Athletes and Eating Disorder Recovery

By Carly Reid, former UCLA Swimmer and Eating Disorder Advocate.

It isn’t a surprise that athletes have extremely competitive tendencies. We will go the extra mile, hour, or training session to get better. Because of this, athletes who develop eating disorders often go unnoticed as their behaviors resemble a determination to get better at their sport. Rather than words of concern, athletes receive praise for being “healthy” eaters and having discipline in training. An eating disorder thrives off of these comments and interprets them as doing the right thing until the athlete’s performance plummets. 

We are exposed to information about how to fuel for optimal performance. Some information, however, could negatively impact someone struggling with an eating disorder. This might be information about what to eat on a rest day and what to eat on a hard training day. A message like “add fewer carbohydrates to your plate on a rest day or your off-season” essentially prescribes a diet depending on how hard we train and generates a fear around certain types of food. We are told what and when to eat after practice and what and when to eat before practice. Rules and suggestions like these could be incredibly damaging for someone with an eating disorder. The mind of an eating disorder aggressively manipulates advice on something as simple as “how to fuel for your sport.” 

How can we come together and acknowledge the rigidity in nutritional advice, especially in athletics? 

Carly Reid, Former UCLA Swimmer

We need to redefine what “healthy” means. Does it mean eating more on a rest day because your brain wants more food? Does it mean having skittles before practice instead of a granola bar? Does it mean having pancakes for dinner instead of a salad? Does it mean educating your coaches and teammates about eating disorders? Does it mean taking a year off of your sport to recover? 

As athletes, we need to come together and fight eating disorders by recovering into a person outside of our sport. We must characterize eating disorders as something that can affect an athlete at any size. Recovery is for everyone, no matter where your body ended up or if it didn’t change at all. 

Athletes are competitive, but more importantly, we are determined. 

How can athletes use their competitive and determined traits to recover? 

  • If you pushed through a tough practice, got a school record, scored a certain amount of points for your team, you can conquer your fear foods. 
  • One practice at a time, right? Turn it into one meal and snack at a time. Each time, you will improve and learn new skills. 
  • Focus on your technique! Recovery technique, that is. How can you make each meal different, and how can you learn new coping mechanisms throughout the day? 
  • Focus on your team. Connect with others in recovery. Follow accounts that are beneficial to your recovery. Listen to podcasts. Read books. 
  • Go the extra mile…with recovery. Are you still hungry? Physically, mentally, or emotionally? All hunger counts;  listen to what your body wants! 
  • Stay disciplined. Are you being honest with yourself and those helping you? How can you ask for more help? 
  • Break a record. How many days can you let your body rest and relax?  

Things to remember! 

You aren’t alone, but if the “you aren’t alone” messages aren’t doing it for you, then find out why you don’t connect to them. Understand that recovery looks and feels different for everyone and that athletes are just a portion of numerous individuals in recovery. Take yourself outside of the athletic world and focus on how you can recover into a person. It is okay if you recover into a different body than you had in your sport. Instead of focusing only on “strength” and “athleticism,” focus on how awesome life is, how your personality is back, and how present you feel in daily tasks.  

Ask yourself, how can I still be an athlete but fuel my body for a bigger reason than performance? How can I inspire others and tell them it’s okay if you choose recovery over being an athlete? 

Carly Reid is a former UCLA Swimmer and Eating Disorder Advocate.

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Valentine’s Day Food Fun

Gearing up for everything pink or red as Valentine’s Day approaches!   Here are some fun ways to celebrate ALL DAY day long. This is also a great way to practice exposures with food – that is, the process of desensitization to foods that might escalate anxiety. Cooking with the those foods AND eating them, will help reduce food fears.

BREAKFAST

📸 1:  Dragonfruit Waffles:  A family favorite from @bumkinsbaby and seen on  @eattherainbow_kids

📸 2: Heart Pancake Kebobs, recipe here.

LUNCH:  

📸 3:  Loving these PBJ cut outs, with chocolate and red fruits/veggies by @mydiaryofus

📸 4: Beet Hummus, goat cheese + arugula on bread from @healthfulblondie 

SNACKS:  

📸 5:  Chocolate covered heart strawberries from californiastrawberries.com 

📸 6:  Beet Hummus Veggie Snack Tray by @pestoandpotatoes

Beet Hummus

DINNER:  

📸 7: Beet Risotto by @platingsandpairings

SNACKS:  

📸 8: Red velvet whoopie pies, recipe here.

📸 9:  Raspberry Vanilla Hot Chocolate by @rachelquenzer 

📸 10: Valentines Day Popcorn

 #valentinesdayfoods #redfoods #pinkfoods #valentines #valentinesday #valentinescelebration #love #loveislove #kidsinthekitchen #feedingkids #feedinglittles #momlife #dietitiansofinstagram #rd2be #performancenutrition #funwithfood #valentinesdayfood #february14 #dragonfruit #beet #beetrisotto #heartshaped  #hearts #heartshapedfood #pinkfood #pinkfoods #redfruits #redvegetables 

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Snacks

I often say that eating 3 meals and 2-3 snacks a day is good strategy for most people:  a young kid, an adolescent athlete, an adult weekend warrior, a pro-athlete, or a non-athlete. How can that be? 

            Snacks help you to keep your metabolism ignited throughout the day. This provides energy and fuels your muscles, your mind, and your workouts, giving you energy to perform. Systematic fueling then helps with recovery. This facilitates peak performance, and helps prepare you for the next day’s workout (otherwise you’d feeling sluggish).  Eating in between meals prevents us from getting ravenous, AKA, “hangry.” A high hunger level causes you to eat quickly, impulsively, bypassing your ability to tune in to your inner wisdom of what your body actually might need.

            Some may try to avoid snacks thinking they will “save calories.” Yet, inevitably what I see happen is that they end up overeating somewhere in their day and/or end up feeling lethargic or irritable. Those who workout hard can often be heard saying, “I’m always hungry.” But the reality is they may not be eating enough at mealtimes, or may just be missing key opportunities to snack, or snack properly.    

Too much exercise and not enough nutrition can suppress the immune system and cause other concerns such as fatigue, low heart rate, delayed growth, hormonal suppression (including low estrogen and testosterone), gastrointestinal concerns, performance declines such as poor recovery, poor muscle growth/strength, and failure to make progress.  This is known as RED-S, Relative Energy Deficiency in Sport (Margo Mountjoy et al. Br J Sports Med 2014;48:491-497).  Some exercise is immune boosting but too much without proper fueling can suppress the immune system.

What counts as a snack? 

            All foods can count as a snack! Snacks do not have to look like classic “snack food.” They may be packaged for convenience, can come from fruits, vegetables, and homemade items, or can be a smaller portioned “mini-meals.”  To create a satisfying and balanced snack, pair a few different food groups together.  This helps to increase satiety and keep blood sugar stable longer.  Choose a full serving of each item, not just a few bites; otherwise you may feel like you checked the box for having a snack, but actually might not have ingested enough here to have a meaningful impact.

How many snacks and how big should the snack be?

            The size of the snack, and number of snacks per day, depend on your nutritional needs and how active you are.  A rough target of around 2 snacks per day makes sense for the average adult.  However, if you are training daily, or training for an event like a marathon, spartan race etc., it is not uncommon to increase to 3 snacks daily.  Adolescent athletes who do team sports and are training daily, typically require 3 snacks daily when in season. Those who are doing more than 1 training session in a day may require more snacks.

What to Eat:

        Many struggle to figure out what to eat when it comes time for snacking.  What are you in the mood for?  Try the 3T’s: Taste, Texture, and Temperature  which we discuss in our book No Weigh! This can help you sort through what you might want.

  • What taste do you want? Salty? Sweet?
  • What texture? Smooth? Crunchy? 
  • What temperature? Cold? hot? 

       Carbs are the primary macronutrient necessary for fueling before and after a workout.  Typically, I recommend a few food groups, paired together to make a complete and balanced snack. Anyone with specialized nutritional requirements or medical conditions should consult with a Registered Dietitian for more guidance to ensure that they are meeting their nutritional needs.  A variety of options include: 

  • Greek yogurt, granola and berries
  • Hummus + pita chips + carrots
  • Dark chocolate and cashews
  • Crackers, cheese and grapes
  • Cookies and milk
  • Pumpkin muffin and Greek yogurt 
  • Beet crackers + tzatziki dip
  • Banana + PB  
  • Graham cracker  + Almond butter  

 

 

 

 

 

 

 

 

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Wendy Sterling, MS, RD, CSSD, CEDRD-S is the Team Nutritionist of the Oakland Athletics. She previously worked with the Golden State Warriors and NY Jets. She is also a Certified Eating Disorder Registered Dietitian and Approved Supervisor through the International Eating Association of Eating Disorder Professionals, and a Board Certified Specialist in Sports Dietetics in the Bay Area in California. She is the co-author of “How to Nourish Your Child Through an Eating Disorder” and “No Weigh! A Teens Guide to Body Image, Food, and Emotional Wisdom.” Follow her on Twitter: @WendyMSRD  and on Instagram: @wendy_sterling.  For more information, check out her website at http://sterlingnutrition.com/.

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Lets Ban the Word “Fattening”

FATTENING. I hate this word. It is often used to express fear about the perceived power that a food is thought to have on one’s weight and shape.

“This is SO fattening….gross!” 

At it’s root, lies fatphobia – the fear of fat or getting fat, or being fat.  For one, the concept of that a food could “add fat or weight” instills fear that something is wrong with adding weight.  This thinking stigmatizes fat bodies. Saying these things, expressing dread, horror and fear, is insulting to your fat friends, and family members. Plus, it’s scientifically inaccurate. One food does not have the power to cause weight gain.

Diets need fat. Foods with fat make food taste good, and helps to keep us full. We need fats for hormone production (estrogen/testosterone), absorption of vitamins A, D, E, K. And foods with fat are often very yummy.

These foods include oils, avocado, nuts, nut butters, trail mix, cookies, brownies, ice cream, etc. 

Those with eating disorders may be scared to include these foods as they may have cut out these in the throws of their eating disorder. Adding these foods, through exposure, will help clients be more free.

Those with eating disorders may also be scared to gain weight, yet it is often necessary for them to reach medical, nutritional and psychological goals.  This includes metabolic recovery, restoration of vital signs, normalization of hormones (estrogen/testosterone), improvement of bone density, return of energy, improvement of mood/depression/anxiety, improved sports performance (endurance, muscle gain, recovery, reaction time, coordination), improved concentration, and many others.  

 

There are some words and phrases that it’s time to leave behind.

“Fattening” is one of them.  

Also, Stop Saying “I Feel Fat” if You Aren’t

Marie Southard Ospina writes it perfectly in the 1.6.20 blog on the Temper:
 
 “When you are not fat yourself, but you use a phrase like “I feel fat” to belittle your appearance, what you are saying to those around you — in particular those who are actually fat  — is that you feel like you look like them and that their type of body is a ghastly, ugly, wretched thing.  

Often times when I hear this, it’s obvious that what the person is really trying to say is that a certain outfit makes them feel frumpy, or maybe that they haven’t slept well and are looking a little more haggard, or that they haven’t eaten a vegetable in some time and feel a little meh as a result. So, rather than insulting someone else’s body, and a whole lot of other people in the process, consider saying what you actually mean.”

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The Rise of Eating Disorders During a Global Pandemic: How to Develop Nourishing Nutritional Habits

 

Many people are reporting the following nutritional challenges during this pandemic:

  • Food insecurity
  • Social isolation (no one to help with meals)
  • Chronic stress
  • Increased/Decreased appetite 
  • Unstructured eating
  • Missed meals
  • Late night eating
  • Grazing in response to stockpiles of food around
  • Eating out of boredom
  • Increase consumption of alcohol

Movement

Plus, there have also been changes in physical activity. Team sports are cancelled.  Traditional fitness classes are not happening.  But it’s not all doom and gloom with activity. Many people are getting out more than they were before, and some of my athletes are now doing even more than they were before. A basketball player I saw just the other day, was originally training 5d/week before the pandemic. She had switched to training 7days a week during the shelter in the place and was doing multiple training sessions a day – I actually had to tell her to cut back.  Too much exercise and not enough nutrition can suppress the immune system and cause other concerns such as fatigue, low heart rate, delayed growth, hormonal suppression (including low estrogen and testosterone), gastrointestinal concerns, performance declines such as poor recovery, poor muscle growth/strength, and failure to make progress.  Some exercise is immune boosting but too much without proper fueling can suppress the immune system.  Plus, there is a post-exercise immune function dip when exercise is prolonged over  > 1.5 hours/ and when intensity is moderate to high [1]. So now is not the time for your marathon training!  

Increased Risk of Eating Disorders

Concern over eating disorders and mental health appear to be on the rise during these past few months during the shelter in place orders.  In March and April 2020, the National Eating Disorders Association, or NEDA, saw a 78 percent increase of calls on their helpline compared with the year before. Similarly, there was a 75% increase in conversations around eating disorders on the Crisis Text Line, a nonprofit organization that provides mental health support by text, since March [2]. 

Food insecurity correlates with eating disorders and has been dramatically increased during the pandemic.   Likewise, eating disorders are also associated with chronic stress, and trauma, which clearly have been heightened during this time as well.  Of note, these risk factors of food insecurity, chronic stress, trauma, are all disproportionally higher in the black community and other marginalized groups, so these groups might be at an even greater risk of developing an eating disorder during the pandemic, though it’s written and spoken about it much less, if at all.

As eating disorders rise, patients, parents, coaches, trainers, clinicians have to be on the lookout for disordered symptoms (see below).  Probably one of the most important thing to know about eating disorders is that they can occur in anyone. There is no one “look.” They affect people in all sized bodies, of all ages, genders, ethnicities etc. Body size means nothing, zero, zilch, about whether a person is sick, or the degree to which a person is struggling to eat.  Clinicians must be on the lookout to be able to detect these issues in all patients.  

What to Look For:

Eating disorders may involve eating too little (restriction), eating too much (binging), vomiting or excessive exercise after eating (purging), or all of the above. For some people there is dramatic and noticeable weight loss, and for others there is no change in weight but instead there are profound medical complications associated with their eating disorder symptoms. There are several other signs as well that may be occurring which may give people a clue that something may be wrong. A person with disorder eating patterns may exhibit one or more of these signs at any given time:  

  • Increased interest in food and exercise (become a red flag when it turns into an obsession).
  • Sorting foods into “good foods and bad foods” and talking about being “scared” or “fearful” of foods.
  • Increased focus on body and shape (some of this is normal during adolescence, but a high degree of distress and preoccupation would be concerning).
  • Body checking (repeatedly touching, examining, dissecting body in mirror.)
  • Weight loss
  • Loss of menstrual cycle (*For males, testosterone levels may be suppressed and can be assessed via bloodwork by an MD).  
  • Obsessive thinking
  • Increased rigidity and lack of flexibility around food/exercise or routines
  • Lack of spontaneity around food
  • Reduction in number of foods they used to eat
  • Lack of variety in diet – a change from previous
  • Avoidance of social situations, especially where food is involved
  • Compensatory behaviors (this is defined as a behavior that is used to eliminate the calories consumed. It is a hallmark feature of Bulimia Nervosa, but is also present in other types of eating disorders as well such as Anorexia Nervosa or Binge Eating Disorder. Compensatory behaviors can be vomiting after meals, excessive exercise, misuse of laxatives, diuretics, diet pills, and teas, or it can be a period of food restriction).

 The Effect of Dieting on Eating Disorders

Despite a global pandemic going on in the background, many are very concerned about impact of their eating habits on their weight. A study conducted by the University of Missouri School of Social Work found that among a sample of almost 900 young adults, over 40% felt it would be worse to gain 25 lbs during social distancing than to be infected with Covid.

Our society riddled with fatphobia, despite a lot of evidence that people can be healthy in larger bodies.  Kids get the message quickly that “thin is good” and “fat is bad.”  Kids are obsessed w/ “6 pack abs,” “chiseled biceps” or are consumed with having a “thigh gap.”    The wt loss and dieting industry is a 72 billion market, yet 95% of diets fail. The failure of diets is part of what drives the economics of the industry’s success; people feel like they have to keep coming back for a different strategy. 

An eight year study, published in 2019 by Stice and colleagues[3], found that a primary risk factor for the development of an eating disorder is a “perceived pressure to be thin,” so this stress  is real and can life threatening should an eating disorder develop.   The National Eating Disorders Association (NEDA) states that young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers [4]. A study of nearly 17,000 children, ages 9-14, found that dieting was a significant predictor of weight gain  and led to increased rates of binge eating in both girls and boys [5].

What to Do:  

If you have concerns about the behaviors of someone you know, bring them in for a physical exam at a medical provider’s office.  A comprehensive exam is a great place to start, but remember, not all of these concerns will show up on a medical exam. The next stop might be a referral to an eating disorder specialist, like a therapist, dietitian, or both.  But don’t delay! We know the prognosis is best for eating disorders when treatment is started earlier.  

Develop Nourishing Habits 

So instead of focusing of  weight loss, or beginning the keto diet, or an intermittent fasting protocol, I ask my clients to develop sustainable nutritional habits that pull from a variety of domains – this is all preventative and protective against the development of eating disorders and disordered eating.  

This includes working on:

  • Managing emotions, stress
  • Maintaining good sleep schedules
  • Reducing screen time usage
  • Reducing alcohol consumption (for adults)
  • Including joyful movement
  • Establishing regular and consistent meal patterns that include family meals
  • Learning to eat intuitively

What is a Meal?

Establishing regularity in a meal schedule is harder is than it sounds. Meals generally look like:

  • Many different food groups paired together
  • To fill out a plate
  • To make a complete meal
  • That is both enough in volume
  • Complete in nutrition
  • And also yummy

When people actually do that, they graze less, find themselves more in tune with their appetite, and the needs of their body.

HUNGER METER

I also teach clients to use a hunger meter, a tool that teaches them to assess hunger and fullness cues. The scale goes from 1-10, where 1 is Starving and 10 is Stuffed. 

1: You can’t think clearly. Irrational. Likely to eat beyond the natural stopping place.

3-4: A great place to be when deciding to eat meals. Likely alittle twinge in your stomach.

6-7: A great place to stop. Full, but not too full. Comfortable.

9: Getting to a place of Thanksgiving day stuffed….

So before panicking and starting on a nutritional path that might be short term and also risky for the development of an eating disorder, think about what nutritional habits you might be able to tweak which would give you success over the long term.  

 

 

 

 

 

 

 

Video Clip on Instagram from Cornell Lecture May 2020

 

RESOURCES

[1] Intense Exercise Training and Immune Function.  Nestle Nutr Inst Workshop Ser. 2013;76:39-50. Epub 2013 Jul 25.

[2] https://www.nytimes.com/2020/06/05/health/eating-disorders-coronavirus.html?searchResultPosition=1

[3] Stice E, Ryzin MJV, A Prospective Test of the Temporal Sequencing of Risk Factor Emergence in the Dual Pathway Model of Eating Disorders. Journal of Abnormal Psychology Journal of Abnormal Psychology, Vol 128(2), Feb 2019, 119-128.

[4] NEDA https://www.nationaleatingdisorders.org/statistics-research-eating-disorders

[5] Relation Between Dieting and Weight Change Among Preadolescents and Adolescents.  Pediatrics  2003 Oct;112 (4):900-6.

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Body Positive Parenting

Those who are diagnosed with eating disorders may have a combination of factors that create “the perfect storm” for these illnesses to develop. This may include one’s individual traits like genes, psychological make up (depression, anxiety, OCD) plus external factors such as cultural cues, dieting/social pressure, a “perceived pressure for thinness,” and body dissatisfaction.  But parents can take actions to minimize risk factors for the development of an eating disorder in their child.  Providing protective factors in the home might sound easy, but it is not simple, given the widespread effects of diet culture.

By:  Wendy Sterling, MS, RD, CEDRD-S & Signe Darpinian, LMFT, CEDS-S

Tips for Body-Positive Parenting

1. Use an “All Foods Fit” Mindset 

Polarizing foods (talking about “good foods and bad foods”) disconnects us from our body’s true wisdom. Categorizing foods this way indirectly reinforces messaging about dieting and losing weight. Talking about “fattening foods” is scientifically untrue. This language teaches kids to fear foods, to tiptoe around eating, and inherently gives the indirect message that fat is bad, and thin is good.

2.  Avoid talking about dieting/weight loss at home 

There is an epidemic now in schools where kids are obsessed about getting “6 pack abs,” “chiseled biceps” or are consumed with having a “thigh gap.”  Unlike the latest trends in jeans, for example, these body craze trends can be deadly. The National Eating Disorders Association (NEDA) states that young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers[1].An eight year study, published in 2019, found that a primary risk factor for the development of an eating disorder is a “perceived pressure to be thin,” so this stress, is real and can have devastating consequences should an eating disorder develop[2].  This focus on thinness starts early. A study looking at body image development, showed that even by age 6, young girls are already preoccupied with their weight and shape[3]. Body image dissatisfaction is common, develops early, and likely stems from a weight-obsessed society and dieting culture.   Talking about weight loss and dieting can have devastating consequences.  

3. Create a Judgment-Free House
Creating a house that is a judgment-free zone, also free of get-thin messages, allows kids to grow up more peacefully with their body regardless of what sized body they have. This is important, especially during adolescence, when kids may feel uncomfortable and confused by their changing bodies. Make home a place of “safety,” free of conversation about how your child’s body looks, should look, how you look, how your clothes fit, or how others looks, and free of thin-biases. Teach kids that “all bodies are good bodies,” and that if their body is bigger, or smaller, or changing sizes in any way, you will love them no matter what. But walking your talk is necessary. Kids have an incredible spidey sense and can sniff out any incongruencies in what we are saying and doing. If you want to raise kids who feel good about their bodies, then the belief system has to be real. When parents talk at the dinner table and comment about people’s weight and say, “Did you see __, he/she/them looks great!” that comment automatically glamorizes thinness, sending a message to kids that thinness is idealized and valued, and if the child wants to be praised and adored, s/he/them “should be” thin. Even saying things such as “no, that does not make you look fat,” stigmatizes fat, suggesting there is “something wrong” with a higher weight. Risk factors for the development of an eating disorder include the pressure to be thin, body image dissatisfaction, and dieting.
Realistically, you are not going to be able to keep your child from destructive messages from the culture or other kids, but you can build resilience within them as well as model the behaviors you want to grow in your home.

4. Teach kids about joyful movement 

Exercising to burn calories, lose weight, or alter one’s appearance creates an unhealthy relationship with physical activity. Linking exercise to food intake in any way (“I ate so much today, so I’m going to go exercise”) teaches kids that they should compensate for food consumed with exercise, which is a dangerous and disturbing message, and over time, potentially can lead to the development of an eating disorder. There are many wonderful benefits of exercise on which parents instead can focus such as an improvement in: mood, energy, sleep, and stress relief. In fact, it is well documented that individuals who exercise for internal goals such as the way it feels, camaraderie, energy, stress relief are more likely to continue their habit of moving versus those who exercise based on external goals such as the pursuit of thinness.

Teaching kids that all foods can be incorporated into a healthy diet (that all “fare is fair”) and that exercise can be joyful and part of a healthy lifestyle will help to encourage a peaceful relationship to food/body. Eating in an attuned way, being mindful of how you speak about your body as well as others’, and reducing the risk factor of body image dissatisfaction (and a whole lot more) will provide protective factors against your child developing an eating disorder.

Body Positive Instagram Post 

 

 

 

 

 

REFERENCES:

[1] https://www.nationaleatingdisorders.org/statistics-research-eating-disorders

[2] Stice E, Ryzin MJV, A Prospective Test of the Temporal Sequencing of Risk Factor Emergence in the Dual Pathway Model of Eating Disorders. Journal of Abnormal Psychology Journal of Abnormal Psychology, Vol 128(2), Feb 2019, 119-128.

[3] Smolak, L. (2011). Body image development in childhood. In T. Cash & L. Smolak (Eds.),  Body Image: A Handbook of Science, Practice, and Prevention (2nd ed.).New York: Guilford.

 

Wendy Sterling, MS, RD, CSSD, CEDRD-S is a Certified Eating Disorder Registered Dietitian and Approved Supervisor through the International Eating Association of Eating Disorder Professionals, and a Board-Certified Specialist in Sports Dietetics in the Bay Area in California. She is the Team Nutritionist of the Oakland Athletics. She is the co-author of “How to Nourish Your Child Through an Eating Disorder” and “No Weigh! A Teens Guide to Body Image, Food, and Emotional Wisdom.” Follow her on Instagram at @wendy_sterling and @platebyplateapproach   or  Twitter: @WendyMSRD.  For more on her practice, check out her website at: www.sterlingnutrition.com

Signe Darpinian, LMFT, CEDS-S is a Licensed Marriage and Family Therapist (LMFT), Certified Eating Disorders Specialist and iaedp™-Approved Supervisor (CEDS S). She is a public speaker, co-author of No Weigh! A Teen’s Guide to Positive Body Image, Food, and Emotional Wisdom, and host of Therapy Rocks! a personal growth podcast. With private practice offices in two California locations, she is able to service both the Central Valley Region as well as the San Francisco Bay Area. 

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Why Athletes Should Rest

For all athletes, rest is important. Athletes looking to get better may falsely think that adding a second training session in the same day will advance their training.  According to Renee Urban, PT, Board Certified in Orthopedics “Many people feel that if they are not reaching their training goals the answer is to train harder. In actuality, they may just need more recovery time.” Over-training, may put them more at risk for injury, an energy imbalance (where energy out doesn’t match energy in), fatigue and potentially serious medical complications such as a low heart rate, low blood pressure or dizziness.  If an energy imbalance exists, whether it’s due to intentional reasons (dieting) or unintentional reasons (overtraining), every area of the body will be affected. Insufficient fueling has the power to affect cardiac, gastrointestinal, menstrual, hematological, immunological and psychological functioning. 

Athletes who are not properly fueling or just simply can’t keep up with their energy demands may find that though they are train hard, they fail to improve, or worse, their performance declines.  Sometimes their coach or parent may notice first. They may see playing time reduced, or may get benched altogether. In this state, they might be slower, weaker, have less endurance, be more prone to injury, have a reduced training response (failure to progress despite training hard), be more irritable, and feel more depressed. This is ironic, given their initial goal of achieving health and excelling at their sport. In 2014, researchers gave a new name to this energy imbalance as it pertained to athletes, “RED-S,” which stands for Relative Energy Deficiency in Sports (1). “For an athlete to make desired training adaptations, one must include adequate rest and consistent, strategic nutrition to maximize energy balance,” says Rebecca McConville MS, RD, LD, CSSD, CEDRD, author of Finding Your Sweet Spot: How to Avoid RED-S. Working with a sports dietitian, someone who is a Registered Dietitian and also a Board Certified Specialist in Sports Dietetics, can help assess an athlete’s diet and training load, and tease out whether an energy deficit exists and help get them back on track.

Days offs from exercise can help keep a person’s energy balance in check.  Many athletes say, “rest is unnecessary” or “a waste of time.” But according to Urban, during exercise the body and muscles undergo stress and strain. “It is essential to allow for adequate recovery in order to allow the body to return to its optimal state (homeostasis). It is during this time that tissues can heal, energy can be restored and the body can adapt to be able to handle the stress of exercise next time.” Rest helps the muscular, nervous, and immune systems recover, strengthen and rebuild, while allowing athletes to minimize soreness, inflammation, and illness.  On days off, the body may not technically engage in exercise but it is very active while healing and repairing itself.  These days will help to recharge your batteries and increase your enthusiasm for the sport; after all, doing the same training day after day can be monotonous.  Between the physical and emotional benefits, rest days clearly offer a performance advantage. Have you ever seen Steph Curry, of the Golden State Warriors, come back after a day of sitting on the bench?  On fire, even more so than usual.  

What do you do on a rest day?  

Including meditation, massage, hot baths, acupuncture, gentle stretching or yoga can help improve the body’s recovery and healing time.  Taking naps, resting muscles that are activated during your training is recommended.  It will be amazing to see how much power and energy the athlete gets from simply resting.

Cross training, active hot yoga, cycling etc. – does not count as a “rest day.”  They idea is to stretch out the muscle and literally let the body heal. 

Eating disorders and rest For any person who is recovering from an eating disorder, rest days should be non-negotiable and exercise should be contingent upon not only being medically cleared, but also meeting their nutritional needs.  Athletes with eating disorders must be able to adjust their meal plan to account for their activity, and also must be able to sit out when told to do so.  They also must be able to meet their treatment medical and behavioral expectations. The scope of the exercise plan and the number of rest days can be determined by the treatment team and might change over the course of treatment.

Can’t rest?  

Some people absolutely cannot take a rest day and may ultimately struggle with compulsive exercise.  For more about characteristics of what constitutes “balanced”vs.“unbalanced exercise, you may which to check out this article entitled, “When Exercise Turns Compulsive.  You can also take this self-assessment quiz “Compulsive Exercise Test.”  Compulsive exercise can lead to depression, anxiety, injury, worsening performance, social withdrawal, among other negative complications.  If you find that several of these warning signs apply to you, it is recommended that you seek professional help to better understand your relationship with exercise.

  1. M. Mountjoy, J. Sundgot-Borgen, L. Burke, et al., “The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sports (RED-S).” British Journal of Sports Medicine 48, no. 7 (April 2014): 491–97, doi:10.1136/bjsports-2014-093502. 

Copyright @ How to Nourish Your Child Through an Eating Disorder 2018

 

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The “Plate-by-Plate® Approach” offers guidance for parents nourishing their child through an eating disorder

“I wish this meal-time guidance provided by Wendy and Casey had been available when I was age 11 and an eating disorder was raging and embedding in my brain. Together with the support of Family-based Treatment, my parents would have felt confident and empowered to help me quickly get my life, and that of our entire family,  back on track.”

June Alexander

Post by Wendy Sterling, MS, RD, CSSD, CEDRDS and Casey Crosbie, RD, CSSD

Parents are often frightened and overwhelmed when a health professional announces their child has a diagnosis of an “eating disorder.”  Parents wonder how involved they should be in helping their child – should they stand back and allow their child to navigate this difficult time by themselves? Or should they roll up their sleeves, and start preparing and supervising their child’s every bite?  Their independent child might proclaim that they “have it under control” and parents might want to desperately allow that, but as they watch their child chop the apple even smaller and push their food around even more, they realize quite quickly, that their child does not have this under control at all.

Family-based Treatment

Parents are best equipped to help their child fight against this terrible disease, and can help their child successfully, right at home, in a way that is safe and effective.  This approach, is known as Family-based Treatment (FBT) and is the most researched and effective method for eating disorders treatment to date1-3.It is the leading outpatient treatment for adolescents with eating disorders, and is generally considered to be the first recommended line of treatment.  With this approach, parents are initially asked to take charge of their child’s nutrition entirely: meal preparation, grocery shopping, and all choices regarding food planning, in the face of their child’s clear inability to do so, “for now.” Parental involvement can prevent the child from requiring a higher level of care such as a partial hospitalization – or inpatient program (these programs can sometimes become necessary if the child’s eating disorder behaviors cannot be interrupted).

Re-thinking meal support

Historically, FBT did not include a dietitian.  With the help of an FBT-certified therapist, parents are empowered to tap into their parental instinct, and to feed their child what they know their child needs in order to restore health. The presence of an “expert” or a “meal plan” was thought to disempower the parent.

Although parents know best what their child needs, feeding a child with an eating disorder is not intuitive for most.  The caloric requirements necessary to accomplish this task can be 2-3x that of the child’s baseline, making this task challenging, even for the most nutritionally savvy parent.  Second, malnutrition makes refeeding and weight restoration challenging – a child will feel bloated, constipated, overly full, and the eating disorder will negotiate every bite – “chicken over steak” or “brown rice instead of pasta” making mealtimes exhausting.

Parents often express feeling confused, overwhelmed, and quite frankly, stressed. Their questions include: How do we start?  How do we navigate these challenges?  Are there tricks to ease the physical discomfort associated with malnutrition? How long does it take to get better? How far apart should we space the meals? How big should the meals be? Is it okay if our child eats brown rice every day, as long as she is eating…?

When parents learn that eating disorders are life threatening, they understandably may become fearful of “feeding their child incorrectly” or “not doing it fast enough” or simply just want to reach out because they “need some support.”

Solution: The Plate-by-Plate Approach®

As registered dietitians with over 30 years of combined experience treating eating disorders in adolescents, we have written a book entitled, “How to Nourish Your Child Through an Eating Disorder: A Simple Plate-by-Plate Approach to Rebuilding A Healthy Relationship with Food,” to address these concerns and questions raised by families undergoing FBT who are seeking additional guidance.  We have developed the “Plate-by-Plate Approach®” to help parents navigate the high-calorie demands of malnutrition and weight gain, while helping them reacquaint their child with foods they used to love.

No measuring or counting

No measuring or counting is involved. We find this approach is helpful at a time when kids are facing the challenge of reducing their obsessiveness with numbers and their rigidity, while working on becoming more flexible with food.  In time, this approach eventually provides for a seamless transition back to normal eating.

There are 3 key aspects to this approach:

1) Parents are put in charge of all aspects of food (however, the approach can be used directly with teens not involved in FBT as well)

2) Parents need only a 10-inch (25.4cm) plate to help their child accomplish the medical goals of weight restoration, metabolic recovery, resumption of menses, and reversal of medical complications

3) There is an emphasis on variety and exposure to all foods from the start.

For all eating disorder diagnoses

The Plate-by-Plate approach® is designed for use with all eating disorder diagnoses, and can be adapted to accommodate each individual’s nutritional goals. Through use of the following visual as well as photos of example plates, parents are guided to feed their child 3 meals and 2-3 snacks per day without ever taking out the measuring cups. The plates can be adjusted as the needs of the child change throughout treatment – increasing during times of weight restoration, and decreasing once the child hits their target weight range.  The book provides ideas for how to adjust the plate based on individual nutrition goals and needs as well as ideas for how to make mealtime more successful for everyone involved.

Variety helps build confidence

Parents are encouraged to include a variety at all meals and snacks to increase their child’s comfort level with food.  Weight restoration and resumption of menses are important, but by themselves, are not enough – the work must continue in order for the child to successfully rebuild their relationship with food.  Encouraging variety helps to excavate remnants of eating disorder thinking, all while shaping the child into a confident and fearless eater. We ultimately want kids to be able to eat cake on their birthday (and their friend’s birthdays too!) without having an intense escalation in anxiety, eat in restaurants, travel and have pizza with their friends.

How to start using the Plate-by-Plate Approach®

To follow the Plate-by-Plate approach, parents are encouraged to begin plating balanced meals, according to the diagram below, and to fill 100% of the plate.  Parents should choose a meal schedule of “3 meals + 2 snacks” (or “3 meals + 3 snacks” if the child is already successful with “3 meals + 2 snacks”), and stick to that meal timing each day.

The child may negotiate for a plate that is mostly fruits and vegetables but parents should be aware that a high fruit/vegetable plate will likely contribute to increased gastrointestinal distress and bloating. A plate that is too high in protein, as some kids might request, will likely cause increased fullness, making it difficult to complete the rest of the meals that day.

The Plate-by-Plate Approach® is a simple and effective strategy to help with the nutritional rehabilitation of adolescents struggling with eating disorders.  Parents can use this approach, alongside FBT, for additional nutrition guidance. Ultimately, parents have the final sign-off for how they choose to plate the meal. If the plate looks good, even if it’s not quite matching our suggestions, that’s okay.

While FBT offers parents a general map to follow during their child’s nutritional rehabilitation, the Plate-by-Plate Approach® adds a compass, both pieces integral in navigating the tricky terrain of eating-disorder recovery. The exact route taken, however, is still very much in the hands of parents.  Parents are empowered to lead their child through nutritional rehabilitation and eventually transition to normal eating.

For More Information:  

For more information, this approach is detailed in the book, “How to Nourish Your Child Through an Eating Disorder: A Simple Plate-by-Plate Approach to Rebuilding a Healthy Relationship With Food,” available on Amazon. This approach has been featured in the Journal of Nutrition and Dietetics in an article entitled, ” “The Use of the Plate-by-Plate Approach for Adolescents Undergoing Family-Based Treatment.”   Check out our web site: https://www.platebyplateapproach.com/ where you will find more resources and ready-to-download handouts!  And for more information about plates, encouragement and support, follow Wendy and Casey on instagram @platebyplateapproach!  

 

REFERENCES

  1. Lock J, Le Grange D. Treatment Manual for Anorexia Nervosa: A Family-Based Approach. 2nd ed. New York, NY: Guilford Press; 2015.
  1. Lock, James. “Evaluation of Family Treatment Models for Eating Disorders.” Current Opinion in Psychiatry, vol. 24, no. 4, 2011, pp. 274–279. doi:10.1097/yco.0b013e328346f71e.
  1. Lock J, Le Grange D. Family based treatment of eating disorders. Int Journal of Eat Disord. 2005;37:S64–7)

About Wendy

 Wendy Sterling is a Registered Dietitian and a Board-Certified Specialist in Sports Dietetics. She is the co-author of How to Nourish Your Child Through an Eating Disorder:  A Simple, Plate-by-Plate Approach to Rebuilding a Healthy Relationship with Food.”   ” and “No Weigh! A Teen’s Guide to Positive Body Image, Food, and Emotional Wisdom.”She worked at The Healthy Teen Project as well as the Eating Disorder Center at Cohen Children’s Medical Center of New York. She has been published in the International Journal of Eating Disorders and theJournal of Adolescent Health for research on osteoporosis, menstruation, and metabolism. The Plate-by-Plate Approach® was also written about In Journal of the Academy of Nutrition and Dietetics July 2019.  She is team nutritionist for the Oakland A’s.

About Casey

Casey Crosbie is a Registered Dietitian and a Board-Certified Specialist in Sports Dietetics. She currently serves as program director for the Healthy Teen Project in Los Altos, CA and is co-author of How to Nourish Your Child Through an Eating Disorder:  A Simple, Plate-by-Plate Approach to Rebuilding a Healthy Relationship with Food.”   Casey previously served as lead dietitian for the Lucile Packard Children’s Hospital Comprehensive Care Program for Eating Disorders at Stanford. She was published in Nutrition in Clinical Practice and in the Journal of Adolescent Health for research focusing on refeeding syndrome in adolescents with eating disorders. The Plate-by-Plate Approach® was also written about In Journal of the Academy of Nutrition and Dietetics July 2019

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When Exercise Turns Compulsive

Similar to eating a healthy diet, being fit and exercising regularly attracts praise and admiration in our society. All too often, however, these lifestyle changes can shift from being mindful, balanced, and healthy to being all-consuming, obsessive, and harmful.

It is important to understand the intent or motivation to exercise. Exercise that is completed to focus on altering weight, and shape, or “burning calories” might be of concern. Instead, ideally one would focus on the benefits that come with exercise such as improved energy, mood, and sleep. Exercise should be enjoyable and energizing, not completely exhausting or painful. In a healthy relationship with exercise an individual should be able to vary the intensity of workouts, meaning that training can occur at a lower intensity some of the time and more intensely at others. Someone who is compulsively exercising may only know and exhibit one gear—high intensity, or near maximum effort—during workouts. They may struggle with a fierce adherence to rigid exercise routines, whereas those who exercise mindfully, can be more flexible. For example, if it’s cold and raining outside, a balanced exerciser may decide to skip a run and opt for a cup of tea and a good book by the fire. Conversely, a compulsive exerciser will go out in the cold and rain, perhaps in the early morning hours when it’s still dark out, to run miles and miles anyway. While following a balanced diet, an individual who exercises moderately will often see incremental performance gains, whereas an individual who exercises compulsively will likely experience a decline in performance over time.

Signs That You Have a Balanced Relationship to Exercise 

  • You are able to listen to your body and respond appropriately. This might result in feeling up to moving some days and feeling as though rest is needed on other days.
  • You participate in activities with internal goals like the expectation of fun versus external goals such as weight loss.
  • You see your exercise as flexible, meaning that you might need to adjust your workouts when school, social, or family commitments arise—for example, you don’t expect to workout four days a week during finals.
  • You allow your body to rest, knowing that rest will not diminish your desire to exercise on other days.
  • You eat enough food to adequately fuel your level of activity.
  • Exercise changes with the seasons (for example, in the rainy season you may increase yoga and decrease soccer).

Signs That You Have an Unbalanced Relationship to Exercise 

  • The gym is on fire but you have two minutes left on the treadmill, so you stay on.
  • You feel anxious if you don’t get to do your workout on a particular day.
  • You think of working out as a way to make up for what you ate.
  • You work out even when you are sick, injured, or tired.
  • You are working out to delay physical changes to your body.
  • You work out for external goals only (physical appearance).
  • You work out in odd places at odd times.
  • You don’t eat enough for the energy you are expending.
  • Your family or friends have expressed concern that you are exercising too much.
  • You force yourself to exercise even when you do not feel like doing so.
  • You often miss out on attending social or family gatherings as a result of your workouts.

To assess if you have an unbalanced relationship with exercising, feel free to check out the Compulsive Exercise Test from Almost Anorexic. If you find that several of these warning signs apply to you, it is recommended that you seek professional help to better understand your relationship with exercise and to explore how you might be able to be more flexible and spontaneous.

A summary of how mindful exercise differs from compulsive exercise can be seen below.  Thank you to Kate Bennett, PsyD, Sport Psychologist (2017), who has give us permission to use this in our book.

  Mindful/Healthy Exercise Compulsive Exercise
GOAL: To challenge oneself and engage in a variety of activities that are enjoyable and energizing

 

To alter one’s appearance and/or negative discomfort
PERFORMANCE OUTCOMES: Incremental gains

 

Plateaus/decreases
MINDSET: Work hard/rest hard

 

Move to move/rest is unnecessary
PACE: Athletes have many gears, including very slow, and they use all of them

 

One gear only: fast/intense
ROLE: Exercise is only one part of identity and it is enjoyable Exercise is the ONLY form of identity and activity is mandatory
APPROACH: Flexible and adaptable

 

Rigid
APPROACH: Curious/open to new information

 

Close-minded
APPROACH: Resourceful, driven, and rational

 

Compulsive and anxious
INJURY: Modify due to illness and injury

 

Train through illness and injury

Copyright @How to Nourish Your Child Through an Eating Disorder 2018

Copyright@No Weigh!! A Teen’s Guide to Body Image, Food, and Emotional Wisdom 2018

The above blog was adapted from “How to Nourish Your Child Through an Eating Disorder:  A Simple, Plate-by-Plate Approach to Reestablishing a Healthy Relationship with Food,” and “No Weigh!!! A Teen’s Guide to Body Image, Food, and Emotional Wisdom.

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Moving Beyond Brown Rice: What is Orthorexia?

By Wendy Sterling, MS, RD, CSSD 

This post is an adapted excerpt from Wendy Sterling’s book in progress, “How to Nourish Your Child Through an Eating Disorder:  A Simple, Plate-by-Plate Approach to Reestablishing a Healthy Relationship with Food.” This book is co-written by Casey Crosbie, RD, CSSD, Lead Dietitian at the Healthy Teen Project, and forthcoming by The Experiment publishing house Spring 2018.  

“I cut out gluten and dairy, I don’t eat meat, I don’t eat fried foods, I don’t eat processed foods, and I definitely don’t eat foods that have sugar.” Um, so what do you eat? “Orthorexia,” term coined by Steven Bratman, MD in his popular book, “Health Food Junkies,” refers to an obsession with health and nutrition that becomes all-compassing. Dr. Bratman recently wrote, “Orthorexia is an emotionally disturbed, self-punishing relationship with food that involves a progressively shrinking universe of foods deemed acceptable.”

Though not a formal eating disorder diagnosis, orthorexia refers to those who have become excessively preoccupied with “eating healthy” and “eating clean,” to the point it disturbs the flow of one’s life. Orthorexia refers to someone who will “only eat” brown rice and not white rice, or only eat organic, cage-free, grass-fed, free-range foods. Someone with orthorexia may have an eating disorder or may not; there tends to be a focus on “quality” vs. “quantity” and a focus on “health” vs. “losing weight.” And in a world of quinoa and soba noodles, it’s easy to blend in. But there is a difference between someone who has an allergy or a “preference” vs. someone who is hiding behind those things because they are actually scared to step out of their comfort zone.

“It took a long time for me to be able to see how debilitating orthorexia was, and how it was just not a sustainable lifestyle. It’s seems so obvious and irrational from the outside, but the feeling is so powerful that when you’re stuck that deep and you’ve convinced yourself for so long of your ways, it takes many “wake up calls” to undo all the layers of denial.”   – Current client working on orthorexia

With the influx of health messaging, orthorexia has become increasingly common but can be very debilitating, especially for teenagers.   Kids who are looking to “become healthy” are attracted to this messaging yet an extreme adherence to these messages can, ironically, cause kids to become unhealthy both physically or psychologically. Consequences of orthorexia include increased irritability, depression, anxiety, poor relationships with others, social avoidance, feelings of guilt, and an excessive amount of time spent thinking about and/or preparing meals, taking time away from other activities.

Teens who are restrictive and maintain strict guidelines for what they will or will not eat continue to be restrictive years later. They struggle to eat pizza with friends, eat in restaurants, and attend even basic social events like football games or concerts because “there is nothing for me to eat there.” I have worked with kids who have packed measuring cups with them when traveling (highly discouraged, and in fact, is sign that the person is not ready to travel). I have had clients bring “their food” to birthday parties and other events. This immediately makes you seem different and becomes just another way that eating remains difficult and “front and center” in your life.

Below are some characteristics typically seen with orthorexia. Some people may have 1 or 2 of these behaviors/beliefs around food, but with orthorexia, a person usually exhibits most, if not all, of the behaviors below.

 

Do you sort foods into good foods and bad foods?

Someone with orthorexia (or even a chronic dieter) categorizes foods as “good” and “bad.” “Good foods,” also known as “safe foods,” are typically foods a person considers to be “good” or “healthy.” Examples of safe foods may be fruit, yogurt, vegetables, chicken, and fish (and will vary per person). Conversely, fear foods are foods that feel “scary” to eat. You may label a food as “fattening” or “disgusting,” “unhealthy,” “gross,” or “too high in sugar.” Fear foods might include potato chips, ice cream, cookies, cake, brownies, and candy.

How varied is your diet?

Typically, those with orthorexia, show a lack of variety at meals and snacks, not only throughout the day, but also throughout the week. If you keep a seven day food record, logging all meals and all snacks, how good is your variety? Are you eating the same thing for breakfast most days? For snacks? Is the format of your meals the same? If so, it is time to brainstorm how you can expand your variety. This not only helps to ensure flexibility, but also helps your body get a variety of different nutrients from different foods. For example, chicken is low in iron. If you ate chicken every day, you would be missing out on getting enough iron. Similarly, if you ate an orange every day, you would be missing out on getting the potassium found in bananas.

How flexible are you when it comes to food?

Due to firmly held beliefs around food or how food should be prepared, someone with orthorexia may struggle to find something to eat when out of their home environment.  This mostly plays out in restaurants, on the road, in college, when traveling, at a friends house, at a birthday party etc.

One of my clients refused to eat at In and Out Burger on the way home from his soccer game. “I would rather not eat than have fast food,” he said at the time. But it was four hours later until he was able to eat at home. He missed the recovery window post workout, which arguably would harm him more than having In and Out. In fact, sports nutritionists (myself included) would likely agree that given the choice between eating fast food or skipping the post workout meal and eating nothing, it is better for you to eat fast food post workout.

Flexibility around food is important. For example, if you run out of quinoa, are you able to eat the white pasta your parents are serving at night? Or if you go to your friend’s house for dinner, and she serves mashed potatoes, are you able to eat it? If you find yourself bobbing and weaving when it comes to food, it is a sign that your flexibility around food might need a tune up.

Can you eat spontaneously?

All of your friends are going out for ice cream. Are you able to join them? What if they’re going for ice cream at an odd time that you normally wouldn’t expect to eat? Can you join them anyway? The ability to be spontaneous is a gateway to freedom from rigidity around food.

Can you have a bite of food out of turn?

OK, you ordered your own entrée but your boyfriend looks over and says, “Yum, this is amazing, try it.” He is eating a Sizzling Beef dish, with a horseradish cream sauce. Can you try it? Does it bother you that it’s an extra bite outside of your entrée?  Similarly, can you try your grandmother’s homemade soup when she offers you a spoonful, rather than say no because it’s not officially part of your meal plan?  You may have heard that it’s not good to pick and graze throughout the day. But that is not what we are talking about here. We are talking about the ability to try something new, to have fun with food, to try something you might not order, and to be able to have a random bite of food, out of turn, just because you feel like it.

Do you have a million specific requests and instructions for the waiter?

“Steam the vegetables, put the sauce on the side, no bacon, no butter, a side of lemon, and please add 3 ice cubes in my water with a straw.” Be honest. Do people find it really annoying to eat in a restaurant with you? Usually with orthorexia, a person may have specific food requests about what they want, how they want it prepared, and which ingredients to omit from their order.

Can you eat other people’s cooking?

You’re running late, have a lot of homework, and your mother offers to cook dinner. Will you let that happen? Or will you insist on being in the kitchen overlooking how she is making it? Do you complain that she is using too much oil? Too much cream? Adding too much cheese? Are you able to attend Thanksgiving without feeling like you need to bring along your own food? Unless you have a food allergy, bringing your own food is a sign that something may be wrong. If fear wasn’t a factor, most people would be excited to have someone else cook for them.

Is your food plain and dry?

Typically, those with orthorexia, eat a very plain diet. They will say it’s “clean ” but others may say it’s “boring.” A typical meal might be a plain breast of chicken, sweet potato, and a salad without dressing.  There is no stir-fry sauce, seasoning, flavor, or herbs.  Food is meant to be enjoyed, the combination of spices and flavors bring out the tastes of different ingredients in the dish. For some reason, those with orthorexia may think that sauces are unhealthy and should be avoided. Or that you should skip the salad dressing when eating salad. Really? That sounds like a torturous way to eat. The best way to expand what you eat and how you make foods is to find new recipes. In some cases, using a meal service like Blue Apron, Hello Fresh, Gobble or Home Chef, can push you out of your comfort zone in this area, in a good a way.

 

The primary goal of reducing orthorexic behaviors is to be able to eat anything without a heightened state of anxiety present – cake on your birthday without an intense fear around it, eat in restaurants, travel, and go out for ice cream with friends. It takes repeated exposure and practice to make these experiences less scary. Though fearful initially, I have found my clients to be highly responsive in working on this. A current client shared with me the following, “Introducing new foods again is scary, but there comes a point when you realize how freeing it is to not be so bound by your rules, and that outweighs any scared and negative feels associated with it. It’s not to say I don’t still cringe at eating certain things, and still overanalyze things, but that voice slowly becomes quieter and my rational mind is able to win out more often than not.”

If you or someone you know is struggling with orthorexia, below are some suggestions to consider. This work is best done with the help of a Registered Dietitian or Therapist who specializes in Eating Disorders.

Things to Consider to Fight Orthorexia:

  • Watch out for this common pitfall. “I don’t like bread, but I would have quinoa.” This might make sense – trading a grain for a grain, right? But this perpetuates the fear of bread. Unless you are not actually scared of bread, in which case, then it might just be a you have a preference for something else. But if it is a preference, you should be “able” to have bread if that’s the only thing being served.
  • Sometimes a person may avoid the bread, but then eat more chicken and broccoli to make up for it. This unfortunately reinforces the fear that something is wrong with eating whichever food you avoided that night.
  • One food is not capable of “making someone fat.”
  • The goal of reducing the orthorexia is not weight gain. The goal is a more expanded palate, more variety, and less anxiety around food. Many people can work on the orthorexic component of their diet while keeping their weight stable.
  • Make a list of your “Safe Foods” and “Fear foods.” What foods scare you? Frequent exposure to that which scares you helps minimize fear.   Begin to practice trying some of the foods on your Fear Foods list. Start by making a “food hierarchy” ranking the foods that scare you from least to most. Start with the easier fear foods and gradually work towards more scary foods. Once in trying-new-foods-mode, you will be amazed at how free you feel. If you are a parent, help your child practice exposure by asking him/her to practice eat a variety of foods.
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