"I'm Thankful You're Not Me"

by Adriana Lewis


As Thanksgiving nears it starts to be a time where people reflect on their life and be thankful for everything they have. This year I’m thankful for those who are not like me and do not live like me.  I’m thankful for those who will actually enjoy their thanksgiving meal and eat their dessert. I’m thankful for those who will focus on time spent with family and not time spent on what and how much they ate. I’m thankful for those who will eat leftovers for days to come. I’m not thankful however, that this will not be me.


While those around me enjoy their meal I’ll stress out over every forkful I put into my mouth. I’ll appoint my husband my food body guard and push me out of the way of any dessert that may try to “endanger” me. I’ll focus on whether or not my family saw me put that third spoonful of mashed potatoes into my mouth or whether or not I finished my stuffing. Instead of leftovers I’ll eat lettuce and carrots for days to make up for me feast, which quite honestly probably will be a normal sized plate of food but to me seem like the Mt. Everest of dinners. This will be my Thanksgiving.


I’m told it is a mindset and I have the power to change it. If that were the case this article wouldn’t be written. My Thanksgiving would look like the typical American Thanksgiving. My fear is that I’ll never be able to change and be thankful for the same reasons everyone else is.. I know one day I may not be here to express my thanks if I continue on the path I’m on. One day at a time I suppose and hopefully one day will be a year from Thursday when I can say “today I’m thankful for my meal.”


Click here for Eating Disorder Resources. | Click here to visit #RecoveryUncovered

Sensory Issues in Feeding Small Children

This article was written by Teri Olbrot, OTRL, an occupational therapist with decades of experience in feeding young children and is currently in private practice.

 

Sensory Issues in Feeding Small Children

Introduction:

Picture a baby, teetering on his little bottom as he finds his balance, reaching out with tiny fingers for his first bites of food.  A whole new world of sensory experiences is at his fingertips!  A baby’s early feeding experiences should bring rich sensory discoveries of taste, textures and smells.  Exploring new foods and learning to eat should be happy, exciting, and fun for a child.  Unfortunately, that is not always the case.  As an occupational therapist, I frequently work with young children and their families regarding eating and feeding concerns.  Some of these children are ill and need different strategies and assistance to receive their nutrition.  Other children have the ability to eat, but self-limit their diet in unhealthy ways, putting their growth and development at risk.  While many children might be “picky eaters” at different times in their lives, most will outgrow their pickiness, if it isn’t reinforced.  This article is about another group of children, those who don’t respond to the typical interventions and have developed intense and often phobic responses to food.  Their poor relationship with food causes distress to themselves and their families, who are desperate to feed them, and presents a risk to normal growth and development.  Sensory Integration Theory offers an explanation for these difficulties and possible solutions.  

 What is Sensory Integration Theory?

Sensory Integration Theory was first described by Jean Ayres, an occupational therapist and neuroscientist, who defined it this way:  “The neurological process that organizes sensation from one’s own body and the environment and makes it possible to use the body effectively within the environment.”  This theory offers one way to understand a child’s difficulty with food.

Eating is a profound sensory experience, intimately involving the senses of touch, smell, taste, sound and sight.  Why we prefer one food over another is an enigma, difficult to explain.  The mouth feel of smooth pudding is very pleasant for some, but noxious to another.  A crunchy or chewy texture will please some and cause others to gag.  

Eating and feeding skills also involve the proprioceptive senses (muscle memory and motor planning) and vestibular senses (knowing where our body is in space).  We use these skills to grade how hard to squeeze a sandwich as we bring it to our mouth;  to determine how to grasp the handle on our coffee cup and take a sip while reading the newspaper; and how to navigate a spoonful of soup as it travels through space on its way to our lips.  

Another sensory skill is self regulation, which plays a big part in eating skills and mealtimes.  Self regulation involves impulse control, delayed gratification, following directions, and cooperating with others.

Our environment and meal time experiences also affect our sensory system.  Memories of eating and being fed with love, watching others eat with pleasure and joy, and experiencing new foods without pressure or force, influences our sensory system in a very positive way.  When eating is painful or difficult due to illness, when food tastes bad to us or if we simply aren’t hungry but must eat, our sensory reactions are impacted in a negative way.   

How negative eating patterns are reinforced:

Parents are often mystified and justifiably concerned when their child won’t eat and will try anything to get them to “just take a bite.”  Extended family and friends frequently weigh in on the matter, more often than not, adding more pressure than viable solutions.  Some of the more common strategies used, often learned by parents during their own childhood, include making the child stay at the table until the food is eaten, using a preferred food as a reward, or comparing the non-eater to someone else who eats “better.”  Even positive reinforcers, like stickers, high fives, verbal praise, are of limited or no value in building a healthy relationship with food.  There is no point in asking a child to “please eat it for me.”  

Once a pattern of refusal is in place, parents may beg, plead, threaten, bribe or punish their child out of desperation and helplessness.  They may follow their child around with food, or present an array of possibilities at mealtime, in the futile hope that maybe this time, their strategy will work.  Often, they rely on “junk” food to get calories in, or settle for a diet of highly flavored processed food such as chicken nuggets, sweetened cereal, or flavored yogurt.

 Is it a sensory problem?  Is it a behavior problem?

Paradoxically, the harder parents, caregivers, and even therapists try, the more imbedded the child’s eating problems may become.  Like the fable of the Wind and the Sun, we need to find a way to “warm up” the child, gaining his trust and cooperation, so that he or she feels safe enough to put his defenses down.  Force may win a battle or two, but never leads to a healthy relationship with food or happy family meals. 

It can be difficult to tease out where the sensory issues end and the behavior issues kick in, but as a child adapts his behavior in response to his environment, sensory issues can easily become problem behaviors.  The sensitive gag reflex may resolve, but the protests to and refusals of the foods that triggered it will remain.  

Tools for Therapists and Parents:

While a typical child will respond like a charm to modifying the mealtime environment, it is rarely that simple for a child with deeply imbedded sensory issues.  Mealtime modifications, however, are a crucial first step in the treatment plan.    

Here are some typical recommendations for structuring mealtime:  

    

  • Plan meals and snacks at regular intervals, i.e., every three hours.  Serve only water between these times.
  • Limit mealtimes to about 20-30 minutes.
  • Facilitate self feeding whenever possible by offering age appropriate foods cut into sticks or chunks that the child can manage on their own.
  • Limit verbal prompts.  “Take a bite,” “just try it,” “you liked this yesterday,” are not helpful.  This is very challenging for desperate parents and therapists, who feel they must do SOMETHING!  Pretend you don’t care.  Enjoy your own meal, while pleasantly smiling and making conversation.  Fake it!   T. Berry Brazelton points out in his book, Touchpoints, that if a parent or therapist permit a power struggle at mealtime, the parent/therapist will always lose.  It is much more empowering for a small child to watch us squirm than follow their appetite
  • Refer to Louise Satter’s Division of Responsibility:  Parents provide structure, support, and opportunities for eating; children choose how much and whether to eat.  

 Once a functional mealtime environment is established, the treatment plan continues.  An occupational therapist’s job is to analyze an activity (eating and feeding), determine where the activity has broken down, (food is thrown on the floor) then modify or change the activity in a functional way to meet a goal.  For instance, the first goal for the child who throws food on the floor is that he allows the food to stay on the plate.   The process can be summarized as follows:

 1.         Determine the “just right challenge” for the family and the child.  Break things down to what is doable today.  

2.         Implement gentle persistence.

3.         Be cognizant of what you can control and what you cannot.  The family and therapist control the treatment strategies; the child controls the pace of progress.

4.         Remember the goal:  Good growth and development; a happy relationship with food.  

5.         Keep your expectations modest because you might not get what you want.  Individual tastes and preferences are very personal.  Accepting someone just as they are, especially a child, is a huge gift. 

 With time and patience, teamwork, and a carefully designed treatment plan, a well nourished child and peaceful mealtimes are entirely possible.  

 

 

Person as Recovered: an Individual's Personal Perspective On Her Own Recovery

9-22-17

Person as Recovered

By an anonymous contributor

-my perspective/how does it feel to go through an eating disorder and see the other side…

 

Recovery is a long road, a winding rollercoaster with plenty of up and downs, twists and turns, but there are plenty of peaceful plateaus in which to focus on everyday life.  I am still whipping through the dramatic turns and dives as I confront my past and find peace in my present.  I am lucky; I have a wonderful child, a loving and supportive husband, and people that I can trust, including a support team.  I know that others do not have this.  Yet, I still need to ride the rails and learn to cope with the turbulence. 

Just in the past couple of weeks I have had a couple of tragic life setbacks.  Yes, they are the type of things that many others - with and without an eating disorder (ED) - hunkered down in their past, or present, experience.  For me they are compounded by the personal crisis dealing with the emotional and practical issues that helped trigger and strengthen my EDs.  At times the stress and anxiety can be too much to bear.  While it is important to address those issues that triggered and helped nurture my EDs, it has been a difficult journey to finally reach the point where I am ready to work with my therapist to confront and process those sources - those memories. 

This final big push to my long term recovery only started in the fall of 2015.  For me it all started with a dream.  (It is amazing the ways our minds and bodies operate when dealing with trauma.)  It was hard to confront what the dream/nightmare revealed, but soon afterwards my physical aches and pains began to diminish. Looking back, I realize that a great deal of my medical issues, fatigue, and emotional struggles, were symptoms of these childhood traumas. 

Hx:

My negative relationship with food started when I was very young.  By the time I was in middle school my ED was taking over, and by the time I was a freshman in high school I was hospitalized.

My family life was dysfunctional, and memories of sexual trauma and denial fueled my ED.  With the memories of the traumatic experiences suppressed, I could not understand the negative feelings and behaviors I was experiencing.  Yet now that I have begun to remember and process those ideas I am feeling better - emotionally and physically.  Recovery is a real thing.  It is obtainable.

During the height of my EDs’ reign, I could go two weeks without food or water.  While I still at times need to eat robotically with not much thought or enjoyment going into it, now I listen to what my body needs and I eat what I need to keep my body healthy.  I am rewarded by feeling better adjusting my diet to fit the needs of my body (i.e. increase my omega-3 fatty acids) when dealing with inflammation and drawing out the lactic acid with a couple shots of vinegar to deal with muscle pains.

While in the throes of my ED’s influence, I would purge to save myself from the possible harm I may have done by ingesting food.  Yet now I realize that the opposite was true and the food helps me do the things I love.  Play/work hard and eat well.  I am beginning to enjoy eating.

While I still have a long way to go to reach internal peace, my self-harming behaviors are in my past, as I have replaced them with alternate ways to deal with continuing struggles to come to terms with my past, make sure that I have a firm foothold in the present, and discover my potential future.

Get Your Tickets for Coloring Outside the Lines

Saturday, November 4th from 12 noon to 2 p.m. at Kazoo Books, 2413 Parkview Ave.


Local coloring book author Heidi Limburg will be on hand to talk about how to hand draw your own coloring book. Coloring pages and art supplies will be provided.


Colorful snacks along with handcrafted nonalcoholic beverages created by Angie Jackson the “Traveling Elixir Fixer” will be provided. The Traveling Elixir Fixer is known for her incredibly creative drinks infused with farm fresh herbs and fruits.


Tickets are $5 per person and can be purchased by clicking here.

http://www.southwestmichiganeatingdisorders.org/coloring-ticket

Bring a friend and enjoy a fun afternoon of relaxing coloring activities to support a great cause.

Direction: Away from Perfection

By Delaney Novak


All year SMEDA has been documenting several people's recovery journeys on our Instagram, #RecoveryUncovered, we are also featuring recovery stories on our blog. Here is Delaney's story.


What if I told you you’ll never be perfect?


Some shrewd, insightful human beings may shrug their shoulders, say something about how perfection is overrated and extremely uninteresting: “How pedestrian of you!” one of these levelheaded individuals might scoff as they go on their merry way.


Well I’m here to tell you that those individuals do not have eating disorders. What does that mean?


That means that half of you reading this are not those people, and the other half: you’re reading this because you know someone who is not those people.


Why?


Because if one has an eating disorder, they may very likely be a perfectionist.
My name’s Delaney and I am a perfectionist (the first step to recovery is admitting you have a problem, right?).


I’ve been plagued with the need to be perfect for as long as I can remember. Don’t believe me? I brought proof (what can I say, I’m a perfectionist!).


When I was in kindergarten, our class had to make Mother’s Day cards with cut-outs of our traced feet that had flowers growing out of them (the inside of the card said, “I love you from the top of my head to the tip of my toes!” How cute).

What Has SMEDA Been Up To Lately?

SMEDA's Current Outreach Activities

Bronco Bash:
SMEDA set up a booth at the 2017 Western Michigan University Bronco Bash on Sept. 8th. Students could sign up to win one of several prizes - including a $25 gift card to Down Dog Yoga or a one-hour free nutrition consultation with Trina Weber, registered dietitian. A beautifully-decorated wooden frame was available for students to take selfies with signs that read, "I'm with beautiful!" or "I'm worth it!" Over 60 students showed an interest in SMEDA!        -Trina Weber, MS, RD, LLC    (See FB for photos from the event.)

Instagram Project:
Part curated art project, part recovery journal, Southwest Michigan Eating Disorders Association has undertaken a unique community awareness project entitled “Recovery Uncovered.” . The project documents the powerful stories of recovery from an eating disorder of a number of people living in southwest Michigan. Their journeys will be documented on Instagram from September 2017 to February 2018. Along the way these survivors will document visually what it took to recover from their eating disorder.
People can subscribe now to “Recovery Uncovered” by searching on Instagram or going to the SMEDA website at http://www.southwestmichiganeatingdisorders.org/ and signing up there to follow the journey as it unfolds.

SMEDA is still accepting applications from eating disorder survivors, who would like to share their recovery journey as part of this project. Interested individuals should contact 123smeda@gmail.com .

-Angela Morris

 

 

 

 

Helpful Suggestions: For Parents of Elementary Students

This article was written by Cortney Modelewski, MA, LPC professional counselor at Cognitive Behavior Solutions and an active member of SMEDA.

For Parents of Elementary Students:  Working to Create a Positive Relationship with Food

My daughter decided she didn't like jelly after coming home from a sleepover. Her friend declared hatred of all fruit-flavored spreads, and my daughter soon followed suit and has not eaten jelly, jam, preserves, or marmalade within the last three years.
    
She is eight, and she continues to struggle with the conflicts between her wariness of food, her environment, and her hunger. These challenges are typical of elementary age children, especially younger ones.  Dovey et al (2008) provided a review of the research on children's eating behaviors. They outline the difference between what people call “picky eating,” which is having inadequate variation in diet, and “neophobia,” which is refusal or reluctance to try new foods. Environmental (i.e. home, school, and culture) and genetic factors play roles in how and why children develop these eating behaviors.

While you can't change your child's genetics, you can make changes to their environment. Here are a few tips from my household, which consists of a couple of vegetarians and a meat-and-potatoes guy, who collectively have food neophobia, sensory processing issues, food intolerance, and a food allergy.

1.    Caretakers are role models. I am not a big fan of breakfast. My child has started to say she doesn't like breakfast. I decided to suck it up and eat some toast in the morning because I want my child to eat breakfast before going to school.
2.    Enlist authorities. Our pediatrician gave my child the same speech I had given, but my child responded to the pediatrician because she's a doctor. She also started eating red peppers after a dietitian came to her school and talked about how vegetables are awesome.
3.    Make food fun! Kids like to make their own creations, and also like it when they have surprises at mealtime.
4.    Negotiate packed lunch menus. Say, “Would you like baby carrots or cucumbers in your lunch?” If my daughter has a better idea, such as broccoli, I am all for it.
5.    Try to have everyone in the family eat the same things. My husband may throw some meat on his plate of spaghetti, but we're all still eating spaghetti. This ties into the first tip. Also, your family does not pay you to be a short order cook, so don't do it. It's more frustrating and reinforces problematic beliefs and behaviors your child may have.
6.    It's okay to be frustrated when your child doesn't eat, but try not to fight. I have had many dinner wars in my time as a parent, especially after a cooked meal has followed a twelve-hour workday. Not worth it. Ask your child to taste the food – which doesn't need to include chewing and swallowing – and then drop it for the night.
7.    Unless you have a specific diet due to religious beliefs, there is no reason to call food good or bad, and if a person in your family has a medical problem that restricts certain foods, giving the restricted menu to your entire family every so often may help the child and others in the family understand the need for meals.

If you are concerned about your child's eating habits, do not be afraid to make an appointment with their primary-care provider to discuss these concerns.  UWHealth (2014) notes some red flags including weight loss, choking on food, frequent complaints about stomach pain, vomiting or diarrhea after eating, and moodiness. Your child may have a treatable eating disorder, anxiety disorder, or medical condition.

References and Resources

Terence M. Dovey, Paul A. Staples, E. Leigh Gibson, Jason C.G. Halford, Food neophobia and ‘picky/fussy’ eating in children: A review, Appetite, Volume 50, Issue 2, 2008, Pages 181-193, ISSN 0195-6663, http://dx.doi.org/10.1016/j.appet.2007.09.009.

University of Wisconsin Hospitals and Clinics Authority [UWHealth] (2014). Health facts for you.  https://www.uwhealth.org/healthfacts/parenting/518.pdf

We Can! Ways to Enhance Children's Activity and Nutrition. https://www.nhlbi.nih.gov/health/educational/wecan/index.htm

Helpful Suggestions: Going Back to School for Middle and High School Students

This article was written by Cathy Cook, LLPC, TLLP, RD Nutritional Therapist at Life Coach Psychology and an active member of SMEDA.

Going Back to School for Middle and High School Students

     The start of middle and high school brings excitement to see old friends, meet new friends, and the possibility to learn new material and succeed. The new school year can also bring anxiety ridden thoughts of “will I fit in?”, “can I succeed in school?” and “where will I sit for lunch and with who?” Going back to school can be an exciting, hopeful time but can also be a dreadful, anxious time, especially with an eating disorder.

      Before getting into tips with the transition, it’s important to understand an aspect of adolescence. All adolescents experience to some degree aspects of egocentrism which was first discussed by psychologist David Elkind. He described two related beliefs of natural self-centered behavior, which can be seen in the late tween and teen years:   the “imaginary audience” which includes a belief that peers are watching and critiquing their every move, and the “personal fable,” a belief that they are somehow special, unique and invincible. Why am I bringing this into a discussion of eating disorders in middle and high school? Because this is the target age of those thoughts and behaviors that can exacerbate eating disorder behaviors, and keeping them in mind may provide an opportunity for discussion and understanding.  

      Knowing your child, and considering normal adolescence, here are some thoughts to help ease the transition:

1)    Start the new school routine a few days or week ahead including sleep patterns and meal times.  

2)    Discuss expectations of meals including morning breakfast, snacks and lunch, monitoring to ensure a balanced meal is prepared including a protein source, carbohydrates, fruits and vegetables.

3)    Talk about possible triggers exploring the obvious and unseen, considering friends and fitting in, bullying, boyfriends and girlfriends, drive to succeed and possibilities of failure.

4)    Consider after-school activities which your child would enjoy, as this is a time when kids who are home before their parents may binge or engage in eating disorder behaviors.

5)    If there is an active eating disorder, consider meeting with the school counselor or nurse to discuss monitoring mealtime intake, snacks and activity level during the day. It may be necessary to arrange meals to be eaten with the counselor, however be aware that friends may question this and want to be included.

6)    With an active eating disorder or recovery, be firm with ground rules and willing to implement if needed. If a meal is skipped or weight is not being maintained, have an alternate plan in place such as eating with your child at school or being sidelined from sports. Being clear and communicating ground rules is a must.

     Good communication, a plan, and knowing where to go for help if needed can help ease the transition back to school. Remember, being confident about your child’s recovery can increase both their confidence in their own recovery and in school.

 

Sources:
Lock, J., & Le Grange, D. (2015). Help your teenager beat an eating disorder (2nd ed.). New York, NY: The Guilford Press.

What is Adolescent Egocentrism. (2017). https://www.verywell.com/
     definition-of-adolescent-egocentrism-3287985

Eating Disorder, Me? No Way!

by Adriana Karanec-Lewis

"I'm diagnosing you with anorexia" my psychiatrist told me. Anorexia I thought to myself. Me? No way, uh uh, no how. Sure I count my calories everyday, sure I exercise everyday, sure I always know what I weigh, sure I cut out processed sugar and alcohol from my diet, sure I get anxious when I am at a party or a restaurant, and sure I only use recipes that show the calorie count per serving. Yes my BMI is extremely low and I have no energy throughout the day but c'mon that doesn't mean I have an eating disorder. When I look at myself in the mirror I don't "see" an anorexic woman. I see someone who still has weight to lose in certain areas and could improve her appearance. But isn't that what most women think about themselves anyway? Don't all women want to be a single size digit and see double digits on the scale? Oh wait a minute, not all women are like that?

After my diagnosis it was time for me to face the hard truth. Just because I seem to not see myself as anorexic and just because no one in my circle of friends/family/acquaintances has ever come up to me and told me they are worried about my eating and my appearance does not mean I do not struggle with a disorder. After researching and talking to my therapists (yes, that is therapists plural) I realized that an eating disorder does not have one specific look. I may look like someone who is just lucky enough to be skinny but my behavior tells me otherwise. What started out as me wanting to lose weight after my third and final child soon became an issue of control. Not only do I have an eating disorder but I was diagnosed with post partum as well and so my eating habits became about being able to control one aspect of my life. I am a mother and wife and in charge of our household which as many know can be exhausting, daunting, stressful, emotional etc. So I used my exercise and eating as a way to feel in control of my life and I let it get out of hand. I deal with nightly sweats, have a hard time controlling my bladder, experience panic attacks when out in public, binge eat a few times a month to satisfy my sweet tooth that I suppress, and obsess over my eating throughout the day. You can imagine how this greatly interferes with my life as a mom and wife. I have very little energy to interact with my children, feel embarrassed around my husband, and choose to stay home most of the time instead of being social.

However, none of these has made me worry about myself or made me think that I needed to somehow get help and start recovering. What did cause me to finally seek help is when I almost passed out at work in front of a large group of children. I worked at an elementary school and this happened when I was helping in the cafeteria shortly after Halloween. When a co-worker came to my rescue and drove me home that was the very first time I admitted out loud to someone that I had a disorder. From that day on I tried to eat more protein and reach a higher number of calories than I normally did. I also started talking to my therapist about it, looked for support groups, and even looked into outpatient programs. The mom in me said there was no way I could do outpatient and leave me children behind. But in order to be a mom I knew I had to do something. My children are still young and I do not want to leave them motherless. They are my everything and I knew I had to somehow start accepting help. This summer I started equine therapy which I love more than sitting in an office rehashing my day with someone who may have an understanding of my disorder but can't really "get me." Working with horses puts me at ease and peace. I can whisper to them whatever is on my mind without judgement. They have a calming effect on me. For me this is a start and though I haven't changed much of my behavior I am slowly starting my own recovery process. In mid-August I came clean with my older two children as my husband felt they needed to understand as best they can what mom is going through. It has always been about my children and my road to recovery is for them. I could not imagine being gone from their life and not hearing 'I love you mom" anymore. As hard as recovery is and as much as I refuse help at times I know in my head and heart I have to continue on this recovery journey. People who suffer from any type of eating disorder must find that one thing in their life that is worth them living for and getting better for.
 
For more recovery stories, look for out Instagram project, Recovery Uncovered.

Helpful Suggestions: Eating Disorder Symptoms and the Transition to College

This article was written by Victoria Cane, Ph.D, LP, a member of SMEDA.  She is a licensed psychologist with a focus on treatment of eating disorders and emotion-regulation disorders for over 10 years.

Eating Disorder Symptoms and the Transition to College.


As an eating disorder treatment provider working with clients who are transitioning to college, my first thoughts aren't always welcome ones. If someone is struggling with symptoms like inability to sustain weight or general management of nutrition, or has not achieved abstinence from behaviors like bingeing/purging, it is hard to give support to taking on something as stressful as leaving home to start college life. And it is stressful. I recall my first semester at NYU and I'm really proud I made it through. There were times I wasn't sure I was going to. There was just so MUCH to take in and acclimate to. I had no idea I would become a psychologist back then (my major was drama) but I do recall the girl I met during that first week and being truly baffled that she would consider broccoli and a gallon of diet coke to be dinner when there was so much else to choose from at the cafeteria.

Parents/loved ones of those who have struggled with an eating disorder often find themselves paralyzed at the thought of not supporting the move to college. After all, it represents growth, progress, a natural next step in life development. My point as a provider, however, is that some of those growth markers, both literal and figurative, need to be in place first. This is where full participation in recovery-oriented treatment is so important. Although one study indicates that the transition doesn't necessarily trigger the onset of symptoms (the study found that most eating disorder symptoms were present before college), it also found that body image disturbance may worsen and symptoms were certainly not helped (Vohs, 2001).  One on-line resource very clearly calls for symptom absence before transitioning.

Assuming that the student has indeed engaged in their own recovery and symptoms are not acute at the time of transition, I begin to talk about transition management, including: finding mental health and medical resources beforehand and signing appropriate releases, identifying ways of staying accountable including weight checks if applicable, identifying other potential supports like student groups, and have a solid plan for what we call "cope-ahead" strategies; that is, rehearsing stress management skills before they are needed. We may also make a plan to check in and/or return to regular contacts when the student is on break.

In the type of therapy I rely on most often in the treatment of eating disorders, Dialectical Behavior Therapy (DBT), the provider hopes and "shoots" for the desired outcome at all times, while simultaneously being prepared for and helping the client prepare for set-backs. We do not "expect" set-backs, but should they occur, we make every attempt to correct them as quickly as possible. When a client leaves for college I wish them well and cheer for them. I think of them as fall gets colder, and I hope they are okay. Should they need to take a break to focus on health, and they seek my help, my immediate questions return to "what are the goals?" and "what is needed for recovery?"

 

On-line resource: http://www.mirror-mirror.org/transitioning-to-college.htm

Other resources:

Anonymous. (2012). Life Transitions May Trigger Eating Disorders. U.S. News and World Report. Retrieved September 18th 2013 from: http://health.usnews.com/health-news/news/articles/2012/04/25/life-transitions-may-trigger-eating-disorders

Strober, M., & Johnson, C. (2012). The Need for Complex Ideas in Anorexia Nervosa: Why Biology, Environment, and Psyche All Matter, Why Therapists Make Mistakes, and Why Clinical Benchmarks Are Needed for Managing Weight Correction. International Journal of Eating Disorders, 45, 155-178.

Vohs, K.D., Heatherton, T.F. and Herrin, M. (2001), Disordered eating and the transition to college:  A prospective study. Int. J. Eat. Disord., 29:  280-288. doi:  10.1002/eat.1019

 

 

 

 

Southwest Michigan Eating Disorders Association Kicks Off 6 month Project on Instagram: Recovery Uncovered documents recovery journey

Southwest Michigan Eating Disorders Association Kicks Off 6 month Project on Instagram
Recovery Uncovered documents recovery journey

Kalamazoo, MI, August 16, 2017– Recovery Uncovered documents the recovery journey of several southwest Michigan individuals on Instagram

Southwest Michigan Eating Disorders Association or SMEDA, will be kicking off a unique community awareness project entitled “Recovery Uncovered” on September 1st 2017. The project, part curated art project, part resource directory and part recovery journal will document the powerful stories of recovery from an eating disorder of a number of people living in southwest Michigan. Their journeys will be documented on Instagram from September 2017 to February 2018. Each month will feature a different theme starting with “Setting the Intention” and ending with “A Life Worth Living.”  Along the way these survivors will document visually what it took to recover from their eating disorder.
“Recovery isn’t a straight trajectory up; there are ups and downs along the way. We wanted to document what that looked and felt like.” says SMEDA board member and caregiver parent, Angela Morris. Along the way, participants will share some of their favorite resources.
People can subscribe now to “Recovery Uncovered” by searching on Instagram or going to the SMEDA website at http://www.southwestmichiganeatingdisorders.org/ and signing up there to follow the journey as it unfolds.
People seeking help and inspiration for their own journey to recovery will find this project helpful. As well as professionals, caregivers and others who want to have a better understanding of the effects of this terrible illness and the tremendous effort it takes to make the journey to recovery.
“We wanted to make sure the final theme for the project was ‘A Life Worth Living,’” explained Morris. “That was a phrase we frequently heard in therapy for my daughter. In the darkest times it was hard to imagine, but we wanted to present this journey to show people that there is hope and there is – most definitely – a life worth living out there waiting for each one of them.”
SMEDA is still accepting applications from eating disorder survivors, who would like to share their recovery journey as part of this project. Interested individuals should contact 123smeda@gmail.com .

Helpful Suggestions: Road Trip Tips

     This article was written by Gary Snapper, LPC, LLP, an active SMEDA Board member.  He is a licensed Professional Counselor and a Limited License Psychologist who founded Cognitive Behavior Solutions in Kalamazoo. He specializes in the treatment of eating disorders, anxiety disorders, and personality disorders.

 

Road Trip Tips


     The end of summer is the time for road trips. Whether we are visiting family on the other side of the state, traveling to the beach, forest, or mountains, or simply packing up and going somewhere new, we need to eat during the trip.

     Eating during road trips brings its own set of challenges. Boredom can lead to eating more than we typically do. Apparent lack of healthy options can lead to eating more “junk” food. Escaping our day-to-day routine when leaving home can trigger additional escape urges, including escaping our healthy eating routines.

     A handful of simple strategies can help us cope with these and other food -related challenges that we face during summer road tripping:

  1. Packing some portable healthy foods and snacks can help us stick to the routines that we have worked hard to adopt at home. Some examples are trail mix, bagged vegetables, and hummus.
  2. Planning occasional stops at grocery stores can allow us to restock those healthy items during our travels.
  3. Eating frequently and in smaller amounts can address boredom, reduces the risk of binges, and helps ensure that you use up the food that you bring on the trip.
  4. Limit or avoid substances that are more likely to make us feel bad such as alcohol, deep fried foods, and refined carbohydrates.
  5. Choose water as your primary source of fluid during the trip. Many drinks on the market today provide little nutrient value and are overflowing with sugar, caffeine, alcohol, or synthetic sweeteners, none of which our bodies are designed to process effectively. These additives may diminish our sense of well-being.
  6. Don’t forget to enjoy the journey along the way. Prioritize physical-activity breaks several times per day while on the road. Packing Frisbees, soccer balls, and/or walking shoes help you to engage in light activities at rest stops or parks along the way.  Activity helps our bowels function, increases our metabolism, and increases absorption of the nutrients that food offers us.
  7. When you choose to sample local fare, make it worthwhile. Mindfully focus on the value of the foods chosen for flavor or novelty, and try to avoid food choice just due to convenience.
  8. Don’t be so rigorous in your food choices that you forget to have fun on the trip.  Be kind to yourself if you do opt for some unhealthier items while on the road.  Remind yourself that perfection is not the goal, but mindful eating is.


 

SMEDA Kicks Off 6 Month Project on Instagram

Kalamazoo, MI, August 16, 2017– Recovery Uncovered documents the recovery journey of several southwest Michigan individuals on Instagram


Southwest Michigan Eating Disorders Association or SMEDA, will be kicking off a unique community awareness project entitled “Recovery Uncovered” on September 1st 2017. The project, part curated art project, part resource directory and part recovery journal will document the powerful stories of recovery from an eating disorder of a number of people living in southwest Michigan. Their journeys will be documented on Instagram from September 2017 to February 2018. Each month will feature a different theme starting with “Setting the Intention” and ending with “A Life Worth Living.”  Along the way these survivors will document visually what it took to recover from their eating disorder.

“Recovery isn’t a straight trajectory up; there are ups and downs along the way. We wanted to document what that looked and felt like.” says SMEDA board member and caregiver parent, Angela Morris. Along the way, participants will share some of their favorite resources.

People can subscribe now to “Recovery Uncovered” by searching on Instagram or going to the SMEDA website at http://www.southwestmichiganeatingdisorders.org/ and signing up there to follow the journey as it unfolds. People seeking help and inspiration for their own journey to recovery will find this project helpful. As well as professionals, caregivers and others who want to have a better understanding of the effects of this terrible illness and the tremendous effort it takes to make the journey to recovery.

“We wanted to make sure the final theme for the project was ‘A Life Worth Living,’” explained Morris. “That was a phrase we frequently heard in therapy for my daughter. In the darkest times it was hard to imagine, but we wanted to present this journey to show people that there is hope and there is – most definitely – a life worth living out there waiting for each one of them.”

SMEDA is still accepting applications from eating disorder survivors, who would like to share their recovery journey as part of this project. Interested individuals should contact 123smeda@gmail.com .

Everything in Moderation, Including Moderation

by Kylie Jensen
Dietetics Student Senior WMU ED Survivor


Earlier today, a classmate of mine (and good friend) had posted an article on Facebook about the dangers of social media promoted orthorexia. While the article, “When being Healthy is Unhealthy,” by Nicole Schmidt from The Walrus (found here: https://thewalrus.ca/when-being-healthy-is-unhealthy/#.WUK3-XGk5Mg.twitter) had many good points, it boiled down the whole healthy body promotion of Instagram to the phrase, “Strong is the New Skinny.” As the article described, this phrase and mentality “strong is the new skinny” allows orthorexia to flourish and be praised in plain sight without friends, families, and followers noticing the development of this disease. After I finished reading this article, I read the comments.

Another classmate (and also a good friend) had agreed that, yes, the article raised some important points, but the methods many use to become healthier and their documentation on social media should not be punished as dangerous. Most importantly, she had discussed that it is possible to live a healthier lifestyle without pushing it to extreme measures.       Now, this article did contain some good food for thought and opportunity for discussion, but it really reminded me of a time when I had been prone to using the phrase “strong is the new skinny.”

In the summer of my junior year of high school, my parents told me they would drive me to any college I wanted for a tour. I was overly excited to begin my college career as a dietetics student so I eagerly made my list and packed my bags for a college tour road trip. Our first stop was Northern Michigan University, a beautiful school at the top of my list.      

During this time, Northern was still in the process of developing a dietetics program, so I did not necessarily see what I had wanted, I kind of plugged my ears and plastered a fake smile as I toured the campus. After a few hours of touring the various facilities and landscapes, my parents and I met with a professor who was head of the developing program that would cover dietetics. Again, this professor, although very nice was not what I was looking for. Being a stubborn high school student, I continued to sit completely absent-minded while my parents conversed with the professor. About half way through our time with her, she had said something that would change my life forever:            

“Everything in moderation, including moderation.”               

At this point in my life, I had “begun” recovery from anorexia and bulimia and I still had a long ways to go. Looking back at it, my anorexia had mated with orthorexia at the beginning of this period of my life and end. I had used the “strong is the new skinny” approach to hide my troubles with my body image and promote my new “healthy lifestyle” while receiving praise from loved ones for doing so before and after my climax with anorexia.      

So at this point in my life, I had just passed my climax with Ana, and was convincing myself and those around me that I was recovering through excess amounts of working out and still strict dieting to be strong instead of skinny. Immediately after this professor, God bless her, had spoke those words, I became present again.      

Through years to come, I became a dietetics student at Western Michigan University, and a fully recovered individual from anorexia and bulimia nervosa. Although the reasons for me wanting to become a dietitian had greatly changed with recovery, this phrase still prompts me to stop and think.      

We often say, “everything in moderation,” to justify our behaviors that others and ourselves disagree with. We may say it before eating something our current diet restricts or considers a “bad food.” We may even say it to others as a response to their comments on our “lifestyle change” that had prompted quick weight loss. We may say it and have said for a multitude of reasons, but phrases like this one and ‘strong is the new skinny” should not have to be used to justify our behavior.             

“Everything in moderation, including moderation.”                 

It may seem confusing, but moderation and this justifying of our actions should also be in moderation. What happens when someone with orthorexia hiding behind the “everything in moderation phrase” actually listens to herself? Does she actually enjoy the cupcake instead of half-heartedly convincing herself it is okay to eat this once because of moderation? Does he consider his “lifestyle” change could use some moderation in itself?      

If we begin moderating our moderation, maybe our relationship with others and ourselves and food could be whole-hearted. Maybe we could actually enjoy something without having to justify our actions to ourselves. Food for thought.

 

Movie--Trigger Warning

by Angela Morris

A new movie, entitled To the Bone,  http://www.imdb.com/title/tt5541240/, will start on Netflix July 14th. It is described as a “dramedy” or comedy drama about a young woman dealing with anorexia.  The various merits of the show can be discussed later, but as someone who may be intimately involved with caring for someone or personally dealing with an eating disorder, it is important to note that this movie may be “triggering.”


Recently, my niece asked me what “triggering” meant since she heard it around our house a lot. Here is the break down I gave her. Probably the classic use of the word triggering comes from work with people suffering from PTSD or Post Traumatic Stress Syndrome. A person with PTSD may be a war veteran who was in a war zone where there was a lot of bombing. Now out of the war zone and back home, loud noises, like fireworks, could potentially “trigger” that person. Once triggered, basically all of the feelings that came with being in the war zone flood your body again, essentially putting you right back into that place.
http://www.webmd.com/mental-health/what-are-ptsd-triggers#1


However, for eating disorders, “trigger” is used a little differently. Our family’s understanding of this came when we traveled to Washington, D.C. to advocate for better treatment for eating disorders during a nationally organized event. It was the first time my child was around a lot of other people who all struggled with the same issue; all in a variety of states of recovery. That exposure lead to a much different outcome than we had expected. Rather than the sense of empowerment we hoped that lobbying on behalf of the issue would bring, instead the reaction we got after my daughter scanned the room was, “I don’t deserve to be here. I’m not sick enough.” Thus we learned how damaging the “trigger” of comparison can be when not completely recovered.


Even well-meaning books and movies, that want to describe someone’s journey through the illness, can be used as a “manual” for eating disorders. (http://www.alloy.com/well-being/eating-disorder-memoirs-and-books-helpful-or-triggering-910/  And visuals like those found in movies like To the Bone, while purporting to raise awareness, for some may actually be making it worse. According to Christine Morgan, Butterfly Foundation chief executive  “We know that images of people who are seriously ill with an eating disorder are powerful triggers. We also know that these images can inspire copycat behavior, especially for those suffering with Anorexia Nervosa.”
http://www.dailytelegraph.com.au/lifestyle/health/new-netflix-movie-to-the-bone-criticised-by-body-image-experts-for-promoting-anorexia/news-story/d06d2c2344096eb73c41f967ed858622


As anyone recovering from an eating disorder will tell you, our weight obsessed society holds plenty oftriggers that can derail a person’s recovery. Here are some great tips from NEDA on how to deal with triggers in general: https://www.nationaleatingdisorders.org/blog/3-tips-coping-triggers-eating-disorder-recovery  In terms of this upcoming movie, each person will have to determine what they are able to view safely, but it is important to be aware that the same content won’t be experienced the same way by everyone.


Note: If you are interested in sharing information or a perspective from a caregiver or survivor point of view in an upcoming blog post, we want to hear from you. Contact 123smeda@gmail.com.

Back to Basics: Positive Body Image (Watch for Warning Signs of Eating Disorders)

     This month’s article was written and provided by Lindsay South, MA, LPC, RPT and the president of SMEDA and an active member of our group since the foundation of the organization.  She has been in practice since 1988 and treats children ages 5 to 12, adolescents, adults and families, working with issues like attention deficit and hyperactivity, learning disorders, weight and body image, eating disorders, divorce adjustment and trauma.

   

Watch for Warning Signs of Eating Disorders

     As summer is in full swing and bathing suits and shorts abound, many young teens become self conscious about their bodies. Both boys and girls are feeling more and more pressure to maintain a certain body type.

     The Winter 2006 issue of the National Eating Disorders Association (NEDA) newsletter points out that, although obesity among teens has doubled in the last 30 years, so has the emphasis on eating, exercise and weight. Messages about diet and exercise can become triggers for some teens to develop an eating disorder.

     In my practice, parents often bring a reluctant child in for counseling about eating. Adults report a confusing picture of their child’s weight changes, different eating patterns and food choices.

     Why is one teen affected and not another? Why are some girls, and a growing number of boys, more likely to take an attempt to lose a few pounds and change eating patterns into a clinical eating disorder?

      Research suggests that eating disorders do have a genetic component. Numerous studies reveal that children with a family history of either bulimia or anorexia are at greater risk for developing one of these disorders themselves. Strong themes of perfectionism, competitiveness and drive, which may be harnessed successfully by siblings or parents, if turned toward dieting, can produce obsessive dieting and exercise behavior.

      Trauma or intense family conflict can certainly make children vulnerable to the development of an eating disorder. Environmental factors, including media and advertising, are a tremendous influence. Uncharacteristically thin views of women and extremely buff, bulked up men fill magazines of young readers. This constant barrage of unrealistic body images creates a lot of body dissatisfaction.

      How can you help your puberty-aged child? NEDA developed these guidelines to provide a healthy “to do” list:

  • Model fitness and balanced nutrition by striving to feel good, not achieve a certain appearance.
  • Help your children feel good about themselves no matter what they achieve.
  • Remember that dieting is not innocent behavior; it alters neurochemistry.
  • Intervene rapidly through expert consultation when dieting appears extreme and increasingly compulsive.
  • Take off blinders and be objective about any changes in behavior and eating habits.
  • Encourage self expression, verbalization of emotions, and independent thought and action whenever possible.
  • Have an open door policy of talking to your child about everything — magazine articles, family conflicts, school difficulties, relationship problems, etc.
  • Encourage eating all foods in moderation, rather than labeling particular foods “good” or “bad” or going on a restrictive diet.
  • Discourage extreme perfectionism and exactness in everyday activities.
  • Encourage a balanced lifestyle with attention to play, relaxation, work, relationships and spirituality.
  • Address family conflicts and sources of strain openly and honestly.

      If you have tried these principles at home and continue to have concerns about your child, one of the best places to go for an initial consultation is your pediatrician. Locally, the Southwest Michigan Eating Disorders Association maintains a website, http://www.southwestmichiganeatingdisorders.org/, which additional resources and a listing of nearby physicians, registered dieticians, and counselors skilled in the treatment of all types of eating concerns. Getting a jump start on eating related problems is far easier than treating a more entrenched disorder.

May 2016 - May 2017 SMEDA Projects and Activities Completed

May 2016-May 2017 SMEDA Projects and Activities Completed

Compiled by

Lindsay P. South, MA/LPC, RPT-S
President, SMEDA

Ø  Development and Design of SMEDA logo

 

Ø  Website Redesign and Launching (Angela Morris and Peter Butts)

o   Blog Posts on topics such as Holiday Eating, Yoga and Eating Disorders

o   PayPal attached

 

Ø  Monthly publication of SMEDA Newsletter (now posted on-line as a blog), coordinated by Laura Smidchens.   Articles on topics such as Dialectical Behavior Therapy for Eating Disorders” and “Men and Eating Disorders” (both by Gary Snapper, LLP/LPC).

 

Ø  SMEDA Facebook Page posts with links to current research on eating disorders (Laura Smidchens & Vinay Reddy, MD)

 

Ø  Parent Support Group Reconceived into face to face parent meetings, online and telephone support and Parent Mentorship program (Angie Morris, Community Board Member and parent)

 

Ø  Free Monthly Support Group meeting for adults struggling with ED (Trina Weber, RD).  Approximately 7 adults attend regularly.

 

Ø  Dewpoint, support groups for adolescent girls and women with eating disorders at Well of Grace Ministries, Stevensville, MI (Flori Mejeur, SMEDA Lakeshore)

 

Ø  Outreach to local K-12 schools:  classroom presentations on Intuitive Eating, Eating Disorders Prevention, and What to Do if you Suspect Someone Might Have an ED (Moorsbridge Elementary, West Middle School and Portage Northern High School) (Trina Weber, RD)

 

Ø  October 2016 Co-sponsorship of and participation in St. Joseph Mercy annual eating disorders conference

o   Discounted rates for SMEDA members to attend @ $25 a person.

o   Info on SMEDA presented at table

o   (Trina Weber, RD, Deb Frisk, RD, Kris Gibson, MD, Lindsay South, MA, Sheryl Lowzowski-Sullivan, PhD, Cathy Cook, LLPC) SMEDA Professionals and 1 community board member (Angie Morris) attended.

 

Ø  Art Hop- Friday, February 2, 2017 at WMU’s Homer Stryker School of Medicine (Laura Smidchens)

 

Ø  Coffee Tasting Fundraiser-Saturday, February 11, 2017 ( 5 Coffee Roasters and at least 8 Companies involved)(Angie Morris, parent)  Profit:  $2,407.77

 

Ø  Public Speaking and Outreach:

 

1)      Brief presentation at Rambling Road Pediatrics clinical staff meeting -August 2016, (Lindsay South, LPC) this led to cultivation of new relationships with Dr. Dodich and Dr. Dobson, two female pediatricians at Rambling Road Peds.

2)      Panel Presentation to Dietetics Association in Battle Creek-September 27, 2016 (  Jillane Mofitt-Bernacki, LMSW, Danielle Seabold, parent/community board member)

3)      Presentation at Grace Health, Battle Creek on “Food Relationships and Identification of Disordered Eating Behaviors” during the monthly behavioral health staff meeting, February 17 , 2017 (Cathy Cook, LLPC, TLLP, RD)

4)      Lunch and Learning presentation to Potawatomi Reservation, March 15, 2017. ( Jillane Mofitt-Biernacki, LLMSW, Danielle Seabold, parent SMEDA board member)

5)      Article on the problems associated with dieting, (Title?), February 2017 Good News Gazette

6)      Article on eating disorders, “When Dieting turns into a Disorder,” South Haven Tribune, February 8, 2017. (Interview with Kristin Fiore, SMEDA Community Board Member and Susan Katz-Scheinker, RD, Flori Mejeur, LMSW)

7)      Radio interview with Lori Moore during Eating Disorders Awareness Week,  February 2017(Kris Gibson, MD and Angie Morris, parent)

8)      Panel Discussion at WMU after “Food Prisons,” a play about ED (Trina Weber, RD and Kris Gibson, MD)

9)      TV interview about eating disorders, February 2017 (Kristin Fiore, Community member/Down Dog Yoga)

10)   Panel Discussion on eating disorders, Kalamazoo College.  (Kris Gibson, MD, Deb Frisk, RD and Jillane Mofitt-Biernacki, LLMSW)

11)   Meetings with local representatives in Lansing to spread awareness for eating disorders. Representative Hoadley read a resolution on the House floor to support eating disorder awareness at 11:36 a.m. , February 22, 2017 (Jillane Mofitt-Biernacki, L LMSW and dietetic students)

12)   SMEDA Lakeshore mailed out over 100 letters to medical practices, counseling offices, and school counseling centers in Berrien County to raise awareness about ED and highlight SMEDA as a resource (March 2017, Flori Mejeur, Abby Black, RD)

13)   On March 28, 2017 SMEDA Lakeshore highlighted a presentation by Dr. Stephanie Style at Lakeland Regional Center.  The presentation was live streamed and was watched by over 600 people.  SMEDA members were present and offered resources and referral information.

14)   Guest Lecture, Introduction to Eating Disorder at WMU for Amy Getman’s undergraduate dietician course. March 13, 2017 (Danielle Seabold, parent SMEDA board member)

15)   Presentation at DeVos Children’s Hospital Conference entitled, “Adolescent Eating Disorders:  Early Detection and Treatment,” an Eating Disorders Interprofessional Teaching Event for third year medical students, undergraduate nursing students, Masters level dietician students and psychology PhD candidates, April 26, 2017.  Kristine Gibson, MD, WMU Stryker School of Medicine.

16)   Panel representation in Kalamazoo College’s Abnormal Psychology class discussion on eating disorders, May 24, 2017 (Jillane Moffit-Biernacki, LLMSW)

 

 

Ø  Monthly Case Presentations on eating disorders at SMEDA general meetings (Gary Snapper, LLP/LLP, Lindsay South, LPC, Trina Weber, RD, Cathy Cook, LLPC, TLLP, RD)

 

Ø  Topical Presentations for SMEDA general meetings:  “How to Cope with Therapy Interfering Behaviors” and “Evidence Based Treatment of Binge Eating Disorder” (Gary Snapper, LLP/LPC)

 

Ø  Conference for professionals on Eating Disorders and Substance Abuse coordinated with Castlewood Treatment Center, St. Louis in planning stages for Fall 2017 (Gary Snapper, LLP/LPC)

 

Ø  Formation of SMEDA’s Instagram Group, a new commitment to reaching young people about eating disorders.  First meeting:  Saturday, May 20.  Sawalls Health Food, second floor restaurant. (Angie Morris and Emily Marre)

 

A Survivor's Story of How Words Can Help or Hurt

by Kylie Jensen
Dietetics Student Senior WMU ED Survivor


When I was in high school, my mom would pack me the most beautiful salads you have ever seen. The lunch ladies used to compliment how beautiful and healthy the salads looked and early in my junior year, one lunch lady had asked me if I was trying to lose weight. A minor thing to discuss really, since my struggle with orthorexia, anorexia nervosa, and then bulimia nervosa have been promoted, like most, from a multitude of things.


Many of people have interviewed me about my experience and many fellow classmates and friends have asked for my story. And they always ask, “What started it.”


I hold all the traits of the typical ED survivor:


    •    Genetics: a bad relationship with food and eating disorders run in my family.
    •    Competitive sport: I was a competitive dancer for 16 years.
    •    Intellectually inclined: I graduated high school with a 4.6.


I could continue to list off some of these characteristics, but I think you get the point.


So when I began to open up about my story and reflect on what really did ‘start’ it, I began to notice patterns. My struggle began with a repeat of one simple comment, “have you lost some weight? You look so good.” Now I am sure a lot of people would just love to have someone ask them this, but this type of comment makes me sick.


As humans, we are already so fragile and when Ana began to control my body and mind, I reached my breaking point. I lived two separate lives. The “good” life where I went to school smiling about the new way I looked, telling everyone about how healthy I ate and how good it has made me feel, and preaching about my new amazing way of life on social media. This kept the compliments coming, and Ana happy. But then when I was home alone in my room, running my hands up and down my chest noticing bones I have never before, Google searching and Instagram searching “anorexia” and shaking it off, wiping the tears away, I was living the “bad” life.


Ana left me in constant debate with myself. The devil on my shoulder grew big and strong screaming in my ear, “you look great, but not great enough. You are better now, but not the best.” While the angel on my shoulder shrunk smaller and smaller whispering, “you are stronger than this. You are not okay. You are not yourself.”


Now, as I finished my Junior year of College, four years later, I can’t help but think how things would have been different if that lunch lady had asked how I felt instead of if I was trying to lose weight. Maybe, I would have told her I wasn’t. Maybe I would have told her I felt great but she wouldn’t believe me, and get me help. Maybe, my struggle would have ended a lot sooner.


If we stopped commenting on other people’s weight loss/gain and asked instead, “hey how do you feel? How you doing lately?” could we help eliminate ED? If we notice people really restricting themselves nutritionally, judging their body in the bathroom mirror, and asked them this simple question, we could change someone’s life. We could help them when their little angel on their shoulder is crying out for help.


I am trying to be the person I wish I had. It does not take a toll on someone to just ask them if they are okay and really listen. I hope that any one who reads this will understand how greatly our words and actions impact everyone around us. Be the person who takes ten seconds to ask someone if they are okay. Be the person to notice that maybe they’re not. Be the person you would have wanted yourself to have when there was a moment in life where you were at your breaking point.

 

Back to Basics: Positive Eating (General Guide for Families and Individuals)

This month’s article was written by Jillane Moffit, LLMSW, an active professional member of SMEDA.

Positive Eating

     The kitchen is a great place to help develop positive eating habits. Speaking positively about healthy foods and role-modeling balanced eating is essential in helping develop a healthy relationship with food.

 Plan and prepare meals

      Children can learn about positive eating by playing a helpful role in meal planning and preparing family meals, such as washing vegetables, doing some mixing, reading recipes and chopping ingredients…  Cook meals at home and try to encourage your child to help you. Involve your kids in the shopping, too.  Involving the whole family in preparing food will lead to more support for what is served at the table.

      Talk about foods from the five food groups and what they do for your body. For instance, “this apple is so crunchy and delicious – its flesh is helping to keep me staying regular and it’s filling me up with its nutritious sweetness.” Or “these carrot sticks contain a super nutrient called beta carotene that helps my eyes stay sharp and focused.” Or “this delicious glass of milk contains calcium – it helps my bones and teeth stay strong.”

 Eat breakfast

     Breakfast is the first important meal of the day.  Encourage your child to eat a nutritious breakfast every day, using foods from the five food groups.  Enjoying a healthy breakfast gives you and your child the best start to your day. When breakfast is a part of the family routine it provides more energy and better concentration.

 Continue mealtime routines

     The experience at the dinner table can have an impact on your approach to food later in life. Follow your hunger cues and offer a balanced diet. The benefits of meals go beyond nutrition.  Sharing food and talking around the table encourages other healthy behaviors.  Mealtimes are an opportunity for children and adults to build stronger bonds with those closest to them. It also gives them the chance to receive the support they need to minimize negative influences.

 Don’t forget about physical activity

     Being physically active is an important part of a healthy lifestyle.  Make time to play outside or be active.  Be a role model and make physical activity an event by going for a walk, riding a bike, playing in the park or kicking a ball around.  Start increasing incidental exercise such as walking to school or shops, taking the stairs (not the elevator), sweeping the path, or doing some gardening.

 References

Australian Institute of Health and Welfare 2012. Australia’s food & nutrition 2012. Cat. no. PHE163. Canberra: AIHW.

 Berger, E. (2013, Sept. 27). About Kids Health. Promoting positive eating habits.  http://www.aboutkidshealth.ca

Harper, K.U., Sanders, K.M. (1975) The effect of adult’s eating on young children’s acceptance of unfamiliar foods. Journal of Experimental Child Psychology. 20: 206-14. 10. 

NHS Information Centre for Health and Social Care 2007-2008. 5.

 ‘Who’s feeding your toddler?’ Infant & Toddler Forum survey 2010.

 www.healthykids.nsw.gov.au

Back to Basics: Men And Eating Disorders

     This month’s article was written by Gary Snapper, LPC, LLP, an active SMEDA Board member.  He is a licensed Professional Counselor and a Limited License Psychologist who founded Cognitive Behavior Solutions in Kalamazoo. He specializes in the treatment of eating disorders, anxiety disorders, and personality disorders.

 Back to Basics:  Men and Eating Disorders

     Most people associate eating disorders with women; women with anorexia, women who binge and purge their food, women who binge eat. Many are surprised to learn that men are also susceptible to eating disorders.  Examples of men struggling with disordered eating have appeared in medical records over the centuries. The earliest recorded example of a man with anorexia is a commonly considered case from 1689. The English physician Richard Morton described the case of a male adolescent who began fasting at 16 years of age.   Dr. Morton described the trigger for the fasting as “studying too hard,” along with “the passions of his mind.”  Dr. Morton told the adolescent to abandon his studies, move to the country, take up riding and drink plenty of milk.  This change in lifestyle led to the young man recovering, “his health in great measure.” If only all treatments of anorexia could be accomplished so directly.

     Today, males are estimated to represent up to 25% of cases of anorexia, with only 5% of these seeking treatment.  As with females, stigma contributes to treatment avoidance in males with ED.  One study concluded that being labeled gay or feminine can act as a stigma in male eating disorders, preventing some males from seeking treatment.  Another source of stigma is the pervasive female focus in the literature, support services, research, and treatment options.  One survey concluded that over 99% of books published on eating disorders assume a female bias in pronoun, as well as in the topic focus. Males who start to search resources for ED treatment are likely to observe these biases, and may be reluctant to continue their exploration.

     Comparative analyses between male and female eating disorders are needed, including manifestations, treatment options, outcomes and stigma.  Initial studies suggest a number of gender-specific trends in eating disorders.  For example, mortality of eating disorders may be higher in men.   Another trend is that males with ED tend to have a higher incidence of overexercising than do females. A study comparing results between 108 men and women receiving residential treatment for eating disorders, identified that men scored lower (less intense) on questions regarding body dissatisfaction, bulimic behavior and drive for thinness. This supports the hypothesis that assessment tools may be more effective if created to be gender specific. Similarly, further research might help steer the development of gender- aware treatment protocols to enhance effectiveness of therapy options. 

     Unfortunately, as with treatment of eating disorders in women, men with eating disorders have limited options for evidence-based treatment.  For adolescent males and females with Anorexia, there is a research-supported treatment option termed Family Based Therapy (or the Maudsley approach).  This therapy approach includes three phases of treatment.  Phase I is focused on refeeding at home, with parents encouraging the teen to eat more food per meal with the goal of weight restoration. Phase II focuses on client empowerment, giving more control back to the teen and decreasing parental supervision over time. Phase III focuses on establishing a healthy adolescent identity (increased autonomy, developing healthy boundaries toward and from parents, and fostering increasing independence over time). Studies suggest that weight restoration occurs in 70-90% of both male and female participants, with 5-year weight retention.

     For adults of both genders, research continues to support the use of Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and Interpersonal Psychotherapy (IPT) as treatments of choice for Bulimia Nervosa, Binge Eating Disorder, and Anorexia Nervosa (mildly effective).  Unfortunately, as with all eating disorders, even the most effective treatments are not as effective for individuals with more intense symptoms of each type of eating disorder. Underfunding for research of treatments for eating disorders is yet another challenge to overcome.

     In summary, despite centuries-old records of males with eating disorders, research on males with eating disorders is and has always been limited.  The available research suggests that although current evidence-based treatments may be equally effective for both genders, males’ symptoms manifest differently and are less likely to be diagnosed than those of their female counterparts.  Males also avoid seeking treatment for different reasons than do females.   Attention to these differences and a more inclusive support environment are needed to help males get the treatments currently available that might benefit them.

References:

1)      Stanford, S.C. Volume 20, 2012 - Issue 5: Males and Eating Disorders. A Clinical Comparison of Men and Women on the Eating Disorder Inventory-3 (EDI-3) and the Eating Disorder Assessment for Men (EDAM). The Journal of Treatment and Prevention.

2)      Striegel RH, Bedrosian R, Wang C, Schwartz S: Why men should be included in research on binge eating: results from a comparison of psychosocial impairment in men and women. Int J Eat Disord. 2012, 45 (2): 233-240. 10.1002/eat.20962.

3)      Striegel-Moore RH, Leslie D, Petrill SA, Garvin V, Rosenheck RA: One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. Int J Eat Disord. 2000, 27 (4): 381-389.

4)      Zhang, Chengyuan. Journal of Eating Disorders 2104 2:138. What Can We Learn From the History of Male Anorexia Nervosa?