Are you or your child off to college or other big school transition?
This might be a time when ED rears it's ugly head as a way to cope with the stress of transitioning and living on one's own (and let's not forget the pressure to do well in school and make friends).
In the video above I go over why college is a big trigger for eating disorders, signs to watch out for that you or someone you know is struggling with food, and how to find help.
Don't wait until it is too late!
Below you can grab your free PDF checklist with the first steps to recovery so you have this info at your fingertips, along with a easy 1-page form to help start the conversation with your health professionals if you are not sure what to tell them.
With everyone and their brother having an opinion on how to eat or live a healthy life, how do you discern if information is legitimate?
It is important to remember that nutrition is a science, and not an opinion. And, scientific facts are allowed to change as we learn more through more advanced technology and research studies. Science is constantly evolving, so it is smart of us to double-check what the current best-practices are, especially when it comes to healthcare.
Several factors need to be considered when deciding if a product or diet plan is safe and effective. I review these in the following short video:
Health and diet does not need to be difficult or over-analyzed... But, you do need to know that studies done have been done in ways that can be extrapolated to larger populations, just like with any drug trial.
If you learn nothing else from me, I hope you watch this video and learn how to determine for yourself if what you are reading is true and safe.
Let me know what your top takeaways were in the comments. Did anything get you thinking?
The concept of choreographing meals is one that I came up with when working with a client.
As a dancer, I like to bring art and creativity to my work with eating disorders. Here is a fun way of looking at food if you are stuck in a food rut.
By Alyssa Los
Alyssa is in the process of becoming a Registered Dietitian through the California Polytechnic State University of San Luis Obispo. Alyssa has worked with the fabulous Not Your Average Nutritionist for two weeks learning about how to implement motivational interviewing and sensitivity when discussing body image into her future practice. In her free time, Alyssa enjoys yoga, hiking the beautiful Central Coast mountains and trying out unique, new foods.
Recovery from eating disorders is a process.
When one restores their weight a state known as hypermetabolism is likely to occur. So what does this complex word mean? To break it down, hypermetabolism is the increased rate of how the body processes food into energy. When our bodies are put into a starvation state such as Anorexia Nervosa, it is common that our metabolic rate or the speed of which we process energy is slowed down. Therefore, when food is reintroduced at a higher rate our bodies have to learn how to process food as well as it needs even more calories to replenish our body’s hair, nails, bones and other essential cells our amazing bodies form!
Due to hypermetabolism, increased energy needs are required to meet our body’s demands. If you are in the process of recovering, a trusted health care professional will guide you to restoring you back to your individualized body weight. For those in recovery, approximately 50-60 kcals/kg of body weight is needed, but a Registered Dietitian is still essential at this stage as ranges can differ (1).
If you are in the process of weight restoration you may have experienced waking up at night soaked in sweat. Night sweats are a common occurrence caused by hypermetabolism seen in recovering anorexic clients. The reasoning behind this incidence is due to human bodies relearning how to utilize their new energy intake. Often our bodies end up turning the energy we are feeding ourselves into heat in the process. A study by Marzola and colleagues shows that anorexic patients had approximately a 15% higher energy expenditure with elevated body temperatures at night time compared to non-anorexic counterparts (1). Other common symptoms of hypermetabolism include gastrointestinal problems, headaches, low blood sugar and anxiety (2). Please see a professional for help as introducing foods should occur at a low pace to prevent refeeding syndrome, a disorder characterized by low Phosphorus, Potassium and Magnesium levels leading to heart irregularities, respiratory failure and seizures (3).
Remember, food is the reason we are alive. Without it our hair falls out, our nails don’t grow, our bones become brittle and many other negative consequences can occur. Reduction of fat stores in the body also results in a common condition in anorexic patients called amenorrhea, loss of your menstrual period for over 3 months (4). Therefore, when our bodies are restricted from food intake our internal biological system only focuses on the most essential parts of keeping us alive.
The metabolism is a complex and astonishing part of our bodies. It makes up every cell and practically has a mind of its own adjusting to fluctuations in intake. So the next time you wake up sweating know your body is working hard to get back on track and replenish itself back to its regular state!
Lately I have seen an uptick in clients who “look” fine on the outside need urgent medical care. This got me thinking about the lies that the eating disorder voice (“Ed” for short) tells us.
Ed wants to be in control (which is funny because most people with eating disorders think they are in control. Silly humans.) and will tell you lies to keep up the disease process.
Have you ever hear the voice in your head say:
“You’re not thin enough yet.”
“You are not sick enough/you're not as sick as [other person].”
“Your heart rate is so low because you work out so much”
“You’re doing fine, you can [insert ED behavior] more [often/more strictly]”
“You’re the exception to the complications, it won't happen to you.”
Or something similar?
These are often precursors to the downfall of health.
Recently, I saw someone who had been dealing with bulimia on top of being an athlete have such low iron that she needed an immediate blood transfusion in the emergency room (Thank you to the doctor I work closely with for catching that!). I had another client peeing reddish urine with a “puffy” body that she said was hot to the touch that we believe is doing damage to her kidneys (or maybe experiencing rhabdomyolysis) from restricting (she ended up in higher-level care). Another is having severe gastrointestinal issues that are most likely due to years of laxative abuse and restricting that was misdiagnosed as “gastroparesis” until she finally saw a specialist.
The thing that all of these clients had in common? They said they were “fine” and didn’t need to go to the doctor. They weren’t “that bad” in their ED behaviors.
This is what scares me. How many people are walking around with medical issues that they have become so used-to that it feels normal?
PSA: Tell all of your providers from primary care physician, to specialists to therapists and dietitians about your eating disorder. Yes, even if you haven’t told anyone else. We can’t help you if we don’t know what is going on, and some providers won’t ask.
If you are struggling with disordered eating please take this as your sign to make sure you are getting regular check-ups from medical professionals that understand eating disorders and the hidden dangers. It can save your life.
Don’t wait to seek help. You have to be your own health advocate.
Today I wanted to explain a little more about my virtual nutrition counseling (eek! I'm excited).
I have been counseling individuals with eating disorders for 5 years now, and have had an occasional phone or facetime client (they signed papers stating they knew it wasn't HIPAA compliant), and with that I learned what worked/didn't work for me.
Along with some research into security, and my own policies, I now have HIPAA-compliant (secure, from a health-care/insurance standpoint) video ability along with my already HIPAA compliant electronic health records.
That's a lot of fancy words for saying that I have confidential video conferencing ability wherever you can get internet.
Virtual counseling can be just as effective as in-person counseling. If you show up, not just physically - but mentally, and do the work, it is not really different from in-person counseling.
It is great for those who cannot get to a specialist in their area either due to travel ability/time, or availability of counselors; as well as those who are more comfortable having the distance (for instance, because of social anxiety).
When we work together virtually, I can send you handouts via email (paperless = save the earth, and you are less likely to lose track of them), and pull up notes and your types questions/food journal while we chat. I treat the time just like an in-person session (same length of time, same information covered, same contact/communication). The only downsides are that I (usually) cannot see your whole body (which might sound great to you, but visuals are important for some medical issues, and body language is such a big part of how we communicate), and I can't give you a hug if you are having a rough day.
Some important things to note if you do want to work with me:
1. I only take outpatient-level eating disorders, disordered eating, and occasional performance artists.
2. Because of state licensure I cannot work with individuals from most states (or out of the U.S.A.). At the moment I can work with individuals in the following states: California (always, as I live in CA), New York, Alaska, Washington state, Colorado, Michigan, New Jersey, Connecticut, Massachusetts, Pennsylvania, Arizona, and Virginia. (Subject to change at any time).
3. I REQUIRE that you have an in-person therapist that I can communicate with about your care. This is for your safety, to make sure we are on the same page with helping you, and that I know there is someone seeing your whole-self that can help you if things go downhill or you need other local services.
See the details page of my website for all the info.
Interested? Contact me to discuss if we would be a good fit.
I can't wait to meet you!
A while back I posted about the body positivity I see in the drag queen community.
Due to a good friend who stage manages the local drag shows, I have had the fantastic opportunity to help out with a few events recently and have had a blast hanging out with the queens in the dressing room.
And, girl, can they teach us all a thing or two about body acceptance!
For those that don’t know, a drag queen is (typically a man, but can be female/non-binary) who dresses up in women’s clothes (usually gowns and over-the-top makeup, complete with huge false eyelashes), typically for purposes of entertainment (ex: drag show).
As I watch these queens get ready I noticed several things that I think us unconfident biological females can take away from the experience:
1. Curves. Many of the queens actually add padding to accentuate curves. They add hips and breast, and it is not in jest. They genuinely think this is beautiful. How many of us have tried to hide our feminine form? To starve or run-off the curves? The queens would be appalled. Takeaway: rock the curves you were given.
2. They take up space. Even when getting ready the world is their stage. The tables, floor, and every surface is “theirs,” they don’t try to contain their fabulousness. It almost seems a point of pride to have more space and to drive out another queen (though the locals here tend to get along well and help each other, too). Takeaway: It is ok to take up space!
3. They are unapologetic in how they present. Queens don’t shuffle-along with heads hung low trying to disappear, they f-ing shine! A queen sashays in her stilettos, head up, shoulders back, checking that her lipstick is on-point. She does not apologize for being there, being the center of attention, or walking in front of you. Takeaway: Hold your head up proud, walk confidently, and as Coco Chanel said, “if you are sad add more lipstick and attack!”
Today I want you to think of one way you can live a little more like a drag queen (and I am not saying you need to load on the makeup if that is not you!). How can you stand confidently in a room? What will it take to look up instead of at your feet? What clothes make you feel fabulous in your current body? Wear them!
You are fabulous darling!
By Marissa Pendlebury
Marissa is a "compassioneer" helping others recover from eating disorders like she did. Her passion for helping others break away from their eating disorder led her to develop "Nourishing Routes" a platform for empowering others who suffer from EDs. She is also author of Nourishing Routes - Love Food, Adore Your Body, Become Yourself. More about Marissa, here: www.nourishingroutes.com
(Not Your Average Nutritionist is not an affiliate. The ideas/opinions in this post are not necessarily the ideas/opinions of Not Your Average Nutritionist staff.)
Recovery from an eating disorder is quite a contested area.
For one, not everyone believes that full recovery is possible - particularly among the medical community, who might suggest that there will always be some element of control around food in a person’s life. However, there are many testaments out there, my own included, that recovery actually IS possible. So why is there a bit of a divide between the view of recovery of medical professionals and those in recovery?
In short, full recovery for me and many others, has its roots in the meaning that recovery holds for each individual - based on unmeasurable personal experiences and not a text book full of calculations and people’s opinions. Full recovery is a unique concept for every person who has encountered an eating disorder first hand, and is not for any medical professional - notably those who have never had a true insight into the eating disorder mindset - what recovery truly is or means. Still, look into any research journal and article related to eating disorders, and the word recovery and categorising recovered and non-recovered individuals is batted about more times than a hyperactive tennis ball.
For me, recovery is about regaining life, freedom and love of oneself. It is not just based on gaining a certain amount of weight, or getting within a Body Mass Index range that is deemed ‘healthy’ by medical standards (which tend to be flawed anyway). Equally, just because someone does get to a ‘healthy’ weight, which is the bench marker most research findings on eating disorders tend to use to assess recovery, doesn’t necessarily mean that individuals are free from restriction and control. For example, when a person does gain weight to a point that seems ‘healthy’, they may still be engaging in behaviours that provide them a feeling of safety, such as limiting the consumption of certain food groups and/or ensuring that they follow a particular diet (e.g. clean eating or plant-based food only). They may still, after eating over a certain quantity of food or Calories, feel an uncomfortable pang of guilt or an urge to compensate what they have eaten by using exercise or restricting food at the next meal or day.
Some individuals suggest that ‘normal eating’ should be the goal of recovery. However, there are many negative behaviours and feelings are encountered by the majority of the population in terms of the way they eat and see food. In particular, over recent years, we have created a diet-obsessed culture where fixations around healthy eating, alongside developing unhealthy relationships with food and body, is the norm for the many rather than the few.
With the above issues in mind, making ‘normal’ eating or getting to a ‘healthy’ weight the aim of recovery seems to be a substandard goal in reclaiming back life following an eating disorder. Moreover, what might seem a healthy weight to a medical professional, is not the true healthy weight for the person in recovery, since their body might naturally function more optimally at a higher weight - even above the optimal weight medically set out for their height. What we have to understand here is that, despite living in a world with an advanced medical system and forms of monitoring wellbeing, that medical standards of recovery are still flawed and not applicable to every individuals’ unique recovery journey.
So what does this mean for your own recovery and where do you set your own bar and goals?
In a nutshell, your recovery goals need to, ideally, be focussed around attaining a lifestyle that will allow you to feel free, able to socialise, revolve your activities around life rather than food, and be able to eat whatever foods you like without feelings of guilt or an urge to compensate. This lifestyle might look completely different to someone else’s in recovery, but it is important that your journey is founded upon your own values and what is ‘healthy’ to you. This might exclude the need to regularly consume nutritionally dense, low sugar plant based foods for the rest of your life (as might be advised for the majority of the non-eating disorder population). Alternatively, your values might involve being able to relive positive food memories and socialise with friends while eating pizza or your favourite fast food to your heart’s content - rather than a Calorie Quota or diet regime.
To help you gauge what recovery means for you, I’m going to share some of the key things that allowed me to understand what real recovery would look like in the context of my own life. These are listed below:
-Being able to go to sleep and wake up without wondering what I'm going to be eating in the morning.
-Scheduling my day around life, rather than around what I will and won’t be eating.
-Not spending hours planning meals for the next day or obsessively calculating Calories.
-Going to a restaurant spontaneously, rather than planning in advance and scrolling through menus online to pick a "healthy" or low-Calorie option.
-Ordering a meal to come as it is stated on a menu rather than making a billion adjustments so that it feels safer, ‘healthier’ and guilt-consuming to eat.
-Enjoying the prospect of eating with others rather than creating very safe and lonely spaces to eat in (with rigid controls and the need for everything to be perfect).
-Planning a day with social activities in mind first, and then food, without worrying about where and when we will be eating .
-Going into the supermarket and choosing foods that I genuinely enjoy, including my favourite chocolate bars, rather than healthy cereal bars that are lower in Calories but taste dreadful.
-Choosing snacks based on how appetising they look rather than looking at Calorie labels or how much fat and/or sugar that they contain.
-Looking forward to planning time out with friends without worrying about food or wearing a fake smile and personality.
-Feeling part of the real world and able to be fully myself while stepping outside the small bubble that used to keep me feeling safe but also restricted and lonely.
-Laughing whole-heartedly and finding joy and fun in everyday life.
-Not worrying about eating meals at certain time periods, and being able to eat spontaneously at any time of day.
-Baking cakes and tray bakes, licking the mixture out of the bowl before it goes in the oven, and actually eating the results myself.
-When going out to a cafe, ordering coffee and tea with ‘normal’ or full-fat milk without asking for skimmed or ‘skinny’ alternatives.
-Being able to eat a main course AS WELL AS a starter and/or dessert without guilt - and continuing to still eat throughout the day or evening if I feel peckish.
-Honouring feelings of hunger, even if I might feel like I have probably eaten my energy requirements for that day already.
-Hearing about a new diet or wellness regime on social media and not being tempted to follow it; knowing that it is just a lure away from what is going to help you find life rather than more restriction and rules.
-Being able to have a full day of relaxation and spending large amounts of time sedentary without worrying about how much exercise or physical activity I "should" be doing.
-Walking around the block for enjoyment rather than trying to walk a certain number of steps and obsessively trying to walk further in order to burn off more energy.
-Being able to move my body for pure fun and enjoyment rather than because it makes me feel like I can deserve food, or compensate for what I have recently eaten.
-Looking in the mirror and feeling appreciative of my body rather than focussing on the parts that don’t appear perfect or like someone else’s body I admire.
-Being able to listen to other people talk about dieting, losing weight, or their body shape without feeling the urge to restrict food.
-Not feeling guilty for eating more than other people I am eating with.
-Not feeling triggered or having the urge to restrict food when encountering someone who is slimmer than me, or has an eating disorder.
-Carving out time for self-care everyday without needing to "earn" permission to take care of myself and enjoy things.
-Allowing myself to buy nice things that I like or enjoy without feeling that I don’t deserve them or have to earn them in some way (other than actually earning money).
-Sometimes eating more than my body needs or what i’m hungry for, just because I can and am enjoying eating, without directing negative thoughts and feelings towards myself afterwards, or trying to compensate later.
-Knowing that my identity and purpose of existence on this planet is not to worry about the quality of food I eat, what I weigh, or the thickness of my thighs.
-Being able to love who I am right now, unconditionally, while being able to think about life goals that don’t involve or revolve around food, exercise or trying to control weight.
With these different aspects and dimensions of recovery in mind, you might be able to see how ‘real’ recovery is not just solely based on a physical marker of health. Recovery is just as much about emotional and social functioning in the real world, alongside an identity that is separate from a being who revolves their world around food, weight and/or exercise. Real recovery, for me, requires us to not only to gain weight, but also the courage to step out a transparent bubble that has held us feeling both safe and a captive prisoner. We may have been able to see the real world, and even believe that we were a part of it, but this bubble has been an unbreakable barrier between the life we currently live and the one we deserve and were born to thrive in.
When we can step outside of this bubble, or even burst it all together, of course the world is going to feel overwhelming, scary and even foreign in terms of your ability to navigate every day social and emotional situations. However, the more your identity and self-worth grows beyond the limitations of a specific weight or the amount and types of food you eat, the chains of restriction become looser and looser every single day. Real recovery isn’t about waking up one day and having your eating disorder cast aside by a magical spell that bursts the bubble. Real recovery is the journey itself - each day making a choice to choose life and your long term happiness rather than pleasing the anxiety relief of succumbing to the controlling voice of an eating disorder.
Maybe real recovery for you still involves hearing a foreign voice every now and then, tempting you back into the false sense of security an eating disorder one offered, but then having the strength to say no and walk away. For example, despite feeling unworthy of food or needing to earn it through exercise or hard work, you choose to eat that biscuit with your tea anyway and order whatever the hell you like off a menu without succumbing to immense guilt.
Recovering from any type of trauma follows a similar path - recovery from trauma isn’t about never experiencing trauma again, but it is about having the strength to conquer anxiety, tackle fears and navigate your own life again. In a similar way, real recovery is the non-relinquishing strength and determination to reclaim back our lives. If we can think of it like this, then there really is no black and whites of recovery, no specific weights and nothing we can set in stone on a medical chart or research article. The realm of real recovery is within the depths of your own mind and personal functioning. No one on this earth can determine or understand your real recovery other than you, but this is part of the beauty that makes the journey towards recovery such a wonderful one. Not only does it make us stronger, but it allows us to ask ourselves questions about our true values, beliefs and purpose. In this way, even though eating disorders can be soul destroying, and recovery seems like a constant uphill battle, it prepares us for an inner journey. This is a journey to really know, in our hearts, who we are, how we are connected with the world, and the enormity of what we are capable of.
On a final note, I would just like to say, your eating disorder and mission for recovery so far, no matter where you are at, is not wasted time. Every day you have battled on, even when you have felt you couldn’t fight any longer, have all played a role in making you YOU. Your real recovery is all about you - finding the courage to look inside the darkness, but also the immense beauty, intelligence and wisdom that you were born with. Never lose hope, because real recovery is always just a heartbeat away. When you choose the life your heart beats to no one other than you can say that real recovery isn’t possible.
This review was written for my college class "Psychology of Eating," 2016.
Elizabeth Parker, MS, RD
About the author
Dr. Brian Wansink, who has been called the “Sherlock Homes of eating behavior,”1 founded the Food and Brand Lab at Cornell University in 1997. He was born in Iowa in 1960, and at the time of publication of this book (2007), he has created and lead over 250 studies in consumer behavior. Wansink has a PhD in Consumer Behavior from Stanford University, and has since taught marketing and consumer behavior at both Dartmouth and Cornell Universities. He is the recipient of numerous accolades including, “Humorous Ig Nobel Prize”, and was named “ABC World News Person of the Week” in January 20081. Current work includes, Executive Director of the USDA's Center for Nutrition Policy and Promotion, promoter of the 2010 Dietary Guidelines, professor of Consumer Behavior at Cornell University, and most notably author of “Mindless Eating,” and Slim By Design.”1
Mindless Eating aims to share with the American population exactly what is influencing our food choices and eating habits through explaining research on consumer behavior. Dr. Wansink and his team of researchers have completed hundreds of studies on why people eat what they eat, and what influences how much we eat. Using easy-to-read, and entertaining anecdotes of his studies, Wansink share tips and strategies for “mindlessly” changing our food environment to promote better health and weight loss, without deprivation.
Chapter-By-Chapter Synopsis and Main Messages of Mindless Eating2
Chapter 1, The Mindless Margin: Wansink’s studies showed that we have a “mindless margin”2 of approximately 100 Calories more or less from our calorie needs that we do not really notice, and can lead to weight loss or gain. To make this easier, Wansink suggests serving yourself 20% less of most foods (food that you want to cut back on), and 20% more fruits and veggies than you normally would have.
Chapter 2, The Forgotten Food: Seeing evidence of how much you are eating in real time (for instance, leaving the bones from chicken wings you have eaten on your plate, or wrappers from candies in front of you) you are far more likely to eat less than if there was no evidence of what you ate. Since we eat with our eyes first, having large volumes of food (regardless of calorie density) works. Our stomach really has only three settings: starving/ could eat more/ stuffed; so we use external cues to stop eating instead of relying on hunger.
Chapter 3, Surveying the Tablescape: The size of food packages (how we buy or store food) has a direct influence on how much people eat. The larger the container the larger the serving size. This directly impacts the waistline. We drink more from short, wide, beverage glasses, and eat more from larger diameter plates or bowls, and more from larger serving scoops. This chapter also discusses why restriction-diets, such as Atkins and grapefruit diets, work through limiting variety of food options, making dieting “mindless” through “sensory specific satiety.” More options = more consumption.
Chapter 4, The Hidden Persuaders Around Us: We tend to eat more of what we premeditate or see before eating. If we know a food is there, we will think about it and be more likely to eat a larger amount than if we just happen upon the food. This can be helpful for choosing more healthy foods. Wansink suggests setting a bowl of fruit out where it is easily seen, and you will eat more fruit. Proximity to food is another trap for eating more. If food is easy to get to we will eat more than if the food is farther away/ harder to get to. Chapter 4 explains why bulk shopping causes weight gain - having more of the same food at your disposal means you eat more to get to “the right number”2 of items in the pantry. We can counteract this by “hiding the extras” of multi-packs in an opaque container, another room, or adding any level of difficulty. Some other tips from this chapter: Make a shopping list, and eat before you shop.
Chapter 5, Mindless Eating Scripts: We have “scripts” or habits when it comes to how and when we eat. These can be situational (like eating by the time on the clock), or influenced by others (taking more food until everyone at the table has finished). Watch how much and how fast your dining companions eat - we are easily swayed by them! Multitasking while eating (say, watching TV, reading, or driving) distracts us from our food and will lead to more mindless munching than if we were not multi-tasking. The longer the “distraction,” the more we eat. Another influencer in how fast we eat is ambiance. Lighting, music, sound level and other mood-settings influence our pace and consumption of food. Similarly, the scent of food can draw us in to purchase/eat food that we had not planned on eating. Temperature and time of year also influence our eating habits. When it is getting colder/is cold, we eat and drink more to stay warm. When it is warm we move more and drink more water to stay cool.
Chapter 6, The Name Game: We taste what we expect - based on visual cues such as colors and descriptions, how appetizing the food looks (or does not), presentation (including what it is served on), as well as our other senses. We also associate brand name with superiority.
Chapter 7, In The Mood For Comfort Food: A study done in favorite “comfort foods” showed a marked difference in male and female choices. Males choose more “hot meal” foods (like pasta) that evoked feeling of being taken care of, and females choose more “snacklike foods”2 like chocolate, not because they do not like the food the men mentioned, but because those foods made them think of the work of making the meal. Comfort foods tend to be associated with specific happy memories or traditions that supply positive emotions. In the same way, negative associations can cause dislike for foods. We also choose foods based on personality, as this chapter explains. Competition for food (knowing whether or not it will still be there later) influences our decision to “eat the best first, or save the best for last.”2 Youngest children or those from large families, thus set themselves up to eat the more calorically dense parts of the meal first (as opposed to veggies/ salad) and are more likely to gain weight.
Chapter 8, Nutritional Gatekeepers: Nutritional gatekeepers are the person(s) in the household that makes and buys most of the food - and they have the most influence over what we eat. Most often, those with “good cooks” in the house ate, and liked, more vegetables. This is due to veggies taking more work to prepare, and thus need a “cook.” Parents and caretakers influence children’s food preferences from very early on. Children are able to recognize facial expressions of love and disgust, and notice what the person making the face is eating. They use these associations to decide how they will feel about the food when offered it, and future behaviors around foods. Additionally, using creative names and associations for commonly disliked foods, increased children’s consumption when labeled “dinosaur trees,” as opposed to “broccoli.”
Chapter 9, Fast Food Fever: We are designed to seek out “safe foods” that have salt, sugar, and/or fat. It is no coincidence that restaurants, food companies, and even home chefs add these ingredients to food when they want diners to eat. Much of this chapter focuses on marketing and packaging done by food companies. Restaurants also use “health halos” to make us believe that, because they advertise healthy options, that all of their menu items are lower-calorie. By doing this the average diner is likely to add on sides, drinks, or dessert, because they thought they had eaten a “healthier” main dish. Low-fat options also have this health halo effect, and cause many to eat more calories than if they had been told it was the regular fat version. Another factor in how much we eat is the “serving” we are eating from. Where is the natural stopping point- with a single-serve package, or one “sleeve” of cookies? We are influenced by where there are built-in stopping points.
Chapter 10, Mindlessly Eating Better: Fighting an obesogenic culture is not about making huge changes, but eating “better” with do-able “mindless” strategies, laid out in chapter 10. Here Wansink gives strategies including, “food trade-offs,” “food policies,” and “the power of three [behavior changes].”2 These strategies are explained to help us break habits and, in an achievable way, mindlessly eat a little better.
Appendix A: Description, advantages, and disadvantages of popular diets (including this book).
Appendix B: Quick tips for “dieting danger zones”2.
Frequently Asked Questions.
The intended audience for this book is anyone who eats. We make hundreds of food options every day, so there is no one who would not find at least a small tidbit of helpful knowledge from this book. The main aim of book is to educate consumers on simple ways to make eating smarter easier.
Commentary & Evaluation
I enjoyed reading the quick, to-the-point, research abstracts throughout the book. The use of psychology in the explanations of study findings was especially informative, for example, how males and females chose different types of comfort foods based on what made them feel “pampered”2. Each chapter made specific points and ended with strategies, influenced by the studies discussed, for the reader to use; this dispelled the myth that you “can’t teach an old dog new tricks,” or an adult new eating habits.
Overall the strengths of the book included: easy to read format; promotion of slow, steady weight loss by changing just 100 Calories per day or ~10 lbs per year; simple tips to be more mindful of what you are eating and potential for weight loss; and solid research that is referenced in other periodicals, including Rowland and Splane’s Psychology of Eating.3 One example is the description of “sensory specific satiety” 2,3 referenced in both books, as well as our idea of what a portion size is, based on what is placed in front of us.3
Weaknesses of the book included: 3,500 Calories = 1 lb. Other research proves this is not necessarily true. Authors Herrin and Larkin make a specific point to show that “3,500 Calories = 1 pound myth”4. These eating disorder experts explain that mathematically 3,500 Calories seems correct, but taking into account body processes for making muscle, bone, and other tissues, 3,500 Calories is only an approximation, and not a hard rule of weight loss or gain.
I would recommend this book for most people. Wansink’s tips are easy to follow, and his research study descriptions are eye-opening. As a Registered Dietitian, I have shared verbal synopsis of some of his research with clients I am counseling (for weight loss), that make them re-evaluate how they are choosing their food. Several clients have bought the book, themselves, and reported finding it fascinating and helpful in restructuring how they store and plate food. The only people I might not recommend this book to those suffering from anorexia nervosa. This is because the book is structured more for weight loss and maintenance, and eating more “healthy” foods, which could trigger someone who is restricting intake.
Eating Disorders, A Guide to Medical Care and Complications, 2nd Edition. By Philip S. Mehler, M.D., and Arnold E. Andersen, M.D. This book was published in 2010 by John Hopkins University Press. The original edition was published in 1999. This review was written for "Nutrition Therapy for Eating Disorders" college paper (2016).
Authors Mehler and Andersen, are both medical doctors, and professors at Universities. Dr. Andersen is a board-certified psychiatrist who, with colleagues, has started programs for inpatient, PHP, outpatient diagnostic and continuing care for eating disorders. He attended medical school at Cornell, and has spent 15 years as faculty at John Hopkins Medical Institution. He has published research focusing on many aspects of eating disorders.
Dr. Mehler is a graduate of University of Colorado Medical School, and is now the Chief Medical Officer of Denver Health Medical Center. He is a Certified Eating Disorder Specialist (CEDS) and a professor at the University of Colorado Medical School. He is widely published, and is especially interested in research of patients with weights 30% or more below ideal body weight, and treatment of anorexia and bulimia nervosa.
The goal of Eating Disorders, A Guide To Medical Care and Complications, is to provide a single-source of most treatment recommendations for the medical treatment of patients presenting with an eating disorder. The authors provide a step-by-step approach: determining a diagnosis of an eating disorder, the purpose of the treatment team, medical evaluation, nutrition recommendations, specific complaints/ signs/ and symptoms patients present, special topics (including athletes and males with eating disorders), ethical conflicts, and information for non-medical educators. The authors use each chapter to give case studies and answer specific frequently-asked questions about the topic of the chapter in hopes to increase best treatment practices.
Eating Disorders, A Guide to Medical Care and Complications is a reference manual for both medical doctors seeing patients with eating disorders, as well as non-medical professionals (psychiatrists, psychologists, dietitians, nurses, sport coaches, and others who interact with individuals at risk of eating disorders). There are 15 chapters, plus an appendix, in this nearly 300 page book. I will go into more depth on the main messages from these chapters in the following paragraphs.
Chapter 1, “The Diagnosis and Treatment of Eating Disorders in Primary Care Medicine.” This chapter (as well as many parts of the book) emphasizes that eating disorders (ED) present in “many disguised forms” (p. 3) to clinicians, and that the diagnosis of an ED is not made by ruling-out every other possible issue. This chapter focuses on risk factors that increase chances of getting an eating disorder, as well as diagnostic factors to be assessing (including cultural value of thinness), and an overview of treatment modalities such as Cognitive Behavioral Therapy (CBT). Tables throughout the book give concise lists of things to look for (in this chapter, list of myths and facts about EDs, for example), questionnaires, and laboratory ranges.
Chapter 2, “Team Treatment, a Multidisciplinary Approach,” explains the other members of the treatment team, why different professionals are necessary (not just one clinician doing everything), and how to effectively communicate with the team. This chapter includes the registered dietitian (RD), but explains that the physician, nurse, or RD can do weight restoration and meal plans (more on my thoughts about this later). Chapter 2 also covers the levels of care, how to decide which level is appropriate, and when to change the level of care; as well as the details of treatment approaches, including “having fun.”
Chapter 3, “Medical Evaluation of Patients with Eating Disorders, an Overview,” discusses the role of the physician in assessing clinical signs and symptoms of patients with EDs. This includes which exams and lab tests are recommended for each specific type of ED, how to read them in the context of an ED, and when labs/exams need to be repeated. Lists of physical signs and complaints from patients are given, and differential diagnoses that an ED might present as. The authors again state, “The guiding principle is that a diagnosis of an eating disorder is not made by a rule-out approach of all possible medical disorders, but by confident determination of the presence of an eating disorder through screening questions and a brief mental status examination” (p. 70).
Chapter 4, “Nutritional Rehabilitation, Practical Guidelines for Refeeding Anorexia Nervosa Patients.” It is worth noting, that this is the only chapter on nutrition in the book, and it only focuses on very underweight anorexia nervosa patients – no other eating disorder diagnoses. The majority of the chapter, although short, focuses on refeeding syndrome and enteral/parenteral feeding modes, with help from the “dietician” (yes dietitian with a “c”). Good discussion of medical complications with refeeding accompanies this chapter.
Chapter 5, “Evaluation and Treatment of Electrolyte Abnormalities,” gives excellent information about lab values associated with EDs and what they mean in regards to malnutrition, and different methods of purging. Notes on treatment of abnormal labs are given.
Chapter 6, “Gastrointestinal Complaints.” This topic is of high interest to RDs that read this book. The etiology of several issues with malnutrition and binging or purging are explained, as to what the patient may complain of, and clinical evaluation is provided. The explanations given are great talking points with patients on how to treat their discomfort. For example, gastroparesis, or delayed emptying from the stomach to small intestine is common in restriction. It explains that patients will often complain of bloating, which is worsened with a high fiber diet. Treatment includes weight restoration, resuming eating, and limiting high fiber foods like legumes and bran.
Chapter 7, “Cardiac Abnormalities and Their Management.” It is well known that malnutrition can have horrific effects on the cardiovascular system including sudden death. This chapter explains vital signs, etiology, and when to order EKGs or other tests.
Chapter 8, “Osteoporosis and Gynecological Endocrinology.” Up until the DSM-V, amenorrhea was a diagnostic factor for anorexia nervosa. With the DSM-V it was removed, but it is still important to the health of the individual to understand the hormonal issues that occur with malnutrition. This chapter goes into great detail on reproductive hormones, bone density (including DEXA readings), % of body fat needed for normal menstruation (10%, for most women), hormonal therapy (contraindicated, for the most part), and nutrition for bone health.
Chapter 9, “General Endocrinology.” Beyond female reproductive hormones, there are many other potential endocrine issues with EDs. This chapter covers these hormones, such as cortisol, growth hormone, insulin-like growth factor, thyroid hormones, blood glucose, and more. Complications of diabetes with EDs is discussed here.
Chapter 10, “Oral and Dental Complications.” Dentists and dental hygienists are often the first to see patients with bulimia nervosa and can be an integral player in identifying these patients, who might not be noticed otherwise. These oral signs and symptoms of bulimia nervosa are listed with descriptions, and some treatment methods are given.
Chapter 11, “Athletes and Eating Disorders.” The book explains that many sports increase the risk of a person having an eating disorder, especially those that have a great desire for a specific body type or “making weight,” such as ballet, wrestling, rowing, running, and others. Female Athlete Triad, over-exercise, perfectionism in athletes, and performance anxiety are discussed, along with anabolic steroid complications. Treatment recommendations, and the “role of coaches in promoting or preventing eating disorders” (p. 191), are excellent sections in this chapter.
Chapter 12,”Males with Eating Disorders,” shows that males are often overlooked, and not treated differently than females with EDs. This chapter gives excellent insight into the differences with males, and “reverse anorexia” or the need for a “big, muscular body.” Insight into what males are most at risk, and why males diet are interesting points in this chapter.
Chapter 13, “Using Medical Information Psychotherapeutically.” The main point of this chapter is when, and how, to discuss medical information with the ED patient, to not cause fear or make it sound trivial.
Chapter 14, “Ethical Conflicts in the Care of Patients with Anorexia Nervosa,” covers modern biomedical ethics parameters, and how they apply specifically to treating patients with anorexia nervosa. This is of particular concern when a patient refuses recommended treatment. The authors re-iterate, “patients with severe anorexia nervosa give the illusion of sanity even when they are driven by deadly irrationality, failing to appreciate that anorexia nervosa has the highest death rate in psychiatry…” (p. 234).
Chapter 15, “Medical Information for Nonmedical Clinicians and Educators.” This chapter is geared toward coaches, teachers, therapists, and others with a non-medical background that work with eating disorder patients (or in trying to prevent them). Out of control dieting and excessive weight loss, healthy nutrition, exercise, and risk factors are discussed. Also discussed are when should one be referred to treatment, how to approach someone you think may have an eating disorder, as well as easy-to-read information for coaches and parents.
“Appendix: Behavioral Guidelines for Staff to Use with Patients Who Have Eating Disorders.” This chapter gives guidelines for treatment center meals and other issues, as taken from the University of Iowa Hospital and Clinics, Behavioral Health Services, Eating Disorder Program.
My Thoughts on the Book:
Overall, I found this book to be a wealth of knowledge. Not much is published on the medical complications and treatment of eating disorders, and this was exactly what I was looking for to use when helping the doctors of my clients give the best care. I appreciated the tables, which neatly laid out information such as lists of symptoms, lab results and what they mean, medications, and in-depth explanations of complications such as gastroparesis and cardiac complications.
It was distracting that the authors did not correctly spell the word “dietitian.” Half of the time they spelled it correctly, and the other half they spelled it with a “c” (dietician) or they wrote “nutritionist.” The authors also misspelled “monounsaturated” as “monosaturated” fats (p. 220). Furthermore, they left the RD out of the list of team members in the section on “communicating with eating disorder specialists” (p. 29), listed the “physician, nurse, or dietitian” as the person in charge of weight restoration and refeeding, did not include the RD in learning how to shop for groceries and prepare food, and the fact they said, “…once-a-week psychotherapy with an experienced advanced registered nurse practitioner” (not a psychotherapist?) (p. 44). The International Association of Eating Disorder Professionals states, “RDs are the experts, in both food science and nutrition science, trained through education and experience to understand the complex relationship of food intake to overall physiological health” (IAEDP, 2015). Furthermore, the chapter on nutrition, was short and not very informative, which confirms my understanding that M.D.’s, though able to write diet orders and give “nutrition counseling” legally, are often not well versed in nutrition, or how to effectively explain it to someone else.
This book will be helpful to nutrition professionals, like myself, in understanding what clinical manifestations eating disorders are causing, as well as how to interact with physicians sharing patients, and how to explain to patients what is going on from etiology to treatment. Despite my issues with the author’s lack of understanding what the RD does, I would recommend this book to others working with eating disorders. There are other books specifically for nutrition treatment best practices. For example, Nutrition Counseling in the Treatment of Eating Disorders, 2nd Ed., by Herrin and Larkin, references this book in their description of refeeding syndrome (p. 193, Herrin & Larkin), gastrointestinal discomfort, and in referencing other topics. While Eating Disorders, A Guide to Medical Care and Complications comes from the perspective of treating the symptoms, the fundamental goal of nutrition counseling is behavioral change (Herrin & Larkin, p. 51).
Herrin, M., and Larkin, M. (2013). Nutrition Counseling in the Treatment of Eating Disorders, 2nd Edition. New York, NY: Routledge.
International Association of Eating Disorder Professionals (2015).The CEDRD in Eating Disorder Care. IAEDP.
Mehler, P.S., and Andersen, A.E. (2010). Eating Disorders, A Guide to Medical Care and Complications, 2nd Edition. Baltimore, MD: John Hopkins University Press.
There is now an updated 3rd edition you can get HERE.
Libby is a Registered Dietitian focusing on student eating disorder treatment and prevention. She is working on the central coast to create wellness in individuals and the community.
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