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Recently, I stumbled upon an advertisement for a boot camp class for kids. They're marketing it as designed to get kids moving (for health), but still. . .  Kids don't belong in a gym. While physical activity is important among our youth, no matter how many ways you spin it, kids need not be exercising or cooped up in a gym class to get their bodies moving.

Kids should be outside playing tag and climbing monkey bars. They should be cannon balling into swimming pools and running through sprinklers in the hot, summer sun. They can be playing sports or dancing, riding bikes or flying kites. They don't need to be in a gym class with a trainer working them out. I'm not saying those classes aren't fun for some kids or don't provide physical or mental health benefits for others. I'm sure they do. And  having worked in the fitness industry on and off for 20 years, much of that time in gyms, I can attest to the many advantages that exercise classes can offer. But for our younger set, gyms aren't the right place. Signing our children up for boot camp reeks of diet and fitness culture shoved down the throats of our most impressionable folks. 

If you want your children to move their bodies, find a way to accomplish this that highlights the joy and freedom inherent to unadulterated movement. Take them hiking or toss around a Frisbee. Swim and climb and skate. Play hallway soccer (what better goal than a door frame?), a favorite game in our house.

But just please, keep them out of the gym while you can.


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


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Do You Struggle with Food?Are you constantly thinking about food? Wondering what or when you'll next eat, afraid you'll go overboard for the day? Do you frequency try to ignore a nagging hunger? Do you find yourself reviewing your intake and planning ahead based on what you've already consumed? Do you think there's a "right way" and a "wrong way" to eat? Have you tried most diets out there, only to give up, defeated after days or weeks or months? Has your weight yo-yo'ed with each new diet attempt? Are you caught up in a cycle of monitoring your intake carefully and then emotional- or binge-eating when you're not? Is food a constant struggle?
It doesn't have to be.The fact is, if you're thinking or worrying about food a large part of your day, you're likely not eating enough. You're probably restricting your overall intake - or certain types of food - toward the goal of weight loss or weight control. This leaves you perpetually underfed and likely anxious and irritable at times.
Diet Culture and Disordered EatingMost of us are heavily schooled in diet culture. We're aware of what kinds of foods we "should" and "shouldn't" eat and we've likely internalized a number of food rules that impact when and how much we eat. Some of us might just dabble in diets from time to time. For others, the behaviors become more extreme, devolving into disordered eating and, in some cases, clinical eating disorders.

Diet culture is what separates you from your innate preferences and rhythms around food. It tells you that you shouldn't eat after a certain time at night and that you should limit your amount of certain types of foods. It tells you that your plate should be small and that you should stop eating at the first sign of hunger fading, never experiencing the physical and psychological sensation of being full. It values "honorable" food choices over comfort and satisfaction.
But these rules are not for you.What Is Intuitive Eating?What if there was another way? There is.
Intuitive eating, as developed by Evelyn Tribole and Elyse Resch (in their publications of the same name) encourages us to return to our innate ability to trust ourselves and our bodies with food. The 10 Principles of intuitive eating include (quoted directly from their site):

1. Reject the Diet Mentality Throw out the diet books and magazine articles that offer you false hope of losing weight quickly, easily, and permanently. Get angry at the lies that have led you to feel as if you were a failure every time a new diet stopped working and you gained back all of the weight. If you allow even one small hope to linger that a new and better diet might be lurking around the corner, it will prevent you from being free to rediscover Intuitive Eating.

2. Honor Your Hunger Keep your body biologically fed with adequate energy and carbohydrates. Otherwise you can trigger a primal drive to overeat. Once you reach the moment of excessive hunger, all intentions of moderate, conscious eating are fleeting and irrelevant. Learning to honor this first biological signal sets the stage for re-building trust with yourself and food.

3. Make Peace with Food Call a truce, stop the food fight! Give yourself unconditional permission to eat. If you tell yourself that you can’t or shouldn’t have a particular food, it can lead to intense feelings of deprivation that build into uncontrollable cravings and, often, bingeing. When you finally “give-in” to your forbidden food, eating will be experienced with such intensity, it usually results in Last Supper overeating, and overwhelming guilt.

4. Challenge the Food Police Scream a loud “NO” to thoughts in your head that declare you’re “good” for eating minimal calories or “bad” because you ate a piece of chocolate cake. The Food Police monitor the unreasonable rules that dieting has created . The police station is housed deep in your psyche, and its loud speaker shouts negative barbs, hopeless phrases, and guilt-provoking indictments. Chasing the Food Police away is a critical step in returning to Intuitive Eating.

5. Respect Your Fullness Listen for the body signals that tell you that you are no longer hungry. Observe the signs that show that you’re comfortably full. Pause in the middle of a meal or food and ask yourself how the food tastes, and what is your current fullness level?

6. Discover the Satisfaction Factor The Japanese have the wisdom to promote pleasure as one of their goals of healthy living In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence–the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting and conducive, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you’ve had “enough."

7. Honor Your Feelings Without Using Food Find ways to comfort , nurture, distract, and resolve your issues without using food. Anxiety, loneliness, boredom, anger are emotions we all experience throughout life. Each has its own trigger, and each has its own appeasement. Food won’t fix any of these feelings. It may comfort for the short term, distract from the pain, or even numb you into a food hangover. But food won’t solve the problem. If anything, eating for an emotional hunger will only make you feel worse in the long run. You’ll ultimately have to deal with the source of the emotion, as well as the discomfort of overeating.

8. Respect Your Body Accept your genetic blueprint. Just as a person with a shoe size of eight would not expect to realistically squeeze into a size six, it is equally as futile (and uncomfortable) to have the same expectation with body size. But mostly, respect your body, so you can feel better about who you are. It’s hard to reject the diet mentality if you are unrealistic and overly critical about your body shape.

9. Exercise–Feel the Difference Forget militant exercise. Just get active and feel the difference. Shift your focus to how it feels to move your body, rather than the calorie burning effect of exercise. If you focus on how you feel from working out, such as energized, it can make the difference between rolling out of bed for a brisk morning walk or hitting the snooze alarm. If when you wake up, your only goal is to lose weight, it’s usually not a motivating factor in that moment of time.

10. Honor Your HealthGentle Nutrition Make food choices that honor your health and taste buds while making you feel well. Remember that you don’t have to eat a perfect diet to be healthy. You will not suddenly get a nutrient deficiency or gain weight from one snack, one meal, or one day of eating. It’s what you eat consistently over time that matters, progress not perfection is what counts.
Incorporating Intuitive Eating into Your LifeDespite how "intuitive" intuitive eating might sound, learning to practice these principles can present a significant challenge for many. Eating intuitively might create anxiety as you forsake your food rules in lieu of trusting your body, from which you've disconnected following years of dieting. Rejecting the diet mentality, and eating according to hunger and fullness cues, can feel like free-falling without a parachute. . . at first. You probably will struggle with making food choices and knowing how to trust when you're actually hungry and when you've eaten to satisfaction. You might try to turn intuitive eating into a diet, berating yourself for eating emotionally or eating past fullness on occasion.

If you experiment with intuitive eating, you might worry that your eating will be chaotic, that you'll never settle in to a balance of food preferences guided by "gentle nutrition," or that you'll gain a large (or for some, even a small) amount of weight. You might worry that if you loosen the reins on exercise, you'll never move your body again. You might fear that without food to cope, you won't be able to handle emotions like sadness, anxiety, anger, guilt, or states like boredom, loneliness, or uncertainty.
These are all typical concerns when someone begins to eat intuitively.But, with time and consistent commitment to these principles, something will start to shift. You might notice that you're not thinking about food all day, every day. Sure, you might wonder what you'll eat later, check out the menu of a restaurant you hope to try, or indulge in a specific craving, but the food reel that once occupied your mind isn't playing front-and-center all the time. You might notice that you're more relaxed around food, especially when presented with large spreads, like buffets. You might notice your preferences starting to shift. You might realize that you're not constantly low-grade hungry and that your fullness and satisfaction last you a while. When you're full, you might be able to stop eating, even if there's still food on your plate, knowing that another eating opportunity is right around the corner and available as soon as you want it. You might realize, likely after the fact, that you were able to tolerate a difficult emotion or experience without turning to food. You might begin to think about food as an enjoyable part of your life, not the enemy.

These shifts will occur gradually, and you might not notice them at first, but you will notice them. You might even start to live more intuitively, honoring your preferences regarding how you spend your time and with whom and trusting your mind and body to guide you with wisdom and clarity. "No, that just doesn't feel right for me," you'll say.
Diet culture will try harder to reclaim you.At every turn, diet culture will try to suck you right back in. Your television and computer will beckon you with promises of a thinner you. Your friends and Facebook feed will share how the latest diet trend helped them drop 20% of their body weight. Your colleagues will share with pride how much better they feel now that they're avoiding whatever they're avoiding. You'll start to think, "Maybe just one more time." The "shoulds" will try to lasso you away from yourself. There's something so seductive about a plan.

But, then you'll realize that such seduction is an empty promise. Sure, dieting can result in weight-loss, but the majority of people who diet gain back the weight they lost (and often more). Dieting will follow through on some promises, though. What dieting once again will bring you is a hyperfocus on food. You'll lose time, energy, and bandwidth spent fixating on what you eat. You'll pass up opportunities to socialize with friends and family, afraid of the food they'll serve. You lose trust in your body's signals, alerting you to hunger and fullness as they naturally will. This is the diet guarantee.
How Gatewell Can HelpOur therapists and registered dietitian are trained in intuitive eating. We've helped countless people (including ourselves!) develop healthier relationships with food. We can help you understand how dieting has failed you (that's right, how dieting has failed you, not the other way around) and help you implement the principles of intuitive eating so that eating and food are returned to their rightful places in your life - opportunities for nourishment and pleasure, without all of the obsession, stress, and baggage you've accumulated along the way. At some point in your life, maybe childhood - or even infancy - you knew how to do this eating thing like a natural. That innate way of interacting with food can, with the right set of skills, be relearned. You can learn to respect your mind and body enough to trust them to guide your behavior, not some external, money-hungry source. You can learn to live according to what feels right for you.

If you're ready to get off the diet roller coaster, to say farewell to weight-loss gimmicks and yo-yo attempts at managing your weight, we're here to help. Food is simply food, and we want to help you live the rest of your life more peacefully and intuitively and without a constant struggle. Contact us to find out how.

*This piece was originally focused on the Gatewell Therapy Center blog.


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


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One of the questions I'm often asked has to do with how "pure" one's recovery must be. Part of eating disorder recovery involves a paradigm shift from attacking one's body to body neutrality or acceptance. For some, perhaps the more black-and-white thinkers of the bunch, this means that anything we might want to do to enhance our appearance isn't aligned with recovery.

Wrong.

There's nothing anti-recovery about focusing on, and enhancing, your appearance. Whether it's wearing make-up, getting your hair styled, or buying new clothes, many appearance-related behaviors don't threaten the core and spirit of recovery.

Some, on the other hand, do. When trying to decide whether a particular beauty dservice or process is in line with the values of recovery, you might want to ask yourself these two important questions:

1) Does the behavior cause me harm?
2) Can I do without the behavior?

In general, if the answers are "no" and "yes," this is a behavior that is a choice and has no negative consequences. With that in mind, if it's something you want to do, why not do it?

If a particular appearance-related behavior you're considering does cause harm (physical, emotional, etc.), then you might want to think twice. Cosmetic surgery, for instance, might cause physical pain (and come with certain risks) and can create a dependence on additional procedures over time, though certainly not always.

The second question helps you establish how important the behavior is to you and how much of a choice engaging in it is, versus a need or compulsion. For those who are graying, for instance, and choose to color their hair, could you imagine yourself going without your regular root touch-ups? If so, it seems the behavior (hair dyeing) doesn't have much power of you, which might provide support for continuing to do it.

Think about other examples: straightening your hair, using cream to reduce skin discoloration, microblading, shaving your legs, getting regular manicures, using injectable fillers. Ask yourself the two questions above to get more of an understanding of any consequences of this behavior and your relationship to it. Many things we do to improve how we look (or how we think about how we look) can be in line with eating disorder recovery, while some, you'll see, cannot.

And yes, you can wear make-up in recovery.


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com



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

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

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

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

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

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

Setbacks:

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

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

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

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


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

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

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

Where can you add joy in your exercise routine? Can you craft a playlist that makes you happy? Can you skip instead of run? Maybe get off the elliptical and dance? The more joy we find through movement, the more likely we are to continue engaging in physical activity. Joyful exercise is not an oxymoron. Find a way to make movement fun for you.
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Recovery is a bumpy road, and there are often unexpected twists and turns, even with significant support. It's important during this process - and I might argue always and even for those without eating disorder histories -  to avoid cultural trends that can exacerbate symptoms or interfere with full recovery. The following are several examples that I have seen obstruct the recovery process:

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

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

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

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

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

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


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com



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

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

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

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

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


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com



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

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

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

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

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

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

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

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

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

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

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

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

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

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

If you are thin and these examples resonate with you, know that know matter how much you might fight with your body, you don't live in a culture that echoes and amplifies your internal dialogue. Be aware of your privilege and use your voice to help challenge cultural weight bias.
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Recently, a reader contacted me to weigh in on physical activity among those with compulsive exercising and/or disordered-eating tendencies. I figured my thoughts might be useful to others:


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

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

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

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

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

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com




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

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

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

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

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

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

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

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

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

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

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

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

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


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com





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