Anyone Need a Body Image Boost??

While the first official day of Summer has not yet arrived (it's June 21st if anyone was wondering!), Memorial Day has come and gone and regardless of where you live, the weather is probably/hopefully starting to get a little warmer. I know that here in Raleigh, NC, the weather has been downright HOT. These 90 degree days filled with humidity have me a little concerned about what August may bring. But at least it's finally pool weather right???

Well, for some women (I would bet most), warmer weather and getting into a bathing suit can trigger anything from a few nerves to a full on panic attack. The obsession with our bodies continues to reach new heights, and sometimes what we need is to step back and get a giant body image boost. Dr. Michael Levine and Dr Linda Smolak, together with NEDA, compiled a list of 10 "will-powers" for improving body image. I have been using this list with some of my clients lately (because I think that it is pretty great), and because I have gotten a lot of feedback on how helpful it has been, I wanted to share a few of them with all of you. My hope is that the following list may help us all to spend more time enjoying the sunshine, the company of friends and family, and the water this summer, rather than focusing on what we perceive to be the flaws and faults in our bodies!

1. I will ask myself, "Am I benefiting from focusing on what I believe are the flaws in my body weight or shape?

2. I will think of 3 reasons why it is ridiculous for me to believe that thinner people are happier or 'better.' I will repeat these reasons to myself whenever I feel the urge to compare my body shape to someone.

3. I will surround myself with people and things that make me feel good about myself and my abilities. When I am around people and things that support me and make me feel good, I will be less likely to base my self-esteem on the way my body looks.

4. I will practice taking people seriously for what they say, feel and do. Not for how slender, or 'well put together' they appear.

5. I will list 5-10 good qualities that I have, such as understanding, intelligence, or creativity. I will repeat those to myself whenever I start to feel bad about my body.

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.

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.

20 Ways to Love Your Body

I have been preparing for a presentation on eating disorders that I will be giving tomorrow at a local high school, so I have been scouring the NEDA website looking for cool ideas, stats and other things to make my presentation non-boring to high school students (who are probably going to think I'm old and boring anyways- JK!!). Anyways, while I was scanning some of NEDA's resources online, I came across a list of '20 Ways to Love Your Body' compiled by Margo Maine, PhD that I thought some of you might enjoy reading! I am just going to copy and paste it below (with my additions in italics:)), or, you can also follow this link and check it out on NEDA's site.

20 Ways to Love Your Body by Margo Maine

1. Think of your body as the vehicle to your dreams. Honor it. Respect it. Fuel it.

2. Create a list of all the things your body lets you do. Read it and add to it often.

3. Become aware of what your body can do each day. Remember it is the instrument of your life, not just an ornament.

4. Create a list of people you admire: people who have contributed to your life, your community, or the world. Consider whether their appearance was important to their success and accomplishments.

5. Walk with your head held high, supported by confidence in yourself as a person [who is made by God and created beautifully!].

6. Don't let your weight or shape keep you from activities that you enjoy.

7. Wear comfortable clothes that you like, that express your personal style, and that feel good to your body.

8. Count your blessings, not your blemishes.

9. Think about all the things you could accomplish with the time and energy you currently spend worrying about your body and appearance. Try one!

10. Be your body's friend and supporter, not its enemy.

11. Consider this: your skin replaces itself once a month, your stomach lining every five days, your liver ever six weeks, and your skeleton every three months. Your body is extraordinary--begin to respect and appreciate it.

12. Every morning when you wake up, thank your body for resting and rejuvenating itself so you can enjoy the day.

13. Every evening when you go to bed, tell your body how much you appreciate what it has allowed you to do throughout the day.

14. Find a method of exercise that you enjoy and do it regularly. Don't exercise to lose weight (or punish yourself because of what you have eaten) or to fight your body. Do it to make your body healthy and strong and because it makes you feel good. Exercise for the three F's: fun, fitness, and friendship.

15. Think back to a time when you felt good about your body. Tell yourself you can feel like that again, even in this body at this age.

16. Keep a list of 10 positive things about yourself (and look at it!)--without mentioning your appearance. Add to it!

17. Put a sign on each of your mirrors saying, "I'm beautiful inside and out."

18. Choose to find the beauty in the world and in yourself (because it is all around).

19. Start saying to yourself, "Life is too short to waste my time hating my body this way."

20. Eat when you are hungry. Rest when you are tired. Surround yourself with people that remind you of your inner strength and beauty.

Some of these may resonate with you more than others- I really appreciated number 4 and number 8. Gratitude is SO important; being thankful and having perspective can go a long way. Hopefully this list provides you with a few things to think about and some helpful pointers to start appreciating and loving your body! :)

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.