This past weekend, we had a major storm out here in New England. In fact, I’ve never seen so much snow at once! As I was watching Facebook, my inbox, and news reports I was intrigued with everyone’s efforts to prepare for the upcoming deluge. In fact, I found it incredibly interesting. Many people headed to the grocery store and stock piled their cupboards, fridges, and freezers (along with grabbing cash and filling up their gas tanks).
I think this behavior has such relevance to the world of nutrition. When we fear impending famine, we stock pile “just in case.” How many of you repeat this pattern with your diets? If you have ever participated in a “diet” than you have repeated it even if you don’t know it! Creating a famine by cutting out certain foods or food groups actually triggers a natural and healthy survival mechanism to feast. This survival mechanism causes us to think obsessively and crave those forbidden items. And as many of you know from experience, when we are both psychologically and physically restricted we don’t just crave moderate amounts of those items, we yearn for COPIOUS amounts of them. And before you know it, a terrible pattern has emerged… Famine (even with the best of intentions) has set you up for feasting.
As an eating disorder therapist, I am very interested in working with how people who have developed fears and anxieties around food and body image. For many with eating disorders, the same type of 'fight or flight' reactions that occur when seeing bugs develop around eating a meal, clothes shopping, and many more everyday occurrences. When you have an ED, a meal or going clothes shopping can be as scary and overwhelming as picking up a snake. Obviously, extreme fear reactions to something you need to stay alive or something that you need to leave house can make for a very difficult situation, indeed.
Luckily, there is a therapy available that is specifically designed to address this issue and one that I have found very helpful in dealing with the fears that occur in eating disorders. Exposure therapy is a behavioral technique intended to bring a person into a feared situation in such a way that it is no longer anxiety provoking. It is the considered a necessary part of treating anxiety, and as anxiety is a core feature of eating disorders; exposure is easily incorporated into standard treatment.1,2
For example, a person who is recovering from an eating disorder may need to buy new clothes, but finds shopping extremely difficult. The change in the size of clothes, while an indication that she is getting healthier, may trigger eating disorder thoughts or a panic attack. A person may even reengage in eating disorder behaviors to avoid the change in body size and shape. During the course of exposure therapy, she would be taught the skills to manage the acute symptoms of anxiety and act of shopping would be broken down into small steps. Together with the therapist, at the site where she would like to buy clothes, the person would complete each step. Every time she experienced anxiety, she would stop at that step and utilize her skills to reduce the distress. When the anxiety was sufficiently managed, the person and therapist would go on to the next step. Eventually, she is able to buy and wear the new clothes, making the weight gain easier and more likely.
By breaking the experience down into manageable steps and addressing the anxiety in increments, the situation becomes safe. The exposure may need to be repeated or used for other feared situations, depending on the person. However, in completing an exposure, she has reduced the risk of relapse and can continue making progress in her recovery.
In working with people with eating disorders, I see clients struggle with very real fears around food and body image. However, there is hope and there is relief. Exposure therapy, in conjunction with standard treatment, can help address the specific fears and anxieties that occur in eating disorders.
2 Pollice C, Kaye WH, Greeno CG, Weltzin TE. Relationship of depression, anxiety, and obsessionality to state of illness in anorexia nervosa. Int J Eat Disord. 1997; 21:367.
Do you have any body-image or food related fears? Are there situations you avoid because of these fears? What are your thoughts?
Casey W. Becker, LMHC, of Mended Wing Counseling, is now offering exposure therapy as an adjunct to standard outpatient treatment. To find out more, please call at (617)797-7949, send an email to firstname.lastname@example.org or visit the website at www.mendedwingcounseling.com.
While meditation may sound a little hokey to some of you, there is good research to show for the benefits of incorporating a meditation practice into your life. Interestingly enough, "neuroscientists have found that meditators shift their brain activity to different areas of the cortex - brain waves in the stress-prone right frontal cortex move to the calmer left frontal cortex. This mental shift decreases the negative effects of stress, mild depression and anxiety. There is also less activity in the amygdala, where the brain processes fear."
So you may be asking yourself- how in the world do I begin? Check out Audio Dharma, a fantastic resource a client recently told me about. It's free! A wide variety of meditation experts provide free talks, lectures, articles, and guided meditations. It's a safe way to begin and you can commit as little time as you'd like.
I think I'm going to go close my eyes now. :)
Marci Anderson, Dietitian in Cambridge
Check out this article below. Apparently a husband and wife (both physicians) have decided to take celebrity health issues and turn them into “teachable moments.” What do you think about this?
On one hand, I hate the fact that it feeds into our unhealthy obsession with people who (in my humble opinion) are not always great role models of physical or mental health. But on the flipside, it may provide more reliable information and squelch health and nutrition myths. Check out the website here. I’d love to hear your thoughts.
When Your Patients Want That Pill the Stars Are Taking
By Marianne Mattera | July 26, 2010
When movie stars, rock stars, top athletes, and other celebrities use a
medicine, or an herb, or a home remedy it often makes news. News that is
likely to generate questions from patients. What do you tell them? Where do
you go to find out about these pill and potions, some of which are far from
Well, soon you can find such information at MedPage Today.
This week, we'll begin bringing you blog posts from "Celebrity Diagnosis," a
website run by a husband-and-wife team of physicians, Michele Berman and
Mark Boguski, who provide what they call "teachable moments in medicine" by
reporting on "common diseases affecting uncommon people" and the sometimes
uncommon remedies they use to treat them.
Like kombucha tea. That's a folk remedy currently popular with such
Hollywood notables as Gwyneth Paltrow, Kirsten Dunst, Lindsay Lohan,
Madonna, and Halle Berry. It's supposed to be good for everything from
anorexia to atherosclerosis. And it's the subject of the first Celebrity
You'll learn what the tea is, what studies have been done on it, whether
there are possible side effects, and what role it may have played in
activating Lindsey Lohan's alcohol-monitoring bracelet -- a tidbit that will
prove you're up on the latest in the world of pop culture.
Having that reputation may not be one to which you've aspired, but it may
give you the cache necessary to steer some patients away from things that
The posts from Celebrity Diagnosis should also help you understand why
you're getting some of the questions you've been getting lately, or why so
many patients are coming in asking you about a given condition. Google
searches about lupus escalated after Snoop Dog revealed that his daughter
has lupus and Lady Gaga announced she had "borderline lupus." Berman and
Boguski knew those queries would be coming and dealt with the subject.
How they know these things, we don't know. What we do know is that we'll be
bringing you interesting reading -- with sound research behind it -- that
should help you answer the questions your patients will ask.
Look for the first installment on Tuesday and let us know what you think.
Yesterday, I received several emails with a link to this article on a condition called "Orthorexia." Most people read the article and wondered if it was serious, wondered if it wasn't some sort of exaggeration or joke.
And while I admit, reading about it online may seem strange or even ridiculous, it is a true disorder that affects both the physical and emotional health of a lot of people. Just read my recent client spotlight. What began as "healthy eating" and exercising for her, quickly became orthorexia, which then became a much more severe eating disorder that required residential treatment and intensive outpatient care.
Now of course I believe in healthy eating and exercise- my life is committed to supporting it in myself and others! BUT, the distinction between healthy living and orthorexia are two important words: unhealthy obsession. You can read more on the Orthorexia home page, written by Dr. Steven Bratman who coined the term and wrote the book "Health Food Junkies."
<Ironically, I just loaned my copy to a client who has suffered mental, emotional, and physical distress FOR YEARS due to an unhealthy obsession with "healthy" eating and exercise.> My clients who suffer from orthorexia share a single characteristic- the obsession diminishes rather than enhances their quality of life. Relationships suffer, social isolation ensues, they have often feel paralyzed, depression/anxiety is worse, sleep patterns are affected, etc.
My philosophy is that moderation with food, exercise, and in life- is the key! And I also believe that we are meant to find enjoyment, satisfaction, and fulfillment from the food we eat. Anything taken to an extreme is unhealthy. If you have always been interested in "healthy" living and are curious as to whether or not you are taking a bit too far, the assessment below may be helpful to you. This is taken from Dr. Bratman's book.
Dr. Bratman suggests that you may be orthorexic, or on your way there, if you:
o Spend more than three hours a day thinking about healthy food.
o Plan your day’s menu more than 24 hour ahead of time.
o Take more pleasure from the “virtuous” aspect of your food than from actually eating it.
o Find your quality of life decreasing as the “quality” of your food increases.
o Are increasingly rigid and self-critical about your eating.
o Base your self-esteem on eating “healthy” foods, and have a lower opinion of people who do not.
o Eat “correct” foods to the avoidance of all those that you’ve always enjoyed.
o So limit what you can eat that you can dine “correctly” only at home, spending less and less time with friends and family.
o Feel guilt or self-loathing when you eat “incorrect” foods.
o Derive a sense of self-control from eating “properly.”
Bratman suggests that if more than four of these descriptions applies to you, it may be time to take a step back and reassess your attitude toward what you eat. If they all apply, you’re in the grip of an obsession.
This seems to be a controversial topic. I'd love to hear your thoughts.
Striving to live a balanced life in hectic Harvard Square,
So my Dad sent me this article from Yahoo! News. A recent research study shows that women who have a normal perception of body image based on psychological screening tests still have brain scans that reveal they are concerned about getting fat. In fact their brain scans are similar to women with full blown eating disorders. On the other hand, the brain scans of men showed no indication that they were concerned about body image.
What's the difference between the sexes? Social pressure. Women spend so much time fretting about their physical appearance because we are expected to look a certain way. What a waste of energy and time that could be spent in more productive and worthwhile pursuits!
So ladies, next time you have an obsessive body thought come in to your mind, here are some alternative thinking patterns that may help you get on a healthier track:
1.) I'm not entertaining this thought, I have more important things to think about, like (fill in the blank).
2.) Rather than obsessing about how much I weigh, I'm going to focus on doing positive things for my body like giving it nourishing food when it's hungry, sleep when it's tired, a hot bath when it's sore, and exercise when it's sluggish.
3.) Instead of berating myself, I'm going to list 2 positive things my body has done for me today (then list them).
I know this sounds awfully cheezy, but we have got to stop this body hating obsession. Negative body thoughts do nothing to improve our appearance, physical health, or emotional well-being. But learning to speak to ourselves in a positive, loving, and healthy way can improve all of those things. And it's just one positive thought at a time.
If you feel consumed about body fearing and body hating thoughts, you may want to think about getting some support. I have a list of resources. To get you started, my friend and colleague Deb Schachter has an upcoming workshop to help you improve your body image on May 8th. Contact her for details!
Your dietitian in Cambridge,
In case you didn't know, it's National Nutrition Month. A time to celebrate delicious and nutritious eating all month long! The American Dietetic Association has provided a Good Nutrition Reading List that you may find helpful. I'm currently reading "The Rules of Normal Eating" and am lovin' it!
Many of the clients that I see for individual nutrition counseling struggle with their body image. I was scoping out some resources and came across a couple I thought were worthy of sharing. I hope they may be of use to you or someone you know.
I wanted to provide one more useful tool for those struggling with an eating disorder. I recently learned about the "You are Not Alone" Eating Disorder Support Letter. Subscribe and receive a monthly inspirational letter to support you along your path to recovery. Please forward this along to anyone you think may benefit from this wonderful service (both patients and clinicians).
If you are looking for more support for your eating disorder and are in the Cambridge/Boston area, please do not hesitate to contact me.
In good health,
Marci E. Anderson
February 21-27 is National Eating Disorders Awareness Week (NEDAW)
NEDAwareness Week is a collective effort of primarily volunteers, eating disorder professionals, health care providers, educators, social workers, and individuals committed to raising awareness of the dangers surrounding eating disorders and the need for early intervention and treatment.
The Theme: It's Time to Talk About It
The Mission: Prevent eating disorders and body image issues while reducing the stigma surrounding eating disorders and improving access to treatment.
How It Works: A calling for everyone to do just one thing to help raise awareness and provide accurate information about eating disorders.
Doing My Small Part
I am passionate about and fulfilled by the work that I do providing nutrition therapy for my clients who battle with an eating disorder. But one of the biggest barriers to treatment is helping my clients get coverage from their insurance company.
I recently learned about the Anna Westin Foundation, an organization committed to helping others gain coverage for eating disorder treatment. After their daughter died of anorexia nervosa as a consequence of their insurance company refusing to cover care for their daughter, Kitty and Mark Westin fought and settled a suit against BCBS of Minnesota. They are now committing their lives to ensuring that this doesn't happen to others.
So if you know someone who is struggling with gaining coverage for eating disorder treatment, please pass this link along to them.
And consider what one thing you can do to support NEDAW.