Something I talk about frequently with my clients is the concept of "normal eating." We are all born with the innate ability to tell when we are hungry and when we are full. Our brain and gastrointestinal sensors help us to desire a variety of foods that will nourish our body... but somewhere along the way society can confuse our senses of what eating is supposed to be like.
In the dietetics and eating disorder industries, a quote about normal eating has become the gold-standard. Leading child eating-behavior-expert, Ellyn Satter's quote is as follows:
What is Normal Eating?
By: Ellyn Satter, MS, RDN, MSSW
Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it -not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.
In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.
This quote came directly from: http://www.ellynsatterinstitute.org/hte/whatisnormaleating.php
©2016 by Ellyn Satter published at www.EllynSatterInstitute.org
For more about eating competence (and for research backing up this advice), see Ellyn Satter's Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook, Kelcy Press, 2008. Also see www.EllynSatterInstitute.org/store to purchase books and to review other resources.
How I experienced “To The Bone” as an eating disorder expert & Why you need to carefully consider if you should watch it
There was a lot of buzz leading up to the release of Netflix’s “To The Bone” on July 14, 2017. As a Registered Dietitian who specializes in eating disorders I was intrigued. In this film, actress Lily Collins played Ellen, a young woman with anorexia nervosa who goes into a couple of different treatment centers and bounces back out to home or hospitals. Collins has been very forthcoming that she previously struggled with anorexia nervosa, which made me more nervous about her losing weight for the role.
When I first heard that there was going to be a film made about eating disorders, I thought this would be a great opportunity to raise awareness of what eating disorders are like. And hopefully get people talking in a productive way about the different types of eating disorders and how it is not a good thing to get one...but as the trailer and initial interviews came out in the weeks leading up to the release, I instead became worried that it would not only depict the stereotypical white emaciated anorexic girl (which it did), and be triggering to those dealing with body image issues (it probably will), or teach new bad habits (for some it will - that scares me most of all!). Here is my take on the film as I watched it and took notes, the good, the bad, and the triggering (spoiler alert).
OPENING: I must commend Mockingbird Productions for starting the film with the statement, “The film was created by and with individuals who have struggles with eating disorders, and it includes realistic depictions that may be challenging for some viewers.” I hope they don’t consider that their liability statement, but they tried. In the opening scene we see “Ellen” at a residential treatment center in art therapy class. She looks visibly bony, and it only gets worse through the film (not sure if it changes due to eating less, make-up tricks, or what, they did claim the use of some prosthetic bones, though). In articles that came out prior to the film release, it was said that Collins lost weight under supervision of a “nutritionist.” I don’t know who this “nutritionist” was, but there is no way in a true health professional that knows a thing about eating disorders would allow someone to lose that much weight, ethically, especially since she has a history of anorexia and might suffer physical and mental complications of going through the trauma of extreme weight loss again. I also use “nutritionist” because that is the word I found for the unnamed person who guided her weight loss, and if it was actually a Registered Dietitian or other licensed health professional they would (or should) have their license revoked for unethical behavior.
Weight cycling (large fluctuations up or down) is very hard on the body, which likes to maintain homeostasis (or “same-ness”). Every time we lose weight our metabolism (calorie needs) goes down. When we gain weight back our metabolism does not go all the way back to “normal,” this is why it gets harder and harder to lose weight if you have been on many diets. In addition to lowered metabolism, as was briefly mentioned in the film, the body has to rely on energy (calories) from muscle and organ tissue to survive, which can cause irreversible damage. Having Collins go through extreme weight loss again could have done real damage to her body (organs, bone density, fertility, cardiovascular system) that she might not know about until years later.
CALORIE TALK: In the following scenes there are definite strengths and weaknesses apparent to anyone who is in the field of eating disorders. As seen in the trailer, there is a scene where Ellen is quickly counting calories on a dinner plate. This is a strength in that it is very realistic to how a person with anorexia’s mind typically works, but any time calories are brought up (in a few scenes) it is a potential trigger for some viewers. It also glamorizes the “ability” of knowing what is in your food. With so many people on diets that require calorie counting, I am sure many think it would be “easier” to have anorexia to be able to not only count fast, but to abstain from eating. If you are one of those people reading this - IT IS NOT WORTH IT! (Contact me personally, I will walk you through the why nots, I don’t have the space in this article). By the way, eating disorders (ED) are not a choice. They have genetic and environmental components and are a person’s way of coping with a perceived problem or trauma, similar to the way an alcoholic turns to alcohol to numbs themself from emotion.
BEHAVIORS: Continuing on, maybe it is because I live in a part of California where cigarettes are banned in public spaces, but smoking is not nearly as common among ED/weight loss as it was 10+ years ago. Ellen is seen smoking throughout most of the film, and I hope people don’t continue that stereotype along with most EDs being anorexia nervosa (they’re not - binge eating disorder and “other specified feeding and eating disorders” are much more prevalent).
Other behaviors throughout the film that the director/actors got right are body checking (Ellen keeps checking her arm circumference with her hand, and her roommate calls her out on it), flushing meds down the toilet due to fear of weight gain (don’t go off meds without Dr approval), the roommates “barf bag” and laxatives, cutting breading off of chicken, passing out when she stood up fast (this is caused by low blood pressure when not eating enough), stair running to “burn” calories, and the doctor noticing the bruises on the bones of the spine and calls her out on doing sit-ups.
WEIGHT: More triggering, but truthful scenes, include Collins taking off her shirt to get weighed, and at the end of the film you see her naked (artfully laid on the ground to cover private areas). She is truly emaciated. This took my breath away- as you can only do so much with makeup, she had to lose a lot of weight for this role. It makes me so sad. Near the end of the film (spoiler) she has a “dream” where she is healthy and happy, and she has some weight on (probably shot first before she lost the weight), and she is gorgeous. There are no bones protruding, she is on the slim side of normal weight.
The treatment facility where most of the film takes place did a good job of having a range of body types and disorders. Most people with ED are not underweight. There was a larger binge-eater, some average-size people with bulimia and anorexia, a male, a pregnant woman, and different races (though still overwhelmingly white). While the other behaviors of binge eating and bulimia were touched on, the film was primarily about anorexia. I wish they had shown more of the other disorders, to make a point that EDs are not just thin white girls.
PROFESSIONALS: I thought the doctor, therapist, and nurse were all very well written and played. Any of their interactions were probably my favorite part of the film. In group therapy, the therapist was great at getting the participants back on topic in a realistic way, and concluded a talk with “there is never thin enough.” The nurse and doctor being more upfront and brazen with their speech is likewise true to life. They all easily call out Ellen on her behaviors and things happening to her body (ex: lanugo hair, body burning muscle and organs when not eating) in very realistic ways.
TREATMENT: The treatment facility that most of the film takes place in is a good depiction (though a bit cleaner/newer than most) of a residential treatment center. They call it inpatient in the film, which is incorrect, it is residential. Something that seemed off to me, but maybe some places do this, is that the patients were allowed to eat what and how much they wanted for every meal with no real consequences, and most of the time no professionals ate with them. From my visits to and talks with treatment centers, there is always at least one staff member present, and if they do not finish their meal, typically a liquid supplement like Ensure or Boost would be required. I did like that the anorexic man said he gets a “crazy burst of energy” when he eats. I have heard that from a lot of my clients when they start eating again.
It was realistic for the nurse to go through Ellen’s bags when she arrived at the facility. They check for any diet or self-harm tools as depicted in the film. It might give viewers ideas about how to hide things when not in treatment, though, so that worries me. The bedrooms rooms not having doors is not necessarily typical, but there would not be locks on the rooms or bathroom.
When the families are talking about treatment modalities in the waiting room I did not like that they were putting down methods like “Maudsley” (family therapy for children with anorexia), and family therapy was depicted in a bad light. Both of these can be very helpful in real life.
RELATIONSHIPS: Ellens relationship with her family, though realistic, is not necessarily typical. Though many have tumultuous relationships with family members, they are not usually so blatant (but this is a movie - so it had to be interesting). Families are also typically not the “cause” of an ED, though relationships get harder as someone sinks deeper into their ED. ED is a relationship, and it makes it very hard to get close to, or let others into, your life. It was notable that Ellen was never hugged (except by sister) until the end of the film. Unfortunately, lack of touch (whether by choice, or because family is not affectionate) is a common thing I see in clients.
Something I think was unrealistic or glamorized was the relationship that developed between Ellen and the man in treatment. I have never heard of a relationship coming out of treatment, and if it did it would probably not be a healthy one. Also, can I just say that it was weird that right after she told him about her trauma of men and touch that he kisses her and climbs on top of her without permission? That seemed wrong and was uncomfortable to watch.
CONCLUSION: This film got a lot of things right about EDs and treatment, and the acting was very realistic. So realistic, that I had to process this for a day before I could write this article. Though I have had a healthy relationship with food and my body for years (after restricting in college), and treat people with all of these issues and symptoms every day, I had flash-backs to my personal struggles, and had to go look at myself in a mirror to remind myself I am not scary-skinny. The fact that that happened concerns me for how others who are not as strong in their recovery will handle seeing this. My recommendation is that if you struggle with body image or disordered behaviors (whether or not a diagnosable ED) you should not watch it, or be ready to process it with a therapist or trusted friend. This film has a great potential to trigger people who have these propensities, and to teach bad habits that help them “get away” with disordered behaviors. That being said, viewers could find those behaviors other places online, so it is not necessarily the fault of the filmmakers.
I do think this would be a good film to watch for those who have a loved-one dealing with an ED, especially anorexia. It is a realistic depiction of high-acuity anorexia nervosa, and discusses symptoms other consumer media leaves out.
*Article is re-printable with permission. Please contact Libby for permission to put it on your site.
Registered Dietitian, Libby Parker, is the owner of Not Your Average Nutritionist, LLC - a private practice on the central coast of California. Libby offers nutrition counseling for teen-young adult, specializing in people with eating disorders. Additionally, Libby teaches nutrition courses at a local college, and works to educate other professionals on the best practices for assessing and treating eating disorders with her online training site, EatingDisorderTraining.com. Find out more about Libby at: www.notyouraveragenutritionist.com
I have had several people that know me ask why I changed my business name, and more specifically - why "nutritionist" instead of "dietitian" in the name?
First the overall change: "Libby's Fit Nutrition" was the name I set up when I started my practice and I had a very different clientele. I was working with mostly stay-at-home-moms and middle-aged women on getting fit and healthy and losing weight. I was/am a personal trainer and was incorporating fitness into my sessions.
As my business and passions evolved into exclusively working with disordered eating that name didn't fit, and worse, was triggering to some people. A new name was needed, but I didn't want to pigeonhole myself into one niche, nor did I want to make people ashamed of talking about my services by blatantly stating "EATING DISORDERS!"
My wonderful husband actually came up with "Not Your Average Nutritionist" and we played with Dietitian and Nutritionist for a while. Although I am a "Registered Dietitian" and proudly state that that is a far more valid and necessary credential, many people still call dietitians "nutritionists," and search for that when they are actually seeking a dietitian.
(Also, a lot of people spell dietitian wrong - it is NOT dietiCian!)
So, I am a Registered Dietitian, but all dietitians are "nutritionists." It is important to note that not all nutritionists are dietitians, so do watch for that. If you want more of an explanation why the difference is important check out my other post -HERE.
What do you think of the new name?
A common myth I hear from people is that we need to "cut out carbs."
No, we need the majority of our daily calories from carbohydrates.
Yes, different conditions require different amounts, but we still need quite a bit.
If we are eating the correct amount of calories for our needs our composition should be broken-down roughly into the percentages shown below.
I created a quick cheat-sheet for you about how much Carbohydrate/Fat/Protein we need. You can get your own PDF by entering your e-mail below.
March 8th is National Registered Dietitian Day!
Which this year, coincides with International Women's Day.
So what does that mean for the approximately 97% female RDs?
Double the awesomeness!
Not only are women making things happen, but RDs are changing (and saving) lives and often going unnoticed, not unlike many historic female positions.
A study in 2007 showed a median wage gap of $4,965 between male and female RDs. Even in female-dominated fields men tend to make more. Today as we celebrate RDs, also think about the gender parity.
Today, thank your dietitian; female, male, or otherwise.
For more info:
I am so glad you asked!
Most people don't know; and honestly that is why I am now going by "Not Your Average Nutritionist" as my new business name, despite being an actual Registered Dietitian.
As of 2017: Anyone, even with no training, can call themselves a "nutritionist." Literally.
You can buy a certification online with no education, you can just call yourself a nutritionist without buying anything, or you can have a degree in nutrition and dietetics.
A Registered Dietitian (or RD, or RDN) is also a "nutritionist," but there is a key difference - specific educational requirements! The same way a medical doctor or nurse goes through specific training, degree programs, and supervised residency/internships, dietitians have requirements.
A RD has at minimum completed:
-A Bachelor's of Science in Nutrition and Dietetics (or a Master's Degree in the same, if their B.S. was in a different field). This is heavy in biology and chemistry courses that get more specific to the molecules that make up foods/vitamins/minerals, and how the body processes them. Classes in counseling and teaching are also important aspects of the nutrition curriculum.
-A dietetic internship (D.I.) of at least 1200 hours in a variety of settings that RDs work in, under supervision. This is similar to a medical residency, and has strict requirements for what must be experienced, and competencies met and signed-off by supervising RDs. Dietetic Internships are also highly competitive, with less than 50% acceptance rate (at least that was the case in 2011). The process of being accepted requires not only good grades, but multiple essays, recommendation letters, work experience, interviews, and fees to apply to most sites.
-Upon completion of the D.I., the person, will study for, and take a national registration exam of 140+ questions covering areas of clinical nutrition, calculations, food service, counseling theory, and metabolism. A passing score makes the test-taker a RD!
-But wait - there's more! Every 5 years, there is a minimum of 75 hours of continuing education that must be documented and submitted to the Commission on Dietetic Registration (CDR), including at least 1 hour of Ethics training, to maintain the credential. Most RDs, like myself tend to go well over our required 75 hours, because there is constantly more to learn!
What else is special about RDs?
-Registered Dietitians are the only profession that can legally call themselves "nutrition experts," and give "Medical Nutrition Therapy" (MNT). MNT is diets/diet advice for specific medical concerns that is beyond generic nutrition advice like "eat more vegetables." Some disease states are very nutrition dependant for life and health. Medical Doctors are legally allowed to give nutrition advice, and sign off on dietary components in clinical settings, but most MDs have had only class of nutrition education in their whole college experience! (Some, of course, understand the importance and go on to do more).
(pssst... get a free macronutrient handout HERE for general healthy eating)
RDs can have many different kinds of jobs.
-Many work in hospitals or clinical settings where they are dealing with acute illness, and providing MNT.
-Some (like myself) go on to have additional training in counseling skills and psychology, to deal with clients on a behavioral and mental health basis.
-Other's get additional certifications in specialty areas like diabetes (certified diabetes educator), or renal (kidney) nutrition.
-Some work in food service, creating menus, ordering food in bulk, running a kitchen staff (doing staffing), working with food allergies and calorie counts.
-Research /or/ Research and Development have many RDs working to find best practices or develop new food products.
-Education. Whether teaching nutrition in colleges, or teaching classes or individuals in public health, RDs have a lot of info to cover that can help increase quality of life and prevent disease.
-Work in food technology and agriculture to create more nutritious food or solve hunger problems.
.....and many more potential areas! The field is growing, and so are options for dietitians!
I believe the median salary is low, because most people still do not understand what RDs can do for individuals, and the world. My hope is that more people will understand the importance of RDs, and the difference between "Registered Dietitian" and "Nutritionist" so that the jobs will go to the educated.
"All RDs are nutritionists, but not all nutritionists are RDs." - Academy of Nutrition and Dietetics.
(originally posted 12/20/2016. libbysfitnutrition.com)
A gift to my lovely readers, a printable format for a food and feelings journal. I use this format with all my clients so we can search for connections between triggers and eating behaviors.
Simply add your e-mail below to get a PDF to print off your own copies.
One page does not mean that is all the space you get for a day, use more paper if necessary. If you are working with a dietitian or therapist, this format can be helpful to show them several days of logging what you eat.
Let me know what you think.
(originally posted 12/10/2016. libbysfitnutrition.com)
It's the time of year when gift-giving is on the mind, and I know that many of you, like myself, love to give donations in a loved-one's name to help others in need.
I would like to put a shout-out to "Dancing With Ed," a 501(c)3 organization dedicated to raising awareness of eating disorders in the dance community through online eating disorder education, resources and social media awareness projects.
You can donate to Dancing With Ed through Paypal.me:
Or, if you prefer to donate by mail send to our corporate office:
1025 Southwood Drive Unit U
San Luis Obispo, Ca. 93447
*make checks payable to Dancing With ED, Inc.
Connect on social media:
Thank you, and happy holidays!
(originally posted 12/2/2016. libbysfitnutrition.com)
You have probably read other articles on tips for eating around the holidays, but in my experience, repetition is never a bad thing when it comes to making a new habit. In fact, maybe there will be things on this list that you have NOT heard yet...you never know what is going to be of great use to you...so read on, and apply as needed. :)
1) Drink water! Hydration is often forgotten with coffee, hot cocoa, and alcohol fighting for top contenders in your liquid category at this time of year. Thirst is readily mistaken for hunger when tasty options are before you. So remember to drinkyour 8 glasses of water (or tea) every day. Try drinking a pint before you leave the house, carrying a water bottle with you, alternating alcohol with water, and eating water-rich foods such as apples, cucumber, grapes, and salad greens.
2) Eat what you really want. Don't keep munching on things you "should" eat, and end up over eating because you are not fulfilling your cravings. This is probably the only time of year for your aunt's famous sugar cookies, Grandma's pie and stuffing, and other family goodies; enjoy them, savor them. You will probably end up eating less over all if you don't deny what you want.
3) Fit in exercise every day. Whether it is a dance DVD in your living room, a run in the brisk morning air, a walk with the family (or the dog), or a class/weights at the gym. Be like Nike and, "Just Do It." Not only will it burn calories, but it will keep you in a better mood - and that is helpful to everyone around you as well!
4) Don't let ALL your meals be splurges. Big Christmas dinner? Eat healthy breakfast and lunch that day so you are not overdoing it. It is easy to fall into the habit of splurging at every meal during this season, whether that is what is in the house, or you feel so stressed you "deserve it," remember there are celebrations all year round, and you need to focus if you do not want to become 'round.' Do eat what you love, but you don't have to sample that so-so dish, just because Aunt Sally made it.
5) Send away the leftovers. Hosting a get-together? At the end of the meal, pack up leftovers into small containers and send most of it away with guests. If there is less in your fridge, there is less for you to pick at later.
Have other tips that work well for your holiday stress levels around food? Share in the comments below!
Libby is a Registered Dietitian focusing on eating disorder treatment and prevention.
Not Your Average Nutritionist, LLC