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Ashley Solomon, Psy.D is a psychologist who specializes in the treatment of eating disorders, body image, trauma, and serious mental illness.

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10 Jul

Where are the fat eating disorder therapists?

Ideas to Consider 5 Comments by Ashley @ Nourishing the Soul

A few weeks ago, a wanted-to-be scientist name Rachel Fox, bravely shared the fat-shaming she’s endured during her years as an undergraduate science major at a prestigious university. The overt and covert discrimination by the scientific community has led her to make the decision to say goodbye to the field altogether.

Her story should make us angry. Not only on her behalf for another human to have to endure insensitivity and harassment based on size, but also for ourselves. We’ve just lost a potential brilliant scientist because our society is so bigoted that we can’t see talent beyond a jean size. She could have been the next scientist to cure a terminal illness or discover a new planet. What if Jonas Salk or Stephen Hawking were told to avoid milkshakes and made to feel less than?

Fox’s op-ed piece left me reflecting on where else larger people are missing. I started to look around at my own field and wondered… how many aspiring therapists have changed course because they didn’t feel welcomed by the community?

In the field of eating disorders, I’d anecdotally suggest that there is a disproportionate number of clinicians with smaller bodies, as compared to the general population. I can take educated guesses as to why this might be. One reason might be that of fields in psychology, those with histories of their own eating disorders are perhaps drawn to working with this population. And while the vast majority of clinicians with their own histories of eating disorders are fully recovered, they may continue to be more aware of their own body size and possibly engage in some weight-control practices. More optimistically, it could be argued that these clinicians may be disproportionately smaller because they tend to be more mindful about their eating, practicing what they preach and not using food in unhealthy ways.

But the cynic in me wonders if there is not something more disheartening going on. Are we losing therapists of larger body sizes because they are not feeling welcomed into this field?

There is some research to suggest that this may have some validity. For starters, patients with eating disorders are often considered to be much more highly attuned to others’ weight and shape, including those of their therapists. While some with eating disorders claim that they “judge” only their own bodies, many others acknowledge feeling hyperaware of others’ bodies and even making assumptions about their therapists based on body size. A recent study (Rance, Clarke, & Moller, 2014) examined patients’ perceptions of therapists bodies and found that some patients assessed a fat therapist as less trust-worthy and more likely to lose control. This study asked patients to report on their experiences, but often the beliefs, assumptions, and feelings are less overt and conscious. It’s not difficult to imagine how a patients’ weight bias, particularly in the midst of an eating disorder in which weight and shape’s importance often gets elevated, can create a seemingly hostile environment for a therapist.

I wonder, though, if more of that hostility and distrust doesn’t actually come from within our own ranks, however. A study by Puhl, Latner, King, and Luedicke (2013) reveled weight bias among eating disorder professionals. In fact, 56% of us reported having observed our colleagues express negative comments about obese individuals. If more than half (and I’d suggest it’s actually much more than half) of us observe these behaviors occurring — and are we addressing them? — it’s easy to imagine how uncomfortable a fat therapist might feel in that setting.

Just as in the STEM field, the eating disorder realm is full of assumptions about what professionals should be doing with food. Insiders and outsides, explicitly and implicitly, seem to assume that someone who treats eating disorders should be of a middle-of-the-road weight, or even thin. If someone deviates from this, the assumption becomes that they must not really know how to manage a relationship with food. Thus, how in the world could they teach or inspire someone else to do the same?

Obviously — or, apparently, maybe not so obviously, these assumptions are unfounded. But they permeate our experience in this field and it’s easy to see why we don’t observe as much diversity in body shape and size among therapists.

Perhaps the best thing that we can do to avoid losing talent and diversity is to become ever more aware of own stereotypes and biases. Once we can acknowledge these, we can take more conscious steps to not allow them to guide our decision making and treatment of others in our field.

Do you think people of larger sizes are underrepresented in the eating disorder field? Why or why not?

 

**Please note that I don’t believe that there are not fat eating disorder therapists. I personally know many. I do believe that there aren’t as many as one might expect and that there are reasons for this…

16 Jun

An apple a day won’t keep your waistline at bay, but…

Ideas to Consider 2 Comments by Ashley @ Nourishing the Soul

A recent study in A Cancer Journal for Clinicians indicated that, despite popular wisdom, consuming more fruits and vegetables won’t reduce rates of obesity.

The dictum that eating more of the nutrient dense foods would slim our society has taken hold in recent years, and has become the basis for a number of public health initiatives encouraging fruit and vegetable consumption. But according to researchers, these programs are based on false assumptions.

Namely, the belief is that if people eat more fruits and vegetables, they’ll fill up and take in less calorically dense foods. Some of us have heard the tip to eat an apple before a meal because you’ll consume less of the higher calorie items, or to always start with a salad.

But what actually happens is that we tend to eat the apple or the salad, and consume just as much. In fact, it could be the case that our eating the “healthy” item psychologically primes us to feel we then deserve something “unhealthy.” Researchers found that people eat on average 30 more pounds of vegetables and 25 more pounds of fruit than 50 years ago, and yet they believe that we are heavier as a nation.

So what can we take away from this research?

If we are eating fruits and vegetables to reduce our waistlines, we might be sorely disappointed. But we still might have less disease, think and feel emotionally better, have prettier skin, and have more energy. And I think those are all much better reasons to consume than to have a lower number on a scale.

Oh, and they are delicious and better for the environment than animal-based products and highly processed foods. So there’s that.

We also have to recognize the difference between what is true for a society and what is true for an individual. While increasing fruit and vegetable consumption overall didn’t reduce population-wide weight, eating them could have an impact on an individual. That may not even be weight (or it could be…), but could be even more important health indicators.

So the message you’ll read here is this: don’t give up on your fruits and veggies. And don’t worry so much about what will make you thinner. Listen to your taste buds and tune in to the foods that make you feel happy and healthy.

10 Jun

Could Naming Your Eating Disorder Help or Hurt?

Ideas to Consider 199 Comments by Ashley @ Nourishing the Soul

On the heels of a wonderful #aedchat, I’ve been spending a lot of time thinking about the concept of externalizing eating disorders. (If you missed the tweetchat, you can read the entire transcript here.) To grossly over-simplify, externalizing an eating disorder refers to the technique of considering the eating disorder as a separate entity from one’s self.

Jenni Schaefer, author of Life Without Ed, is often credited as being the first to really popularize this idea. In her book, now ten! years old, she talks about assigning her eating disorder the name Ed and coming to think of Ed as an abusive boyfriend, one that she loathed but was also afraid to leave. Jenni shares over the course of the book how creating this distance between herself and the eating disorder allowed her to garner the strength to begin fighting back, eventually making real change and forging a path to recovery. Creating “Ed” was a starting point for her in changing the way she saw herself and the disorder.

Many other therapeutic traditions have adopted a similar approach. Narrative therapy teaches individuals to reconceptualize their disorders garner a new sense of strength and the power to rewrite their stories. to In Family Based Treatment, for instance, practitioners introduce the eating disorder as a separate entity, a grave disease, to patients and families. The rationale is that the family needs to be united against this “intruder.” Indeed, many families come to this on their own. They observe how this awful “being” has seemed to come to posses their child, leaving at times a shadow of their loved one’s former self in its wake.

In my own work, I’ve heard from countless individuals how externalizing their eating disorder helped them begin to distinguish between their own thoughts and those of the eating disorder. Over time they began to recognize their true (“healthier”) self as distinct from this disorder who’s goal was to trick and deceive them. Once they were able to recognize this distinction, they could begin to attend more to the true self, letting the Ed or Ana or Mia fade further into the background (or kicking him or her to the curb).

While I observe how powerful an intervention this can be, I do find myself concerned that it has become almost an expected part of the treatment process. When one group member in an eating disorder group I run expressed that this didn’t resonate for her, other members told her that she would “get there” and seemed to indicate this as a sign of her not being further along in recovery.

Eating disorders can be so insidious and I think externalizing and visualizing them can be helpful in undermining their strength. But this doesn’t work for everyone. And not only that, I think there are some potential costs that come for some with treating the eating disorder as a separate entity. Hearing Dr. Kelly Vitousek talk at a conference a couple of years ago, I was struck by a number of these costs.

For one, I worry that it oversimplifies a very complex and nuanced issue. One of the issues that we continually challenge in eating disorder treatment is the practice of dichotomous (“black and white“) thinking, and creating two selves – healthy/sick or good/bad — seems to perpetuate that approach. It could be more powerful, in some cases, to consider the complexity of the disorder and acknowledge that the traits we may associate with each “self” — e.g. perfectionism with the anorexia — are not solely good or bad. Those traits are part of the person himself or herself and can be used in pursuit of more or less workable goals.

Further, while they are painful and destructive, eating disorders often emerge initially as a means of self-protection and safety. For some, a the world has become too dangerous or chaotic or unpredictable and the eating disorder serves an important function. To separate it from one’s self and villainize it could prevent one from fully acknowledging the role the eating disorder has played.

Some individuals end up feeling invalidated by this approach, that what they think or feel is treated by others as “just Ed talking” versus him or her. When I once remarked to a patient of mine that it felt like “Ed” was the loudest person in the room and I wished I could hear her instead, she became very upset and reminded me that she was the person behind all of the words, and it was important that I hear them all, not dismissing any because they were “Ed’s.” It was an important learning moment for me, and I’m cautious, even when a patient externalizes her own disorder, to not treat what is shared in that way.

And finally, could seeing the eating disorder as distinct from one’s self impair accountability? I’ve observed this go various ways with individuals with whom I’ve worked. I do think there can be a risk is over-externalizing, to the point where an individual feels that they are actually powerless over this much stronger being. The person feels that he no longer has any control, so why bother? It requires energy to fight a monster, and if someone is physically malnourished and weakened by the symptoms, they could feel unable to take on Ed, finding it easier to submit.

The bottom line is that this is an intervention that should be used judiciously. It’s not a one-size-fits-all approach, and one has to consider the individual or one’s self before determining if creating an “Ed” is the right way to go.

Have you used this technique in your work or recovery? If so, what was your experience?

02 Jun

What It Means When McDonald’s Sponsors Dietetic Conferences

Ideas to Consider 10 Comments by Ashley @ Nourishing the Soul

mcd{image credit :: thomas hawk}

I promise I don’t go to conferences for the food – at least not solely – but when I’m forking over a large sum and spending all day in educational seminars in alternately chilly and stuffy conference rooms, I could use a good meal around noon-time. So I would be a bit miffed to get a plastic-packaged meal from an everyday fast food joint. If I was attending the annual conference of my state’s dietetic association, I’d be downright irritated.

Nutritionists and dietitians at the annual California Dietetic Association conference in April were treated to lunch by McDonald’s, the premier sponsor of the event. If you cocked your head and raised your eyebrows in reading that (I’ll say it again… premier sponsor), you’re not alone. Nutrition professionals in attendance – and I – had the same reaction.

McDonald’s is now sponsoring dietetic conferences? Where will Big Food not go?

And lest you think that McDonald’s is an anomaly, other exhibitors included Nestle and Better Buds, maker of an enzyme-modified butter product with the benefit of “flavor masking” (yum…?).

Now, just because McDonalds supported the conference and gave out free lunch doesn’t mean that the actual educational sessions the dietitians were attending were influenced, right? Well, Mother Jones reported that sessions included talks about the safety of genetically modified foods, the value of Walmart in communities, and the defense of high-fructose corn syrup.

The bottom line is that there are many sides to every debate, and none of the above topics are clear cut. Personally, I would be frustrated to think that dietitians in our communities are hearing only one perspective on any of these ideas. Villainizing any one food or food group – whether it’s wheat, sugar, dairy, or something else – isn’t an approach I would support. So I’m not suggesting that all the points made by Big Food are inherently wrong.

But we all know that it’s hard to argue with a giant, especially a giant with billions of dollars who are primarily invested in keep shareholders happy.  Not healthy, but happy. Decreased sales because of panic around trans fats is a crisis for thousands of companies in the U.S. And trying to reduce the panic by changing public discourse is a hell of a lot cheaper (and less risky) than changing their entire product line. I get it. Business has an agenda, and that agenda is not always in line with public health.

But we trust our dietetic professionals to sift through the noise of and tell us how to navigate this chaotic world of food – a world that’s unparalleled in its range of options and misinformation. And when those professionals get caught up in the agenda of Big Food, I get concerned.

And it’s not just some dietitians in California at a convention that I worry about, it’s the larger scale canoodling between organizations like the Academy of Nutrition and Dietetics (AND), the largest of its kind, and companies like Coca-Cola and Mars.

Put simply, how can an organization whose primary objective is to enhance the public’s health make reasoned recommendations when dependent on organizations with a completely different mission?

Back to the real world where money is what makes it go round… The reason the AND and the School Nutrition Association and so many other similar organizations accept these sponsorships is because they need money to survive and do their work, and it’s easy to submit to the allure of cold hard cash coming from Big Food with plenty of it.

So if our dietetic organizations need money to exist and enact their missions, and other sources aren’t available, what happens? We get our dinner served with a slice of Big Food agenda. Maybe it’s better than going hungry… Perhaps only time will tell.

What do you think? Should corporations like McDonalds be sponsoring dietetic events?

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