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The Center for Eating Disorders provides treatment for adults, adolescents and children with complex eating disorders. Everything they do is guided by extensive experience and the latest research into the biological, psychological and social factors of anorexia nervosa, bulimia nervosa and binge eating disorder.
Kitty Westin is an advocate for people affected by eating disorders and has become a nationally and internationally recognized authority on the impact mental illness has on individuals, their families and the community. She is also a licensed psychologist. Following the death of her daughter, Anna, from anorexia in 2000, Kitty founded the Anna Westin Foundation (now known as The Emily Program Foundation) a Minnesota-based 501c3 on a mission to eliminate eating disorders. She is past president and a current board member. She is also recently retired from the board of the Eating Disorders Coalition, a national advocacy organization based in Washington D.C. after nearly two decades of service.
In honor of National Eating Disorders Awareness Week, Kitty will give a special presentation in Baltimore called Shattering Stigma, Advocating for Change. In advance of this free community event, we asked Kitty to reflect on her advocacy work, her resilience, and her hopes for future eating disorder activism.
Q & A with Kitty Westin
Before your own family experienced the pain and suffering of an eating disorder firsthand, what did you know about these illnesses? What was your perception of eating disorders in general?
I am a trained psychologist and I knew very little about eating disorders. I think I had no more than an hour of lecture about eating disorders when I was in my graduate studies. I don’t ever remember being cautioned to notice early warning signs when my 3 daughters were growing up.
What gives you the courage and hope to continue telling your daughter Anna’s story at events like the one coming up in Baltimore?
When Anna died it felt like my world was blown apart and I had no idea how to put it back together. Her death was like losing a limb – I am aware of the loss every day and the pain never truly goes away but you learn how to live without it. In the beginning, I somehow knew that telling our story without guilt or shame could possibly help someone else and we could transform the horror of Anna’s death into something positive.
Over the past twenty years, the scientific understanding of eating disorders has evolved significantly but we’re still missing important information about the impact of eating disorders. Why is that? What do we need to know to move forward
Shame and stigma get in the way all the time! People who are struggling with eating disorders or any mental health condition often feel stigmatized and judged and that very often prevents them from seeking treatment, talking with their family and friends, or speaking out against the injustices they face. And, we don’t have enough research dollars or NIMH funding to encourage researchers to study eating disorders. NIMH spends approximately $28 million per year on eating disorders and $505 million on Substance Abuse disorders
What do you think is the biggest or most enduring misperception regarding eating disorders and who they impact? What can we do to continue to try to combat the misinformation?
Many people think eating disorders are behavior problems or a choice as opposed to a serious mental disorder. We need to talk openly and honestly about eating disorders. We must address our toxic culture ofthinness.
What does it mean to fight for “health parity” for
people with eating disorders? What are the current challenges and opportunities?
Mental Health parity is the law of the land. It is a violation of the law for insurance companies to refuse to cover treatment of eating disorders “on par” with any medical/surgical issue. However, insurance companies often find loopholes and refuse to cover eating disorder treatment, especially higher levels of care like intensive day programs, inpatient and residential care.
What are some of the ways that stigma can impact individuals and families dealing with eating disorders and mental illnesses in general?
Stigma prevents people from the very things that define quality of life; such as healthy relationships, meaningful work, homes and respect.
Many of us in the eating disorders community have watched and admired your hard work for nearly two decades, and it’s abundantly clear that you embody the definition of RESILIENT. How can we all – activists, clinicians, individuals with mental illness, caregivers and support people – work on cultivating more resiliency in our own lives?
Everyone who is in the “war” against eating disorders needs support and I think it helps to join an “army” made up of people fighting the same issue. There is power in numbers. Nobody can do this alone and there is no need to try to do it alone. There are numerous ways to find support and be an advocate.
Though you recently announced your retirement from a leadership position at The
Eating Disorders Coalition (EDC), when you think to the future where do you see potential successes in the fight against eating disorders?
The EDC definitely had a huge victory when language from the Anna Westin act was passed as part of the 21st Century Cures Act in 2016! However, there is much still to do. One very important thing is to make sure that the Cures Act is implemented correctly. And, we are working with agencies like HHS and DOD. We are asking CDC to add questions designed to address eating disorders into National Health Surveys.
Who do you think could benefit from attending “Shattering Stigma, Advocating
for Change” on February 25 in Baltimore?
My message is designed to reach a wide audience including people who are struggling with mental health issues, their family and friends, professionals and providers and anyone interested in learning about stigma and the impact it has on individuals and the community.
What do you most hope attendees will take away from listening to your presentation in Baltimore on February 25th?
My hope is that my words will encourage people to stand up and use their voices to affect change. There is no hope without action.
Kitty Westin has received numerous awards for her advocacy work and has written several book chapters and articles related to eating disorders advocacy and the impact they have on society. An important milestone for Kitty was being present on December 13, 2016 when President Obama signed into law the ground-breaking health care initiative, the 21st Century Cures Act. The Cures Act includes extensive language from the Anna Westin Act, a bill that will improve access to treatment for eating disorders and education of all health care professionals.
Many thanks to Kitty Westin for her time and responses above. If you’re interested in attending her keynote presentation on February 25,click the image below to find out more and be sure to RSVP.
Looking back on this holiday season, it’s safe to say that social gatherings and celebratory feasts posed some significant challenges for anyone trying to develop a more peaceful relationship with food – including those in recovery from an eating disorder. That’s why The Center for Eating Disorders at Sheppard Pratt launched a social media campaign called the “12 Days of Eating Disorder Recovery.” The initiative shared tips on how to maintain healthy relationships with food through the holiday season and beyond. These are summarized below – one for each day of the 12 days – so you can use them to navigate future holiday seasons and get a little help finding the joy and peace within the hustle and bustle.
Day 1: Keep expectations realistic and set manageable goals that will help you stick to your plan.
Regardless of where you’re at in recovery, celebrations, holiday feasts and schedule changes can pose challenges. Planning ahead and setting realistic expectations can help you stay focused on what truly matters.
Day 2: Grab a notebook or journal and write down all the reasons why recovery is important to you.
While you’re at it, make another list of support people. Figure out in advance who you will call if things get overwhelming or if you simply need to get out of your own head. Things that help you cope daily are still needed during the holidays.
If you’re headed out of town, pack your suitcase with your notebook along with other recovery tools. This could be tangible things like a fidget cube, fun book, art supplies or a favorite essential oil.
Day 3: Connect in safe and meaningful ways with others in recovery.
Recovery from an eating disorder is a journey that requires support, encouragement and ongoing motivation. Individuals with eating disorders and their loved ones can find hope and help in others who understand what they’re going through. Support groups and therapy groups can be a great way to strengthen recovery skills and help remind you that you are not alone.
Day 4: Set a goal today that has nothing to do with food, weight or your eating disorder.
It’s common for social gatherings to revolve around food in our culture, especially during the holidays. These celebrations often lead to an intensified emphasis on meals and eating for those working on recovery from an eating disorder. Keep doing what you need to do to fuel your body in recovery, but try also setting a goal for yourself that has nothing to do with food or your eating disorder.
Day 5: Don’t let your eating disorder make decisions for you in the grocery store. Use price or brand to inform decisions instead of reading nutrition labels.
Whether we like it or not, grocery shopping is part of adulthood. But for the millions of individuals living with an eating disorder, this everyday task feels overwhelming and becomes a significant barrier to recovery. If you are worried about buying items for upcoming gatherings or celebrations, this tip can help make grocery shopping more manageable.
Day 6: Defuse grocery shopping stress by bringing a friend, avoiding crowds and shopping at smaller stores in off-peak hours.
If you’ve had negative experiences with grocery shopping, you can start developing more positive associations. A Registered Dietitian may provide some easy steps for managing your grocery list.
Ask your dietitian for support, or consider adding one to your treatment team if you haven’t done so. You can also go with a friend or support person the first few times to help distract from any eating disorder thoughts and avoid being triggered by diet products.
Day 7: Infuse your New Year with body positivity and gratitude.
Be prepared to see your newsfeed flooded with New Year’s resolutions, gym memberships and diet plans in the coming weeks. To balance triggering and unhealthy messages, remember to reality check all the bogus weight-loss ads and surround yourself online and IRL with body-positive people and organizations.
Pay attention to which images and messages contribute to your feeling badly about yourself or your body and do what you can to remove them from your daily life. When you notice them, remove them (unsubscribe, throw them away, etc.) or challenge them.
Focus on gratitude for the functionality of the breath in your body, the ability to move, see, hear, taste or touch. Try to elevate those in your mind as you go through your day.
Create your own New Year’s goals with body positive thoughts. Work to set aside unhealthy ideals and embrace your body.
Day 8: Tackle eating disorder stigma by dispelling myths among friends and family.
Major misconceptions about eating disorders are widespread, even among those closest to us. Family can be a key component to recovery success. Unfortunately, some family and friends may still subscribe to ED myths that lead to stigma and might make it harder to ask for help or to seek treatment. Help educate and increase awareness about eating disorders among your loved ones.
Day 9: Friends and family can be a great support network. Be open with the people closest to you about how they can best support you. Holiday conversations often revolve around what people are eating or not eating, who’s eating too much or too little and even criticism or praise about body weight and size. Did this happen for you during Chanukah or Christmas this year?
The start of a new year can be a great time to enlist family members as allies by being open about your needs and boundaries. Set the stage for healthier gatherings in the new year by having a post-holiday conversation with them about how their words impacted you and what they can do instead to support you at the table and in other stressful situations.
Day 10: Meditate or listen to soothing music to start your day in a positive place.
It’s not just about food and body image. Incorporating mindfulness in the new year can be a way to care for your overall mental health. If you’re heading back to work or school after winter break, find a way to change up your routine to build in mindfulness practices. Even just three minutes of meditation can help you set a positive intention for the day.
You can be mindful in your social connections too. Cultivate awareness about the different support each generation of your family can offer. Hanging out with cousins can be a nice way to connect and get support on specific life stage issues like being away at college, parenting stress, job hunting, etc. On the other hand, reaching out to older generations, like grandparents, is an opportunity to see how priorities can shift throughout life. Even the youngest generations have something to offer you in your recovery-focused festivities.
Day 11: Aim for balance and flexibility rather than perfection.
Individuals who are perfectionists often struggle with the urge to compare themselves to people around them. Research has shown perfectionism to be a significant risk factor for the development of eating disorders.
Constantly striving to be perfect with food or appearance during the holidays can lead to tension and stress. Even those holiday photo cards hanging around your house can trigger negative social comparisons. Try making some small changes to help ease perfectionist tendencies this time of year.
Day 12: Support is essential to your wellbeing. Recovery is possible with treatment and support.
Whether you are an individual working on recovery, or a loved one who is close to someone in recovery during this time of year, it’s important to remember that support is essential to wellbeing.
Remember, you don’t have to go through this alone.
Ask for help.
If you are experiencing symptoms of an eating disorder and you’re not connected to a therapist or receiving treatment, don’t wait any longer. There is no reason to go through this alone. Call (410) 938-5252 for a free phone assessment today.
This holiday season, and year-round, carry these tips with you. Recovery is possible and recovery is worth it.
We recently received a note from a family who started the hard work of recovery three years ago. Her words were reflective and resonated with our staff who know that it can feel quite overwhelming for patients and families at the beginning of treatment. Knowing how isolating it can be to go through recovery as an individual and as a caregiver, we asked this parent if we could share her note so that other families might know they are not alone and that it does get better. She graciously agreed and we are honored to share her words with you below.
You can read more patient and family testimonials here.
If you or a loved one are in need of treatment, support or resources please call us at (410) 938-5252.
In our previous post we discussed a variety of reasons that individuals with eating disorders, especially those in the early stages of recovery, may choose not to watch the Netflix film To The Bone or other films they know could create roadblocks in their continued recovery.
With that said, triggering media has always been around and will always be a part of our society so it’s helpful to know how to navigate it. Many individuals in long-term recovery or later stages of treatment might feel prepared to watch a film or read a book about eating disorders, despite triggering content. Many of our clinicians have helped to shape such exposure into therapeutic experiences for patients who are ready. For example, during periods of strong recovery, seeing a film like To The Bone can be an opportunity to reflect on one’s own experience, see things from a new perspective, process lingering eating disorder thoughts or channel anger towards the eating disorder in productive ways.
If you’ve considered all of the options and decide you do want to watch a film about eating disorders, these are a few things to consider that can help you do so in safe and productive ways.
Don’t watch alone. Watch with a support person you can trust and communicate openly with them about how it is impacting you in the moment. You might even consider pausing the show periodically to breathe, reflect and talk.
Time it right. Only watch it when you know you’ll be attending a therapy session or support group within a few days so you can explore your reactions and get help challenging any distorted thoughts or concerns about what you see on screen. If you currently have a lot of other life stressors or you’re in a time of transition (moving, starting school, going through a divorce, etc.) you may want to consider waiting to watch until things settle down.
Challenge the ED thoughts. Consider journaling about aspects of the movie that you find triggering and then refute and challenge the inaccurate, negative or distorted thoughts.
Be an activist. Write a letter to the director of the film or to the editor of a local newspaper regarding what you liked or didn’t like, what was helpful vs. not helpful or what you’d like to see more of when it comes to films about eating disorders. For example, while To The Bone features one person of color and one male in supporting roles, the movie’s star and protagonist is a young, white, upper-middle class woman with anorexia. This doesn’t help to dismantle stereotypes about who is and isn’t impacted by eating disorders. Consider writing a letter that advocates for greater diversity in eating disorder representation or about another aspect of recovery that feels important to you.
Create an escape clause. Allow yourself the option to stop watching at any point throughout the film. Eating disorders can be associated with all-or-nothing thinking so it may feel like once you start the movie you have to finish it, but remember it’s not so black and white. At any point, if you feel triggered or uneasy about what you’re watching, turn it off.
Plan ahead. Decide in advance upon an alternative show to watch or a self-care activity you can do when the film is over (or if you stop watching early) that will help you sustain a more recovery-focused mindset.
Do you use these strategies or have other ideas for navigating triggering media safely? Tweet them to us @CEDSheppPratt and we’ll add to the list.
Navigating “To the Bone” and other Potentially Triggering or Inflammatory Movies about Eating Disorders
Like most things in life there are benefits and risks that come with exposure to media, especially media that depicts sensitive or potentially life-altering subject matter such as eating disorders, suicide or mental health. As you may have already noticed from the controversial conversations about it, the Netflix movie, To the Bone is no different. The film depicts a young woman, Ellen, in the throes of her eating disorder and follows her through the recovery process which the synopsis points out, includes
help from a “non-traditional doctor” played by Keanu Reeves. It may come as no surprise that the main character, Ellen, is a young, white, very thin, upper middle-class woman, and that the particular eating disorder she is dealing with is anorexia nervosa. Hollywood tends to over-rely on this stereotyped depiction of eating disorders, despite the fact that in reality, eating disorders and the people they impact are much more diverse.
As one of the nation’s longest-running providers of evidence-based treatment for children, adolescents and adults with eating disorders we’ve been asked by numerous patients and families in the previous weeks how to handle such a film. And while To The Bone may be a new film, this is far from a new question. Over the last several decades, similar questions have been raised in response to documentaries, blogs, fictional books and memoirs written by individuals recovering from eating disorders.
Decades of observing the impact of this type of media has reinforced our recommendation that individuals who are currently struggling with an eating disorder or those who are in the early stages of treatment and recovery don’t typically benefit from watching movies or reading books that display any of the following characteristics:
extremely graphic depictions of people engaged in eating disorder symptoms such as bingeing, purging, chewing/spitting, body checking, over-exercising, self-harming or abusing drugs and alcohol
detailed descriptions of ED thoughts and behaviors that are left unchallenged, unexplained or are not paired with sufficient education regarding the consequences
conversations that include specific numbers such as weights, clothing sizes, calorie counts or repetitions of exercise.
If you notice any of these characteristics in a movie, show or book, it should be a red flag that it might not be a beneficial resource or recovery-focused activity for someone who is currently struggling.
We always look to support popular media that finds a way to raise awareness and stimulate meaningful discussions about eating disorders in safe and non-triggering ways. With that in mind, we went into our own viewing of this newest movie with high hopes and an open mind. Unfortunately, what we found was that To The Bone ultimately ticks off all three of the red flags mentioned above. Furthermore, the film’s depiction of treatment methods and treatment protocols are far from helpful, safe, or accurate. As a team of specialized professionals, many of whom have spent their entire careers learning about, researching and utilizing evidence-based treatments for eating disorders, this film was, quite frankly, disappointing and at times difficult for our staff to watch.
On the flip side, it did do a good job of illustrating the immense pain and struggle faced by those who are impacted by these illnesses. It also got people talking about an issue that is usually hushed in society despite the fact that eating disorders impact 20-30 million people. Our hope would be that some viewers of the film gain insight or information that could help them check in with a friend or loved one who is showing warning signs and needs help.
Taking into account both perspectives and the possibility for all the positive and negative impacts, it’s crucial to think critically about the media introduced to us as communities, families and individuals.
If you are a therapist, a parent, educator or friend of someone with an eating disorder…
It’s really important to empower anyone considering watching a film about eating disorders to feel like they can disengage safely and with your support. Let them know it’s okay to decide not to watch because it has the potential to be harmful for them and their recovery. This can be a hard but powerful decision because it builds confidence and sets a precedent for recovery-focused decision-making. How? Today, it might be saying no to a Netflix film that “everyone else is watching and talking about” but tomorrow it could be saying no to a dangerous cleanse that a favorite celebrity is promoting on social media or saying no to a friend that encourages you to step on her bathroom scale. Learning how to say no to such things, even when the societal pressure and internal urges are strong, is imperative for long-term recovery.
If you have an eating disorder or are in recovery from an eating disorder…
If you’re like a lot of our patients, seeing a trigger warning at the start of a film or hearing in advance that it might be detrimental isn’t always a deterrent and might even make the content more intriguing. We’ve heard from some of our patients that they choose to watch the film despite their own reservations and knowledge of the content. Most of the reactions included versions of the following:
I found myself comparing my body to the actress in the film and thinking that maybe I wasn’t deserving of or didn’t really need treatment since I wasn’t as thin as her.
I found myself wishing I could go back to my eating disorder.
I was tempted to use “a little bit of my ED behaviors” and was reassuring myself I wouldn’t let it get that bad.
If she [the actress Lily Collins] can “lose weight safely” for this role after recovering from an eating disorder in real life than maybe I can too.
Despite what may be positive intentions for this film, it’s important to be realistic about how it actually plays out for the millions of people with eating disorders who watch it. While not everyone will have reactions like these, we think it’s important for individuals and support people to know it’s a possibility that the person who is struggling with an eating disorder may overlook the negative aspects of the eating disorder on screen and only see the perceived positive or glamorized aspects.
If you are struggling with whether or not to watch this film, or engage with any other eating-disorder focused media, remember that it’s okay to say no. At the very least, we encourage you to discuss your decision with a treatment provider or trusted support person. If you decide together that watching this type of film might actually be beneficial at certain stages of recovery, check out these guidelines for watching safely.
Some of the most important ways to enhance recovery and prevent relapse include: continuing regular contact with treatment providers, following evidence-based recommendations, engaging in regular self-care and creating a home environment that is conducive to your continued healing and recovery. In this case, that might also include creating a Netflix watchlist that doesn’t have anything to do with eating disorders.
Do you have thoughts on the film or the media surrounding it? Join the discussion on our Facebook page.
Written by Kate Clemmer, LCSW-C, Community Outreach Coordinator, The Center for Eating Disorders at Sheppard Pratt
The Center for Eating Disorders at Sheppard Pratt’s 2017 Professional Symposium is coming up on Saturday, October 7 and will be preceded by a half-day ethics workshop on October 6. This year’s event features a distinguished panel of speakers made up of some of the field’s top clinicians and expert researchers from around the world, including Australia, Israel and the U.S. Meet this year’s keynote speakers below and then head over to the official event page for a detailed agenda and registration options.
Eating Disorders: State-of-the-Art Treatment
A Professional Symposium in Baltimore
Meet the Speakers:
Carly Guss, M.D., MPH is a clinical instructor in pediatrics at Boston Children’s Hospital and Harvard Medical School. She received her BA from Yale University and her medical degree from the University of Michigan Medical School. After completing residency in pediatrics at Brown University, she pursued a fellowship in Adolescent Medicine at Boston Children’s Hospital and received her master’s in public health from the Harvard TH Chan School of Public Health. Her research interests include transgender and gender nonconforming adolescents’ experiences in primary care as well as the relationship of gender identity and body image; she has published numerous articles on these and other topics. Dr. Guss’ most recent research on transgender public school youth and their risks of disordered weight management behaviors was recently published in the Journal of Adolescent Health and she also presented this work at the most recent Society for Adolescent Health and Medicine’s annual conference.
James E. Mitchell, M.D. is the NRI/Lee A. Christoferson M.D. Professor and Chairman of the Department of Clinical Neuroscience at the University of North Dakota School of Medicine and Health Sciences, where he is also the Chester Fritz Distinguished University Professor. He also serves as President and Scientific Director of the Neuropsychiatric Research Institute. Dr. Mitchell’s research focuses on eating disorders, obesity and bariatric surgery. He is past president of the Academy for Eating Disorders and the Eating Disorders Research Society. He has received the Lifetime Achievement Award for Research in Eating Disorders from the Academy for Eating Disorders, the National Eating Disorders Coalition Award for Research Leadership, and the Research Award from the Eating Disorders Research Society. He serves on the editorial boards of the “International Journal of Eating Disorders” and “Surgery for Obesity and Related Diseases”. He has written over 500 scientific articles and is author, co-author or editor of 18 books.
Shiri Sadeh-Sharvit, Ph.D. is a clinical psychologist with over 15 years of experience studying and working with individuals with eating disorders. Her research focuses on developing and examining novel, cutting-edge treatments for under-served patient groups. Dr. Sadeh-Sharvit received her PhD in clinical child psychology from Bar Ilan University in Israel, and since 2013 is a Visiting Instructor in the Eating Disorder Research Program at Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine. At Stanford, Dr. Sadeh-Sharvit studies interventions to support parents with eating disorder histories in facilitating healthy development in their children. Her book “Parents with Eating Disorders: A Treatment Guide”, (co-authored with James Lock, MD, PhD) is forthcoming with Routledge. Dr. Sadeh-Sharvit has received grants from the Child Health Research Institute, the National Eating Disorder Association, and the Davis Foundation. She is also currently involved in two NIH-funded studies of innovative online interventions for eating disorders.
Joanna Steinglass, M.D. is the Florence Irving Associate Professor in Clinical Psychiatry in the Center for Eating Disorders at Columbia University Medical Center and the New York State Psychiatric Institute. Dr. Steinglass graduated from Amherst College and received her medical degree from Harvard Medical School. She completed her psychiatry training and an NIMH-sponsored research fellowship in eating disorders at Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute. Dr. Steinglass has had NIMH and private foundation support since 2006. The focus of her work is both the cognitive neuroscience of anorexia nervosa, and the development of mechanism-based treatments.
Stephen Touyz, Ph.D. is Professor of Clinical Psychology at the University of Sydney where he serves as Chair of the Executive Committee of the Centre for Eating and Dieting Disorders at the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders. Additional roles include member of the Steering Committee of the National Collaboration on Eating Disorders funded by the Commonwealth of Australia, inaugural treasurer of the Australian and New Zealand Academy of Eating Disorders and past president of the Eating Disorders Research Society (USA). In 2012, he was given the prestigious Leadership in Research Award by the Academy of Eating Disorders (USA) in recognition of his pioneering research in the field, and in 2014, he was awarded the first Lifetime Achievement Award by the Australian and New Zealand Academy of Eating Disorders and the Ian Campbell Memorial Prize by the Clinical College of the Australian Psychological Society for his outstanding contribution to the profession
Don’t miss out on this year’s symposium and accompanying ethics workshop. Visit eatingdisorder.org/events today and tell a colleague.
“Get Lean in 2017” “Shrink Your Gut,” “Add Bulk To Your Arms” “Get Rock Hard Abs,”
These are just a few of the typical headlines that can be seen on fitness and “health” magazines geared towards men. While there has been fairly widespread awareness cultivated around the media’s negative impact on women’s body image, not as much attention has been paid to how the media targets men and boys with similar body shaming tactics.
Our culture in general, and the media specifically, often pushes women to lose, lose, lose so they can be smaller, thinner and closer to an elusive definition of “perfect” but the opposite message is often being pushed towards men; most advertising and traditional media suggests the male quest for perfection requires they be bigger, stronger and more muscular. Products previously peddled exclusively towards women – hair removal items, weight loss diets, tanning products, and plastic surgery – are expanding their markets by making men take a harder, longer and much more critical look at their own appearance.
A 2016 review of five national studies found that 20 to 40 percent of men were unhappy with some aspect of their looks, including physical appearance, weight, and muscle size and tone. An earlier study found that college aged men who viewed media images of muscular men showed a significantly greater discrepancy between their own perceived muscularity (what they think they look like) and their ideal body (what they feel they should look like). The researchers suggested their results could show that even brief exposure to such idealized images can increase body dissatisfaction in men.
Despite this ongoing push for men to get bigger and stronger, over the last decade we’ve also seen the juxtaposition of thinner versions of masculinity. You can see it when looking at modern male mannequins with impossibly small waists and very slim – yet sculpted – abdomens and legs. Conflicting body ideals abound. So what is the message after all…get bigger, but stay lean? Be muscular, but still fit in those trendy skinny jeans? It’s mind numbing to try and understand, and even more impossible to attain, yet these are the messages that boys are forced to decipher from a very young age and often continue to wrestle with into adulthood and middle age.
Given all of this, it isn’t that surprising a 2014 study of more than five thousand males aged 12 to 18 years found nearly 18 percent of boys are highly concerned about their weight and physique. Of the boys who were highly concerned with their weight, about half were worried only about gaining more muscle, and approximately a third were concerned with both thinness and muscularity simultaneously.
It’s important to note that, as is also the case with females, photoshopped advertisements and a general lack of diversity in the media’s representation of bodies does not in and of itself cause eating disorders. Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are complex illnesses with genetic and biologic underpinnings. However, environmental triggers such as narrow or unrealistic body ideals in the media can contribute to increased levels of body dissatisfaction which has been identified as a risk factor for eating disorders.
Dealing with unhealthy media messages is something that almost every man will have to deal with. As is also the case with girls and women, the dangers lie in the drastic steps some boys and men may take to try to manage increasing body image anxiety. Guys who are more dissatisfied with their bodies may be more likely to engage in risky weight loss, bulking or sculpting behaviors such as extremely restrictive diets, cleanses, steroids, supplements or excessive exercise. These are unhealthy and potentially dangerous behaviors for anyone. However, in boys and men who are genetically at risk for eating disorders, these types of behaviors can set the stage for an eating disorder, triggering changes in the brain, disrupting metabolic functioning, dysregulating hunger/fullness cues and often worsening body image, mood and anxiety symptoms. Boys and men who have a history of trauma, are involved in sports or careers that promote weight loss and perfection, and those with close family members with a history of an eating disorder are also at higher risk for developing one themselves.
Eating disorders have long been miscategorized as purely a women’s issue, even by some healthcare professionals. As a result it’s quite common for major warning signs like excessive exercise or drastic changes to diet to be overlooked or even congratulated in men. Stigma and stereotypes in the eating disorders combine to make it difficult for men who are stuck in the cycle of disordered eating to break out of it and get help. It is suggested that 25-40% of people with eating disorders are men, yet they only make up about 10% of people seeking treatment.
Talking openly about eating disorders can help minimize shame and embarrassment for males struggling with these issues. At The Center for Eating Disorders at Sheppard Pratt, we’ve been treating men with eating disorders for more than twenty-five years and we’re encouraged by the changes we hear in the conversations more recently. More men have been speaking out locally and using national platforms to raise awareness. In just the last year, Zayn Malik of the band One Direction discussed his struggle with an eating disorder and anxiety, performer/songwriter Matthew Koma wrote a poignant blog about his recovery from anorexia, and Joey Julius, a football player at Penn State, made a series of public statements regarding his decision to seek treatment for binge eating disorder. Their messages all point to a resounding hopefulness stemming from the reality that treatment is available and men can heal from their eating disorders and body dissatisfaction.
So what can you do to help the men in your life?
Start by checking in with them. The Let’s Check Incampaign is all about empowering individuals, families and communities to talk openly about eating disorders and to strengthen support for individuals of all genders who might feel alone. When it comes to eating disorders, early identification and prompt help-seeking can make a big difference. You can play a role in supporting prevention and recovery from eating disorders simply by educating and preparing yourself.
Know the risk factors and pay attention to any sudden shifts in diet, exercise routine or increased negative comments about themselves or their body. If you’re unsure, the confidential online assessment is a quick tool that can help you gauge whether someone you love might be at risk. Second, if you are seeing increasing warning signs plan to check in with your friend or loved about your concerns and provide them with compassion and resources. A fact sheet, conversation guide and additional resources are available at www.letscheckin.com/.
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Regis Aguglia, LCSW-C, Family Therapist at The Center for Eating Disorders at Sheppard Pratt Regis Aguglia earned his Masters in Social Work from the University of Maryland in 2010. Prior to joining The Center for Eating Disorders in 2014, Regis provided individual, family and group therapy in outpatient and school-based settings and gained experience treating individuals struggling with substance abuse. As a Family Therapist in The Center’s inpatient and partial hospital programs, Regis works with families to understand the impact of an eating disorder on the family system and helps to strengthen communication, coping skills, nutritional stability and recovery-focused support. Regis also facilitates a number of inpatient therapy groups including dual diagnosis groups for patients with co-occurring substance abuse and a specialty group for boys and men with eating disorders.
At some point during treatment for an eating disorder, most individuals will meet with a Registered Dietitian. One of the many important things you’ll do during those sessions is identify and discuss your personal list of fear foods. This is an important step that allows the dietitian to individualize treatment, help you plan for and overcome obstacles, and work alongside the rest of the treatment team to empower you in your recovery.
What are fear foods? A fear food, or challenge food, is a term for foods that one finds difficult to incorporate into everyday eating. This term is used for foods that feel scary to eat, often because of negative thoughts or feelings related to the food’s nutrient content. Fear foods can be items or categories of food that one perceives to be “bad” and which, when consumed, might trigger feelings of intense guilt or shame. As a result, people with eating disorders often completely avoid or restrict their fear foods. Sometimes, just being around a particular food or being faced with the possibility of eating it can result in increased anxiety.
For people with anorexia, bulimia or binge eating disorder, these fears and the perception of certain foods as “bad” are often related to anxiety about anticipated weight gain and/or an inability to stop eating the food once they begin. In other words, there tends to be a strong belief that eating a fear food will instantly make you fat or that eating a certain food will make you lose control and overeat.
A person’s list of fear foods might be specific, like ice cream or peanut butter. For others, their fear foods might encompass a whole category like all desserts or fried foods. Someone else’s fear food list might include an entire nutrient group such as carbohydrates. Common fear foods are also items considered by many to be tasty, but may also be labeled as “junk food” in our current culture.
Where do fear foods come from? Fear foods develop from personal values, attitudes, feelings and even memories associated with a certain food. Messages from the people close to you – family, friends, coaches, teachers, healthcare providers – all play a significant role in determining your thoughts about food and can ultimately influence your (dis)comfort with particular food items.
Fear foods may also stem from a variety of impersonal sources including trending cultural ideas about food, media messages, advertisements or even nutrition information intended to be educational and beneficial. For example, there are multitudes of articles and news stories that include lists of supposedly good vs. bad foods, or foods that are better/worse for health.
Another frequent source of fear or shame related to food is dieting. Given that most diets limit or cut out certain foods, dieters start to believe that the eliminated food is bad. The more diets a person goes on, the more fear foods they are likely to have.
What are some consequences of avoiding fear foods?
Limited variety and lack of enjoyment in meals
Obsessive thoughts about the feared food
Increased eating disorder symptoms and heightened risk of relapse
Prolonged negative relationship with food
People without eating disorders may have fear foods too but the consequences for those with eating disorders are much steeper since we know that limiting variety and continuing to avoid specific foods during recovery raises one’s chances for relapse. Two of our CED dietitians recently wrote in more detail about this topic for our friends at Eating Disorder Hope in a post entitled, The Importance of Incorporating Fear Foods and Challenge Foods in Recovery.
Remember, no single food has the power to make you thin or fat. And, ironically, the avoidance of a food is typically what leads a person to overeat it.
If you think you might need assistance reintegrating fear foods or overcoming negative thoughts about food and eating in general, please call The Center for Eating Disorders at (410) 938-5252 for a free phone consultation.
In individuals with different eating disorder diagnoses, or those with co-occurring disorders, fear foods might manifest differently. For example, in individuals with ARFID, anxiety may be related to a fear of choking or to a perceived health consequence of eating the food item. In individuals with PTSD, fear foods may stem from associations with the traumatic experience. In both cases, treatment methods may differ, and the treatment team should take into account the origin and underpinnings of each fear food when providing education and support.
Hannah Huguenin, MS, RD, LDN
Samantha Lewandowski, MS, RD, LDN
Kate Clemmer, LCSW-C
When cheering on the elite athletes at the Rio Olympics and in other high-profile sporting events, it can be easy to lose perspective and you may find yourself comparing your physical body to those at the peak of their sport careers. Lost in these comparisons, we too often become self-critical and forget the long journeys, support communities, financial resources, sacrifices and sheer hard work that comes with being an Olympic athlete.
Engaging in body comparison not only hurts you but serves to fuel the overall toxic culture of body shaming. After all, even Olympic athletes are subject to mean-spirited remarks about their appearance. In the most recent summer games, Ethiopian swimmer Nobel Kiros Habte faced some harsh comments for not matching the “look” of his peers, as did Mexican gymnast Alexa Moreno. Many others have faced similar backlash through the years.
Just as athletes are not immune from body shaming, it’s important to remember the “perfect” athletic body does not equate to perfect health. Making snap judgments about someone’s fitness or health based on their appearance is misleading – it’s rarely possible to tell, for example, if someone has an eating disorder just by looking at them. Athletes are not immune to eating disorders or struggles with body image. American cyclist and two-time national champion Mara Abbott has been open about her experience with anorexia. In a candid column for a cycling blog, she reflected on how it affected her performance: “Personally, having taking a hiatus from sport in 2012 due to an eating disorder, I can attest that my thinnest was definitely not my strongest. I really mean that. Please read that sentence more than once.”
As we gather around the television with our friends and families to celebrate athletic achievement, we can support the competitors, ourselves and each other by focusing less on physical appearance and more on the hard work and powerful accomplishments of these world-class athletes. After all, Olympic bodies can be powerful, graceful, tough and resilient but they are also diverse. From gymnastics to archery, swimming to shot put, let’s allow our athletes to be inspirations, not because of or in spite of their looks but for the attitude and spirit they project in aiming for their goals. Let’s enjoy watching all sporting events – whether it’s a World Cup game or a pee wee soccer league – from a place of body appreciation and as part of a body positive summer.