Anorexia Nervosa: One Size Does NOT Fit All

Posted on February 18, 2021February 18, 2021 by Alison Pelz, LD, RD, CDE, LCSW

Unfortunately, there are many incorrect assumptions associated with eating disorders. One I see a lot is the assumption that in order to have an eating disorder, particularly anorexia nervosa, one has to have very low body weight.

This is simply not true.

Sadly these assumptions block those suffering from eating disorders from getting the life-saving treatment they need.

In fact, most people with eating disorders don’t necessarily fit neatly into an eating disorder category.

Eating disorders are more about how the person relates to food, exercise, and body than what a person looks like.

Let’s take a closer look at an eating disorder called “Atypical” Anorexia Nervosa (AAN). I put the word atypical in quotes because it is my understanding that more people suffer from AAN than anorexia nervosa, so there is really nothing atypical about it. Basically, AAN is the same as anorexia nervosa with one exception – those with AAN don’t meet the criteria for being underweight like those suffering from anorexia nervosa. In fact, some with AAN may live in a large body.

Symptoms of ANN are exactly the same as anorexia nervosa. AAN includes significant caloric restriction, intense fear of gaining weight, and overvaluation of body size and shape (ie. evaluating self-worth based on weight and shape).

Typical signs of Atypical Anorexia Nervosa could include:

Extreme concern about weight and shape
Preoccupation and worry about food
Restriction of total calories consumed
Avoidance of eating certain types or categories of food
Avoidance of social situations that involve food
Misuse of exercise or overexercising.

Often the assumption is that only white, young, female, and very thin people experience eating disorders. Because of this assumption, many eating disorders go undiagnosed. It is not uncommon for people with eating disorders, particularly those who live in large bodies, to get prescribed weight-loss diets which actually makes the eating disorder worse.

Is AAN as dangerous or serious as other eating disorders?

All eating disorders can be harmful to both physical and mental health. Eating disorders can be associated with isolation, rigid thinking, poor self-esteem, anxiety, depression, poor focus, and sleep disturbance.

What to do if you think you have an eating disorder:

Because of the abundance of misleading and harmful nutrition, weight, and exercise information, sufferers of eating disorders are often led to believe that they can recover from their eating disorder on their own. Sadly, this often prolongs the eating disorder and the suffering. If you think you have an eating disorder, here are some next steps to take:

Find a treatment provider who has experience in treating eating disorders.
Find a therapist and/or dietitian. This can be a good place to start. In your search make sure the clinician has expertise in treating eating disorders.
Read about eating disorders.
Listen to podcasts.
Know that recovery from eating disorders is possible!

If you’re looking for more support in eating disorder recovery, I can help you make peace with food and your body. Drop me a note today.

5 Reasons not to Diet in 2021 (or Ever)

Posted on January 13, 2021January 12, 2021 by Alison Pelz, LD, RD, CDE, LCSW

Unless you are taking a break from social media and the news, you most likely have been bombarded with messages about dieting and weight related New Year’s resolutions. Diet programs are promising the magic bullet for good health and weight loss in the New Year.

Maybe this year you are re-thinking your New Year’s resolutions. Perhaps you are beginning to notice that dieting is taking up too much space in your life or you are tired of worrying about what you eat or what you look like. It could be you are looking to “get off the diet roller coaster” permanently and heal your relationship with food and your body.

If you are ready to give up dieting, you’re not alone. Consider these five reasons to quit dieting for good:

1. Dieting for permanent weight loss is ineffective.

While dieting can be effective for weight loss for some, usually weight loss is short-lived. In fact, scientists have little to no evidence to show that dieting is an effective means for keeping lost weight off. Maybe you haven’t been able to stick to your diet. It is not you, it is the diet. Diets are nearly impossible to follow for the long term. And then when diets are “broken”, it leaves the person feeling bad about themselves and disconnected from their body, doing more damage than good.

2. Dieting is a known risk factor for developing disordered eating or a full-blown eating disorder.

The causes of eating disorders are complex and can be caused by a range of biological, social, and psychological factors. Researches have identified that dieting is a risk factor for developing an eating disorder. The majority of clients that I treat with an eating disorder have had experience with dieting, usually motivated by body dissatisfaction. Dieting can contribute to more problems with your relationship with food instead of solving them.

3. Dieting can wreak havoc on your mental health.

Diets often promise control over food and even our lives. Starting a new diet can even feel exhilarating. But, have you ever noticed when you are dieting you spend more time thinking about food? Or you begin to feel out of control around food, maybe experience binge eating-like behavior? You may even avoid certain social situations in order to stay on the diet.

Additionally, when a “diet rule” is “broken” (not because of laziness or lack of willpower on your part—remember, clinical studies show that diets can’t be followed long term), you might experience increased feelings of shame, loss of control and failure. These feelings can drive us further from self-care and contribute to a poorer relationship with food.

4. Diets reinforce weight bias and stigma.

Weight bias and stigma are just what they sound like- discriminating against people based on their body size, usually large body size. Diets inherently send the message that large or fat bodies are “bad” or “unhealthy”, which reinforces fatphobia. It is well documented that rates of weight bias and stigma are on the rise. In fact, weight stigma and bias happen at higher rates than discrimination based on age or gender. Weight bias and stigma can affect physical and mental health independent of body size in various ways, including an increase in stress, poorer mental and physical health, and can contribute to problematic eating behaviors independent of body size. To read more about weight-bias and stigma, click here.

5. Diets often de-emphasize other determinants of health.

You have probably heard the saying, “You are what you eat”. This couldn’t be further from the truth. What and how we eat may be one part of our health, however, there are multiple factors that contribute to health. There are several determinants of health including genetics, economic status, environmental and physical influences, medical care, and social factors. Diet programs often give the illusion that by eating in a particular way you are guaranteed good health, often neglecting other health factors.

These are just a few good reasons to ditch dieting. However, you may be thinking, “Now what? How do I not diet? How do I feed myself?”. These are common and valid questions. If you have been dieting on and off for years or have an eating disorder, navigating food in our society that is steeped in diet culture can be confusing and downright daunting.

Here are some resources to get you started on learning how to improve your relationship with food and your body:

If you’re looking for more support as you make peace with food and ditch the diets for good, I can help you learn to trust your body and learn to feed yourself again. Get in touch today!

Diet Culture, COVID-19, and Weight Stigma: 2020 in Review

Posted on December 16, 2020December 15, 2020 by Alison Pelz, LD, RD, CDE, LCSW

At the end of every year, I like to put together a post that collects everything I’ve published on my blog over the last year. And what a year it’s been. This year is nothing like we imagined it would be. We have lost almost a year of being with family and friends, experiencing new things, and living our ‘normal’ lives. If you’re feeling grief about this year, the lives lost and changed, and what could have been, you’re not alone.

This year has been hard, sad, lonely, scary, weird, and pretty much any other adjective out there. It can be hard to hold space for all of those things at once, so be gentle with yourself as you work through your feelings about 2020.

Here’s what I wrote about this year:

This year, I wrote a lot about the COVID-19 pandemic and how that interacts with folks in eating disorder recovery.

When things get hard, communities thrive. The eating disorder recovery community is more important than ever with many of us isolated and unable to connect with other ED survivors in real life. I wrote about 5 Ways to Stay on Track With Eating Disorder Recovery During COVID-19, Virtual (and Free) Eating Disorder Support Groups During COVID-19, and Coping With COVID-19 and Eating Disorder Recovery: Tips for College Students.

Rejecting Diet culture

One of my favorite ways to learn about rejecting the diet mentality is through podcasts! I put together a list of my top podcasts to help you break free from diet culture. (I also included a tip for how to find anti-diet resources: “It’s easy to be wary of what you find related to body positivity and anti-diet resources, since the movement has been flooded with people trying to cash in without spreading the actual message of the anti-diet movement. When looking for a trusted resource online, make sure that they mention on their website (hopefully prominently!) that they believe in dismantling diet culture, center larger bodies, and don’t mention weight loss anywhere on their site.”

Eating Disorders

Eating disorders are a complicated subject. One of my goals is to help people challenged with ED and other food & weight-related concerns to move from constantly worrying about food and their weight to being free to create the lives they want. The first step here is understanding what eating disorders actually are. To help, I discussed 3 Important FAQs about Binge Eating Disorder on the blog. While some of us understand the basics of eating disorders and anxiety on our own, it’s rare to see a blog post connect the two and tell you what you need to know if you’re living with an eating disorder and an anxiety disorder. I wrote about frequently asked questions related to eating disorders and anxiety to share what I know!

Weight Bias + Stigma

Weight bias is everywhere we look in our culture. It’s led to systematic discrimination of larger bodies in many areas of life – medical care, job opportunities, social interactions, to name a few. So many folks railing against people in larger bodies don’t realize that what really causes negative health outcomes is a result of stigma, not a result of having a larger body, so I wrote about how weight bias and stigma are the real hazards to health, not body size.

If there are any topics you’d like me to cover in 2021, let me know! You can message me here. If you’re looking for even more resources, make sure you’re following me on Facebook and Pinterest!Every week, I share resources from myself + other experts in the field on both platforms!

FAQ: Eating Disorders and Anxiety

Posted on December 2, 2020December 1, 2020 by Alison Pelz, LD, RD, CDE, LCSW

It is normal to feel worry and fear from time to time. We all have experienced worry before a big test at school, a deadline at work, or a big event. Anxiety is a normal part of life. In fact, fear can help us stay safe by alerting us to possible danger, and a little bit of worrying can be motivating for some to take care of tasks. However, if you frequently feel and have intense worry, this could be an indication of an anxiety disorder.

Q: How common is anxiety?

A: Anxiety disorders are the most common mental health conditions. It is estimated that worldwide, more than 264 million people have anxiety, and about 40 million Americans have it. Anxiety is more common in girls and women than in boys and men. There are different kinds of anxiety disorders including generalized anxiety, obsessive-compulsive disorder (OCD), panic disorders, phobias, and post-traumatic distress disorder (PTSD), to name a few.

Q: How do I know if I have an anxiety disorder?

A: The short answer is: Talk to your doctor to help determine if you have an anxiety disorder.

Let your doctor know if you experience any of these common symptoms of anxiety, including excessive and uncontrollable worry, feelings of nervousness, restlessness, and tension, trouble sleeping, gastro-intestinal upset, sweating, trembling, rapid heart rate, or a sense of panic or impending doom. Again we all experience anxiety from time to time, but if you frequently experience some of the symptoms above, it may be time to talk to your doctor.

Q: I have an eating disorder and I think I have anxiety. Can you help me with both?

A: Studies show that 50-80% of people who have an eating disorder also struggle with anxiety. It is not always clear which comes first – the eating disorder or anxiety – or if the anxiety and eating disorder emerged roughly at the same time.

Anxiety usually makes the eating disorder symptoms worse, so it must be treated simultaneously with the eating disorder.

It is standard in eating disorder treatment to also treat co-occurring conditions whether it is anxiety, depression, or another condition. Many therapies or methods used to treat eating disorders can also be used to treat anxiety.

Q: How is anxiety treated?

A: Anxiety is very treatable. Anxiety disorders can be treated with psychotherapy as well as medication. I use Cognitive Behavioral Therapy to help treat anxiety and eating disorders. In a nutshell, Cognitive Behavioral Therapy (CBT) is a well-studied treatment that proposes that thoughts, feelings, and behaviors are interconnected and greatly influence one another.

CBT helps identify and challenge thoughts that are distorted or inaccurate that often lead to intense and pervasive feelings such as anxiety and depression.

Practicing CBT skills with “homework” between counseling sessions is something that I use regularly with clients. It has been my experience that clients like to have tools that they can use outside of sessions to help them manage their anxiety and eating disorder, plus it can speed up treatment the more the skills are practiced.

To learn more about anxiety and treatment here are some resources to get you started:

If you have started to notice that your anxiety is getting in the way of your normal functioning, it may be a good time to talk to a therapist. Get in touch here!

Weight Bias and Stigma: The Real Hazards to Health

Posted on October 21, 2020October 20, 2020 by Alison Pelz, LD, RD, CDE, LCSW

Privilege disclosure: I am aware of and acknowledge my privilege as a white, cisgender, heterosexual, thin, and able-bodied person.

What are weight bias and stigma?

Weight-based discrimination is just what it sounds like. It is discriminating against people based on their body size, usually large body size. Other terms used to describe it include fatphobia and sizeism. It is well documented that rates of weight bias and stigma are on the rise. In fact, weight stigma and bias happen at higher rates than discrimination based on age or gender.

Furthermore, weight bias and stigma are socially acceptable and are reinforced in the media through the negative portrayal of those living in large bodies.

Weight stigma and bias are present in most aspects of life including education, business, and healthcare. The effects of weight bias and stigma on physical and mental health are the focus of this post.

Weight bias and stigma can affect physical and mental health independent of body size in various ways:

Increased stress.

Experiencing weight bias and stigma increases chronic stress levels. Chronic stress has been shown to increase the risk of cardiovascular disease and other physical ailments. Additionally, chronic stress can wreak havoc on our mental health and general well-being.

Poorer healthcare treatment.

It has been well documented that weight bias and stigma are pervasive in our healthcare system. Studies show that the most frequent source of weight bias is family and the second most frequent source is healthcare providers. People who experience weight bias and stigma often have a negative experience at their doctor’s office, which often leads to avoidance or putting off medical care, including preventative health screenings.

Often-times large bodies are not assessed the same way thin bodies are, and body weight is blamed for every ailment. I have heard countless stories from clients about the poor healthcare they received. For example, a patient might seek medical attention because of a sore throat, but their body weight is discussed or been pointed out as the problem. (This would not happen to people who are in what the medical community refers to as a “normal-sized” bodies.)

Poorer mental health.

Studies show that weight bias and stigma, independent of body size, can contribute to increased vulnerability to depression and anxiety, poor body image, decreased self-esteem, and increased suicidality.

People who live in large bodies may experience internalized weight bias, meaning that they believe that the stereotypes about them are true. Internalized weight bias can lead to negative feelings about oneself and contribute to poorer mental health.

Additionally, eating disorders often go undiagnosed in people with large bodies because they “don’t look” like they have an eating disorder. People in large bodies do get and are at risk for eating disorders. Furthermore, diets are often prescribed to people in large bodies, which is a known risk factor for developing an eating disorder and exacerbating existing eating disorders.

People living in large bodies are also at high risk for bullying and teasing which also negatively impacts mental health.

Increased problematic eating behaviors.

People who live in large bodies are prescribed weight-loss diets in efforts to “improve health.” There are several problems with this approach.

First, there is little research that dieting is an effective treatment for long-term weight loss.

Second, weight is highly determined by genetics and is not as modifiable as the healthcare system or diet programs lead us to believe.

Third, a larger body does not indicate poorer health.

Fourth, dieting is a known risk factor for problematic eating behaviors such as binge eating, dietary restriction, purging, and even full-blown eating disorders.

Unfortunately, weight bias and stigma are rarely discussed in traditional medical and mental healthcare settings, further perpetuating them. Weight bias and stigma continue to reinforce the idea that large bodies are unhealthy with little to no data to back this up. What we do know for sure is that weight bias and stigma themselves, independent of body size, contribute to poorer health outcomes.

If you are experiencing weight bias and stigma (or want to learn more about it) here are some great resources:

If you are a healthcare provider here are additional resources to consider:

Michelle May, MD and Jennifer L. Guadiani, MD (Both provide training on weight-inclusive care.)
Project Implicit (Help assess implicit bias.)

For more resources on weight bias + stigma, intuitive eating, and anti-diet culture, sign up for my newsletter!

Coping With COVID-19 and Eating Disorder Recovery: Tips for College Students

Posted on September 23, 2020September 22, 2020 by Alison Pelz, LD, RD, CDE, LCSW

Let’s face it – starting a new year in college during the COVID-19 pandemic is rough. College life looks much different than it used to, with virtual classes and less socializing, to name a few things. If you add an eating disorder into the mix, it can make starting the semester feel downright daunting.

If your eating disorder symptoms have increased since the pandemic started you are not alone. Eating disorder behaviors are a way to manage and cope with stress, so more stress can equal the exacerbation of eating disorder symptoms.

Furthermore, the nature of physical distancing can lead to feelings of worry, sadness, hopelessness, and loneliness which also can trigger eating disorder behaviors, including dietary restriction, purging, binge eating, and overexercising.

Starting a new semester (or starting college for the first time) is associated with many “positive feelings” and excitement. However, along with these positive feelings, students may experience feelings of isolation, worry, and sadness, again exacerbating eating disorder symptoms.

Remember it is normal to be experiencing more stress, worry, and sadness during the pandemic. However, there are tools that you can use to manage your feelings.

Below are some tips to help you cope with stress, the pandemic, and your eating disorder:

Keep connected with your treatment team.
- Whether you are doing treatment in person or virtually, keeping regularly scheduled appointments is key to keeping your eating disorder recovery on top of the priority list. If you feel like you need more support during this time, ask your team about more frequent visits and/or attending virtual groups. To learn more about eating disorder treatment teams or how to get treatment, click here.

Stay social.
- College with a side of COVID can be very isolating especially if you participating in virtual learning. It is not uncommon to experience an increase in loneliness. Social connection with family and friends can help reduce feelings of loneliness, sadness, and worry. Keep socializing in whatever way feels safe to you a top priority.

Make time for hobbies and other coping skills.
- Coping skills and hobbies can help manage stress and uncomfortable feelings such as worry, sadness, and anger. Healthy coping skills are activities that you can help you positively manage stress. These can include talking with a friend, spending time outside, playing with a pet, reading, cleaning, doing a puzzle, praying or meditating, or volunteering, to name a few. Hobbies such as crafting, art, photography, and the like can also help reduce feelings of stress.

Keep a routine.
- Having a routine can help reduce stress levels by adding structure and organization to your day, even during the pandemic. Having a general—but not rigid—routine around eating, sleeping, socializing, and studying can be helpful in your recovery from your eating disorders and generally improve mental health.

Remember that it is normal for eating disorder symptoms to increase during times of stress, and the COVID-19 pandemic is a very stressful time. By practicing the tools above, you can learn ways to reduce your stress and continue with recovery.

If you would like to learn how I help clients manage stress or you need help in your eating disorder recovery, please click here to schedule a free 15-minute phone consultation.