RED-S Prevention

By Wendy Sterling, MS, RD, CSSD, CERDRD-S

Relative Energy Deficiency in Sport (RED-S) is common and occurs when there is a mismatch between energy intake and energy expenditure. This has a big impact on every system of the body including metabolism, menstrual function (and hormones in general), bone health, immune function, cardiovascular health, gastrointestinal health, and growth and development.  There is negative effect on mood (more irritable, depressed and anxious).

And not surprisingly, sports performance suffers! There will be reduced muscle strength, decreased endurance, increased injury risk, decreased training response, impaired concentration/coordination (a big deal in precision sports, or dance, gymnastics where concentration matters). Of course this can carryover to academic performance too. 

Prevention is Key!

Some tips here:

  1. Take rest days: I usually recommend 1-2x/ week. Really resting the muscles is recommended to allow for the parasympathetic nervous system activation. Examples of rest day activities include: stretching, yoga, short walks. But mostly, trying to relax!  You might “catch up” w/ food on these days, if you didn’t eat enough on training days. 
  2. Eat every few hours: This helps to stimulate the metabolism, and keeps body fueled. By eating regularly, this will also line up well with your pre and post workout snacks
  3. Include all food groups (carb, proteins, fats, veg/fruit, fats, and dairy or dairy alternative). Take a full plate of food, and eat it! This keeps meals balanced and “enough.”
  4. Add fats: This can help boost testosterone levels and estradiol levels. Fats are also necessary to absorb Vitamin D which is necessary to absorb calcium.  Bone health is at risk if hormone levels are low. 
  5. Add extra fuel for added workouts!  
  6. Track menstrual cycle: Download an app to track your menstrual cycle. This will help you notice when there is a chance in your cycle (both in length of cycle,  flow, and time between cycles). Check out free apps like Period Tracker, Period Diary, or Clue. 
  7. Talk to a sports dietitian to help you assess your energy balance needs. Look for a “Certified Specialist in Sports Dietitian” (CSSD) or a “Certified Eating Disorder Registered Dietitian”(CEDRD) to who can also help with energy balance.  
  8. Talk to an MD (who can assess vitals, lab work etc  and see if there are concerning changes) and a sports psychologist (who can make sure you mindset is in okay).  Make sure mindset and stress are okay throughout the grind of the season. 

MORE READING:

Read about Relative Energy Deficiency here.

RED-S is a Real Problem for Runners

The Athletes Starving Themselves for Success (BBC) RED-S

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Why Does My Child Crave Sugar?

I speak with a lot of #parents who tell me that they they have a child who eats “tons of sugar” or who has “no control.” Going deeper, I most commonly see that kids overrespond to sweets when:

-They are hungry! This can be due to missed meals or caloric restriction (#dieting)

– Or when sugar is banned, restricted, or forbidden in their house

Many kids head to school and into sports, having missed breakfast and/or having barely touched their lunch. “Just a banana” doesn’t count for breakfast.  Ideally, all meals would have all five food groups (grains, protein, fruit/vegetable, fats, dairy). Complete meals help kids feel full throughout the day (and reduces obsessing about food and cravings). Helping to make sure your child’s lunch is delicious and filling is important. Check with your child:  How is your lunch?  Is it filling enough? 

Note: kids living in larger bodies need MORE food to feel sufficiently satisfied (not less, contrary to what society/ diet culture tries to sell you).

When hungry, there is a tendency to bypass one’s natural stopping place. We see high cravings for all foods, any foods, including sugar, sweets, and anything a hungry kid can find – but especially ones that provide quick and easy nutrition. 

Identifying high hunger levels throughout the day, and then finding ways to minimize these levels is key.  We help kids to do this in our book No Weigh! And we teach parents more about this, in our forthcoming book, “Raising Body Positive Teens: A Parent’s Guide to Diet-Free Living, Exercise and Body Image” (out March 2022). 

For more resources on this topic, see:

Stress eating lately? The ‘hunger meter’ can help

Therapy Rocks! Podcast:  Disrupting Habits that Don’t Help

What To Do When You Want Food but You’re Not Hungry

#sugarcravings #adolescentnutrition #dietculturedropout #foodisfuel # selfcare #parenting #teens #haes  #allbodiesaregoodbodies #bodypositive #nutritioneducation

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What is Overtraining Syndrome?

Recently, Olympic swimmer Simone Manuel revealed she was suffering from “overtraining syndrome” after experiencing fatigue, depression, insomnia & decreased performance. 

The Philadelphia Inquirer wrote:

“Overtraining syndrome is an important and often under-recognized problem in athletes. It can start in youth sports and progress up to the highest level of competition. An athlete’s body is like a machine, and without enough rest between workouts or fuel from nutritional support, the machine can be strained and start to break down. Overtraining syndrome occurs when the body starts to break down from prolonged overuse, leading to physical and emotional symptoms. It has sometimes been referred to as “burnout” and has led some athletes to change sports, or drop down in levels of competition, or even retire from sports.” 

Rest is an essential ingredient in one’s training program

Competitive athletes like to train! Rest is very hard for many, but is an essential ingredient in one’s training plan. Some athletes say, “rest is unnecessary” or “a waste of time.” But rest helps the muscular, nervous, and immune systems recover, helps to strengthen and rebuild, while allowing athletes to minimize soreness, inflammation, and illness.  Rest helps with recovery and performance gains. For more about why rest days are important, check out this article.

SIGNS OF OVERTRAINING SYNDROME: 

  • Fatigue
  • Decreased performance (slower, weaker, less endurance)
  • Reduced training response (failure to progress despite training hard)
  • Altered heart rate (too slow/fast heart rate – check with MD!)
  • Changes in vital signs in positions (change in pulse or blood pressure)
  • Hormone changes (decreased estrogen/females, decreased testosterone/males, increased cortisol- stress hormone)
  • Repeat injuries or pain
  • Decreased interest/enjoyment in sport
  • Loss of motivation
  • Depression, anxiety, irritability
  • Trouble sleeping
  • Changes in weight
  • Perpetually sore muscles, and more! 

A sports dietitian (Certified Specialist in Sports Dietetics – CSSD), a sports medical doctor, and a sports psychologist can be helpful to those experiencing this. 

#overtraining #overtrainingsyndrome #relativeenergydeficiencyinsport #reds #sportsnutrition #swimming #swimmer #olympictrials #olympics2021 #olympicswimming #performancenutrition #recovery #sleep #mentalhealth

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Rest Day Nutrition

Many have been told to “eat less” or to “avoid carbs” on a rest day. But on a rest days, the body is busy! Rest days are filled with healing, rebuilding, repairing, and muscle growth. This requires FOOD, which includes CARBS + proteins + fruits/vegs + fats and more!

Many will feel hungry on these days….and feel confused by it. But it makes perfect sense. The athletes I see in my practice almost always fall short of their nutritional needs on training days. Exercise can suppress hunger. And complicated training schedules and/or logistics may make it difficult to get everything in on training days.

We strategically use rest days to catch up on nutrition. While hard for some to do, this is necessary to prevent a low energy availability state (which negatively affects everything from performance to hormones to cognitive function to mood).

A few questions to consider for your rest day nutrition, are listed below. Eat more if you answer yes to any of the questions below – this means you need to boost your rest day nutrition!

1. Do you feel hungry on your rest days?

2. Do you have multiple training sessions a day during the week?

3. Are you traveling for your sport – long drives, bus rides, plane rides?

4. Are you a picky eater? 

5. Do you have an eating disorder or struggle with disordered eating?

6. Do you need to/want to gain weight? 

7. Do you have a known low heart rate or unstable vital signs (such as changes in positions from laying to standing?)

8. Are your hormones low (estrogen or testosterone?). For females, are your periods regular?

9. Are you training long hours during the day? Or are you an endurance athlete?

10. Do you have a busy schedule (training, working, being a student etc)?

If you answered yes to any of the above, you might need to re-evaluate your rest day nutrition plan!

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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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