January 1, 2012
The Fear of Food | Lindsey Koehler
In a previous blog, I shared the concept of the three As in the recovery process: ADMITTING you have a
problem, becoming AWARE of when you are engaging in the behavior and taking ACTION to change. For most
of us in recovery, taking the first step to admit we have an eating disorder is difficult enough; however, taking
the additional step to share our story with someone else is an entirely different issue in itself.
Whether or not you share your struggles is a personal choice. However, in my own experience, discussing the
issues with others can be crucial in developing a strong support system throughout your recovery process.
I would like to share some points to consider when talking to others about your eating disorder and/or
disordered eating behaviors. I hope you find them helpful and meaningful.
Understand your “intent” in sharing.• Be clear from the beginning why you want to share with this
person and the details you’re willing to share. You can’t be certain as to an individual’s response;
therefore, set realistic expectations and be prepared for any reaction. Also, be willing to ask for what
you need from the individual, as he or she may not know how to support you.
Consider your audience.• How you approach a family member, friend or a colleague may differ. Be
thoughtful in how and where you decide to have the conversation. Make sure there is appropriate time
available for you to share your thoughts and feelings. If needed, have a support person with you when
you share your story.
Provide educational and support materials.• It’s important that individuals are educated about eating
disorders; many people don’t understand the complexities of these diseases, which can lead to saying
the wrong thing. By offering support materials such as pamphlets, books or websites for the person
you’re telling about your eating disorder, you can help him or her better understand what you’re going
Location, location, location.• Be sure to find a quiet place to talk away from distractions. Distractions
will only make the situation more difficult for both of you.
Communicate effectively.• Prepare yourself and what you want to say, be focused and speak in a clear
voice. Let the person know that what you’re saying is important and you’d like them to listen closely.
Give the individual time to absorb what you’re saying.• Hearing that a friend or loved one is struggling
with disordered eating behaviors or body image issues can be startling at first and a lot to take in. Give
the individual a few minutes to process what you’re saying.
Discuss next steps.• A common question after telling someone about your eating disorder is “What
do you and/or we need to do now?” Perhaps you want the individual’s assistance in moving forward
with a treatment plan; so be prepared to discuss your treatment options and plans. For some helpful
treatment resources, see my previous blog, “Getting Help for Anorexia and Bulimia: Eating Disorder
Resources You Can Use.”
Be kind to yourself.• Give yourself praise for taking this big step. Remember, it takes courage, strength
and bravery to tell others our story.
My hope is that in sharing your story, you’ll continue to gain the support you need to build lasting recovery. For
additional support, you can always contact the Clinical Assessment Team at Eating Recovery Center.
For those of you who have shared your story with others, what were some things you did to get the support
January 2, 2012
Telling Your Loved Ones “I Have an Eating Disorder” | Julie Holland
For most people, each new year brings about a new set of resolutions for change; changes in our lives, our
ambitions or ourselves. My advice: Why make the same ‘resolutions’ that typically are unsuccessful? Instead,
forget a ‘resolution’ and each day make a commitment to being healthy and living happily in every part of your
Far too often New Year’s resolutions focus on weight loss or diet in an attempt to kick start the new year and
the “new” you. I think it’s far more important to focus on who you are and what you can do rather than how
you look. It’s time to make a commitment to improve who you are as a person, rather than a resolution to
Here are a few recommendations for facing each day with a positive focus:
Make healthier choices for your body through movement.1. Instead of taking the elevator, try taking the
stairs. You’re sure to have an extra bounce in your step when you reach your office. Instead of circling
endlessly in the mall parking lot searching for the perfect, close parking spot, go ahead and take that
spot near the back of the lot.
Focus on what your body does for you, rather than how it looks.2. Recognize the strength of your
body and praise it for what it’s capable of doing for you each and every day. This year, shift the focus
of exercise away from burning calories or losing weight. Instead, find an activity you enjoy – dancing,
horseback riding, hiking – and experience what your body can do.
Remember and use your five senses when making food choices.3. Look at your food, smell your food,
touch your food and listen to what is happening during each meal. Enjoy the process of eating and
move way from labeling food as “good” or “bad.”
Look at how far you’ve come, not how far you have to go.4. Maybe one of your commitments for 2012
is to find a new job or buy a house, but it just isn’t happening right away. That’s OK. Focus on what
you’re actively doing to meet those goals, whether it’s looking through the want ads, revising your
resume or saving money each paycheck for a down payment. These small steps each day will help you
meet your commitment. Just give it time and be kind to yourself.
At Eating Recovery Center, we strive to help patients realize how far they’ve come with eating disorders
treatment and what an amazing commitment they’ve made to their health by seeking treatment. It’s not an
easy path to take, but it’s certainly not impossible. So let’s start with nixing New Year’s resolutions and instead
make commitments to be healthier each and every day.
What healthy commitments are you going to make starting today? And, how will you start your day differently
tomorrow? I look forward to hearing your comments.
January 18, 2012
Nixing New Year’s Resolutions | Julie Holland
There’s no argument that childhood obesity is a serious health concern. More than one-third of children ages
10-17 are obese or overweight* and obesity rates among U.S. children grew from 14.8 percent in 2003 to 16.4
percent in 2007.**
Obesity is related to more than 20 major chronic diseases, including heart disease and diabetes, and
January 24, 2012
Anti-Obesity Ads: How Far is Too Far in Addressing Childhood Obesity? | Julie Holland
children who are obese are more than twice as likely to die prematurely before the age of 55 compared to
Education and nutritional intervention is key to combating childhood obesity rates; however, are anti-obesity
ads effective in addressing the issue or are they crossing a line into body shaming?
As some of my readers may already know, I struggled with eating disorders from the time I was seven years old
through much of high school. From a very young age I battled with negative body image and a low self-esteem;
being perceived by my peers as the “fat girl in class” was never easy. This perfect storm of factors triggered an
onset of binge eating disorder, anorexia nervosa and bulimia nervosa until I was nearly 20 years old.
Many obesity prevention campaigns promote balance and moderation, practices I agree with and that I think
we can all support. However, a recent anti-obesity campaign in Georgia has come under fire for, according to
critics, shaming and stigmatizing children who are obese. It probably goes without saying that this anti-obesity
campaign hits close to home for me. Although I’ve been in recovery from my eating disorder for 30 years now,
maintaining a positive body image and self-esteem is something I work on each and every day. When I see TV
ads identifying overweight children as “fat” and placing a negative connotation on that label, I worry about
what someone genetically predisposed to an eating disorder might think and feel.
Many people – including children – are at a higher risk of developing an eating disorder, either because
eating disorders run in their family or because they have a temperament that’s more susceptible to eating
disorders development. For these individuals in particular, any number of events or life experiences can trigger
disordered eating behaviors or a full-blown eating disorder. Having someone tell you, “you’re fat” or “you need
to lose weight” can be emotionally and mentally traumatizing, especially for a child. We need to be extremely
cautious in how we approach the childhood obesity epidemic so as not to stigmatize our children or make
them feel less valued or loved.
Because obesity – with its associated health risks – is a growing health issue, it’s certainly an issue to be
addressed. However, it’s equally important that we accept body diversity and ensure that obesity prevention
efforts take into account our children’s body image and self-esteem. Healthy bodies come in all shapes and
If you’re concerned your son, daughter, friend or loved one may have an eating disorder, visit www.
EatingRecoveryCenter.com to chat confidentially with a member of our Intake Team and get all your questions
answered about eating disorders and eating disorders treatment.
What do you think of the anti-obesity ads? Comment and share your thoughts below!
Women aren’t the only ones who struggle with body image issues. New research revealed that 35 percent of
men would sacrifice a year of their life to achieve an ideal body weight or shape.
This study, collaboratively conducted by the Centre for Appearance Research (CAR) at UWE Bristol, The
Succeed Foundation and Central YMCA*, examined British men’s attitudes toward their appearances.
Researchers found that more than four in five men (80.7 percent) regularly engage in conversation about
one another’s bodies and that most are unhappy with their muscularity. The study, which was released in
December 2011, also found that more than half (58.6 percent) of men said that “body talk” affects them
personally and mostly in a negative way.
Findings of this nature underscore the importance of breaking down “body ideals” and reinforcing body
acceptance at any shape or size for both women and men. You’ve all heard me talk about “fat talk” on the
blog and discuss how critical it is to be aware of the body-focused comments we make about ourselves.
Talking about having a “fat day” or rejoicing when you fit into your “skinny day jeans” can have a profound and
negative impact on your own body image as well as on the body image of those around you.
The same goes for the male-focused body-related comments we make. Noting a “six pack” versus a “beer
belly” or calling someone “chubby” can elevate male body image issues and cause men to strive for an
unrealistic body ideal.
For both women and men, it’s time for us to stop placing value judgments on the way we look and start
appreciating our bodies for what they can do.
Are you concerned about your own body image or does a friend seem to be preoccupied with body image
issues? Visit Eating Recovery Center’s website to get your questions answered or chat confidentially with a
member of our Intake Team.
January 30, 2012
STUDY: Body Image Issues Aren’t Just for Women Anymore | Julie Holland
January 3, 2012
Eating Disorders and College Freshmen
Dr. Kenneth L. Weiner was interviewed for a morning show segment about eating disorders and
college freshmen as they return home for the holidays.
See the CD at the back of this clipbook for full video.
January 5, 2012
College Students Can Face Eating Disorders | Sarah Jones
January 10, 2012
The Truth Behind Common Eating Disorder Myths | Ken Weiner
A recent study revealed that 40 percent of Americans have themselves experienced or know someone who
has experienced an eating disorder, such as anorexia or bulimia.* Despite rising awareness among the general
population and health care professionals alike, misconceptions about these serious diseases, which have the
highest mortality rate of any mental illness, remain pervasive.**
Myth: Eating disorders revolve around food.
Truth: Eating disorders are complex illnesses with biological, psychological and sociological underpinnings.
While behaviors associated with eating disorders may begin with a fixation on calories and weight, eating
disorders generally stem from issues beyond food and body size. They also signify an attempt to control
something of substance in an individual’s life.
The mistaken belief that eating disorders are about food compels friends and loved ones to encourage
individuals to “just eat,” when in fact, the disorder from which they’re suffering is incredibly complex.
Myth: Eating disorders are an illness of choice.
Truth: Eating disorders are a mental illness, and no one chooses to have an eating disorder. The women, girls,
men and boys suffering from eating disorders are generally wonderful people with a horrible illness. They’re
often the best and the brightest and come from good families that care deeply about their well-being. On the
surface, these individuals look like they have everything in the world going for them, and
recovering from the disease is far more complicated than simply making healthy lifestyle choices.
Myth: Eating disorders aren’t serious illnesses.
Truth: The mortality rates associated with eating disorders are higher than any other mental illness, including
depression, bipolar disorder and schizophrenia. Anorexia nervosa, which is characterized by refusal to maintain
a healthy body weight and an obsessive fear of gaining weight, is the most lethal eating disorder. Half of one
percent of patients die every year from anorexia, and it has a mortality rate of 20 percent within 20 years,
meaning that one in five people that have had anorexia for two decades will die as a result of the illness.
Even for patients whose eating disorders don’t prove fatal, there are often severe medical complications
associated with starvation and purging, including bone disease, cardiac complications, gastrointestinal distress,
organ failure and infertility.
Myth: Dysfunctional families cause eating disorders.
Truth: While previous models of eating disorders treatment viewed families and dysfunctional dynamics
therein as a contributing cause of these illnesses, the community has moved away from the blaming of families
toward an understanding that families aren’t a cause, but rather an integral part of eating disorders recovery.
While families don’t cause eating disorders, these illnesses have been shown to run in families and are as
inheritable as bipolar disorder and schizophrenia. Between 40 and 50 percent of the risk of developing an
eating disorder is genetic, and a woman with a mother or sister who has anorexia is 12 times more likely than
the general population to develop the disease and four times more likely to develop bulimia nervosa. Those
that develop an eating disorder likely had a latent genetic predisposition toward the illness and a precipitating
event, such as going on a diet, a traumatic event or significant life change, triggered their anorexia, bulimia or
Myth: Eating disorders are a women’s illness.
Truth: While eating disorders involve many women’s issues and females represent a large part (90 percent) of
the affected population, research suggests that male eating disorders now account for at least 10 percent of all
cases. Interestingly, despite significant biological, psychological and sociological differences between men and
women, the etiology of eating disorders remains fairly constant between the two genders. Like in their female
counterparts, eating disorders in men and boys are genetic in nature and are often supported by psychological
and sociological pressures such as traditional gender roles and socially accepted ideas about masculinity.
Eating disorder myths can prevent individuals, families and professionals from recognizing these illnesses and
seeking appropriate treatment. Education and awareness are the strongest antidotes for misinformation, and
promoting a better understanding of eating disorders among the general public and the healthcare community
can support early identification, effective intervention and lasting recovery for the men, women and children
suffering from eating disorders.
Learn more about eating disorders and debunk eating disorders myths here.
January 12, 2011
Parents: Important Advice About Your College Student and Eating Disorders | Pamela
Eating Disorders Can Be Fatal: Here’s What Parents Should Say and Do If They Think Their Child Has an Eating
College students have tremendous pressures on them these days. As parents and grandparents we read,
hear and worry a lot about binge drinking and drug use on college campuses. There are quieter but equally
destructive – in fact, even deadly – ways college students are harming their health as well: eating disorders.
In Parents: 10 Winter Break Warning Signs of Eating Disorders in Your College Students, I shared expert advice
on what parents should look out for while your college students are home for the holidays. Experts stressed
that parents and other family members should be “vigilant,” especially with college freshmen.
Here, I’d like to share more expert advice on what to do and say if you suspect a loved one is suffering from
an eating disorder — especially a college student coming home for visits. Maybe they are starving themselves
with anorexia or bingeing and purging with bulimia. Or both. Whatever disordered relationship they may have
with food, it means they are in crisis, in pain, and need your intervention.
Elizabeth Easton, PsyD, is the clinical director of child and adolescent services at Eating Recovery Center. She
offers some “dos and don’ts” for parents or other family members who become concerned about a loved one’s
As Dr. Easton explains, there are two possible scenarios as your loved one returns home from college for a visit
and you suspect an eating disorder:
Signs and Symptoms:
Weight Loss and Depression: “Your loved one has lost a significant amount of weight, become very isolative or
socially withdrawn and appears more pre-occupied with weight and/or food.”
Obsession with Exercise: “Additionally, there’s a significant change in his or her exercise drive and/or
compensatory behaviors (vomiting after eating, abuse of diet pills or laxatives, etc…). These behaviors often
mean the person is more entrenched in the eating disorder and is relying on eating disorders behaviors to cope
with stress, depression and anxiety.”
Eating Little, and in Ritualized Ways: Maybe he or she is eating a small amount but is cutting it into tiny pieces,
eating in some private pattern.
If this sounds like your child:
What To Do: “The first priority is your child’s physical health. Your son or daughter needs to be taken to a
physician for an assessment (current weight versus ideal, any weight loss since leaving for college, current
blood work and vitals). If your child refuses to go to the medical appointment or cooperate with the
assessment, stress how critical it is to be healthy, especially if he or she wants to successfully return to school
the next semester. In other words, if he or she wants to return to independent life back at school, he or she
needs to demonstrate that he or she can manage his or her health and well-being through cooperating with
Parents Stay Focused on Health: “Parents should focus on what needs to be done, rather than simply asking,
“Are you OK?”. Kids can easily ‘skate’ around yes or no questions and give parents answers without details.
Also, he or she may not be willing – or capable – to identify the illness and engage in the treatment process.
They often need others to take the lead and help them face this issue head on.”
Be Firm: “Parents need to be firm and stay involved. If you are concerned about your child’s health and
potential for an eating disorder, tell your son or daughter what’s going to happen, instead of asking for
permission. For example: ‘In an hour (or tomorrow or this afternoon), we’re going to see a physician and
explore what’s going on with your weight and overall medical functioning. We need to make sure you’re
Some Kids ‘Wake Up’: “Parents should also remember that some kids will ‘wake up’ when they find out there’s
a medical concern. Other kids, especially those who are deeply entrenched in the eating disorder, will see it as
a challenge and hear the confirmation of weight loss as a motivator to continue to use the eating disordered
Stay Connected - Be Supportive and Tough: “Although parents should be firm, it’s important to stay involved
and acknowledge the stressful and painful process your child is going through. Making threats such as he
or she can’t return to school until they “get better” can be shaming for a child and won’t foster productive
conversations. Instead, validate how hard and invasive the assessment and treatment process can be, while
firmly insisting that you’ll be there to support them and follow through on getting them the help they need.
In my next post, Dr. Easton explains what to do if your child or loved one falls into a second category of possible
January 17, 2012
Parents’ New Year’s Resolution Weight Loss Behaviors Can Contribute to Eating
Disorders in Children
As millions of Americans resolve to lose weight in 2012, parents’ new diet and fitness regimens may have an
unintended, negative outcome—triggering disordered eating behaviors or body image issues in their children.
Because children often will mirror what they observe in their adult counterparts, Eating Recovery Center, an
international center for eating disorders recovery providing comprehensive treatment for anorexia,
bulimia and binge eating disorder, urges parents to be mindful with their food- and body-focused words and
behaviors while undertaking New Year’s resolutions.
“Children and teens are very susceptible to picking up value judgments about body shape and size,” said
Elizabeth Easton, PsyD, clinical director of Child and Adolescent Services at Eating Recovery Center. “If we teach
them – through dieting, over-exercise behaviors and critiques of our own bodies – that there is a ‘good’ body
type, then that is exactly what children will strive for at all costs if they are susceptible to an eating disorder or
poor body image.”
According to the National Eating Disorders Association, weight and body consciousness among children begins
at very young ages, with research finding that 81 percent of 10-year-olds are afraid of being fat and 46 percent
of 9- to 11-year-olds are “sometimes” or “very often” on diets.
More than one-third of “normal dieters,” many of whom begin dieting at young ages, progress to pathological
dieting, a condition marked by continual dieting and from which 20 to 25 percent of individuals develop
eating disorders. When considered alongside a recent Thomson Reuters and National Public Radio poll, which
reveals that one-third of Americans have made a New Year’s resolution to lose weight in the last five years, this
research illustrates the perfect storm parents can unknowingly initiate by adopting aggressive or unhealthy
weight loss regimens.
Eating Recovery Center encourages parents to follow these four tips to model healthy behavior, help their
children embrace healthy attitudes about their bodies and minimize the chances that children will adopt
negative thoughts and behaviors related to food and body image.
Do not diet.1. Instead, resolve to eat healthier, well-balanced meals. Through their own behaviors,
parents can teach children how to focus on moderation without rigidly labeling foods as “good” or
Shift your perspective on exercise.2. Instead of looking at exercise as a dreaded weight loss tool,
approach it as a fun activity for feeling good and improving overall health. Plan family outings and
activities and children will follow their parents’ example.
Be aware of comments you make about your body.3. Children are far more astute than parents may give
them credit for, and they often mirror observed behaviors. Offhand comments about having a “fat day,”
failing at your weight loss resolution or feeling too snug in an old pair of jeans can have a bigger effect
on a developing child’s body image than many may think.
Be aware of comments you make about others.4. Criticizing others for “gaining a few pounds” over the
holidays or complimenting someone for resolution-driven weight loss can lead children to believe that
there are “good” and “bad” body shapes and sizes.
“Because eating disorders have a genetic component, children with a family history of anorexia, bulimia or
binge eating disorder are particularly susceptible to negative diet- and body-focused words and actions,”
explains Dr. Easton. “In these children, seemingly innocent body image comments or dieting behaviors can
quickly spiral out of control.”
Parents are encouraged to seek an eating disorders assessment if they notice troubling food- or body image-
oriented behaviors in their children. Recovery is entirely possible with early intervention and proper eating
disorder treatment from qualified professionals.
January 17, 2012
Parents’ New Year’s Resolution Weight Loss Behaviors Can Contribute to Eating
Disorders in Children
January 20, 2012
Could your weight loss #resolution have unintended consequences for your kids? Find out more! http://bit.
January 12, 2012
Does Your Child Have an Eating Disorder? | A.V. Flox
Eating disorders affect five to ten million young and
adult women and one million men in the United
States. What is a parent to do when we suspect our
child may be exhibiting symptoms of disordered
eating? Come to think of it -- what are symptoms of
To answer these questions, I called up Liza Feilner,
a licensed professional counselor and senior
therapist at the Eating Recovery Center’s Child
and Adolescent Behavioral Hospital who for nine
years has been working inpatient with individuals
suffering from eating disorders.
A lot of us don’t always have the opportunity to observe our children’s eating behaviors throughout the day,
meeting up with them only at dinner time. In the following list, Feilner offers some tell-tale signs that a child
may be exhibiting symptoms of an eating disorder.
“Remember, you’re looking for changes to previous patters that they’ve set with their eating,” says Feilner.
Symptoms of disordered eating
Weight loss or weight fluctuation. These are well-known indicators, though Feilner warns that neither of these
in themselves are the only determinant that somebody is struggling with an eating disorder.
Significant changes in food behavior. “If suddenly they’re cutting out a particular food group, that may signify
a change in food behavior,” warns Feilner. “For example, they may cut out fats or carbs or certain foods and
begin getting more rigid with what they are willing to eat.”
Limiting intake. “I already ate.” “I’m not very hungry tonight.” If your child is consistently skipping meals or
otherwise trying to limit their food intake by pushing food around the plate or taking really small bites to make
it seem like they are eating, watch closely for other symptoms of disordered eating.
Ritualistic behavior. Eating disorders tend to turn the consumption of food into a very rigid ritual. Any peculiar
eating behaviors -- such as finishing one item on the plate before moving on to another, for example -- should
signal a parent to become more observant.
Overindulgence. If your child is getting several helpings of something -- and this is a change from their
previous behavior -- it might indicate binging. “Usually people who are binging will be drawn to what they have
identified in their minds as ‘bad’ foods, so overindulging might involve desserts or carbs, of whatever they
believe to be ‘worse’ for them,” says Feilner.
Increased time spent in the bathroom. Any increase in the amount of time spent in the bathroom, or going to
the bathroom immediately after a meal could be a sign that your child is purging. “Vomiting is a way to purge,”
says Feilner. “But you also need to be aware of other forms of purging. Is there any evidence of laxative use or
Rigidity in exercise behaviors. There is healthy working out and disordered working out. If a child is
prevented from working out, does it cause them a disproportionate level of distress? “Most people would be
inconvenienced if they couldn’t do their normal workout routine, but they would get on with their day,” says
Feilner. “Somebody with an eating disorder has so much anxiety -- they’re using exercise to alleviate their guilt
around food -- that they’ll become very agitated if they can’t exercise.”
Changes is style of dress. “You see this go both ways,” says Feilner. “Some kids might start wearing more
revealing clothes, showing off what they have accomplished, and other kids may start wearing really baggy
clothes to hide weight loss.”
Negative evaluations. You might hear your child talking more about their bodies, making comments about
being fat or giving a generally negative evaluation of their appearance.
Obsession with health. It’s important to mention that disordered eating doesn’t always look like a disorder.
An emphasis on healthy eating can also lead to an increased preoccupation with food. “It almost is socially
acceptable, because it looks like self-control or discipline, when in reality it might be making food increase in
importance until their rules surrounding food and general preoccupation begin dominating their lives,” says
Increased involvement in food purchasing decisions. “Some kids will insist on going to the grocery store
or going over the food labels,” says Feilner. “They want to exert some control over what is bought and
So what are some things a parent can do when they come across these behaviors? Communication, seeking
support and being a good role model are key to responding to your child’s unhealthy eating behaviors:
Don’t take a heavy handed approach. Eating disorders are about more than food, emphasizes Feilner. “Don’t
take a heavy handed approach and say, ‘you’re going to eat this.’ A more effective approach is expressing your
concern,” she says.
“Don’t interpret their behavior for them,” says Feilner. “Mirror back their behavior by saying, for example, ‘I
notice you’re going to the bathroom a lot after meals and I’m concerned that maybe you’re struggling and I’m
wondering if something is going on. Why do you think you’re going to the bathroom so much?’ or ‘I notice that
you’re losing weight and I’m worried about that.’ Express your concern in a way that invites conversation rather
than says, ‘you’re doing this, therefore you have an eating disorder and you’re going to eat.’”
Seek outside support. If you have evidence that your child is exhibiting disordered eating, seek outside
support from a medical doctor who can assess your child; a dietician who can give some information about
healthy meals and listen for some of the behaviors that can be problematic; and a therapist to discuss the
underlying issues. “Ideally, you want people who already work together and can function as a team, but at
the very least, seek people who are willing to communicate with each other. It’s really important to have a
cohesive group of people who can support the kid and the family,” says Feilner.
Watch your body judgments. Parents can impact on their children with their behaviors and attitude. Be
mindful of your body attitudes, try to cut down on talk about weight and physical imperfections, and avoid
assigning judgments to people based on their weight. “We see a lot of kids whose parents make negative
comments about people who are overweight,” says Feilner. “Some kids internalize the fear that they may
become a person who is rejected because of how they look.”
Consider food attitudes. Assigning values to food, even simple labels like “good” and “bad” can inform
disordered behaviors. This also extends to attitudes about people -- judging people based on their behavior
with their food as “good” or “bad” can impact a child’s perception of consumption and later inform disordered
Beware your exercise habits. As a parent, you should model that exercise is healthy, but be careful not to show
that it is connected to your ability to function. “One of the tells that exercise is becoming a problem is when a
person can’t be without it for a day,” says Feilner. “If there is a disruption in a parent’s exercise routine are they
distressed and upset? Showing your kids how to be flexible is important.”
Careful with compliments. Limit the amount of compliments that are appearance-based. “You look thin.”
“You’re very fit.” “I was that small when I was your age.” These body-focused comments are intended as
compliments, but they shift an unnecessary amount of pressure on your child to maintain a physical ideal.
Don’t assume. Eating disorders don’t just affect women. As mentioned above, there are at least one million
men who suffer from disordered eating in the U.S. alone. Just because your child is a boy, or of normal weight,
or even fit, does not mean they are immune to developing an eating disorder.
One shocking recent statistic, released by the American Academy of Pediatrics in fall 2010, is that from 1999
to 2006, hospitalizations for eating disorders increased sharply - 119% - for children younger than 12 years old.
The academy also noted significant increases in prevalence of eating disorders among minorities and males.
I spoke to Ovidio Bermudez, MD, medical director of child and adolescent services at Denver’s Eating Recovery
Center and a board member of The National Eating Disorders Association (NEDA). The 119 percent rise in
hospitalizations for such young children, Dr. Bermudez said, is “likely to be a good proxy for a rise in incidence,”
meaning that as incredible as it sounds, it probably accurately reflects the increase in the number of kids under
12 who are suffering from eating disorders, especially, as Dr. Bermudez points out, when you consider how
carefully third-party reimbursing organizations scrutinize hospital stays, and how reluctant they are to okay
The reasons for this scary rise in children’s hospitalizations, says Dr. Bermudez, are complex, the result of a
variety of forces that have created a “perfect storm very likely related to changes in the environment and
changes in people’s experience.”
Here’s how Dr. Bermudez believes this “perfect storm” has taken shape: Imagine that we can divide children
our society into two groups, one that is genetically protected from eating disorders (meaning they have no
family history of them), and another that is “genetically vulnerable” (meaning there is a family history of such
disorders). Suppose a child in the latter group grows up in a “protective environment,” let’s say where there
is no dieting peer group, no obsession with fashion and popular culture, or perhaps no obsessively dieting
parents. Such a child is not likely to develop an eating disorder. “If that environment is altered and becomes a
‘promotive environment,’” explains Dr. Bermudez, “even someone who is more genetically protected” might
be affected. The child who is really going to be adversely affected, though, and who is most likely to develop an
eating disorder is the genetically vulnerable child exposed to the promotive environment.
Dr. Bermudez speculates that what we’re seeing now is a cultural shift from a “protected” environment to a
“promotive” environment and notes, “in a lot of ways we’re seeing the same thing in other areas: childhood
obesity, diabetes, and respiratory illnesses. My sense is that we are changing, the earth is supporting
seven billion of us and that brings all kinds of added challenges, not only from a physical, and environment
standpoint, but from an emotional and socio-cultural point of view.”
Dr. Bermudez cited 2010 findings from the American Psychological Association’s annual Stress in America,
survey, which found that the number one stressor on families is their financial situations, and that nearly
half of all children reported feeling saddened or worried about family problems. He calls it “stress by proxy,”
meaning that kids “are not living the financial difficulties to the extent that their parents are, “but they were
picking up the stress because we don’t live in isolation.” He adds, “the world in general, is becoming a more
stressful place to grow up, in. Everyone has access to mass media and there are things being promoted that
aren’t healthy, about body image, fitness, about the tolerance of violence.....and we know that exposure
February 7, 2012
What’s Behind the Dramatic Rise in Childhood Eating Disorders Hospitalizations? |
In addition to be bombarded by potentially triggering mass media messages, kids face other challenges: “social
competition, pressure to perform, to be multitalented, and engaged in so many things,” adds Dr. Bermudez.
The pace of change and the level of tension in our society, he believes, are creating a culture that’s very
difficult for our kids to get a stake in.” The message: “If you’re not a super go-getter, you may not make it,” and
not everybody takes that message well.
So what can parents do? “First of all,” says Dr. Bermudez, “alleviate stress for yourself, and for your family.
Maybe you do with less: work two jobs instead of three, and take care of yourself in appropriate ways.” (The
American Psychological Association Stress in America report notes that managing stress levels, eating right,
and getting enough sleep and exercise are key.)
Another thing: “Without kind of pushing your kid outside of the space within the bell curve, you want your kid
to skew toward the side of less intensity, and fewer expectations of immediate performance.” When he speaks,
Dr. Bermudez tells audiences, “I’m so grateful that a good chunk of my childhood was in Cuba, playing in the
streets and flying kites...I didn’t take any lessons...now kids take everything, and if they’re not doing that,
they’re out of the mix.”Instead of trying to cram in sports, arts, academic and enrichment programs all at once,
Dr. Bermudez suggests rotating them “rather than all of them all the time at all costs.”
Another way you can help counteract an increasingly “promotive” environment is to, as Marcia and I advise
in our book, model healthy attitudes and behaviors when it comes to food, eating, shape and size, and make
exercise an enjoyable and regular part of your lives.
It’s National Eating Disorders Awareness Week, and this year’s theme is “Everybody Knows Somebody.”
Increasingly, that “somebody” might be a woman in her 30s, 40s, 50s or beyond. Although eating disorders
often appear in adolescence, or (as I wrote in my last blog post) even earlier, they are also becoming more
prevalent among middle-aged and older women.
Emmett R. Bishop, MD, a founding partner and medical director of adult services at the Eating Recovery Center
in Denver, told me about the noticeable rise in older women seeking treatment for eating disorders at his
facility. Although hard data is hard to come by, Dr. Bishop, who has been treating eating disorders for 30 years
now, says, “I’ve been around long enough to see the trend, and we’re seeing considerably more” such older
women. At the time of my recent conversation with Dr. Bishop, at least six of the 28 or so inpatients at the
center were older women. Several were over 40, a couple patients were in their 60s and there was one 80-
year-old patient. Dr. Bishop called this a patient demographic “that you would not have seen ten years ago.”
Often, these patients have been in treatment before and are returning after a relapse. Usually there has been
a triggering incident, which might be a stressful life event such as divorce or medical illness. Gastrointestinal
illnesses that cause inadvertent weight loss can trigger a new onset of dieting, and “exacerbate a fight [the
patient] is already fighting,” explains Dr. Bishop.
In other cases, the eating disorder has been obvious to family members but ignored by all, until physical
complications make it impossible to do so anymore. When they do start, the physical problems can be
numerous. Years of under-eating leads to “deterioration of the body, which leads to everyone becoming
alarmed,” says Dr. Bishop. “It’s a common theme in this group: body decline.” Even so, Dr. Bishop notes that
February 27, 2012
Rise in Middle-Aged and Older Women with Eating Disorders | Nancy Matsumoto
February 9, 2012
Eating Disorders Treatment Saves Lives: An Interview with Scarlett Ramey | Julie
these patients are most often coerced by their families to come in for treatment, whether because of shame or
entrenched denial, or both.
The pattern among patients in their 30s and 40s, however is different. Often worried about the effect of
their eating disorder on their children, they are more motivated to seek treatment on their own. Dr. Bishop
frequently hears the comment, “I’m concerned about what kind of example I am for my teen-aged daughter.”
In many cases, the daughter is also struggling with eating issues, he notes, but there are also the instances
“where I’ve had daughters come in and react in opposition. For as many who identify with their mothers, there
are those who react and want their mother to ‘get her act in order,’ so to speak.”
The physical symptoms that tend to affect the long-term eating disorder patient, says Dr. Bishop are
gastrointestinal and bladder dysfunction. If a patient has purged for years, chronic esophageal problems
demand treatment, while long-term food restriction can lead to constipation-related issues that are very
difficult to treat. Dr. Bishop is puzzled as to why bladder problems are so prevalent among the long-term eating
disorder patient, but says it’s been an emerging issue, “even among patients in their forties.”
Another condition Dr. Bishop says is prevalent among “the chronically semi-starved individuals,” as he puts
it, is poor cognition, noting, that besides lack of clear thinking, “it’s hard for them to shift gears [mentally].”
Even though insurers can be reluctant to cover nutritional rehabilitation for such patients, Dr. Bishop has seen
dramatic improvements in cognition with nutrition counseling and weight restoration, and an increase in
motivation to get better on the patient’s part. His belief, one that clinicians often must do battle with insurers
to uphold, is: “We should never give up on patients.”
Only one in 10 men and women with eating disorders receive treatment.* Only 35 percent of people
with eating disorders that receive treatment are doing so at a specialized facility for eating disorders.**
Understanding the importance of seeking treatment is a crucial step in the recovery process. I thought it would
be interesting to hear another treatment professional’s point of view on eating disorders treatment and what it
means for lasting recovery.
So today my colleague, Scarlett Ramey, MS, RD, CD, founder and president of Ramey Nutrition (www.
rameynutrition.com), shares her thoughts on qualified eating disorders treatment and what it can mean for an
individual struggling with anorexia, bulimia or binge eating disorder.
Question: Why do you think eating disorders treatment is so important?
Answer: Our society has a growing concern with body image. It’s becoming one of the most important
determinants of self worth and identity. Eating disorders treatment helps people to understand what their true
self worth is and deal with their body image issues and eating disorders behaviors. Treatment also helps to
empower patients so they can see an enjoyable life without the eating disorder. Additionally, treatment raises
awareness of eating disorders and serves as an educational tool for friends and families wanting to know more
about the diseases affecting their loved one.
Q: What about treatment do you believe is so valuable to the patients?
A: For someone seeking inpatient or residential eating disorders treatment, I think the most beneficial part
is the 24/7 care provided by a medical treatment team. A chronic eating disorders patient requires constant
medical care and observation in order to break the eating disorders behaviors and move forward.
There are so many “parts” to treating eating disorders, from the different types of therapies to the meal plans,
but each “part” has its place—as long as the patient is present and willing. Not every therapy is right for every
patient, but allowing the patients the option to express themselves through body movement or art projects
creates a treatment plan and atmosphere that the patient can embrace and make the most of.
For individuals seeking treatment, remember to do your treatment center research. Different centers do
different “parts” of treatment really, really well. Make sure the treatment center you decide on fits your
individual needs, medically and emotionally.
Q: What advice do you have for individuals seeking eating disorders treatment?
A: My advice to an individual needing treatment: You’re worth it. It’s no secret that treatment can be
expensive, hindering it for some. For this reason, I tell all my patients that they’re worth the treatment; they’re
worth living. Taking the step to treatment is scary and patients need to feel someone “in the corner” as they
make those decisions.
For the family of someone needing treatment, I think they want to have all the answers about eating disorders
to feel supportive. These are complex, mental illnesses and families don’t need to understand them completely
to support a loved one in treatment. It’s also important to note families need their own therapy too. As a
family member, when your wife, husband, son or daughter is struggling with anorexia or bulimia, you’re
struggling too. Many treatment centers offer family support groups; I encourage you to take advantage of
these groups and deal with your own questions and concerns.
Q: When do you think eating disorders treatment is most successful?
A: Nobody is ever excited to go to treatment, even if you’re making the choice for yourself. So, in order
to increase the chance treatment is successful, I believe a patient needs an ongoing support group that
encourages them to push through with treatment. By validating a patient’s feelings and telling him or her,
“you’re right, you need this treatment,” the patient feels supported and confident in his or her decision to seek
Additionally, the collaborative approach to treatment with an entire team of medical professionals, from
doctors to therapists to nutritionists, helps effectively address the biological, psychological and sociological
parts of eating disorders.
Q: Anything else you’d like to share about eating disorders treatment?
A: At Ramey Nutrition, we don’t offer 24/7 care for our patients, so when those patients return home and
transition out of inpatient or residential care, we strive to make that transition as seamless as possible. At
treatment centers like Eating Recovery Center, a patient arrives back home with a full report on their treatment
program and experience helping the “aftercare” treatment team – people like me – continue the care and
treatment plan a patient has become accustomed to while in a treatment center.
Thank you, Scarlett, for sharing your experiences with eating disorders treatment. It’s always great to hear
another colleague’s point of view on the reasons qualified treatment is so important.
Comment below with your own advice for individuals seeking treatment or people helping a friend or loved one
make that important step towards recovery.
*Ruth Striegel-Moore, et al., One year Use and Cost of Inpatient and Outpatient Services Among Female and Male Patients with an
Eating Disorder: Evidence from a National Database of Insurance Claims, International Journal of Eating disorders 27 (2000).
**Characteristics and Treatment of Patients with Chronic Eating Disorders, by Dr. Greta Noordenbox, International Journal of Eating
Disorders, Volume 10:15-29, 2002.
February 14, 2012
Are Models Too Thin? A Look at the Fashion Industry’s Efforts to Ensure Healthy
Runway Models | Julie Holland
Twenty years ago the average fashion model weighed 8 percent less than the average woman. Today she
weighs 23 percent less.*
As this season’s fashions were revealed at Fashion Week, which began February 9, I commend the Council of
Fashion Designers of America (CFDA) for taking a stand to prevent eating disorders through its model health
guidelines. Every year for the past five years, the CFDA releases model health guidelines, which designers are
encouraged to follow, in order to ensure girls under the age of 16 aren’t hired to walk in the shows and address
the concern that some models are unhealthily thin. While unhealthily skinny models continue to be hired by
designers, these guidelines represent a small step in the direction of making a healthful change.
In the CFDA’s Health Initiative, Diane Von Furstenberg, CFDA president, stresses the importance of all designers
sharing the responsibility of protecting women and encouraging positive body image by emphasizing that
“beauty is health.” According to the CFDA, the Health Initiative is about awareness, education and safety, not
policing. Although a specific body mass index isn’t required to work, models are recommended to receive
regular medical care to ensure their wellbeing.
A brief overview of the CFDA Health Initiative’s guidelines:
Support the well being of younger individuals by not hiring models under the age of 16 for runway•
Develop workshops for the fashion industry (models and their families) to raise awareness about eating•
disorders including their warning signs, complications and treatment options.
Provide healthy meals and snacks backstage at Fashion Week and at shoots. In addition, offer fitness•
and nutrition education.
Source: New York magazine’s fashion blog, The Cut**
It’s my hope that guidelines such as these will spur cultural change in the fashion industry, and encourage
designers to place health above size. Changing the idea of “size zero fashion” and society’s warped views of
what is “healthy” and “beautiful” won’t happen overnight. But everyone – from individuals to the fashion
industry – is responsible for urging that change along. Remember, it’s not what you’re body looks like; it’s what
it can do for you. Embrace the unique.
Are you concerned about a friend or loved ones potential disordered eating habits? Visit the Eating Recovery
Center website to confidentially chat with a member of the Intake Team and have all your questions answered.
How will you appreciate your body and embrace a change in society this Fashion Week? Comment and share
February 20, 2012
Parenting a Healthy Body Image | Julie Holland
Childhood is a place for dreams, imagination and growth. It’s the time in life when we’re free to let our natural
curiosities take the wheel as we bloom both physically and mentally.
As parents, we play a significant role in encouraging this growth as our children go through every day, learning
about the world around them. In our society, which is hyper-focused on dieting methods and unattainable
beauty ideals, the role of parenting is especially important in children’s development of a realistic and healthy
body image. Knowing this, parents should monitor how they speak and act around their children; it’s a key
factor in ensuring that each child receives a chance to develop a healthy self-concept and body image.
Here are some quick tips to jumpstart your success as a healthy body image role model:
Avoid dieting.1. Dieting is an unrealistic way of thinking for children. In order to help your child develop a
healthy understanding of food as nourishment, provide well-balanced, healthy meals and avoid labeling
certain foods as “diet foods” or “good” or “bad” foods.
Make regular exercise fun for everyone.2. We all have those days where we dread the very thought of
exercise. It’s human nature! However, it’s important to remember how our own attitudes can easily rub
off on our children. Try referring to exercise as a healthy activity rather than a means to lose weight. In
doing this, you can lead by example and plan family trips to the park, pool or local recreation center.
Remember that exercise doesn’t just occur in the gym or on the treadmill. There are many fun and
exciting family activities that involve body movement.
Practice positive self-talk.3. Children are notorious for mimicking observed behaviors; after all this is how
they learn. Although negative “fat talk” may come as second nature every now and then, these small
comments could have an intense affect on your child’s own body image down the road. Instead, aim to
offer comments of confidence and positivity. Remember, you’re beautiful and so is your child.
Develop a consciousness of others.4. Growing up, our parents always told us, “If you have nothing
nice to say, don’t say anything at all.” Well, they were right. This idea is just as important for parents
to practice as their children. Negative comments about the size and shape of others might lead our
children to believe there’s a certain way the human body is supposed to look. Guide your child to
define his or her own positive definition of beauty.
Not only will these tips lead you to model a healthy body image for those around you, but you’ll also find
the positivity improving your own health and happiness. If you’re concerned about a friend’s or loved one’s
negative body image, visit Eating Recovery Center’s website to learn more about what a negative body image
can do to your overall perception of self.
What healthy changes or improvements will you make to your own body image behaviors to ensure a positive
environment for your child? What do you already do that you are proud of? Comment and share below!
February 27, 2012
National Eating Disorders Awareness Week: It’s Time to Heighten Our Awareness
and Increase Our Understanding Because ‘Everybody Knows Somebody’ | Julie
More than 10 million women and 1 million men currently struggle with an eating disorder. The significant
– and growing – prevalence of eating disorders in the U.S. makes eating disorders awareness extremely
important, especially as we observe this year’s National Eating Disorders Awareness Week (February 26-March
3) with the theme, “Everybody Knows Somebody.”
Eating disorders are the deadliest mental illnesses and they can have a damaging effect on an individual’s
body image, self-esteem and mental health. During this National Eating Disorders Awareness Week, as well as
for the rest of the year, I invite you to educate yourself and loved ones about eating disorders and help raise
awareness of these diseases, which can alter the lives of men, women, boys and girls.
Remember, eating disorders can happen to anyone, regardless of their age or gender. As eating disorders
continue to grow in “nontraditional” demographics, it’s important to be aware of eating disorders warning
signs and vigilant for unhealthy food- and body-focused behaviors in all of the people you love.
During National Eating Disorders Awareness Week, we should all make an effort to recognize risky behaviors
associated with eating disorders and learn how we can all provide support for individuals of all ages and
genders who struggle with anorexia, bulimia, EDNOS or binge-eating disorder. Please join me in reducing the
stigma that surrounds eating disorders by learning to recognize five passive behaviors or mindsets that may
indicate that someone has an eating disorder.
Although I have previously discussed a few of these on my blog, National Eating Disorders Awareness Week
puts them at the forefront of our minds.
Cycles of Dieting.1. Repetitive cycles of dieting can go hand-in-hand with patterns of weight fluctuation.
For some, this constant change in weight may lead to the development of body image problems and
can even trigger the development of an eating disorder.
Family History.2. If a woman’s sister or mother has anorexia, she is 12 times more likely to develop the
illness and four times more likely to develop bulimia. It’s especially crucial for these individuals to be
conscious of disordered behaviors such as over-exercise and unhealthy attitudes toward food.
Labeling.3. It’s important to be aware of how we label foods and food groups. Placing “good” or “bad”
labels on foods because of their nutritional make-up could lead to unhealthy attitudes and patterns of
consumption. Rather, we should focus on moderation.
Negative Talk.4. Making negative comments about our own appearance or the appearances of those
around us can contribute to the development of an eating disorder or hinder eating disorders recovery.
These comments can affect ourselves and those around us, like our children and loved ones.
Food Habits.5. Emotional, reward or punitive ties to food can foster an unhealthy relationship with
those foods or food groups. Instead of using food to reward positive behavior, refer to it as fuel to help
develop a positive mindset.
Visit www.nationaleatingdisorders.org for more information about National Eating Disorders Awareness Week
and learn how you can get involved across the country.
February 9, 2012
Eating Disorders: Hope for Recovery | Susan Hickman
Dr. Johnson did a recorded interview for Susan Hickman’s radio show on eating disorders, treatment
See the CD at the back of this clipbook for full audio.
For additional support and resources on eating disorders recovery and a complete listing of National
Eating Disorders Awareness Week events sponsored by Eating Recovery Center, visit the website at www.
How will you help raise awareness and reduce stigma surrounding eating disorders this week? Comments and
February 15, 2012
Is Your Teen into the eTriggers Trend? | Julie Weingarden Dubin
Though not a clinical term, eTriggers is a shortened
way of referring to electronic- or technology-based
activities that could potentially trigger someone
to engage in dieting, exercise or disordered eating
behaviors, says Ovidio Bermudez, M.D., the medical
director of child and adolescent services at Eating
Recovery Center in Denver, Colorado.
Kids and teens may use game consoles, computers,
tablets and phones to study diet and exercise
techniques. For example, calorie-counting smart
phone or tablet apps that manage calorie intake or
exercise-focused video games that measure current
weight and calories burned. Healthy when used in
moderation, but when taken too far, they can enable
In addition, there’s a myriad of websites, such as pro-anorexia or pro-bulimia websites or forums, that offer
harmful tips to help children and adolescents learn and practice disordered eating behaviors, Dr. Bermudez
adds. It’s important to recognize that these activities do not “cause” eating disorders. Eating disorders are
complex, heritable diseases that involve bio-psycho-social factors, says Dr. Bermudez. “These triggers can
simply kick-start one behavior that may be taken to an extreme, and they can serve as enablers for unhealthy
food- or exercise-focused behaviors that have already begun.”
They want to be the best
Through websites, phone apps, games and social media forums,
technology can trigger or enable an eating disorder. “An important
part of the mindset of individuals struggling with eating disorders is a
desire to learn ‘how to do it better’ and how to compete with others,”
says Dr. Bermudez. “Both of these can be cemented by accessing
information related to losing weight.”
Plus, they compare themselves to other people with eating disorders
and motivate themselves to “do it better” by learning new ways to
drop weight and bond with others around their successes or failures
in eating disorders behaviors.
Need to Know
It’s not just kids genetically predisposed to eating disorders who
have to worry about the dangers of e-Triggers. Any kid can get lured in. Parents are ultimately responsible
for monitoring the appropriateness of their kids’ screen use.Keep an open dialogue with your children about
healthy habits and technology.
Be aware of the technology your kids have access to and the amount of time they spend using it on school
days and weekends. Keep an open dialogue with your children about healthy habits and technology.
February 17, 2012
Interview with Enola Gorham
Enola did a live interview about eating disorders and warning signs while traveling in Nashville.
See the CD at the back of this clipbook for full video.
Four in 10 Americans have either suffered from or know someone who has suffered from an eating disorder,
according to the National Eating Disorders Association. During National Eating Disorders Awareness Week
(February 26-March 3), Eating Recovery Center ( www.EatingRecoveryCenter.com), an international center for
eating disorders recovery, highlights eating disorders pervasive impact on Americans of all ages and genders.
A classic misconception of eating disorders is that they are a teenage girls disease, when in fact, we are seeing
more older women, younger children and men of all ages entering treatment, said Kenneth L. Weiner, MD,
FAED, CEDS, founding partner, chief executive officer and chief medical officer of Eating Recovery Center.
Genetic risk factors and environmental triggers for these diseases don’t discriminate based on age or gender.
The 2012 National Eating Disorders Awareness Week theme is Everybody Knows Somebody, which is truer now
more than ever, as eating disorders and body image dissatisfaction continue to experience what experts term
epidemiological drift, which is marked by a conditions swift growth in incidence in new populations.
Older women: Eating Recovery Center has seen a marked increase in older women seeking treatment•
for eating disorders. From 2010 to 2011, admissions of women over the age of 30 increased from
27 percent of total admissions to 33 percent of total admissions. In the same timeframe, admissions
of women over the age of 40 increased from 13 percent of total admissions to 15 percent of total
Men: A recent British study shows that more than 80 percent of men regularly engage in conversation•
about their bodies, that three in five men are unhappy with their muscularity and that more than one-
third of men would trade a year of their life to achieve their ideal body weight or shape.
Younger children: From 1999 to 2006, hospitalizations for eating disorders increased sharply 119•
percent for children younger than 12 years of age, according to recent analysis by the Agency for
Healthcare Research and Quality.
Its important to be aware that eating disorders can happen to anyone—men, older women and younger
children, continued Dr. Weiner. Do not discount disordered eating behaviors or concerning body image issues
just because they are displayed by an individual believed to be outside of the traditional eating disorder
Eating Recovery Center encourages individuals to quickly respond if they notice troubling food- or body
image-oriented behaviors in their loved ones, regardless of age or gender. Eating disorders recovery is entirely
possible with early intervention and proper treatment from qualified professionals.
If you notice troubling behaviors in an adult friend or loved one• , find a quiet time and place for a
private, respectful meeting to discuss your concerns; and ask if he or she has considered whether or
February 21, 2012
Eating Recovery Center Raises Awareness of Eating Disorders in “Nontraditional”
Groups During NEDAW
not he or she may have an eating disorder. While you continue to express your support, offer to help•
your friend or loved seek treatment.
If you notice troubling behaviors in your child or adolescent• , engage your child in conversation
and speak to what you have noticed instead of making accusations; visit a medical provider if you
are concerned about your childs physical health; and identify a mental health provider for an eating
For more information about National Eating Disorders Awareness Week, visit www.nationaleatingdisorders.
Join Eating Recovery Center at these events during National Eating Disorders Awareness Week:
An annual candlelight vigil honoring those who have passed away from eating disorders, hosted by The•
Eating Disorder Foundation, Thursday, March 1, A Place of Our Own, 1901 E. 20th Ave., Denver, Colo.
Mind and Body Fair, hosted by the University of Northern Colorados Womens Resource Center,•
Monday, February 27, 10 a.m. to 1 p.m., Greeley, Colo.
Eating Recovery Center Patient Art Show, February 27 to March 2, an exhibition of patient artwork,•
1830 Franklin Street, Denver, Colo.
A National Eating Disorders Awareness Week informational table in the Colorado State University•
Student Center, Wednesday, February 29, 8 a.m. to 5 p.m.
National Eating Disorders Association Walk, hosted by The Eating Disorder Network of Central Florida,•
Saturday, March 3, Orlando, Fla.
February 24, 2012
What to Do If Your Friend Has an Eating Disorder | Jennipher Walters
The signs are all there. Your friend is intensely afraid of being
fat, she talks nonstop about how many calories are in her food
and what she weighed this morning, and she’s starting to avoid
situations where she’s expected to eat. While you don’t know for
sure, you start to get worried that your friend might be developing
— or already be suffering from — an eating disorder.
It’s a tricky subject. You want your friends to be healthy and you
want to be fit with them, but what happens if your best friend
starts to take it too far? Do you stand up and say something? Do
you risk hurting your friendship or making her angry and pushing
It’s worth it to speak up even if you’re not sure, says Bonnie
Brennan, clinical director of Eating Recovery Center’s Adult Partial
“I think that it is a mistake not to address your concerns with a friend for fear of hurting his or her feelings,”
Brennan says. “If a friend does not have an eating disorder and is offended by your inquiry, that emotion will
usually last a very short time, even a few minutes. On the other hand, if you are correct about your friend’s
eating disorder, you may be saving a life, as eating disorders have the highest mortality rate of any other
With numbers of those suffering from eating disorders on the rise and societal pressure to be a certain size
at a fever pitch, it’s estimated by the National Eating Disorders Association (NEDA) that as many as 10 million
females and 1 million males in the United States are fighting a life and death battle with an eating disorder
such as anorexia or bulimia, and millions more are struggling with binge eating disorder. That’s why the
theme to this year’s National Eating Disorders Awareness Week — which is this week — is “Everybody Knows
“I often have patients lament that no one ever challenged them or said anything,” Brennan says. “They will
admit that they might have reacted angrily at the time but that it is more painful to think that no one cared or
that others were afraid of them.”
Although the signs of an eating disorder vary from person to person, Brennan says, they can include an
intense fear of being fat, weight loss, avoiding situations in which expected to eat food, using the bathroom
directly after a meal, excessive exercise, having conversations that are highly centered on food or calories or
weight, “having to” prepare separate meals, and fear of not knowing what ingredients are included in foods
(such as at a restaurant).
So just how do you go about talking to a friend who might be suffering? Brennan recommends finding a neutral
setting and time to meet, and then expressing your concerns and asking if anything has been particularly
distressing to her lately.
“When speaking with your friend, use non-judgmental language and ‘I’ statements,” she says. “It is OK to point
out behaviors and emotions you have lately noticed, but avoid blaming or shaming. Be prepared to listen and
don’t try to problem solve. Offer to help your friend find a professional to talk to.”
If your friend acts negatively or defensively, Brennan recommends reminding her that you care for her and
that you’d rather ask about the troubling behaviors than let them go unnoticed. Then, offer to talk when she’s
ready and be available if she wants your help. If your friend admits that he or she is struggling, offer to help
him or her find a professional, she says.
“Avoid playing the food police,” she says. “Rather, ask your friend if he or she needs support if you notice that
he or she eats too little or too much.’
It’s important to also understand that eating disorders are not a choice, Brennan says. They are biologically
based mental illnesses, and some people are genetically hard-wired to be more at risk for an eating disorder
than others. Furthermore, eating disorders in men is on the rise, so don’t rule out the possibility of an eating
disorder with your male friends if the signs are there.
Bottom line, one of the most important things you can do as a friend is to let your friend know he or she is
loved and accepted by you, even if he or she is suffering from an eating disorder, Brennan says. And it’s always
best to speak up — because it might save your friend’s life.
Have you ever confronted a friend about disordered eating? Would you? Is there a friend you might talk to
after reading this?
February 28, 2012
NEDA Week: Eating Disorders In Midlife | Margarita Tartakovsky
Misinformation about eating disorders abounds. One of
the most common myths is that eating disorders largely
affect young, white girls.
But EDs don’t discriminate. They affect people of any age,
race, religion size, shape and sex.
Today, I want to focus on an often neglected group:
women in middle age. Even when it’s recognized that
middle-aged women struggle with eating disorders, the
talk almost always turns to cultural pressure. While there
is increasing pressure for women to stay young and be
slim, eating disorders are more complex than the desire
for a certain silhouette.
As I said yesterday, eating disorders are a complex interplay of genetics, biology and environment.
Below, Enola Gorham, LCSW, CEDS, clinical director of adult services at the Eating Recovery Center, shares
her insight on eating disorders in middle age. She discusses why more middle-aged women are seeking
professional help for eating disorders, why EDs affect them, the unique challenges of treatment and more.
Q: I’ve read that more and more middle-aged women are seeking help for eating disorders. Why do you
think that is?
A: There has most likely always been a large group of women who have had eating disorders, but were
never diagnosed because doctors and therapists were not trained in the disorder. Recent attention to eating
disorders has resulted in most doctors and high school counselors being “on the lookout” for symptoms of
eating disorders in their younger populations. The older women, those who have had this disorder long before
it was a “looked-for” diagnosis, often just struggled with it.
Many women spent time working with their doctors trying to find a medical reason for their eating issues.
Doctors simply did not look for eating disorders in older/adult women. A doctor’s training would have him
or her look to IBS or other medical issues. Also, bulimia has only been listed as an official diagnosis since the
1980s, so it is a relatively new diagnosis. The eating symptoms of individuals who previously suffered from this
disorder likely would not have been identified as an eating disorder.
We now are seeing more older women seek treatment because the diagnostic criteria is understood by more
doctors, and doctors are increasingly looking beyond the “classic” young girl population as the only ones who
can develop eating disorders. Also, there are many women who have had eating disorders for a long time, and
“continue” to be in treatment as they enter middle age. In addition, there are those that have never had
treatment, knew they needed it, but were focused on their families, their children and so on, and did not get
treatment for themselves until something became acute.
Q: Why do eating disorders affect people in middle age?
A: We are seeing that there are some personality traits that predispose people to use management of food
to try to relieve some other issue in their lives. Perfectionist, persistent, type A and anxious women have the
traits that set them up for trying to manage food and finding that it helps them to feel better emotionally.
Because of their perfectionist, persistent traits, they will engage in food management behaviors even more and
will end up triggering a vicious cycle of trying to manage emotions with food management.
If they also have co-morbid disorders such as obsessive-compulsive disorder (OCD) or depression, they become
even more trapped in trying to apply their food management rules to make themselves feel better.
Most middle-aged women have most likely been doing some version of trying to manage uncomfortable
emotions with food for most of their lifetimes. They might get treatment at middle age because someone
recognized the disorder, they recognized the disorder in themselves and finally can spend time getting help or
their family is negatively affected and they can no longer ignore the problem.
I think it is a minority of women who “start” their eating disorder in middle age. This could happen from a
major life stressor, like trauma, which places them in a hyper vigilant, controlling/protecting stance. In this
case, they begin to use food to manage the resulting emotions. A life transition – such as kids leaving home
or parents dying – could also cause a middle-aged woman to turn to using food management, which then
becomes a process she cannot stop.
Q: What are the biggest myths about eating disorders in middle age?
A: Eating Recovery Center’s patients range in age from 10 to 81. The popular notion of an “eating disordered
patient” is: young, white and affluent. However, the truth is far from this misconception. I think the previous
notion of “young, white and affluent” had to do with after school specials, and the large number of studies on
eating disorders that were conducted on younger girls with anorexia, due to the fact that anorexia was easier
to visibly notice in younger girls and it was easiest to do ongoing work with younger girls due to concerned
parents bringing them into treatment.
Q: Do eating disorders manifest differently across age such that people in middle age may show different signs
and symptoms or their course may be different? Are there unique challenges to treating EDs in middle age?
A: Middle-aged women can be very hard to treat because, first, they are invested in the idea that their eating
disorder is actually a medical problem, and they struggle to see how this is a psychological problem.
Second, they also can be caught in the belief that eating disorders only impact young girls, so they are
fearful that the treatment will not apply to them, or that they will not fit into eating disorders treatment
Middle-aged women may have had the illness for a very long time, and it is a very ingrained coping
mechanism, so for many, it can be hard to even imagine stopping. Also, if they have been relatively functional
in life — well employed, a parent, etc. — they may struggle with why they need to do the hard work to get
well, and quickly give up and return to the illness.
Finally, the illness may have cost them a great deal in their life, and it is just too hard for them to take an
accounting of this, and easier to stay ill.
The illness itself does not tend to be different, except that as we age, we all have less of an ability to bounce
back physically, so natural aging issues can make the illness more complex and treatment needs to address
more areas of physical issues. In addition, because the illness may have impacted a woman’s life for a longer
time, they will likely have more mental and emotional “clean up” to do.
Q: What would you like readers to know about treatment?
A: Though the specific life circumstances of a young patient and an older patient may differ, treatment is
essentially the same for older women as it is for younger women. Based on the acuity of the illness, the first
priority is to ensure that patients are medically and psychiatrically safe.
At Eating Recovery Center, we then individualize nutritional, medical and psychiatric interventions, and work
with patients in individual and group therapy sessions to help them learn how to accept themselves, their
thoughts and their feelings, and live a valued life beyond their eating disorder.
Q: Anything else you’d like readers to know about EDs in middle age?
A: Regardless of age, the sooner an individual enters treatment, the better her chances are for a positive
outcome and lasting recovery. If you think a loved one may be struggling with an eating disorder, urge them to
get an assessment from a qualified professional sooner rather than later.
Thanks so much to Enola Gorham for speaking with me!
February 29, 2012
How do you know if you have an eating disorder? | Nancy Melear
Dr. Weiner did a live, in-studio interview about eating disorders and the associated warning signs for
National Eating Disorders Awareness Week.
See the CD at the back of this clipbook for full video.
March 2, 2012
The Takeaway: Older Americans Rejecting Marriage; Anorexia and Aging | Elizabeth
Sociologists Wonder: Who Will Care For Single Seniors? A growing number of older men and women are
“opting out” of marriage, the New York Times reports. Since the 1990s, the divorce rate for boomers has
climbed more than 50 percent, even as it stabilized among other age groups. Meanwhile, less adults got
married in the first place. The result is a surprising number of Americans in their 50s and 60s heading into old
age sans spouse.
Most of the reasons for this shift are positive: Boomers have felt less social pressure to marry, or to stay in
marriages that aren’t working. Woman are increasingly financially independent. People are living longer.
But we need to pay attention “not only to the factors that precipitate (this shift), but also to the
consequences,” said Susan L. Brown, co-director of the National Center for Family & Marriage Research at
Bowling Green State University. An analysis conducted by Brown and colleagues found that in 2010, about a
third of adults ages 46 through 64 were divorced, separated or had never been married. This is up from 13
percent in 1970.
Because the post-boomer generations have far lower marriage rates than their elders, sociologists expect the
number of single seniors to rise sharply in coming decades—and the trend could drastically transform our
traditional portrait of aging in America. Unmarried older adults lack a partner to rely on for care, and with
family caregiving (and retirement savings) down also, governments and social services agencies will have
to shoulder an increasing responsibility for senior care. Stats show unmarried boomers are five times more
likely to live in poverty as married counterparts, and three times as likely to receive food stamps or disability
Anorexia and Aging: This week is National Eating Disorder Awareness week, and one of the more interesting
NEDA stories I’ve seen is about eating disorders in the middle-aged. Folks tend to think about eating disorders
as a teen or young adult problem. Dr. Emmett Bishop, of Colorado’s Eating Recovery Center, said data on older
adults with eating disorders is scarce. But his center has seen an “upsurge” of older patients.
Margarita Tartakovsky at PsychCentral points out that “even when it’s recognized that middle-aged women
struggle with eating disorders, the talk almost always turns to cultural pressure. While there is increasing
pressure for women to stay young and be slim, eating disorders are more complex than the desire for a certain
Friday Quick Hits:
• More than 9 million American retirees don’t have enough money to cover basic living expenses,
according to a new study.
• Many small business owners aren’t prepared for retirement: About a third have no personal or
business-sponsored retirement plan and haven’t estimated how much money they need for retirement.
• Grateful Dead 101? Florida Professor Barry Barnes believes the Grateful Dead can teach us a lot about
business and personal finance. A new book by the 68-year-old former Deadhead (“Everything I Know
About Business I Learned from the Grateful Dead”) explores the ‘innovative lessons’ he earned from
the band’s “marketing genius.”
• And the first LGBT senior center in New York City opened Thursday. “It is going to be … a beacon of
light all across this country,” said Michael Adams, executive directive of the nonprofit SAGE, which is co-
operating the center with the city Department for the Aging.
March 2, 2012
Tumblr Cracks Down on ‘Thinspiration’ Blogs | Annie Hauser
“Let me be empty and weight less and maybe I’ll find some peace tonight.” That rather disturbing mantra is
the message behind Thinspox, a hugely popular Tumblr account that posts a steady stream of images of stick-
thin women who serve as “thinspiration,” or inspiration to lose weight, for the account’s followers. These blogs
promote weight loss, often through unhealthy means, and idealize models, dancers, and women on the street
who have waif-like figures.
In response to the popularity of this blog and dozens like it, Tumblr is considering a new policy of prohibiting
blogs that “actively promote self-harm.” As part of the possible new guidelines, Tumblr enlisted the National
Eating Disorders Association to help craft language to display next to self-harm searches. The NEDA seeks to
remind Tumblr users and anyone struggling with an eating disorder that they are not lifestyle choices, but
rather “mental disorders that when left untreated, can cause serious health problems, and at their most severe
can even be life-threatening.”
Some critics believe Tumblr’s new policy limits free speech — and won’t do much curb the problem. One
critical article wrote that “pro-eating disorder websites do not cause eating disorders … if you think censoring
these websites will lead more women to recovery, consider whether people fought in wars before there was
violence on TV.”
Still, Julie Holland, MHS, CEDS, of the Eating Recovery Center in Denver, Colo., applauds Tumblr for its decision
to stand up against self-harm. “Tumblr’s policy is promoting and encouraging wellness and prevention instead
of encouraging promotion of illness and self-harm,” Holland says. “I love the statement they have chosen to
include about eating disorders as a mental disorder. This goes back to the lack of understanding among a large
portion of the population about the genetic component of eating disorders.”
In addition to Tumblr, eating disorder awareness educators are concerned about a similar “thinspiration”
subculture that’s developing on the photo-sharing platform Pinterest. Pinterest, which has only been around
since 2011, contains thousands of photos of thin women, often nude with protruding ribs, tagged as “workout
inspiration,” or “thinspiration.” The theoryBusiness Insider’s Jim Edwards espouses is that now that thinspo
material is being banned from Tumblr, this pro-ana (shorthand for pro-anorexia) community needs somewhere
March 2, 2012
Eating Disorders In Middle Age Bring Unique Challenges, Treatments | Mary Kate
While young women are often the faces of eating disorders,
diseases such as anorexia, bulimia and binge eating can affect
any age -- and recent data suggest the numbers are rising
among middle-aged women. The issue is in the spotlight in the
U.S. during National Eating Disorders Awareness Week, which
runs through March 3.
Post 50 women with eating disorders, known as “EDs,” may face
unique emotional and physical issues. “Women at mid-life now
have unprecedented opportunities and also unprecedented
stresses,” Merryl Bear, director of Canada’s National Eating
Disorder Information Centre, told the Toronto Star. “There’s an
increased fear of aging and societal pressures to change one’s
body to bring it closer to the societal ideal.”
From 2001 to 2010, the rate of EDs among the middle-aged increased by 42 percent, said Holly Grishkat,
Ph.D., regional assistant vice president and director of The Renfrew Center in Radnor, Pa., an eating disorder
An Australian study published in 2008 also revealed a rise in eating disorders in older adults, particularly with
binge eating and food restriction. The study found that in adults between 55 and 64, binge eating increased
from 1.7 percent in 1995 to 7.4 percent in 2005, and strict dieting or fasting increased from zero percent in
1995 to 9.7 percent in 2005.
While concerning, these numbers may largely reflect individuals with histories of eating problems, rather than
new cases, experts say. Many who face eating disorders in midlife have confronted them in the past. In fact, 94
percent of middle-aged women who are anorexic developed the disorder when they were younger.
“It’s rare -- not impossible, but rare -- for a woman 50 or beyond to develop an eating disorder for the first
time,” said Dr. Margo Maine, clinical psychologist and co-author of “The Body Myth: Adult Women and the
Pressure to Be Perfect.” “Most in their 50s and 60s are women who had eating disorders when they were
That doesn’t mean middle-agers’ experiences with eating disorders are the same, however. Since EDs are
frequently associated with younger women, older adults may be ashamed to admit that they have these
disorders. As one middle-ager confided on a message board: “People always refer to bulimia as an adolescent
disease; I feel like such a failure that I’m almost 50.”
Grishkat believes shame is a significant component of eating disorders in middle age. “I think women who are
coming out with it in midlife feel like ‘I should be the role model here and not the one with the disorder,’” she
Older women often remain silent during group therapy sessions with younger women, Grishkat added.
Acknowledging these struggles, Renfrew has created a program called “30-Something And Beyond,” which
is specifically for adult women who suffer from EDs. This in-patient program places women with roommates
of a similar age and in therapy groups that focus on issues more likely to affect middle-agers. (Renfrew also
provides outpatient, midlife-focused therapy groups.)
Through this program, Renfrew can focus on triggers that are specific to its middle-aged patients.
One such trigger is loss, which “tends to be a big underlying factor for eating disorders,” Grishkat said. Midlifers
may be dealing with a range of loss, from ailing and dying parents to children moving out, to divorce -- factors
that may not resonate with the younger generation.
One post 50 who has dealt with loss and an eating disorder is Mary Sponhaltz, who discussed her experience
with The Eating Disorder Center of Denver. Sponhaltz struggled with anorexia in the wake of her father’s death
from cancer. Over three years, Sponhaltz tended to her father, leaving her husband and children for long
“I was already worn thin emotionally and losing weight drastically when he was alive because I wasn’t taking
care of myself,” Sponhaltz told The Eating Disorder Center of Denver. “But once he died, the eating disorder
kicked in. It numbed me so I wouldn’t have to feel.”
Aging is another potential trigger. Physical changes in midlife may cause or reignite eating disorders. As
psychiatrist Anne E. Becker -- director of the Eating Disorders Clinical and Research Program at Massachusetts
General Hospital and president of the Academy for Eating Disorders -- recently told Harvard Women’s Health
As our society values youth and as baby-boomers reinvent what it means to be middle-aged,
there are growing social forces that can undermine older women’s self-esteem and potentially
lead to body dissatisfaction — for example, if you think the surface of your skin or the contours
of your body aren’t supposed to match your chronological age. That, combined with health
concerns about obesity, can make people feel bad about their bodies and, in turn, could result
in eating strategies that undermine well-being.
In an Austrian study of 475 women between 60 and 70 years old, published in the International Journal
of Eating Disorders in 2006, 45 percent of the women indicated that their self-esteem depended on their
shape and weight. The same study revealed that “over 60 percent [of the women] stated ‘moderate’ or ‘low’
satisfaction with weight and shape.”
This pressure to maintain youth may stem from the culture in which post 50s grew up. Dr. Blake Woodside,
director of Toronto General Hospital’s in-patient eating disorder program, told the Toronto Star that the
increase in midlife eating disorders can be traced to the ‘60s, when ideals changed and the “thin is in” culture
March 5, 2012
Tweens and Technology: Eating Disorders in the Internet Age | Julie Holland
Today, technology and social media are more readily available to our tweens and teens than ever before. From
smart phones to tablets to laptops, our kids can take the best – and the worst – of the Internet wherever they
As parents, we must be mindful of what is available online and what our kids are accessing as it can be highly
influential on a tween’s developing mindset and self-esteem.
Finding unhealthy solace in online communities.
Eating disorders are very secretive diseases that can often initially go unnoticed until disordered eating
behaviors or other warning signs become more obvious. In the interim, many tweens struggling with eating
disorders turn to websites commonly referred to as “pro-ana” or “pro-mia” websites. These sites provide
struggling tweens with “advice” on losing weight and social support when unhealthy weight loss goals are met.
Pro-eating disorders websites can push someone on the verge of an eating disorder over a dangerous edge.
What are all those apps on your child’s smart phone?
Calorie counting and exercise applications are easily accessible—many are even free. When used wisely
Whatever the cause, eating disorders can have serious side effects, including osteoporosis, heart problems
and gastrointestinal issues. In a recent interview with Life Goes Strong, an online site for midlifers, Dr. Emmett
Bishop, MD, FAED, CEDS -- founding partner and medical director of adult services at the Eating Recovery
Center -- outlined some specific health issues that middle-agers with EDs may face:
Older individuals have much less resilience when it comes to physical damage from eating
disorders. A lot of things can go wrong with vital organs, bone density can be impacted, dental
health can suffer, and as tissues become less elastic, I’ve seen people aspirate from purging. A
whole host of medical issues can arise as people abuse their bodies over time. Eating disorders
are the deadliest mental illnesses and premature death is very common.
Older women also face somber statistics when it comes to EDs and death. Senior women comprise 78 percent
of all deaths caused by anorexia, and the average age that women die from the disease is 69.
But middle-agers with EDs shouldn’t give up. “There’s hope,” Grishkat said. “Even if you’ve had [an eating
disorder] for 30 years, our data show that the women in midlife and older tend to be more determined and
ready for recovery than a lot of the younger women.”
If you’re struggling with an eating disorder, call the National Eating Disorders (www.nationaleatingdisorders.
org) helpline at 1-800-931-2237.
To learn more about National Eating Disorders Awareness Week, click here.
and in moderation, these tools can keep you on track for maintaining a healthy weight and learning how to
healthfully manage in food and exercise. However, for someone genetically predisposed to an eating disorder,
smart phone and tablet apps can often act as an “eTrigger,” causing moderation to quickly spiral out of control
into restriction and other disordered eating or over-exercise behaviors.
Parents’ role in technology use.
Parents play an important role in monitoring their kids’ technology use. This includes maintaining an open
dialogue with their tweens and teens about what they see in the media and online, asking how they interpret
what they see and discussing what a healthy use of technology looks like. In addition, it’s important as parents
to model healthy technology use behaviors for our tweens and teens. If we’re overly absorbed in our phones,
laptops or tablets, how can we expect our children to know other ways of interacting with technology?
Technology isn’t all bad.
Technology – when used in a healthful way – can actually help to inspire eating disorders recovery. For
example, at Eating Recovery Center we use technology such as MP3 players and biofeedback video games to
help our patients learn how to manage anxiety and embrace lasting recovery.
In addition, although the Internet may have a plethora of negative images and information, there’s also plenty
of support for individuals who are in eating disorders recovery or overcoming body image issues. One of my
favorite sites is something-fishy.org. This website is dedicated to raising awareness about eating disorders and
reminding individuals with an eating disorder that they aren’t alone and can experience lasting recovery.
In fact, I think that’s a very important detail to remember: lasting eating disorders recovery is possible,
especially with early intervention. If you’re concerned about a child’s eating behaviors or curious about
offhand comments about body shape and size, visit the resources section on Eating Recovery Center’s website.
These resources can arm you with vital information about eating disorders and help you discover how to
broach the subject with your child
Comment and share below how you’re using the online space to better your body image and self-esteem!
March 12, 2012
Tumblr’s Ban on Pro-Ana and Pro-Mia Websites | Julie Holland
“Thinspiration” is a term often used by individuals who engage in disordered eating behaviors, such as
restricting, over-exercising or bingeing and purging. Using pictures of unnaturally thin males and females as
weight loss “inspiration,” these individuals strive to achieve unrealistic body ideals. Often, they engage in these
behaviors in a community setting through pro-anorexia and pro-bulimia websites, commonly referred to as
pro-ana and pro-mia websites.
Pro-ana and pro-mia websites can be incredibly damaging, because they reinforce, validate – and even applaud
– eating disordered behaviors. One online resource has become aware of the prevalence of these sites and is
taking a stand to minimize their harm.
Taking action against pro-ana and pro-mia
Late last month, Tumblr, an online forum that lets users effortlessly share anything, began removing user blogs
that promoted or glorified self-harm behaviors, such as eating disorders, self-mutilation or suicide. This action
has met with mixed reviews.
While some may take issue with Tumblr’s actions under the umbrella of freedom of speech, I believe that
when you put pro-ana and pro-mia websites in the context of the potential harm they can cause, Tumblr’s
actions were warranted. It’s important to keep in mind that eating disorders are the deadliest mental illness.
Anorexia nervosa’s mortality rate is 12 times higher than the death rate associated with all other causes of
death for females 15-24 years old.*
As someone who struggled for many years with eating disorders, I understand the importance of having a
safe and appropriate outlet in which to express emotions and receive ongoing support. However, a more
appropriate and recovery-oriented outlet can be found in the scores of online, phone and in person eating
disorders resources that offer qualified help. National organizations such as the National Eating Disorders
Association (NEDA) or International Association of Eating Disorders Professionals (iaedp) and treatment centers
across the country offer resources related to eating disorders treatment, therapy options and family support.
Meeting “thinspiration” head on
In addition to removing blogs that promote self-harm, Tumblr is also referring users who search for self-harm
related terms to the appropriate resources. For example, if a user were to search for “anorexic,” “purge” or
“thinspo,” Tumblr will issue public service announcement-focused language such as:
“Eating disorders can cause serious health problems, and at their most severe can even be life-threatening.
Please contact the [resource organization] at [helpline number] or [website].”**
I applaud Tumblr for taking a stand against damaging – and even deadly – content and conversations. It’s
vital that we, as a community, be more attuned to the dialogue we engage in online and offline that can send
someone down a dangerous path.
At Eating Recovery Center, we address the potential risks of social media and online communities for patients
as they leave treatment by offering ongoing support systems and alumni programs. These resources help
patients have a safe and familiar place to connect when they’re struggling with the images around them.
What do you think of Tumblr removing self-harm blogs and providing resources? What are some recovery-
focused resources you have used for your own support? Comment and share below!
National Eating Disorders Awareness Week just ended and I think that should be the beginning of our
conversation, not the end. There is a lot of helpful information available on how younger and younger kids are
struggling with eating disorders, how 5-year-old girls are saying they are “fat” and how boys are now struggling
in significant numbers with one of the deadliest mental illnesses there is.
March 6, 2012
Aging and Anorexia: Silent Crisis of Eating Disorders in Older Women? | Pamela
What you probably have not read, seen or heard much about is the increase in eating disorders among older
people, particularly women. There was so little information, in fact, that I checked in with the folks at Eating
Recovery Center, where I have gotten a lot of expert advice on eating disorders. Turns out, they are seeing
a real upswing in cases of older people struggling with eating disorders and thought it was a great topic
to explore. It presents with similarities and differences than the disordered eating in younger women, but
because older people are more vulnerable in many ways, an eating disorder in midlife and beyond can be even
Dr. Emmett Bishop, MD, FAED, CEDS, founding partner and medical director of adult services at Eating
Recovery Center, was kind enough to take time to help educate me - and now you - on this silent but significant
Q: What are the myths surrounding eating disorders in older people and what are the facts?
Dr. Bishop: “The biggest myth is that this group does not have eating disorders. Although this group has flown
under the radar, we are seeing quite a few women in treatment in their 40s, 50s and 60s. We even recently
treated an 80-year-old woman.”
Dr. Bishop warns that one of the most damaging and dangerous aspects of eating disorders in the aging is that
too often, family members will assume the weight loss is related to simply being old, or “that’s just the way she
is,” rather than exploring if something is going on.
March 12, 2012
Outsources: Interview with Joe Eiben | Norman Strizek
Joe did a live interview about eating disorders and his experiences treating these diseases.
See the CD at the back of this clipbook for full audio.
March 16, 2012
Newsmakers: Michael Spaulding-Barclay
March 16, 2012
5 Things Not To Say To Someone With An Eating Disorder | Margarita Tartakovsky
A while ago, Therese Borchard, who writes one
of my favorite blogs, Beyond Blue, penned a piece
about things you shouldn’t say to someone who’s
struggling with depression. This inspired me to
think about what you shouldn’t say to someone
with an eating disorder. While people may not be
as direct as the statements below, we know that
some still say various versions of them.
1. Why can’t you just eat?
This is the same as asking someone with
depression to just snap out of it. If they could,
they would. In her book, Brave Girl Eating: A
Family’s Struggle With Anorexia, Harriet Brown
poignantly describes what it was like for her
daughter to eat.
That year, I learned just how brave my daughter
is. Five or six times a day, she sat at the table and
faced down panic and guilt, terror and delusions and physical pain, and kept going.
In another chapter, Brown equates her daughter’s eating to jumping out of an airplane:
[My husband] Jamie and I are crying now too, as we understand for the first time exactly how courageous our
daughter is. Each time she lifts the spoon to her lips, her whole body shaking, she is jumping out of a plane at
thirty thousand feet. Without a parachute.
2. Why can’t you just stop eating?
People will often say this — or think it — to people who struggle with binge eating disorder (or bulimia). The
thinking is that you have control over your eating; just use a dose of willpower and stop. But that’s the problem
with binge eating — you feel a loss of control while you’re eating (it’s one of the symptoms).
It’s probably hard to understand, but that’s why eating disorders are illnesses that require treatment.
Willpower has nothing to do with an ED.
3. Try such and such diet — it worked for so and so.
Unfortunately, it’s not uncommon for people to believe that dieting can eliminate or reduce binge eating. This
belief probably comes from the idea that dieting gives you rules. When you have specific and strict regulations,
you naturally stay in line.
(Also, how often have you seen a commercial of a teary-eyed actress talking about how such and such diet
program healed her out-of-control eating?)
For starters, dieting is a Band-aid. It doesn’t get at the other symptoms and underlying problems of eating
disorders. It’s also probably how the person got to where they are in the first place. While EDs are biologically
based, dieting is a common trigger.
It only makes matters worse. Research has actually shown that restricting leads to overeating. (It’s one of the
many reasons dieting is futile for everyone.) The only treatment for binge eating is to see a professional who
specializes in eating disorders.
4. Everyone hates their body (or everyone overeats, or everyone skips meals sometimes).
It’s hard watching a person you love struggle. Sometimes we think relating to their words will make them feel
better. So if they say something disparaging about their body or talk about skipping a meal or eating a lot in a
short period of time, we quickly let them know that they’re not alone. We’ve been there. We can relate.
But in reality, this can shut the person up and stop them from sharing any more of their thoughts and feelings.
(Which is a big problem because eating disorders are secretive as it is.) Worse, it can normalize their eating
disorder and validate it.
While many of us might’ve struggled with some ED behaviors and thoughts, it’s very different from actually
struggling with an eating disorder. Again, eating disorders are serious illnesses that require treatment.
5. Yes, I’ll keep your ED a secret.
Maybe you’ve noticed the signs of an eating disorder and confronted your loved one or maybe they came to
you first. Either way, they beg you to keep their eating disorder a secret. I would say, “No way, no how.”
Eating disorders are dangerous. Even if someone doesn’t look emaciated and sick, they can still suffer serious
problems. In her memoir, Purge: Rehab Diaries, Nicole Johns, who struggled with EDNOS, talks about being
“normal weight” and having a slew of very serious health problems.
Throughout her 20s, Johns is “hospitalized for fainting, a concussion, electrolyte imbalances, and three
different kinds of heart-rhythm irregularities.” During this time, she’s abusing diet pills, starving and purging. In
just two years, she has to go to the ER six times because of her heart problems.
The reality is that EDs can be deadly — and secrets don’t lead to treatment, and treatment is essential.
According to Kenneth L. Weiner, MD, CEDS, of the Eating Recovery Center:
Eating disorders are the deadliest mental illness. A woman with anorexia nervosa is 5.6 times more likely to die
than another woman of her same age. The most frequent causes of death from eating disorders are suicide
(32 percent), complications associated with anorexia (19 percent), and cancer (11 percent). The average age of
death for an individual with anorexia is only 34 years.
If your loved one confides in you, the best thing you can do for them is to help them seek treatment. Here’s
more on how to help. (And here’s info on picking a good therapist.)
I hope you’ve found these statements of what not to say helpful.
March 29, 2012
Eating Disorders in Children are on the Rise; Eating Recovery Center Urges
Prevention at Home
Between 1999 and 2006, hospitalizations for eating disorders in children 12 and younger rose 119 percent,
according to a 2010 study by the American Academy of Pediatrics. In an effort to curb the growth of anorexia,
bulimia, EDNOS and binge eating disorder in this young patient population, Eating Recovery Center (www.
EatingRecoveryCenter.com), an international center for eating disorders recovery, urges parents to take
preventive measures at home to stop eating disorders before they start.
“While clinicians have yet to identify the absolute keys to preventing eating disorders, we do know that
positive parental involvement and heightened awareness can help foster the development of healthy
relationships among children, their bodies and food,” explains Ovidio Bermudez, MD, FAAP, FSAHM, FAED,
CEDS, medical director of child and adolescent services at Eating Recovery Center.
Eating Recovery Center offers 10 recommendations to help parents practice eating disorders prevention at
Understand your own feelings and attitudes toward body image, body size, weight and health.1.
Model healthy attitudes and behaviors toward eating, exercise, body weight and shape and self-2.
acceptance. Children will often mirror their parents’ thoughts and actions surrounding these issues.
Educate yourself about the complex nature of eating disorders. An informed parent is more aware and3.
more likely to notice early warning signs or concerning behaviors.
Help your child manage stress. Reduce complexity in your child’s life to prevent or relieve anxiety and4.
fear, which may lead to disordered eating in children who are particularly vulnerable to stress.
Focus on eating at ease during mealtimes. Promoting the social value of mealtimes strengthens family5.
ties and relationships. Stressful, tense eating situations are counterproductive in efforts to develop
healthy patterns around food consumption.
Maintain open lines of communication. Interaction is the antidote for the isolation and secretiveness6.
that can sometimes allow a child to transition negative beliefs and attitudes into disordered eating
Examine your child’s dieting and exercise habits. From a neurochemical perspective, these are not7.
always benign activities. With the help of a medical professional, explore whether weight loss or
increased exercise are healthy choices that support normal growth and development.
Monitor the beliefs and attitudes of your child’s friends. Children are eager to fit in and will often mimic8.
their friends’ attitudes and behaviors—even those that are negative and potentially destructive.
Watch your child’s technology use. Websites and social media create a sense of “community” in which9.
your child can learn about and compete at disordered eating behaviors. Studies have shown that both
pro-eating disorder and pro-recovery online messages have risks to impressionable young minds.
Be aware of anxiety and depression, and seek care if your child shows signs of these conditions.10.
The negative self image that is often associated with these conditions can lead to efforts to manage
emotional insecurities via dieting and exercise.
“Even if parents are not able to prevent eating disorder-related behaviors in their children, prevention activities
– such as being well informed about eating disorders and recognizing changes in attitude or behaviors that may
suggest your child is at risk – are invaluable for enhancing early recognition and timely intervention,” continues
If your child begins showing symptoms of disordered eating, immediately seek eating disorders support
from a qualified professional. Early intervention significantly improves the likelihood of recovery. For more
information about Eating Recovery Center’s eating disorders treatment programs for children and adolescents
ages 10 through 17, please visit www.EatingRecoveryCenter.com.
Reaching a weight-loss goal requires months—if not years—of dedication. And sometimes, when you reach
that milestone, it can be hard to dial back into maintenance mode. If you’re not careful, you may encounter a
new batch of health problems related to your weight. “Being too thin stresses the body in a unique way,” says
Ilene Fishman, a licensed clinical social worker and co-founder of the National Eating Disorders Association.
So how skinny is too skinny? It’s hard to explain—and even trickier to calculate. A normal weight, according
to the U.S. Department of Health and Human Services, is when your body mass index (BMI) falls somewhere
between 18.5 and 24.9, but no two bodies are exactly alike and index numbers alone are not a good way to
gauge your health.
Sadly, those nearing a painfully thin frame become less and less likely to acknowledge the problem. “Often
patients say ‘I’m not that thin,’ that’s distortion, it’s not reality,” says Fishman. And the same distortion can
keep your scale dipping deeper in the wrong direction.
Whether you believe you’re underweight or not (no offense to the naturally thin), these are signs you may not
be getting enough nutrients in your body.
Believe it or not, when your body is undernourished, you may feel energized and have an urge to move.
“That’s the brain telling the body to start moving to go get food,” says Dr. Ovidio Bermudez, MD, Medical
Director of Child and Adolescent Services at the Eating Recovery Center in Denver. And as your body begins to
become anxious physically, you start to drag emotionally. “You become depressed, anxious, and fearful,” says
Your joints look large
If you’ve lost too much weight, you could be purging your body’s “good” weight—your muscle. “Most people
think that as we lose weight we lose fat mass, but the reality is that we tend to lose more lean body mass
than fat mass,” says Bermudez. The result is joints and bones that look over-exaggerated because of the loss
of muscle tissue around them. Your skin can also become dry and wrinkled because it is losing its protection
against your bones. “People begin to take sort of a hollow look,” he says.
Mother nature stops visiting
You may not jump for joy when your cycle kicks in, but an unexpected cancellation from Aunt Flow can be
a sign that something is wrong. “Your brain is trying to figure out how to make it,” says Bermudez. A missed
period is sometimes an alarm that your body is shutting down reproduction until it bounces back and gets
enough nourishment to fully function.
April 1, 2012
Signs You’re Too Skinny | Jennifer Weaver
Exercise is no longer fun
If going to your favorite spin class starts feeling like a chore, it may be a sign that you’re overdoing it. Obsessing
over workouts to the point where they begin interfering with the rest of your life and feeling abnormally
fatigued are also indications that it may be time to take a step back.
You’re up all night
Experiencing a mild case of insomnia? Before you blame that late-afternoon cup of joe, take stock of your
eating and exercise routine. It’s much harder to sleep on a completely empty belly (easy 400 calorie fixes), and
if you’ve been trimming too much from your diet, the same anxious/obsessive attitude that keeps you in the
gym could be keeping you up all night.
There is no one-size-fits-all approach to reaching a healthy weight. If you are experiencing one or more of
these changes, consider making an appointment with your doctor.
April 1, 2012
The Scary Rise in Adult Eating Disorders | Jenny Deam
A major life transition or change, such as puberty or leaving for college, is a common eating disorders
trigger. However, eating disorders specialists are taking note of the more unexpected eating disorders
causes: manipulating medications and taking a new lifestyle diet too far. For someone with the genes or the
temperament that predisposes him or her to an eating disorder, manipulating medication or eliminating food
groups for a variety of reasons can trigger dangerous disordered eating behaviors.
Insulin manipulation: Diabetes and eating disorders
Most of what we eat is broken down into glucose, which our cells use for fuel. Insulin allows your cells to either
use the glucose for fuel or store it as fat. However, for individuals with type 1 diabetes, their bodies no longer
produce insulin. Therefore, they use daily insulin injections to help their bodies absorb glucose.
Some people with diabetes who are also genetically predisposed to eating disorders have been known to use
insulin manipulation as a form of weight control. They under-dose, or skip their insulin entirely, which causes
sugar to be eliminated from their bodies via urine and never to be stored as fat or used as fuel.
Although not an official medical term, this behavior is often referred to as “diabulimia.” People with bulimia
nervosa will purge through vomiting, laxative abuse or over-exercise to compensate for binging, while people
with diabetes restrict insulin to achieve similar results. Like all eating disorders patients, these individuals are
striving for unrealistic body ideals and a desire to be thin.
This potentially deadly combination strips your body of its nutrients and fuel. People with eating disorders
who are abusing insulin can find themselves weak and lethargic and, in extreme circumstances, may fall into a
coma as their bodies turn to other tissues for energy. The overwhelming desire for these individuals to be thin
negates any of the other medical risks such as kidney or heart failure, blindness or even amputation.
Gluten free and other diet fads: Community supported restrictive diets
We live in a society fascinated with the latest diet fads. From cleanses to anti-carbohydrate or high-protein
diets, each one introduces a “new” way to lose weight and live healthfully. Most recently we’ve seen the rise
of veganism and gluten free diets. Originally intended as a dietary regimen for people with celiac disease,
a gluten free diet can help people who are unable to break down gluten and absorb it, minimize damaging
results on their bodies.
For individuals who are genetically predisposed to an eating disorder, cutting major food groups, such as
gluten, dairy or meat from their diets when it’s not medically necessary can be a serious eating disorders cause
trigger. They start restricting because it’s part of a new diet designed to help them live healthfully and find
themselves tumbling down that slippery slope into an eating disorder.
If you or one of your friend’s or loved ones is practicing “diabulimia” and manipulating insulin or is drastically
changing his or her diet as a means to lose weight, visit the Eating Recovery Center website to find resources
and treatment options and learn how to approach him or her to express your concerns.
April 4, 2012
Unexpected Eating Disorders Causes and Triggers | Julie Holland
Two years of blogging have quickly passed and I feel truly blessed to have had this opportunity to share my
eating disorders knowledge and experiences with a supportive group of readers. It’s a privilege and honor to
be able to participate in something I’m truly passionate about: raising awareness of eating disorders.
In honor of the two-year anniversary, I’m recapping some of my favorite blogs from the past year. Being a
working mother of a 10-year-old daughter, a major focus of this year has been the importance of balancing
personal responsibilities with the goal of being a healthy role model for not only our children, but for others in
our lives. We’re faced with the increasing presence of eating disorders across a diverse population; therefore,
it’s critical we work together to provide ourselves with accurate eating disorders information and increase
awareness of and support for eating disorders across the community.
Here are a few of my favorite blogs and their messages from the past year.
Eating disorders don’t discriminate
Although there is a common misconception that eating disorders primarily affect women and teenage girls,
statistical evidence supports a different story. The number of eating disorders in children, young boys and girls,
has increased drastically. From 1999 to 2006, hospitalizations for eating disorders increased by 119 percent in
children younger than 12 years. It’s crucial that we remain informed and aware of eating disorders triggers and
warning signs in order to protect those we love because nearly everyone knows someone affected by eating
For more information on the rising number of adolescent eating disorders visit my past blog post here: http://
Awareness and prevention is just as critical in adults as in teenagers
A woman with a sister or mother who has anorexia nervosa is 12 times more likely to develop the disease,
and four times more likely to develop bulimia nervosa. Although I do find it critically important to note that
eating disorders aren’t only a women’s disease, the fact that more than 10 million women struggle with eating
disorders in the United States can’t be ignored. If you’re concerned your mother, sister, aunt, cousin or friend
may be practicing disordered eating behaviors, address your concerns with them if you feel comfortable doing
so. Remember that help for eating disorders isn’t a simple solution. Statements such as, “You just need to eat.”
aren’t going to fix the problem; and can even add to the problem. Women struggling with eating disorders
benefit from continued support during recovery.
For more information on how to intervene when it matters most and available eating disorders information
visit my past blog post here: http://bit.ly/ikBWHZ
Teachers should be aware of eating disorders triggers and warning signs
Eating disorders as a whole are one of the deadliest mental illnesses. While unusual or unhealthy eating
behaviors are characteristic of anorexia, bulimia, binge eating disorder and eating disorder not otherwise
specified (EDNOS), eating disorders hinder mental, physical and emotional health. On a daily basis, adolescents
are faced with unrealistic cultural images and ideas about how their bodies should look. As a teacher and
potential role model, you may need to monitor or address disordered eating behaviors. When doing so, be a
thoughtful listener, avoid judgmental or hurtful comments and offer eating disorders resources when the time
is right. Be aware of your own behaviors – dieting, exercising or self-talk – that could be influential.
For more information about what teachers should know about eating disorders and prevention, visit my past
blog post here: http://bit.ly/tVdjeR
April 9, 2012
Celebrating Two Years of “The Truth About Eating Disorders” with a Review of My
Favorite Eating Disorders Information and Resources | Julie Holland
If you would like to increase your knowledge of eating disorders or learn more about what to do if a friend or
loved one is showing signs of an eating disorder, visit Eating Recovery Center’s website.
Thank you for your support and readership over the past two years. As we move into yet another year of
increasing awareness and spreading “The Truth About Eating Disorders,” I would love to hear your feedback
and ideas for future blog topics. Please comment and share below!
For American workers, developing a physical or emotional stress-related condition associated with their career
is becoming more and more common*. Struggling to function under extremely high-pressured expectations,
members of today’s workforce too often find it easier to sweep personal needs under the rug, hoping to deal
with them later. Unfortunately, this build up of work-related stressors can be one of many eating disorder
Some of the main causes for eating disorders include various forms of psychological or social distress. Could
your current career be contributing to the development of disordered eating behaviors?
A highly competitive academic or social environment.• Here are a few “career contributors” that could
potentially place someone at a higher risk for developing an eating disorder: Eating disorders can be
the product of competitive, high-stress environments. Faced with a seemingly endless number of
deadlines, meetings and responsibilities, people will commonly experience the feeling of being out of
control in a “go fast society.” This feeling can be a serious cause for eating disorders as individuals seek
to find some sort of control—often in what and how much food they eat.
Major life events.• In the transition from college to the workforce or from one career to the next,
uncertainty or changes in routine can disrupt a usually stable environment. An increasingly demanding
career situation can often lead people to burning the candle at both ends and, in extreme cases,
possibly finding comfort in disordered eating.
Increase in body mass index (BMI).• Whether you’re an investment banker, salesperson or the president
of the United States, we’re all human. A stressful career can lead to unhealthy weight gain due to lack
of sleep or exercise or improper nutrition.
Mood disorder, anxiety and depression.• These comorbid mental conditions are all predisposing
biological factors and contributing causes for eating disorders. The ever competitive and demanding
work world has proven to trigger an increase in negative moods, levels of anxiety and experiences of
depression. With a lack of personal time to address our own needs, it’s easy to see how our careers
might contribute to the development of an eating disorder.
Insufficient time.• Some work environments don’t allow sufficient time for employees to sit and enjoy a
proper meal. This can make it difficult for employees to stop for a while and recharge their batteries for
an afternoon of assignments and meetings.
If you’re feeling stressed at work, try taking a step back from the situation. Think about the people and
experiences you value for a few minutes. Take a walk around the block or chat with a coworker to take your
mind off the stressors. Remind yourself about what’s really important: you.
If you know someone or if you personally are experiencing any of these conditions in relation to your career,
use Eating Recovery Center as a resource to answer your questions about eating disorders and treatment
April 16, 2012
Could Your Career be Part of What Causes Eating Disorders? | Julie Holland
Eating disorders are the deadliest mental illness, currently affecting more than 11 million Americans. If you
are – or know – one of the millions of people struggling with these diseases, asking questions and educating
yourself about eating disorders can be the first step in changing your life or the life of a loved one. A multitude
of resources are available to help you educate yourself, from local, community-focused organizations to
national associations, financial support options and non-profits with a mission.
Previously, I’ve written about eating disorders resources; however have recently updated the list. There are
many valuable resources available to provide education and support recovery.
National and regional eating disorders resources
Resources and support for eating disorders are available across the country. Depending on where you find
yourself in the search for treatment, a regional or national group may offer the best support for you and your
loved ones. Here are just a few of the national and regional resources available.
Body Balance Coalition
913.631.3800 ext. 102 | Dr. Michelle Micsko
This Kansas City-based organization brings eating disorders professionals from both the Missouri and Kansas
together to provide assistance to individuals struggling with eating disorders.
Columbia River Eating Disorder Network
A group of professionals in Oregon and southern Washington dedicated to providing qualified eating disorders
treatment and promoting community awareness of eating disorders.
Eating Disorder Coalition of Iowa
An organization comprised of Iowa community members, families and professionals with a passion to prevent
eating disorders and promote hope and healing for eating disordered individuals.
Eating Disorder Recovery Support
415.898.9839 | edrs.net
A resource focused on prevention and education, it offers educational information and referral sources in the
San Francisco bay area.
National Association for Men with Eating Disorders
239.775.1145 | namedinc.org
One of the only organizations in the United States geared specifically to men with eating disorders. It offers
support and strives to educate the public on males with eating disorders.
Oklahoma Eating Disorder Association
405.418.4448 | okeatingdisorders.org
This association focuses on preventing disordered eating behaviors by promoting awareness and supporting
positive body image throughout Oklahoma and the surrounding states.
April 24, 2012
Eating Disorders Resources Updated: Supportive Organizations for You, Friends and
Loved Ones | Julie Holland
Reaching Out Against Eating Disorders
516.510. 9001 | roaed.org
A New York City-based organization addressing the needs of individuals struggling with disordered eating
behaviors as well as their families and friends.
Financial support resources for eating disorders treatment
Due to the complex nature of eating disorders, treatment is rarely an in-and-out process. It can take weeks,
months and even years for individuals to reach full recovery. Families and individuals can find help for this
journey in the financial support resources available. Here’s a brief list of financially minded resources.
Kirsten Haglund Foundation
Kirsten Haglund, a former Miss America and eating disorders patient, created this foundation to encourage
individuals to stand up for their health and help secure financial aid for those seeking treatment.
Manna Scholarship Fund
770.495.9775; ext. 107| mannafund.org
Based in Georgia, this scholarship opportunity provides funds for residential and inpatient eating disorders
treatment for individual lacking adequate insurance coverage.
Mentor Connect strives to connect people with relevant mentors to guide individuals struggling with eating
disorders through the treatment and recovery processes.
In memory of Jennifer Mathiason, this funding organization offers financial assistance to individuals seeking
treatment in inpatient or partial hospitalization eating disorders programs.
866.785.8407 | theprojectheal.org
An organization created by three teenage girls who befriended one another during eating disorders treatment
now raises money to provide scholarships for others seeking eating disorders treatment.
Other non-profits and foundations for eating disorders resources
Although millions of men and women suffering from eating disorders in the United States, there are many
more – friends and loved ones – who also need support and assistance. These non-profit organizations are just
some of the possible places friends and loved ones can find support.
Andrea’s Voice Foundation
Based in California, this website promotes education and understanding toward the prevention, identification,
diagnosis and treatment of eating disorders.
616.301.8000 | hopenetwork.org
A Michigan-based organization which offers support for friends and families dealing with a loved one’s eating
Eating for Life Alliance
In response to a reported 24.3 percent increase in college eating disorders behaviors, this Massachusetts
organization offers colleges and students valuable access to educational resources for the prevention and
treatment of eating disorders.
Eating Disorder Activist Network
This network offers resources and strives to unite communities around the awareness and prevention of
disordered eating behaviors and negative body image issues.
The Anna Westin Foundation
Following the passing of Anna Westin, this foundation is a support resource for individuals directly – or
indirectly – affected by eating disorders.
The Emily Program Foundation
651.379.6134 | emilyprogramfoundation.org
With the understanding that eating disorders are isolating diseases, this Minnesota foundation prides itself on
working to eliminate eating disorders through advocacy and education.
The Renfrew Center Foundation
877.367.3383 | renfrew.org
Through educational programs and community outreach, this foundation helps the general public to better
understand the complexities of eating disorders and prevent their development.
Niche-based eating disorders resources
Experiencing lasting recovery from eating disorders can often be done by way of an individual’s passions,
whether activity or religion focused. Although not a comprehensive list by any means, the organizations listed
below offer support for eating disorders recovery, complimented by faith and/or artistic guided therapies.
615.599.6948 | findingbalance.com
A Christian focused organization, it offers resources for living healthier lives free from disordered eating
behaviors and negative body image issues.
615.831.6987 | mercyministries.org
A free of charge, faith-based treatment program, this organization offers eating disorders treatment to young
women helping empower them and find lasting recovery.
NORMAL in Schools
917.771.4977 | normal-life.org
This national non-profit educates communities about eating disorders and promotes positive self-esteem and
body image through arts and mindfulness-based activities.
If you or a friend or loved one is in need of advice or even eating disorders treatment, contacting any of
the above resources can be an important and life-saving first step. Additionally, please visit Eating Recovery
Center’s website to chat confidentially with a member of the Intake Team about your questions, concerns and
When it comes to eating disorders, the conventional wisdom -- or the belief that anorexia, bulimia and other
related disorders are a “teenage girl’s disease” -- isn’t so wise. In fact, it’s just plain wrong. While it is true that
the majority of eating disorders (95 percent) first display in young women between the ages of 12 and 25.8,
eating disorders affect individuals of all ages. In fact, the patients admitted to Eating Recovery Center ranged
from 9 to 81 years old in 2011.
The emergence of eating disorders in older women has individuals, families and even medical, psychological
and dietary professionals scratching their heads. They’re often incredulous that the serious symptoms and
behaviors they’re observing in their loved one or patient is actually an eating disorder, asking themselves:
“How could this be an eating disorder? They’re too old!” Because eating disorders don’t discriminate by age,
no one is too old for an eating disorder.
I asked my colleague Enola Gorham, LCSW, CEDS, clinical director of adult services at Eating Recovery Center, to
answer several common questions about the topic of eating disorders in older women.
Question: Are more middle-aged women getting eating disorders? Or are we just getting better at diagnosing
Answer: There has most likely always been a large group of women who have had eating disorders, but were
never diagnosed because doctors and therapists weren’t trained in identifying the disorder. We’re now seeing
more older women with eating disorders seek treatment because the diagnostic criteria is understood by more
doctors and other practitioners, who are increasingly looking beyond the “classic” young girl population as the
only ones who can develop the illness.
Previously, many women spent time working with their doctors trying to find a medical reason for their eating
issues, and doctors simply didn’t look for eating disorders in older/adult women. In fact, their training would
have compelled them to look to irritable bowel syndrome (IBS) or other medical issues and the eating-related
symptoms of women suffering from anorexia, bulimia or other related disorders likely wouldn’t have been
identified correctly as an eating disorder.
Some mature women continue to be in treatment as they enter middle age, while others have never had
treatment despite knowing they needed it. For this latter group, a common excuse for avoiding treatment
during their younger years was a laser focus on their families, children and/or jobs. Seeking treatment at
middle age is a byproduct of finally having time to spend getting help, or because their families or careers were
negatively affected and the problem could no longer be ignored.
Q: Why do eating disorders affect women in middle age?
A: It appears that only a small minority of women “start” their eating disorder in middle age; rather, most
April 17, 2012
Diagnosis of Eating Disorders in Older Women Increases as Awareness Grows | Ken
women have had the disorder long before it was a looked-for diagnosis and simply struggled with their illness
on their own. In some instances, however, an eating disorder could result from a major mid-life stressor or
trauma that propels individuals into a hyper-vigilant, control/protect stance. A life transition -- such as divorce,
kids leaving home or parents dying -- can also trigger a middle-aged woman to turn to food management as
an emotional coping mechanism, particularly among those with “type A” personality traits of perfectionism,
persistence and anxiety.
Q: What are the unique challenges to eating disorders treatment in middle age?
A: Middle-aged women can be a difficult patient population to treat for several reasons. If they have had the
illness for a very long time and it has become an ingrained coping mechanism, it can be hard for them to even
imagine stopping. Many of these women are so highly invested in the idea that their eating disorder is actually
a medical problem that they struggle to see how it is a psychological problem for which treatment would be
beneficial. Also, if these mature women have been relatively functional in life -- i.e. educated, well-employed,
married, parent -- they may struggle to understand why they even need to do the hard work to get well. Older
patients themselves can also subscribe to the belief that eating disorders only affect young girls, so they’re
fearful that treatment won’t apply to them, or that they won’t “fit” into structured eating disorders treatment
environments due to their age. Finally, this population often has more awareness regarding how much their
illness has cost them in their lifetime. It can be incredibly painful to take an accounting of the damage, which
may result in the belief that it’s “easier” to stay ill.
Generally speaking, the illness itself doesn’t tend to be different, except that as we age, we all have less of an
ability to bounce back physically. Therefore, natural aging issues can make eating disorders more medically
complex and treatment plans should address these physical issues. Though the specific life circumstances of
a young patient and an older patient may differ, treatment is essentially the same for older women as it is
for younger women. Based on the acuity of the illness, the first priority of treatment is always to ensure that
patients are medically and psychiatrically safe.
Regardless of age, the sooner an individual enters treatment, the better her chances are for a positive outcome
and lasting eating disorders recovery. If you think a loved one may be struggling with an eating disorder, urge
them to get an eating disorders assessment from a qualified professional sooner rather than later.
Have more questions about eating disorders in older women? Chat live with a Master’s-level therapist here.
For more by Kenneth L. Weiner, M.D., FAED, CEDS, click here.
For more on eating disorders, click here.
If you’re struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.
April Dunlap was 17 and weighed 165 pounds when she began a diet and exercise regimen. After three
months, the 5-foot-5 teen had lost the 20 pounds she had hoped to shed. But she kept going. “It was like a
drug,” she said. “I always wanted to lose a little more.”
When she hit 120 pounds, Dunlap’s mother worried that April was losing too much weight. The family’s doctor
agreed. Four months after Dunlap’s diet began, she found herself in a treatment program for anorexia nervosa.
After only 10 days, she had gained enough weight to be discharged from the hospital.
“If it wasn’t for my mother, it would have taken a lot longer for me to realize I had a problem,” said Dunlap,
now 28 and living in Charleston, W.Va.
Dunlap’s whirlwind experience with her eating disorder is becoming increasingly common today: A new breed
of patient is getting treatment well before the disease drags them into a downward spiral toward starvation,
sustained heart damage, weak bones, kidney damage, long hospitalizations and numerous relapses.
Health experts are seeing a glimmer of hope that the devastation wrought by eating disorders may be easing
nearly 30 years after the illnesses first sprang into the public consciousness with the death of singer Karen
Carpenter from anorexia-induced heart failure. Among the encouraging signs: More patients are getting
medical treatment based on sound science; they’re getting it earlier in the course of the disease; and they’re
recovering faster, often without the need for hospitalization or residential care.
One eye-opening statistic appears to speak to the trend: A recent government analysis found that
hospitalizations for people with the primary diagnosis of an eating disorder plunged 23% between 2007-08
and 2008-09. It was the first such decline since the federal Agency for Healthcare Research and Quality began
tracking such hospitalizations in 1999.
“Any little movement is significant, and this is a pretty big one,” said William Encinosa, a senior economist at
the agency who worked on the report, which was published last year.
Eating disorders, which primarily affect teenage girls, are loosely categorized as mental illnesses centered
on obsessive thoughts, emotions and behaviors regarding food. Anorexia involves self-starvation leading
to excessive weight loss that damages the heart, bones, nervous system and organs. An estimated 1 in 200
Americans has the disease, and the death rate is 4%.
Bulimia is characterized by bingeing followed by self-induced vomiting, use of laxatives or excessive exercise
to purge food and prevent weight gain. It affects 2% to 3% of Americans and is not thought to be as deadly as
anorexia, though a 2009 study in the American Journal of Psychiatry found it was lethal in nearly 4% of cases,
mostly due to suicide or electrolyte imbalance caused by dehydration.
Another type of eating disorder, binge eating, rarely leads to hospitalization or death.
April 17, 2012
Experts see hopeful signs on eating disorders | Shari Roan
The stigma surrounding anorexia and bulimia have kept many patients isolated. But for a variety of reasons,
eating disorders are coming out of the shadows.
Surveys conducted by the National Eating Disorders Assn. show that Americans are more familiar with anorexia
and bulimia now than they were 10 years ago. That awareness has been accompanied by a weakening of the
stigma associated with eating disorders that might, in the past, have prevented some people from seeking help
quickly, said William Walters, who manages the telephone hot line for the New York-based organization.
”Parents are being more proactive. Coaches are being more proactive about their athletes,” he said. “People
feel they can ask for help.”
Encinosa credits the heightened awareness to a combination of education in schools, TV shows on the topic
and public statements by such celebrity patients as Princess Diana and Paula Abdul.
In April Dunlap’s case, a made-for-TV movie about two high school students with eating disorders put her
mother, Gloria, on alert. When April began her rapid weight loss, Gloria took action.
“I could see it wasn’t normal,” Gloria Dunlap said.
Some experts are skeptical that the big drop in hospitalizations reflects actual improvement in treatment.
More insurance companies are steering patients to outpatient programs or partial hospitalization, in which
patients attend day programs but go home at night, said Dr. Ovidio Bermudez, medical director of the Eating
Recovery Center in Denver. Perhaps the drop in hospitalizations simply means insurers are being stingy.
Nor does the federal data indicate whether deaths from eating disorders have declined, since mortality rates
are not tracked.
There is no evidence that the incidence of eating disorders has dropped, Bermudez said. To the contrary,
anorexia and bulimia have been spreading among populations other than white teenage girls.
For decades, the eating disorder lexicon had two main entries: anorexia and bulimia. But modern research
reveals that these fall woefully short of encompassing the many facets of disordered eating. In the early ‘90s,
the American Psychiatric Association introduced a new diagnostic category: eating disorders not otherwise
specified (EDNOS). A catch-all label that includes dozens of subdiagnoses, EDNOS applies to patients who don’t
meet the exact criteria for anorexia or bulimia but still have very troubled relationships with food or distorted
body images. Today, EDNOS diagnoses significantly outnumber anorexia and bulimia cases. “The atypical has
become the typical,” says Ovidio Bermudez, M.D
April 17, 2012
Beyond anorexia, bulimia: Lesser known eating disorders | Jenny Deam
The new disorder: Orthorexia
What it is: A fixation with healthy or righteous
Orthorexics often eat only organic foods, eliminate
entire food groups, or refuse to eat anything that
isn’t “pure” in quality, says clinical psychologist
Sari Shepphird, Ph.D. Unlike anorexics, they don’t
necessarily think they’re fat or strive to be thin;
some are motivated by a fear of bad health, a
fixation with complete control, or the desire to
improve their own self-esteem. Ironically, severe
orthorexia can lead to malnourishment.
The new disorder: Pregorexia
What it is: Extreme dieting and exercising while
pregnant to avoid gaining the 25 to 35 pounds of
weight doctors usually recommend
“There’s more social pressure on women to look thin during and after pregnancy,” says Shepphird. “But
pregorexia comes with very serious health problems.” Starving moms-to-be are at risk for depression, anemia,
and hypertension, while their malnourished babies are often miscarried or born with birth defects.
The new disorder: Binge Eating
What it is: Compulsive overeating, often to deal with negative emotions or stress
Binge eaters consume large amounts of food very quickly, until they’re uncomfortably full. Most sufferers eat
in secret to hide their habits. Many feel powerless to stop eating and are disgusted with themselves afterward;
but unlike with bulimia, they don’t attempt to reverse a binge by vomiting or fasting. While not all patients are
overweight, obesity, and its related health problems, are obviously a risk.
The new disorder: Anorexia Athletica
What it is: An addiction to exercise
Sufferers work out well beyond the requirements for good health, often to the point that their gym time
interferes with their job or relationships. “Instead of throwing up, so-called compulsive exercisers purge
calories by working out religiously,” says Shepphird. “Often, if they don’t keep up with their rigorous
routine, they feel tremendous anxiety or guilt.” They’re also at risk for potentially fatal cardiac problems and
The new disorder: Drunkorexia
What it is: Restricting food intake in order to reserve those calories for alcohol and binge drinking
A University of Missouri study found that almost 30 percent of female college students exhibit drunkorexic
behavior, “saving” their calories for booze in order to avoid gaining weight or to get drunk faster. Bad idea:
These women are upping their chances for alcohol poisoning, uninhibited sexual behavior, and long-term
consequences like heart and liver diseases.
Always-complicated eating disorders can involve myriad symptoms, self-deprecating comments, wild mood
swings, an obsession with cooking but not eating, but the biggest tip-off that your friend might have a problem
is an extreme change. As in, your hamburger-loving bud suddenly turns vegan, or your otherwise social pal
refuses to dine out. “If it seems as if food controls her life, or fitting into a certain pair of jeans can make or
break her day, it might be time to get help,” says eating disorder treatment specialist and psychotherapist
You might be hesitant to butt in, but remember this: “Eating disorders have the highest mortality rate of
any psychiatric illness,” says Parker. “Even if you’re not 100 percent sure, approach her anyway.” Start with
a nonjudgmental general question such as “Are you stressed?” It’s important to be supportive rather than
If she doesn’t open up, sit down with her privately and say, “You might not agree with me, but I have to
say something because I care about you.” There’s no need to give advice (you’re not a trained pro), but you
can offer to make phone calls or leave her with a pamphlet from a place like the National Eating Disorders
April 23, 2012
Newsmakers: Kenneth Weiner
Submission Type: Professional Recognition
Current employer: Eating Recovery Center
Current title/position: Founding Partner, Chief Executive Officer, Chief Medical Officer
Industry: Health Care
Position level: C-Level
Reason for being recognized: The Colorado Psychiatric Society awarded its 2012 Outstanding Achievement
Award to Dr. Kenneth L. Weiner, a Denver-based psychiatrist specializing in the treatment of eating disorders.
Company headquarters: Denver, Colorado
Mother’s Day is the recognized day to celebrate the wonderful women in our lives who have provided us with
love and support throughout our lives. In addition, our moms are also the source of our genetic make-up,
which can dictate mannerisms, physical appearance and predisposition toward certain illnesses and diseases.
Perhaps you have your mother’s eyes or you both walk the same way and share similar traits. You may also be
at risk for developing an eating disorder if she has struggled with one.
Although eating disorders like anorexia nervosa and bulimia nervosa were previously thought to be the
product of strictly psychosocial influences, this is no longer the case. The biological origin of eating disorders is
now a hot topic in research centers. In fact, 40 to 50 percent of the risk associated with developing an eating
disorder has been identified as genetic. With the combination of biology and environment often working
against us, it’s important to know your family history as well as the predisposing factors of eating disorders.
New evidence has confirmed a connection between eating disorders and heritability. Individuals with certain
temperaments and traits may be vulnerable to develop symptoms of an eating disorder due to genetics.
Some predisposing factors you should be aware of include: family history of eating disorders or chemical
dependency, mood disorders, anxiety and depression.
Eating disorders aren’t a disorder of choice
The prevalence of genetics as a cause and concern for disordered eating speaks to the importance of knowing
your family’s history. An individual with an anorexic mother or sister is 12 times more likely to develop anorexia
and four times more likely to develop bulimia. Similarly, 20 percent of anorexic patients meet the criteria of
Asperger’s syndrome (a milder variant of autism spectrum disorder), which often leads to predisposing factors
like social isolation and eccentric behavior in childhood.
Dieting can trigger an eating disorder
While genetics is a key variable in determining an individual’s chances of developing an eating disorder, we
can’t discount the consequences of psychosocial factors. In today’s diet crazed culture, dieting can be deadly
for those teens genetically at risk of developing an eating disorder. Other predisposing factors like a family
history of severe or compulsive exercise as well as a disengaged family environment can trigger unhealthy
behaviors for at-risk individuals.
This year, I invite you to celebrate Mother’s Day by rejoicing with the wonderful women in your lives. Take the
time to learn more about who they are as a person and about their history. Do you know if eating disorders are
or have been prevalent in your family?
Learn more about eating disorders, their genetic link and the available resources at EatingRecoveryCenter.com.
May 7, 2012
Do Your Mother’s Genes Influence Your Risk for Developing an Eating Disorder? |
May 13-19, 2012, is National Women’s Health Week, an annual weeklong celebration and promotion of
all things related to women’s health. This year’s theme, “It’s your time,” underscores the importance of
empowering women by making health a top priority. Women are encouraged to take action to improve mental
and physical wellbeing to reduce the risk of certain diseases, such as eating disorders. Currently, 80 percent
of American women are dissatisfied with their appearance and the growing number of women with eating
disorders in America is upwards of 10 million. These alarming numbers make National Women’s Health Week
the perfect time to take a stance and address the importance of exploring qualified eating disorders treatment
The importance of seeking qualified eating disorders treatment
For females ages 15 to 24 who suffer from anorexia nervosa, the mortality rate associated with the illness is
12 times higher than the death rate of all other causes of death. This alarming statistic underscores the need
for women to understand why qualified eating disorders treatment is important and how to find the best
treatment options and resources for you.
Recovery isn’t a simple solution considering the complexities that surround this disease. Eating disorders are
biological, psychological and social diseases rooted in genetics, personality, societal norms and values, as well
as personal belief systems. Effective eating disorders treatment requires that each element of diagnosis be
addressed. As eating disorders awareness expands from the stereotypical “teenage girl’s disease,” individuals
and health professionals need to be well versed in the warning signs and potential complications eating
disorders can cause in young girls and boys, men and older women.
What is qualified eating disorders treatment?
The most beneficial and long-lasting treatment for eating disorders includes a treatment team providing
psychotherapy or counseling, along with specific attention to the patient’s medical and nutritional needs. The
use of medication is also helpful in some cases. I recommend that eating disorders treatment:
Be tailored specifically to the individual patient, his or her family and his or her support system.•
Vary according to the severity of the patient’s eating disorder.•
Address the individual patient’s needs, stumbling blocks, strengths and weaknesses in order to facilitate•
eating disorders recovery.
The majority, 95 percent, of young women who develop an eating disorder do so between the ages of 12
and 25.8.* Therefore, the type and frequency of therapies involved with eating disorders treatment must be
diverse, yet influential enough to effectively treat this age range.
Who is qualified to treat an eating disorder?
Qualified eating disorders professionals understand that eating disorders are no longer treated as a “disorder
of choice.” Typically, eating disorders care is provided by a licensed health professional such as a psychologist,
psychiatrist, masters level therapist, dietitian, nutritionist or primary care physician. Regardless of where you
seek treatment, a treatment provider should address the following:
Eating disorders symptoms.•
Psychological, biological, interpersonal and cultural forces contributing to the patient’s condition.•
Support groups, nutrition counseling and psychiatric medication as needed.•
Case sensitive medical supervision and outpatient aftercare resources.•
May 14, 2012
National Women’s Health Week: It’s Your Time and Your Health | Julie Holland
The International Association of Eating Disorders Professionals (iaedp) provides the only certification for eating
disorders professionals in the U.S. You can locate a certified professional (CEDS, CEDRD, CEDRN) in your area by
visiting their website www.iaedp.com.
Lasting eating disorders recovery is possible
Research shows that the earlier an individual is diagnosed gains access to treatment, the greater the likelihood
of lasting eating disorders recovery. Qualified eating disorders professionals are available to support
individuals and loved one through the recovery process.
For more information about eating disorders treatment, recovery and resources, visit Eating Recovery Center’s
website. For more information about National Women’s Health Week visit www.womenshealth.gov/whw.
Eating disorders take a toll on an individual physically, mentally and emotionally. Furthermore, recovery can
be impacted without adequate support or if the individual is engaging in other compulsive behaviors. For
individuals who indulge in alcohol, both socially and as a way to deal with emotions, there are additional
complexities and consequences associated that make lasting recovery that much more difficult.
Most studies have reported that eating disorders and substance use disorders, such as alcoholism, frequently
co-occur.* Doctors are seeing an increase in the potentially deadly combination of eating disorders and
alcohol, often in one of the three following ways.
College students are minimizing their food-based caloric intake in order to “save” calories and more1.
comfortably drink when they go out with their friends.
Men and women struggling with eating disorders use beer, wine and cocktails, rather than food, as2.
main sources of sustenance.
Eating disordered individuals use alcoholic beverages to deal with uncomfortable emotions and to ease3.
the stress they’ve come to associate with eating.
Regardless of the behaviors individuals may practice, over indulging in alcohol when already restricting
nutrients can be a deadly cocktail.
One thought related to why eating disorders and alcohol abuse are so often seen occurring together is the
fact that both disorders, according to The Seattle Times, have “behaviors that are glorified and reinforced.
Binge drinking is almost as cool and hip as losing weight and being thin” in today’s society.** Thankfully
the combination of eating disorders and alcohol has reached a tipping point and the public – and medical
profession – are taking notice.
When an individual restricts calories, he or she strips his or her body of the vital nutrients it needs to function
day in and day out. Prolonged restriction will eventually cause the body’s systems to begin to shut down. When
alcohol is introduced into this situation, the shock to the body and its systems can trigger irreversible damage
The sooner you, or someone you love, seek treatment for an eating disorder or alcohol abuse, the better the
chances are for a full, lasting recovery. For individuals watching a friend or loved one struggle with disordered
May 21, 2012
Eating Disorders and Alcohol Are a Deadly Cocktail | Julie Holland
behavior, it can be difficult to know how to best provide support. Remember that recovery is an ongoing
process and takes more than days and weeks; it can take months and even years.
Additionally, individuals in recovery from an eating disorder need to be cautious of crossover addictions that
can occur in recovery. Eating disordered individuals often display addictive personalities and personality traits.
Therefore, they need to be cautious of compensatory coping behaviors once eating disorder recovery has
Are you or someone you know struggling with an eating disorder or perhaps substituting food with alcoholic
beverages? Visit Eating Recovery Center’s website to confidentially chat online with a member of the Intake
Team. He or she can expertly answer your questions and get you the information your need.
Please comment below with your questions about the relationship between eating disorders and alcohol or
eating disorders in general. I’m happy to answer what I’m able or direct you to the best possible resource!
The month of May brings so much excitement for summer and so many celebrations. It’s also Global Employee
Health and Fitness Month, an observance that reminds us how important it is for employers to help their
employees stay healthy so that they can successfully contribute to their jobs and lead happy, healthy lives.
I thought that this was a perfect time to speak with my colleague at Eating Recovery Center, Chief Human
Resources Officer, Scott Fisher, about what human resources professionals should know regarding eating
disorders and their employees.
What advice do you have for human resources professionals addressing eating disorders in the workplace?
Human resources should manage an eating disorders issue in the same manner it handles any medical issue.
There are three possible scenarios relating to eating disorders in the workplace. One, an individual in human
resources observes concerning behaviors; two, an employee approaches human resources regarding his or her
own disordered eating behaviors; and three, an employee comes to human resources for help regarding his or
her child or loved one who is exhibiting disordered eating behaviors.
Human resources professionals are trained to focus on medical or psychological conditions as they affect
an employee’s ability to perform his or her job duties. Therefore, it’s critical to maintain the focus on the
employee’s performance and participation at work. When you’re approaching an employee you’re concerned
about, concentrate on the observable behaviors that are causing problems and then appropriately counsel the
employee as you try to gain commitment to improved performance.
I believe the majority of human resources professionals are in the same boat as the general public. They don’t
appreciate the potential severity of eating disorders or the secondary illnesses or conditions that can often
come into play with eating disorders, such as anxiety or depression. When eating disorders are identified as
an issue, it’s not a quick fix issue that can be solved with a referral to the employee assistance program. It’s an
ongoing process in which the employee benefits from professional support during eating disorders treatment
May 29, 2012
Eating Disorders in the Workplace: Advice and Resources for Human Resources
Professionals | Julie Holland
What resources should human resources professionals be aware of for their employees?
Regardless of the medical issue, there are a few things that all human resources professionals should be aware
of and recommend. For example, the Family Medical Leave Act (FMLA) and the Americans with Disabilities Act
of 1990 (ADA) are both valuable resources for employees and their families struggling with a medical issue in
the family. FMLA allows eligible employees to take unpaid, job-protected leave for specified family and medical
reasons with continuation of group health insurance coverage*, alleviating some of the stress associated
with medical issues and leave. The ADA provides guidelines for both employers and employees on workplace
management of illnesses and conditions that qualify.
Group health insurance customers, member services teams or your company’s insurance broker are also
potential resources that employees or individuals without insurance expertise can access for information and
Employee assistance plans (EAPs), while not a total solution, are always confidential and can be a beneficial
resource for individuals who need help in a crisis situation and guidance to develop a longer-term action plan.
Are there any laws, etc., that restrict what human resources professionals are able to do related to
approaching an employee?
As is true with any medical condition, human resources professionals can’t invade someone’s privacy and must
respect the confidentiality of protected health information. However, it’s fine to approach an employee with
genuine concern and say, “You don’t seem to be yourself these days.” or “We’ve noticed some performance
issues; is there something going on in your life that HR can help with?”
Thank you, Scott, for your insight and opinion for human resources professionals addressing eating disorders
in the workplace. If these few questions leave you wanting to know more about human resources and eating
disorders, please visit Eating Recovery Center’s website for more information or to contact us.
May 7, 2012
Is Facebook Hurting You? | Carolyn Carver
Joe Eiben and a former patient did interviews regarding eating disorders and body image as it relates
to social media.
See the CD at the back of this clipbook for full video.
May 8, 2012
Eating Disorders Continue to Grow Among Children | Nancy Churnin
May 10, 2012
Encouraging healthy choices in preparation for summer fun, food and fashion
May 11, 2012
Ernst & Young names 2012 Entrepreneur of the Year finalists
Ernst & Young LLP has named the finalists for its Entrepreneur of the Year 2012 awards in the Mountain Desert region.
The awards recognize entrepreneurs who demonstrate excellence and extraordinary success in such areas as
innovation, financial performance and personal commitment to their businesses and communities.
Finalists were selected by a panel of independent judges.
The awards will be presented during Ernst & Young’s annual gala on June 28 at the Seawell Grand Ballroom in the
Denver Center for the Performing Arts .
Now in its 26th year, the Entrepreneur of the Year Program has expanded to recognize business leaders in more than
140 cities in more than 50 countries throughout the world.
Regional award winners are eligible for consideration for the national award, which will be announced Nov. 17 at an
event in Palm Springs, Calif.
The finalists are:
Mike Durham, CEO, ADA-ES, Inc., Highlands Ranch.•
Jeff Bisberg, CEO, Albeo Technologies Inc., Boulder•
John Griffith, president, Alpine Waste & Recycling, Commerce City.•
Terry Shadwick, President & CEO, BluSky Restoration Contractors, Inc. (Centennial, CO)•
Heidi Ganahl, CEO, Camp Bow Wow, Broomfield.•
Matt Larson, founder and CEO, Confio Software, Boulder.•
Jeremy Woan, Chairman and CEO, CyraCom International, Inc., Tucson, Ariz.•
Ken Weiner, Founding Partner, CEO and chief medical officer, Eating Recovery Center, Denver.•
Bruce Johnson, CEO and president, Global Healthcare Exchange LLC, Louisville.•
Jud Valeski, CEO, Gnip, Boulder.•
Clate Mask, CEO and co-founder, Infusionsoft, Gilbert, Ariz.•
Glenn Jones, CEO, executive chairman of the board, Jones/NCTI, Centennial.•
Matt Taylor, CEO, Mercury Payment Systems, Durango.•
Dale Katechis, founder, Oskar Blues Brewery, Longmont.•
Matthew Pittinsky, CEO, Parchment Inc., Scottsdale, Ariz.•
Andre Durand, CEO, Ping Identity Corp., Denver.•
Russell Sigler, chairman, Russell Sigler Inc., Tolleson, Ariz.•
Mike Buchen, president & CEO, SKYDEX Technologies Inc., Centennial.•
Katherine Ott, CEO, SlimGenics, Centennial.•
Shawnee Huckstep, CEO, TechWise, Colorado Springs.•
Jack Hays, vice president, Strategic Business Development, WPD/Rockwater Energy Solutions, Grand Junction.•
Thomas Sandgaard, founder, chairman and CEO, Zynex Inc., Lone Tree.•
In special recognition, Mike Fries, president and CEO of Liberty Global, will be awarded for Entrepreneurial Excellence.
You might think of anorexia as a female disease, with a greater impact on women’s health than on men’s
health. But don’t tell that to Victor Avon, 28, of Brick Township, N.J. An extremely obese teenager, Avon lost a
large amount of weight to arrive at his healthy goal. The trouble was that he kept losing more and more weight
after that — to the point where his life was in danger. His struggles with anorexia were not much different from
what women experience.
“I spent several years in the grips of the disease. It was such a dark world,” he says. “I never thought I would
change and, quite frankly, I didn’t want to change. But it almost killed me. I finally decided to hospitalize
myself and spent three months in a program, which was the hardest thing I’ve ever done in my life. Since being
discharged in June 2008, I have done everything I possibly could to prevent my disorder from taking me back to
Avon isn’t the only male to struggle with anorexia — nor is anorexia the only “women’s disease” that
can impact men’s health. Here, a look at six conditions that are typically associated with women but that
significantly affect both sexes.
Anorexia and Other Eating Disorders
The rate of women to men with eating disorders is about 9 to 1, but in other respects, anorexia and other
such conditions are fairly similar in the way they affect men’s and women’s health, says Emmett Bishop, MD,
founding partner and medical director of adult services at the Eating Recovery Center in Denver. The main
difference? Risk factors.
“Men generally have different motives in terms of their weight loss,” Dr. Bishop explains. “Sometimes weight
loss is prompted by athletic activities such as losing weight for sports performance. Men will also often develop
anorexia nervosa more from an ‘orthorexic’ standpoint — by eliminating certain foods or food groups in an
attempt to eat more healthfully. On the flip side, with bulimia nervosa, men’s motivation is the same as it is
with women, a set of behaviors used in an attempt to manage emotions.”
Breast cancer, perhaps more than any other condition on this list, is considered primarily a women’s disease.
(Think of all the pink!) Yet it can affect men’s health, too. Though it’s 100 times less common in men than in
women, more than 2,000 new cases of male breast cancer are diagnosed each year.
Many of the risk factors for breast cancer in men are similar to those in women, such as age, family history,
heavy alcohol use, and obesity. But men have some unique risks as well, including testicular disorders,
liver problems, certain occupations that cause risky exposures, and Klinefelter syndrome (having an extra X
chromosome). They also may fare worse in terms of survival: According to a recent study presented at the
meeting of the American Society of Breast Surgeons, male breast cancer patients tend to have lower survival
rates, larger and higher-grade tumors, and more lymph node metastasis.
May 30, 2012
6 Women’s Health Conditions That Men Get, Too | Wyatt Meyers
Some 80 percent of people with the bone disease osteoporosis are women, but low bone mass can negatively
affect men’s health, too. In fact, American men with or at risk for osteoporosis in 2002 totaled more than 14
million — a number that’s expected to grow to more than 20 million by 2020.
The impact of osteoporosis on men’s health and women’s health is similar: If left untreated, the condition can
increase the risk of fractures, cause severe pain, and even lead to a loss of mobility. The big difference with
this classic women’s disease in men is its timetable. Men don’t experience the rapid loss of bone mass in their
fifties that women do, typically after menopause sets in. But between the ages of 65 and 70, risk factors for
both sexes become more equal — men and women lose bone mass and experience a decrease in calcium
absorption at the same rate.
Though menopause is unquestionably a rite of passage for women, men also go through some hormonal
changes as they age — a phase sometimes referred to as “male menopause” — that play a parallel role in
“Men have similar hormonal changes as women,” says Gregory David Albert, MD, a cosmetic surgeon in Miami.
“As men get older, their testosterone level decreases compared to other hormones, namely estrogen. This will
increase a man’s risk for developing gynecomastia [breast enlargement] and osteoporosis.” Staying active and
eating healthy foods may help delay the change, Dr. Albert adds.
HPV, or human papillomavirus, has serious implications for women’s health because of certain strains’ link
to cervical cancer. However, studies have found that men get this so-called women’s disease just as much as
women do. In fact, almost all sexually active people of both sexes will get it at some point. And while men
can’t get cervical cancer, they’re vulnerable to several other HPV-linked cancers, even moreso than women.
Specifically, studies done at Ohio State University found a link between HPV and throat cancer in men. These
findings have led to recent recommendations for boys as well as girls to get the HPV vaccine to protect men’s
Lupus is an autoimmune disorder — your body’s immune system attacks its own organs and tissues. Ninety
percent of people affected are women, but the impact of lupus on men’s health is significant — the symptoms,
prognosis, and treatment are largely the same. The unique challenges that men may face stem from the fact
that it’s thought of as a woman’s disease — some doctors may not be looking for lupus as the cause of a man’s
symptoms, so getting a diagnosis might not happen as quickly as it could. Also, it may be more difficult to find
lupus support groups just for men.
May 30, 2012
Demand for Child and Adolescent Eating Disorders Care Prompts Eating Recovery
In response to an increasing demand for child and adolescent eating disorders care, Eating Recovery Center,
an international center for eating disorders recovery, has expanded its Partial Hospitalization Program for
Children and Adolescents. With the opening of a new facility in Denver’s Lowry neighborhood, this 11-hour-
per-day, family-based treatment program will nearly triple current capacity. Eating Recovery Center’s child and
adolescent programs, which provide inpatient, residential, partial hospitalization and outpatient treatment to
boys and girls ages 10 through 17, have been in high demand since the Center opened its Behavioral Hospital
for Children and Adolescents in January of 2011.
The prevalence of eating disorders in adolescence and childhood has steadily increased in recent years.
According to the American Academy of Pediatrics, from 1999 to 2006, hospitalizations for eating disorders
increased by 119 percent for children younger than 12 years.
“The growing need for eating disorders treatment programs with specialized expertise in managing the
therapeutic and medical needs of children, adolescents and families is apparent,” said Ovidio Bermudez, MD,
FAAP, FSAHM, FAED, CEDS, medical director of child and adolescent services and chief medical officer of Eating
Recovery Center. “The expansion of the Partial Hospitalization Program for Children and Adolescents enables
Eating Recovery Center to address this trend by providing comprehensive treatment to a significantly larger
number of patients and families.”
Offering a critical stepping-stone in the eating disorders recovery process for young patients, the Partial
Hospitalization Program enables patients and their families to participate in daily programming that
emphasizes communication skills, relapse prevention strategies and healthy parent/child interactions. Through
individual, group and family therapy and staff-supported meals, families begin to work toward returning to “life
as usual” outside of their child’s structured eating disorders treatment environment. The overall focus is on
recovery and well-being.
Patients participate in a combination of individual, group and family therapy emphasizing recovery skills
and the role of families in lasting recovery. They engage with a licensed teacher at Eating Recovery Center’s
Learning Center in the afternoons to facilitate a seamless transition back to school following treatment. While
their child is in treatment, parents and family members receive twice-a-day education lectures and participate
in support groups. Multi-family groups and family meals are also embedded in the weekly schedule to foster a
supportive community for patients and family members.
“Our treatment philosophy recognizes the importance of family involvement, education and empowerment in
the recovery process,” continued Dr. Bermudez. “Treatment programming acknowledges that many child and
adolescent patients are too developmentally young to take full ownership of weight restoration, sustainable
recovery skills and aftercare, and provides parents with tools to continue to facilitate recovery at home.”
When patients are medically and psychiatrically stable, the structure and support of 24-hour care environment
is not necessary and there is willingness and availability among both patient and parents to engage in intensive
outpatient treatment, the Partial Hospitalization Program can be a meaningful starting point for families to
begin the recovery process. Alternatively, patients can step down to this level of care from Eating Recovery
Center’s inpatient and residential programs for children and adolescents. In the latter instance, continuity of
care is a priority and patients will retain the same treatment team throughout their full course of treatment.
The only privately owned licensed psychiatric hospital in the U.S. exclusively dedicated to treating eating
disorders and providing all levels of care for adults, adolescents and children, Eating Recovery Center’s Denver-
based facilities include the Behavioral Hospital for Adults, the Behavioral Hospital for Children and Adolescents,
the Partial Hospitalization Program and Outpatient Services for Adults, and the Partial Hospitalization Program
for Children and Adolescents. In addition, Eating Recovery Center, in partnership with Summit Eating Disorders
and Outreach Program, offers Partial Hospitalization and Outpatient Services in northern California.
For more information about eating disorders programs or to learn about Eating Recovery Center’s admissions
process, visit www.EatingRecoveryCenter.com.
May 31, 2012
Eating Disorders Hospital Opens New Denver Site | Jennifer Brown
Another center to treat children and teens with eating disorders has opened in Denver’s Lowry neighborhood.
The Eating Recovery Center in Lowry will offer an 11-hour-per-day treatment program for girls and boys ages
10 through 17. The expansion of the privately owned center was a result of increased demand.
Hospitalizations for eating disorders increased by 119 percent for
children younger than 12 from 1999 to 2006 in this country, according
to a study from the American Academy of Pediatrics.
The “partial-hospitalization” option, meaning children spend their
days at the center but go home at night, includes family therapy
and staff-supported meals. Family meals are also part of the weekly
Near downtown Denver, the Eating Recovery Center has round-the-
clock programs for adults and adolescents, as well as partial-hospitalization programs.
The downtown center, which resembles a spa with its jet tubs, yoga and massage, first opened in Denver in
As a therapist and active member of the eating disorders treatment field, a question I often hear is, “What is
healthy weight loss?” or “Is there such a thing as a healthy weight loss plan?” This is always a tricky question
because planning to be healthier should revolve around a lifestyle change and moderation, rather than
reducing numbers on a scale.
To help me address these questions, I spoke with my long-time friend and Certification Committee Chair,
Tammy Beasley, RD, CSSD, LD, CEDRD, creator of Rev It Up: Your Healthy Lifestyle Roadmap. In the interview
below, Tammy lends her expertise on the issue of healthy weight loss without the use of diets and “quick fixes.”
Question: Is healthy weight loss even possible?
Answer: With the way our society focuses on “thinness” and fad diets, it’s difficult to find many people who
combine the word “healthy” with “weight loss” successfully. However, it can be done if the following takes
Realigning your expectations to be appreciative of small step changes that lead to long-term results.1.
Recognizing your body’s own “fuel gauge.” Understanding hunger and fullness signals can be the key to2.
managing your weight for a lifetime.
Redefining your definition of healthy to include so much more than just what the scale itself says to3.
There is nothing more fickle than that bathroom scale. Our bodies are mostly water (65 percent, in fact), so
quick changes you see on the scale are predominantly “water weight” changes, not true body fat changes. In
addition stress, hormone fluctuations, medications and even barometric pressure changes based on weather
patterns can cause temporary increases in body weight. It’s so important that your definition of health, and
healthy weight loss, extends past one number on a scale.
Q: What is healthy weight loss?
A: If we look at it from a technical standpoint, a healthy weight loss rate is about 1 pound of body fat per week
for women, and 2 pounds per week for men. Anything above and beyond that rate of loss is usually not fat
loss. It’s so critical to not let society’s pressure for fast results discourage you in your own progress. Slow is
indeed healthy, and changes you are making that are leading to gradual weight loss are doing so much more
for your metabolism and self-confidence than just reducing a number on the scale.
More often than not, healthy weight loss comes from following a life plan that doesn’t exclude any single
food group but allows for a variety of foods eaten in smaller frequent meals throughout the day. It’s all about
moderation and choosing your foods wisely from all of the food groups while listening to your own body’s cues
for when you’re hungry and when you’re full. Ultimately, healthy weight loss comes from a foundation of trust
between you and your body, and a belief in your body’s ability to change and work with you instead of against
June 4, 2012
What is Healthy Weight Loss? | Julie Holland
Q: What risks, if any, do you associate with dieting?
A: The word “diet” in and of itself causes most women, and men for that matter, to cringe. Dieting, if
defined by restrictive behaviors expecting quick results, is very risky to not only your body, but also your
psyche. Dieting is the number one precursor to developing an eating disorder. Dieting typically represents an
unrealistic plan based on a list of “good” and “bad” foods without a focus on moderation. The majority of time,
a diet sets you up for failure because it’s a pre-determined, unrealistic meal plan that pushes you out of the
driver’s seat, throws you into the passenger seat, not allowing you to learn from your own decisions about
what to eat and when. It’s learning from your own choices – going too long between meals increases your
cravings, eating too many fried foods make you feel sluggish, trying to save up your calories for one big meal
always backfires – that actually result in positive changes and true, lasting ownership of your body’s healthy
Q: What’s your take on all the numbers, BMI, pounds lost, etc., considered with weight loss?
A: So much of losing weight these days focuses on numbers: your BMI, the number on the scale, how much
weight you’re losing each week. Weight loss doesn’t usually occur in a steady downward trend, but rather in an
up and down, stair-step pattern. Plateaus are normal, and weight loss can continue if you stay in tune to your
body and keep your expectations realistic.
BMI, or body mass index, is a measurement of the relative percentages of fat and muscle mass in the human
body, based only on an individual’s height and weight. I rarely use BMI when working with clients because
it doesn’t take into account an individual’s activity level or true lean body mass. If a superstar athlete like
LeBron James falls into the overweight category according to his BMI, I find it difficult for BMI to be considered
the “end all” tool for weight loss itself. Circumferences and the way your clothes fit you are more realistic in
assessing your healthy weight loss progress than a broad calculation like BMI or numbers on the scale.
If you’re considering weight loss, you should speak with your physician to obtain medical clearance, and then,
more importantly, speak with a registered dietitian about your goals and how they fit within your lifestyle
habits and/or patterns. It can also be helpful to enlist the support of a good friend or a close family member
who will objectively, enthusiastically and faithfully encourage you and hold you accountable for your progress.
Thank you, Tammy, for all your expertise and insight on healthy weight loss; it’s certainly a topic that I hope to
continually address on the blog. I invite all my readers to comment below with their questions or concerns as it
pertains to healthy weight loss and eating disorders.
Remember, if you feel your weight loss plan or that of a loved one has left the realm of healthy and slid over
into unhealthy, it’s important to seek help. Visit EatingRecoveryCenter.com to chat confidentially with a
member of our Intake Team or to learn more about treatment for body image issues.
June 22, 2012
Staying Mindful About the Lessons We Teach | Julie Holland
As many of my readers know, I’m blessed to have the opportunity to watch my 10-year-old daughter, Anna,
learn and grow every day. Recently, as is customary for her school’s 4th grade class, she went on her first
overnight educational school field trip.
Among other lessons, the trip taught my daughter and her classmates about avoiding wastefulness, taking
responsibility for themselves and understanding the consequences of the choices they make. These are
valuable lessons that I believe everybody should take the time to understand and actively incorporate into
their own lives. However, for these students, minimizing wastefulness was taught during meal times; any
leftover food was measured and the children were encouraged to have “less waste.”
This led to a misunderstanding of the activity’s purpose among the children as well as some interesting
conversations. For some, they felt it meant they should eat everything on their plates. Others felt they should
choose minimal food (less than what they really wanted) in order to not be wasteful. For someone like me who
has struggled with her own eating disorders and is active in the eating disorders field, it was clear that what
could have been an important lesson was misconstrued and could perhaps lead to unhealthy eating habits,
thoughts and behaviors.
At each meal, the students selected and dished out their food and ate their fill. Once finished, they weighed
the food left on their plates to see exactly how much was thrown away and going to waste. My daughter
is very fortunate; she’s never had to wonder if her plate will have food on it at each meal. In that respect, I
appreciate this lesson and agree that it’s important to be thoughtful in making food choices and to recognize
that we shouldn’t take things for granted. However, for individuals either genetically predisposed to an
eating disorder or in recovery from disordered eating behaviors, this exercise could have a negative effect.
Seeing weights and specific numbers associated with the amount of food consumed could potentially
trigger obsessive and disordered eating behaviors that could spiral out of control. Additionally, encouraging
children to eat past the point of satiety so as not to “waste” food can cause them to develop unhealthy food
I applaud my daughter’s program for focusing on teaching an important lesson: to be aware of what you’re
putting on your plate and the choices you’re making in your life. However, I encourage summer camps and
other children’s programs to be more mindful of the messaging in their educational activities that could
potentially trigger unhealthy eating behaviors in children.
This is an important lesson for parents as well. I encourage parents to be mindful of what you’re teaching at
home regarding eating and food choices. Try not to dichotomize food into “good” and “bad” food groups; but
rather, neutralize all foods and teach moderation. And remember that our children watch and listen to us each
and every day. They learn not only from the words we speak, but also from the behaviors we demonstrate. Are
you modeling healthy eating behaviors?
I encourage all of my readers, and all of their friends, families and loved ones to educate themselves about
eating disorders and their warning signs, and to live outside of eating disordered behaviors. If you’re
concerned that yourself or someone you love may be struggling with an eating disorder or body image
issue, visit EatingRecoveryCenter.com to chat confidentially with a member of the Intake Team to get all your
I hope you all can use my blog as a resource to learn more and ask questions. The more aware we all are about
eating disorders and how to prevent them, the more likely more people struggling with these diseases will be
able to experience lasting eating disorders recovery.
Comment below with your take on this exercise or if you have any questions!
June 28, 2012
How to Become a Champion of Eating Disorders Awareness, Education and
Prevention in Your Own Community | Julie Holland
More than 11 million Americans struggle with eating disorders, and these individuals aren’t limited to a
specific gender, race or socio-economic group. Eating disorders don’t discriminate; they affect individuals of
all backgrounds, genders, shapes and sizes. This fact underscores the importance of strengthening the eating
disorders community and fostering lasting recovery through eating disorders education and awareness.
As an active member of the eating disorders community, I’d like to use this opportunity to highlight ways
we can spread information on eating disorders and support eating disorders prevention as a community.
Remember, you don’t have to be in recovery from an eating disorder to get involved. Whether you’ve known
someone with an eating disorder or you’re simply interested in helping others, you can most certainly have an
impact on preventing eating disorders.
The Eating Disorder Foundation is a Denver-based nonprofit dedicated to lasting recovery. One specific goal
of The Eating Disorder Foundation is to strengthen what is accomplished in therapy during treatment through
supportive and educational programs. These programs are now available at The Eating Disorder Foundation’s
new location, a renovated house offering a comfortable, relaxed recovery environment. You can help The
Eating Disorder Foundation achieve its goals by donating, volunteering or joining a committee. For more
information on how you can get involved, check out the Eating Disorder Foundation website and volunteering
The National Eating Disorders Association (NEDA) takes pride in creating a nationwide network of eating
disorders communities that work together to encourage long-term eating disorders prevention. Rather
than simply talking about eating disorders awareness, NEDA encourages individuals to “walk about it” in
noncompetitive fundraising walks around the nation. You can also join NEDA’s Solutions Through Advocacy
and Reform (STAR) program and learn more about eating disorders and advocacy opportunities in your own
community. Get more information on eating disorders and sign up for NEDA news and updates on the NEDA
The new Eating Recovery Center Foundation (ERCF) was established to continually support the advancement
of the eating disorders field through professional education and research. The Foundation provides education
and development programs for eating disorders professionals to help them increase their knowledge and
strengthen clinical treatment skills. It also supports research initiatives that deepen our understanding of
these illnesses and how they can best be treated. In addition, the Foundation works to raise funds to support
eating disorders patients seeking treatment at Eating Recovery Center, to ensure that they can remain in the
appropriate level of care in order to experience lasting recovery. Please contact Scott Fisher at Eating Recovery
Center to inquire about the Foundation (sfisher@EatingRecoveryCenter.com) and learn how you can get
Eating disorders support groups are also a great way to get involved with the eating disorders community
and continue your recovery efforts. They can also help you make that first step on the path of eating disorders
recovery through identifying treatment options for individuals suffering from disordered eating behaviors and
support for family members and/or significant others. What’s so wonderful about support groups is that they
exist all over the country. So odds are, no matter where you’re located, there is some sort of group or outlet
available in which you can find comfort and help.
Here are just a few support groups with local chapters:
The• National Association of Anorexia Nervosa and Associated Disorders is dedicated to the prevention
and alleviation of eating disorders and offers a listing of support groups by state on its website: anad.
Overeaters Anonymous• is a national organization providing a recovery program for compulsive eaters;
with local meetings happening all over the United States and Canada; oa.org/meetings can help you
find local support.
You may also find either of blog posts on eating disorders resources helpful:
Getting Help for Anorexia and Bulimia: Eating Disorder Resources You Can Use•
Eating Disorder Resources Updated: Supportive Organizations for You, Friends, and Loved Ones•
Keep in mind, these are just a few of the innumerable ways to raise awareness and get involved in the eating
disorders community. Across the country there are local opportunities to get involved and show your support
for friends, loved ones and even strangers who have struggled with disordered eating or body image issues.
Utilizing your local eating disorders resources can be a great way to find out what your community has to offer.
June 5, 2012
Families Don’t Cause Eating Disorders, But Can Be Critical to Lasting Eating
Disorders Recovery | Ken Weiner
Families do not cause eating disorders.
It’s true that older models of eating disorders treatment viewed families and dysfunctional family relationships
as a contributing cause of these illnesses; however, the treatment community has moved away from the
blaming of families toward an understanding that families aren’t a cause, but instead are critical to eating
disorders recovery. In a recent address to families of men, women and children suffering from eating disorders,
Dr. Ovidio Bermudez, M.D., FAAP, FSAHM, FAED, CEDS, a noted eating disorders treatment thought leader and
colleague of mine at Eating Recovery Center, communicated this point by saying, “We have drifted away from
shaming and blaming families and have moved toward an understanding that families are an integral part of
eating disorders treatment, not only in helping an individual respond well to treatment, but also to go on to
Understand that whole families are affected by eating disorders, and everyone deserves support. Regardless of
an individual’s stage in the recovery process, there are some meaningful strategies that families can employ to
help support a loved one as he or she confronts and combats his or her eating disorder.
Understand the eating disorder isn’t your fault. This is so important -- even at the risk of sounding redundant,
I’ll say it again: Families do not cause eating disorders. You aren’t responsible for the development of this
complex, devastating disorder in your loved one, so don’t blame yourself. With this realization, commit to
being part of the solution and do everything in your power to support the recovery process.
Listen. Families often find eating disorders difficult to understand and even more difficult to accept. While it
may sound overly simplistic, a good way to learn about the experience of your loved one is to listen to what he
or she is saying. Don’t feel like you need to have all the answers or give advice. Instead, listen actively and do
your best to create an environment in which your loved one can be honest with you and reach out for support.
Talk sometimes, too. While listening is important, don’t shy away from expressing yourself and your concerns
about your loved one’s health. While these conversations can be uncomfortable at times and the reaction from
your loved one can vary from receptive to outraged, know that secrets and things left unsaid rarely support a
meaningful eating disorder recovery.
Educate yourself. Resources abound to help you learn about eating disorders, viable treatment options for
your loved one and the ways in which families can support their loved ones throughout the eating disorders
recovery process. The Internet can be a good place to start your research about the illness and treatment
options, and can also help you to connect with other families that have experienced similar situations with
eating disorders and recovery for support. For example, the National Eating Disorders Association has a robust
collection of online resources for family and friends.
Participate in the eating disorders treatment process. To the extent that it’s possible and appropriate, be
willing to participate in your loved one’s eating disorders treatment plan. Educational programming and family
therapy for anorexia, bulimia and binge eating disorder seek to prepare parents and siblings to effectively
support a loved one’s recovery following discharge from treatment. Weekly family therapy sessions will likely
be part of your loved one’s programming, and can be conducted in person or by phone when proximity of
the treatment center prohibits travel. Specific goals of the family contact vary, and depend largely on each
patient’s unique background and struggles. Additionally, some eating disorders treatment centers offer family
programming to educate, support and care for families of eating disordered patients at every stage of the
There is nothing more difficult than watching a loved one struggle with illness, particularly an illness that takes
control of the mind and body and causes extreme disturbances in an individual’s behaviors and feelings. Know
that recovering from an eating disorder truly does “take a village” and that your support and participation in
the treatment process can make a genuine difference in your loved one’s life and recovery.
Have more questions about the role of family in the eating disorders recovery process? Confidentially chat live
with an eating disorders specialist at www.EatingRecoveryCenter.com.
For more by Kenneth L. Weiner, M.D., FAED, CEDS, click here.
For more on eating disorders, click here.
If you’re struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.
June 7, 2012
GTN News: Eating Problems (interview with Julie Holland)
Julie Holland traveled to Gainesville, Fla., to do a mini-media tour raising awareness about eating
disorders in the southeast United States. Her interview ran on two different TV stations, WGFL and
WNBW, at 5:30 and 6 p.m., respectively.
See the CD at the back of this clipbook for full video.
June 8, 2012
Mid-life eating disorders on the rise | Tammy Vigil
Bonnie Brennan and a patient did a recorded TV interview about eating disorders developing during
See the CD at the back of this clipbook for full video.
June 11, 2012
Why Thinspo And Fitspo Are So Popular…And Banning Them Isn’t The Answer |
Hanna Brooke Olsen
Thinspiration, or “thinspo,” may have been
banned from social media sites like Pinterest
and Tumblr, but its “healthier” counterpart,
“fitspo“—which, for all intents and purposes,
is basically the same thing with an emphasis
on muscles instead of bones—is still shared on
essentially every major channel of electronic
communication. One is abhorred as eating
disorder trigger, and the other is more
widely accepted as “healthy” or “normal,”
but neither one is likely to go anywhere any
time soon—because the fact is, this kind of
imagery impacts us deeply on many levels.
So many levels, in fact, that banning it is not
only unlikely to erase the problem, but more
likely to make those who depend on it become
defensive of it.
Bonnie Brennan, MA, LPC, and clinical director of the adult partial hospitalization program at Eating Recovery
Center, says that both thinspo and fitspo are about more than just motivation—and, she says, they’re more
similar than you might think.
“The amount of time in the brain spent on engaging in the activity looks very similar,” says Brennan. “At Eating
Recovery Center, we have patients whose eating disorder is about fitness. One thing that’s common, from in-
patients to those who are just exploring disordered eating, is an attempt to change the body as a way to create
or get rid of emotions. ”
What is it about these images that not only make them popular, but make them feel so essential to so many
individuals that they’re constantly looking for a new outlet to share and consume them once they’ve been
banned? Here’s how Brennan explained it:
The way that I look at it and try to explain it to my patients is that people are human beings, looking for relief
from pain. We want to avoid negative emotions, and we experience emotions in our body, and there’s a bodily
sensation that happens. So we go and look at this kind of imagery for whatever it means for the person looking
for it. It provides the fantasy of relief from whatever we’re struggling with. It’s almost like a drug–you’re
chasing something impossible.
Unfortunately, the rationale behind many bans of the material—that it can trigger or cause eating disorders in
young people—isn’t quite accurate. Because, says Brennan, while it can be a trigger, for many individuals
suffering from emotional distress or disordered eating behaviors, it goes well beyond that initial shift–it’s what
fuels the fire, and fills a void.
The trigger is not often what maintains the eating disorder for the long-term, so for those who go back to
looking at the images, they’re usually finding a maintenance piece. It’s almost like voyeurism. It’s a sense of
intimacy, to connect with others who feel this way… A lot of time, with the fitspo stuff, they come with a
recipe or a workout guide. They can serve as a template, or a guide to life. You can work toward achieving a
goal and feeling better about yourself, but it’s not long-lasting.
And many women struggling with an eating disorder (whether it be exercise bulimia, ED-NOS, full-blown
anorexia, or another form) grow protective over thinspo and fitspo, because it does become so integral to
maintaining and continuing their disorder. Much like drug addicts, they’ll be upset if they think they can’t get
what they need—which is why bans often don’t work. Bans also enforce the secrecy that accompanies eating
disorders. When it’s hidden away and forbidden and banned, says Brennan, it’s harder to know when someone
you love may be spending too much time engaging with it, because they’ll either hide it–or they’ll go find a
more “acceptable” substitute, like fitspo.
At the end of the day, says Brennan, individuals or groups who gather around thinspo or fitspo are just looking
for an answer, which they believe will come as the result of a thin or a fit body. And that’s the real root of all of
this—that many of us believe we would be happier, or feel better, or be more successful if we were more fit,
more toned, more thin, more whatever—which is unfortunately true, in some cases. (Thin women have been
statistically shown to make more money and be more respected in the workplace.)
But banning certain kinds of images and persecuting those who find solace in them only attacks a symptom
of a much larger disease—society’s obsession with thinness and fat-phobia. When there’s no need for
thinspo and fitspo (or when we can be inspired by these images without needing them to feel better about
ourselves), then maybe they’ll begin to recede. Until then, promoting diversity in mainstream imagery (natural
models, more emphasis on positive body image, more exposure to various body types) can help build a more
supportive culture of non-thin bodies. But as long as there are women (and men) in pain and seeking relief,
these images will find a way to get online for anyone who wants them (and those of us who don’t).
June 26, 2012
Children and Teens Point to Summer Camp as the Place Where Eating Disordered
Behaviors Often Begin
More than 10 million American children attend a camp each summer. Because these children often spend
weeks – and sometimes months – away from parental supervision, Eating Recovery Center, an international
center for eating disorders recovery, urges parents to be aware of summer camp triggers that may contribute
to the development of an eating disorder in their camp-going children.
“Every year, Eating Recovery Center sees many young patients who cite summer camp as the place where their
disordered eating behaviors either began or intensified,” said Jamie Manwaring, PhD, primary therapist
at Eating Recovery Center’s Behavioral Hospital for Children and Adolescents. “It is important to recognize that
summer camps do not ‘cause’ eating disorders; however, camps’ environments can often be triggering for a
child with the genetic or temperamental predisposition for an eating disorder.”
The onset of puberty, typically occurring between the ages of 10 and 14 for girls and 12 and 16 for boys, is one
of the two most common times when eating disorders develop. Children in this age range who have a family
history of eating disorders, who have previously engaged in disordered eating or who have highly sensitive,
perfectionistic temperaments may be more likely to be triggered by camp activities or situations.
Potentially triggering activities or situations may include a competitive athletic environment, exposure to
bunkmates’ or friends’ disordered eating behaviors, an intense focus on health and nutrition or anxiety about
trying to “fit in” with new camp friends. Without ongoing parental supervision, children who begin engaging
in disordered eating behaviors will often maintain, or intensify them throughout the duration of camp without
their parents’ knowledge.
To help parents plan a healthy, fun camp experience for their children and proactively practice eating disorders
prevention, Eating Recovery Center offers these five tips:
Look into the way meals are structured at your child’s camp. Are mealtimes staffed so that camp1.
counselors sit with campers and are available to notice if a child has stopped eating or drastically
changed his or her eating habits?
Do some comparative research if you intend on sending your child to a sports camp. Children with a2.
family history of eating disorders may be better suited at a camp that is focused on recreation and fun,
rather than one that is focused on competition and intense fitness.
Send your child to camp with positive messages. Emphasize to your child that the goal of summer3.
camp is to have fun and meet new friends. Remind your children that you love them for who they are,
not what specific activities they excel at, and that it does not matter if they are the fastest runners or
strongest swimmers at camp.
Check in with your child while he or she is at camp. Use phone calls, emails and letters as an4.
opportunity to ask open-ended questions about his or her camp experience. Look and listen for any
sudden changes in your child’s overall outlook.
Keep an eye out for signs of eating disorders when your child returns home from camp. Is your child5.
eating smaller portions or restricting certain foods altogether? Has eating become a power struggle?
Has your child’s exercise regimen significantly increased or have you “caught” him or her exercising in
secret? Do you suspect purging after meals? If the answer to any of these questions is yes, it may be
time to seek help for a potential eating disorder.
“When parents see children after they have been away at a month- or summer-long camp, changes in body
weight, overall health, general demeanor and outlook can become that much more noticeable,” explains Dr.
Manwaring. “If your child exhibits worrisome behaviors after returning home, do not wait to seek help. With
eating disorders, the earlier the intervention, the more successful the treatment will be. Early intervention
Parents are encouraged to seek an eating disorders assessment if they notice troubling behaviors in their
children or adolescents when they return home from camp. Eating disorders recovery is entirely possible with
early intervention and proper treatment from qualified professionals.
June 29, 2012
Dr. Ken Weiner challenges the norm in treating eating disorders | Lisa Wirthman
Anorexia and bulimia have traditionally – and errantly – been seen as a “teenage girl’s” disease, but recent
trends and an online study from the University of North Carolina Eating Disorders Program released last month
reveal that more and more women in mid-life are struggling with disordered eating behaviors and body image
issues. In fact, last year, Eating Recovery Center saw patients ranging from 9 to 81 years old, underscoring the
fact that eating disorders affect people of all ages.
Bonnie Brennan, MA, LPC, clinical director of the adult partial hospitalization program at Eating Recovery
Center, shares her thoughts on the rising incidence of eating disorders in older women.
Often, women who are seeking eating disorders treatment in mid-life aren’t doing so because
they’ve recently begun exhibiting disordered eating behaviors; but rather, because a past
struggle with food and eating disorders is emerging once again due to a major life event.
As many women enter their 40s and 50s, they find themselves with new experiences they’ve
never had to face before. Whether their children are leaving for college and having an “empty
nest,” a parent becoming ill or passing away or going through a divorce, baby boomers are
facing major life changes that could potentially trigger the onset or relapse of eating disordered
It’s also important to note that much of the recent research that has been published is helping
more women in mid-life understand that what they’re experiencing is in fact an eating disorder
and that they should seek treatment. Decades ago, we simply didn’t have the background and
education about eating disorders like we do today and many doctors didn’t even think non-
teenage women could have anorexia or bulimia. In the past, these doctors’ training would
likely have led them to believe these patients were dealing with irritable bowel syndrome
(IBS) or other medical issues. In fact, several women in Eating Recovery Center’s adult partial
hospitalization program have mentioned doctors telling them they were “too old to have an
eating disorder” when these women were first looking for answers.
This online study found some interesting information as it pertains to weight issues and eating disordered
behaviors among older women:
71.2 percent stated they were currently trying to lose weight and many are going about it in unhealthy•
About 13 percent of women older than 50 said they’d currently binged, purged or practiced other•
behaviors associated with eating disorders; 27.7 percent reported having eating disordered behaviors
at some point in the past.
About 8 percent of women who participated in the study admitted to vomited or used laxatives to lose•
weight in the last five years, which is surprisingly the same proportion found in young women.
July 3, 2012
Eating Disorders in Older Women: More Common than Expected, Study Finds | Julie
The release of this online study creates an opportunity for all of us to educate the public that eating disorders
don’t discriminate based on age. We all need to remind our loved ones about potential eating disorders
warning signs and help those that need help start down the path of eating disorders treatment. Regardless of
an individual’s age, the sooner he or she seeks treatment, the better his or her chances are for lasting eating
If you’re concerned that a friend or loved one may be struggling with an eating disorder or body image issues,
find a quiet place to talk with him or her, discuss your worries in an open and caring manner and urge your
loved one to speak with a eating disorders specialist and address the issue. This can be especially difficult if it’s
someone close to you like your mother or aunt. Just remind your loved one that you’re worried for her health
and want to make sure she’s healthy—physically, mentally and emotionally.
Ms. Brennan recently spoke to a Denver TV station about one woman’s attempt to be the “perfect mom” only
to find herself struggling with an eating disorder. Check out the interview about older women with eating
Comment below with any questions you have about eating disorders in older women, or in general, or visit
EatingRecoveryCenter.com to confidentially chat with a member of our Intake Team.
July 11, 2012
Is “Fitspo” the New “Thinspo”? | Julie Holland
It may seem like “thinspiration” images and the associated communities are old news. For months now,
thinspiration – images and articles “inspiring” readers to persist in their disordered eating and dieting for the
sake of being thin – have been in the media spotlight. The idea of “thinspo” was addressed and, more often
than not, removed from social media and online communities like Tumblr, Facebook and Pinterest. However, a
new phrase, “fitspo,” is quickly replacing the hole left by removing thinspo pictures and articles.
What is fitspo?
By only looking at the name, fitspo images may seem harmless. They’re merely photos with inspiring messages
helping people find the motivation to continue a healthy lifestyle, right? Wrong. These images of “fit” women
and men continue to fuel our society’s unhealthy obsession with being thin and having the so-called perfect
body. Fitspo images take away from the healthy mantra of living a lifestyle of moderation, complete with the
appropriate amount of exercise; and instead, draw the focus to an unattainable body type found by losing
weight and exercising more than necessary.
Is fitspo really that dangerous?
On the surface, it doesn’t seem that motivating words about exercising (even on those days you’d rather take
a break) would be harmful. However, for an individual genetically predisposed to an eating disorder, seeing
photos of thin, fit, active men and women day after day could trigger negative thoughts that about his or
her own self image. If these thoughts become pervasive enough, individuals may start to practice disordered
eating behaviors such as restricting certain foods or entire food groups or over exercising.
Wanting to live an active, healthy lifestyle is one thing; putting workouts and food restrictions above friends,
family, even work, may mean it’s time to reach out and ask for help.
I’m concerned about a friend or loved one’s behaviors, what should I do?
If you find yourself worrying that a friend or loved one is focusing too much on how many times he or she has
“hit the gym” this week or discussed his or her obsession with attaining the “perfect body,” I suggest you try:
Expressing your concerns• to them in a quiet, stress-free environment.
Eating disordered individuals become quite skilled at avoiding questions and topics, so• use specific
examples and ask direct questions to keep the conversation on topic.
Just because you may be ready for a friend or loved one to seek help doesn’t mean he or she is•
prepared. Leave yourself open for additional conversations; you can even offer to go with them to
speak with a therapist or eating disorders specialist if you feel comfortable doing so.
If you’re concerned that perhaps your own behaviors may be getting out of hand, visit www.
EatingRecoveryCenter.com to confidentially chat with a member of our Intake Team. You may ask questions
and learn if an eating disorders assessment would be an appropriate next step.
Remember, fitness isn’t about being perfect; it’s about being healthy.
I look forward to reading your comments below on what you think about thinspo and fitspo!
July 26, 2012
Summer Olympic Games: A Chance to Celebrate Athleticism and Increase Education
About Eating Disorders in Athletes | Julie Holland
This Friday marks the opening ceremonies for the 2012 London Olympic Games, putting the excitement of
athletics and competition at the forefront of our minds. However, this year’s Summer Olympics also creates an
opportunity to address a serious issue: eating disorders among athletes.
Tuning in every two years to watch the Olympics is exciting. It’s fun to see all the countries enter together at
the opening ceremonies and cheer on your favorite athletes in different sports and events. However, as an
active member of the eating disorders field, I also want to use this time to raise awareness and educate others
about eating disorders in athletes, especially as the majority of experts agree that certain sports and athletic
events can put athletes at a higher risk for developing an eating disorder.
According to research by Eating Recovery Center’s chief clinical officer, Dr. Craig Johnson, at least one-third of
female college athletes have an eating disorder.
Many people may stereotypically think that ballet is the only sporting activity that has a high prevalence
of eating disorders, while there are actually several sports where eating disorders persist. Body- or weight-
focused sports like gymnastics, swimming and diving, and even wrestling and horse racing may be harmful to
athletes who are either genetically predisposed to an eating disorder or struggling with their own body image
Elite athletes often share similar personality traits and characteristics with eating disordered individuals. Both
types of individuals strive for perfection and are quite often people-pleasing high achievers. These personality
traits can lead to disordered eating when weight becomes a determining participation factor or the focus is on
a particular outfit an athlete wears in competition. Coaches, trainers and even parents should be aware of how
their athlete handles these requirements and stay attuned to potential warning signs.
A few common warning signs specific to eating disorders in athletes include:
Decrease in performance.•
Increase in exercise outside of normal or routine preparation activities.•
Stress fractures and other “overuse” injuries.•
Along with staying aware of potential warning signs, coaches, trainers and even fellow athletes and team
members can actively practice prevention strategies to minimize the risk of eating disorders among athletes.
Prevention strategies for coaches and trainers include:
Stress and promote overall performance rather than weight, body fat percentage or other quantitative•
Recognize your role in the relationship with your athletes; use that strength and influence to educate•
them about eating disorders and prevent their development.
Arm yourself with an understanding of potential eating disorders risks associated with your sport and•
team. Learning about preventative measures and eating disorders resources can be immensely helpful.
Preventative strategies for athletes:
Be aware of your own and your fellow athletes’ perspectives on food, weight and body image as well as•
the available eating disorders resources should they be needed.
Avoid quick fix or last minute weight loss solutions by preparing early for weight management events•
such as competitions or weigh-ins.
Engage in and stay active with comprehensive nutrition assessments that help to educate you about•
healthy weights, body fat percentages and associated behaviors.
It’s important to remember that eating disorders don’t discriminate. Regardless of athletic ability or gender,
elite athletes can still struggle with potentially dangerous body image issues and disordered eating behaviors.
Therefore, as an athletic community, coaches, trainers, parents and fellow athletes should educate themselves
to help others prevent eating disorders.
July 3, 2012
2012 Eating Recovery Center Foundation Eating Disorders Conference Features
Nation’s Leading Experts
Denver, Colo., has emerged as a national hub for the treatment of eating disorders. This August, the experts
who elevated Denver to this status, along with a group of other highly regarded professionals, will gather in
the Mile High City to share trends, new research and emerging best practices in the field of eating disorders
treatment at the 4th Annual Eating Recovery Center Foundation Eating Disorders Conference. Formerly known
as the Rocky Mountain Eating Disorders Conference, the event will be held August 10-11, 2012, and is hosted
by the Eating Recovery Center Foundation, a non-profit organization established to promote education,
research and patient access to treatment.
“In the eating disorders field, it is imperative that we share resources, best practices and promising research
in order to help our patients achieve the best outcomes possible,” said Kenneth L. Weiner, MD, FAED, CEDS,
chief executive officer and founding partner of Eating Recovery Center, an international center for eating
disorders recovery. “The Eating Recovery Center Foundation Eating Disorders Conference is a forum in which
professionals and advocates alike can learn from each other, collaborate and share the innovative practices
that are moving our field forward.”
This interactive educational program features plenary speakers, panel discussions and Q&A sessions, and
supports connection and collaboration among attending physicians, therapists, nurses, dietitians, advocacy
organizations and other members of the eating disorders treatment community. Highlights of the 2012 eating
disorders conference include:
Eating Disorders in the DSM-V: What Might We Expect?; Joel Yager, MD, FAED•
Acceptance and Commitment Therapy in Action; Enola Gorham, LCSW, CEDS•
The State of Evidence-Based Treatment in the Field of Eating Disorders; Craig Johnson, PhD, FAED, CEDS•
Updates in Refeeding Practices for Adolescents with Anorexia in the Inpatient Setting; Ovidio•
Bermudez, MD, FAED, FSAHM, FAAP, CEDS
Cognitive Remediation Therapy for Eating Disorders: A New Adjunct to Treatment; Emmett Bishop, MD,•
The 2012 Eating Recovery Center Foundation Eating Disorders Conference will again be held at the Denver
Marriott City Center. Prior to July 12, 2012, registration for professionals is $150 and includes all sessions,
12 continuing education credits, conference handouts and resources, lunch and dinner on Friday, breakfast
and lunch on Saturday and periodic refreshment breaks. Single-day registration is $100. Student-discounted
registration is $125 and $75 for single-day attendance. Space is limited and registration prior to the event
is recommended. Register instantly online at EatingRecoveryCenter.com or by mail after completing the
This year, Eating Recovery Center will also offer conference attendees the opportunity to attend a pre-
conference four-hour ethics workshop. Titled “Should Gandhi Have Been Force Fed: Ethical Issues in the
Treatment of Eating Disorders,” the workshop will be held Friday, August 10, from 8:30 a.m. to 12:30 p.m.,
prior to the start of the general conference. Presenters include eating disorders treatment expert Craig
Johnson, PhD, FAED, CEDS, chief clinical officer of Eating Recovery Center; Rev. David W. Kenney, MA, MA,
Cand. D.Be., of The Clinical Ethics Consultancy; and Andrew Braun, MBA, chief operating officer of Eating
Recovery Center. Workshop registration costs $25 with conference registration and $50 without conference
The new Eating Recovery Center Foundation (ERCF) was established in 2012 as a 501(c)(3) foundation with
a three-fold purpose: to provide professionals in the eating disorders field with education and development
programs that increase their knowledge and strengthen clinical treatment skills; to support research initiatives
that deepen our understanding of these illnesses and how they can best be treated; and to create a fund that
provides financial grants to Eating Recovery Center patients who require financial assistance.
For more information or to register for the 4th Annual Eating Recovery Center Foundation Eating Disorders
Conference, visit http://bit.ly/EatingDisordersConference2012 or call 877-218-1344
July 3, 2012
Eating Disorders in Athletes | Ken Weiner
With the 2012 London Olympic Games right around the corner, sports and athletic competition are increasingly
on the minds of many men, women and children around the globe. However, in the shadow of sport’s epic
moments of glory lies a troublesome reality -- the incidence of eating disorders in athletes.
Experts generally agree that certain categories of athletics place these high-achieving individuals at a greater
risk for developing anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified (EDNOS). In
fact, research published by Craig Johnson, Ph.D., FAED, CEDS, chief clinical officer of Eating Recovery Center,
found that at least one-third of female college athletes have some type of eating disorder. 
According to Ron Thompson, a licensed psychologist specializing in eating disorders treatment at the
Bloomington Center for Counseling and Human Development, consultant to the NCAA and International
Olympic Committee Medical Commission and author of multiple books, including Eating Disorders in Sport,
several factors converge to make athletes a special population at risk for eating disorders:
The pervasive belief in the sport world, held by both coaches and athletes alike, that the leaner athlete•
performs better, which leads to dieting.
Aesthetic, judged and endurance sports, including gymnastics, dance/cheerleading, cross country,•
swimming and wrestling.
Sports requiring revealing uniforms, which can put participating athletes at risk for body dissatisfaction•
and competitive thinness.
“Good athletes” possess similar personality traits to those who suffer from anorexia, which may predispose
them to potential development of an eating disorder.
”I believe that the greatest risk to athletes is the challenge to identify an eating disorder within the sport
world; if an at-risk or symptomatic athlete isn’t identified, they cannot be treated,” explains Dr. Thompson.
 “Issues complicating identification involve ‘sport body stereotypes’ in which thinness is accepted as both
normal and desirable, as well as the presumption of health with good performance.
Interestingly, the very same perfectionistic, overachieving and people-pleasing temperament that fuels
achievement in athletic competition -- both elite and casual -- closely mirrors the personality traits of those
individuals who tend to develop eating disorders. For both male and female athletes, the combination of
these traits, along with the body shape- and weight-focused demands of many competitive sports, creates the
perfect storm that can trigger eating disordered thoughts and behaviors.
Warning signs of eating disorders among athletes can be difficult to identify, as they can be masked easily and
often go unreported by the athletes themselves. However, common indicators specific to sport participation
include a decrease in performance, an increase in exercise outside of routine training activities, stress fractures
and other overuse injuries.
If you observe these warning signs in yourself or in your athletic friends and families, support from a qualified
eating disorders treatment professional and resources for eating disorders help may be necessary. Treatment
programming and environment isn’t distinctly different for athletes than non-athletes struggling with eating
disorders. However, identifying strategies to protect recovery following discharge, especially as athletes
consider re-engaging in athletic activity on a casual or competitive level, is incredibly important treatment
component for an athlete.
1. Johnson, C., Powers, P.S., Dick, R. Athletes and Eating Disorders: The National Collegiate Athletic Association Study. John Wiley &
Sons, Inc., 1999, International Journal of Eating Disorders 26, 179-188.
For more by Kenneth L. Weiner, M.D., FAED, CEDS, click here.
For more on eating disorders, click here.
If you’re struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.
July 10, 2012
Interview with Dolores D. Schoonover
Dolores did a 45-minute interview about eating disorders for a local Denver Spanish-only radio station.
Full audio not available.
July 11, 2012
People on the Move: Ovidio Bermudez
Andrew Fiskehas joined the finance & acquisitions department of Davis Graham & Stubbs LLP as an associate.
Department of Energy has awarded a Colorado State University physicist Kristen Buchanan, a five-year,
$762,000 Early Career Award to improve scientific understanding of spin dynamics in magnetic materials.
Taylor Morrison Denver announced that Bob Eck has joined the company as vice president of land resources.
Citi Private Bank announced that Brian Becker was named director and ultra high net worth private banker in
the Denver office.
Life Care Physician Services LLC recently placed Dr.Michael Todd as an on-site physician at the new Life Care
Center of Stonegate in Parker.
Lincoln Financial Media announced that John E. Kagesigned a new contract that continues his role as program
director at KQKS-FM.
Eating Recovery Center promoted Dr. Ovidio Bermudez to chief medical officer.
CH2M Hill appointed Dwight H. Pullen Jr.as the director of the aviation market in the company’s transportation
Renal Ventures Management LLC named Christopher Pyrek as vice president of business development.
Dennis Manalo, of Fast Enterprices, has joined ChildWise Institute as a board member.
Denver Metro Chamber of Commerce announced that Jennifer Websterhas accepted the position of senior
vice president of public affairs and communications.
Mountain states region of the Anti-Defamation League named Andrea Shpall regional chair at ADL’s annual
Move Colorado recently named Mickey Ferrellthe organization’s interim executive director.
ServiceMagic Inc. appointed Karl Sowa as the chief marketing officer.
Cody Wertz has been promoted to principal at GBSM.
The Bureau of Land Management welcomes Lura Matthewsas the service first coordinator for the Colorado
University of Colorado Cancer Center announced that Dr. D. Ross Camidge, is the recipient of the 2012 Addario
Lectureship Award which recognizes efforts to eradicate lung cancer.
July 12, 2012
Mid-Morning Live: Interview with Dr. Bishop
Dr. Bishop did a life interview in Savannah, Ga., while traveling for a speaking opportunity.
See the CD at the back of this clipbook for full video.
July 19, 2012
The Moore Center for Eating Disorders Expands Treatment by Partnering with
Eating Recovery Center
Eating Recovery Center, an international center for eating disorders recovery providing comprehensive
treatment for anorexia, bulimia, EDNOS and binge eating disorder, announced today that it has partnered with
The Moore Center for Eating Disorders. Located in Bellevue, Wash., The Moore Center is the largest eating
disorders clinic in Washington state.
This affiliation brings synergies to both organizations, enabling The Moore Center to enhance its current
treatment options by strengthening its connection with an international inpatient and residential center of
excellence for the treatment of eating disorders, and providing Eating Recovery Center patients an additional
high quality treatment option to explore as they step down from higher levels of care. Patients at both
facilities will experience the benefits of two of the best programs sharing medical and clinical practices and
Eating Recovery Center will additionally lend organizational depth and breadth to The Moore Center, allowing
the Washington facility to utilize Eating Recovery Center’s management and administrative services.
“At Eating Recovery Center, we continue to seek out established professionals who share our values and our
culture, and who are committed to providing the highest quality eating disorders care,” said Kenneth L. Weiner,
MD, FAED, CEDS, founding partner and chief executive officer of Eating Recovery Center. “The Moore Center
has long been a trusted source of expert eating disorders care in the Pacific Northwest, and I have worked
closely with the program’s dedicated team for more than 10 years. I strongly believe that this group is the right
team with which to share our successful clinical programs.”
Since it was founded in 1991, The Moore Center has provided specialized and comprehensive treatment for
eating disorders in a medical setting. The treatment center will continue to be led by program founder and
medical director Mehri D. Moore, MD.
“Partnering with Eating Recovery Center enables The Moore Center to not only expand our treatment options
and provide higher levels of care to our patients, but also leverage the expertise and experience of some of the
nation’s most respected eating disorders treatment experts,” said Dr. Moore. “By incorporating clinical models
developed by Eating Recovery Center’s leadership team into our treatment program, we strive to provide the
best possible care for our patients and support their lasting recovery.”
The Moore Center’s eating disorders treatment programs include:
Comprehensive partial hospitalization programs for adolescents ages 13 through 18 and adults ages 19•
An intensive outpatient program that expertly treats eating disorders while minimizing interruption in a•
patient’s daily life.
Additional “step down programs” that ease a patient’s transition into everyday life while continually•
promoting lasting eating disorders recovery.
Eating Recovery Center’s affiliation with The Moore Center is part of Eating Recovery Center’s ongoing effort to
provide centers of excellence for the treatment of eating disorders in geographically diverse locations.
For more information about Eating Recovery Center, visit www.EatingRecoveryCenter.com. To learn more
about The Moore Center for Eating Disorders, visit www.moorecenterclinic.com.
July 31, 2012
Know the Signs: Is Your Young Child at Risk for an Eating Disorder? | Elizabeth Easton
Eating disorders are complex mental illnesses that have long been primarily – and wrongfully –associated
with teenaged girls. The fact is, eating disorders simply do not discriminate. In recent years, more adults and
children, of both genders, have sought treatment for these potentially life-threatening diseases.
In fact, from 1999 to 2006, hospitalizations for eating disorders increased sharply – 119% – for children
younger than 12 years.* And in Denver, Eating Recovery Center, a local treatment center, recently expanded its
child and adolescent programming to accommodate increasing demand.
It’s important for parents of children at any age to educate themselves about eating disorders in order to
prevent them, and to recognize and treat them if they do occur.
Why are eating disorders in children and adolescents on the rise?
Genes load the gun and environment pulls the trigger. Children with a family history of eating disorders or who
have a highly sensitive temperament are more likely than other children to be affected by the world around
them to the point that they will engage in disordered eating behaviors.
As the world becomes a more stressful, complicated place, as our culture continues to promote unrealistic
ideals and as our children become more and more over-programmed, these kids turn to disordered eating as a
way to cope.
How can you tell if your child has an eating disorder?
As a parent, it’s important to keep an eye out for changes in mood and behavior and to act quickly if you
suspect your child is showing signs of an eating disorder.
Warning signs of an eating disorder:
Weight loss or drastic fluctuations.•
Preoccupation with weight, food, food labels and dieting.•
Excessive drinking of fluids or denial of hunger.•
Avoidance of meal times and situations involving food.•
Withdrawal from friends and activities.•
Self-induced vomiting or abuse of laxatives, diuretics or diet pills.•
Excessive, rigid exercise regimen.•
Change in dress: over-sized to cover the body or revealing clothes to flaunt weight loss.•
How can parents prevent eating disorders?
Though there is no surefire way to prevent an eating disorder from developing, there are a few ways to
minimize the chances that your child will be triggered into disordered eating behaviors.
Know your genetics.• If eating disorders run in your family, your child may be more prone to disordered
Focus on who your child is, not what he or she does.• Take the focus away from your child’s
accomplishments, and instead praise your child for who he or she is.
Don’t put your child on a diet.• Diets are one of the most significant triggers for eating disorders
development. Instead, focus on moderation and overall health.
What should you do if you suspect your child has an eating disorder?
It’s important to first focus on opening the lines of communication. The goal isn’t to argue over whether or not
your child has been eating, but rather to start a conversation.
Ask questions; don’t make accusations.• Speak to what you’ve noticed and ask direct questions. For
example, “I’ve noticed that you haven’t been eating carbohydrates lately. Why are you cutting back on
these types of foods?”
Empathize, but remain firm.• Emphasize that your child isn’t in trouble, but that you’re worried. Tell your
child what will happen next. For example, “Tomorrow morning, we’re going to talk to a doctor about
your overall health.”
Seek qualified resources.• Your family’s physician, your child’s pediatrician or a local eating disorders
treatment center can arm you with useful information to help you better understand your child’s illness
and to seek treatment if necessary.
One of the most important things for parents to understand is that eating disorders are not “caused” by
parents. Rather than focusing on the “cause,” focus on what role you need to play in his or her recovery.
Supporting your child’s healthy future is the most important role you can play.
Guest blogger Dr. Elizabeth Easton is clinical director of child and adolescent services for Eating Recovery
Center’s Child and Adolescent Behavioral Hospital.
Chief Marketing Officer Julie Holland’s EverydayHealth blog “The Truth About Eating Disorders,” is temporarily
unavailable while it moves to a new location on the EverydayHealth website. In the meantime, Julie’s blogs will
be posted here on the Eating Recovery Center blog.
Eating disorders recovery is an ongoing, lifelong process. Leaving the familiarity and security of an eating
disorders treatment center can be overwhelming at first. However, through identifying community resources
and turning to those around us for support and guidance, lasting eating disorders recovery can be reality.
That’s exactly what we saw last weekend at Eating Recovery Center’s 2nd Annual Alumni Retreat. Each
summer, we invite all former adult patients to attend a two-day retreat to connect with old friends and
treatment professionals and find support wherever they may be in their eating disorders recovery process.
During the retreat, alumni are able to attend sessions that speak to what they participated in while seeking
treatment at the Center, such as Acceptance and Commitment Therapy (ACT), which supports the idea that
people can live a valued life in the presence of negative thoughts and feelings. Alumni events are opportunities
to extend lessons learned in treatment to each individual’s own life.
Eating disorders relapse prevention
One crucial element that we stress during each alumni event, and in aftercare planning, is eating disorders
relapse prevention. Although an individual may be in recovery from an eating disorder, it’s a lifelong journey to
stay in recovery; therefore, Pam Cleland, MS, LPC, aftercare coordinator at Eating Recovery Center, offers these
four ways that individuals can prevent themselves from experiencing an eating disorder relapse.
Be consistent with your outpatient treatment team. Regular visits with your therapist, dietitian,1.
psychiatrist and other members of your team are crucial to lasting recovery.
Follow your meal plan diligently. Your nutritionist carefully plans out your meal plan so that it can be a2.
source of empowerment as you continue in recovery.
Surround yourself with friends, family and loved ones who are understanding, nonjudgmental and can3.
help in preventing relapse.
Never forget your internal values. Focusing on your internal values will help improve your “selfs”: self-4.
esteem, self-awareness and self-confidence.
An eating disorder relapse doesn’t have to be a major setback, as long as you use your support network and
treatment team to work through it. Pam encourages individuals to remember an eating disorders relapse
doesn’t mean failure.
Using exercise in a healthy manner
For eating disordered individuals, it can be difficult to find a healthy way to return to exercise, especially if
they’re recovering from bulimia nervosa and compulsively exercised to purge calories. Additionally, it’s not
realistic to believe a patient will remove all exercise for his or her life; after all, it’s a healthy activity. As a
patient, what is important is developing a healthy “movement plan” with your nutritionist or dietitian
August 1, 2012
Look to Your Community for Support in Lasting Eating Disorders Recovery | Julie
that incorporates relevant activities, your meal plan and addresses the dangerous implications of over-
Eating disorders recovery is a process
Eating disorders recovery is all about practicing. Throughout eating disorders treatment, patients are taught
different ways to practice non-eating disordered behaviors, practice how to handle negative thoughts and
practice supporting their own wellbeing. However, if you find yourself, a friend or a loved one going through
an eating disorders relapse, be kind to yourself and accept those personal limitations that inevitably exist,
but don’t set you back. Know that “failure” doesn’t define you and embrace that you’re willing to take on
August 31, 2012
Effectively Managing College Stressors While in Eating Disorders Recovery | Julie
Chief Marketing Officer Julie Holland’s EverydayHealth blog “The Truth About Eating Disorders,” is temporarily
unavailable while it moves to a new location on the EverydayHealth website. In the meantime, Julie’s blogs will
be posted here on the Eating Recovery Center blog.
Puberty and the transition to college are the two most common times for eating disorders to develop. In our
instant gratification-focused, social media-enthused society, individuals recovering from an eating disorder
and embarking upon college face a whole new set of stressors. Identifying potential relapse triggers and
implementing effective prevention tools is crucial in sustaining your eating disorders recovery.
College life and eating disorders don’t have to go hand in hand. In fact, with the help of a support system –
friends, family and treatment team – individuals in recovery can stay on the right track as they transition into
a collegiate environment. Always remember to keep the lines of communication open and have a focus on the
college-bound individual’s wellbeing while staying active in his or her eating disorders recovery.
Unplugging from social media
All too often, college-aged coeds rely too heavily on their peers’ reactions and comments through social media
channels and minimize communication through interpersonal relationships. For someone in recovery from an
eating disorder, social media takes on a different tone and many former eating disorders patients choose to
disengage from social media all together.
“It’s a fantasy life that is really just an image that people are trying to hold themselves to that standard that’s
ultimately killing them,” explains Joe Eiben, MA, LPC, a primary therapist at Eating Recovery Center, in an
interview with KOAA-TV. ”Facebook is the new fashion magazine on some level. Men and women alike will
start to have drops in self-esteem after spending time online looking at pictures of friends, pictures of how
they want to look, looking at old pictures of how they may have gained weight.”
Leaving high school and moving on to college doesn’t have to derail your recovery process or cause a relapse
in eating disordered behaviors. College and eating disordered behaviors don’t have to be a reality if you keep
lessons learned during treatment and your personal values at top of mind.
Take your newfound independence in strides
For many 18-year-olds who are itching for their independence after years living under their parents’ roofs,
making the big move to college is an exciting one. However, if you’re recently leaving eating disorders
treatment, you may want to consider a school close to home for the first year or so. Remember, it’s a much
easier transition to attend a nearby school for a semester or two than to move several states away and find
yourself struggling to maintain eating disorders recovery.
Lasting eating disorders recovery
Eating disorders recovery is a time-intensive, ongoing process; and it doesn’t just happen overnight. So as
you venture to college, don’t forget about your outpatient treatment team and your aftercare plan provided
to you prior to leaving treatment. Remember to work on maintaining your relationships with those who
played pertinent roles in your recovery: doctors, dieticians and therapists. These individuals always appreciate
progress reports and they’re certainly available to offer support during difficult times as needed.
Along with your treatment team, many individuals in recovery find it helpful to stay in touch with those they
met and bonded with at the eating disorders treatment center. Having someone who truly understands what
you’ve been through can help you make it through the tough days. Many treatment centers have initiated
alumni reunions, support groups or other programs and resources for their former patients, making it that
much easier to maintain friendships.
Whether you’ve been in recovery for years or only weeks, there can be difficult times and trying days. Eating
Recovery Center offers the opportunity for individuals to chat confidentially with a member of the Intake Team
should you need the support.
August 1, 2012
Does This Baby Make Me Look Fat? | Jennifer Wolff Perrine
August 10, 2012
Comorbid Diagnoses: When Other Illnesses Occur Alongside an Eating Disorder |
I often remind the readers of this blog that eating disorders are complex illnesses with physical, psychological
and sociocultural roots and implications. Yet another reason supporting this complexity is the elevated
incidence of eating disorder comorbidities. In other words, other psychiatric and medical conditions often
present alongside anorexia nervosa, bulimia nervosa and binge eating disorder. In many cases, the two
diagnoses are intertwined in some way, with one illness having contributed to the development of the other
Common eating disorder comorbidities include:
Depression and anxiety. Disordered eating behaviors like restricting intake, purging or food rituals can serve
as powerful stress relievers for those suffering with anxiety and depression. Research suggests that roughly
two-thirds of patients admitted to eating disorders treatment programs will also meet diagnostic criteria for
depression and/or anxiety. For half of these patients, the depression and anxiety predated the onset of the
eating disorder, indicating that the mood disorder may have been the first illness to occur.  Additionally,
there has been found to be a higher incidence of major depression in first-degree relatives of people with
eating disorders. 
Obsessive-compulsive disorder (OCD). Eating disorders symptoms can often mirror OCD symptoms. Rigidity,
compulsivity and the creation of elaborate rituals around food and exercise often display in both diagnoses. In
fact, 40 percent of patients seeking eating disorders treatment will meet diagnostic criteria for OCD. 
Bipolar disorder. Seen most commonly alongside bulimia, bipolar disorder shares several key symptoms
with bulimia, including weight issues and impulsivity. Researchers have also found a correlation between the
severity of an individual’s bipolar symptoms and the likelihood they will develop disordered eating behaviors.
Substance abuse. Abuse of drugs and alcohol offers a mechanism for those suffering from eating disorders to
numb their pain and anxiety. The use of substances that decrease or suppress appetite in an effort to manage
weight tends to be an anorexia comorbidity, while the abuse of substances with no effect on appetite or
weight tends to be a bulimia comorbidity. Research suggests that 25 percent of individuals entering treatment
for eating disorders will meet criteria for substance abuse problems, as well as a higher incidence of substance
abuse in first-degree relatives of people with eating disorders. 
Medical comorbidities. In addition to these psychiatric comorbidities, certain medical conditions commonly
occur alongside eating disorders. Bone disease, cardiac complications, gastrointestinal distress and various
other organ problems can emerge as co-occurring complications associated with starvation and purging.
Diabetes has also become a common eating disorder comorbidity, so much so that the media -- and some
members of the medical community -- have adopted the term “diabulimia,” which refers to the deliberate
manipulation of insulin to help diabetics lose weight or maintain a desired weight.
Understanding how comorbid conditions are intertwined with an eating disorder and treating both the eating
disorder and co-occurring illness are critical to lasting recovery. It also highlights the important role of both
medical and psychiatric physicians in the treatment process. Comprehensive eating disorders treatment should
involve a collection of extensive information regarding past diagnoses and medications, as well as psychiatric
and medical screenings upon admission. This information helps the treatment team craft an individualized
treatment plan for each patient that recognizes the eating disorder and other diagnoses. However, when
comorbidities are present, the initial objective of treatment is psychiatric and medical stabilization, which must
be achieved before patients can meaningfully engage in the therapeutic recovery process.
Have questions about eating disorders and comorbid conditions? Confidentially chat live with an eating
disorders specialist at EatingRecoveryCenter.com.
 Blinder, Cumella & Sanathara, “Psychiatric comorbidities of female inpatients with eating disorders.” Psychosom Med. 2006 May-
 Mazzeo SE, Bulik CM. “Environmental and genetic risk factors for eating disorders: what the clinician needs to know.” Child Adolesc
Psychiatric Clin N Am 2008; 18: 67-82.
 Blinder, Cumella & Sanathara, “The Importance of Addressing OCD and Other Anxiety Disorders Symptoms in the Treatment of
Eating Disorders.” 2006.
 Baek, J. H., Park, D. Y., Choi, J., Kim, J. S., Choi, J. S., Ha, K., Hong, K. S. (2011). “Differences between bipolar I and bipolar II in
clinical features, comorbidity, and family history.” Journal of Affective Disorders, 131, 59-67.
 Kaye, W., and Wisniewski, L. 1996. “Vulnerability to Substance Abuse in Eating Disorders.” NIDA.159, 269-311.
August 29, 2012
Eating Disorder Triggers High During Back to School Transition
Research has shown that life changes, such as the transitions to middle school, high school or college, can
serve as triggers that may contribute to the development of an eating disorder. For this reason, Eating
Recovery Center, an international center providing comprehensive treatment for anorexia, bulimia, EDNOS
and binge eating disorder, encourages parents of children and adolescents making these life transitions to be
vigilant for early signs of eating disorders.
“Children and adolescents who are high-achieving, perfectionists and who have highly sensitive temperaments
are generally at a higher risk than other children for developing an eating disorder,” said Julie Holland,
MHS, certified eating disorders specialist and chief marketing officer of Eating Recovery Center. “For these
individuals, unhealthy coping mechanisms may be utilized to manage the stressors associated with significant
A 2012 study from the Journal of Clinical Nursing found that significant transitional events, as well as a lack
of support following traumatic life events, could serve as eating disorder triggers. Researchers identified
school transitions as one of the six main factors that triggered eating disorders among the individuals who
participated in the study.
School transition experiences such as adapting to a new environment, meeting increased academic
demands, struggling with social pressures and grappling with the physiological changes that occur during
adolescence can create a perfect storm in which an individual with a highly sensitive temperament or a genetic
predisposition for an eating disorder may turn to disordered eating behaviors as an anxiety management tool
or coping mechanism.
To help parents manage their children’s transitions to new school environments, Eating Recovery Center
highlights five back to school tips to help parents promote healthy attitudes about food and body shape and
Look for discreet warning signs1. . Although weight loss can be an indicator of disordered eating, it
may not be immediately apparent. A child may be displaying signs of an eating disorder if his or her
schoolwork and grades begin to suffer, if he or she becomes socially withdrawn and increasingly
anxious, tired and lethargic. Parents should also be aware if their child begins wearing roomier or
layered clothing, even on warm days.
Avoid comments about your child’s body shape or size.2. When shopping for new school clothes avoid
commenting on your child’s weight or body size and instead focus on his or her preferences regarding
color, style, etc.
Have an honest conversation about peer pressure3. and the dangers of replacing food calories with
alcohol calories if your son or daughter is getting ready to make the move to college. Discuss the
physical consequences of disordered eating and drinking behaviors, such as liver damage from
excessive alcohol consumption or the significant internal damage poor nutrition can cause.
Remind your teenage athlete not to overdo his or her training4. in an effort to make a high school sports
team. Watch for signs of over-exercise, such as sports preparation when he or she is injured or sick, or
exercise that significantly interferes with daily activities and schoolwork.
Be a positive body role model.5. When helping an adolescent recover from the body-focused bullying
that can sometimes accompany going back to school, a parent who has positive body image will have
far more credibility than one who consistently criticizes his or her own looks.
“It is important to remember that what triggers an eating disorder may not be what perpetuates it,” said
Holland. “Though school transition pressures may have precipitated an eating disorder, the factors that
enable its continuation are often complex. Early intervention and treatment from qualified eating disorders
professionals are essential to maximize opportunities for lasting recovery.”
To help parents learn more about helping their children more effectively deal with pressures that could
lead to the development of an eating disorder, Eating Recovery Center has launched a free Community
Education Series for parents. In the first seminar in this series, “Helping Your Kids Deal Effectively with
Back to School Stressors: Opportunities for Parents,” parents will learn about being a healthy role model,
communicating effectively and identifying steps to intervene when they are concerned about their child’s
eating behaviors. The inaugural seminar is Thursday, September 6, from 6:30 to 8 p.m. at Eating Recovery
Center’s Partial Hospitalization Program for Children and Adolescents, 100 Spruce Street, Suite 200, Denver,
Colo. 80230. To RSVP for the event, please contact Emili Coringrato by Tuesday, September 4, at ecoringrato@
EatingRecoveryCenter.com or 720.258.4014.
If you are a parent of a child beginning middle school, high
school or college this fall, you should be especially vigilent
for early signs of eating disorders.
The reason, says a 2012 study from the Journal of Clinical
Nursing, is that significant transitions, as well as a lack
of support following traumatic life events, can lead to
disordered eating, with school transition identified by
researchers as one of the six main factors triggering eating
disorders among study participants.
Children and adolescents who are high-achieving, perfectionists and who have highly sensitive temperaments
are generally at a higher risk than other children for developing an eating disorder. For these individuals,
unhealthy coping mechanisms may be utilized to manage the stressors associated with significant life changes.
School transition experiences, such as adapting to a new environment, meeting increased academic demands,
struggling with social pressures and grappling with the physiological changes that occur during adolescence,
can create a perfect storm in which an individual with a highly sensitive temperament or a genetic
predisposition for an eating disorder may turn to disordered eating behaviors as a way of managing their
anxiety or coping mechanism.
Parents can help
To you manage your child’s transition to a new school environment and minimize the risk of eating disorders,
here are five back-to-school tips designed to help promote healthy attitudes about food and body shape and
1. Look for warning signs. Although weight loss can be an indicator of disordered eating, it may not be
immediately apparent. A child may be displaying signs of an eating disorder if their schoolwork and grades
begin to suffer, or if they becomes socially withdrawn and increasingly anxious, or tired and lethargic. Another
possible sign: your child begins wearing roomier or layered clothing, even on warm days.
2. Avoid comments about your child’s body shape or size. When shopping for new school clothes avoid
commenting on your child’s weight or body size and instead focus on his or her preferences regarding color,
3. Talk about peer pressure, alcohol use. If your son or daughter is going off to college for the first time, have
an honest conversation about peer pressure and the dangers of replacing food calories with alcohol calories;
and discuss the physical consequences of disordered eating and drinking behaviors, such as liver damage from
excessive alcohol consumption or the significant internal damage poor nutrition can cause.
August 29, 2012
Eating Disorders Can Be Triggered During Back-to-School Transition | Julie Holland
4. Advise teen athletes not to overtrain. Remind your teenage athlete not to overdo his or her training in an
effort to make a high school sports team. Watch for signs of over-exercise, such as sports preparation when he
or she is injured or sick, or exercise that significantly interferes with daily activities and schoolwork.
5. Be a positive body role model. When helping an adolescent recover from the body-focused bullying that
can sometimes accompany going back to school, a parent who has positive body image will have far more
credibility than one who consistently criticizes his or her own looks.
It is important to remember that what triggers an eating disorder may not be what perpetuates it. Though
school transition pressures may have precipitated an eating disorder, the factors that allow it to continue are
often complex. Early intervention and treatment from qualified eating disorders professionals are essential to
maximize opportunities for lasting recovery.
To help parents learn more about helping their children more effectively deal with pressures that could
lead to the development of an eating disorder, the Eating Recovery Center has launched a free Community
Education Series for parents. In the first seminar in this series, “Helping Your Kids Deal Effectively with
Back to School Stressors: Opportunities for Parents,” parents will learn about being a healthy role model,
communicating effectively and identifying steps to intervene when they are concerned about their child’s
eating behaviors. The inaugural seminar is Thursday, September 6, from 6:30 to 8 p.m. at Eating Recovery
Center’s Partial Hospitalization Program for Children and Adolescents, 100 Spruce Street, Suite 200, Denver,
Colo. 80230. To RSVP for the event, please contact Emili Coringrato by Tuesday, September 4, at ecoringrato@
EatingRecoveryCenter.com or 720.258.4014.
August 29, 2012
Could You Be Orthorexic? | Jene Luciani
Striving to be a healthy eater seems good for you, especially when you’re cutting out things like added sugars
and adding more fresh veggies. But some people go to such extremes to clean up their diets that they develop
an eating disorder called orthorexia nervosa.
“A person with orthorexia almost obsessively eats only certain foods that they’ve deemed to be ‘healthy’ and
won’t touch anything else,” says Jennifer Lombardi, executive director at Summit Eating Disorders, a partner of
the Eating Recovery Center in Denver, Colorado. “The initial intention of the person is to become healthier by
eating higher-quality and ‘purer’ foods, but she takes this to extremes, and it spirals out of control, leading to
poor health, dangerously low body weight, injury, or illness.”
Unfortunately orthorexia is harder to identify than disorders such as anorexia or bulimia. “One major obstacle
is that we live in a culture that emphasizes the importance of being fit, eating healthy, and aspiring to make the
‘right’ choices when it comes to food, so what’s essentially turning into an illness for someone can be masked
under the veil of healthy living,” Lombardi says.
To tell if your diet has gone to the extreme, ask yourself these questions from the National Eating Disorders
Do you wish that occasionally you could just eat and not worry about food quality?•
Do you ever wish you could spend less time on food and more time on living and loving?•
Does it sound beyond your ability to eat a meal prepared with love by someone else—one single•
meal—and not try to control what is served?
Are you constantly looking for the ways foods are unhealthy for you?•
Do love, joy, play, and creativity take a backseat to having the perfect diet?•
Do you feel guilt or self-loathing when you stray from your diet?•
Do you feel in control when you eat the correct diet?•
Have you positioned yourself on a nutritional pedestal and wonder how others can possibly eat the•
food they eat?
Similarly, be concerned about friends if you notice any sudden and drastic changes in their behavior, find them
labeling foods as “good” or “bad,” realize that they’ve completely eliminated entire food groups such as carbs
or fat from their daily meals, or find them planning their entire lives around food, Lombardi says. If you’re
worried, talk to your friend and be clear about your concerns for her, giving specific examples of what you’ve
noticed, says Lombardi, then encourage her to seek treatment.
Whether for yourself or for a friend, Lombardi suggests using a site such as edreferral.com to search for
experienced professionals near you. The good news is that, as with any eating disorder, “lasting recovery is
entirely possible, especially if treatment is sought early on,” she says.
September 1, 2012
Food and Your Feelings (It’s Complicated) | Alice Oglethorpe and Noelle Howey
September 4, 2012
Dr. Easton interview about back-to-school eating disorders triggers
Dr. Easton did a live, in-studio interview about eating disorders triggers during back-to-school
See the CD at the back of this clipbook for full video.
Chief Marketing Officer Julie Holland’s EverydayHealth blog “The Truth About Eating Disorders,” is temporarily
unavailable while it moves to a new location on the EverydayHealth website. In the meantime, Julie’s blogs will
be posted here on the Eating Recovery Center blog.
Community-supported restrictive diets are becoming more and more common in today’s society. If an
individual has the genetic or temperamental risk for developing an eating disorder, choosing to eat strictly
vegetarian, vegan or gluten free for non-medical reasons can be a precursor for the onset of an eating disorder.
Following a strict diet and avoiding certain food groups could also be an individual’s veiled attempt to minimize
disordered eating behaviors that are being used to lose weight.
A recent study, published in the Journal of the Academy of Nutrition and Dietetics, found that women who
struggle with disordered eating behaviors are four times more likely to be vegetarian than women without
eating disorders. It’s suggested that eating disordered individuals engaging in a vegetarian lifestyle may be
trying to legitimize their food avoidance. In addition, some study participants were in various stages of eating
disorders recovery: fully recovered, partially recovered and not recovered (or active in the eating disorder); and
the study found that as individuals progressed further in their recovery, the likelihood that they were eating
strictly vegetarian decreased greatly, from 33 percent of eating disordered individuals to only five percent of
fully recovered individuals.
No, “vegetarian eating disorders” aren’t a new type of eating disorder, but these behaviors certainly are ones
to be taken seriously.
September 14, 2012
Vegetarian Eating Disorders: New Study Links Vegetarian Diets to Eating Disorders |
At Eating Recovery Center, nutrition for eating disorders patients is a crucial part of the treatment process. Our
dieticians take each eating disorders patient’s diet into consideration and actively discuss his or her motive or
desire to be vegetarian, vegan, etc. Although not always intertwined with an eating disorder, restrictive-style
diets like vegetarianism can play a role in the development of an eating disorder as well as cause barriers to
lasting eating disorders recovery.
If you, a friend or a loved one is eating vegetarian and engaging in disordered eating behaviors, you may want
to speak with an eating disorders specialist, family doctor or dietician to learn more about vegetarianism and
eating disorders and how to approach your friend or loved one to seek eating disorders treatment.
Major life changes are known for their potential to serve as eating disorders triggers, especially among
children and adolescents. For many young people, back-to-school is an anxiety-provoking time of year as it
often means transitioning to a new school, entering freshman year of high school or college, or even returning
to an environment where bullying often takes place. In an effort to manage wavering self-confidence and
negative perceptions about their bodies, many may seek to alleviate their stress by adopting unhealthy coping
Adolescence is notorious for being a time of profound academic and social pressures coupled with intense
physiological changes that can create the perfect storm for body image issues and disordered eating behaviors
to develop. Parents can play an important role in lowering the chances that their teens will engage in
disordered eating as a coping tool. Prevention begins with parents modeling healthy thoughts and behaviors
toward food, body image, health and exercise. As an eating disorders therapist and a parent of a tween, I strive
each and every day to be a positive body role model for my daughter. Frequently I observe first-hand, in my
own family and among those families with whom I work, how parents with a positive body image are able to
set a good example for their children. Furthermore, “practicing what you preach” gives our comments and
advice that much more credibility and authenticity.
Not only should parents strive to be positive role models in their own thoughts and behaviors toward food and
related issues, but it’s also vital that parents understand how to approach their child should disordered eating
behaviors become a concern.
Here are three important ways that parents or other adult role models can help to arm their children against
eating disorders triggers and negative body image:
September 19, 2012
Back-to-school stressors can become eating disorders triggers; parents can help |
Openly and honestly discuss peer pressure.1. Young adults face incredible pressure to “fit in,” and that often
results in making changes to one’s appearance or experimenting with drugs and alcohol. It’s important to
discuss the dangers of disordered eating and substance abuse as a means to “look cool” or hang out with a
Focus back-to-school shopping on style.2. It’s no secret that children and teenagers are growing and their
bodies are changing, although this can often result in frustrating dressing room experiences. Try keeping
the focus away from your child’s clothing size or body shape when shopping for back-to-school clothes and
instead encourage kids to choose clothes based on color, style and how the clothes make them feel.
Keep your young athlete’s training schedule under control.3. Students participating in sports at any level
face performance pressures; however, parents must be proactive and manage their young athlete’s training
regimen to make sure it doesn’t become unhealthy or spiral out of control. Excessive athletic preparation,
especially that which interferes with daily activities and schoolwork, can be detrimental and can actually
lead to injuries and poorer performance.
For some children and adolescents, disordered eating behaviors may not result in significant weight loss that’s
immediately apparent. As a result, parents, teachers and coaches should be cognizant of other signs of eating
disorders as well. If a student becomes unusually withdrawn from school activities and friends, if his or her
grades begin to suffer or if he or she is wearing roomier clothing, even on warm days, it may be an indicator of
something more serious, such as an eating disorder.
Although addressing back-to-school eating disorders triggers may seem daunting, if parents, friends and
loved ones intervene early and seek treatment form a qualified eating disorders professional, it’s that much
more likely a young person will experience lasting eating disorders recovery. If you’re concerned your son or
daughter may be struggling with body image issues or an eating disorder, set aside a quiet time to talk with
him or her directly, but without placing blame. Be sure to express how certain actions and behaviors concern
you and ask detailed questions that don’t simply require a “yes” or “no” answer, as adolescents can often find
ways to “skate around” yes or no questions.
Visit www.EatingRecoveryCenter.com for eating disorders resources and the opportunity to confidentially chat
with a master’s-level therapist to get all of your questions answered.
September 24, 2012
Stigmatizing obesity undercuts effectiveness of public health campaigns | Christine
With more than 78 million American adults considered obese, public health organizations and others have
launched campaigns to motivate people to lead healthier lifestyles and shed some pounds. They include
first lady Michelle Obama’s “Let’s Move” initiative, which intends to resolve the nation’s childhood obesity
epidemic within a generation.
In some instances, however, the messages in obesity-prevention campaigns make people who are an unhealthy
weight feel bad about themselves because they seem to shame the obese, said a study published online Sept.
11 in the International Journal of Obesity.
One example is a Georgia campaign that said, “Being fat takes the fun out of being a kid.” A majority of the
1,014 study participants considered the message stigmatizing.
“By stigmatizing obesity or individuals struggling with their weight, campaigns can alienate the audience
they intend to motivate and hinder the behaviors they intend to encourage,” said lead study author Rebecca
Puhl, PhD. She is director of research at the Rudd Center for Food Policy and Obesity at Yale University in New
To address this problem, Puhl recommends that primary care physicians discuss with patients inaccurate
or potentially stigmatizing obesity-prevention information they hear about or read. She also encourages
doctors to make sure the educational materials they have on wellness in their offices promote specific healthy
behaviors people should adopt, such as eating a variety of fruits and vegetables each day, rather than focusing
on just losing weight.
“Messages that focus on promoting specific health behaviors are likely to be more effective” than messages
focused on weight, Puhl said.
A report published online Aug. 20 in Circulation found that some public health approaches can be effective.
They include health warnings on cigarette packages, policies that make nutritious food more affordable and
improving sidewalk design to encourage physical activity.
When it comes to obesity, Ovidio Bermudez, MD, encourages physicians to briefly address the importance of a
healthy diet, exercise and a good body image at every patient visit, even if the individual is a healthy weight.
“If we get across to patients the message that nutrition, physical activity, wellness and self-acceptance are
important aspects of health, I believe we will make a difference” in reducing obesity and eating disorders, said
Dr. Bermudez, who specializes in psychiatry and adolescent medicine. He is chief medical officer at the Eating
Recovery Center in Denver.
One in three U.S. adults is obese, as are 17% of children and adolescents, according to the Centers for Disease
Control and Prevention. The prevalence of obesity in youths has nearly tripled from 1980, when about 6%
For the journal study, researchers issued online surveys to 1,014 U.S. adults 18 and older in July 2011 to
gauge reactions to messages from major obesity-prevention campaigns implemented in Australia, the United
Kingdom and the U.S. The initiatives were identified through Internet searches, assessing published reports
and examining information from public health organizations such as the CDC.
Each participant was randomly assigned 10 messages from a total of 29. Individuals were asked to answer 13
questions that assessed their perceptions of the message’s relevance, helpfulness, likability and whether it
induced motivation to engage in healthy behaviors or promoted stigmatization of obese people.
Participants also were asked to rate how positive or negative each message was by using adjectives provided
by researchers. Positive adjectives included the words “effective,” “motivating” and “informative.” Negative
descriptors included “complex,” “confusing” and “stigmatizing.”
Researchers found that 36.5% of participants were considered to be a normal weight, 33.4% were overweight
and 26.5% were obese. The remaining adults were considered underweight, which is defined as a body mass
index lower than 18.5.
Participants responded more favorably to obesity-related health campaigns that emphasize specific health
behaviors and personal empowerment for health compared with campaigns that imply personal blame and
stigmatize the obese.
The most-stigmatizing message came from Australia: “Childhood obesity is child abuse.” The study found that
62.4% of participants considered the statement denigrating.
The least-stigmatizing message was the first lady’s campaign urging the nation’s youth to “Move every day!”
Just 28.9% described it as disparaging.
A United Kingdom campaign — “Eat well. Move more. Live longer.” — received the most positive reaction and
the most positive description by participants. Additionally, 85.3% of adults said they probably would comply to
its health recommendations.
“It’s very clear that negative messaging to the public, where shame, blame and stigma are the intent or driving
forces, do not work,” Dr. Bermudez said.
In some instances, participants’ weight status impacted how they perceived a health message. For example,
obese adults were more likely to view the U.S. message “Skip seconds … Lose your gut” as stigmatizing
compared with nonobese individuals.
Organizations that develop “obesity campaigns should be mindful of people who are obese and are very
vulnerable to stigma and prejudice,” Puhl said. “More systematic research is needed to help guide the content
and messaging of these campaigns to make sure they’re helping and that they’re not detrimental” to the
September 24, 2012
Hiring A Personal Trainer Helped Me Ditch My Eating Disorder | Aminah Mae Safi
I’ve been a perfectionist since long before I had any other issues, though anxiety, depression and crippling self
doubt eventually followed. I had disordered eating patterns well before I had body image issues, though now
they have been intertwined for some time. And for me, part of my support network, part of finding my way
back out of my impulses to control my food, part of my recovery, involved hiring a trainer.
My original disordered eating patterns had nothing to do with weight loss, and everything to do with control. I
didn’t realize it at the time, but I loved planning out what I was going to eat, and then seeing that plan through.
It was harmless enough in the beginning: I’d plan out a snack of, say, buttermilk biscuits with honey and a
chocolate milk. Or I’d decide to eat spicy fries and pizza for lunch. Hardly health food, or food for weight loss.
Except, little by little, I would get stressed if I couldn’t figure out the right plan for my meals, or if my original
plan fell through.
Several triggers turned my
self-criticism and disordered
eating into full-on body loathing
and the preliminary stages
of a serious eating disorder. I
had a bad summer home after
my freshman year at college,
with friends who spent most
of their time exercising and
counting calories. My brother
was beginning some of his
worst battles with what would
eventually be diagnosed as
bipolar disorder. My friendship
with my best friend was splitting
apart at the seams, and I was
grasping at straws to feel in
control of something.
I turned to my food. If I could
just keep on top of my food, if I could just control what went into my body and how it looked, I had decided
everything was going to be alright. I was lucky to have (and still have) a supportive partner, who, having dealt
with eating disorders in his own immediate family, was vigilant around my behavior. So, I never went down to
a critical weight. I might have looked a bit on the thin side, but I never reached a state where my body truly
started to shut down, though I did eventually become lethargic and anxious.
I mention my size because as Jennifer Sommer, MS, RD, CSSD, Registered Dietitian at Eating Recovery Center
in Denver notes, there are caveats to my own approach to eating disorder recovery. Namely, that individuals
who get down to a very low body weight should not embark on exercise regimens without the consultation of
a doctor or a medical professional:
[Exercise] can be a part of recovery but it’s a little bit of a tricky subject and not appropriate
for everyone. A benefit of exercise is obviously the increase in endorphins, which can help to
improve mood. This can be beneficial with eating disorders, as depression and anxiety often
coexist. Also–exercise does not need to be cardio to be beneficial. Studies have actually shown
that people receive more mental health benefits from yoga and strength training. However,
before embarking on an exercise program, individuals should be screened by a medical
professional for osteoporosis, abnormal labs, low heart rate, electrolyte imbalance or other
medical issues that could be dangerous if they started exercising.
Throughout my early twenties, I kept my eating disorder at bay. Sometimes it would flare up and rear its ugly
head–hello, Grad school! Other times, I kept it at what seemed like safe distance. But, if I’m being totally
honest, it was always there, humming in the background, controlling my decisions on food and my body,
constantly trying to steer me down the path of self-loathing.
Then one day, I decided I wouldn’t take it anymore. It was, coincidentally, around the time I decided to be a
writer. I knew I was going to spend ninety percent of my time being rejected, and I knew I had to recharge my
own inner battery. I had had enough with the self-doubt and the anxiety, and I decided I needed to take action.
But any time I’d ever tried therapy, I’d often left angrier and more confused than when I’d started. So I started
my mission elsewhere.
I had just joined a gym nearby and they were running those specials on two free training sessions with a
personal trainer. I decided to take the plunge. I was, against the tempting voice in my mind, incredibly clear
with my trainer. I told her I had body image issues and I told her I wanted to workout to get strong and fit, not
for size reduction or weight loss. I won’t lie, it took a lot of will and determination not to tell her I just wanted
to lose a few pounds. But I was up front with her, and I think that’s what has made all of the difference.
The first month or so was rough. I put on a bit of weight from actually developing my muscles. I had to hide
the scale in order to prevent an anxiety attack in the mornings. I pushed on though, because even knowing I
needed to remove myself from my dependency on my bathroom scale felt like a small victory. Working out and
training with weights, I felt good in a way I hadn’t in years.
I had, growing up, always been athletic. But throughout college, post-grad, and graduate school, I had let my
fitness slide. I’d only gotten thinner since graduating high school, so I hadn’t thought not regularly exercising
was as big of a deal as the food I’d put in my body. Particularly in terms of individuals with eating disorders
who have abused exercise in the past, Sommer notes that:
It actually would be better for the person to try a new activity that he or she did not abuse
in the past. I think it would be difficult for an individual to participate in an activity they have
previously associated with an eating disorder or with losing weight, and to change their mind
frame around it to try to make it healthy. It would be a lot less risky for an individual who has
abused an exercise-related activity to participate in a totally separate activity that he or she has
not abused in the past. That is what we recommend for our patients.
Starting with a new activity helps frame exercise in a much better place. Instead of hopping on the elliptical
to punish my body for what I might have seen as an eating misdeed the night before, I was training to build
strength and to feel good about my bodies capabilities. Here, Sommer agrees:
At Eating Recovery Center, we try to emphasize that [exercise] is about health. We really focus
on appreciating what the body is capable of, what the body can do and how individuals can
avoid taking that for granted. We also try to help patients focus more on enjoyment than on
exercise when it comes to physical activity.
As I started working out with my trainer, I became so aware of what my body was capable of— thirty mile bike
rides down the coastal route, skiing for days in a row without feeling winded, catching a glance of the pacific as
I trained in the mornings. I didn’t get tired parking down the street, several blocks away from my apartment. I
wasn’t constantly fighting a cold. Hell, I could open pickle jars without help.
And food, my body craved food. I had to listen to what my body wanted again. A long time vegetarian, and a
sometimes vegan, I went back to eating meat occasionally. My body was healing itself and telling me what it
needed and I had to listen. My food became less something I could plan for. Trips to the farmer’s market were
no longer anxiety ridden experiences where I had to already have every meal for the week accounted for.
Instead, I just picked up what sounded good, leaving behind what didn’t. I started being able to eat dessert
again without feeling I needed to apologize to myself about it.
In a recent article in the Los Angeles Times, doctors have found that treating patients with eating disorders
at home, where their normal life is less likely to be interrupted, has provided better rates of success. Patients
can learn to cognitive behavioral therapy in their own environment. For me, finding a supporting trainer with
whom I remained open and honest was my behavioral therapy. She reminded me of my strength goals; she
pushed me when I wanted to give up. In short, she made me accountable to myself.
Maybe hiring a trainer isn’t for everyone, and I know how expensive it can be. There’s no copays I get on those
checks. But I reconditioned my brain to appreciate my body for its strength, its health, and its capabilities.
Granted, I had a trainer who focused on making me feel athletic again, rather than one trying to cut down my
size. In fact, she constantly reminded me not only that I didn’t need to loose any weight, but also how far I had
come in terms of strength and endurance.
When I look in the mirror now, I see a strong body and I’m proud of the work I’ve done, both physically and
mentally. I see a body that does roundhouse kicks and pushups. I see a woman willing to face the worst parts
of herself every day, until they no longer scare her. I see the scars I’ve earned, from scraping my legs and
knocking my knees, from falling down and picking myself up— the physical manifestations of an interior battle.
I won’t lie, I still have those days where my illness screams in my head, trying to make its painful thoughts
drown out all of my success. But those days are fewer, and far between. Usually, I can stop these thoughts in
their tracks by reminding myself of everything my body has gone through. And now, I don’t hide the scale in
the bathroom, though I don’t leave it out either. I just don’t need that number to pop up and tell me what kind
of day I’m going to have. For me, that’s been the greatest gift of all.
September 24, 2012
One Woman’s Struggle with an Eating Disorder after 50 | Katie Couric
Dr. Bermudez and a former patient, Sandy Cristenberry, did a taped interview on eating disorders
among older women.
See the CD at the back of this clipbook for full video.
In the United States, 90 percent of young women who develop an eating disorder do so between the ages
of 12 and 25. For these young women, body image issues and eating disorders stem from a variety of
predisposing biological and environmental factors. For example, the fast-paced, highly competitive academic
and social environments commonly found on college campuses can often trigger eating disorders among
Making the transition to college is one of the two most common times that eating disorders develop, and
sorority life can be an especially prolific breeding ground for eating disorders in college. However, there are
many ways that sororities and other Greek organizations can play a key role in eating disorders prevention by
instilling positive body image in women and promoting awareness. Strategies for prevention include:
Invite an eating disorders specialist to a chapter event
Greek life in college is full of honored rituals, chapter traditions and weekly events. In order to address body
image issues and eating disorders, sororities can invite local eating disorders treatment experts to speak to
sorority sisters about the warning signs of anorexia, bulimia and other eating disorders, as well as available
resources and suggestions for approaching a friend or loved one who is displaying concerning behaviors. Eating
Recovery Center speaks at colleges and universities throughout the U.S. having found that by offering expert
advice and opening the lines of communication among members, sororities can become educated, supportive
champions of eating disorders prevention.
Visit Eating Recovery Center’s website to learn more about eating disorders specialists as a valuable resource.
Commit to ending “fat talk” with Fat Talk Free Week every October
“Fat talk” unknowingly permeates our everyday conversations. Comments like, “these pants make my butt
look big,” or “I shouldn’t eat that cookie unless I’m going to the gym later” can negatively affect your own
self-esteem and that of friends and loved ones. Thanks to Fat Talk Free Week, an annual five-day body activism
campaign that aims to acknowledge the dangers of the “thin ideal” and address body image issues and eating
disorders, sororities have a platform through which to raise awareness about the impact of the comments they
make about themselves and others and make a commitment to end “fat talk.”
Learn more about Fat Talk Free Week 2012 at endfattalk.org.
Make eating disorders resources known and available
NEDA, the National Eating Disorders Association, strives to bring people from all walks of life together to create
a stronger, more aware eating disorders community. Sororities can take an active role in that community,
and help to promote positive body image in women and raise awareness about eating disorders in college
by attending a local NEDA conference. The entire house can attend for a meaningful group outing, or the
sorority’s wellness director can attend and report back to the chapter, sharing important eating disorders
prevention and treatment resources available to the Greek community.
Learn more at nationaleatingdisorders.org.
October 1, 2012
College sororities can promote eating disorders prevention | Julie Holland
Participate in National Eating Disorders Awareness Week
National Eating Disorders Awareness Week (NEDAW) is an annual week-long event that seeks to raise
awareness about eating disorders and prevention. Generally held during the last week in February, NEDAW
allows individuals and groups like sororities to serve as eating disorders awareness activists and participate in
more than 280 events across all 50 states. Sorority chapters can take a proactive step toward eating disorders
prevention and join a local NEDAW walk as a group, or check out the activity guide and additional resources
on the NEDAW website. NEDAW is the perfect opportunity for sororities to create a supportive, educated and
influential chapter in their college community.
Learn more at nationaleatingdisorders.org/programs-events/nedawareness-week.php.
October 11, 2012
Study examines the role of pro-ana websites in eating disorders recovery | Julie
Search the Internet for “thinspiration” or visit pro-eating disorders online communities (commonly referred to
as pro-ana (pro-anorexia) and pro-mia (pro-bulimia) websites) and you’ll find startling, sometimes disturbing
images and blogs encouraging individuals to engage in unhealthy disordered eating behaviors to achieve
unrealistic body shapes and sizes. For this reason, many online communities, including Tumblr and Pinterest,
chose to ban all pro-eating disorders material from their sites to protect the health of their users. In the wake
of the “thinspiration” and pro-eating disorders content being banned, researchers at Indiana University have
released the results of a study suggesting that pro-ana and pro-mia websites may actually help to facilitate
eating disorders recovery.
The study, which evaluated 33 female pro-ana bloggers between the ages of 15 and 33, revealed that these
study participants were often looking for support from a community of individuals who understands the
intense trials of this mental illness, and that they weren’t actually encouraging others to share in their
disordered eating behaviors through their posts and online communication. Other key findings include:
Most pro-ana bloggers understand that their disordered eating behaviors are serious problems.•
Eighty-two percent identified their eating disorders as mental illnesses, while only 9 percent of those
interviewed believed that anorexia was a “lifestyle.”
The majority of the pro-ana bloggers said their mood improved after writing, underscoring the•
powerful impact of creative expression activities like journaling in the recovery process.
While it’s true that support from like-minded and similarly situated individuals can be extraordinarily helpful
in working towards eating disorders recovery, members of recovery-focused communities must support the
pursuit of treatment, practice their own positive body image behaviors and adopt healthy attitudes toward
food. To this end, many eating disorders treatment centers offer alumni programs that can help individuals
build a healthy community and provide support to prevent dangerous relapses.
Furthermore, understanding the seriousness of an eating disorder is crucial to finding recovery, as is seeking
treatment from a qualified eating disorders professional. Eating disorders are the deadliest mental illnesses;
therefore, it’s important to seek treatment from professionals with the medical and clinical expertise necessary
to properly manage these complex illnesses and facilitate lasting eating disorders recovery. These treatment
professionals help to identify and develop the tools to practice recovery during and after treatment. For
example, journaling and creative expression can be very therapeutic, as identified by the University of Indiana
researchers. Treatment professionals recommend writing about events that occurred, what can be learned
from those experiences and how these lessons can be used in eating disorders recovery, rather than just
lamenting on the day’s frustrations.
Eating disorders treatment professionals can also help individuals to be responsible users of the Internet
and social media. Despite recent decisions by some online communities to ban unhealthy content, this
information is still very prevalent. According to a recent Mashable article, searching the hashtag “#thin” on the
photo sharing community Instagram results in more than 170,000 results, while searching “thinspiration” on
Pinterest leads to countless boards and pins dedicated to achieving an unrealistic and unhealthy body ideal. At
Eating Recovery Center, therapists encourage patients to look at web content and social media with a critical
eye. A simple exercise that can extend to anyone with a laptop, smart phone or tablet is to ask yourself, “Is this
really a healthy community?” and “Is my mood affected after I spend time on social media?” If the content you
view online doesn’t affect you positively, perhaps consider spending your time elsewhere, like reading your
favorite book or spending time with friends and family.
October 16, 2012
Banish “fat talk” and promote positive body image and self-esteem | Julie Holland
Recent research has found that four out of five U.S.
women are dissatisfied with their appearance,* and
81 percent of 10-year-old girls are afraid of being
fat.** These statistics underscore the importance
of promoting self-confidence and body acceptance
among not just women and girls, but men and boys
as well. While the “thin ideal” is widely promoted
by the media and can be difficult to avoid, we can
take one very important step toward encouraging a
healthy body ideal by banishing “fat talk.”
Fat talk is comments—made about ourselves or
others—that stress the importance of weight and
size. Common examples of fat talk include muttering
under your breath about your outfit making you look
fat or telling a loved one that a rich dessert will go
straight to her thighs if consumed. These comments
place an emphasis on weight as a measure of worth,
and can have unforeseen and sometimes devastating
consequences for individuals prone to eating
disorders. Our society has trained us to be incredibly critical about our appearance and body shape and size,
so much so that the majority of people don’t even realize that their comments are negative. Even seemingly
harmless comments such as, “You’re looking great, very thin!” can reinforce the thin ideal and can add to body
So what can we do to stop fat talk and its negative affects? Each year, Fat Talk Free Week, which is October
22-26 this year, offers an opportunity to take a critical look at the body size and weight-related comments you
make about yourself and others and commit to changing that rhetoric. Below are five strategies that can help
banish fat talk and encourage healthy body image and self-esteem.
1. Be proactive. Take proactive steps to combat eating disorders, body image issues and negative self-esteem
before they have a chance to develop. Educate yourself about eating disorders and the interplay between body
image, self-esteem and these complex illnesses. Learning about important risk factors, signs and symptoms
can help you understand how fat talk can contribute to eating disorders, especially in individuals that are
predisposed to developing the illness.
2. Confront the messages of the media. More often than not, television, movies, magazines and the Internet
perpetuate the “thin ideal.” This pervasive message offers a great opportunity to practice self-awareness.
Ask yourself, “Are the images in magazines and online unrealistic?” and “Are these images portraying healthy
people who can live full, active lives?” In addition to asking these questions of yourself, help children ask these
questions too. Learning the skill of critical thinking, especially as it pertains to body image and self-esteem
and self-confidence, will help them evaluate the information they take in from the media rather than simply
accepting the information placed in front of them.
3. Remember, you’re a role model. Parents, teachers and coaches are some of the most crucial role models
for helping children and teenagers develop a positive body image. If you have a child, spend time with children
or work wit kids and young adults, make a concerted effort to be cognizant of the comments you make. Even
offhand, well-intentioned comments that make judgments about weight can be damaging to the way children
view their bodies. Instead, commit to only making positive, healthy comments when it comes to body image,
shape and size.
4. Encourage moderation. Food provides nutrients to help bodies grow strong and stay active; however, food
conversations can also be a prime source of fat talk when we’re being critical of calories, fats, carbohydrates
and how various foods can impact our body shape and weight. Avoid labeling foods as “good” or “bad.”
Instead, focus on eating a well-rounded, healthy diet where sweets and treats are complemented with
nutritious grains, proteins, fruits and vegetables.
5. Take stock of your own thoughts and comments. Banishing fat talk starts with developing an awareness of
your own thoughts and comments and transitioning them into messages that are more positive and healthy.
Focus on the beautiful color of a friend’s outfit, rather than how it fits. Or praise your daughter for selecting
a well-rounded snack as opposed to focusing only on the cookie and how many calories it has. Remember, to
give it some time, your positivity will start to rub off on others and they’ll begin doing the same.
If you’re still not sold on the importance of avoiding fat talk, consider this: Researchers found that many young
children would rather be dead than fat.*** To the eating disorders treatment community, that is a sad, urgent
finding. Let’s embrace Fat Talk Free Week and carry its intention into every day thereafter…if not just for
ourselves, then for the children in our lives as well.
“Like” this article to show your commitment to banishing fat talk and promoting positive body image and
October 23, 2012
Debunking common myths about eating disorders | Julie Holland
Eating disorders are the deadliest mental
illnesses, and four out of 10 Americans have
either suffered from an eating disorder or
know someone who has.* Yet misinformation
about these diseases remains prevalent,
and unfortunately, the shame and secrecy
associated with eating disorders can make
it difficult for some individuals to seek the
treatment they need in order to experience
lasting eating disorders recovery.
Addressing common myths about eating
disorders helps to not only educate the
general public, but also remove the stigma
associated with anorexia, bulimia, binge eating
disorder and eating disorder not otherwise specified (EDNOS). When misperceptions are addressed and eating
disorders are understood and accepted as serious mental illnesses, the men, women and children who struggle
with these diseases are more likely to recognize their disordered eating and feel more comfortable addressing
their illnesses by seeking treatment.
To raise awareness and curb misinformation, below are five common myths about eating disorders, followed
by the facts.
1. Eating disorders are a women’s disease. Although commonly thought of as a “teenage girl” disease, the
prevalence of eating disorders in men and boys is increasing. Eating disorders statistics reveal that more than
one million men currently struggle with eating disorders.** It’s unclear whether these illnesses are actually
becoming more common in men and boys, or if more eating disorders awareness activities and less fear about
seeking treatment has prompted more males to identify their eating disorders and seek treatment.
2. The cure for eating disorders is to “just eat.” While eating disorders involve calorie restriction and/or
purging of calories after consumption, they’re complex mental illnesses that aren’t really about food. These
illnesses often emerge from issues of control that go far beyond food and calories. Therefore, it’s also quite
common for what triggered an eating disorder – trauma or another precipitating event – to be completely
different from what maintains it—usually disordered thoughts and behaviors around food and calories.
3. Eating disorders don’t run in families. Genetics and heredity play an active role in the development of an
eating disorder. A woman with a sister or mother who has had anorexia is 12 times more likely to develop
the disease and four times more like to develop bulimia.*** Just as it’s important to understand family
history when evaluating the risk for cancer or Alzheimer’s disease, it’s vital that individuals understand if their
family members have struggled with eating disorders or displayed disordered eating behaviors to maximize
opportunities for prevention and illness recognition.
4. Eating disorders are a choice. People don’t engage in disordered eating behaviors because they are simply
choosing to eat fewer calories or they don’t want to be healthy. Eating disorders are complex illnesses with
medical, psychological and sociocultural implications and they can be deadly if appropriate treatment isn’t
5. Eating disorders only affect wealthy individuals. Men, women and children from all walks of life and
socioeconomic backgrounds can, and do, develop eating disorders. Regardless of family income, everyone
experiences certain life transitions like puberty, which is one of the most common times during which eating
disorders can develop.****
Setting the record straight when it comes to myths about eating disorders is an ongoing process for the
community of eating disorders treatment professionals. However, the distribution of accurate eating disorders
facts and important information about treatment resources can not only help prevent the development of
disordered eating behaviors and negative body image, but also support those suffering from these illnesses as
they access appropriate treatment.
Do you have more questions around myths about eating disorders? Comment below, subscribe to these
articles or visit www.EatingRecoveryCenter.com to confidentially chat with a member of the Clinical
Assessment team to discuss your questions.
September 13, 2011
Eating Disorders Recovery: Q&A with Jen M., Part 2 | Julie Holland
October 2, 2012
Informed Parents and Coaches Can Help Prevent Eating Disorders in Young Athletes
as Fall Sports Begin
Driven athletes possess similar personality traits to individuals who suffer from anorexia nervosa, which may
predispose them to the potential development of an eating disorder. For this reason, and as fall sports kick
into full gear, Eating Recovery Center, an international center providing comprehensive treatment for anorexia,
bulimia, EDNOS and binge eating disorder, encourages parents, coaches and athletes themselves to understand
and minimize athletic activities and pressures that could potentially lead to eating disorders.
Experts agree that certain categories of sports tend to place athletes at a greater than average risk for
developing an eating disorder. High risk sports often include dance, gymnastics, wresting, endurance running
and swimming. In fact, research published by Craig Johnson, PhD, FAED, CEDS, chief clinical officer of Eating
Recovery Center, found that at least one-third of female college athletes have some symptoms of an eating
“The same perfectionistic, high-achieving temperament that fuels athletic achievement closely mirrors the
traits of individuals who tend to develop eating disorders,” said Dr. Johnson. “For this reason, it is important
for athletes and their parents and coaches to be aware of and responsive to eating disorders risk factors in the
To help parents of athletes reduce eating disorders risks, Eating Recovery Center offers the following guidance:
Keep a watchful eye for signs of over-exercising or obsession with achieving a specific weight or body•
size for competition.
Focus on the excitement of playing a sport or the importance of being part of a team, rather than on•
performance and wins and losses.
If eating disorders run in your family, be cautious about placing your child in body shape- or weight-•
focused sports, including those mentioned above.
Coaches can also assist in eating disorders prevention by recognizing their leadership role and•
exercising that influence to support the health of their athletes. Eating Recovery Center offers coaches
the following advice:
Be mindful of the comments you make about athletes’ body types, shapes and sizes; seemingly•
harmless remarks can be very triggering for genetically predisposed individuals.
If weighing athletes or measuring body fat is a component of preparation for your sport, make efforts•
to privately assess athletes and keep numbers confidential when possible.
Open lines of communication with your athletes and engage in a dialogue if you are concerned about•
an individual’s weight loss or behaviors.
Additionally, individual athletes should adhere to the following recommendations to ensure safe and•
healthy athletic participation:
Focus on creating balance in your life and make time for non-athletic endeavors such as schoolwork,•
hobbies and time with friends and family.
Recognize the value of resting when you are injured or ill; pushing yourself harder during these times•
can result in further injury or illness.
Being asked to drop weight for an athletic event can be incredibly triggering; plan plenty of time for•
safe weight loss preparation and encourage teammates to do the same.
Eating disorders in athletes of all ages can lead to lower levels of athletic performance, organ malfunction,
bone deterioration and osteoporosis, as well as cardiovascular problems. Early intervention and expert
treatment from eating disorders professionals can minimize the chances for negative long-term health effects.
For more information about eating disorders in athletes, visit www.EatingRecoveryCenter.com.
October 22, 2012
Stop Calling Yourself Fat: 5 Ways To Trash Negative Thoughts For Fat-Talk Free Week
| Aminah Mae Safi
Be honest: How mean have you been to yourself
this weel? To other women? To a celebrity who
you think gained a little weight? Because when
we’re all being 100% truthful, the fact is that
most of us engage in more fat-talk about ourself
and other women than we’d like to admit. This
week, Tri Delta is instating a moratorium on
internal body-snarking, fat-shaming, and other
body-negative thoughts. It’s Fat-Talk Free Week,
and we’ve got some tips from the good folks at
Eating Recovery Center on how you can finally
quell your inner critic–and start feeling better
Started in 2008, Fat-Talk Free Week is an initiative
to bring attention to all of the negativity that women feel toward their own bodies, and the very real health
and wellness consequences those thoughts can have. Multiple studies have shown that fat-talk and poor body
image can lead to depression and even a greater risk of obesity. But how do you break the cycle and end the
fat-talk, when the message that thin is the same as healthy, beautiful, and successful are all around?
The truth is, while obesity is a serious public health crisis in our country, eating disorders are also a deadly
plague on both women or men. But the solution to both of these lethal problems isn’t demonizing overweight
or obese people, nor is it internalizing the latent fat-shaming that occurs both in the media and society. It’s
adopting a more positive approach to our bodies–and, as a result, learning to take care of them.
Wanting to get in shape, be stronger, and eat better is not the same as harboring toxic, negative thoughts
about your own body and its appearance. Eliminating fat-talk, then, is a great way to not only take a step
toward fighting obesity and eating disorders–as well as to feel better about yourself, and further the
conversation about the human body, health, self-esteem, and mental wellness.
This week, take the Fat-Talk Free Challenge. Not sure you can do it? The folks from Eating Recovery Center, an
international center which provides comprehensive treatment for eating disorders, has compiled a list of ways
to end negative thoughts about yourself (and others), while helping to cultivate a health-centered rhetoric
about weight, food, and body-image. Here’s what they have to say:
Focus on what your body can do for you, rather than what it looks like
The human body is an amazing machine–just imagine a robot that could do all the things a body can do, and
how difficult it would be to create. And yet, most of us look past the fact that it can move in about a million
awesome ways, and, instead, focus on tiny things about it that we view as imperfect.
Rather than dwelling on your appearance
and all the things about your body that make
you feel badly about yourself, make a list of
the reasons your body rocks. You may be
surprised by all the cool things it can do.
Banish self-destructive behaviors
Smoking, drinking to excess, eating
unhealthy foods, crash dieting, and even
critical self-talk are all ways that we punish
the bodies we view as imperfect. But, as
we’ve established, your body is really cool–
and it deserves the highest level of care.
Instead of doing things that are bad for your
body, treat yourself to something that’s good
for it, like a yoga class or a massage. Then,
say some kind words about it. When you treat your body with respect, it’s a lot easier to feel proud of it.
Be aware of the comments you make about others
“You look so thin!” may seem like the perfect compliment for all women, but it’s really not–because it sets up
fatness as the opposite of a good thing. Instead of making comments to or about others regarding weight (and
yes, that includes bashing celebs and even pundits for their weight fluctuations), think about what message
you’re putting out there.
The same goes for words and phrases which, while they may seem funny, are actually very derogatory.
“Thunder thighs,” “bat wings,” and even “love handles” are mean ways to point out supposed imperfections
in others–and they add to the problem. You may not use them about your own body, but using them at all still
underscores the current of fat-shaming and negative thoughts that plague the national conversation.
Compliment yourself–more than once
Saying kind words about your own appearance or self is often seen as braggy, but no one’s asking you to Tweet
about how strong you are or how thick and lovely your hair is this morning. Instead, silently find something
kind to say about yourself. As Eating Recovery Center told us, “instilling a positive body image starts with the
messages you develop about yourself. Make a practice out of complimenting yourself several times a day.”
Be a critical consumer of media
You know, deep down, that every single image you see has been altered to make it fit the cultural standard of
perfection–and yet, it can be so hard to remind yourself of that when you start to get into “I hate my thighs”
mode. Bookmark this article, which features an interview from a photo editor, in which every way that models
and other celebs are made to look perfect is laid out clearly. It’s a good reminder that what you see is definitely
not what you get–and that holding yourself up to that same standard is impossible.
Then, seek out positive media sources (ahem, like this website) and images, which can help ground you back
into reality. When the negative thoughts start to take over, just remember: It’s not real. No one is perfect. You
are amazing. Because you are!
October 22-26, 2012
Status Updates | FitBottomedGirl
Join @EatingRecovery & be #FatTalkFree and focus on what your body can do for you, rather than what it
looks like. http://bit.ly/FTFW12
Do away with self-destructive behaviors. Overly critical comments can wreak havoc on body image. http://
Be aware of your comments about body shape and size; they can be more damaging than you think. http://
Practice complimenting yourself several times a day. Instilling a positive body image starts with you. http://
Media images are often unrealistic; body shapes & sizes can be digitally altered & impossible to achieve.
October 24, 2012
Stop the Fat Talk! | Alana Nunez
“Ugh, I feel so fat!”
“My thighs are huge.”
“I can’t believe I ate that entire bowl of ice cream.”
If any of these sound familiar, you’re not alone. Women participate in so-called “fat talk” every day, criticizing
their own bodies and complimenting others. Yep, something that seems positive such as “You look great, have
you lost weight?” or “You look amazing in that mini! You’re so thin!” also counts as fat talk.
“Ugh, I feel so fat!”
“My thighs are huge.”
“I can’t believe I ate that entire bowl of ice cream.”
If any of these sound familiar, you’re not alone. Women
participate in so-called “fat talk” every day, criticizing their
own bodies and complimenting others. Yep, something
that seems positive such as “You look great, have you lost
weight?” or “You look amazing in that mini! You’re so thin!”
also counts as fat talk.
But this week, women are encouraged to silence that
conversation and start a new one.
Started in 2008 by Tri-Delta sorority, the third week of every
October is designated as Fat Talk Free Week and has become
a time to reflect upon, accept, and talk about our bodies in
a more positive and constructive way. Although the initiative
began on college campuses, it has spread to women and men of all ages.
Julie Holland, M.H.S., chief marketing officer of the Eating Recovery Center, shares her tips on how you can
participate in Fat Talk Free Week and develop a more positive body image in yourself and your friends:
1. Try not to emphasize looks: Shift your attention from appearance to values and behaviors. “It is not about
what our body looks like, but rather what it does for us,” Holland says. “Take the focus away from the mirror
and take note of all the great things your body helps you do and be.”
2. Be aware of the messages you share about your own body. Make an effort to say at least three positive
things about your body every day; after all, fostering a positive body image in others starts with doing so in
3. Recognize that every body is different. Genetics influences our body size, shape, and weight.
4. Learn to listen to your body’s needs and appreciate what your body can do for you. “Eat when you are
hungry and stop when you’re satisfied,” Holland says. Rest when you are tired and move your body to get
adequate exercise so that you can experience life to its fullest.
5. Be a critical consumer of media. Beautiful though they may be, celebrities and models in magazines and on
TV get a lot of help from Photoshop.
“Body shapes and sizes in the media are often digitally altered and impossible to achieve,” Holland says. “At
Eating Recovery Center, we encourage our patients to ask questions of images from the media: ‘Is this image
realistic?’ or ‘Does this image portray a healthy body image?’ I encourage everyone to remember that a large
percentage of photos we see are altered.”
Do you find yourself using fat talk? How do you plan to participate in Fat Talk Free Week? Are you going to tell
your friends to join in?
October 25, 2012
Experts Share 11 Tips To Stop Fat Talk | Margarita Tartakovsky
Fat talk has many faces. It’s anything from “I hate my body,” to
“I can’t believe I had cake,” to “You think you have big thighs?
Umm, hello, look at mine.”
On Monday, to celebrate Fat Talk Free Week, I shared my 10
tips to stop bashing your body.
Today, I’m honored to share the wise suggestions of several
experts from the Eating Recovery Center.
These tips are important for building a positive body image
and leading a healthy, joyful life. Because the last thing fat talk
brings anyone is health or joy.
1. Adjust your perspective. “If your mom, spouse or best
friend gained five or 10 pounds, would it change the way you
feel about them? Why would it be different for you?” said
Jamie Manwaring, PhD, primary therapist at Eating Recovery
Center’s Behavioral Hospital for Children and Adolescents.
The reason our loved ones are in our lives is because of who
we are, not what we look like, she said. And here’s the thing: If people are only in our lives for our looks, do we
really want them in our worlds in the first place?
2. Evaluate your surroundings. There are just some shows and some people who make us feel terrible about
ourselves. The ones who boost our body-bashing and perk up our inner critic.
Ask yourself, “Do I feel better or worse about myself and my body after watching that show or hanging out
with that friend?” Manwaring said. Surround yourself with positive media and supportive people.
3. Focus on your body’s abilities. “Our bodies help us run fast, climb mountains and swing in the park,”
according to Julie Holland, MHS, CEDS, a chief marketing officer at Eating Recovery Center. “Don’t forget how
important those things are over how your body looks,” she said.
4. Get rid of clothes that don’t fit — and buy what makes you feel beautiful right now as you are. “Keeping
reminders of what we used to – or want to – wear only reinforces the negative voices in our heads that say we
should look a certain way or be a certain size,” Manwaring said.
5. Be aware of what you say about others. “When you comment on a celebrity or close friend’s weight gain –
or loss – others around you might take that comment more to heart than you think,” Holland said.
You never know where people are coming from and how they feel about their bodies. Anyone can internalize
these kinds of comments.
6. Accept compliments, and dish them out. When someone compliments you, how often do you say, “yes,
but…”? According to Jane Miceli, MD, a psychiatrist at Eating Recovery Center, our minds go to this place fairly
Instead, “Learn to truly hear a compliment and say thank you to whomever gave it to you,” she said. She also
suggested expressing genuine compliments to others three times a day for a week. “…And watch your world
7. Compliment yourself. It’s hard enough accepting a compliment. Saying something nice about yourself may
seem utterly impossible. But as Holland said, “Instilling a positive body image starts with you.” She suggested
making this into a game. For instance, compliment yourself at every red light, she said.
8. Go beyond food and “fat.” Fat talk is usually a facade. It usually means that something else is going on, said
Bonnie Brennan, MA, LPC, clinical director of Eating Recovery Center’s Partial Hospitalization Program. If you
notice that you’re engaging in “fat talk,” focus on what’s really bothering you, she said, “without using any
words having to do with food or body.”
She gave the following examples: “I feel out of control”; “I’m going to be rejected”; or “My life is changing.”
Often, fat talk has less to do with calories, food, fat and stretch marks and more to do with fears “of not being
loved or accepted in some way,” she said.
9. Go beyond “Do I look fat in this?” If you find yourself asking this question, instead ask yourself, “What am I
seeking?” Brennan said.
If someone else asks you this question, consider these responses, which Brennan received from groups of
patients with eating disorders: ”I love you just the way you are”; “You are a beautiful person inside and out”;
“There is no answer that is the right answer.”
10. Embrace acceptance. The more we embrace acceptance, the more we can relinquish “unhelpful struggles,”
according to Dr. Miceli. Often, she said, we wage a war against ourselves and our biology.
The next time you’re engaging in a certain activity, ask yourself: “Is this a joyful activity or a control strategy
based on fear?” she said.
11. Cultivate compassion — both for yourself and others. “As humans our minds see the flaws first, in
ourselves and in others,” Miceli said. She suggested working to “love more and judge less” and “to see the
other 95 percent of yourself and those around you.”
It’s commonly thought that eating disorders
treatment strictly involves medical stabilization,
psychological support through sessions with
therapists and collaboration with dietitians
to return to and maintain a healthy weight
for lasting recovery. However, many eating
disorders treatment centers around the
country actively support alternative forms of
therapy and treatment. From massage to art
therapy to psychodrama and music, holistic
therapies provide alternative channels through
which eating disordered individuals often feel
more comfortable expressing themselves and
processing painful emotions.
When integrated with more “traditional”
treatment methods, yoga therapy can be
incredibly helpful in encouraging eating disorders
patients to reconnect with their thoughts,
emotions and physical feelings, which often
become disconnected when they engage in
disordered eating behaviors as a means to
manage their anxiety and not “feel” their feelings. Therapists employ the use of “therapeutic yoga” to help
eating disorders patients – who generally have distorted body images and unrealistic self-concepts – foster an
increased ability to separate thoughts from actions, develop greater self-compassion and maintain healthier
relationships with their bodies. These skills are crucial to maintaining lasting eating disorders recovery.
“There are many ways that therapeutic yoga benefits individuals struggling with eating disorders,” explains
Jocelyn Jenkins, MA, LPC, yoga instructor and primary therapist at Eating Recovery Center. “The most
recognizable benefit I see is that patients are able to use movement as a form of self-care and self-exploration,
rather than for eating disordered behaviors.”
During a therapeutic yoga group, patients are offered a safe, instructor-guided environment in which to explore
the emotions and feelings that arise during different yoga postures. As patients move through a series of yoga
postures while focusing on their breath, they move slowly and intentionally, and are encouraged to allow all
thoughts to arise. These skills are practiced again and again over time and patients learn to use yoga therapy as
a coping skill for dealing with painful thoughts and sensations, rather than as an eating disordered behavior.
November 5, 2012
Therapeutic yoga and eating disorders treatment | Julie Holland
“Therapeutic yoga and eating disorders treatment can benefit all patients, across all levels of care,” said
Jenkins. “However, it’s important that patients are screened for osteoporosis and osteopenia before
starting any sort of therapeutic movement regimen. With either of these diagnoses, there are postures and
movements that should be avoided, but yoga therapy can still be used.”
Many eating disordered individuals view exercise purely as a means of burning calories, losing weight and
sculpting their bodies. Exercise can also be used as a form of emotion avoidance. However, therapeutic
yoga avoids the negative or harmful uses of exercise and instead emphasizes a mind/body connection, self-
acceptance and anxiety management for eating disorders patients.
As Jenkins explains, “our physical, mental and emotional lives are all interconnected and cannot be isolated
from one another. Therefore, it’s not possible to change one aspect without influencing the whole. However,
yoga therapy helps us focus on and grow our awareness of this connection.”
“Like” this article if you acknowledge the benefits of yoga and eating disorders treatment, and share your
insights and questions on the topic below.
Individuals struggling with disordered eating
behaviors and negative body image issues will
often put up a seemingly impenetrable wall of
shame and secrecy, which often leaves friends
and family members frustrated as they try to
communicate concerns to their loved ones and
help them seek eating disorders treatment.
Due to the complex nature of eating disorders,
which are mental illnesses with serious physical
and sociocultural implications, friends and family
should be thoughtful and aware of their words
when approaching a loved one they fear is
showing symptoms of an eating disorder.
Eating disorders are a serious issue
Eating disorders affect individuals physically, mentally and emotionally and shouldn’t be taken lightly. If a loved
one is displaying worrisome or potentially dangerous behaviors, arrange a private time to talk with him or her,
away from any distractions. Friends and family should be open and honest about concerns while remaining
respectful and supportive of their loved one’s feelings. It is important to avoid accusatory “you” statements
like, “You’re acting irresponsibly,” which can feel critical and blaming. Instead, “I” statements are effective in
reiterating concerns; for example, “I am concerned that you’ve stopped eating lunch with us.”
Several attempts at intervention may be necessary
Malnutrition stemming from restricted caloric intake and significant weight loss can distort individuals’ self-
perception and alter their ability to see the signs of an eating disorder. While friends and family quite obviously
see the eating disorders symptoms, loved ones may be in denial or clinging strongly to their eating disorder
because it helps them escape from painful thoughts and feelings. If a loved one initially resists the
November 12, 2012
What to do if your loved one shows signs of an eating disorder | Julie Holland
idea that anything is wrong with his or her eating behaviors, try again. And again. Restate concerns as many
times as it takes, encourage them to seek an evaluation from an eating disorders professional and leave the
door open for further conversations.
Eating disorders recovery is not a “quick fix”
Experiencing lasting recovery takes significant time and involvement, from not only the eating disordered
individual, but also his or her treatment team and recovery support system. Disordered eating behaviors
often manifest over an extended period of time, and friends and family may not be aware of the extent of the
restrictive or compensatory behaviors that are occurring or how engrained those thoughts and behaviors are
in their loved one’s everyday life. It is important to remember that offering simple solutions, such as, “If you’d
just stop vomiting, then everything would be fine!” or “Just eat normally!” do not acknowledge the seriousness
of these illnesses or the time and effort it takes to achieve sustainable recovery. Instead, friends and family
should remind their loves one that they care deeply for him or her and that they are there as support before,
during and after treatment.
Although friends and family may be hesitant to intervene because they anticipate resistance and push back
from their loved one regarding observed symptoms of an eating disorder, expressing concern can ultimately
save lives. While eating disorders have the highest mortality rate of any other mental illness, continued
support from friends and family can help individuals struggling with eating disorders find the courage to seek
treatment and experience lasting eating disorders recovery.
If you found this article helpful and informative, please “like” it at the top of the page or subscribe to receive
email updates when new articles are available.
Eating disorders were once thought to be a “teenage girl disease”—in other words, a condition that only
affected young women. However, with each passing year, a rising number of men and boys are diagnosed with
eating disorders and come forward for treatment for body image issues. In fact, it is now believed that at least
10 percent of individuals struggling with eating disorders are men.*
Many wonder if this increase means that the actual number of men and boys struggling with eating disorders
is rising, or if the general public and medical community are simply becoming more cognizant of eating
disorders in men and boys, and therefore diagnosis is more common. From a biological standpoint, the
likelihood of a man developing an eating disorder is relatively equal to that of a woman, especially if the
individual has a family history of eating disorders, which have been found to have a strong genetic component.
For men and women alike, extreme diets, intense exercise regimens and pressure to live up to physical ideals
can trigger an eating disorder, especially if there is a genetic predisposition.
Like women, men often struggle with body image issues and are not always satisfied with how their bodies
look. Recent research suggests that approximately 80 percent of men would like to change their weight,
and nearly half of the men surveyed want to be thinner or more muscular.** These desires, paired with the
glamorized images of trim and muscular men often seen in the media, can make men feel even worse about
their own body images and actually trigger dangerous eating disorders behaviors. The pursuit of these ideals,
or the recognition that perfection cannot be achieved, can often result in depression and a range of feelings
including isolation, competitiveness and low self-esteem from which eating disorders can emerge.
November 20, 2012
Increased incidence of eating disorders in men | Julie Holland
This sentiment is echoed by Kenneth L. Weiner, MD, FAED, CEDS, a noted expert in the field of eating disorders.
“Like in their female counterparts, eating disorders in men and boys are often supported by psychological and
sociological pressures, such as traditional gender roles and socially accepted ideals of masculinity,” explains Dr.
Weiner, who serves as chief executive officer of Eating Recovery Center. “Just as media messages targeted to
women and girls promote unrealistic ideals of beauty and tips for achieving the coveted thin physique, males
are bombarded with media messages about masculine ideals of strength and six-pack abs.”***
While it is important that the healthcare community and general public understand that male eating disorders
can and do occur, it is equally important that the estimated one million men and boys struggling with these
illnesses seek treatment in order to experience lasting eating disorders recovery. Because eating disorders are
still widely viewed as a “woman’s disease,” many males may continue to shy away from seeking proper eating
Dr. Weiner further notes that when seeking male eating disorders treatment, it is important to seek recovery
resources with experience in addressing this fundamentally underserved eating disordered population and
an understanding of their individualized recovery challenges. These challenges can often include developing a
healthy relationship with exercise, limiting or avoiding exposure to athletic activities or professions that place
specific emphasis on weight or body size, and examining issues related to relationship and/or family dynamics.
Eating disorders are not gender-specific, nor do they discriminate by age, nationality or socioeconomic status.
Early intervention is always important to help men, women and children struggling with these illnesses
experience lasting recovery. If you are concerned about a loved one’s thoughts or behaviors, or have questions
about eating disorders in men and boys, chat confidentially with a member of Eating Recovery Center’s Clinical
Assessment team to get answers.
November 19, 2012
Eating disorders not just a women’s disease | Rod Carter
Dr. Weiner did a recorded interview in Tampa, Fla., while traveling for a speaking opportunity. The
interview was later complemented with a patient interview and story. It ran three times at 5 and 6
a.m. and 5 p.m.
See the CD at the back of this clipbook for full video.
November 21, 2012
Protecting Eating Disorders Recovery During the Holiday Season, Part I | Ken Weiner
The holiday season can be a particularly challenging time of year for individuals struggling with eating
disorders. The food-centric festivities surrounding most holidays can feel overwhelming to patients, regardless
of their stage in the recovery process. In response to the anxiety that can accompany heightened exposure to
food and gatherings of friends, family and colleagues, treatment professionals often observe an escalation of
eating-disordered thoughts and behaviors and lapses in recovery during this time of year.
From Halloween through New Year’s Day, gatherings can tend to feel like a constant focus is placed on food,
and the food served isn’t often the healthiest of options. For some, being surrounded by comfort foods and
sweets can make eating in moderation a difficult task. For others, the overabundance of food and a focus on
sitting down together for family meals can cause anxiety.
According to Marla Scanzello, MS, RD, director of dietary services at Eating Recovery Center, the key to
navigating holiday eating with confidence lies in planning for challenges that may arise, as well as placing an
emphasis on practicing flexibility and asking for support.
“Many patients struggle to accept when things don’t go as planned, and they have difficulty realizing that one
meal doesn’t make or break their eating disorders recovery progress,” explains Scanzello.
No matter your stage in the recovery process, practicing these five strategies can help you protect your eating
disorders recovery during the holidays and avoid potential triggers for eating disorders relapse.
1. Shift the focus from food, meals and counting calories to celebrating and spending time with loved ones.
Spending your time evaluating available food to identify the healthiest options keeps you “in your head” and
prevents you from meaningfully engaging with the people that care about you most. Accept that food is a part
of seasonal get togethers and reframe your thoughts to emphasize interaction with family and friends over
meals themselves and the types of foods served.
2. Avoid “good food”/”bad food” talk. In general, healthy eating is all about moderation, and this notion is
particularly true when it comes to traditional holiday fare. Rather than labeling foods as “good” or “bad,” try to
enjoy healthy portion sizes during each course.
3. Avoid “overbooking” your schedule with holiday functions. Shopping for holiday gifts, attending all the
holiday functions and hosting your own parties can make for a stressful holiday season. It’s important not to
“overbook” yourself during this time and maintain an awareness of your stress level. Trust your instincts and
take a break if events and obligations become overwhelming. Don’t worry about disappointing friends and
family if you’re unable to attend this gift exchange or that dinner; they’ll understand that protecting your
recovery is your No. 1 priority.
4. Surround yourself with people who have healthy relationships with their bodies, food and weight. If
possible, bring a trusted family member or friend with you to holiday gatherings, and be sure to keep lines of
communication open and honestly discuss your challenges, victories and goals with members of your support
network. If you’re comfortable doing so, share your thoughts and feelings with trusted individuals; if they
understand why the holidays can be a difficult time for you, it will help them provide eating disorders support.
5. Continue working with your outpatient dietitian. Ongoing nutrition counseling with a registered dietitian
provides powerful guidance, support and education to help patients overcome their fear of food and normalize
eating behaviors, particularly during times of stress. If holiday travel keeps you from keeping your regularly-
scheduled appointments, consider speaking with your dietitian by phone for a brief check in or corresponding
by email about your experiences and dietary challenges.
For more information about eating disorders treatment or protecting recovery during the holiday season, visit
If you’re struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.
November 28, 2012
Protecting Eating Disorders Recovery During the Holiday Season, Part 2: Advice for
Friends and Family | Ken Weiner
In my last post, I outlined several strategies that those in recovery from an eating disorder can draw on during
the holiday season to protect their ongoing recovery. Family and friends can be additional champions to
support a behavior-free holiday season, and a supportive network is essential to navigating this often hectic
time of year. However, despite the best of intentions, loved ones can sometimes inadvertently cause stress and
anxiety in their efforts to spend quality time together and carry on their long-standing traditions.
The advice below seeks to help friends and family understand the unique needs of someone recovering from
an eating disorder and be a champion for sustainable recovery during the holiday season.
1. Take it easy. As much as you want to re-engage your loved one into all of your holiday traditions, ease into
the holiday season by focusing on activities that don’t involve food, such as putting up decorations or sending
2. Be mindful of the needs of your loved one during holiday gatherings. Eating-disordered patients and
individuals in recovery are often “people-pleasers,” and will hide their anxiety in an effort to meet the
emotional needs of friends and family. If your friend or family member doesn’t feel as though they can attend
an event, support them in this decision even if you feel disappointed. If your loved one is willing and able to
attend a holiday gathering, support them if they need to “escape” for some fresh air to keep their emotions
in check, and be willing to leave early if the festivities begin to feel overwhelming. It may be helpful to agree
on a signal or sign that your loved one can use when he or she needs your help to change the subject during
a conversation with a nosy neighbor or a tipsy relative, or when he or she needs to take a moment away to
3. Plan ahead. Provide as much information as possible to your friend or loved one regarding holiday activities
-- where, when, what types of food will be available and whether alcohol will be served. Information and
preparation can help patients in recovery plan ahead, practice flexibility and avoid situations that might trigger
an eating disorders relapse.
4. Consider scheduling family therapy sessions when family members are together. Family relationships can
play an important role in eating disorders recovery. Ask your loved one if it would be appropriate to invite
relevant family members to participate in therapy sessions when they’re in town for the holidays. Families with
members scattered across the country can make use of holiday vacations spent together to address important
issues, or use therapy sessions to learn how to help the entire family navigate the holidays while supporting
your loved one’s recovery.
5. Make your loved one’s eating disorders recovery a priority. Altering holiday traditions in the short term can
significantly impact your family member or friend’s wellbeing in the long term. Changing traditions or creating
new traditions to meet the needs of your loved one in recovery can feel disappointing and scary, but remind
yourself that eating disorders recovery is fragile and that you have the power to help protect it.
Eating disorders are complex illnesses, and in spite of abundant love, support and understanding from friends,
families and colleagues, relapse can happen. In many cases, outpatient care -- appointments with a therapist,
psychiatrist or dietitian or participation in an intensive outpatient program (IOP) a few days each week --
can address the recurring thoughts or behaviors. In some cases, however, a higher level of care may be the
recommendation of an eating disorders professional to restore medical, psychological and sociocultural health.
To learn more about eating disorders treatment and addressing escalating eating disordered thoughts and
behaviors this holiday season, chat live with a master’s-level therapist at www.EatingRecoveryCenter.com.
If you’re struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.
For more by Kenneth L. Weiner, M.D., FAED, CEDS, click here.
For more on eating disorders, click here.
November 27, 2012
As Holidays bring heightened risk for Eating Disorders Relapse, Eating Recovery
Center promotes strategies for protecting recovery
Americans who regularly have high levels of overall stress are most likely to feel stress specific to the holidays,
according to a recent survey conducted by Mental Health America. For individuals in recovery from eating
disorders, who are typically predisposed to higher levels of anxiety, this is particularly true. The frenetic pace of
the holiday hustle and bustle and increased emphasis on food-centric gatherings can lead to heightened stress,
and in severe cases, eating disorders relapse. To help individuals in recovery from an eating disorder maximize
the chances for a healthy, happy holiday season, Eating Recovery Center recommends patients and their loved
ones take proactive steps to plan for recovery-focused holiday celebrations.
“Treatment professionals frequently see increases in eating disordered thoughts and behaviors in patients
during the holiday season. Often, these lapses in recovery are a response to the anxiety that can accompany
gatherings of friends and family, as well as more emphasis on and exposure to food,” explains Ovidio
Bermudez, MD, FAAP, FSAHM, FAED, CEDS, chief medical officer and medical director of child and adolescent
services at Eating Recovery Center. “To minimize the effects of these stressors and protect recovery during the
holiday season, it is important to plan activities that emphasize recovery, commit to a manageable schedule
and prepare for the ‘what-ifs’ that may arise.”
Eating Recovery Center offers the following strategies to help individuals in recovery, as well as their support
systems, healthfully navigate the holiday season and minimize chances for eating disorders relapse.
If you are in recovery from an eating disorder:
1. Turn the focus from food. Make togetherness, rather than food, the central theme of your holiday season
and seek opportunities to plan and attend events that do not center around a meal.
2. Avoid “overbooking” your schedule. Prioritize your health and wellbeing over attending every holiday party,
and be realistic about what you can manage.
3. Surround yourself with people who have healthy relationships with their bodies and food. If possible, bring a
trusted family member or friend with you to holiday gatherings for support.
If you are supporting someone in recovery from an eating disorder:
1. Include your loved one in holiday activity planning. With the help of his or her treatment team, your loved
one can guide you as you plan new recovery-focused holiday traditions.
2. Give your loved one “the 411.” Provide information about holiday activities in advance, including what types
of food will be available and if alcohol will be served. Preparation can help those in recovery avoid situations
that might trigger a relapse.
3. Make your loved one’s recovery a priority. Consider altering holiday traditions in the short-term to protect
your friend or family member’s wellbeing in the long-term.
“Additionally, staying connected to an outpatient treatment team, including dietitians, therapists and
physicians or psychiatrists, can be extremely helpful during the holiday season,” explains Dr. Bermudez.
“Whether from eating disorders treatment professionals, friends or family, it is important that individuals in
recovery from an eating disorder seek out the support they need to successfully navigate this complex time of
To learn more about Eating Recovery Center as a treatment resource for addressing escalating eating
disordered thoughts and behaviors this holiday season, visit www.EatingRecoveryCenter.com.
One of my goals this year is to reclaim the holidays from the clutches of commercialism, family drama and
the belief that things have to be perfect. It’s ironic that the biggest holiday season of the year is also the most
stressful for many people. It’s as if we all decided to throw ourselves a party with the foreknowledge that it’s
going to be miserable. Wouldn’t just going to work instead be the more peaceful option?
How crazy! It’s sobering, though, to remember that for the many people struggling to recover from an eating
disorder, the stakes are much, much higher. The holidays aren’t just a challenge to common sense, they can be
“Even for patients who are making good progress in overcoming an eating disorder,” says licensed professional
counselor Bonnie Brennan, “we may have to hit the ‘reset’ button after the holidays.” Brennan, who is cinical
director of the Eating Recovery Center’s Adult Partial Hospitalization Program in Denver, tells the story of one
patient who quailed at the thought of making the annual holiday trek to the family home. The house was
usually packed to the rafters with extended family, affording very little privacy and opportunity to escape from
the “family ledger of past resentments.”
Even ostensibly warm and nostalgic annual rituals such as posing for the annual family picture could erupt into
discussions about past differences, by both the patient and her siblings.
Since she couldn’t put a physical wall between herself and the family, says Brennan, the next best thing her
patient could do to set boundaries was to sneak off into the garage or the laundry room, where food for the
holiday festivities was temporarily stored. There, she could binge in secret, “taking a time out, but not in
the most functional way,” explains Brennan. The sensation of numbness that follows a binge, of “not being
emotionally present, was a way of putting an invisible wall around herself.”
So what was Brennan’s advice? To politely tell her family’s inner circle that as much as she loved them, it was
not healthy to be at the annual extended family holiday gathering, and instead to plan smaller events with
individual family members throughout the year. For the holidays the patient planned to stay in her hometown,
where she and her husband and children could visit with family friends in environments she knew she would
Instead of being honest about the reason for not coming to the family gathering, some people in this situation
might be tempted to finesse their way out of the situation, offering excuses other than the truth. Brennan
disagrees with this approach, saying, “Unless there’s some dire consequence to being transparent it’s usually
healthier to be straightforward about why you might be making the decision to take care of yourself. You
can say to your family member, ‘I love you, I really appreciate you but I need to take care of myself during
this family holiday’…eating disorders thrive in secrecy and it’s about how to have relationships that are more
meaningful and authentic.”
Fair enough. But what about extended family members? Do you really have that conversation with them too?
Brennan believes, yes, not necessarily immediately, but gradually over time letting everyone know the truth.
November 30, 2012
Saying No to Holiday Gatherings to Protect Recovery | Nancy Matsumoto
Since there is a strong genetic component to eating disorders, it’s highly possible that you might see evidence
of an emerging disorder in a niece, nephew or second cousin. “There is a benefit to letting blood relatives
know because 40-50% of the risk of developing an eating disorder is genetic. For example, a woman with a
sister or mother with anorexia is 12 times more likely to develop anorexia nervosa and four times more likely
to develop bulimia nervosa” explains Brennan. “You might be helping a family member get early access to
December 1, 2012
Diabetes and Eating Disorders — Together They’re Linked With a Double Dose of
Health Consequences | Ellen Lachowicz Morrison, MS, RD, LDN, CEDRD
Anna is 17 years old, has a medium frame, and a naturally round body type. At the age of 10, she was
diagnosed with type 1 diabetes after experiencing significant weight loss. Once she began taking insulin, her
weight returned to normal.
Currently, Anna eats three meals and one snack per day, adding up to about 2,200 kcal. Her medication
regimen includes both basal insulin and rapid-acting insulin. Anna checks her blood sugar three times per day,
and it’s always in the normal range. Nevertheless, she presents with weight loss and recurrent glycosylated
hemoglobin A1c levels above 12%. Anna is pleased with the 15-lb weight loss and her BMI of 18.3, but her
mother is concerned about her elevated A1c levels and the associated complications.
During the initial nutrition assessment, the dietitian asked Anna why she thought her blood sugar readings
were normal while her A1c levels were elevated. Anna confessed she doesn’t always give herself the full
dose of the rapid-acting insulin and sometimes skips it all together. This led to the discussion of how she
manipulates her blood sugar readings by placing diluted juice or blood on the blood sugar test strips. She said
she always takes her basal insulin to avoid diabetic ketoacidosis, a potentially life-threatening complication in
which the body fails to adequately regulate ketone production, causing the accumulation of keto acids and a
decrease in blood pH. Anna has been manipulating her insulin for more than six years and is beginning to show
signs of microvascular complications.
Anna suffers from the dual diagnosis of type 1 diabetes and bulimia nervosa, the combination of which is
characterized by bingeing on large amounts of sugary or carbohydrate-rich foods and purging the excess sugar
through urination. Individuals with bulimia nervosa who don’t have diabetes binge on large amounts of food
but purge with the use of laxatives, self-induced vomiting, or excessive exercise to prevent weight gain.
The preferred clinical acronym for patients with type 1 diabetes and bulimia nervosa is ED-DMT1, although the
lay press started using the term “diabulimia” in 2007 to identify this complex diagnosis. ED-DMT1 is defined
as the manipulation of insulin to induce weight loss or avoid weight gain.1 Although the fourth edition of the
Diagnostic and Statistical Manual of Mental Disorders text revision doesn’t list insulin specifically, this behavior
is a form of purging calories through glycosuria.
This continuing education course will discuss the prevalence of diabetes and eating disorders, and review the
symptoms and treatment strategies dietitians can use in practice to care for this vulnerable patient population.
According to the 2011 National Diabetes Fact Sheet from the Centers for Disease Control and Prevention, 25.8
million American children and adults have diabetes. This number represents 8.3% of the US population. One
in every 400 children and adolescents has the disease and, more specifically, it affects 11.8% of adult men and
10.8% of adult women.
Bulimia nervosa is more prevalent in women who have type 1 diabetes; binge-eating disorder, a condition
characterized by episodes of compulsive overeating, is more prevalent in women with type 2 diabetes.2 Having
type 1 diabetes and anorexia nervosa, a psychiatric disorder associated with an unrealistic fear of weight gain,
self-starvation, and a distorted body image, is extremely rare.3
Research data on ED-DMT1 is scarce due to the limited number of studies, sample size, diversity within the
sample, methodology, and the diagnostic criteria used.2 In addition, most of the studies include only women,
so the prevalence in men is unknown. Some data suggest the ratio of ED-DMT1 is 10:1 for women and men,
respectively.4 It’s estimated that women with type 1 diabetes are 2.4 times more likely to develop an eating
disorder than those without diabetes, and that the mortality rate for those with ED-DMT1 triples compared
with those who have diabetes alone.4 Since most individuals are in denial in the early stages of an eating
disorder, obtaining accurate data is difficult.
According to research compiled by the National Eating Disorders Association, as many as 10 million females
and 1 million males in the United States suffer from an eating disorder such as anorexia nervosa or bulimia
nervosa, and millions more struggle with binge-eating disorder.
Consequences of Eating Disorders in Diabetes
The behaviors associated with bulimia nervosa in diabetes patients have cognitive, emotional, and social
consequences (see Table 1 below). Individuals with bulimia can experience chronic thoughts of food and
eating, anxiety and depression, and feelings of isolation and mistrust of self and others. Patients often have
distorted thinking that minimizes their concern for the long-term adverse health effects of elevated blood
sugar, despite the fact they face the possibility of diabetic ketoacidosis, coma, and even death. Because of
irrational thinking caused by the eating disorder and their obsession to be thin, they’re willing to cope with
the immediate effects of high blood sugar, such as dehydration, fatigue, and difficulty concentrating, which
become a comfortable discomfort in an effort to lose weight.
If patients with weight-related type 2 diabetes develop anorexia nervosa, which is rare,5 it’s well known that
the resulting weight loss may reverse the disease process of insulin resistance, and the patient may become
free of diabetes symptoms. Patients with diabetes and binge-eating disorder experience increases in blood
sugar levels following a binge-eating episode. The weight gain that often results from this repetitive behavior
can trigger or accelerate the associated complications of diabetes, such as neuropathy and retinopathy, along
with the risks of obesity, cardiovascular disease, hyperlipidemia, hypertension, difficulty breathing, sleep
apnea, and increased fatigue.
If a dietitian suspects a patient has an eating disorder, he or she should ask important questions about eating
disorder behaviors during the nutrition assessment. The dietitian can ask patients if they’re restricting food,
bingeing, purging (eg, self-induced vomiting; misusing laxatives, diuretics, or diet pills; using ipecac to induce
vomiting); manipulating insulin and blood sugar readings; exercising excessively; and engaging in eating rituals.
Are they avoiding foods, distorting portions, weighing themselves frequently, and other associated behaviors?
Moreover, it’s helpful to ask if there are other family members who have struggled with eating disorder issues.
Asking questions about herbal remedies also should be included, since this population may use them in
weight-loss efforts and experience negative side effects when used with diabetes medications.6
Treatment for diabetes patients with eating disorders is complex. It often requires collaboration among
members of a healthcare team to address various aspects of a patient’s health (see “The Treatment Team”
below). Dietitians are a vital part of this team. Nutrition counseling focuses on correcting disordered
eating behaviors and beliefs about food, weight, and exercise. RDs provide patients with nutrition education,
encourage them to experiment with healthful foods and behaviors, assist in normalizing food patterns, and
One challenge dietitians face when working with diabetes patients with eating disorders is how to educate
them about carbohydrate counting and label reading while avoiding the discussion of calories and weight,
which is often contra-indicated in individuals who are obsessed with food and body size.7 Choosing not to
discuss the patient’s weight is a widely used practice in eating disorder treatment centers and by dietitians
who specialize in eating disorders. Eating disorders aren’t about food, calories, weight, or vanity; they’re about
unresolved emotional issues. Patients who focus on food and weight in an attempt to control their emotions
do so with grave health consequences. This is a key factor for dietitians to understand when working with this
In an outpatient setting, the healthcare team must follow the patient closely. Trust between the patient and
team members develops slowly, so it’s important for members to be nonjudgmental of the patient’s size,
thoughts, and behaviors, and when validating the patient’s feelings and struggles. This is best done using an
individualized treatment approach. If one isn’t already on the team, a referral to a certified diabetes educator
with experience treating eating disorders may be warranted. The immediate goal is to stabilize the patient. The
long-term goal is to regain metabolic balance, correct malnutrition and, if necessary, restore the patient to a
normal weight. 7
When treating clients who manipulate insulin intake, the healthcare team should give the responsibility of
insulin administration, blood sugar monitoring, and carbohydrate counting to a parent or spouse. If a patient
uses an insulin pump, switching to single injections often is recommended. Patients can earn back these
responsibilities as they successfully move forward with treatment.6
It’s important for dietitians to know that calorie counting, food restriction, and frequent weighing are contra-
indicated in patients with eating disorders since these behaviors are central to eating disorder obsessions used
to cope with emotions.7 Therefore, helping clients decrease these behaviors is a common goal in treatment.
Using a nondiet approach such as Intuitive Eating or Health at Every Size often is more beneficial. With Intuitive
Eating, the typical dieting behaviors are replaced with identifying hunger and satiety cues to determine what,
when, and how much to eat. With the Health at Every Size approach, health parameters, not the size of the
individual, are the main focus.
Moving patients away from the idea that there are good and bad foods is essential, since they’re extremely
self-critical and often judge themselves as good or bad if they eat foods labeled as such. The message should
be that all foods are acceptable. Dietitians can counter their patient’s negative self-talk by asking them to
reframe their statements in a nonjudgmental way. The statement “I was bad yesterday because I ate pizza,”
can be changed to “I chose to eat pizza as part of my meal plan.” The statement “I had a bad day because I ate
ice cream,” can be changed to “I ate ice cream, but I wasn’t physically hungry. What can I learn from this?”
Patients will need much support with this, since positive self-talk may be foreign to them.
Eating disorders are psychological diagnoses with physiological complications. Dietitians are trained to address
physiological health issues but not so much the psychological factors. Thus it’s important for RDs to receive
additional training in this area, not to perform psychotherapy but to learn how best to work with these clients
and their therapists.6
Frequent communication with the therapist and other team members on how the client presents in the RD
session as well as their current eating disorder behaviors is essential for proper treatment.
Psychological diagnoses that commonly occur with eating disorders may include anxiety, depression,
obsessive-compulsive disorder, bipolar disorder, borderline personality disorder, and post-traumatic stress
disorder. Moreover, self-harming and suicidal ideation often occur in these populations.
Dietitians working with these patients should be trained in the most common psychotherapy approaches
used in treatment so healthcare team members are on the same page and can communicate effectively.
Mixed messages from team members will confuse patients and interfere with treatment. Some psychotherapy
treatment approaches used include cognitive behavioral therapy, dialectical behavior therapy, acceptance and
commitment therapy, and psychoanalysis.6
Cognitive behavioral therapy addresses dysfunctional emotions, behaviors, and thought processes through
a goal-oriented systematic process. It involves teaching patients to think in a different way to allow them to
change their behaviors. Dialectical behavior therapy combines cognitive behavioral therapy with emotional
regulation and mindfulness skills. Acceptance and commitment therapy is a cognitive behavioral therapy
approach using acceptance and mindfulness strategies taken from the Buddhist religion to evoke behavior
change. With psychoanalysis, repressed feelings are brought to light in an effort to resolve conflict between the
conscious and unconscious.
According to Emmett Bishop, MD, FAED, CEDS, founding partner and medical director of adult services at the
Eating Recovery Center in Denver and a highly respected eating disorder expert, rational behavior therapy,
a form of cognitive behavioral therapy, is gaining in popularity. Rational behavior therapy is used when an
individual isn’t in touch with his or her emotions, which is common in the adolescent population. It addresses
how one thinks, setting aside emotions.
Craig Johnson, PhD, FAED, CEDS, chief clinical officer at the Eating Recovery Center and a leader in eating
disorder research, adds that the Maudsley approach is an effective treatment for children and adolescents. The
basis of Maudsley is to empower parents as authorities on feeding (or refeeding) their child; food is seen as
medicine. Dietitians who are trained Maudsley practitioners can provide this treatment, although the approach
assumes the parents know best about how to feed their child. In this instance, the practitioner works as a
facilitator of the process.
Before taking any therapeutic approach, dietitians must resolve any body image and self-esteem issues they
may have since these struggles are at the crux of eating disorders, said Katherine Zerbe, MD, an expert in
the field of eating disorders at the Oregon Psychoanalytic Center in Portland, during a 2012 presentation for
the North Carolina Psychoanalytic Society. If this isn’t accomplished, the dietitian’s unresolved issues will
negatively influence the therapeutic process and impact treatment.
Moreover, dietitians will need to understand and validate the patient’s feelings without allowing their own
emotions or opinions to surface. They also will need to be cognizant of transference and countertransference
issues. Transference occurs when clients transfer their feelings for a family member or other person onto the
clinician. Countertransference takes place when clinicians transfer their feelings onto the client.
These conflicts make it necessary for both the therapist and the dietitian to obtain ongoing supervision with
difficult cases by seeking assistance and guidance from a therapist or highly trained RD. Education is ongoing
and ever changing, so monthly individual or group sessions are recommended.
Counseling Strategies for Dietitians
According to Deborah Russo, PsyD, a private practitioner who specializes in eating disorders, counseling
techniques that have been effective in diabetes patients with eating disorders are motivational interviewing,
assessing motivation for change, and mindful eating.
Motivational interviewing involves recognizing that clients who need to make changes in their lives approach
counseling at different levels of readiness. For motivational interviewing to be successful, four basic principles
should be employed: expressing empathy, developing discrepancy, rolling with resistance, and supporting self-
The main goals of motivational interviewing are to establish rapport and elicit change in thought patterns to
help the individual move toward behavior changes.8 For example, patients will work on moving away from
saying “I can’t” and toward saying “I can” or “I’m willing,” and learn to evoke language that’s commitment
based, such as “I will” vs. “I’ll try.” This involves partnership not confrontation, eliciting a response from
the patient rather than focusing on didactics, autonomy rather than authority, and exploration instead of
To accomplish this, RDs can ask “What do you think prevented you from accomplishing your goal?” “What
change do you see yourself making this week?” or “I’m curious about how you developed this belief. Can we
explore this more?”
To be effective, dietitians must zero in on goals that are important to the patient. The goals can be small as
long as they help the patient feel successful, but they should be specific, realistic, and centered on the present
and future8 (eg,”I will eat 100% of my meal plan daily” or “I will check my blood sugar three times a day
Assessing Motivation for Change
It’s important for dietitians to determine the degree to which patients are ready to change their eating
behaviors. They can do this by using what’s called the Transtheoretical Model, which evaluates change as a
process that involves progression through the following stages:9
Precontemplation: There’s no intention to take action in the foreseeable future, and the patient may be1.
unaware his or her behavior is problematic.
Contemplation: The patient is beginning to recognize his or her behavior is problematic and may review2.
the consequences of continued actions.
Preparation: The patient intends to take action in the near future and may begin taking small steps3.
toward behavioral change.
Action: Steps are taken to modify behavior and acquire new healthful habits.4.
Maintenance: The patient sustains action for a while and is working to prevent relapse.5.
An additional step, Termination, may be considered when there’s no temptation to practice old behavior, and
the patient is committed to the new behavior as a way to cope.
In this model, resuming old behaviors is viewed as a return from the Action or Maintenance stage to an earlier
stage. It’s not viewed as a failure but as a learning experience. Knowing what stage the patient is at will help
the dietitian direct the session to best meet the patient’s needs.
Mindful eating involves slowing down the eating process to appreciate all aspects of the dining experience:
appearance, color, texture, aroma, taste, changes in taste and texture as one chews, and how it feels when one
Eating mindfully has been gaining popularity both in dietetics and psychology. It’s an effective tool to help
individuals get in touch with their body’s hunger and satiety cues as well as other ways the body
communicates. Michelle May, MD, and Megrette Fletcher, MEd, RD, CDE, coauthors of the book Eat What
You Love, Love What You Eat With Diabetes, say they’ve been using this approach successfully with diabetes
patients for many years.10
May uses the mindful eating technique to help patients learn what foods they like and don’t like. It’s been
the author’s experience that many people with binge-eating disorder learn that they binge on foods they
don’t like. This may speak to the belief that they don’t deserve pleasure. These new insights can help patients
eliminate those foods from their diets.
Mindful eating also helps patients make associations between emotional issues and certain foods. If patients
are used to isolating themselves during meals, mindful eating principles can encourage them to eat with
Closing a Gap in Treatment
ED-DMT1 is defined as the manipulation of insulin to induce weight loss or avoid weight gain. Although
research is limited, it’s estimated that women with type 1 diabetes are twice as likely to develop an eating
disorder, most often bulimia, than women without diabetes. Women with type 2 diabetes are more prone to
developing binge-eating disorder. Binge-eating episodes and the weight gain that often follows can accelerate
the onset of diabetes complications.
As mentioned previously, eating disorders coupled with diabetes can have cognitive, emotional, and social
consequences, leading to treatment that can be complex. Close communication between members of a
healthcare team is important for successful treatment. The dietitian is a vital part of the team, assisting the
individual in changing his or her perspective on food, weight, and exercise habits. A nondiet approach is
recommended for this population, since obsession with calorie counting, frequent weighing, and other typical
dieting behaviors are common.
Effective counseling strategies include motivational interviewing, assessing motivation for change, and mindful
eating. Dietitians working with patients are advised to receive training in the most common therapeutic
approaches. Often transference and countertransference as well as other negative therapeutic dynamics occur
during counseling sessions, calling for regular supervision from a therapist or a more experienced, well-trained
December 4, 2012
4 Ways To Navigate The Holidays When You Have An Eating Disorder | Margarita
The holidays can be a difficult time for people
recovering from eating disorders. There’s the
abundance of food and the potential for family conflict.
There’s the addition of tons of tasks to your list. It can
be overwhelming, no doubt.
That’s why I’m pleased to share some insight from
experts at the Eating Recovery Center on how to
overcome these kinds of obstacles and stay healthy.
1. Have a plan. Dr. Ovidio Bermudez, MD, chief medical
officer and medical director of child and adolescent
services at Eating Recovery Center, stressed the
importance of communicating with your treatment
Create a plan for the holidays that emphasizes recovery,
and prepare for the what-ifs that might come up, he
said. For instance, consider how you’ll navigate the
stressors that used to trigger a relapse for you. Consider
the many healthy options you’ll use to cope with stress and potential challenges.
2. Be gentle with yourself. Recovery takes practice. According to Bonnie Brennan, MA, LPC, clinical director of
Eating Recovery Center’s Partial Hospitalization Program:
If you do find yourself overeating or resorting to disordered eating behaviors, be gentle with
yourself. The holidays are the hardest time of the year for individuals with eating disorders and
you are not expected to be perfect. It is important to remember that a healthy relationship with
food takes practice. You wouldn’t expect a piano student to play a concerto perfectly in front of
an audience would you? Use any slips this holiday season as opportunities to reinvest in your
recovery rather that beat yourself up and add to the pain.
3. Focus on what you value. Cultivate gratitude about what’s important to you this holiday season. According
to Elizabeth Easton, PsyD, clinical director of child and adolescent services at Eating Recovery Center’s
Behavioral Hospital for Children and Adolescents:
Try focusing on the holidays in a broader context with an emphasis on what you value. This can
help individuals in recovery from an eating disorder shift from getting lost in the details that
may trigger feelings of anxiety, sadness or fear.
When we focus on the “bigger picture” during the holidays, the chance to spend time with
friends and family, finding [a] present for a loved one or the opportunity to slow down and
recognize what you are grateful for, the holidays no longer focus on eating disordered behaviors,
but rather our values.
“Remember that you are celebrating and honoring traditions, both within your family and, when applicable, of
your religious and cultural upbringing,” said Karen Trevithick, PsyD, CEDS, clinical director of outpatient services
at Eating Recovery Center.
4. Focus on relationships. Eating disorders tend to narrow your world, and separate you from the people in
your life. During the holidays, instead of isolating yourself, try to connect with others.
This can be as simple as starting a conversation. “When you are spending time with friends and loved ones, try
to engage in conversations,” Trevithick said. “It is OK to be curious about others and their own experiences this
These are additional tips from Eating Recovery Center’s press release:
Turn the focus from food. Make togetherness, rather than food, the central theme of your holiday•
season and seek opportunities to plan and attend events that do not center around a meal.
Avoid “overbooking” your schedule. Prioritize your health and wellbeing over attending every holiday•
party, and be realistic about what you can manage.
Surround yourself with people who have healthy relationships with their bodies and food. If possible,•
bring a trusted family member or friend with you to holiday gatherings for support.
By the way, you might find this post on holiday coping helpful. Stay tuned tomorrow for insight on supporting a
loved one with an eating disorder during the holidays.
December 6, 2012
6 Ways To Support Someone With An Eating Disorder During The Holidays |
As a partner, family member or friend,
you might be unsure about how to help
your loved one during the holidays.
You want to support them through this
potentially tough time. But you just don’t
know how to go about doing that.
Here’s some insight from the experts at
Eating Recovery Center that might help.
1. Avoid being the food police.
According to Bonnie Brennan, MA,
LPC, clinical director of Eating Recovery
Center’s Partial Hospitalization Program:
Unless a treatment team has given you a plan to monitor and portion your loved ones’ food, do
not play “food police.” This can raise your loved one’s anxiety and backfire big time. So, I advise
friends and loved ones to “drop the rope” and focus on enjoying the wonderful person in front
of you. After all, the holidays are about connections with others and food is only one piece of
2. Respect their recovery. As Brennan said, “Some individuals with eating disorders are not ready for a big
meal or party or eating in front of many people with so many different food choices. If that is the case with
your friend or loved one, respect where he or she is at in the recovery process.”
3. Keep things simple and small. “Depending on where a friend or loved one is in the recovery process, this
holiday season may be time to keep plans simple and small. When your holiday plans involve traveling and
seeing many different people and relatives in different contexts, it may be too overwhelming for the individual
with an eating disorder—and for you too!” Brennan said.
4. Let go of perfection. “Although you may long for an ideal holiday celebration, you have a friend or loved one
who is challenged with a life threatening illness. Remember to stay recovery-focused and that things will not
be perfect,” Brennan said.
5. Ask your loved one how you can help. According to Elizabeth Easton, PsyD, clinical director of child and
adolescent services at Eating Recovery Center’s Behavioral Hospital for Children and Adolescents:
If you are a parent or family member of a loved one recently in recovery from an eating
disorder, it is important to be aware and mindful during the holiday season. Ask your loved one
questions and try to validate the possible stressors of holiday events. For example, “What can I
do to support you with during tonight’s holiday party?”
6. Pay attention to your own relationship with food and your body. This can include everything from how you
speak about food and yourself — “Oh, that has too many calories” or “That’ll go right to my hips” — to how
you approach New Year’s resolutions. “For instance, set a New Years resolution to ‘focus on health’ as opposed
to ‘lose weight’ or ‘cut out carbohydrates,’” Easton said.
There are many ways you can support someone who’s recovering from an eating disorder. Reach out, and ask
them how you can help. Be compassionate, and communicate your concern and support.
If you’re not sure what else to do, contact your loved one’s treatment team or another clinician who specializes
in eating disorders for insight.
Last week, the American Psychiatric Association announced that it had approved several revisions to the fifth
edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the manual widely used by mental
health clinicians to diagnose disorders. The first significant update to the DSM in almost 20 years has many
eating disorder professionals thrilled. Among the changes to the latest edition is the reclassification of binge
eating disorder as an official, recognized mental health diagnosis. With this change, experts anticipate that
clinicians will better recognize the symptoms and behaviors of individuals with binge eating disorder, and that
patients and families will have less difficulty identifying and affording appropriate treatment.
Binge eating disorder affects many men, women and children in the United States. In fact, research suggests
that binge eating disorder affects as many as 3.5 percent of American women and 2 percent of American
men.* Individuals with binge eating disorder symptoms engage in regular episodes – at least twice a week for
six months – of eating larger than normal amounts of food in a short amount of time (any two-hour period).
These bingeing episodes are generally accompanied by an out-of-control feeling and are often followed
by intense feelings of disgust, depression or guilt. This shame and disappointment can sometimes trigger
compensatory behaviors, such as purging, laxative use or excessive exercise, but unlike the compensatory
behaviors associated with bulimia nervosa, these behaviors are not sufficient to entirely counteract the
amount of food eaten during a bingeing session.
Warning signs of binge eating disorder that parents, friends and loved ones can look for include:
sudden weight gain;•
eating outside of regular meal times;•
withdrawing from normal activities, friends and family;•
and even missing money due to purchasing large quantities of food.•
In addition, an overabundance of wrappers from consumed food, or the swift disappearance of food that
generally lasts longer may also indicate signs of binge eating.
Another important warning sign is family history. Like other eating disorders, it is commonly understood
that genetics play a role in the development of binge eating disorder. A strong drive toward perfectionism, a
tendency for rigid, “black and white” thinking and engaging in risky behaviors are a handful of the inheritable
personality traits commonly seen in binge eating disorder patients. Individuals with these characteristics are
more likely than others to develop an eating disorder, especially if their latent predisposition toward the illness
is triggered by a traumatic event, including bullying, divorce or abuse, among others.
One commonly misunderstood factor in identifying and addressing binge eating disorder is its relationship with
an individual’s weight.
December 11, 2012
Binge eating disorder defined | Julie Holland
“Individuals do not have to be overweight to have binge eating disorder,” explains Chevese Turner, chief
executive officer of the Binge Eating Disorder Association (BEDA). “They can be at a normal weight and even
underweight, underscoring the importance for medical and healthcare providers to be well educated about
binge eating disorder symptoms.”
The issue of weight extends into binge eating disorder recovery as well. Equating recovery to body size
can actually be quite harmful, as those struggling with eating disorders have long associated success and
acceptance with body shape and size. Eating disorders recovery is not solely about losing or gaining pounds to
achieve a healthy weight for physical and emotional functioning, but also about intense work to address and
eliminate dangerous disordered eating thoughts and behaviors, including bingeing episodes.
Subscribe to receive email alerts with the latest articles, and please share your comments and questions about
binge eating disorder.
The holidays are a busy time of
year for everyone, full of hustle
and bustle, gifts to purchase and
parties of friends, family and
colleagues. Despite the inescapable
holiday cheer and a long list of
festivities to attend, stress levels
often rise during the holiday
season. For individuals in recovery
from an eating disorder, this stress
can be that much more intense as
schedules become overwhelmed
with invitations to events that
center around food, including
cocktail parties, family dinners and
For an individual in eating disorders
recovery, the key to managing that recovery during the holidays is preparation. Gathering information about
upcoming events and ongoing involvement with an outpatient treatment team can help protect recovery and
limit the negative effects of holiday stress.
Surround yourself with positive body image role models.
It is important for individuals in recovery to surround themselves with friends and family who have healthy
relationships with their bodies and food. Eating disorders recovery is an ongoing process, and one meal or a
disappointing experience at a holiday event does not make or break an entire recovery process. Look to these
individuals to provide eating disorders support during the holidays.
December 19, 2012
Protect your eating disorders recovery during the holiday season | Julie Holland
Do not forget about your outpatient treatment team during the holidays.
With rising stress levels, disordered eating behaviors are more likely to increase. Look to your psychiatrist,
therapist and/or dietitian for support and guidance throughout the holiday season. If travel schedules interfere
with regular appointments, consider speaking with your eating disorders treatment team by phone, or attend a
support group for other individuals in recovery.
Make the holidays about family and friends—not about food.
The food-centric festivities of the holidays can be challenging for an individual in recovery from an eating
disorder. Encourage friends and family members to plan events that emphasize spending time together rather
than sitting down to a large meal. Making holiday crafts or looking through old photo albums of past holidays
can be fun ways to celebrate and enjoy seasonal time with loved ones without the activities revolving food.
If gatherings of friends and family involve a meal, allow yourself to have reasonable portion sizes of food that
Develop New Year’s resolutions based on a balanced lifestyle.
The holidays are quickly followed by the New Year’s resolution “season,” where it can seem as though
everyone is resolving to hit the gym, diet and lose weight. Although being active is part of a healthy lifestyle,
exercise can be triggering for some and disordered eating behaviors may resurface. This year, focus on making
goals for the coming year that emphasize a balanced lifestyle and help you develop your individual skills and
talents, including taking a painting class, journaling every day or volunteering regularly with a local non-profit
Eating disorders recovery is an ongoing process that takes time and effort. Regardless of whether or not you
have just returned home following treatment or you have embraced recovery for a number of years, employing
recovery-focused relapse prevention strategies can help protect your recovery during the holiday season.
Parents pass many things down to their
children—unconditional love, life lessons and
family heirlooms. Even key personality traits,
such as ¬perfectionism, introversion and
anxiousness, have been found to be genetically
linked. Unfortunately, medical conditions and
mental illnesses are also passed down from
generation to generation, including eating
Because research has identified a genetic
component in the development of an eating
disorder, some parents mistakenly believe
they are to blame if their child struggles with
anorexia, bulimia, binge eating disorder or eating
disorder not otherwise specified (EDNOS). Additionally, when parents believe their child’s eating disorder is
their fault, they can tend to shoulder the burden of “fixing” their child.
December 26, 2012
Are parents to blame for eating disordered behaviors in their children? | Julie
“As humans, we look for cause and effect—it’s natural,” explains Brittany Lacour, LCSW, DAACS, primary
therapist at Eating Recovery Center. “However, when it comes to an illness, especially a multifaceted illness like
an eating disorder, that has genetic, psychological and social roots, this can lead to finger pointing.”
In eating disorders treatment, finger pointing is not effective for anyone when a loved one – child or adult – is
struggling with an eating disorder. Eating disorders are complex illnesses with several contributing factors; they
are no one’s fault. Eating disorders professionals, patients and families should avoiding playing the “blame
game.” Instead, asking questions such as, “Will this action or line of thinking be helpful to my loved one’s
recovery and my own well-being?” Or, “Am I acting from a place of discomfort and fear, or from a place of hope
and openness?” can help frame thoughts and actions that support eating disorders recovery.
Instead of placing blame when it comes to children with eating disorders, all parties involved in treatment
should focus on the maintaining factors. Concentrate on what is keeping the illness going and what purpose
it is serving for the young patient, as opposed to fixating on the origin of an eating disorder. The reality is
that time only moves in one direction, and getting stuck in the past only serves the illness and the feelings of
helplessness that can emerge as a result. Parents and families should look at the current dynamics of their
relationship with their loved one and work with treatment professionals to identify the function the eating
disorder is serving for their loved one within the family. This involves actively listening to one another and not
getting caught up in an “objective reality battle,” or arguments over whose perceptions are more “true.”
Another natural human inclination is that we attempt to place blame when we have uncomfortable feelings
about a situation, especially when people we love are in danger. Instead of finger pointing, parents and family
members should be thoughtful and shift the focus to expanding their emotional vocabulary to better explain
how the experience of having a child with an eating disorder makes them feel. Eating disorders treatment
professionals – including psychiatrists, therapists and dietitians – can be especially helpful in facilitating these
conversations, providing a safe outlet to express and explore feelings of sadness, frustration and guilt and
helping to identify strategies to move forward and support their loved one as they work toward recovery.
Families do not cause eating disorders, but they play a very important role in eating disorders treatment and
recovery, regardless of the age of the patient.
Comment below with any questions or thoughts to share and subscribe to receive updates when new articles
December 20, 2012
Eating disorder recovery during holidays | Kenneth L. Weiner
Editor’s note: Dr. Kenneth
Weiner is founding
partner and chief
executive officer of the
Eating Recovery Center in
According to the iconic
holiday tune, “ ‘Tis the
season to be jolly.”
myths about the magic
of the holidays set
many Americans up
for a struggle with real
life. For the millions of
men, women and children recovering from an eating disorder, the holiday season can bring heightened stress
associated with an overwhelming schedule of events, painful or frustrating family dynamics and a seemingly
constant focus on food that begins at Halloween and continues through New Year’s Day.
As a result, eating disorder treatment professionals frequently see an increase in eating-disordered thoughts
and behaviors and lapses in recovery during the holiday season.
In reality, the holiday season may not actually be any more stressful for individuals in eating disorder recovery
than everyone else -- at some point or another, we are all likely to deal with anxiety stemming from any variety
of sources, including the hassle of holiday travel or overspending on obligatory gifts.
However, it is important to remember that the people struggling with eating disorders are biologically “wired”
to experience higher levels of anxiety than the rest of us, and their go-to tools to manage their anxiety
-- including starvation, bingeing, purging or over-exercising -- can be unhealthy and sometimes even life-
Add this predisposition toward heightened anxiety to the perfectionistic, overachieving and people-pleasing
temperament of many people with eating disorders and common holiday stressors can compel those in
recovery to revert back to worrisome thoughts and behaviors in an effort to manage their anxious feelings.
The following strategies can help individuals
protect their recovery during the holiday
Create your holiday schedule carefully. You
don’t have to attend every holiday party, meal
or gift exchange to get in the holiday spirit.
Prioritize your health and well-being over
external obligations and be realistic about
what you can manage.
Shift the focus from food to family and
friends. For some, rich seasonal fare and
sweets can make eating in moderation difficult. For others, overabundant food and large meals can cause
anxiety. Accept that food is typically a part of holiday get-togethers and turn your focus to meaningful
interaction with family and friends.
Lean on your supportive network. Surround yourself with people that have positive relationships with food
and their bodies, and stay in close contact with outpatient treatment professionals -- including psychiatrists,
therapists and dietitians. Discuss your feelings, victories and challenges with these individuals as they arise and
before issues become significant enough to threaten recovery.
Be kind to yourself. The perfectionistic minds of those suffering from an eating disorder can make it difficult
for them to accept when events do not go as planned. One perceived misstep does not make or break your
recovery progress. Be proud of yourself for making an effort, however big or small and whatever the outcome.
Family and friends also play an important role in protecting eating disorders recovery during the holidays. The
most important thing family and friends can do to support a loved one’s recovery is be flexible with holiday
traditions and willing to begin new customs that involve small groups and don’t revolve around meals and
Making togetherness the central theme of holiday gatherings, rather than orchestrating large reunions
featuring endless platters of seasonal comfort foods, can help minimize the anxiety felt by loved ones and the
likelihood of relapse during this hectic time of year.
In addition to the aforementioned strategies to help individuals, families and friends protect recovery during
the holiday season, a growing community of health care professionals now specialize in eating disorder
prevention and treatment. These clinicians can help adults, adolescents, children and their families healthfully
navigate the holiday season and beyond.
With appropriate support and a strong network of friends, family and treatment professionals, a healthy,
happy holiday season is within reach for everyone.
December 21, 2012
How To Cope With Holiday Weight and Eating Stress…Without Triggering An Eating
Disorder Relapse | Aminah Mae Safi
Twinkle lights, snowmen, menorahs, trimmed trees, presents,
and some of the greatest movies ever made–‘tis the season.
Unfortunately, the holidays also bring stress and, for many,
relapses and triggers for mental health issues, including eating
disorders. Even the most balanced of people feel the anxiety of
the holidays creeping up on them as they start gearing up for
the season. Eating disorders in particular can be triggered, not
only by the stress and anxiety of the season, but also by all of
the focus on food (and holiday weight gain) at so many holiday
I felt this first right before Thanksgiving this year. The minor
panicking moments, the small flare-ups in my temper that
made me feel my control was slipping. But before I had a
serious relapse of my eating disorder, I got an email. The message was from the Eating Recovery Center in Denver
and it reminded those in their community about how the stress of the holidays often triggers relapses in eating
disorders. I’d made it onto their email list-serve from an interview I had done with them on a previous article. Funny
how you get paid forward, but not always in the way you think you will be.
For me, just the knowledge that the feelings I was going through were totally normal made such a difference. It was
just a reminder, more than anything, that my brain was retreating back to its habitual coping mechanisms during
a period of extra stress. So I want to remind those reading, whether they have suffered an eating disorder, are still
suffering, or are supporting someone they love through recovery, that there are ways to mitigate how you react the
stresses of the holiday season. I interviewed Bonnie Brennan, MA, LPC, clinical director of Eating Recovery Center’s
Partial Hospitalization Program to find better ways of dealing with the way eating disorders can flare up during the
One of the best pieces of advice Brennan gave was to take a step back and think of the big picture during the
“For individuals in recovery from an eating disorder, now is a great time to remind yourself that
recovery is an ongoing process. Struggles at this time of the year are perfectly normal and does not
mean that a complete relapse will occur.”
Remind yourself to take each day as it comes. Striving for perfection, particularly in your plans for the holidays,
doesn’t help the healing process. Recognize what you’re going through is entirely normal. Be kind to yourself,
particularly at this time of the year.
When you do over-indulge, Brennan stresses not to compensate for the lapse in your other meals. She also
encourages patients at the Eating Recovery Center to return to their meal plans, not as a rulebook, but in terms of
reminding themselves of what a healthy portion of food is. As Brennan puts it:
“Many people will comment that they are skipping a meal, perhaps breakfast, in anticipation
for the large, heavy holiday meal in the afternoon. I suggest trying to enjoy the holiday meal
throughout the day, instead of all at once, as a form of moderation. For example, it is not against
the rules to have some of the dinner you ate last night for breakfast the next morning.
“Remind yourself that your body knows how to take care of food. One instance of overindulging
does not mean you will return to your eating disorder. One overindulgence will not send you
spinning out of control. It was just one instance, let it go and continue on. Furthermore, don’t
try to skimp on the next day because of you overindulged the day before; eat what your normal
intake would be.”
And while food is often the main focus of the holidays, that doesn’t have to be the only way to celebrate with
friends and family. Brennan mentions how:
“A great way to spend time together would be in non-food activities. For example, making crafts
together, walking around the mall shopping, looking through photo albums and remembering
past holidays are great ways to celebrate the holiday season and do not revolve around food.
Remember that this is your holiday too. Pushing to make things perfect may only make you more
irritable and resentful that the season flew by without a chance for you to relax.”
My favorite idea of finding non-food related ways to celebrate the holidays involves pampering yourself. While
I bought myself a pair of amazing pajama pants for the holidays, I hadn’t thought of Brennan’s idea of actually
wrapping up the present for myself:
“The holiday season does not have to be only about buy gifts for others, you can use this
opportunity to reward yourself with a gift as well. One of mine favorite things to do is buy myself
a gift that no one else would know I wanted, wrap it and put it under the tree. Treating yourself
with a manicure or pedicure or massage is also a great idea. Do something that allows you to relax
and slow down a bit during this busy holiday season.”
For friends, family, and loved ones of those going through eating disorder recovery, the best way to help is mostly
to stay an active listener. Brennan notes that:
“As a friend or loved one of someone recovered from an eating disorder, it is always better to ask
questions than to assume the answer… Rather than trying to fix a specific problem, for example,
preventing someone from purging after meals, ask what you can do to help. Ask questions like, ‘I
noticed you were struggling, what are you needing?’ Additionally, if you as a support system work
to reduce your anxiety around this time of year, it can help those moving through recovery reduce
their anxiety as well.”
Not all of the stress and eating disorder triggers during the holidays come from sitting around a table of food.
Sitting around the T.V. with family, watching football, holiday movies, or hockey is a pretty common scenario for
many people. Be aware of the media you are consuming and how it might affect the way you see your body. In a
note that hit home for me, Brennan talked about how she “advise[s] individuals to be selective about the choice
of TV they watch around the holiday season and the New Year. Commercials and talk shows take on a weight-loss
focus when the focus should instead be more on how you feel, not how you look.”
A minor relapse doesn’t have to lead to a full relapse. A bump in the road to eating disorder recovery, particularly
during the holidays, is totally normal. Stay open and honest with those you love and trust this holiday season.
Don’t lose faith in your recovery. Take time to honor yourself and remember that despite whatever your family
traditions are, you’re allowed to create your own holiday rituals, just with yourself in mind.