Making that first call is tough. But we’re here for you, and we’re ready to help. The Emily Program’s admissions line is open when you’re ready to reach out--seven days a week, including Saturday and Sunday from 9AM-5PM. We interviewed one of our Admissions Specialists, Danielle Berg, to answer some questions about the admissions call so you know what to expect.
TEP: Why do people call the admissions line?
Danielle: People call the admissions line when they want to learn more about The Emily Program! Specifically, Admissions Specialists typically talk with callers who are requesting to start services, or callers who are returning clients looking to reinstate services. Our primary function is to help the caller begin their care journey here at The Emily Program.
TEP: When can potential clients call the admissions line?
Danielle: The Admissions phone lines are open seven days a week! The Admissions phone line hours are as follows: Monday through Thursday: 7:30am-6:30pm CST. Fridays: 7:30am –5pm CST. Saturdays and Sundays: 9am-5pm CST. YES! We’re available for calls on the weekends!
TEP: What information do people need prior to calling?
Danielle: If possible, call with your insurance card in hand. Sometimes callers think that they need to be formally referred by an outside provider prior to speaking with The Emily Program. This is not true! Although we’ll accept referral information, it is not required to have a referral made on your behalf prior to calling The Emily Program. We’re ready to talk when you are!
TEP: What should people expect when they call? Who answers the phone?
Danielle: When someone calls, an Admissions Specialist will explain what the intake appointment consists of. (Basically, at an intake appointment, a therapist will: 1. Determine whether or not an eating disorder is occurring 2. If an eating disorder is present, provide a diagnosis 3. Provide a recommendation for treatment.)
Once the intake appointment is explained, we’ll ask the caller a little bit about themselves: contact information, insurance information, etc. Next, we’ll ask a list of questions specific to the caller’s current food concerns. We’re collecting information that the intake therapist will then read as a way to get to know the caller a bit prior to the appointment.
Once we’ve gathered all necessary information, we’ll be able to schedule the intake appointment. Anyone not within driving distance or who is transferring from another treatment center can do an intake entirely over the phone. From there, it’s up to the client as to whether or not the treatment recommendation is pursued! Care is never forced. The Emily Program is not a locked facility. If the client chooses to seek treatment, the intake therapist will explain next steps during the intake appointment.
We fully understand that calling us might not be easy (to say the least). Our Admissions team is a compassionate group. We fully acknowledge that it takes a strong person to say, “Hey, I need help and I’m ready to talk.” There is no judgment. When someone calls we’ll listen, offer support, and obtain the caller’s information allowing a first appointment to be scheduled.
We work to answer calls as quickly as possible; however, it is possible that when you call our lines might be busy assisting others. If you leave a voicemail, we’ll get back to you as quickly as possible! Call length can vary, but we recommend allowing at least 15 minutes for the call to take place. We also recommend calling from a place that offers you some privacy (if privacy is important to you).
TEP: What usually happens after people call?
Danielle: After the appointment is booked, it’s highly recommend that the client contact their insurance company. It’s up to the client to understand their financial responsibility. Insurance can be tricky, we understand that. Admissions recommends that callers use the Insurance tab on our website for help!
TEP: Why weekend hours? What’s the benefit?
Danielle: We understand that the act of calling Admissions is a courageous one and that you can be ready at any point! We offer weekend phone availability as a way to increase access to care. You can even call with your slippers on! We’ll be ready to talk when you are.
Ready to start your journey to recovery? Want to reach out on behalf of a patient or a loved one? Give us a call today at 1-888-EMILY-77 (1-888-364-5977) or fill out our web form here.
Alok (they/them) is a gender non-conforming performance artist, writer, educator and entertainer. They are known for their sense of style, comedy, a poetic challenge to the gender binary. Alok has been featured on HBO, MTV, The Guardian, National Geographic, The New York Times, and that’s just the beginning. They have also presented their work at over 300 venues in more than 30 countries. You can learn more about Alok here.
Given the lack of diverse voices typically found in discussions of body image, we wanted to interview Alok for our PRIDE month series and ask their opinions on body image and identity as someone who identifies as a South Asian nonbinary person.
TEP: Tell us about yourself!
Alok: Hi my name is Alok as in tell me Alok! I'm a gender non-conforming writer and performance artist with a lot of feelings!
TEP: Where were you born and raised? Where do you currently live?
Alok: I was born and raised in College Station, Texas and I currently live in New York City.
TEP: How do you make a living? What do you like to do?
Alok: I am a writer and performance artist. My favorite thing to do in the world is to have long conversations with my friends. I'm constantly meeting people for coffee or meals and just figuring out our lives and how we got here. There is nothing more wonderful than a day chock full of the people I love and admire!
TEP: We know our lives are shaped by our identities. Could you tell us about how your identity has affected your life?
Alok: In a very real sense -- it's made me have to deal with constant discrimination, harassment, and violence. Navigating the world as a visibly gender non-conforming person means that the world flings a lot of its anxieties and projections on me. I've had to learn how to develop a thick skin and hold my head high in a world that disputes my existence. But it's not all been negative -- my creativity has been nurtured and celebrated, my relationships strengthened, and my conviction on who I am and what kind of world I want built!
TEP: What are your thoughts on the Body Positivity movement?
Alok: To be honest, I've struggled with the body positive movement because it has for so long been dominated by white cis women. What's important to understand is that as a gender non-conforming person of color there is a direct correlation between loving/celebrating myself and being attacked for it. It's not just that I need to be positive about myself, it's that society needs to stop being invested in gender binaries. However, I've recently been uplifted by the visibility of queer and trans Black people and people of color in the body positivity movement not just calling for celebration, but calling for organizing against discriminatory policies and institutions, moving the onus on society and not the individual. I'm fighting for a world where all people can safely self-determine their gender and where all gender expressions are appreciated and recognized as valid, and I think that is deeply related to body positivity.
TEP: Can you speak to your relationship with your body? Studies have shown the majority of us are unhappy with our bodies. Do you identify with this?
Alok: Yes, I am constantly struggling with body-image issues: feeling too masculine, too feminine, too hairy, too ugly, too, too...but I always remind myself that I'm not the problem, the norms are the problem. That it's not my fault that I feel uncomfortable in my body, it's the fault of a profoundly violent and discriminatory world!
TEP: How do you promote body positivity?
Alok: Currently the only trans experiences which are recognized as legitimate are people to identify within the gender binary of "man" and "woman" and often only people who are taking hormones/pursuing medical transition. As a nonbinary person (neither a man nor a woman) and a gender non-conforming person not currently on hormones, for me to exist in my truth and claim my legitimacy and beauty is already an act of resistance. However the work doesn't stop there -- I use my poetry and writing to advocate for people like me, to demand justice for all trans and gender conforming people of color. I believe that advocating against murder and brutality against Black trans women and all trans femmes of color -- all of this is ultimately about body positivity.
TEP: What do you love the most about your body?
Alok: I actually really love my chest hair! It's so confusing that this world still regards body hair as "unhygienic" or something that needs to be removed to be beautiful. It's a built in crop top! I love that I am so creative -- that I can take all of the bad cards the world has dealt me and make some fab accessories out of them!
TEP: Do you have any advice for those struggling with eating disorders or body image issues?
Alok: As someone who has long struggled with body image issues, it was really important for me to recognize that it's not my fault. There are so many corporations and systems and institutions who literally profit off of us not feeling good about ourselves -- this is all a calculated strategy to uplift and prioritize white/cis/thin/hairless/able bodies. So it's not just personal, it's political. And you're not alone! There are so many people out here like me fighting for a world where all bodies are celebrated!
TEP: What is one thing you wish people knew?
Alok: I wish people knew that we are far more expansive than our bodies -- that we carry so much trauma, memory, ancestry, history, energy, spirit! And that you can never really know someone just by looking at their body.
TEP: What is one thing you wish people would stop asking you?
Alok: Are you a man or a woman? (lol)
TEP: We know you are a phenomenal writer, what’s is your favorite piece you wrote?
Alok: My book of poetry FEMME IN PUBLIC! Which you can order here!
TEP: What is your favorite quote, poem, or book?
Alok: This is going to sound geeky but whatever! I love science fiction/fantasy! And growing up I was utterly obsessed with Robert Jordan's series WHEEL OF TIME! It's like so freaking long, but I've read it multiple times!
TEP: Favorite food?
Alok: Malayali Food (from my home in India, Kerala!)
TEP: Any last thoughts?
Alok: I love and need you very much. I am because you are.
According to the American Psychological Association, “Transgender is an umbrella term for persons whose gender identity [internal sense of being male, female or another identity] or gender expression [how gender is communicated through behavior, clothing, body and other characteristics] does not conform to that typically associated with the sex to which they were assigned at birth.” Simply put, it is a term used when a person doesn’t identify with the sex they were given. For example, if an individual is born and deemed male by a doctor but knows that they are female and chooses to present as such, that person may refer to themselves as being transgender. It is important to note that not everyone who appears gender-nonconforming will identify as transgender. In addition, being transgender is not related to a person’s sexual preferences.
Body image issues in the transgender community
Marginalized groups are often portrayed in the public as one overarching stereotype. This causes conflict when individuals do not adhere to the “norm,” e.g. the norm for cis women is to appear feminine. For transgender folks who already identify outside of what society considers “typical,” societal expectations and body image pressures can be severe and dangerous. Oftentimes society views an individual’s gender validity on how “well” they present or how close to the norm they are. This has the potential to leave those who are transgender struggling to achieve unnatural ideals to fit into the mold for what society deems male or female.
Research about body image in the transgender community has shown two common desires. That transgender men want to appear less curvy and more muscular and transgender women want to appear smaller, thinner, and “more delicate” (Diemer et al., 2015). By no means does this accurately describe everyone’s experience, but for those who wish to alter their body to appear more masculine or more feminine, engaging in disordered eating may become a frequent behavior. An article written for Teen Vogue states, “One thing is certain: transgender youth are using restrictive eating in an attempt to control and manipulate their physical appearance in an effort to attain cisgendered Western ideals that even most cisgender people can’t attain” (Blair, 2016).
The prevalence of eating disorders in the transgender community
Eating disorders disproportionately affect those who identify as transgender. While the typical image of someone suffering from an eating disorder is that of a cisgender, white woman, a 2015 study found that transgender youth are four times more likely to suffer from an eating disorder and twice as likely to engage in purging (Diemer et al., 2015). Approximately 13.5% of transgender college students report using diet pills and 16% of transgender individuals have been diagnosed with an eating disorder (Eating Disorder Statistics, n.d.).
Eating disorders in the transgender community may be partially attributed to the attempt to more closely match a person’s physical appearance to their gender identity. Transgender men may rely on their eating disorder to lose weight, and thus, lose feminine curves and appear more muscular. Transgender women may engage in disorder eating in an attempt to lose muscle and appear more petite. (Diemer et al., 2015).
Limited inclusive eating disorder treatment
While transgender individuals have the highest rate of eating disorders, they often go without treatment and/or medical care. Transgender people may never pursue eating disorder treatment because of a lack of access, knowledge, and financial ability. Due to, “systematic discrimination within the healthcare industry to refusals to provide care […] transgender people often do without health care” (Access to Health Care, n.d.). Without proper insurance coverage, the cost of treatment is beyond what most individuals are able to afford. In addition, there are few specialized eating disorder treatment centers that have experience working with clients who are transgender.
Even when people do seek out treatment, the experience can often be negative and difficult. Clients who sought eating disorder treatment report suffering macroaggressions, negative experiences, and a lack of gender competence when seeking care (Duffy, Earnshaw, Henkel, 2016). Without treatment that is tailored to an individual’s specific experience, transgender people often choose to not pursue treatment in order to protect their sense of self and wellbeing—even if that means struggling by themselves on their journey to recovery. While we hope that one day this won’t be the reality for transgender individuals, we recognize that it is a reality for thousands of people every year. We want to help.
How to be a good ally
Validate every individual’s identity. No matter what a person’s identity is, remember that their life experience is valid and important.
Ask people what pronouns they use and then use them correctly going forward. If you make a mistake, apologize, move on, and remember that in the future.
Understand that eating disorders look different for everyone. Each patient’s experience with an eating disorder is unique. Just because two people who are struggling with disorder eating are transgender, does not mean that their symptoms, behaviors, and experiences are going to be the same.
Don’t ask invasive questions. Whether or not a transgender person has had gender-affirming surgery is none of your business.
Understand that there is no “right” way to be transgender. Transgender people have a right to look, sound, and act however they choose.
Listen. Chances are that you don’t understand the transgender experience, so make sure you listen to those around you and lift their voices up. Educate yourself by exploring books, blogs, movies, or other social platforms.
Offer support. If someone in your life is transgender and struggling with an eating disorder, offer to help them find local trans-friendly resources that can help them in their recovery. If they refuse treatment, offer other options, such as online resources, hotline numbers, or simply offer a shoulder to lean on.
As always, The Emily Program is a safe space for transgender individuals to receive eating disorder treatment. We believe the each individual is unique and deserves specialized care. If you or a loved one are struggling, reach out to us at 1-888-364-5977 to connect with a personalized treatment team today.
Blair, X. (2017). Why Transgender Youth Are More at Risk for Eating Disorders Than Their Peers. Teen Vogue. doi:10.1007/978-981-287-104-6_100002
Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. Journal of Adolescent Health, 57(2), 144-149. doi:10.1016/j.jadohealth.2015.03.003
Duffy, M. E., Henkel, K. E., & Earnshaw, V. A. (2016). Transgender Clients’ Experiences of Eating Disorder Treatment. Journal of LGBT Issues in Counseling, 10(3), 136-149. doi:10.1080/15538605.2016.1177806
This is one person's story; everyone will have unique experiences on their own path to recovery and beyond. Some stories may mention eating disorder thoughts, behaviors or symptom use. Please use your own discretion. And speak with your therapist when needed.
by Katie Monsewicz, an avid writer and practicing journalist who has been through The Emily Program's residential treatment program. She wants to help others who have struggled with eating disorders - and those who are still struggling - through her writing and as an advocate for eating disorder recovery.
“Are you pregnant?” one woman asks another.
The other woman replies, “Why, yes, I am! Thank you so much for asking! I just love talking about this little baby bump and gift of life and….”
Except that isn’t how that conversation went.
While at work yesterday, I was leaning over the customer service counter wiping down the table top and one of the cashiers at the grocery store I work at puts her hand on her stomach and whispers, “Are you pregnant?”
You can imagine my horrified reaction and immediate, “NO!”
The thing is, I wasn’t nearly as horrified as I would have been a couple months ago, a year ago, or 5 years ago when my first thought would have been, “Do I look pregnant? Is my stomach too fat? Am I seen eating too much?”
Now I think, “Aw, that’s sweet. And as much as I wish I were starting my family, I just don’t have those kind of resources yet.”
I’ve been through relapses and recovery on up-and-down rollercoasters plenty of times, but this one comment didn’t send me spiraling down into panic and depression like I imagine it would many young girls with eating disorders. My recent recovery experience with The Emily Program, my very loving marriage, and the supportive friendships I have made since then have all taught me something about my own body: It is unique. It deserves love. It is mine.
I’m not ashamed to say I have a little bit of a tummy because I am a FEMALE. I am SUPPOSED to have something down there to support and nourish my future unborn child. I work out regularly, lifting more weights than I am slaving over the treadmill, and I am trying to target my stomach, but I’m not going insane over it. Sometimes I find myself pinching my skin and skulking about it, but I quickly straighten my posture and tell myself, “This is healthy. This is me.”
The cashier later came up to me at work and apologized, saying she just didn’t know because I was “so skinny” and had heard about my recent marriage. “It’s okay,” I told her. “I’m not offended.” She apologized profusely, but what I want her to know is that I’m not upset. I actually laughed it off.
I don’t feel so ashamed of my body as I have in my past with this eating disorder. I’m 21 and I finally feel comfortable in the body I have. I wish all of you reading this the same feeling of being welcomed into your own body.
The work that has been done in the fight for equal insurance coverage has been extraordinarily valuable, both to clients at The Emily Program and people with eating disorders throughout the country.
Nearly a decade ago, a federal mental health parity law was passed to ensure people with mental health issues received the insurance coverage they needed for treatment. In 2010, the Affordable Care Act took things another step forward, outlining the Essential Health Benefits that needed to be covered by insurance plans, which included mental health and substance abuse treatment. Then in 2016, more progress came when the 21st Century Cures Act passed, which clarified that the mental health parity law meant to include eating disorder treatment--specifically residential programming—and should not be excluded from insurance coverage.
Despite this progress, the fight is not over. Dr. Jillian Lampert, chief strategy officer at The Emily Program, recently contributed to a story in Bloomberg Law that reported on compliance issues associated with this mental health legislation and what can be done to address noncompliance. Given the vital importance of this topic, I’d like to continue that conversation.
First, it’s crucial for clients to understand that insurance plans should cover eating disorder treatment. As noted previously, legislation is in place that underscores the necessary nature of coverage for mental health, and the federal government has the ability to enforce these policies.
In spite of this legislation, many clients are told their insurance plans don’t cover eating disorders, don’t cover certain levels of care, or are denied coverage for reasons that don’t relate to the severity of their illnesses.
Change is very difficult in all circumstances. But when it comes to change in insurance coverage for medical care, change can be a high mountain to climb. This is certainly true for mental health insurance benefits. Federal law says that policies need to cover mental health. There is still gray area in terms of whether or not that means all mental health diagnoses need to be, and sometimes exclusions show up in policies. That said, because of parity, if your insurance covers care for a condition on the physical health side of your benefits, it needs to cover it on the mental health side. The interconnected nature of the impact of eating disorders on both physical and mental health clearly indicates that eating disorders should be covered.
It’s difficult to get insurance companies to change in practice and there are still some limitations which persist across varies insurance products. Some limitations violate the spirit of the law, but are legal in a technical sense. On top of that, several states have passed their own parity legislation, which may impact how insurance companies understand their obligations.
However, federal law in almost all circumstances should take priority over state law. The bottom line is that if you have insurance, you should have coverage for an eating disorder. Unfortunately, it also means you might have to fight a little bit harder than you’d like to and push your insurance company in ways that might seem difficult.
The ability to have a comprehensive plan is crucial for someone suffering from an eating disorder. Please remember to fight for your right for full insurance coverage. The Emily Program stands ready to help patients and loved ones navigate their insurance company rules and regulations.
Veteran healthcare executive Doug Foote joined The Emily Program in early May as our Chief Operating Officer. In this newly created leadership role, Doug has direct accountability for business operations, information technology, and change management.
Doug’s appointment is part of The Emily Program’s ongoing commitment to maintaining strong clinical and business processes, contributing a high standard of care, and ensuring a positive client experience across programs.
Prior to The Emily Program, Doug, his wife Denise, and their five sons lived in Florida. While there, Doug worked as the COO for Community Health Solutions of America. Doug’s oldest son just graduated from University of Minnesota –Duluth and his youngest recently turned thirteen.
We caught up Doug and asked him to share a little bit about himself.
TEP: What came first, this job opportunity or the desire to move to Minnesota?
Doug: This job, definitely. But, we love Minnesota. Our kids were born and raised here and we lived here 20 years before we moved. Minnesota is where we want to grow old.
TEP: What interested you the most about working for The Emily Program?
Doug: A primary reason I joined this company is because we have a CEO (Dave Willcutts) of integrity and vast healthcare experience. Dave is a former mentor of mine and is an advocate for patient care. I joined The Emily Program because of the nobility of the cause and the ability to help an underserved population. We have so many opportunities in our careers, and there’s so many great opportunities in the Twin Cities, but to be able to serve and help an underserved population. There aren't that many chances that come by like that. I wanted a purpose-filled career. I hadn't known the statistics about eating disorders, and they blew my mind. The amount of deaths and the ER visits, how can we find that acceptable? We have such a great opportunity not only to improve the quality of lives, but to save lives. How do you beat that? No matter what role you’re in at The Emily Program, you are helping to save lives.
TEP: What’s your favorite summer activity?
Doug: Swimming in the lake with my family.
TEP: Top talent?
Doug: Playing foursquare with my kids. It’s epic! We get very competitive, I’ve even got chalk and a ball in my trunk.
TEP: Final question, what’s one thing most people don’t know about you?
Doug: I am on IMDb as a martial arts villain in a B-grade movie. I studied Kung-Fu for several years and they needed extras in this movie.
At The Emily Program, we believe that people of all shapes and sizes deserve respect, and that everyone has the right to inhabit a body that is comfortable and healthy for them, regardless of cultural expectations. While we recognize that the body positivity movement has flaws, including an underrepresentation of diverse voices, we firmly believe that we should honor and appreciate how our bodies help us move through the world.
But last week's much-discussed New York Times opinion piece “The Problem with Body Positivity” reminded us that the phrase "body positivity" carries a lot of compexity and can mean many different things to different people. This inspired us to reach out and ask for opinions on what "body positivity" meant to individuals in our network.
Here are some of our favorite answers to the question “What is body positivity to you?”
"Being okay with how my body looks. It doesn't mean I have love it but it also means I shouldn't hate it." -Sarah
"Seeing and appreciating my body for what it can do. The crazy coolness of its inner workings. Not shaming it for what it looks like. Being kind and gentle with it." -Tasha
"That you can choose to be any size that is healthy for you and that is okay - the key word here is 'healthy.' Physically healthy AND mentally/emotionally healthy." -Anonymous
"It means advocating for and supporting the idea that each person has the right to inhabit, live with, and enjoy a body that is comfortable and healthy for them, regardless of how that body looks in comparison to dominant cultural expectations. It means freedom from shame. And it means having the autonomy to modify one's body--or not--in ways that feel good and helpful both mentally and physically, whether that means the additions of tattoos or piercings; adding muscle mass through weight lifting; or even letting one's body soften because it means letting go of a rigorous and stressful diet and gaining some peace of mind." -Morgan
"Accepting where your body is at right now, even if you want to change parts of it." -Cheryl
"It means accepting the body I'm in right now, and accepting other people, no matter their size or shape." -Kristin
"It means making choices that will make me feel good, not being too judgmental about myself and my looks, and reminding myself that every body is unique, including my own, and that I can't expect my body to look exactly like anyone else's." -Kelsi
"When you feel good in the skin you're in." -Louisa
"Honoring your body for what it can and does do, rather than for what it doesn't do or [what it] looks like". -J.
A recent survey found that 1/3 of all US adults reported being on a diet or following a specific eating pattern in the past year. The most frequently mentioned diets were intermittent fasting, restricting carbohydrate intake, paleo, low-carbohydrate, Whole30, high-protein and ketogenic/high-fat diets.
There are all sorts of reasons why people focus on changing their eating habits, including improving overall health, avoiding certain diseases, and losing weight. There is, however, a dark side. For individuals who might have a propensity towards eating disorders, engaging in diet changes that impose severe or overly strict guidelines on timing of meals, eliminating or avoiding certain foods or food groups, and especially weight loss dieting, can result in an unintentional slide into disordered eating patterns or even outright eating disorders.
It has been known for years that engaging in weight loss dieting is a risk factor for future disordered eating in both adults and adolescents. (1,2). A recent Mayo Clinic newsletter described how dieting for weight loss can cause the brain to respond as if the person was faced with starvation, noting “There is strong evidence that many of the symptoms of an eating disorder are actually symptoms of starvation. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.”(3)
However, non-weight loss diet programs can also be tricky to navigate for individuals whose genetics, temperament, and environment might put them at risk for disordered eating and developing an eating disorder. As documented in the survey, intermittent fasting is the current hottest diet fad out there, as shown by the attention it receives on social media. The basis of intermittent fasting program is the idea that restricting one’s intake to a certain time of day, or to a certain number of hours each day, can result in weight loss or health benefits. As with most such popular diet programs, they are frequently a mix of some science with a large helping of media exposure, which inflates what is actually known about the benefits of following such a regime.
An example of this is a recent pilot study which looked at the effects of intermittent fasting on the ability to reduce the risk of type II diabetes. In this preliminary study, eight men consumed all of their food for the day between 6:00 a.m. and noon. The rest of the day they consumed no food until 6:00 a.m. the next morning. The results showed improvements in some metabolic markers associated with blood sugar control, as well as improvements in blood pressure. Remember, this was an early study with a very small number of participants and much more work would need to be done to see if these results would hold true in larger, more diverse populations. The lead author of the study correctly pointed out that more work was needed to see if this approach was doable for most people. The issue here is not about whether changing when meals are eaten have health benefits for some people, but it is about the risk that this type of severe restriction presents to people in general (imagine the practical difficulties of implementing such a regime).This is a particularly important consideration for individuals who might have a biological or genetic predisposition towards either restriction and/or binging tendencies, or have personality traits that would be triggered by a rigid black and white mandate.
There isn’t a clear break or line that one crosses when diets go from helpful to dangerous. Normal/healthy eating, disordered eating and eating disorders run along a continuum. Frequently, individuals who struggle with an eating disorder start out with very well intended, rationale and reasonable changes to their eating habits or patterns. If you are thinking about changing the way you eat, it might be helpful to consider the following questions. How would the changes you are considering:
Impact your ability to meet your body's energy and nutritional needs?
Impact your professional or social interactions?
Create undue focus and stress around how, what, or when you eat?
Impact your overall quality of life?
If you have made changes in your eating habits and feel concerned that it could be leading to difficulties in your relationship with food, the following questions from a frequently used questionnaire* might be helpful to consider:
Do you feel like you sometimes lose or have lost control over how you eat?
Do you ever make yourself sick becuase you feel uncomfortably full?
Do you believe yourself to be fat, even when others say you are too thin?
Do food and/or thoughts about food dominate your life?
Do thoughts about changing your body or your weight dominate your life?
Have others become worried about your weight?
*Adapted from the Scoff Questionnaire by Morgan, Reid & Lacey - BMJ, 1999.
If you answer “yes” to two or more questions on this informal survey, it strongly indicates the presence of disordered eating and you should reach out for an assessment.
1. Psychiatry Res. 2014 Dec 15; 220(1-2): 500–506.
Most of us understand what it’s like to get the winter blues, where the only thing we want to do is cuddle up and watch Netflix for hours on end. However, for some of us, these blues are serious enough to be classified as a condition called Seasonal Affective Disorder, commonly referred to as SAD. According to the U.S. National Library of Medicine, SAD is a type of depression that’s directly related to the change of seasons and affects people at the same time every year. Symptoms may include: depression, loss of interest, low energy, sleep disturbances, changes in appetite or weight, negative thoughts, and/or thoughts of suicide (if you are having suicidal thoughts or ideations, talk to your therapist or call the Suicide Prevention Lifeline at 1-800-274-8255. Chat is available here for those who are deaf or hard of hearing). While most people think SAD only appears in the winter, summer SAD is surprisingly common and starts in late spring and lasts until early fall. The most common symptoms of summer SAD are insomnia, poor appetite, weight loss, and anxiety (Mayo Clinic, 2017).
SAD can disproportionately affect people with eating disorders
While many people think of the warm months as a time to look forward to, summer can exacerbate eating disorder symptoms and cause SAD for some of the 30 million people who struggle with eating disorders. Studies have found that “summer SAD,” which is related to an increase in light and temperature, is found at “unexpectedly high” rates in people with eating disorders (Hardin et al., 1991). This may be attributed to the fact that eating disorders can worsen in the summer due to a variety of circumstances, resulting in increased rates of depression. Certain things about summer are thought to contribute to an increased severity in eating disorder symptoms, including:
Warm weather means less clothing. If you struggle from an eating disorder, chances are you are hyperaware of your body, which may make swimsuits, shorts, and tanks feel less than comfortable to wear.
A sharp increase in diet talk. As summer ramps up, we see an increase in ad campaigns targeted at promoting weight loss, which can result in a societal push to become “beach body ready.” Or, at least what the mainstream media considers to be “beach body ready.”
A lack of structure and a potential increase in free time. For students, teachers, or those with lifestyles that change during the summer, an increase in free time and a lack of structure may make maintaining good eating habits more challenging than usual.
Barbeques, parties, picnics and more! Public eating may result in increased anxiety and fear for those living with eating disorders. This could result in a refusal to attend social gatherings, which may contribute to an increase in feelings of loneliness and depression.
Pair these circumstances with summer SAD and the results can be severe (Liang, 2016). A study conducted for the Journal of Psychiatric Research demonstrated that there is a statistically significant increase in hospital admissions of patients with eating disorders during the summer months, suggesting that summer can increase the severity of eating disorders (Liang, 2016).
What can you do?
We know summer isn’t going to stop, so what can we do to make summer a safe time? For those with eating disorders, try the following practices to stay on track with your eating disorder recovery:
If you haven't yet, consider starting treatment. If your schedule opens up in the summertime, take advantage of it and seek professional help for your eating disorder.
Set strong boundaries. If you know certain situations are going to harm your recovery, don’t take part in them. The best thing you can do for your recovery is to take care of yourself and honor your limitations.
Make plans. If you are in recovery and on a meal plan, make sure you can observe this. This may mean bringing your own food to social events or asking what will be offered—and that is okay! Remember, your health is the first priority.
Take part in activities that promote mental health and well being. You could start a meditation practice, try gentle yoga, paint, write, draw, or do whatever makes you feel the most at peace with yourself.
If you're supporting someone else in eating disorder recovery, try the following practices:
Be available to offer support when needed.
Stay alert. Know the warning signs, including appetite loss, change in mood, weight loss, or an increase in body image concerns. If the individual is interested in pursuing treatment, help them look for resources.
Make your gatherings food-friendly! Offer a variety of options and communicate what you plan to serve prior to the event. It may make it easier for someone in recovery if they know what to expect.
Watch how you talk about food. No calorie counting, no food shaming, and definitely no promoting the idea that you have to "exercise off" what you eat.
In the end, we are all in the fight against body shaming and eating disorders together! So, be a vocal, supportive, and informed ally. As always, if you are seeking help with an eating disorder, please reach out to The Emily Program at 1-888-364-5977. We would love to be a part of your recovery journey.
Hardin, T. A., Wehr, T. A., Brewerton, T., Kasper, S., Berrettini, W., Rabkin, J., & Rosenthal, N. E. (1991). Evaluation of seasonality in six clinical populations and two normal populations. Journal of Psychiatric Research, 25(3), 75-87. doi:10.1016/0022-3956(91)90001-q
Liang, C., Chung, C., Tsai, C., & Chien, W. (2016). Seasonality of hospital admissions and birth dates among inpatients with eating disorders: A nationwide population-based retrospective study. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 23(2), 233-240. doi:10.1007/s40519-016-0326-0
This is one person's story; everyone will have unique experiences on their own path to recovery and beyond. Some stories may mention eating disorder thoughts, behaviors or symptom use. Please use your own discretion. And speak with your therapist when needed.
Lisa Whalen, a former Emily Program client, has a Ph.D. in postsecondary and adult education, and an M.A. in creative and critical writing. She teaches writing and literature at North Hennepin Community College in Brooklyn Park, Minnesota. Her essays have been featured in An Introvert in an Extrovert World, WorkingUSA: The Journal of Labor and Society, and MotherShould? Whalen is working on publishing her memoir, Taking the Reins. In the meantime, she is a regular contributor to The Feisty Writer and maintains a blog called Writing Unbridled.
“Who’s your best friend?” my Emily Program therapist asked.
I paused mid-story, blinked, and stared at her with what I’m sure was a baffled expression.
The answer was a no-brainer, but I couldn’t imagine why she’d interrupted me (something she never did) to ask a question that had nothing to do with our current topic: a mistake I’d made at work.
“My sister, Julie.” I replied. “Why?”
Her response sparked an insight crucial to my eating disorder recovery: “What would you say to Julie if she’d made your mistake?”
Whoa, I thought, because everything changed.
I knew instantly that I’d tell Julie, “You meant well. You couldn’t have known . . . Your boss will get over it. It’s not as bad as you think. It’ll probably turn out that everything is fine. If not, you can look for a different job—a better one—because your employer won’t deserve you!”
I realized in that moment rather than explaining to my therapist what had happened, I was ruminating on every possible consequence of my mistake and detailing what I should have done instead. In other words, I was beating myself up for something I had done with good intentions and couldn’t change. What a waste of energy!
It shouldn’t have come as a surprise that I judged myself more harshly than I judged others. Coworkers, teachers, coaches, band directors, parents, and even childhood friends had all told me at some point, “You’re too hard on yourself.” I never believed them. If anything, I’m not hard enough, I thought, recalling the seemingly infinite number of things I did imperfectly every day.
With my therapist’s help, however, I recognized how often I held myself to an impossible standard—one I’d never apply to someone else—and then punished myself for failing to meet it.
“I’d like you to focus on treating yourself like you’d treat Julie,” she suggested. “Pay attention to your self-talk. When it’s critical, question whether you would apply it to your sister. If not, counter it with compassion.”
Once I began paying attention, I was stunned by the frequency and severity of negative thoughts I had about myself. Then I noticed how little benefit they offered. In fact, they did far more harm than good. Instead of helping me become perfect, they made me anxious, socially awkward, withdrawn, and deeply unhappy.
Replacing critical self-talk with compassion became easier with practice. In addition to helping me recover from an eating disorder, it set me up for a fulfilling career teaching college courses. It introduced me to hobbies I became passionate about, like horseback riding. It improved my relationships with family and friends. It led to my marriage. And, perhaps most importantly, it continues allowing me to find humor, and therefore joy, in life’s littlest moments.
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