Thursday, December 14, 2017

5 Keys to Coping with the Holidays

Despite its festivities, the holiday season can present a number of challenges for those in eating disorder recovery. For some, family time can be stressful. Food is often abundant and not on a regular schedule. In many cases, individuals leave the comforts of their homes and routines in order to celebrate with others. Those with co-occurring illness, such as alcohol/substance use disorders, depression, anxiety, or trauma may face additional challenges during this time.

Toward the goal of relapse prevention, a little planning can go a long way. As the holiday season approaches, consider these five “S”s that can help reduce the likelihood of symptoms escalating or re-emerging:

Self-awareness:
Going into the holidays, take a personal inventory. How have you been doing? What has been challenging for you recently? What have you learned from past events? What types of triggers do you anticipate going into the holidays this year?

Strategy:
Planning is the enemy of relapse. While it might be impossible to predict every potential scenario, strategizing certain situations can go a long way. For instance, if you’re attending a holiday gathering, discuss with one of your treatment professionals how you’ll approach food before, during, and after this event. How will you respond if someone comments on what you’re eating or your weight? If you’re sober, assume someone will offer you a drink; have a response ready to go. Have some topics in mind to discuss if the conversation turns sour (e.g., when the inevitable New Year’s diet talk ensues).

Support:
Think about who your supports are and reach out before the holidays approach to see if they’re on board to provide you help if needed. Your interpersonal arsenal might include specific family members, friends, treating professionals, peers from treatment, or others who have identified themselves as healthy supports. Ask your supports if they’ll be available to talk/message at designated times. See if you can check in before and after specific events that you anticipate to be particularly challenging, a practice referred to as “bookending.”

Self-care:
Knowing that the holidays can create additional stress necessitates a ramping up of your standard self-care routine. What can you do that calms you/centers you in preparation for this time? Now is the time to be particularly gentle with yourself. During a stressful situation, are there specific tools you can use to help you through? Do you have an escape strategy ready to go? If something triggers you, and you’re at an event, can you step outside and get some fresh air or contact one of your supports? Are there any pleasurable activities you can get on your calendar following your holiday commitments?

Setbacks:

Recognize that, despite your best efforts, setbacks can happen. How you respond to potential setbacks can influence their duration and severity. Recovery is a process of learning from experience, maintaining motivation and commitment, and cultivating self-compassion.

Sunday, October 29, 2017

Can You Add Joy to Your Workout Routine?

How often do you find joy when you're exercising?

If your answer is "never" or "rarely," it's probably time to reevaluate.

Physical activity need not be a miserable experience. It shouldn't be punitive, compensatory, or self-attacking. While a workout might be challenging or difficult at times, it should never be painful, motivated by fear, or sustained by self-hate.


I encountered the above quote at a gym several months ago. "Pain is temporary. Quitting lasts forever." I'm not sure who said it, but it's wrong. "Quitting" has taken on a negative connotation in our culture, when in fact, ending a workout because it hurts or doesn't feel right can be exactly the self-care that is necessary to sustain a healthy relationship with exercise. For many, pain isn't temporary. If you over-train or cross a threshold of discomfort during activity, you can do irreparable damage that threatens your physical and mental health.

If we enjoy something, we're more likely to continue doing it. That's Behavioral Psychology 101. Can you find the joy in your workout routine?

Recently, while teaching a spinning class at a local university, I spontaneously cued joy. We had just completed one sprint of a two-sprint song. As we were approaching the second sprint, I asked the class if they could do the second sprint "better." Now, typically, "better" in a spinning class means faster or harder or anything that demonstrates greater effort. But in defining "better" for this class, I also asked them, "This time, can you sprint more mindfully? This time, can you sprint more joyfully?" I was surprised by the response. As soon as I said "joyfully," I witnessed a room full of smiles. As much as we attend workout classes to sweat and work hard, we're also looking for joy. And that sprint was more joyful. It was fast and hard, but playful, too. It was better.

Where can you add joy in your exercise routine? Can you craft a playlist that makes you happy? Can you skip instead of run? Maybe get off the elliptical and dance? The more joy we find through movement, the more likely we are to continue engaging in physical activity. Joyful exercise is not an oxymoron. Find a way to make movement fun for you.

Monday, August 21, 2017

5 Things that Have to No Place in Eating Disorder Recovery

Recovery is a bumpy road, and there are often unexpected twists and turns, even with significant support. It's important during this process - and I might argue always and even for those without eating disorder histories -  to avoid cultural trends that can exacerbate symptoms or interfere with full recovery. The following are several examples that I have seen obstruct the recovery process:

1) Waist trainers: You don't need to "train" your waist. Recovery is about training your mind to be more body neutral - or even accepting - than it is about trying to manipulate any body part.

2) Macros, keto meal plans, Paleo, and more: If you are following a certain meal plan that excludes or significantly limits certain foods in favor of others that are judged to be "healthier" or better for weight-control, then you are continuing to do your eating disorder in disguise. Eating in recovery is flexible and varied and allows access to all foods, particularly those that diets tend to shirk.

3) Cleanses/detoxes: These are weight-loss gimmicks that can lead to relapse. Your body naturally detoxes on its own, and cleanses and detoxes are unnecessarily restrictive and can lead to sustained restriction or backfire in the form of binge eating.

4) Food scales: If you're weighing your food, you're not relating to food in a natural and transferable way. This inflexible approach won't get your far in your recovery journey, as it retains the rigidity of the eating disorder mindset and prevents exposure to more adjustable eating patterns, such as spontaneous snacks or restaurant meals.

5) Fitness trackers: Recovery should focus on intuitive movement, rather than exercise that is numbers-based or focused on burning calories. Especially in early recovery, counting anything (and then making behavioral decisions based on these numbers) ignites the eating disorder brain and can trigger relapse. Fitness trackers place too much emphasis on numbers, robbing us of our natural desire to move our bodies in flexible and creative ways.

Can you think of any others to add to this list?


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, July 17, 2017

Don't Judge a Body by Its Cover

When President Trump remarked to French First Lady Brigitte Macron last week, "You're in such great shape," I immediately had a series of questions. For instance, when and where did she compete the presidential (no pun intended) fitness test that he must have observed? Was he most impressed with her strength or endurance, her flexibility or speed? Were there any other assessments he used to gauge her fitness level?

Because clearly, he woudn't have commented, "She's in such good physical shape" just by looking at her, would he? Surely, our president knows that being "in shape" is not attached to a certain look - or shape or size. It's not about structure or form at all. It's about the ability to perform various physical tasks at certain levels and about the body's physiological response to performing these tasks. We might want to assess data points such as her maximal oxygen consumption during exercise and the rate at which her heart rate returns to baseline post-activity.

One's weight or size is easily independent of one's fitness level. There are plenty of thin people who have zero physical training and plenty of fat people who run marathons and hoist heavy things above their heads. What we typically think of as physical indicators of fitness (e.g., a toned body, obvious musculature) are correlational at best. Many individuals are "blessed" with thin or muscular genes without ever needing to hit the gym.

Now, if Madame Macron is, in fact, no stranger to Velib, can lift even half of her body weight repeatedly, or knows a thing or two about downward dog, we might say she's in good shape. But, without this information, her being "in such great shape" is pure conjecture.

What Trump really meant to say was, "You're so thin" before he called her "beautiful." Wasn't it? That's all that he observed. And what he could have done, as a statement to women worldwide, was learn a little bit about her beforehand so he could comment on something more meaningful than her body or simply mention how pleased he was to meet her.


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, June 16, 2017

What Thin Privilege Really Looks Like

Individuals of all sizes may struggle with accepting their bodies; however, it is only those who live in fat bodies who also confront weight stigma. If you have a thin body - despite how much you might dislike it - you live with thin privilege. Want to know what thin privilege looks like?

In a restaurant, you order what you want, unafraid that others will judge or stare if you don't pick the "healthy choice."

You work out at the gym or go for a walk or run outside without fear that others will mock you.

You walk into a doctor's office and don't have to worry that the chairs in the waiting room won't support you.

When you go in to see the doctor, your provider doesn't suggest that losing weight is the answer to all that ails you.

If your doctor orders an imaging test, you don't have to drive an extra hour to a facility that has a machine that will support your body.

When you board an airplane, people don't stare and grimace, afraid you'll be seated next to them.

You can go to a shopping mall and know that most of the stores will carry something in your size. You can ask for a larger size without the sales associate saying, "We might have some in the basement", if they have it at all.

Your dentist doesn't ask you if you have a problem with desserts when you don't even care for sweets.

You can easily maneuver in and out of a pedicure chair.

When online dating, deciding how much of your body to show in your pictures doesn't torment you.

People don't casually - and frequently - suggest you join a gym.

Your coworkers don't automatically assume you want to buy into the office weight-loss challenge.

Family members don't ask you, "Are you sure you want that?" when you reach for seconds.

If you are thin and these examples resonate with you, know that know matter how much you might fight with your body, you don't live in a culture that echoes and amplifies your internal dialogue. Be aware of your privilege and use your voice to help challenge cultural weight bias.

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



Thursday, May 11, 2017

Physical Activity in Recovery

Recently, a reader contacted me to weigh in on physical activity among those with compulsive exercising and/or disordered-eating tendencies. I figured my thoughts might be useful to others:


1) Usually, if someone can't do something without it becoming obsessive/addictive, it's time to stop it for a while and regroup.

2) Those in recovery who begin or resume an exercise program will need to increase their intake to fuel their bodies. Dietitians can help with this.

3) I've found that some people have to cut out exercise as they know it and define things in a different way - i.e., choosing something that hasn't been triggering before. Often, an activity (e.g., a yoga class) that is different AND has set parameter involved can help. Some of my patients can't exercise on their own but can stick to a predetermined number of classes/week (and respect the time limits of these classes). 

4) Accountability is useful. Honest reporting to a therapist - setting intentions and then figuring out what worked and what didn't - is a valuable tool. Checking in with a therapist, or a friend/family member, before/after a workout can help (in the addictions world, it's called "book-ending").

5) If all this fails, and every single effort turns into compulsive or disordered exercise, then I'd say it's more unhealthy to exercise than not and recommend abstaining, at least until something else is in place (e.g., medication, a significant course of therapy, etc.) Exercising to the point of injury or illness  - or in a manner which threatens treatment gains - is disordered, and if it can't be done in a healthier way, it needs to be tabled in the name of health/recovery.

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, April 05, 2017

Am I Sick Enough?

An idea that's been surfacing recently in my work is, "I don't think I'm sick enough to have an eating disorder" or its cousin, "I didn't think I was sick enough to get help."

If you're wondering if you're sick enough to get help, the answer is yes. If you think that you're not, sick enough, it's a good idea to check this out with a professional. The answer might still be yes.

People will say to me, "I didn't think it was that bad because I was eating." Here's the thing: everyone with eating disorders eats. People who don't eat die.

Or they'll say, "I didn't think I was skinny enough to be sick." Let me be clear with this one - eating disorders come in all shapes and sizes. The severity of the disorder is not determined by weight but by how damaged your body, mind, and spirit are as a result of your behavior and beliefs (which are influenced by diet culture, societal weight stigma, etc.)

If you restrict your food, often go hungry, and don't eat what you want, you're sick enough.

If you dislike your body and this causes you distress, you're sick enough.

If your perceived value is tied to your weight, you're sick enough.

If you think that you need to do something to compensate for what you eat, you're sick enough.

If you think about food much of the day (e.g., beyond meal planning or anticipating some restaurants or foods you like to try, you're sick enough.

If you stare at your body in the mirror in disgust, you're sick enough.

If you don't listen to your body and give it what it needs, you're sick enough.

If you use food to cope or numb or just to get through this difficult world, you're sick enough.

And if you compare yourself to another disordered eater and think, "I'm not sick enough," you're sick enough.


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