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ENews Quarterly

February 2012

What Not To Say – Preventing (Eating) Disordered Thinking

source: http://www.life360.com/blog/what-not-to-say-preventing-eating-disordered-thinking/

 

January 2012

Binge Eating Disorder: The Most Common Eating Disorder

Although over-eating around the holidays and on special occasions has become a “normalized” part of American behavior, for those with binge eating disorder  (BED)their relationship with food becomes a way to escape, calm, or disassociate one’s self from unpleasant situations or feelings.

According to the Binge Eating Disorder Association (BEDA), BED is more common than anorexia nervosa (AN) or bulimia nervosa (BN). BED occurs in 1 in 35 adults in the U.S. This translates in studies to 3-5% of women (about 5 million) and 2 % of men (3 million) who seek treatment.

BED is a distinct set of behaviors, often built to protect and serve as a coping mechanism for the individual.  The disorder is characterized by eating a large amount of food in a short amount of time, usually in isolation, and with high levels of distress, shame, and guilt about the bingeing. The disorder is not only rooted in genetics, but is also combined with environmental influences. Those affected use food to deal with stress, low self-esteem, interpersonal issues, weight stigma and bullying, and often co-occurring and untreated psychological disorders like depression, anxiety, bipolar, etc.

Bingeing often becomes an everyday occurrence, and holidays can be especially tough as the person navigates their anxiety around the meals, increased interpersonal situations, and the incessant “diet talk” that accompanies the bounty of food — all of which can be triggers.

BED will soon join the ranks with AN and BN and be recognized as a separate and distinct eating disorder with the publication of the DSM-V in 2013.  Chevese Turner, Founder and Chief Executive Officer of BEDA explains that, “Often people believe BED is a matter of managing weight  – if the individual resolves the weight issue or obesity, the eating disorder will dissipate. Nothing could be further from the truth and we do a huge disservice to those with BED when we conceptualize the weight as the primary problem –it is an eating disorder and should be treated as such.” When losing weight becomes the sole focus, recovery cannot be sustained because the core issues are not being addressed. The fuel for the behaviors must be met with tools that can serve as an alternative to bingeing so that the individual can live a healthy, happy, and productive life.

It is important that treatment providers are able to understand the nuances and best practices for this disorder: “We need to get the treatment community up-to-speed with the evidence-based and clinically accepted treatments that have emerged over the past several years,” says Turner. “It is critical that we are prepared for the individuals and families who are going to seek treatment as the general public becomes more informed about the disorder as a result of the DSM-V recognition.”

Common warning signs that a loved one may have BED are the following: 1) Does the person eat relatively normal sized meals when with others, but stashes food and eats alone even when not hungry?  2) Is there evidence of wrappers or food in bedrooms, cars, etc and is food missing on a regular basis?  3) Is the individual always on a new diet and seems distressed or withdrawn? If you see one or more of these warning signs, Turner suggests that you should express your concerns without blame or guilt and ask the individual to think about the possibility of consulting their doctor, counselor, or nutritionist. Although it is important to express your concern, if you are unsure or worried, it is probably best to seek advice from a professional.

 

December 2011

Holiday Eating: The Good, The Bad, The Scary!

by Tracey L. Cornella-Carlson, MD–Medical Director of Child and Adolescent Eating Disorder Services at Rogers Memorial Hospital

“I’M SO SCARED FOR THE HOLIDAYS!”   I’ll never forget the first time I heard those words.  I was certain something much more terrifying was going to happen than eating a meal.  Nevertheless, in a world of “good” food versus “bad” food, “healthy” versus “unhealthy,” the focus does tend to become the food and not the family and friends at the holidays.  Anxiety surrounding baking cookies or drinking regular hot chocolate (with marshmallows!)  – along with fear of getting too much candy in the stocking from Santa – truly sadden me and make me think what a tragedy it is that many of these supposedly grand, childhood memories and customs have been stolen by eating disorders.  How can we return the emphasis to connecting to others and obtaining  satisfaction via human relationships during these special times instead of emphasizing relationships with food?  I would propose that we encourage loved ones with (and without!) an eating disorder to feed the mind and spirit first, and the body will fall in sync.

In terms of mind – strive for flexibility and try to be reasonable about expectations during holidays. Be pleased with accomplishment of SOME of the “to do” list.  Be gentle with yourself and focus on what you were able to do in a day – and not on what you didn’t do. Learn to appreciate yourself. Be flexible in what you eat during the holidays and how you think about this.   Avoid extremes – no famine before or after the feast.  In other words, don’t skip meals in preparation for a holiday and don’t under-eat the day following a holiday if you believe you have eaten more than usual.  (Thank goodness we do still call that NORMAL eating, after all !)  Take a break from rigidity and self-inflicted criticism.  Set post-holiday, non- food   related goals. Get excited!  Dare to ignore those commercials regarding losing “the holiday pounds.”  There really is no law that says everyone gains weight over the holidays or that people should be dissatisfied with their bodies if they have developed different, temporary eating patterns while attending holiday parties, having company, etc.

In terms of spirit – prioritize — decide what you most enjoy doing during the holidays and make time for those things.  Be selfish and set limits – give yourself the gift of time.  Realize that stress is often created by the time you devote to making others happy.  Challenge yourself to let some things go.  Accept the things or family situations you cannot change…everyone has them.  Pull out your personal list of coping skills! Be grateful. Pay attention to lessons to be learned from people of all ages…… the two-year-old who knows how to say “NO,” and the teenager who is wise enough to value time with friends.

In terms of body –“listen” to your body and remember how “easy” and natural eating was as a child– you ate when you were hungry, and you stopped when you were full. Trust your body and yourself — there do not have to be “good” foods and “bad” foods – attempt to erase that concept of calories from your mind and remind yourself that your body does know what to do with that food. Too much emphasis on trying to make “healthy” choices at holiday meals can actually add stress.   Some people have grown up with fallacies such as “if something tastes really good, then it is really bad for you.”  Desserts or sweets are “bad” or “naughties.” We really need to keep in mind a couple things–one, it’s okay to celebrate the holidays with food. Don’t be afraid to treat yourself to your holiday favorites, things that you can only have when your grandmother is in, or enjoy when they are in season. And two, you CAN enjoy your favorites as long as they are eaten in moderation. So, just like Midwestern weather – the “good” and the “bad” will surely change –but for now, enjoy this season!

November 2011

“Orthorexia: Good Food Gone Bad”

An accurate depiction of healthy eating seems to have gone by the wayside as of late. In an effort to be healthier, Americans are turning to diets that are all-natural, raw, or organic for the sake of their health. And although healthy eating is good, when it becomes an obsession, a person may be in danger of turning healthy eating into something harmful.

More and more people are becoming so overly consumed by nutrition that they are turning their relationship with food and meal times into an isolative and restrictive activity, instead of a time of nourishment and fellowship. And, as healthy eating continues to become a mass market phenomenon, as local grocers are selling more and more alleged “super foods” or “power foods”, this unhealthy and obsessive fixation on health is why treatment providers are seeing more cases of orthorexia . Orthorexia is “a fixation on righteous eating,” which was coined by Steven Bratman, MD in 1997, and although it is not a medically recognized eating diagnosis, it is definitely a type of disordered eating that is becoming more common.

“I believe our culture continues to be utterly confused about how to eat,” said Juliet Zuercher, registered dietitian and nutrition coordinator at Timberline Knolls.” Some vulnerable individuals cling to this ‘eating religion’ for purity sake, but it can take a dangerous turn.”

What makes orthorexia different than other disordered eating patterns is the motivation. While someone with anorexia has a goal to be thin, people who struggle with orthorexia have the goal to eat healthy, but the obsessive thinking and compulsory behavior inevitably result in malnourishment and weight loss even though that is not their primary intention. In addition, eating disorder sufferers focus on the quantity of food and their behaviors are done in secret, whereas, those with orthorexia focus on the quality of food and are boastful about their “purer”, “healthier” life-style.

Just like those with anorexia, those with orthorexia have very rigid rules regarding the types of food they will allow themselves to eat. But, this obsession with “good” and “bad” foods can leave these food purists so malnourished that they can even die. People with orthorexia often avoid processed foods, which are considered “artificial” and preserved products, which are believed to be “dangerous.” Animal products are often avoided as well. In addition, those with orthorexia continue to add more foods to the groups of food that they will no longer eat, including certain fruits and
vegetables.

The problem is that it’s impossible to live on only certain fruits and vegetables. People with orthorexia are often severely thin and sufferers are malnourished. Their diet is lacking in many key nutrients, such as protein, iron, and B vitamins.

Advertisements, books, infomercials, etc., promote diets that exclude certain food groups, or that challenge people to eat according to their blood type, when in reality, moderation, balancing food groups, and avoiding oversized portions is truly the way to advocate for healthy eating. For our emotional and physical health we all need to eat a variety of food from each of the food
groups and engage in productive, social and physical activities.

 

October 2011

“Breaking the Rules”

By Sarah Steinmeyer, PhD, Director of the Eating Disorders Program at SovereignHealth of California

and Deborah McCarthy, RD, ACE certified personal trainer
and the clinical dietician of Sovereign Health

Exercise can bring a level of enjoyment and accomplishment as well as promote health. However, particularly for people who struggle with eating disorders, what begins as a desire to attain a healthy goal can become a form of intense mental and physical punishment: there is an obsessive interest in weight, calories consumed, and excessive training, often to the point of physical injury.  In fact, what begins as compulsive exercisemay progress into a more complex eating disorder.

The 2007 guidelines from the American College of Sports Medicine and the American Heart Association recommend that a healthy adult under age 65 get 30 minutes of moderately intense cardio exercise 5 days a week, or 20 minutes of vigorous cardio 3 days a week and strength-training exercises twice a week. In contrast, compulsive exercisers adhere to a rigorous and inflexible training schedule, usually working toward goals that are increasingly difficult and in fact unhealthy to achieve. “Guidelines” become “rules” which must not be broken.  Asexpectations approach the impossible, the inevitable failure to meet themprompts feelings of irritability, anger, inadequacy and guilt.

These destructive “rules” often come out of one of the thought patterns which have been characterized as cognitive distortions. They are strongly exaggerated or irrational beliefs that generate fear and other negative emotions, and which drive behaviors that are often destructive.  It is always the case that these “rules” don’t lead to a sense of pride or accomplishment, but rather elicit failure and despair when they are not followed exactly, as is ultimately always the case.  Below are some of the most common cognitive distortions as they apply to exercise:

“Shoulds”: Perhaps the most common cognitive distortion is the belief that we must motivate ourselves with the threat of guilt or punishment in order to get anything done.“I should add a new challenge to my workout routine every week (or else I’ll feel guilty).”

Emotional Reasoning: We believe that our feelings are actually facts—if we feel something it is true. “I feel so fat and disgusting!  I can’t possibly be around other people—they will think I’m repulsive.”

Jumping to Conclusions: We defeat ourselves in advance by anticipati.ng negative outcomes. “I won’t be able to maintain this schedule every day—I’ll only going to feel like a failure, again.

Polarized or “Black and White” Thinking: There is no “middle ground;” we fail if our efforts don’t achieve perfection. “If I don’t swim for two hours every day, why bother?”

Control Fallacy: When we believe that our behavior is under the control of others, we are investing in the fallacy of external control. “I couldn’t get my workout in because my boyfriend wanted me to go with him, so it’s his fault that I’m in a bad mood.”

The belief that we can control others’ attitudes and feelings represents the fallacy of internal control. “If I work out a lot I’ll have a dynamite body and I’ll make all my friends jealous.”

While these thought patterns are common to everyone, when they are the major sources of motivation and self-esteem, particularly with reference to self-image, health, and exercise, they can become dangerous.  Cognitive therapy emphasizes identifying these faulty ideas and replacing them with healthier, more reasonable andrealistic alternatives.  Here are some
effective strategies for doing so:

Be aware: Learning to recognize faulty thought patterns is a first step.  Usually feelings of guilt and inadequacy are a clue that we are engaged in cognitive distortions.  By re-examining the thoughts that lead to those feelings we become aware of the “bad press” we are giving ourselves.

Consider your “best friend:” Once we know what we are telling ourselves, it is often revealing to consider whether we would say the same to our best friend, or whether our best friend would judge us that harshly.  Is it true, for example, that you would see her as a “failure” for not meeting her goals?  Or, would your best friend tell you not to go out in public because you didn’t do enough reps and as a consequence looked fat and ugly?

Focus on what you do achieve: Whether it is with reference to exercise or some other activity, we can always find ways we could have done it better…faster…sooner…more  completely…etc.  That stream of thought only robs you of anyfeeling of pride or accomplishment.  Replacing those negative challenges with a realistic assessment of what you did complete (perhaps with some assistance from that “best friend” you have in mind) offers a healthier and more positive point of view.

Stay in the present: It is always possible to see how things could have been better when we look back, but doing so only makes us feel helpless.  We’re blaming ourselves for
not having made changes that—at that time—weren’t available or possible or an option we were aware of.  If you must look back, use it as a reference for a change you want to consider in the future:  “Next time I’ll arrange my schedule so that I can walk during lunch,” for example.

We can avoid feeling helpless when we recognize that our behavior is always under our control.  If you miss a workout because you did what someone else wanted you to do, it was still your choice.  You can make a different choice if the same thing happens again. Owning your power is a great way to deal with feelings of helplessness, and a major factor in building self-esteem.

September 2011

University Life Can Trigger Disordered Eating

Although it’s hard to say goodbye to summer—days filled with smell of freshly cut grass, the sound of children running through the sprinkles and fireworks popping in the sky, the taste of juicy watermelon and burgers on the grill, days laced with baseball games, bike riding, bonfires, and days at the lake, the end of summer inevitably marks the start of something new—a new school year.

Whether you’re a freshman, embarking on an entirely new chapter in your life, or a senior returning for one last “hurrah” before the rest of your life finally begins, many are excited to leave home and gain their much needed space and independence from parents once August rolls around.

While going back to school is a time filled with endless opportunities for students to start fresh, transitioning back to school can have a triggering effect for eating disorders. Eating disorders can be triggered by any kind of major shift or dramatic life-change as well as stress, pressure, instability, etc.

“The two major life transitions that most commonly contribute to the onset of an eating disorder are puberty and leaving for college,” explains Dr. Kenneth L. Weiner, M.D., founding partner and medical director of the Eating Recovery Center in Denver, CO.

Amongst the excitement that a new year brings, consider some of the overwhelming changes that occur when students head back to college in the fall.  Leaving home for the first time, afraid of not having any friends or getting connected, stressing about grades, unsure of how to manage work and studies, feeling pressured to look a certain way, or fear of not being able to perform at the top, whether in sports or academics.

“College can present challenges as students adjust to living away from family, negotiating new relationships and coping with academic pressures,” said Nancy Zucker, Ph.D., head of Duke’s Eating Disorders program. “The transition is especially tough for [young adults who]…may use food and exercise to feel control over their life.”

For some, college truly does signify the start to total freedom and control, and this includes freedom and control over food intake. When students are unable to find healthy ways to cope with the pressure, stress, and angst they feel, some use disordered eating patterns to regain control of a life that may seem out of control. “Unfortunately, many students cope by obsessing over food because it helps them feel in control,” explains Alisa Shanks, Ph.D., an eating disorders specialist at the University of Colorado at Boulder (UCB).

University life can also exacerbate social pressures to achieve a perfect body because college students eat, sleep and work with their peers, which presents endless opportunities to compare oneself to others, Zucker said. Males and females alike may develop unhealthy attitudes and behaviors over food and dieting.

An estimated 11 percent of all college students are suffering from an eating disorder, and an ANAD study found that 86 percent reported onset of their illness by the age of twenty.

It is easy for students to slip through the cracks at college. Even very caring and attentive administration, professors and staff, let alone parents and family who may even be in another state or country, are often not around students enough to pick up the warning signs. So what can you do?

Informed students at schools can play a pivotal role in the early detection of eating disorders and in urging friends to seek treatment. Friends frequently take on the role of family in looking out for each other. This is why it is so vital that you educate yourself on how to recognize the signs of eating disorders and find the tools to help a friend. If you are worried about someone you know and need suggestions on what to do, visit http://www.anad.org/get-help/how-to-help-a-friend/ for more information.

“Overcoming Eating Disorders.” DukeHealth.org. 15 Mar. 2006. Web. 1 July 2011. <http://www.dukehealth.org/health_library/health_articles/overcomingeatingdisorders>.

Hurd, Shannon. “A College Epidemic: Eating Disorders.” Collge Bound Network. Web. 01 July 2011. http://www.collegebound.net/content/article/a-college-epidemic-eating-disorders/1412/.