Saturday, April 21, 2012
Baltimore, MD
7.5 CME/CEUs

Download the Symposium brochure or Register Online

Learn from five international experts in one intensive training day.

Keynote Presentations:

Acceptance & Commitment Therapy (ACT) for Patients with Eating Disorders and Body Image Distortion
Kelly G. Wilson, Ph.D.

Trauma and Eating Disorders: Updates & Advances in Managing the Complex Comorbidity
Timothy Brewerton, M.D.

Fat is a feeling: Emotion-Focused Therapy in the Treatment of Body Image Disparagement
Joanne Dolhanty, Ph.D.

Eating Disorders in the Upcoming DSM-V: Why The Criteria Have Changed and What it Means for You and Your Patients
B. Timothy Walsh, M.D.

Accentuating the Positive and Enhancing Motivation to Change: Essential Tools to Help Patients with Eating Disorders Engage in Treatment
Janet Treasure, Ph.D.

Breakout Sessions:

Using ACT with Your Most Difficult Eating Disordered Patients
Kelly Wilson, Ph.D.

Collaborative Care and Skills Sharing with Families to Facilitate Motivation to Change
Janet Treasure, Ph.D.

Challenges to Therapists in the Long-Term Psychotherapy of Traumatized Eating Disorder Patients
Timothy Brewerton, M.D.

Introduction to Skill-Development in Using Emotion-Focused Therapy in the Treatment of Eating Disorders
Joanne Dolhanty, Ph.D.

Discussion: Enhancing Recovery from Anorexia Nervosa: Any Science to This?
B. Timothy Walsh, M.D.

Registration:

Online Registration is available here: Eating Disorders: State of the Art Treatment – REGISTRATION

Download the Symposium brochure for a detailed agenda and speaker bios.  You can also download and print the brochure to register by fax or mail.

Registration fees include event attendance, all program materials and handouts, 7.5 continuing education credits, continental breakfast, catered lunch, coffee/refreshments and networking opportunities.

More info:

The Center for Eating Disorders’ annual symposium is designed to bring cutting-edge, innovative treatment knowledge to the professionals caring for people with eating disorders. Hear from five international eating disorder experts on a variety of treatment topics designed to strengthen your knowledge of comprehensive eating disorder treatment, and help improve patient outcomes.

The symposium will be of interest to all professionals who make up the treatment team, including psychiatrists, internists, family practitioners, psychologists, registered nurses, social workers, registered dietitians and expressive arts therapists. 7.5 CMEs/CEUs are offered. If you’d like to receive additional announcements about events like this in the future, please subscribe to our professional mailing list.

QUESTIONS? Call (410) 938-4593

In observance of National Eating Disorders Awareness Week 2012, The Center for Eating Disorders at Sheppard Pratt in Baltimore is excited to offer a special community event to raise awareness about the serious nature of eating disorders, the importance of treatment and support, and to help shed some light on the surprising place where eating disorders often hide - on sports teams and among athletes.  On February 26th, former World Champion rower, Whitney Post, will be speaking about her own identity as an elite athlete and how she ultimately used it to her advantage while recovering from an eating disorder.  Today, Whitney is the President and Co-Founder of Eating for Life Alliance and spends much of her time educating college students, professionals, athletes and coaches about eating disorder prevention and treatment.   

In advance of her talk, we asked Whitney to comment on this important topic and provide our readers with a glimpse into her February 26th presentation entitled, Invisible Victory: An Athlete’s Story of Hope & Triumph in Eating Disorder Recovery. 

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Q & A with Whitney Ladd Post:

WP: For starters, we live in a culture that is incredibly rewarding of the goal-oriented, driven, take-responsibility, and perfectionistic qualities of athletes.  In addition, the media sensationalizes athletic bodies, not just athletic performances. In athletes, the body can become an obsessive focus as well as a tool for athletic success. Many of the traits that make people successful and driven athletes, can also be easily misdirected towards disordered eating and an overly-critical body image. In one study of college female athletes, 88 % felt they were overweight or needed to lose weight. Another challenge is that some athletic cultures perpetuate the myth that weight loss improves performance, and athletes may be reluctant to acknowledge a problem or seek treatment. In short, it can be very easy for athletes to hide a serious and dangerous eating disorder because they often appear, from the outside, to be excelling at their sport and may look incredibly fit and healthy.

My goal is for everyone, athletes in particular,  to understand the physical and emotional consequences of eating disorders and disordered eating in the short and long term.  Weight loss in athletics can often be presented as the magical elixir, but if it compromises health it will ultimately compromise performance.  I want athletes to know that it is a highly treatable disorder with early and proper interventions, and I want to address their reluctance to seek treatment. In my experience an eating disorder never gets better if left untreated, only worse.

Research tells us that eating disorders are biologically-based illnesses but that a variety of other factors can also play a role in how and when the illness is expressed in different individuals.  Did being an athlete affect your struggle with the eating disorder?  What role did it play in your recovery?

WP: When people ask me if lightweight rowing gave me an eating disorder, I say absolutely not. I loved being on the water, I loved the sense of team, and I loved working hard to win. Yet, I also had an attraction to the grueling process of making weight for the sport, as part of my willingness to put my body through extremes for the sake of weight loss.  Lightweight rowing offered me a mechanism to play out my unhealthy relationship with food and my body.  My years as a lightweight further entrenched my eating disordered mentality.

Yet, there are many features of athletics that can be applied to recovery if the right goals are set.  The sense of team, commitment, step-by-step training toward a goal, and positive self-coaching as well as support and guidance from others can be applied to the treatment of an eating disorder.  Part of my message is that some of the same liabilities of competition and training can be redirected toward recovery.

Your blog about eating disorder recovery is called “Invisible Victory” – why do you refer to this victory as invisible?

WP: Great question.  For me, all my goals in my sports career involved getting noticed, recognized, and praised.  There was always a teammate or a coach or spectator to witness when my hard work resulted in success.  The situation was very different with my eating disorder recovery.  I had to be my own cheer leader, because so many of my victories were not even perceptible to anyone else.  Monitoring and changing my thoughts, behaviors, and reactions were crucial to creating a new relationship with food and my body.  I had to learn to both accept the invisible nature of my new quest, and celebrate the victories big and small with or without witnesses.

When you were struggling with an eating disorder, did you ever reach a point where you didn’t think recovery was possible?  If so, what helped you push past it and what message would you give to other individuals who may be feeling that way now?

WP: Recovery felt very much the way many of my lofty athletic goals felt.  At times I faced feeling totally devastated, discouraged, and depressed, but I never stopped working in the direction of my goal.  So of course there were many times when I wasn’t sure I would ever find my way out of my little prison in which I was both warden and prisoner, but I never stopped trying.

How has your definition of health changed throughout your life as you were struggling with an eating disorder and now, as an advocate for recovery?

WP: The biggest tangible change over the years has been that my self-worth and self-image are no longer tied to exercise. Exercise is still very important to me, but now I workout mainly for the health, mood, and social benefits (I love working out with a friend).   I believe the best way to advocate for health and recovery is to live it.  I continue to place a high priority on physical, spiritual and emotional health.  Without that, nothing else works very well.

It’s clear from your bio at Eating for Life Alliance (ELA) that you’ve accomplished a great number and variety of personal and professional goals.  What would you say you are most proud of today and why?

WP: I am so happy to be freed up from the narrow vision of the world that defines eating disorders.  Instead of all the daily struggles faced when I defined myself by my body, I am now free to channel my energies to so many things.  For me, recovery from my eating disorder was a gateway to an easier and more fulfilling life.  I have a wonderful marriage and a new family, great friendships, and the opportunity to work professionally on something I am passionate about.  Before recovery these things seemed to always belong to other people, not me.

What do you hope is the take-home message for those who attend your presentation on February 26^th?  Who could benefit from attending?

WP: My message is one that can benefit anyone who has been affected by an eating disorder themselves or has had a loved one with an eating disorder.  It is also important information for any parent, professional, educator, coach or friend who will likely be in a position to help someone someday if they know what to look for and how to respond.

One practical message I plan to get across to athletes and those who work with them is this: although athletes have a unique set of factors that make them more susceptible to eating disorders, they also have impressive assets that can be enlisted in helping them recover.  Eating disorders are common in athletes, and I don’t want anyone to be isolated and without the help she or he needs.

I want to offer education and encouragement to everyone who attends and wants to know more about eating disorders as they pertain to exercise and athletics, as well as to anyone out there who is looking for more hope.

Download the event flyer (pdf)

*   *   *

Many thanks to Whitney Post for taking the time to provide these responses and for having the courage to share her story so that so many others may know they are not alone. 

If you would like to hear more about Whitney’s story of recovery, please join us on Sunday, February 26th at 2:00 pm for our NEDAWeek kick-off event, Invisible Victory: An Athlete’s Story of Hope & Triumph in Eating Disorder Recovery.  All are welcome to attend this FREE event.  We strongly encourage athletes, coaches, athletic trainers and athletic directors from surrounding schools and colleges to attend,  as well as any individual who has been personally affected by an eating disorder, their parents, friends, educators, and health professionals.  Please download an event flyer for details.  Attendance is free but seats are limited so pre-registration is encouraged by emailing: RSVP@sheppardpratt.org. 

This is just one of several special events to be offered over the course of NEDAWeek.  Find out more on our Events Page. 

You can also request a mailing of event flyers or posters for your organization by emailing  kclemmer@sheppardpratt.org.  

All of these holidays come with their own joys and challenges. The annual combination of drinking and diet pressures during NYE can be especially troublesome for individuals working on recovery considering the high rate of overlap between substance abuse and eating disorders: 

Approximately 50% of individuals with an eating disorder (ED) abuse or are dependent on alcohol or illicit substances compared with approximately 9% of the general population …

…Conversely, females who report alcohol problems and/or binge drinking were more likely to report recent ED symptoms …

  Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788663/

During the hard work of ED recovery, it can be very easy for individuals to fall into the trap of “symptom substitution”.  This occurs when someone is refraining from acting on their eating disorder symptoms but begins to engage in, or increases their reliance on, other unhealthy behaviors such as binge drinking, drug use or self-injury.  Individuals who struggle with an ED and alcoholism can encounter an especially slippery slope during holidays like NYE that promote and normalize heavy drinking.      

If you struggle with substance abuse and find yourself challenged by the idea of the alcohol-focused NYE celebration, or you’re worried about how it might affect your ED recovery, it’s a good idea to plan ahead and create a recovery-focused party plan.  Here are a few tips and ideas to get you started:

Explore your options.  If your friends are planning an evening of bar-hopping, drinking games or other events that are heavily dependent on alcohol, it might not be the best option for you this year.  Consider other outlets…do you have neighbors, co-workers, friends from your church or synagogue, siblings, cousins or other family members who will be getting together to celebrate?  Check in to see if they may have a more balanced celebration in mind and could be more supportive of your recovery efforts. You may need to look beyond your most immediate social network to find what you need.

You CAN have fun while in recovery from an eating disorder and substance abuse; don’t convince yourself otherwise. It can be tempting to assume that there are no options for an alcohol-free evening on New Year’s Eve, but resist the urge to isolate as an alternative.  Sitting at home by yourself watching the ball drop in Times Square might seem like the safe option now but could set you up for feelings of loneliness, depression and negative thoughts as you head into the new year.   Try, instead, to connect with at least one other person and plan something special like going to see a movie or a concert, or catch a comedy show. 

Identify a sober buddy. If you are looking forward to attending a NYE party and you know there will be alcohol there, find out if there is anyone else who will be abstaining from alcohol, and team up for support.  Don’t limit yourself to other people in recovery; consider your friend’s wife who is 6 months pregnant and not drinking, or your friend who is a nurse and has to leave the party to go straight to work at 2 am.  Create alliances to help safeguard your recovery.  At the very least, let your host or a good friend know in advance that you won’t be drinking so they can help alleviate any pressure to do so on the night of the event.

BYO.   Just because you are choosing to focus on recovery and may be abstaining from alcohol doesn’t mean you shouldn’t participate in the midnight toast. In fact, if you’ve been working hard on getting well and finding happiness outside of the eating disorder and/or alcoholism, you probably have a lot of reasons to celebrate the arrival of the New Year, and toast to the progress you’ve made thus far.  Pack your own bottle of sparkling cider and raise your glass in your own honor.

Fun alternatives. If recovery-focused plans fall through or just don’t seem to be coming together, consider some creative alternatives like offering to babysit your nieces and nephews or a bunch of the neighborhood kids.  Put your energy into creating a fun, kid-centric New Year’s Eve celebration for them that you can enjoy too.   Think silly string, noise makers, confetti and some glittery dress-up outfits from the thrift store.

Safety First.  Even if you don’t struggle with substance abuse, but you know you will be drinking on NYE, aim for moderation and be sure that you have a safe travel plan in place.  Either stay-the-night at your host’s house or arrange for a trustworthy designated driver. You can also look into public services in your city that offer free rides home on NYE.  If you’re in the Baltimore area you can call  877-963-Taxi to take advantage of the Tipsy? Taxi!

#DitchingDieting  Be prepared to be bombarded with new year’s resolutions and people’s new diet plans in the weeks that follow.  In an attempt to balance those triggering and unhealthy messages, set up a system in advance to expose yourself to more accurate information about dieting and engage in a body-positive community.  If you’re on Twitter, follow the hash tag #DitchingDieting, and learn more about the toxic diet culture in this post, Dare to Resolve to Ditch Dieting  from Adios Barbie. 

As the year comes to a close, remember that your recovery, your happiness  and your well-being is worth more than a few hours of partying on New Year’s Eve.  Try something new this year by allowing yourself the time and space to celebrate in a way that is safe and supportive of your emotional growth and your current stage of recovery.  Strive to be mindful and present as you welcome in a year of gratitude, positivity, strength and confidence.

Happy New Year from The Center for Eating Disorders at Sheppard Pratt!   

We were inspired by all of the wonderful sharing on this topic in our weekly support group this week and decided to put together a last-minute packing list  for your holiday travels.  If you’re headed out of town, consider using this checklist to make sure your suitcase is full of the recovery tools.  If you’re hosting or staying home this holiday, grab the proverbial suitcase anyway and keep some of these things on hand for a healthy, joyful holiday at home.

Packing List for Recovery:

1. Your Motivation.  If you’ve ever written a list of all the reasons why recovery is important to you, make a copy and keep it someplace where you will see it repeatedly over the holiday.  If you’ve never made one of these lists, grab a pencil and get started.  Each time you make it through a triggering moment without acting on symptoms you can put a star next to one of the items on your list for positive reinforcement that you are moving away from the ED and towards the things in life that matter most to you.

2. Your cell phone. Its true, most people don’t go anywhere without their phone these days but if you’re away from your primary support people and your not seeing your treatment providers this week, you phone can become your lifeline.   Have several people identified in advance that you can call if things get overwhelming or you simply need to do some reality checking and get outside of your own head.  Talk to them ahead of time to confirm that they will be available to answer your call or return a text during the holiday.  Don’t forget your phone charger.

3. Comfy, cooperative clothes that show off your festive style but also feel good to you.  If you’re stuck out-of-town with clothes that don’t fit well, aren’t comfortable, or make you self-conscious, you may be setting yourself up for physical sensations and/or thoughts that are triggering.

4. Playing cards, word games or MadLibs – If things are tense or awkward you’re feeling like too much attention is on you or your eating disorder, be ready with an activity that can serve as a distraction.  You’ll be surprised how quickly everyone, you included, starts focusing on verbs  and adjectives instead of the ED when invited to join in a game of MadLibs.

5. Healthy Boundaries. Many people you see or spend time with around the holidays may not know that you’re in recovery from an eating disorder or even understand what that means.  If you are put in charge of a holiday task or invited to participate in something that is not in your best interest or puts your recovery at risk, don’t be afraid to say no – you have the right to do that.  If your cousin is joining a gym as part of her new year’s resolution and keeps begging you to come along with her for moral support, find a way to let her know that at this time the gym would not be a healthy place for you.  You could add that you support her in her efforts toward better health and hope she can understand and support you in your efforts too.

6. Your pet. Not only do they offer unconditional affection and a great distraction, but they  can also set a good example for balance and structure during the holidays.  Everyone else might be stressed, overwhelmed, or irritable, but Fido still needs to eat, drink, get fresh air and sleep the same as any other day.  Follow his lead, just make sure you’ve okayed the furry visitor with your hosts.

7. A sense of humor, perhaps obvious, but it truly can offer a way to manage your own stress and de-stress everyone around you.

8. Your old standbys. If you have coping skills or items that help you on a daily basis don’t leave home without them.

• an iPod with a motivational playlist
• your journal
• positive affirmations
• deep breathing techniques or meditation tools
• painting or drawing supplies
• CED’s online recovery forum - available 24 hrs a day
• Recovery-focused books like ”Life Without Ed” by Jenni Schaefer and “Life Beyond Your Eating Disorder” by Johanna Kandel.

What other essential coping techniques or stress-relief strategies will you be packing for the holidays?  Share your ideas on our Facebook page.

You may also be interested in these posts:

Tips for Overcoming Holiday Stress & Anxiety – Part I: The Food

Tips for Overcoming Holiday Stress & Anxiety – Part II: The Stress

The Resolution Solution

Wishing everyone a healthy and happy holiday season from all of us at The Center for Eating Disorders at Sheppard Pratt!

It seems like many colleges and universities have moved away from the standard exam schedule. In fact, it can seem like you are constantly studying for exams or writing papers, with no downtime or lull in the semester at all. Midterms and finals just mean a heightened level of existing anxiety or stress. Unfortunately, for many college students, that means there comes a point in the semester when it seems like there are way too many obligations and way too little time to manage them all.  If you are simultaneously working on recovery from an eating disorder this can be incredibly frustrating, particularly if everything seems to be equally important on your to-do list. While it can be easy to lose sight of how critical your recovery is in the midst of these academic priorities, its crucial to remember the potential consequences.  Turning to your eating disorder behaviors will only intensify the stress you’re body is under, making it mentally and physically harder to concentrate, harder to interact and connect with other people (i.e. study groups, roommates, support people) and much harder to accomplish that long list of study tasks.

Self-care, nourishing your body, following treatment recommendations and practicing your new healthy coping skills is what will eventually get you through the stress of mid-term or final exams.  While the hectic nature of college academics can’t be completely avoided, we can offer some tips to help make it feel more manageable and less likely to derail your progress in recovery.

Prioritize: Make a list of all of your upcoming responsibilities. Pull out the larger projects and see if you can break these down into smaller, more achievable tasks. For example, break down “10 page research paper” into: print articles; read articles; write an outline; write the rough draft; write the bibliography; and revise the paper. Write deadlines next to each item on your list and then organize your to-do list by due-date or high priority items. Don’t forget to breathe.

Eliminate unnecessary responsibilities: Do you really have to do everything on your list? You might have some things on there that are optional projects, or possibly some student organization meetings that are not imperative for you to attend. Perhaps you can ask for less hours at work during exam weeks. Remember that you can also always talk to your professor; if you have 3 exams scheduled on one day, one of your professors may actually be willing to allow you to take the exam for their class on a different day. If you just can’t adjust your schedule, know that this stress is temporary. Focus on the end point and plan a reward for yourself after big assignments are turned in.

Don’t give up on the basics: As tempting as it may be, you still need to prioritize sleeping, eating and self-care. In fact, it is even more important that you take care of yourself during this stressful time. Always strive to get as close to 8 hours of sleep each night as possible, remembering that lack of sleep can have a significant effect on hunger and eating patterns.  Make sure you are scheduling times to eat your meals and snacks and that you are thinking ahead. If you know you won’t have time to go back to your room for a meal, remember to pack your food with you or bring money to eat while you are out. 

“The time to relax is when you don’t have time for it.”   

~Sydney Harris

Relaxation is vital. Take some time every day to take a deep breath and be still. Enjoy what the season has to offer.  Consider setting aside 30 minutes or an hour during your busy time to catch up with a friend or roommate – no multi-tasking or studying allowed during that time.

Keep your appointments: When things get hectic, it may be tempting to cancel your therapy or nutrition appointments so that you can spend more time studying.  This often makes sense in a moment of panic or stress but can easily lead towards losing sight of  recovery’s importance.   Cancelling appointments during high stress or high pressure times can be a risk  factor for relapse.  Consider a rock climber choosing to take off her safety harness right when she gets to the highest and steepest part of the cliff.  You’d probably question that decision right?  The same applies to your “safety harness” and your support system during difficult times.  If you are struggling to get to your appointments, speak to your therapist about this and decide together what is the best way to balance your responsibilities with your recovery in mind.

Reach Out:  Recovery can feel like a full-time job sometimes, and college is a full-time job for many students.  You may be realizing that you are struggling so much with both that you just can’t focus on your academics the way that you want to. You may have missed a number of classes, gotten behind in lectures or just feel too overwhelmed to truly focus. Don’t be afraid to talk with your professor and see if there is any way that you can catch up, delay some deadlines, or work with a tutor to help you in that class.  You don’t have to go through this on your own.  Ask for help and explore your options for support on campus. If you think you need to withdraw from a class and have missed the Drop/Add deadline, or if you are thinking about taking a medical leave of absence, schedule an appointment with the Dean of Students, an Academic Advisor, or someone at the Counseling Center – that is what they are there for!  

While academics and exam stress can be overwhelming, just remember that you have options regarding how you handle that stress and how you let it affect you. You have already accomplished so much this semester.  Reflect on what has been working well so far and praise yourself for a job well done. If there are things that have been a struggle, now is a good time to evaluate what aspects of your self-care and stress tolerance could be improved.  Try  coming up with a reasonable plan to put into action for the rest of the semester and continue reflecting on it to see what is working and what isn’t. If you are stumped as to how to do this, reach out to others for support and additional ideas.

CED wishes you a memorable semester of academic success, balance and self-care.  For more insight on the intersection between college and eating disorder recovery, check out our whole blog series at: Battling Body Image Concerns & Disordered Eating on Campus .  

If you are struggling with an eating disorder and need help or support, please call The Center for Eating Disorders at (410) 938-5252.  You can also reach us by email at EatingDisorderInfo@sheppardpratt.org .

Written by Jennifer Moran, PsyD, CED Therapist & College Liaison

Learning to eat mindfully is a key step in repairing the relationship between your mind and body and trusting your body to guide your eating choices. However, it’s important to point out that not every college student is ready to fully embark upon a mindful eating approach.  Individuals who’ve struggled with an eating disorder may require a period of more structure, meal plans and guidance from a professional dietitian in order to help their bodies return to a place of health and re-establish trust in feelings of hunger and fullness.

When you, with input from your treatment team, feel ready to move towards mindful eating one helpful resource is Mindful Eating 101 by Dr. Susan Albers. In the first part of her book, Dr. Albers differentiates between mindful eating and mindless eating and outlines the seven main habits of mindful eaters which we reviewed in part 1 of this post. In this follow-up, we take a look at some of the specific strategies that Dr. Albers offers to help make mindful eating a reality on a college campus.

First, it is important to pay attention to the language that you use, as language can ultimately shape your behaviors. For example, imagine trying on a pair of pants in a department store fitting room and noticing that they feel too tight. You might think “I am so fat,” which may lead you to decide to diet or deny yourself of proper nutrition in order to lose some weight. Alternatively, you might think “This brand really sizes their pants in a funky way,” which may lead you to try on a bigger size or even try to find pants from a different designer. It’s the same situation, with two very different results. Imagine how one’s self-esteem would be affected in both scenarios. In the first scenario, you can see how someone might start to feel badly about themselves and their body, perhaps even leaving the store without purchasing anything (or buying pants that don’t fit but vowing to fit into them by a specific date).  In the second scenario, the person has not been personally affected, will likely maintain positive self-esteem and will most likely go on to buy a great pair of pants that they feel good wearing. Starting today, be mindful of your speech to others and to yourself. Be aware of the language that might lead to unhealthy choices and try to use more affirming statements.

Similarly, avoid using the word “fat” to describe what is actually an emotion. Have you ever heard someone say that they are having a fat day? The person is most likely actually having a frustating day, an angry day or a sad day. Think about the difference in how someone might cope if they label their feelings as fat versus sad.  Someone who is sad might reach out to others for support, while someone who is labeling themselves as fat may come up with a new unhealthy diet plan. It is so important to identify the true emotion so that you can more accurately address it.  Think about it this way…if your best friend came up to you and said she was feeling sad you would probably not tell her to go try a new diet or hit the gym for an extra 2 hours.  Most likely you would comfort her, listen to her and maybe offer to take her somewhere to cheer her up.  After you identify your own emotions, try being compassionate towards yourself and comforting yourself as you would a best friend in a similar situation.

Once you have started paying attention to your language and emotions surrounding food and weight, you may be  ready to work on practicing mindful eating. Here are some tips from Dr. Albers’ book.

Get out of your rut: Sometimes we follow routines so mindlessly that we don’t stop to consider that there is an alternative to the same foods that we eat every day. Instead of automatically reaching for that oatmeal packet, consider what you might actually like to eat for breakfast and prepare that instead. You might want to try the dining hall instead of packing your lunch or vice versa to add some instant variety to your eating patterns.

Commit to mindfully eating one bite of your food during each meal. Try to savor the food using all of your 5 senses to really be present and in the moment. Its no secret, college can be pretty chaotic and stressful.  But one mindful bite per meal sounds like a pretty reasonable goal, right?

Rate your hunger level. Before you eat, try to gauge just how hungry you are. Let this guide you in making choices about what you put on your plate. Pay attention to how you are feeling physically while you are eating so that you can stop when you are satisfied and not when you are either too full or still hungry. This is especially helpful when confronting the dining hall buffet; ask yourself what you are actually craving so that you have a specific meal in mind instead of mindlessly grabbing food because it looks good.

Be Flexible: If you’ve ever struggled with an eating disorder or fallen victim to fad diets, you may have adopted some very persistent thoughts that tell you to avoid certain foods.  Unfortunately, when you follow rigid rules about eating, it becomes very hard to eat mindfully.  Notice your thoughts about food without judgment, and try not to let them influence the food choices that you make or how you feel about yourself for eating them.  Be flexible at each meal and eat what you are truly hungry for, stopping when you are full.

Don’t skip meals. Ever. It’s as simple as that. By skipping meals, you are setting yourself up to overeat or to make impulsive food choices.  Dieting and skipping meals also lowers your metabolism. Your body does not operate well without consistent energy, so it is very important to offer yourself balanced, consistent meals throughout every day.

Accept your emotions: It’s completely normal to experience a full range of feelings, from sadness to anger to joy. Emotions are temporary states that help to give you information about the situation that you are in. Some people try to act on their eating disorder symptoms as a way to avoid emotions, but this is not a healthy or successful strategy and often makes a situation much worse.

Create a safe environment. Do you notice that you tend to eat mindlessly in the same places or at the same times everyday?  Maybe you frequent the vending machine outside your Calculus class. If you are hungry, then eating that snack is a healthy response to your body’s signal.  But if you tend not to be hungry at that time, think about whether you are eating purely because you’re bored, frustrated or overwhelmed by the math class or simply out of habit?  Consider some alternatives.  Focus on allowing extra time for a very fulfilling and enjoyable breakfast just before your class so you’ll be better able to pay attention and less likely to turn to food for distraction or coping purposes.
 

Be wary of alcohol. It’s no secret that drinking alcohol impairs your judgment. Sometimes people will eat more when they are drinking because they are not able to clearly follow their body’s signals. Others may be tempted to restrict to compensate for the calories from alcohol and find themselves even more impaired because there is no food to help their body process the alcohol. If you are of age and choose to drink, drink responsibly and in moderation.

Plan for the holidays and breaks. During this time of year, there is probably Halloween candy around everywhere you look, and in just one more month the “official” holiday season will be in full swing.  Special occasions such as Thanksgiving, Hanukkah, Christmas and New Year’s seem to lead to an even more intense emphasis on eating and weight for those who are already struggling.  For some college students, the trips home will be extra stressful because of the family culture around food, meals and social gatherings.  Plan ahead – try to predict what might be triggering for you during the holidays and put support in place that will help you continue to eat in a mindful way. More tips for holiday eating and recovery can be found here.

Find a friend.  How many diets have recommended that you find a friend to go on the diet with so that you can have someone to keep you accountable? Instead of spiraling down the diet hole with a buddy, why not apply the same social technique but with a positive focus? Find a friend who is also interested in learning about mindful eating and encourage each other to practice these skills together.

Use your treatment team. If you are working on recovery from an eating disorder or from negative body image concerns, it is important to work with a trained professional who can help guide you through the process. The members of your treatment team are well-versed in mindful eating and can help you to set goals for achieving positive change, while also being able to point out obstacles that are posing a challenge to achieving your goals.

Whether you eat most frequently in your college dining hall, at a restaurant, or in your own dorm room or apartment, there is no secret formula for exactly what you are supposed to eat and how. The trick is simple: if you can work towards trusting your body and eating mindfully, your body will get just the right nutrition that it needs and your weight will naturally reach its healthy set point.  Your body is very smart and knows what it wants and needs at any given moment. Pay attention, follow its cues, and you may find that you suddenly have more physical and emotional energy than you have experienced in quite a long time.

If you are interested in learning more about mindful eating, visit Dr. Albers’ website, www.eatingmindfully.com for further tips and information.

If you are worried that you have an eating disorder and would like to find out about your treatment options, please call us at (410) 938-5252 or visit us on the web at www.eatingdisorder.org

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

“I’m having a fat day.”

“Does this outfit make me look fat?”

“I can’t go on that date until I lose more weight – I’m so disgusting.”

Have you ever uttered these words? Have you thought them? Heard other people say them? These types of statements have become far too acceptable as part of our every day speech and social conversation. In an effort to combat this way of speaking to ourselves and others, Tri Delta Sorority launched their fourth annual Fat Talk Free Week going on right now, October 16-22, 2011.

The following description of this initiative is posted on their website:

Fat Talk describes all of the statements made in everyday conversation that can contribute to women’s dissatisfaction with their bodies by reinforcing the thin ideal. Examples of fat talk may include: “I’m so fat,” “Do I look fat in this?” “I need to lose 10 pounds” and “She’s too fat to be wearing that.” Statements that are considered fat talk don’t necessarily have to be negative; they can seem positive yet also reinforce the need to be thin –“How do you stay so skinny?” or  “You look great! Have you lost weight?”

Fat Talk Free Week, our cause campaign in support of Reflections, is an annual week-long event to raise awareness about the damaging effects of Fat Talk. We’re encouraging everyone to change the conversation to create a more positive body image for women everywhere!

Negative body image is one of the most persistent symptoms of an eating disorder. In fact, for many people, their eating disorder symptoms will be well under control before their body image begins to improve. This is a frustrating experience that can also be very triggering, leading some, unfortunately, to revert to their eating disorder behaviors. Fortunately, there are some steps you can take to actively work on nurturing and accepting your body. There’s still time to enlist some friends or family members to take part in Fat Talk Free Week to support you in creating a world less focused on appearance and unrealistic body ideals.

Stop Fat Talk: Instead of talking with others about your appearance, start conversations about which classes you are taing, your weekend plans or how you are feeling that day. Compliment others on their accomplishments, style, or humor instead of highlighting their appearance or weight. If others are engaging in fat talk, politely redirect the conversation or let them know about your goal for the week and encourage them to join in.  You can connect with others on the End Fat Talk Facebook Page.

Make a List, Don’t Check it Twice: On one half of a piece of paper, write a list of the things you dislike about your body. On the other half write the things that you like about your body, you accomplishments and your personality. Tear off the half that details the negatives and rip it up into pieces. Throw it in the trash where it belongs! Put the positive half somewhere that you can look at it frequently to remind yourself of your great qualities.

Treat Your Body: This would be a great week to schedule a massage or a pedicure. Strapped for cash? Check out local spas that might have student discounts or get some friends together and swap accessories that emphasize your favorite feature. Sometimes, it is a treat to simply take a nice, long shower at home and actually take time to enjoy the scents of the shampoos and soaps that you use.

Apologize: It may seem silly, but every time you catch yourself thinking a negative thought about your body, pause and apologize to your body for being so harsh. Instead, try to express your gratitude for what your body does for you. For example, if you are thinking your thighs are too big, stop and thank your legs for giving you the ability to walk from place to place.  You might even want to write your body an apology letter for having been so critical in the past. Then write your resolutions for how you will treat it better in the future.

Get Creative: Tap into your inner artist and create a poster for CED’s 6th Annual Love Your Tree positive body image and poster campaign.  Colleges and  student organizations in the state of Maryland can even request a free Love Your Tree creative workshop for your campus facilitated by the program’s creator, Julia Andersen.  More details here.

Out with the old, In with the new: This would be a great week to do your body a favor and get rid of any old clothes that don’t fit or simply don’t make you feel great when you wear them. What is the point of holding onto jeans that don’t cooperate with your body? They’re only taking up space in your closet, and you could be focusing on the jeans that fit you and flatter you now. Host a clothing drive in your dorm or with your friends; donate those clothes to Goodwill or take them to a consignment shop. Everyone wins!

We at The Center for Eating Disorders encourage you to sign the Fat Talk Free Week Pledge.  Over 3,000 other people have already made the commitment to befriend their bodies, will you?

Remember, Fat Talk Free doesn’t have to end on Friday.  See how much better you feel when you focus on life outside of clothing sizes, diet goals and the media’s harmful messages about beauty. You may find that you want to make it a daily commitment.  Need a little extra motivation?  Check out Positive Body Image is Always In Season: 7 Tips for Year-Round Body Image Boosting and join us on Facebook.

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Written by Jennifer Moran, PsyD. as part of CED’s 8-part college blog series for students struggling with disordered eating and body image concerns on campus.

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

Simple Steps to Strengthen Your Support System and Safe Guard Your Recovery

Have you ever looked through the wrong end of a pair of binoculars? Objects that are actually close appear clearly but look to be quite far away. If you are feeling socially isolated and alone, you may feel the same way about the people in your life: they are physically close but seem to be just distant enough that you can’t reach out to them. Maybe you are struggling to find the right group of friends at school and are feeling like everyone else has bonded with others to form tight-knit groups that are hard to penetrate. Or maybe you have been struggling and thus avoiding some of those people that are close to you. Either way, when you are feeling alone, it is hard to fight the eating disorder thoughts and urges that might creep in and try to keep you company.

Attending college is a unique experience in that there are so many people with similar interests, who are usually similarly aged, living and/or studying together in one spot. If you haven’t found the right group of people, keep looking, as they are likely somewhere on campus just waiting to welcome you into their lives. If you have been isolating, now is the time to commit to getting up and pushing yourself to reconnect with others, even if you don’t really want to.

Be true to yourself. If the idea of going to a loud fraternity party sounds unappealing to you, chances are good that you aren’t going to meet your ideal friend at one. Take some time and think about what you would really like to do that might bring you pleasure. Would you rather spend a quiet evening with a small group of people or enjoy the outdoors with a hiking club? Would you enjoy a student service organization that hosts weekly charity events? Whatever your interest is, there are bound to be others on campus who share it. Contact your Student Affairs office to find a list of all of the student organizations on campus. If you see any that intrigue you, contact the president and find out meeting details and upcoming events. Peruse the school newspaper for lectures, concerts, theater events or student activities that seem interesting and challenge yourself to go to at least one.

If there is a person in your class that seems like someone you might like to get to know better, try approaching him/her.  Depending on how comfortable you are with speaking to new people, you might want to start with a simple greeting. A different time, you might want to ask them a question about the homework assignment to get a conversation started. Progress from there to asking them to study together, and if you seem to get along well, invite them to something fun that is not related to your class.  If it is hard or stressful for you to eat your meals with others for the time being, invite them to activities that are before or after meals so that you can enjoy your time together. On the other hand, if you do better eating around other people, try to schedule activities that include meals or snacks.

If you cannot seem to find the right group of people on campus, try looking to the general community in your area. Pick up a local paper and look for events or activities that are open to the public. You might find that there are more people who have similar interests off-campus, and this is a great way to connect with them.

If you continue to struggle to connect with others, talk with your therapist about joining a therapy group. Groups can be a great way to talk about your experience with others who are experiencing similar types of situations. Here at the Center, we host an open Support Group every Wednesday night from 7-8:30 PM.  Therapy and Support groups are not meant to replace social relationships but can offer a lot of support and are a great place for practicing interpersonal interaction. You might also consider joining our recovery-focused Online Forum to connect with others in a more informal capacity.

When you are trying to fight an eating disorder, the process can sometimes feel so draining and exhausting it can be tempting to give in to your urges.  Feeling alone on a campus full of people can make it even more difficult, so it’s important to accept that there is power in numbers.  It may take some courage and effort to reach out initially and try some of the tips listed above, but the payoff is worth it.  Once you welcome people into your daily life that you can turn to for support, even if it is just to distract you for awhile, you will have the extra strength to stay focused on recovery and you might even have a little fun in the process.

This is the 4th post in our 8-part blog series  about eating disorders on campus

Written by Jennifer Moran, PsyD. , CED Therapist & College Liaison

One of the most common fears that we hear from incoming college freshmen is about gaining the dreaded “Freshman 15.”  The Freshman 15 refers to the myth that college freshmen will gain 15 pounds during their first year at school. It has become one of those terms that Americans toss about in conversation as if it is a proven fact, an inevitable reality. There is certainly a flurry of articles written about it at the start of each academic year, dutifully outlining tips to avoid weight gain. But is the Freshman 15 something that really happens? Could the added anxiety  and efforts around trying to prevent the anticipated weight gain actually make things worse?

It doesn’t take more than a simple literature review to determine that the Freshman 15 is, in fact, a myth. Two recent studies found that freshmen did tend to gain some weight during the first year of college, but it was closer to a total of 2-5 pounds, which is significantly less than the rumored 15. (1,3).  So where did the exaggerated myth come from, and why do the studies show that there is even a slight weight increase?

For most students entering their freshman year at college, it is the first time that they are living away from home and making independent lifestyle choices. While this can be very freeing (no more curfews!), it can also be overwhelming in terms of managing a well-balanced, nutritious day of eating and hydrating in the midst of other academic and social obligations. This can lead to problems with weight gain or weight loss, both of which can be indicative of behavior changes or health concerns. Let’s look at some common causes for weight changes and problematic eating on a college campus:

Erratic Schedules: High School provided a very structured day, with bells nicely ringing at the beginning and end of every period. In college, you often have different schedules on different days, which can make it hard to find a consistent meal time. This may lead to an increase in the number of times you wait too long between meals or even skip one. Skipping meals deprives your body of nutrients and can ultimately lead to over-eating at the next meal, which can also lead to weight gain.

Dining Halls: Many schools have buffet style cafeterias. The good news is that this provides plenty of choices for you at each meal. The bad news is that many people struggle to recognize what an appropriate portion size is and may lose touch with their internal hunger and satiety cues.  Some students, especially those afraid of the Freshman 15 myth,  may feel anxious about the food choices and will over-compensate by taking too little food.  Others may have difficulty adjusting to the abundance of food in the college cafeteria and might repeatedly overeat and feel uncomfortably full after meals.

Dieting: Sometimes people are so afraid that they will gain weight in college that they start dieting before the school year even starts. In reality, dieting has actually been shown to be a predictor of weight gain (2). Restrictive eating can eventually lead to over-eating, as well as problems with your metabolism, which can also lead to weight gain. In fact, 95-98% of people who go on a diet gain back all of their weight (or more) within 1-5 years.

Poor Sleep: Many college students don’t get a full 8 hours of sleep each night. Fatigue can impact mood, hormone levels, fullness/satiety cues and can lead to impulsive choices when eating, which can all affect your weight.

Alcohol: Remember that you can choose not to drink and still have an enjoyable and memorable college experience.  However, if you make the choice to consume alcohol, moderation really is the key to responsible drinking.  In addition to some of the obvious risks associated with drinking, unfortunately, some people restrict their food intake to try to compensate for the calories consumed via alcohol. This ill-advised strategy deprives the body of the essential nutrients that must be obtained to fuel the body. Before you protest and say that a multivitamin can fix that, know that your body best consumes those nutrients if they come from actual food in regular intervals throughout the day.  Multivitamins should only be considered as a supplement to your food and not ever as a substitute for proper dietary intake.  Restricting food in an attempt to compensate for binge drinking calories has been referred to by some internet outlets as “drunkorexia”.  Trendy terms like this  can be dangerous since they often downplay or trivialize the serious underlying problems of eating disorders and substance abuse.

Age: Have you ever stopped to notice that most adults look pretty different from high school students? Your body continues to develop and mature even after puberty. While the bulk of that maturation may have already happened during your early to mid-teens, expect your body to continue to change. This may mean that it is completely natural to gain a couple of pounds, even if your diet and exercise patterns remain stable throughout college.  It is unrealistic to expect your weight and body to stay exactly the same as they were when you were in high school.

Tips for College Wellness:

1. Eat three meals every day, even if you are very busy and have to take the food with you to eat in class.
2. Eat mindfully. Try to follow your body’s cues; eat when you are hungry and stop when you are full. This can be particularly hard given tip #1 above, but even if its not ideal to eat amidst distractions like a class lecture, a sorority meeting, or your fantasy football draft, its still possible to check in with your body’s hunger and fullness cues during those times and respond appropriately.
3. Don’t forget to hydrate yourself throughout the day.  Don’t think water is a big deal?  Consider that every single system in your body depends on water so if you you don’t get enough, vital organs and systems can’t function properly.  Keep a water bottle attached to your school bag to make it easy to hydrate and so you have a constant reminder to get in your eight, 8-oz glasses of water each day.   Student athletes may need even more than this.
4. Resist the pressure to go on a diet (even if all your roommates are doing it). Instead, make an effort to eat a wide variety of foods in moderation. Don’t forget to eat plenty of whole grains, fruits, vegetables, proteins, fats/oils and dairy.  Take the focus off your weight altogether by not weighing yourself.  Evaluate your well-being based on how you feel physically and emotionally, your energy levels and your health behaviors.
5. Try going Fat Talk Free courtesy of TriDelta’s Reflections Body Image program
6. Avoid focusing too much on your body or your weight by redefining ”Freshman 15″ in your own way. Make a list of 15 activities or experiences that you would like to try before the end of the school year.  Then find ways to commit to doing them.  Too often, people reflect on their college years and only remember a blur of studying, stress and concern about their weight/bodies.  Redefining your own meaningful list of Freshman 15 is a great way to ensure that you truly enjoy the college experience.

If you have other suggestions or ways to focus on your own wellness amidst the Freshman 15 fears on campus,  please leave a comment below or join in the conversation on our facebook page.  If you are concerned that you or a friend may have an eating disorder, you can take our confidential, online assessment quiz.

For more inforamtion about The Center for Eating Disorders at Sheppard Pratt, visit www.eatingdisorder.org or call us at (410) 938-5252.

Written by Jennifer Moran, PsyD

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References:

1. Federation of American Societies for Experimental Biology. “Fabled ‘Freshman 15′ Pound Gain More Often Only 5, Report Researchers.” ScienceDaily, 7 Apr. 2008. Web. 22 Aug. 2011. (http://www.sciencedaily.com/releases/2008/04/080406153357.htm)

2. Lowe, M., et al. (2006) Multiple types of dieting prospectively predict weight gain during the freshman year of college. Appetite 47, 83-90.

3. Mihalopoulos NL, Auinger P, Klein JD. (March/April 2008) The Freshman 15: Is it Real? Journal of American College Health, 56(5), 531-534.