Tag: binge eating

Does Your Teenager Have an Eating Disorder? Signs and Symptoms You Should Not Ignore

On By jodietitianIn UncategorizedLeave a comment

scaleThey came to their visit together. Jessica (not her real name) did not want t be there. I let her stay in the waiting area fixated on her cell phone (she made up her mind she hated me, at least that is what her facial expression conveyed). Instead, I took her mother into my individual counseling room to get the story before I met with Jessica. It was one I have heard before. In fact, the entire scenario became predictable. Mom was all over the place, at first angry that her teenager was being so rebellious, she was driving them all crazy. She refused to go anywhere with the family, she hid out in her room, refusing to sit at the family dinner table. Vacations were a night mare. “She used to be such a sweet girl, so happy and care free, she LOVED helping me in the kitchen and really enjoyed going out for pizza with the family, but now she is like someone else. We don’t know what to do”. Next, after the anger, comes the crying. “She looks horrible. She passed out the other day and it was so scary. Yet, she won’t stop this. It does not make sense!”Jessica took to wearing very loose and baggy clothes, and it wasn’t until her mother walked in on her changing that she noticed her protruding ribs and the obvious weight loss. After lots of threatening, Jessica agreed to go to her pediatrician’s and was then referred to us. How did it get to this point, and how did this family miss it?

Eating disorders can happen at anytime, but transitions are especially tough. Back to school, back to college, back to normal life. Simple, predictable, or is it? Not for everyone. Times of transition and change, such as starting a new school, going away to college, new teachers, different friends, all of it can be a challenge for some kids. Times like these can be risky when it comes to falling into the grip of an eating disorder. Couple that with society’s obsession with losing weight and it is pretty easy to understand why lots of eating disorders often go unnoticed until it is almost too late. As a parent, what signs or symptoms should you look for? Some things that you should not ignore:

  • Weight loss. Sounds obvious, but actually, especially in teenagers who are larger or fatter, parents mistakenly tend too think the weight loss is a “good” thing. Even doctors make the mistake of automatically praising weight loss, especially if it brings a child closer to a “healthy” BMI (gag).  That meaningless number does it again…….clouds the judgement of otherwise smart and well-meaning people (parents and professionals alike). The great news is the American Academy of Pediatrics came out with a new report in August highlighting the risk of treating obesity in adolescents with disordered eating as well as the importance of focusing on health verses weight. See this article in American Academy of Pediatrics for the specifics. The bottom line is that we need to get off the losing weight bandwagon, fight the cultural message that everyone needs to be thin, or a certain BMI, and NEVER EVER praise weight loss in a teenager. Yes, there are times when a kid may lose weight. A teenager who is very sedentary who goes away to college and finds themselves having to walk 9 miles a day just to get to all their classes may indeed lose some weight. This is not what I am talking about. But even then, making a big deal about weight loss is never good. Even this kid, if they get lots of attention for losing weight may decide they like the attention, and start doing things to purposefully lose weight (I have seen this happen many times). Don’t do it. Don’t compliment weight loss in a kid. Instead, compliment growing up and being successful.
  • Food refusal. When your teenager has always loved your home-made macaroni and cheese, and even begged you to make it, but now refuses to eat it, NOT GOOD. Unless there is a really good reason for refusing a favorite (recent stomach bug, stomach ache, cramps, etc) don’t ignore this red flag. Should you try to force your kid to eat it, or pressure them to answer you as to why they don’t want it? Like I said, one refusal because they don’t feel good is normal, but a few times in a row is just not normal, however responding with anger is not helpful. Instead, I have found those parents who are able to open up a caring dialogue with their teen have a better chance at getting to the bottom of it. It is important to pay attention to all signs and symptoms so you can then make a plan to address it. Forcing food or anger does not help.
  • Decreased socialization. For a teenager with an eating disorder, any situation that involves food and eating is threatening. You will start to notice they don’t want to go to their friends houses, or to birthday parties, and they especially will try to get out of family functions (those typically aren’t a teen favorite anyway, but they are doubly horrifying because of the food involved). They may lose interest in going to what once was a favorite restaurant and a big treat. They will refuse to eat the family’s favorite pizza on “pizza night”. Red Flag.
  • Loss of menstrual period. Not that you need to keep track of your teenage daughter’s cycle, but if you notice she does not ask you to buy feminine hygiene products the way she usually does, ask. Don’t ignore it as this can be a sign of weight loss and inadequate calorie intake.
  • Obsession with exercise. If you notice your teen going out for long runs, or running both morning and night, or if you notice the bedroom door is always closed and when you walk in she just so happens to be exercising, this could be a sign that something is not right. Yes, being active is good for all of us, but if doing calisthenics is something new and different, and especially if your teenager seems to be hiding it, then this is also a red flag.
  • Going to use the bathroom after every meal. If this has always been normal for your child that is one thing, but if it is a new behavior, it could mean they are purging or throwing up their food. You can check the bathroom for evidenced or you may hear it, but don’t ignore this. Vomiting on a regular basis is an eating disorder behavior and could leads to electrolyte imbalances that can be deadly.
  • Body checking. Do you notice your teenager looking at her body, especially her stomach obsessively? Does she tend to squeeze her arms as if to check for fat? This is a common behavior for people with body image issues and should not be ignored, especially if other signs are present.
  • Obsession with food labels, writing food in a journal, or counting calories. I can’t tell you how many food journals complete with calorie counts I have seen in my life. It is NOT normal. It is NOT a good thing. Yes, there are apps and websites and even the My Plate site has trackers for this. I hate them.This is as far away as normal, intuitive eating as you can get.

So what should you do if you notice any of these symptoms? Remember, your teenager is not doing this on purpose. They can’t stop. It is a very complicated disease and the triggers and causes are different for each person. It is important to be empathetic, kind and loving and to avoid blaming as this will not help. The first step might be to call your pediatrician and share your concerns. They will probably want to see and evaluate your child and may recommend therapy and a visit to a dietitian. Be sure that both specialize in treating eating disorders. Your teenager probably won’t be happy, but you can also get support from the therapist as far as how to handle resistance. The sooner you address the issue, the better chances for recovery. Remember, it does not matter what size your kid is, if they are fat or thin. It is very easy to ignore some of these red flags, like I said, some are so socially acceptable and desirable that it is sometimes hard to see what is going on. Don’t ignore these signs. They won’t go away on their own, and the longer you put off getting help the harder it will be.

There is hope. You can get your old teenager back.But you gotta move fast.

For more information and for great resources, check out the website: Eating Disorders Awareness and Prevention.

Do You Live With the Food Police?

On By jodietitianIn UncategorizedLeave a comment

stock-illustration-19467692-policemanI saw a patient today that made me sad. She shared a story I have heard one too many times. The reason the story is bothersome is because the things some people do in the name of caring are so obviously not helpful at all, and actually very harmful. It seems like a no-brainer to me, if that makes sense. By that I mean those simple things, like manners, that everyone should know. Saying or doing something that if you have one iota of intelligence, you would know it is wrong.

But for some reason, people don’t get it.

So I decided to write about it because even if just one person reads this and changes, or reads this and shares it then maybe someone will stop. What I am referring to is the food police. Not the one stuck in your head. The real live one(s) many people live with.

The story goes like this: the teenager, who always played soccer and was thin and fit in high school goes off to college, stops her sports so she could focus on studying and then gains weight. Mom is not happy about this (and neither is the college kid), and mom wants to help her daughter. So she makes comments about what her daughter  is eating when she is home visiting: “are you sure you want that much? Do you think you really need that?” On top of this, her dad and her younger brother have also joined the forces. They watch what she eats and feel they are “helping” her when they comment about those cookies or chips or ice cream sandwiches, “those aren’t for you, they are for your brother, you don’t need them!”

Or consider the young wife who has a few kids, gains weight and no longer fits into those tight jeans. She already beats herself up about this, and knows her husband is not happy. He says he just wants to help and that is why he feels the need to tell her when she has had enough.

What happens when mom, dad, brother and hubby leave? What would YOU do? If there was white chocolate mousse in my house (my favorite, and something you just can’t find easily), and someone said it was “not for me”, I will tell you what I would do. I would wait until they left, or went to sleep, and I would sneak it. Actually, no, that is not true because that would make me feel guilty if I had to lie. I would probably be honest and tell them directly that they better not leave it there because I will steal some!

But most people in this position are not able to be direct and stand up for themselves. They find it hard to say “look, I love chips, so if they are here, I am probably going to eat some, and I would appreciate it if you would mind your own business!” No, what I see is that children and adults alike all do the same thing when they live with the food police. They sneak. They binge eat. They feel guilty. Part of it is that they really do crave the food but much of it seems to be almost a passive aggressive resentful act against those trying to control them.

I remember clearly a middle aged woman who was in one of my non-diet weight management classes many years ago. Her husband was the food police (just trying to help her). She would sit and eat her Special K cereal with skim milk while he scoffed down his bacon and pancakes every morning. Then, she would watch through the window as he drove out of the driveway and around the corner. Once he was out of sight, she went straight to the fridge. She would binge on all of the foods he would not want her to eat. He did not understand why she was not losing weight when she barely ate. She had a lot of work to do with making that relationship healthy and one that would truly support and not control her.

So what would I recommend to family members who really do want to help? (You can share this with them if you agree):

  • ASK your loved one how you can help.
  • LISTEN to what they say. Sometimes it is helpful to NOT have certain foods in the home if it triggers someone to binge eat. Binge eating often leads to other disordered behaviors such as purging, and this is not what you want to happen. Little Johnny can have Oreo’s at his friends house or buy them at CVS, if his sister is struggling at the moment, he can live without them at home. Hubby can live without ice cream at home (go out for a cone when you want one! and take your wife if she wants to go too)
  • STOP talking about weight. Or body size. Theirs, your own, your neighbors, Oprah’s, anybody’s!
  • ACCEPT the beautiful person your loved one is that has nothing to do with the force of gravity on their body (which is all weight is, right?)
  • PROMOTE health in your home. Make healthy meals. Play outside. Dance, play games, have fun.
  • TRUST that your adult child or your spouse or whoever will figure out what is best for them. Be an example, NOT the police.
  • IF you notice any disordered eating behaviors, don’t ignore it. Educate yourself (check out NEDA)for some support.

And if you are the one feeling like the criminal living with the food police, consider sharing this post. Blame it on me! If the dietitian admits she would be sneaking the white chocolate mousse….well, maybe they will understand.

Binge Eating Disorder: New Approaches to Appetite Control

On By jodietitianIn Uncategorized1 Comment

ice creamToday I attended a conference presented by Walden Behavioral Care on the topic of Binge Eating Disorder (BED). Dr. James Greenblatt, Chief Medical Officer at Walden and author of the book “Answers to Appetite Control:New Hope for Binge Eating and Weight Management”  spoke about the complicated interactions between our physiology and brain when it comes to binge eating.  There are specific criteria that define a diagnosis of BED and just one of the criteria includes “recurrent episodes of binge eating characterized by both of the following: (1) consuming an abnormally large amount of food in a short period of time compared to what others might eat in the same amount of time and under the same or similar circumstances, and (2) experiencing a loss of control over eating during the episode. Additionally, in BED there is “significant distress” about the binge eating.

Dr. Greenblatt stressed that some binge eaters experience cravings that are physiologically based, in other words, the cravings are a result of your biology rather than just the environment or a social trigger. In fact, some research showed that brain scans of those who scored higher on a “food addiction” rating scale were similar to those of drug addicts.  There was an elevated activation in the reward circuitry in response to food cues. Again, this does not mean that if you binge eat, you are “addicted” to food, but that everyone is different and some people have the physiology that makes it much harder (and it is not their fault).

In addition, disordered eating such as binge eating often co-exists with mood disorders such as bipolar disorder, anxiety disorders, depression and ADHD . In fact, ADHD has been linked to BED (apparently the act of chewing helps to decrease day dreaming brain waves and helps you pay attention). The odds of developing a binge eating disorder is 12 X greater in children with ADHD. Dr. Greenblatt stressed the importance of treating the mood disorder first before the binge eating could be addressed.

Another very important point was regarding the importance of protein. There are over 250 neurotransmitters that send impulses throughout our brains and affect our thoughts, feelings and behaviors, many of these directly affecting our appetite regulatory mechanisms. They are all derived from amino acids. Adequate protein intake is critical, often an issue for some. For example,  vegetarians and vegans may not get enough protein (especially if they are not educated on nutrition) and chronic dieters often have inadequate intakes. And, even if a person does consume adequate protein, it may not always be available, such as in the case of insufficient digestive enzymes or excessive antacid use.

Finally, there was mention of how for a small percentage of people, certain foods substances may contribute to food addiction and binge eating, such as high fructose corn syrup and MSG (he also discussed the gluten craze as well as casein but I may save that for another post!) This does not mean we need to cut out any foods  or that we should never eat them, it just is important to have balance in your life.

The importance of medication (such as mood stabilizers) in some cases was also  mentioned, as well as how medication was not helpful in other cases. The bottom line is that everyone is different, and it is very important to get evaluated by a professional. BED is a serious and debilitating eating disorder, but there is help.

If you are interested in the book which contains a wealth of information from Dr. Greenblatt, check out: http://answerstoappetitecontrol.com/ 

Are You in Diet Jail?

On By jodietitianIn Uncategorized1 Comment

Idiet jail first encountered the term “Diet Jail” in 1975. I was a biology major at Clark University in Worcester, Mass. I remember clearly working with the lab teacher who was doing his research on birds (he kind of looked like a cool woodpecker). He made me count bird chirps he had taped on a recorder. I decided I did not want to be a biology major because counting bird chirps was incredibly boring. So I met with my adviser who asked me what I was interested in. My best friend Joyce was a vegetarian and ate very interesting things such as yogurt with sunflower seeds and honey, and so I told him, I though vegetarianism was interesting. He told me I should be a dietitian. I did not know what that was, but anyway, I ended up transferring to the University of Connecticut to study nutrition. For my first nutrition class (Nutrition 101) I had to do a  report about fad diets and at the time there were many books out there on the market, including the Atkins Diet. But I found one called “The Psychologist’s Eat Anything Diet” by two psychologists, Dr. Pearson and his wife, also Dr. Pearson.  It changed my thinking in a way that lasted, well, forever. The authors were decades before their times in the strategies they were promoting, before we knew about mindful eating or how our bodies regulated themselves regarding calorie intake, fat, carbohydrate intake, etc. They described what they called “diet jail” where individuals who diet tend to “lock themselves up” in a jail where only the healthy foods exist. In other words, they tell themselves they are only going to eat healthy foods such as grilled chicken, vegetables, fruits, salad, etc until they lose the weight. So psychologically it is as if they “lock themselves up” in a world where only the healthy foods are available (or allowable). But outside the jail are all the other foods, the “bad” foods. The chips, cookies, ice cream, burgers, pizza, you get the picture. All the foods they have determined they are not allowed to eat (while they are on that diet). And so, most people can last a bit in Diet Jail. Yes, they get cravings, but they use their “willpower” and overcome them. Unfortunately, we now know our bodies send out very loud signals when we are not getting enough carbohydrate or fat (the foods that do not exist in Diet Jail!) and so eventually, our bodies drive our brains to give in. Add this physiological drive to an environmental trigger, such as walking into your friend’s home who just baked some homemade chocolate chip cookies, and things change. Your brain, which is triggered by the deficiency in your body, tells you to eat a cookie! It has just what you need, what you have been missing, that fat and carbohydrate! But you can’t have someone throw just one cookie into your jail cell, so you have to step out of the jail to get that one cookie…….the problem is, once you take that bite, your realize you are out there! Out of Diet Jail! And since you know you will go back in (you tell yourself that on Monday you will really start again!) you better eat while you are out here! So you decide to order pizza, and then have ice cream (a lot) because, heck, you are going to start again on Monday. Often a full blown binge results. Because you know this is just this one time. Soon you will be back on track. Back in Diet Jail. Until the next time.

As repetitive as this cycle is in so many people’s lives, they do not seem to stop. The next diet craze offers the next magic scheme. Weight is lost and then regained. Back then we did not know the physiological reasons people were driven to eat but now we do. We know if you restrict you will suffer from “disinhibition” or breaking out of Diet Jail.Often referred to as the “what the hell” effect. It is a very sad and draining cycle.

So why not take those bars down? Why not entertain the thought of changing what you have been doing that is not working? What if you were to start to believe that all foods are equal? No food is good, no food is bad, they all have a place in your life. Yes, we need certain nutrients to feel good, have energy, normal bowel movements, prevent disease, etc. So educate yourself (I will gladly help you!), experiment, enjoy your cultural traditions (yay. pasta fagioli!) but start paying attention to your body. Are you hungry? Are you full? Are you so confused that you might really want to get some help (such as from an eating disorder specialist?). Wherever you are, it is ok, just take some time to truly reflect on your patterns. My hope for you is to enjoy eating, be healthy, and take down those darn bars.

What is “HAES”?

On By jodietitianIn Uncategorized4 Comments

images

I have a few simple questions to ask before I explain what HAES is:

1. How many people have you known who have “gone on a diet” specifically to lose weight?

2. Have you ever known someone who has gone on a diet and who has lost weight and kept it off? I am not talking about the person who took up a sport or quit smoking and adopted a healthier life style. I am talking about someone who followed a specific “diet plan” such as a low carb diet or meal replacement diet or counting calories or points kind of diet.

3. Have scientists discovered the one diet that works to help people lose weight and keep it off? Of course we know researchers have been looking into this, since people have been struggling with trying to lose weight for a long time. The “obesity epidemic”is always in the news. So have they found the one diet that works?

Not sure of your answer for question #1, but for #2, I am guessing the answer is NO, and for question #3, I will tell you the answer is NO. What most of the public does not know (because who would be interested in the research over the years regarding dieting except someone like a dietitian?) is that many researchers have been looking into dieting behavior for decades. In fact, when I went back to graduate school and did my research on “cognitive restraint” back in the ’90’s, I was angry! I could not believe the world did not know that the “experts” already knew many of the reasons dieting did not work! But then I realized, it is about the diet industry combined with desperate people wanting to lose weight.

I was not the only one who was angry. There now exists a split among health professionals working with people with weight issues (actually, the split has been there for many years but only recently gaining attention). Thanks to the more recent research and new groundbreaking books (see below) by Dr. Linda Bacon, the “Health at Every Size” Movement  has now been brought into the public eye and the movement is gaining momentum.. Those of us who believe in promoting health instead of some perfect weight, are no longer alone. Yes, there are still doctors, nurses and dietitians who will put someone on a diet (boy could I tell you some horror stories). So it is important to ask any professional you are working with which side of the fence they are on. Are they familiar with the HAES Approach? If not, they may be a bit behind the times. Or, they may still be influenced by a society who values a certain physical appearance instead of health.

Here is an excerpt taken the HAES website at http://www.haescommunity.org/  :

“Health at Every Size” is based on the simple premise that the best way to improve health is to honor your body. It supports people in adopting health habits for the sake of health and well-being (rather than weight control). Health at Every Size encourages:

  • Accepting and respecting the natural diversity of body sizes and shapes.
  • Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
  • Finding the joy in moving one’s body and becoming more physically vital.

  • and from Dr. Linda Bacon: “Health at Every Size is the new peace movement.”

    “Very simply, it acknowledges that good health can best be realized independent from considerations of size. It supports people of all sizes in addressing health directly by adopting healthy behaviors.”

    If you are tired of dieting and ready to focus on health instead of some magic number on the scale, check out  Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon, PhD and her most recently released book, Body Respect (http://thebodypolitic.biz/bodyrespect/), co-authored with Lucy Aphramor

  • And be sure to check out the HAES website at http://www.haescommunity.org/

The Milkshake Study

On By jodietitianIn dieting, weight3 Comments

milkshakes

About 40 years ago, a landmark study was conducted that launched the research investigating why diets fail. This important study is sometimes referred to as “The Milkshake Study” (Herman CP, Mack D. Restrained and unrestrained eating. Journal of Personality. 1975;43:647–660). In this experiment the researchers administered a “Restraint Scale” questionnaire to determine who the dieters were (restrainers) and who the normal eaters were. They then had subjects participate in what the subjects believed was an ice cream tasting where they were to rate the ice creams. They were given either one milkshake “pre-load”, two milkshakes pre-loads or no pre-load and then told to eat as much ice cream as they wanted or needed to rate them. What was expected was the more milkshakes a subject consumed before the tasting the less they would probably eat (because they were already full, right?). But that is not what happened!

Instead, the researchers found that those individuals who were highly restrained (dieters) actually ate MORE ice cream with the more milkshakes they had before they started tasting! They hypothesized that dieters who constantly restrain their intake tend to become “disinhibited” after they break their diet boundary (sometimes referred to as the “what the hell” effect). This study triggered many more years of research into “cognitive restraint” and its negative consequences (binge eating being one).

Unfortunately, most people are not aware of this vast body of research, and so the diet industry has been able to continue making its billions. The good news is that finally a “Non-Diet” approach to weight management has been researched and proven to be effective in promoting health. Keep posted for more information and resources to come!!!