To the Bone: A Blog to the Lovers and the Haters...and Everyone in Between

  • posted by Marci Evans
  • Monday, June 26, 2017

 


Back in the mid-1980’s I stumbled upon a Hallmark or Lifetime movie about bulimia. The show demonstrated in detail, a lot of which I can still remember, how the young, pretty, skinny white actress engaged in her symptoms. I remember staring at the screen, mesmerized. The show didn’t make me want to copy the girl’s behavior. Gratefully I never went on to develop bulimia. But in the ensuing years, eating disorder specialists began doing research on the harms of these kinds of movies as well as the unintentional harm caused in health class lectures which intended to provide education but ended up planting ideas in young minds.
So I felt a large pit in my stomach when I saw the trailer to the new Netflix movie about one girl’s struggle with anorexia. I posted my feelings about it in a quick rant on my FB page Saturday night and was shocked to see that in 24 hours it had been shared nearly 150 times, far more than anything I had written before. The comments I received on this post are why I’m writing this blog in response. The first dozen or so comments are from sufferers of eating disorders. Many of those who commented later are from those defending the film. I’d like to share with you some of the comments I received from those who suffer from an eating disorder. And provide a response to some of the arguments defending the movie.

 

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"It's exactly the sort of thing I was drawn to when I was really, really sick - all those horrible Lifetime movies and ED books that give tips and tricks to the vulnerable. Not good."
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"As someone recovering from anorexia, it's absolutely miserable to see this stuff and my eating disorder voice becomes about 20 times louder (thus making it 20 times harder to eat).
It has stirred up so much in my already murky mind. Two minutes of this movie and I can barely hear myself think."
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"This movie is irresponsible, at best. It's perpetuating stereotypes that make seeking and accepting treatment much more difficult. Time for a Netflix hiatus."
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"I am very passionate about my recovery-- and what it took to get to where I am today. Here. I am proud of my 10 years of hard work. I am not easily triggered. In fact, I can't remember the last time I felt truly triggered. EDs voice isn't as strong as mine these days. You can imagine my surprise when I watched this trailer and felt that pit in my stomach and that voice a little louder than it has been in the past 10 years. My biggest fear is that someone who is in delicate stages of recovery will see this and feel the same. I am so disappointed that this movie has been made."
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"Ever since I saw the trailer, I've struggled more. I think what bugs me the most is knowing that the actress has had ED herself. Yet, they made her lose weight for the role. Some articles say she had to "relive anorexia." I keep reading she lost weight in a healthy way and had a dietician, but her weight is anything but healthy. What kinda of dietician allows that? It's triggered me into thinking that if she can be that size and it's healthy, then...why can't I? Also, if you look at her social media pages, young girls are asking her how she stays so small and saying they want to be like her."
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For some people, it IS “just” a movie that will spark some dialog. That’s fact. But I implore you to consider that this very film about anorexia has already and will continue to harm SOME people. Ironically, the people it will harm will be some of those who are vulnerable to develop or already suffer from an eating disorder. That to me, breaks my heart.

 

My response to those who provide arguments FOR the movie:
#1 “This movie shows real issues. We shouldn’t ignore real issues that affect people.”
I agree on all counts. And the cool thing is that there are so many ways to talk about the reality of eating disorders while reducing harm by the way we do it. There are large organizations who do this well and whose missions I support. I’ll provide resources at the bottom.
Rape is also a very real issue. But most of us wouldn’t defend the viewing of rape scenes in a movie as a great teaching tool to spread awareness. Nor would we show it to our children to generate discussion.
Based on the trailer I’m deeply worried about the film. But I don’t think our only two options are films like this one or nothing at all.
#2 “This movie spreads awareness.”
I also agree. It’s stirred so much controversy and people are definitely talking, including me! But I believe in human creativity and ingenuity. Movies like this have been made since the 1980’s. Have we not improved in over 3 decades?? We have the capacity to do better! While I don’t have the creative skill, I have no doubt that an incredible movie about eating disorders can and hopefully will one day be made. A movie that raises awareness, sparks conversation, hopefully raises money, and doesn’t harm the vulnerable. I feel like the film "Embrace" is a perfect example. It tackles the tough and very real topic of negative body image while doing so in a mostly inspiring way. 
#3 “We should give people freedom to make films about eating disorders and we should not suggest censorship.”
I also agree. People will continue to make all kinds of films and I am going to continue working with my clients and with my social media platforms to help my clients become conscious and thoughtful consumers of media. I do this literally all day from my office. To be clear, the petition is to ask filmmakers to have a content review by professionals.
#4 “It’s a movie and not meant to cause harm. It’s demonstrating real life.”
I can’t speak to the intention of the movie. For certain, this movie will not be at all harmful for some. I’m confident that viewing it wouldn’t harm me. But it will harm the vulnerable. And the vulnerable are whom I’m interested in. They are the reason I wrote my FB post. They are the reason for this blog. I have sat with countless clients who have told me, “I got the idea for my bulimia by watching that Lifetime movie. Had I only known that I’d still be suffering 20 years later…I wish I never saw that film.” So yes, YES, I want to yell out “let’s find another way to raise awareness and have conversation.”
 
My entire career is dedicated to the treatment of people suffering from eating disorders. To you I say:
1. If watching this trailer has triggered you, make a commitment to not watch it. If you feel up to it, share your experience as to why you feel it’s harmful. You have a voice. Use it!
2. There are so many ways to suffer with an eating disorder. If your eating disorder doesn’t look like what is shown in this film, your struggle is still real and valid. You deserve support. And you deserve treatment.
3. There is no healthy way to do what Lily Collins did for this film. I don’t know who the nutritionist was for the film. And the idea that what she did for the film could be accomplished “healthfully” is as far from any truth I can imagine. It is literally NOT A THING. Erase that from your minds. To think of the young people asking Lily for advice on how she did it and how they can be small like her is breaking my ever-loving heart.
I’d love to see greater awareness for eating disorders. But we can do better. We can do so much better.

 

Reporting and Portrayal of Eating Disorders by Mindframe (scroll down to "Other Media Resources"

 

Build Enduring Strategies with the Intuitive Eating Group Program

  • posted by Marci Evans
  • Tuesday, May 23, 2017

We're so excited to announce our new Intuitive Eating Group Program

Do You Want to Improve Your Relationship with Food?

Looking for Guidance on How to Honor Your Nutritional Needs?

Struggling with Recovery From an Eating Disorder?

Marci RD Nutrition has a 5-week Intuitive Eating Group Program that will Transform You and Your Life!  We will help you navigate the complex journey of learning to listen to your body’s needs while in a supportive group environment! 

This program, led by Eating Disorder and Intuitive Eating expert, Sarah Patten, will help you:

  • Discover how to listen and reconnect with your body's hunger and fullness cues
  • Learn to trust yourself to make decisions around what or how much to eat
  • Take back your power around food
  • Reconnect to your body's innate wisdom to determine the right amount of food for you
  • Develop self-trust around eating challenging or “forbidden” foods
  • Practice being more mindful at meal times in a safe and supportive environment
Why Join our Group Program? 
  • Exposure to challenging meals in a supportive environment fosters greater self-trust while decreasing fear and anxiety over time.
  • Avoidance of particular foods or eating in a social setting is a big risk factor for relapse and can hold one back from making peace with food once and for all.
We will help you become more confident in your ability to feed yourself in an adequate, varied, and enjoyable way. 

 

intuitive eating support group

Who Should Consider Participating?  

  • People looking to heal their relationship with food and develop lifelong skills around eating and body trust. Participants must be appropriate for an outpatient level of care and must be working with an individual therapist and dietitian.
  • An initial 15-minute phone screening is required to determine appropriateness of fit for the group and to allow for Sarah to understand each individual's goals and challenges prior to joining.
Groups will be led by Sarah Patten, a registered dietitian, eating disorder expert, Intuitive Eating specialist, and registered yoga teacher.  To register for the program, contact Sarah via email or by telephone: 

617-945-2404


 

What Does the Program Include?
 
Five (5) weeks of meal support led by a Registered Dietitian and Intuitive Eating specialist that includes the following:
  • Inclusion in a small group – limited to 6 participants
  • Personalized goal setting
  • Orientation to the keys of effective exposures
  • Mindfulness based eating exercises
  • Dining together as a group
  • Guided meditation experiences
  • Post-meal processing
  • Handouts and resources
  • Access to a Registered Dietitian who leads you in this program
When Will the Group Be Held?
 
Dates:
June 13th, 20th, 27th, July 11th and July 18th
 
Time:
7:00 pm-8:15 pm
 
Location:
Marci RD Nutrition Counseling Office
22 Hilliard St., Cambridge, MA 02138
1st floor, door on the right
 
Your Investment in the Program:
$225.00 for the 5-week program - Registering for the full series is required.
 
Registration Information
  • Group size is limited to 6 participants.
  • To reserve your seat in the program, contact Sarah. Your seat in the program will be officially reserved once payment is received in full.
 
We look forward to have you join us for the 5-week Intuitive Eating Group Program!

Dietitians: Are you Ready for the EDRDpro Symposium?

  • posted by Marci Evans
  • Wednesday, March 22, 2017

Yes, the EDRDpro Symposium is the only international, web-based eating disorder conference for nutritionists, therapists, and students.

Have you ever had the chance to participate in something that makes you giddy with excitement?? That’s exactly how I feel about the upcoming #EDRDpro Symposium - a 4 day online symposium with 15 eating disorder experts. How lucky am I to be included??

Whether you are a dietitian or not, I invite you to seriously consider registering for this event. There is an amazing lineup of experts on the topics of eating disorders and body image for this incredible 4-day event. The range of topics is multi-faceted and timely: building your brand, working with athletes, mastering the media, how to move away from a weight-centric treatment focus, exercise in recovery, raising healthy eaters, and so much more!

Many of you have asked for more information on my most recent venture - the complicated mix of digestive disorders and eating disorders. At the #EDRDpro Symposium I will be speaking on “The Gut Microbiome, Digestive Health, and the Eating Disorder Client.” I’ll be providing attendees with “my Top 10 Tips for Supporting Digestive Well-Being” in a user-friendly handout, along with an in-depth presentation which covers the most up to date research. I can’t wait to share it with you!

edrdpro symposiumYou may be wondering how I developed such a passion for speaking on digestive well-being, specifically for the eating disorder client. I can sum it up in a few bullet points:

  • Childhood gastrointestinal (GI) issues are among the top 10 risk factors for the development of an eating disorder
  • Up to 98% of clients with an eating disorder also struggle with some sort of GI issue. I care because it’s affecting so many people and very few know how to deal with both issues simultaneously.
  • Ongoing GI issues takes a toll on emotional well-being, body image, and the length of time it takes to recover from an eating disorder

The amazing thing is that there are so many solutions to improving gut health AND eating disorder recovery. And I want more people to know about it.

Here are more of the details on this event:

Early-Bird Registration is March 20th-27th and the cost is $299

Prices increase to $399 after March 27th (which is still a steal in my book!)

With registration you get:

  • 15 webinars available to you to watch at your own pace
  • 15 hours of CPE credits
  • Bonus videos and tips
  • Resources and tools to use in your practice
  • Expert insight
  • Private Facebook group just for participants to ask questions, build communities, and interact with the expert contributors during the symposium.

I hope to see you there! Remember to register early

 

Digestive Disorders and Eating Disorders: A Complicated Mix

  • posted by Marci Evans
  • Monday, March 06, 2017

Several years into my work as a nutrition therapist I found myself really grappling with a clinical dilemma. Many of my clients were not only suffering from an eating disorder but they were also suffering from pretty severe digestive issues. And these digestive issues were not only complicating their recovery but they were seriously impacting my clients’ quality of life. In fact, many clients who had made tremendous strides in their eating disorder recovery were suffering with digestive symptoms that other clinicians had promised would go away once they got better from their ED.

So I delved into the research, participated in a year long integrative nutrition therapy training, exchanged supervision with colleagues who specialize in digestive health, attended workshops, and I thought A LOT. In fact, I want to make a big shout out to my friend and colleague Lauren Dear who is an amazing digestive health dietitian and has taught me so much. (Sidebar: I have the honor to speak with Lauren at three upcoming conferences. See below!)

All of this study (and continued study!) led to a series of talks on the intersection of EDs and digestive disorders that I have and will be giving in 2017. And with enthusiasm, I’m writing to let you know that I am also in the process of developing an online self-study course on the topic. I will have it ready this spring and can’t wait to share it with you. I believe in my heart it will help you feel more capable in helping your clients heal. Below I’ll provide links with upcoming places I’ll be speaking on this important topic. But for now, I’d like to share some juicy tidbits!

Critical Research Nuggets:
  • Up to 98% of clients with eating disorders have a functional gut disorder (FGD) (Note: FGDs are things like Irritable Bowel Syndrome, gatric reflux, bloating, constipation, and diarrhea (to name a few).
  • People who suffer from FGDs and EDs share the same underlying mental health challenges- namely anxiety and depressive disorders
  • These mental health challenges can lead to digestive symptoms that can perpetuate long after the ED symptoms have resolved
  • EDs can actually cause FGDs and FGDs can make a person vulnerable to the development of an ED. This means it is BOTH the chicken and the egg.
  • Childhood GI issues are a key risk factor for the later development of an ED
  • Both EDs and FGDs negatively impact body image. A person who suffers from both has a double whammy to contend with!
  • Anorexia Nervosa changes the gut microbiome by deceasing bacterial diversity. Lower numbers of bacterial diversity are associated with greater levels of eating disorder psychopathology.
Specific Concerns for the ED Population
Traditionally, medical providers and dietitians have encouraged an elimination diet of some kind to treat these enduring and often puzzling symptoms. However, eliminating foods is really the opposite of the goal of nutrition therapy for EDs. Restriction, even if medically indicated, complicates ED recovery. In my personal experience, I have seen well-intended clients/practitioners advocate for an elimination protocol that has led to full blown relapse. So what are we to do as clinicians who feel desperate to help our clients fully recover and treat any concomitant digestive health concerns? I have a few take home points for you to consider.

Key Take Home Messaging

 There are many non-harmful interventions to try with clients.

  1. Most if not all behavioral interventions that support ED recovery will also support digestive health. Root out remaining ED behaviors as most will reinforce negative GI symptoms.
  2. Sensitive systems require CONSISTENCY & BALANCE.
  3. A stressed out person will likely have a stressed out gut. Help clients embrace hypnotherapy, meditation, deep breathing, guided relaxation. The relationship between head brain and gut brain is REAL!
  4. Food variety improves the gut microbiome and is a key ingredient to ED recovery.
  5. The goal is to include as many foods as possible for mental, emotional, and psychological well-being.
  6. Integrate the use of digestive enzymes, probiotics, and well-researched supplements to help manage symptoms.
  7. Fuel healthy bacteria by integrating fermented foods and drinks.
  8. Incorporate a stool or squatty potty for more anatomically supported elimination (ie the squat position makes it way easier to poop!).
  9. Eliminate “diet foods” as they contain a lot of additives that worsen digestive symptoms and are often a culprit in the ED
  10. Play with changing the texture of foods rather than eliminating them all together
One Last Request
Clinicians, please stop telling your clients that all of their GI problems will resolve by eliminating ED behaviors and enduring the refeeding process. While this may be true for some clients and for some symptoms, the research is quite clear that this is often not the case! But the good news is that with a varied and creative toolbox, it’s possible to support ED recovery and improve your client’s digestive well-being.

Upcoming Talks

MEDA’s National Conference- March 11th, co-presenting with Lauren Dear
ANCE- The Massachusetts Dietetic Association’s Annual Conference- March 31st, co-presenting with Lauren Dear
EDPRO Online Symposium- April 28th-May 2nd (early bird registration opens March 20th!)
iaedp Online Live Webinar- August 10th, co-presenting with Lauren Dear

 

Selected Citations
Abraham, S., & Kellow, J. (2011). Exploring eating disorder quality of life and functional gastrointestinal disorders among eating disorder patients. Journal of Psychosomatic Research, 70(4), 372–377.
Boyd, C., Abraham, S., & Kellow, J. (2010). Appearance and disappearance of functional gastrointestinal disorders in patients with eating disorders. Neurogastroenterology and Motility, 22(12), 1279–1283.
Janssen, P. (2010). Can eating disorders cause functional gastrointestinal disorders? P. Janssen Eating and functional gastrointestinal disorders. Neurogastroenterology & Motility, 22(12), 1267–1269.
Kleiman, S. C., Watson, H. J., Bulik-Sullivan, E. C., Huh, E. Y., Tarantino, L. M., Bulik, C. M., & Carroll, I. M. (2015). The Intestinal Microbiota in Acute Anorexia Nervosa and During Renourishment: Relationship to Depression, Anxiety, and Eating Disorder Psychopathology. Psychosomatic Medicine, 77(9), 969–981.
Peters, SL. (2016). Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. Sep;44(5):447-59.
Sato, Y., & Fukuco S. (2015). Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol, Oct;8(5):255-63.
Surdea-Blaga, T., Baban, A., Nedelcu, L., Dumitrascu, D. (2016). Psychological interventions for irritable bowel syndrome. Journal of Gastrointestinal and Liver Diseases, 25(3).
Voci, S. C., & Cramer, K. M. (2009). Gender-related traits, quality of life, and psychological adjustment among women with irritable bowel syndrome. Quality of Life Research, 18(9), 1169–1176.

 

BED and The Well-Trained Clinician: Are You Helping Without Harming?

  • posted by Marci Evans
  • Monday, February 06, 2017

The Need for Well-Trained Clinicians


This blog post was originally posted on the Binge Eating Disorder Awareness Blog. I've reposted it here to spread the word! 

Binge eating disorder (BED) may seem new since it was just added to the official list of mental health diagnoses. But the truth is that using food to manage difficult internal experiences and emotions has been around a long time! While it’s official status is “young” in the eating disorder (ED) world, well-trained clinicians are desperately needed! The problem being that many clinicians haven’t been properly trained on how to treat BED, which is distinctly different than treating weight. Often, clinicians conflate the two and unintentionally create a whole host of problems!

While the ED field has a long way to go in developing substantive research to guide our treatment protocols for BED, we must borrow from related fields of research to guide our way.

The first area of research ED clinicians need to become familiar with is weight stigma. Similar to other oppressive forces in our culture, weight stigma infiltrates all of our lives in sneaky and insidious ways. And sadly, even ED clinicians are top offenders when it comes to bias and stigma relating to weight.

What is Weight Stigma?
Check out this succinct PDF on weight stigma developed by BEDA. In short, weight stigma is negative judgment, bias, assumptions, attitudes, and treatment based on a person’s size. Most importantly, when a person experiences weight stigma it makes them vulnerable for WORSE health outcomes. This means that when people are stigmatized they are less likely to get proper care and are less likely to improve in any health parameters. This is why a weight neutral approach to improving health of people suffering with BED.

Why A Weight Neutral Approach
A weight neutral approach makes no assumptions about a person’s health or habits based on appearance. And it deems every individual deserving of health enhancing interventions regardless of whether it produces a change on the scale. Two important philosophies, Health at Every Size (HAES) and Intuitive Eating (IE), provide the scaffolding and guidance for clinicians to generate interventions that will improve the health of clients without interjecting harmful weight stigma. Integrating these philosophies into the backbone of BED treatment is critical to helping without harming.

Seeking Additional Treatment
It is imperative that ED clinicians seek additional training in weight stigma, HAES, and IE. I have developed an online training for ED clinicians that is focused on how to provide nutrition specific counseling that is HAES informed, weight neutral, and grounded in research. I developed it because I am passionate about reducing weight stigma and improving treatment for people with EDs. There are relatively few resources for clinicians so I created am online training that is affordable and accessible from your own home. You can learn more about my online training for dietitians interested in eating disorder work here

Additionally, here are some other resources I recommend:

Let’s elevate the field of ED treatment and provide our clients with BED with the best possible care.