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Eating Disorder Prevention

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.

Performance Nutrition for Dancers

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dancer in arabesqueI love this time of year when the weather turns cool and fall dance season is in full swing. As I spend my time off trying to see as many dance performances as possible, my time in the office is spent helping my dancer clients fine tune their nutrition habits for this busy dance season.

What you eat and when you eat can have a big impact on your energy, focus, endurance, and recovery. Here are my nutrition tips to help you perform at your peak this season and beyond.

Let’s start with a refresher on what you need to eat and why:

Enough energy (aka calories)
Undereating can have serious consequences like decreased strength and stamina and increased risk of injury. Dancers need to consume enough energy for classes, rehearsals, performances, and the activities of day-to-day life.

Good sources: Aim to get most of your energy from nutritious choices like whole grains, lean protein, low-fat dairy, fruit, vegetables, and healthy fats. But remember, the goal is to eat a mostly healthy diet, not to be perfect.

Carbohydrates (aka carbs)
Carbohydrates are the main source of energy for your brain and muscles. Eating the right amount of carbs will help keep your energy and focus up during class, rehearsals, and performances.

Good sources: Whole grains (such as whole wheat bread, brown rice, whole grain pasta, oats), quinoa, starchy vegetables (corn, peas, potatoes), beans/legumes, fruit, milk, and yogurt

Protein
Protein is necessary for muscle growth, strength, repair, and recovery and for your metabolism and immune system to work properly.

Good sources: Meat, poultry, fish, tofu (and other soy foods), seitan, dairy (milk, cheese, yogurt), eggs, nuts, seeds, beans/legumes

Fat
Fat is needed for normal brain and nerve functioning, regulating body temperature, and hormone production (which plays a role in bone health). Fat provides an additional source of fuel for the muscles and helps us absorb fat soluble vitamins (vitamins A, D, E, K).

Good sources: Nuts, seeds, avocado, olive oil, canola oil, fatty fish (like salmon)

Vitamins and Minerals
Dancers can usually get the vitamins and minerals they need by eating a well-balanced diet that provides enough energy and includes a variety of fruits and vegetables. Dancers with food allergies and/or restricted diets (for example, vegans) may need to take supplements. Here are three vitamins and minerals that are especially important for dancer health:

Calcium & Vitamin D are needed for good bone health. Calcium is found in dairy (milk, cheese, yogurt), soy products, collard greens, and almond butter. Fatty fish (like salmon) and fortified foods (like dairy and plant milks) provide some vitamin D, but there aren’t many good food sources of this important vitamin. The best source of vitamin D is sun exposure. Many dancers don’t get enough vitamin D and may need to take a supplement.

Iron helps make red blood cells which bring oxygen to the muscles. Iron is found in red meat, fortified grains, beans/legumes, and spinach. The iron in vegetarian foods is better absorbed when eaten with vitamin C rich foods (like citrus).

Fluid
Staying well hydrated is important for dancers because even slight dehydration can negatively affect concentration and performance. Fluid needs vary based on factors such as age, gender, activity level, sweat rate, and environment. To meet fluid needs, dancers should drink liberally before dancing and during breaks and meals, as well as sip fluids throughout classes and rehearsals. Water is usually best, though sports drinks (like Gatorade, Powerade, etc) may be helpful for dancers with high energy needs, heavy sweating, or long periods of intense dancing without enough break time to eat solid food.

When to eat: How to use meal timing to optimize performance and recovery

Pre-Dance
3-4 hours before: Eat a well-balanced meal including carbohydrate, protein, and fat.
Example: turkey and avocado sandwich on whole grain bread with an apple

30-60 minutes before rehearsal or a performance: Have a carbohydrate-rich, easy to digest snack to top off your energy stores.
Examples: fresh or dried fruit, applesauce, sports drink

Bonus TIP: As you get closer to the time you will be dancing, choose foods low in fat and fiber (both slow down digestion and may cause stomach upset). Use rehearsals to practice your pre-show meals and snacks – it’s not a good idea to try new foods or drinks on the day of a performance!

During Dance
You may need extra fuel during long rehearsals, performances, or days with many hours of intense dancing. Taking frequent bites of easy to digest, carbohydrate-rich foods or sipping on a sports drink can help keep your energy levels up.
Examples: dried fruit, clementine segments, applesauce, pretzels

After Dance
Within 30-60 minutes after you finish dancing: Have a snack or meal that includes carbohydrate and protein. Carbs replenish the muscle fuel you used while dancing, and protein is needed for muscle repair and recovery.
Snack examples: low-fat chocolate milk, protein and fruit smoothie, apple and peanut butter

Bonus TIP: Include antioxidants (found in brightly colored fruits and veggies like red peppers, broccoli, berries, spinach, & carrots) and anti-inflammatory omega-3 fats (found in salmon, tuna, ground flaxseed, & walnuts) in your post-dance meal to help with recovery.

Putting it all together: Sample dancer meal plan for a rehearsal day*

Sample Dancer Meal Plan*Portion sizes vary based on individual needs

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)

In Honor of Independence Day: Find Your Freedom from Diets and Disordered Eating

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Happy 4th of July!As we celebrate the Fourth of July– often with barbecues and other food-related events – take a moment to reflect on how your relationship with food and weight may be standing in the way of your life, liberty, and pursuit of happiness.

This Independence Day, declare your freedom from:

  • Rigid food rules
  • Labeling foods as “good” or “bad”
  • Counting calories, fat grams, sugar grams, etc.
  • Fat talk
  • Diet talk
  • Diet books, blogs, and articles
  • Hoping that this diet will be “the one”
  • Judgement, guilt, and shame about your food choices or portions
  • “Making up” or “saving up” for what you eat
  • Denying yourself your favorite foods
  • Determining your worth based on your weight or clothing size
  • Comparing your body to others
  • Comparing what you eat to others
  • Using food (or controlling your food) as a coping mechanism
  • Punishing exercise
  • Letting your focus on food and weight stop you from enjoying your favorite activities and living the life you were meant to live.

Wishing you a Happy 4th of July!