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.

5 Week Mindful Eating Meal Support Series

  • posted by Marci Evans
  • Thursday, January 12, 2017


    Is working on your relationship with food a part of your goals for 2017?

    Marci RD Nutrition is offering a 5-week meal support series with

    eating disorder and Intuitive Eating expert Sarah Patten. Details below!

     

    Who should consider participating?

    Anyone actively working on their eating disorder recovery as well as those focused on improving their relationship with food, re-learning their body's hunger and fullness cues, and developing self-trust around consuming challenging or “forbidden” foods. Participants must be appropriate for an outpatient level of care and must be working with an individual therapist and dietitian.

    Groups will be led by Sarah Patten, a registered dietitian, eating disorder expert, and Intuitive Eating specialist with Marci RD Nutrition.

    What we offer:

    A five-week meal support series focused on consuming adequate and challenging meals in a supportive group environment.

    Our first group will consist of introductions, an orientation to the keys of effective exposures, as well as personalized goal setting. YOU decide how to best utilize exposures in the groups to follow. The remaining four weeks will consist of mindfulness based eating exercises, dining together as a group, and post-meal processing.

    When will the group be held?

    Tuesday evenings from 7-8:15pm; 1/24, 1/31, 2/7, 2/21 and 2/28 (we will skip Tuesday, 2/14)

    Where we will meet:

    Marci RD Nutrition Counseling Office

    22 Hilliard St., Cambridge, MA 02138

    1st floor, door on the right

    Why join our group?

    Exposure to challenging meals in a supportive environment fosters greater self-trust while decreasing fear and anxiety over time. Food avoidance is a big risk factor for relapse and can hold one back from making peace with food once and for all. This group will help you to become more confident in your ability to feed yourself in an adequate, varied, and enjoyable way.

    Cost:

    $225 total ($45/group x5 weeks)

     

    In addition to the weekly support from Sarah and the other group members, you will leave this group with a toolbox of resources to take with you!

    Important registration information:

    Group size is limited to 6 participants. Contact Sarah at Sarah@MarciRD.com to reserve your spot. Your spot will be officially reserved once payment is received in full. Registering for the full series is required. We will not accept partial registration.

     

 

 

Body Positive & Weight Loss

  • posted by Marci Evans
  • Thursday, October 27, 2016

 

Body Positive. It seems to be a term that’s getting a little more press these days. As a self-described “body positive dietitian” you’d think I’d be thrilled! Truthfully, I’m conflicted. I’m conflicted because “body positive” began as a term used to promote body inclusivity, meaning all bodies (fat, thin, short, tall, able-bodied or not) deserve respect AND don’t need changing. Yup, body positive means I’m going to take good care of my body just as it is today and love it fiercely, without any agenda of making it look different.


And now, “body positive” has been swallowed whole, contorted, and used by every weight loss agenda out there. Just as I’ve seen Special K try to trick you into the idea that they want you to love your body as it is (nope they want you to eat it twice a day as part of some stupid diet scheme so their stock prices soar, hate to break it to you, they don’t actually care about your health and well-being), dietitians are hashtagging their instagram posts with #bodypositive #weightloss.

 

Let me say it loud and clear. NO NO NO NO. Body positive is not loving yourself thin. That is a big load of BS which I refuse to eat for breakfast or let slide in my Instagram feed without saying anything.

 

To me, Body Positive means I make choices that serve my overall health and well-being from the inside, not the outside. Body Positive doesn’t worry whether improved self-care results in weight loss because every body is different. Sometimes improved self-care leads to body changes and sometimes it doesn’t. Body Positive is about being your own unique self, not making changes to make yourself look like every other idealized image we’re forced to contend with. Body Positive is expansive and inclusive, not reductionist or “better than.” Body Positive is an experience, not a number.

 

So the next time you wonder whether or not Body Positive and a weight loss agenda can co-exist, you can hear me say “No.” Body Positive is inherently weight neutral. Those of us in the Body Positive movement have so much more on our minds than the number on the scale.