Wednesday, April 22, 2015

Helping Patients with Binge Eating Disorder Drop the Weight (Mentality)

A woman, who reported she struggles with Binge Eating Disorder, contacted me recently online. She was scheduled to participate in a medical weight-loss program but wondered if she should address her BED first. Unfortunately, this woman is not the only person with BED who has fallen prey to the weight-loss industry.

One of the most challenging things in my work with patients with BED is disavowing them of the diet and weight mentality. Most patients come in with a significant diet history and, despite many failed diet attempts, are intent on losing weight in treatment via the latest diet trends.

I've found through the years that with some patients, getting them to commit to working on their binges, rather than focusing on weight, is a relatively easy switch, while others remain firmly entrenched in a weight-centric mentality. With these patients, I see little-to-no progress. They're they ones that drop out of treatment prematurely when I tell them that their most recent return to Weight Watchers or Jenny Craig is contraindicated with our work. It's a major paradigm shift that's required, and my experience is that patients who are able to think outside the box have an easier time catching on. 

Here are 10 treatment factors I've found that can help bring many patients with BED around to more of a focus on their relationship with food than the current number on the scale.

1) Refuse to set a weight loss goal. Instead, set goals around reducing binge eating and improving the patient's relationship to food.
2) Provide information on the relationship between food restriction and binge eating  (e.g., the diet/binge cycle, the Minnesota Starvation Experiment). Create a timeline of the patient's diet/weight history, noting weight losses followed by inevitable gains. 
3) Do not support the patient's participation in eating trends, cleanses, jumpstarts, etc. Focus on what the patient can add to his current "diet," rather than take away.
4) Operate from an intuitive eating perspective and encourage the patient to legalize off-limits foods in a mindful way.
5) Explore the emotional function of binge eating, as well as how an attachment to the diet mentality may trigger binge emotions 
6) Provide information on the "Health at Every Size" movement, as well as on the media's inflated damages of obesity; cite meta-analytic studies suggesting that those who are overweight or low-level obese are just as healthy as their "normal"-weight peers.
7) Educate the patient on societal and internalized weight stigma and the toll these experiences can take on her physical and mental health.
8) Work with the patient on acceptance and self-care of his body as-is.
9) Encourage a relationship with movement that is joyful and reinforcing and thus more likely to persist beyond sporadic, diet-centric efforts.
10) Recognize that recovery from an eating disorder might be a bumpy road but that, with persistence and attention to the above factors, is entirely possible. 

Thursday, April 02, 2015

Women's History Month at Miami-Dade College

A couple of weeks ago, I had the honor of speaking at Miami-Dade College for Women's History Month. A number of the students in attendance, as part of a class project, had constructed life-size body collages exhibiting information about eating disorders. Here's a panoramic shot of the students with their projects, their professor, and me:

So wonderful, right? And here are some of the individual projects close up. The first is a visual representation of the emotional pain and body distortion inherent to anorexia:

The second collage highlights the relationship between eating disorders and pregnancy, commenting on the impact of disordered eating on a growing fetus:

I even got to pose with a life-size Barbie, one student's interpretation of Mattel's popular diva:

This Barbie sported post-it notes highlighting her "thin arms," "thigh gap," and other unrealistic, culturally idealized body features. Even life-size, though, her facial expression was manufactured by a printer, and she's barely three dimensional. There's just something much more compelling about real-life people, isn't there?

One of the most sobering parts of the event  occurred as I was gearing up to speak, witnessing various students, faculty members, and other passersby observe the students' creations. One middle-aged woman took a casual glance at the body projects and commented, "I wish I had an eating disorder."

It's never too late to incorporate another anecdote into a talk. . . .

Wednesday, March 18, 2015

Recovering Around a "Backdrop of Disorder"

Check out my latest NEDA blog about recovering around a backdrop of disorder - thanks NEDA for publishing my words!

Wednesday, March 11, 2015

The Best Worst Question of All

I was recently etroduced to the work of Dana Shavin. Her memoir, The Body Tourist, chronicles her experiences following her recovery from anorexia. I asked her for any insights she might have for my readers about illness and recovery. Here's what she had to say:

The Best Worst Question of All

It’s a great question. And a terrible one.

“What’s the most important thing you learned in your recovery from anorexia?”

I was asked this not long after I left the hospital, by a friend of a friend who was
struggling with depression. It was a great question, because it made me think hard about
what things had really helped, and why and how they helped. And it was a terrible
question, because it asked that I hang my recovery on the peg of one “most important”
thing. To do so would have been to ignore the complexities of anorexia, and the
multitude of important lessons of both illness and recovery.

That said, here is a partial list of the most important things I came to understand that
helped me in my recovery. There are many more things—people, books, therapy,
journaling, taking positive risks, asking for support—that also played a role. As you read
through these, I hope you’ll think about what has helped, or is helping—or would help—you.

--Eating disorders trick us into believing we are thinking clearly, but in truth they are side
trips that lead us away from the real questions we could and should be asking ourselves.
What if, instead of what won’t I eat today and how much can I exercise, I asked
questions like: what are my dreams? My goals? What am I passionate about? What gives
me meaning? What do I want to DO with my time in the world? These questions took me
outside my small, stuck world of anorexia and reminded me that there was a larger world

--Starving, binging and purging, and eating and exercising compulsively are behaviors
rich in metaphor; but ironically, we can only really understand their message once we
STOP engaging in them. I so wanted, while I was ill, a guarantee that my life would be
better/different/happier if I “gave in and gained weight” as I called it. But I learned that
in fact I could not create the better, different, happier life I desired until I stopped the
addictive behaviors. It took every ounce of courage I could muster to trust that I would do
the work of making my life better/different/happier as I regained to a healthy weight. But
it was enormously more empowering to do that work and reap the rewards (I became an
artist and a writer and a dog rescuer and a life coach) than it was to starve, day in and day
out, with no plans, no goals, and no dreams larger than to weigh a bit less than the day

--Recovery is a complex process that starts, but doesn’t finish, in the 28 days or 4
months or year you’re in treatment. It happens over time, and it requires a willingness to
continue questioning (kindly, and without judgment) all the things you thought were true
about yourself, and the world, that led to or sustained your eating disorder. The gift of
looking deeply, honestly, and over time at yourself and your behaviors is the gift of true
understanding and, ultimately, forgiveness.

--The size of a life isn’t inversely proportional to the size of a body (i.e. my life did not
feel larger and richer the smaller I got, as I thought it would) but grows in proportion
to how well we nourish the self. Allowing myself to become fully functioning, curious,
authentic, creative, interested in the outside world, flexible, and open-minded is what
grew—and continues to grow—and expand my life.

--A sense of humor goes a long, long, long, long way. Try to have one about yourself.

--Forgive yourself for whatever it is you are not. Forgive yourself for whatever it is
you can’t do. Forgive yourself for all the ways you believe you have failed. Everybody
fails. Tons of people are failing right now, at something. True freedom comes when you
understand this, and let yourself off the hook.

Dana Lise Shavin is the author of The Body Tourist (Little Feather Books, 2014), a raw,
candid, at times comical look at the six years following her “recovery” from anorexia
nervosa. Her website is

Thursday, February 19, 2015

2015's NEDAwareness Week

Drumroll for NEDAwareness Week!

The theme for this year's event, happening next week (February 22nd -28th), is "I Had No Idea." Programming centers around helping people "get in the know" toward the goals of improved education and awareness and early intervention and prevention of these devastating illnesses.

I'll be participating in the NEDA panel, "'I Had No Idea!' Athletics and Eating Disorders: What Fitness Professionals Need to Know and How They Can Help" on 2/24 in New York City. Later in the week, I'll be a guest in a NEDA Twitter chat: "A Slippery Slope: Identifying Disordered Behaviors Before they Go Too Far" along with Cristin Runfola, PhD and author, Jenni Schaefer. You can follow my Twitter (@drstaceyla) for more information on these events.

Want to attend one of the many NEDAwareness Week events ? Check out the panoply of offerings here or follow the hashtag #NEDAwareness. Get involved - and in the know!

Wednesday, February 04, 2015

Breaking Bad Ads

Anyone see this gem of a Superbowl commercial?

It's titled, "All You Can Eat," and yes, that's the voice of Aaron Paul, of Breaking Bad fame.

Any thoughts?

Here are mine. Food is not a drug. It's something we need to survive. Can people develop unhealthy relationships to food, behaviors that mimic addiction? Yes. But, this commercial doesn't focus on that process or how to heal it. What it does do is villainize food - condemning items that are glazed, fried, baked, iced, etc. The images are presented at a frenetic pace, with food portrayed as harmful and repugnant as the blue product Paul's character helped produce.

The ad ends, "No one's telling you what to do. You can stop whenever you want. Well, sort of. . . You got to eat, right?" Yes, you do have to eat, and this is one of the main reason that abstinence models of addiction don't work with food. Cut out those foods that you're craving? Often, those will become your binge foods. Check out the diet-binge cycle or have a conversation with someone in recovery from an eating disorder to find out more.

The finale presents the words, "It's time to take back control." But to me, control doesn't come in the form of a diet (even a diet that doesn't call itself a diet). Control comes from returning to your innate ability to self-regulate intake and to use food for nourishment (and pleasure) in healthy ways. The ad's tagline? "Weight Watchers: Help with the hardest part." I disagree. In the struggle to heal your relationship with food, getting involved with Weight Watchers, endorsing the diet mentality, and demonizing food items is likely to make the process that much harder.

Thursday, January 15, 2015

Celebrity Weightloss

Last week, the media seduced us with the headline, "Kirstie Alley Slim Again."

Is anyone still buying this?

As writes, "Kirstie Alley is no stranger to a diet. The 63-year-old star has been thin, fat and thin again more times than we can count." Apparently, Alley recently lost 50 pounds. Again.

So, why are we still reading the headlines, listening to the news clips, and studying the before and after pictures?

Diet work - until they don't. Celebrity weight-loss roller coasters are perfect examples of what professionals have come to to call the "weight-cycling industry." What if someone like Kristie Alley, Marie Osmond, or even Oprah, who recently told Barbara Walters she still needs to "make peace with the whole weight thing" were to come out with a statement of success in this arena?

Now, that would be newsworthy.