by Jessica Cushing-Murray
Mental health and issues like eating disorders (EDs) are being talked about more and more on platforms like social media. More people are speaking out about its importance and why these topics need to be addressed and brought up in conversation. And these are all great things - it’s exciting to see people spreading awareness with public social media posts - but posting about it and having a real life face-to-face conversation with someone struggling with an eating disorder are two very different tasks.
On my Division I college athletics team, issues like EDs were known but not necessarily voiced. Everyone knew the risk factors, the warning signs, and the importance of a well-balanced diet, but we didn’t have very many honest conversations about these things as a team. You can be someone who posts on Facebook that you support the education of athletes on the dangers of eating disorders, but you don’t really understand what that means until someone on your team (who you run with and see every single day) becomes so thin that the doctors bench her because they believe that continuing to race would be hazardous to her health.
So what does an open, in-person conversation about eating disorders look like? And why is it so important to have them, especially within the athletic community? The conversation starts with either a troubled person reaching out for help, or with a person concerned about a friend/family member.
Because the stigmatization of issues like eating disorders, or potential to be pulled from the team, athletes are often less inclined to talk about it or reach out for help than a non-athlete. However, in my experience, the most significant occurrence is the chain reaction that starts when one person speaks up about their struggles with eating, exercising, or dieting. All it takes is one brave person to tell a teammate that he/she is having a hard time, and we as athletes hear someone else admitting vulnerability, and are suddenly less afraid to acknowledge our own struggles. These conversations are so instrumental within athletics because we have very strong feelings about avoiding signs of weakness.
My team experienced this in a truly positive way. By one girl confessing something as small as “it makes me nervous to eat a lot of carbs,” it opens up the discussion into eating issues, and we realized that a lot of us were having the same fears and feelings when it came to nutrition. Talking about our own food beliefs with each other helped us realize that we weren’t alone in our thinking and that there are other people who know exactly what we are feeling. Once the conversation is opened up, everyone on the team is able to pitch in helpful ideas.
For some reason, in athletics, we find it harder to discuss mental issues in comparison to physical ones. But the conversation would actually follow the same outline regardless of whether someone is struggling with eating or dealing with a broken bone. For example, say you stress-fracture your tibia (shin bone). In distance running, odds are someone else on your team has had the same injury. They’re going to give you all the advice they can on non-weight-bearing forms of exercise, how important it was to wear the protective boot, and the best/worst days that came along as a result of their injury.
Discussions on issues like EDs would go exactly the same way. Because some people have never experienced food fears or the need to exercise or restrict calories, these people can give insight into their healthy way of thinking that keeps them on the right path to a well-nourished body. Some people have experienced these problems before and have guidance on the tools that can be used to overcome these fears. Others on the team are currently struggling, and the team atmosphere and accountability enables them to go places like the on-campus counseling services to seek advice from professionals. The best part about having other people know is that this difficult step of getting help can be done together and with friends.
So I ask again, why is opening up this conversation so important? Because seeking help and getting well is a process that is held up by a support system of people who want your recovery just as much as you do. There is so much to be gained by not having to go through an eating disorder alone. Talking about our mental struggles and fears and looking for support from the people around us is beneficial for ourselves and can unknowingly be the life-changing difference for others.
If you’ve noticed someone close to you showing signs of an ED, first try to understand that what they are going through is very difficult. Then, see if they’re ready to be open up about it; because talking about it is the first step toward getting help. And when it comes to asking someone about it, realize there are so many different possible outcomes: you can be supportive, have lots of questions, or you may even be wrong about them having an ED, but the worst thing you can do is to ignore it. So, ask. Be the person who’s willing to have a conversation about it. Be the difference.
Check out this podcast episode I was interviewed in!
Episode 35 of "Ignite Her Fire"
Key takeaways: All foods fit in a healthy lifestyle, and you don't have to be hospitalized/look "sick" to get help with your eating, Registered Dietitians are different than "nutritionists" or "health coaches," sugar is not evil, keto is not a good diet plan, we need to STOP talking about our bodies!, a little about my acting...and I'm sorry you have to hear me sing (and yes, I know the lyrics are out of order).
http://www.igniteherfire.com/ or on itunes
A podcast full of stories of badass women living life on their own terms.
Thanks to Sabrina and Shawna for hosting me!
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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.
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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it is not a substitute for medical or mental health advice or treatment.