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emilyprogramfoundation.org

Building Community

AwarenessMedia, Body Image, & More

Kitty Westin, MA LP

Board Member, TEPF

Keri Clifton

Community Outreach Manager


About TEPF

On a mission to save lives, change minds, and

work to eliminate eating disorders.

• Education

• Advocacy

• Financial Assistance

• Family and Friends Support


Why talk about eating disorders?

• Half of all people know someone with an eating disorder

• More than 14 million Americans and 70 million individuals worldwide currently struggle with eating disorders. – That includes 200,000 Minnesotans

• It is estimated that 11% of high school students have been diagnosed with an eating disorder

• The most common behavior that can lead to an eating disorder is dieting.– In 1970: the average age girls began to diet was 14

– In 1990: the average age had dropped to 8


Anna Selina Westin

November 27, 1978 – February 17, 2000


What happened?

Anna age 1

Anna age 20


“My life is worthless right now. Saying goodbye to such an unfriendly place

can’t be as hard as believing in it. And, essentially my spirit has fled already.”

Anna committed suicide on February 17, 2000. She was 21 years old.

emilyprogramfoundation.orghttp://www.youtube.com/watch?v=RKPaxD61lwo


Outline

1. Etiology of Eating Disorders

2. Who Gets Eating Disorders?

3. Understanding Types of Eating Disorders

4. Signs/Symptoms of Eating Disorders

5. Assessment

6. Treatment of Eating Disorders

7. Insurance

8. Health at Every Size


Etiology of Eating Disorders


Familial

Psychological

Biological

THE MULTI-DETERMINED AND

SELF-PERPETUATING NATURE OF

EATING DISORDERS

PREDISPOSING

FACTORS

Sociocultural

PRECIPITATING

FACTORS

PERPETUATING

FACTORS

Stressors

Disorderedthoughts and

eating

Extreme Dieting/Binging/Compensatory

behaviors

Physiologicalsequelae

Psychologicalsequelae

Adapted from Harper-Guifre, H. (1992) Overview of the eating disorders. In H. Harper-Guiffre & K.R. MacKenzie (Eds).

Group psychotherapy for eating disorders. Washington, DC: American Psychiatric Press


Why do people get eating disorders?

Bio-Psychosocial Model of Eating Disorders

Dieting

Genetics

Physical changes

Puberty/Menopause

Brain Chemicals

Stressful events

Coping skills

Identity/self-image

Personality factors

Perfectionism

Depression

Cultural factors

Pressure to “fit in”

Media messages about

appearance

biology psychology

social/environment


Effects of Eating Disorders

• MN Starvation Study/Key’s Study

(Kalm, LM, Semba, RD. J Nutr 2005; 135:1347)


Eating Disorders Happen for Many Reasons

• Eating disorders are not a choice; they are not a lifestyle.

• The person can’t ‘just stop doing it’. They need help.

• Eating disorders can be a way to cope, communicate, and solve problems to help an individual feel whole, secure, safe, and in control.

• Once we can work on other ways to cope and what the person needs, we can help them to make changes.

• A lot of the ideas that people with eating disorders have are strongly supported by societal/environmental norms and are hard to figure how to deal with.


Who Gets Eating Disorders?


People with eating disorders come in all sizes.


Understanding Types of

Eating Disorders


Types of Eating Disorders

• DSM IV• Anorexia Nervosa

• Bulimia Nervosa

• EDNOS

• Binge Eating Disorder

• Compulsive Overeating

• DSM V• Anorexia Nervosa

• Bulimia Nervosa

• Binge Eating Disorder

• Avoidant/Restrictive Food

Intake Disorder

• FEC-NEC

– Atypical AN

– Sub BN

– Sub BED

– Purging Disorder

– NES


Anorexia NervosaAnorexia Nervosa is a serious life-threatening

disorder characterized by deliberate self-starvation. The person becomes obsessed

with food, weight, counting calories, and vigorous exercise.


DSM-IV 307.1 Anorexia Nervosa

• Refusal to maintain a minimally acceptable body weight for a person’s height and age (e.g. 85% of IBW)

– ICD-10 requires 17.5 BMI or below

• Intense fear of gaining weight

• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of current low body weight

• In postmenarcheal females, amenorrhea for at least 3 consecutive menstrual cycles

• Restricting subtype

• Binge eating/purging subtype


DSM-5: Anorexia NervosaA. Restriction of energy intake relative to requirements leading to a significantly low body weight in

the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Specify current type:

• Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

• Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)


Bulimia NervosaBulimia is a serious

life threatening

disorder

characterized by

recurrent episodes of

binge-eating

followed by self-

induced vomiting or

some form of purging

as a means of

controlling weight.


DSM-IV 307.51 Bulimia Nervosa

A. Recurrent Episodes of Binge Eating

1) eating, in a discrete period of time (e.g. within any 2 hour period), and amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

(2) a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives or diuretics, enemas or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:

Purging Type: During the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.

Non-purging Type: During the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.

References: American Psychiatric Association. (1994). Diagnostic and Statistical Manual

of Mental Disorders (4th Ed.) United States of America: American Psychiatric

Association.


DSM-5: Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

(1) Eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

(2) A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications, fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of anorexia nervosa.


Overeating

• Binge-eating disorder (BED) Overeating large

amounts of food with no use of compensatory

mechanisms (e.g. purging, over-exercising, etc.),

person is compelled to overeat, feels out of control,

strong weight/shape concerns

• Compulsive overeating (COE): Overeating may be

more grazing overeating through day rather than

discrete binges, compelled to overeat, and feels out

of control, strong weight/shape concerns


BED DSM-IV Research Criteria

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: (1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances (2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. The binge-eating episodes are associated with three (or more) of the following: (1) Eating much more rapidly than normal (2) Eating until feeling uncomfortably full (3) Eating large amounts of food when not feeling physically hungry (4) Eating alone because of being embarrassed by how much one is eating (5) Feeling disgusted with oneself, depressed, or very guilty after overeating

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least 2 days a week for 6 months. E. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa


DSM-5: Binge Eating DisorderA. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

(1) Eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances

(2) A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)

B. The binge-eating episodes are associated with three (or more) of the following:

(1) eating much more rapidly than normal

(2) eating until feeling uncomfortably full

(3) eating large amounts of food when not feeling physically hungry

(4) eating alone because of feeling embarrassed by how much one is eating

(5) feeling disgusted with oneself, depressed, or very guilty afterwards

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least once a week for three months.

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.


DSM-IV 307.50 Eating Disorder

Not Otherwise Specified (EDNOS)

1. All of the criteria for anorexia nervosa are met except that the individual has regular menses.

2. All of the criteria for anorexia nervosa are met except that, despite substantial weight loss, the individual's current weight is in the normal range.

3. All of the criteria for bulimia nervosa are met except that binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.

4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (eg, self-induced vomiting after the consumption of two cookies).

5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

6. Binge eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.

Reference: American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) United States of America: American Psychiatric Association.


DSM-5: Feeding and Eating Conditions Not

Elsewhere Classified

• Atypical Anorexia Nervosa

– All of the criteria for Anorexia Nervosa are met, except that, despite significant

weight loss, the individual’s weight is within or above the normal range.

• Subthreshold Bulimia Nervosa (low frequency or limited duration)

– All of the criteria for Bulimia Nervosa are met, except that the binge eating and

inappropriate compensatory behaviors occur, on average, less than once a week

and/or for less than for 3 months.

• Subthreshold Binge Eating Disorder (low frequency or limited duration)

– All of the criteria for Binge Eating Disorder are met, except that the binge eating

occurs, on average, less than once a week and/or for less than for 3 months.

• Purging Disorder

– Recurrent purging behavior to influence weight or shape, such as self-induced

vomiting, misuse of laxatives, diuretics, or other medications, in the absence of

binge eating. Self-evaluation is unduly influenced by body shape or weight or

there is an intense fear of gaining weight or becoming fat


rr…r

Comorbidities

• Major depression

• GAD

• Panic disorder

• Suicidal ideation

• Self injury

• Binge drinking

• Nicotine and marijuana use

• Frequent exercise for females


Signs/Symptoms of

Eating Disorders


concerns Healthy ➜➜➜➜ ➜➜➜➜ ➜➜➜➜ ➜➜➜➜ Problematic

Weight control

Practices:

Healthy eating

behaviors

Dieting Unhealthy

weight

control

Anorexia or

Bulimia

Nervosa

Physical activity

behaviors:

Moderate

physical

activity

Minimal

or excessive

activity

Lack of, or

obsessive,

physical

activity

“Anorexia

athletica”

Body image: Body

acceptance

Mild body

dissatisfaction

Moderate body

dissatisfaction

Severe body

dissatisfaction

Eating behaviors: Regular eating

patterns

Erratic eating

behaviors

Binge eating Binge eating

disorder

Weight status: Healthy body

weight

Mildly

overweight

or underweight

Overweight or

underweight

Severe

overweight

or underweight

Neumark-Sztainer D, “I’m, Like, SO Fat!”: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight Obsessed World. New York: The Guilford Press; 2005.


Medical Complications

• heart rate < 40 bpm

• blood pressure <90/60 mm Hg or orthostatic hypotension

with pulse increase of 20 bpm or bp drop of >10-20 mm

Hg/minute from lying to standing

• glucose < 60 mg/dL

• potassium < 3 mEq/L or other critical electrolytes

• temp < 97.0°F

• Dehydration

• poorly controlled diabetes

• high suicide risk

• Amenorrhea

• Bradycardia

• unexpected osteopenia or osteoporosis


SIGNS AND SYMPTOMS OF EATING DISORDERSIn your interactions, you may notice one or more of the physical, behavioral,

and emotional signs and symptoms of eating disorders.

Physical• Weight loss or fluctuation in short period of time.• Abdominal pain.• Feeling full or “bloated.”• Feeling faint, cold, or tired.• Dry hair or skin, dehydration, blue hands/feet.• Lanugo hair (fine body hair).

Behavioral• Dieting or chaotic food intake.• Pretending to eat, then throwing away food, eating in secret, hiding food, disrupting meals • Exercising for long periods of time.• Constantly talking about food.• Frequent trips to the bathroom.• Wearing baggy clothes to hide a very thin body.• Purging; restricting; binge eating; compulsive eating; compulsive exercising; abuse of diet pills,

laxatives, diuretics, or emeticsEmotional

• Complaints about appearance, particularly about being or feeling fat.• Sadness or comments about feeling worthless.• Perfectionist attitude.


Recognize the signs of someone at risk.

Common Scenarios:

• The student who eats only a small amount of each food on her plate because she’s afraid

of getting fat.

• The adolescent boy or girl who comes home to an empty house and eats whatever snack

foods are available.

• The young girl who skips breakfast and lunch, has a candy bar and diet soda after school,

finds a way to skip the evening meal with her family—and then goes on a secret eating

binge in the evening.

• The wrestler who fasts for 2 days before his match to make weight, then eats nonstop for

the next day or two.

• The dancer, gymnast, or cheerleader who refuses meat, eggs, milk, or any foods she

imagines might make her fat and unable to perform.

• The bright and confident class president who is teased about the size of her body and

begins a fad diet to lose weight.

“many individuals diagnosed …remember being teased or recall that their problems

first began when they started dieting” - BodyWise


Worried about someone?

Start the conversation. If you suspect someone is struggling with eating disorder behaviors, ask if it is okay to discuss his or her eating habits. For example, “I’m concerned about your eating. May we discuss how you typically eat and your relationship with food?”

Ask more questions. These 6 assessment questions can help assess the situation. (Adapted from the SCOFF Questionnaire by Morgan, Reid & Lacy)

– Do you feel like you sometimes lose or have lost control over how you eat?

– Do you ever make yourself sick because you feel uncomfortably full?

– Do you believe yourself to be fat, even when others say you are too thin?

– Does food or thoughts about food dominate your life?

– Do thoughts about your body or weight dominate your life?

– Have others become worried about your weight and/or eating?

Give feedback. In this informal survey, 2 or more "yes" answers strongly indicate the presence of disordered eating. Refer as needed.


If You Are Concerned

• Recognize that some people do not have the skills to deal

with the underlying emotional turmoil that often

accompanies eating and exercise problems.

• Share information with others who know the person. Find

out if they have noticed similar signs.

• Decide together the best course of action and who should

talk to the person and family members.

• Refer as needed


Assessment


A Comprehensive Assessment

Complete History

• Assess• Rate and amount of weight loss/change

• Nutritional status

• Methods of weight control

• Review• Compensatory behaviors

• Dietary intake and exercise

• Menstrual history in females (hormone replacement therapy including oral contraceptive pills)

• Comprehensive growth and development history, temperament, and personality traits

• Physical Examination• Supine and standing heart rate and blood pressure

• Respiratory rate

• Oral temperature (looking for hypothermia)

• Height, weight, growth charts for children and adolescents, nothing changes from previous measurements

• Laboratory Evaluation• Lab and imaging studies suggested can be found in AED’s Report 2011 – Critical Points for Early Recognition

and Medical Risk Management in the Care of Individuals with Eating Disorders


Key questions

• What are the behaviors?

• Is there preoccupation?

• Is there impairment?


The challenge of screening• Clients may present with other issues correlated with

disordered eating

• Clients may not recognize the severity of their symptoms

• Clients experience significant shame

• Clients don’t want to address their eating disorder

• Changes in eating patterns or exercise patterns? What are

they?

• Any concerns for you around your eating patterns?

• Does it feel that your size and shape is connected with your

self esteem

• What percentage of the day are you thinking about food or

weight or shape?


Treatment of Eating Disorders


Treatment for Eating Disorders

• Treatment is dependent on what the person needs.

• Treatment can look a lot of ways:– Residential, or 24 hour care

– going to a clinic for one-on-one sessions with a counselor, a dietitian, and a doctor

– attending a group program for an hour or for most of the day

• Family involvement in the treatment process is especially important!


Services at

The Emily

Program

• Group Therapy & Support Group

• Individual Therapy

• Gastric Bypass Evaluation

• Nutritional Evaluation & Counseling

• Family & Couples Therapy

• Psychiatry Services

• Medical Services

• Intensive Outpatient Programs

• Intensive Day Programs

• Anna Westin House Residential Program

• Holistic Services:

– Yoga

– Art

– Music

– Spirituality

– Body Image


Who does what, when , and how often?

DIETICIAN

• Meal Planning

• Nutrition Education

• Establishment of wt

range

• Education regarding

physical aspects of ED

• Weight monitoring

• Strategizing food

related activities

• Body image

• Teach Coping Skills

THERAPIST

• Assesses/treats

symptoms of related

diagnoses (anxiety,

depression)

• Monitor and address

suicidal thoughts/self-

injury

• Explore etiology and

maintaining factors of

ED

• Body image

• Teach coping skills

PHYSICIAN

• Medical monitoring

and treatment of

medical conditions

related to ED

• Medication

monitoring

• Weight monitoring

• Education regarding

physical aspects of ED


Intensive ProgrammingIOP Locations

• St. Paul – Como: Adolescent Family Intensive (AFI), Mindfulness Based (MB), Compulsive Over Eating (COE)

• St. Louis Park: Adult, MB, COE, Dialectical Behavior Therapy (DBT)

• Duluth: IOP

• Seattle: Adult

IDP/PHP Locations

• St. Paul – Como: Intensive Day Program (IDP), Adolescent Intensive Day Program (AIDP)

• St. Louis Park: IDP

• Seattle: Partial Hospitalization Program (PHP)

Residential Locations (St. Paul)

• Anna Westin House (AWH)

• Anna Westin House –Adolescent and Young Adult (AWHAYA)


Empirically Supported

Treatments for Eating Disorders

Cognitive Behavior Therapy-Enhanced

Rationale: focuses on the core psychology of ED:

over-evaluation of weight and shape

– Modify thoughts and behaviors that cause and

maintain eating disorder symptoms. Change how

you feel by changing how you think

– Most extensively studied treatment for eating

disorders; considered first line treatment

– Outcomes: 1/3 drop out; ½ remaining get well




Dialectical Behavioral Therapy

Rationale: People with ED struggle with affect

regulation and affect contributes to onset and

maintenance of ED symptoms

• Mindfulness: nonjudgmental observation and

experiencing of emotions, urges, and thoughts

• Emotion regulation skills: Decrease vulnerabilty to

negative emotions and increase positive emotions

• Distress tolerance: Acceptance of reality and negative

emotions




Family Based Therapy (Maudsley)

Rationale: Adolescents are embedded in a family

system so treatment should be as well

• Parents in charge of refeeding

• 10-20 sessions over 20 weeks

• Three phases – weight restoration, transition of

responsibility, and establishing healthy identity

• Very favorable for young adolescents


• rrr

• Separate from disordered thinking

• Normalize preoccupation

• Collaborate in challenging and

replacing ED thoughts

• Focus on developing self

• Visualization

• Mission statement

• Wise self

Life without ED


Normal Eating

“In short, normal eating is flexible. It

varies in response to your hunger, your

schedule, your proximity to food and

your feelings.”

- Ellyn Satter, RD


• Develop strong, nuanced, internal sense of self

• Broaden conception of body image

• Broaden experience of body sensation

• Explore underlying emotional response

• Actively surround with positive images

• Use affirmations to attend to other aspects

of self

Working with body image


Recovery is Possible

• People do get better.

• Treatment may take time.

• Even if someone “looks” better it doesn’t mean they really are.

• If you know someone who is in treatment for an eating disorder, don’t forget to keep treating your friend like a friend; ask them how they are doing, be their friend. Also, avoid talking about food or weight!


Insurance


Anna’’’’s Story

• Insurance in MN

• Legislative Changes

• Coverage for Low

Income Individuals

• FREED Act

• Truth in Advertising

Act or 2014


How will ACA help people with mental health

issues and eating disorders?

• ACA addresses lack of access and quality of

care in BOTH public and private systems.

• Soon; 90% of Americans will be covered

under insurance including people with serious

mental illness and substance abuse disorders.

• More people eligible for Medicaid including

single, childless adults.


Insurers can no longer:

• Deny coverage for a pre-existing condition.

• Charge people with “poor health” more than people with

“good health”.

• Cannot discriminate based on mental or physical disability.

Un-enroll people when they get sick.

• No lifetime or annual limits on benefits.

• Ignore Mental Health Parity Law.


Eating Disorders Coalition for Research,

Policy & Action

www.eatingdisorderscoalition.org


What Do We Do?

• Biannual Lobby Days

• Congressional briefings

• Congressional hearings

• Bill writing

• Press Conferences and Media events


Other Advocacy efforts:

• State Advisory Council on Mental Health

• Mental Health Legislative Network

• Media Monday

• Public speaking: professional conferences, community groups, other organizations

• Work with insurance companies

• Media interviews and connections

• Family and Friend support


Health at Every Size


Where We Are Trying to GoEating Disorder Context

Help Individuals…

•Eat and be active in tune with the body’s needs

•Eat when hungry and stop when satisfied

•Eat a variety of foods without a fear of fat

•Appreciate the body

•Think critically about media

•Employ many coping skills


““““War”””” on Obesity


vs.

Key Obesity Prevention

Messages

Calories in = Calories out. It’s all about

balance.

Eat 5-9 servings of fruits and vegetables

every day.

Be active at least 60 min. most days

Decrease consumption of sugar-

sweetened beverages

Limit intake of high fat and high sugar

junk foods (chips, pop, candy, etc.)

Decrease consumption of fast food and

watch out for large portion sizes

Limit screen time (TV, computer)

Key eating disorder messages

Listen to your body. Eat when you’re

hungry and stop when you’re full

There are no "good" or "bad" foods

All foods can be part of healthy eating.

Eat lots of different foods, including fruits,

vegetables, and even sweets.

If you are sad, mad or bored—and you

are not really hungry—find something to

do other than eating.

No matter what you weigh or how you

look, exercise and staying active are

healthy and help you do what you want

Healthy bodies and happy people come in

all sizes


Weight must

be considered

in context


Health at Any Size

• Body fat can be beneficial

• Fat in the arteries and fat on the body are different and not

necessarily related

• Men/women classified as “overweight” who exercise

regularly and are physically fit have lower all-cause death

rates than thin men/women who do not exercise

• Weight loss does not necessarily improve health or lengthen

life

• “Thinner is better” – body weight is fairly unrelated to health

status and death

Big Fat Lies by Glenn Gaesser PhD


Health at Every Size (HAES)Supports:

Health enhancement – attention to emotional, physical, psychological, social and spiritual

well-being, without focus on weight loss or achieving a specific ‘ideal weight’.

Size and self-acceptance – respect and appreciation for the rich diversity of body shapes and

sizes (including one’s own), rather than the pursuit of an idealized weight or shape.

The pleasure of eating well – encouraging eating based on internal cues of hunger, satiety,

pleasure, appetite and individual nutritional needs, rather than on external food plans or

diets for weight loss.

The joy of movement – encouraging appropriate, enjoyable, life-enhancing physical activity,

rather than following a specific routine of regimented exercise for the primary purpose of

weight loss.


Health at Every Size (HAES)

Does not support:

Ideal weight – the indiscriminate use of the standardized ‘ideal’ weight category as a

measure of a person’s health status.

Weight loss – dieting, drugs, programs, products or surgery for the primary purpose of weight

loss.

Body assumptions and bias – that a person’s body size, weight or body mass index is

evidence of a particular way of eating, physical activity level, personality, psychological state,

moral character or health status.

Body size oppression – any form of oppression including exploitation, marginalization,

discrimination, powerlessness, cultural imperialism, harassment or violence against people

based on their body image, body size or weight, and any approach to health, eating or exercise,

the provision of products, services or amenities that perpetuates body size oppression.


Recommendations on how to help teenagers maintain a healthy

lifestyle without increasing risk for an eating disorder from Dianne

Neumark-Sztainer PhD, MPH, RD

• Talk less, do more

• Losing weight does not necessarily mean improving health

• Model the behavior

• Encourage family meals and changes to the whole family's

diet

• Keep the focus on overall health, not weight

• Ensure the person knows he/she has worth regardless of their

weight

• Change language used around children’s weight


The Truth About DietingThe Truth About Dieting

• 95% of people who initially lose weight on “diets” gain it all back—sometimes even more than they lost.

• In a recent study, teens who dieted regularly gained moreweight over a 5 year period than those who didn’t diet at all.

• People who diet are more likely to binge-eat, become depressed, and are at higher risk for eating disorders and obesity.

• Dieting can also lead to deficiencies in calcium, iron, and other important nutrients for daily function.


Activity: The Diet DilemmaActivity: The Diet Dilemma

It’s time for us to give it a try—grab a straw and try out the Air Diet!

The rules:

•No “cheating” your diet (no extra gulps of air or laughing)

•If you have asthma or start to feel dizzy or anxious at any time, return to normal breathing

immediately


Resist the urge to diet. DIETS DON’T WORK IN THE LONG RUN and are a risk factor for eating disorders.

Focus on Health


Mindful Eating

• A small yet growing body of research suggests

that a slower, more thoughtful way of eating

could help with weight problems

• In a study mindfulness-based therapy seemed

to help people enjoy their food more and have

less sense of struggle about controlling their

eating

Harvard Health Publications


Tenants of Mindful Eating

• Take the time to figure out what you really want to eat

• Choose to eat food that is pleasing to you and nourishing to your body by using all your senses to explore, savor, and taste

• Learn to be aware of physical hunger and satiety cues to guide your decision to begin and stop eating

• Give yourself unconditional permission to eat it

• Listen to your body when it tells you it has had enough or if it wants something else

• Let go of habitual responses to food and eating


January 2000

“May all your love, joy and pain, all your fears and desires

lead you to your own promises, may your dreaming

never end and your voice never die.”

Anna Westin


Additional Resources

• Eating Disorder Anonymous

• Overeaters Anonymous

• Academy of Eating Disorders

– Professional Development


[email protected]

www.emilyprogramfoundation.org

Resources

www.aedweb.orgwww.eatingdisorderscoalition.orgwww.tcme.orgwww.mollykellogg.comwww.about-face.orgwww.something-fishy.org

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