written by Megan Fahey, MS, RD, CDN from Monte Nido & Affiliate’s Clementine Program
The upcoming holidays can be challenging for those in eating disorder recovery. Clementine Registered Dietitian Megan Fahey, MS, RD, CDN addresses some of these challenges by offering tips for supporting a loved one in eating disorder recovery during this holiday season.
It is once again the most wonderful (and stressful) time of year! Along with shopping, decorating and gift giving, cooking and baking are included on the never-ending to-do list. From Thanksgiving dinner through New Year’s celebrations, food undeniably plays a central role at holiday gatherings. For an individual struggling with an eating disorder, or working to maintain recovery from one, the overwhelming focus on eating can take away from celebratory experiences with family and friends. The following are tips to offer you or your loved one support around the holiday table.
Schedule holiday plans in advance in order to make any necessary adjustments to your meal plan. Gather details on the location and timing of each event, as well as the type of food served. Work with your dietitian prior to a holiday party to create a balanced plate from the dishes that will be available. Focus on incorporating a variety of textures, colors and flavors to enjoy. Keeping in line with a 3 meal + 3 snack meal plan model, try selecting appetizers or desserts for one or more of your “snacks” to normalize your style of eating for the holidays. If you or your loved one have food allergies or dietary restrictions, be sure to collaborate with the hostess and bring alternative dishes as needed. Although the meal plan is a tool to help you navigate decisions around food at the table, it is important to maintain flexibility around timing of eating and selection of food. Becoming attuned to your physical body will ultimately shift your focus away from an external meal plan. Eating disorder recovery is possible when you provide yourself permission to nourish yourself based on your body’s internal cues and desires.
Ask for Support.
This is a time of year to connect with those around us. Open up to a trusted family member or friend to communicate whatever support you may need to follow your established meal plan. Identify particular food behaviors you are working on and explain how your “ally” can best support you at the table. Maybe you need a second set of eyes assessing your portion sizes, or someone to pace with you during the meal. It may be stepping aside before and/or after the meal to briefly process your emotions and check in with your hunger / fullness levels. Eating disordered thoughts and urges are isolating, even when surrounded by a room full of people. Reach out and ask someone to help you process the emotion of the holiday to help resist eating disorder urges before, during and after the meal.
Mindfulness practices such as deep breathing will activate the parasympathetic nervous system and ease the muscles of the digestive tract. Your mindset while eating impacts not only the quantity of food you consume, but also how well your body is able to digest and absorb the nutrients present in the meal. Take a moment before the first bite to place both feet on the floor and take a few deep breaths to help calm your nervous system and ground yourself at the table. Although it sounds simple, mindful breathing will restore oxygen to the brain, helping you think clearly and make more effective decisions.
Create New Traditions.
It is not uncommon for holiday discussion to revolve around food, often times referencing the “good” or “bad” qualities of each component of the meal. This can be especially triggering to hear if you are working to establish a more nourishing relationship with food and your body. Although it is not possible control the attitudes of those around you, try introducing games or music at your family gathering to help shift the focus from food talk to interpersonal connection. Set a goal to interact with family members in a different way by engaging in conversation around shared interests or offering non-appearance related complements to at least 3 people. Remember that most people experience some level of anxiety at holiday gatherings and may also benefit from creating new traditions for the day.
Give to Yourself.
During this season of giving, it is extremely important to tend to your own needs. There is such a beautiful energy in the spirit of the holidays, which can be overshadowed by your anxiety around food and eating. Create time in your schedule for self-care, incorporating relaxing activities to balance social holiday events. Implement a gratitude practice to connect with the abundance of your life. You have worked so hard on this journey of eating disorder recovery and are inherently worthy of experiencing all of the joy of the holiday season.
On Wednesday, November 1st, MEDA hosted its annual Fall breakfast at the Newton Marriott, where over 200 people were in attendance. This year’s event was entitled “Redefining Beauty”, and it featured Kate Eckman, a model, author, and television presenter, as the guest speaker. Speeches were also given by Beth Mayer, MEDA’s Executive Director, and Kayla Grossman, who shared her story of recovery. Attendees of the breakfast also saw the debut of MEDA’s new awareness video.
As an intern for MEDA, and an individual in recovery from an eating disorder, I found the event to be a wonderful source of inspiration and positivity. To start the morning off, Kate Eckman gave an empowering speech on the importance of body positivity. She shared a personal story on facing body shaming in the modeling industry, and how she combats body negativity in her industry. Hearing Kate speak so openly about the challenges she has faced and how she has risen above the negativity was incredibly inspiring.
At one point in her talk, she had the audience pause, and just take a moment to be thankful for our bodies, and what they can do for us, regardless of their shape or size. In my recovery journey, I often forget to take time to be appreciative of my body. With an eating disorder, it can be easy to overlook the incredible things that our bodies can do. Having Kate remind us to pause and to be appreciative and grateful for our bodies was a wonderful reminder that our bodies are so much more than a size or a shape.
Beth Mayer, MEDA’s Executive Director, also gave a great speech encouraging all of us to continue to fight the battle against eating disorders. She spoke about the ways in which the organization, and members of the community, can join together to reduce body hatred and promote body acceptance. Beth’s words served as an excellent source of empowerment and inspiration to those in attendance. Beth also spoke about the importance of working together and encouraged audience members to get involved with MEDA. It gives me hope to see how hard people like Beth are working to fight eating disorders, and create a climate of body positivity.
During the breakfast, MEDA also premiered its new awareness video. The video has been in the works for months, and it features staff members, professional members, and former clients who speak about what MEDA’s services and mission. The video also provides information on eating disorders, and the importance of treatment, while still providing encouragement for viewers that full recovery is possible. MEDA’s video not only raises awareness for eating disorders and the severity of them, but also provides a source of comfort to all those struggling. It reminds viewers that help is available, and that full recovery is possible.
Prior to the conclusion of the event, Kayla, a friend of MEDA’s, shared her recovery story. She bravely shared her journey from not being sure recovery was possible to now being in full recovery from an eating disorder. In her story, she discussed how MEDA has been there for her throughout her recovery journey. Her talk was filled with hope and inspiration for all. Kayla’s story served as an excellent reminder that full recovery from an eating disorder is possible.
At the conclusion of the breakfast, I left feeling empowered and inspired. With people like Kate, Beth, and Kayla, bravely paving the way for recovery and body acceptance, change will happen. By joining together, we can create a place for healing and body love. After the breakfast, I also felt a renewed sense of hope in the possibility of full recovery from eating disorders. Overall, the breakfast was an incredible experience, and I am grateful that I had the opportunity to attend this year. Thank you to all who attended, to all who spoke, and to MEDA, for hosting such a wonderful event.
written by Kari Anderson, DBH, LCMHC, CEDS, Executive Director, Green Mountain at Fox Run and its Women’s Center for Binge & Emotional Eating
The following article is written for clients who struggle with binge and emotional eating. It is not intended for those suffering from anorexia or bulimia due to the mindfulness intervention that is better suited for clients struggling with binge and emotional eating behaviors. It was originally published on Psychology Today on 10/3/17 and is republished here with permission.
Most of us can change what, when, and how much we eat for a little while. But once our newfound “willpower” runs out, we fall right back into old habits. Every single time!
Why is breaking up with destructive eating behaviors so hard to do?
It’s complicated and primal, and has everything to do with your brain trying to help you survive. Yes, even if the eating changes you’re trying to make will make you healthier.
Deep within our brain lies a basic quest for survival, located in the reptilian brain. Food is key to our survival and represents safety. So if someone (even you) starts messing around with your food, all bets are off. That’s because any threat to to your safety, whether real or perceived, evokes fear.
This is especially true for those with a history of food insecurity caused by poverty, eating disorders, or chronic dieting. Adoptive parents of children from countries with food scarcity often report food-hoarding behaviors among their children, even though there is now plenty of food. Staffers at one eating disorder treatment center I read about once found an entire cut of roast beef, frozen, under a patient’s bed. (Evidently, she had gotten into the walk-in freezer when no one was looking.)
Chronic dieting can cause a sense of food insecurity, too. If you grew up with a parent or other caregiver who tried to control your food, or if you have willingly participated in continuous dieting behavior, you will naturally experience some degree of threat when you begin to change your eating habits.
Food also has a strong emotional pull. Part of our habits with food have been built within the reward pathways of our mammalian brain. Not just the reward of pleasure, but those representing connection, bonding and even love. Food is not just food—it can mean so much more.
According to the Porges Polyvagal Theory, a behavioral hypothesis that is gaining recognition, relationships and social engagement with others is the primary way that mammals have developed to calm themselves. This natural regulation is accomplished through neurological processes. When relationships go missing, food often serves a similar function.
Through sensory experiences and the movement of facial muscles, eating neurologically mimics social interaction, providing a feeling of safety and calm. So when someone says food is “my friend, my lover,” they aren’t far off the mark. They are using eating to regulate their nervous system.
As humans, we have a higher-level brain — the human brain or cortex — with the ability to plan, reason, and see things through to the end. Most of our diet plans or goals for changing our eating behaviors take place at times when we are calm (possibly when we have a hand in a bag of chips). Unfortunately, when we are stressed and tired, we lose our “rational brain” and our quest for safety automatically defaults to our reptilian or mammalian brain.
Don’t lose hope. You can change your brain. There are effective methods for healing food insecurity, habitual food reward pathways, and the isolation and food as connection cycle. Programs like Green Mountain at Fox Run offer science-based solutions in a safe healing environment.
The Secret to Changing Eating Behavior, for Good
To change eating behaviors in a lasting way, you must understand what is driving your desire to change. In our culture, we see two main motivators for people making changes to the way they eat: Wanting to be good and wanting to look good. Both tend to be good-enough motivators in the beginning, but they never hold up for long. Here’s why—and info on the type of motivation that does stand the test of time.
Wanting to “Be Good”
More than ever before eating has become such a moral behavior. How many times have you heard the phrase, “sinful indulgence” about a food? Since when is chocolate a moral issue?
Foods have been labeled “good” or “bad” for a long time. Unfortunately, that type of black-and-white, good-or-evil labeling of food also extends to the people who eat it. If you’re not eating clean, then are you dirty? Through this twisted moral lens, eating behavior becomes about who you are, not just what you put in your mouth.
This is especially true for people who are also dealing with the stigma of having larger bodies. There is a widely accepted myth that if you live in a larger-than-average body, you have somehow failed. Feelings of shame can be pervasive. If you’re motivated to change your behavior because of shame that has permeated your being, you are seeking acceptance from others.
But what you need is acceptance from yourself.
I have never known anyone who took the time to take care of themselves when they don’t care about themselves. More often, I see people punishing themselves with food (or a lack of it), especially when they feel they have failed to “be good.”
Shame—whether it comes from inside yourself or from others—is not a good motivator. That’s because a natural response to shame is anger. Getting mad and rebelling is one way the powerless (and shamed) can feel powerful. Some call it rebellion, others call it sabotage. It is the inner drive that tells you “you can” when everyone else tells you “you can’t.”
We have been sold out to the 65-billion-dollar diet (or clean food) industry that sends the message we can’t trust ourselves with food, and that we need to pay them to tell us how to eat. When faced with these shaming rules, we say, “I can eat anything I want, and I will!” It’s a natural response, but one that can simply reinforce the shame spiral we’re trying to escape.
Wanting to “Look Good”
The second big reason people often want to change their eating habits is to look “good.” And the definition of “good” is usually driven by our society’s thin ideal — the notion that thinness defines beauty and health.
As a result, too many of us regularly attempt to change our body size or our weight. Sometimes we do it in the name of health because we’re routinely told that we need to lose weight to be healthy. But our best laid plans to do this are often made with our bellies full, or as was the case with me, my hand in a bag of chips. The planning sessions frequently take place on Sundays or the eve of a new month or year. Or, the calendar comes out, weeks are counted back from a special event for which we want to “look our best” and a formula involving points, or calories in and calories out, or daily steps is used to define our course of action.
We set out eagerly on the new plan and do just fine—until, that is, we hit a moment of being totally stressed out.
You see, we can’t effectively use our executive brain function—the parts that are able to reason and weigh evidence and make fact-based decisions—during difficult moments. Our brain’s default to neural pathways laid down by fear and other emotions. We succumb because we are not thinking about our new 12-week goal; we are thinking about surviving right now, and we will start again….tomorrow.
Then when we are in our “right mind” again we start recalculating. But the more“diet fatigued” we are, the longer it takes us to gain enough energy to get back on the wagon.
Wanting to “Feel Good”
If the motivations of wanting to “be” good and “look” good don’t work in the long run, what does?
Behavior change science tells us that intrinsic motivation is the key, motivation that comes from within, that is internally driven by what is important to you.
This eluded me for a long time. I would think to myself, “Well, my health is important to me. Why isn’t this enough to motivate me?” Then someone asked me, “When do you know you are healthy? When the doctor tells you?” No, I know it when I feel good!
The doctor’s statement is an example of external motivation. Knowing when you feel good and wanting to do what’s needed to keep feeling that way is an example of intrinsic or internal motivation. Unfortunately, many people are so disconnected from their bodies by shame that they don’t know when they feel good, or bad.
How to Reconnect with Your Body & Mind
The pathway to reconnecting to your body and your internal motivation is through mindfulness. When we can be still and be present in the moment, without judgement, we can listen to our bodies and our internal feedback loop of wisdom for the answers. We can watch our thoughts and sense our emotions, which are both symptoms of our well-being. The next step is to simply observe how our behaviors make us feel in our daily reality. Then we find it easier to repeat the behaviors that make us feel well.
We can notice that some foods we eat, in certain amounts, combinations and at certain times either feel good or don’t feel good. We can notice that we have a choice about what we eat and when—that no one but our own bodies is telling us what to do.
When we begin to feel better, we can move more and have more energy. We can begin to sleep better and feel more rested.
By simply pausing and noticing, our awareness of behaviors that make us feel good can create new reward pathways in our brains. “This feels good!” Mindfulness focuses our attention to the daily experience, moment by moment. Our reward becomes the twinkly little lights of a life well lived moment by moment, rather than putting pleasure on hold until we can finally allow for, at the end of the day, a floodlight of reward. The behaviors involved with floodlights of reward —overeating, for example—usually don’t make us feel good at all in the long run.
As we tune into our clarity of thought and the energy we get from balanced blood sugar, we begin to feel good and can better experience a joyful life now.
Developing Trust in Self and Food Again
People feel good when they are getting their most basic needs met. If we are truly feeling autonomous and competent in our decision-making regarding our eating behavior, we simply eat in a way that makes us feel good. It is here where we make decisions based on competence, not shame, and have access to our executive functioning, allowing us to pause and make decisions rather than act out of habit.
This is the premise of intuitive eating: developing a trust in self and trust in food again. The ability to ask ourselves,“Will this decision bring clarity of mind, and the energy I need to be my best self?” If the answer is no, then what will?
Interested in how this motivation approach is being used to change eating behaviors? Review Green Mountain at Fox Run’s research on this topic.
For a larger image you can use in your practice, go to Green Mountain’s website. https://www.fitwoman.com/resources/infographics/
written by MEDA Clinician & Director of Community Education, Monique Bellefleur, Ed.M, MHC
For many, Halloween means dressing up in a silly costume, taking the kids in your life trick-or-treating, and marathon watching Stranger Things 2 and for most, Halloween involves in some way, shape, or form a big bowl of candy.
For people struggling with Binge Eating Disorder (BED), Halloween can mark the start of a 2-month long holiday obstacle course with a finish line of January 2nd: navigating an alternate path past the CVS candy aisle, trudging through family and work holiday get-togethers, hurdling over Thanksgiving, Christmas, & New Years with a final face-off against the January 1st “New Year, New you!” weight-loss ads.
This obstacle course takes a heck of a lot of endurance especially if all the while you’re trying to steadily hold your progress in BED recovery like your own Olympic torch – never to be dropped, never to be extinguished, and held high with pride. Don’t be surprised if your metaphorical arm gets tired…It’s not easy to run with a fiery torch in your hand!
All jokes aside, here are some tips for maintaining your progress in BED recovery through the holiday season (You CAN do this!):
And finally, remember that “normal” eating is flexible eating. You are not a good person for eating brussel sprouts, and you are not a bad person for eating pumpkin pie. All foods fit. It is normal to occasionally overeat, and if you do overeat, it does not mean that you need to punish yourself with restriction the next day. Eat breakfast like you normally would and continue holding your eating disorder recovery torch high.
Written by Monte Nido & Affiliates East Coast Medical Director Dr. Molly McShane, MD, MPH
Dr. McShane is a board certified psychiatrist and practices psychotherapy and medication management for a range of psychiatric conditions. Dr. McShane dives into the neurobiology and genetics of mental health disorders in this week’s blog post.
It is an exciting time in the world of brain and mental health research. Over the past few years, there has been an exponential increase in research findings in the neurobiology and genetics of mental health disorders. While we have known for decades that mental disorders are related to dysfunction in brain pathways, we are now able to say that mental illnesses are brain diseases.
Most diseases develop, progress and/or resolve due to a number of factors including biology, genetics, psychological co-morbidities and environmental exposures. Like most diseases, eating disorders typically occur in individuals with a genetic predisposition, meaning they born with genes inherited from their parents, which are associated with eating disorders. Data shows that 50 to 80 percent of the risk of developing an eating disorder is related to genetics. Clinically, we know this. It is very common for my patients to tell me they have family members with eating disorder histories. In fact, first degree relatives of patients with eating disorders are over eleven times more likely to have anorexia nervosa compared to controls. There are over forty genes involved in the regulation of eating disorder behaviors, motivation, reward, personality traits and emotions. The relationship between the genes and environment is complex. These genes may be turned on or off by environmental triggers. Of course, environment (exposure to social media that over-emphasize image, involvement in certain activities like dance, modeling or wrestling, etc.) can play a significant role in the development of an eating disorder.
Certain temperaments are associated with the development of eating disorders. While specific genes have not yet been identified with temperament, we do know that temperament traits are often constant throughout life, before, during and after experiencing an eating disorder. The temperament traits commonly seen in individuals with eating disorders include harm avoidance, perfectionism, neuroticism, compulsivity, dysphoric mood, low self-directedness, impulsivity, sensation seeking, lack of planning and lack of persistence. Individuals with eating disorders may experience one or more of these temperament traits throughout life, while the eating disorder symptoms often change over time. It can be helpful to address the management of temperament traits in therapy.
Brain research has revealed that neurochemistry is disrupted in individuals with eating disorders. Serotonin and dopamine are neurotransmitters that are involved in complex signaling pathways. These pathways are dysregulated in eating disorders, mood and anxiety disorders. Dopamine is involved in functions related to reward, pleasure, movement, compulsion and perseveration. Serotonin is involved in functions related to mood, memory processing, cognition and sleep. Considerable evidence suggests that altered serotonin and dopamine functions contribute to dysregulation of appetite, mood, impulse control and temperament in individuals with eating disorders. Restriction causes reduced plasma levels of tryptophan, the precursor to serotonin, which modulates serotonin activity and therefore symptoms of anxiety and depression. In individuals without eating disorders, dopamine is associated with a positive reinforcement effect in feeding. In other words, eating feels good.
In anorexia nervosa, dopamine dysregulation diminishes the reward effects of food, so that eating does not necessarily feel good. Data suggests low levels of dopamine receptors and weakened responsivity of dopamine is associated with increased eating and weight. We also know that appetite-regulating hormones, like leptin and ghrelin, may affect dopamine functioning. Leptin is an appetite suppressing chemical, and ghrelin stimulates the appetite. In patients with anorexia nervosa, ghrelin is abnormally low. In patients with binge eating, leptin is abnormally low. These findings help confirm that eating disorders are not due to “lack of will power”. There are chemical alterations in the brain that affect the development and persistence of eating disorder symptoms.
The more we as providers understand the biological basis of eating disorders, the better equipped we are to provide effective treatments. Based on new research in the field, novel medications are being studied that may help us better treat eating disorders. Psychiatric medications that target serotonin and dopamine pathways, such as SSRIs, can be very helpful in the treatment of eating disorders and co-morbid anxiety and mood disorders. Usually, the best treatment for eating disorders is a multidisciplinary approach involving a therapist specializing in eating disorders, a psychiatrist, nutritionist and primary care physician.
Content originally posted on October 5, 2017 at http://www.oliverpyattcenters.com/part-one-mental-illnesses-are-brain-diseases/