Judaism and Eating Disorders

by Jill Lewis, MA, LCSW, CEDS

Why is that girl moving back and forth? She must be over-exercising.

Why can’t he just eat the burger and the cheese? That must be a ritual from the eating disorder.

Why is she refusing pork and shellfish? She must be restricting.

These are just a few of the comments that religious Jewish patients have encountered. According to Jessie Brownstein, an expert in Jewish education: “Food is to be enjoyed. God gave it to us and brought it to this world…We should not be serving food. Food should be serving us.” When someone who comes from a Jewish religious background is struggling with an eating disorder, we need to be aware of their customs and rituals. The values and morals that observant Jews uphold are based on what was written in the Torah thousands of years ago. We must seek to understand the customs and the importance they have for the patient, and not just assume they are based on an eating disorder. A patient asked to have only meat products for lunch and refused a snack that had dairy only a few hours later. The patient had to explain to the treatment team the concept of not mixing milk and meat, and where the customs stem from. The therapist, dietitian and patient were able to have a healthy open dialogue that this patient wasn’t avoiding or restricting food, she was imply honoring the laws of Kashrut (the bodies of Jewish religious law concerning suitability of food).

If you meet someone who is religious, ask questions about their customs, ritual, faith and how it plays a part in their eating disorder and their recovery.  Provide a nurturing space for them to explore and understand their customs, why they practice them and the importance that they hold. Encourage them to question the ways that their customs intersect with their eating disorder and help them to explore the changes that need to be made for their recovery without judgment.  Seeking knowledge about someone’s needs is crucial in the recovery of anyone with an eating disorder, there is no reason it should stop with someone who is religious.

Jill Lewis, MA, LCSW, CEDS provides individual, group, couples, and family therapy for people struggling with eating disorders. Jill has worked at the Renfrew Center and Balance Eating Disorder Treatment Center. She has psychodynamic training from The New York Psychoanalytic Society, as well as group training from Eastern Group Psychotherapy Society. She maintains a practice in New York City and Atlanta. 

 

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What is an interpersonal group and should my patient attend?

by Jill Lewis, MA, LCSW, CEDS

We are a part of groups everyday of our lives, our family group, friend group, work, school, etc. An interpersonal process group provides the unique opportunity for patients to access and understand their interpersonal dynamics, not just with a therapist, but with other members of the group and community. What happens in a group will inevitably reflect their lives outside. For example, quiet group members are likely quiet outside the group and the feedback they get in group about being quiet will be relevant to them outside of the group. In this extremely enriching environment, our complex dynamics get played out, providing opportunities to explore and understand why they are happening. Interpersonal process groups help patients confront and deal with uncomfortable feelings and engage in healthy conflict, which allow people to step out of their repeated patterns, challenge, share, and access painful and stuck parts of themselves.  For example when one member of a group has similar characteristic to a patients parent. The dynamic of working through this anger, pain, and love within the group, is unbelievably powerful. It becomes a safe environment to identify their hurt and confront it.  This is extremely valuable within the eating disorder community, and it is truly how patients receive the ultimate success with confronting the interpersonal dynamics, finding their voices, and being seen. Being a group member helps a patient learn that they are not alone with their struggles—both in terms of symptoms use and the relational issues that the symptoms are rooted in.  It also helps patients create allies and support within the group which in turn can strengthen the supports they have outside of group.   Groups also help patients manage difficult feelings as they arise and work through them actively with the help of a therapist and their peers. It makes sense that the group treatment model that works in residential, PHP, and IOP settings would also be a critical component of outpatient treatment. Many patients are apprehensive about the group process for fear or not understanding what it can offer or being too exposed. Help our patients understand the value of stepping outside of their comfort zones so they can get this enriching experience that they so deeply need and deserve.

Jill Lewis, MA, LCSW, CEDS provides individual, group, couples, and family therapy for people struggling with eating disorders. Jill has worked at the Renfrew Center and Balance Eating Disorder Treatment Center. She has psychodynamic training from The New York Psychoanalytic Society, as well as group training from Eastern Group Psychotherapy Society. She maintains a practice in New York City and Atlanta. 

 

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Sick of Toast and Barbecue WHAT? Using unintentional humor to address eating challenges in eating disorder recovery

By Jacy Pitts, RD, CSP, LD

Many of my clients, on at least one occasion, vent their frustrations about why eating is so difficult. “WHY???” they ask. “Why can’t I just eat? Eating is not supposed to be this hard!” These frustrations are usually accompanied by visible distress: body tension, tears, raised voices, and clenched fists. It’s very important to sit in this space with them for a moment and acknowledge that yes, eating has become very, very hard, and if eating normally once again were so simple, they would have already done it by now. Once in a while, I’m given an accidental gift: the opportunity to help clients wade through the muddy waters of this conundrum and share a laugh or two along the way. Here are a few favorite funny moments:

One client - let’s call her Olivia B since I’m currently watching Law & Order SVU - came in for a third nutrition session. Olivia B had finally agreed to start seeing me after months of prompting by her therapist. In order to help break her restrictive and rigid eating tendencies, at our first session we had mapped out a meal plan structure that aimed to give her more fuel, more consistently throughout the day. Together, we had listed examples for meals and snacks that would work with her meal plan. Included in a sample breakfast was “toast”. So, fast forward to this third nutrition session. She sat down on the couch, balled her fists, and said very emphatically, “I’m so sick of toast!! I talked with my therapist about it this week, and she said you probably didn’t mean that’s the only carbohydrate I could choose at breakfast. But it was the only one listed on my worksheet, so that’s all I’ve been eating.” Now in that moment, I did not even consider laughing. It would have been ill-timed and she’d never have come back. We discussed how she seemed ready to have more choices at breakfast, and expanded her menus. However, after several more sessions, she initiated the conversation of reflecting how rigid her thought process had been at that third session. I agreed that it was, and how wonderful that she’d been able to gain perspective and improve her flexibility with eating different types of carbs. And then we laughed - a LOT. But I didn’t laugh harder or louder than Olivia B - I’ve learned this is very important!

I asked another longer-term client, who was having a particularly difficult week, to please send me a list of a few dinners that she could prepare and eat with her children for the remainder of the week. She had recently discovered that she enjoyed cooking dinner for her sons, and was benefitting from the connection that came from sharing a meal with them again. Later that day, I received her list, which included “barbecue children” as an entrée. (Darn autocorrect.)  I quickly replied “Please don’t barbecue your children!” and we both laughed until we cried. We continued to get many good laughs about this from time to time, and it helped to lighten her load. She had so many stressors in her life, and it was an opportunity to take a break from those, even if for a moment. I felt incredibly grateful to be able to laugh along with her.

Another interesting trend I’ve noticed is that many of my clients (so many!) wear socks that have food on them. Should we call these “fear food socks”?! Seriously, the socks represent, by and large, the foods that clients avoid: pizza, donuts, ice cream, hamburgers, tacos, etc. I’ve occasionally pointed out the irony that they can wear these without thought, yet have purposefully avoided eating them. One client proudly declared, “I’ve also got food underwear!” Much to their chagrin, I point that wearing food must mean that some part of them is ready to begin the process of challenging their fear foods.

Cheers to more toast-worthy tales.
 

Jacy Pitts, RD, CSP, LD is a Registered Dietitian with offices in Smyrna and Buckhead. She sees eating disordered clients of all ages and genders. Board Certified in Pediatric Nutrition since 2007, Jacy specializes in working with children, teens, and families. Her office has a fully equipped kitchen and meeting space for meal/group support to help clients build skills in recovery.

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Moving Toward Variety: Helping Clients Diversify Their Meals

By: Jacy Pitts, RD, CSP, LD

As eating disorder practitioners, we are all familiar with the concept of adding variety to a client’s often-limited food repertoire. As a non-diet dietitian who works with clients of all ages and all eating disorder diagnoses, I find that safe or preferred foods, or ways of eating them, are common amongst all groups. Eating is already scary… so eating a new food, texture, color, or combination, in a new place or with new people can really push clients out of their already-uncomfortable comfort zone. How do we tackle the complicated task of moving clients toward adding more variety on their plates (and in their lives)?

One of the top questions I get from clients when providing guidance around eating or meal planning is: “Is it okay to eat the same thing every day for lunch?” This is tricky, because although something is better than nothing, it’s really not okay in terms of their long-term recovery. So my response is usually something like, “Well, do you want to get better? Then let’s work on that.”

In fact, a small exploratory study (n=41) by Schebendach et al., found that eating patterns which were lower in both energy density and variety were associated with poorer treatment outcomes in weight-restored women with anorexia. The study also observed “food monotony” in this subset, and that less palatable foods tended to amplify this effect. Let’s look at a real-life example: that client who mixes a concoction of high-volume, low-calorie foods that don’t go together and calls it a meal? Food monotony, less palatable. Guess what helps combat the monotony effect? Adding highly palatable foods, or, as we often call them, “fear foods”. Think combination dishes, fats, desserts, and sauces. Normalizing these foods as part of balanced eating can help prevent relapse.

Here are a few thoughts and tips on steering clients toward more variety:

Invite clients to eat with you during a session. Eating is a fundamental way we connect with other people. This form of connection is often impaired in our clients due to the isolating nature of eating disorders. Allowing a client to explore the process of connecting with another person over a meal or snack, in a safe and trusted space, can give them the stepping stones to eat in other environments later on. This vulnerability that comes with a shared eating experience can lead to new insights about how the eating disorder functions and the ways in which it keeps them stuck. The example of a client staying stuck in food monotony is just one of many. Do you have to then eat together every session? No. Even one shared experience of eating a meal or snack can provide valuable information for both the practitioner and client and open a dialogue of specific areas that need improvement…with the goal, of course, to increase variety over time.

Food is fuel, and fuel helps us function. This is a favorite saying of mine, and its purpose is to neutralize the belief that there are “good” and “bad” foods, and that the body is fully capable of utilizing a variety of foods for fuel. Fuel and balance are words that I use often with clients. Sometimes, this means exploring with a client the rigid belief that they simply must load up on vegetables at every opportunity, every day, or they have not achieved the pinnacle of healthy eating. Such a vegetable-heavy style of eating actually is not balanced. Heavy vegetable consumption may displace other critical nutrients, such as calcium from dairy or dairy alternatives, iron from protein-rich foods, and a slew of other vitamins and minerals from major groups such as grains or fats. Recently, I had a client switch from eating a large salad at lunch every day to a smaller yet more nutritionally balanced panini, and the following week, she reported how much less bloated and gassy she felt. This felt very rewarding in that she had a reduction in unpleasant body sensations and she had been able to add variety with her eating. Other times, this means explaining the trajectory of carbohydrate breakdown in the body and how it is used by the muscles and brain. Understanding how carbohydrates are used has helped many of my clients shift from carbohydrate avoidance to carbohydrate inclusion…and more variety.

Take a trip down memory lane. What was a favorite childhood food memory? Did the client stop eating that food during their eating disorder? A teen client once shared that she used to eat a donut for breakfast every Friday, and since her eating disorder hit, it had been two years since she had done so. She actually knew the exact date. One day, I received a picture of her eating a donut and giving a big “thumbs up”. She discovered that in reality, her anxiety was wrapped up in the thoughts of eating the donut (anticipatory anxiety) and that once she made the leap to eating it, her anxiety lessened significantly. Help a client imagine a present-day exposure that stems from a favorite food in childhood…. imagined exposures often lead to real life ones. 

Create a bucket list with them: I will know I am fully recovered (or well on my way) when I can do/eat ________. For some clients, one item might be cooking with oil or butter again, or eating a hamburger patty with the bottom and top bun at the same time. It might be having a pan of brownies in the house and not eating them all in one sitting. It might be driving by a favorite fast food restaurant without feeling that they must order something in the drive-thru. Over time, help the client to work their way up the list, from the least to most anxiety-inducing.

 

Jacy Pitts, RD, CSP, LD is a Registered Dietitian with offices in Smyrna and Buckhead. She sees eating disordered clients of all ages and genders. Board Certified in Pediatric Nutrition since 2007, Jacy specializes in working with children, teens, and families. Her office has a fully equipped kitchen and meeting space for meal/group support to help clients build skills in recovery.

 

Beauty in Every Shade: A Look at Racial and Ethnic Diversity in Eating Disorder Treatment

By: Joy Ssebikindu, LPC

A visibly anxious young girl walks into your office with her parents for an assessment; however, these symptoms are far beyond any illness that her parents have ever seen or heard of – markedly an Eating Disorder. Your new client shyly answers your questions, somewhat honest regarding her eating disorder behaviors and reluctant to say that she is ready for something different as she is not sure that she is. Her ideal: what she sees marketed as beautiful – skinny, young, and skin resembling the “nude” of the Crayola crayon. How do you tell your young client that her ideal is not attainable? How do you compassionately convey to your client, of minority descent, that they will never be a White girl, with natural blonde hair and blue eyes – that their eating disorder will never fulfill that desire?

Although it is highly recognized that Eating Disorders touches all genders, races, socio-economic status, the field is at the brink of tackling best practices in treating such disorders with consideration for the intersectional markers. Truth be told, as an African American female therapist, I have struggled through conversations with Black girls and women who simply wish to be someone else. In being someone else, they truly believe that their world would be different and they will be embraced wholeheartedly by the others. And as one of the few African American females in this community, I often wonder how my White colleagues would handle such a conversation with a client who does “look” like them. Better yet, I wonder if such a conversation would take place.

As the face of Eating Disorders evolves, here are a few things to consider:

1.     Check your biases at the door: Begin each new relationship afresh, open to their interpretation of their experiences.

2.     Open the conversation: Diversity and the –isms associated can be difficult and daunting to discuss for some. Ground yourself and display a willingness to listen. Globally, this is the beginning of great therapeutic work.

3.     Be curious about how your client makes meaning of their race, age, creed, etc.: Know that though they be familiar, every experience is unique to the individual; therefore, seek to understand how they have made meaning of their differences.  

4.     Be sensitive to the family and community supports that your client may have or not: Recognize that mental health, eating disorders, and the idea of treatment may be a novel idea for the family and communities from which they come from.

5.     A note to treatment centers: Be aware that representation matters so seek to diversify your staff. I did not fully understand the value that I had in this community until recently – value that has been found in every ‘thank you’ that I have received from people of color for being willing to engage in a profession/specialty not yet truly embraced by all. 

I am curious how you “treat” the unfamiliar? I want to hear how you as a clinician bring awareness to your client’s differences without shaming them for their uniqueness. Email me at jssebikindu@gmail.com. Consider the conversation open…

Joy Ssebikindu, LPC, NCC is a “Double ‘Dore” having graduated from Vanderbilt University with her BA in Sociology and Child Development, and her M.Ed in Clinical Mental Health Counseling. Shortly after finishing graduate school, Joy moved to Atlanta in pursuit of a career as a mental health therapist, where she continues to provide therapeutic services today in her private practice and as the Primary Therapist at Center for Discovery.

HAES is the New Black

By Jill Lewis

Health at Every Size (HAES) is the new approach to living a healthy, body accepting, food-loving life. It is not a diet. It is about losing the constant body shaming, body comparison, undereating, overeating, and roller coaster of dieting that so many people have torturously been putting themselves through for decades. It can be scary to decide to truly love yourself in your body and to eat those foods that are pleasurable and delicious, but HAES provides you with the tools to do so.

HAES promotes the following 8 principles:

1. Do no harm

2. Create practices and environments that are sustainable

3. Keep a process focus rather than end-goals day to day quality of life

4. Incorporate evidence in designing interventions where there is evidence

5. Include all bodies and lived experiences

6. Increase access, opportunity, freedom and social justice

7. Given that health is multidimensional, maintain a holistic approach,

8. Trust that people and bodies move towards greater health given access and opportunity.

Let’s be real here folks; this isn’t a magic pill that happens overnight. This is hard work that requires attention, compassion, love for yourself, so much of which has been pushed aside and beaten up. If you could start with one thought and one notion of compassion for yourself, you are on your way. It is easy to stay in a diet, eating disorder, self-destructive mentality. That familiarity can keep you stuck for a lifetime. HAES is “a model to support the health of people across the weight spectrum that challenges the current cultural oppression of higher-weight people.”

My challenge for you is to find your inner and outer you. We all get one incredible life on this earth. Waiting until you lose that pesky 5lbs or 100lbs in order to help your life happen just means that you keep waiting.

What if your life started right now? RIGHT NOW!?

You are beautiful, strong, intelligent and compassionate. You have the power to decide, so let’s start with not wishing our bodies away, but living and accepting them for what they are. 

Jill Lewis, MA, LCSW, CEDS provides individual, group, couples, and family therapy for people struggling with eating disorders. Jill has worked at the Renfrew Center and Balance Eating Disorder Treatment Center. She has psychodynamic training from The New York Psychoanalytic Society, as well as group training from Eastern Group Psychotherapy Society. She maintains a practice in New York City and Atlanta. 

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5 Ways To Reclaim Your Body Image

By Rebecca Clegg

As I was at the checkout line at the supermarket yesterday, I found myself looking at the magazine rack that is placed, innocently, no doubt, right there amidst the candy and other temptations you don’t really need but find yourself considering every time you go to pay.  It’s the beginning of the year – Diet Season. And it oozed from the magazine rack with all its judgmental glory.

One magazine’s entire cover was devoted to headless shots of ‘celebrity’ bodies, dividing the best from the worst, with florescent circles and arrows pointing out cellulite, flab, and less than firm areas of flesh. 

Another one featured a splash of celebrities in gym clothing and swim attire, promising to provide the diet secret never before revealed that will make 2017 your best year ever!

Yet another cover offered up Gwyneth Paltrow’s Skinny diet secrets along side an article that promised to give you 15 tips for firming and toning.

I could go on and on, but I’ll cut to the chase. Every single magazine with the exception of Time Magazine made mention of weight loss, Fat, Dieting, or Body Image. And as it so happens, Time Magazine’s focus was on how to eat (in today’s world (organic vs. processed food, etc…).

And you wonder why we are obsessed with our weight, food, and how our bodies look?

My mood shifted as I read the headlines on each of the magazines. I felt anger and disgust, resignation and sympathy all at once.

The fact that we are a culture obsessed with weight and body image did not come as a surprise to me.  This unfortunate truth is something I have been aware of for a long time.  We are a nation that is brainwashed.  Socially conditioned to believe that our weight and the shape of our body is a critical component of our worth. 

What I found myself connecting to was how vital it is that we be proactive in our efforts to detach ourselves from this unhealthy obsession.  I often tell clients as we are working together that the moment they leave my office, they will be inundated with 100’s of messages, overt and covert, which will directly contradict everything we have talked about during the session. 

One hour a week of focusing on loving your body and feeling good about yourself as opposed to a constant barrage of messages telling you that being thin is a necessary component to being worthwhile, and that you are not good enough as you are, is hardly a fair ratio.  

I don’t point this out to be pessimistic, or to rain on their parade as the saying goes. 

I do this to create a seat for empathy, so as to help them understand that this obsession with body image and dieting is something they have been taught, and to highlight that the indoctrination of thought continues on a daily basis. 

Understanding this helps clients to understand that in order to change their body image and general focus, consistent, repetitive proactive measures must be taken. 

Look at this as though there are two bank accounts.  The Negative Body Image Account, and the Positive Body Image Account.  Each Day through media and other interaction with people, we (knowingly, and unknowingly) make deposits into the negative body image account.  You must take it upon yourself to start depositing into the positive body image account, as you are likely to “draw” from the account with the most “money” in it.

What can you do to offset the constant stream of body obsession and negativity?

Here are a few ways to begin to change your focus and rebuild your self worth and body image:

Go On A Media Detox:  Commit to putting aside any and all magazines, blogs, television shows, or various forms of media that emphasize body size, dieting, weight obsession or generally make you feel like you need to work harder in order to be worthy.  If this feels impossible or overwhelming, start small. Choose just one, or perhaps just do this for a week. 

Indulge in Positive Messages:  If exposure to body shaming media hurts your self esteem, then deductive reasoning would have it that body positive media could help build your self esteem.   There are a number or books, blogs, movies, and documentaries that serve to build and empower the body image and self worth of women in our culture.  Be proactive, and seek them out.  It is that which we place our attention on that becomes our focus. You choose.

Affirm the Positive:  Find 5 things about you or your body that you are grateful for and repeat your gratitude for these things daily.  I don’t get hung up around specifics (i.e. 10x’s a day vs. 50x’s a day).  The only thing I know is that learning is centered on repetition, and the more you repeat something, the more it becomes accepted.  Some people choose to do this in the form of a gratitude journal, and others prefer to make these affirmations their daily mantras, incorporating them into meditation or quiet time. 

Practice ACT: ACT stands for Acceptance and Commitment therapy.  ACT basically espouses the following:  We are culturally indoctrinated with certain thoughts.  To try and change those thoughts is nearly impossible.  It is much kinder, loving, and quite frankly, easier, to accept those thoughts as what they are - old cultural ideas that have just gotten in your head.  Then you move on to commitment to change.  Commitment to living from a kinder, gentler thought that is more aligned with what you want to believe.

Practice Non-Judgment: When you are out in the world, or watching television, practice-seeing beauty in all women, of all shapes and size.  If you notice a judgment arise regarding size, or shape, recognize this as cultural brainwashing, and choose to see the beauty that is there.  This practice is especially helpful to reclaim our subjective beliefs around beauty and shed our social conditioning. 

Rebecca Clegg, NCC, LPC, is the president and founder of Authentic Living, an Atlanta based psychotherapy private practice specializing in the treatment of women in recovery from eating disorders, compulsive overeating & emotional eating, and individuals seeking assistance in their weight management efforts.  She is also the founder of Life Beyond The Diet, an online community that offers health coaching and educational programs focused on helping women heal their relationship with food and create an overall healthier lifestyle. www.lifebeyondthediet.com

Let’s Take the Word “Healthy” Out of Our Vocabulary!

By Leslie Cox

This is the time of year when many people choose to start a diet.  As a pediatric nutritionist specializing in eating disorders, this gives me cause for concern.  The majority of my patients tell me their eating disorder started months earlier because “I just wanted to eat healthy”.  For children and teens, it is easy to misinterpret what “healthy” eating means.  This often leads to unhealthy dietary practices such as skipping meals and fad diets.   Maybe we should look for another word to use besides “healthy” when talking about nutrition.

As I reflect back on the last year, I think the most popular diet trend for my patients is a vegan diet.  While a carefully planned vegan diet can meet a teenager’s nutritional needs, it should send a red flag to parents if their child announces they want to be a vegan.  Vegans do not eat meat, fish, poultry or use other animal products or by-products such as eggs and dairy products.  A poorly planned vegan diet can result in inadequate intake of calories, protein, calcium, Vitamin D, zinc, iron, and Vitamin B12.  For children and teens, this can be especially harmful as growing kids have the highest calorie needs of any age group.  A vegan diet omits all animal sources of nutrition, therefore these foods need to be replaced by plant-based sources of proteins and nutrients such as beans, pasta, grains, nuts and nut butters; plant based dairy products, oils, and fortified food sources of Vitamin B12.   In my experience, most of my patients who have opted for a vegan diet do not want the additional grains and fats they need to make up the difference in animal foods they are no longer consuming.   My patients often report not liking the taste of plant-based cheeses and meat analogs.  If this is the case, then a vegan diet is not for you.

So where are kids getting their nutrition information?  Jokingly, I tell my patients that I don’t think I knew what “vegan” meant until I was in college!  Unfortunately, today many kids get their nutrition advice from YouTube and blogs by non-professionals.  One former blogger, Jordan Younger, aka “the Blonde Vegan”, made her living blogging on her vegan lifestyle.  During this time, she developed an eating disorder.  Her 2015 book “Breaking Vegan” is an insightful memoir of her journey through veganism and extreme dieting and coming to terms with the fact that her plant-based lifestyle was no longer good for her health.  She still blogs but is now known as “the Balanced Blonde”. 

So when talking with our kids and our patients, what word should replace “healthy”?  I like the word “balanced” when talking about nutrition.  What is balanced for one may be different for another.  Does your diet meet all your nutritional needs?  Do you like the taste of the foods in your diet?   Can you find these foods in social situations or when dining out with family and friends?  These are questions to ask our kids if they are opting for a diet change. 

 

Leslie Cox, MS, RD is a registered dietitian, board certified in pediatric nutrition who specializes in all forms of eating disorders.  Leslie works as a clinical nutritionist at Children’s Healthcare of Atlanta where she is a founding member of the inpatient eating disorder team which provides medical stabilization for children and adolescents with eating disorders.  Leslie also specializes in medical nutrition therapy for children and adolescents with a variety of gastrointestinal conditions; complex feeding issues requiring nutrition support, and infants and children with failure to thrive.  

TOP 3: Highlights from ICED

By Meg Martinez, MA

Greetings, Atlanta IAEDP chapter!

As one of your research co-chairs, I’d like to take this opportunity in the June blog to present to you the highlights of this year’s International Conference on Eating Disorders (ICED), which was held in Boston at the end of April.  I was fortunate enough to be able to attend the conference, and what a conference it was!  All the stars were out in force.  Spotted were the Academy’s past presidents Tim Walsh, Kelly Klump, Pam Keel, Steve Wonderlich as well as research superstars Michael Stroeber, Jennifer Wildes, and Christopher Fairburn (that’s right, Christopher Fairburn of CBT for eating disorders, in the flesh!).  It was a busy and intellectually stimulating 3 days, and I could fill pages with everything I took away from it (in fact, I already have, you should see my notebook!).  However, just for you, I’ve come up with this list of my top 3 conference highlights.  So here they are:

3. Past president Cindy Bulik’s keynote address on new directions in anorexia nervosa (AN) research.  I will admit, a lot of what Dr. Bulik presented was over my head, but I got the sense sitting there that I was looking through a window into the future.  The data Dr. Bulik presented suggested a significant role of the immune response and of the gastrointestinal microbiome in the pathology of AN and, even though I didn’t totally get it, it was exciting stuff!  Beyond the data presented, Dr. Bulik’s talk was a wonderful example of interdisciplinary scholarship and collaboration; her example should serve as a model for the entire field.

2. Then-president elect Carolyn Becker’s talk in the second plenary session, titled “Adoption of treatments: Who gets picked and who gets left behind?.”  As Dr. Becker put it, the task assigned to her by the conference’s scientific committee was to answer the following question: why are treatments with lots of empirical support them not implemented by clinicians (e.g., CBT for eating disorders), but treatments with less support are (DBT, FBT, ACT, etc)?  It was a tall order for one 15-minute talk, but Dr. Becker did a great job.  As she suggested, there are five reasons why clinicians are drawn to treatments with less empirical support.  First, clinicians are drawn to treatments with big promises: we see the suffering of our patients and, when caught in the “tension between the slow pace of science and the immediate needs of [our] patients,” we look to those treatments that claim to ameliorate our patients’ suffering the best.  Second, clinicians like treatments that are flexible or “blended,” as these treatments promise to treat a broader range of patients, require less re-training, and can sometimes let clinicians avoid the techniques we don’t like (e.g., exposure; see below).  Third, therapists like treatments that address and validate the frustrations felt by clinicians, our patients, and their families.  Fourth, clinicians are drawn to treatments that are associated with charismatic leaders and good marketing (because we are, after all, only human).  And finally, clinicians like treatments with easy and accessible training infrastructures.  If we’re going to like to have to do something new, we don’t want to have to pay thousands of dollars and take several weeks off to attend a training workshop.  Although the content of her talk was provocative, I thought Dr. Becker did a fantastic job of answering the question posed to her in a way that respected both the clinicians and the researchers in the audience and encouraged individuals on each side to consider the wisdom of the other’s position.

And last, but certainly not least…

1. Then-current president Glenn Waller’s workshop, entitled “Using exposure with response prevention in CBT for eating disorders: Why we don’t, why we should, and how to do so.”  For those of you who have not gotten the opportunity to see Glenn Waller speak, I highly recommend it.  He’s a really funny guy, and he has a way of challenging everything you think you knew.  Much like the workshop he gave at last year’s ICED (which was on why clinicians using CBT for eating disorders don’t but should weigh their patients as directed by the treatment), I left this workshop thinking about all the patients of mine who could benefit from exposure with response prevention (ERP).  In effect, Dr. Waller’s point was that ERP can be a powerful tool for the treatment of anxiety, including the anxiety we see in patients with eating disorders.  Through ERP, patients learn that anxiety is short-lived and will decrease without the need for compulsive behaviors (cutting food into small pieces, purging, restriction, etc).  However, many clinicians don’t take advantage of this powerful tool because we are anxious about 1) making our clients anxious (as is the goal in ERP), and/or 2) not implementing the procedures correctly.  The bottom line was that we should be using these techniques; as Dr. Waller put it, “like your patients enough to push them” in treatment.  I was so excited by this workshop that I added Dr. Waller’s book, Cognitive Behavioral Therapy for Eating Disorders: A Comprehensive Treatment Guide, to my Amazon wishlist.

So there you have it, folks: my top 3 conference moments.  If you found this stuff as exciting as I did, I encourage you to consider attending ICED 2016 in San Francisco (May 5-7, with a clinical teaching day on May 4; for more information see http://www.aedweb.org/ICED2015/future.php).  Additionally, if you have any questions about this stuff, or the research world in general, feel free to reach out to me; as one of your Research Co-Chairs, it’s my job to help you bridge the gap between research and practice. 

Meg Martinez is a doctoral student in Emory's clinical psychology program studying with Dr. Linda Craighead. After receiving her bachelor's degree from Yale University in 2010, Meg worked at the Columbia Center for Eating Disorders in New York, NY.  Under the leadership of Drs. Tim Walsh, Evelyn Attia, and others, Meg was involved in cutting-edge research projects including a large clinical trial of a novel pharmacological treatment of Anorexia Nervosa.  Currently, Meg's research interests focus on the development and evaluation of novel psychotherapies for the treatment of Anorexia.


The Gift That Keeps On Giving

By Keira Oseroff, LCSW

As a young social worker, newly licensed and fresh out of graduate school, I found myself working as a case manager on a women's unit, specializing in the treatment of eating disorders at a local psychiatric hospital. I say I found myself there, but truth be told, I didn't find myself there by accident. Acutely aware of my own history of food and body image issues, I understood the great responsibility I had to model emotional and physical health. And, amazingly, I remained calm about food and my body, even while pregnant.

Twenty-seven years old and half way through my pregnancy, I learned I was having a daughter.  The calm I had experienced vanished into thin air! Holy s#*t! What if she struggles with food and weight and body image? What if she's too thin? What if she grows up a fat kid like me? What if she has an eating disorder? How will I teach her to love and accept her body, accept herself and develop a healthy relationship with food? Those questions swirled around and around inside my mind.

My questions were answered 6 weeks into my maternity leave when a colleague from the unit came to visit me. Part of her baby gift to me was a copy of “Child of Mine,” a book written by Ellyn Satter focused on childhood feeding dynamics. Receiving that gift changed the trajectory of my life and my career! Devouring the information, I had a road map for how to feed my daughter. It made so much sense! And I would practice, and practice and practice. The journey included infinite opportunities to confront my own values and beliefs about food and about my children's capacity to learn and grow normally. Practicing Satter's Division of Responsibility (sDOR) also creates countless opportunities to develop trust, healthy boundaries and emotional regulation skills (for adults and kids). I continued to learn, studying all of Satter's books and attending her intensive trainings.

Satter's feeding dynamics model, anchored by the Division of Responsibility (sDOR), is profoundly simple and rich in complexity at the same time. The concept of the feeding relationship as a metaphor for parenting shaped my professional clinical practice with people healing from disordered eating, and on their own mission to guide their families toward fulfilling and healthier relationships with food - and with one another. There is no doubt in my mind that it's a powerful weapon to be used in our arsenal for the prevention of eating disorders and childhood obesity.

The years that have followed have resulted in hundreds of confident, competent, joyful eaters... two of which are now 10 and 13 years old. Now, as a new faculty member of The Ellyn Satter Institute (ESI), I have the privilege to participate in sharing Satter's growing body of work, strongly supported by the research, in an even broader way! 

Keira Oseroff is a Licensed Clinical Social Worker, specializing in the treatment of those struggling with eating disorders, childhood feeding issues and dual diagnosis. She received her Bachelor’s degree from The George Washington University and her Master’s degree in Social Work from the University of Georgia. Since 1999, Keira has worked in a variety of clinical settings including residential treatment and private practice, working with individuals, couples, families and groups. She is passionate about the important distinction between treating people, not disorders.


Eating Disorders: Not Just a Young, Rich, White Girl’s Disease

The first time I truly learned about eating disorders and the significant mental and physical effects on one’s body and life was in 1999 during my doctoral program at The University of Georgia (UGA).  I was born in Jamaica, migrated to Florida and completed my undergraduate training at The University of Florida (UF) and my master’s degree at a historical Black university in Washington, DC – Howard University (HU).  Up until then, it seemed that eating disorders only affected young, rich, White girls.  In fact, in my homeland of Jamaica, this is still a foreign illness.  But times seem to be changing.  As a young girl, I remember being encouraged to have “meat on our bones.”  But as countries become more influenced by the American standard of beauty, people in other countries, including Jamaica, are steering towards the White American stereotypical image of beauty.

While at UF (1989-1993), I had heard rumors of fellow dorm mates, friends, and sorority sisters engaging in extreme dieting (fad diets and diet pills) and excessive exercising.  However, no one mentioned the words “eating disorders.” Later, while at HU (1993-1995) I learned that one of my friends suffered and recovered from anorexia when she was a young girl living in Jamaica.  She reported that the Jamaican physicians did not know enough about eating disorders or how to treat her.  So, they flew doctors in from Canada to treat her.  I am happy to say she recovered and continues to live a healthy life.   I must admit, that even though she detailed her journey, eating disorders were still foreign to me.  This issue still seemed to be a “young, rich, white girl’s” disease as it was portrayed in the media.  Up until this date, the only other person I knew who suffered from an eating disorder was Karen Carpenter, the singer.   

While studying for my Ph.D. at UGA (1998-2002) and working in the campus counseling center, I began to see more cases of disordered eating, eating disorders and body image issues.  I became more and more curious and wanted to learn causes, effects, and treatment of these illnesses.  Since my eating disorder cases at this time were young, White females, I also became curious about the cross-cultural and diversity issues among eating disorders.  So, when it was time to decide on a dissertation topic, it was not difficult.  I decided to research the cross-cultural comparison of eating disorders among college students. 

My curiosity and intrigue continued to grow, so I pursued my internship/residency training in the inpatient and outpatient units at The Medical College of Georgia (MCG) and my post-doctoral training at the Atlanta Center for Eating Disorders (ACE).   While at MCG, my first Black eating disorder client was a woman in her 80’s who reminded me of my grandmother.  She had a similar body shape and wore her hair in a similar bun!  That’s the first time I felt that this illness “hit home.”  This woman had been battling bulimia for over 40 years!  She was not young, she was not rich, and she was not White.   I also treated a young Black boy (around age 8 years) who was anorexic.  That’s when I knew I wanted to specialize in eating disorders.

Since moving to Atlanta and working at ACE and in private practice, many of my eating disorders and body image cases have been women of color of various socio-economic groups and ages.  But sadly, many people of color still think that eating disorders are a rich, White girl’s disease.  In fact, some of my ethnic diverse clients don’t even realize they have an eating disorder until I tell them that they have one.  In addition, many of them have significant body image issues, oftentimes hating their skin color, facial features, hair, and body shape.

Over the past 12 years, I have conducted presentations in schools, colleges, and the community.  Last year I conducted a presentation called “Curvy, Curly, and Chocolate – Loving Your Body from Head to Toe.”  The focus of the presentation was to encourage people to love the curves of their body, the natural curls of their hair, and the chocolate color of the skin, whether it is white chocolate, milk chocolate, or dark chocolate. 

As an eating disorders treatment professional it is my hope that I can successfully help all people I encounter overcome their eating disorder.  I also hope to reach ethnic diverse communities and educate them about the symptoms and treatment of eating disorders.  It is concerning that so many are suffering and don’t even know that they don’t have to suffer and that help is out there.   I invite you to join me in connecting with more diverse populations, of all ages and socio-economic groups.  Let’s develop ways we can reach these populations.  They need us!

Dr. Judi-Lee Webb is a licensed psychologist and Certified Eating Disorders Specialist.  She has been in private practice in Atlanta and treating eating disorders and other mental health issues since 2003.  She is the co-owner of New Directions Counseling Center in Smyrna and is opening a second location in Buckhead this summer. She is also the founding President of iaedp-Atlanta Chapter. www.newdirectionsatlanta.com


Self Care: How It Affects Both Us AND Our Clients When We Don’t Do It

By Sasha Asumaa, LPC, CEDS

I find it so interesting that we therapists spend so much time telling and guiding others on how to better take care of themselves, but often when it comes to ourselves we don’t take our own advice! Why is that? I am a firm believer that we must practice what we preach and we must walk the walk if we are going to talk the talk. I also firmly believe that our clients can tell when we are taking care of ourselves and when we are not. Would you take advice from someone to take better care of yourself if you knew they weren’t doing the same? I sure wouldn’t.

Let’s just take a moment for you to reflect on what happens when you don’t take care of yourself properly. What happens when your spouse/partner doesn’t take care of themselves properly? What happens when your clients don’t take care of themselves properly? Here’s a list of some possibilities:

-Tired
-Grumpy
-Get sick
-Communicate less and fight more with family and friends
-Abandon our coping skills
-Don’t take our medicines as prescribed
-Use alcohol/drugs/eating disorders/etc.

Several years ago I stopped and reflected on my own life, the hours that I was working, and how that was affecting myself, my family, AND my clients. I was going to work and then I was coming home and working, sometimes into the middle of the night-, which had me sleeping in another bedroom so I wouldn’t disturb my husband. I was tired, and stressed, and always thinking about work. I wasn’t engaging as much with my husband, who is a huge introvert, so I doubt he minded too much, but there’s still only so long a marriage can withstand that. Now, this is pre-children, so at least I wasn’t affecting anyone else, but I’m glad I figured it out before I got there! There would be times that I would come in to see clients and they would ask me if I was feeling ok or was I sick. They are very tuned in to me, just as I am to them, so of course they would notice! I think this probably spearheaded the effort for me to take better care of myself honestly. I big part of my job is to lead by example and I take that very seriously.

Many of us have to work hard to take care of ourselves and find balance. Here’s what I did to get/do to maintain my balance…

1.     I stick to work hours as much as possible. This is especially important for those in private practice.  I don’t return calls/emails before 9:00am or after 5:00pm. There are some exceptions to my rule (aren’t there always)- like going to networking dinners, and if it’s something that I know I will forget to respond to knowing what the next day looks like for me, then I will go ahead and do it to make my life easier. But for the most part I’m pretty stringent about this. I turn my ringer/tones off so that I can’t even hear notices so that I can focus on taking care of my family and myself.

2.     I actually do coping skills. You know- those things we are always telling clients to do? Yep. Those. I use them. Everyday. I’m sure many of you do too, but it sure is easy to let them slide!

3.     I take vacations. I’m terrible actually. I have to leave town. If I don’t leave town I’ll find a way to go to work. I’ll tell myself “it’s just an hour or two,” and then I’ve missed the whole point, which is that I needed to take a break and recharge.

4.     I meditate. It’s good for the soul and keeps me calm. What else can I say? I need as much calm as I can get!

5.     I exercise most days out of the week. It just makes me feel better to move my body, and it’s great for your brain too!

6.     I am home for dinner. Most nights anyway. Unless I am at a networking dinner or out having fun with my girlfriends, I make sure to take that time to connect with my family.

7.     I set healthy boundaries with my clients. There’s not a lot of contact outside of therapy sessions. Any concern a client has really needs to be addressed in the office, so we set up a time to do that. If I do find someone needs more, I refer clients to a higher level of care or a different kind of therapy that offers support outside of the office, like DBT skills coaching. Side note- this is just like taking care of ourselves, we need to be able to show our clients how to set healthy boundaries so that they can do it themselves.

8.     I’m careful about what I take on. I am one of those people that commit to something 150% when I say I will do something. I am fiercely loyal and reliable. So when I am approached to take something on or asked to do something, I really think about whether I have time to do it, when exactly I will have time to do it, and how it will affect my schedule and my life in general.

9.     I go to the doctor.  I take time to check in and make sure my body is functioning the way it needs to and is “supposed to”. I make as much effort to keep my body healthy as I can, so that my head can stay right too.

Alrighty- so let me come back to how this affects our clients. It’s pretty simple actually. If my clients see that I am not taking care of myself, how motivated are they going to be to do the same? Not much. Chances are if I am not modeling it, then there’s a slim chance that they are even going to make even a little bit of an effort. It’s like it gives them a pass to say, “see it’s too hard for my therapist who is in the business of teaching people how to take care of themselves to do it, so it must be impossible.” So many of my clients come through the door already believing that they cannot take care of themselves. They need help correcting that belief, not making it more believable and stronger.

My glorious mentor told me years ago, this business is just about planting a seed for some. How about planting a seed for not only your clients, but also yourself, and the family and friends surround you?  What does your self-care regimen look like? Does it need some fine-tuning? 

Sasha Asumaa is a Licensed Professional Counselor in the state of Georgia. She has 10 years of experience working with eating disorders including pre and postoperative bariatric surgery, anorexia, bulimia, and binge eating disorder in both a hospital and outpatient setting. Sasha also has a passion for working with women ages 15 and up with chronic illness, thyroid disease, infertility, trauma, addiction, and family and relationship problems including domestic violence. Sasha is currently in private practice in the East Cobb area of Marietta. 

What Nutrition Messages are We Sending Our Kids?

By Leslie Cox, MS, RD, CSP, LD

As a registered dietitian since the late 80’s, I have seen a lot of nutrition fads come and go.  The increasing popularity of organic, gluten-free, Paleo, and other similar diets has me particularly concerned. Not only is the science behind these theories flawed and lacking, these nutrition messages are particularly harmful to young people. As adults, we have the ability and life experience to make informed choices about our diet, but children do not. They do not have the capacity to understand concepts such as GMO’s or insulin resistance; instead, what they hear is “good food, bad food”. I specialize in pediatrics and eating disorders and what I hear from my clients as a result of these messages is troubling.

Recently I met with a high school student who had lost a large amount of weight and had not had a period in a year. Her overall health was so poor that she needed to be hospitalized. She told me that she was eating an organic diet that she saw on the Dr. Oz show and was also avoiding all dairy products because “cow’s milk is bad for you”. 

Another client diagnosed with anorexia nervosa at age 9, recalls her 4th grade teacher giving extra points if students brought in an “unprocessed snack”. This meant that if she wanted extra points, she could not bring a granola bar, goldfish, or any food with a food label.  In another classroom, her Spanish teacher was infusing nutrition messages into the Spanish lesson with phrases such as  “white milk is good” and “chocolate milk is bad”.   

As concerning as this is, I find it interesting as there is a new ad campaign touting the benefits of chocolate milk as an ideal post workout beverage. The site www.gotchocolatemilk.com is supported by a list of accomplished athletes, including former Olympic speed skater turned Ironman Apolo Ohno.   

So how did our country get to the place with such opposing nutrition messages? 

As rates of obesity continue to climb, so does the number of younger people diagnosed with an eating disorder. I believe that people of all ages are searching for the answer to optimal health in their life.  Unfortunately, the answer is not about food or a diet. It is about a lifestyle – moderation, balance and variety in both food and exercise is the key.  Unfortunately, this does not make headlines, nor is it trendy or flashy.  

We need to ask ourselves why the Japanese and Swiss have a high life expectancy and low obesity rates?  White rice is a daily staple in Japan and the typical diet in Switzerland consists of bread, pasta, potatoes, cheese, and a variety of red meats. Just something to consider before talking with our kids about nutrition and dieting.

Leslie is a registered dietitian specializing in pediatric nutrition and eating disorders in children, teens, and adults. She is in private practice with offices in Atlanta and Gainesville and is on staff at Children's Healthcare of Atlanta where she is a member of the inpatient eating disorder treatment team. Leslie also works at GI Care for Kids where she provides medical nutrition therapy for children with a variety of gastrointestinal conditions, weight issues, and feeding difficulties.  

In This Together: Giving Thanks for The Eating Disorder Professional Community

By Rebecca Clegg, NCC, LPC

A few days ago I met with my peer supervision group for our monthly meeting. A few hours after the meeting, my phone started to light up with text messages, from different members of our group. They were simply expressing their sincere gratitude and appreciation for one another, and for the very fact that we had created such a supportive place for each of us to commune and gather.  My phone lit up, but so did my spirit, as I truly felt the gratitude for having this type of support system.

It is commonly quoted that “It takes a village to raise a child”.

I often think of this in terms of my work, in so much as it “takes a team to treat an eating disorder”.  All of us in the eating disorder treatment community know this because we live and breathe this truth on a daily basis.  

Can you imagine doing this in isolation? I for one do not want to even try!

The opportunity to have a group like iaedp in the Atlanta area has highlighted for me how fortunate I am to have access to such a broad scope of talented and competent treatment professionals.  At a recent iaedp Atlanta chapter meeting, someone visiting from outside of the area pointed out how good we have it, juxtaposed to her own area, where resources and support are in short supply.  I thought about being in private practice in an area where I didn’t have the type of support I do here, and it made me all too aware of how fortunate I am to have access to the resources I have. 

My time in this organization has only further accentuated the fact that we are all working towards a common goal, and none of us are in this alone. Whether it is through collaborative treatment, referral access, sharing resources, or supervision, the role we play in supporting one another is immense. 

As I was reflecting on writing this blog, I knew I wanted to incorporate gratitude as it is the holiday season and it seemed like a timely topic.  Walking away from my meeting this week, it stuck me that there was no better topic to write about than my gratitude for the community of professionals who collaborate to treat eating disorders.

Being that it is the holiday season, and so often our focus turns to those things in life for which we are truly grateful, I for one am holding a space for the partnership and support of the community of professionals involved in the iaedp Atlanta Chapter and the ED treatment community at large.  I am not in this alone, and for that, I am truly thankful. 

Rebecca Clegg, NCC, LPC, is the president and founder of Authentic Living, an Atlanta based psychotherapy private practice specializing in the treatment of women in recovery from eating disorders, compulsive overeating & emotional eating, and individuals seeking assistance in their weight management efforts.  She is also the founder of Life Beyond The Diet, an online community that offers health coaching and educational programs focused on helping women heal their relationship with food and create an overall healthier lifestyle. www.lifebeyondthediet.com