ED Information

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.  

 

 

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

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

 

 

 

 

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.


 

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.

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?

 

Back to Basics: Eating 101

This month’s article was written by Trina Weber, MS, RD, an active SMEDA Board member.  She is a registered dietitian who specializes in the awareness, prevention, and treatment of eating disorders. She owns a private practice in Kalamazoo.

 Back to Basics: Eating 101

     Many in our society are afraid of food. There are numerous ways to eat – low-carb, gluten-free, lactose-free, Paleo, or raw vegan, to name a few. Some have genuine food allergies and sensitivities, but too many people cut out whole food groups because they are led to believe the popular myth that it's “better for you”.  If a plate containing a ham and cheese sandwich with lettuce, tomato, and mayonnaise, an apple, and some carrots was placed in front of most people, I wonder who would eat it? Some would ask: Is the produce organic? Did the ham come from a free-range pig? Can I get this on gluten-free bread?

      Grocery stores don't make it any easier. There are so many choices between brand names, organic vs. non-organic, flavors, and cost that it easily becomes overwhelming. I reviewed pasta sauces at my local grocery store. There were nine different brands to choose from, and each brand had between 3 to 6 different flavors to choose from. That's almost 50 choices for just ONE food! I assume most of us buy several food items when we're grocery shopping.

      So what do we do? We have to decide what is important and what is reasonable. If heart disease runs in your family, watch the sodium and saturated fat intake. If cancer runs in your family, eat a larger proportion of organic foods. If finances are tight, do the best you can with what you have. Be watchful that you are not cutting out too many food groups, decreasing variety, or becoming too rigid with food. If you want to be a vegan, aim for about 80% of your intake to be plant-based, but be open to animal products for the other 20%. Most of us get invited to parties and other social events that provide little to no vegan foods. Choose not to be so rigid that you “have to” bring only your own food, go hungry at the party because there is nothing you “can” eat, or, the worst decision of all, miss out on a fun social opportunity because there won't be any foods there you're willing to eat.

      Choose not to micromanage your food. Stay focused on the big picture, which is choosing moderation, balance, and variety to ensure you get the best nutrition for optimal body function. (Notice I didn't mention weight?) We're all a work-in-progress, and do our best given our circumstances each day. Don't worry - if you feel like you “messed up” at a meal, you'll have another meal opportunity in a few short hours.

 

 

Art Hop Series: Eating Disorders with Anxiety and Depression

The Art Hop exhibit countdown:  1 days left

Art Hop                                                                                                                                 February 3, 2017 5pm to 8pm                                                                                                             300 Portage Street (WMU Homer Stryker M.D. School of Medicine)

Lindsay P. South, MA/LPC, an active SMEDA Board Member and a Registered Play Therapist-Supervisor, has written this brief explanation about one way to manage anxiety and depression that may accompany an eating disorder.  Her piece will be displayed at the exhibit along with food play examples.  http://www.southwestmichiganeatingdisorders.org/directory/

 

Eating Disorders and Anxiety

Many individuals struggle with comorbidity:  co-occurring diagnoses.  Although malnutrition certainly makes anxiety and depression worse, sometimes even after weight is restored, it becomes clear that an anxious wiring system was present long before the eating disorder developed.  Restricting food, overeating, or purging just becomes another way of managing underlying anxiety.

Anxious children can learn to manage their anxiety.  In her workbook, “What to do When You Worry Too Much,” Dr. Huebner helps kids externalize their anxiety with the creation of a worry monster.  Making these creatures and learning to talk back to them is a cognitive behavioral method of helping kids be in charge of their anxious thinking.