I read a great blog entry a few days ago on parents, adolescents and body image-- topics that have been on my mind a lot lately due to the nature of my work! For parents who are trying to navigate the rough waters of a child or teenager who is struggling with an eating disorder and poor body image, it can be daunting and difficult to know how to respond. For this reason, I often recommend a great book to parents called The Parent's Guide to Eating Disorders, written by Marcia Herrin and Nancy Matsumoto. I had a chance to ask Dr. Herrin a few questions which I will share with you below; she happened to also write the blog entry that I mentioned. Whether or not you are a parent, I think this information can be helpful because you likely have parents yourself, or parental figures in your life, or maybe you know young adults, children or teenagers that you work with, mentor, teach, volunteer with, etc.. While some of this info may not apply directly, some of it can be adapted to encourage healthy attitudes with food. To access the blog that Dr. Herrin writes with Nancy Matsumoto (who is doing some exciting work with athletes and eating disorders that I look forward to sharing with you soon), follow this link- the blog entry is copy and pasted below as well.

Watch Dieting and Bad-Body Talk in front of your Kids

In brand-new, not yet published research, my friend and colleague Dianne Neumark-Sztainer and colleagues at the University of Minnesota and the University of California, San Diego have found that messages from parents about weight and body image have a significant effect on adolescent body image. I have worked with a number of families in which a child, usually a daughter, is all of a sudden worried about her weight triggered by a parent who is dieting and/or talking a lot about how much she (or he--dads can have an affect here too) doesn’t like her body. I tell parents that if they are going to diet, DON”T TALK ABOUT IT!! in front of the kids. Dianne’s group also found that when parents when parents eat well, overweight teens tend to follow their example. Watch for this study: Family Weight Talk and Dieting: How Much Do They Matter for Body Dissatisfaction and Disordered Eating Behaviors in Adolescent Girls? in next issue of the Journal of Adolescent Health.

I think that it is important to point out that parents are not to blame for eating disorders!- however, there are ways that a parent can impact her child for the better and support the child in such a way that is effective! I had the awesome opportunity to ask Marcia Herrin, a nutritionist specializing in working with eating disorders and weight issues, a few questions, and wanted to share some of the helpful tips that she suggests for parents. Dr. Herrin is very respected in the eating disorder field- she founded the Dartmouth College Eating Disorders Prevention, Education and Treatment Program. She has a masters in public health as well as a doctorate in nutrition education. She currently runs a private practice and works with children and adults struggling with eating disorders and weight issues. For more information on Marcia, follow this link.

Me: You and Nancy have partnered together in your book The Parent's Guide to Eating Disorders. This book provides a lot of very helpful information for parents who may be worried about their children's eating attitudes and behaviors. If you could share two or three helpful tips for parents raising children, what might you say to them to help them to encourage healthy attitudes about food?

Marcia: Do not comment on your child's weight. Eat together as a family as often as possible. Do not talk about dieting or weight issues (yours or anyone else's) in front of your child. Do make sure lunch and dinner meals include protein and dessert.

Me: If you are a parent who suspects that your child is struggling with food, whether an eating disorder or disordered eating, what steps might you encourage them to take to help their child?

Marcia: First call your child's doctor or your area's most respected expert for their assessment of the situation. Then talk directly (calmly and kindly) to your child about your concerns and observations. Let them know that you are worried but not mad. In our book we say if you are "open, receptive, curious, honest, tentative, and work hard at understanding your child's point of view... no matter what words you use, your chances of success will be greater."

Me: Chapter 8 in your book is wonderful. It touches on body image and the ways that our own body image affects the body image of our children (and by extension those around us). Can you share a little bit about how a parent's negative or unhealthy view of their body or food can affect a child? Do you have any advice for parents who struggle with their body image or self-esteem?

Marcia: "Keep it to yourself" is the advice I give parents about their own struggles with body image or self-esteem. One of the riskiest situations is when a child observes one parent teasing the other about their weight or eating habits. Parents, even if they struggle to believe it themselves, need to preach "it is not what you look like that matters; it is who you are as a person and what you do."

Me: You write about PAMS (Parent-Assisted Meals and Snacks) and appear to have much success with this model, which has been adapted slightly from the Maudsley method. Can you share the heart behind this method and the success that you have seen with teenagers that you have worked with?

Marcia: One strength of PAMS comes from "saving face." When parents take over responsibility for the eating disordered child's food, the child has to eat even if she doesn't want to. She doesn't have to give up her eating disorder. She can relax knowing her parents aren't going to let her starve to death. She doesn't have to agree to eat, she is made to eat. PAMS helps parents know what and how much to feed their child. Some parents can figure this out on their own, but PAMS helps parents who are stressed and overwhelmed by their child's eating disorder hit the ground running with an approach to food that works. I have been in the field of eating disorders for nearly 25 years and I have never seen any other technique turn an eating disorder around as dramatically as PAMS does.

For more information on PAMS and other related topics, check out The Parent's Guide to Eating Disorders. If you are a parent who struggles with body image or food, the most important thing that you can do for your child is to work towards being healthy yourself! Whether that means seeking out a nutritionist, a therapist, or a consultation with your doctor, it is critical for you to be the very best you that you can be, for you and for your children! When Marcia says 'keep it to yourself' regarding your struggles, she means do not talk to your children about it. But it is okay and vital to talk about it with professionals, friends and family members if you are dealing with these feelings and behaviors.

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.

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).

A few days ago, I read this article on the Huffington Post by Kimberly Dennis, MD, entitled Eating Disorders: Be the First Line of Defense. I wanted to re-post it here because it includes a lot of educational and statistical information that serves to re-iterate what eating disorders are. It also helps to dispel myths about eating disorders. It seems to me that the goal of this article is to provide a little bit of education to readers to help us become more aware, and possibly apprehend when a friend, loved one, or acquaintance may be exhibiting concerning behaviors related to food. This article is certainly not exhaustive, but I think it provides some basic info that everyone should know! I have copied and pasted the article below.

Eating Disorders: Be The First Line Of Defense

While the majority of us may not work in the emergency room, or even work in the healthcare industry, we can still save lives.

In the United States, as many as 10 million women and one million men are fighting a life-and-death battle with anorexia or bulimia, according to the National Eating Disorders Association. More often than not, dentists can provide the gateway to critical medical treatment for these individuals.

By becoming aware of certain signs and symptoms, you can uncover illness that may otherwise go unnoticed - and untreated. With the right knowledge, you can save a life.

A deadly disease spreads - faster

Eating disorders are potentially deadly, biologically-based psychiatric illnesses. Anorexia nervosa has the highest mortality rate of any psychiatric illness, nearly 12 times greater than any other cause of death among women between the ages of 15 and 24.

What's more, eating disorders among young women are increasing at an alarming rate. Nationally, the incidence of bulimia in women ages 10 to 39 tripled between 1988 and 1993, and continues to grow.

Anorexia typically begins at the start of puberty and is more common among adolescent girls and young adult women. It affects one to two percent of the female population, and 0.1 to 0.2 percent of men. Because more than 90 percent of all those who are affected are adolescents and young women, the disorder has been characterized as primarily a young woman's illness. But it should also be noted that males and children as young as seven years old have been diagnosed with this illness, as well as middle-aged and elderly women.

Patients are diagnosed with anorexia when their body weight falls to 85 percent or less of their normal, healthy weight. Typically, these patients have an obsessive preoccupation with body weight and calories, as well as an intense fear of gaining weight or becoming fat. Their body image is grossly distorted, resulting in an unwarranted psychological impact on how they see and value themselves.

There are two types of anorexia nervosa: the restrictive eating type and the binge-eating/purging type. Binge eaters rapidly consume a large amount of high-calorie food in a very short time - perhaps 1,500 to 3,000 calories or more. Those who purge may do so with self-induced vomiting, excessive exercise or the misuse of laxatives, diuretics or enemas. Approximately 70 to 80 percent of people with bulimia purge by means of self-induced vomiting, while 30 percent use laxatives. Some who purge, however, do so without actually binge-eating first.

Recognizing the danger signs

The physical complications associated with anorexia are potentially life-threatening, since dehydration and malnutrition can damage vital organs. This can result in:

- low blood pressure

- electrolyte imbalance

- cardiac arrhythmias

- thyroid gland deficiencies, which can lead to cold intolerance and constipation

- appearance of fine, baby-like body hair

- bloating or edema

- decrease in white blood cells, leading to increased susceptibility to infection

- osteoporosis

- seizures related to fluid shifts due to excessive diarrhea or vomiting

- kidney damage or failure from chronic use of diuretics

Signs of an eating disorder are:

• Exhibits concern about her weight and attempts to control weight by diet, refusal of food, vomiting or laxative abuse.

• Prolonged exercising despite fatigue and weakness.

• Peculiar patterns regarding handling food.

• Exhibits abnormally fast weight loss, without any other known medical condition.

• Experiences depressive moods and self-deprecating behavior.

If you recognize these signs, fight the urge to remain silent. Remember, denial is a big part of eating disorders - another reason they can become fatal and a major obstacle to recovery. Act in a caring and non-judgmental way, simply stating what you see, and asking how you can help.

Also, you can go to the Web site of the National Eating Disorders Association (www.myneda.org) or call Timberline Knolls at 877-257-9611, and we would be happy to help find a professional in your area. That referral just might save a life.

Kimberly Dennis, M.D., is the medical director at Timberline Knolls (www.timberlineknolls.com). Located in Lemont, Ill., this innovative residential treatment center is designed exclusively for women with emotional disorders, including eating disorders, addiction and self-injury behavior. Dr. Dennis is a member of the American Medical Association, the Academy of Eating Disorders, the American Academy of Addiction Psychiatry and the American Society of Addiction Medicine.

Opportunity!!

I wanted to let you all know of a cool opportunity (media inquiry) that I have read about it in a few different places recently-- read below to find out about how you might help out a reporter writing a story on the link between mothers and daughters and body image/eating disorders.

The ad is posted below:

"I'm looking for women in their 20s and 30s (and hopefully some of their mothers) who have struggled with eating and body image. At this point I need women who struggled with these issues but didn't necessarily have clinically-defined eating disorders. So, women who have struggled with bingeing, purging, restricting, body-loathing, and feel like their attitudes are connected to their mothers behaviors and attitudes. If this is you, and you'd be willing to share, I'd really appreciate it. You can contact me at dekapp@mac.com.

Best, Diana Kapp"