nsurance companies are sooooo frustrating to deal with - you are not alone!
Due to individual insurance regulations and federal rules there is no "set" coverage that all insurance companies have to go by. Your best bet when seeking coverage is to call your insurance company and get a Case Manager to walk you through the to-dos.
The earlier you contact your insurance company in the process, the better. Additionally, the more "evidence" for need of treatment (doctor's referral notes, lots of documentation) that you have the better.
I made a round-up of the previous 3 blog posts (updated the links so they are current)
that I wrote about on insurance and packaged it up in a PDF for you.
Get it here:
How to get your insurance company to pay for treatment
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Unfortunately, unless it is part of a treatment program, Dietitians are very rarely covered by insurance. (Wha?!)
You can petition your insurance for some reimbursement by asking your RD ("nutritionists" without the RD credential are never covered because they are not qualified) to send you a "superbill" for services that have been provided (typically annually or quarterly) to submit to insurance (after paying out of pocket) to try for reimbursement. With enough supporting documentation (again, referrals from medical doctors help a lot!!) you can often get reimbursement (no promises, each company has it's own ways of dealing with each individual).
Good luck!! I hope this helps!
If you have more tips on how to get insurance to pay please leave them in the comments below, or email me to have it included.
I am thrilled to have this guest post about vegan nutrition!
Many of my eating disorder clients have adopted a vegan diet, for better or worse, and are not meeting their nutritional needs. Vegan and vegetarian diets are very healthy when done correctly, but if the whole purpose is to cut more things out in the name of restriction, then malnutrition is almost certain.
If you are vegan, or contemplating starting a vegan or vegetarian diet, read-on to learn about plant-based sources of certain nutrients that are often hard to get when animals are off the table.
The Vegan Diet - A Guide to Nutritional Needs
By: Emily Baird
Emily is a 1st year nutrition student at Cal Poly who plans to become a registered dietitian. She has been vegan for 2 years, and plans to incorporate that into her career.
Every year more and more people are making the transition to a vegan diet, and for good reason! The vegan diet can have so many health benefits for our bodies including disease prevention, weight management, and protection against cancers. But with being vegan, also comes the common questions about: “How do vegans get enough protein?” “How are they getting any B12 in their diet?” “How to vegans get calcium if they don’t drink cow’s milk?”. And although these are valid questions, a well-balanced diet full of fruits, vegetables, beans, legumes, and carbohydrates is all a vegan needs to fulfill their nutritional requirements.
Iron is an important component of the red blood cells that carry oxygen from the lungs to the rest of the body, as hemoglobin. Think of it like the engine to a car; the engine provides the car with the power it needs to make it move. Similarly iron allows hemoglobin to have the needed strength to get oxygen where it needs to go. Without it, the body cannot make hemoglobin, which means organs and tissues won’t get the oxygen they need.
There are two types of iron - heme and non-heme. “Non-heme” iron is found only in plants foods and is harder for the body to absorb than “heme” iron which is only found in meat products, so we need to eat more plant-based iron to truly get the same amount as if we were eating meat.
Many plant foods are naturally high in iron, but there are also many packaged foods that are now being fortified with iron. The recommended daily allowance (RDA) is between 8 - 18 mg (depending on age and gender, up to 27 mg during pregnancy). Be sure to include a source of vitamin C with your iron for better absorption.
VEGAN SOURCES OF IRON
1 cup soybeans: 8.8 mg
2 tbsp flax seeds: 4.1 mg
½ cup cooked lentils: 3.3 mg
½ cup fortified total whole grain cereals: 8 mg
(For a complete list click here)
Calcium is responsible for building and maintaining strong bones and teeth. When the body isn’t supplied with sufficient amounts, it increases the risk of developing disorders like - osteoporosis, hypercalcemia, kidney disease, and even alzheimer's. Calcium can be included either by nutrient dense foods or by incorporating calcium fortified foods. Most breakfast cereals, milks, breads, and juices contain added calcium, but be sure to read the nutrition label to be sure. The RDA is around 1000 - 1300 mg. Vitamin D intake is essential to adequate calcium absorption.
VEGAN SOURCES OF CALCIUM
100 g calcium set tofu: 350 mg
¾ cup calcium fortified plant milk: 240 mg
⅓ cup cooked kale: 110 mg
¼ cup dried figs: 95 mg
(For a complete list click here)
Zinc is essential for the body’s immune system to function properly. It also works in cell division, cell growth, the breakdown of carbohydrates, and wound healing. Although it is so important for our bodies, not much is actually needed; the RDA for zinc is 11 mg for men and 8 mg for women. Even though plant sources of zinc are not absorbed as easily as animal sources, vegans were shown to only have a slightly lower amount of zinc.
VEGAN SOURCES OF ZINC
Tofurky italian sausage: 9 mg
½ cup hummus: 2.3 mg
1 tbsp nutritional yeast: 2 mg
¼ cup roasted pumpkin seeds: 2.3 mg
(Click here for a complete list)
Your body must have vitamin D in order to properly absorb calcium in the body. Vitamin D is not typically a problem for vegans during the summer months, but those living in colder climate may be at risk of developing a vitamin D deficiency. The RDA is 600 - 800 IU. Just about 10 to 20 minutes (depending on skin tone) in the sun per day will provide the body with sufficient levels. But those living closer to the northern hemisphere, may need to include more vitamin D rich foods in their diet.
VEGAN SOURCES OF VITAMIN D
1 cup portabella mushrooms: 634 IU
1 serving instant oatmeal: 180 IU
1 cup fortified soymilk: 120 IU
1 cup fortified orange juice: 100 IU
(Click here for a complete list)
SHOULD I BE INCLUDING SUPPLEMENTS?
Eating a healthy variety of plants and grains will ensure that the body gets sufficient levels of nutrients. The exception to that is vitamin B12. Vitamin B12 is not as easily accessible through plant based foods, so it can be important to include a supplement in your diet. If you are overwhelmed by what kind of B12 supplement to choose, check out this article. Nutritional yeast is an example of a vegan food that does naturally contain B12. It is usually used as a cheese replacement or topping, and can supply 2.4 mcg per 3 tbsp (which is the RDA).
A well-balanced, plant based diet will supply the body with all the nutrients that it needs to thrive. There are many people who question the vegan diet and believe that vegans are lacking essential nutrients, but with the right knowledge of nutritional needs, a vegan diet can be very beneficial.
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In 2012 I started my private practice with one client, a pad of paper, pen, and a business license.
5+ years later I have a thriving business of clients, online work, contractor positions, and my own office; but it took some work to get there and figure out all the details along the way.
In this article, I am going to give you the quick guide of necessary things to do/get and what to skip to get your practice up and running without taking out a loan.
Assuming you are already a licensed professional (RD):
1. Get malpractice insurance. You want to be covered if any lawsuits come up (RDs are very low risk). As a sole-proprietor I think I paid $99/year, now I pay $118/year as an LLC (I will explain what these are below). If you have worked elsewhere you might already have malpractice insurance. For RDs, "Mercer Proliability" is the main company used.
2. Depending on where you will be practicing, you need to go to the city or county for a business license. This has an annual fee as well, but it establishes you as a business. There are a few kinds of business structures, but as a one-person business you really only need to know about 2 of them: "Sole-proprietor" and "Limited Liability Company" or "LLC." I am no legal expert, so I won't go too deep into this, but here are the basics (google "sole-proprietor" or "LLC" or "business legal structures" for more info):
A sole-proprietor is what most RDs choose/start as. This is what I chose to start with, and it was easy. It has the lowest fees, and for legal/tax purposes you and your business are one in the same.
LLC is a step-up from sole-proprietor, in that it separates you from the business and adds a buffer of legal protection. LLCs can be single-member, or multiple "members." The cost and taxes are higher/more complicated, but you can hire employees.
3. Choose a "Doing business as" name (aka: "DBA"). This can be your own name (easy) or a business name. Make sure your name has not already been taken. Wherever you register your business they can guide you in how to search names, and the requirements. Chose carefully - this is how the public sees your business; but it can also always be changed later (I did this. It was a hassle, but worth it).
4. Separate your personal money from the business's money. When I started my business I opened a business checking/savings account (which I recommend doing as soon as your business name/license go through) and put $3K of my own money in it to get started (you can probably do this all with $1K, but I didn't know at the time). The fact that that money was basically my whole savings made it so I couldn't fail - it was my money on the line. I recommend this for starting a business. Take a risk on yourself and prove that you can succeed.
5. Get the bare office essentials (you probably have most of this): notepad and pens (I like to use legal pads) for taking notes during a session; hanging file folders; a way to lock up client notes (filing cabinet with lock or locking briefcase - I got a locking briefcase for $20 that became my traveling "office" the first 2 years); cards and stamps (it's nice to handwrite thank you notes to clients - I aim to send one to all my new clients).
6. Business cards: don't bother getting more than 250, you will change your info/logo/etc once you figure your business out more. You don't have to have business cards, but it looks/feels more professional.
*bonus tip - skip other physical marketing materials (flyers, banners, rack cards, newspaper ads) when you are just starting out. They are expensive, and really don't work that well. This comes from my personal experience. I spent 100's of dollars on marketing materials that got me maybe 1-2 clients. NOT WORTH IT until you are in the big-time (and maybe not even then).
7. Have a website - even if it is a work in progress! Everyone looks online nowadays, this should be listed on your business card, and potential clients can look at it to see a photo of you and services you offer/philosophy/etc. There are several free (starting) website builders out there. I use Weebly, but Wordpress is very popular, as are Wix and Squarespace. See what you like/seems easy enough for your skill level. I like weebly because it is drag-and-drop, but it doesn't have all the features that something like Wordpress has with "plug-ins."
Things you can wait on:
Ready to go start your practice? I hope this helps you get started with lower start-up costs!
If you have questions feel free to shoot me an email. I am contemplating taking business start-up clients for mentoring (there is a cost for this).
I am so excited, because an idea I have had rolling around in my brain for months has finally come to fruition!
Yesterday, January 8th, I opened for enrollment my course for performers,
"Whole Health for Performers!" This course is "A scientifically-based mind-body approach to get the most out of yourself, so you can focus on creating the performance of a lifetime."
This class is aimed at non-pro level actors, dancers, singers, musicians, directors, drama teachers, and techies who get their heart rate up on (or back) stage.
We cover: Physical fitness, Eating healthy, even when you are busy, Avoiding digestive issues on stage, Hydration, Vocal health, Mental health in the theatre, Better coping skills, and more, with step-by-step "homework" with each module so you actually TAKE ACTION on your goals!
It is being offered at a low cost of $97 for beta testing. This means you get to be a voice in the creation of this course! I will be tweaking the course based on your suggestions, and will be offering free live Q & A sessions to overcome personal barriers in a private facebook group for those who sign up. I normally charge $125/hour for individual counseling, so this is a steal!
Keep your eyes peeled for more educational courses coming later this year! I have some free education available on the online education page under "services" - check them out too
(I admit they are my first online creation, and not the prettiest!).
If you are in the performing arts, and want to take better care of your body on and off stage, what are you waiting for? Go to the course now!
Don't just take my word for it, a wonderful article about this course was written by the creator of OnStage Blog. Here it is for more info:
It has been a BUSY year for Libby and "Not Your Average Nutritionist"!
At the end of the year I like to do a re-cap of what happened and celebrate wins (I teach my clients the importance of recognizing small wins as proof you are moving forward). On that note, here's a list of upgrades and accomplishments that I (Libby) put into the business this past year:
-Finished my Master's degree in Nutrition science with an emphasis in eating disorders! That plus the bachelor's degree and supervised practice to become a RD (see what it takes to become a RD HERE) is 8 years of higher education, yo!
-Recipient of the "Top 20 Under 40" award (for any business industry) in the community, for my work and commitment to the community. (As far as I know I am the first RD to win this award!)
-Created a new business name (in February), legal structure (sole-proprietor to LLC), website, and graphic design (all taking hundreds if not thousands of dollars and countless hours - by myself).
-Hired a graphic designer to make a new logo (coming by the end of 2017 - and I am so excited!!)
-Was published as an expert in several news outlets (see press page).
-Over 1000 hours in one-on-one counseling with eating disorder clients. Worked with my supervising CEDS, and other professionals to really get to a place of great competence and confidence in my work.
-Another year teaching at Allan Hancock College in the Nutrition department (over 3 years now). I'm teaching a class this spring in Santa Maria if you want to join!
-Turned down 2 amazing job offers so I could stay focused on my work with eating disorders. (This was hard, but as Steve Jobs put it "Focusing is about saying NO.")
-Growing our treatment team at Cal Poly, working with professionals in other disciplines on eating disorder client cases (man, what a difference it makes to keep each other up to date on treatment protocols, and client cases!).
-Seeing amazing results from my clients (honestly the best reward of the job)! See testimonials on the main page of this site, Linked-in, Facebook, and Yelp (check filtered reviews).
-Created my first online courses (more to come - get on the email list for updates!)
-Started an Instagram account and made graphics (paid for graphic creating software).
-Worked with (& paid) coaches for PR and Business.
-Worked 3 jobs, finished school, bought and sold a house, while acting in 4 musicals and a movie!
This year was amazing, personally and professionally, and I cannot wait to see what 2018 holds!
I have some great education coming down the pipeline for you! Make sure you are in the email list to be the first to know about educational courses coming out - sign up by clicking the button below.
(A lot of people ask me how I started my business, and why I got into the field of eating disorders. While I do usually tell whomever asks, I have put-off writing this for a while. Maybe because I haven't felt that I have really "made-it" yet, maybe because I don't want to get that personal. Anyway, here's how I came to be "Not Your Average Nutritionist."
When I first passed my Registered Dietitian exam, I was about to get married, and was looking for a local job in my field.
That was going to be a lot harder than I first realized.
I spent about a year and a half (!!!) applying for, interviewing (several rounds), and networking for various jobs in any position as a dietitian. Unfortunately, there was always someone with 10 years of experience, or bilingual speaking, that would swoop in and get the job. (Eventually I did end up with a temp job with County Public Health after that year and a half).
While I was looking for my first "real job," an email had come through our local dietetic association from a young woman who was starting college locally, and was relapsing into anorexia nervosa (for which she had previously had some outpatient treatment). She was looking for a female, Christian, dietitian to work with her. I sent an email back asking if she wanted to give me a try (being new and all).
Now to give a little more background on the eating disorder part of this, in school/internship we spend very little time on eating disorders as undergraduate nutrition majors. Of course we had to learn some about it, but it just does not go very deep at that level of education (which is also why I went back for my Master's). So why did I think I could do it?
#1, I was desperate; and #2, I had struggled with restrictive eating during my early college years, and understood her mindset. She agreed, and I met with her and her mom to see if we would be a good fit. This was the start of my entrepreneurial journey.
Fast forward a few months and I had read countless books on eating disorders and sought out a mentor in (who I didn't realize at the time was a founding expert in the field, and whom many others call "a rock-star!") a local RD, Francie White, who allowed me to come watch her work, and help with the IOP/PHP treatment center in Santa Barbara, CA. Since I (still) didn't have another job (other than teaching some group fitness classes), I set my mind towards making a legal business.
With the help of a local non-profit organization, SCORE, I figured out what I needed to do to get a business license, and set up bank accounts. My first business name was "Libby's Fit Nutrition." I thought I would focus more on helping stay-at-home moms with weight loss and fitness. I did have a handful of those clients (whom I met in their homes), but pretty quickly I was finding that a lot of people who desired "weight loss" really had disordered eating or bad dieting practices, and I found myself doing more education around that. The more I worked with these clients and learned about EDs, the more passionate I became. I took some more psychology classes through community college, and contemplated what to get a Master's degree in.
Fast forward another 2 years or so, I was working as a teacher (Allan Hancock College) and in Corporate Wellness (Provant/PG&E). My online presence had generated a lot of interest from college students who were having issues with disordered eating. I was seeing so many students from Cal Poly (the local college), that I was talking on the phone almost every week with one of the school's nurse practitioners (the amazing, June Stanley) about shared clients. One night as we were talking about how many students she was seeing with eating disorders, she (I thought, jokingly) said "we should just have you on campus." Little did I know that conversation would lead to BIG things for me.
A few months later, I turned on my phone to see a voice mail from Dr. David Harris, Cal Poly's Executive Director of Campus Health and Well-Being. His message asked me to call back and set up a time to meet. He heard I was THE person to go to for eating disorders, and wanted to hire me to be on campus to work with the students at no cost to them. (Fun fact: when I walked into that first meeting after saying hello, his first words were, "when can you start?")
I started working at Cal Poly in Spring of 2016, as the first Registered Dietitian (as far as we know) to be specifically hired at a CSU to work with students with eating disorders!
I love my job! It is so nice to have co-workers who respect me and my opinion, since starting we have developed a multi-disciplinary treatment team, getting involved with athletic trainers and coaches for more open communication about the college athletes health and eating disorders, and I have been able to provide some in-service trainings to the medical staff.
This past year I changed my business name to "Not Your Average Nutritionist," to better represent what I was doing (not many RDs are competent in the area of eating disorders, and even less seem to focus more on the person and coping skills than the food piece), and I was no longer focusing on the fitness aspect. I also changed the legal structure from a sole-proprietorship to a LLC, for more legal support and the ability to hire staff in the future. I have a lot of lofty goals for my business in the next 10 years or so, but for right now I want to slow-down and savor the process.
So, where am I with my business now?
- Still working part-time at Cal Poly (over-booked, but feeling competent)
- Seeing some private clients.
- Almost done with my M.S. in Nutrition Science (emphasis in EDs).
- Working with a supervisor (Cynthia Saffell, MS, RD, LCSW, CEDS) for an advanced credential in EDs (IAEDP - CEDRD).
- Teaching at Allan Hancock
- Feeling better about my own body image than ever.
- ...and getting ready to launch a new phase of my business in 2018! Stay tuned for online nutrition courses!
Moral of the story:
Do great work.
The rest will fall into place.
You got this!
So exciting! This is now my third "Top Nutrition Blog" list to be included on:
"Top 21 Nutrition Blogs You Should Know About"
I have previously been listed on "Top 100 Nutrition Blogs" (2016), " 100 Leading Sites for Holistic Nutrition Consulting & Therapy" (2014), and " Best 150 Health and Nutrition Blogs" (2017).
Thank you to all my readers! You are the reason I do this.
I am hosting a 5-day challenge for those of you struggling with disordered eating, who want to kick-start making peace with food and your body.
The challenge will include:
-Daily emails from me with inspiration and a recovery task
(typically takes 10 minutes or less to do).
-Daily facebook live videos where I will talk about the topic of the day,
and you can chime in with questions and comments
that I can answer in real time.
Wait, how much does it cost?
This challenge is totally FREE!!! - I want to support you in your recovery!
September 11-15, 2017
Sign-up before the 11th at: http://eepurl.com/c14CMb
Make sure to "like" and "follow" the facebook page: Not Your Average Nutritionist
(btw- this is my first automated email sequence, so I apologize for any flubs, we are going to learn together! Your first opt-in to the email will only have you confirm that you are on the list. I won't send an email about this until September 10th.)
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. So....
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.
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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 on topics of eating disorder recovery with her online training site. Find out more about Libby at: www.notyouraveragenutritionist.com (check out the "online courses").
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Libby is a Registered Dietitian focusing on eating disorder treatment and prevention. She is working on the central coast to create wellness in individuals and the community
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