At some point during treatment for an 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.
Hannah Huguenin, MS, RD, LDN
Samantha Lewandowski, MS, RD, LDN
Kate Clemmer, LCSW-C
You can download and print your own copy of this handout here. Hang it by your desk or stick it in a favorite notebook to remind yourself about the importance of nourishing a healthy online experience.
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 experiences 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.
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.
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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.
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.
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.
Melissa 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.
Few things are 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 Beyondby 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
For more information and tips on healthy eating during college, read Mindful Eating on Campus: Part 2 HERE…
Written by Jennifer Moran, PsyD, Therapist and College Liaison at The Center for Eating Disorders at Sheppard Pratt; Originally published on 10/11/11
1. Vichaya Kiatying-Angsulee and freedigitalphotos.net
2. Susan Albers / mindfuleatingcafe.com
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Food logs are one of a variety of therapeutic tools used during treatment for an eating disorder. Food logs – also referred to as food records or food journals – can take many forms. Some people prefer to jot things down free form in a personal notebook while others do best filling out the prepared charts provided by their dietitian. Many others have gone tech-friendly and use an app on their phone to track info and share it with providers. Regardless of the form it takes, a food log does much more than track your food. A helpful format for food logs will include the time of day, a description of the meal or snack, actual food and beverage intake, location/setting of the meal and, most importantly, an individual’s thoughts and feelings before, during and after eating. Completing food logs and subsequently reviewing them with a registered dietitian can be a pretty powerful part of the recovery process. Not surprisingly, and perhaps because they can be so powerful, many individuals also experience some resistance to using them. If you’ve ever been encouraged to complete food logs as part of your treatment for an eating disorder but had trouble starting or committing to the process, we thought it might help to know why a dietitian would recommend doing them and the specific ways in which they can aid in the recovery process.
Completing food logs throughout the week maximizes time spent in session with your providers. Weekly nutrition counseling sessions are often 30 minutes long. It could potentially take up the most of that half hour to do a 24 or 48-hour verbal recall of your meals during the session. It’s easier to get down to business if the logs are already done. Plain and simple.
Food logs are like x-rays. If you hurt your arm and asked your doctor to put a cast on it, she would require you to get an x-ray first to see if, how and where it was broken. If you refused, she would only be able to give you broad advice, like “take a Tylenol and get some rest.” (If you’ve broken a bone before you probably know that wouldn’t help a whole lot). On the other hand, if your doctor could look at the x-ray of your arm she could fit you for the exact type of splint or cast needed, assign the proper amount of physical therapy, and provide individualized prescriptions for your pain. In much the same way, food logs allow the dietitian to give you tailored advice and individualized strategies, rather than simply relying on a general, one-size-fits-all nutrition goal.
Food logs provide insight into your bigger picture. Sure, your food logs communicate specific details from each meal, but they also show trends and patterns over the course of the week related to meal times, location, hunger/satiety cues, situational triggers and thoughts. Dietitians can often see connections on the food logs that patients don’t always see themselves. Seeing “the forest for the trees” allows the dietitian to offer the most useful and beneficial feedback to the patient. Let’s say you arrived home from work late and ate an entire large pizza. Looking back on the food log we may see that you had an 8-hour gap without a meal that caused you to feel extremely hungry. Perhaps a goal would be set to have an afternoon snack available for those situations to help you get to dinner hungry, but not ravenous. On the other hand, maybe you had a stable breakfast, lunch, and afternoon snack, but your dietitian notices you hadn’t allowed yourself pizza in six months despite the fact that it’s one of your favorite foods. A more appropriate goal in that situation would be to practice food habituation with pizza (exposure to a food over time makes the food less compelling) and having a support person around when you’re eating it for a while. The bottom line: It’s harder to learn from the incident when we only see it from one angle. Food logs help us both have more perspective on why things happen, to know whether the set-up was physical or emotional and how to address the physical and emotional needs going forward.
Food logs provide a way to monitor progress. Nutrition therapy is about making changes that improve your relationship with food and your health. We tend to set small weekly goals that create momentum towards overarching goals and bigger changes over time. How will either of us know if the goals are met if we don’t keep track of them? Keeping a food log provides an objective look at progress from week to week and month to month. It also takes the pressure off of you and your dietitian to recall from memory all of the details of your food and symptom use from the past month. Rest assured, as you heal from your eating disorder you will have many more important things to use your brain for!
Returning to a normal and healthy relationship with food means appropriately responding to hunger and fullness signals. It’s impossible to do that if your signals are broken from chaotic or disordered eating. The best thing to get your digestive system and metabolism back on track is structured eating – meaning adequate amounts of food with adequate frequency. Food logs aid in structured eating accountability, and structured eating over time sharpens your signals. Food logs and structured eating can provide the training wheels to help you get to a place of intuitive eating.
Food logs help connect your mind with your body. Putting your pen to paper before, during or after a meal increases mindfulness with eating which can decrease mindless eating. Logging intake with your thoughts improves your ability to tell the difference between emotional hunger and physical hunger. This practice also increases awareness to how certain foods make your body feel – energy, mood, mental clarity, digestive happiness, etc. Being aware of how foods make your body feel is important in working towards more sustainable and fulfilling eating practices.
Keeping up with food logs can help prevent relapse during transitions. If you’ve ever received care for an eating disorder in an inpatient or partial hospital setting, you know the transition into outpatient or even intensive outpatient treatment can be difficult as you are once again responsible for completing more meals on your own. One way to help maintain the stability or progress you made in the higher level of care is to continue to self-monitor your intake and associated emotions during that transition and promptly discuss any specific challenges you encounter with your outpatient providers. If you’re completing food logs, it’s easier to catch a slip-up before it becomes a full-blown relapse.
As mentioned earlier it’s not uncommon for individuals to question the benefit of food logs or to experience some resistance to the idea of completing them. A common reaction from patients is that, “writing down everything I eat makes things worse“ or “I don’t like doing food logs because it reminds me of acting on my eating disorder.” As providers, we completely understand that rigidly tracking food and exercise can often be a symptom of the eating disorder. That being said, there is a big difference between keeping a detailed, private food diary and collaborating with a dietitian to complete food logs during treatment. For one, the end goals are very different. If you tracked your food before it was probably to monitor strict adherence to dangerous eating disorder behaviors or dieting techniques. Those logs probably involved weighing, measuring, and counting calories and were done to benefit the distorted rules of the ED, not to honor or nourish your body. Conversely, the goal for food logs in treatment is to monitor weekly goals, help normalize eating behavior and to improve your relationship with food. When doing food logs with a dietitian, there is no good vs. bad, no shaming, no judgement. The role of the dietitian is not to be the food police waiting to condemn you. Rather, their role is that of a supportive detective. To examine the data, to see if there is something that is setting you up for problematic eating behaviors and then provide you with education and ideas to help make improvements going forward.
Still not sure? Here are a few additional tips for those of you who may have lingering fears about food logs…
For those that are embarrassed to show anyone… Does it make you nervous or uncomfortable to think about showing someone else a record of your daily eating behaviors? If you are worried that your dietitian will be shocked, grossed out, alarmed, or otherwise disturbed by your food log it can be helpful to think of the dietitian like any other specialist. Take a dermatologist for example. You might feel nervous or uncomfortable during an annual skin check but to the dermatologist, that’s what they do everyday – they look at freckles and moles all day long. Food logs and weights can be things that feel vulnerable to share, but remember, those are just pieces of data that the dietitian analyzes and they’ve seen and heard it all before. It’s their job to look at meal patterns and associated thoughts/behaviors. Vulnerability takes courage, but being courageous can lead to positive change. If you’re feeling shameful about sharing your food logs, remember this quote from AA – “secrets thrive in the dark and die in the light.” Being honest with your dietitian and allowing him or her to see your food logs is one of the first steps in moving away from the pain of the eating disorder.
For those who struggle with perfectionism… Food logs aid in improving nutrition behaviors just like practicing an instrument aids in learning the skill of playing an instrument. Writing down logs is intended to keep you in the mindset of practicing your nutrition goals for the week. The more often you practice a particular skill, the more it becomes a habit over time. That progression will not be perfect, and that’s a good thing. Even when you have a rough week and the goals aren’t met, food logs are still very helpful! As providers, we actually learn more from the rough days than we do from the stable days. The logs allow us to see and discuss what some of the barriers might have been to meeting the goal, so we know what to try or be mindful of the following week. Portraying a “perfect” day of eating when it’s not what actually happened is not helpful. Recording struggles or slip-ups in a food log allows us to work together to correct the focus and try again. Just like it takes practicing a song on the piano before you can play it without looking at the music – food logs keep you intentional in your practice of positive nutrition behaviors before you can naturally engage in the behaviors without the logs.
For those who don’t want to be stuck doing food logs for the rest of their lives (a.k.a. everyone)… Food logs are used to benefit an individual’s relationship with food and establish normal eating. To that end, the goal is never for someone to be reliant on tracking their intake or completing food logs for the rest of time. Rather, this is a temporary tool to help bridge the gap between eating disordered and eating intuitively. It might seem counter intuitive to spend your time tracking food in an effort to heal from a disorder that caused you to obsessively focus on food. But if your goal is to one day be free from disordered eating, it can help to remember this: learning a new behavior often requires focusing on it more before you can focus on it less.
If a dietitian has recommended that you try doing food logs and you were never quite ready to give it a try but you continue to struggle with your ED, it might be worth taking some time for self-reflection. Would it be worth trying something new? Consider what you would do if your car was stuck in the mud and the first two tow trucks to the scene couldn’t pull you out because they didn’t have the right tools. What would you say to a third one that came along with a different towing device? Trying something new can sometimes help you to get unstuck. Even if you have tried food logs before and just couldn’t commit to the process, perhaps approaching an old tool with a new perspective or deeper understanding of how it works, could make all the difference.
Not wanting to try food logs or other therapeutic tools suggested by your team, can be a form of avoidance. Consider whether you might be avoiding an awareness of particular behaviors or feelings. Are you trying to avoid being accountable to make changes? Are you avoiding acknowledgement of your body’s basic needs? If any of these resonate with you, try being honest with your dietitian or therapist about why you may have been resistant to doing food logs in the past. Ask for some strategies to make them more manageable or less anxiety-producing. Food logs do take time and you may not always like doing them, but there’s no denying that they can play an important role in facilitating positive change with the support of your treatment team. At the end of the day, doing food logs is temporary. A healthy relationship with food and your body lasts a lifetime.
Written by Hannah Huguenin, R.D. and Kate Clemmer, LCSW-C
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Are you struggling with an eating disorder but you’re not sure where to go for help? Contact The Center for Eating Disorders at Sheppard Pratt at (410) 938-5252 to do an initial phone assessment or visit eatingdisorder.org to learn more. You may also want to check out our upcoming free events and workshops.
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Hannah Huguenin MS, RD, LDN
Hannah Huguenin received her Bachelor of Science degree in Dietetics with a minor in Chemistry from Olivet Nazarene University in Illinois. She received her Masters degree from the University of Kansas Medical Center in Kansas City where she also completed her Dietetic Internship. During this internship, Hannah completed a rotation on an acute care eating disorder unit at the Research Medical Center in Kansas City. She has been with The Center for Eating Disorders since 2008, and provides individual nutritional counseling for the outpatient population. In her role at the Center, she provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.
Kate Clemmer, LCSW-C
Community Outreach Coordinator
Kate Clemmer earned her Master of Social Work degree from the University of Maryland, Baltimore in 2005 with a focus on Management & Community Organization and a specialization in Child, Adolescent & Family Health. Before joining the Center for Eating Disorders in 2008, Kate provided school-based therapy to adolescents and families in Baltimore City and coordinated a multi-school health education and prevention program. As the CED’s Outreach Coordinator, Kate currently facilitates trainings and workshops in the community, provides outreach to individuals interested in the Center’s services and coordinates the Center’s annual community events. These events include an annual Symposium for health professionals, the Love Your Tree Body Image Campaign, and National Eating Disorders Awareness Week. Kate also facilitates the Center’s community support group for individuals with eating disorders and their friends/family, held on Wednesday evenings.
Photo credit: freedigitalphoto.net and (in order) Stuart Miles, Boaz Yiftach, Africa
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MATT WETSEL is an eating disorder and body image writer and advocate. After suffering from anorexia as an undergraduate in college, Matt got involved with the Eating Disorders Coalition (EDC) doing volunteer lobby work and is now a member of the EDC Junior Board. Matt launched the blog, Until Eating Disorders Are No More in 2011 and remains a consistently well-informed and responsible voice in the recovery community. We’re honored to feature some of Matt’s personal insights about recovery in the post below and at the upcoming event Recovery in Real Life. You can read Matt Wetsel’s full bio here.
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Q & A featuring Matt Wetsel
Q: What is one fact about eating disorders that you think is most important for people to know and understand?
MW: We say it all the time but it’s always worth repeating, eating disorders are serious and must be taken seriously. Especially in America, we live in such a toxic culture that values thinness, promotes dieting, equates weight loss with health without exception, and encourages people to want to ‘improve’ their bodies as if they aren’t good enough already. All of these factors contribute to the trivializing of eating disorders, in popular culture but also within the medical establishment and especially the insurance industry.
It’s so expected of people to diet, to lose weight, etc. that it’s easy to slip into disordered eating behaviors that are actually quite unhealthy and, for some people, pave the way to an eating disorder. These behaviors are so normalized that the warning signs aren’t usually seen as such, but instead are rewarded by the culture and encouraged.
Q: What are some day-to-day differences between life with an eating disorder and living life in recovery/recovered from an eating disorder?
MW: I recall some studies that reported someone with an eating disorder spends maybe 90% of their waking hours thinking about food, weight, etc. When I was sick that was definitely true. It takes up so much of your time and energy that it starts to feel like it’s a part of you. When I would think about recovery, I was honestly terrified of what would be left of me if the eating disorder wasn’t a part of my life. I’d plan my social life, my free time, everything around food. I’d check the scale multiple times per day. I’d avoid friends and family just to avoid potentially having meals with them.
Now, meals are a central part of time I spend with people. I love to cook for friends, go to potlucks, things like that. I eat when I’m hungry, I stop when I’m full. I don’t remember the last time I felt anxious about eating, because it’s been years and years. Even when other hardships in my life have occurred (and there have been a few), I have healthy mechanisms for dealing with grief, depression, anxiety, etc. when life gets challenging. I don’t know what I weigh, and I don’t care.
Q: What feedback would you give to the support people – friends and family – of individuals struggling with eating disorders? How can they best help to aid in the recovery process?
MW: This is a tough but important question. I’m always afraid to be too specific because good advice for one situation could be terrible advice for the next, depending on circumstances. That said, I think it’s very important to not let the person you’re trying to help or support be the sole source of information on eating disorders. Take time to educate yourself on the subject through other outlets. Make time for yourself and find ways to let go once in a while. If you have to, see a therapist of your own. If you don’t take care of yourself, you’ll be less capable of supporting someone else. It’s like on an airplane, you always put your own oxygen mask on first. That’s hard advice to take when you’re watching someone struggle, but it’s true.
Q: Everyone defines recovery differently. What does recovery mean to you?
MW: Much like the previous question about day-to-day differences, recovery, in a word, means freedom. When you spend so much of your time and energy worrying about food, it’s difficult to be productive in other aspects of your life. All of my relationships suffered while I was anorexic. My GPA tanked. I was in pretty constant physical discomfort.
In contrast, I’ve made lifelong friendships doing advocacy work. I ran a half marathon in 2011 that would have been impossible if I hadn’t recovered. I’m free to figure out who I am and what I want to do with my life without anorexia calling every shot, and that’s a really beautiful thing.
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On February 22, 2015, Matt Wetsel will co-facilitate a free workshop with Benjamin O’Keefe entitled, Eating Disorders: Creating a More Inclusive Recovery Culture. The workshop will examine how cultural experiences affect treatment, the experience of the body and the eating disorder recovery process.
Diet season is officially upon us.
Weight loss companies are well aware that millions of Americans are actively making New Year’s resolutions. Armed with teams of marketers and millions of dollars, they’ve spent the last twelve months crafting their year-end advertising. And year after year they are wildly successful, at least in terms of revenue. According to this report, global weight loss markets were expected to be worth $586.3 billion in 2014. The U.S. is the largest contributor to that figure and was projected to reach $310 billion last year.
Yes, the weight loss industry has been preparing for an entire year. But, you can be prepared too. The first step is anticipating the messages that you will be bombarded with so you’re not caught off guard. Here are just a few of the diet industry’s strategies you are sure to encounter in the new year:
- They will make a lot of promises for a “better” you, a “more successful” you, a “happier” you, but most emphatically, a “thinner” you. They will use those terms interchangeably to try to convince you that you cannot be better, happier or more successful without weight loss. You can.
- They will pay celebrities enormous amounts of money to endorse what they are selling. Average salaries for celebrity weight-loss endorsers range from $500,000 to $3 million via ABC News.
- They will tell you this time will be different.
- They will make faulty connections between weight and health.
- They will use scare tactics and personal stories to appeal to your emotions.
- They will use before and after pictures that may or may not be the same person, are often retouched and photoshopped, or might just be stock images of someone who never used their product.
- They will try to convince you that your body cannot be trusted to do one of it’s most basic jobs. They will insist you need to pay them money to rely on external rules or charts for when and how much to eat.
- They will ignore the natural and healthy diversity of bodies by telling you everyone can be thin if they work hard enough. This also happens to be one of the four toxic myths that promote most body image and weight concerns. This cycle works very well for diet companies because the more concerned people are with their bodies, the more likely they are to engage in weight control behaviors. In other words, it is in their best interest to keep you dissatisfied with your body so that you keep buying their product and it keeps being ineffective.
- They will share short-term statistics from studies funded by their own investors to show how well their diet plan works for the first 3-6 months. They will not respond to requests for independent, long-term outcome studies.
- They may tell you their product is “not a diet but a lifestyle”.
- They will tell you your health is at risk. They will not tell you about studies like this which found the risk of mortality was higher among people in the underweight category than it was for those in the overweight category OR like this one which showed increased health behaviors led to improved health markers even in the absence of weight loss.
- They may even include the phrase “results not typical” in fine print at the very bottom of their full page ad or in speedy verbal disclaimers at the end of a commercial.
- It is only January yet still, they will tell you that summer is just around the corner and then attempt to make the case that your body is not “ready” for the beach. Spoiler Alert: If you have a body and you have the chance to go to a beach, then you are ready.
- Are we missing anything? Can you think of other trends or predictable marketing slogans used by the diet industry to try to sell their products? You can add to the list on our Facebook page.
Why is it important to be prepared?
The National Eating Disorder Association reports that 35% of “normal dieters” progress to pathological dieting, and 20-25% of those individuals will develop eating disorders. This is not because eating disorders are simply “diets gone too far” but because diets trigger biological, emotional and mental shifts in the way you process food and information about that food. It is well established that diets can…
- Dysregulate and weaken your body’s natural cues for hunger and fullness.
- Trigger obsessive thoughts about food and weight
- Cause intense cravings for off-limit foods
- Create anxiety about certain types of food and in response to specific situations involving food such as eating with other people or in public places when the diet-safe food is unavailable.
- Establish a pattern of failure, low self-esteem and distrust of one’s body
- Assign moral judgment to foods
- Develop a system in which exercise is used as a form of punishment instead of a fun or social activity
Clinging to the diet mentality or getting caught up in weight cycling is futile, not to mention potentially harmful to your health and your wallet. For individuals at risk for eating disorders, or for those in recovery, these dieting side effects can be even more dangerous and may create risk for relapse. This year, don’t let the diet season bring you down. Be prepared to stand up against diet pressures by knowing exactly what to expect. If you find yourself getting overwhelmed or tempted by the ads this season, print out the list above and try checking off all of the marketing tactics you notice. Then choose to move towards nourishment, self-care and non-judgment by inviting a body-positive friend to lunch, scheduling a massage, setting the table for a mindful eating experience or reaching out for extra support from a treatment provider.
Other Helpful Resources:
- Mindful Eating on Campus: Parts 1 & 2
- The Resolution Solution
- A Message for People Considering Their Next Diet (pdf) from Linda Bacon, PhD
- Ringing in the New Year in a New Way
- What is Intuitive Eating?
Join CED on Facebook for body image inspiration and recovery support.
*Above image courtesy of freedigitalphotos.net and a454
Linda Bacon, Ph.D. is an internationally recognized authority on weight and health. She will stop by Baltimore this fall for two events aimed at dispelling long held myths about weight and health within the medical community and in our society at large. A nutrition professor and researcher, Dr. Bacon holds graduate degrees in physiology, psychology, and exercise metabolism, with a specialty in nutrition. She has conducted federally funded studies on diet and health, and published in top scientific journals. Dr. Bacon’s advocacy for Health at Every Size (HAES) has generated a large following on social media platforms and the international lecture circuit. Her book, Health at Every Size: The Surprising Truth About Your Weight, called the “Bible” of the alternative health movement by Prevention Magazine, ranks consistently high in Amazon’s health titles. Her latest book, Body Respect: What Conventional Health Books Get Wrong, Leave Out, or Just Fail to Understand, co-authored by Lucy Aphramor, is a crash course in all you need to know about bodies and health.
We recently had the pleasure of corresponding with Dr. Bacon to get answers to some of your most popular questions about HAES, the work she does dispelling diet myths and her newest book, Body Respect. You can find Part I of her responses below, and Part II is available here.
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Q & A with LINDA BACON, Ph.D.
Q: What led you to pursue writing about and researching health and weight science?
LB: My journey began from own personal pain: in my adolescence and early twenties, I believed that I was fat, that there was something wrong with being fat, and if only I lost weight, everything in my life would be better: my parents would be more proud of me, I’d be more popular… Those thoughts sent me on the painful journey of fighting my weight, and included an academic search for a solution. What I found along that academic journey surprised me: the research contradicted many of the commonly accepted beliefs I held about weight. I developed a critical lens through my work first as a psychotherapist, next as an exercise physiologist and later a nutritionist. And that critical lens has been so valuable in re-learning how to look at myself, and my own relationship with food and my body, and come to a sense of peace and contentment. The war that was originally waged against my self – the fat on my body – was more appropriately waged against oppressive attitudes about fat. I’m now on a mission to share what I’ve learned, both to support others in their personal journeys and to support social change. Our culture plays a huge role in fueling our disconnection with self and it’s critical we move towards a more just and compassionate world so that this struggle isn’t so normative. No one should experience the pain and body shame that I – and many others – routinely do.
Q: What are the most important tenets of Health at Every Size (HAES)?
LB: I see three aspects as being most important: 1) RESPECT, including respect for body diversity; 2) CRITICAL AWARENESS – challenging cultural and scientific assumptions; valuing people’s lived experience and body knowledge; and acknowledging social injustice as a hazard to health and well-being; and 3) COMPASSIONATE SELF-CARE – in eating, movement, and other areas. There’s a lot packed into those words, so here’s the simpler response: HAES is all about supporting people in moving towards greater acceptance and improved self-care, and advocating for the institutional and social change necessary to support that.
Q: Why do you think so many people continue to rely on dieting when the data isn’t there to back it up as an effective remedy for weight loss or improved health?
LB: I have a lot of compassion for dieters. The dieting belief system is so strongly a part of our culture and medical belief system, it makes sense that many people would buy into it and believe they are doing the right thing. And there is so much fantasy imbued in the results: the belief that one will be seen as attractive and successful, and that it will ameliorate disease. It makes sense many people grab onto it, and get a sense of hope when they try. And we’re taught to believe the “experts” rather than to trust our own experience. So when the diet fails to give them lasting results, the dieter blames him or herself, rather than the diet.
The diet is the problem and it’s the diet that fails, not the dieter. It takes courage to take our power back and recognize that the problem is out there, not in ourselves, that we have a system inside us well-designed to help us manage our weight, if only we trust it. The HAES journey is about helping people to understand that the source of their pain is not the weight itself – but the weight prejudice, and to reclaim their power to know what, when, how to eat, and a new attitude towards other self-care behaviors.
Not long ago, I had a very poignant experience of the damages of the diet mentality. I attended a wedding reception where there was a beautiful buffet of gourmet food. At one end of the buffet was the proud father of one of the brides. (I’m in California, where it’s legal for lesbians to marry.) He had helped plan this party; to him, sharing food was part of the ritual that brought his daughter’s friends and family together. At the other end, three women approached. One looked at the display and said, “Oh, I really shouldn’t.” Her friend commiserated, saying, “It really is tempting, isn’t it?” They all looked on sadly. This is the world we have created. These women are “good” dieters. For them, virtue lies in confronting the temptations of good food, exerting their willpower, and overcoming their desire.
This saddens me. I want a world where food is about nourishing us, body and soul, where we can celebrate with the shared ritual of eating. Where you eat what you want without guilt… and without bingeing. Where eating is uncomplicated by weight concerns.
Fortunately, that world is possible and the Health at Every Size movement helps to articulate it. I live in it myself, and I’ve tested it in a randomized controlled clinical trial. And my results have been reproduced by others. We have shown that people – yes, even “obese” people who are experienced dieters – can learn to dump the diet mentality and celebrate food, and that it results in improved nutritional choices and improved health outcomes. And that it does not result in that feared weight gain.
Q: In your new book, Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight, you and your co-author Lucy Aphramor write a lot about the influence of social justice on weight and health. What’s the most important thing you think people should understand about the impact of inequality and social differences on weight and health?
LB: I can sum it up in three words: “our stories matter.” Our experiences in the world get lodged in us on a cellular level. The experience of oppression, for example, triggers a chronic stress response, which in turn leads to weakened immunity and increased risk for many diseases. When we focus solely on an individual’s weight or health habits, we miss these structural and political inequities, and it stops us from addressing the policies and systems that have a far greater impact on our health. It also supports a culture of blaming individuals for their disease: e.g., “it’s your fault for getting diabetes; if only you ate better.”
How we get treated in the world has a huge impact on our health. Acknowledging the power of social status in determining health can help take the blame off of the individual and will have more significance for tackling health disparities than getting more people to stop smoking, or to be more active, or to eat more nutritiously. This doesn’t mean that we need to stop talking about behavior change: helping someone take better care of themselves is valuable. But it needs to be put in context. Once we understand this, it opens up new avenues for self-care and for how health care gets practiced.
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Interested? Want to learn more about Dr. Bacon’s research and how the focus on weight can obstruct us from achieving health? Read more in Body Respect Q&A with Linda Bacon: Part II.
Then join us in Baltimore on November 7th and 8th to see her speak. Visit our Events Page to reserve your seats.