Someday Melissa

There has been quite a bit of media coverage over the last two or three days on the story of Melissa Avrin, a 19 year old girl who lost her battle with bulimia last year. (The cause? A heart attack.) Her mother, Judy, was on the Today show last week and there have been a few articles published recently, all aimed at raising awareness about eating disorders, but also honoring and remembering Melissa's life. Judy has become an advocate and will be lobbying tomorrow April 26, and April 27 in Washington DC to support the FREED Act (Federal Response to Eliminate Eating Disorders Act). To find out more about the advocacy work that you can take part in, follow this link which will take you to the Eating Disorders Coalition site.

But back to Melissa's story- I would really, really encourage you to check out this article, which was published in the New York Times on April 21st. Judy has been raising awareness and speaking out about losing her daughter to an eating disorder over the course of this past year and she is also finishing up a documentary on her life (called Someday Melissa), which she is hoping to have completed by June. Sharing Melissa's story may help to dispel myths about bulimia, as well as connect a face and a story with an illness that is so commonly misunderstood. Melissa was young- 19 years old- and did not survive her battle with bulimia. Her eating disorder took her life, and it is a really heartbreaking story. What is so tragic is that she represents so many who struggle; while many do overcome this battle, there are still some who are like Melissa and are losing their fight. The more that we all can do to raise awareness, provide education, and advocate for more accessible treatment is a step towards saving lives.

To view a trailer of Judy's documentary on Melissa's life, follow this link. It is definitely worth checking out. It is a short, five minute video that is really powerful. Judy found Melissa's journal after she passed away, and after reading through it, was inspired to make a movie that would change peoples lives- as that was one of Melissa's goals that she had journaled about wanting to accomplish someday. Judy is using her grief to advocate, raise awareness and instill hope in the lives of others who are struggling with an eating disorder. If you or someone that you know is struggling with an eating disorder, I hope that Melissa's story may inspire you towards health. You are not alone, and it is possible to beat this disorder with the right treatment! To read different stories of hope and freedom from eating disorders, courtesy of the National Association of Eating Disorders (NEDA), follow this link.

"I Shouldn't, I've been so bad..."

"I have been SO bad today!" "I ate soo much yesterday, I cannot possibly eat today." "After that breakfast, I'm good until dinner!" How many times have you heard these kinds of comments, or made them yourself?? These are comments that we probably have all made at some point, and have also probably heard someone else make. So what's the problem with this kind of thinking about food?? Well, aside from being a form of 'fat-talk', this kind of thinking is very black-and-white, which is not usually an effective way to think about things. We see each decision or action as a total success or a total failure, which is rarely ever the case.

But even more than that, this kind of thinking about food fuels a diet mentality. I am not a nutritionist, and my training is not in nutrition, so I try to steer clear of getting into specifics about food! However, because I do work with clients who have eating disorders, I work with nutritionists (as we share clients) who educate me, in addition to any reading I might do! Anyways, Anna Lutz, a nutritionist that I have shared many clients with (who is currently on maternity leave- congrats Anna!) has had some helpful things to say on this very topic. First, our bodies do not take days into consideration. The patterns and behaviors that we establish with food over time are what matter to our bodies! In this vein, if we feel we have overeaten one day or are uncomfortable with a meal that we had last night or last week, our bodies do not react directly to that one event. One example of this is the way in which our bodies do not make drastic changes in 24 hours, even if we ate an extra serving or two of dessert the night before! Our bodies just don't work like this, even if we feel like they do! If we are consistently overeating or bingeing, then we are likely to notice a change in our bodies- and that is because we are establishing a pattern, and patterns are what our bodies respond to.

Our bodies will naturally gravitate towards our healthy weight (set point) when we are listening to them, by eating when we are hungry, and stopping when we are full. If we have a mentality towards food in which we have to 'make up for yesterday', it perpetuates an unhealthy cycle or pattern (binge/restrict) which does not move us in the direction of normal/healthy eating. This cycle also interferes with our bodies being able to find our set point! So next time you are tempted to cut out a meal one day or restrict calories because of what you ate the previous day, consider that your body reacts to patterns over time, and perhaps focus on trying to eat 'normally' by responding to hunger, stopping when you are full and choosing foods that you feel will satisfy you. For more information on eating 'normally', follow this link to read about The Rules of Normal Eating by Karen Koenig. This is a great book that I'd encourage you all to check out!

App-orexia??

Apple has secured a pretty dominant place in pop culture (and the world of technology!) and continues to do so with every increasing product that they put out--it's hard to imagine life without the iPod:). Just yesterday, the iPad came out and people woke up in the middle of the night to go wait in line to purchase one. There are many perks of having an iPad (or an iTouch, or an iPhone, etc)- one of them is that you can download applications, or 'apps' as they are commonly referred to. There are over 3 billion (!!), and they serve a variety of purposes (entertainment, news, health, finance, etc).

Something that I have noticed lately is the increased attention being given to apps that are designed to assist people in their dieting endeavors... by tracking their daily intake of food and calories. I read a really good article recently (which you can read here) that challenges the notion that these apps cause eating disorders. A lot of articles have come out saying that these apps cause eating disorders, but many people use these apps to count their daily caloric intake and never develop an eating disorder (although this does not elevate my opinion of them- more on that in a minute). Eating disorders are not usually 'caused' by one thing (for more on this and other eating disorder myths, follow this link). People with a genetic predisposition to developing an eating disorder may be triggered by using a calorie counting app, but the app is not usually the culprit. One phrase that I have heard often (as related to causes of eating disorders) is that 'genes load the gun, and environment pulls the trigger.'

While these apps may not cause eating disorders, I think that they can foster an unhealthy dependence, as well as an unhealthy attitude towards food and calories. It is important to be able to fuel our bodies and get what we need nutritionally, and it is good to be knowledgeable about healthy portion sizes! But if we cling too tightly to numbers, whether it is how many calories we are eating, or the number that is on the scale, I think that we run the risk of being occupied with the wrong things. Health is important. And our health does not just consist of our physical health- it consists of our emotional health, our mental health, and our spiritual health as well. I think that each component of our health is extremely important and without one piece, we cannot function at an optimal level. Rather than getting hung up on numbers, it might be to our benefit to focus on our overall health- how we feel, how quickly we can recover when we are active, building character, finding lasting significance, identity and purpose through faith, and working to maintain stability and positive coping skills through the ups and downs of life!

When Is It Time To Speak Up?

Nancy Matsumoto (a freelance journalist who has contributed to the New York Times, Newsweek, Time, etc..) and Marcia Herrin (a nutritionist specializing in eating disorders who founded the Dartmouth College Eating Disorders Prevention, Education and Treatment Program), have co-authored a great book called The Parent's Guide to Eating Disorders. They also have a blog called Eating Disorders and Nutritional News. To read a little more about Nancy and Marcia, follow this link! I wanted to share a recent blog post written by Nancy because I think it is a very authentic post that addresses a topic that people often ask and wonder about. The title of the post is 'Knowing When to Express Concern About a Friend's Eating Disorder.' Follow this link to read it, or you can read it below (copy and pasted).

In other fun news, I had the opportunity to ask both Nancy and Marcia some questions recently about some different eating disorder topics which I am excited to share with you soon! :) :) Follow this link to check out their website.

Knowing when to express concern about a friend's eating disorder

A recent experience reminded me that even when we know what the right thing to do is, it’s still hard to know when to do it. Over the course of the past year, I have become friends with a woman, I’ll call her Jane, in my Japanese language class. I recognized the telltale signs of anorexia in her right away: the hollow cheeks, the clothes hanging off her skeletal frame, the way she liked to bring food for others, but didn’t want to eat much herself.

Later, Jane told me that she did not see herself as too thin, she thought she looked normal, maybe even a little bit heavier than she wanted to be. This, too, is a classic symptom of the body dysmorphic disorder that often accompanies anorexia.

I wondered if I should say something, to express concern and find out if Jane was in treatment. Had I been just half as emaciated as Jane was, I would not have been able to think straight; I would have felt dizzy and probably fuzzy-headed from malnourishment. But Jane’s mind was razor sharp. She was an encyclopedia of kanjicharacters, devoured the finer points of grammar that made my eyes glaze over, and read the appendix of our dry text book for fun.

Although she was always the most prepared person in our class, Jane was also always late to class. I thought she had a job that she couldn’t leave early. Later, she told me that she had no job; the digestive problems caused by her anorexia meant that she simply had to wait until she felt well enough to leave her apartment. Often, she didn’t arrive until the last 20 or 30 minutes of our two-hour class.

Then Jane went away to Florida on vacation. It was sunny and warm there, but she returned with a wretched cold and looked thinner than ever. She looked terrible. “Feel my hands,” she told me and another classmate. Even though our classroom was overheated as usual, her hands were icy cold. Suddenly, she had entered crisis mode. Being in Florida surrounded by friends who were healthy, fit, and enjoyed active, outdoor lives had suddenly made her want those things for herself. She looked in the mirror and for a moment saw how different she looked, how starved and unhealthy the woman who stared back at her was. It was a moment of clarity that lasted long enough for Jane to realize she needed help.

For the first time, Jane also opened up to me and a few others in our class about her eating disorder. She was desperately seeking a treatment center, she told me. Even though all the doctors she spoke to felt she should be hospitalized, she hoped to stay at home and find outpatient treatment. I was scared for her life, and I could tell she was, too. I berated myself for not saying anything earlier. Maybe I could have prevented this sudden and horrible downturn. I knew what was happening to her and I didn’t say anything.

I thought that she would think me too pushy, or a know-it-all. I worried that I would be intruding. After Jane spoke openly about her worries, I was able to refer Jane to Marcia, who then recommended a good psychologist in New York for her to see. When I saw Jane at class yesterday, she told me she liked her therapist but was worried that she would not be able to afford many more treatments. She couldn’t afford to spend the $5,000 out-of-pocket minimum her insurance plan required before it would cover 50 percent of the therapist’s bills. Even paying for half of the treatments would be a stretch.

When I asked Jane today whether it would have offended her if I had spoken up, she told me, “I wouldn’t have reacted negatively, because I know what’s going on with me. I’m not sure that I would have done anything about it; you have to be ready.”

The kind of epiphany she had recently, when she recognized what she looked like and how sick she was, Jane told me, has happened before, although it never lasts. “I want to do something, and then I’ll go into hibernation again,” she said. Two weeks ago she had a phone interview with the Renfrew Center in Pennsylvania, but then decided not to go.

Jane said she wanted so much to be healthy and active but added, “I don’t know how to be active, to sleep and to squeeze food in. I can’t eat because it makes me feel bad, and I’m afraid I will get sick. I’m like a child; I want to be taught to eat again.” Then, she added, “I don’t know if I’m going to make it. If this can help someone else, please write about it.”

I asked Marcia if she thought I had done the wrong thing by waiting to voice my concerns to Jane. Marcia responded, “You have to trust your instincts on when to speak up, and it sounds like you did. I have reminded other concerned friends in similar situations that you can trust your instincts if your motives are pure. We all need to remember that we can't force another adult to take action (without taking legal action first). What Jane needs now is encouragement to hang in there long enough to benefit from treatment. Sometimes this is a good time to suggest or lend a book. Maybe Life Without Ed byJenni Schaefer or, Gaining: The Truth About Life After Eating Disorders, byAimee Liu. Good books can lead to good discussions, too. “

As a nutritionist who often sees eating disorders patients who cannot afford professional treatment and/or have difficulties with insurance issues, Marcia told me, “I have lots of thoughts about this.” The first is that Jane’s dilemma is typical of our insurance system, which slaps large deductibles on eating disorders treatment and follows with inadequate reimbursements. The patient goes without treatment and, in the worst cases, ends up hospitalized in an intensive care unit at upwards of $1,000 a day.

Marcia’s second thought was that it is often hard for patients make recovery their number one priority in life; everything else should be secondary. This is not easy in cases where the patient doesn’t have the complete support of loved ones, however.

Jane’s comment about feeling like a child who needs to learn how to eat again, Marcia noted, is a perfect description of what a good nutritionist can help an eating-disordered patient do, and why seeing a nutritionist or dietitian who specializes in eating disorders is so important.

“Another thing that can be inspiring,” Marcia said, “is to help the other person see that her life is important to others—children, spouses, families, friends, even pets, and to you!”

I will tell Jane that she is important to me, and to our class. I hope that if you are concerned about a loved who is in despair over an eating disorder, you will do the same thing.

Take care,

Nancy

Marcia Herrin and Nancy Matsumoto, co-authors, The Parent’s Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com).

Bring Change 2 Mind

I just started watching a TV show recently called Modern Family. It is hilarious. I've only seen it a few times, so I'm not sure I can do the premise justice, but it's essentially a sitcom that chronicles different members of an extended family and their interactions. (If you're curious, follow this link to check it out.) Anyways, I really do like it, but last week when I was watching, one of the characters made a joke about eating disorders. It's hard to explain what happened since I don't really know any of the characters names, but one of the children was annoyed with his mother and said- "mom, go tend to your eating disorder or something." I'm not sure if this was supposed to be funny, but after the day I had, I was NOT laughing. An eating disorder is a mental illness, and there's nothing funny about that. I didn't turn off the TV and refuse to watch the rest of the episode, but it just struck me that if you replaced 'eating disorder' with any other mental illness- say, schizophrenia- it probably wouldn't be funny either. So why did someone think making a joke about an eating disorder would be funny? This just reminded me that eating disorders aren't widely viewed as psychiatric illness yet.

I think one of the biggest myths about eating disorders is that they are a lifestyle choice- not a mental illness. Yes, there is choice involved in recovery- you have to choose to take steps to recover. But an eating disorder is a mental illness, so it's not as simple as 'just eating'. Glenn Close, the actress famously known for playing Cruella Deville in 101 Dalmatians (ha ha, just kidding- I think she is famous for her role in Fatal Attraction, which I've never seen-- and some other movies too..), started a non-profit called Bring Change 2 Mind. The mission is to raise awareness about mental illness, to work towards de-stigmatizing it while also providing support for those who deal with mental illness. Close's sister and nephew, who both suffer from different mental illnesses, were the inspiration that fueled her to initiate this endeavor. PsychCentral wrote a little article awhile back in October when it launched - to read it, click HERE.

I'd encourage you to check out her site! I'll be honest- right now, there is a slightly annoying pop-up when you access the site, but that's just because Bring Change 2 Mind recently partnered with NAMI (National Alliance on Mental Illness) for NAMIWalks Campaign (a walking campaign to raise money for and awareness of mental illness!). The pop-up is a video, and even though it's slightly annoying, it's actually worth watching :) Once you get past the video, the site is great- there are resources for those who want to learn about mental illness or find support if they are struggling with one, there are videos of people sharing their stories, and there is additional information available that serves to encourage real understanding of mental illness! Right now, eating disorders are not part of their featured mental illnesses- they feature depression, post traumatic stress disorder (PTSD), bipolar, and schizophrenia. However, there are many mental illnesses, eating disorders included, that will hopefully be added as their non-profit grows! At this point, what seems important is that this is an organization that is dedicated to promoting awareness and knowledge about mental illness to de-stigmatize... which is awesome. If you are interested in finding out how you can be involved in any capacity, you can check out the 'be involved' tab on their site!