Category Archives: Eating Disorders

5 Things About Binge Eating Disorder Perhaps You Didn’t Know

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At the Austin Eating Disorder Specialists  professional group  meeting in November I had the pleasure of hearing Dr. Susan C. Mengden, the co-executive director of the Eating Disorder Center of San Antonio, present on “Treating Binge Eating Disorder in an Intensive Outpatient Setting”.  She offered some good reminders about Binge Eating Disorder that I would like to share:

1.  Binge eating disorder (BED) is the most common type of eating disorder.  It affects men and woman almost equally.  External risk factors for BED, according to Dr. Mengden include physical/sexual abuse, bullying, family dynamics and poor self-esteem and/or shyness.

2.  Up to 30% of those seeking weight loss services most likely meet the criteria for binge eating disorder. Weight loss or weight loss surgery does not cure binge eating disorder.  Before any type of weight loss is considered the binge eating disorder must be dealt with or weight loss is almost impossible.  If you feel that you may have binge eating disorder, consider getting screened for it and don’t try to diet your way out of it—most likely dieting will make the BED worse.

3.  Anger and anxiety is are the predominant emotions that lead to binge eating.  That is, anger and anxiety are the emotions that most often trigger binge eating episodes.  I like to remind clients that eating disorders are functional.  That is, there is some benefit that the sufferer is getting out of doing the eating disorder behaviors.  Eating disorders are not due to lack of will power on the sufferers’  part.  Overeating helps, short-term, soothe uncomfortable emotions.

4. Restriction is often common in binge eating disorder.  Usually with those who struggle with binge eating have chronically dieted and tend to diet (or restrict food) on a regular basis.  Restriction is well documented to exacerbate binge eating (Can’t mess with biology!) and food restriction can lead to increase anxiety (see #2).

5.  Body dissatisfaction is present in almost all cases of binge eating disorder regardless of body size.  Body dissatisfaction and the drive for thinness usually leads to dieting.  Improved body image is needed to help in the recovery from BED.

To learn more about Binge Eating Disorder go to:

Binge Eating Disorder Association

National Eating Disorder AssociationContinue reading→

An ED Professional’s Opinion on FDA’s Requiring Calories

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Food LabelingI feel so so very torn about the FDA’s new requirement of putting calorie counts on menus of restaurants, movie theaters, amusement parks, etc…..I do not recommend people tracking their calories to regulate their weight or for health reasons as it gets us away from eating intuitively.

Calorie counting promotes dieting behavior (which we know doesn’t work for long term weight regulation).  Dieting is a known risk factor for developing an eating disorder (ED).  And calorie counting may exacerbate eating disorder symptoms in someone who is in recovery from an ED.

And to my knowledge, the jury is still out if putting calories on menus is helpful in improving overall health.

On the other hand, I do think we need to improve the quality of our food in this country in order to promote the health of our nation and our environment.  I wonder if requiring food establishments to be transparent about calories, if it would force the food companies to improve overall food quality???

I am the first one to admit I don’t have the answer to our dilemma, but I do feel like Life Time Fitness may be onto something here…  In their magazine, Experience Life, in their recipe section they do not include nutrition information (calories, carbohydrate grams, etc.) . Unlike other popular “health magazines”.

Not only does Experience Life magazine exclude nutrition information of their recipes, they go the extra mile and provide a health promotion message instead.  Here is their explanation as it appears in their recipe section of the magazine:

“Why No Numbers?

Readers sometimes ask why we don’t publish calories, carb and fat counts with our recipes.  We believe that if you’re eating primarily whole, healthy foods (array of sustainably raised vegetables, fruits, nuts, seed, legumes, meats, fish, egg, whole-kernel grains, and healthy fats and oils), you really don’t need to stress about the numbers (which are often inaccurate or misleading anyway).  We prefer to focus more on food quality and trust our bodies to tell us what we need.”

Sounds good to me.  Folks what do you think????

Eating Disorder Prevention: Lessons learned at NEDA

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NEDA Conference

Last week I attended the National Eating Disorder Association’s (NEDA) annual conference in San Antonio.  I have attended many professional conferences on eating disorders, but NEDA’s was unique.   Attendees and presenters included professionals who treat clients with eating disorders, eating disorder prevention specialists and those who have been affected by eating disorders (individuals that are at different points in their recovery & family and friends of loved ones with an eating disorder).

I attended several different sessions ranging from binge eating disorder, media & eating disorders, eating disorders in midlife to name a few.  I wanted to share the with you two important points about eating disorder prevention that I learned:

1.  Resources (money, people) are the largest barrier to implementing eating disorder prevention programs.  There are genetic risk factors that contribute to the development of eating disorders (being female is one example).   And there are modifiable risk factors such as body dissatisfaction and dieting.

Eating disorder prevention programs obviously target the modifiable risk factors in order to prevent some eating disorders.  An example of an evidence based eating disorder prevention program includes: The Body Project  which aims to reduce the drive for thinness in adolescent and college age females.

Want to become more involved in the prevention of eating disorders?  Check out these resources: National Eating Disorder Association  and Eating Disorders Coalition .

2.  Obesity and eating disorder prevention programs could be combined to help reduce eating disorders and help improve health.  While there are plenty of obesity prevention programs in schools and in other public and private health arenas, eating disorder prevention is rarely included.  As I reflect on my own community here in Austin, I am not aware of obesity prevention program that also include an eating disorder prevention component.

Could the “war on obesity*” cause unintentional harm–exacerbate eating problems (including weight regulation) and eating disorders in some people?   Most likely yes.  Let’s take a look at caloric restriction (dieting) which is commonly promoted to help reduce obesity.  Dieting is linked with an increase risk of eating disorders in youth (Haines et al 2010, 2007; Field et al 2003).  Dieting has been linked with an increase in binge eating and can increase the risk of weight gain.  Furthermore, there is little to no evidence that dieting works to regulate weight over ones lifespan in the obese population.

In the spirit of “do no harm”-obesity and eating disorder prevention programs should be developed and executed together.  Prevention programs that promote good nutrition while allowing for a variety of foods, family meals, fun physical activity, promotion of size acceptance, positive body image, etc.  mostly like help with weight regulation and help prevent some eating disorders. Prevention programs should discourage dieting and weight shaming.

 *There are so many things that make me uncomfortable with the “war on obesity”.  I would need to write a whole other blog post to list all the injustices and wrong information associated with the “war on obesity”.  I use the term here “war on obesity” in this post because, unfortunately, it is familiar language in our culture.  To read more info about myths associated with obesity and the ” war on obesity” please check out Health at Every Size.  To learn more about weight stigma click here.

Ditch the Diet

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Dieting can make our eating problems worse.

Q:  I can lose weight on diets, but then I get off track.   I gain even more weight back than I lost.  This has happened several times.  I am tired of this.  What do recommend?

A:  Weight cycling (losing/gaining of weight) is a common pattern seen with chronic dieters.  It can leave dieters feeling frustrated and hopeless.   And ultimately feeling like a failure.  I believe that diets fail, not the people who follow them.  Diets fail because they usually don’t give us all the tools to be successful.  Diets are really good at telling us what to eat and what not to eat–setting food rules.  Some diets can be good at telling us how much to eat.  But, diets don’t usually teach us to monitor our internal cues for hunger and fullness, how to eat at restaurants or parties, how to deal with emotional eating or binge eating, how to be flexible with food, take into consideration our food preferences, how to feed our families, etc.

There are many studies to support that dieting works–for awhile–but there isn’t much data to show the effectiveness of dieting with long-term weight loss.   The dieting industry makes billions of dollars promoting their diets, pills, plans, etc.  Well meaning health care professionals encourage patients to diet, which can often add fuel to the fire.  Studies also show that dieting can increase the risk of eating disorders.

So what is a dieter to do?  I encourage a more holistic approach.

1.  Take stock in why you want to lose weight.  Make a list of all of the reasons why you want to lose weight-health (be specific), looks, increase self-confidence, moving around easier, etc.  Body weight is part of all of these-health, looks, self-confidence-but not all of it.  Let’s take health for example.  There are many ways to improve health-physical activity, eating nutrient dense foods, getting enough rest, etc.   I encourage people to focus on all areas in order to meet their health goals not just weight loss.

2.  Assess your eating style and rule our an eating disorder.  According the Binge Eating Disorder Association, 30-40% of people seeking commercial weight loss services in U.S. meet the criteria for Binge Eating Disorder the most common type of eating disorder.  Click here for a free and confidential eating disorder assessment tool.

Here are some questions to help assess your eating style:  Are you a grazer?  How many meals do you eat per day?  Do you eat while distracted (working, watching TV, on devices)?   What type of food do you eat most often?  What types of foods do you like best?  How often to you go to the grocery store?  How often do you eat out or away from home?   Do you know when you are hungry and when you are full?  Do you eat when not hungry?

Once familiar with your eating style, it makes it easier to target behaviors you want to change in order to meet your goals.

3.  Mindful Eating.  Mindful eating is eating when you are hungry and stopping when you are full, eating all types of food (not just diet foods), taking both health and pleasure when considering food choices and eating without distractions.  Once you have become clear about why you want to lose weight, have become familiar with your eating style (and ruled out an eating disorder) then begin to practice mindful eating.  Be patient with yourself, changing eating habits take time.

Are you feeding your feelings?

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Emotional OvereatingCompulsive overeating, food addiction, binge eating, yo-yo dieting, disordered eating–what does it all mean.   Finding clarity on what particular food problem you have helps inform what that best way to treat it.  In my last few posts I have highlighted two great groups available in the Austin Area for those who struggle with emotional overeating eating.  Today I am going to clarify what emotional overeating is.

Simply put emotional overeating is habitually eating in response to emotions–all kinds-happy emotions or distressing emotions-when not physically hungry.  Often the assumption about emotional eating is that there is a marked stressful event (trigger) and then the eating occurs.  For example, you get chewed out by your boss and then proceed to eat a bowl of candy to deal with feelings of shame, frustration and anger.  Often emotional overeating is more subtle, occurring more covertly.   And more often then not, there isn’t a clear trigger.  Emotional overeating could look like when you are at work or studying and you find yourself snacking, though you are not hungry.   Feelings associated with this situation could be boredom, frustration or fatigue.  Evening time is common time when emotional eating can occur-fatigue or worry may be festering at this time (Perhaps feeling stressed by the incident with the boss that happened earlier in the day.).

The defining elements of emotional eating is habitually eating when not physically hungry in the presence of aroused emotions.  Part of normal eating is eating when not hungry, but  it crosses over into emotional overeating when it is the rule not the exception.  Emotional eating is not a diagnosis per se, but can be a component of an eating disorder such as binge eating disorder or bulimia nervosa, etc.  One doesn’t have to have an eating disorder to emotional overeat. But, emotional overeating can lead to feelings of helplessness, failure, shame, etc.  Emotional overeating can lead to preoccupation with weight/shape and food.  Emotional overeating can lead to unwanted weight gain, but not in all cases.

If you think you may struggle with emotional eating self-help books, groups and/or counseling can be helpful.

 

 

 

Weight Stigma Awareness Week

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BEDAIt is coming September 22-26th, 2014…Weight Stigma Awareness week sponsored by The Binge Eating Disorder Association!  According to the on-line Merriam-Webster dictionary stigma is defined as “a set of negative and often unfair beliefs that a society or group of people have about something”.

Weight stigma is wide spread through our culture.  It shows up as bullying, verbal assaults and exclusion to name a few.  Weight prejeduce can arise in areas such as employment/occupation, education and health/mental health care.

Weight stigma often is internalized by individuals which can lead to shame, hopelessness, isolation, etc.   Studies suggest that weight bias may actually INCREASE the likelihood of obesity, binge eating and staying obese.   According to the Rudd Center for Food Policy and Obesity, family members are one of the biggest sources of weight bias.  In one study of over 2400 overweight and obese women, 62% of the study participants reported that on multiple occasions they had been stigmatized by their families because of their body weight.

Ways to Reduce Weight Stigma

1.  Get educated on the complexities and causes of obesity.  It is not as easy as calories in and calories out.

2.  Understand that improving ones health can include a multitude of things, such as eating a nutrient dense foods and exercising, not just being thin.

3.  Challenge bias attitudes.  Speak-up.  Don’t just let gossip or criticism about someone’s body weight go unchallenged.

4.  Treat people of all sizes with fairness.

5.  Support media sources such as magazines, TV programs, blogs, etc. that focus on size acceptance vs. fat bashing.

6.  Take stock in your attitude about your own body.

7.  If you are a parent and you think your child may be experiencing weight bias go to the Rudd Center for Food Policy and Obesity.  They have lots of good information about how to talk with your child about it.

The Binge Eating Disorder Association (BEDA) has lots of great on-line event during Weight Stigma Awareness week including featured bloggers, social media events and tool kits.  To learn more click here.