Tuesday, February 09, 2016

How Weight Information Can Increase Overeating/Binge Eating - Four Pathways

Recently, I found myself explaining to someone’s mother how encouraging her daughter to weigh herself was exacerbating her eating disorder symptoms (binge eating, in this case). As I did so, it occurred to me that there are four pathways to this relationship. They might seem intuitive, but it helped to spell out the matrix of consequences for this family.

If someone (let’s call her Veronica) steps on the scale and sees a number that’s higher than she anticipated, she might experience distress. For many who struggle with binge eating disorder, food is the most convenient and effective coping mechanism. So, the urge to binge can increase.

If she weighs herself and sees a number that’s higher than predicted, she could also have an urge to restrict her intake in an attempt to suppress her weight. As it typically does, restricted intake will likely result in future binge episodes.

Now, if Veronica steps on the scale and sees a number that “passes the test,” or one that is lower than expected, she could similarly restrict her intake as a way to continue this weight-loss trend. Again, binge eating is a likely consequence.

And if she weighs herself and sees a number that’s equally satisfying, it’s possible she might choose to celebrate by overeating or might feel that she is entitled to eat past fullness as a reward for her success.

Many will endorse one or more of these possibilities as potential outcomes of weighing themselves in early recovery. While some professionals believe that access to weight information in eating disorder treatment is always contraindicated, I think that there are certain benefits to learning this information.

Often, those who struggle with binge eating eat sporadically and infrequently – and avoid certain foods – setting themselves up for future binges. When encouraged to eat more intuitively, they might have fears about excessive weight gain. Witnessing weight trends can provide evidence that a more regular meal plan, which reduces the frequency of binge episodes over time, will not result in significant weight gain. Here, weight information serves as an evidence-based cognitive challenge. But, patients in early recovery might still be triggered by weight information, and it’s important to determine where individuals are in their recovery and to provide space to process and learn from concerns that arise as the result of weight information.

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Friday, December 18, 2015

Happy Holidays/NEDA Article/Another Award

Guess what? This blog one another award! I'm in great company - be sure to check out the rest of the winners.

Also, I have a new article up for the National Eating Disorder Association (NEDA).

Recovery is possible.

Happy holidays.

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Wednesday, December 02, 2015

Interviews in Recovery - A Conversation with Erin Mandras

Recently, I had the opportunity to e-meet Erin Konheim Mandras, ex-athlete/coach and mom of two, who recovered from anorexia. We decided to interview each other for different perspectives on eating disorder recovery. Below is my interview with Erin - enjoy!

SR: What connection, if any, do you see between your athletic participation and the development of your eating disorder?

EM: I believe that my participation in athletics and soccer significantly contributed to the development of my eating disorder. The competitive component, along with pressures to perform and succeed, are all elements that can lead to an unanticipated disorder, such as anorexia. Also, athletes want to be as physically fit as possible, and with a personality that tends to take things to the extreme, exercise can go too far. 

SR: How did you get motivated to recover? 

EM: I became motivated to recover from my eating disorder far before I actually made any changes. Parts of me wanted to get better and feel better at my lowest point, but the act of changing my diet was too scary, and I just didn't know where to start. My psychiatrist and parents offered me an incentive to gain weight­­ which ultimately became my excuse to start turning my behaviors around. Mostly, I did not enjoy the way I felt and how obsessed I had become with food. 

SR: How did you recover? What helped? 

EM: I, first, acknowledged I had a problem. I just needed to be surrounded by a lot of support, therapy, and medication to slowly alter my thoughts and behaviors about food, my diet, and my body image. Then, my parents, with the support of my psychiatrist, offered me an incentive to gain weight. I had a goal and an excuse to start getting better. Once I began slowly introducing food back in my diet, my body wasn't able to comfortably handle and digest it. So I began added foods that I had already been eating, but in larger quantities. Then, I wanted to get rid of anything that was associated with my eating disorder; that brought me back to the feeling of weakness, obsession, and frailty. This included clothing, shoes, food stored in my apartment, soccer equipment, and more. This helped establish a clean slate involving different and new behaviors. With the combination of all of the support I had while having an eating disorder, the will to want to get better, and an incentive to help get me on the right track, I was able to recover. 

SR: What was the most challenging thing about recovery?

EM: The most challenging part of recovery was seeing the number on the scale go up. I knew it was for my best interest and to regain health, but I couldn't bear seeing it increase. I feared it would go up quickly and uncontrollably, so with this fear in mind, increasing my food consumption was also terrifying. What should professionals know about recovery from a patient’s perspective? Professionals should understand that an individual experiencing such a disorder is a person possessing certain qualities; competitiveness, drive, and motivation. Therefore, if you are able to turn "the truck around and re­route it" by using an incentive (something that individual would have a desire to achieve), then that may be a good start. At the same time, a person with an eating disorder needs to be able to acknowledge there is a problem, and a solution; it will just take time, patience, and the same qualities used to get oneself that low, to get healthy again. 

SR: What message do you have for those who are currently struggling with an eating disorder? 

EM: I empathize with those who are currently struggling with the disorder. Though they may believe they are healthy, fine, and highly functioning, it is no way to live life. It consumes your mind, heart, and ability to give your most to yourself, your loved ones, and the world. Even if you are succeeding in your career, family, and social life, think how much more you would have to offer if your life didn't revolve around the pure focus of food, calories, and scale. Life is too short. If you have a problem, seek help. You cannot do it alone. You need all the support you can get. You can do it! 

SR: Any favorite resources (e.g., websites, books) for those in recovery? 

EM: There weren't as many accessible resources twelve years ago as there are now. I wish I had blogs, like yours and mine, readily available while battling and struggling from my eating disorder. If anything, I would have been reassured that I wasn't alone. That is why I will continue writing, speaking, and connecting with those experiencing similar challenges I faced, and continue to face in regards to food, eating disorders, and body image. I urge people to use my blog as a resource, and to feel free to contact me anytime with questions or concerns. I can relate to many people on many different levels!

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Wednesday, November 04, 2015

Holidays, Fitness, and Food

Here we are on the cusp of the holiday food season, and the diet/exercise talk has already intensified. On the day before Halloween, that dreaded candy-workout image reappeared on social media - you know, the one that identifies different types of Halloween candy by what types of workouts you'll need to burn them off?

Here's why this type of thinking is dangerous: If you choose the Reece's over the Twix only for calorie count, you're missing out on an opportunity to eat intuitively, to find pleasure and enjoyment from food. To me, it doesn't so much matter if you choose one or the other (or neither or both), but if you're going on calorie count alone, you're ignoring your preference, something that could end up backfiring in the long-run.

Do your kids want candy? Let them eat it. The allure will fade away soon. I like this mom's approach. 

And how about those exercise equivalents? So often, we're positioning exercise as a punishment for something we enjoy. We're robbing movement of its innately reinforcing value and instead suggesting that exercise only exists for the purpose of calorie compensation. But this isn't true! This is a myth that the diet and fitness industries use to lure people to buy products, pills, plans, and memberships. But what if fitness were fun?

For several months now, I've returned to my fitness roots, leading group cyling classes at a local university. I can't tell you how much I enjoy teaching again! I love the opportunity to encourage and inspire students, to lead them through a challenging but manageable course, to appreciate good music together. I love that I'm helping them improve their physical and mental health. 

But my favorite part of returning to teaching is making a small dent in an often disordered industry, one that celebrates unhealthy weight loss, views exercise as punishment for eating, and tries to motivate through self-attack. My classes are about building strength and power, celebrating our capabilities, and mostly, about having fun. I'd rather have students approach me after class and tell me that they enjoyed my music (which they do!) than comment on their calorie burns. It's the joy of movement, and the feelings around it, that sustain a lifelong commitment to physical activity.

So, if you want the Twix, eat the Twix. If you want to exercise, do that, too, But keep these things mentally separate to avoid that slippery slope. 

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Monday, October 26, 2015

Anna's Law and Eating Disorder Lobby Day

"My insurance is cutting out."

That dreaded sentence professionals fear most.

When I first began doing this work, I was struck by the irony of hoping someone would become more symptomatic so her insurance company would authorize her to get help. . . that someone already receiving care would continue to struggle so that her insurance would keep paying for the care she so desperately needed. Even then, her insurance might cut funds for lack of sufficient progress. It's the Catch-22 of health insurance. Do well and they cut off. Don't do well enough and encounter the same risk. 

I've seen patients denied access to care because they aren't sick enough. I've seen insurance cut out when patients most need support. And I've seen insurance refuse to pay when patients and families are struggling to finance a physically, emotionally, and fiscally debilitating illness.

Something has to change.

The Anna Westin Act of 2015, also known as Anna's Law, was introduced by Kitty Westin, who lost her daughter to anorexia. Kitty's advocacy efforts focus on holding insurance companies accountable for paying for eating disorder care. To learn more about why we need Anna's Law, click here.

Tomorrow marks the final 2015 eating disorder lobby day. If you can't be in Washington this week, you can still do something. Donate, write a letter, contact your state's insurance commissioner when an insurance company refuses to pay. Help a growing movement gain momentum toward the goal of making eating disorder treatment accessible and affordable for all.

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Monday, September 07, 2015

Enough with the "New Skinny"

"Strong is the new skinny."

"Healthy is the new skinny."

"Curvy is the new skinny."

Everything is the new skinny.

These slogans, presumably constructed to promote body acceptance and offer an alternative to the thin ideal, still posit a common end-goal. We're still striving for some iteration of skinny and continuing to promote thinness as the gold standard of success.

So let's step away from skinny as the solution - and focus on strength, health, curves, or whatever else we value without a tired target diluting our intention.

We don't need another skinny.

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Tuesday, July 28, 2015

Misinterpreting Intuitive Eating

As a proponent of intuitive eating, I'm often presented with challenges to the model that seem to misinterpret its basic premise. I've heard some interpret intuitive eating to mean that we're advocating that people eat cake each and every time they're hungry.

But that's really missing the point. Intuitive eating is a flexible practice that encourages you to trust your body - but it encourages you to be mindful of the signals your body is sending before, during, and after you eat.

In her piece, "Why I'm Not an Intuitive Eating Coach," Isabel Foxen Duke offers some additional misconceptions around the practice of intuitive eating. While she's right - that many will turn intuitive eating into a diet - the premise of intuitive eating is based on rejecting the diet mentality, so if you're turning it into a diet, you're not doing intuitive eating. If you're creating rules related to intuitive eating, then you're still interacting with the food police.

Intuitive eating, as discussed by Tribole and Resch, offers a set of 10 practices that are just that - practices. They aren't rules, rigid guidelines, or anything else so structured as to invite rebellion and dissent.

That said, they offer a decent blueprint for developing a healthy relationship with food. Note that only two of the ten practices involve how people normally define intuitive eating - eating when you're hungry and stopping when you're full - "Honor Your Hunger" and "Respect Your Fullness." When someone turns intuitive eating into a diet, she's really ignoring the rest of the principles and overly, rigidly focusing on these two.

What's more, intuitive eating, in my understanding, was developed as a compassionate approach toward healing disordered eating. If people eat past fullness or use food to cope with feelings, they aren't shamed or berated by their counselors; rather, the information is used as a learning opportunity. The spirit is of collaboration and compassion, diametrically opposed to the diet mentality.

Intuitive eating promotes eating for nourishment and pleasure, a balance, which, as a delicate dance, is fluid, evolving, and forgiving.