Eating disorders such as anorexia nervosa and bulimia often provide individuals with a sense of purpose; as if they are on a mission to remake themselves and finally become happy. People suffering from an eating disorder may have that inner voice telling them they will be happy if they can just lose the weight. This same voice tells a person with anorexia or bulimia that their worth is primarily measured by how they physically look. (more…)
According to research from Harvard Medical School, eating disorders such as anorexia, bulimia and binge eating, afflict more than 30 million Americans, while millions more experience disordered eating and weight control behaviors. This statistic is even more sobering when one considers the fact that eating disorders have the highest mortality rate of any psychiatric disorder in the United States. Numbers like these have real consequences on people’s health and overall quality of life. Often people are trapped in a vicious cycle of weight gain and severe dieting. In many instances, dieting does not produce permanent weight loss. Instead, it creates an unhealthy diet cycle where a person’s body weight quickly cycles up and down. What is needed is a holistic understanding of health that does not stigmatize body weight. People should focus on healthy behaviors and physical well-being instead of body weight.
The central idea behind the act of dieting tends to create problems. Extreme diets can actually damage people’s metabolism as well as their mental perception of food and eating. This means that individuals can end up in a worse place versus when they started the diet. The diet cycle can start here, with people’s weight gain and loss having a yo-yo appearance. The rise and fall of body weight creates the appearance that people are actually at war with their food (and weight). What is more beneficial for people is an active and healthy lifestyle, as well as an acceptance of their physical appearance and body weight.
When people are informed that they are overweight, there are unintended consequences. This information can reduce people’s satisfaction with their body and create other negative emotions and behavior. This is due to the fact that modern society tends to reinforce the message that “thin” is beautiful and good. People who struggle with their weight tend to also have lower self-esteem. The stigma of being overweight can help to set up a cycle for additional weight gain or the development of eating disorders like bulimia or anorexia. Individuals at all body weights often respond to stress and anxiety by eating. This emotional-induced eating will likely only encourage more weight gain. An increase in body weight can create a feeling of lower self-esteem and anxiety in a person. People quickly become trapped in an unhealthy feed back loop of weight gain and dieting.
More has to be done in order to make it safe to be a larger-bodied person. Most eating disorders are often accompanied by trauma, but body shaming and fat loathing only make these diseases worse. Actions from the fashion and food industry, as well as pop culture, almost seem to encourage eating disorders. However, attempts have been made to address the issues surrounding perceptions of physical imperfections, body weight and fat shaming. A few examples from fashion and marketing are from lingerie retailer Aerie and the increasing popularity of plus-size models. Since 2014, the ad campaigns of lingerie retailer Aerie (American Eagle) reportedly uses non-airbrushed photos of women of various body shapes and colors. Successful Fashion designer Chris Siriano has stated that there have “always been customers of different sizes since day one.” Currently, one half of Siriano’s fashion collection is made in extended sizes. These are positive steps in the right direction, but body weight fears and stigma surrounding fat is still a common occurrence.
For additional questions about the connection between body image, body weight and the diet cycle, contact the staff at River Centre Clinic. Their programs provide a full range of treatment options for children and adults with a primary diagnosis of an eating disorder. For immediate and confidential feedback, take River Centre Clinic’s EAT-26 (Eating Attitudes Test) assessment.
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Body Weight, Diet Cycle
Guest contributor: Lee R.
When asked to write this blog post, I turned immediately to my good friend Google to look up some statistics and check out the latest research. What I found, or what I did not find, was revealing, albeit not entirely surprising to me. Google Scholar turned up 1,360 results for the search “LGBT eating disorder” in the last 10 years, whereas simply “eating disorder” racked up over 59,000 hits for the same time period.
It is not clear whether or not the LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, etc.) community is underrepresented in eating disorder research, but it certainly is not prominent, appearing in only 2.3% of the research references. But that should not be interpreted as meaning that the disease does not impact the LGBTQ+ community. In fact, it’s quite the opposite.
The Trevor Project and NEDA (National Eating Disorder Association) came together in 2018 to research the prevalence of eating disorders in LGBTQ+ youth1 and the results were staggering. About 54% of the sample had been diagnosed with an eating disorder, and an additional 21% suspected they had an eating disorder due to disordered eating habits. In another study2, it was found that nearly 16% of transgender college students had been diagnosed with an eating disorder in the past year, as opposed to approximately 2.5% of their straight, cisgender counterparts.
Though the research on LGBTQ+ eating disorders is scarce, what does exist speaks volumes. Eating disorders run rampant through this community, yet it is rarely spoken about in the LGBTQ+ community itself, and even less frequently in the mainstream eating disorder treatment community. Where there is currently silence, there needs to grow a discussion on how LGBTQ+ eating disorders develop and progress, how they present, and the best treatment modalities to help sufferers receive the best care possible.
That is not to say that mainstream providers cannot appropriately serve the LGBTQ+ community. However, if providers were educated specifically on how eating disorders impact the LGBTQ+ community, there may be an even greater success rate for recovery. As a start, here are 5 things I, and a few others in the community, wish treatment providers were more aware of:
- Gender dysphoria exists and can make it difficult for a person to live in their own body. Gender dysphoria is the feeling of distress that occurs when someone’s gender does not match the one they were assigned at birth. It can often focus on specific parts of the body that society reads as one sex or another. It can result in restriction of food, compensatory behaviors, or binge eating. Providers need to be aware of gender dysphoria, because of the added complications to recovery. Poor body image or body dysmorphia is not the only physical hurdles in those who experience gender dysphoria. Additionally, gender dysphoria is not necessarily due to poor body image, though one may trigger the other.
- Internalized homophobia is also a thing that exists. Internalized homophobia refers to the prejudices that members of the LGBTQ+ community turn inward after seeing and hearing the prejudices in society. This can lead to negative views and even shame of their own sexuality. This shame and negativity can then lead to further flawed thinking and disordered eating habits.
- Language is important. Using my pronouns is not just a suggestion. While I’ll probably present it as a timid request and tell you “it’s fine” when you mess them up, my pronouns are actually very important to me. They help me feel more at peace with who I am, especially in such a tumultuous time as the beginning stages of eating disorder recovery. By using the correct pronouns for me, you not only convey that you respect who I am, you also help me build trust and rapport. Additionally, using gender-neutral language is imperative. People of all genders can have eating disorders, using female-centric language is outdated. Help everyone feel at home by neutralizing your language.
- Do not assume we are just confused. I identify as a queer non-binary person. I am not confused about who I love or what gender I am; I am completely confident in both aspects. And it is quite possible your clients will be too. When they do come out to you, know that this means they trust you. Do not insist that it’s “a phase” or that it’s due to their eating disorder. In fact, it’s likely the other way around: eating disorders often develop and progress due to minority stress, internalized homophobia, and gender dysphoria. If your client is in the beginning stages of exploring their gender and/or sexuality, do not diminish their journey by crediting the eating disorder.
- Having culturally sensitive resources available to us is so important. Whether it’s an LGBTQ+ process group, a therapist who is a member of the LGBTQ+ community, or even something as simple as gender-inclusive bathrooms, having resources readily available to us helps us feel included and heard. Knowing that a treatment team is culturally competent can be a great relief for LGBTQ+ people who may otherwise have felt like they needed to keep their identity a secret.
This list is by no means extensive; it really is just a beginning. Every client is unique, and the best way to get to know what they want you to know is to open an honest conversation with them.
I have found in my experience that the staff at the River Centre Clinic is willing to have those honest conversations with their patients. When I first arrived at RCC in 2014, I was unsure if I wanted to come out as genderqueer. I began by talking about it with several of the other patients who then encouraged me to tell the staff. Once I did come out to everyone, the support I received from the staff and my peers did not waver. The staff was willing to learn more about my identity and use the pronouns I chose. Even when I returned in 2016, they remembered my identity and treated me with the same respect and compassion with which they treated everyone else. I believe that the acceptance I received was a vital component in making my recovery as strong as it is today.
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1 – National Eating Disorder Association. (2018). Eating Disorders Among LGBTQ Youth [Press release]. Retrieved from https://www.nationaleatingdisorders.org/sites/default/files/nedaw18/NEDA -Trevor Project 2018 Survey – Full Results.pdf
2 – Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144-149.
The River Centre Clinic offers outpatient programming for children with eating difficulties. Childhood can be full of different phases and eating changes. Although this is fairly common behavior, it can leave parents feeling troubled. Disturbances in feeding become problematic when it causes the child to become upset or worry and when he or she is not eating enough to sustain proper nutrition and facilitate proper growth. Complications around eating can take many forms including but not limited to:
- Trouble with food textures/sensory issues
- Temper tantrums during meals
- Refusing to eat
- Limiting food groups
- Choking, gagging, or vomiting after eating
- Body image concerns
Although eating issues during childhood may seem to be just a frustration for parents and caregivers, there are real medical concerns including, nutritional deficiencies or a reliance on liquid supplements and vitamins. The staff at River Centre Clinic are carefully selected, not just for their experience in treating symptoms and underlying causes of eat problems, but also for their compassion and willingness to extend themselves on behalf of all clients. The staff is clinically trained in working with children suffering from:
- Selective/restrictive eating (picky eating)
- Food, choking, vomiting phobias (Functional Dysphagia)
- Lacking interest in food/eating
- Food avoidance due to sensory issues
River Centre Clinic’s outpatient therapists work with children and families to lessen the stress and anxiety surrounding mealtimes. They work closely with families to ensure that every member is part of the healing process. Many times, changes are necessary to the environment and routine that will require the assistance of parents and caregivers.
The Clinic’s Childhood Eating Problems Program is based on well-established and evidence-based therapy models that integrate individual and family therapy. The treatment is based on applied behavioral principles, enhanced cognitive behavioral principles and directive play therapy techniques, which integrate individual and family therapy and is applied in an individualized manner for each patient. River Centre Clinic treats eating problems that may be coupled with co-occurring disorders and problems, including but not limited to:
- Anger Management
- Autism Spectrum Disorders
- Behavioral Problems
- Conduct Disorders
For further information about this program, or to schedule an initial assessment, contact Anna Lippisch, MSW, LSW, Director of Childhood Eating Problems Program, at 419-885-8800.
A residential treatment program can become a safe space for many patients. It may feel scary going back to your home, job, or school. While in treatment, you have invested time working on your recovery and hopefully whatever environment you are returning to can foster a pro-recovery environment. Despite the environment, many patients have a few slips during the recovery process post-treatment. River Centre Clinic’s hope is that you have learned strategies to prevent those slips from becoming a relapse. These five tips are not all-inclusive, but they are some of the best strategies to ensure recovery.
While in treatment you have learned how to meal plan and it most likely began to feel like a normal process towards the end of your stay. However, directly after treatment, meal planning may feel inflexible. It may be tempting to not follow your plan precisely or to completely stop planning. Rest assured that you will not have to meal plan forever to maintain your recovery. While the timeline differs for each individual as to when they can stop meal planning, patients who stick to their meal plan as ordered are less likely to relapse. Be open and honest with your outpatient therapist regarding your concerns with meal planning and create a strategy that works for both of you.
Connect with your outpatient treatment team regularly.
Before you leave residential treatment, you will have hopefully connected with an outpatient therapist and set up your first appointment post-treatment. Talk to your therapist to determine who else you should connect with to create a team of health professionals that advocate for your recovery. Often a team including a therapist, dietitian and primary care physician, all skilled in treating eating disorders, are highly beneficial for post-treatment care.
Utilize your team.
Connecting with a team of skilled health care professionals post-treatment is a vital part of recovery. Just as important, is connecting with a team of friends and family. Your tribe should include people that you feel comfortable talking to about your eating disorder, meal plan and urges. Take time to talk to these special individuals about the type of support you need. Ask your therapist if you can schedule a designated appointment for your tribe to help them understand your recovery
process and how they can help.
Define one self-care ritual and stick to it!
Stress is inevitable and it can make recovery more difficult. But you can combat stress by taking care of yourself and incorporating self-care into your daily routine. Self-care can look different depending on the individual. Do you enjoy reading, a nice hot bath, journaling, listening to music, meditation? These types of activities can be incorporated into your routine to help manage stress.
Know the difference between a slip and relapse.
A slip usually happens suddenly and may take you by surprise. Maybe you were having a particularly busy day and realized at 4:00 p.m. that you missed your afternoon snack. If you’re able to get right back to your planned meals and squeeze in the missed calories, consider that a slip. While a slip is still a setback, it’s much more minor than relapse. Relapse is when a slip turns into consistent eating disorder behaviors. To prevent this from happening, acknowledge a slip if it occurs. Call someone in your tribe or your therapist, if you are able to, so that they can help prevent guilt and shame that you may feel from your slip. These feelings will only exacerbate the problem. Focus on the progress you have made and brainstorm
solutions to prevent a future slip.
Make your own stoplight list.
How will you know when you are falling back into old eating disordered habits? By creating a personalized red, yellow and green flag list with the help of your therapist, you will have a written set of guidelines which will help you to recognize when you need to reach out for assistance. Look specifically at your own personal relapse cues and recovery behaviors and create a comprehensive list. Being sure to identify high-risk indicators that you are doing poorly (red flags), warning signs that you are slipping back into old habits (yellow flags), and signs that you are living a recovered lifestyle (green flags) is integral to keeping on track. Be sure to include both physical and emotional indicators of each.