? Who is qualified to provide nutritional counseling for this population?

MH: The most important goals of nutrition counseling are to correct disordered beliefs and behaviors about food and exercise; enhance motivation to restore healthy eating; and to establish a normal, carefree approach to eating and weight control.

The fundamental credential for practicing nutritionists is the RD (registered dietitian) degree. Registered Dietitians are uniquely qualified to provide medical nutrition therapy in the treatment of eating disorders. RDs are skilled in nutritional counseling, able to recognize clinical signs related to eating disorders, assist with medical monitoring, and are cognizant of psychotherapy and pharmacotherapy treatments. While other health professionals may be able to assess dietary intake and identify areas where change is needed, the expertise provided by RDs adds impact and credibility to the nutrition information and advice. Unfortunately, the therapeutic skills required to provide effective nutrition treatment are not routinely included in dietetic education programs.

Why is it important for all members of a treatment team to have a thorough understanding of nutrition and the metabolic processes involved in eating disorder treatment/recovery?

MH: When relevant scientific facts are disclosed and explained by all team members to eating-disordered patients it can motivate patients to discontinue eating-disordered thoughts and behaviors. To have the most impact, team members must have accurate information delivered in a confident manner. Enumerating the health consequences of unchecked eating-disordered behaviors indicate that providers take eating disorders seriously. It is motivating when providers can point out that most, if not all, the physical symptoms patients suffer from can either be avoided or reversed with weight restoration or cessation of purging.

What are the mains topics you will be expanding upon during your September 25th presentation for professionals in Baltimore, Maryland?

MH: I will be discussing specific nutritional approaches for patients with anorexia nervosa, bulimia, and binge-eating disorder and nutrition techniques derived from Motivational Interviewing, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Family Based Therapy.

Many thanks to Dr. Herrin for her time and clinical expertise in providing these responses. You can visit our blog to find out more about Dr. Herrin and the other symposium speakers.

If you would like to register to attend the September 25th symposium in Baltimore, please visit www.eatingdisorder.org. Don’t delay! Space is limited and early-bird and student discounts expire on September 17th.

You may also download and print the PROGRAM BROCHURE (pdf) or call (410) 938-4593 with any questions.

*Eating Disorders: State of the Art Treatment is approved for 7 cme/ceu credits for physicians, nurses, psychologists, counselors, social workers and registered dietitians.

Read our other 2010 Speaker Q & A Blogs here:

Cognitive Process & Remediation in Anorexia Nervosa – Q&A with James Lock, MD, PhD

Utilizing Transference & Countertransference to Deepen the Treatment of Eating Disorders – Q&A with Kathryn Zerbe, MD

This relatively new research, out of Eastern Virginia Medical School, proposes that a progression toward obesity begins as early as three months old.  Researchers have referred to their findings as a “tipping point”, suggesting we further scrutinize weight during the earliest months of life.  The study’s online abstract states, “that the critical period for preventing childhood obesity in this subset of identified patients is during the first 2 years of life and for many by 3 months of age.”

This raises a lot of serious concerns about how we might be encouraged to interpret these results.  Should worried parents or concerned childcare providers cut down on or restrict breast milk and formula out of fear for an infant’s future weight category?  Will parents of healthy, naturally larger babies be inclined to panic during weigh-ins at the pediatrician’s office or be made to feel they need to enforce low calorie diets to help their baby or toddler lose weight?  Not only do these things not work to prevent children from becoming overweight, they are also incredibly dangerous and can disturb a young body’s natural hunger and fullness cues, setting the groundwork for a harmful relationship with food later in life. The same disruption can happen when infants or children are persuaded to eat when not hungry or made to eat significantly past the point of fullness.  Ellyn Satter, a family therapist, registered dietitian and internationally recognized authority on eating and feeding speaks to this process on her website, stating,

“Children who eat and grow at the extremes make their parents so nervous that they often interfere. It backfires. In our weight-obsessed culture, parents may try to restrict a robust child with a hearty appetite because they assume that enjoying food and eating a lot means she will get fat. It doesn’t, and it doesn’t work. Children who don’t get enough to eat—or fear they won’t—become preoccupied with food and tend to overeat when they get a chance…

…Pressure on children’s eating always backfires. Trying to get a child to eat more than she wants makes her eat less. Trying to get her to eat less than she wants makes her eat more.”

Understanding the paradoxical outcome of restricting early feedings leads us to question the messages sent by this research study as well as those introduced by most childhood obesity prevention campaigns today.  As a country, we should pause and ask ourselves if increasing anxiety about infant and childhood weight might be hurting more than it is helping?  Promoting an even earlier vigilance and stigma around weight and bodies seems only to be muddying the water further, adding to the very “problem” that studies such as this one seem to be trying to address.

Negative messages about food and weight passed from our culture to our infants and children can lead to strained feeding and food relationships, a diet mentality, low self-esteem and negative body image.  All of these things are also risk factors for the development of disordered eating and eating disorders, including anorexia, bulimia and binge eating disorder which is the most prevalent and is often associated with obesity.  For most adults concerned about a child’s weight or well being, the obvious next question would be, “well than what am I supposed to do?”

Consider moving away from a hyper-focus on weight, body type, BMI or any other calculator of weight. Like most efforts involved in parenting, it’s not an easy task to accomplish particularly when it seems like every newspaper article, concerned relative, or public service campaign is telling you to do the opposite.  Do your best to focus instead on your child’s overall health (remembering that weight does not = health).  Honor and accept your child’s natural body size and shape.  Create positive goals around eating that involve paying attention to your baby’s or child’s internal hunger and fullness cues instead of relying on external messages about how much is “too much”.  Positive goals might also include taking steps to decrease the stress related to feeding a family by learning about and adopting Satter’s Division of Responsibility (DOR) in feeding which can be utilized from the earliest stages of infancy throughout adolescence. As  stated on EllynSatter.com, our goals as parents and as a culture with regards to feeding should be to:

“emphasize competency rather than deficiency: providing rather than depriving: and trust rather than control.” *

We would add that providing education rather than stigma; positive goals rather than “tipping points”: and fostering tools rather than anxiety will go a long way in helping to nurture a culture that cares more about health and less about size.

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*Quotes are copyright © 2010 by Ellyn Satter. Published at www.EllynSatter.com. For more about raising children who eat as much as they need and get bodies that are right for them (and for research backing up this advice), see Ellyn Satter’s Your Child’s Weight: Helping Without Harming, Kelcy Press, 2005. Also see www.EllynSatter.com/shopping to purchase books and to review other resources.

photo courtesy of  pediatrics.about.com

Harriet Brown’s presentation on Aug. 25th at The Center for Eating Disorders is FREE and open to the public. More information is available on our Events Page.

Q & A with Harriet Brown: Part I

Before your family went through this very personal experience with anorexia nervosa, what knowledge did you have of eating disorders and the treatment process?

HB: Probably about what most people know, which is basically nothing. I bought into all the usual myths: Anorexia affected white girls from rich families. Anorexia was a bid for attention, a way to act out in a dysfunctional family. I had no idea what I thought about treatment—I probably never gave it a thought, honestly.

When and how did you first become aware that your daughter was struggling with an eating disorder?  What were your initial reactions?

HB: We’d been aware of the possibility for a while—Kitty was a gymnast, and she’d always been on the thin side. I’d even asked her pediatrician about six months before she was diagnosed whether Kitty was maybe too thin; she’d grown half an inch and not gained any weight in a year, at age 13. The pediatrician reassured us, which in retrospect was a mistake; all adolescents need to be growing and gaining weight, and failure to gain can be as much a symptom as losing weight.

My husband and I first noticed an uptick in anxiety, but no weight loss. That’s why I was confused—I thought there had to be sudden dramatic weight loss. Kitty developed some obsessive tendencies around food and other areas, and her anxiety bloomed to the point of interfering with daily life. By now my husband and I were very alarmed. Around then Kitty lost a few pounds—4 or 5—and suddenly we put 2 and 2 together and realized we were dealing with anorexia.

Our first reaction was to push her to eat. That’s when we began to understand what we were dealing with. The harder we pushed her to eat, the more she resisted, and that was not like Kitty. By the time she was formally diagnosed, three weeks later, we were in a state of utter shock and panic. That sense of panic persisted for several months as we tried and failed to get her to eat, as her physical condition deteriorated; she landed in the hospital for dehydration and bradycardia at one point. That hospitalization was a turning point for all of us. We’d been trying to get her to eat, and failing; she was insisting she wasn’t hungry, she’d already eaten, her stomach hurt, all the excuses an individual with an eating disorder offers up. And part of us believed her, because we’d always been able to believe her. I think I was in denial. I know I was, actually. There was a moment, in the hospital, when after 4 hours of re-hydration, her heart rate still didn’t come up. The doc transferred her to the peds ICU. I remember distinctly running alongside the bed and arguing with the doctor about why she didn’t need to be in the ICU. I look back on that moment with horror, because it shows how much in denial I was that this was a life-threatening illness. No parent really wants to think that. And in retrospect I think all families pass through a stage of denial like this, and the best thing you can do is hurry them through it so they can get to the hard work of helping their child recover.

We flailed around unsuccessfully from June to August, when we stumbled on the notion of family-based treatment and decided immediately to try it. That’s when we started to make progress.

…to be continued.

Check back to read more of Harriet’s incredibly poignant account of her daughter’s illness and recovery.  In part II, Harriet talks about the most important thing she learned in the process of parenting a child with anorexia and the critical steps her family took along the way.

If you’d like to comment on this blog, or you want to receive updates when Parts II and III of this blog are posted, please join in the discussion and become a fan of CED’s Facebook page.

You can learn more about Harriet Brown and the upcoming release of her book, Brave Girl Eating: A Family’s Struggle With Anorexia, by visiting her website, www.harrietbrown.com.