NEDA Week – Let’s Keep the Conversation Real

Today is the final day of National Eating Disorders Awareness Week 2018. I’ve been honored to participate this year and I hope you will all join me in continuing the conversation. In our work as advocates for those with eating disorders, there are two vital gifts we can offer: compassion and hope.

How can we offer compassion?

  • By expressing concern about someone showing symptoms of disordered eating
  • By NOT taking it personally when someone with an eating disorder refuses help (Denial is strong and fear can be overwhelming. Continue to express concern and offer resources and support. But do not make it about you. You may be involved, but it’s not personal.)
  • By offering support to those in recovery and truly listening to what they need from us
  • By educating ourselves about the factors that underlie eating disorders (some of which include trauma, emotion dysregulation, an invalidating environment, and an insecure or avoidant attachment to a parent figure)
  • By NOT saying, “You don’t look like you have an eating disorder” or “You should just eat less” (or “more”, or insert anything after the words “You should just…”)
  • By encouraging self-compassion and gentleness when we hear someone speaking negatively about their body
  • By reminding ourselves and others that “fat talk” does not help anyone

How can we offer hope?

  • By NOT participating in diets, nutritional fads, or dividing up foods into “good” and “bad”
  • By calling out (or gently talking with) anyone who uses negative or body-shaming terms
  • By writing to legislators and insurance companies to ask for more extensive coverage of residential eating disorder treatment
  • By learning about and promoting the “Health At Every Size” movement
  • By having conversations with our children about bodies, weight, and shape (e.g., “Bodies come in all shapes and sizes and differing abilities. Everyone is important and has value no matter what shape or size they are or how much they weigh.”)

I would love to hear more suggestions from you. What are you doing (or what will you do) to offer compassion and hope to those around you? “Let’s Get Real”. We can do this together.





How Mindfulness Is Changing My Relationship With My Body

As National Eating Disorders Awareness Week 2018 nears its end, let’s talk about mindfulness. The term is everywhere, but there are many misconceptions about it. Mindfulness can, but does not have to include meditation. It is not about de-stressing or relaxing, though those two things can be a result of mindfulness. Mindfulness is not something you learn once and that’s it.

Mindfulness is the practice of bringing your full attention and non-judgmental awareness to the present moment. (For more on mindfulness, read here.) In other words, mindfulness requires intentional engagement using the five senses to notice what is happening right now. It is something that we must choose again and again and again (though it becomes more automatic over time). Our “monkey minds” have well-worn neural pathways that either send us back to the past to ruminate on things that have already happened or blast us forward into the future with feeble predictions usually based on fear or past experiences. These pathways are so well-used that most of us do not really know what it is like to be fully present to the here and now. But all of us are capable of mindful awareness.

Mindfulness has been increasingly researched as an effective therapeutic modality for the treatment of mental illness. Depression (in which the mind is stuck on things past) and anxiety (in which the mind is fearful of the future) both respond well to treatments that include mindfulness. Mindfulness is also helpful in the treatment of eating disorders.

My practice of mindfulness began as a simple cognitive exercise early in my recovery. After every binge, my therapist told me to tell myself, “That was the past. There is only the present.” Doing so helped me break free from the self-loathing I engaged in after a binge and focused my attention on how I felt right now. Later, my mindfulness practice was a little more involved. After a binge, I described the physical sensation to myself without judgment. That was so difficult at first! My mind kept saying, “I feel disgustingly full.” Or “I feel fat and horrible”. Over time, though, I learned to describe the sensations without judgment: “The sensation feels like a stretching across my lower torso. The sensation covers an area about three inches tall and twelve inches wide. There is some warmth in that area.”

Describing things as they are gives us the opportunity to detach a bit, to observe things from some emotional distance. It serves the purpose of severing the link between our behaviors and who we are. After all, if I am “out here” observing my sensations, who is “in there” having the sensations? Mindfulness is a powerful reminder that the true self, the soul, our “center” (whatever you call it) is unchanging and that is where our self-worth lies…not in our behaviors or words or choices and not in our past or our future. As such, our self-worth exists before we’re born and cannot be diminished by anything we say or do. This may be difficult to believe if you’ve received messages such as “You’re worthless unless you…”, but it is absolutely True. Self-worth is not conditional.

At this point, years after I’ve broken free from the cycle of bingeing and self-loathing, I use mindfulness as a tool in my daily life. It is an anchor to the present when I find that my monkey mind is running the show. I use all kinds of ways to bring my awareness back to the present, but the easiest for me is to focus on my breath. Without trying to change the quality of my breathing, I simply notice the air coming in and going out. I notice the physical sensations of breathing. has a five-minute breathing meditation you can try, though you really don’t need more than a few seconds of awareness in order to practice mindfulness.

Mindfulness has so many applications and is such a healing practice. Unfortunately, it’s surrounded by misconception. Take some time to read about it and notice your response (thoughts, sensations, feelings) while reading about it. That, too, is mindfulness!



Binge Eating Disorder: The Most Prevalent Eating Disorder in America


“Let’s Get Real”, America. Most of us know someone who struggles with body image distortion or disordered eating (restricting calories, dieting, binge-eating, etc.). But, with the prevalence of Binge Eating Disorder estimated at nearly 3% of adults, we are bound to know someone with this disorder. Despite the prevalence, there is still stigma surrounding this disorder, as many people who struggle with B.E.D. are overweight. And, let’s face it: In America, “Fat is bad. Thin is good.”

In 2004, when I first sought counseling for disordered eating, B.E.D. was not an official diagnosis. It was listed in the “disorders that need more research” section of the Diagnostic and Statistical Manual of Mental Disorders. My symptoms were officially diagnosed as “Eating Disorder, Not Otherwise Specified”, a catch-all category for any disordered eating behaviors that were accompanied by marked distress for the individual but did not fit the criteria for Anorexia Nervosa or Bulimia Nervosa. In the first five years of my treatment, I struggled to “own” the label, “Binge Eating Disorder”. I had doctors, psychology professors, and friends tell me: “You don’t look like you have Binge Eating Disorder.” Their comments were, I guess, aimed at making me feel better. However, I simply felt invalidated.

Fortunately, my therapist at the time, reviewed with me the criteria for Binge Eating Disorder (those listed in the back of the manual, for research purposes). My symptoms were nearly identical: recurrent episodes of binge-eating, or eating more than is typical in a discrete time period (less than 2 hours); a perceived loss of control over eating; eating beyond the point of feeling full, eating when not physically hungry, eating alone due to embarrassment, and self-loathing after an episode.  The binge eating occurs at least once a week for a period of at least 3 months. Read the full list of current criteria here.

Do any of those symptoms sound familiar? If so, you’re not alone. Treatment for B.E.D. includes individual counseling, group therapy, and/or support groups such as Overeaters Anonymous or Food Addicts Anonymous and may involve increasing awareness of the function that food serves (i.e., to mitigate boredom, to suppress sadness, etc.) and learning how to more effectively manage the feelings underlying the over-eating. Tomorrow, I will write about how mindfulness, especially mindful eating, has been a major part of my recovery from B.E.D. and how it continues to positively impact my relationship with my body, years after my symptoms of B.E.D. have remitted.

So, let’s keep talking about B.E.D. Let’s gently correct people when they use self-denigrating, fat-shaming language. Let’s do whatever we can to destigmatize this disorder, so all feel safe to seek help.



Eating Disorders among the Orthodox Religious


On this fourth day of National Eating Disorders Awareness Week, “Let’s Get Real” and talk about eating disorders within the context of orthodox religious faiths such as Judaism and Islam. Both groups have rich and wonderful traditions and value the closeness of the community. And both groups have been and continue to be persecuted. It makes sense that a group that is persecuted and stereotyped would want to protect itself from further stigmatization and scrutiny by denying problems occurring within. Unfortunately, that means many individuals in these communities are reluctant to seek help and remain undiagnosed. An additional factor that may contribute to difficulty recovering from eating disorders is the fasting that is often required in orthodox faiths. Though an important part of religious participation and spiritual experience, fasting can contribute to the all-or-nothing thinking that is common among those with eating disorders and can lead to bingeing and purging “forbidden” foods or restricting calories for longer than is healthy.

Nadia Shabir (pen name Maha Khan), a Muslim writer and advocate, speaks openly about her fifteen year struggle with disordered eating and discusses the challenge of fasting during Ramadan. She writes, “As soon as the Ramadan fast opens, more people who are vulnerable to developing the illness fall into the vicious destructive cycle of eating disorder behaviours; many people binge and then purge, and others try to restrain thereby causing more harm to their body”. Read more about her story and the hope she holds for change within Islam.

In the Jewish culture (whether Orthodox or not), food mindfully prepared and shared with family is very important. The National Eating Disorders Association writes, “Preoccupations with food can exacerbate eating disorder issues for those who struggle. Eating disorder thoughts and pressures tend to be stronger during holiday times. The individual might “save” her calories during the week in order to indulge at the Shabbat or holiday meal, however, this usually leads to either bingeing or further restricting, due to the intense fear of overeating.” Read more about these concerns and available resources here. In my area of the country, The Renfrew Center offers treatment programming sensitive to the customs and practices of Judaism. Read more about their programming here.

So, where do we go from here? Well, the take home message is eating disorders do not discriminate. We cannot assume someone is protected from mental illness just because they have a strong faith and the support of a religious community. Let’s make sure everyone feels safe to talk about eating disorders by keeping the conversation going. Let’s listen to the individuals inside these communities to learn more about their experiences instead of assuming we know what it’s like for them. Let’s affirm the bravery of Muslims like Nadia Shabir and encourage them to continue sharing. And let’s identify or develop resources in our schools, universities, and health care systems for those who might be struggling. The work must continue until all feel safe enough and valued enough to seek help.



Eating Disorders among Medical Professionals


It’s day three of National Eating Disorders Awareness Week 2018 and I want to continue my series of posts on eating disorders in groups that don’t get much media attention. We started with eating disorders in boys and men and yesterday looked at eating disorders in athletes. Today, I want to talk about disordered eating among medical professionals.

In 2007, while I was interviewing individuals for my book, I spoke to two individuals, “Robert” and “Karen”, who were involved in the medical field. Both were EMTs and Karen was about to start medical school. Both spoke of their work as fulfilling, but intense, in which “life and death decisions” are made daily. The job exposed them to what is now called “secondary trauma” and contributed to seeking control in other aspects of life, namely through dieting. (Both note that they had experienced disordered eating before joining the medical profession, but felt the most out-of-control during the years spent in that profession.)

In recent years there has been an increase in research about secondary trauma, that is the physical and emotional impact of working with people who are traumatically injured or terminally ill. Those who go into this work often say, “I can’t imagine doing anything else.” And the healthiest of medical professionals has a well-established self-care routine that involves physical, emotional, social, and spiritual activities. But for many doctors, nurses, and medical technicians, the hours are long, the breaks are few, and the intensity is great. Medical professionals experience secondary trauma, immense stress, and tend toward perfectionism. Their need to maintain professional standing amongst peers contributes to difficulty seeking help. Clearly, they are at high risk for developing and struggling to recover from eating disorders.

So, to me, the work is clear: we need to normalize eating disorders in this population and destigmatize help-seeking. In my graduate program for Clinical-Counseling Psychology, there was a general consensus that mental health providers would do well to see their own mental health providers. I think the same holds true for medical professionals; all can benefit from processing the trauma and stress that is experienced at work. I hope medical schools are beginning to emphasize self-care as part of their curriculum. If not, let’s start advocating for such changes at universities and encouraging the medical professionals we know to seek the help they so deserve.





Eating Disorders among Athletes


Today, as we continue National Eating Disorders Awareness Week, I want to highlight eating disorders among athletes. As a therapist who works in college mental health, I have seen many athletes with disordered eating or negative body image. As I work with these students, it is clear that the culture of some sports teams reinforces an unattainable and unhealthy body type. Particularly troublesome can be sports that emphasize a lean, muscular body type (e.g., gymnastics, figure skating, wrestling, cross country track, etc.). The significant and regular emphasis on attaining a shape or weight that maximizes performance can make it even more difficult to break free from maladaptive behaviors once they start. Some individuals I’ve counseled have made the difficult decision to take a break from their sport in order to focus on recovery.

In recent years, in order to address the challenges faced by student athletes, the National Collegiate Athletic Association (NCAA) has issued training manuals and programs for coaches, as well as awareness campaigns for student athletes. Take a look at their pamphlet, “Mind, Body, and Sport” to learn more about the symptoms of anorexia, bulimia, and binge eating disorder and to learn about what coaches are being encouraged to look out for among their athletes.

As awareness and discussion of eating disorders among athletes increases, so does the number of professional and college athletes who are publicly sharing their challenges with eating disorders. Take some time to read their stories below:

Figure skater Adam Rippon speaks out about the severe restriction of calories that takes place among figure skaters:

Penn State University kicker Joey Julius shares his struggle with bulimia and binge eating:

Former Michigan State University soccer player Erin Konheim Mandras discusses her development of and recovery from anorexia:

Do you know any athletes? “Let’s Get Real” and start talking with them about the fact that healthy bodies come in many sizes. Let’s advocate with coaches for environments that support slow (sustainable) and healthy athletic training. Let’s keep the conversation going in order to reduce the stigma around help-seeking among athletes. There’s a lot of work to do. Let’s go!


Eating Disorders Among Boys and Men

Today marks the start of National Eating Disorders Awareness Week for 2018. The theme this year is “Let’s Get Real”. I’m honored to take a very small part in advocating for those who struggle with eating disorders by sharing with you some information about and stories from men who struggle with eating disorders.


In America, one-third of individuals with an eating disorder are male, though boys and men are thought to be under-diagnosed given the stigma males face in regard to help-seeking. Binge-eating disorder is the most often diagnosed disorder among males, though they can exhibit many subclinical disordered eating behaviors such as over-exercise to achieve a body ideal and dieting, purging or using laxatives to lose weight.

Though we read a lot about the objectification of women and the incredibly harmful impact it has on girls’ and women’s self-esteem, we often overlook the fact that objectification of men in the media also contributes to low self-worth. For men attuned to such images, lean and muscular is the ideal. Those who cannot attain it (which is nearly everyone but a tiny fraction of individuals who are genetically predisposed to this body type or spend hours working out on their own or with trainers) are made to feel less-than. The same lie that is sold to women through the thinness ideal is sold to men in the muscularity ideal, namely that being lean and muscular will make you more masculine (“more of a man”), more successful, and happier.

In 2007, when I was conducting interviews for my book, I spoke to two men who struggled with Binge-Eating Disorder. Both talked about their disappointment in themselves for not being able to maintain a certain body type or weight or eat in moderation. One called himself “big boned” as a child, but noted that his self-perception changed negatively over time. Another noted he realized in college he was “way too chubby”. Both men got caught in the cycle of weighing themselves, perceiving the number to be too high, attempting to diet or cut back, experiencing cravings, giving in to a craving, overeating, and feeling ashamed. The shame then sparked renewed commitment to dieting and the cycle continued.

We, as a society, need to notice when our boys start talking about their weight and shape. We need to educate them, as we are starting to do with our girls, that body weight and shape have no relation to self-worth. We need to teach them that masculinity has nothing to do with being “tough” or having a certain body shape. We need to teach them how to mindfully listen to their body’s needs, trusting their bodies to self-regulate. We need to teach age-appropriate emotion vocabulary so boys and young men can express their feelings. We need to teach healthy ways to cope with disappointment, perceived failure, anger, and sadness. Eating disorder prevention is a community affair. We all need to come together in order for sustainable change to occur. Let’s Get Real. Let’s create a society in which all body types are accepted and boys and men are free to be themselves instead of wasting their potential trying to achieve a false ideal sold by the diet and fitness industry.

In peace,


(Statistics and information gathered from: