emilyprogramfoundation.org Building Community Awareness Media, Body Image, & More Kitty Westin, MA LP Board Member, TEPF Keri Clifton Community Outreach Manager
emilyprogramfoundation.org
Building Community
AwarenessMedia, Body Image, & More
Kitty Westin, MA LP
Board Member, TEPF
Keri Clifton
Community Outreach Manager
emilyprogramfoundation.org
About TEPF
On a mission to save lives, change minds, and
work to eliminate eating disorders.
• Education
• Advocacy
• Financial Assistance
• Family and Friends Support
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Why talk about eating disorders?
• Half of all people know someone with an eating disorder
• More than 14 million Americans and 70 million individuals worldwide currently struggle with eating disorders. – That includes 200,000 Minnesotans
• It is estimated that 11% of high school students have been diagnosed with an eating disorder
• The most common behavior that can lead to an eating disorder is dieting.– In 1970: the average age girls began to diet was 14
– In 1990: the average age had dropped to 8
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“My life is worthless right now. Saying goodbye to such an unfriendly place
can’t be as hard as believing in it. And, essentially my spirit has fled already.”
Anna committed suicide on February 17, 2000. She was 21 years old.
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Outline
1. Etiology of Eating Disorders
2. Who Gets Eating Disorders?
3. Understanding Types of Eating Disorders
4. Signs/Symptoms of Eating Disorders
5. Assessment
6. Treatment of Eating Disorders
7. Insurance
8. Health at Every Size
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Familial
Psychological
Biological
THE MULTI-DETERMINED AND
SELF-PERPETUATING NATURE OF
EATING DISORDERS
PREDISPOSING
FACTORS
Sociocultural
PRECIPITATING
FACTORS
PERPETUATING
FACTORS
Stressors
Disorderedthoughts and
eating
Extreme Dieting/Binging/Compensatory
behaviors
Physiologicalsequelae
Psychologicalsequelae
Adapted from Harper-Guifre, H. (1992) Overview of the eating disorders. In H. Harper-Guiffre & K.R. MacKenzie (Eds).
Group psychotherapy for eating disorders. Washington, DC: American Psychiatric Press
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Why do people get eating disorders?
Bio-Psychosocial Model of Eating Disorders
Dieting
Genetics
Physical changes
Puberty/Menopause
Brain Chemicals
Stressful events
Coping skills
Identity/self-image
Personality factors
Perfectionism
Depression
Cultural factors
Pressure to “fit in”
Media messages about
appearance
biology psychology
social/environment
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Effects of Eating Disorders
• MN Starvation Study/Key’s Study
(Kalm, LM, Semba, RD. J Nutr 2005; 135:1347)
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Eating Disorders Happen for Many Reasons
• Eating disorders are not a choice; they are not a lifestyle.
• The person can’t ‘just stop doing it’. They need help.
• Eating disorders can be a way to cope, communicate, and solve problems to help an individual feel whole, secure, safe, and in control.
• Once we can work on other ways to cope and what the person needs, we can help them to make changes.
• A lot of the ideas that people with eating disorders have are strongly supported by societal/environmental norms and are hard to figure how to deal with.
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Types of Eating Disorders
• DSM IV• Anorexia Nervosa
• Bulimia Nervosa
• EDNOS
• Binge Eating Disorder
• Compulsive Overeating
• DSM V• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating Disorder
• Avoidant/Restrictive Food
Intake Disorder
• FEC-NEC
– Atypical AN
– Sub BN
– Sub BED
– Purging Disorder
– NES
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Anorexia NervosaAnorexia Nervosa is a serious life-threatening
disorder characterized by deliberate self-starvation. The person becomes obsessed
with food, weight, counting calories, and vigorous exercise.
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DSM-IV 307.1 Anorexia Nervosa
• Refusal to maintain a minimally acceptable body weight for a person’s height and age (e.g. 85% of IBW)
– ICD-10 requires 17.5 BMI or below
• Intense fear of gaining weight
• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of current low body weight
• In postmenarcheal females, amenorrhea for at least 3 consecutive menstrual cycles
• Restricting subtype
• Binge eating/purging subtype
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DSM-5: Anorexia NervosaA. Restriction of energy intake relative to requirements leading to a significantly low body weight in
the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Specify current type:
• Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
• Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
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Bulimia NervosaBulimia is a serious
life threatening
disorder
characterized by
recurrent episodes of
binge-eating
followed by self-
induced vomiting or
some form of purging
as a means of
controlling weight.
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DSM-IV 307.51 Bulimia Nervosa
A. Recurrent Episodes of Binge Eating
1) eating, in a discrete period of time (e.g. within any 2 hour period), and amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
(2) a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives or diuretics, enemas or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Specify type:
Purging Type: During the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.
Non-purging Type: During the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas.
References: American Psychiatric Association. (1994). Diagnostic and Statistical Manual
of Mental Disorders (4th Ed.) United States of America: American Psychiatric
Association.
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DSM-5: Bulimia Nervosa
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
(1) Eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
(2) A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications, fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
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Overeating
• Binge-eating disorder (BED) Overeating large
amounts of food with no use of compensatory
mechanisms (e.g. purging, over-exercising, etc.),
person is compelled to overeat, feels out of control,
strong weight/shape concerns
• Compulsive overeating (COE): Overeating may be
more grazing overeating through day rather than
discrete binges, compelled to overeat, and feels out
of control, strong weight/shape concerns
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BED DSM-IV Research Criteria
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: (1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances (2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B. The binge-eating episodes are associated with three (or more) of the following: (1) Eating much more rapidly than normal (2) Eating until feeling uncomfortably full (3) Eating large amounts of food when not feeling physically hungry (4) Eating alone because of being embarrassed by how much one is eating (5) Feeling disgusted with oneself, depressed, or very guilty after overeating
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least 2 days a week for 6 months. E. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa
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DSM-5: Binge Eating DisorderA. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
(1) Eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
(2) A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
B. The binge-eating episodes are associated with three (or more) of the following:
(1) eating much more rapidly than normal
(2) eating until feeling uncomfortably full
(3) eating large amounts of food when not feeling physically hungry
(4) eating alone because of feeling embarrassed by how much one is eating
(5) feeling disgusted with oneself, depressed, or very guilty afterwards
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for three months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.
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DSM-IV 307.50 Eating Disorder
Not Otherwise Specified (EDNOS)
1. All of the criteria for anorexia nervosa are met except that the individual has regular menses.
2. All of the criteria for anorexia nervosa are met except that, despite substantial weight loss, the individual's current weight is in the normal range.
3. All of the criteria for bulimia nervosa are met except that binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.
4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (eg, self-induced vomiting after the consumption of two cookies).
5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
6. Binge eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.
Reference: American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) United States of America: American Psychiatric Association.
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DSM-5: Feeding and Eating Conditions Not
Elsewhere Classified
• Atypical Anorexia Nervosa
– All of the criteria for Anorexia Nervosa are met, except that, despite significant
weight loss, the individual’s weight is within or above the normal range.
• Subthreshold Bulimia Nervosa (low frequency or limited duration)
– All of the criteria for Bulimia Nervosa are met, except that the binge eating and
inappropriate compensatory behaviors occur, on average, less than once a week
and/or for less than for 3 months.
• Subthreshold Binge Eating Disorder (low frequency or limited duration)
– All of the criteria for Binge Eating Disorder are met, except that the binge eating
occurs, on average, less than once a week and/or for less than for 3 months.
• Purging Disorder
– Recurrent purging behavior to influence weight or shape, such as self-induced
vomiting, misuse of laxatives, diuretics, or other medications, in the absence of
binge eating. Self-evaluation is unduly influenced by body shape or weight or
there is an intense fear of gaining weight or becoming fat
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rr…r
Comorbidities
• Major depression
• GAD
• Panic disorder
• Suicidal ideation
• Self injury
• Binge drinking
• Nicotine and marijuana use
• Frequent exercise for females
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concerns Healthy ➜➜➜➜ ➜➜➜➜ ➜➜➜➜ ➜➜➜➜ Problematic
Weight control
Practices:
Healthy eating
behaviors
Dieting Unhealthy
weight
control
Anorexia or
Bulimia
Nervosa
Physical activity
behaviors:
Moderate
physical
activity
Minimal
or excessive
activity
Lack of, or
obsessive,
physical
activity
“Anorexia
athletica”
Body image: Body
acceptance
Mild body
dissatisfaction
Moderate body
dissatisfaction
Severe body
dissatisfaction
Eating behaviors: Regular eating
patterns
Erratic eating
behaviors
Binge eating Binge eating
disorder
Weight status: Healthy body
weight
Mildly
overweight
or underweight
Overweight or
underweight
Severe
overweight
or underweight
Neumark-Sztainer D, “I’m, Like, SO Fat!”: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight Obsessed World. New York: The Guilford Press; 2005.
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Medical Complications
• heart rate < 40 bpm
• blood pressure <90/60 mm Hg or orthostatic hypotension
with pulse increase of 20 bpm or bp drop of >10-20 mm
Hg/minute from lying to standing
• glucose < 60 mg/dL
• potassium < 3 mEq/L or other critical electrolytes
• temp < 97.0°F
• Dehydration
• poorly controlled diabetes
• high suicide risk
• Amenorrhea
• Bradycardia
• unexpected osteopenia or osteoporosis
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SIGNS AND SYMPTOMS OF EATING DISORDERSIn your interactions, you may notice one or more of the physical, behavioral,
and emotional signs and symptoms of eating disorders.
Physical• Weight loss or fluctuation in short period of time.• Abdominal pain.• Feeling full or “bloated.”• Feeling faint, cold, or tired.• Dry hair or skin, dehydration, blue hands/feet.• Lanugo hair (fine body hair).
Behavioral• Dieting or chaotic food intake.• Pretending to eat, then throwing away food, eating in secret, hiding food, disrupting meals • Exercising for long periods of time.• Constantly talking about food.• Frequent trips to the bathroom.• Wearing baggy clothes to hide a very thin body.• Purging; restricting; binge eating; compulsive eating; compulsive exercising; abuse of diet pills,
laxatives, diuretics, or emeticsEmotional
• Complaints about appearance, particularly about being or feeling fat.• Sadness or comments about feeling worthless.• Perfectionist attitude.
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Recognize the signs of someone at risk.
Common Scenarios:
• The student who eats only a small amount of each food on her plate because she’s afraid
of getting fat.
• The adolescent boy or girl who comes home to an empty house and eats whatever snack
foods are available.
• The young girl who skips breakfast and lunch, has a candy bar and diet soda after school,
finds a way to skip the evening meal with her family—and then goes on a secret eating
binge in the evening.
• The wrestler who fasts for 2 days before his match to make weight, then eats nonstop for
the next day or two.
• The dancer, gymnast, or cheerleader who refuses meat, eggs, milk, or any foods she
imagines might make her fat and unable to perform.
• The bright and confident class president who is teased about the size of her body and
begins a fad diet to lose weight.
“many individuals diagnosed …remember being teased or recall that their problems
first began when they started dieting” - BodyWise
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Worried about someone?
Start the conversation. If you suspect someone is struggling with eating disorder behaviors, ask if it is okay to discuss his or her eating habits. For example, “I’m concerned about your eating. May we discuss how you typically eat and your relationship with food?”
Ask more questions. These 6 assessment questions can help assess the situation. (Adapted from the SCOFF Questionnaire by Morgan, Reid & Lacy)
– Do you feel like you sometimes lose or have lost control over how you eat?
– Do you ever make yourself sick because you feel uncomfortably full?
– Do you believe yourself to be fat, even when others say you are too thin?
– Does food or thoughts about food dominate your life?
– Do thoughts about your body or weight dominate your life?
– Have others become worried about your weight and/or eating?
Give feedback. In this informal survey, 2 or more "yes" answers strongly indicate the presence of disordered eating. Refer as needed.
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If You Are Concerned
• Recognize that some people do not have the skills to deal
with the underlying emotional turmoil that often
accompanies eating and exercise problems.
• Share information with others who know the person. Find
out if they have noticed similar signs.
• Decide together the best course of action and who should
talk to the person and family members.
• Refer as needed
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A Comprehensive Assessment
Complete History
• Assess• Rate and amount of weight loss/change
• Nutritional status
• Methods of weight control
• Review• Compensatory behaviors
• Dietary intake and exercise
• Menstrual history in females (hormone replacement therapy including oral contraceptive pills)
• Comprehensive growth and development history, temperament, and personality traits
• Physical Examination• Supine and standing heart rate and blood pressure
• Respiratory rate
• Oral temperature (looking for hypothermia)
• Height, weight, growth charts for children and adolescents, nothing changes from previous measurements
• Laboratory Evaluation• Lab and imaging studies suggested can be found in AED’s Report 2011 – Critical Points for Early Recognition
and Medical Risk Management in the Care of Individuals with Eating Disorders
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Key questions
• What are the behaviors?
• Is there preoccupation?
• Is there impairment?
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The challenge of screening• Clients may present with other issues correlated with
disordered eating
• Clients may not recognize the severity of their symptoms
• Clients experience significant shame
• Clients don’t want to address their eating disorder
• Changes in eating patterns or exercise patterns? What are
they?
• Any concerns for you around your eating patterns?
• Does it feel that your size and shape is connected with your
self esteem
• What percentage of the day are you thinking about food or
weight or shape?
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Treatment for Eating Disorders
• Treatment is dependent on what the person needs.
• Treatment can look a lot of ways:– Residential, or 24 hour care
– going to a clinic for one-on-one sessions with a counselor, a dietitian, and a doctor
– attending a group program for an hour or for most of the day
• Family involvement in the treatment process is especially important!
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Services at
The Emily
Program
• Group Therapy & Support Group
• Individual Therapy
• Gastric Bypass Evaluation
• Nutritional Evaluation & Counseling
• Family & Couples Therapy
• Psychiatry Services
• Medical Services
• Intensive Outpatient Programs
• Intensive Day Programs
• Anna Westin House Residential Program
• Holistic Services:
– Yoga
– Art
– Music
– Spirituality
– Body Image
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Who does what, when , and how often?
DIETICIAN
• Meal Planning
• Nutrition Education
• Establishment of wt
range
• Education regarding
physical aspects of ED
• Weight monitoring
• Strategizing food
related activities
• Body image
• Teach Coping Skills
THERAPIST
• Assesses/treats
symptoms of related
diagnoses (anxiety,
depression)
• Monitor and address
suicidal thoughts/self-
injury
• Explore etiology and
maintaining factors of
ED
• Body image
• Teach coping skills
PHYSICIAN
• Medical monitoring
and treatment of
medical conditions
related to ED
• Medication
monitoring
• Weight monitoring
• Education regarding
physical aspects of ED
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Intensive ProgrammingIOP Locations
• St. Paul – Como: Adolescent Family Intensive (AFI), Mindfulness Based (MB), Compulsive Over Eating (COE)
• St. Louis Park: Adult, MB, COE, Dialectical Behavior Therapy (DBT)
• Duluth: IOP
• Seattle: Adult
IDP/PHP Locations
• St. Paul – Como: Intensive Day Program (IDP), Adolescent Intensive Day Program (AIDP)
• St. Louis Park: IDP
• Seattle: Partial Hospitalization Program (PHP)
Residential Locations (St. Paul)
• Anna Westin House (AWH)
• Anna Westin House –Adolescent and Young Adult (AWHAYA)
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Empirically Supported
Treatments for Eating Disorders
Cognitive Behavior Therapy-Enhanced
Rationale: focuses on the core psychology of ED:
over-evaluation of weight and shape
– Modify thoughts and behaviors that cause and
maintain eating disorder symptoms. Change how
you feel by changing how you think
– Most extensively studied treatment for eating
disorders; considered first line treatment
– Outcomes: 1/3 drop out; ½ remaining get well
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Empirically Supported
Treatments for Eating Disorders
Dialectical Behavioral Therapy
Rationale: People with ED struggle with affect
regulation and affect contributes to onset and
maintenance of ED symptoms
• Mindfulness: nonjudgmental observation and
experiencing of emotions, urges, and thoughts
• Emotion regulation skills: Decrease vulnerabilty to
negative emotions and increase positive emotions
• Distress tolerance: Acceptance of reality and negative
emotions
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Empirically Supported
Treatments for Eating Disorders
Family Based Therapy (Maudsley)
Rationale: Adolescents are embedded in a family
system so treatment should be as well
• Parents in charge of refeeding
• 10-20 sessions over 20 weeks
• Three phases – weight restoration, transition of
responsibility, and establishing healthy identity
• Very favorable for young adolescents
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• rrr
• Separate from disordered thinking
• Normalize preoccupation
• Collaborate in challenging and
replacing ED thoughts
• Focus on developing self
• Visualization
• Mission statement
• Wise self
Life without ED
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Normal Eating
“In short, normal eating is flexible. It
varies in response to your hunger, your
schedule, your proximity to food and
your feelings.”
- Ellyn Satter, RD
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• Develop strong, nuanced, internal sense of self
• Broaden conception of body image
• Broaden experience of body sensation
• Explore underlying emotional response
• Actively surround with positive images
• Use affirmations to attend to other aspects
of self
Working with body image
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Recovery is Possible
• People do get better.
• Treatment may take time.
• Even if someone “looks” better it doesn’t mean they really are.
• If you know someone who is in treatment for an eating disorder, don’t forget to keep treating your friend like a friend; ask them how they are doing, be their friend. Also, avoid talking about food or weight!
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Anna’’’’s Story
• Insurance in MN
• Legislative Changes
• Coverage for Low
Income Individuals
• FREED Act
• Truth in Advertising
Act or 2014
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How will ACA help people with mental health
issues and eating disorders?
• ACA addresses lack of access and quality of
care in BOTH public and private systems.
• Soon; 90% of Americans will be covered
under insurance including people with serious
mental illness and substance abuse disorders.
• More people eligible for Medicaid including
single, childless adults.
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Insurers can no longer:
• Deny coverage for a pre-existing condition.
• Charge people with “poor health” more than people with
“good health”.
• Cannot discriminate based on mental or physical disability.
Un-enroll people when they get sick.
• No lifetime or annual limits on benefits.
• Ignore Mental Health Parity Law.
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Eating Disorders Coalition for Research,
Policy & Action
www.eatingdisorderscoalition.org
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What Do We Do?
• Biannual Lobby Days
• Congressional briefings
• Congressional hearings
• Bill writing
• Press Conferences and Media events
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Other Advocacy efforts:
• State Advisory Council on Mental Health
• Mental Health Legislative Network
• Media Monday
• Public speaking: professional conferences, community groups, other organizations
• Work with insurance companies
• Media interviews and connections
• Family and Friend support
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Where We Are Trying to GoEating Disorder Context
Help Individuals…
•Eat and be active in tune with the body’s needs
•Eat when hungry and stop when satisfied
•Eat a variety of foods without a fear of fat
•Appreciate the body
•Think critically about media
•Employ many coping skills
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vs.
Key Obesity Prevention
Messages
Calories in = Calories out. It’s all about
balance.
Eat 5-9 servings of fruits and vegetables
every day.
Be active at least 60 min. most days
Decrease consumption of sugar-
sweetened beverages
Limit intake of high fat and high sugar
junk foods (chips, pop, candy, etc.)
Decrease consumption of fast food and
watch out for large portion sizes
Limit screen time (TV, computer)
Key eating disorder messages
Listen to your body. Eat when you’re
hungry and stop when you’re full
There are no "good" or "bad" foods
All foods can be part of healthy eating.
Eat lots of different foods, including fruits,
vegetables, and even sweets.
If you are sad, mad or bored—and you
are not really hungry—find something to
do other than eating.
No matter what you weigh or how you
look, exercise and staying active are
healthy and help you do what you want
Healthy bodies and happy people come in
all sizes
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Health at Any Size
• Body fat can be beneficial
• Fat in the arteries and fat on the body are different and not
necessarily related
• Men/women classified as “overweight” who exercise
regularly and are physically fit have lower all-cause death
rates than thin men/women who do not exercise
• Weight loss does not necessarily improve health or lengthen
life
• “Thinner is better” – body weight is fairly unrelated to health
status and death
Big Fat Lies by Glenn Gaesser PhD
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Health at Every Size (HAES)Supports:
Health enhancement – attention to emotional, physical, psychological, social and spiritual
well-being, without focus on weight loss or achieving a specific ‘ideal weight’.
Size and self-acceptance – respect and appreciation for the rich diversity of body shapes and
sizes (including one’s own), rather than the pursuit of an idealized weight or shape.
The pleasure of eating well – encouraging eating based on internal cues of hunger, satiety,
pleasure, appetite and individual nutritional needs, rather than on external food plans or
diets for weight loss.
The joy of movement – encouraging appropriate, enjoyable, life-enhancing physical activity,
rather than following a specific routine of regimented exercise for the primary purpose of
weight loss.
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Health at Every Size (HAES)
Does not support:
Ideal weight – the indiscriminate use of the standardized ‘ideal’ weight category as a
measure of a person’s health status.
Weight loss – dieting, drugs, programs, products or surgery for the primary purpose of weight
loss.
Body assumptions and bias – that a person’s body size, weight or body mass index is
evidence of a particular way of eating, physical activity level, personality, psychological state,
moral character or health status.
Body size oppression – any form of oppression including exploitation, marginalization,
discrimination, powerlessness, cultural imperialism, harassment or violence against people
based on their body image, body size or weight, and any approach to health, eating or exercise,
the provision of products, services or amenities that perpetuates body size oppression.
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Recommendations on how to help teenagers maintain a healthy
lifestyle without increasing risk for an eating disorder from Dianne
Neumark-Sztainer PhD, MPH, RD
• Talk less, do more
• Losing weight does not necessarily mean improving health
• Model the behavior
• Encourage family meals and changes to the whole family's
diet
• Keep the focus on overall health, not weight
• Ensure the person knows he/she has worth regardless of their
weight
• Change language used around children’s weight
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The Truth About DietingThe Truth About Dieting
• 95% of people who initially lose weight on “diets” gain it all back—sometimes even more than they lost.
• In a recent study, teens who dieted regularly gained moreweight over a 5 year period than those who didn’t diet at all.
• People who diet are more likely to binge-eat, become depressed, and are at higher risk for eating disorders and obesity.
• Dieting can also lead to deficiencies in calcium, iron, and other important nutrients for daily function.
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Activity: The Diet DilemmaActivity: The Diet Dilemma
It’s time for us to give it a try—grab a straw and try out the Air Diet!
The rules:
•No “cheating” your diet (no extra gulps of air or laughing)
•If you have asthma or start to feel dizzy or anxious at any time, return to normal breathing
immediately
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Resist the urge to diet. DIETS DON’T WORK IN THE LONG RUN and are a risk factor for eating disorders.
Focus on Health
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Mindful Eating
• A small yet growing body of research suggests
that a slower, more thoughtful way of eating
could help with weight problems
• In a study mindfulness-based therapy seemed
to help people enjoy their food more and have
less sense of struggle about controlling their
eating
Harvard Health Publications
emilyprogramfoundation.org
Tenants of Mindful Eating
• Take the time to figure out what you really want to eat
• Choose to eat food that is pleasing to you and nourishing to your body by using all your senses to explore, savor, and taste
• Learn to be aware of physical hunger and satiety cues to guide your decision to begin and stop eating
• Give yourself unconditional permission to eat it
• Listen to your body when it tells you it has had enough or if it wants something else
• Let go of habitual responses to food and eating
emilyprogramfoundation.org
January 2000
“May all your love, joy and pain, all your fears and desires
lead you to your own promises, may your dreaming
never end and your voice never die.”
Anna Westin
emilyprogramfoundation.org
Additional Resources
• Eating Disorder Anonymous
• Overeaters Anonymous
• Academy of Eating Disorders
– Professional Development
emilyprogramfoundation.org
www.emilyprogramfoundation.org
Resources
www.aedweb.orgwww.eatingdisorderscoalition.orgwww.tcme.orgwww.mollykellogg.comwww.about-face.orgwww.something-fishy.org