Are You Pretty? Appreciating Your Body and All You Are Worth

Ok, I admit it. My last post was hardly uplifting. Frightening? Sure. Honest and to the point? Definitely. Necessary? Absolutely! It's my hope that it gave those of you who needed it a giant kick in the butt; that it helped you to recognize your own risk, by looking at Andrea's story. That perhaps it got you thinking about increasing your accountability and moving toward better self-care.

But it certainly didn’t leave you empowered to think more positively about your self, I suspect. So I'll try to remedy that with a couple of fabulous videos brought to my attention by the very same Doris Smeltzer, MA from Andrea's Voice http://www.andreasvoice.org. She brought me to tears (in her presentation about her daughter's life, and then death, from bulimia), but left me smiling in the end, empowered by these two awesome clips.

Please take the time to view them and share them with everyone you know. The first is of Eve Ensler, of Vagina Monologue fame, entitled Love Your Tree. 

http://www.youtube.com/watch?v=UEUsbLNAfW0

I simply loved this perspective on viewing your body.

The second is of Kate Makkai, a poetry slammer doing Pretty . http://youtu.be/M6wJl37N9C0

It's powerful in both its content and its delivery. I love the messages. 

Share these messages with your friends, your daughters, and most importantly, make them your own and take them to heart. And let me know what you think!

Eating Disorder Denial. Missing the Big Picture Isn't Pretty.

Professional conferences don't tend to bring me to tears. But the opening session for this year's MEDA conference (Multi-service Eating Disorder Association www.medainc.org ) broke with convention.

Doris, now a therapist, was simply a mom, a seemingly fine and quite likeable mom at that. She had a lovely husband (or so he appeared from the video clip displayed), provided a nurturing home (from what I could casually assess from her words and images) and had two lovely daughters. And now she has only one. Her younger daughter, Andrea, died 12 years ago from bulimia.

I am not new to this field of eating disorders, nor am I naive about the risks of having an eating disorder. In fact, not infrequently I am the treatment team member reality checking about the need for a higher level of care, pointing out the writing on the wall, so to speak.

Yet Doris caught me off guard. Even for me, her story about Andrea was alarming. Andrea became bulimic toward the end of her first year of college. Perhaps not atypical. But Andrea got help reportedly after only 2 weeks of eating disorder behavior, of purging. A therapist, MD, and dietitian were all a part of her recovery team, seeing her weekly.

Andrea reportedly looked healthy, by her mother's account. She was a normal weight—also not unusual. Bulimics are often normal or average weight, but restricting bulimics may present underweight. The danger, of course, is that being a healthy weight in many ways increases your risk. Strange? Here's why. At a healthy weight your risk may be minimized—by your own distorted thoughts, by your family and loved ones who see you as visibly healthy, and by the medical community which may not be triggered to ask the necessary questions about your eating disorder behaviors. Yes, we could all be in denial.

Just last week I had a rather unpleasant situation arise following a new patient session. Abby presented for her first visit along with her mother. Here's the summary: Her weight was below a healthy BMI and less than 90% of her healthy and usual body weight. She had lost significant weight, about 20% of her weight from the past year. Abby was restricting her food intake, eating close to nothing all day. Abby planned a binge, and subsequently purged once daily. She also was active, playing a team sport and exercising on her own. Admittedly the exercise wasn't compulsive, just frequent.

Oh, I forgot to mention that one month prior she presented to her pediatrician because her mom was concerned about Abby's hair loss, a common occurrence in eating disorders and with malnutrition, which can certainly also be caused by other conditions. At that time, her weight was just as low, and she had been in her disordered pattern for close to a year and a half.

Well, how would you assess the situation?

Toward the end of our lengthy initial session, it was clear that Abby was struggling to accept much if any change. I think a glass of skim milk was about all she would agree to increase—certainly not enough to keep her safe. So I made it clear that all exercise needed to cease. I urged a higher level of care—given how little change she was prepared to make—and a follow up with the MD (sooner that the 3 month visit that was planned).  And what was the end result? I was fired by Abby's family, and not thought  favorably of by the MD;  my direct acknowledgement of the need to be addressing this case differently was not well received.

Why share all this?

Because even I can get sucked into denying the reality of a situation. Because all of us are far too accustomed to measuring health and risk, based largely on body weight. And often that misses the boat. Because while I like to focus on the positive changes, the improvements patients are making over time, sometimes just heading in the right direction is not enough protection from the risk of maintaining an eating disorder. Because the health impact of eating disorders, both physical and psychological, are major, and shouldn't be minimized—not by the dietitian, the therapist, the physician, your family or community. 

And certainly not by you. Because eating disorders can result in death. And Doris can attest to the fact that this is no exaggeration.

Thank you, Doris, for sharing your wisdom with all of us at the conference and for allowing me to reference Andrea’s story on this blog. 

If this blog motivates even one eating disordered individual to change, or one health practitioner or family member to shift her thinking, it will be a great achievement. And please check out Doris’s website at www.andreasvoice.org

Thanks for taking this post seriously, and for passing it along to all those who need to read it.

Out of Into the Mouths of Babes. Weight management without the rules. 

Ok, so my baby is 20 (years, not months) but as a parent I can still appreciate it when kids say the darndest things, especially when it relates to food regulation.

This past weekend we visited our son at school and indulged him with a lovely Japanese meal out. To be fair, he would have felt more indulged by a home cooked meal, but logistically that just wasn't happening, so dining out it was. Together with my husband, we ordered an assortment of appetizers including delectable sushi. And then it came to ordering our entrees. Now in the past, even the somewhat recent past, I vividly recall the eye rolling and comments when I would place my order. I would feel my sons cringe as I'd politely inquire about the food preparation, frequently requesting a meal "light on the oil", with less ghee at an Indian restaurant or easy on a rich and creamy sauce.

It's what makes me comfortable--I prefer the taste, and it allows me to dine out and feel physically comfortable afterwards. I'd prefer to have it my way than to simply avoid delicious tasting entrees and fine cuisine. So I bit my tongue and stifled my chuckles when my son ordered his noodle-based dish, requesting of the waiter "can you make that light on the oil?"

And there was no prompting from me, I might add; my terriaki salmon order with white rice and vegetables was rather straight forward, necessitating no modifications for my satisfaction. 

The way my son described it, he was so tired of the richness of the frequent meals out that he wanted to eat something that felt better.

Later, he described his recent experience dining at the local burger joint in his college town. He ordered a burger and fries meal at lunch. Sooo, you're thinking? Well, my 6'1" slim and fit son ordered the kids' meal as opposed to the regular portion, and, he added, it was more than adequate. He knew that with restaurant portions tending to be quite excessive, that a kids' size would better meet his needs. Okay, perhaps the fact that he had only $20 left in his campus bank account may also have been an influence. Nonetheless, I was struck by this awareness and ability to self regulate even in restaurants, even after leaving the world of his nutritionist mom behind. And from what I've observed of restaurant portions, his selection was quite wise.

Yes, this is a child raised with chocolates, cookies, ice cream and home baked goods. He was never limited by others regarding how much he ate or what choices he was allowed. The only deprivation he might have experienced is a lack of fast food, as that has never been part of our family repertoire.

Remember those bagels described in a previous post? (http://dropitandeat.blogspot.com/2011/01/why-carbs-got-bad-rep-and-what-you-can.html)  With no knowledge of their 7.5 oz weight (he rarely reads these posts and this knowledge would not have been a deterrent) nor of their calorie content, my other son found them impossible to comfortably consume, at least topped with cream cheese.  And last summer, I remember him (also 6'1" healthy and fit, I might add) ordering a kiddie size ice cream at our local, full fat dairy ice cream stand. Yes, he knew that the small serving (measuring approximately 2 full cups) was beyond his need.

No, not my son, but a happy cupcake maker
in NYC, who enjoys his cupcakes!

Let me clarify that these are healthy young men without disorders. They eat all kinds of foods and enjoy great desserts. One stays active through the year with recreational sports, one only seasonally when he trains for a bike event, and both use their legs for local transportation around their campuses.

Neither sets rules about calorie limits, nor restricts his intake to 

certain hours of the day. There is nothing unique about them, other than that they were raised perhaps without nutrition rules. 


In fact, in some ways, at some points, I felt I had failed to educate them, to teach them nutrition basics; we talked little of nutrition and dietary requirements, and I often felt that their classmates were more well-versed in diet basics. Until I realized that in fact I had taught them--by example, through what was served, through watching me enjoy my chocolate snack or my rugelach(http://bit.ly/iOoR2L), and by modeling balance both in and out of the home. And, by providing an atmosphere devoid of negative messages about my body and of theirs. 

"That's just fine," you may be thinking, "but I wasn't so fortunate to be raised in such a household! Now what am I supposed to do?"

 Well, let me confess-- neither was I. There were plenty of messages about weight and weight loss needs in my childhood home, and food was pushed for the sake of avoiding wrapping up leftovers. Stating that I was full was generally followed by encouragement for dessert, although in the next breath the command to "hold your stomach in" was frequently stated. I never really understood how one is supposed to hold their stomach in while still breathing…

A Picasso at MOMA, NYC

My patients, also, are rarely so fortunate. They present feeling hopeless and out of control with their eating. Or, so rigidly controlled by their disorder, fearing that acknowledgment of their body's signals will open the flood gates and cause a non-stop food frenzy. But over time, with guidance, they begin to trust the process, and their bodies. They are shocked that they can keep a 1/2 gallon (actually, they're 1.75 quarts now, unfortunately) of their favorite ice cream around and it will last more than the night! They learn that after the initial leap of faith where they break the rules, and choose foods that satisfy, that they can begin to trust their bodies. But at the start, no one believes it. They all believe they are different, that their bodies don't follow these same laws of nature.

Managing your eating is in part intuitive and involves listening to your body and its signals. But that assumes that the signals are present. If you've been severely restricting, you will require more structure to get this system working. If your hunger is not present, if you struggle with anxiety or depression, or are on meds which may impact appetite, then you too will need more structure to start. 

A Matisse at MOMA, NYC. A print hangs in my main office.

But besides the intuitive part, there are strategies like those mentioned above that help with comfort around eating and weight regulation, regardless of the direction your weight needs to go. 


To summarize:

• Ask for what you need. When dining out, choose restaurants that will accommodate your preferences, without rolling their eyes! Feel free to request sauces on the lighter side or on the side.
• Request a second plate. For those simply overwhelmed by the quantities of food, the second plate allows you to take control of your portions. For those struggling to lose weight (who actually need to), this separation can help you reorient to what a reasonable portion is.
• Give yourself permission to eat again later, if you need to--if it's in your meal plan, or simply if you're hungry--regardless of time of day.
• Work on tasting your food and enjoying it with all your senses. Sometimes with eating disorder recovery, there's a focus on simply getting through the meal. But ultimately, wouldn't it be great to enjoy the food?
• How many years have you been struggling with your eating? Your thoughts and behaviors will not change overnight, even if these guidelines seem so sensible. So be kind to your self and be patient, and appreciate any changes you experience, rather than just focusing on weight changes. Appreciate the change in energy level, strength, weight preoccupation, mood and sense of hope you may now have.

Hoping this post doesn't trigger anyone.  And, that my sons are not reading this and rolling their eyes!