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Understanding therapy for eating disorders – an interview with Colleen Reichmann, Psy.D.

We interviewed Dr. Colleen Reichmann to find out more about what it’s like to be a therapist who specializes in eating disorders. 

Q: Why did you become a therapist?

I became a therapist because, quite simply, I wanted to give back! I have struggled with my own mental health issues, and have seen first hand the healing power of therapy, which inspired me to pursue a career in psychology.

Q: What made you decide to go into eating disorder treatment as your specialty?

I mainly made this decision because of my own past history-I struggled with an eating disorder for around a decade. I was told that I would be a “chronic” patient and felt so hopeless at times. When I finally began to really recover, I realized that I wanted to use this journey to help others who are struggling with eating disorders. This is not to say that I understand your eating disorder, because everyone is different. My past history simple gives me what I like to call an “empathy chip” for this particular illness and journey.

Q: What training have you received to be an eating disorder specialist?

Unfortunately, I did not receive much specialized training in the core parts of my graduate program, as it was a generalist program. I sought out research experiences (assistantships and my masters thesis and dissertation) that focused on eating disorders. I also attended conferences and trainings outside of school as much as I could. I completed my predoctoral and postdoctoral internships at inpatient eating disorders units, which were huge training experiences. Currently, I am pursuing my CEDS specialist, and expect to be finished within a year or so!

Q: How do you pursue ongoing education as an eating disorder specialist?

I attend conferences. Specialized eating disorder conferences are absolutely crucial. I make it a point to find training opportunities that offer an inclusive, Health At Every Size perspective on issues within the ED community.

Q: How do you typically approach treating a child (up to age 18) for an eating disorder?

Typically I utilize family based therapy (FBT) if at all possible. (I have received some specialized training in FBT). If parents are invested, involved, and ready to learn, I find it is ALWAYS best to include them in the treatment process. After all, you know your child far better than I do! If this is not possible, I offer interpersonal/feminist-relational therapy, with cognitive behavioral therapy techniques threaded throughout. I believe that insight-focused work AND behavior/action-focused work is necessary when it comes to recovery from an eating disorder.

Q: What treatment format do you typically recommend for a child (up to age 18)? For example, how often do you like to meet, for how long, and do you involve family members? Do you involve other caregivers like doctors and nutritionists?

I recommend at least weekly individual session, (50 minutes each), and every other session would ideally involve parents. I also recommend monthly (or more if needed) meetings with an eating disorder-informed MD, and weekly meeting with a dietitian (pediatric dietitians are very helpful for children under 12/13), and non-diet, fat-positive dietitians for everyone else!

Q: What would you like parents to know about having a child who has an eating disorder?

I would like parents to know that this is not your fault. This is a serious mental illness with research-proven genetic underpinning. You cannot “give” your child an eating disorder. You can, however, be a powerful piece of their recovery. I would also like to remind parents who feel helpless/powerless that you likely fed your child successfully for many years. You have the power and the knowledge to help your child-all you need now is guidance and support in how to apply that power now that your child is struggling with an ED.

Q: What mistake(s) do you think parents make when parenting a child who has an eating disorder?

I commonly see parents trying to “appease” their child when it comes to recovery. This is understandable-if your child is begging you not to eat something, to make something different, or to eat less, it is so common and human to want to comfort your child by giving in. To this I say, much like other aspects of parenting, the most comforting action for your child is not what will be best for him/her/them in the long term. Empathic firmness works best here.

I also see parents trying very hard to understand the eating disorder or rationalize what is happening to their child. Often times, it is impossible to find the rationality in someone who is struggling with an eating disorder. Please know that this is an illness with a largely fear-based brain component. Meaning that, neurochemically, your child’s brain is likely reacting similarly around food to someone who struggles with an extreme phobia and is being asked to confront it. So please do not feel hopeless if explaining the rational need for food/eating does not get through to your child.

Q: Do you see any promising new research or techniques that you think will make an impact on the future treatment of eating disorders?

I have recently seen some research that involves “bridging the gap” between research and field work when it comes to family based therapy. (This “gap” refers to the difference between the great outcomes that we have seen in controlled studies, versus the less-powerful outcomes that we see when this research is applied to real-life clients). I think this idea of focusing on the gap and how to close it will be very helpful to the field.

Additionally, we are seeing more and more providers discussing the role of intersectionality, identity, oppression, and marginalization when it comes to eating disorders. This is helpful because it allows us to begin addressing and confronting the environment that leaves some people vulnerable to eating disorders.  (Versus acting as if recovery happens in a vacuum).


colleen Reichmann psyd

Colleen Reichmann, Psy.D. is a licensed clinical psychologist who specializes in the treatment of individuals with eating disorders and body image issues. She has worked at various inpatient eating disorder treatment facilities and is the blog manager for Project HEAL. She lives in Virginia Beach with her husband and golden doodle and currently works at a group practice.

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When your child gains weight in eating disorder recovery

woman looks at herself in the mirror and worries she has gained weight after an eating disorder

It’s quite common for your child to gain weight in eating disorder recovery. Regardless of your child’s current or previous weight, recovery can result in weight gain. While your child learns to eat intuitively and feed their body what it needs, their body weight will very likely fluctuate.

Weight gain in eating disorder recovery

You should be prepared not only for weight gain, but also your child’s reaction to weight gain. While eating disorders go much deeper than weight, poor body image is a critical symptom.

When your child struggles with weight gain, it’s a sign they are still struggling with their eating disorder. Your child’s treatment team will be working to help your child separate their sense of self-worth from their body size. Meanwhile, you’re at home, seeing your child suffer mightily with the weight gains associated with recovery from an eating disorder.

When a child gains weight in eating disorder recovery, they may believe that recovery is bad or wrong. These feelings can reduce them to tears. When they go to put on a favorite outfit, an outfit that they remember as being loose, they may discover that it is too tight. Fear of weight gain is a normal and natural part of recovery, and the only way out is through.

Here are a few tips for parents who are supporting a child who gains weight in eating disorder recovery.

Accept the weight of your child

Your child probably hates the size of their body. It’s very traumatic to gain weight in eating disorder recovery. It will take time for your child’s body to adjust to non-disordered eating. And it will take at least as much time for your child’s mind to adjust to a non-disordered body.

You may be surprised by how much weight your child gains in eating disorder recovery. You may even be shocked and uncomfortable with it. Some people fluctuate up and down dramatically during eating disorder recovery. It is natural for you to worry that your child is swinging too far in any direction. And unless your child is medically underweight, you feel very uncomfortable.

We live in a fatphobic society, and your concerns about your child’s weight are normal under these circumstances. But your concerns will not help your child heal from an eating disorder. It is very important that you accept your child’s body at every size throughout recovery and beyond. 

Take some time to learn about Health at Every Size, which can help put your fears to rest. The health impacts of having adipose tissue are small compared to the health impacts of an eating disorder.

Try this practice. You will have negative thoughts about your child’s body size. When that happens, notice the thought, and then change your mind.

For example, your first thought might be about how she looks: “she looks fat in those shorts!” Notice that thought, and replace it with something positive about how your child feels. “I’m so glad she’s feeling strong and healthy.” Alternatively, replace it with something positive about what their body does. “Her body is getting stronger every day.” This takes practice, but it’s essential in helping your child heal.

Your child will sense if you are uncomfortable with their body. Even if you say nothing out loud, they know. This is an unfortunate fact of parenting. But it’s something we can work on. Notice every time you have a negative thought about your child’s weight, and change your mind.

Trust your child’s body

Someone who has an eating disorder has severed the brain-body connection. They train themselves to overcome feelings of hunger and satiety. They become disconnected from the natural instinct to feed and move the body in healthy ways.

Eating disorder recovery includes reconnecting the mind and body. It involves building mind-body communication pathways. They must learn to trust a body that they have previously determined to be untrustworthy. This is hard.

Intuitive eating can be very helpful, but it is an advanced concept. Intuitive eating requires listening to the body and giving it what it needs. This is something that takes time to develop, especially for someone with an eating disorder.

As your child learns to trust their body, you can help by trusting their body. This goes against the cultural messages that tell us bodies must be controlled. But controlling the body resulted in an eating disorder for your child. It’s time to try something different.

Parents must trust their kids’ bodies, even when our kids don’t feel they are trustworthy. We must trust even when we are scared that our kids will get “too fat.” We can’t know whether they will fully recover, but we can trust that their bodies will try to survive.

Body trust-building statements

Here are some trust-building statements to say out loud to yourself, other family members and your child:

  • If we listen to our bodies, they find balance.
  • Our bodies are naturally self-regulating.
  • It takes time to tune into how our bodies feel and what they want, and we’re working on it.
  • We were born knowing how to eat, when to eat, how much to eat, and what to eat. Sometimes our thoughts get in the way of this inborn knowledge. But, with practice, we can reconnect with our intuitive body wisdom.

Be prepared for the fallout of weight gain during eating disorder recovery

While eating disorders are about much more than food and body size, food and body size are massive triggers for someone who has an eating disorder. When bodies gain weight in recovery, alarm bells ring. Eating disorders tell us that weight gain is very, very wrong. Your child will have to face weight gain in order to succeed in recovery. It’s not easy, since our society insists that weight gain is always bad. Be patient, and be prepared for messiness.

They may rage and scream. Your child may cry and mourn. Their body has become your child’s expression of self-worth. As their body changes, your child may feel worthless and unlovable.

These feelings not over-dramatized or exaggerated. Your child is truly hurting and mourning the loss of the eating disorder’s role in their life. The eating disorder was a valuable and important coping mechanism, and losing that coping mechanism is traumatic.

It is hard to see our children suffer. It is hard not to want them to calm down and stop feeling angry and sad. But it is critical that our children receive the space they need to express the very real panic, fear, and despair that comes with losing an eating disorder and gaining weight.

When the fallout comes, and it may come all day, every day for a while, take a deep breath and remember that it’s real, and it needs space.

Don’t try to distract your child from the pain. Don’t try to take it away or tell them that it’s overblown. Listen to your child every time they want to talk about this. Let the pain come. It will pass. The best thing a parent can do is to be present and supportive through their child’s feelings. Your ability to tolerate the feelings will help your child learn to tolerate the feelings.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Weight stigma and your child: what parents need to know

Weight stigma and your child: what parents need to know

Parents need to know the dangers of weight stigma because it impacts everyone. And whether your child is thin, fat*, or in between, their health is impacted by weight stigma.

*Throughout this article I use the word “fat” as a descriptor. It is important to note that this is different than using “fat” as a slur. Many fat justice advocates say that we need to de-stigmatize the word fat. Instead, we should use it appropriately as a neutral descriptor to normalize fat bodies.

Popular media and healthcare providers scream about the dangers of fat cells. But the real danger is weight stigma and weight discrimination. Weight stigma contributes to physical and mental health complications. These include weight cycling (a natural and expected physiological response to dieting) and eating disorders. Therefore we need to tackle weight stigma in order to reduce these risks to our kids’ health.

body image for girls ebook

What is weight stigma?

Weight stigma is discrimination or stereotyping based on a person’s weight. It reflects internalized societal attitudes towards body size and impacts how we treat each other. Therefore understanding and counteracting weight stigma will help your child avoid body hate, disordered eating, and eating disorders.

Weight stigma is damaging for people who are larger. But it’s also bigotry that impacts people of all body sizes. Ask just about anyone walking down the street today and they are likely carrying internalized weight stigma and body loathing. This impacts their feelings about their body and themselves. There is no benefit to weight stigma, and there are many downsides.

The media and weight stigma

Media and entertainment outlets frequently portray strongly biased views of people who live in larger bodies. They promote weight stigma constantly by depicting fat people in dehumanizing and stigmatizing images. These include newspapers, magazines, books, movies, documentaries, videos, photographs, social media accounts, and more.

The media shows fat people eating fattening foods, sitting, and wearing tight, ill-fitting clothing. But it shows thin people eating colorful salads, exercising, and looking stylish.

The media portrays fat people as lazy, weak-willed, self-indulgent, and a drain on the nation’s resources. This is an ignorant an bigoted presentation. It has solidified the strong belief that fat is bad and thin is good. It’s important to note that the media’s revenue comes from advertising. It’s undeniable that the +$70 billion weight loss industry supports the very existence of our media outlets.

Healthcare and weight stigma

The second leading source of weight stigma are people in the medical and healthcare professions. This creates a significant barrier to healthcare for anyone who lives in a larger body. No visit to the doctor, regardless of the purpose, begins without an attempt to weigh the body.

Anyone in the “overweight” and above categories is lectured about their weight. This is regardless of why they came for a visit. It is also based only on weight, not health behaviors. Many receive lectures about weight reduction. This is despite the fact that there is no proven, safe, and effective method for reducing weight.

Weight stigma in healthcare often results in delayed diagnosis and treatment for many people who have serious medical conditions. Doctors are notoriously fat-phobic. Surveys show the majority of doctors actively dislike larger patients. And this is a major problem considering that more than 60% of their patient population is plus-size.

The playground and weight stigma

Our kids grow up in an ecosystem that is full of weight stigma. As early as preschool, children prefer thin figures in drawings and stories [1]. By elementary school, larger children report unsatisfactory peer relations, including social rejection [2].

Children who are larger are at increased risk for being targets of weight-related teasing [3]. And they also experience more non-weight-related teasing and bullying [4], and other forms of victimization such as physical aggression [5].

As early as the first grade, fat kids are treated differently by their peers. They are more likely to be treated poorly and be disliked. They often struggle with loneliness and friendships. Larger children are more likely to be rejected, made fun of, teased, picked on, and disliked [6].

This is the trickle-down effect of parents, teachers, doctors, and the media actively promoting weight stigma. Children are ostracized, bullied, and discriminated against. And this trauma has lifelong consequences that are much more serious than adipose tissue.

Weight stigma leads to poor health and eating disorders

The “War on Obesity” has failed to reduce the national weight. It has, however, succeeded in increasing weight stigma, which many researchers say is deeply health-damaging. Some people suggest that weight-shaming is good because it encourages kids to lose weight. But weight teasing and bullying in adolescence leads to higher (not lower) weight 15 years later.

This means that the “War on Obesity” is actually causing people to gain weight. People who are exposed to weight stigma are also more likely to exhibit eating disorder behaviors including extreme dieting and self-induced vomiting [7].

In cultures with fat stigma, we see more young women who express dissatisfaction or disgust with their bodies, which is an essential precursor (and continuing accompaniment) of eating disorders. [8]. 

There is a strong relationship between the “obesity epidemic” and the proliferation of eating disorders. “If fat bodies were accepted and not hated in our culture, fat people would not embark on restrictive eating or disordered eating in order to lose weight, and the majority would not develop eating disorders.” [9]

You may think it’s healthy to put your child on a diet. But diets have serious consequences. Instead, parents should help them manage the impact and reduce kids’ exposure to weight stigma.

What you can do at home

How you treat your child at home can be an important way to reduce their risk of eating disorders. A home that rejects weight stigma and dieting is safer for your child’s body and mind. And it’s also the right thing to do. No other marginalized community is as openly ridiculed and hated as fat people, and that’s simply unacceptable.

Here are a few basic rules to implement at home. Enforce these rules across all family members and anyone who enters your home without exception. Your child needs to know that bigotry and discrimination are not allowed or acceptable, no matter what.

1. No diets

Nobody in the home should even go on a restrictive diet with the purpose of losing weight. Read why

2. Stop food policing

A wide variety of food should be available to everyone in the home without restriction or monitoring. Read why

3. Don’t fat shame

Don’t allow anyone to tease or criticize another person’s body. This applies to anyone in the family, outside of the family, a celebrity, a stranger, etc. Read why

4. Avoid glorifying body-types

Everyone should learn to avoid making comments about “perfect bodies” and glorifying any particular body type. Don’t praise people for weight loss, discuss methods to achieve weight loss or a “perfect butt,” “washboard abs,” etc.

5. No scales

There is no reason to keep a scale in the home. Throw it away.

6. Health at Every SizeⓇ philosophy

Learn about and embrace the HAES approach to health. Read why

What you can do at school

School is the place in which your child is most at risk of fat stigma. Approximately 43% of larger adolescents reported being teased by peers [10]. Therefore to help your child avoid weight stigma, you must advocate for unbiased schools and classrooms. Here are a few goals for your child’s school environment:

1. Language

Health should not be linked to body weight. Dieting of any kind should never be promoted.

2. Dress codes

Dress codes disproportionately impact people who are larger. Make sure your school is fighting weight stigma by eliminating dress codes. Or at least be sure to enforce them consistently across all body sizes.

3. Weighing

Children should not be weighed at school. There is no educational justification for weighing children at school. School weigh-ins perpetuate weight stigma and have no value. Read why

It may be tricky to advocate for your child’s safety at school, but it is essential. Want ideas? Read Lindo Bacon’s guide for teachers and administrators. 

What you can do at the doctor’s office

Weight stigma in the healthcare setting is pervasive and leads to lifetime health impacts. People who experience weight stigma attend fewer doctors’ visits, screenings, immunizations, and more. Help your child learn to navigate the health system by doing the following:

1. Don’t talk about weight

Doctors have been advised by their pediatric association not to discuss weight with children. There are many good reasons for this. The pediatric association knows that weight stigma is a problem. And although many doctors still bring up weight in front of children, parents can confidently interrupt and stop such conversations.

don't talk about my child's weight cards

2. Don’t tell my child to “watch” their weight

Tell your doctor not to suggest weight loss – even the seemingly benign “move more/eat less,” which is entirely unhelpful. Additionally, the term “watch your weight” was coined by Weight Watchers, a multi-billion dollar company that profits off weight stigma. There is no medical evidence that “watching” weight is health-promoting. And it can lead to dangerous preoccupation and obsession with weight.

3. Treat my child without bias

Weight bias is unconscious, which is why it’s so damaging in the healthcare setting. Bring it to the forefront by stating openly that you are dedicated to fighting weight bias. By making it open and conscious, you reduce your child’s exposure through thoughtless comments.

You may feel intimidated and uncomfortable advocating for your child in this way, but you simply must. If your child’s doctor is not open to having these discussions with you, then you must find a different doctor. Period.

Fight the good fight

Our children need to learn anti-discrimination practices. These include fighting for the unbiased treatment of people who have marginalized race, sexuality, gender and gender identity, and weight. Since weight stigma is openly promoted in our culture, this is a revolutionary but much-needed act.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.


References

[1] Su & Aurelia, Preschool children’s perceptions of overweight peers, Journal of Early Childhood Research, 2011

[2] Gable, Krull, & Chang, Implications of Overweight Onset and Persistence for Social and Behavioral Development Between Kindergarten Entry and Third Grade, Applied Developmental Science, 2009

[3] Gray, Kahhan, & Janicke, Implications of Overweight Onset and Persistence for Social and Behavioral Development Between Kindergarten Entry and Third Grade, 2009

[4] Gunnarsdottir, Njardvik, et al., Teasing and social rejection among obese children enrolling in family-based behavioural treatment: Effects on psychological adjustment and academic competencies, International Journal of Obesity 2012

[5] Hayden-Wade et al., Prevalence, characteristics, and correlates of teasing experiences among overweight children vs. non-overweight peers, Obesity Research, 2005

[6] AW Harrist, TM Swindle, et al, The Social and Emotional Lives of Overweight, Obese, and Severely Obese Children, Child Development, 2016

[7] Puhl, et al., The Role of Stigma in Weight Loss Maintenance Among U.S. Adults, Annals of Behavioral Medicine, 2017

[8] Polivy and Herman, Causes of Eating Disorders, Annual Review of Psychology, 2002

[9] Watkins P., Hugmever A. D., Teaching about eating disorders from a Fat Studies perspective, Transformations, 2012

[10] Van den Berg, Neumark-Sztainer, et al, Racial/ethnic differences in weight-related teasing in adolescents, Obesity, 2008

[11] Reiter-Purtill, Ridel, et al, The benefits of reciprocated friendships for treatment-seeking obese youth, Journal of Pediatric Psychology, 2010

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But, seriously, my kid is addicted to sugar. A discussion about sugar addiction with dietitian Marci Evans

It’s really common to hear parents openly discussing their kids’ “addiction” to sugar. As a registered dietitian, how do you respond to the idea that sugar is addictive?

Marci: I’ve been carefully watching the science of food addiction for the past six years. Frankly, my interest stems from an instinctual sense of dis-ease about the idea that sugar is addictive. Aside from the fact that the “news” about sugar as an addictive substance sounds a lot like fear-mongering to me, it also doesn’t square with my clinical experience as a dietitian. My quick answer is that I don’t believe that sugar is addictive in the same way as caffeine, alcohol, tobacco, cocaine, and other substances.

Why do you think “sugar addiction” is such a hot topic right now?

Marci: Aside from the many, many headlines telling us that sugar is a huge problem and is directly leading to the “obesity epidemic,” I think that the biggest issue with sugar is that, like everything, once a human is told that something is “off limits,” our brain kicks into deprivation mode.

But a lot of people feel like they are addicted to sugar, right?

Marci: I frequently hear people talking about food, including sugar, and telling me they feel as if they are addicted, by which they mean they feel they cannot stop themselves, and they would really like to stop.

It’s important to note here that someone feeling as if they are addicted to something is not the same as being physically addicted to something. But the body’s desire to eat and drink is not based on addiction.

So far, there is absolutely no scientific evidence that any food is addictive. Humans must eat food to survive. No specific compounds have been found in food that is like the compounds found in drugs and alcohol. The human drive for food is considered adaptive, while the drive for addictive substances is considered maladaptive.

But what about the Yale Food Addiction Scale? That’s science!

Marci: The Yale Food Addiction Scale is a 25-point questionnaire currently used to assess food addiction in individuals. The scale was built on what’s called qualitative research. The Yale scale was created when researchers asked participants to rank how appealing certain foods are to them. They used study participants’ responses to establish a diagnostic quiz. The scale ranks sugar as “highly addictive.”

My primary problem with the scale is that it doesn’t account for past dieting/food deprivation. And research clearly demonstrates that deprivation is a precursor to seeing addictive like responses in the brain.

Unless we rule out past deprivation, the feelings of addiction are actually demonstrating a normal response and a response we would expect. It is a mistake to state that it is telling us anything about a food/particular substance as being addictive.

I don’t use the Yale Food Addiction Scale when assessing clients, as I do not find it helpful in supporting people who have complex relationships with food.

What about the rats that they say became addicted to sugar?

Marci: There has been research showing that rodents consume sugar in an “addictive-like” way. But it is important to note that this only occurs in settings that involve sugar restriction.

This is critical because it is the reason I don’t promote restricting any food items, including sugar. When rats are kept in captivity and offered sugar on an intermittent basis, they exhibit binge-like eating, which researchers identify as addictive behavior. However, when the rats are offered sugar constantly, they do not exhibit this behavior, nor do they eat excessive amounts of sugar.

From my perspective, the study of the rats actually supports not vilifying sugar, since doing so can lead to binge behaviors that may look and feel like an addiction. Again, there is not proof that this behavior is based on the substance itself, but rather the restriction of the substance.

What are your final words on sugar addiction?

Marci: Parents, don’t buy it! A balanced, healthy relationship with food may include sugar for your child, and that’s OK. When I’m working with people who have eating disorders, one of the most important things I can do is help them embrace all foods and engage with highly palatable foods like sugar. Higher weight and binge eating disorder, both of which are frequently associated with “sugar addiction,” are far more complex than any single food item. What I see clinically is that food restriction is a more significant problem and a precursor to weight gain and eating disorders than sugar.


Marci EvansMarci Evans, MS, CEDRD, LDN, has dedicated her career to counseling, supervising, and teaching in the field of eating disorders. She is a Certified Eating Disorder Registered Dietitian and Supervisor, certified Intuitive Eating Counselor and Certified ACSM personal trainer. In addition to her private practice and three adjunct teaching positions, Marci launched an online eating disorders training for dietitians in 2015 and is co-developing a specialized eating disorder internship at Simmons College. Website

 

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Stop hating fat people, being afraid of getting fat, talking about people being “too fat” and all forms of fatphobia

beautiful woman living in a larger body

We must look carefully at our society’s deep hatred of fat on a personal, societal and political level. We must question ourselves as a society when we openly and loudly criticize 70% of our population. In a society in which it is socially acceptable to ridicule and complain about people who live in larger bodies, our children are suffering from eating disorders at higher rates every year.

Eating disorders are more than fear of fat

Eating disorders have their roots deep in the psyche. They are typically built upon genetic, temperamental, experiential, societal and other factors. Often we see them in conjunction with Anxiety Disorder, Depression, Obsessive Compulsive Disorder and Post Traumatic Stress Disorder.

But before therapists can work on the deep underlying factors of an eating disorder, they often have to address fatphobia, the fear of getting and/or being fat and the belief that being fat is both a choice and a moral failing.

Most people who have eating disorders are afraid of fat

Many eating disorders begin in a casual pursuit of the “perfect body.” With the media focus in the last decade on the “obesity epidemic,” fatphobia has become an acceptable form of discrimination against a significant portion of our population. Almost everyone feels they are justified in shaming people who live in larger bodies.

Headlines scream at us constantly:

  • The Growing Toll of our ever-expanding waistlines (New York Times)
  • Obesity epidemic at new high, costs $150B a year, hurts military recruiting (Washington Examiner)
  • As America’s waistline expands, costs soar (Reuters)
  • Nearly half of America’s overweight people don’t realize they’re overweight (Washington Post)

People think obesity is a personal failure

Obesity is frequently perceived as a preventable disease brought on by people who gorge themselves on fast food and candy and never exercise. Obesity is seen as something we must “eradicate” and “end forever,” even though, throughout history, and throughout the world, there have always been people who are in larger bodies.

Science has different things to say about obesity than the headlines suggest

Despite all the headlines and everything we believe we “know” about obesity as an “epidemic,” the scientific research suggests that we know very little about the cause of rising human weight, or its direct link to disease and death.

  • People who are overweight or moderately obese live at least as long as normal weight people, and often longer [1, 2, 3, 4].
  • Pooled data for over 350,000 subjects from 26 studies and found overweight to be associated with greater longevity than normal weight [5].
  • Data in the elderly (among whom more than 70 percent of all deaths occur) found no evidence of excess mortality associated with overweight [6].
  • When socioeconomic and other risk factors are controlled for, obesity is not a significant risk factor for mortality; and… for those 55 or older, both overweight and obesity confer a significant decreased risk of mortality.” [7]

Fatphobic headlines get more clicks

The media gains more click-throughs (which is directly linked to revenue income) when they publish articles with a fat bias. Moderate headlines and articles that present a nuanced look at fat do not garner as many clicks/revenue.

The media flagrantly appeals to our fear of fat, and makes gross assumptions, extrapolations and correlations about weight. Headlines are built to draw eyeballs, and rarely reflect the scientific data accurately.

swimsuit models over the years (1)
Even as our waistlines have expanded, the media’s presentation of what is “beautiful” has changed dramatically.

Images of thin, emaciated women and bulked-up, lean men get more clicks than those of people living in average or larger bodies.

When the media drives our perception, and the media is driven by clicks, we must acknowledge irresponsible behavior in relation to fat bias.

Obesity can be linked to the diet industry

The diet industry tells us that each individual is personally responsible for their body weight and has the ability to change it. But remember that the diet industry is a money-making machine that only survives if people continue to gain weight and repeatedly pursue weight loss.

“The first thing is that you can’t believe anything that [the diet industry says]. And that’s by definition, because their job isn’t to tell you the truth — it’s to make money. And they’re allowed to lie,” says Traci Mann, Ph.D., author of Secrets from the Eating Lab, in an interview with the Washington Post.

In fact, for all of the yelling about sedentary lifestyles and fast food consumption, the greatest correlative factor for increased weight may be the size of the diet industry, which has ballooned from $10 billion in 1985 to almost $70 billion in 2012.

The diet industry growth

While the diet industry is seven times larger than it was in 1985, our BMI has increased from 129.9 in 1960 to 152.1 in 2010 (17%). And eating disorders have steadily increased – in both women and men – at the same time.

Hmmm … let’s think about that.

There is no proven cause for obesity

It may surprise you to know this, but even though we all assume that obesity is driven by eating too much and exercising too little, there is no evidence for those factors as being the cause of weight gain.

  • People who have higher BMIs do not eat more calories than people who have average* BMIs.
  • People who have higher BMIs do not exercise less than people who have average* BMIs.

*Given that 70% of the population is “above average” BMI, the word “average” is not actually accurate.

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There is no proven cure for obesity

Even if we did agree with the idea that obesity is the worst thing ever, we do not have a cure for obesity. In 95% of cases, people who have lost weight on a diet have regained the weight plus more within two years (UCLA).

Diets are not a cure for obesity, and they have tremendous potential to cause harm. With no proven “cause” or “cure” for obesity, the vitriol our society places on people who are living in larger bodies is irresponsible and cruel. 

This is known as discrimination

The most common openly-acknowledged and casually repeated discrimination most people engage in is fatphobia. People who live in larger bodies are openly accused of overeating, not exercising, being morally suspect, intellectually inferior, physically disgusting and taking money out of our pockets.

But it goes beyond casual ridicule. Weight bias, stigma, and discrimination is correlated with poor medical care and lower income.

There is a word for this: discrimination.

How fatphobia leads to eating disorders

This agreement to vilify the majority of citizens in our society leads parents to inadvertently hurt their children in a desperate attempt to save them from being “overweight.”

Parents put their children on diets, both openly and surreptitiously. If they accept their child’s “high” body weight, they are attacked in articles like this one: Parents’ Denial Fuels Childhood Obesity Epidemic (New York Times).

The pressure for parents to control their children’s weight is high, and it negatively impacts a child’s self-perception.

And this is how fatphobia feeds the development of eating disorders. The hatred of one’s body is virtually unrecognizable from the hatred of one’s self. And when we hate ourselves, we turn our hatred on our bodies and starve them. Food restriction is the core behavior at the heart of anorexia, binge eating disorder, and bulimia.

Eating disorders are about much more than weight, but we cannot ignore fatphobia as a significant contributing factor in their development. It is at our peril that parents ignore society’s hatred of fat, and we must curb our instinct to judge and ridicule people who live in larger bodies.


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We recommend the book Two Whole Cakes, by Lesley Kinzel. It is a short and easy read that quickly and without apology explains what it’s like to live in a larger body in our society. The best part is that it’s written from a place of power, not victimhood. Lesley writes about the political, financial, emotional, and spiritual struggles resulting from America’s obsession with weight.

Also consider reviewing: Weight Science: Evaluating the Evidence for a Paradigm Shift, by Linda Bacon and Lucy Aphramor, Nutrition Journal, 2011

And read: Why diets don’t actually work, according to a researcher who has studied them for decades


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.


[1] Flegal KM, Graubard BI, Williamson DF, Gail MH: Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005, 293: 1861-1867. 10.1001/jama.293.15.1861.

[2] Durazo-Arvizu R, McGee D, Cooper R, Liao Y, Luke A: Mortality and optimal body mass index in a sample of the US population. Am J Epidemiol. 1998, 147: 739-749.

[3] Troiano R, Frongillo E, Sobal J, Levitsky D: The relationship between body weight and mortality: A quantitative analysis of combined information from existing studies. Int J Obes Relat Metab Disord. 1996, 20: 63-75.

[4] Flegal K, Graubard B, Williamson D, Gail M: Supplement: Response to “Can Fat Be Fit”. Sci Am. 2008, 297: 5-6.

[5] McGee DL: Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol. 2005, 15: 87-97. 10.1016/j.annepidem.2004.05.012.

[6] Janssen I, Mark AE: Elevated body mass index and mortality risk in the elderly. Obes Rev. 2007, 8: 41-59. 10.1111/j.1467-789X.2006.00248.x.

[7] Lantz PM, Golberstein E, House JS, Morenoff J: Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults. Soc Sci Med. 2010, 70: 1558-1566. 10.1016/j.socscimed.2010.02.003.

[8] Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, et al: Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010, 363: 2211-2219. 10.1056/NEJMoa1000367.

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Parents, you’re not to blame for your child’s eating disorder, but here is what you should know about it, by Beth Mayer, LICSW

First, parents should know that no eating disorder is “caused” by any single thing. Eating disorders are complex, and genetics, temperament, and environment all play a role, as do frequently co-existing conditions such as anxiety, depression, and OCD. Thus, no parent has the power to single-handedly create or prevent an eating disorder.

There are many parents who are afraid of being vilified and blamed for their child’s eating disorder. Parents are not to blame for their child’s eating disorder, but there is a lot of room for growth and education for everyone involved. When parents approach their child’s eating disorder from that place, rather than from a place of defensiveness, they are much more effective at helping their child heal.

Parents work hard to be good parents – and we have to keep working at it for life

I tell parents that of course, it’s not their fault that their child has an eating disorder, and now, what can you do from here? It’s so helpful when parents are able to bring curiosity rather than defensiveness to the situation.

As parents, we often try to educate our children, but we must remember that we need ongoing education ourselves. I’m almost 60, and I’m still learning and growing and changing. There is no magic time in our lives when we know everything, and we can always learn new things.

All parents feel we have worked hard to be good parents. And we have. All of us. And if your child gets an eating disorder and you can see ways in which you can accept that some of your choices lacked education, and if you have to learn new things and adjust your behavior moving forward, that doesn’t mean you are to blame.

We live in a fatphobic society

We live in a fatphobic society. So, of course, many parents are terrified if their child gains weight. Sometimes parents try to help their kids lose weight to help them live a better life. I get that. I understand.

Societal education tells us that dieting is the solution to being overweight, so it makes sense when parents think their kids should diet. Even though it is a well-known and scientifically accepted fact, very few people know that diets fail 95% of the time and that the most common side effect of dieting is weight gain.

My feeling around eating disorders is that the parental influence is often an accidental side effect of trying to protect their children. It’s just that you didn’t understand everything yet. Your intent to protect your child is to be applauded, but now it’s time for a new approach.

Parents (and kids) can’t expect parental perfection

As parents, we can’t expect perfection from ourselves, and kids can be taught to accept their parents’ imperfections, too. Parents and their kids need to understand that parents are humans – they make mistakes, and they have weaknesses. The fact for everyone is: you got what you got; now what are you going to do about it?

As parents, it’s very hard to know what’s right. We have to be really generous with parents. There is no perfect way to raise your children, especially around food and body.

Talking about hunger and satiety

I’d like people to talk more about hunger and satiety, and to feed themselves accordingly. I think that too often parents think about how to control their kids’ weight instead of accepting hunger and satiety. In our office, because we are so aware of these topics, we all eat at random times. There is no “right time” to eat here, because each of our bodies asks for something different, sometimes every day.

Of course, our kids are in a rigid school system, and they have very little opportunity to feed themselves this way. I think most kids don’t eat enough at school. It’s a very stressful place, and there’s very little time to eat. As a result, many kids come home from school and their bodies need another meal. When the body is hungry, we should feed it. There’s no “right time” to be eating.

Next, you can address issues such as whether a child is using food to self-soothe. If so, what skills can we teach our kids to help with their stress? They spend all day under pressure at school then they come home and feel the pressure to keep up with their homework. There’s very little time to recalibrate and relax, which the human body needs.

As parents, we can help our kids find ways to nourish their bodies and offload their stress in non-food ways. We can ask, what moves you, what excites you? We can’t change the school schedule, but can accommodate hunger and help kids manage their stress.

About recovery from an eating disorder

I warn families that many of them will gain weight. Not just the child in recovery, but the parents and siblings, too. This is a natural response to regulating eating patterns after the disorder. This is hard because the message in society is that if you’re gaining weight, something’s wrong. But learning to respect the body’s hunger and satiety, and recovering from an eating disorder, is a process, not an event. The body and mind both need time to adjust.

I tell my clients there are things they can change, but it’s unreasonable to expect dramatic changes all at once. Just because we express a desire for change doesn’t always mean we’re capable of changing. I believe in being very gentle with the process of change, and being OK with not having a map. Change is slow, it’s hard, and it can be painful.

I have found that most people who recover from an eating disorder end up healthier in body and mind than the average person. But I also tell them that they are recovering into a very disturbed world. That’s the reality. But with education and self-compassion, parents can help our children, and ourselves, navigate our current society with hope for a future where all people can feel good in their bodies.


beth-874x1024-2Beth Mayer, LICSW, has been working in the eating disorders field for 34 years. She has been the Executive Director of MEDA for 15 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College.

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When your adult child has an eating disorder

When your adult child has an eating disorder

It is never a good time to discover that your child has an eating disorder. But parents can feel a special type of despair and worry when they learn that their adult child has an eating disorder. 

You may have worries like:

  • Is this my fault?
  • Should I have known about this?
  • Why didn’t my child tell me sooner?
  • What does this mean about my child’s future?
  • Can my child ever recover?

All of these worries make a lot of sense. After all, your adult child is facing a major health problem. But there is so much hope, and you have a significant opportunity to help. In fact, there are parents who play a huge role in helping their kids recover – even if their kids are grown up! And yes, people do recover from eating disorders. You can help.

What you can do if your adult child has an eating disorder

There is no expiration date on parenting. Just because your child is an adult does not mean they don’t need your support. In fact, they need it just as much as ever. But this is a time to take on new opportunities for learning and growing as a parent and a person. If you are up to the challenge, please take it on!

There are many things that are out of your control when your adult child has an eating disorder. But that does not make you powerless. Every parent has incredible influence over their child’s emotional health at any age. Here are the things I recommend parents do when an adult child has an eating disorder:

1. Learn about eating disorders

Eating disorders are biopsychosocial disorders. This means they are based on biological, psychological, and social factors. An important part of the social aspect is family of origin. This is why parents can be instrumental in helping a child recover from an eating disorder.

The more you can learn about eating disorders, the more you will be able to help your child. But here’s a little secret: it’s tempting, but don’t focus too much on food, eating and weight. Eating disorders are mental disorders, which means they are rooted in psychology and behavioral patterns. When you keep in mind that your child is facing distorted thoughts and maladaptive behaviors, you will behave differently than if you think it’s all about the food and weight.

Learn about the triggers that your child may need to avoid during recovery, especially stress. Support them in their recovery by understanding that they likely need to change aspects of how they behave with you and the rest of your family in order to recover. The more you can accept them through recovery, which may be messy, the greater your chance of maintaining a strong relationship beyond recovery.

Learn everything you can so that you better understand what your child is going through. Most people misunderstand eating disorders, so an informed and compassionate parent is incredibly powerful.

2. Let go of what you cannot change

You will not be able to help your adult child heal from an eating disorder if you are living in the past, regretting things you did or did not do. And it also doesn’t help to defend yourself against any thoughts that the past wasn’t perfect. We all have regrets. We all have things we wish we hadn’t done or had done differently.

And an eating disorder is likely going to bring up the past for your family. While it’s important to try and understand your child’s eating disorder, don’t get too caught up in a single event, person, or situation that you blame for it. Eating disorders arise based on a combination of factors – it’s never just one thing.

Try to leave your memory of the past in soft focus and try instead to understand your child’s perspective of the past. What memories do they have, and how can you help them process their childhood? Be curious about their experience rather than trying to insist upon your view of what happened. Perspective is personal, so curiosity is always a better approach than trying to change someone’s mind.

Rather than focusing on the past, consider how you can learn and grow to become the parent your child needs you to be right now.

3. Don’t ignore the pain

Just because you can’t change the past doesn’t mean you ignore the past or refuse to talk about it. It’s very likely that your child will bring up some things about their childhood and your family that they believe contributed to the eating disorder. You can help your child find peace and healing by not being afraid to have hard conversations about pain.

You cannot change the past, but there is some healing to be found in looking at it together with the goal of understanding and soothing old hurts. Pain that is ignored doesn’t go away. And time does not heal wounds. Wounds are healed when they are actively and intentionally cared for, and that includes being willing to look at how the past may still be impacting your child today.

Try to set defensiveness aside and be vulnerable to your child’s unique experience of growing up with you as a parent. If you can face their pain with compassion and stay in your role as their parent, they will be more likely to turn to you for support during their recovery. If you cut them off or ignore their pain, they are unlikely to seek your support.

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4. Work on yourself

Many of us live under the assumption that we only have two options for dealing with the tremendous pressure of being a parent: run ourselves ragged by trying to be perfect, or put our hands in the air (or heads in the sand) and feel powerless to do anything. 

Neither of these approaches will bring you closer to your child. They will not help your adult child who has an eating disorder recover. If you can, get some therapy or coaching. Your child will have to change in order to enter full recovery, so it’s best if you have someone who can help you navigate that change with grace and compassion for everyone.

You don’t have to do a bunch of deep work on the past (unless you want to). A professional can help you navigate the here and now with more compassion and peace. This will help you be a better parent and build a stronger relationship with your child.

5. Let your child be an adult

Your child is an adult. It is time to let go of the idea that you have control over their life. You cannot “fix” your child or make everything better by the sheer force of your will.

Moving back in and feeding your child may not be feasible or preferable for them. Your adult child needs to find a recovery path that makes sense for them.

Be careful about over-investing emotionally and financially in your child’s recovery due to parental guilt. Of course you want to help your child. But you need to navigate this area very thoughtfully due to the emotions involved. Find a trusted professional who can help you navigate this path consciously and thoughtfully.

6. Let your child talk to you about the disorder and recovery

You may be very uncomfortable with your child’s eating disorder. But your ability to hear your child’s pain and listen without judgement will make a huge impact on their recovery. 

Many adults who are in recovery from an eating disorder are eager to talk about their experiences and feelings. They are learning new ways to be with themselves and others. Eating disorder recovery is both exciting and terrifying, and it helps to talk about it with friends and family.

But they often find that other people don’t want to listen. It often feels as if everyone wants to “fix” them or they want them to get better. But many times friends and family find it too scary to hear about what’s really going on. This can leave the person feeling isolated and alone, which can lead to relapse.

It will mean a lot to your adult child if you allow them to talk about their disorder and treatment. Just remember to keep your focus on them and their experience, and process your own feelings about it with someone else.

You can do this!

Parenting an adult child who has an eating disorder is probably not what you thought you would be doing at this stage in your life. But parenting has no end date. You are still one of the (if not the single) most important relationships in your child’s life. This may be a crossroads for your relationship. If you are able to rise up to the challenge, your child, and your relationship, will be stronger for it.

Here are some more things to consider when thinking about your adult child’s eating disorder:

Heredity

We see genetic similarities in people who have eating disorders. And it’s not uncommon for eating disorders to run in families. Twin studies have discovered that identical twins raised separately may share eating disorder behaviors.

But even if you don’t see anyone in your family tree who has an eating disorder, eating disorders rarely occur all by themselves. They are often accompanied by anxiety disorders, depression, obsessive compulsive disorder, ADHD, autism, and other disorders that are involve emotional processing challenges.

Now look at the tree. Do you see some similarities? Your child’s eating disorder is just one of many ways that people with certain genetic patterns learn to process emotions.

Society

Eating disorders are called “biopsychosocial” disorders, which means they combine biological (genetic), psychological, and social elements.

You simply can’t divorce eating disorders from our society. First, we live in a fatphobic diet culture. The thin body is promoted as “healthy” and “good.” While fatter bodies are considered “lazy” and “stupid.” The weight stigma in our culture is persistent and pervasive. From doctors’ offices to classrooms to sports fields, kids are taught to fear fat.

We also live in a culture that has a fair amount of foodphobia. For example, right now there’s a great deal of fear about sugar and “junk food.” Think of the preschool teacher who insists that kids only bring “healthy” snacks. And even though they come from the best intentions, these fears about food can create an environment in which disordered eating thrives.

There are many issues with our society that could be listed here. But I’ll end with the fact that our society shows very little support for parenting. As a result parents (mostly mothers) are overloaded and exhausted. Many are juggling the societal expectations of being a perfect woman, wife, mother, friend, and adult daughter to ailing parents. And that’s before we get to any career or school work.

American society makes it hard to be a good parent, and kids struggle not because their parents don’t care, but because the social structure and support just isn’t there.

Family Dynamics

Family dynamics make up a big part of the environment our kids grow up in. The first thing to know is that family dynamics are systems. No single person is responsible for the system. It’s never the case that one parent is perfect and the other parent is terrible. There is always a system at work. This system is driven by the parents’ inborn temperament, childhood experiences, and mental health.

And these things, of course, were influenced by the family dynamics we encountered when we were children. Sometimes you might see a direct link, but we more often see flip-flopping. People who were raised by domineering parents may lack structure and boundaries with their own kids. And people who were emotionally neglected as kids may become overly emotionally involved with their own kids.

And of course if we have a partner/spouse, additional children, in-laws, step-kids, half-siblings, etc., all of them influence family dynamics. Each person in the family plays a role and has an influence.

While we can’t do much to change genetics or society, we can make changes within our family dynamics to support a child who is in recovery for an eating disorder. And that can be your goal. Because your child is an adult and must pursue recovery for themselves, but you can help by improving your relationship with them and the family dynamics so they feel safe and secure when coming home to you.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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What I want parents to think about before sending their child to an Eating Disorder Treatment Center, by John Levitt, PhD

parents should carefully consider the implications of sending a child away to a treatment center for eating disorder treatment

I often get calls from parents asking me about how to get their child into a (usually inpatient or residential) eating disorder treatment program, but I almost never get calls from parents who want to know how they can avoid sending their child to a treatment center.

I think many parents assume that a treatment center is the only option for their child, but that’s often just not the case. There are definitely times when an inpatient or residential treatment center is the best option for their child’s eating disorder recovery, but it’s important to know that the potential costs for sending one’s child to a treatment center (financially, personally, and socially) are possibly very high — and relapse rates can also be very high as well!

Treatment centers are run by good people who are generally doing good work. That said, treatment centers are businesses, and you as parents are the consumers. Don’t be afraid to be a smart consumer. Ask a lot of questions. Ensure you understand what you are getting into. That is, make sure you know what you will be paying for and what outcome(s) you can expect. Parents should become the experts on what they are “buying” before taking the leap to send their child anywhere!

Parenting for positive food and body

First, it’s important to know what treatment centers can – and can’t – do. Treatment centers are places where your child can stabilize his or her eating disorder symptoms. Their weight will hopefully improve and likely stabilize and their eating disorder symptoms will likely be reduced or even eliminated completely while they are staying at the treatment center.   Associated symptoms of depression and anxiety and so forth are also likely to improve.

That said, when they get home, they are faced with the same life stressors and conditions that may have at least bred the eating disorder, or minimally, were associated with the eating disorder prior to going to going to treatment!   Once home, this is where the true treatment begins. Your child needs to learn to live with a sense of self-worth and self-efficacy that is enduring and resilient across people, places, and situations — and they often won’t find that in a treatment center. You just can’t practice all of the requirements of life in a controlled setting. Full treatment does not happen in a program, it happens in life.

I recommend that parents ask treatment centers a variety of questions such as: how long does it usually take to stabilize a child’s eating disorder(s) (including issues related to mood etc.), how will the treatment center ensure that you, the parent(s), are an essential part of the treatment, and how will the treatment center prepare your child, and the parents, for the child’s return home — ensuring the maintenance of their treatment gains.   In addition, even at admission or pre-admission, parents should ask about what will be needed upon the child’s return home; after completing that treatment. That is, what will your child need following their stay at the center? You should not receive vague answers to any of these questions because they are critical to efforts to achieve full recovery.

I understand how frustrating it can be to have a child who has an eating disorder at home. I understand the desire to send the child “away” to get better because you just don’t know what else to do. But I would be very judicious about sending one’s child away. As long as your child is going to return home to the parent, that parent is going to need to get his/her own tools and support to continue the healing process.

Parents need to be educated, supported and trained to support their children in healing from an eating disorder. Some treatment centers build that into their programs. Ask them about it.  Make sure that they will involve you and make up your mind to be involved!

Also, don’t be afraid to ask about the costs involved. Many treatment (e.g., residential) centers are running 60 days. That’s a long time for your child to be away from home and away from school. It’s can also be about $60,000 plus. That doesn’t take into account post-center treatment. That can be equivalent to your child’s college tuition.

I don’t want to discourage parents from using inpatient or residential treatment centers. I just want parents to understand what is involved in some types of treatments, carefully review the alternatives, if any, and enter treatment with realistic expectations and get their questions answered! It’s important for parents to be really clear about what is realistic to expect.


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John L Levitt, PhD, CEDS, FAED, FIAEDP, is the co-editor of the book, Self-Harm Behavior and Eating Disorders: Dynamics, Assessment, and Treatment, and was on the Editorial Board of Eating Disorders: The Journal of Treatment and Prevention Email: levittj@aol.com Phone: (847) 370-1995

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Eating disorders are about much more than eating – a guide for parents who have children with eating disorders

Eating disorders have a perception problem. They are a disorder beginning with the word “eating,” which makes people think they are as simple as food, but they are much more complex than that. Those of us who have eating disorders are using food and our bodies as a coping and communication tool, so the food is actually the least important part of the disorder.

When our children develop eating disorders, it’s because things have gone wrong on many levels. If, as parents, we focus only on the eating part of the disorder, we fail to help our children achieve true healing.

Parenting for positive food and body

Healing from an eating disorder requires so much more than the right eating plan. As parents, we must recognize the myriad elements that contribute to the development of an eating disorder, including:

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Anxiety

Anxiety occurs in a significant portion of people who suffer from eating disorders. Anxiety is a natural and healthy feeling that arises in our bodies on a regular basis. The problem is not the anxiety itself – it is our inability to process our anxiety in a healthy way. For those of us who have trouble with anxiety, our bodies and minds refuse to metabolize our anxiety and fear. Instead of processing anxiety, we may use starvation, binging, purging and other coping mechanisms to numb feelings of anxiety.

Depression

Depression is a common partner to anxiety and eating disorders. Everyone feels sad sometimes, but someone who has depression remains in an unbroken depressed mood state. Negative thoughts become pervasive, taking over our ability to think clearly or make rational decisions about our own self-worth. Those of us who have depression may use starvation, binging, purging and other coping mechanisms in an attempt to self-medicate our depression.

Control

Many of us who have eating disorders are also on the spectrum for Obsessive Compulsive Disorder (OCD), which is a coping mechanism that drives us to seek ways to control our experience of the world. This is an attempt to self-soothe gone awry. When the world becomes overwhelming for us, we focus on the small things that we can control. You are probably familiar with people who compulsively wash their hands. Those of us with eating disorders may compulsively count our calories and arrange an ideal diet of clean, healthy foods in an attempt to control our overwhelming sense of powerlessness in the world.

Perfectionism

We all want our lives to move relatively smoothly, but perfectionism is far beyond the pursuit of a good life. For those of us with perfectionistic tendencies, we mistake our ability to be loved and accepted with our ability to act appropriately in every situation. When we have eating disorders, our perfectionism can drive us to pursue a “perfect” body because we think that will lead to happiness and love. We try to control our external appearance because we believe that a perfect body will signal to the world that we are perfect people and deserve love, attention, and affection.

Body Image

We live in a society that tells us we need to be thin to be healthy, loved and happy. We know* that the way to achieve thin-ness is to eat less and exercise more, so most of us pursue some level of dieting to achieve the thin goal. For those of us who have eating disorders, we take body image very seriously. Our body image becomes tied up in how we believe the world sees us. We think that if we can only achieve bodily perfection, we will be perfectly OK inside, too.

Self-Deception

In the United States, we know the odds of becoming a millionaire, writing a best-selling book, going to the moon, or becoming a headline actor are very slim. And yet, the societal message is that if we put in the effort, we can beat the odds and achieve almost anything. As we mature, we gain clarity that hard work isn’t enough to achieve those things – there are many more elements involved, most importantly, our genetics, our family connections, and our access to cash. Those of us who have eating disorders fall prey to the millions of societal messages that say we can achieve the perfect body if we just work hard enough. We are deceived into thinking that we can beat the odds and achieve perfection in spite of our genetics, family of origin and bank accounts.

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Self-Worth

Feeling worthy is a fundamental human right, and yet many of us who have eating disorders believe that we are unworthy, unloveable, unimportant and impotent. No matter how we look or what people say, our deepest belief that we are not worthy. This distorts everything, and we feel inexplicably driven to achieve self-worth through external means. Instead of seeking community, education, philanthropy or political activism, we seek ways to prove our worth through our bodies. Our lack of self-worth puts every single one of our problems in the lens of our body’s shape and size.

Weight

Today’s feminine ideal** is the same weight and shape as a pre-pubescent girl. It’s no surprise that many eating disorders begin in girls as they enter puberty – this is the time when we are biologically programmed to gain weight. Our breasts, hips, thighs and bellies must grow to prepare our bodies for creating life. Those of us who have eating disorders often associate this new weight with being unattractive. Rather than looking around and seeing the natural body diversity in the world, we begin a battle with a number on the scale. The number becomes a way that we can convince ourselves that we are beautiful and attractive.


It is impossible to cover the many aspects of what leads to disordered eating in a single article. The purpose of this article is to illuminate the idea that as parents we can become aware of the many factors beyond food that influence our children and their unique eating disorders.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.


*This approach does not actually lead to long-term weight-loss. 95%-98% of all dieters regain all weight lost utilizing this approach. Read more

**Because the majority of eating disorders are in females, we have focused this section on the female body, but it also applies to males, who also get eating disorders.

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Worried about the kids? Fear of obesity is much more health-damaging than high weight itself

An interview with Dr. Lindo Bacon

We have the highest respect for Lindo Bacon, PhD, who is a leader and an inspiration in the body diversity and acceptance movement. In this interview, she addressed a question parents can’t avoid in today’s society: am I doing my child a disservice if I don’t worry about his or her weight?

Question from More-Love.org

Everywhere we go, we see and hear messages about the dangers of obesity and the idea that each individual must take action against (and has control over) it. How do you think that impacts our children? Do you have any advice for parents regarding how they should talk to their children about the “war on obesity?”

Response from Dr. Lindo Bacon

What we’ve really done is create a war against larger people, and our kids pick up on that messaging. It creates a harmful bias against larger people and causes people to feel bad about their own bodies, whether they are fat or fear becoming fat.

This anti-obesity culture also feeds us damaging misinformation about weight and health, and best practices around eating. Buy-in to conventional messaging causes us to disconnect from internal hunger cues that are perfectly attuned to what and how much our bodies need as well as the ways our bodies want to move naturally and joyfully in daily life. This makes us less able to care for their bodies.

I encourage parents to address this head on. Talk about the messages the kids hear. Help your kids critically deconstruct those messages. Help them navigate the misinformation they encounter, and to build their defenses. Help them see that their body is amazing because it houses them. Support them in learning to read their bodies, to trust themselves, to nourish themselves, body and soul.

I do realize that’s a big ask, and that I haven’t provided the usual short simple steps that people often look for in blog posts. My message can be distilled into very simple guidance: Recognize that you and your kids came pre-packaged with an inner guide that can help you to eat well and live well. You – and your kids – can exorcise those cultural messages and trust yourselves. This inner knowing can help you manage your weight much better than diet rules.

And, please, do show compassion for yourself and your kids along the journey. This isn’t a simple switch activated by intellectual awareness and you can’t just talk your kid into this awareness. Cultural messaging gets internalized and is powerful!

Rest assured, however, that extensive research – and many, many personal stories – confirm: regardless of whether this journey helps you or your kid to lose weight, it can definitely help you both to lose the burden of weight.


This video from Dr. Bacon’s Body Manifesto series delivers the science behind her plea for an end to the “War on Obesity”


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Dr. Lindo Bacon is a professor, researcher, co-author of Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight, author of Health At Every Size: The Surprising Truth About Your Weight, and international speaker. Dr. Bacon is changing lives through her teaching, research, writing, and transformative workshops and seminars. Website

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The cause of eating disorders, and when a diet is an eating disorder – an interview with Lindo Bacon, PhD

In your understanding, what causes an eating disorder?

Lindo Bacon, PhD: Eating disorders are a complex interplay of genetic inheritance, environmental exposures, and other personal experiences, and the degree to which different contributors play a role varies tremendously between individuals.

For some, the genetic contribution may be so powerful that it can override the effects of positive things like excellent parenting, social support, and media literacy skills. For others, hard lives, including challenges like childhood trauma or neglect, can lead people to absorb the idea that their only value can come from controlling their body, which leads to their eating disorder.

Understanding the cause may be helpful for some individuals. For example, if you learn that your body is less sensitive to the hormone serotonin, you may have trouble with self-soothing, which makes you vulnerable to using food to soothe yourself. In that case, it is helpful to focus on acknowledging these challenges (and lightening up on the self-blame that often accompanies!), better developing your skills to sit with emotions and to soothe yourself; some people may also find that medications that help regulate serotonin are helpful.

Regardless of the cause, most of us can benefit from improving skills to identify what we need and how best to nourish ourselves. Sometimes the drive to eat may really be a drive to distract yourself from difficult feelings, and talking to a friend is much more effective nourishment than ice cream; other times, the ice cream will do a better job of giving you what you need.

When does dieting turn into an eating disorder?

Lindo Bacon, PhD: Dieting, which I’ll define here as restrictive eating with the goal of managing weight, is always a manifestation of disordered eating. I’m less interested in defining that turning point between disordered eating and a clinical eating disorder, as dieting is always unhelpful, regardless of whether it develops into a full-blown eating disorder.

A diet provides you with rules about what you’re supposed to eat or not eat. Attempts to control your food intake through willpower and control require that you drown out the internal signals. Yet, those are the very signals that can guide you to good health and satisfaction. No doctor, dietitian, or diet guru knows what you need better than that inner knowing.

That’s a scary concept for many people; they believe that they can’t be trusted. That’s why I tested in a research study whether people can reclaim the innate knowing we’re all born with. And what I found – which supports what many other researchers have found – is that even people with a long history of dieting can effectively dump dieting and reconnect with body trust and that it’s way more fun and successful at helping people achieve what they are looking for.

Incidentally, my research also found that people were able to enjoy chocolate much more after participating in the research study than ever before. Apparently, the pre-study guilt associated with eating “bad foods” contributes to an allure, a difficulty in appreciating it, and binge eating, not better self-control or eating habits.

chocolate

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A professor, researcher, co-author of Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight, author of Health At Every Size: The Surprising Truth About Your Weight, and international speaker, Dr. Lindo Bacon is changing lives through her teaching, research, writing, and transformative workshops and seminars. She holds graduate degrees in physiology, psychology, and exercise science with a specialty in nutrition, and for almost two decades taught courses in social justice, health, weight, and nutrition. She has also conducted federally funded studies on health and weight and published in top scientific journals. Her years of experience as a psychotherapist specializing in eating disorders and body image add important depth to her work. Visit www.lindobacon.org for links to writings, videos, a newsletter, social media, her inspiring Body Manifesto, and more.

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For parents who are afraid that their kid is going to be fat, an interview with Beth Mayer

We live in a fat-phobic society, and I understand when parents tell me they want to protect their children from getting fat, but sometimes it seems like parents think that their main goal is to control their child’s weight when that is actually very dangerous.

I totally get that it’s hard to have a child who is heavier than the norm. I know that parents are under tremendous pressure today, and want to try to help their children succeed in all ways, including weight.

But while there are a lot of reasons for eating disorders, one thing we see consistently is that body shame usually precedes eating disorder behavior. It is a very good idea for parents to avoid trying to control their children’s bodies at any age.

These are some of the things I tell parents who are concerned about their children’s weight:

Genetics drive body size

Something you should think about really early on is the genetics in your family. If you are in a larger body, if your partner is in a larger body, if all of your relatives are in larger bodies, then it is very likely that your children will be in larger bodies. And that’s not something for you to control – that’s just your child’s genetic body type. While we’re on the topic of genetics, it’s important, regardless of where your child falls on the spectrum, never to compare siblings or relatives bodies or eating habits.

Don’t restrict food

The fact is that the more you restrict your child’s eating, the more likely they are to fight back, either by eating more or less than you think they should. I can tell you that when people feel at a young age that there are a lot of food limitations, they often feel that they want to binge more as they gain independence in life.

Talk about food

Talk about food preferences, satiety, and hunger. Talk to kids about what satiety and hunger feel like by talking. Talk about good feelings after eating, like “that was so delicious, my stomach feels so good right now, that was exactly what I wanted to eat.” This demonstrates that food is nourishing, not a reward or punishment. Don’t say things like “I feel so disgusting, I can’t believe I ate that.” Or “I’m going to have to work that off in the gym later.” Enjoy your food and help your children learn to enjoy their food. When they truly feel nourished by food, there is no need to use food against themselves.

Allow food preferences

Respect your children’s individual preferences. In addition to the fact that most of us get naturally more adventurous with age, each of us also has food preferences – foods we naturally and persistently like and dislike. Encourage children to recognize and honor their own preferences. Show that you trust your child and your child’s body even when it wants different things than yours does.

Work on yourself

Parents need to be aware of their own issues. You have to be aware of your own body and how you feel about your own body. Kids notice everything. They notice when you pull your shirt out because you feel fat. They know when you are dieting, even if you think you’re hiding it from them. You can’t shield your child from your own eating habits, so it’s important that you work on your own body relationship.

Puberty usually means weight gain

Talk to your children about what will happen to their bodies during puberty. Nobody talks about the very natural fact that most healthy bodies get rounder during pre-adolescence and adolescence. Reassure them that if they don’t fiddle with it, it will even out and end up being exactly where it’s meant to be.

Fat is not a feeling

The minute a kid says something like “I feel fat,” which can start when they are very young, ask them what they are really trying to say. Often it is actually I feel scared, I feel lonely, I feel out of control. Fat is not a feeling. What is your child really trying to tell you?

Toxic society

Take a look at the society we live in, particularly the negative body images in the media. Talk to your children and let them know that natural bodies are perfectly acceptable, and there is no need for us to feel that we must live up to the airbrushed perfection presented to us.

We live in a very disturbed society around food and body. And I’m afraid that I don’t see that going away. I think we just have to accept it, but that doesn’t mean there aren’t things we can do to help our children survive the worst of it. I believe all parents have a lot of opportunities to learn more about how to help our kids feel good about their bodies.


beth-874x1024-2Beth Mayer, LICSW, has been working in the eating disorders field for 34 years. She has been the Executive Director of MEDA for 15 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College.

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Four things parents can do to help their child heal – completely – from an eating disorder

Our children are developing eating disorders at ever-younger ages. As we face this problem, we have a choice: we can get mad and feel hopeless and helpless, or we can see the disorder as an opportunity to grow and learn, and to help our child, ourselves, and our entire families and communities get stronger and reverse this troubling situation.

A model of eating disorder development

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Biological factors of eating disorders

Eating disorders are believed to stem from a combination of biological and environmental factors. For example, your child might have been born with a genetic predisposition to being highly sensitive. Children who are highly sensitive tend to need specialized soothing techniques to maintain emotional homeostasis.

Additionally, your child may have a tendency towards anxiety and depression. All three of these conditions, which are believed to be inborn and hereditary, frequently co-occur with eating disorders.

Environmental factors of eating disorders

In addition to biological factors, eating disorders are often associated with environmental factors. For example, many people who have eating disorders have experienced some form of bullying or even abuse. Everything from schoolyard taunting to incest and sexual abuse can set the table for eating disorder development.

People who have eating disorders also tend to feel weak emotional connections. For whatever reason, they tend to feel “different” and “separate” from their family members and peer groups. Many people with eating disorders report feeling this “difference” from a very early age.

In addition to these two environmental precursors to eating disorder development, the media environment, which portrays endless slender body images and very little diversity in body shape and size, can deeply impact children and teenagers.

Maladaptive coping behaviors

When confronted with this “soup” of biological and environmental conditions, a child may learn maladaptive coping behaviors that she believes keep her safe. These behaviors may include restricting, bingeing and purging food.

Other maladaptive coping mechanisms include self harm, substance abuse, sexual promiscuity and shopping and other addictions. These maladaptive coping behaviors are frequently observed together. While a child is developing her coping mechanism of choice, she may try many or even all of the available behaviors to seek control over her emotional distress.

In developing maladaptive coping mechanisms like an eating disorder, your child is seeking to control her emotional landscape. The behavior is very distressing, but remember that it is actually her way of attempting to soothe herself.

Four things to do for a child with an eating disorder

In an effort to save our children from the distressing behaviors, we sometimes rush to a quick-fix, and wish her to “just stop” what she is doing.

But if we only attempt to “get rid of” the maladaptive behavior without providing her with adaptive coping strategies, she will likely relapse and even take her behavior to new levels.

Taking away someone’s maladaptive coping behavior before providing her with new coping behaviors is like taking away a life ring from someone who is drowning.

Instead, work with your child on a daily basis to learn new, adaptive coping behaviors. All humans experience challenges. But if your child is using maladaptive coping behaviors, then she needs active training on how to handle her challenges given her unique biology and environment.

1. Self Acceptance

A key adaptive coping behavior for a child who has an eating disorder is to learn self acceptance. The disordered brain sends terrible messages about failure, lack of worthiness, and value. Work with her to build her understanding that she shouldn’t believe everything she thinks, and help her insert new messages of worthiness and success on a constant basis.

2. Assertiveness

Additionally, your child needs to learn to assert her needs clearly and non-passively. While you may find her frequent tantrums or sulking periods deeply upsetting, recognize that they are a maladaptive way for her to ask for what she needs. Work with her to clearly ask for what she needs without yelling, stonewalling, whining or defensiveness. It will take time for her to trust that her family can hear what she really needs. Be patient.

3. Emotional Hygiene

Emotional hygiene is a critical adaptive coping behavior. Just like we brush our teeth twice per day, we should check in with our emotional health at least as often. This can involve a simple 5 minute meditation or journaling session twice per day during which you encourage everyone in your family to observe their emotional health and verbalize (if possible) how they are feeling. This is a practice that every member of the family should engage in, not just something your “sick child” needs to do while she is in eating disorder recovery.

4. Community Connections

Finally, all human beings thrive in social settings that drive a sense of community and belonging. Since your child has likely been feeling “weird” for most of her life, find ways to build traditions and rituals into your family life to build a safe place where she can feel as if she is part of a unit. Help her find communities and groups (preferably live, face-to-face groups vs. online and on social media) that can help her build her own community of other like-minded people where she can thrive.

Helping your child heal from an eating disorder is difficult, but it is possible!


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.