Are you or is someone you know working on recovery from an eating disorder?  The Renfrew Center is offering an excellent (and might I add free!) workshop/webinar.  Topics include goal setting, body image concerns during the summer, and coping with the challenges of vacations. 

Here's a link for more info.

Anyone who knows me well, knows that I think measuring things like weight and BMI isn't all that useful.  I just don't feel that the information tells us a whole lot about our health. I believe that it gives us a sliver of information, not the whole picture.  I believe that focusing on behavior is much more important.  Working towards healthier eating habits and moving our bodies more is far more productive for our health than being concerned about the number on the scale (which for someone who works with eating disorders knows that weight tells very little about health).

Check out the book "Big Fat Lies" if you are interested.  The author describes (in detail) the flawed data that our current BMI and weight charts as based on.  I highly recommend it.

Just today, a client forwarded me an article I couldn't help blogging about because it's just so darn ridiculous.    Apparently a new study shows that your neck measurement may actually be a better way to determine your body fattness.  What!?  As if we need another number to be concerned about.  

The study authors had the following to say:

"We've been using BMI to advise parents and patients for making healthy choices," he said. "Unfortunately, often we tell someone their BMI is 27 or 30, most of the time it doesn't mean much. To tell you that your neck is wide, these are some of the risks associated to it -- that we feel people would be able to relate to it better than BMI."

I couldn't help but laugh. Let me be so bold as to offer you some advice- stop obsessing about numbers.  Stay focused on what you can do today and every day to be healthy: get plenty of sleep, stay hydrated, eat lots of produce, make an effort to move your body, you get the idea.

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,
Marci

Each month I look forward to posting a client spotlight.  And I'm so grateful that "A" was willing to share her story with all of you.  It has been so gratifying to work with her as she has worked hard to develop a happy/healthy relationship with food.  She has fought hard in her recovery from an eating disorder and along her path found two keys to healthy eating and exercise- cooking and climbing.  Read on and enjoy.




Six months ago I hit a low point in my battle with an eating disorder. I had literally run my body into the ground through a long-standing combination of over-exercise and under-eating. It took three full months in a treatment center to restore my body to health, but it continues to take work to restore my mentality surrounding food and eating healthfully. Thanks to the support of Marci and my therapist, (as well as constantly checking in with myself on a daily basis), I can honestly say that I am in a place that I haven’t been in for years. My approach to both food and nutrition has been transformed. No, I don’t pretend to say that disordered thoughts and tendencies don’t exist – but I know how to fight them.

Background
I never intentionally tried to compromise my health or destroy my body with an eating disorder. Rather, it felt like something I could control in the middle of an emotional tornado. I had always been an athlete, rowing through college then running marathons in the years afterward. I thought I knew about sports nutrition and healthy eating. But what was originally a way of staying healthy became an addiction; I only allowed certain foods into my body, at certain times, in certain amounts. I shut off everything my body was telling me. I continued pushing myself physically, until my body nearly gave out. I was mentally, emotionally, and physically spent. I had a brutal awakening in January of this year and realized that I couldn’t continue treating my body this way. So I decided to give up all control for the sake of getting both my healthy and my life back.

The early stages of treatment were both physically and emotionally intense, uncomfortable, and even painful.  But the challenge now is regaining a healthy perspective around eating, exercise, and maintaining life balance. I am a different person now – physically, yes, but more important, mentally. While there is clearly no single thing that helps individuals recover from an eating disorder, two processes have remarkably helped me find my way to a fresh food mentality: cooking and climbing. Let me explain. :)

Cooking
I had never really cooked a meal to share with others; sure, I cook my own food, but I had never truly enjoyed food preparation because of my tight restrictions on what I allowed myself to eat. I ate a baked sweet potato but never cheesy mashed potatoes. I grilled fish with lemon but would never have given it a maple glaze, for example. I can’t explain it, but there were so many foods I wouldn’t eat in the midst of the eating disorder simply because the dish, as a whole, terrified me. I met a friend, however, whose joy was in cooking delicious meals and who graciously began to share that skill with me. I began to help with the cooking a couple times each week as we made dinner for ourselves. Something about the process of creating a meal and being involved in each piece of onion dicing or butter melting made something in my head suddenly click. Once I prepared a “challenge food” in this context, from start to finish, it was no longer scary or off limits – I could easily see exactly what it was, and in breaking it down into ingredients and steps. What had been a looming pasta nightmare, for instance, became a delicious, hearty pasta dinner that I could enjoy with a great friend. So challenge by challenge, I realized the key to tackling my fears was just to cook them! And I know now that all I have to do when confronted with something that I hesitate to eat, or when I think twice about whether something is “healthy enough,” is cook it myself and understand that it is simply food – delicious and nutritious in all of its forms.

Climbing
Coming from years of exercising for the wrong reasons, I have been careful, in my recovery, to approach exercise as something that I WANT to do for the sake of enjoyment. The same friend has recently reintroduced me to hiking and backpacking as a fantastic form of physical activity. I must admit that in recent years I haven’t been an enthusiastic hiker…it did’t provide the physical challenge and intense vigorous exercise that I thought I needed. But in re-learning what is healthy and good for my body, as well as what is thoroughly fun in the process, I am coming to absolutely love the periodic hikes and trips I have been taking through New Hampshire’s White Mountains. But they have been invaluable as well in what they have taught me about my body’s needs regarding nutrition.

I have realized through the months of treatment that I need to put a lot more food into my body in the course of a day than I was ever aware of, simply to get through a normal, busy weekday. Butthrowing in about 4000 feet of elevation and miles of trail, I discovered that food is, plain and simple, fuel for my body. Without sufficient amounts of food, I cannot perform. I have been at the point of tears on a trail, body exhausted. Yet after refueling I’m suddenly happy and able to continue going.
Of course, we all know that proper nutrition allows us to live and have the energy our bodies need. But it wasn’t until a hard day of hiking that I was able to see the direct correlation between food in and energy out. Easy. It was so freeing to realize that to some extent, it doesn’t matter what I put in – I need the fats, the carbohydrates, EVERYTHING, in order to do what I want to do.

But this applies to the rest of life too! Pretty much any food, in moderation, can and will be used by my body to live the active, healthy life I want to live. And in consuming every food, in a variety, I am happier. Eating what I want to eat, when I want to eat it, is less of a challenge when I acknowledge that food is fuel. End of story.

So of course, the mental battles of eating habits are there, and they may always be, but they are few and far between. And when they arise, I know how to fight them. I am committed to living a life that isn’t dictated by my food choices, but enhanced by them. And I’m getting closer!

I just finished reading "Good-bye Ed, Hello Me" by Jenni Schaefer and I am a HUGE fan.  Jenni wrote about being "in recovery" in her first book "Life Without Ed" (which is also a phenomenal book that I highly recommend).  But in this follow-up book, she talks about what life is like and what life has to offer post-eating disorder recovery.

Things I loved about the book:
Guides to developing a new identity that isn't connected to body, weight, or an eating disorder
Short chapters that can be read in 5 minutes- easy to pick up and put down
Practical self-help tools and exercises
Importance of incorporating spirituality into your recovery
Suggestions and insight for friends and family of those struggling with an eating disorder

I highly recommend this book for anyone hoping to recover from an eating disorder, those in recovery from an eating disorder, as well as family/friends who are trying to support someone through their recovery.  Happy reading!

In March I wrote a blog post about Oprah's interview with Geneen Roth.  And just last week, she had Ms. Roth on her show.  Unfortunately I missed the show but have been thinking a lot about her vow to never diet again.  And several questions came to mind:

* How many billions of dollars will the dieting industry lose now that Oprah has hopped off the band wagon?
* How many women will decide that they are tired of going on/off diets?
* If not dieting, what will Oprah have time to think about instead?
* What will happen to Bob Green, her nutritionist?
* She may not be dieting, but is she dealing with her emotional/compulsive need to eat?
* How do we define dieting and are all diets bad?
* What's the difference between dieting vs. embracing a healthy/balanced lifestyle?
* Does giving up on dieting mean total self-indulgence?

One of my colleagues noted that Oprah is heavier now that she has decided to "stop dieting."  I will just say that there is a big difference between ending a diet and actually dealing with the underlying issues of emotional eating.  Oprah may be feeling less emotional stress now that she doesn't have the stress of dieting in her life, but she will likely continue to gain weight if she isn't dealing with the triggers which encourage her to reach for food.

I fully believe that Oprah, along with anyone else who can identify with her emotional connection to food, can work through this emotionally painful stuff, learn to cope without food, and begin to embrace a much physically and emotionally healthy way of living.  

And most of us will be interested to watch her along the way. Let's hope that she is on to something permanent this time.

I spent the weekend attending the 2010 MEDA Conference: Getting Unstuck: Revitalizing the Prevention and Treatment of Eating Disorders.  The closing keynote speaker was Kitty Westin, a woman who's daughter commit suicide as a consequence of her eating disorder.  Kitty has turned her grief into activism and has committed her life to advocacy for the research, prevention, and treatment of eating disorders.

She informed us that on 4/27/10 a monumental bill called the FREED Act was introduced into legislation. The Federal Response to Eliminate Eating Disorders (FREED) Act is the first comprehensive legislative effort introduced in the Senate to confront the seriousness of these diseases by:
*expanding research
*improving training and education of treatment providers
*improving surveillance and data collection to track prevalence and severity of eating disorders
*facilitating eating disorders prevention through grants
*providing more opportunities for affordable care.

Eating disorders are devastating illness.  Anorexia has the highest mortality rate of all psychiatric illnesses and the suicide mortality rate of people suffering from anorexia and bulimia is 23 times that of the general population. As a dietitian who works almost exclusively with eating disorders, I urge you to contact your local congressman and advocate for their support of this bill. I did so and it took approximately 5 minutes.  Those 5 minutes may result in the passing of a law that radically opens doors for better research and treatment of these debilitating illnesses.

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, 
Marci

A recent randomized clinical control trial of using yoga in the treatment of eating disorders appeared in the April issue of the Journal of Adolescent Health.  The study compared traditional treatment at an outpatient eating disorder center as compared to individual yoga plus standard care.  After 8 weeks, those in the experimental group showed lower Eating Disorder Examination scores and reduced food preoccupation following the yoga sessions.  Results show yoga as a promising adjunct therapy to eating disorder treatment.

A few reasons I think yoga is great:
*Teaches you to remain in the "present moment"- a skill that is greatly needed in our busy world and an essential component for anyone looking to change their food habits or relationship with food.  Learning how to be more present in your body allows you to listen to your body's hunger and fullness cueing.
*Helps you maintain posture and flexibility with age.
*Improves balance which helps to prevent falls.
*A great way to destress

Interested in using meditation to de-stress but don't have the means or desire to go to a yoga class?  Try this 10-minute self-guided mediation at your desk!

Your neighborhood nutritionist in Cambridge,
Marci

I find immense joy in sharing my client's successes (click on the Tag "Client Spotlights" for more inspiring stories).  Here's another spotlight that gives me goosebumps.  Check out J's story of learning to surrender control and find peace with food.

Recently, I've caught myself at random times having an unfamiliar feeling: I'm no longer controlled by food; I enjoy it and the nourishment it provides.

When I went to see Marci a few months ago, I could only say these words in the abstract and imagine what it would feel like to really mean them. At the time, I had a whole repertoire of strategies to prevent myself from gaining weight, among them eating Slim Fast bars with a few real foods thrown in around them. I was afraid to eat anything else, but would catch myself binging once my hunger reached an uncontrollable level. This was my secret burden; I carried it everywhere like an old jacket that no longer fits. It was having an enormous impact on my daily life, energy level, and well being (besides not being effective in weight loss), and by the time I saw Marci I was really ready for change: The jacket had to come off.

The first thing I had to do, and the most difficult step of all, was to surrender my logic and trust in a new way of thinking about food. Eating three times a day seemed impossible, and I was afraid of gaining more weight. Nevertheless, I stuck with the program and eventually became comfortable with it. Then, I noticed little changes: I wasn't thinking about food all day long. I had the energy to go to the gym, work better, and socialize more. Even if I couldn't trust myself with food at that moment, I could trust Marci, and this got me through.

Weeks later, I did lose a few pounds. But this seemed minimal compared to the freedom I felt for the very first time in my life. It was like a new beginning. Grocery shopping was enjoyable, and the world of food looked more manageable. Although I still struggle with emotional eating, I have come farther than I ever thought was possible -- and know that, with help, others can do the same.

Finding a healthy relationship with food is a journey.  And finding supports along the way is crucial.  If you find that you are struggling more than you'd like with food- considering enlisting support from family, friends, or a professional you feel you can trust.  I'm happy to provide you with a list of referral sources for therapy or talk to you about nutrition therapy if you feel it may be helpful to you or someone you love.

Your nutrition therapist in Cambridge,
Marci