When we think of Eating Disorders, we usually picture an emaciated, frail, skeleton of a girl that is often depicted on talk shows. The reality is people with eating disorders are not all skin and bones. Normal weight and overweight people can be plagued by the unrelenting intrusive thoughts about food and weight. Normal weight and overweight people can be restricting their food, self inducing vomiting and engaging in excessive, obsessive exercise. There are 30 million people suffering with eating disorders and 10 million are males. February 21-27 is National Eating Disorder Awareness week. To find out if you or someone you love may be struggling with an eating disorder, take the three minute confidential screening developed by The National Eating Disorders Association. This is a wonderful resource for individuals and parents, however it is not meant to replace a clinical assessment completed by a specialized licensed professional.
Please go to : http://screening.mentalhealthscreening.org/NEDA
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.
Are you looking for a summer job? Please note: if you are struggling with an eating disorder or even disordered eating, restaurant jobs are not a good choice! Food establishments are very tempting to want to work for. The pay is good and there are many to choose from. However, being surrounded by food, watching people eat, and working during meal times often can spell R E L A P S E. Just imagine that your shift that starts at 5:00 and ends at 11:00 pm. What happens to dinner? Imagine being flexible and eating dinner at 11:30 pm. Eating at night does not cause weight gain (unless you exceed your caloric requirements), but would you be OK with eating this late? Or would you eat dinner at 4:00? See how complicated this is! Additionally most people in recovery benefit by eating with other people. Your family and friends love you, but you may be on your own if dinner is at 4:00 or 11:30 pm.
So when looking for a summer job, think twice before applying at restaurants. Places to consider are craft stores, pet stores, shoe stores, book stores, and jewelry or accessory stores. And be sure to ask about lunch and dinner breaks!
Some of the best advice comes from my clients. Below are two statements of wisdom that can help keep you on the path of recovery:
“You can’t control the uncontrollable.” Yup, it’s true. Some things are not under the human power to control. One of those is the basic shape and size of your body. Your body is uniquely yours designed by your genetics. Food intake and exercise do play a role in your body shape, however if you have hourglass curves and yearn for a boyish figure, prepare for disappointment. Remember a German Shepard can’t be a Greyhound, no matter how healthy the German Shepard eats.
“Following my meal plan is part of my beauty routine.” A meal plan can be as basic as 3 meals, 1-2 snacks or more detailed, such as an exchange plan. Everyone, even those without eating disorders, can benefit by a meal plan. Regular meals boost energy, speed metabolism and help prevent overeating. Having regular meals requires weekly planning ahead and shopping and daily preparation and cleaning. This can be tedious and time consuming. When the process breaks down, we tend to make poorer choices.
This is the season of thankfulness and giving. Consider giving
yourself the gift of self compassion. One way that you can start
practicing self compassion is by saying something positive as you
stand in front of the mirror. Instead of pointing at your stomach
with disgust or analyzing your face for wrinkles, try saying "People
love me for who I am, not what I look like," or "I am more than my
body." Repeat this whenever you see your reflection-in a window,
elevator or walking between parked cars. Make this your best gift this
“You’ve gotten so big!” “You look like you’re getting curvy.” “ How do you get those skinny jeans off?” “You look so much healthier.” Yes, it’s that time again. Thanksgiving is the time where relatives are reunited and grandparents, aunts and uncles often give unsolicited comments about appearance.
I’m sure that these comments are well intentioned and are meant to be compliments. However, to the sensitive, appearance conscious young person (btw, is 90% of all young people), these comments ferment and often are misinterpreted. “You’ve gotten so big” means you’ve gained so much weight. “You look like you’re getting curvy” means you look hippy and wide. “How do you get those jeans off” means you are fat and you don’t know it. And “healthy” for most of my clients is code for fat. Even complimenting weight loss can be interpreted as you are valued more when you are smaller.
One of the most unappreciated comments that my clients talk about is “You don’t look like you have an eating disorder!” Remember, just because someone is weight restored does not mean that they are not struggling with intrusive food thoughts, unhealthy behaviors and negative body image.
What do young people want to hear? “You look happier.” Or “you seem to have more energy.” Better still, most of my clients would prefer no comments about appearance at all; instead a sincere “How are you?” may be the best way to reconnect.
“Now, I’m going to stuff my ears with cotton balls so I don’t have to listen to you anymore.” This is what one of my long time clients announced to me a few weeks ago. While she was slightly joking, she was also slightly being serious. Eating disorder recovery is hard. It’s a disorder where one must learn to eat, but not too much; learn to incorporate favorite foods, but in moderation; follow a meal plan, even if hunger and fullness cues are sending different messages. Eating disorders are an illness where one third do not get well. Those that recover, must be mindful and ever vigilant to squash negative thoughts and urges to use eating disorder behaviors.
My heart goes out to all persons in treatment for an eating disorder. These courageous people must be honest with themselves, willing to talk about things they don’t want to talk about and accept feedback that they don’t want to hear. Imagine having to talk about your own embarrassing, secret issues and negative coping behaviors and accept feedback. Cotton balls, anyone?
It’s true that breakfast is the most important meal of the school day. Studies show breakfast eaters have better attendance in school, improved test scores, and are less likely to be overweight. Here are some breakfast do’s and don’ts for busy parents and sleepy teens:
Delicious, but BEWARE, you'll be cranky in about 2 hours:
1. Kid’s cereal and milk
2. Granola bar or Protein bar
3. Waffles and Syrup
Acceptable, but count on needing a snack before lunch:
1. Greek yogurt and apple
2. Smoothie with protein powder
3. Yogurt parfait prepared with Greek yogurt, granola, fresh fruit
Energized and Fueled until lunch time:
1. Scrambled egg with cheese and tomatoes wrapped in whole wheat tortilla, grapes, milk or yogurt
2. Whole wheat toast or English muffin with nut butter, banana, milk
3. Overnight oats (1:1 ratio of rolled oats and greek yogurt or nonfat milk, dried fruits or nuts, chill overnight), strawberries
4. Canadian bacon, egg and cheese on whole wheat bagel, apple slices
5. Apple and peanut butter, granola bar, milk
“I’m following the Paleo diet.” “Sugar is bad for you.” “Gluten makes me bloated.” “I only eat foods that have ingredients I can pronounce.”
To most of us, conversations about food and diet goes in one ear and out the other. We might participate by asking a few questions or by adding our own beliefs about healthfulness, however at the end of the day, we are unlikely to make long lasting changes based on these conversation tidbits. Most of us will talk about wanting to decrease belly fat and, 1 hour later, munch on a cookie or walk through Costco sampling the food.
Unfortunately for those struggling with eating disorders, discussing or even overhearing diet advice is completely different. When a person struggling with eating disorders hears “I only eat whole grain pasta,” they think “Wow, I’m not eating healthy enough. I need to switch to whole grain pasta.” This modification begins innocuously as requesting the family to buy whole grain pasta, but may quickly progress to refusing to eat pasta unless it is whole grains, and eventually eliminating pasta completely. Remember, persons with eating disorders have temperaments that include perfectionism and obsessiveness. Their brains get stuck on ‘whole grains’ so if the only option is white pasta, they may be inflexible to the point of not eating. Eating a serving of white pasta one time is too risky for the rigid ED brain. Their thinking may sound like this: “Should I eat this? Will I be bloated if I eat this? Will my stomach hurt? If I eat this, should I change my eating later? Will this cause my weight to change? What if my clothes feel tighter? What is the calorie, carbohydrate, fiber, fat, protein difference? I’m trying to eat healthy and this white pasta will ruin it.”
Eating disorder treatment includes working on rigid thinking, filtering unhelpful information, normalizing eating and food exposures, however, every statement that the person with an eating disorder hears requires them to deliberately decide if the information is helpful for them. It is not easy for them!
Of course, we don’t live in a bubble! We all hear conversations that we don’t want to. However, if you know someone with an eating disorder be mindful that idle chit chat about food and dieting may unintentionally cause stress.
I attended a seminar last year about mindful laughter. The speaker had the audience stand up and purposefully laugh out loud for 1 minute. Yes, this sounds silly and I'm sure we looked even sillier. However, what a way to feel connected and have fun! Laughter lowers the stress hormone and strengthens the immune system. The average 6 year old laughs 300 times a day whereas the average adult laughs only 20 times a day. One way that I keep laughter in my life is by watching Ellen! Watch this excerpt for not only a few chuckles but also a bonus body image lesson.
True Confessions: I have been watching the 15th season of The Biggest Loser. I’m embarrassed to admit it because, as a Certified Eating Disorder Registered Dietitian, the Biggest Loser goes against all the principles that I know about permanent weight loss. I support moderation and balance in food and exercise. Participants of The Biggest Loser exercise 5 hours a day-about the amount of time most people work!
Last night was the finale and Rachel was awarded the grand prize. After seeing her gaunt face and bony body I’m wondering if her grand prize is Anorexia Nervosa. Yes, I know her BMI is within an acceptable range but the diagnosis of anorexia encompasses more than BMI. I wonder if she is able to consume an adequate amount of food so that she is not hungry or thinking about food all of the time. I wonder if she can eat a variety of foods, including grains and occasional sweets or desserts and restaurant foods. Does she have guilt or remorse after eating? Does she obsess about food, weight or exercise? How much does she need to exercise to maintain this new low body weight?
Anorexia Nervosa and Binge Eating Disorders are both disorders of extremes. Both are deadly and both interfere with quality of life. I hope that Rachel doesn’t end up spending her $250,000 prize on eating disorder treatment.
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.
1. Myth: “Pasta, rice, potatoes, and bread are fattening.”
Carbohydrates, specifically grains are still singled out as the culprit for weight gain ever since the wave of low carbohydrate diets in the 90’s. The truth is that grains are no more likely to lead to weight gain than any other food. The simple, but boring truth is: excessive calories from any source causes weight gain.
Hint: Choose 100% whole grain pasta, brown rice or whole wheat bread as these products have added fiber and are associated with decreased inflammation, a lower risk for heart disease and a decrease in all-cause mortality. Additionally be careful with calorie dense sauces and condiments such as butter, gravies and alfredo sauces. Instead go for marinara for pasta and try savoring the nutty nuances of brown rice and whole grain breads without rich toppings.
2. Myth: “Gluten free products will help with weight loss.”
In the past couple of years gluten free products have exploded and currently about 30 percent of Americans report reducing their intake of gluten. Gluten free products were originally developed for people with celiac disease-which affects 1% of the population-and those with gluten sensitivity-about 5 to 10% of people according to the NIH. For those who do not have celiac disease or gluten insensitivity, save your money. Gluten free products often have the same or even more calories than regular products. After all, gluten-free chocolate chip cookies are still chocolate chip cookies. The absence of gluten does not affect whether a food will lead to weight gain.
Hint: The key factor to weight loss is taking in less calories than you expend. Work on increasing fruits and veggies rather than eliminating gluten.
3. Myth: “Eating at night causes weight gain.”
Do you buy into the adage, “breakfast like a king, lunch like a prince, and dinner like a pauper?” If so the media wins again. Many people believe that eating in the evening makes the body store fat because it is not burned off with activity. In reality the time of day has nothing to do whether weight is lost or gained. Many people tend to overeat at night which leads to packing on the pounds but eating within your calorie requirements, even at 11:00 pm, will not cause weight gain.
Hint: Eating every 3 to 5 hours can help stabilize blood sugar and prevent overeating.
4. Myth: “You can weigh whatever you want to weigh.”
Do you get to choose your height? Choosing your weight is similar to choosing your height. Weight, like height, is influenced by your genetic makeup. Certainly eating within your caloric requirements and being physically active can help you lose weight; however if your family tends to be rounder than your chances of having a similar body type is high.
Hint: Accept that a natural normal weight for your body is based on an adequate, healthy diet and regular physical activity. If you radically reduce your intake in order to maintain a certain weight you’ll likely end up feeling feeling deprived, hungry and have low energy.
5. Myth: “If you can pinch an inch, you need to lose weight.”
Pinching an inch is NOT an accurate indicator of body composition. Not everyone carries weight in the same place therefore pinching in any one particular area is not indicative of excessive weight. Additionally without calipers and specific training, it’s impossible to know how much of what you’re grabbing is skin and how much is actually fat. Other factors such as age and skin elasticity also need to be considered. The bottom line is pinching your body may lead to feeling unnecessarily overweight.
Hint: You probably know if you are sporting extra pounds. Choose reasonable, measurable goals such as increasing water intake or eating less restaurant foods rather than losing inches.
“That dress makes your butt look big…”
What happened to the age old mom’s wisdom “if you don’t have anything nice to say, don’t say anything at all?” Perhaps people feel the need to give “constructive criticism.” Most likely however, the recipient of this “advice” ends up thinking they are fat and ugly. If you don’t have an eating disorder and have a good body image then perhaps these negative thoughts are fleeting. Imagine, however, the recipient who does worry about her size, shape and, like the typical American, overvalues thinness. Imagine that she constantly compares herself (negatively) to others, struggles with self esteem and is supersensitive. This scenario could be a set up for an eating disorder.
Can one comment cause a spiral into an eating disorder? No. The causes of eating disorders are complex and involve numerous factors including genetics and psychosocial traits. However when my clients talk about the development of their eating disorder almost all can identify a bone-headed comment that was directed towards their body. These comments haunt them for YEARS.
So, what can you say? Listed below are comments about appearance that WOULD be welcome:
1. You think I look nice.
2. You think I look very nice.
3. You think I look beautiful.
4. You think I look happy.
5. You think my smile is contagious.
6. I have a big piece of spinach in my front teeth.
7. My blouse button has come open and my bra is showing.
8. I am wearing two different shoes. (Please feel free to mention that.)
9. My clothes are inside out.
If in doubt, don’t say it!
The Anorexic’s Favorite Holiday
Tomorrow is Yom Kippur also known as the anorexic’s favorite holiday for those struggling with eating disorders. Yom Kippur is the holiest and most important day of the year in the Jewish faith. It is the Day of Atonement and recognized in part by abstaining from food and drink for nearly 26 hours. This can be tricky for people struggling with eating disorder thoughts and behaviors. Two common scenarios of fasting are :
Conversations with Jewish scholars concur; persons struggling with eating disorder behaviors could be excused from fasting due to health reasons. They suggest that sacrifice can take many forms, including fasting from TV, gaming, or even participating in gossiping. My recommendation is honor the holiday by focusing on prayer and/or attending services.
Happy New Year!
Pam Chin-Lai, MS, RD, LD, CEDRD specializes in the nutritional rehabilitation of eating disorders in children, adolescents and adults.