Dear Teachers, Coaches and Counselors,
As a mom, thank you for the endless hours spent caring, supporting, mentoring and teaching young people. Your job is truly one of selflessness. As a dietitian with an expertise in eating disorders, I would like to pass on a few suggestions to promote normal eating and healthy body image. Even if Health is not your subject, random dialogue about weight and food can be potentially harmful to those young people who are struggling with eating disorders.
We live in toxic environment for eating disorder recovery. We are constantly bombarded with media messages that thinness equals perfection, success and beauty. Add that to our own relentless negative self talk that we are not good enough, not thin enough, not smart enough, and just not enough can take a toll on fragile tools of recovery. Here are the top 5 ways to prevent relapse.
1. Avoid the scale. Weighing, for most people, is a surefire way to slide the slippery slope to relapse. Most people struggling with eating disorders, distortions and low body esteem are likely to misinterpret their weight, regardless if their weight is higher or lower than expected. If their weight is higher than expected, feelings of being out of control, self loathing and body hatred are common. This can lead to more food restriction and excessive exercise. Sometimes weighing can trigger overeating. The person struggling with the eating disorder may feel so frustrated and defeated, they end up over or binge eating. This may go on for days or months until the next cycle of restricting.
If weight is lower than expected, the reward center of the brain does a happy dance. Fireworks explode and the Hallelujah chorus breaks out….until the person with the eating disorder looks down. “Hmmmm, one more pound and my stomach will be flat.” And thus begins the never ending quest for perfection.
2. Avoid “Recovery” Instagram, Tumblr, and similar sites. These so-called recovery accounts are another quick route to a rocky recovery. These sites typically advertise a person’s lowest weight, goal weight, current weight and pictures of stomachs, thighs and food. Is it really helpful to know all of this information? Those struggling with eating disorders tend to be a competitive group and these pictures are an invitation to relapse. Some of my clients also find talking about recovery or reading recovery books or blogs can be triggering. The authors often tell stories about the worst of times in the midst of their eating disorder which can lead my clients to minimize their own issues with food and body image. Perhaps even worse, my clients feel they are “failing recovery.”
3. Follow your meal plan. If you are in recovery from an eating disorder it is probably safe to assume that your hunger and fullness cues are faulty. Continued under eating causes hunger cues to disappear. Additionally depression and anxiety can lower hunger and appetite. Continued overeating creates an increased hunger. Most people in recovery need to use a meal plan as their guide for at least a year before embarking intuitive eating. Meal plans teach normal eating habits and skills that need to be relearned before doing it on your own. Meal plans normalize eating and even after hunger cues return, they provide a foundation for eating intuitively, the ultimate goal.
4. Not practicing daily gratitude. Need an attitude change? Try listing the things you are grateful for. Even negatives can turn into positives with perspective. For example, are you hating your body? Be thankful that you have a body and that you can walk, run and laugh. Gratitude can help shift values and broaden ideas.
The common assumption about people with anorexia is that they don’t eat or eat only healthy, nutritious foods, are frightfully thin and that they do not want to restore weight. This is true for some people who struggle with anorexia, but not all. In fact, people with anorexia range vastly in symptoms and appearance. The following misconceptions are things I hear regularly from my clients and families:
Myth 1. People with anorexia don’t eat. While some people with anorexia eat minimally, others eat regular meals and snacks. The commonality is that the person with anorexia consistently eats less than their body requires which leads to weight loss or maintenance of an artificially- low body weight.
Myth 2. People with anorexia only eat healthy foods. Fruits and veggies, no processed foods, whole or no grains are rigid rules of some people with anorexia, but just as many anorexics consume hamburgers, cookies and candy. How can this be? Many anorexics have figured out that quantity, not quality leads to weight manipulation. If intake is less than needs, regardless if the intake consists of calorically dense foods, weight loss is achieved. Other people with anorexia “eat for show.” In social situations, eating is normalized; however when alone the individual with anorexia makes up for eating by restricting.
Myth 3. People with anorexia are skeletal and frail. This is probably the most misunderstood myth. Because the media sensationalizes only the sickest girls with anorexia, our society tends to think that anorexia is defined as those girls whose appearance is extreme. The other reason this is difficult to understand is because all bodies are different. Weighing less than 85% of expected weight differs since expected weight is dependent on many factors including ethnicity, genetics, age and body frame.
Myth 4. If someone has been thin throughout her life, she doesn’t have a problem. In some cases a child or adolescent who has always been thin increases in height but does not keep up with expected weight gain.
Myth 5. People with anorexia do not want to gain weight. Some people who struggle with anorexia have a realistic body image and do in fact want to restore weight.
Everyone knows someone with an eating disorder and just because a person eats and looks “OK” doesn’t mean that she is healthy.
“I don’t eat all day but I still can’t lose weight!” If this describes you, then you may benefit by having your metabolic rate measured. Metabolism is a complex system of hormones and enzymes that converts food into fuel and determines how efficiently that fuel is burned. The process of metabolism determines the rate at which we burn our calories which, ultimately, affects how quickly we gain weight or how easily we lose weight.
Metabolism is influenced by many factors. Some of the factors that we cannot control include genetics, gender (males burn calories faster than females), and age (metabolism slows down about 5% per decade after age 40). The factors that we can control include the way we eat and exercise. Here are the facts to increase your metabolic rate:
Children instinctively know how much to eat. However, many children’s eating patterns may derail over time. Given the right temperament, environment and genetics these patterns may escalate into eating disorders. The following are 3 common scenarios that are important to watch for.
The Picky Eater: Jacob is an 8 year boy whose mother describes him as picky since age 2, but over the past year, has become increasingly difficult to fee. Jacob is sensitive to texture and smells. He will eat kid foods such as fries, chicken nuggets and pizza but he won’t touch fruits, veggies, and most animal protein. In addition Jacob eats excruciatingly slow, taking 8-9 bites before finishing a chicken nugget. Dinner lasts 45 minutes and mom prompts him to finish. Jacob has always had a slight build but has fallen from the 5th percentile for weight to less than the 3rd percentile.
What to Do:
Family meals are a priority for picky eaters. Family meals foster warmth, security, love and offer opportunities to model healthy attitudes towards food. Keep the mood light and relaxed. Avoid nagging or using meal time to discuss subjects that may cause tension.
Serve new foods in a kid-friendly way. This means cook the broccoli with cheese sauce or serve carrots with ranch. Put butter on vegetables or peanut butter on apples. Sure, its added fat however your child will certainly have more success with tastier vegetables and with time, will begin to accept “naked” vegetables. Be patient with food acceptance. It takes at least 10 exposures to new foods to be accepted and a picky child will require more exposures. Even if the food is not accepted for months, continue to place a bite on the child’s plate. Resist encouraging your child to take a bite. Studies support that the more a child feels forced to eat the more likely food will become a control issue. Also be careful to not applaud your child for trying a new food. The less attention that a picky eater receives about eating the less likely the child will spiral into disordered eating.
So what if your child will not eat the main course. Should you make him a peanut butter sandwich or bowl of cereal. NO! Unless you want to be a short order cook until your child moves out of the house refrain from offering alternatives. Instead offer milk and have sides that your child will eat, even if its fruit or bread.
The Vegetarian: Sarah is 13 and wanting to be vegetarian after watching an animal rights documentary. She has begun avoiding red meat but will still eat grilled chicken. She is continuing to eat dairy products, eggs and fish.
What to Do:
Imagine Sarah’s mom telling Sarah “you can’t eliminate meat, how would you get protein? You don’t even like beans or nuts and those are the main protein sources that vegetarians eat. I do not support you eliminating meat!” How do you think Sarah would react? Most likely Sarah will become even more convinced to be vegetarian. Now picture Sarah’s mom saying “ok, you can give it a try if you like.” If the elimination is not made into an ordeal and Sarah’s mom continues to cook foods she knows Sarah will eat (ie, grilled chicken) than the novelty of being vegetarian may disappear. Only 2% of teens are vegetarian so chances are good that this phase will be short. Equally important is to monitor that your child does not begin to restrict other foods, for example progressing to vegan, gluten free or eliminating starchy carbohydrates.
The Dieter: Alley is a 15 year old teen who wants to lose a few pounds because she feels her stomach, legs and face are big. She weighs herself daily. She uses an app to monitor her food intake. She avoids all starchy carbohydrates and desserts.
What to Do:
Make time to eat with your dieting teen. Teens who eat alone are more likely to under or overeat. Dieting teens frequently say they’ve eaten when they haven’t. Even if the whole family cannot eat together try to ensure that the dieting teen eats with at least one parent. At a minimum sit with your dieting daughter while she eats.
Avoid power struggles. If you demand that your child eat, she may make up for later by restricting, exercising, or self inducing vomiting.
Limit special foods that she may request. If you buy 35 calorie bread, pounds of fruits and veggies, spray butter, nonfat everything, your child may have a difficult time reintroducing regular foods. Make it a family rule for everyone to eat the same dinner. Once your child starts eating her own diet foods it is very difficult to reintroduce mom’s spaghetti and meat sauce.
Adolescent girls who diet have a 20% chance of developing an eating disorder within one year. Signs that signal that your child may require intervention include an increasingly restrictive intake, rigid and obsessive thoughts about food and a significant weight loss. Enlist the help of a treatment team before its too late.
Do you eat with enjoyment, find satisfaction with food and radiate positive vibes about your body? Or are you tortured with food, endlessly trying to limit your intake, only to be seduced by a Sprinkles cupcake? Take this quiz to find out how healthy your relationship with food and body image is.
When you look in the mirror do you:
A. Examine closely for new bulges, dimples or folds
B. Promise to limit desserts and wine
C. Think, “Hey! I’m looking pretty good!”
Someone compliments your appearance. You reply:
A. Thanks, but I’d look better if I lost 10 pounds
B. So, do you! Have you lost weight?
Your pantry consists of
A. Sandwich thins, fat free dressing, fat free yogurt and 100 calorie packs
B. Mostly fruits, vegetables and lean protein
C. A variety of all foods, including treats
Your 20 year high school reunion is approaching. Do you:
A. Promise to go to the 30th reunion when you lose weight
B. Choose the healthiest option and increase exercising
C. Pull out your yearbook to reacquaint yourself with names and faces
In the bookstore you gravitate to:
A. The latest book on weight loss
B. Cooking Light
C. Your favorite fiction
How You Score
For every “a” answer, give yourself 1 point. For every “b” answer, 2 points. For every “c” answer, 3 points. Add up your points and match your total score to one of the three following categories.
You may be struggling with low body image. This is characterized by persistent negative thoughts about your body and weight. Regardless of your weight, whether low, normal or high, you are never satisfied and always seeking to improve. There’s always some area that needs toning or firming. Your eating habits tend to be all or none. Either you’re eating low calorie, low fat foods or gulping chips and queso, enchiladas, rice and beans. Mondays begin with new vows to diet.
This pattern of dieting and overeating is detrimental not only to your metabolism but just as importantly, your sense of well being. If you’re not eating “good” you tell yourself you’re a loser and lack will power. If you’re eating “good” you’re on top of the world. In truth being “good” or “bad” has nothing to do with food intake! Additionally categorizing foods only further perpetuates the cycle of dieting and overeating.
Learning to eat a balance of all foods without judgment and guilt is the first step to breaking this pattern. Once “bad” foods are incorporated into your diet, overeating tends to subside. As eating becomes normalized, weight loss may actually occur.
You value health and it shows! You eat a balance of foods and practice moderation. Be careful, however, to not label foods. An occasional burger or cookie helps to prevents deprivation which prevents overeating. Nothing is fattening or unhealthy unless eaten in excess consistently! Also be careful when complimenting someone about weight loss. If that person regains, she may feel awkward and self conscious when she sees you again. Weight comments, even weight loss, places emphasis on appearance and isn’t a person more than their appearance?
You have a positive body image and a peaceful relationship with food. You recognize your body is your vehicle for life and appreciate all that it does for you. You’re able to accept the natural changes your body undergoes as it ages. Your food intake consists of a variety of foods, all of which you enjoy without guilt. You listen to your body signals about when to eat and when to stop.
Eating out is fun because you order what you like and are able to stop eating when comfortably full. You feel good about yourself and for who you are. Congratulations on modeling normal eating!
Pam Chin-Lai, MS, RD, LD, CEDRD specializes in the nutritional rehabilitation of eating disorders in children, adolescents and adults.