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. 

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. 

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. 

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. 

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. 

How to Parent Healthy Body Image and Why it Matters

Check out my recent article on parenting and body image on recovery.org.

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. 

How Much Do We Know About Purging Disorder?

I'm posting this on behalf of K. Jean Forney, a graduate student who studies eating disorders at Florida State University. She's researching purging disorder and looking for support for her project.

The Diverse Presentations of Eating Disorders

K. Jean Forney, M.S.

Typically, when people hear “eating disorder,” they think of anorexia nervosa, the eating disorder characterized by low weight. People sometimes think of bulimia nervosa, which is characterized by binge eating (eating a large amount of food while feeling out of control) and compensatory behaviors, like self-induced vomiting or intense exercise. Awareness is growing about binge eating disorder, the eating disorder characterized by recurrent binge eating without any sort of compensatory behavior.

It turns out a significant portion of people with eating disorders don’t meet criteria for these disorders, but still have clinically significant eating disorders. These clinically significant eating disorders cause distress, impairment, and medical complications. These individuals typically fall into the “eating disorder not otherwise specified” or “Other specified feeding or eating disorder” group. This is problematic, because that group is pretty heterogeneous. Some of those people engage in binge eating, some people eat most of their food at night, others only exercise excessively but aren’t underweight or binge eating. Because it’s heterogeneous, it’s hard to generalize any research findings on this “other specified” group. Things that are true of someone who excessively exercises without binge eating probably aren’t true of people who eat most of their food at night. Without naming and separating these conditions, it’s hard to study and develop treatments, because they are too diverse.

Another member of this “other specified” group is purging disorder. Purging disorder is characterized by purging behaviors, such as self-induced vomiting or laxative abuse, in people who do not experience binge-eating episodes. Estimates range from .5% to about 5% of women experience purging disorder in their lifetime, and there are few estimates available for men. The research available right now suggests that individuals with purging disorder have a higher mortality rate than the general population. It’s a serious condition to have.

Problematically, because purging disorder isn’t a “full” diagnosis like anorexia nervosa or binge eating disorder, no one has studied treatments for it. We are starting to collect evidence about how purging disorder is different from other disorders, but we need to know more about the prognosis and course of the illness, and factors that influence prognosis, in order to better develop treatments.

That’s why I am raising funds to study the long-term outcome of purging disorder and to compare it to the outcome of bulimia nervosa. I will identify what factors (attitudes about shape and weight, feeling out of control while eating, and hormones related to eating) predict outcome, providing clues as to where we can intervene. Please consider taking a moment to share my project and consider donating.

https://experiment.com/projects/long-term-outcome-of-women-with-purging-disorder

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. 

The Innateness of Movement

I've been spending a lot of time with kids and babies these days, and one thing I've noticed is that little people love to move. Babies and toddlers like to wiggle and jump. Grade-school kids love to tumble and climb. They dance and scoot and swim and ride bikes. Left unattended, kids will naturally choose movement over stagnation on many occasions throughout the day. In fact, they'll voluntarily run down the sidewalk if you let them. But most adults won't.

Many adults don't like to move. We view exercise (even the word sounds challenging) as a chore. We set up contingencies around movement that render it a chore.

Can you return to your innate love of movement? To the baby who jumped from the door frame for 30 minutes because he could, to the little girl who bopped in her bedroom to her favorite songs because why wouldn't she dance, to the boy who chased his buddies down during a hearty game of tag?

If movement isn't this natural, this inspiring to you, then find another way. Moving our bodies should be invigorating, not depleting, and can uniquely connect us to the earth and our most innervated selves. Make fitness fun.

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. 

Bad Research

In May, The New York Times posted an article about a research study that found that it's possible to lose 11 pounds in four days. I'm disappointed in The Times for featuring this study, and if you're a budding researcher or at all interested in debunking weight-loss myths, follow along with me as to why.

First, the study consisted of 15 participants, an embarrassingly low sample size. Let's just say we can overlook that fact for a second. The article reports that the participants were "healthy but overweight Swedish men." Ask yourself: "Am I a healthy but overweight Swedish man?" If not, the sample doesn't represent you.

You'll also notice that the sample doesn't represent women, Swedish men of different health- and weight- statuses, non-Swedish men - you get the picture. It's a homogenous sample, and that's not the goal of good research.

Next, let's take a look at the experimental condition (note: there was just one condition and not a control group, further decreasing research validity). During the study, participants ate about 360 calories a day and exercised for almost nine hours. Like The Biggest Loser on steroids. . . When we think of research, we like to choose conditions that can be replicated in the real world, to increase the study's internal validity. How likely is it that most people could drop down to such a caloric deficit and exercise for so many hours in their "real lives?" If not, then the results we see could somehow be an artifact of the experimental conditions.

Finally, let's talk about the conditions themselves. To repeat, these men consumed approximately 360 calories a day and exercised for almost nine hours. This sounds more disordered than some of the most serious eating disorders I've encountered. Will these men go on to develop a disordered relationship with food or exercise? Who knows? But, I'm not sure where we draw the line with ethical research and what type of research review board approved this study's intervention. I could argue that infecting research participants with some sort of food poisoning could also result in such rapid and significant weight-loss, but that would obviously be unhealthy. But would it be any more unhealthy than what these researchers prescribed?

And if we're to generalize from this research and start prescribing a few days of extreme caloric restriction and over-exercise to treat those who are overweight, do we want to run the risk of some patients going on to develop disordered eating? Did the researchers look at the participants' attitudes toward food and weight as a result of the intervention? I'm reminded of the Minnesota Starvation Experiment. What happens after a year? Is weight loss really the ultimate goal?

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. 

Body Commodity

When did your body become anything other than a carrier for you?

When did your body become something to. . .

-think about

-judge

-criticize

-dissect

-change

-punish

-abuse

When did your body become some thing?

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. 

A Critical Analysis of "All About the Bass"

You might be wondering how Meghan Trainor's "All About the Bass" fares on the body image front. Let's take a critical look. 

Trainor's catchy, end-of-summer anthem promotes body acceptance in a number of ways. Early on, she sings: "Yeah it's pretty clear, I ain't no size two/But I can shake it, shake it like I'm supposed to do." While she might not embody America's thin ideal, Trainor still moves and appreciates her body. She reiterates this point, noting that "You know I won't be no stick-figure, silicone Barbie doll,/So, if that's what's you're into/Then go ahead and move along." Here, Trainor defies the internalization of unrealistic, reductive beauty standards and instead rejects those who demand her compliance with such rigid norms.

Trainor goes on to decry the widespread practice of photo retouching, stating: "I see the magazines working that Photoshop/We know that sh*t ain't real/Come on now, make it stop."

Finally, Trainor riffs, "Every inch of you is perfect from the bottom to the top," encouraging women to accept and respect their bodies in their entireties. 

Despite these self-esteem boosts, Trainor falters some in the body-acceptance quest. When she croons, "'Cause I got that boom boom that all the boys chase," she objectifies her body, its value determined by the strength of the male gaze it invites. The singer likely learned this message from her mother, who taught her that appeal (read: worth) can be measured vis-a-vis her shape: "Yeah, my momma she told me don't worry about your size/She says, boys they like a little more booty to hold at night." That we exchange shape for size as commodities in our relational transactions doesn't make them any less materialized.

Trainor notes she has "All the right junk in all the right places." One may ask, what are "all the right places"? Yet, because of our culture's widely-accepted beauty standards, we'd likely see a lot of agreement here. The designation of "right" versus "wrong" places for "junk" (arguably pejorative, even though it's the "right" junk) creates an unrealistic expectation for many women. It may be okay to shirk the thin ideal, but you'd better do so in a legitimate way.

Lastly, when Trainor sings, "I'm bringing booty back/Go ahead and tell them skinny bitches," she unnecessarily snubs thin women and creates an "us" versus "them" mentality, a dichotomy that won't go far in promoting wide-reaching body positivity.

So, yes, while championing a curvier frame, unedited photos, and body acceptance, Trainor also promotes a woman's body as object, glorifies a certain body type/shape, and marginalizes skinny women, discouraging body acceptance across the spectrum. The tune is more weight- and size-inclusive than other mainstream representations of women, and the video refreshingly includes men and women of color, but the message advocates for a certain shape, unnecessarily sidelining women whose bodies don't conform. 

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.

Stop Demonizing Food

I have to tell you, I'm a little sick of the sugar thing. And the carb thing, the wheat thing, the soda thing, the salt thing, and whatever thing we might be hearing about tomorrow.

Now, I'm not recommending mass amounts of any of these foods, as they're often consumed in the American diet. A daily Super Big Gulp likely won't do any body good. But to demonize any food item unnecessarily polarizes foods into healthy vs. unhealthy or good vs. bad, which sets the stage for all kinds of disordered eating.

And here's the thing: no food makes you fat. Not a baguette, a bowl of noodles, a cupcake or macaron. Overeating these foods may predict weight gain over time - eating more than our bodies need can do this - but part of the reason we're overeating is that we're so consumed by diet culture that we're hybridizing feast and famine. 

"I can't have bread. I can't have bread. I can't have bread." And then, because bread is actually available, "Oops, I had too much bread."

The more we learn about weight, the more we understand the genetic influences on this variable. What you weigh is largely a function of your genes and their products, particularly hormones that control appetite and satiation.

When we cut out certain foods to lose weight, there is often a backfiring effect, in which we end up overeating these foods due to the experience of physical and psychological deprivation. Developing a healthy relationship with food involves being able to interact with all kinds of food in a healthy way. It means moving past feared foods and and food rules.

I recently came across an eating disorder treatment program that advertises that it's food plan requires patients to "abstain from 'junk food,'" "eliminate highly processed foods," and "weigh and measure portions" while in treatment.

In my opinion, barring certain foods and requiring the weighing/measuring of foods is contraindicated with eating disorder recovery. In treatment, patients should be exposed to a variety of foods and should not be allowed to engage in food calculations and calibrations - these behaviors are symptomatic of the disorder itself and the goal of treatment is to extinguish them.

Referring to less nutritious food as "junk food" reinforces the eating-disorder mentality and eliminating certain foods in treatment doesn't teach patients how to interact with these foods, a required skill in the real world.

Food isn't the problem. It's our relationship to it that becomes distorted and dysfunctional. The more we demonize food, the more we prevent ourselves from cultivating a healthy relationship.

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.

The Shame in Advertising

By now, you've probably heard of Gap's Twitter fiasco, in which the clothing retailer landed itself in an uncommon, too-skinny debate after tweeting this photo last week:

The internet erupted with comments like “Seriously, @Gap? In what world do people look like this?” The model was referred to as "a pencil in plaid," and some claimed she needed to eat a cheeseburger.

Body image defenders swooped in to defend Gap's choice and accused online commenters of skinny-shaming the plaid-clad model. Many cited skinny-shaming as just as painful and dangerous as shaming those on the other side of the weight spectrum. 

And it's true, these comments are hurtful and misinformed. I'd love to live in a world where we refrained from judging and criticizing each other's bodies - period. 

But, this has nothing to do with this particular model's body. All she did was put in a day at the office. Oddly, I read five articles on this subject, and I couldn't even locate the model's name. It just reinforces the idea that no one's really interested in her.

What we need to do is step back and look at the larger context. If clothing companies routinely featured models of varying weights, the Gap ad would likely have fallen through the cracks - the model's body understood as yet another iteration of body assortment, rather than an exemplar of female beauty. Most clothing companies, however, widely promote our culture's thin ideal. The National Association of Anorexia Nervosa and Associated Disorders reports that says only five percent of American females are naturally shaped like the models we see in advertising (arguably an even smaller percentage when compared to the ultra-thin Gap model), and yet advertising sells us this ideal - at all costs.

We need to see more body diversity in the media and in advertising. We need to understand that certain images, when insufficiently balanced by others, can dangerously normalize eating disorders. And we need to recognize that the Gap controversy isn't about the skinny-shaming of a too-thin, nameless model but about an industry that perniciously thrives on selling an unrealistic, unattainable ideal. Here's where the shame lies.

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.

Defining Plus-Size

Plus-size model Robyn Lawley made waves on the internet a couple of weeks ago by posting an unedited, bikini-clad photo of herself on Instagram:

The controversy? That Lawley is defined as plus-size.

Many were outraged that the tall, thin model could ever be considered too curvy or heavy for "normal-size" modeling. But the lanky (6'2"!), Size 12 beauty is certainly plus-size when you consider that the average American model wears a Size 0 and that Size 6 is often considered plus-size.

So, yes, Lawley is thin and yes, she's plus-size. In an industry where skinny is lauded at all costs, where models' "flaws" are airbrushed into oblivion, and where Size 000 now exists, Lawley, though thinner than the average American woman, is simply too big for mainstream modeling.

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.

Changing the Conversation

In a recent Nutrisystem commercial, Marie Osmond asserts: "As women, we always talk about how we should look or what’s the best way to lose weight."

Is this the conversation all of us are having? Are we all conspiring around this goal? And if so, what we can do to challenge it?

The truth is, it's spot on for many of us. Some women are engaged in evolving dialogues that have nothing to do with weight or shape. But it's sometimes challenging to get women from the first group to the second.

In a recent interview, a reporter asked me for tips on what else women can talk about if we're to ditch fat and diet talk. My tip is, there are no tips - because the answer is infinite - if we remove fat/diet talk from our language, we get to talk about everything else.

Women have so much more to talk about than food and weight. We have jobs and families and hopes and ideas, feelings and interests and beliefs. If we remove fat and weight talk from our dialogues, we're freed up to talk about anything else - everything else - to explore and create and connect in a deeper way, and ultimately, to be more of our authentic selves.

And shouldn't this be the goal?

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.

Unconditional Body Acceptance

One thing that's struck me recently in the body image world is a sort of conditional body acceptance in the first-person narratives I've read - let me explain. . . .

I accept my body after baby - the weight and stretch marks and scars and marks - because I created and hosted the miracle of life.

I accept my wrinkles and sags as I age, as they tell the story of my long and winding journey.

While these stories are often poignant and certainly move our dialogue along, a tacit message is, I'm okay with my imperfections, but only because I've carried a baby or arrived at a certain age. 

But here's the thing: You don't need to have a baby or be of a certain age or accomplish or endure anything else to explain away a feature on your frame. Belly fat is okay with or without child and lines and wrinkles can pop up at any age. In the words of Sonya Renee Taylor, "The body is not an apology." Make no bones about it.

The rimples and dips and creases and puckers, the swelling, distention, flab and fat that your body naturally houses - you don't need an excuse.

Your body is okay.

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. 

10 Things I Wish the Public Knew About Eating Disorders

Dr. Ed Tyson, a medical doctor who specializes in treating eating disorders in Austin, Texas, recently wrote an article, entitled, "Ten Things I Wish Physicians Would Know About Eating Disorders."

Inspired by this piece, I've compiled my own list of ten things I wish the public knew about eating disorders:

1) Eating disorders come in all shapes and sizes. You cannot guess if someone has eating disorder by looking at him/her. This goes for body type, race, gender, etc. (Side note: Someone who's average weight or heavy could have a restrictive eating disorder - and not the binge/compulsive/emotional eating disorder you might think - don't assume behaviors based on size.)

2) An eating disorder is not a desirable condition of glamour or restraint. It is a mental illness in which a disorder takes control of a person's thoughts, emotions, behaviors - and life.

3) Eating disorders are not about vanity or simply the internalization of society's thin ideal. Yes, our culture's thin ideal can play a big part in triggering an eating disorder (which is why I fight so hard against it), but there are other factors (genetic and constitutional) that increase susceptibility to eating disorders. The thin ideal also plays an unfortunate backdrop for eating disorder recovery - another reason I work so hard to challenge it.

4) There are other ways to purge (in bulimia nervosa) outside of vomiting. Some patients abuse laxatives, diuretics, enemas, or engage in excessive exercise - and some compensate for binges by significantly restricting their food outside of the binges - all can constitute bulimia.

5) There are evidence-based treatment approaches for eating disorders. These are treatment modalities that have been proven effective in research studies. Such treatments include cognitive behavioral therapy, family- based treatment, and dialectical behavior therapy. Seek out providers who practice evidence-based treatment.

6) Along these lines, seek out providers who are licensed professionals and who have experience and expertise in eating disorders. Life coaches, health coaches, personal trainers, etc. are not equipped to deal with serious psychiatric disorders.

7) Diets, including juicing, cleansing, and other plans, are not recommended for the treatment of eating disorders. Cutting out specific foods or food groups is contraindicated for eating disorder recovery. Same goes for 12-step programs that prescribe diets or similarly limit food intake.

8) School practices, such as BMI reporting and class weight-loss or calorie-counting assignments, can trigger pathology in those who are susceptible.

9) Disordered eating can be painful and self-destructive, even if it never shifts into a full-blown disorder. Let's take disordered eating and other eating disorders (besides the most talked about) seriously.

10) It is possible to recover from an eating disorder. The sooner someone gets treatment, the better the chances at full recovery. Recovery, though, is not linear, nor something to perfect. It might be a long and windy road, and life can happen along the way.

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. 

Freedom Is. . .

Inspired by Independence Day - what does freedom from food and body concerns look like to you? Feel free to add to my list of 20. . . .

1. Allowing yourself to eat when you're hungry.
2. Allowing yourself to stop when you're full.
3. Recognizing these functions are a work in progress.
4. Saying "yes" to a variety of foods, including those that used to be off-limits.
5. Prioritizing food flexibility as a goal.
6. Ignoring the latest diet trends (including _______-free, juicing, cleansing, etc.), recognizing they do more harm than good.
7. Giving yourself permission to make mistakes.
8. Learning from setbacks.
9. Exercising when you feel healthy and capable but not when you're sick or tired.
10. Learning to appreciate the benefits of movement when it isn't tied to a specific weight goal.
11. Tossing clothing that no longer fits without any self-reproach.
12. Treating your body well, despite the fact that it might not be your ideal body.
13. Saying "yes" to people and opportunities, despite how you feel about your body.
14. "Zooming out" from fixations on weight and shape - regarding yourself and others.
15. Finding a life purpose greater than maintaining a particular weight or size.
16. Refraining from comparisons - your body may need more or less food than someone else's and it may also be naturally bigger or smaller than someone else's. 
17. Ditching the scale, the measuring tape, the skinny jeans, the mirror, or any other external means of tearing down or validating yourself. 
18. Building yourself up due to other attributes outside of your weight and shape.
19. Surrounding yourself with people who also want to be free.
20. Accepting where you are, wherever you are, while recognizing you are still capable of growth and change.

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. 

BMI Report Cards Fail Professional Support

Recently, the Academy for Eating Disorders (AED) issued a position statement on Body Mass Index (BMI)/weight reporting in New York City Public Schools. The grade? Big fail.

The AED opposes BMI report cards, referred to as "Fitnessgrams," in New York City on several grounds. According to their press release, “Although the New York Department of Education reports the belief that providing information about students’ weight and BMI to be beneficial in ‘helping students set personal goals’ and developing a healthy lifestyle, experts in eating disorders and body image strongly disagree.

Why do health professionals oppose BMI reporting practices? 

First, BMI is not an accurate measure of body composition. BMI can be influenced by a host of factors, beyond body fat, including musculature and frame. Second, weight is not a proxy for fitness. There are kids (and adults) who are thin and unhealthy and others who are heavier but in good health. We need to disentangle these concepts. Third, BMI reporting highlights our culture’s thin ideal, which can contribute to the development of disordered eating and weight-related bullying. 

A number of states and school districts have similarly tracked students' weight, including schools in Arkansas, Pennsylvania, Florida, Tennessee, Wyoming, Massachusetts, and Illinois. In some schools, parents are able to opt out of their children being weighed.

Parents who are informed of their child's overweight/obese weight status, as many are given current statistics, may run the risk of implementing misguided dietary practices, without professional advice. Kids, too, may decide to restrict their diets based on these reports. Such dieting practices can contribute, with the right set of genetic and constitutional factors, to the development of an eating disorder. 

If students are issued their BMI report cards publicly, the climate is ripe for unhealthy comparisons, fat-shaming, and weight-related bullying. Weight screening programs can increase body dissatisfaction in a world where fat is out and thin is in. For children and teens who are obese, this may compound the experience of stigma and shame already associated with their weight. They are likely to feel judged, labeled, and blamed.

If your child's school district has implemented BMI reporting, consider these tactics:

• Opt out if you can and leave health discussion about your child to medical professionals.
• Discuss the negative impact of such practices on children with the school's (and district's) administrations.
• If age appropriate, have a discussion with your child on the limited information weight provides.
• Focus on a balanced diet and sufficient activity at home – these behaviors are more important than weight.
• Encouraged acceptance of different shapes and sizes - as psychotherapist Kathy Kater's book states, "Real Kids Come in All Sizes."

My book, Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight is now on Amazon as a paperback and Kindle and at BarnesandNoble.com. Enjoy!