Love the Message – Conflicted About the Messenger

March 30, 2016

Recently I stumbled upon an ad that Nestle’s Lean Cuisine brand aired earlier this year for it’s “Weigh This” campaign. The two-minute ad features women who are asked about their greatest accomplishments in life and their answers range from family and other important relationships in their lives to school, career and travel. The catch phrase is “if you’re going to weigh, weigh something that matters.” They also have a “diet filter” where you can sign up to have the word “diet” blocked from your media.

I love this ad and this message (haven’t tried the diet filter yet but like the concept). What’s not to love? I believe we (especially women) spend a ridiculous amount of time worrying about our weight. And because our culture has so completely fused the ideas of weight and health, if someone makes positive lifestyle changes that could improve their overall health and wellbeing, but they don’t lose weight doing it, they often give up on those changes. What’s the point if it doesn’t lead to weight loss, right? Ugh.

My dilemma about this ad is that it comes from a food company that specializes in frozen meals and has been solidly part of our “diet culture” for decades. Sure, this campaign is to re-spin the company toward health and wellness vs. dieting, but let’s be clear, pre-packaged frozen meals deliberately low in calories are still supporting a diet mentality and approach.

It is great that Lean Cuisine has reformulated their recipes and taken out some of the nasty or at least questionable additives that do a lot more for food manufacturers (via longer shelf life) than for eaters. It is also great that they are supporting a Girls Leadership organization. But I’d be a lot more excited about this ad campaign if it was put forth by a farm that produced high quality fresh food or a local farmer’s market. Sigh. (My farmer friends are now laughing hysterically at the idea they would have that kind of cash for advertising!) I prefer the trend towards eating more whole, fresh foods and preparing more of our own meals to buying packaged frozen meals. I realize however, that convenience is still in the top 3 reasons why people eat what they eat.

With a mix of optimism and trepidation I share this ad campaign. I do appreciate the small steps toward change. As I tell my clients “aim for progress not perfection.” I celebrate that at least someone (with a big advertising budget) is supportive of non-diet messages. The Lean Cuisine website states a goal to “ignite a relevant and authentic social conversation about weight and value perception among women” and that is a conversation I want to have more often!


Eating Problems: Get Answers…Today!

February 23, 2016
  • Do you worry constantly about what and how much you eat?

    The Struggle

    The Struggle

  • Are you afraid that eating “the wrong foods” will make you fat?
  • Does it seem like you spend too much time thinking about food and eating?
  • Do you fast, diet, use laxatives, diet pills or “cleanses” to make up for eating too much food (or the “wrong” kinds of foods)?
  • Do you eat in secret or feel like you don’t deserve to eat?
  • Do you feel out of control when you start eating or when you eat certain foods – as if you cannot stop until the food is gone or you feel physically sick?
  • Is figuring out what and how much to eat really stressful for you?
  • Do you ignore hunger and/or fullness cues? Or is it hard for you to tell if you are hungry or full?
  • Do you avoid entire food groups or specific foods out of fear they will make you fat or unhealthy?
  • Does stress lead you to either avoid food or overeat?
  • Do you exercise to “earn” your food?
  • Do you exercise even if you are sick or injured?
  • Is exercise mainly a way to burn calories and something you don’t otherwise enjoy?

Many of these statements are common thoughts, beliefs and behaviors that we don’t think are a problem. In fact we live in a culture that promotes many of these things. We don’t hear much about healthy eating or exercise that become problems when taken too far. For some people however, many of these statements can be clues to problem eating or even full-blown eating disorders.

Food is often used to comfort, numb or distract from uncomfortable feelings or problems that seem overwhelming. If this is a once-in-a-while thing you may be fine. But when this is the main way you cope (or don’t cope) it can be a serious problem.

How do you know if what you are experiencing related to food is “simply” emotional eating vs. a full-blown eating disorder? This year’s Eating Disorder Awareness Week promoted by the National Eating Disorder Association (NEDA) can help you explore this question. The theme this year is:

3 Minutes Can Save a Life. Get Screened. Get Help. Get Healthy.

 The NEDA website ( has a free, confidential screening tool and lots of information about eating disorders both for people who may be suffering with an eating disorder and for friends, family and others who are concerned about someone who may have an eating disorder.

Whether what you (or a loved one) are struggling with is an eating disorder or other eating issues that is causing physical or emotional distress, you are not alone. And, there is support and guidance available. Don’t wait – act right now.




“I love food too much!”

November 12, 2015

not sure about this snowman“I love food too much!”

I hear some version of this sentiment frequently from clients who struggle with their weight. Sometimes clients struggle with some form of eating disorder that involves binge or compulsive overeating but many times there is no diagnosis (at least not a formal one). They truly believe their excess weight is the result of some kind of character flaw, such as low willpower or an unusual fondness for food. Or perhaps they are addicted to food in general –or more commonly to carbs or sugar in particular.

The reality is that love often has little or nothing to do with our eating and weight problems, at least not in the ways we think it does. We can love food—arguably an important survival skill, but struggle with other aspects of our relationship with food. Food cravings or a feeling that we can’t stop once we begin eating certain foods may be confused with love. Unfortunately, like many of our primal relationships, we are not encouraged to delve too deeply into what is really happening because we should just automatically do the right thing. I mean we are all born knowing how to eat, right?!

With rare exceptions related to developmental problems, yes, we are all born knowing how to eat. We are even born generally knowing what to eat as well as when we are hungry and how much food we need. However, once we transition from breast milk or baby formula things can get complicated with food. We begin to rely on external cues to tell us all of these things related to eating. We eat when it is meal or snack time. Our parents or caregivers put food on our plates, largely choosing what we eat, and coax us to eat it all. I’m dating myself here but as kids many of us were expected to aspire to the “Clean Plate Club,” apparently in solidarity with starving children in Africa who weren’t as lucky as we were in the food department.

As young, inexperienced eaters it makes sense that our families and caregivers select which foods are available to us and schedule meals and snacks. The problems arise when kids are cajoled to eat beyond satiety or fullness. After many years of eating when, what, and how much we are “supposed to” eat according to external forces, we can lose touch with our ability to recognize early signs of hunger and fullness. When portion sizes are determined by others (moms, chefs, packages, diet rules, food pyramids, etc.) we don’t pay much attention to our fullness unless we still feel hungry or are overly full after eating. What we eat is based on all kinds of factors and there are many foods we are coached to eat sparingly or avoid altogether.

Foods that are considered “bad” become weapons with which we beat ourselves up when our eating doesn’t conform to what we’ve been told we “should” eat. When we eat “perfectly” (note the quotations because there is no such thing as a perfect diet) we are somehow elevated in status. When we eat well we are “good” and when we don’t we are “bad.” Adhering to some arbitrary set of dietary rules becomes a measure of us as people. Who we are is linked to what we eat –or don’t eat. Crazy isn’t it?!

Circling back to where I started, when we accept the idea that we should never eat certain foods, we set ourselves up to feel deprived. Sometimes we deprive ourselves of adequate calories or certain nutrients that we believe will make us fat (or not help us lose weight). The lack of enough food or a nutritional imbalance can lead to food cravings. This is particularly common with low carbohydrate diets, especially for people who have high levels of physical activity.

Other times we get enough calories but we don’t allow ourselves to eat foods we enjoy so we become fixated on these foods. When we finally have an opportunity to eat the forbidden foods we naturally want to eat a lot of them and may feel out-of-control around them. In these two scenarios we set ourselves up either biologically or psychologically to eat particular foods and/or amounts of food that feel (and may in fact be) excessive. This type of eating is then followed by guilt for not following our food rules, and shame for being flawed people who lack willpower or suffer from a food addiction.

Admittedly the topic of food addiction is complicated. I realize there is compelling research that shows sugar and highly addictive drugs like cocaine can light up the same areas of our brains—of course so do other rewarding behaviors like sex and exercise. Clearly, eating and abusing drugs are very different behaviors however. Labeling food problems as “addiction” creates the illusion that we know how to treat these problems: rigid abstinence.

After 15 years of clinical experience and extensive education and training related to dysfunctional eating and eating disorders, it is clear to me that we must treat eating problems individually. There is no single protocol that works for every person. Also, despite the progress we have made as a society in recognizing that addictions are not choices, there is still a considerable amount of stigma attached to any kind of mental illness, including addictions. So, even if labeling food and eating problems as “addictions” is accurate (which it may or may not be), it is not necessarily helpful.

What is helpful when we believe we “love food too much” or are in some way addicted to food?

First, we can start by pretending we don’t know what the heck is going on. Instead of assuming we understand our problems, we can be more curious about them. We approach our eating habits with the series of questions we would use to explore anything we didn’t know much about: what, when, where, why, how?

“Curiosity will conquer fear even more than bravery will.” –James Stephens

Instead of immediately berating ourselves for eating that cookie or choosing a burger and not a salad, we can ask some questions. When was my last meal? Was I overly hungry when I arrived at the table? Was I frustrated with a situation at work and looking for something comforting? Did I eat quickly which made it hard to know when I was full (it takes our brain about 20 minutes to get the signal we’ve had enough)? Was I in a place where the burgers are awesome and the salads not as good? Am I sick of so many food rules and ready for something tasty and easy at the end of a long day? Many of my clients find the acronym HALT helpful to identify why they feel uncomfortable– am I: Hungry, Angry, Lonely or Tired?

There is much more we can do to unravel problems related to food and weight, however replacing assumptions that we are somehow flawed or cursed, with curiosity about what else may be going on in our complex relationship with food (and ourselves) is a good place to start.

I Had No Idea: a “healthy” passion can become a problem

February 26, 2015

Passion drives many athletes and outdoor enthusiasts here in Jackson Hole, Wyoming. Surrounded by rugged mountain ranges and access to raging rivers, this recreational Mecca is a sort of proving ground for athletes who want to push their limits skiing, rock climbing, boating, biking, running and more. There is a strong subculture here that sets a high bar for “normal” exercise.

Passions Can Become Problems

Passions Can Become Problems

More than 20 years ago during my early years in Jackson a friend and I did a 24-mile day hike up in Grand Teton National Park, a major feat for us east coast transplants. We got an early start and crested the top of the divide feeling pretty good about our accomplishment until a couple of local friends came jogging up the trail and passed us wearing fanny packs with water. If you climb or ski something here someone has climbed or skied it faster, or as part of a multi-peak day, or they first biked from town, swam across a lake, and were heading down to reverse their route after passing you. Seriously.

This Uber-athlete mentality makes it difficult to define “excessive exercise.” Disordered eating patterns that often accompany problem exercise are also normalized here. Sometimes eating takes obvious disordered forms such as severely restricting all food intake or bingeing and purging food. Less obvious disordered eating can be adhering to rigid food rules such as “eating clean” or following any number of fad diets that are socially accepted. This does not mean anyone who is consciously eating well to improve health or athletic performance has an eating disorder but points to the difficulty in identifying problems in subcultures like ours where extreme behaviors are normalized.

A group of friends on a long backcountry ski tour together may have no idea one member of the group has not eaten for 12 hours because she “ate too much” yesterday. Or she needs to hike, skin and ski first to “earn” her next meal. Or she “feels too fat” to eat. Or the food available doesn’t meet her strict guidelines of acceptable food. And with the exercise itself, if someone works out despite illness or injury or never takes a rest day, she is badass, dedicated, someone to be admired.

Excessive exercise as a form of purging in Bulimia Nervosa was added to the DSM-5 (the manual that outlines criteria for a variety of mental illnesses including eating disorders) in June of 2013. Exercise has long been recognized as a problem in a variety of eating disorders but it was not previously defined as a form of purging in place of other purging behaviors such as self-induced vomiting.

Unfortunately, the general public health messages that encourage people to “move more and eat less” don’t acknowledge any downsides to either of these mandates. “Earning” meals or treat foods with exercise is commonly encouraged and the fine line between balancing calories and physical activity or obsessing about these habits is often blurred. Exercise habits can’t be adequately assessed based simply on the number of hours or days each week, the type of activity, or even the intensity, we must look at what drives the exercise.

Is it enjoyable?

What happens if you miss a day of working out?

Has exercise replaced time you spend doing other things you enjoy or time you spend with friends and family?

Do you fuel and hydrate to support your activities?

Do you feel better afterwards or do you just feel relief that you exercised?

All of these questions must be considered in the context of the whole person. An elite or professional athlete may have to train on days conditions are less than ideal and training can appear compulsive to an outside observer and a recreational athlete who sometimes overdoes it may not have a problem. The point is we need to know that despite all of tNEDA - Exercisehe positive benefits associated with physical activity, exercise can have a dark side. People who exercise while malnourished and underweight can experience accelerated bone loss and exercising after food restriction or other forms of purging can cause dangerous electrolyte imbalances.

If you suspect someone you care about has no idea that their passion may have crossed a line into dangerous territory – seek support. NEDA has a free Coach and Athletic Trainer toolkit with ideas that may apply to recreational athletes who are not being coached. Also from the NEDA website are the following risk and protective factors for athletes that may be helpful to consider in the broader context of appropriate or “healthy” exercise.

Risk Factors for Athletes:

  • Sports that emphasize appearance, weight requirements or muscularity. For example: gymnastics, diving, bodybuilding or wrestling.
  • Sports that focus on the individual rather than the entire team. For example: gymnastics, running, figure skating, dance or diving, versus teams sports such as basketball or soccer.
  • Endurance sports such as track and field/running, swimming.
  • Overvalued belief that lower body weight will improve performance.
  • Training for a sport since childhood or being an elite athlete.
  • Low self-esteem; family dysfunction (including parents who live through the success of their child in sport); families with eating disorders; chronic dieting; history of physical or sexual abuse; peer, family and cultural pressures to be thin, and other traumatic life experiences.
  • Coaches who focus primarily on success and performance rather than on the athlete as a whole person.
  • Three risk factors are thought to particularly contribute to a female athlete’s vulnerability to developing an eating disorder: social influences emphasizing thinness, performance anxiety and negative self-appraisal of athletic achievement. A fourth factor is identity solely based on participation in athletics.

Protective Factors for Athletes:

  • Positive, person-oriented coaching style rather than negative, performance-oriented coaching style.
  • Social influence and support from teammates with healthy attitudes towards size and shape.
  • Coaches who emphasize factors that contribute to personal success such as motivation and enthusiasm rather than body weight or shape.
  • Coaches and parents who educate, talk about and support the changing female body.


Fire & Smoke: I Had No Idea

February 23, 2015

This year’s eating disorder awareness catch phrase put forth by the National Eating Disorder Association (NEDA) is “I Had No Idea.” The list of I Had No Idea moments I have experienced as an eating disorder professional is long. From my first client struggling with Anorexia, the inadequacy of my standard formal education as a Registered Dietitian, even with a Master of Science degree in Foods & Nutrition, was obvious. I immediately began reading, studying, and consulting with more experienced colleagues about eating disorders. I attended a workshop specific to CBT (Cognitive Behavioral Therapy) for eating disorders led by Christopher Fairburn and a national conference featuring several high profile experts in the eating disorder field back in 2008, and still I had much to learn. As most eating disorder professionals will admit (in candid moments at least), we learn the most from our clients and patients.

Eating disorders work is about more than learning for me – I am truly inspired by my clients. Their perseverance in the throes of incredibly difficult challenges humbles me. One of the best I Had No Idea professional moments for me was learning that eating disorder clients can fully recover. While not all clients do for a variety of reasons, knowing that full recovery is a possibility and believing each of my clients has this potential is an idea I am grateful to know now.

In addition to the important work I do with clients, one of the incredible aspects of being part of the eating disorder treatment community is just that – a sense of community. We work in an area of nutrition, mental health and medicine that requires us to incorporate what we have learned over the past few decades about good practice, and perhaps more importantly, to stay open to new developments. I feel honored to work among so many dedicated, intelligent, and passionate professionals doing this work.

I plan to write this week about some of the topics the National Eating Disorder Association (NEDA) has made a part of this year’s awareness campaign. [See the list and more info here.] Beyond busting myths and stereotypes, encouraging more people to recognize disordered eating and related issues (like problematic exercise), and advocating for people struggling with eating disorders everywhere, I also want to be open about some of what I have learned on my professional journey working with eating disorders.

Fire and Smoke

I begin with an analogy I learned from a colleague at the intensive outpatient clinic for eating disorders where I worked for two years in the Seattle area. Jeanne Wiccomb, Director of the Intensive Outpatient Program, described the outward behaviors we see in eating disorders as the smoke. Beneath the smoke is the fire, with a variety


Smoke of the Eating Disorder

of “fuels” that can start the fire or keep it going.

Those of you who have attended one of my eating disorder presentations here in Jackson over the past year and half have probably seen the poster I made depicting this Fire and Smoke analogy for eating disorders. For those who have not I include pictures here of the newest rendition of my Fire & Smoke poster.

As you can see the smoke consists of the various behaviors we often use to define an eating disorder. Food restriction, binge eating, various forms of purgeing (including dysfunctional exercise), and the “other” category with additional forms of self-harm such as cutting that we see commonly with eating disorders.

Many people, including health and medical professionals, have no idea that these behaviors (the smoke) are not the eating disorder itself. This smoke is how the eating disorder presents itself but is only part of the whole picture.

The fire that produces the smoke can be caused by a number of “fuel” sources. Sometimes the fuel that starts the fire differs from fuel that keeps the fire going. Potential eating disorder fuel sources include:




Fire & Fuel

Fuel for the Eating Disorder Fire

Chemical dependency

Addictions (drugs, smoking, shopping, sex, exercise, gambling)

History of Trauma or other abuse (physical, sexual, emotional, psychological)

Poor body image

Low self-esteem

Personality characteristics & temperament (perfectionist, rigid, compulsive traits, obsessional, harm avoidant, sensitivity to rejection, reward dependent, anxious)

Feeling of Powerlessness

Life Transitions – life cycle, lifestyle changes, loss (death, divorce, move)

Troubled Personal Relationships

Sensitivity to rejection

Peer pressure

History of Bullying or Teasing Related to Weight/Size

Media Messages and Images (Unrealistic Thin or Muscular “Ideals”)

Cultural Ideals of Beauty – emphasis on outward appearance

Prejudice Against Obesity – Body Shaming

Inability to express emotion in healthy or appropriate way (emotional dysregulation)


Brain chemical imbalance?


There are many things I love about this analogy (in addition to the opportunity to do a really fun art project making this poster!). The treatment process and recovery journey is often long and complicated. Conceptualizing the eating disorder as a fire with many possible fuel sources helps us “see” why it can take so long to recover, why simply getting rid of the outward behaviors (or clearing smoke) is not enough, and why relapse is common or considered part of the process.

I have worked with eating disorder clients for nearly 15 years and I have yet to meet a client with only a single fuel source. When I show this poster to clients and their families they often immediately identify several possible contributors. This helps families, especially parents to feel less guilt, and clients to feel validated in the difficulty of their struggles. This also helps all of us see that socio-cultural factors such as the media portrayal of the “Thin Ideal” for females and the “Muscular Ideal” for males or problematic relationships may not cause eating disorders, though these can be significant contributors.

If you know someone who has no idea what eating disorders really “look like” I invite you to share this analogy and graphic with them.

Beyond Broccoli’s Response to Article: “6 Things I Don’t Understand About the Fat Acceptance Movement”

December 29, 2014

This morning I read a blog post by Carolyn Hall entitled “6 Things I Don’t Understand About the Fat Acceptance Movement.” I realize that as with so many contentious current issues, people on all sides are so entrenched in their own views they struggle to step back and look at the whole picture. We all do this – we judge what we see and hear based upon our own life experiences. The bigger problem occurs when we are not open to changing our preconceived notions. As I tell my university students – if we want to be part of the solution to our current problems we must learn to communicate with people who don’t think like we do. This post is an attempt to do just that.

frozen creek

Though I felt frustrated reading this article I recognize Hall’s questions are shared by many who are unfamiliar with the nuances of the HAES (Health at Every Size) approach and provide an opportunity to respond with my take on these questions. I assume this author genuinely wants to hear a different view point and respond to her 6 points accordingly. Each response is based on my 14 years of work as a Registered Dietitian with a major focus on a non-diet approach to health, and a specialty working with problem eating all along the continuum, including eating disorders.

1. America is extremely accepting of fat.

Only someone who has not lived in America in a fat body could make this statement. To be clear, despite feeling fat most of my life starting in preadolescence, and going through periods of being 20-25 pounds or so above what is considered “healthy” for my height, my work with clients in larger bodies has shown me that I do not really know what it is like to be fat in our culture. I am haunted by their life stories however, and I can assure you this statement is not accurate.

I do agree with Hall that our culture accepts and even encourages many of the factors that contribute to unhealthy lifestyles, including excess weight and inadequate physical movement. As a whole (with some very vocal exceptions) we accept a food system that produces and promotes a plethora of unhealthy foods and makes them cheap, convenient, and accessible 24/7 for most of us. We accept that our “busy lives” don’t include time to prepare and eat health-promoting food at regular intervals and without distractions. We don’t encourage people to connect with their internal cues of hunger and fullness or with how their physical and mental health is linked to their eating habits. We accept a fear-based approach to education about virtually everything, including nutrition, and then blame people who don’t make sustainable changes based on fear (a topic for another post).

2. “Body positivity” should include health.

I cannot speak for every member of the Fat Acceptance or Health At Every Size Movements but I can tell you as a longtime advocate of a non-diet approach to health, and an eating disorder professional, my motivation to do this work is a focus on health. As with all social “movements” I suspect there are advocates with extreme and more rigid views than mine but having read many books by HAES proponents, any suggestion that health is not a key part of this movement is a misinterpretation.

The problem I see is that weight and health are so intertwined we overlook the fact that many lifestyle changes related to food, exercise, stress resilience, and more, can improve health with little or no change in body weight. Even if weight loss can increase health benefits, which is likely to be true in the extreme cases of morbid obesity the author refers to throughout her article, as long as positive lifestyle changes are tethered to weight loss, we encourage yo-yo dieting and unsustainable changes linked to metabolic mayhem that are not likely to yield long-term health benefits.

Body positivity does not mean you love being fat or want everyone to be fat. Accepting that you are a human being with worth that extends beyond your appearance is body positivity. In my experience working with people who struggle with food, weight and body image, the preoccupation with body weight, shape and size occurs in underweight, overweight and healthy weight individuals, male, female and transgendered. Shifting the focus toward what Connie Sobczak calls “intuitive living” in her excellent book Embody, is about self-care in every aspect of our lives. As long as we are only focused on a number on the scale we are not truly engaged in sustainable self-care.

3. “Health at every size” seems physically impossible.

Again, Hall is hung up here on the extremes – as many critics of the HAES approach are. As stated above, the main idea is that we need to shift the focus from weight to health, for everyone. Weight gain, or loss, may be part of the bigger health picture for people at the extremes of anorexia and morbid obesity. However, I see clients on a regular basis who are within a “healthy” weight range and routinely engage in unhealthy behaviors in an attempt to change (or maintain) the way they look.

I cannot count the number of times clients report compliments about how “good” they look or how much weight they’ve lost after days of erratic eating, purging, starving themselves, or exercising in dangerous ways. They not only hear this positive feedback from friends and co-workers but health professionals – doctors, personal trainers, and yes, sadly, nutritionists. All of us can be blind to the physical and emotional health consequences of a weight-focused vs. health-focused culture.

4. People are allowed to not be attracted to certain body types.

I have no issue with this statement. Attraction is thankfully diverse and individualized. My issue is that the fat shaming prevalent in our culture is an accepted form of discrimination and prejudice. Though I don’t believe we are anywhere near “post-racial” or beyond any other form of discrimination widely accepted earlier in my lifetime, I see examples on a regular basis of serious discrimination based on weight that is totally accepted in mainstream culture. Even people who still believe race, ethnic background, sex, gender, or religious preferences are undesirable, don’t express such views widely (except of course on the internet). Yet somehow there is a general acceptance of negative comments made about someone’s weight. As a society we allow fat to be a code word for lazy, stupid, weak, and other harmful judgments.

Promoting the idea that people come in different shapes and sizes does not mean we all suddenly have to be attracted to fat people. This is more of a social justice issue than a personal attraction or general health issue.

5. Food addiction is a real medical problem.

A complete response to this point is easily an entire blog post unto itself. In brief however, the concept of “food addiction” is controversial, particularly if we attempt to address this “diagnosis” as we do addictions to other substances. There are many issues that contribute to both what and how much we eat on a regular basis. While biochemistry and neuroscience can explain pieces of this complex puzzle, any attempt to reduce problem eating to “simple addiction” is not helpful.

Foods that are highly processed and bypass our internal cues of hunger and fullness are a problem. As stated previously these foods are cheap, convenient, and accessible. They are also heavily promoted using results from billions of dollars of food psychology research. I fully agree we need to address these issues.

To understand eating problems more completely however, we need to include the biochemical aspects of our response to food, along with our long-established neural pathways or habits, various influences in our food environments, and other aspects of human behavior. Evolutionary psychology can also help us better understand our currently maladaptive tendencies with the curiosity and compassion we need to make significant and sustainable changes to our behavior.

Like it or not, eating habits are complicated and reductionist “solutions” must be recognized as such. The HAES movement may not focus on all of the points I mention here but it does recognize the “answers” to the “obesity crisis” are not simple.

6. Childhood obesity is something we can’t be accepting of.

I could not agree more on this point. I know many health professionals who endorse non-diet and HAES approaches and none of them are “pro-obesity” of any sort, especially among children. Raising children to eat based on fear – don’t eat this or that because you will get sick, or worse, get fat, is not helpful. Continuing to advocate a weight-focused vs. overall health-focused paradigm will not help our children. They need to know that eating nutritious foods and moving their bodies daily is good for their brains, bodies, mood, energy levels, and overall health. But they also deserve to know that thin does not equal healthy; that as they transition from childhood to adolescence and then into adulthood, their bodies will grow and change, and these changes don’t mean they are unacceptable when they don’t fit narrowly defined ideals of beauty.

Our children need to know there is no “perfect body” or “perfect diet.” In fact it would be great if they abandoned the notion of perfection altogether. Striving to do the best they can is awesome. Chasing the illusion of perfection can be dangerous.

It is our responsibility as adults to provide an environment for our children that supports good health and a sense of well-being. In our current culture this is no easy feat. It is clear however, that what we have been doing for the past few decades is not working. Focusing on short-term fad diets, succumbing to the trappings of modern society that support unhealthy lifestyles and then blaming people who gain weight or don’t exercise enough, using fear-based tactics in an attempt to change people’s habits, are not helpful strategies to produce the changes we want to see.

I don’t like the phrase “fat acceptance.” I prefer “human acceptance” which gets more to the core of our various health problems linked to weight. In fact we know that the statistics related to weight and health also apply to socioeconomic status and health. This doesn’t mean we don’t pay attention to these relationships but hopefully it means we try harder to understand the complexity of the issues beyond what we see on the scale.

There is no single way out of the mess we are in related to poor health as a society. Blame, shame, fear, anger, and a lack of compassion for ourselves and others are not working to make us healthier physically or mentally. What I am drawn to in alternate paradigms such as Health at Every Size (HAES) is the refusal to reduce our current health problems to weight alone, nor to continue clinging to approaches that don’t work. It is time for a fresh perspective and frankly I don’t care what we call it as long as it takes us in a more positive direction.

Find Willpower in Self-Compassion and Calm

December 4, 2014

Have you ever tried to change a habit related to food or eating?

What I’m going to share with you today applies to any behavior chSwanange. I’m going to use a food example that most of us can relate to as eaters entering the holiday season.

Imagine this scenario:

You decide this year that you are going to take it easy on sweet treats throughout the holidays. Not only do you feel better on a daily basis when you keep sweets in balance, but this change is consistent with your long-term health goals.

You go to work and shortly after you arrive a co-worker walks in with a plate of home-baked cookies – your favorite kind. And there are a lot of them. You graciously accept a cookie then immediately start criticizing yourself for eating it. That voice inside starts in: “Not even an hour into the workday and you’ve eaten a cookie, so much for that healthy eating goal.”

Then you have a second cookie. The voice gets louder, and harsher. By the time lunch rolls around you’ve lost count of how many cookies you ate. You go out to lunch and order dessert after your cheeseburger and fries because at this point you have “blown” your healthful eating plan for the day.

You have just experienced a well-known behavioral psychology phenomenon called the “What-the-Hell Effect.” This cycle of indulgence-regret-greater indulgence was first described by psychology researchers Polivy and Herman.

Now I want you to think about what happens in these “What-the-Hell” situations for you. What are some of the things you tell yourself?

The most common response I hear from my clients is “I have no willpower.” They believe they “cave in” to temptation because somehow they just don’t have enough willpower or their love of food is so powerful they cannot resist that first cookie. They are convinced that first cookie paves the way to “What-the-Hell.”

The reality is that the initial decision to revert back to an old habit, to eat that first cookie, is NOT what leads to the What-the-Hell behavior. It is our feelings of guilt, shame, loss of control, or loss of hope that follow the first relapse that lead us to continue the path away from our longer-term goals.

According to Kelly McGonigal, a psychology researcher at Stanford who studies Willpower, to break this “What-the-Hell” cycle of indulgence-regret-greater indulgence we need self-forgiveness. We may think guilt motivates us to correct our mistakes but it’s just one more way that feeling bad leads us to give in.

Now here is where things get really interesting. There is another important factor in this scenario: your brain.

Some of you may be familiar with neurobiologist Dan Siegel’s “Hand Model of the Brain” (if not click here). The limbic area of the brain is where our “fight/flight” response starts when we are faced with a potential physical or emotional threat. Dr. Siegel calls this the “lower brain”.

The cortex, including the prefrontal cortex or the “upper brain,” covers the limbic area, and enables us to reason and to see the bigger picture –specifically our longer-term goals. Decisions from our lower brain are impulsive, short-sighted and reactive.

When we berate ourselves for eating the cookies, we engage the stress-response in our lower brain and set ourselves up to continue not acting in accordance with our longer-term goals. Blood actually diverts away from the cortex or upper brain.

When we beat ourselves up mentally, our brain works against us!

Study after study of adults shows that self-criticism is consistently associated with less motivation and worse self-control.

Self-compassion – being supportive and kind to yourself, especially in the face of stress and failure, is associated with more motivation and better self-control.

Psychologist Kristen Neff describes 3 core components of self-compassion:

  • Self- kindness (treat ourselves as we would a loved one who is struggling)
  • Recognize our shared humanity (we are all imperfect –connects us)
  • Mindfulness of our inner critic and our discomfort (to respond differently we first must be aware of what is happening)

Going back to our example of the cookie, what if your initial response is “wow, that cookie is delicious” and you eat it slowly, savoring the taste, appreciating that your co-worker made this cookie from scratch?

Afterwards when you are tempted to have another cookie (or 5), you take a few deep breaths instead. You gently remind yourself that enjoying a cookie here and there is consistent with your longer term health goals, but wolfing down 4 more cookies right now probably isn’t. You don’t beat yourself up for eating that first cookie. You are human and many humans like cookies!

When your inner critic kicks in and starts screaming: “You idiot! Why did you eat that cookie? What were you thinking?” you calmly respond, “I wanted the cookie and it was delicious.” End of story. If you stay calm, blood continues to flow to all parts of your brain and you are able to remember your longer-term goals.

This self-compassionate and calm response takes away the driver of the “What-the-Hell” (WTH) effect– if there is no guilt and self-criticism, then there is nothing to escape.

As we enter the holiday season filled with all kinds of ways to tempt us away from our health-promoting self-care habits, a time when we are prone to the “What-the-Hell” effect and to impulsive decisions made by our “lower brain” due to stress, let’s think about sharing some of the compassion we give freely to others, with ourselves as well.

In addition to the many holiday stresses, alcohol, sleep deprivation and distraction can also trigger our “lower brain” and cause us to abandon our longer-term goals. In these situations we need to be extra kind to ourselves. We also need a strategy to help calm our stress response and promote resilience.

One of the simplest stress relievers is to take 3 deep belly breaths. LET’S TRY THIS – 3 deep belly breaths, each followed by a long, slow exhale. ONE, TWO, THREE.

If you were stressed and your limbic brain was threatening to take charge, those 3 deep breaths just redirected the blood flow to your whole brain. Now your cortex has a chance to be part of your decision making.

This calmness in combination with self-kindness may be your most enjoyable holiday treats ever –ones you can look back on in January with a smile on your face!

Gratitude: Antidote to “Not Enough”

November 25, 2014

I didn’t get enough sleep

I don’t have enough money

I need to exercise more

There is never enough time to get everything done

I’m not ___________ (thin, fit, attractive, rich, strong, smart, etc.) enough

Does your day start or end with any of these thoughts? What about throughout your day? Is there enough? Do you do enough? Are you enough?

Regardless of the abundance that surrounds us we often perceive a “culture of scarcity” – a mindset that can lead us to focus on what we lack versus what we have. A couple of years ago I was introduced to the work of Brene Brown, a psychology researcher who studies shame and vulnerability. Through her work she observes ways this “culture of scarcity” plays out in our everyday lives. The observation that struck me most is that people who struggle with emotional eating or binge eating, sometimes use food in response to these feelings of “not enough.” Brene suggests one possible antidote to subconscious and conscious feelings of scarcity and inadequacy: a gratitude practice.

“Piglet noticed that even though he had a Very Small Heart, it could hold a rather large amount of Gratitude.” ― A.A. Milne, Winnie-the-Pooh

While it may be naïve to think a simple gratitude practice is the solution to behaviors as complex as binge eating, I am intrigued by the idea that focusing attention on what we have versus what we lack can help us feel more fulfilled in our everyday lives. Many clients struggling with emotional eating issues describe food as a way to “fill” some type of void that has nothing to do with biological hunger. Despite their “knowing” this is a reason they eat, they struggle to stop such behaviors. I often encourage clients to identify what is driving the eating because if it is not physical hunger then no amount of food will “fill” them. The idea behind this strategy is that whatever the real need is that drives this eating cannot be met if it goes unidentified. Unfortunately the process of unraveling underlying needs is not simple and takes time.

Is it possible that focusing more on what we are grateful for may help us feel more “full” in a positive way? Can we “fill up” on gratitude to replace mindless activities that don’t serve us well?

I decided to try a gratitude practice myself, just to see what would happen. Though I don’t currently struggle with eating issues, I definitely fall into that scarcity mindset with respect to time, money, and many other things I wish I had more of. When I learned about the scientific studiesGratitude jar related to gratitude I wondered if this practice could impact other behaviors that distract my daily life and keep me feeling “busy.”

Last fall shortly after my return to Jackson, I was sitting at my desk with Ginny curled up next to my chair. I glanced at my favorite wedding picture propped on my desk beyond my computer, and then out my front window toward Snow King Mountain bathed in afternoon sunlight. Overwhelmed with gratitude, I wanted to freeze that moment. I was home in Wyoming with Dave and Ginny, I re-launched my dream career at Beyond Broccoli, and I was surrounded by mountains, a community I care deeply about, and immediate access to so many of the things I love to do. I knew that at some point the proverbial “honeymoon phase” of this new chapter of my life would fade, so I decided to start a gratitude practice. My hope was that at some point when the mundane aspects of everyday life replaced my bursting enthusiasm for all-things-Jackson, I could retrieve a few of these strips of paper and remind myself of all the aspects of my daily life that provide richness beyond measure.

I already journal regularly so I chose to try a gratitude jar instead. I got a Mason jar from the kitchen and removed the steel lid. I cut a piece of paper into small strips and wrote a few of the things I was grateful for in that moment. I continued to do this daily for a while, savoring simple moments that made me feel joy and contentment. Dog walks and puppy kisses, random acts of kindness, playing in the snow, sunshine on cold winter days, feeling love and support. It didn’t take long to notice moments of gratitude everywhere I went. Now I don’t even have to read my little scraps of paper – I glance at the jar on my desk and am filled with gratitude.

I don’t know if this gratitude strategy can decrease general thoughts and feelings of scarcity for everyone. I do know this has been a powerful practice for me. I am more aware when I start down the scarcity mind set path and can stop myself or at least recognize what is happening. Though things are going pretty well right now, as with most years the past 12 months included moments of fear, pain, and discomfort, and there were losses. I can’t say I felt less of these uncomfortable emotions, but I do think I was a bit more resilient. The way I see it there is no downside to a gratitude practice and for me nurturing resilience following life’s inevitable hardships, is enough.

“To love someone fiercely, to believe in something with your whole heart, to celebrate a fleeting moment in time, to fully engage in a life that doesn’t come with guarantees – these are risks that involve vulnerability and often pain. But, I’m learning that recognizing and leaning into the discomfort of vulnerability teaches us how to live with joy, gratitude and grace.”
Brené Brown, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are

Overweight and in Recovery from an Eating Disorder

November 17, 2014
Photo from a client in recovery

Photo from a client in recovery

Last week following a presentation about eating disorders to a group of mental health professionals a participant stood up and shared that a relative of hers had just returned from eating disorder treatment and was overweight. What should she (the relative in recovery) do?

Each time I hear this question my heart sinks. We live in a culture where the primary metric for health is weight. If someone does not meet clinical criteria for a “healthy” weight range she is encouraged by everyone around her, often including her health providers, to “diet.” It astounds me that even when a person has struggled with a full-blown eating disorder the focus remains on weight, and too often “dieting” is the recommendation. Keep in mind that a “diet” for someone with an eating disorder is like a drink for someone addicted to alcohol.

Responding to the question about what to do next is difficult for many reasons. First, I know nothing about this person’s eating disorder journey – how it began, the form it took, the treatment she received, current support, etc. What I do know is that no matter what her journey looks like, working with a combination of outpatient therapist and dietitian with training and experience in eating disorders is the ideal next step. I’d like to say this type of follow up care is essential based on the many stories I’ve heard from my eating disorder clients about working with professionals not experienced with eating disorders. Unfortunately the reality of living in areas where specialized services are not available makes this an ideal scenario rather than an essential one.

The long term nutrition goal is to create a positive relationship with food (body and emotions too but these are more in the psychotherapy realm). Here are my top 3 next steps for nutrition in eating disorder recovery after some type of residential or inpatient treatment:

  • Seek support related to a more intuitive and mindful approach to eating. There are several books and websites on these topics. For Intuitive Eating resources Evelyn Tribole’s website is great and for Mindful Eating guidance Michelle May, MD has some really good resources
  • Be aware of any type of food restriction – especially if your eating disorder includes binge eating. This is one of the most counter-intuitive aspects of eating disorder recovery for those who struggle with binge eating. This is also commonly ignored among dietitians and other health professionals not experienced in eating disorder treatment. The focus is too often on the binge rather than the food restriction that can begin a cycle of disordered eating. Skipping meals and snacks, avoiding certain foods or food groups, only allowing yourself to eat at certain times, or arbitrarily determining portions sizes rather than relying on your body to tell you what and how much you need, are all forms of food restriction that can be harmful in eating disorder recovery.
  • Watch for “always” and “never” thoughts and statements. These words are red flags for “black-and-white” “all-or-nothing” types of thinking that support disordered eating behaviors of all kinds. These words are rarely true when it comes to food and can help you identify struggles that lurk beneath the surface during your recovery journey.

There are many more issues to address in support of long-term, sustainable eating disorder recovery and a positive relationship with food. If you are overweight as you face the next stage of your recovery these steps can help you stay focused on health and well-being while you support your body’s return to a healthy weight range tailored to your individual needs.

It Takes a Team to Support Eating Disorder Recovery

November 13, 2014
Photo by Fiona Conway Summer 2014

Photo by Fiona Conway Summer 2014

Earlier this week a colleague and I gave a presentation on eating disorders to a group of mental health professionals in Idaho Falls. It was a whirlwind of information crammed into a relatively short span of time but it felt important. I welcome opportunities to share what I’ve learned about eating disorders – including the treatment process and recovery journey, with both the public and other professionals. Each time I engage with a group about this work, I walk away wanting to do more, wishing we had more time and more resources to empower more mental health, nutrition and medical professionals to identify patients and clients who need support around the most basic of human needs: food and connection.

As we prepared for the eating disorder talk I also realized how powerful it is to partner with a colleague with both experience and a deep understanding of this difficult work we do. I have struggled since my return to private practice to recreate some of the magic I experienced as an integral part of a cohesive multi-disciplinary team in an outpatient clinic devoted to eating disorder treatment.

I now realize that what was special about being part of such a team was that in addition to our increased effectiveness in treating our patients in an environment of ongoing team communication and a strong foundation of knowledge surrounding these complex disorders, we knew innately how to support each other in our work. Whether it was tears, laughter (that could seem inappropriate to an outsider at times), a well-placed hug, or a simple nod of understanding, I felt a little less alone in the often tumultuous sea of treatment and recovery we were helping our patients to navigate.

The outpatient setting presents many challenges for both clients and practitioners. The amount of services covered by insurance is often inadequate and there are many environmental factors that make eating, exercise and body image a daily struggle. Though clients who are appropriate for this more minimalistic level of care are less acutely sick, patching together adequate support for them is often difficult. For those of us committed to working with eating disorders in this less-than-ideal outpatient setting, recognizing when we need support ourselves and being good models of self-care for our clients is essential. I am grateful for my new colleague and friend in this work and look forward to what we can offer our community as a team.