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Sara Weber, LPC How to understand and respond to college students with food issues or poor body image.

Sara Weber, LPC How to understand and respond to college students with food issues or poor body image.

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  • 1. Understanding and responding to collegestudents with food and body imageissues Sara Weber, LPC Counseling & Mental Health Center, UT Austin
  • 2. Overview  Binge, Purge, Starve…What’s the difference?  Why does this happen?  Beyond the behaviors  College students and eating disorders  Treatments for Eating Disorders  The Phases of Recovery  How to help a friend or loved one.  Take Home Messages
  • 3. What’s the Difference?Eating Disorders (anorexia, bulimia and binge eating) have many things in common even though they manifest differently. All eating disorders: Seem like they are only about food and weight but it isn’t that simple. Are a way of coping: using food, exercise, and weight obsession as a way to organize life & manage emotions. Create a sense of security, control, predictability, etc. Involve an intense emotional connection with food and weight. Can happen to men, women, old, and young.
  • 4. AnorexiaAnorexia is characterized by the belief that “If I can get thin enough, my life will be better”. Start off as a desire to “get thinner”, “lose some weight” Stability and success in life is dependent on being thin. Even when others believe s/he is thin enough, s/he doesn’t “feel” thin. Perception is warped by malnutrition. Restricting foods, fasting, over-exercising, purging to lose weight. Malnutrition can promote restriction via delusions. Physical complications complicate re-feeding.
  • 5. Anorexia: Warning Signs Preoccupation with weight  Rapid, significant weight loss Relentless drive to be thin  Obsessively reading cookbooks Withdrawal from friends or  Cooking for other people group activities  Intense sensitivity to criticism Irritability or mood swings  Intense fear of failure Fear of specific foods  Food rituals Compulsive calorie or fat gram  Rigid and compulsive counting scheduling Lying about not eating  Growth of fine hair (lanugo) on Preoccupation with how food is arms, face, or back prepared  Hair loss Perfectionist standards; high  Injuries (fractures, pulled achievement muscles)
  • 6. Anorexia: Medical Complications Weakening of the heart due to  Osteoporosis (bone loss) malnutrition (possible heart  Lowered immune system failure) function/ low resistance to Low blood pressure infection Low body temperature  Low blood sugar Low heart rate  Kidney impairment or failure Irregularities or loss of  Bone, ligament, and tendon menstruation injuries due to malnutrition Fertility problems  Memory loss Dehydration  Gastrointestinal disturbance Electrolyte imbalance  Metabolic changes Anemia (low iron)
  • 7. BulimiaBulimia is characterized by competing beliefs that food will solve every problem (binge) and that it is “poisonous” and must be avoided/eliminated (purge). Like Anorexia, most people start off with the desire to lose “a little” weight. Compensatory methods used to “purge” include: vomiting, laxatives, over- exercise, or restricting after a binge. Purging methods are usually less effective than the individual realizes. What constitutes a binge depends on the perspective of the person engaged in the binge and the difference can be vast. Food is used to “numb out” but the anesthetizing effects are fleeting so the urgent need to “get rid of” the food emerges. Purging can also feel numbing. Typically average to high weight with sometimes dramatic weight changes . Underweight individuals have higher health risks.
  • 8. Bulimia: Warning Signs Preoccupation with weight  Intense sensitivity to criticism Binge eating  Withdrawal from friends or Going to the bathroom right group activities after eating  Irritability or mood swings Hoarding or stealing food  Swollen facial glands (chipmunk Overuse of laxatives, water pills, cheeks) diet pills.  Marks on knuckles Secretive eating  Depression (suicidal thoughts) Eating when not hungry  Feeling “out of control” with Water retention, swollen limbs eating or life Self-hatred or disgust  Weight fluctuations Withdrawal or isolation  Perfectionist standards; high achievement
  • 9. Bulimia: Medical Complications Abnormal heart rate (possible  Lowered immune system cardiac arrest) function/ low resistance to Irregularities or loss of infection menstruation  Kidney impairment or failure Fertility problems  Gastrointestinal dysfunction Dehydration (ulceration, pain, bleeding, Electrolyte imbalance bloating, constipation, non- responsive bowels) Anemia (low iron)  Metabolic changes Esophageal bleeding or rupture  Tooth decay Increased risk of throat and mouth cancer
  • 10. Eating Disorder NOSEating Disorder Not Otherwise Specified includes all other variations of disordered eating: Sudden weight loss and restriction but not underweight or hasn’t lost her menstrual cycle. Binge eating / purging infrequently. Binge eating but no purging, “binge eating disorder”. Chewing food and spitting it out. Chronic, excessive dieting, reducing quality of life. Orthorexia: A fixation with healthy or righteous eating. While an anorexic wants to be thin, an orthorexic does not desire thinness but wants to feel pure, healthy and natural.
  • 11. Why does this happen?Contributing factors are varied: Physical changes in puberty Brain Chemistry Family Changing family roles Personality Characteristics Overwhelming events Cultural FactorsDieting is a risk factor. Almost all EDs start with dieting.
  • 12. BiologyPuberty Brain Chemistry Both men and women  Anxiety & depression are experience dramatic changes in dictated by brain chemicals their body during puberty. called neurotransmitters. Women need to increase body  Serotonin- Regulates hunger fat in order to initiate and fullness. Disturbances are menstruation. associated with binge/purge. Women often don’t realize the  Norepinephrine- Regulates necessary changes of puberty mood, alertness, & response to and resort to drastic behaviors to stress. Disturbance connected to go back to pre-pubescent shape. Anorexia.  Genetics are a factor.
  • 13. FamilyFamily Relationships Changing Family RolesFamilies of people with eating Normal development ofdisorders have some independence and identity is acommonalities: product of family’s teaching. Difficulty expressing Too much, too soon: emotions. Expecting child to be Lack healthy bonds: Too close independent and responsibly (enmeshed), Too distant too quickly. (neglect) or an erratic Overprotecting: Not trusting combination of both. the child to make good choicesRemember families are typically on their own. doing the best that they can!
  • 14. Personality and Life EventsPersonality Characteristics Overwhelming EventsThere are varied personalities in Precipitated by an event that feelsthose with ED but there are some overwhelming or traumatic.commonalities:  Leaving home for the 1st time Perfectionist  Death in the family/ friend Highly-driven  Bullying or teasing Ambitious  Verbal or physical abuse Anxious or “high strung”  Sexual trauma Sensitive  Moving homes Intuitive  Divorce “People pleasing”  Marriage Self-doubting & insecure
  • 15. We wonder why women and men hate themselves?
  • 16. Cultural FactorsAlthough it hasn’t always been this way, a person’s value is often associated with thinness, fitness. Many of us base our self-worth on the extent to which we can conform to society’s idea of the “perfect” body.
  • 17. Cultural FactorsWomen: Unrealistic standards of thinness, beauty, & shape Female thin-ideal: thin, toned, busty Thin = happy, successful, loved, accepted, desired.Men: Unrealistic standards of strength, power, and success Male “buff”-ideal: cut, lean, muscular
  • 18. Cultural FactorsCould we be part of the problem? Thin Ideal worship Dieting Fat Talk
  • 19. Do I Fat Talk?
  • 20. The Language of Fat1. How many times this week have you had negative thoughts about your body or someone else’s body?2. How many times this week have you thought about a better life five pounds from now or when you are prettier, sexier, more fit?3. How many conversations have you had with other people this week about food, weight, exercise, or dieting?4. How many times this week have you compared yourself to other people or to images in the media?5. How many hours each day do you spend wishing you looked different?
  • 21. You can be part of the solution
  • 22. The Eating Disorder is a life Saver!
  • 23. Beyond the BehaviorsThe eating disorder is an adaptive behavior:self-preservation. Life is extremely intense for someone who develops an ED. S/he wasn’t sure how to handle life before the ED. The eating disorder is a source of support. “Best friend” : shielding him/her from the overwhelming parts of life that s/he can’t face alone. Helping “numb out” when things get to be “too much”.
  • 24. Beyond the BehaviorsEmotions Feel emotions very intensely Lack confidence in ability to tolerate emotions ED behaviors “numb out” and the emotions are avoided for the time being. “Stuffing” with food. “Purging my feelings out”. “Starving denies I have feelings”. “I feel fat” is a cover up for emotions that are hard to face. Lost the ability to identify, face, and manage emotions.
  • 25. Beyond the BehaviorsSelf-ConceptLoss of identity: interests, personality, etc. Focus on food and appearance as the solution to problems, prevents normal development of self-concept and eats away at existing identity. Life is the ED.Negative self-concept: never good enough, smart enough, pretty enough. Arguably a way to appease their drive (perfection) but it actually sabotages success in life.Perfection: “Be perfect, or be nothing”.Innate inadequacy: Fraud myth- “one day, pe0ple will discover the truth and abandon me”.Body Image: Bases self-worth on body size.
  • 26. Beyond the BehaviorsRelationships Relating to others can be confusing, frightening, and distressing. Values relationships greatly. People pleasing and very good at reading others’ needs and responding to them. Doesn’t accept help/love very easily b/c of fear of being vulnerable. Vulnerability is debilitating so they often end relationships before they get too close. Doubts of their worth and fear of abandonment prevent them from feeling safe or secure in relationships.
  • 27. College Survey ~ 1,000 students● 20% of respondents believe that at some point they have suffered from an eating disorder . National research says it is only .05-4%.● More than half of those polled said they know at least one person who has struggled with an eating disorder.● Almost 80% of students have dieted & avoided or skipped meals.● 45% of the students know someone who compulsively exercises, almost 40% know someone who purges by vomiting, and 25% know someone who abuses laxatives.● Among those who confirmed they have had an eating disorder or still suffer from it, nearly 75% of that group never received treatment. National Eating Disorders Association, 2007
  • 28. College- Unique Challenges Significant transition- academically, socially, time- management, responsibility (bills, car, health), self-care (eating, sleeping). Communal eating. Eating schedule may depend on peers. Roommates influence eating and body image. Consistent interpersonal challenges- constant social interaction. Getting “lost in the crowd”: Once the big fish in a little pond but now a little fish in a big pond. Losing identity from high school (sports, cheerleader, popular, best at…etc.) Coping with and managing long-distance family & friend relationships.
  • 29. College- Unique ChallengesThe college environment is especially toxic for body image: Body change between age 18-22 years is normal yet unexpected for most college students. Fear of the freshman 15 Shopping together, sharing clothes, high pressure fashion bubble. Events focused on body image: Rush, “socials”, football, parties, “going out”. Prime-time for dating creates an incubator for dialogue & concern about body and appearance. Going back to home town during break encourages comparison of body changes with peers from high school.
  • 30. TreatmentEating Disorder specialists are necessary.Choose a team from the beginning: Psychotherapist – license not as important as training. Dietitian – Using nutrition info for good and not evil Physician – Medical monitoring is key! Psychiatrist – Optional (as needed) Group – Reducing shame, not feeling alone. Family therapy- If needed, crucial for some people.
  • 31. The Mindful Eating Program Outpatient “light” Assessment focused “Academic Success” is our main goal Strength-based Not a treatment program. Recovery support. Services:  Bi-weekly therapy  group counseling, and  medical monitoring.
  • 32. ME: Assessment & ReferralStudents are asked to complete a thorough assessment. Psychological Medical Dietetic Sometimes psychiatric and/or off-campus specialists (cardiologist) are required for the full assessment.After this assessment we provide feedback about the next steps and offer guidance in developing a treatment plan.If a student is outside of our scope of care, they are given treatment recommendations by the team. Off-campus, outpatient treatment team (weekly, ongoing) Intensive Outpatient Therapy Inpatient treatment
  • 33. The Phases of RecoveryStabilization: Medical, behavioral, nutritional, & psychological (anxiety/depression, insight, communication, changing thinking, working with emotions).Exploring: gaining a deeper understanding of how the ED functions in their life. Developing healthier coping strategies. Addressing body image.Recovering life: 1) maintain progress, 2) resume life activities & develop new ones, 3) become fully engaged in life without relapse.
  • 34. When a friend or a loved one is facing eating issues.
  • 35. As a professional, you can help… Know about eating disorders  Warning signs  Health risks  Costs (personal, financial, emotional) of the struggle Bring it up (if it is your role)  “Do you have any concerns about your relationship with food or exercise?” Do not focus on weight  Focusing on weight, size, or good/bad eating is not helpful. Instead the focus should be on health behaviors- movement, nutrition, self-care. Listen and don’t judge  Remind yourself that they are struggling with an eating disorder because they are trying to manage something that must be very challenging for them right now. Have compassion for their struggle. Acknowledge your emotions & take care of yourself
  • 36. As a friend, you can help… Learn about eating disorders Talk to him/her Be and stay aware Break through secrecy Listen Help him/her get support Acknowledge your emotions Take care of yourself Focus on life beyond the illness Encourage authenticity
  • 37. You can help!
  • 38. Don’t Diet…• Avoid categorizing foods as “good/safe” vs. “bad/dangerous.” Remember, we all need to eat a balanced variety of foods.• You will not be happier just because you are thin, busty, or fit. Look around and consider examples of thin people who are miserable and large people who are happy.• Dieting harms your body- yes even so-called “healthy” diets. Your body needs variety and nutrition- don’t sacrifice your health to be thin.• Larger people can be healthy too. Eating nutritious foods and staying active is the prescription for health- regardless of your size.• Encourage a culture that values a healthy relationship with food. Slow down, enjoy food, & listen to your body.
  • 39. Fat Talk – Stop it!Begin listening more closely to the language other women and men are using to speak to each other and the language you are using with yourself.Decide to avoid judging others and yourself on the basis of body weight or shape. Turn off the voices in your head that tell you that a person’s body weight says anything about their character, personality, or value as a person.Pay attention to the media messages that reinforce Fat Talk.Begin to explore the emotions that are going on “behind” Fat Talk…are you feeling scared, ashamed, vulnerable?Request honesty and intimacy with others- change the subject when the Fat Talk takes over your conversations.
  • 40. What you need to know! Anyone can recover from an eating disorder. Recovery is a tough road but a journey worth taking! College is a prime time to develop an eating disorder (or for an old struggle to come back). Professionals can offer compassion for patients so that the patients can have compassion for themselves. Talk about eating disorders, weight, and food in ways that challenge the status quo & change the paradigm. Reach out to people you see struggling- you might plant a seed, you might save a life.
  • 41. Why She Feels Fat by McShane &
  • 42. As a friend, you can help… Learn about eating disorders Talk to him/her Be and stay aware Break through secrecy Listen Help him/her get support Acknowledge your emotions Take care of yourself Focus on life beyond the illness Encourage authenticity
  • 43. You can help… Learn about eating disorders  Websites, books, talking to a therapist and someone who has been through it before. Talk to him/her  Remember that they feel the ED is vital to their survival and will feel threatened if you criticize it.  Use I statements, “I feel… when you…” or “I am worried about ….(specific behavior)”.  Remind him/her that you are there to listen and check in occasionally so that s/he doesn’t feel like you are ignoring the issue now that you brought it up.
  • 44. You can help… Be and stay aware  Keep your eyes open for subtle improvements  Stay tuned into possible relapse behaviors and bring them up the same way you did when you initially confronted him/her. Break through secrecy  There is a strong drive to hide the ED, even after admission that s/he wants to recover. Talk about this struggle to keep the ED a secret and offer compassion for this desire while also challenging him/her to be as transparent as possible. Listen  Listening is one of the most important things you can do. This is hard if you don’t know how to help or don’t understand what they are going through but listening openly is still a valuable support to offer.
  • 45. You can help… Help him/her get support  Offer your support in any way possible. Ask often if there is anything you can do for him/her.  Help him/her find things to enjoy again- hobbies, activities, interests. Encourage putting time and energy into things s/he might enjoy and offer to go too. Acknowledge your emotions & Take care of yourself  It can be maddening to be in a support position of someone with an ED. Take care of yourself and get support when needed.  It is ok if you can’t be the primary support person all the time.  You can model emotional awareness and self-care.  Rely on your own support system.
  • 46. You can help… Focus on life beyond the illness  Plan activities and enjoy time together that isn’t related to the ED at all. These may need to be non-food events.  Don’t put life on hold for the ED (although be mindful of limitations of recovery length, e.g. don’t start a new degree).  Focus on aspects of your friend or loved one that were there before the ED took over (personality or interests) Encourage authenticity  There is a tendency to deny that they are really struggling so look ways s/he may be trying to look “fine” and intervene to offer help and challenge them to acknowledge their struggles.
  • 47.