Happy Thanksgiving!

As Thanksgiving approaches, now is a good time to increase your mindfulness in taking care of yourself daily and especially through the holiday season.

Some experience holidays as joyous, cheerful times to connect with family and friends. Others experience the holiday time as tense, sad and depressing. And of course, there is the huge spectrum that exists between those two experiences. But generally speaking, holiday times are usually replete with emotion. Likely, a mix of emotions.

Whatever your experience is, it is up to you to honor it. Absent of judgment. With connection and with consciousness.

And the food… when thinking of Thanksgiving food, we oftentimes conjure up images of large tables overflowing with food. For those struggling with eating disorders, or who have a more complicated relationship with food, it will undoubtedly trigger anxiety, fear and overwhelm.

When you approach this holiday season, and the many mealtimes throughout, slow down. Become mindful. Check in with yourself and notice how you are feeling both emotionally and physically. Continue to check in with yourself throughout the day, the meal, the holiday. Take a time-out if you are feeling overwhelmed. Confide in a family member, significant other or a friend. Text someone. Stay in touch with someone who knows what is going on for you and assure yourself that you are not alone.

Become curious about which emotions you honor and which you tend not to. Become curious about when you choose to honor your hunger and satiety and when you choose not to. And above all, have a meaningful Thanksgiving and make sure to give gratitude to yourself!

How has my work with eating disorders impacted me personally?

About 7 years ago I created the curriculum on Eating Disorders for New York University’s Graduate School of Social Work. I LOVE teaching this course and feel a tremendous amount of gratitude for the opportunity to teach such eager men and women something that I feel so passionately about.

Someone in this past class asked me something that no one has asked me yet – How has my work with eating disorders affected my own relationship with food, my body and myself? I didn’t have a quick answer. I really had to think about it. Am I negatively affected in some ways? Am I positively affected in some ways? Do I eat more, as many people describe as a common “side effect” of working with eating disorders?

I gave it some thought and then very genuinely talked my way through my answer. It’s true that on days when the topic of actual food arises, I tend to leave craving foods I wasn’t otherwise thinking about. But I can generally get back in touch with what I really want and satisfy myself. Sometimes that doesn’t happen and the craving is really strong. I’m okay with that, too!

Regarding my body, I spend a lot of time with my patients discussing and exploring body acceptance, honoring ones body and doing all of this in the face of familial and societal pressures. I truly feel that body dissatisfaction, to some degree, has become almost a rite of passage for everyone, both men and women. Doing this work has offered me a daily reminder of the choice I have (we all have) to either reject or to succumb to these pressures and fall into the “I’m not good enough” thinking that lives in tandem with the “thin ideal.” Even in moments when I have a tinge of “not good enough,” I quickly find myself automatically catapulted into some sort of anger or frustration about being told that I have to look a certain way in order to be acceptable.

I shared the above and then continued, “Overall, it has made me more empowered! I never feel so healthy and empowered as I do when I leave my office at the end of the day – most of the time.” WOW! I was a little surprised to hear myself say this with such gusto but it’s true! Working with both men and women struggling with eating disorders has empowered me! Of course, it can be difficult, frustrating, devastating and many other things but what I feel the most is EMPOWERED! Why? I think it’s quite simple. Life in general, as well as doing this work genuinely and authentically, as I hold myself accountable to do, has forced me to develop my own personal ethos and it is from there that I try every day to live both personally and professionally. My ethos includes things like empowerment, authenticity, direct communication, vulnerability and compassion for myself and others.

Today I would like to invite you to consciously consider your own personal ethos and if it matches how you are living most of the time (and let’s face it, none of us are perfect – that’s not what this is about). If you don’t have a personal ethos, then I’d like to invite you to create one for yourself!

Can You Really Be Addicted To Food?

I am frequently asked about the idea of “food addiction” and have wanted to formally address this idea for quite some time. Then I came across the amazing blog written by Evelyn Tribole, MS, RD and Elyse Resch, MS, RDN, CEDRD, Fiaedp, FADA. You may recognize their names and may even have their amazing book, “Intuitive Eating,” on your bookshelf!

Evelyn addressed the idea of “food addiction” clearly and concisely so I figured why mess with success! Here is her original blog post:

Can You Really Be Addicted To Food?

There has been a lot of media attention on food addiction research.  Scientists are curious about this possibility because the brain region (and neurochemicals) involved with substance abuse, are also implicated in overeating.   But there are a lot of reasons, other than addiction, that can explain the rewarding aspect of eating.

Survival of the Species – This brain-reward system is believed to be necessary in order to ensure human survival. This involves the brain chemical, dopamine, which triggers both a pleasurable feeling and motivation behavior. Engaging in activities necessary to survival (such as eating and pro-creating) triggers a rewarding-feel-good experience.

Hunger Enhances Reward Value-Hunger by itself, enhances the reward value of food, in which more dopamine is triggered.  For example, you might find yourself suddenly interested and motivated to cook a meal, if you discover you are hungry.   Dieting (which can be a form of chronic hunger) also has this effect.

Pavlovian Conditioning– The dopamine effect could be attributed to Pavlovian conditioning (recall the classic study, in which Pavlov’s dogs salivated at the mere ringing of a bell.  This anticipatory salivation occurred because the dogs were conditioned to receiving a treat after a bell rang, each time). This is not addiction.

Dopamine Deprivation? Many pleasurable activities trigger dopamine, including socializing, hiking, and playing games. The great majority of people I see in my practice who binge-eat, are often leading very unbalanced lives, which “deprives” them of the dopamine benefits. When needs are not being met, food becomes even more enticing, more rewarding.

Music Lights up Dopamine Brain Centers. Recently,a new study showed that when people listen to music, it lights up the same region of the brain (nuclear accumbens), which has been implicated in the euphoric component of psychostimulants, such as cocaine [Salimpoor 2011]. Just the anticipation of hearing the music lit up the dopamine brain centers. (Yet, I really don’t think you can make the case for “music addiction”)

Food Addiction Studies Limited & Flawed-The research on “food addiction” is way too early to be drawing any conclusions. The great majority of studies have been on animals. The limited research on humans has only been brain-imaging studies with a very small amount of people and not much exclusion criteria [Benson 2010].

Yale Food Addiction Questionnaire– has generated a lot of headline news.  Yet, upon a closer look, the questionnaire seems to actually be measuring compulsive eating or rebound eating from chronic dieting [Gearhardt 2009].  Here is a sampling of the questions:

• I find myself consuming certain foods even though I am no longer hungry.  (Classic compulsive eating or distracted eating can cause this).
• I worry about cutting down on certain foods. (Chronic dieting and overeating can cause this)
• I have spent time dealing with negative feelings from overeating certain foods, instead of spending time in important activities such as time with family, friends, work, or recreation. (Chronic dieting and compulsive eating can cause this)

To read more questions and details on scoring the questionnaire see [ http://abcn.ws/dN8FcI and Gearhardt 2009]

Studies Show Eating “Forbidden Food” Decreases Binge Eating–Finally, there are three studies to date, in which binge eaters, eat their “forbidden foods” as part of the treatment process. [Kristeller 2011, Smitham 2008] Binge eating decreased significantly in all of these studies.  If food addiction was a causative issue, you would not expect these types of results. Food addiction theory would predict increased binge eating, triggered by eating “addicting food”. Yet, the opposite happened.

So rather than fear-mongering about food addiction, how about putting your energy into satisfying eating experiences, without distraction or duress; and working on creating a balanced lifestyle, while getting most of your needs met (which includes getting enough sleep).

Selected Citations and Resources

Benton D. The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical Nutrition 29 (2010) 288–303.

Berridge KC & Kringelbach ML. Affective neuroscience of pleasure: reward in humans and animals. Psychopharmacology (Berl). 2008 August ; 199(3): 457–480.

Gearhardt An et al. Preliminary validation of the Yale Food Addiction Scale. Appetite 2009 (52):430-436.

Herrin M &  Matsumoto N. The Truth About So Called Sugar Addiction.  Eating Disorder News. March 2011.

Kristeller JL, & Wolever RQ (2011). Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Jan 2011; Eating disorders, 19 (1), 49-61.

Salimpoor VN. Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nature NEUROSCIENCE. Feb 2011;14 (2):257-262.

Smitham.L.Evaluating an Intuitive Eating Program for Binge Eating Disorder: A Benchmarking Study.University of Notre Dame, 26 November 2008.

Reprinted with permission Copyright © 2011 by Evelyn Tribole, MS, RD Published at www.IntuitiveEating.org

•Rights to Reproduce: You may reproduce this post, as long as you leave it unchanged, you don’t charge for it, link to it, and you include the entire copyright statement. Please let us know you have used it by sending a website link or an electronic copy to Etribole at gmail dot com.

DISCLAIMER: The information is intended to inform readers and is not intended to replace specific advice from a health care professional.

National Eating Disorder Awareness Week

If you live in New York City, you may have noticed that the Empire State Building was aglow in green and blue yesterday, February 25th. Why?

It’s National Eating Disorder Awareness Week (February 23 – March 1)!

Organized by the National Eating Disorders Association (NEDA), the aim of National Eating Disorder Awareness Week is to raise awareness and educate about eating disorders and body image issues, prevent eating disorders and to reduce stigmas surrounding these issues.

This week has been full of events to celebrate eating disorder awareness. To name a few, there have been NEDA walks, Art Projects, Art Exhibits, Scale Smashing, Support Groups, Eating Disorder Screenings, Film Screenings, Fundraisers, Recovery Forums. Love Your Body Zumba Parties + Yoga Classes! Visit the the National Eating Disorder Awareness website for events in your area.

Last year I created Destructively Fit in order to address eating disorders within the fitness world. It’s been a pure love-project for me and I’m grateful for all of the support that I have received. But… I would love your help to spread the word and to effect some serious change within the fitness industry as a whole. In honor of National Eating Disorder Awareness Week, please spread the word about Destructively Fit and get connected on Facebook and Twitter!

Help spread awareness and help make a difference with this ubiquitous and dangerous issue. Here are some stats for you:

• 25 million American women are struggling with eating disorders
• 7 million American men are struggling with eating disorders
• 81% of 10 year old girls are afraid of being fat (Dove Self Esteem Fund Initiative)
• 51% of 9-10 year old girls feel better about themselves when they are dieting
• 45% of boys are unhappy with their bodies
• 67% of women 15-64 withdraw from life-engaging activities, like giving an opinion and going to the doctor, because they feel badly about their looks (Dove Self Esteem Fund Initiative)
• An estimated 90-95% of college students diagnosed with an eating disorder are members of fitness centers (McLean Hospital, 2004)
• Of American elementary school girls who read magazines, 69% say that the pictures influence their concept of the ideal body shape. 47% say the pictures make them want to lose weight (Martin, J. B. (2010). The Development of Ideal Body Image Perceptions in the United States. Nutrition Today, 45(3), 98-100.)
• Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives. (Neumark-Sztainer, D. (2005). I’m, Like, SO Fat! New York: Guilford)

If you or someone you know is struggling, get help now! Eating disorders are treatable and early intervention is critical! Remember, you are not alone and you can feel better!!!

To find resources in your area:
National Eating Disorder Association: 1-800-931-2237
EDReferral.com

the biggest loser, is anyone really winning?

I can’t begin this post without first stating that in no way is this about Rachel Frederickson. I don’t know her, I never met her and I’ve never had any contact with her. I am also not a part of The Biggest Loser and don’t really know what goes on the behind-the-scenes.

While writing this, it feels uncomfortably clear that Rachel will likely be reading much of what is written about her and her body. She will read the criticisms, concerns and maybe even how impressed and inspired people are. I want to express that the intention of this post is to draw attention to the larger issues at hand and not to criticize Rachel in any way.

However, Rachel is at the center of this long overdue firestorm around The Biggest Loser and is an example of what I’ve been ranting about for years.

260lbs to 105lbs (a 59.62% loss of total body weight) in 7.5 months time. At 5’4″, that equates to a BMI of 18 – clinically underweight.

I have enormous respect for the men and women who choose to wage their internal battles and to do so publicly, is another level of courage. We all need motivation and if going on a reality television show is that for someone, then who am I (or any of us) to judge.

Some are entertained and maybe even motivated by these heartfelt stories. The network and staff make money from these same stories. It’s a fair trade. Participants get services for the fee of doing it publicly. As long as everyone is consenting and willful, so be it.

I do, however, have an enormous problem with the treatment of those who are willing to be vulnerable (body and soul) in front of an audience of millions and share the innermost struggles that have haunted them for years, most times decades. Their willingness to do this does not give license for inadequate and improper treatment.

To my knowledge, most (if not all) of these participants at some point in their journey have an emotional epiphany that their relationship with food is actually related to their relationship with themselves and that this is the root of the problem. This is an eating disorder defined! So if we acknowledge this, now we have a show about men and women who are struggling with eating disorders and we are watching them deal with the food and exercise part of their treatment. Except… where is the treatment? Where is the intense psychotherapy that is necessary to deal with the underpinnings of eating disorders? We know that a positive prognosis for eating disorder recovery has to do with three things: specialized treatment, adequate amounts of treatment and long-term follow-up. The Biggest Loser offers none of these things. So in essence, The Biggest Loser is treating the symptom of the eating disorder (the food piece) without addressing the things that will actually affect real, long-term and meaningful healing and change.

My other concerns are about the fitness professionals on the show offering some sort of intermittent therapy throughout these weight loss journeys. Offering any type of therapy falls outside of their scope of practice and is in direct conflict with their Code of Ethics.

We also know that losing a large amount of weight in a short period of time is dangerous. Additionally, having formerly sedentary individuals take on rigorous and intense exercise regimes is also dangerous. I realize that there is a full medical staff who monitors them but the fact that this is necessary is my case in point.

I can go on and on about how these types of shows are exploitative but the fact remains that these are the types of shows that bring in ratings and money to those involved so there is an investment in keeping them alive and running. I will table that for another time.

But I will say… if we are going to have shows like these, despite my stated opinion, then they need to be done responsibly. The issues need to be dealt with appropriately and the participants need to be taken care of.

The Biggest Loser finale seemed uncomfortable for everyone. Rachel Frederickson’s transformation was undeniably extreme and the looks on the trainer’s (and everyone’s) faces reflected that. I can understand the way the show unfolded because it would have been even more awkward and even unfair to Rachel for the show to have been halted and an intervention be made right there, on the spot, in front of millions. The show progressed as it needed to.

Since then…

Jillian Michaels’ Twitter response was this:

The Biggest Loser’s Twitter response was this:

Rachel’s The Biggest Loser trainer’s, Dolvett Quince’s, Facebook response was this:

Rachel Frederickson had a media conference call yesterday morning (you can see the transcript at realityworldtv.com) and when asked about her food and exercise routine, Rachel explained that she was given a 1600 calorie budget by her “support system” at The Biggest Loser and would take “maybe three or four classes a day and just really have fun with all the people in the room. It was pretty cool! I’d be in Zumba and then I’d be going to spin class, and actually, I never used to like running. And so now, I really like running.“

The interviewer’s response: “That is a lot of exercise in one day though! Impressive.”

“Impressive?!?!” – REALLY?!?!?!

What is critical is what happens now. I don’t point a finger at any one person in particular but collectively, there is a huge problem here. Do we accept this transformation as “impressive” or do we dig a little deeper and stay with the uncomfortable truth that there is more here than what meets the eye? And will “we” as a society turn the other cheek and thus, sign off on the irresponsibility that is happening here with The Biggest Loser and shows of the like?

The Holiday Stress of a Guy with an Eating Disorder

Photo by James Bland
(courtesy of Brian Cuban)

by guest blogger Brian Cuban!
Brian Cuban is an author whose best-selling book “Shattered Image: My Triumph Over Body Dysmorphic Disorder” chronicles his first-hand experiences living with, and recovering from eating disorders, addiction and Body Dysmorphia Disorder (BDD). Brian speaks regularly about his recovery and breaking the male eating disorder stigma.

Anyone who has suffered from an eating disorder is probably skilled in the art of hiding it from his/her loved ones and friends. Such deception is an integral part of the disorder, a part of dealing with the shame of self and fear of being discovered. For me, this caused extra stress and increased depression during the holidays. While everyone else was celebrating the love of family and the anticipation of the new year, I was worried about my disordered eating behaviors being discovered. Ashamed that I felt I had to hide my “dirty secret.” That’s what it was to me. For many years, I had no idea there were words such as “anorexia” or “bulimia.” It was just a routine I engaged in like breathing. I also knew it was not something guys were supposed to experience. It was a “girl thing.” Guys are leaders. Guys watch football on holidays. Guys don’t stick their fingers down their throat or starve themselves. This was 1979, before Karen Carpenter tragically passed away from complications related to anorexia, putting eating disorders into the national spotlight but also solidified the stereotypes of eating disorders being a female issue.

While there has been some progress since then, for the most part that perception remains unchanged. It is the perception of many men going through it. The perception of those who have heard about it and read about it. The perception of the media who report on it. The hard reality? I was anorexic, then bulimic for twenty-seven years staring in 1979. More hard reality? Depending on which study you look at, 15-25 percent of those diagnosed with eating disorders are male and recent studies have indicated that that percentage could be even higher.

For me and most other sufferers it was not about percentages. It was about loneliness and shame. I thought I was the only male suffering, especially during the holiday season. How could I feign a normal relationship with self-image and food during a time when it was deemed acceptable to not eat “normally?”

Fortunately, in 2007, I was able to begin recovery and gain control of the thoughts that led me to believe that the only normal relationship with food was through eating disorder behaviors. Through considerable amounts of therapy and self-discovery of how my childhood filled with fat shaming and bullying over my weight led to those feelings, I became able to channel them in to positive thoughts about myself and the reality of how I deal with food and self-image.

A positive thought for me is the realization that even if I eat a little too much or way too much holiday food, it’s only one or two days out of a long life filled with other days of a relatively healthy eating routine. It has no effect on what people think of me, and their thoughts are none of my business regardless. I still have tough days. Recovery is a process. During the process I have found that the following mental exercises help me avoid extra eating related stress during the holidays. Stress that can trigger unhealthy disordered eating thoughts:

1. Going into the season I plan to have a regular exercise and eating schedule. I force myself to eat regular meals during the day. This prevents me from easing into thoughts of binging and excessive exercise. I am aware that the binging can lead to thoughts of purging. I am also aware that trying to make up for a binging session with extreme exercise routines can trigger me into an exercise anorexia mindset.
2. I rely on the support of family, friends and my shrink. They are the primary system of trust that I developed once I realized that there is no shame in seeking treatment and speaking out about my disorder. I allow them to support me and listen to my fears without judgment. This has been one of the biggest tools of my recovery.

But the realization that it’s okay to plan for the thoughts that have plagued my past and realize they are not me is reassuring and should be for all of us who have an eating disorder. We’re all loved as individuals and there is plenty of support to be found during the holidays. If you are ashamed and worried about the stress and guilt of this time of year, seek out those who love you. Seek out those who have been where you are. We are out here. And we are ready and willing to help. You just have to step forward, even just a little one.

Destructively Fit is a TOP PICK!

Exciting news! Destructively Fit is one of Body Local‘s TOP PICKS for fitness professional continuing education! Click here for their newsletter!

And why is Destructively Fit so important for fitness professionals?

• An estimated 90-95% of all college students (both men AND women) diagnosed with an eating disorder belong to fitness facilities (McLean Hospital). I strongly believe that this statistic transfers to those post-college!
• Studies estimate that up to 42% of all gym-goers struggle with a destructive relationship with exercise!

Fitness professionals are in a unique position to begin addressing these issues with their clients and even help them get connected to the support they need in order to feel better about themselves – body + soul!

Please help spread the word about this critical training necessary for everyone in the world of fitness!

thanksgiving

As Thanksgiving approaches, now is a good time to increase your mindfulness in taking care of yourself daily and especially through the holiday season.

Some experience holidays as joyous, cheerful times to connect with family and friends. Others experience the holiday time as tense, sad and depressing. And of course, there is the huge spectrum that exists between those two experiences. But generally speaking, holiday times are usually replete with emotion. Likely, a mix of emotions.

Whatever your experience is, it is up to you to honor it. Absent of judgment. With connection and with consciousness.

And the food… when thinking of Thanksgiving food, we oftentimes conjure up images of large tables overflowing with food. For those struggling with eating disorders, or who have a more complicated relationship with food, it will undoubtedly trigger anxiety, fear and overwhelm.

When you approach this holiday season, and the many mealtimes throughout, slow down. Become mindful. Check in with yourself and notice how you are feeling both emotionally and physically. Continue to check in with yourself throughout the day, the meal, the holiday. Take a time-out if you are feeling overwhelmed. Confide in a family member, significant other or a friend. Text someone. Stay in touch with someone who knows what is going on for you and assure yourself that you are not alone.

Become curious about which emotions you honor and which you tend not to. Become curious about when you choose to honor your hunger and satiety and when you choose not to. And above all, have a meaningful Thanksgiving and make sure to give gratitude to yourself!

no pain, no gain?

The idea of “fitspo” (short for fitspiration / fitness inspiration) has been on my radar for a while and I’m glad that it has received increased attention over the past few months! A huge part of my attempt to address this issue, and the issue of destructive behavior in the fitness world has been the creation of Destructively Fit®. Check out the recent press and more articles about Fitspo!

For me, it’s difficult to discuss “Fitspo” without first saying something about “Thinspo” (short for thinspiration / thin inspiration). Thinspo was first found on pro-ana and pro-mia (pro-anorexia and pro-bulimia) websites that shared eating disorder tips and tricks, blogs, journals and photos of emaciated women and men reinforcing destructive ideals and behaviors, particularly eating disorders. Oftentimes, the men and women who were engaged in these websites were those with an incredibly strong link between their identity and their eating disorder and demonstrated a significant denial of self.
(note: due to the efforts of media watchdogs, most of these websites have been removed from the internet)

While some Fitspo is truly healthy and inspiring, plenty of it is unhealthy and hauntingly similar to Thinspo, offering unrealistic and damaging expectations and fitness ideals. Many of the photos are of uber-cut scantily clad men and women.

Just to give you an idea, I’ve seen many messages like these:
“do it for the thigh gap”
“eat wise, drop a size”
“do it so you don’t have to untag yourself in pictures because you look fat”

I’ve seen an abundance of these types of Fitspo tweets:
“you can’t be small if you eat it all”
lists of foods that make you less hungry
how to have a “flatter stomach”
“diet mistakes”
lots of tips + tricks that have nothing to do with fitness – at least in my opinion!

No pain, no gain? Healthy exercise is not about getting hurt. It’s about paying attention to your body. While it has always been important to maintain a balance and groundedness in your own self and your own personal health and fitness goals, it seems more important than ever to keep these things in mind and also, to manage your expectations!

Learn to recognize healthy and unhealthy messages and ALWAYS #HonorYourBody!

the proven benefit of writing

Maybe there is something to this journaling thing!

For nearly the past 15 years, I have encouraged many of my patients to try engaging in some sort of creative expression in order to engage with themselves in a less inhibited way. Some jumped right on board, some were resistant. But almost invariably, those who gave it a wholehearted go eventually felt that it was useful and even cathartic.

I was excited to read about a new study, the first of its kind, that explored the power, and sometimes healing powers, of writing. While pushing generally inexpressive people to write about traumatic events can be counter-therapeutic, writing can be an effective outlet for those who are more expressive. For this group of people, writing can significantly speed up healing time, reduce stress, improve sleep and decrease stress hormones.

If you are a less expressive person, journaling may be something to work towards. But for those of you who are somewhat expressive, if shorter healing times, less stress and better sleep sound good to you, it may be worth trying!