Is your school or classroom a body-positive space for students?


It is widely accepted, from preschool to high school, that teachers and school staff play a big part in helping students to develop positive self-esteem. Many of those same teachers may not be aware that one of the most significant factors in an individual’s overall self-esteem is body image. So why does the way we see/think/feel about our bodies matter so much and what does that have to do with our classrooms? Consider the following:

  • 31% of adolescents do not engage in classroom debate for fear of drawing attention to how they look.1
  • 20% of teens say they stay away from class on days when they lack confidence about their appearance.1
  • On days when they feel bad about their looks, 20% of 15 to 17 year old girls will not give an opinion and 16% will avoid school altogether.2
  • A study of more than 11,000 teens found that students who saw themselves as overweight (regardless of actual weight) had lower academic performance than those who did not. This is important because it means the perception of being overweight – likely because of cultural bias and negative stereotypes that come with that – was a more significant determinant of academic performance than medically defined obesity.

If the way kids feel about their bodies impacts attendance, classroom engagement, academic performance and individual self-esteem, it makes a lot of sense for schools to be paying attention to body image.  Below are just a few ways you can work to establish a school environment that is body positive and doesn’t reinforce harmful weight stigma, appearance ideals or the diet mentality.


6 Guidelines for a Body Positive Classroom


Representation matters. 

Do a thorough scan of books, posters and other materials around your classroom. Do they include a wide representation of people with diverse bodies – both in weight and shape but also skin color, gender presentation and physical ability? Will all kids see themselves represented in the positive imagery around your classroom?

If your class involves physical fitness or health messaging, consider whether your resources show kids and adults of all shapes and sizes being active or just thin/muscular people? Are fatter bodies exclusively used in imagery meant to deter or shame people for specific behaviors? If you’re in need of new imagery, check out these inclusive stock fitness photos from The Body Positive Fitness Alliance.

Above all, remember that kids who feel good about their bodies, regardless of their weight, are more likely to engage in healthy behaviors and less likely to engage in risky or harmful behaviors like smoking and bingeing.4 To help bring body positivity into your class, add books and resources to your lesson plan or syllabus that promote body acceptance and provoke age appropriate conversations about the natural diversity of bodies. Messaging that focuses on 1) how health behaviors can make us feel, or 2) developing gratitude for the functionality of our bodies as opposed to what they weigh or look like, can promote self-care and confidence. A list of age-specific body positive resources is included at the end of this post – please scroll down to check it out!


Leave all personal diet-talk at the door and enforce that rule with fellow teachers and school staff.

We know that kids are listening to the adults around them even when we don’t think they are. Casual background discussions about cutting out carbs, trying a new “cleanse” or berating oneself for eating a cupcake are not as innocent as you might think. When little ears – or even mature high school ears – overhear their favorite teacher or respected mentor talking about food and bodies in critical or shameful ways they can internalize those messages. There are many reasons why we encourage adults not to introduce kids to dieting, including the fact that kids who diet are up to 18 times more likely to develop an eating disorder.5

Furthermore, there is no long-term evidence that any fad diets like keto, paleo, Whole30, Atkins or otherwise lead to reliable or sustainable weight loss. In fact, diets have been associated with longterm weight gain. Specifically, adolescent girls who diet are at 324% greater risk for obesity than those who do not.6


Normalize the variety of healthy body changes that take place before and during puberty. 

For example, it’s completely normal (and necessary) for a young girls’ body to store up extra fat before she gets her period for the first time. It’s also common for boys and girls to gain weight and fill out just prior to growth spurts in height. Remember this happens at very different times for different kids. If they experience these normal changes as abnormal or bad, it puts them at risk for body dissatisfaction and disordered eating. But If kids (and teachers and parents) can learn to anticipate these changes they may be more likely to trust their bodies as they grow and mature.


Incorporate MEDIA LITERACY into your curriculum.

It doesn’t matter if you teach preschool story time or AP Literature, there are countless opportunities to talk about how to handle cultural messages kids receive about beauty, appearance, health, and weight. The Center for Eating Disorders provides body image and media literacy workshops for educators and parents as well as arts-based campaigns like the Love Your Tree campaign. We also encourage school staff to pursue training in evidence-based prevention programs such as The Body Project and to work with local organizations to incorporate student activism projects that challenge the thin ideal and inspire brands to do better.

 

Weight-based bullying is more common than all other forms of teasing. Establish a policy against weight-based bullying and actively work to reduce body commentary in general.

What’s the difference between a teacher proclaiming “you look amazing! Have you lost weight?” and a student teasing her classmate for “packing on the pounds” over the summer? Not much actually. They both reinforce a negative bias towards larger bodies and establish an unnecessary focus on appearance/size. In our culture it is assumed that saying something one thinks is “nice” about someone’s body is a good thing but praising specific aspects of one’s appearance can be just as detrimental for the school community as a whole because it reinforces the dangerous appearance ideals. Consider the following scenarios:

Malik gets nicknamed “string bean” by the principal because he had a growth spurt and grew much taller and slimmer than his peers. Malik was already feeling self-conscious about his height and knows the principal was just kidding around but now he does everything he can to avoid seeing him in the hallways.

Dean came back to school a size smaller and friends are requesting her “weight loss secrets”. They don’t know she was in treatment for an eating disorder over the summer and has developed heart problems and other health complications as a result.

So what is a school or classroom policy that addresses all of the situations above? Something similar to “We just don’t comment on other peoples bodies” can be the most effective message to dissuade body-talk (praising or teasing) among students and staff.


Encourage colleagues – administrators, school nurses, coaches and physical education teachers – to review the evidence for any interventions they are implementing with regard to weight, health or nutrition. 

Every school should be asking whether there is quality, health-focused research to back up the intervention and does this program have the potential to do more harm than good? The truth is, many of these practices lack research and may have harmful consequences, yet many schools and childcare centers continue to implement them. Examples of such campaigns and curriculums currently include:

  • Publicly weighing kids in gym or health class
  • Giving kids assignments that require them to count calories and track their food
  • Hosting “Biggest Loser” weight-loss competitions among school staff
  • Sending home BMI report cards for students or calculating BMI in class.
  • Shaming kids’ lunch items or teaching very young kids to label food items as good/bad or healthy/junk.

When it comes to BMI report cards, even the Centers for Disease Control (CDC) notes in their report that “Little is known about the outcomes of BMI measurement programs, including effects on weight-related knowledge, attitudes, and behaviors of youth and their families. As a result, no consensus exists on the utility of BMI screening programs for young people.7

There is no indication that providing kids and parents with BMI information leads to any significant behavior change or improved health outcomes. Furthermore, unless safeguards are solidly in place, a risk of harm exists when children are simply told there is something wrong with their body size. Risks for body comparison and weight-based teasing also increase.8

What else are you doing to reduce weight-based teasing and make your classroom a safe place for students of all shapes and sizes? Tweet us @CEDSheppPratt today and share your experiences. 

 


Body Positive Resources:

For School Administrators:

Preschool/Elementary Kids & Parents:

Middle School:

High School/College:


Links to References:

  1. Ignoring it doesn’t make it stop.
  2. Beyond stereotypes: rebuilding the foundations of beauty beliefs.
  3. Perception of Overweight is Associated with Poor Academic Performance in US Adolescents
  4. Does Body Satisfaction Matter? Five-year Longitudinal Associations between Body Satisfaction and Health Behaviors in Adolescent Females and Males
  5. Onset of adolescent eating disorders: population based cohort study over 3 years
  6. Risk Factors for Body Dissatisfaction in Adolescent Girls: A Longitudinal Investigation
  7. A Report on the Facts and Concerns About BMI Screening in Schools

NEDA Congressional Briefing on Eating Disorders

CED Co-Director, Dr. Steven Crawford, among panelists to speak on Capitol Hill

The National Eating Disorders Association (NEDA) in conjunction with the Congressional Mental Health Caucus hosted a Congressional Briefing on Capitol Hill on October 2, 2018. This briefing was held to educate representatives and legislative aides about eating disorders in overlooked populations. Panelists at the briefing included Chevese Turner (moderator), Mike Marjama, Claire Mysko, Janell Mensinger, PhD, and Steven Crawford, M.D.

Dr.Crawford, co-director at The Center fo Eating Disorders at Sheppard Pratt, began by discussing the different eating disorders and the risks and causes associated with them. He explained the differences in each disorder and the ways someone can help if they notice symptoms of an eating disorder in someone they care about. These include, seeking more information on the subject, locating resources, not focusing on weight, and encouraging the person to seek specialized treatment.

Dr. Janell Mensinger, an Associate Research Professor at Dornsife School of Public Health at Drexel University, presented on eating disorders and population weight. Her presentation focused on people in higher weight bodies and she explained how weight-related harassment is over four times more common than bullying. She stressed that we, as a society, need to shift focus from weight to health and provided research that shows eating disorders and extreme dieting are increasing among people in higher weight bodies.

The next panelist Claire Mysko, CEO of NEDA, spoke about a prevention program called the Body Project. The Body Project is a group-based intervention that helps decrease eating disorder symptoms and body dissatisfaction in high school girls. There are currently 388 trained facilitators for this program across the United States. Mysko also mentioned how NEDA is working on a similar program for young men.

The final panelist was former Seattle Mariners Catcher Mike Marjama who now serves as a NEDA Ambassador. Marjama presented his personal struggle with body dissatisfaction and an intense desire to change his body, which led to extreme behaviors around food and exercise, an eating disorder diagnosis and eventually hospitalization. His treatment and recovery however, led him to a baseball career and renewed appreciation for mindfulness and balance. After retiring he decided to speak openly about his disorder and his story has since been featured on Good Morning America. As an Ambassador for NEDA his goal is to help boys and men see through outdated stereotypes about eating disorders so they can get the help they need.

Eating disorders are one of the most dangerous mental health issues and should not be taken lightly. Unfortunately, they are too often overlooked in people with higher weight bodies, in athletes of all calibers and in traditionally marginalized populations. Our hope is that the information shared in the Oct 2nd hearing will assist legislators in creating policies that not only support prevention and treatment for eating disorders but improve overall public health.

Additional Advocacy Resources:

  • Get involved, learn about state-specific legislative actions and become a NEDA advocate.
  • Read summaries of current legislative actions, read about current initiatives and get involved with advocacy days on Capitol Hill with the Eating Disorder Coalition.
  • You can find out more about The Center for Eating Disorders’ recent advocacy work here.

Written by: Julie Seechuk, Social Work Intern 

8 Tips for Raising Body Positive Kids (Who are also Competent Eaters)


If your goal is to raise kids with high levels of self-esteem, eating competence, body satisfaction and a healthy weight (which is different for everyone) then join the chorus of advocates saying #wakeupweightwatchers and ditch the diet mentality for yourself and your family.  We know weight-loss diets don’t work. We also know they can cause serious harm, especially when introduced to kids and teens.  Let’s prevent the weight loss industry from profiting off our children’s generation.

So if dieting doesn’t work to help kids maintain a healthy weight, what is a parent to do?  These 8 tips are a great place to start.

  1. Make a commitment to having family meals together as often as you can within your family’s schedule. Having regular sit-down meals as a family has been shown to be a protective factor against a range of health and mental health problems including disordered eating.1,2,3,4 
  2. Introduce and incorporate a variety of foods from different food groups at every meal. This doesn’t assume your kid will actually eat them but it’s important to expose them, even if it’s just on someone else’s plate.
  3. Teach and model body acceptance (as opposed to body criticism or body comparison). Kids are always listening and watching how the adults around them relate to their own bodies.
  4. Support your child’s natural ability to regulate hunger and satiety. Promote trust in their ability to self-regulate. We recommend learning more about Ellyn Satter’s Family Feeding Model and the Division of Responsibility in feeding.

Research has shown that size acceptance and learning to use hunger and fullness cues produces sustainable improvements in blood pressure, cholesterol levels, physical activity, self-esteem, and depression compared to dieting.” 5

 

  1. Engage in physical movement as a family with the goal of adventure, fun, coordination and social connection. Try not to frame exercise as punishment, as a way to gain permission to eat or as a means to an end (i.e. weight-loss).
  2. Incorporate all foods without fear or mixed messages. Food is energy and fuel but it’s also okay for it to be enjoyable too. Don’t forbid specific foods or categories of foods (unless there is an allergy of course). Refrain from using food as a reward at home and in the classroom as this can confuse kids, encourages them to eat in the absence of hunger or may lead to a pattern of rewarding oneself with food.6
  3. Refrain from labeling foods as “good foods” vs “bad foods”. Connecting foods with negative labels like bad, toxic or junk foods, can send kids a message that food is related to morality. Even young kids may internalize these labels. Ex) I ate a bad food, therefore I must be bad or I should feel badly. This can trigger strong feelings of guilt or shame related to eating as well as increased emotional eating.
  4. Support healthy sleep habits. Kids who don’t get enough sleep, or have chaotic sleep schedules, show changes in hormones that regulate hunger and appetite. Not getting enough sleep can also impact the way a child’s body metabolizes certain foods.7

While these tips are meant to be a very basic place to start, they might still feel overwhelming since we live in a culture of toxic messages about food and weight. It’s hard to let go of anxiety about our kids’ eating behavior and weight. These can also be difficult to implement if you have your own history of body image struggles, eating disorders or dieting.

If you’re worried that your own relationship with food or weight might be complicating the way you approach these issues with your kids or teens you’re not alone. It can be helpful to get support from a therapist with eating disorder expertise or other non-diet practitioners. At The Center for Eating Disorders at Sheppard Pratt we provide a number of services that can help, including:

If you’re interested in any of these services, please call (410) 938-5252 for more information. 

Previous Post: 10 reasons NOT to introduce dieting during childhood & adolescence


References:

  1. Losing weight won’t make you happy
  2. Are Family Meal Patterns Associated with Overall Diet Quality during the Transition from Early to Middle Adolescence?
  3. Family meals during adolescence are associated with higher diet quality and healthful meal patterns during young adulthood.
  4. BENEFITS OF FAMILY DINNERS
  5. 10 Reasons to Stop Dieting Now
  6. Secrets of Feeding a Healthy Family: how to eat, how to raise good eaters, how to cook
  7. The connection between sleep and growth

Additional Recommended Reading: Weight Science: Evaluating the Evidence for a Paradigm Shift

 

10 reasons NOT to introduce dieting during childhood & adolescence


Weight Watchers recently announced that it will offer free memberships to teens starting this summer. This announcement led to parents, physicians, dietitians and therapists around the world speaking out – and rightfully so – about the harmful effects of encouraging dieting in our kids. Why? Weight-loss diets have not been shown to provide any long-term health benefits.  Furthermore, dieting remains a major predictor for the development of eating disorders and worsens negative body image.

If you have kids or teens in your life that are feeling the pressure to diet or lose weight,  here are ten important facts and considerations to bear in mind.


1. Restrictive diets negatively impact children’s normal stages of growth and development. 

“Dieting is associated with potential negative physical health consequences. Nutritional deficiencies, particularly of iron and calcium, can also pose short- and long-term risks. In growing children and teenagers, even a marginal reduction in energy intake can be associated with growth deceleration1

2. Dieting is a major risk factor for the development of eating disorders. It can be hard to recognize eating disorders in teens or children, as many harmful attitudes about weight and food have become normalized in our culture. However, the problem is very real. And eating disorders don’t discriminate by gender, body type, ethnicity, or social status. According to Dianne Neumark-Sztainer, Ph.D., in the U.S. alone, more than 50% of adolescent girls and 33% of adolescent boys have used unhealthy weight control behaviors. Even when such behaviors don’t develop into clinical eating disorders, they can still have a significant negative impact on physical and mental health.

3. Dieting disrupts children’s innate ability to eat intuitively. Dieting teaches kids to override natural hunger and fullness cues which can have lifelong effects.

4. Diets often rely on externally mandated measures of food or fullness which  undermine our innate ability to feed ourselves well. Using external systems such as “points” or other charts and arbitrary ways of monitoring food intake teaches kids to shut down or ignore their own internal regulatory systems (including hunger and satiety cues) and to mistrust their own bodies.

5. Focusing on weight is problematic as it is not a reliable measure of health. Furthermore, weight-focused discussion in and of itself is a risk factor for obesity and eating disorders.

“Several studies have found that parental weight talk, whether it involves encouraging their children to diet or talking about their own dieting, is linked to overweight and EDs.” 2

6. Dieting teaches kids to associate eating with feelings of guilt and shame as opposed to viewing food as fuel and energy.

7. Dieting negatively impacts body image. Weight fluctuations, common with dieting behaviors, often end up fueling the cycle of body dissatisfaction and disordered eating.

8. Findings clearly indicate that dieting and unhealthy weight control behaviors predict significant weight gain over time.3 Weight loss diets are actually associated with higher lifetime BMI.

9. Weight loss diets are associated with decreased metabolism, food preoccupation, and binge eating.4

10. Weight loss diets are associated with increased rates of depression and decreased self-esteem.5,6

Once we all understand the facts about how diets actually impact children (and adults), we can help families focus on implementing actual evidence-based strategies that we know are more likely to result in positive outcomes and healthier kids.

The question becomes: How can family members and friends best support our nation’s youth towards a peaceful relationship with food and positive body image without introducing potentially harmful diet routines?

Check out our next post, 8 Tips for Raising Body Positive Kids (Who are also competent eaters) for some basic ideas and strategies.

References:

  1. Dieting in adolescence
  2. Preventing Obesity and Eating Disorders in Adolescents
  3. Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index
  4. Intuitive Eating Category: Studies
  5. Risk and protective factors for depression that adolescents can modify: a systematic review and meta-analysis of longitudinal studies.
  6. Losing weight won’t make you happy 

Contributors:
Rebecca Hart, R.D.
Caitlin Royster, R.D.
Rebecca Thomas, R.D.
Kate Clemmer, LCSW-C
Hannah Huguenin, R.D.

12 Tried and True Ways People Upheld a Recovery-Focused Holiday


Looking back on this holiday season, it’s safe to say that social gatherings and celebratory feasts posed some significant challenges for anyone trying to develop a more peaceful relationship with food – including those in recovery from an eating disorder. That’s why The Center for Eating Disorders at Sheppard Pratt launched a social media campaign called the “12 Days of Eating Disorder Recovery.” The initiative shared tips on how to maintain healthy relationships with food through the holiday season and beyond. These are summarized below – one for each day of the 12 days – so you can use them to navigate future holiday seasons and get a little help finding the joy and peace within the hustle and bustle.


#12DaysofEDRecovery

Day 1: Keep expectations realistic and set manageable goals that will help you stick to your plan.

Regardless of where you’re at in recovery, celebrations, holiday feasts and schedule changes can pose challenges. Planning ahead and setting realistic expectations can help you stay focused on what truly matters.


Day 2: Grab a notebook or journal and write down all the reasons why recovery is important to you.

While you’re at it, make another list of support people. Figure out in advance who you will call if things get overwhelming or if you simply need to get out of your own head. Things that help you cope daily are still needed during the holidays.

If you’re headed out of town, pack your suitcase with your notebook along with other recovery tools. This could be tangible things like a fidget cube, fun book, art supplies or a favorite essential oil.


Day 3: Connect in safe and meaningful ways with others in recovery.

Recovery from an eating disorder is a journey that requires support, encouragement and ongoing motivation. Individuals with eating disorders and their loved ones can find hope and help in others who understand what they’re going through. Support groups and therapy groups can be a great way to strengthen recovery skills and help remind you that you are not alone.


Day 4: Set a goal today that has nothing to do with food, weight or your eating disorder.

It’s common for social gatherings to revolve around food in our culture, especially during the holidays. These celebrations often lead to an intensified emphasis on meals and eating for those working on recovery from an eating disorder. Keep doing what you need to do to fuel your body in recovery, but try also setting a goal for yourself that has nothing to do with food or your eating disorder.


Day 5: Don’t let your eating disorder make decisions for you in the grocery store. Use price or brand to inform decisions instead of reading nutrition labels.

Whether we like it or not, grocery shopping is part of adulthood. But for the millions of individuals living with an eating disorder, this everyday task feels overwhelming and becomes a significant barrier to recovery. If you are worried about buying items for upcoming gatherings or celebrations, this tip can help make grocery shopping more manageable.


Day 6: Defuse grocery shopping stress by bringing a friend, avoiding crowds and shopping at smaller stores in off-peak hours.

If you’ve had negative experiences with grocery shopping, you can start developing more positive associations. A Registered Dietitian may provide some easy steps for managing your grocery list.

Ask your dietitian for support, or consider adding one to your treatment team if you haven’t done so. You can also go with a friend or support person the first few times to help distract from any eating disorder thoughts and avoid being triggered by diet products.


Day 7: Infuse your New Year with body positivity and gratitude.

Be prepared to see your newsfeed flooded with New Year’s resolutions, gym memberships and diet plans in the coming weeks. To balance triggering and unhealthy messages, remember to reality check all the bogus weight-loss ads and surround yourself online and IRL with body-positive people and organizations.

Pay attention to which images and messages contribute to your feeling badly about yourself or your body and do what you can to remove them from your daily life. When you notice them, remove them (unsubscribe, throw them away, etc.) or challenge them.

Focus on gratitude for the functionality of the breath in your body, the ability to move, see, hear, taste or touch. Try to elevate those in your mind as you go through your day.

Create your own New Year’s goals with body positive thoughts. Work to set aside unhealthy ideals and embrace your body.


Day 8: Tackle eating disorder stigma by dispelling myths among friends and family.

Major misconceptions about eating disorders are widespread, even among those closest to us. Family can be a key component to recovery success. Unfortunately, some family and friends may still subscribe to ED myths that lead to stigma and might make it harder to ask for help or to seek treatment. Help educate and increase awareness about eating disorders among your loved ones.


Day 9: Friends and family can be a great support network. Be open with the people closest to you about how they can best support you.

Holiday conversations often revolve around what people are eating or not eating, who’s eating too much or too little and even criticism or praise about body weight and size.  Did this happen for you during Chanukah or Christmas this year?

The start of a new year can be a great time to enlist family members as allies by being open about your needs and boundaries. Set the stage for healthier gatherings in the new year by having a post-holiday conversation with them about how their words impacted you and what they can do instead to support you at the table and in other stressful situations.


Day 10: Meditate or listen to soothing music to start your day in a positive place.

It’s not just about food and body image. Incorporating mindfulness in the new year can be a way to care for your overall mental health. If you’re heading back to work or school after winter break, find a way to change up your routine to build in mindfulness practices.  Even just three minutes of meditation can help you set a positive intention for the day.

You can be mindful in your social connections too. Cultivate awareness about the different support each generation of your family can offer. Hanging out with cousins can be a nice way to connect and get support on specific life stage issues like being away at college, parenting stress, job hunting, etc. On the other hand, reaching out to older generations, like grandparents, is an opportunity to see how priorities can shift throughout life. Even the youngest generations have something to offer you in your recovery-focused festivities.


Day 11: Aim for balance and flexibility rather than perfection.

Individuals who are perfectionists often struggle with the urge to compare themselves to people around them. Research has shown perfectionism to be a significant risk factor for the development of eating disorders.

Constantly striving to be perfect with food or appearance during the holidays can lead to tension and stress. Even those holiday photo cards hanging around your house can trigger negative social comparisons. Try making some small changes to help ease perfectionist tendencies this time of year.


Day 12: Support is essential to your wellbeing. Recovery is possible with treatment and support.

Whether you are an individual working on recovery, or a loved one who is close to someone in recovery during this time of year, it’s important to remember that support is essential to wellbeing.

Remember, you don’t have to go through this alone.

Ask for help.

 

If you are experiencing symptoms of an eating disorder and you’re not connected to a therapist or receiving treatment, don’t wait any longer.  There is no reason to go through this alone. Call (410) 938-5252 for a free phone assessment today.


This holiday season, and year-round, carry these tips with you. Recovery is possible and recovery is worth it.

Easing Anxiety About Grocery Shopping During Eating Disorder Recovery

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Easing Anxiety About grocery Shopping - Woman with Shopping Cart [IMAGE]Whether we like it or not, grocery shopping is a necessary task of adulthood. It can be annoying or simply unenjoyable for anyone who is living a busy life or just doesn’t enjoy shopping or cooking. Most adults however, make it in and out of the grocery store regularly without significant disruption, problems or stress. But for the millions of individuals living with an eating disorder, an everyday task like buying food for themselves or their families feels completely overwhelming. Just thinking about going food shopping can trigger intense anxiety and may result in avoidance or elevated eating disorder symptoms. Actually going to the store and getting out before the milk gets warm seems impossible at times.

Since having consistent, structured and fulfilling meals are such a fundamental part of eating disorder recovery, being able to source and purchase the food for those meals then becomes a primary part of treatment.  If someone is too anxious to step foot in the store, obsesses over the label on every item or finds they just wander aimlessly, it can really inhibit their ability to bring home the foods they need to meet their nutritional goals. As a result, difficulties with grocery shopping can become a significant barrier to recovery. That’s why our Outpatient Nutritional Coordinator put together these tips to help individuals with eating disorders (or anyone really) navigate the grocery experience and become more confident in your shopping ability.

Plan, Plan, Plan: This is one of the most impactful tips! Planning your meals ahead saves you time and money. It can also decrease anxiety at meal times since you know that you have something in place and what to expect. In order to maintain stable meals, you must have a menu planned and food available to meet that plan; remember to incorporate foods from all food groups. Set aside one hour, one day a week for meal planning. Planning ahead also cuts down on the amount of trips to the store you need to take during the week.  One to two trips to the grocery store per week is reasonable

Organize your list: Based on your planned menu, create a grocery list. Breaking it down into the sections of the grocery store can cut down on time spent in the store. People that “wing it” end up wandering too long or revisiting the same aisle two or three times. Keep a pad of paper in your kitchen or a list on your phone where you can write down food staples that you run out of during the week; add them to your main grocery list before you go.

Be realistic: Set realistic expectations when you plan your meals. What do you have going on this week?  Which nights will you have more time to cook?  Which nights do you need something easy to assemble?  At which meals would it make sense to use leftovers?   Pick up a variety of foods that require different levels of preparation.

Mission possible: Set a time limit and stick to it.  Make it your mission to be at the register in 30 minutes or less.

Add support: Go with a friend or support person for the first few times. Whether they know you have an eating disorder or not, this will help distract from any eating disorder thoughts in your head and will keep you more on task.  Letting your support person know your goal of being at the register in 30 minutes or less can also help hold you accountable to not wasting time wandering aisles or compulsively comparing items.

Stick with what you pick: If you find yourself spending too much time reading labels or comparing similar products, try to make the decision based on which one is on sale that week. Choosing the item based on price can also help expose you to different brands and allows you to discover which one your taste buds truly prefer.  Another way to decrease label reading is to view the grocery store ad online before going to the store when making your list.  This allows you to view items without being able to read their labels and to commit to having them on your grocery list based on what is on sale.  This is helpful for reducing time comparing products, getting exposure to trying different products out, and can save you money!

Shrink the store: Sometimes it’s fun to shop at a large grocery store and to have a lot of options, but for some people more options = more anxiety. If that’s the boat you’re in, try shopping at a smaller store such as Aldi, Eddie’s, or the grocery section at Target.   It’s a lot easier to decide which yogurt to buy when you have three options instead of thirty!  Having less options of yogurt, cereal, bread, crackers, etc, can reduce time spent in the aisles and will help you get out of the store faster.

Ditch the diet products:
Avoid being lured into fat free, sugar free, “diet products.”  They do not satisfy and will only leave you feeling hungry and stuck in the “diet mentality.”  Normalized eating incorporates regular products that are more satisfying and enjoyable.

Avoid the crowds: Try to shop at times when the grocery store is not as busy. Typically during the week, 3-6pm tends to be the busiest time at the grocery store.  Sundays are also very busy days.  Try to go in the morning, later in the evening, or on Saturday.   You can also look your grocery store up on google maps and look at their “popular times” bar graph to see less busy times to shop.

Check your status:
Be mindful of your vulnerability factors.  Are you tired? Stressed? Hungry? If the answer is yes, plan on engaging in some self-care first and going to the grocery store when you are feeling more rested, stable and satiated.

Ask an RD: If you need help planning meals, making grocery lists, expanding variety, and setting goals for improving your confidence with grocery shopping, ask your dietitian for support. If you do not have a dietitian, consider adding one to your treatment team if you are working through an eating disorder.

Remember that with learning any new skill, it takes practice and time.   If you have negative experiences with grocery shopping in your past, try some of these tips to begin developing more positive associations with going to the grocery store. Over time, this will help decrease your anxiety around grocery shopping. Plus, having food available for meals will help you stay on track on your journey to recovery.


The Center for Eating Disorders is excited to announce the launch of a brand new Grocery Shopping Support Program designed to aid individuals working on recovery from eating disorders including anorexia, bulimia and binge eating disorder. Parents/Caregivers of children and adolescents are also eligible for participation. Program components and goals include:

  • Snack/meal/menu planning
  • Grocery list development
  • Incorporation of challenging foods
  • Efficiently utilizing time spent in stores
  • Managing impulsive food purchases
  • Identifying triggers and coping skills
  • Decreasing anxiety around food and food purchases
  • Exposure to food-based environment
  • Individualized treatment goals

If you’re interested in scheduling a grocery support appointment, please call (410) 938-5252.  If you have questions about the program you can also email Hannah Huguenin.


Written By: Hannah Huguenin MS, RD, LDN
Outpatient Nutrition Coordinator

Hannah has been an integral part of The Center for Eating Disorders’ staff since 2008, and provides individual nutritional counseling for the outpatient population. In her role at The Center, she manages the outpatient nutrition team and leads program development. She was instrumental in building the Center’s new Grocery Shopping Support Program. Hannah also provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.

What is a “Fear Food”?

 


At some point during treatment for foods_fearan eating disorder, most individuals will meet with a Registered Dietitian. One of the many important things you’ll do during those sessions is identify and discuss your personal list of fear foods. This is an important step that allows the dietitian to individualize treatment, help you plan for and overcome obstacles, and work alongside the rest of the treatment team to empower you in your recovery.

What are fear foods?
A fear food, or challenge food, is a term for foods that one finds difficult to incorporate into everyday eating. This term is used for foods that feel scary to eat, often because of negative thoughts or feelings related to the food’s nutrient content. Fear foods can be items or categories of food that one perceives to be “bad” and which, when consumed, might trigger feelings of intense guilt or shame. As a result, people with eating disorders often completely avoid or restrict their fear foods. Sometimes, just being around a particular food or being faced with the possibility of eating it can result in increased anxiety.

For people with anorexia, bulimia or binge eating disorder, these fears and the perception of certain foods as “bad” are often related to anxiety about anticipated weight gain and/or an inability to stop eating the food once they begin. In other words, there tends to be a strong belief that eating a fear food will instantly make you fat or that eating a certain food will make you lose control and overeat.

A person’s list of fear foods might be specific, like ice cream or peanut butter.  For others, their fear foods might encompass a whole category like all desserts or fried foods. Someone else’s fear food list might include an entire nutrient group such as carbohydrates. Common fear foods are also items considered by many to be tasty, but may also be labeled as “junk food” in our current culture.

Where do fear foods come from?
Fear foods develop from personal values, attitudes, feelings and even memories associated with a certain food. Messages from the people close to you – family, friends, coaches, teachers, healthcare providers – all play a significant role in determining your thoughts about food and can ultimately influence your (dis)comfort with particular food items.

Fear foods may also stem from a variety of impersonal sources including trending cultural ideas about food, media messages, advertisements or even nutrition information intended to be educational and beneficial. For example, there are multitudes of articles and news stories that include lists of supposedly good vs. bad foods, or foods that are better/worse for health.

Another frequent source of fear or shame related to food is dieting. Given that most diets limit or cut out certain foods, dieters start to believe that the eliminated food is bad. The more diets a person goes on, the more fear foods they are likely to have.

What are some consequences of avoiding fear foods?

  • Limited variety and lack of enjoyment in meals
  • Social isolation
  • Obsessive thoughts about the feared food
  • Worsening anxiety
  • Increased eating disorder symptoms and heightened risk of relapse
  • Prolonged negative relationship with food

People without eating disorders may have fear foods too but the consequences for those with eating disorders are much steeper since we know that limiting variety and continuing to avoid specific foods during recovery raises one’s chances for relapse. Two of our CED dietitians recently wrote in more detail about this topic for our friends at Eating Disorder Hope in a post entitled, The Importance of Incorporating Fear Foods and Challenge Foods in Recovery.

Remember, no single food has the power to make you thin or fat. And, ironically, the avoidance of a food is typically what leads a person to overeat it.

If you think you might need assistance reintegrating fear foods or overcoming negative thoughts about food and eating in general, please call The Center for Eating Disorders at (410) 938-5252 for a free phone consultation. 


In individuals with different eating disorder diagnoses, or those with co-occurring disorders, fear foods might manifest differently. For example, in individuals with ARFID, anxiety may be related to a fear of choking or to a perceived health consequence of eating the food item. In individuals with PTSD, fear foods may stem from associations with the traumatic experience.  In both cases, treatment methods may differ, and the treatment team should take into account the origin and underpinnings of each fear food when providing education and support.


Blog Contributors:
Hannah Huguenin, MS, RD, LDN
Samantha Lewandowski, MS, RD, LDN
Kate Clemmer, LCSW-C

Adventures in Self-Care with Melissa Fabello, Part II

 

MF 003
In honor of National Eating Disorders Awareness Week 2016 (Feb. 21-27), we asked body acceptance activist and eating disorder recovery advocate, Melissa Fabello to share her thoughts on some essential eating disorder awareness topics.  If you missed it, you can find her thoughts on self-care, perfectionism and dieting in Part I.

Below, in part II she opens the door to important conversations about body neutrality and intersectionality, and she also shares the one thing she wants people struggling with eating disorders to know about recovery.

 


Q & A with MELISSA FABELLO: Part II

 

Q: You recently wrote an awesome list of 50 body acceptance resolutions for 2016. In that list you introduce body neutrality as an alternative goal when body positivity feels like too much pressure. What did you mean by that?

MF: There are so many aims of the body acceptance or body positivity movement that I love. I have found so much comfort, joy, and support within those communities, and I am forever grateful to them for that. I’ve also found some missteps that I think need correcting, one of which being the push for everyone to feel beautiful and to love their bodies. I think that’s a lovely goal, and I also think it’s too lofty for reality.

Because the truth is that no one loves their body every single day – no one. Part of how body image works is that it can shift and that we all have good days, and we all have bad days. Mostly, when we have healthy body image, we simply see our body for what it is without ascribing any meaning to it whatsoever, and we exist, full of acceptance, in that body. To me, that’s what body neutrality is about. It’s about acknowledging and accepting our body as is, rather than pushing ourselves to have extreme feelings about it either way.

And I like to think of it as an option – not an alternative to the mainstream body acceptance movement. I like to think of it as something that someone can choose to work toward, if that goal feels more realistic than one of unconditional love. Perhaps, even, I like to think of it as a stop on the train toward a more loving relationship with our bodies. I just think that pushing people to love their bodies can backfire if it creates another standard to live up to.

 

Q: In all of your writing and in advocating for individuals with eating disorders, you take great care to acknowledge the true diversity of those who are impacted. From gender to age to race and socioeconomic status, why is it so important to you to highlight these marginalized voices in your work?

MF: Intersectionality – the understanding that intersecting social identities exist, a term that was coined by Kimberlé Crenshaw – is an absolute must in any and all work, I believe, but especially in work that stems from feminism. The ways in which we’re impacted by society differ, based on our identities. As a queer woman, for example, I experience life differently than a straight woman or a queer man. As a white woman, I experience life differently than a woman of color or a white man. Our positionality within the complicated web of identity matters because it affects how we move through this world. This is true in regards to body image and eating disorders, too.

We talk a lot about the thin ideal in our work – and that’s a very real, valid concern. We talk less, though, about how our beauty ideals are also centered on whiteness, on a heteronormative idea of gender roles, on access to money, on youth, and many other intersections. The further that we get away from the ideal, the more suffering we may experience as a result, and the more pressure we may feel to approximate those ideals. And I think that when we center the most marginalized – the people furthest from that ideal – in our work, then we help more people. When our work focuses on white, middle class, cis women, for example, then those are the only people that we help.

The eating disorder field has long focused its efforts on a very specific population, and I think it’s far past time to admit that and to work actively to eradicate the ways that that focus perpetuates systems of oppression like white supremacy and classism, among others. Different voices need to be centered because different 670_06_NEDAW_TWITTER_01_2016_P12experiences exist and have been ignored.

 

Q: Who do you think could benefit from attending your presentation, Adventures in Self-Care: Everyday strategies for nurturing an imperfect recovery in the real world?

MF: I think that anyone could, honestly! It’s been my experience that conversations around self-care can be difficult to have because so few people practice it. I’m going to talk a lot about what self-care means and why it’s important, but I’m also going to give ideas on how to start cultivating more self-care practices in your life – in ways that are easy and practical. I think that anyone who feels like sometimes life is overwhelming and they need some “me” time could benefit from this conversation – and isn’t that everyone?

 

Q: Lastly, what is the one thing you would want to tell someone who is struggling with an eating disorder and may be feeling ambivalent, hopeless, overwhelmed by or resistant to the prospect of recovery?

MF: I want them to know that those are very real and valid feelings to have. I want them to know that we’ve all come up against that at some point or another. And I want them to know that one of the biggest obstacles to recovery is believing that it’s one huge accomplishment that looks a certain way. It’s not. Recovery is about a whole bunch of tiny successes that lead you to a healthier, happier place – defined by you. Recovery is in your reach because you get to decide what it looks like and how to get there. But first, you need to take the first step of believing (even skeptically!) that it’s a possibility. And it is. I promise you that it is.

 

Continue the conversation with us on Facebook and Twitter using the hashtag #bmoreselfcare. 


Many thanks to Melissa Fabello for taking the time to share her passionate and thoughtful responses. If you’d like to hear more from Melissa, join us in Baltimore on February 21 to help kick-off National Eating Disorders Awareness Week. Don’t forget to RSVP. Space is limited. 

Download an Event Flyer to share or post:
Adventures in Self-Care…Everyday strategies for nurturing an imperfect recovery in the real world (PDF)

You can find Part I of our Q&A with Melissa here.

 



 

Adventures in Self-Care with Melissa Fabello: Part 1

 

If you’ve ever seen one of her YouTube videos than you probably already know Melissa Fabello is a talented and passionate activist.  She also writes boldly and beautifully about eating disorder recovery, body image, diet culture and a host of other important issues. In advance of National Eating Disorders Awareness Week and her presentation in Baltimore on February 21, we asked Melissa to share her thoughts on why self-care is not self-ish, the intersection of eating disorders and perfectionism, and her experience with recovery in a society obsessed with dieting.  We are honored to share her responses with you below.

 

 


Q&A with MelissA Fabello – Part I

 

Q: A lot of people assume self-care to be synonymous with personal hygiene or the daily chores of living. This can sound like a pretty boring topic. Given that you will be in Baltimore on February 21 to discuss the Adventures in Self-Care as part of National Eating Disorders Awareness Week, can you explain more about what self-care really is and why it’s something we should be talking about?

MF: To start, I would actually argue that self-care should, indeed, be a daily chore of living. It should be an intentional practice that we partake in – every single day – in order to take care of ourselves. It really can be as simple as getting the right amount of sleep, drinking enough water, or eating a meal that fuels your body. It’s finding ways to insert self-care into those daily chores of living, which in turn, creates a life that may feel a bit more adventurous.

And when I say “adventurous,” I don’t necessarily mean thrill-seeking, but rather, simply, more livable. And what is more of an adventure than life itself? Self-care puts you in the position to live life more fully and to experience it more broadly because it cultivates your self-awareness and forces you to consider what makes you the happiest.


Self-care, really, is just any set of practices that are nourishing to you – physically, emotionally, and spiritually. Those practices can be preventative (like taking care of your physiological and mental health needs to the best of your ability every day), and they can also be intervention methods (think: calling out sick just to spend the day taking a bubble bath and reading novels). But the point is that they are necessary to all of our lives, but especially necessary when we’re in eating disorder recovery.

 

Q: We often hear from patients who fear that engaging in self-care is a selfish act. How would you respond to someone worried about being, or being perceived as, selfish?

MF: That’s a real concern, and it needs to be validated as such. We live in a culture that’s driven by capitalism, and the number one value held by capitalism is that of productivity. Have you ever slept in because your body needed rest, but then berated yourself for not getting up early enough to start in on your housework? Or have you ever taken a much needed day off to marathon your favorite TV show, but then felt bad that you didn’t work on your school work, even though you hadn’t taken a day off in two weeks? That guilt is the product of believing that our worth is tied up in how productive we are.

670_06_NEDAW_TWITTER_01_2016_P12 This is especially difficult for women. In our society, men are frequently defined by what they do out in the world. Women, though, are judged by how they take care of others. As such, women’s moral development, according to Carol Gilligan, is all about how we understand ourselves in relation to other people. Women, in particular, are taught that taking care of ourselves and putting ourselves first is not only a selfish act, but even an immoral one. And that’s just straight up sexist.


One small shift we can make is to redefine what “productivity” means to us. I have an ex-girlfriend who was a hustler, trying to make it in the music business. As such, every day when we talked, she’d ask me, “What did you do today?” or “What did you accomplish today?” And sometimes that really overwhelmed me – because what if I didn’t “do” or “accomplish” anything? But the truth is that even if what I did that day was laugh while playing with my cat, or if what I accomplished was taking a trip to the bookstore for fun, then I’ve been productive. I’ve produced something: self-care. I think we need to remind ourselves that taking care of ourselves is an accomplishment.

 

Q: Perfectionism is one of several genetic traits that have been identified by research to be associated with an increased risk for the development of eating disorders. From your experience and observation, how does the topic of self-care intersect with tendencies toward perfectionism?

MF: I like to think of myself as a recovering overachiever, although I still fall back into those old habits sometimes. Again, in a culture where we’re taught to value our productivity, it can be hard not to fall into perfectionism as a way to prove our worth. But the truth is that we need to learn to be okay with the fact that none of us is perfect, that we’re all going to make mistakes.

One of the most valuable pieces of self-care advice I’ve received lately is that of learning to be okay with “good enough.” I’m one of those people who, when I give 75%, will feel guilty and ashamed for not giving 100%. What happens that’s interesting, though, is that no one can ever tell that I didn’t give something my all. As far as they can tell, I gave 110% because what I did was absolutely, positively awesome. Learning to be okay with “good enough” means giving something a shot, but not letting it run our lives, and feeling comfortable with the amount of attention that we were able to give something.

Part of self-care is being able to say, “I can’t (or don’t want to) work on this anymore because it’s possible that continuing to do so will damage my mental health. So I’m done now.” And that means letting go of the idea that we – and everything associated with us – has to be perfect.

 

Q: Another risk factor for eating disorders stems from the emotional and physiological consequences of dieting. What other impacts do you see from a culture that markets diets as a valid form of self-care and a path towards self-acceptance?

MF: I’ll be honest: The day that I actively decided to go through weight restoration was the day I realized that I could never be both thinner and happy. I could only ever be one of the two. I could spend every second of every day counting, measuring, and restricting in an attempt to achieve self-acceptance through (what I thought was) self-improvement, or I could attempt to apologize to my body and recreate a healthy relationship with food and within that freedom, find happiness. That concrete realization – that I couldn’t work toward a “better” body and experience day to day happiness – was a huge shift for me.

A spoken word poem that I really love, “When the Fat Girl Gets Skinny” by Blythe Baird, has a line in it that says: “This was the year of eating when I was hungry without punishing myself / And I know it sounds ridiculous, but that sh– is hard.” And it is. It is hard. Because we live in a culture that is so focused on dieting as, like you said, “a valid form of self-care and a path towards self-acceptance” that deciding to go against that grain and to seek validation and happiness from elsewhere is a radical act. And make no mistake: Giving up diet culture is a radical act, both personally and politically. Our culture thrives on making us feel small, weak, and less-than. Rebelling against that pressure, declaring that you will not be contained, and saying “no” to everything that our culture and media want us to believe? That is an incredibly courageous act.

 

Be sure to check out Part II of our discussion with Melissa in which she delves into body image and the concept of intersectionality as it relates to eating disorders.

Join the conversation on Facebook and Twitter using the hashtag #bmoreselfcare. 


MF 006Melissa A. Fabello, M.Ed. is a body acceptance activist, sexuality scholar, and patriarchy smasher based in Philadelphia. She is currently a managing editor of Everyday Feminism, as well as a doctoral candidate at Widener University, working toward a PhD in Human Sexuality Studies. Melissa has worked closely with The National Eating Disorders Association, The Representation Project, and Adios Barbie on campaigns related to body image, eating disorders, and media literacy. Find out more about Melissa and her work at melissafabello.com.