Eating Disorder

Navigating Menu Calorie Counts in ED Recovery

A couple weeks ago, my partner was going through the mail and found my journal from the Academy of Nutrition & Dietetics (that usually goes straight into the recycle bin because hi, it's 2018 and if I want to find a research article, I'll just look online). He started flipping through and was reading bits and pieces and started reading one particular study about calorie counts being listed on menu items (spoiler alert: calorie labels didn't change health outcomes in any significant way).

Sigh. 

With the new calorie labeling law going into effect earlier this month, I've had a lot conversations about this with my clients recently. If you're in the US, you've probably noticed that all restaurants (with 20+ locations) are now required to list calorie counts on their food items. As both a clinician and a consumer, I have a lot of issues with this. In fact, the original draft of this post was almost double the length because I wrote about these issues in great detail. But because I don't want to make you read a short novel, they've been scrapped (for now) and will re-emerge in a likely part two soon. What I want to address here is how challenging it can be to see calorie labels when you're recovery from an eating disorder. Because when your treatment team is emphasizing calories don't matter and then you walk into a restaurant where every item has a calorie count, it is confusing to say the least.

I totally understand how difficult it can be to be in recovery from an eating disorder and be faced with this information every time you go out for a meal. And the advice I would give to you in a perfect world would be "just order what sounds good!" But I also know that is a lot easier said than done. So here are some tips to remember when you're faced with calorie labels on menus:

1. Take a deep breath. Reminding yourself of some positive affirmations may be helpful  (I am worthy of recovery, I am allowed to listen to my body, I am safe no matter what I order, I am capable of managing this situation, etc). Try to create some space for yourself in that moment.

2. Recognize that these numbers do not have any bearing in your value as a person. They don't have the power to make you good or bad. They can't make you a failure. 

3. Think about what sounds appealing to you. Do you want something hot or cold? Crunchy or soft? Salty or sweet? Are you having any cravings? Use these answers to guide you towards the things that sound good to you in that moment. 

4. Give yourself a time limit. It can be easy to get sucked into a world of complex food math (maybe I should get that salad because it's X calories or I could get 1/2 of that sandwich and a small order of fries and that would be Y calories but if I do that, I can only have Z calories at dinner which throws off my whole day because I had ABC for breakfast and then what about my nighttime snack and on and on and on). To avoid- or at least shorten- that moment of uncertainty and panic, give yourself a time limit to decide what you're going to order. For example, if you're in line at a coffee shop, give yourself 30-60 seconds to decide on a drink and then stick with it when you go to order. If you're out to lunch with a friend, let yourself look at the menu for 3-5 minutes before making a decision and closing your menu. Set an actual timer on your phone if you think it will help. This isn't designed to be stressful, just a way for you to avoid getting sucked into that food math vortex. Give yourself enough time to look at your options and then make a decision without ruminating on it.

5. Order without overthinking. Think about what sounds good, look at the menu for a couple minutes, and then order what sounds appealing and manageable. Remember that not every meal needs to be *perfect*. Remember that you're allowed to eat all foods. And remember that every time you make choices that go against ED rules, you're taking one more step into recovery.

6. Try to stay grounded when your food comes. If you're with out with someone, try to focus on your conversation with them which is likely far more meaningful than nutrition labels. And if you're alone, consider bringing a journal and writing your way through the experience (or if that feels too intense, write about something different altogether). 

Seeing calorie counts can seem unmanageable but remember it is merely external information and that most of recovery is about re-connecting with your body's internal wisdom. In a perfect world, we would be able to clear our internal hard drives of all calorie counts, Weight Watchers point, macros, and all the other things we've memorized because there's no real need to know exactly how many calories are in 24 almonds or how many points are in a banana. This is all just  information that has no meaningful effect on your body; none of these numbers can determine what is most nourishing for you. Reconnecting with your body's needs and listening to your intuition is infinitely healthier than making frantic decisions based on what are essentially arbitrary numbers.

The goal I have for my clients (and anyone in ED recovery) is to be able to see calorie labels as neutral information.  The nutrition information that you once had memorized as well as the lyrics to your favorite song doesn't just fade away- although take comfort in the fact that as the distance between you and calorie counting grows, these numbers will start to blur and eventually pieces fade away altogether. What you are able to do is start working towards a place where this information doesn't have so much power over you. You're able to move to a place where knowing calorie information is like knowing exactly how many gigahertz the wifi is or the exact temperature of your refrigerator- both fine to know but probably not going to impact your life in any significant way. When we start placing less importance on external information and create more body trust, we're able to make decisions that nourish our minds and our bodies without guilt- and that is the ultimate goal in recovery.

Cover photo by Benjamin Zanatta 

Fat is Okay! And Other Messages I Wish I Got From Straight/Curve

Last week, I went to a screening of the film Straight/Curve that Project HEAL put on as part of eating disorder awareness week. I knew the premise and I was excited for an uplifting film about body image and diversity, but I walked away confused and angry (like, really angry). This isn’t meant to be a review of the film- I am far from a film critic-but as a Health at Every Size provider and as someone who has gone through her own recovery, I found a few things really problematic that I want to touch on here for anyone who has seen the film (or who hasn’t).

For anyone who hasn’t heard of the film, this is the description you get from a quick Google:
“A majority of women say they do not feel represented in fashion or in the media. Filmmaker Jenny McQuaile examines the industries and obstacles responsible for this body image crisis and showcases leaders who are fighting for diversity in the media.”

Hooray!! I naively thought as I walked in. Finally blowing the lid off the bullshit diet culture nonsense that media forces upon us daily. That is…not what I found. The movie starts with the director and her team discussing about a dozen women who are all outside the modeling “norm” and how diverse they are. Then they pan to the models getting out of the car….and I’m not kidding when I say I thought those where the examples of what we were moving away from. It took me a few minutes to realize those were the diverse models.  

Before I keep going, I want to say: I have respect for all these women. They are, indeed, outside the norm for modeling (they are all above a size 0/2 that we are used to seeing in models, some of them were WOC, some of them were older than the average model). A few of them shared their histories with food and without a doubt, I have compassion for all of them and their journeys. I’m excited that the modeling industry is recognizing some variety. But as far as everyday, non-model bodies go, they weren’t particularly diverse. And there was no other discussion to acknowledge that; no mention of how bodies come in a lot more shapes/sizes/colors/abilities/genders/sexualities than what those 12 or so women represented. So while I appreciate them talking about their experience in the modeling industry, I wish the conversation zoomed out to discuss the bigger picture (no pun intended).

As far as diversity goes, I was happy to see that they included women of all ages including older and middle-aged women who are so often left out of the conversation. They also represented some people of color and some size diversity. Something I would have liked to see more of was representation of folks with different abilities, who are also frequently left out of the conversation. Also, there was no representation of non-binary folks or femmes who aren’t classically feminine. The film did include one model who was part of the LGBT+ community but again, I would have loved to see more (and more diverse) stories. I had the privilege of being on the panel discussion afterwards with the creators of ThirdWheelED who both identify as queer and who were gracious enough to make that part of the discussion afterward (and I highly recommend checking out their site if you haven't already which has a lot of great resources listed). It's hard to feel good about your body when you don't see your body represented anywhere else in mainstream media (especially a movie that's about representation). 


And then there was the scene when one of the models was talking to her daughter about body image. Her daughter, who was maybe 6 or so, was saying that a girl at school had called her fat and with no hesitation, the model answered, “you’re not fat”. And I sat there wishing with everything in me that her response instead had been “it’s okay to be fat” or “who cares if you are?!”  or even just "no, you're not fat but some people are and that's okay and normal" because that’s the message that the audience (kids/adolescents/young women and their parents) need to hear. And again, I want to point out how much compassion I have for the woman who said that. I get that a mother's instinct is to protect her kid and “fat” historically has been used as an insult. And I also get that she is trying to raise her daughter to love her body in a world that teaches women to hate themselves. But there was such a perfect opportunity for a discussion about size diversity and using “fat” as a descriptor (rather than an insult) and I felt sad to watch that moment pass by.

And finally, I want to touch on one scene that has stuck with me since Thursday night, that makes me rage a little bit every time I think about it. There was a scene in which one of the models, a thin woman who I believe has recovered from an eating disorder, went to get her body composition measured (first question: why?!) and the subsequent reports showed the distribution of fat on her body (second question: why?!). The doctor detailed the different types of fat a person has on her body and then declared her particular fat as being okay. And I swear you could probably see the heat rising into my cheeks as I sat watching thinking ALL FAT IS OKAY”. Listen. I took anatomy & physiology. I know there are different kinds of fat and I understand their functions. But for a movie whose purpose was to broaden the idea of beauty and promote body diversity, “fat is only okay sometimes” feels like really questionable messaging (and also, totally against everything I stand for but that’s beside the point). The truth is that you are not wrong no matter where the fat lays on your body and more than that, you don’t have to get anyone’s permission to feel okay in your body.

I appreciate what Straight/Curve was trying to do and it was a step in the right direction. As someone who is hoping for our culture to move towards body diversity and fat acceptance with leaps and bounds, that step felt a little frustrating but I understand that’s not the way the world works (but I can dream about a world where it does, right?) There were some problematic pieces but overall, I was left wanting moreThis movie is opening some doors and it’s not enough. This movie planted seeds and we have so much work to do. I dream of the day when we can see a movie about body diversity that involves women of all sizes and shapes and abilities and genders and sexualities and ages and ALL THE THINGS. Marginalized women, we need your voices! We need your movies! And dear reader, if you have suggestions for movies like this, please leave it in the comments because I would looove to watch.

Until next time xo
Meghan

Photo by Annie Spratt 

21 People on They Wish Other People Understood About Their Eating Disorder

I am so excited to share this post with you all because there is so much knowledge and inspiration and truth here but before you get started I just want to put a trigger warning right up top. If discussion of eating disorder thoughts and/or behaviors is likely to trigger you, I recommend just skipping over this post and coming back next week. I did censor a couple number/weight/health specific things/piece together quotes from longer messages that some people sent that I note. However, to keep every response authentic, I quoted people word for word so if it sounds different than the way I write....that's because it is! And to everyone who responded and shared a part of their story, I'm so grateful for you and your willingness to put your message out there. With that all being said...enjoy! This is 21 people's responses to the question "what do you wish other people understood about your eating disorder/recovery?" And let me know if you like the format of this post- I enjoyed it a lot and hope to do more in the future.

"One thing I would want people to know/understand is that my weight is NOT an indicator of how much I'm struggling! I could be eating and be a health weight but that doesn't mean that I'm not struggling as much as/more than I was when I was underweight. Weight loss/gain is a side effect of an eating disorder, but it should not the focus to determine a person's struggles." - Lara

"It was not about wanting to be skinny!!!!" - H

" I wish people knew that offering me a low calorie food, 'healthy' food, or small portion of food is harmful to my recovery. I know many people do this out of love. They think giving me something that I have less anxiety about eating will help me. In reality, it gives me more anxiety about eating. It makes me think that I don't deserve to eat an energy dense food, an 'unhealthy' food, or a larger portion. It makes me feel embarrassed to eat in front of them and not eat what they have offered me. It makes the anxiety of eating what I want, what I crave, and what my body deserves much harder." - Helena

"That even though I look better and seem better after getting out of treatment AGAIN in November, I'm not cured. I've spent 15 years hating/destroying my body so changing my attitude to acceptance is GOING TO TAKE TIME." - @lucybaehrphoto

"That full recovery is not easy, but is possible; that everyone's recovery will look different; and that the most challenging part of recovery (sometimes) is trying to embrace your body, self, and balance in a society that is so disordered around food." - A

"That my weight and how it fluctuates doesn't mirror how my eating disorder is in practice. Sometimes at my biggest I've been the most restrictive, been in turmoil and felt physically worse then when I've been at my thinnest. I've been denied help for over 10 years because my BMI hasn't been low enough. I had all the physical symptoms and more importantly mental symptoms of an eating disorder but was denied treatment. I had XYZ medical problems (censored) and was mentally severely depressed and underweight for me. I cried out for help for all of those ten years but was denied treatment as my [BMI wasn't low enough]. I don't think I'll ever totally be ok because I was never given the right intense treatment I needed." -Madeline

"That I seemed okay when I really wasn't! And that not going inpatient doesn't mean it wasn't (isn't) real." - Em

"1. I wish I wasn't so petrified of people finding out about it. I worry people will look at me differently. Or treat me differently. 2. It feels nearly impossible to recover when we live in a world where despite what you might think and despite recent (AND AWESOME) body diversification movements the thin ideal is so deeply engrained we don't even realize it's power over us disordered or not." - Annie @_annie.18

"That people could understand it's not just about losing weight or getting super skinny (especially when someone in larger). Oh and sometimes I feel like I'm able to challenge myself and have something that would be a fear food for me and then a week later I might not feel like I can do it, but that doesn't mean I'm failing or relapsed." - Michelle

"That we didn't ask for our eating disorder! So many people think, oh they just really want attention or they caused it etc." - Bobbie

"I wish people understood you can struggle with anorexia and be at a normal weight or 'overweight.' I get invalidated so often because people say 'You never LOOKED like an anorectic. When I feel like people don't realize that eating disorders are MENTAL illnesses, they don't have a certain 'look.' If people give ME, a thin-passing white girl, shit for not looking anorectic enough (which is triggering AF) then I can't imagine how they would treat a marginalized person with anorexia." - Suzie, @suziethesurvivor

"Something I, personally, wish people understood is that eating disorders are not the result of pure vanity of stubbornnes on the part of individuals who just 'choose not to eat/over-exercise/binge, etc.' So many factors combined (genetics, personality factors, trauma, DIET CULTURE) and manifest in some of the most intelligent, loving, caring individuals you will EVER meet, but the answer isn't as easy as 'just eat more' or 'gain the weight and deal'. It goes so much deeper." - Emily M. 

"I wish people knew that binging can still be binging whether it's with almonds, cookies, or vegetables." - Molly @taco_bout_nutrition

"I wish people knew how damaging diet culture is to some people, now I have recovered in my eating people say to me 'it's okay to be healthy and go on little diets but just don't go extreme again' and this kills me as they don't know how much diet culture affected me and it's hard to get them to understand." - @yourmindisamazing

"That I didn't choose to be this way. I didn't wake up and decide that I wanted to put myself through this. I'm not doing it for attention. I'm sick physically and mentally and people need to understand that." - Lily

"I wish others knew how much eating disorders are inexplicably intertwined with people's identities, including religion and culture...I often feel underrepresented in the ED community due to religious beliefs. Last year, I was...gaining weight. This coincided with Ramadan, a month when Muslims fast from dusk to dawn. For the first time in my adult life, I did not fast- my doctor advised against it. People who are physically and/or mentally ill, as well as children, elderly, and menstruating/pregnant/nursing women are exempt from fasting. Logically, I knew I wasn't in any condition to fast for 30 days, but it was difficult engaging with relatives and peers partaking in fasting and spiritual reflection. I told very few family and friends I wasn't fasting since I felt so much shame, an emotion ED thrives off of. Like EDs, Ramadan goes far beyond food...I found other ways to 'feed' my soul." - Annonymous

"I wish people knew that my lowest weight doesn't define me. It doesn't make me more or less sick than before. The number did not then, nor does not now, dictate recovery. I also wish people knew I can still have an eating disorder and be not just a normal weight, but also weight restored." - Sarah @sarah.gets.stronger

"I wish people knew that not all eating disorders are started by body image. Some come about due to wanting to feel control, an effect of depression or circumstance, or many other things we don't even realize." - Lily

"I wish people would know that just because I am weight restored does not mean I am still not struggling. I wish my brother would realize that this isn't a choice I made and to stop getting frustrated at me when the voice is loud and I start panicking because I would love to just sit down and eat anything I want but I am still in the recovery process and I still have my bad days where I am scared and don't want to fight." - C

"That looking 'great' cause I was 'thin' was not a compliment and it always triggered me." - Michele @thesunwithin

"I wish people would forever get over it being about weight and look like models. I am mot by any means discrediting the experience of those who were weight shamed and used an eating disorder as a tool to get an ideal body or for any other purpose, but I wish people didn't assume that was the reason for my ED. I wish that people knew how problematic labels are and how they don't truly describe the experience of having an ED. They don't explain all the risk factors and experience that came together to create the perfect storm of what become the only way to cope with so much." - Jules @healing_every_day

 

Cover photo by Jake Melara 

Shifting the Narrative Around Eating Disorders: 4 Myths Busted

Today is the first day of National Eating Disorder Awareness Week so I wanted to take a bit of time to dive into the research around eating disorders and bust some (very popular) myths. I hope you’re ready cause we are divin’ in.

NEDA week.jpg

Myth #1: Eating disorders aren’t that common.
Fact: Let’s talk about how prevalent eating disorders are. For some reason, eating disorders still feel like a taboo topic in mainstream culture although it seems like maybe less so over the past few years (or maybe it’s just because I’m submerged in this work that it feels that way). According to the National Eating Disorder Association, about 30 million people (20 million women and 10 million men) will struggle with a clinically significant eating disorder at some point in their lifetime, meaning about 10% of the US population. However, it’s worth noting that that study only accounts for *clinically significant* eating disorders- meaning that doesn’t count anyone who doesn’t fit the DSM criteria perfectly or who may have subclinical EDs or who may never seek treatment and fly totally under the radar. So the fact is the number of folks who will struggle with disordered eating is likely much larger than 30 million.

Myth #2: People can just “get over” their eating disorder by eating.
Fact: This is painfully inaccurate (and a dangerous way to think about EDs). Eating disorders are rarely about the food- and “just eating” is seldom (if ever) the cure. Eating disorder recovery is a process sometimes taking months but usually taking years. It can involve therapy, nutrition counseling, medication, regular doctor’s visit, psychiatrists, treatment centers, and/or intensive programs. It can involve meal plans, journaling, exercise restriction, relearning body cues, reading books and blog posts and listening to podcasts and trying to make your body feel like home again. Like any other mental illness, it’s not something you can just “get over”. In fact, eating disorders have the highest mortality rate out of any mental illness. According to the National Association for Anorexia Nervosa, every 62 minutes someone dies as a result of his or her eating disorder. One every hour. That is a staggering number and one we can’t lose sight of when we talk about how serious eating disorders can be.

Myth #3: Eating disorders only affects young, thin, white women.
Fact: Again, this is a dangerous way to view eating disorders. Eating disorders know no boundaries- meaning they affect everyone regardless of gender, race, socioeconomic status, sexuality, ability or age. And while yes, it is true that thin, white women take up a lot of space in the online recovery communities (speaking as a thin, white women who engages with the recovery community), that doesn’t mean they are the most affected. It just means that, unfortunately, they are the most likely to get their stories told because we live in a culture that, unfortunately, has a preference for thin, white, conventionally attractive people. In reality, people of color experience eating disorders at a similar, if not increased, rate as white folks. Beyond that, people of color are statistically less likely to be asked about eating behaviors/ED symptoms by their doctor. LGBTQ+ folks are at a greater risk of eating disorders. Although only 5% of the population identifies as gay men, 42% of men who report having an ED identify as gay. Queer folks also have a higher prevalence of lifelong subclinical eating disorders than straight people. 16% of transgender college students report having an eating disorder, which is much higher than the national average. And 13% of women over the age of 50 engage in ED behaviors. The bottom line- eating disorders don’t discriminate. And we should be doing more to change the narrative around eating disorders and making everyone’s stories heard, especially those in marginalized bodies. One of my favorite organizations doing this is Trans Folks Fighting Eating Disorders, which you should absolutely check out and donate to if you feel so inclined.

Myth #4: You have to be in a thin body to have an eating disorder.
Fact: This is by far one of the most common myths I hear circulating and one of the ones that is most important to talk about. This year, NEDA Week’s theme is “Let’s Get Real” with the hopes to shift the conversation to stories we don’t often hear. As I mentioned, there are a lot of ED stories we don’t often hear- like from POC and trans folx and people in the LGBTQ+ community. But one narrative that we hardly ever hear in mainstream media that tends to  make people uncomfortable is the stories of people in larger bodies who have eating disorders. And before you go, “oh of course people in larger bodies can have eating disorders! Binge eating disorder!”, it’s important to recognize that yes, people in larger bodies can have BED (just like people in smaller bodies can) but people in larger bodies can also have restrictive eating disorders, especially given diet culture which tells them over and over again that they have to lose weight. As Deb Burgard so eloquently puts it, we prescribe in fat people the same thing we diagnose as anorexia in thin people. People in larger bodies are almost unequivocally given half thought out diet advice at their doctor’s office- whether there’s a real health concern or not (even if there is a real health concern, weight loss is seldom, if ever, the solution- but that’s a conversation for another time). And it’s easy to let some non-ED informed medical professional’s advice go to far- all the sudden instead of just forming a couple “healthy” habits, you’re down the road of measuring out every morsel of food, torturing yourself at the gym for multiple hours a day, and restricting foods/food groups. And instead of people being worried about the sudden change in weight/behavior, you get praised and rewarded. So on top of having the same symptoms as someone in a smaller body with a restrictive eating disorder, you’re actually getting rewarded for it – which is horrible, confusing, and infuriating all in one neat package. Assuming that eating disorders only happen to thin women is a dangerous assumption and one we should work hard to move away from. If you’re looking for accounts of people who have experienced an eating disorder in a larger body/not the “typical” ED body, I highly recommend starting with Clare @becomingbodypositive, Dani @iamdaniadriana and Ragen Chastain’s work (and see where the interwebs take you from there!)

The biggest takeaway from this (I hope) is that we need to change the narrative around eating disorders. We need to make room for stories that don't fit the "typical" eating disorder narrative. I'm happy to see that NEDA made their theme "Let's Get Real" this year in an effort to make this happen and give us a real look into how eating disorders affect each and every one of us. 

References (if you’re into that kinda thing):
1. https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/statistics
2. http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/
3. https://www.nationaleatingdisorders.org/people-color-and-eating-disorders

Cover photo by Heidi Sandstrom.