By: Lauren MacLeod
Lauren is finishing up her dietetic internship at Cal Poly San Luis Obispo to become a registered dietitian. She hopes to work in outpatient counseling and has enjoyed working with the eating disorder population.
Body Positivity/Body Acceptance - Comes from The Body Positive, which was founded in 1996 as an alternative treatment for anorexia nervosa; it shifts focus away from changing body weight. The core competency of body positive movement is:
“uncover the messages that have influenced your relationships with your body, food, and exercise and develop a weight-neutral, health-centered approach to self-care to become the authority of your own body by sorting out facts from distorted societal myths about health, weight, and identity.”
In summary, body positivity is about accepting your body as it is and encouraging lifestyle choices that focus on health, not weight.
Fat Acceptance - A political movement focusing on equal rights and medical treatment of fat* people. The National Association to Advance Fat Acceptance (NAAFA) was established in 1969, when fat people realized they were being discriminated against in the workplace and medical settings based on body size. NAAFA gives them access to education and support for self-empowerment.
*“Fat” is a word that is being reclaimed, as “queer” has been reclaimed by the LGBTQ+ movement. It is meant to be empowering, not demoralizing.
Health at Every Size - Health is not determined by weight, but rather by healthy lifestyle changes: eating all foods in balance (intuitive eating), and mindful and enjoyable movement. It focuses on taking care of your body at whatever size it is, and looking for actual markers of health, such as blood pressure, rather than a number on the scale. It was established by Linda Bacon, PhD in her book Health at Every Size: The Surprising Truth About Your Weight. She has since written another book to combat the modern fight against diet culture: Body Respect.
Intuitive Eating: A term championed by Evelyn Tribole and Elyse Resch (CEDRDs) in 1995 through their book Intuitive Eating. It is composed of 10 principles that focus on rejecting diet culture, listening to what our bodies truly want and need, and repairing our broken relationships with food. It is not a diet, but rather the way humans naturally eat when listening to their body.
Diet Culture: I think the Eating Disorder Registered Dietitians and Professionals really hit the nail on the head with their definition: “...a belief system that focuses on and values weight, shape, and size over well-being. Variations of diet culture also include rigid eating patterns that on the surface are in the name of health, but in reality are about weight shape or size.”
Eating Disorder vs Disordered Eating: An eating disorder fits the diagnostic criteria as defined by DSM (Diagnostic and Statistical Manual of Mental Disorders). Disordered eating classifies irregular eating behaviors that do not neatly fit in to an existing diagnosis, but may still pose health risks, physical and/or psychological.
No matter which definitions you identify with, I hope to help you find a way to love yourself. Even if you cannot accept the body you’re in now, can you appreciate all the work that it does for you? Maybe you can even work towards loving it tomorrow.
"A question I keep getting is, "when can we talk about specific foods?"
With all the "super foods" for health/weight loss/etc, everyone wants a magic bullet.
But, it's not that simple. There are other things we need to consider before we can think about how turmeric and kale are going to change your life.
I came up with the "hierarchy of nutrition needs" to explain what is most important for you to be working on right now. Start at the top of this upside-down pyramid and see where you are at.
1) Enough food. The most important piece is simply to make sure you are eating enough food/calories to support your body. Low calorie diets, famine, food insecurity, these need to be conquered before we can move on to the following steps (Consult a Registered Dietitian for your unique calorie needs - please don't use a book/article/formula to make up your own).
2) Balance of Macronutrients. Carbohydrates, fats, and proteins are our macronutrients, and we need all of them in proportion to have a healthy diet. In general carbs should make up 45-65% of your calories, fat should make up 20-35%, and protein 10-35%. Where on the range you fall depends on many factors including growth, type of activity, and medical issues like diabetes.
3) Spacing food out over the day. Once you have figured out how much to eat, it will really behoove you to space it out over your waking hours. I don't care how popular intermittent fasting has become, your body likes a continuous trickle of nutrients coming in to keep it running at its best. Our body actually stores more fat when we eat too much food in a short period of time. If you had the same [foods/calories/everything exactly the same] on 2 different days, and one day you spaced it out with meals and snacks, and the other day you ate it all in a short time frame (2-4 hours), you would store more of that food as fat on he day you ate it all in a shorter period of time, and your body wouldn't be able to use all of the nutrients. When in doubt- space it out!
4) Micronutrients. Micronutrients are vitamins, minerals, and phytochemicals in our foods that are a necessary part of our body function. These are nutrients like calcium, iron, and zinc. I'll spare you the long boring lecture, but once you have the above mastered the next step is making sure you get the correct balance of micronutrients. In general, this is not something you need to calculate or be overly concerned about if you eat a wide variety and colors of foods.
5) Specific Foods. Only after figuring out the other steps should you think about what specific foods you are eating for health. As stated before, there are no "super foods" or "miracle foods." That being said, it never hurts to try out different fruits/veggies and dishes. Just don't take it to extremes. Even kale or carrots in excess can cause problems. As it is said, "the dose makes the poison" (-Paracelsus). Try to create balance in your diet and eat a rainbow of foods.
You'll feel better.
Recently, I was asked to speak at the San Francisco dance school "ODC" for the "Dancer's Day of Health." This day was all about health information and free screenings for freelance professional dancers. We had medical doctors, mental health professionals, physical therapists, and of course - dietitians, all giving their time to screen and educate the dancers.
The panel I spoke on asked us each to briefly say what our role is on the dance medicine team. Here are my bullet points of what the Registered Dietitian does:
“The #1 goal of nutrition counseling is behavior change” – Herrin & Larkin
We help dancers specifically:
When you work 1-on-one with a RD you are going to get help on eating for your individual lifestyle, medical needs, and your personal preferences. No generic meal plans, and any RD worth their salt will come from a place of “all foods fit” and “health at every size” meaning we can focus on health behaviors and risk factors without weight being the focus or “fix.”
Do you need a RD in your dance life?
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.
I have been working on this for a while, and now can share that my first YouTube video has been posted!!!!
This first video is a shorter version of my free course on the different types of eating disorders.
Other videos are coming soon on debunking popular fad diets (starting with the "keto" diet) and medical complications of eating disorders.
Please go check out my channel, and subscribe to the channel to be notified when a new video comes out. Here is the link: www.youtube.com/channel/UCfmXodqj-5iWPqLYOVQI67Q
....and the video!
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As a RD, I have gotten so many questions about the fad diet du jour: the "Keto" or "Ketogenic" diet. I finally decided to just write down the research in a reader-friendly version. Additional video on the history and use of the ketogenic diet at the bottom of this post. Here you go-
The ketogenic (or “keto”) diet is just another fad diet.
The Keto diet is an amped-up Atkin’s diet (that we all know now was/is terrible for your cardiovascular system, and not a sustainable way to keep weight off) where the majority of what you eat comes from fat, and carbohydrates are extremely limited (In contrast, a healthy diet should be a much more balanced macronutrient distribution of 20-35% protein, 45-65% carbohydrate, and only 10-35% fat). This skewed macronutrient distribution is actually very dangerous for the human body for several reasons -
#1, We use carbohydrate as fuel for our brain. Glucose is needed for cognitive function, and many people on the Ketogenic diet experience brain fog and difficulty focusing. Ketone bodies (specifically: beta-hydroxybutyrate (built up in blood serum), acetoacetate (found in urine), and acetone (responsible for that bad breath)), which are created when carbohydrates are not present, are not as effective (or healthy) for our brain. This may also cause metabolic acidosis which is characterized by a reduced pCO2 and/or lower pH (we need to stay in balance!).
#2, On a ketogenic diet, your intake of fruits and vegetables is extremely limited (if eaten at all) and we all know how important the fiber, vitamins, minerals, and other compounds in fruits/veggies are. On that note…
#3, The keto diet is extremely low in fiber! Fiber is not only protective against many gastrointestinal cancers, it is also a big factor in fullness and weight loss. Furthermore, constipation is very common on low-fiber diets like the Keto diet.
#4, Ketosis/ketoacidosis is what is happening in the body/brain on a chemical level – this is the body making fat into something the brain can use when carbohydrates are not available. It's a lot of work for the the body to produce, not as efficient as carbohydrate, and can be incredibly dangerous for diabetics. Additionally, we have some cells with few-to-no mitochondria. These cells are carbohydrate-dependant and must be fueled by glucose. These cells include certain cells with no mitochondria in our blood (erythrocytes), eyes (cornea, lens, and retina); cells with few mitochondria include renal medulla, testis, and leukocytes. (https://link.springer.com/article/10.1007/s11883-003-0038-6)
#5, “Keto breath.” Halitosis (bad breath) from (acetone) ketone bodies makes for an acetone-like smell on your breath that no amount of brushing/mouthwash can fix. Medical professionals look for (smell for?) this in malnourished patients.
#6, High blood lipids/cholesterol/blood pressure. It’s a high fat diet- you didn’t see this coming? The body can only break nutrients down at a certain rate, and high levels of fat in the diet may lead to high levels of blood lipids are responsible for blockages (atherosclerosis), and other cardiovascular complications up to death. While you can reverse the numbers, the plaque buildup in arteries is almost impossible to reverse. Not worth it! (note: some people do see lowered blood lipid profiles on this diet).
#7, Following this diet is often a form of disordered eating or may lead to an eating disorder (just as with any restrictive diet). Cutting out whole food groups is not healthy. We need all 3 macronutrients in appropriate proportions (majority coming from carbohydrates) to have a healthy body. Our body needs a variety of foods for best health. The reason this diet “works” for weight loss is that it restricts the types of foods that people tend to over-do-it-on like chips, candy, pastries, etc. Any diet that cuts out your favorite foods will cause weight loss, but at what cost (physically and mentally?)
#8, Not all fats are created equal. Most people starting a Keto diet are not differentiating between saturated (solid at room temp, and not something we want in large quantities) and unsaturated fats (liquid at room temp, and “healthier”). Getting this wrong also increases complications from the diet. Additionally, many people who followed a diet high in medium-chain-triglycerides (MCT) experienced undesirable digestive issues.
#9, It may mess with your thyroid and other hormones – lowering your metabolism (isn’t the point of this diet weight loss? That’s counter-intuitive…), energy, and fertility. Every time we lower our metabolism through dieting it lowers the “set-point” of our metabolism, making it harder and harder to lose weight. This is an adaptive response for mammals in famine, but not what the average person wants nowadays.
Who it the Keto diet appropriate for?
The only population that the ketogenic diet is scientifically proven to be beneficial (and safe) for is a select group of people with epilepsy (seizure disorders). This is the position of the Academy of Nutrition and Dietetics.
The Keto diet especially sucks for athletes (and people working out to lose weight)
Since our preferred fuel source is glucose (carbohydrate) from either blood glucose or glycogen (fancy term for carbohydrate stores in the liver and muscle cells), running exclusively on fat slows athletic performance as the body works much harder to break down fat (dietary and adipose storage).
Additionally, the lower protein intake and change in hormones in the body with a keto diet lower the ability to build and maintain muscle mass. If “mirror muscles” like biceps are not motivating enough to keep you off it- remember that our organs like the heart are also muscle tissue that would be broken down by this diet, causing organ damage or failure.
It’ll get you, mentally and emotionally
Ketogenic diets cause headaches, brain fog, and often irritability and obsession with food. This type of diet will very likely make you think about food an unnecessarily large amount of time, and make it difficult to be social (not being able to eat at the same places as your friends; oh, and that bad breath!).
You may feel more depressed (especially if you are already prone to depression and/or taking antidepressants) as serotonin (the “happy” neurochemical) is produced from carbohydrates. If you take an SSRI know that this class of medications work directly on serotonin that is present, and the diet requires a minimum about of carbohydrate (as we learned from the works of Ancel Keys in his starvation study) to allow the SSRI medication to work.
So, what’s the verdict?
In case you didn’t get it from the above – the Keto diet sucks. Not only is it a fad-diet (aka – not suitable for long-term weight loss/lifestyle), it can be very dangerous.
If you need help figuring out what to eat, contact a Registered Dietitian. In the meantime, if you do need some structure, balanced eating like the Mediterranean diet or DASH diet is a better way to go.
For a YouTube video with more information on this diet: click the image below
Don’t give up the foods you love. There is room for all foods in a healthy diet. We just need to keep proportions and variety in mind to fuel our body optimally.
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Eating disorders affect approximately 10-13%
of college age females, and about 2-3% of college-age males.
Professionals have noted kids as young as 6 years old talking negatively about their bodies and trying to diet.
How can we help our kids navigate the world with
a healthy body image?
Over the next 3 weeks I am offering a free support group/class for parents in San Luis Obispo.
We will go over what eating disorders are, warning signs, how to talk to your kid/someone with an eating disorder, what you can do to model healthy behaviors, and whatever else you want to talk about.
This will be a safe space to talk about this stigmatized mental & physical illness.
Please invite your friends! This class is open to all.
While it is aimed at parents of middle/high schoolers, it is for anyone who wants to better understand what eating disorders are and how to help a loved-one.
I am not assuming that you or anyone in your family has an ED just because you showed up - this is good information for everyone, because we all know someone with an eating disorder.
Sundays at 6 pm, March 4, 11 & 18.
(Ideally come to all, but you can drop-in to any of them)
First Presbyterian Church (church library)
981 Marsh Street
San Luis Obispo, CA 93401
Hope to see you there!
Sign up for more free education whether or not you can make it to the classes:
Libby is a non-diet Registered Dietitian focusing on eating disorder treatment and prevention. She approaches health from the inclusive standpoint that any "body" can focus on health regardless of size. She is a ally in diversity.
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Disclaimer: This website is for educational & informational purposes only,
it is not a substitute for medical or mental health advice or treatment.