EDNOS

I have posted in the past (here) about 'eating disorders not otherwise specified' -- commonly referred to as EDNOS. As a diagnosis, EDNOS is not very specific-- if one does not meet the criteria for anorexia or bulimia, then he or she is lumped into the EDNOS diagnosis. In this way, it can sometimes be seen as the 'kitchen sink' diagnosis. This can be problematic for many reasons-- mainly, a single diagnosis used for people that experience a range of different behavioral symptoms (binge eating- no purging, purging- no bingeing, night eating, etc) is not necessarily effective when it comes to treating the eating disorder. There was an article published in the NY Times awhile back that I have been meaning to post that you can access by following this link which addresses this very issue. I would encourage you all to check this article out! It helps to bust a few common eating disorder myths and provides a little more background on EDNOS. For more info on EDNOS, follow this link.

More on The Biggest Loser...

Back in April, I wrote about The Biggest Loser. Actually, I didn't really write about it so much as just post a link to a great article about it that someone else wrote! Follow this link to check out the post and article. Or if you didn't read that post (or the article) and don't feel like doing it now, I'll try to provide a quick re-cap : ).

First, I know that there are a lot of people who love watching this show (including some of my friends and family- hi guys!). This critique is not meant to encourage anyone to stop watching the show, but more so just to encourage critical thinking about what really is going on and if it is healthy! I watch a little TV that is regularly critiqued for many reasons (the bachelorette, for one- haha), so believe me, I am not throwing stones. But my overall thoughts on the show can be summarized by saying that the show seems to perpetuate some pretty unhealthy views regarding weight, body image, health, and happiness, as well as unhealthy, immoderate and unsustainable practices (exercising up to 6 hours a day?). The only reason that I bring this whole thing up again is because an article was published a few days ago by Kate Ward on Entertainment Weekly.com entitled "Former 'Biggest Loser' Contestant Claims Show is 'Dangerous'; NBC Issues Response." In light of my post a few months back, I thought that this article was an interesting follow up. Check out this link to view the article, or read the copy and pasted version for your convenience below! If you all have any thoughts or comments about this, I would love to hear them (as always)!

About twice a year, we tune into the latest season of The Biggest Loser and watch in admiration and awe as a dozen or so contestants quickly shed pound after pound from their bodies, until they’re left looking like healthy, happy individuals. But, if former contestant Kai Hibbard is to be believed, oftentimesBiggest Loser graduates are anything but.

The season 3 contestant — who lost 118 pounds on the show — appeared on CBS’ The Early Show this morning to discuss her claim that the NBC show is hurting its contestants, and promoting an unhealthy body image. (See the video embedded after the jump.) Beginning her interview by voicing appreciation for being part of something that has inspired people to lose weight, Hibbard went on to accuse Biggest Loser of supporting a “myth that’s dangerous,” and claims the show stretches the truth when it comes to its shooting schedule: “I have people that come up to me and talk to me and ask me why they can’t lose 12 pounds in a week when I did. It didn’t happen. It’s TV…a week is not a week in TV.” (Hibbard also discussed dehydration, which is used to affect the outcome on the scales, something Biggest Loser fans are already fairly knowledgeable about.)

The former contestant also went on to explain how Biggest Loser affected her own health:Hibbard says she suffered from an eating disorder after shooting wrapped, which only ended after her husband and friends staged an intervention when they saw her substitute coffee for meals, and began to notice her hair falling out. “I left with a very poor mental body image,” she said on the Early Show. “I found myself loathing what I looked like the more weight that I dropped because of the pressure on me.” What’s more, Hibbard claims at least six former contestants from seasons after hers have approached her to complain about their own unhealthy experiences.

When asked to comment, NBC issued the following statement to EW: “Contestants on The Biggest Loser are closely monitored and medically supervised. The consistent health transformations of over 200 contestants through nine seasons of the program speak for themselves.” Of course, Biggest Loser is not new to controversy — nearly every season, the show comes under fire from viewers and health professionals alleging the show’s lose-weight-fast format is unhealthy for its cast members, especially since the show seems intent on adding bigger and bigger cast members with each new season. (Just see the latest Biggest Loser winner, Mike Ventrella, the heaviest contestant to ever enter the ranch.) But now that a former contestant is alleging the show is dangerous, is it easier to believe?

Some of you may have heard about the t- shirt that Urban Outfitters recently pulled from their online catalogue after much hate mail was received. The shirt said 'Eat Less' and was featured on a waif-y model. It is hard to believe that they actually went there! But they did, and while it may have been to generate some publicity (tacky, much?), enough people protested that they thankfully took it off of their website. I also heard that the shirt has been pulled from stores--so hopefully that is true!

A couple of my therapist friends who I got to know while doing some contract work at the Carolina House brought an awesome article to my attention that I just have to share. Below is this article that was published in Durham's Independent Weekly newspaper and written by Rebekah L. Cowell (follow this link to see the article) about some local women who are in recovery and working towards exposing myths about eating disorders that this t-shirt's message was perpetuating.

Amy Lambert used to tell herself what Urban Outfitters is telling millions of other young women: Eat Less.

It wasn't unusual for Lambert, who had an eating disorder for more than eight years, to consume little more than one container of yogurt in a day. Now recovering, Lambert led a protest last week outside of Urban Outfitters at Southpoint mall in Durham.

Last week, Urban Outfitters placed in their online catalogue a gray V-neck T-shirt worn by a rail-like young woman. On the front, in script, the words "Eat Less."

"Urban Outfitters targets a young demographic, and they are reinforcing the idea that eating disorders are a choice, not an illness," she said.

Four other women from a Durham Eating Disorder Support Group joined the peaceful protest, brandishing signs that read, "Messages Can Re-Enforce Deadly Beliefs" and distributing fliers titled "Messages in Media: 'Eat Less' is Humor That's Not Funny."

Mall security shut down the protest 30 minutes later.

"We want to make it a friendly family environment," said Public Safety Officer Sellers, who refused to disclose her first name. "We can't just have people here doing that [protesting and handing out literature]."

Urban Outfitters did not return the Indy's calls or e-mails regarding the ad campaign, but after national outcry the T-shirt was removed from the chain's website, though the shirts that have already been shipped will be in stores. When the Indy visited the store and asked for the T-shirt, it was not on the sales floor. An employee who didn't want to be named called the slogan "harsh."

At least 24 million Americans suffer from eating disorders, which have the highest mortality rate of any mental illness. Twenty percent of people with an eating disorder will die prematurely from complications related to their disease. Telling an individual with an eating disorder to "eat less" aggravates emotional, psychological and physical issues. And for those still stuck in dangerous patterns, it is a message of validation, says Chase Bannister, clinical director for Carolina House.

In fact, the T-shirt has been posted on "pro-anorexia" sites as a source of "thinspiration."

"The banner-statement 'Eat Less' can be a stinging trigger for women and men with anorexia, bulimia or binge-eating disorder," Bannister added, "ultimately providing reinforcement for the distorted belief our patients work so hard to stamp out: 'I will never be okay unless I'm thin.'

The women said by holding the protest, they sought to empower themselves and spread a message of acceptance for a healthy body. Sandy Yarnall had anorexia for more than half of her life. She finally received treatment in 2008. "I struggle every day with wanting to go back to a very unhealthy size, and where I was before recovery, and seeing that message did distress me."

Rebecca Clemins has had an eating disorder for 25 years. "Urban Outfitters put this tee on a waif-like model, which enforces the idea that being waif-like is preferred, and they are encouraging a lifestyle that is killing young women," she said.

"I can't imagine endorsing something that creates so much misery," said Carson Hadley, who developed her eating disorder in eighth grade. She had to drop out of high school during her senior year to get in-patient treatment at Carolina House. "That shirt reminded of what I can't be if I want to live."

I am so proud of the women who participated in this protest, shared their stories, fought to raise awareness and exposed myths about eating disorders. This can certainly be an inspiring act for those with eating disorders who are working towards health to see- that not only is recovery very possible, but that it can also be empowering to take a stand and work towards educating people about the truth about eating disorders.

Athletes and Eating Disorders- Part 2

If you missed part 1 of Athletes and Eating Disorders, you can scroll down a little to read it, or you can click here! I had the honor of interviewing Nancy Matsumoto (co-author of The Parent's Guide to Eating Disorders and a free-lance writer in NYC--follow this link for more on Nancy!), who is working on completing Toolkits for NEDA (National Eating Disorders Association) that are geared towards coaches and trainers. Both disordered eating and eating disorders impact many athletes, and one of the ways to promote health amongst athletes is to educate coaches and trainers, who are in unique positions of influence to point athletes towards the proper treatment and care of their bodies. Nancy, in my previous post, mentioned a phenomenon called the Female Athlete Triad, that I wanted to expand on (courtesy of NEDA).

Below is NEDA's description of this term/phenomenon:

The Female Athlete Triad includes 1) disordered eating, 2) loss of menstrual periods and 3) osteoporosis (loss of calcium resulting in weak bones). The lack of nutrition resulting from disordered eating can cause the loss of several or more consecutive periods. This in turn leads to calcium and bone loss, putting the athlete at greatly increased risk for stress fractures of the bones. Each of these conditions is a medical concern. Together they create serious health risks that may be life-threatening. While any female athlete can develop the triad, adolescent girls are most at risk because of the active biological changes and growth spurts, peer and social pressures, and rapidly changing life circumstances that go along with the teenage years. Males may develop similar syndromes.

The Female Athlete Triad puts female athletes at risk, and also inhibits their athletic performance. I am glad Nancy mentioned this because it is something that not many people know about (even in the field of eating disorders!). Below are the last few questions/answers of my interview with Nancy- I hope that you will find this informative (like I have)!

Me: What are some things that you have been struck by or learned about eating disorders and athletes through this process?

Nancy: One thing I’ve learned about athletics and eating disorders is that for the coach, the line between encouraging athletes to achieve peak performance levels and promoting unhealthy eating and training behaviors is blurred. For this reason, when coaches and trainers, are told they need to be more vigilant in spotting and addressing dangerous behaviors it can sound to them like their ability to do their jobs is being questioned and curtailed. They want to create winning athletes, and the traits that create champions—perfectionism, the desire to please coaches, and strong drive to succeed—are those often associated with eating disorders. They may fear that in order to encourage healthier behaviors among their athletes, they will have to discourage the very traits that make their athletes excel. What we hope the Toolkit will do is show that the better nourished and healthier the athlete is, the better her or his performance will be, and that although eating-disordered behaviors may seem to improve performance in the short run, in the long run they do not support athletic excellence.
Me: For many elite athletes who are competing at world class levels (whether collegiately, professionally, in the Olympics, etc), particularly in sports that may encourage (implicitly or explicitly) a high degree of scrutiny over body composition and weight for performance purposes (gymnastics, ice skating, running, wrestling, etc), eating disorders and disordered eating are increasing. Do you have any thoughts about how we might work towards helping athletes approach their performance and bodies from a more healthy standpoint?

Nancy: Yes, education and support for both athletes and coaches is very important. Some coaches are still not fully aware of the risks for and dangers of eating disorders among their athletes. We hope that once they do understand the facts, they will be open to discussing these risks with the team, stop making negative comments about weight or size, establish a zero tolerance policy for eating disordered behaviors, and foster a climate in which an athlete feels she or he can discuss these issues without fear of reprisal. For athletes, it’s great to have a sports nutritionist speak to the team about the importance of adequate fueling and hydration in their sport, to go over the warning signs for problem eating and exercise behaviors, and to encourage them to seek help at the earliest signs of a problem.

A lot of these strategies are about de-stigmatizing eating disorders, making athletes understand that disordered eating and eating disorders are a common problem among athletes, and that they can and should be discussed. Athletes should also know where there is help available, and that these problems can be solved with the right professional treatment. In many athletic settings, lack of knowledge about eating problems creates a climate of fear among eating-disordered athletes that makes it very difficult for them to admit to this problem. This causes a lot of suffering in silence. All the recovered athletes I spoke to talked about the tremendous stress of having to perform while also sustaining their disorder in secret.

When the Toolkits are completed and available, I will be sure to post a link so that any of you who may be interested in passing this information on to a coach you know, an athlete that you know, or if you are a coach/athlete yourself that desires this information, that you will be able to access it! By raising more awareness and promoting education for coaches and trainers, we can hopefully provide more care and restore health to those who are suffering from eating disorders and disordered eating. For more information on eating disorders, follow this link to access the National Eating Disorders Association site.

Athletes and Eating Disorders- Part 1

Just a few days ago, I was saddened to read about a 16 year old high school sophomore named Krista Phelps, who recently lost her battle to anorexia. A talented, high school athlete from Des Moines, Iowa, Phelps collapsed and died while running. Just a few days prior, she had been 'healthy' (according to this article) and competing in her second state track meet. The community is grieving this devastating loss, and in the midst of their grief, some interesting questions about athletes and eating disorders are being raised. This is not a new topic of discussion- many athletes have come forward to share their experiences with eating disorders and disordered eating (read about Tanith Belbin's story here). An anonymous coach is quoted in this article about Phelps as saying "anyone who's coached girls sports long enough knows of at least one [girl who has had an eating disorder]."

There seems to be a very fine line among athletes who train to be as fit as possible to achieve their best performance, while also remaining healthy and taking good care of themselves. It seems to me that coaches are in a unique position to pick up on warning signs and act as a liason for their athletes who may be struggling with an eating disorder by directing them towards the proper treatment. The challenge is that many coaches do not know what to look out for, and do not always know how to handle such fragile and potentially life-threatening situations! For that reason, the National Eating Disorders Association (NEDA) has initated a project to make toolkits for trainers and coaches. Nancy Matsumoto, who co-authored The Parent's Guide to Eating Disorders and has written for publications such as People Magazine, The LA Times, The NY Times and The Wall Street Journal (among others), has been appointed to create these toolkits. I had a chance to ask her a little more about how she got involved and what NEDA is doing to help come alongside coaches to support athletes who struggle with eating disorders. In light of Krista Phelps tragic death, I think this is something that would benefit us all to hear.
Me: I have been excited to hear that you are working with NEDA to make toolkits for trainers and coaches to help educate them about eating disorders. I know that this is still a work in progress and is not yet available, but can you share a little bit about your involvement with this project?

Nancy: Sure! Through my work as a former People magazine correspondent and as co-author with Marcia on The Parent’s Guide to Eating Disorders, I have reported various articles on eating disorders and body image. NEDA asked me to bid on the job of Toolkit Coordinator for their newest online Toolkit for coaches and trainers, and I was lucky enough to be contracted to do the job. NEDA’s existing online Toolkits are the Parent Toolkit and the EducatorToolkit. I started working on the Toolkit in January. At the moment, the Advisory Committee, made up of about a dozen experts in the field, is reviewing the Toolkit. We hope it will be online in late spring or summer, and will be publicized at the NEDA conference in New York City in the fall. We are now brainstorming on ways to publicize the Toolkit, so you can definitely help with that by telling your readers about it. If you have other ideas of ways to publicize the Toolkit, please let me know!
Me: What kind of information is being provided to trainers and coaches in these toolkits, and what are the goals of such a project?
Nancy: The first sections of the Coaches Toolkit will provide basic information on the different eating disorders: anorexia, bulimia and EDNOS, binge-eating disorder and disordered eating. It will answer frequently asked questions and debunk common myths about eating disorders; detail factors that put athletes at risk for eating disorders (for example participating in a weight-class sport, such as crew or wrestling, aesthetic sports, such as gymnastics or figure skating, or endurance sports, cross country, Nordic track skiing); discuss eating disorder symptoms common to athletes, and the Female Athlete Triad (a syndrome of three interlocking symptoms, disordered eating, irregular periods and low bone mass). There will be sections on encouraging healthy exercise among athletes, the role of the coach in eating disorders, and prevention among middle and high school athletes. Oh, and there will also be athletes’ own stories and conversations with professionals: nutritionists, psychologists and coaches themselves. The goal is to reach out to, educate and offer support to coaches and trainers who are on the front lines of eating disorders, but often do not know how to recognize or handle the problem.

I think that Nancy highlighted very well an issue that is all too common- coaches and trainers, who are on the front lines, need education and support to properly handle athletes with eating disorders. To see what else Nancy had to say, check back here soon for the rest of her interview! And to find out a little bit more about Nancy, follow this link to view her website!