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10 Truths About Eating Disorders

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Let's Get Real About Eating DisordersIt’s National Eating Disorders Awareness Week and in honor of this year’s theme, “Let’s Get Real,” here are 10 Truths About Eating Disorders you should know:

1. Eating disorders do not discriminate – they affect people of all ages, genders, sexual orientations, races, ethnicities, body weights, and socioeconomic statuses.

2. You can’t tell if someone has an eating disorder by looking at them.

3. Genetics and the environment both play a role in the development of eating disorders.

4. Eating disorders are not a choice.

5. Eating disorders have the highest mortality rate of any psychiatric illness.

6. You don’t have to feel fully ready to give up your eating disorder to get treatment.

7. Dieting is a common (and preventable!) catalyst for developing an eating disorder.

8. Disordered eating (unhealthy eating behaviors that do not meet the full criteria for an eating disorder) should not be dismissed as “not that bad.” It’s a serious health concern that needs attention and treatment.

9. Full recovery is possible, and the sooner someone gets help, the better the chances of recovery.

10. Recovery isn’t easy, but it is worth it.

Inspired by these posts from AED and NEDA.

Weighing in on “To the Bone”

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Eating Disorders Expert Reviews To the Bone

As a Registered Dietitian specializing in eating disorders, To the Bone, the Netflix movie about a young woman with anorexia nervosa, has been a recent hot topic among my eating disorder colleagues and in my sessions with clients. Lead actress, Lily Collins, and writer/director Marti Noxon, have both been open about their personal battles with eating disorders and have promoted their movie as a way to spark important conversations about these serious illnesses.

I completely agree that we need to be talking about eating disorders more, and if the media buzz and ongoing commentaries about To the Bone are any indication, this movie has accomplished that goal. But is starting a dialogue about eating disorders a good enough outcome to justify the potential harm this movie may cause?

Whatever positive intentions may have been behind To the Bone, it fails both as a film made purely for entertainment purposes, and certainly as an eating disorder advocacy piece. I agree with the criticism that this film perpetuates stereotypes about eating disorders. It often felt like the writers had a checklist of eating disorder symptoms and behaviors they arbitrarily ticked off to try to bring authenticity to the story (Lanugo – check. Chewing and spitting – check. Body checking – check.), but it didn’t work.

My concern with To the Bone is that the graphic depictions of eating disorder behaviors and close up shots of the lead character’s extremely thin body may be harmful to those currently dealing with an eating disorder and those at risk of developing an eating disorder. But more importantly, I strongly disagree with many of the messages in this movie, including:

You have to hit “rock bottom” before you will recover. With eating disorders, rock bottom can mean irreversible medical complications, including death. Eating disorders are serious, but treatable conditions. The goal is to intervene as soon as possible before severe consequences occur because the sooner a person gets treatment, the better the chance of recovery. The last thing we want is for anyone to think they aren’t sick enough to seek help.

You have to be fully ready to recover for treatment to work. Ambivalence about recovery is extremely common. Many of my clients don’t feel completely ready for recovery when they start treatment – and that’s ok! Part of them wants to recover, and part doesn’t. Part of them recognizes the negative impact of their eating disorder, while another part isn’t ready to give it up. Especially in the early stages of recovery, when malnutrition makes it hard to think rationally or see the effects of the eating disorder clearly, the healthy voice that wants to get better may barely be a whisper. But that’s no reason to delay getting help.

You’ll be able to eat in a way that supports recovery without any guidance or supervision. The patients in the treatment facility in this movie are seemingly on their own to decide what to eat, how much to eat, and even if they will eat. The group meals are completely unsupervised and there are more eating disorder behaviors around the table than there are people (one patient eats peanut butter straight from the jar for dinner, while another pushes a couple eggs around her plate for most of the meal, etc.). I don’t know of any treatment center that would advocate this approach because nutrition is such a key part of recovery. Learning to eat in a way that provides adequate energy and nutrients for healing while challenging the food rules and rigidity of an eating disorder doesn’t happen spontaneously – it requires specific guidance, support, monitoring, and healthy role modeling from a dietitian and the rest of the treatment team.

It’s possible to lose weight and become underweight in a healthy way. There’s been a lot of criticism about Lily Collins’ weight loss for this role, which she’s defended by saying it was done “safely” under the guidance of a nutritionist and was necessary to tell this story (I’d love to know who that nutritionist is! I’ll bet it wasn’t an eating disorder specialist!). First of all, having an emaciated body is not mandatory to portray someone struggling with an eating disorder. There are many women with serious eating disorders that don’t appear obviously underweight (even though they are at too low of a weight for their body). Even if the actress or director felt this character needed to look underweight, wonders can be done with makeup, wardrobe, and special effects. Bottom line: Losing weight to become underweight CANNOT be done in a healthy way. More importantly, weight loss is a major trigger for relapse from an eating disorder, making it both unhealthy and unsafe for Ms. Collins.

Spreading inaccurate and potentially harmful messages like these is irresponsible, particularly for a film that claims to want to help those with eating disorders. So when clients ask me if I think they should see To the Bone, my answer is NO because this movie is unlikely to help in their recovery and it is likely to be extremely triggering.

National Eating Disorders Awareness Week 2016

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NEDAW 2016: 3 Minutes Can Save a LifeIt’s National Eating Disorders Awareness Week. This year’s theme, “3 Minutes Can Save a Life. Get Screened. Get Help. Get Healthy,” highlights the importance of early detection and intervention. The sooner someone gets treatment for an eating disorder, the better the chance for recovery.

Unfortunately, those struggling with eating disorders and disordered eating often dismiss their behaviors as “not that bad,” keeping them from seeking help. Troubling signs, symptoms, and behaviors may be ignored because of the erroneous belief that you need to look a certain way to have an eating disorder. We need to spread the message that eating disorders do not discriminate. You don’t have to be a certain weight, shape, gender, or age to suffer from an eating disorder. There is no one eating disorder “look.”

Our dieting and weight obsessed culture doesn’t help matters. Harmful food and exercise behaviors are normalized and even encouraged. We are constantly bombarded with the message that weight loss by any means is a good thing. Nothing could be further from the truth. Countless men, women, and even children begin dieting without realizing that their efforts to lose weight and/or get “healthy” can be the catalyst for developing an eating disorder. You can read more about the dangers of dieting here.

Each and every person suffering with an eating disorder/disordered eating deserves to get the help they need. Without treatment, eating disorders can have serious and life threatening consequences that can impact every aspect of a person’s life, including their health, relationships, and career. But it doesn’t have to be that way. Treatment is available and recovery is possible.

Whether you are concerned about your own food or exercise issues or are worried about a loved one, don’t delay reaching out for help. Getting treatment sooner rather than later can save years of suffering.

Here are some useful resources:

Confidential screening that only takes 3 minutes to complete: NEDA Eating Disorders Screening

National Eating Disorders Association (NEDA) Treatment Finder

International Association of Eating Disorders Professionals (IAEDP): Find an Eating Disorder Professional

International Federation of Eating Disorder Dietitians (IFEDD) Treatment Finder

Sports, Cardiovascular, and Wellness Nutrition (SCAN): Find a SCAN RD
(search by area of expertise ->disordered eating & eating disorders)

Academy of Nutrition and Dietetics (AND): Find an Expert
(search by expertise -> eating disorders)

Let’s Put an End to Weight Stigma

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Weight StigmaToday is day three of the 4th Annual Weight Stigma Awareness Week, hosted by the Binge Eating Disorder Association (BEDA). According to the Merriam-Webster dictionary, a stigma is “a set of negative and often unfair beliefs that a society or group of people have about something.” In the case of weight stigma, the unfair beliefs are based on a person’s weight, shape, and/or size.

Sadly, weight based stereotyping is pervasive in our society and seems to be a socially acceptable form of prejudice. From the media to the schoolyard to the workplace, children and adults are judged everyday based solely on their size. For example, a person of larger size than what our society considers acceptable may be perceived as lazy or lacking discipline. A thin person may be wrongly labeled as having an eating disorder.

Verbal abuse, bullying, and discrimination are common manifestations of weight stigma. Whether the consequences are subtle or overt, weight stigma can negatively impact all aspects of a targeted person’s life, including their self esteem, interpersonal relationships, education, employment, and healthcare.

One way to begin combating weight stigma is to challenge our own misconceptions.

Wonder if you might hold any weight biases? Ask yourself these questions:

1. A thin person is healthier than an overweight person. TRUE or FALSE? 

2. Weight loss is always a positive outcome. TRUE or FALSE?

3. If a person feels bad enough about their weight, they will be motivated to change it. TRUE or FALSE?

If you answered FALSE to all the questions, you are correct. If not, here is the truth:

1. Thin does not always mean healthy. Think about a thin individual who chain smokes, eats fast food daily, and doesn’t exercise. Would that person be healthier than someone with a BMI in the overweight range that doesn’t smoke, follows a healthy diet, and exercises five times a week?

2. Although weight loss as a consequence of adopting healthier behaviors may be positive, weight loss by any means is not healthy. In fact, many methods of weight control are anything but healthy.

3. Shaming people about their weight actually increases the risk of obesity and eating disorders.

To learn more about weight stigma, check out some of the Weight Stigma Awareness Week tools and resources on the BEDA website.

Musings on J.Crew and the New Size 000

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J.Crew Launches Size 000J.Crew has been heavily criticized since announcing the launch of their new women’s size 000, equivalent to an XXXS. A J.Crew spokesperson (as reported on today.com), defended the new size, saying it was launched to meet the demand for smaller sizes in Asia. The need for a triple zero is a direct result of J.Crew’s practice of vanity sizing, although the company is not exactly admitting it (only saying their sizes “run big”).

As the average weight of American adults has steadily increased over the last five decades, retailers have had to offer increasingly larger sizes to match this trend. But instead of just adding larger numbered sizes, J.Crew and other manufacturers have adjusted sizes downward. A size 12 may be labeled as an 8, an 8 becomes a size 4, and so on. With no real standards for clothing sizes, this practice, known as vanity sizing, has easily become the norm.

From petite to plus size, we all deserve to have stylish clothes that fit us well

Perhaps an unintended consequence of this practice is that women who were wearing a size 2 or 4 a decade ago have basically been vanity-sized out of adult clothing options. If the addition of size 000 is really about meeting the demand for smaller sizes, and their sizes already “run big,” why not adjust the sizes upward and add a size 22 or 24? J.Crew’s triple zero addition implies that there is something wrong with larger sizes – a fallacy worth taking a stand against.

Even the term “vanity sizing” is infuriating. It implies that the smaller the number on the tag, the better we feel about ourselves, making it more likely that we will buy. Do clothing manufacturers think we want to be lied to? Do they think we can’t be trusted to buy the clothes that fit us best just because we may not like the size on the tag?

Public Outcry

Since the launch of the new size, responses have ranged from blaming J. Crew for giving women eating disorders to contempt for those women who will fit in the new size. Blaming J.Crew for causing eating disorders oversimplifies these complex psychological disorders and is misguided. The harshness directed at women who may benefit from the addition of the new smaller size is downright wrong.

The recent criticism of J.Crew has also brought necessary attention and scrutiny to the practice of vanity sizing. I am not in favor of deceit, particularly for the purpose of monetary gain. Many women I know, including myself, would much prefer consistency in clothing sizes. I would love to walk into a store and know my size without having to try on 10 pairs of pants to figure out what to buy.

Vanity sizing needs to be addressed before negative number clothing sizes begin showing up in stores, but unfortunately the practice is probably not going anywhere any time soon. So what can we do?

Let’s start by not giving clothing companies the power to determine how we feel about ourselves

So many women today are unhappy with their bodies. Do I think that the unrealistic images that are portrayed in magazines and on runways contribute to our discontent? Yes. Do I think that we will all magically feel better about ourselves if that someday changes? No. Any validation that we feel when we see a certain number on the scale or fit into a certain clothing size is fleeting. Our sense of self-worth is much deeper than that. And it is up to us, not the clothing companies or fashion industry, to build and nurture our self esteem and confidence.

I have at least five different sizes of pants hanging in my closet that all currently fit me. Am I a better, more attractive person on the days that I wear my smaller-sized pants? I am not going to let a completely arbitrary number like my clothing size determine my self worth.

Whether we are inclined to direct judgment towards ourselves or others based on body shape and size, it helps to remember that the size you wear says nothing about who you are as a person. Just because a woman fits into a size 000 does not mean she has an eating disorder. And a woman wearing a plus size is not necessarily unhealthy or any other negative stereotype associated with larger sizes.

The triple zero controversy has people riled up, and some of the backlash aimed at J.Crew is warranted. But I prefer to focus my energy on reminding myself how powerful compassion and acceptance towards ourselves and others can be. I pledge to celebrate the things I love about myself and my body, regardless of the number printed on my clothing tags. Who’s with me?