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The following written testimony was provided by Steven Crawford, M.D. in advance of the Maryland State Medical Society House of Delegate’s vote on the matter of advocating for the inclusion of eating disorder questions in state and national health monitoring tools. 

Additional information on the position of Dr. Crawford and The Center for Eating Disorders at Sheppard Pratt can be found by reading the following articles: 

Data Collection Critical to Understanding Eating Disorders – Baltimore Sun

30 million people will experience eating disorders — the CDC needs to help – The Hill

More detailed information about resolution 10-18 is linked in the testimony below.

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Testimony of

Steven F. Crawford, M.D., Co-Director
The Center for Eating Disorders at Sheppard Pratt

Before the

MEDCHI, THE MARYLAND STATE MEDICAL SOCIETY HOUSE OF DELEGATES

April 29, 2018

Resolution 10-18 – The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools

My name is Dr. Steven Crawford, and I am pleased to appear today on behalf of The Center for Eating Disorders at Sheppard Pratt.  For nearly 30 years, on a daily basis, I have been involved in clinical care, teaching, and research of life-threatening eating disorders including anorexia nervosa and bulimia. I started my career in at Mercy Center for Eating Disorders, and subsequently I have held leadership positions in psychiatry at St. Joseph Medical Center, and currently, with Dr. Harry Brandt, I co-direct one of the largest hospital based eating disorders programs in the United States at Sheppard Pratt Health System.  I am a member of the Academy For Eating Disorders, a Distinguished Fellow the American Psychiatric Society, and a faculty member of the University of Maryland School of Medicine.

I come before you asking your support of Resolution 10-18 which asks for the “The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools.”

In the United States there are an estimated 20 to 25 million people who suffer from anorexia nervosa, bulimia nervosa and related eating disorders.  These illnesses destroy lives and devastate families throughout Maryland.  Anorexia nervosa has the highest death rate and the highest suicide rate of any psychiatric illness.   Further, the eating disorders are unique in that virtually every major organ system in the body can be affected by starvation, poor nutrition, and the dangerous behavioral patterns associated with eating disorders.  Sudden death is not uncommon.

After over two decades of mandatory surveillance of eating disorders signs and symptoms under the CDC’s Youth Risk Behavioral Surveillance System, the Centers for Disease Control (CDC) and state stakeholders voted to remove the mandatory eating disorders surveillance questions in 2015. The questions were removed under the pretense of changing public health priorities.  This, despite growing prevalence of eating disorders, an increasing awareness of their impact and the knowledge that every 62 minutes, someone dies as a direct result of an eating disorder.  Eating disorders should be among the top priorities of CDC because of their high death rate and the evidence that early identification and treatment are essential.

In this resolution, we request support of Med-Chi in advocating to the Maryland Department of Health for the immediate re-instatement of eating disorder questions in any current and future statewide Youth Risk Behavior Surveys (YRBS).  These efforts, if successful, would position Maryland as a national leader in tracking, assessing and mitigating the negative medical, social and financial burdens caused by eating disorders.

Additionally, we are working with the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), the National Eating Disorders Association (NEDA), and The Eating Disorders Coalition (EDC) to ensure the eating disorder questions are reinstated on a national level through the CDC surveillance systems.  This resolution additionally asks the MedChi’s American Medical Association (AMA) Delegation ask our AMA to advocate that the CDC reinstate the eating disorder questions into the YRBSS.

It is our hope that the House of Delegates will support this critical initiative by passing resolution 10-18.

UPDATE: On April 29, 2018, the MedChi House of Delegates voted to adopt resolution 10-18.

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Pregnancy and motherhood can be extremely daunting. The “what-ifs?”, “can I manage it all?” and “what will my body do?” internal dialogue often begins quite early in the process of parenthood, even among women without eating disorders.  When a woman struggles with body dissatisfaction and disordered eating, normal concerns throughout pregnancy and parenting can escalate into major anxiety. They may also fuel a new or renewed focus on weight and shape that can lead to harmful behaviors like restriction, purging, bingeing or obsessive exercise. Co-occurring depression – or postpartum depression – can also be risk factors for disordered eating.

According to data from the CDC, the average age at which women have their first child is 28 and this has been steadily rising for decades. As of 2016 however, the demographic with the highest birth rates are actually women in their early thirties (ages 30-34).1 This holds true across all fifty states as well as all racial and ethnic groups.

Interestingly, women between the ages of 30 and 40 are also increasingly seeking treatment for eating disorders. Eating disorders affect about 10% of women during their reproductive years and this number may be growing.  With this in mind, it has become exceedingly apparent that there is a need to tailor treatment to mothers and mothers-to-be in order to effectively assist women during this stage of life.

Pregnancy-related body image concerns combined with the extra stressors of parenting – and feeding – young children can complicate eating disorder recovery efforts. But there are also opportunities and strengths in this new role and certain things moms-to-be can do to stay recovery-focused during the adventures of pregnancy and parenthood. Below are three very basic tips to help provide a starting point for a healthy transition.

1. BE HONEST.

If you’re currently pregnant, tell your OB or midwife that you have a history of an eating disorder and about your current or past symptoms.

Some women say they feel shame or guilt in expressing feelings of body-dissatisfaction or disclosing ED symptoms to their medical providers, especially during pregnancy and post-partum. If you find yourself battling these thoughts, it’s helpful to remember that eating disorders thrive on silence and secrecy. Keeping symptoms a secret usually means things get worse, not better. Being open with your OB or midwife allows them to better care for you and more accurately monitor the health of your baby. When your providers know about the eating disorder they can also do more to support your recovery efforts; this could include connecting you with a local support group or tailoring discussions about food and exercise appropriately. Remember, eating disorders are serious illnesses – not simply a choice or lifestyle. It’s okay to let go of the guilt and shame so you can move forward with help.

2. EMBRACE IMPERFECTIONS.

You can’t do it all perfectly—nobody can (even if it looks like they do on social media).

More mothers than ever are raising their children while managing full-time careers outside of the home and trying to keep up with ever-increasing expectations for the always perfect outfit, an exquisitely clean house and an expertly planned family vacation.On top of it all, posting finely tuned photos on social media to prove it all happened can almost feel mandatory.Moms who internalize this pressure are understandably overwhelmed because perfection is a race that no one wins. Remember, even the people who look like they have it all together online, are only sharing what they want people to see. It’s essentially a person’s curated highlight reel; the behind-the-scenes shots may not be so picture perfect.

Given that the trait of perfectionism is an established genetic risk factor for the development of eating disorders, it’s easy to see how these increasing expectations and media pressures can create extra challenges for pregnant and parenting moms working on eating disorder recovery. If you find yourself constantly comparing your house, your body, your parenting or your life in general to people you see on TV or friends on social media it’s important to discuss these influences with a therapist or treatment team. You can also do a self-audit of your feed and make some changes to ensure you are cultivating a body positive presence across your social media platforms.

3. PRIORITIZE RECOVERY

Self-care isn’t selfish.

There’s a reason why the flight crew on every plane instructs parents flying with children to put on their own oxygen masks in an emergency before putting one on their child.  It might feel counterintuitive or even selfish to do so but we know it’s not. Why? Because it’s much harder to take care of other people – especially infants and toddlers – if you’re not caring for yourself.  When it comes to mental health and eating disorders, you may need to prioritize your recovery efforts now so that you have the physical ability and mental clarity to prioritize your family in the long-term. Seeking therapy, keeping up with appointments and staying connected to other moms who talk openly and authentically about the challenges of motherhood are integral to recovery.

At The Center for Eating Disorders, we recently launched an outpatient therapy group to help pregnant and parenting moms with eating disorders do the hard work of prioritizing recovery while caring for their families. The group, which meets weekly, focuses on skills for balancing recovery and motherhood, addressing body image concerns and strategies for feeding the family. In addition to building recovery skills, this group can also be a way to help moms recharge and gain support. It is open to pregnant women and parenting moms of any age and stage.

The Moms’ group is held on Thursdays at 10 a.m. at outpatient department in Physician’s Pavilion North, Suite 300. Please contact Kristen Norris for additional information or to enroll in the group. She can also be reached by phone at 410-427-3904.

References:
  1. Mathews TJ, Hamilton BE. (2016). Mean age of mothers is on the rise: United States, 2000–2014. NCHS data brief, no 232. Hyattsville, MD: National Center for Health Statistics.
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April is National Occupational Therapy Month ~ #OTMonth 

If you’ve had an eating disorder yourself, or you know someone who has, you might know all-too-well that one of the side effects of these illnesses is decreased engagement in meaningful, fun or productive activities. Eating disorders have a way of overtaking a person’s energy and time, even altering the way the brain works.

As more time is spent obsessing about food and weight, and engaging in symptomatic behaviors, there tends to be less and less mental energy available for activities unrelated to meals, food or thoughts  of body dissatisfaction.  By no fault of their own, individuals who develop eating disorders often don’t realize how much the eating disorder shifts their focus and leads them away from people, events, and activities they once enjoyed.  This is one of the reasons The Center for Eating Disorders (CED) at Sheppard Pratt has always incorporated Occupational Therapy into our treatment options for individuals with eating disorders.An individual’s “occupation” is any activity that occupies his or her time.  Thus, Occupational Therapists (OTs) fcus on enabling people to participate in meaningful and purposeful activities of daily life. At CED, our OTs work to provide individuals with a setting where the behavioral changes made through Cognitive Behavior Therapy (CBT) and insights learned in other psychotherapies can be converted into new behaviors that become part of the long-term healing process. We’ve written before about some of the ways our OT Department does this through Horticulture Groups.  Similar work is done throughout the year in different ways – including through mindful knitting groups.

Knitting is a craft that requires both physical and cognitive skills and thus engages both mind and body simultaneously. Knitting has the advantage of engaging the senses with the sound of the needles, touch of the yarn and movement of the hands that, together, hold the attention of the mind in the present moment. Repetitive action can be calming, textures can provide grounding opportunities and hand movements offer engagement for mind and body. This can be a much-needed relief for persons with eating disorders whose thoughts are constantly being pulled to the last meal or to the next one, or to persistent negative beliefs about their body, weight or size.

Over the last two years since our knitting program began, the OTs in The Center for Eating Disorders’ Partial Hospital Program (PHP) facilitated two therapeutic knitting groups, running twice a week for 8 months a year as an addendum to our core CBT protocols and additional evidence-based therapies. Participants could join for one session or many and were reminded frequently that each contribution is part of the whole. In these groups, patients who were veteran knitters joined beginners, learning new skills and sharing experiences. The groups were an opportunity for individuals to practice mindfulness and socialize with peers while, as one participant put it, “focus on calming,repetitive activity that also produces a tangible result” completely separate from anything related to one’s eating disorder.  The tangible result? Mindful knitting participants worked to create a collage of knitted squares which, when knitted together, became finished baby blankets.

When asked about the impact of the groups, individuals indicated  they “became more centered, distracted from my negative thoughts”  and “my anxiety level changed”.  Others shared that “the knitting was calming; the repetitiveness of the knitting felt good.” The power of knitting as a therapeutic tool has been documented outside the individual experiences of our patients. According to Corkhill et al., (2014), knitting in groups can impact perceived happiness, improve social confidence and feelings of belonging.

The knitting group, like many of our other OT groups, offers a safe environment to explore a new hobby (or rekindle interest in an old one), challenge perfectionistic tendencies, relax in recovery-focused ways, and stay in the moment with the flow of the needles and yarn.  This opportunity to engage the mind and the body also allowed for reflection on the healing and recovery process. When our most recent group of participants were asked how to apply the skills learned in knitting group to their broader recovery goals, responses included all of the following:

  • “ I can look at each of my new coping skills as accomplishments and enjoy the state of calmness.”
  • “I didn’t give up. I can remember not to give up so quickly.”
  • “I was able to feel good about myself. I can definitely use that for self-esteem issues.”
  • “[I’m] very excited to go home and knit. It’s so helpful to practice being in the moment.

The knitting groups provided a healing experience, new mindfulness skills and a variety of powerful reflections for participants. They also provided participants with an outcome they could feel good about. Upon completion, the group’s resulting baby blankets were donated to newborns at Mt.Washington Pediatric Hospital where they can continue to promote healing in new and important ways.

Would you like to find out more about OT and other treatment options at The Center for Eating Disorders? Call us today at (410) 938-5252.

Blog Contributor: Christine Brown, MS, OTR/L is an Occupational Therapist at The Center for Eating Disorders. Christine received her Masters of Science degree from Virginia Commonwealth University in 1999. Prior to joining the team at The Center for Eating Disorders, Christine spent time providing community-based services as an intensive case manager and worked in a general psychiatric inpatient and partial hospital program.  In her current role at The Center, Christine provides occupational therapy for adults and adolescents in our inpatient and partial hospital programs. She assists patients in increasing engagement in valued roles and meaningful occupations through group and individual interventions. In addition to the knitting group and other OT groups, Christine facilitates the sensory awareness and horticulture specialty groups.

Reference:

Corkhill, Betsan & Hemmings, Jessica & Maddock, Angela & Riley, Jill. (2014). Knitting and Well-being. Textile: The Journal of Cloth and Culture. 12. 10.2752/175183514×13916051793433.

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What does it mean to live authentically? 

Honoring your truth.

In other words, understanding, accepting, and nurturing your various, intersecting identities, to live your best life. This was a major theme throughout a special event held in February at Towson University (TU) to help recognize National Eating Disorders Awareness Week.At the event, speaker Ryan Sallans shared his personal experience of gender identity development and eating disorder recovery with the TU community. Organized by TU’s Counseling Center, the event was well-attended and brought together various university and local organizations, including The Center for Eating Disorders at Sheppard Pratt, TU’s Center for Student Diversity and The TU Body Image Peer Educators (BIPE). Sallans is a well-known public speaker, author, and health educator, and has been featured on Larry King Live, NPR, The Advocate, and many other news and popular media outlets.

Documenting Self-Discovery through Transition and Recovery

Throughout his talk, Sallans highlighted the delicate balance between taking care of oneself and navigating important relationships that often change throughout transition. Of course, each individual’s experience is different and Sallans did well to emphasize his is only one story among many.

Despite transgender and gender non-binary identities being discussed more openly than ever, there remains a stark deficit in information regarding the intersection of body image, gender identity development, and eating disorders. Studies have suggested the prevalence of eating disorders is higher among transgender individuals when compared to the general population (Reisner et al., 2016; Watson, Veale, & Saewyc, 2016). This health
disparity is likely influenced by the pervasive effects of transphobia in our society, which sets the stage for inequality and discrimination at home and beyond, creating unique risk factors for the trans community (Bockting, Miner, Swinburne-Romine, Hamilton, & Coleman, 2013; Watson et al., 2016).

Pair this with the fact that no one is immune to the influence of the multi-billion dollar beauty industry consistently sending a message that, in order to be happy, we must look a certain way. Each one of us, regardless of gender, is sold (to some extent) on the idea that by controlling our bodies, we can achieve happiness, wealth, and popularity. Those working in the eating disorder field have historically referred to this as the internalization of the “thin ideal” or the acceptance of unrealistic or narrow beauty standards (Thompson & Stice, 2001). Transgender individuals are not immune from this culturally normative body dissatisfaction.  But people with eating disorders who identify outside of the restrictive gender binary may also experience amplified body dissatisfaction because their gender identity and their sex assigned at birth do not match (Algars, Alanko, Santtila, & Sandnabba, 2012; Strandjord, Ng, & Rome, 2015).

Furthermore, adjusting to a changing body and gender expression (for those who opt for cosmetic, hormonal, and other gender-affirming interventions), as well as the public commentary this process often evokes, presents its own unique challenges that impact body image and self-esteem (Couturier, Pindiprolu, Findlay, & Johnson, 2014).

How does one survive, and thrive, when faced with such challenges?

Sallans encouraged everyone in the room that night to stay hopeful and connected, which for him means sharing life stories to better understand those that are different. His comments suggested tremendous patience and empathy for his loved ones’ process of arriving at a place of acceptance with his transition, while also emphasizing the need to disconnect at times to protect oneself. Sallans identified a number of strategies and resources he has found useful, starting with a non-judgmental awareness of his needs, his boundaries, and his triggers. He explored the role of psychotherapy, as well as self-guided research on lesbian, gay, bisexual, and transgender issues, in helping him to turn towards his inner truth and wisdom.

Consistent with national guidelines on psychotherapy with LGBTQ individuals, Sallans benefited tremendously from collaborating with an affirmative therapist; someone he was able to confide in during times of confusion and fear surrounding gender identity, at a time when very few were even considering gender outside of the binary. The trust and respect he built with his therapist created a safe space to discuss gender issues and eating disorders, which provided the platform for recovery and ultimately allowed for closer and more authentic connections with family and friends. Outside of therapy, Sallans said he found it incredibly useful to communicate about his emotions and take time out for himself. He acknowledged the need to unplug from negative relationships (and social media) and engage in routine self-care, which for him often includes going for walks and being in nature.

Self-care, use of coping skills for managing negative emotions, positive sense of identity and community, and feeling like you can count on those closest to you are universal factors associated with resiliency (Rutter, 2012). These factors are even more relevant for those who identify outside of the gender binary (Hill & Gunderson, 2015; Watson et al., 2016). If you or a loved one is struggling with an eating disorder and questioning gender identity, see the resource links below to gather information, find community, and get professional support.

For information regarding affirming and evidence-based treatment options and programs at The Center for Eating Disorders at Sheppard Pratt, please contact us at (410) 938-5252 or email us at eatingdisorderinfo@sheppardpratt.org.

Additional Resources:
https://www.ryansallans.com (Ryan Sallan’s Official Website)
www.genderspectrum.org
www.glaad.org
www.pflag.org
www.thetrevorproject.org
https://www.chasebrexton.org/our-services/lgbt-health-resource-center

Written By: Andrea Castelhano, PsyD, Outpatient Therapist – Dr. Castelhano is a licensed clinical psychologist in the outpatient department at The Center for Eating Disorders at Sheppard Pratt. She earned her doctorate in Clinical Psychology at the American School for Professional Psychology at Argosy University, DC where she received training in cognitive behavioral therapy and mindfulness-based approaches to psychotherapy. She also received specialized training in eating disorders, anxiety disorders, and co-occurring self-harm and suicidality. Additionally, she has provided affirmative therapy to individuals in the LGBTQ+ community throughout her training and professional career. Affirmative therapy is a therapeutic approach that respects individuals of all sexual orientations and genders, recognizes the impact of intersectionality on identity development and life experience, and addresses issues including discrimination and heterosexism as they relate to the individual’s broader treatment goals. Dr. Castelhano joined The Center for Eating Disorders in 2018 and brings her experience from a variety of clinical rotations, including a year-long practicum at Children’s National Medical Center Outpatient Eating Disorders Clinic,  APA-accredited clinical internship at Laureate Psychiatric Clinic and Hospital, and post-doctoral fellowship with the University of Tulsa Counseling and Psychological Services Center. She provides individual, family, and couples therapy, as well as psychological testing services. She is fluent in Spanish and Portuguese.

References

Algars, M., Alanko, K., Santtila, P., & Sandnabba, N.K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders: The Journal of Treatment & Prevention, 20, 300-311.

Bockting, W.O., Miner, M.H., Swinburne-Romine, R.E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943-951.

Couturier, J., Pindiprolu, B., Findlay, S., & Johnson, N. (2014). Anorexia nervosa and gender dysphoria in two adolescents. International Journal of Eating Disorders, 48, 151-155.

Hill, C. A., & Gunderson, C. J. (2015). Resilience of lesbian, gay, and bisexual individuals in relation to social environment, personal characteristics, and emotion regulation strategies. Psychology of Sexual Orientation and Gender Diversity, 2, 232-252.

Reisner, S.L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, … Baral, S.D. (2016). Global health burden and needs of transgender populations: A review. The Lancet, 388, 412-436.

Rutter, M. (2012). Annual research review: Resilience – clinical implications. The Journal of Child Psychology and Psychiatry, 54, 474-487.

Strandjord, S.E., Ng, H., Rome, E.S. (2015). Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned. International Journal of Eating Disorders, 48, 942-945.

Thompson, J.K. & Stice, E. (2001). Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science, 10, 181-183.

Watson, R.J., Veale, J.F., & Saewyc, E.M. (2016). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50, 515-522.

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If you are one of the many people on the east coast dealing with this most recent winter storm, you might be struggling to cope with loneliness, boredom or the stress of being stuck at home in heavy snow and cold temperatures. Snow days can certainly be fun but they can also present some challenges for individuals who struggle with mental health issues and eating disorders in particular. That’s why we put together this list of activities and strategies for maintaining a recovery-focused snow day. You can print or bookmark this post and refer back as need for coping skills and ideas for staying recovery-oriented on any unexpected days off throughout the year.

32 Recovery-Focused Activities, Tips & Strategies:

  1. First things first. Review what food you have available and write down a plan for your remaining meals and snacks for the day that is aligned with recommendations from your treatment providers. Post your plan in the kitchen or somewhere you will see it throughout the day. Set up reminders to take the breaks you need to prepare and eat each meal.
  2. Call or text a friend to check-in. 
  3. Paint something.
  4. Start a new knitting or craft project. 
  5. Read an old book that you loved the first time around.
  6. Record your observations about the storm in a journal.
  7. FaceTime with a family member that might be feeling lonely in the storm.
  8. Try this breathing exercise.
  9. Catch up on THANK YOU cards. 
  10. Watch funny videos on YouTube.
  11. Create a gratitude list and add to it throughout the snow storm. When the storm is over, hang it up somewhere where you can admire it and refer back to it.
  12. If you know you tend to get sucked in to social comparisons, limit your time on social media to specific hours each day. Block or hide accounts that you notice only leave you feeling negatively. Follow one or two new accounts that are #bodypositive or recovery-focused. We recommend @NEDAstaff, @LindaBaconHAES and @MelissaDToler to get started.
  13. Look up and print information about eating disorder support groups in your area and make plans to attend once the roads are cleared. Add it to your calendar with an alert so you don’t forget.
  14. Challenge your perfectionism. Do something in a mediocre way and be okay with it. If you don’t consider yourself an artist, it’s okay. Just grab a pencil and start sketching or start tearing up some old magazines for a collage project and get to work. Accept imperfection. Celebrate imperfection.
  15. Make a snow day music playlist full of upbeat classics that warm your heart. 
  16. Go through your closet and gather old or uncooperative clothes that are not serving you or your recovery. Bag them up and get them ready to donate when the snow clears.
  17. Do research on countries and tourist attractions you might like to visit someday.
  18. If you’re an essential employee and need to be at work during the storm, remember that your well-being is also essential. Be assertive about your need for meals, breaks and sleep. 
  19. Throw in a load of laundry you’ve been putting off. When it comes out of the dryer, fold it right away. It’s a great way to keep your hands busy and it’ll be warm too.
  20. Watch a favorite movie and just be present with the movie instead of being on your computer or phone at the same time.
  21. If you’re feeling like the walls are closing in on you, get bundled up and check on elderly neighbors.
  22. Listen to the snow falling and do a 3-minute mindfulness exercise.
  23. Have LEGOs and/or kids in the house? Invite your kids to build something with you.
  24. Send a picture of yourself smiling to someone who has been having a rough time and might need a smile.
  25. Water all of your indoor plants
  26. Drink some hot tea and read the paper
  27. Once the snow passes, put on your boots, explore the outdoors and take some photos; look for people and animal tracks in the snow.
  28. Do a puzzle.
  29. Make a list of compliments you’ve received in the past and honor them, even if you couldn’t accept or believe them at the time they were given.
  30. Make plans for next week. Schedule a meal with a supportive friend or buy tickets online for a show or event you’d like to see.
  31. Make a meal plan and grocery shopping list for the coming week. Email it to a dietitian or therapist on your treatment team.
  32. Don’t have a treatment team?  Call (410) 938-5252 for a free phone assessment and to be connected with an Intake Coordinator at The Center for Eating Disorders who can talk with you about available options.

What else would you add to the list? How are you planning to make your snow day more memorable and recovery-focused? Share your ideas with us on Facebook and Twitter.


www.eatingdisorder.org

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If your goal is to raise kids with high levels of self-esteem, eating competence, body satisfaction and a healthy weight (which is different for everyone) then join the chorus of advocates saying #wakeupweightwatchers and ditch the diet mentality for yourself and your family.  We know weight-loss diets don’t work. We also know they can cause serious harm, especially when introduced to kids and teens.  Let’s prevent the weight loss industry from profiting off our children’s generation.

So if dieting doesn’t work to help kids maintain a healthy weight, what is a parent to do?  These 8 tips are a great place to start.

  1. Make a commitment to having family meals together as often as you can within your family’s schedule. Having regular sit-down meals as a family has been shown to be a protective factor against a range of health and mental health problems including disordered eating.1,2,3,4 
  2. Introduce and incorporate a variety of foods from different food groups at every meal. This doesn’t assume your kid will actually eat them but it’s important to expose them, even if it’s just on someone else’s plate.
  3. Teach and model body acceptance (as opposed to body criticism or body comparison). Kids are always listening and watching how the adults around them relate to their own bodies.
  4. Support your child’s natural ability to regulate hunger and satiety. Promote trust in their ability to self-regulate. We recommend learning more about Ellyn Satter’s Family Feeding Model and the Division of Responsibility in feeding.

Research has shown that size acceptance and learning to use hunger and fullness cues produces sustainable improvements in blood pressure, cholesterol levels, physical activity, self-esteem, and depression compared to dieting.” 5

  1. Engage in physical movement as a family with the goal of adventure, fun, coordination and social connection. Try not to frame exercise as punishment, as a way to gain permission to eat or as a means to an end (i.e. weight-loss).
  2. Incorporate all foods without fear or mixed messages. Food is energy and fuel but it’s also okay for it to be enjoyable too. Don’t forbid specific foods or categories of foods (unless there is an allergy of course). Refrain from using food as a reward at home and in the classroom as this can confuse kids, encourages them to eat in the absence of hunger or may lead to a pattern of rewarding oneself with food.6
  3. Refrain from labeling foods as “good foods” vs “bad foods”. Connecting foods with negative labels like bad, toxic or junk foods, can send kids a message that food is related to morality. Even young kids may internalize these labels. Ex) I ate a bad food, therefore I must be bad or I should feel badly. This can trigger strong feelings of guilt or shame related to eating as well as increased emotional eating.
  4. Support healthy sleep habits. Kids who don’t get enough sleep, or have chaotic sleep schedules, show changes in hormones that regulate hunger and appetite. Not getting enough sleep can also impact the way a child’s body metabolizes certain foods.7

While these tips are meant to be a very basic place to start, they might still feel overwhelming since we live in a culture of toxic messages about food and weight. It’s hard to let go of anxiety about our kids’ eating behavior and weight. These can also be difficult to implement if you have your own history of body image struggles, eating disorders or dieting.

If you’re worried that your own relationship with food or weight might be complicating the way you approach these issues with your kids or teens you’re not alone. It can be helpful to get support from a therapist with eating disorder expertise or other non-diet practitioners. At The Center for Eating Disorders at Sheppard Pratt we provide a number of services that can help, including:

If you’re interested in any of these services, please call (410) 938-5252 for more information. 

Previous Post: 10 reasons NOT to introduce dieting during childhood & adolescence

References:

  1. Losing weight won’t make you happy
  2. Are Family Meal Patterns Associated with Overall Diet Quality during the Transition from Early to Middle Adolescence?
  3. Family meals during adolescence are associated with higher diet quality and healthful meal patterns during young adulthood.
  4. BENEFITS OF FAMILY DINNERS
  5. 10 Reasons to Stop Dieting Now
  6. Secrets of Feeding a Healthy Family: how to eat, how to raise good eaters, how to cook
  7. The connection between sleep and growth

Additional Recommended Reading: Weight Science: Evaluating the Evidence for a Paradigm Shift

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Weight Watchers recently announced that it will offer free memberships to teens starting this summer. This announcement led to parents, physicians, dietitians and therapists around the world speaking out – and rightfully so – about the harmful effects of encouraging dieting in our kids. Why? Weight-loss diets have not been shown to provide any long-term health benefits.  Furthermore, dieting remains a major predictor for the development of eating disorders and worsens negative body image.

If you have kids or teens in your life that are feeling the pressure to diet or lose weight,  here are ten important facts and considerations to bear in mind.

1. Restrictive diets negatively impact children’s normal stages of growth and development. 

“Dieting is associated with potential negative physical health consequences. Nutritional deficiencies, particularly of iron and calcium, can also pose short- and long-term risks. In growing children and teenagers, even a marginal reduction in energy intake can be associated with growth deceleration” 1

2. Dieting is a major risk factor for the development of eating disorders. It can be hard to recognize eating disorders in teens or children, as many harmful attitudes about weight and food have become normalized in our culture. However, the problem is very real. And eating disorders don’t discriminate by gender, body type, ethnicity, or social status. According to Dianne Neumark-Sztainer, Ph.D., in the U.S. alone, more than 50% of adolescent girls and 33% of adolescent boys have used unhealthy weight control behaviors. Even when such behaviors don’t develop into clinical eating disorders, they can still have a significant negative impact on physical and mental health.

3. Dieting disrupts children’s innate ability to eat intuitively. Dieting teaches kids to override natural hunger and fullness cues which can have lifelong effects.

4. Diets often rely on externally mandated measures of food or fullness which  undermine our innate ability to feed ourselves well. Using external systems such as “points” or other charts and arbitrary ways of monitoring food intake teaches kids to shut down or ignore their own internal regulatory systems (including hunger and satiety cues) and to mistrust their own bodies.

5. Focusing on weight is problematic as it is not a reliable measure of health. Furthermore, weight-focused discussion in and of itself is a risk factor for obesity and eating disorders.

“Several studies have found that parental weight talk, whether it involves encouraging their children to diet or talking about their own dieting, is linked to overweight and EDs.” 2

6. Dieting teaches kids to associate eating with feelings of guilt and shame as opposed to viewing food as fuel and energy.

7. Dieting negatively impacts body image. Weight fluctuations, common with dieting behaviors, often end up fueling the cycle of body dissatisfaction and disordered eating.

8. Findings clearly indicate that dieting and unhealthy weight control behaviors predict significant weight gain over time.3 Weight loss diets are actually associated with higher lifetime BMI.

9. Weight loss diets are associated with decreased metabolism, food preoccupation, and binge eating.4

10. Weight loss diets are associated with increased rates of depression and decreased self-esteem.5,6

Once we all understand the facts about how diets actually impact children (and adults), we can help families focus on implementing actual evidence-based strategies that we know are more likely to result in positive outcomes and healthier kids.

The question becomes: How can family members and friends best support our nation’s youth towards a peaceful relationship with food and positive body image without introducing potentially harmful diet routines?

Check out our next post, 8 Tips for Raising Body Positive Kids (Who are also competent eaters) for some basic ideas and strategies.

References:

  1. Dieting in adolescence
  2. Preventing Obesity and Eating Disorders in Adolescents
  3. Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index
  4. Intuitive Eating Category: Studies
  5. Risk and protective factors for depression that adolescents can modify: a systematic review and meta-analysis of longitudinal studies.
  6. Losing weight won’t make you happy 

Contributors:
Rebecca Hart, R.D.
Caitlin Royster, R.D.
Rebecca Thomas, R.D.
Kate Clemmer, LCSW-C
Hannah Huguenin, R.D.

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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.

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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.

#12DaysofEDRecovery

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.

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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.

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