Women's History Month at Miami-Dade College

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

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

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

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

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

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

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


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. 

Recovering Around a "Backdrop of Disorder"

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


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 Best Worst Question of All

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

The Best Worst Question of All

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

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

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

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

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

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

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

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

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

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

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


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. 

2015's NEDAwareness Week

Drumroll for NEDAwareness Week!

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

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

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


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. 

Breaking Bad Ads

Anyone see this gem of a Superbowl commercial?



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

Any thoughts?

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

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

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


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. 

Celebrity Weightloss

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

Is anyone still buying this?

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

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

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

Now, that would be newsworthy.


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. 

Eat-in-Peace Resolutions

Thank you to all who submitted your eat-in-peace resolutions. Below is a sampling of some of the intentions that generously graced my inbox in the last couple of weeks. Take a peek - they're inspiring! Contest winners (whom I notified by email) were chosen blindly by a third party, and the books are on their way! I wish everyone the happiest and most peaceful of new years. . . .

"My resolution is to live my life and not wait to do things when I get thin!! I have put off so many ideas thinking I didn't deserve that till I lose weight."

"Ultimately, I want to work on not judging everything I eat.  For example, I want to stop the inner voice that seems to have a comment about everything I eat.  If I eat ice cream, I want to just have ice cream, instead of thinking "oh, that was more sugar.  I already had sugar today".  Or "I'm having pizza tonight, even though I ate a lot of carbs today and didn't get enough vegetables."  The self judging is something I want to end because it's not necessary and just makes me feel doubtful with everything I eat."

"My resolution is to continue to eat for health and not restrict any foods except those that trigger migraines for me. It will be about wellness, not weight loss."

"I resolve to continue the progress I've made by maintaining my break-up with the scale, by appreciating my values and accomplishments, and by living a life without fear or guilt. I will not speak or think negatively of myself or stress myself out with frivolous worry about food or exercise. I will own my decisions and enjoy this journey."

"My DEWHAED New year’s resolution is to stop comparing myself to others or to a vision of what I want to be – which is usually a skinnier version of me. Instead, I would like to live my life as who I am, in the here and now, with a healthy attitude and a grateful heart for how far I have come."

"Every year, I give something up for the New Year, only to fall flat on my face and feel worse than before. Cheese, carbs, soda. I've lost and gained and lost and gained hundreds of pounds, and at my biggest and smallest, I felt terrible about myself. I binged to my largest size, and I restricted to my smallest.

This year, I'm giving up guilt. My birthday was a few weeks ago and I got a head start on my Resolution by getting rid of my scale. Weighing myself every day was screwing with my head, my whole day was good or bad based on what numbers I saw. From now on, I am going to love myself, to mindfully eat the foods I enjoy without measuring or weighing or counting anything, and I'm going to live, really truly live. I'm going to stop hiding at home and avoiding friends and social situations because I am ashamed of my body. It may not be perfect, but it is mine and it is all I have. This body has been good to me, much better than I have been to it.

I'm a mom now, I need to be healthy not only for myself, but for my son. And health is not just about a healthy weight, but a healthy mind and a healthy relationship with food. I want to be a good role model for my baby. My childhood memories of my mother almost all involve her avoiding cameras and saying "no thanks, I'm on a diet." I want my son to remember me and his childhood differently."

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. 

Holiday Book Contest!

It's hard to believe that my book has been out for six months. For almost eight years, I toiled away on this blog, and then, this past June, the book finally came to print.

In celebration of this half-year publication mark, and in keeping with the holiday spirit, I am going to give away two signed copies of Does Every Woman Have an Eating Disorder? to my loyal readers. It's this community that inspired me to write the book and that continues to motivate me to post regular content on this blog.

To enter the contest, either email me privately (drstaceyny at gmail dot com) or comment below with your DEWHAED New Year's resolution. No diet talk, no rigid exercise plans, no weight-loss promises - only body-positive, revamped resolutions that promote eating in peace and accepting/respecting yourself. No resolution is too small or too big - just an intention to create a healthier relationship with food or your body.

The deadline for resolutions is 12/22. Winners will be selected at random that week, and the books should arrive around the new year. In celebration of good health. . .

Fine print: Please enter the contest only once. For those who submit via email, please include your mailing address to receive a book if you win. If you submit via comment, be sure to send me a follow-up email with your mailing address. By submitting a resolution, you authorize DEWHAED to post your anonymous response. Winners will be selected by drawing so as to preserve resolution integrity.



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. 

Is DBT Effective for the Treatment of Eating Disorders?

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

Dialectical-behavioral therapy (DBT), as developed by Dr. Marsha Linehan, is a type of therapy that helps patients reduce emotional reactivity and improve thought patterns and interpersonal interactions. The therapy, a hybrid of cognitive-behavioral therapy and tenets from eastern philosophies (primarily Buddhism), was created to help those who struggle with borderline personality disorder and chronic suicidality. However, DBT has also shown promise in the treatment of substance use disorders and eating disorders.

DBT is a problem-solving, but accepting approach – one that helps patients change, while accepting them for who they are. This duality (or “dialectical” view) seems to sit well with many patients as they struggle on the road toward recovery. The avoidance of either/or thinking (e.g., “I’m either recovered or I’m a failure”) can help patients restructure other black-or-white thought patterns common in those with eating disorders.

DBT offers an affect-regulation approach to eating disorders – helping sufferers to cope less pathologically with some of the challenging emotions that might precipitate eating disorder symptoms.-STACEY ROSENFELD

DBT offers an affect-regulation approach to eating disorders – helping sufferers to cope less pathologically with some of the challenging emotions that might precipitate eating disorder symptoms. Patients who are treated with DBT learn four broad, overlapping sets of skills in the areas of: 1) mindfulness 2) distress tolerance 3) emotion regulation and 4) interpersonal effectiveness.

Individual skills in the mindfulness module include learning how to use one’s “wise mind” and engaging in non-judgmental awareness. In the distress tolerance module, patients hone crisis coping skills, such as distracting and self-soothing. With emotion regulation, patients learn how to identify and label emotions, as well as how to create a life that is less vulnerable to intense emotional shifts. In the interpersonal effectiveness module, patients learn assertiveness skills, such as asking for what they need and saying no to others’ request.

The Research

Research into the efficacy of using DBT to treat eating disorders has been encouraging, though additional, broader research is warranted. In an early study of women with binge eating disorder, participants treated with DBT showed significant reduction in binge eating behavior, with 89 percent of the sample binge-free at the end of the study and 56 percent abstinent at the six-month follow-up. In a similar study of women with bulimia nervosa, results showed “highly significant decreases” in bulimic symptoms following DBT treatment.

More recently, researchers piloted the use of DBT with adult patients with anorexia, and the treatment showed promise. DBT was associated with increased BMI in participants, evident at six- and twelve-months.

DBT in Action

A number of eating disorder treatment centers offer DBT as a complement to other types of therapies. Patients typically learn DBT in group settings, where the modules are introduced cyclically so that new patients can join the discussion at any time. Patients often report that DBT provides a helpful, solution-oriented adjunct to their treatment. Particularly when distressed, they can rely on their DBT skills to cope with emotional challenges in the moment.

Take the case of Eddie, a 45-year-old man with binge eating disorder. Learning DBT was helpful in reducing his binge episodes through various pathways. He became more mindful of his hunger and mood states through a consistent mindfulness practice. He learned how to better insulate himself against emotional distress – behaviors like consistent sleep hygiene and sufficient food intake helped protect him against any emotional waves he encountered. (Eating enough, too, helped protect him against over-hunger, which often triggered a binge).

Eddie had earmarked some tools from his distress tolerance module so that when he did experience distress, he had some alternatives to bingeing. Some of his go-to self-soothing skills included going for a drive or spending time with his dog. Finally, Eddie had learned that a significant trigger for his binges was feeling overwhelmed by life’s demands and promises to others at work and home. In the interpersonal module, Eddie learned how to say no skillfully to others’ requests, a practice that previously evaded him. These skills collectively helped Eddie experience a significant reduction in binge eating episodes and an improvement in overall wellbeing.

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. 

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.


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. 

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. 

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.