Laura Smidchens

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)

 

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?

 

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.

Art Therapy: Beyond the Therapist's Office

by Laura Smidchens

Art therapy is not only a way for the individual to communicate with the therapist and gain greater insight during a supervised session. It also helps individuals build skills to continue to contemplate and express themselves throughout their lives. Here are individuals’ messages...

We all have an exterior side that we show to the world and a part that we shield and protect. Art therapy helps individuals connect with, confront, and work with that private/hidden side.

The art samples shown in this volume were submitted for display in one of SMEDA’s public awareness Art Hop exhibits. The artists chose pieces that helped express their cur- rent or past relationship with their eating disorder.


Our next Art Hop exhibition will be in February, 2017. Click here for further details.

Art Therapy: Confronting Our Inner Selves

by Laura Smidchens

Art therapy is often done by specially-trained therapists that adjust the artistic medium to better match the clients and their needs. While some methods allow persons to express them- selves in less permanent forms, such as working in sand basins with figures and other items, other methods provide a more permanent form. Either type of art gives clients a safe way to explore themselves and their relationship to their eating disorder (ED) and the world around them.

Whether looking at their goals and the roots that will help them achieve those goals....

 

Or looking at their relationship with others...

Or their relationship with their ED...

The medium and skill are not as relevant as the insights and the personal gains that are made.

The art samples shown in this volume were submitted for display in one of SMEDA’s public awareness Art Hop exhibits. The artists chose pieces that helped express their current or past relationship with their eating disorder.

Our next Art Hop exhibition is scheduled for February, 2017. Please go to our website for further details.

Click here to download the complete newsletter.

Art Therapy: Creating a Voice

by Laura Smidchens

Art allows individual creators to express themselves. For those individuals that either do not have the words to express themselves or find it too painful to talk openly about something, art gives them a way to explore and express their inner selves. Even simple forms of expression can be packed with meaning that allows the creator to organize and analyze their feelings and reactions... Though even in the apparently simple forms of expression, it is important to look at the details...

Click here to read more and see examples.

Keys Study on Starvation

by Laura Smidchens

During WWII the US government supported a research study in preparation to dealing with the starving masses they expected to encounter in Europe. Conscientious objectors volunteered to participate in an extended study on food restriction and the problems that may arise in the refeeding process. While the test was not completed in time for the US invasion into occupied parts of Europe, the experiment provided invaluable knowledge on what happens to a person’s mind and body and, consequently, their behaviors as they are deprived of needed nutrients and calories. Also, the experiment showed that even physically and psychologically healthy individuals, with no history of eating disorders (ED) in their family history, will develop ED symptoms if deprived of enough food.

Anger, Rage, and More Aberrant Behaviors
As the study progressed, many of the subjects began showing reduced tolerance for stress. Anxiety-related issues began to appear among the group laced with argumentative behavior and fits of rage. While the subjects had been highly social at the beginning of the experiment, well into the restrictive period the group dissolved into individuals prone to voluntarily isolating themselves from others.

Behavioral and Emotional Changes
The subjects, along with such aberrant behaviors, began showing difficulty in dealing with stress, increased anxiety, and signs of depression. These symptoms were exhibited in a variety of ways from excessive sleeping to self-harm. Initially two subjects were removed from the study for stopping at a food vendor and binging on unauthorized food. In spite of this example, later in the study a person concluded that the only way to have himself removed from the study was to amputate three of his own fingers. While this was an isolated example, a number of the subjects began cutting themselves to cope with their anxiety.

Click here to read more.