Monday, November 24, 2014

Thanksgiving Goodness Without the Guilt

Thanks to the National Eating Disorders Association (NEDA) for asking me to blog for them! You can check out my first post here, just in time for this week's holiday. Happy Thanksgiving.

Wednesday, November 19, 2014

Black or White

As a psychologist, I'm quick to point out all-or-nothing thinking - the kind of thought pattern that polarizes things into categories of good and bad or, really, any two camps - without leaving room for the middle ground.

So, it may come as a surprise to hear me say that I think professionals and products and plans are either recovery-oriented or not - but I do.

If a therapist is advertising her treatment program, designed to curb overeating, as a tool for weight-loss, I don't see her as recovery-oriented. Part of the reason that people overeat is due to the diet mentality. If a yoga instructor promotes the slimming effects of her teaching, I don't see her as recovery-oriented (or as the kind of yogi whose teachings I'm interested in following). If a health coach is helping people recover from disordered eating by prescribing a particular meal plan, I don't see her as recovery-oriented. And if a food company is selling a product designed to tame cravings or cure stubborn belly fat, I don't see this company as recovery-oriented.

We live in a diet-centric, disordered world. And I know it's reductionistic, but people are either buying into this mentality or working really hard to challenge it. And you can't be promoting recovery unless you're actively challenging our nation's fixation on weight and shape.

So there it is, in black-and-white terms: you're either part of the problem or part of the solution. Pick a side.


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, November 11, 2014

Exercise Addiction: Pushing the Limits of Healthy Behavior

My article appeared originally on Recovery Brands' Pro Corner site.



The statistics are staggering; millions of Americans don’t get enough exercise. In the early part of my career, as a certified personal trainer and group fitness instructor, I focused on this end of the spectrum – helping people to incorporate exercise into their lives and adhere to regular exercise programs. But, as I trained to be a clinical psychologist, I saw more and more of other end of the exercise spectrum. On this other side sit those who have a compulsive relationship to exercise; that exercise despite pain or illness; that feel anxious, angry, or depressed if they miss an exercise session; that unhealthily use exercise to influence their weight or shape; and that engage in rigid exercise behavior, despite little enjoyment from the activity.
Females who under-eat and over-exercise are at risk for the Female Athlete Triad, comprised of disordered eating, amenorrhea, and osteoporosis.-STACEY ROSENFELDWhile not a standalone DSM-5 disorder, exercise dependence is associated with other disorders. Many individuals who struggle with eating disorders engage in compulsive exercise. Those who use exercise as a way to compensate for binge eating (with a diagnosis of bulimia nervosa), will tack on extra activity to compensate for binge eating. Those with restrictive eating disorders might also use exercise in a compulsive way – spending excessive time at the gym and pushing their bodies to the extreme, as an additional way to control their weight.
Medical complications from exercise dependence can include cardiovascular concerns, amenorrhea, stress fractures, and other overuse injuries. Females who under-eat and over-exercise are at risk for the Female Athlete Triad, comprised of disordered eating, amenorrhea, and osteoporosis.
Some who don’t suffer from clinical eating disorders might also engage in compulsive exercise. They might spend excessive time engaged in physical activity in the name of health, or to ward off uncomfortable feelings. Typically, these individuals feel guilty when they miss a workout and can experience signs of withdrawal, such as irritability, anxiety, or depression when their exercise schedules are compromised.
Robert “Raven” Kraft is an iconic example of exercise addiction. Kraft has been running the same eight-mile stretch on Miami Beach, daily, for almost forty years. He’s run during hurricanes; while sick with pneumonia and food poisoning; and despite chronic, crippling pain. When an angiogram brought him to the hospital, he clocked his eight miles by pacing the hospital halls.
Kraft, who suffers from anxiety-driven behavior, admits: “I’m a prisoner of routine, but I’ve become comfortable with it.” He reports: “It’s like, as soon as I get out there, I’m suddenly a different person. My personality changes. I almost seem taller, stronger, bigger. It’s my comfort zone, where I feel right. And once I start going, I feel good.”
While Kraft certainly pushes exercise to the extreme, there’s a fine line between healthy and disordered. Is a regular gym-goer addicted to exercise? Are marathon runners compulsive? Several measures have been developed to assess one’s relationship to exercise, including the Exercise Dependence Scale-21, theCompulsive Exercise Test, and the brief Exercise Addiction Inventory.
Does missing a scheduled workout land you in a sea of negative emotions? Do you refuse to take days off from exercise, even when injured…?-STACEY ROSENFELD
One of the most important criteria in teasing out whether or not a behavior is addictive is how it impacts your life as a whole. Do you prioritize exercise above professional, educational, familial, or social events? Does missing a scheduled workout land you in a sea of negative emotions? Do you refuse to take days off from exercise, even when injured or ill? Do your workouts persist beyond your intentions, with you regularly tacking on unscheduled activity time? Is exercise no longer enjoyable for you, now just a burdensome chore? These are clear warning signs that compulsive exercise might be at play.

If you are concerned about your relationship to exercise, then consider these tips:
  • Schedule regular days off. Your body needs time to repair and relax following demanding workouts. This can help ward off overuse injuries and illness.
  • Take some time away from exercise. Return gradually and monitor for signs of dependence.
  • Engage in physical activity with others, rather than alone. This can help make exercise less compulsive and more enjoyable.
  • Focus on the physical and mental health benefits of exercise, placing less emphasis on weight control.
  • If you are unable to develop a healthier relationship to exercise, try a course of therapy to help you manage the behavior and provide you with other coping resources. Therapy can help you learn to tolerate difficult emotions without turning to excessive exercise for relief.

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, November 04, 2014

You Ate It - Now Move on with Your Life!


Just in time for Halloween, some frightening posts appeared on my Facebook feed. Titled, "You ate it. . . Now negate it!" the posts featured pictures of popular Halloween candies, alongside their calorie contents and the amount of exercise required to burn them off. That mini Snickers that sang to you from your leftover stash? That'll be 50 burpees. Similar charts popped up on the websites of fitness and nutrition professionals, in newspapers and on newscasts, and, lest you think these warnings are targeted only at women, in a popular men's magazine.

In addition to the fact that nutrition science has largely dispelled the calories-in/calories-out myth, as we now know that weight is a complex biological phenomenon, these messages fuel a disordered eating mentality - suggesting that we must compensate through exercise for what we eat and making fitness a remorseful chore, rather than a way to strengthen and honor your body.

As I've written prior, this mimics the unfortunate practice of many fitness professionals, who similarly promote exercise as penance for eating, propagating our culture's disordered mentality -  in a setting that's supposed to be healthy.

My advice? Keep intake and exercise separate. Engage in exercise because it promotes physical and psychological health and because it allows you to feel alive. If you enjoy Halloween candy, a fancy coffee drink, or simply, that extra serving of fettuccine, don't atone via exercise, subsequent restriction, or any other type of compensation. Just move on with your life. . . .


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, October 28, 2014

Fat Girl Costumes

Walmart's Website Features a Section of 'Fat Girl Costumes'

(photo via Jezebel)

This week, Walmart landed itself in the latest controversy involving bodies and advertising. As Jezebel fist reported, the megastore's online catalog featured a section of Halloween apparel called, "Fat Girl Costumes." Jezebel speculated the heading may have been a web developer joke that eluded final editing.

As a joke, this heading is offensive. But, let's look at the larger picture. To start, I commend Walmart for featuring plus-size costumes. Not every retailer offers size-inclusive styles. And the offensive nature of the language itself is only a product of the relative value of fat versus thin in our current cultural climate. The fat acceptance movement, as evidenced by its name, has worked long and hard to reclaim the word "fat," from something offensive to a simple description of body size. If fat weren't such a bad thing, this section of Halloween costumes wouldn't have created such a stir - like clothing for tall women or petite women, we'd just file it away under offerings that cater to the natural diversity of body sizes. But because fat is such a dagger, this title becomes offensive.

So, rather than focusing on some retailer's joke or error, let's celebrate companies that offer plus-size fashions and let's continue to evolve our dialogue so that the use of the word "fat" doesn't fall prey to jokes or mistakes and, when used in earnest, is just a descriptor, not a headline.


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, October 22, 2014

Weight Stigma and Binge Eating: What's the Connection?

My article appeared originally on Recovery Brands' Pro Corner site.
Karina, a 42-year-old obese woman, put off her annual doctor’s appointment again. The reason for her reluctance? Karina fears her doctor’s judgments and admonitions about her weight. Several years back, her doctor read her the riot act about her weight and since that visit, Karina’s weight has climbed even more.
Karina is not alone. Research indicates that higher weight individuals report experiencing weight stigma and negative stereotypes across a variety of situations and at the hands of family members, friends, doctors, bosses, teachers, and often, strangers.
Last month marked the second annual Weight Stigma Awareness Week. The annual event, hosted by the Binge Eating Disorder Association (BEDA), seeks to raise awareness around weight bias and offers tools for addressing weight discrimination in various settings, including schools and doctors offices. This year’s event was replete with contributions from diverse voices in the weight stigma community, and their messages trended powerfully online.
According to BEDA, biased behaviors include “bullying, hate-speech, and exclusions that limit the ability of a person to gain employment, healthcare, and education.”
BEDA defines weight bias as “judgment or stereotyping based on one’s weight, shape and/or size.” According to BEDA, biased behaviors include “bullying, hate-speech, and exclusions that limit the ability of a person to gain employment, healthcare, and education.” Weight bias is an unfortunate byproduct suffered by many who struggle with binge eating disorder (BED). BED, now a standalone DSM-5 disorder, affects approximately 2 percent of menand 3.5 percent of women. The majority of those with BED are overweight or obese.
Unlike their counterparts who struggle with bulimia nervosa, those with BED do not engage in any compensatory behaviors following binge episodes, such as vomiting, over-exercising, or restricting their intake. The result, for many, is weight gain over time. The DSM-5 notes that BED is more common in individuals pursuing weight-loss treatment than in the general public (APA, 2013).
The experience of weight stigma can contribute to the ongoing presentation of the BED. As with any psychiatric disorder, symptoms can intensify during times of emotional and situational stress. Encountering discriminatory and prejudicial comments, gazes, and practices can contribute to the emotional unrest that triggers a binge episode. So, while the public may criticize those at higher weights in an attempt to bully them into smaller sizes, these efforts often backfire. One study of 2,400 overweight and obese adults found that 79 percent responded to weight bias by eating more.
And thus the cycle continues…
The media presents significant information about the health consequences of being overweight. What it fails to do, though, is parse out the impact that weight discrimination has on patients’ physical health. In addition to increasing binge eating, weight bias can cause negative health outcomes through various pathways. First, higher-weight individuals may avoid doctor appointments due to fear of disrespect from their healthcare providers or shame around being weighed. Large bodies may not be adequately accommodated with respect to certain medical equipment, such as blood pressure cuffs, exam tables, and CT/MRI scans.
Additionally, research has shown that the experience of weight stigma is correlated with reduced exercise motivation, resulting in decreased fitness as a function of stigma and body dissatisfaction. Finally, experiencing stigma and prejudice can result in a chronic, elevated stress response, negatively impacting physical and mental health.
…research has shown that the experience of weight stigma is correlated with reduced exercise motivation, resulting in decreased fitness…
Weight bias can also impact those who don’t meet full criteria for BED. Many individuals, fearing judgments and bias around weight, have internalized their own weight stigma. They are preoccupied with their bodies and may engage in disordered eating in an attempt to manage their weight. Some may fall prey to the diet-binge cycle, in which they attempt to lose weight by dieting, only to gain it back by compensatory overeating. They may be searching for the latest fix – low-carb, gluten-free, low-fat, cleanses, juicing – whatever they believe might help them to control their weight. Some develop problems with compulsive exercise. Many others spend the majority of their lives with the nagging feeling that their bodies simply aren’t right.
So, what can you do to fight weight bias?
  • Adopt a Heath at Every Size® (HAES) approach, focusing on health, rather than weight. Learn to eat and exercise intuitively and to respect your body’s natural size – along with body diversity in the community.
  • If you struggle with BED, get help that allows you to address the behavioral aspects of the disorder without condemning you for your weight. Choose your providers carefully, as even health providers can be weight-biased. Ensure they, too, are proficient in the principles of HAES.
  • Become an activist, even if you aren’t heavy. As Isabel Foxen Duke writes, “When we fight for ‘fat acceptance,’ we fight for our sanity around food and weight, regardless of whether or not we ‘qualify’ as ‘fat.’”
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, October 15, 2014

Practicing Self-Compassion with Jenni Schaefer

Thanks to Jenni Schaefer, who recently featured an excerpt from my book on her blog!

Jenni recently celebrated the tenth anniversary of Life Without Ed, so be sure to check out her book's new edition and to congratulate her when you stop by her site.

Like the excerpt? Read more! 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