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Is calorie information on menus really a good idea? The consequences no one is talking about

On January 1, 2017, The Healthy Menu Choices Act will come into effect in Ontario. This Act requires restaurants with twenty or more locations to list calorie information for foods and beverages on their menus. Moreover, fast food joints, movie theatres, supermarkets and convenience stores that serve hot food must post the calorie counts of each item – including alcohol – on their menus, menu boards, tags in display cases and at drive-thrus. Then there’s the definition of ‘menu’ which includes not only paper table menus, but online menus, menu apps, advertisements and promotional flyers – all in the same size and prominence as the name and price of the food item. The act will make Ontario the first province in Canada to require calorie information to be displayed on menus, with the goal of providing consumers with information that will allow them to make more balanced food choices, along with the (hidden) agenda of obesity prevention.

While it is true that Canadians need help eating well, I have significant concerns about the proposed approach. In recent months, many articles have discussed the potential pros and cons of this approach and I expect the conversation will continue to increase as we head towards January. Articles I’ve read thus far discuss downsides that mostly focus on the costs restaurants will incur in testing their products and changing their menus to display calorie information. Here are just three of the many potential down sides that I see, and that no one seems to be talking about.

Calorie counting is a distraction from internal cues that our body provides us with

In most situations, hunger and fullness are great ways to gauge portions sizes that are right for you. The trouble is that we often fail to listen to these cues. We often eat quickly, while on the go, or in front of a screen. Some of us may push off or ignore our hunger. Many of us finish entire meals without even tasting them. Rather than setting a calorie target for meals, experiment with mindful eating. Trust your body; it’s smarter than you think! We trust our bodies to breath when needed and to control our body temperature for us, so why do we feel the need to count and control calories?

Calorie counts are a fear tactic, not an educational tool

Many of our nutrition-related health issues stem from the fact that we are over-worked, over-stressed, lack cooking skills and are out of touch with where our food comes from. We are already bombarded with a ton of nutrition information that leaves us feeling confused. Our society makes assumptions that individuals with a body weight above the ‘normal range’ eat too much or move their bodies too little. Rather than addressing underlying issues, encouraging individuals to choose lower calorie menu options and shaming those who choose higher calorie options is likely to make the situation worse. It promotes a toxic relationship with food, an unhealthy approach to weight and weight loss, and greatly increases one’s risk of dangerous and disordered eating behaviours (and for those already struggling with these illnesses, constant exposure to calorie counts can only serve to increase obsessiveness and exacerbate eating disorder behaviours). Instead, I’d love to see a societal shift that provides education on how to purchase, store and prepare nutritious food options and that helps individuals reconnect with natural hunger and fullness cues.

Calorie counts look at foods in isolation

We all have different calorie and nutrient needs, but we also all have different schedules and routines. There is no ‘right’ or ‘best’ menu option. The option that you choose on the menu should depend on how hungry you are, what you like the taste of, and what you feel like eating, not its caloric value. If you overhear the person at the table beside you ordering chocolate cake for dessert, you have no idea if they order it once a day or once a year. You have no idea what they’ve eaten so far today or what the rest of their day will look like. A single meal is simply a snapshot in time, it does not define you and it should not be used to pass judgement on others.

Calorie counts are coming to menus at chain restaurants in Ontario January 1, 2017. We may not be able to stop them, but we can work to control the effect they have on us. Challenge yourself to slow down, to listen to the cues that your body is giving you, and to use those internal cues to make food choices rather than being drawn to calorie counts. We are more than food, and food is more than calories.

Written by Lindzie O’Reilly, MAN, RD with contributions from April Gates, MSW, RSW

Sifting Through Stereotypes for Better Recognition of Eating Disorders

Eating disorders impact diverse people – but if you were to rely on the representations we have available to us around eating disorders, you might assume that they only happen to young, white, cisgender, heterosexual, thin women. While those of us in the eating disorders field in a research and/or clinical capacity are often aware that people who are marginalized along any number of lines, including race, sexual orientation, gender, and more, get eating disorders, the dominant representation of eating disorders remains this very narrow portrait of a person. The problem with this portrait is not that it is not true – people who fit this image do get eating disorders. However, this portrait creates what Chimamanda Ngozi Adiche refers to as a “single story.” It does not leave room for recognition for those whose disorders look different, which can lead to under recognition, misdiagnosis, and a lack of appropriate care for diverse people experiencing eating disorders. 

One of the most serious issues facing us as a field is the lack of training for primary care physicians and others at the front line of recognition for eating disorders. These individuals may only have dominant representations of eating disorders available to them. Resultantly, they might assume that people in larger bodies, men, racialized people, LGBTQ+ people, and otherwise marginalized folks are somehow “immune” to this kind of distress. The implications of this are twofold:

  • We need to improve training for “first responders” for eating disorders, including general practitioners, nurse practitioners, teachers, coaches, and more
  • We need to broaden our lens on eating disorders to incorporate and represent a wider array of experiences. This means being more proactive in conducting research that is sensitive to and designed with marginalized folks, and making space for stories to accompany the numbers used to inform eating disorder diagnoses and treatments.

Beyond these points, we also need to be working at a societal level for change in which bodies are welcome not only within eating disorder research and treatment settings, but also in society in general. Many of those who don’t fit the stereotype of eating disorders are also facing countless other obstacles in their lives that can make recovery challenging and that can make talking about their experiences of an eating disorder – and recovery – unsafe. Eating disorders are treatable and recovery is possible, but we can do better to build a world where diverse bodies are honoured and welcomed in; this is the kind of world that might make recovery less of an uphill battle against an oppressive cultural current.

The Waterloo Wellington Eating Disorders Coalition is proud to support the 1st World Eating Disorders Action Day. #WeDoAct for systems-level change for eating disorders, today and every day.

-Andrea Lamarre

My Mom, a Survivor

When I was twelve years old I started to fully understand the impact of my mom’s eating disorder (ED) on her health and mind, and, on our family. For several years she struggled with her weight and was frequently on diets and involved in various dieting programs. Although she promoted healthy messages regarding food and body acceptance to me and my sister, she described struggling internally with critical messages about herself. Her diet at this particular time had helped her lose a significant amount of weight and people praised her for it. They looked at her ‘thin’ body and equated that with health, not realizing that in fact she was struggling with an ED and that she was at her physically (and psychologically) unhealthiest. Her life, which had previously revolved around her relationships, her children and her hobbies, became even more obsessed with calorie-counting, exercise and the numbers on the scale. I was aware of some of this at the time, and other things I learned and understood more when she was in treatment and as I got older. For several years she received both inpatient and outpatient treatment for her eating disorder; she is a survivor and I’m proud of her resilience, determination and openness to seeking help.  

Eating Disorders are not always visible, but they are treatable. They can affect sons, daughters, sisters, brothers, aunts, uncles, friends, cousins, and parents. Today is Eating Disorders Action Day— promote ED awareness and treatment. 

Carrie Pollard-Jarrell, MSW RSW

#WeDoAct2016 #WWEDCoalition

International No Diet Day: Why Diets don’t work

How often do you think about what you should or shouldn’t eat, or about your body size? For some this may only represent a small percentage of their experience, whereas others describe it as consuming nearly every waking moment of their lives.

Twenty four years ago, Mary Evans Young (a survivor of an eating disorder and bullying), created No Diet Day. Now recognized as International No Diet Day (INDD), May 6 is a date that encourages people to challenge weight prejudices, raise awareness of the ineffectiveness (and risks!) of dieting and to celebrate body size diversity and the health at every size movement.

How will you celebrate INDD? Many people celebrate by eating mindfully and for pleasure, and by engaging in activities that allow them to enjoy their bodies. The Waterloo-Wellington Eating Disorder Coalition is collaborating with local businesses (and universities) to display positive, empowering messages on signs in shop windows and decals in change rooms. Messages include, “Distorted body image comes from a distorted culture”; “Don’t fight your genes, just change your jeans”; and “Your natural weight is your best weight”. Look for the signs this week!

Billions of dollars are spent on the dieting industry yearly. Industry is the key word. Diets are meant to yield profit and despite the research demonstrating the ineffectiveness of dieting many people are currently on a diet. With children and adolescents, dieting and other weight control behaviours increase the risk of physical health concerns, and the development of eating disorders and other mental health issues.1

Why don’t diets work? Dietician, Caroline Valeriote, offers the following facts:

1.     Goal weights for many diets may be unrealistic for you. Diets don’t often take into account your genetic structure, your body type, how much time and effort you can afford to devote to managing lifestyle and food style changes and your overall health.

2.     Diets that promote unrealistic weight loss goals of greater than two pounds per week means the following:

a.     You are eating too few calories and are at risk of becoming deficient in nutrients

b.     You may be feeling tired and hungry and have a difficult time concentrating and making decisions

c.     The rate at which calories are used (metabolic rate) slows down which is not beneficial to your overall health

3.     Diets don’t often promote physical activity which will increase overall muscle tone and overall fitness. Regular physical activity will increase/maintain your metabolic rate.

4.     Diets will often eliminate certain foods and food groups found on Canada’s Food Guide. Diets eliminating these foods or food groups creates unbalanced intake and often does not recommend healthy substitutions.

5.     Diets usually recommend repetition of several foods. Without variety, the diet will be boring and very difficult to adopt for the long term.

6.     Diets likely promote drastic changes to your overall intake. If this is the case, it will be more difficult to follow because you will have to make too many changes.

7.     Diets are not usually monitored by a registered dietitian or medical professional.

8.     Diets likely recommend very low calorie intake making it very difficult to obtain all the macro and micro nutrients your body needs to be healthy.

9.     Diets often recommend special supplements or foods which can be more costly than regular food. Most often supplements are not well researched for their effectiveness and safety. Supplements cannot replace a well-balanced intake.

10.  Often a diet will discourage you from thinking positively about yourself. A positive sense of self-worth increases your motivation to take good care of yourself and your body though healthy food choices.

 

- Caroline Valeriote, RD and Carrie Pollard-Jarrell, MSW RSW

For more information on eating disorders, body dissatisfaction and the problems with dieting, visit: http://nedic.ca/know-facts/statistics

International No Diet Day - May 6th

Hey downtown Guelph and Kitchener-Waterloo, check it out!

Friday May 6th, 2016 is International No Diet Day, and when you stroll on the downtown streets of the above cities, you will see signs in some of the storefront windows that promote positive body-image or anti-dieting messages.  Make sure to take some time and look for the signs! You may even find a decal or two in a change room. Let's change the message in our culture, conversations and minds!

Here are 10 suggestions of ways to participate in International No Diet Day:

- Take a break from dieting. Try eating when you are hungry and stopping when you are full.    Listen to your body’s signals.

- Stop thinking about foods as “good,” “bad” or “junk food.” Taste, savour and enjoy allfoods to the fullest!

- Make health, not weight loss, your lifestyle goal.

- Give up, or better still, smash the scale

- Clean out your closet and get rid of all your “thin clothes” - donate these items to charity

- Ask local bookstores to display anti-diet and “Health At Every Size” books this month

- Stop focusing on appearance. Don’t make comments like “You look great! Have you lost weight?” Look for other praise-worthy comments to highlight other than personal appearance.

- Engage in physical activities for pleasure and health benefits, rather than regimented exercise for the primary purpose of weight loss

- End weight discrimination by celebrating size diversity. Beauty, health and fitness come in all sizes

- Check out downtown store windows hosting slogans promoting positive body image and size acceptance. Don’t let the fact that International No Diet Day is only one day of the year stop you from practicing the above on a daily basis.

For more background on eating disorders, size acceptance and the Health At Every Size movement, please visit the following websites: www.eatingdisorderscoalition.ca; http://www.haescommunity.org or www.nedic.ca

Bring mindfulness to your table

In a hectic world where many of us rush from one task to another, fitting in a quick meal while we think of what we have to do next has become the norm. When we’re not consciously focused on the food we are eating, we’re less likely to recognize the signals that tell us we are hungry or full or to experience the sensory satisfaction food brings. In fact, if we’re stressed, distracted or in a hurry, it’s easy to finish a meal and realize we haven’t even tasted a bite. Mindless eating is like eating on autopilot; it encourages overeating, undereating and guilt. Learning how to eat mindfully can help us have a better relationship with food and ultimately enjoy better physical and emotional health. 

Mindful eating is the practice of paying attention to the food we eat so that we consume the amount our body needs to be nourished and satisfied. It helps us to explore our internal and external eating cues. Mindful eating is more about how rather than what we eat. 

Here are some strategies to help you practice mindful eating: 

        - Eat at consistent and regular times, which helps you to listen to your body and recognize  

          hunger signals. 

      - Be aware of your meal choices but avoid judgement or “good food/bad food” thoughts. 

      - Eat your meal in the kitchen or dining room rather than in front of your TV or computer. 

      - Slow down and pay attention to what you are eating by using all of your senses- sight, smell,

        taste, touch and hearing. 

      - If you are a fast eater, aim for making a meal last 20 minutes. Put your fork or spoon down

          between bites and chew slowly. 

      - Be in the present moment– focus on the act of eating rather than what you should have

          done or what you plan to do next. 

      - Recognize and observe your thoughts during your meal or snack. 

      - Return your attention to the act of eating if your mind wanders.

      - Learning how to eat mindfully takes practice but can help you learn to savour every bite. 

       - Pay Attention to how your body feels before, during and after your meal. 

Here are some additional resources you may find helpful:

Books: 

  • Eating What you Love, Love What you Eat by Michelle May, MD
  • Eating Mindfully: How to End Mindless Eating and Enjoy a Balanced Relationship with Food by Susan Albers, PsyD, and Lilian Cheung, DSc, RD
  • Every Bit is Divine by Annie Kay, MS, RD, RYT
  • Intuitive Eating: A Revolutionary Program That Works by Evely Tribole, MS, RD, and Elyse Resch, MS, RD, FADA
  • Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food by Jan Chozen Bays, MD
  • Mindless Eating: Why We Eat More Than We Think by Brian Wanksink, PhD
  • Savor: Mindful Eating, Mindful Life by Thich Nhat Hanh and Lilian Cheung, DSc, RD                      
  • Website: The Centre for MindfulEating

 

Dear Body, Love Me

Body love. Body acceptance. Body trust. These are some of the many words used to describe healthy relationships with our bodies. Yet, too many women, men and children struggle with body image dissatisfaction. The causes are complex and it affects those with and without disordered eating. 

In light of February being the month that celebrates love and Eating Disorders Awareness Week, I propose that we celebrate by writing a ‘love letter’ to our bodies. Too often our relationships with our bodies can become neglectful, critical and even abusive. However, our bodies are our constant companions in life. They are our protectors and our alarm system when things are not right. 

Like all healthy relationships, our relationship with our bodies needs respect, care, and acceptance. We need to recognize and accept that our bodies are dynamic, ever changing with age and life experiences (e.g., tattoos and piercings, pregnancy and childbirth, accidents and illnesses, etc.). These changes are not something to be ashamed of but rather reminders of how strong our bodies are and how they’ve helped us survive and thrive. 

Writing a letter to your body is not easy, so find a time and space that is comfortable. Your letter could be handwritten in a journal or a scrap piece of paper, and/or typed or posted online. You could express yourself with pictures and/or photographs, or musically through a song. Use whatever medium allows you best to express yourself—and amazingly in the process using your body. 

To get you started, the following are examples of things you might be grateful for:

-Everyday biological functions: breathing, heart pumping blood, restoration during sleep, absorption of nutrients and creation of energy from food

-Giving clues to your emotional state: the hot flush of anger, the butterflies of nervousness and/or excitement, and the warmth of love and affection for others

-Laughter (especially the deep belly kind)

-Dancing: fast or slow; on your own, with friends, or with a loved one

-Singing (in the shower counts!)

-Creating art through painting, writing, music, etc.

-Hugging loved ones

-Petting and playing with an animal

-Pleasure from (consensual) kissing and sex

-Building strength and endurance through physical activities 

-Creating, feeding and nurturing babies/children

Writing a “Dear Body” letter will not necessarily change how you feel about your body, or how you see yourself. Again, the causes of body image dissatisfaction are complex and recovery is as well. However, this letter may serve as a gentle reminder of all the incredible things your body does for you each and every day. It may even help you build a more ‘friendly’ relationship with your body. And, in those darker moments, you can look at this letter and remind yourself that even though you don’t like certain aspects of your body, as a whole every ‘body’ is amazing! 

By Carrie Pollard-Jarrell, MSW RS

Focus on health and wellbeing in 2016

New year, new habits. Right?

January can be a good time to refocus on health and wellbeing – depending on where you are at in your journey, it could be a time to speak up and get help for an eating disorder, to start to mend your relationship with food for the first time, to re-evaluate and refocus on the goals you’ve made with your treatment team, or to add someone new to your treatment team.

Unfortunately, the above goals are not the goals, or ‘resolutions’ that we typically hear about at this time of year. We are more likely to hear our friends and loved ones talk about their new juice cleanse or their resolution to hit the gym every single day than we are to hear someone speak up about mending their relationship with food.

The holidays can be a challenging and triggering time for anyone trying to navigate recovery – you were likely pushed out of your comfort zone a little and challenged to eat in food environments or to eat types of foods that are not part of your everyday routine. It’s often less acknowledged that January can be an equally, if not potentially more, triggering time of year. 

I see many clients who feel stressed after the holidays and feel urges to engage in eating disorder behaviours to ‘make up’ for the holidays. This combined with the not so helpful messages around New Year’s resolutions that we get from our loved ones and from the media can leave you feeling really stuck. 

I challenge you do to things a little differently this year than maybe you’ve done in the past. In doing so, I challenge you to make your personal health and wellbeing a priority by trying the following.

  1. Get back on track with your meal plan. It’s normal to go off meal plan some days over the holidays. The best thing you can do is to get back on track exactly where you left off – NOT engage in compensatory behaviours or restrict your meal plan. Overshooting your meal plan to ‘make up’ for the holidays will surely create a vicious and dangerous cycle that only reinforces eating disorder behaviours and thoughts. Your meal plan may be different than what others are eating around you and may go against some of the resolutions that your friends and family have been talking about. Rest assured that your plan is the best choice for YOU.

 

  1. Re-evaluate your goals. Where would you like to be this time next year? In five years? What makes you happy? What makes you feel good? This year, take some time to consider longer term goals centred around well-being. In contrast, traditional ‘resolutions’ tend to be short term, unrealistic, and promote an unbalanced approach to food, to exercise and to managing emotions. 

 

  1. Re-evaluate your treatment plan. Once you have decided on your own personal goals, you can then decide on who you need in your life in order to get you there. This might mean seeking help and treatment for the first time, it will definitely mean sharing your goals with your current treatment team, but it could also mean adding someone new to your team or maybe seeking a different approach that is in line with your current goals. Re-evaluating your treatment plan also refers to giving thought to the family and friends you have in your life. Ask for help from your treatment team to articulate to your loved one how they can best support you in your recovery journey. Sometimes this also means moving away from some people in your life that are not helpful supports at the moment so that you are better able to make your personal goals a priority. 

Start your New Year off with a long term focus on your health and wellbeing. Give thought to what you want and what is right for you, regardless of the chatter around you and regardless of what happened over the holidays. The best thing you can do is to get back on track with a meal plan, goals and a treatment plan that are right for you.

- Lindzie O'Reilly

 

Taking a Social Justice Perspective on Eating Disorders

What does it mean to take a social justice perspective on eating disorders? Is it just an elitist catch phrase used to make us focus on only socio-cultural contributors to eating disorders, without taking into account the biological and genetic components of these conditions? What is social justice, anyway, and what in the world do eating disorders have to do with it?

Social justice means thinking at a systems level – meaning political, economic, social and other systems like government, corporations, institutions, and more – to consider how we might better support equitable access to needed services and supports of all kinds for diverse people. It means understanding that people have different social locations – that is, different positions and ways of being in the world. Social locations are linked to the idea of social power, or who in society tends to be more privileged and who tends to be more marginalized. Looking at social justice from an intersectional perspective means considering that differences in social location are not just a matter of belonging to unified groups like “women”; it is important to consider, for example, how the experiences of a white woman who identifies as heterosexual would differ from those of a black woman who identifies as heterosexual, which would again differ from those of a white woman who identifies as queer (and so on and so forth). 

In the context of eating disorders, a social justice lens can help us to understand how people with eating disorders might, for example: 

  • Be able (or not able) to access treatment
  • See themselves recognized as “legitimately suffering” in the eyes of authority figures like doctors 
  • Experience disconnects or unity in their own sense of distress around food, weight and shape and those of their families
  • Experience treatment as helpful or unhelpful
  • Have a good sense of what recovery might look like for them

Of course, taking a social justice lens helps us to understand other aspects of the experiences of people with eating disorders and their families. However, these examples help us to see how this lens can help us to move beyond simplistic perspectives on eating disorders that present them as issues of personal choice or vanity. Using a social justice lens means pointing out that people with eating disorders face many stereotypes and stigmas in general, which might be made worse if they do not fit the “expected picture” of what someone with an eating disorder looks or acts like. It also helps us to identify what we need to do to make treatment more accessible and appropriate for diverse people.

Perhaps the clearest example of how using a social justice lens can help us to see the complexities of people’s lives is access to treatment. Often, I meet parents who love the idea of family based treatment for eating disorders – family based treatment puts treatment in the hands of parents who support their child to recovery and has been shown to be quite effective for younger patients who have a short course of disorder and who have never been hospitalized. However, many parents are unable to quit their jobs or move to an urban centre to find a practitioner skilled in this approach. Socioeconomic constraints like needing to keep working and location constraints like living in a rural area without access to many (if any) eating disorder specialists prevent these families from being able to reach the support they need and desire. 

Cultural norms can also be serious impediments to treatment access. We often take for granted that people will be able to identify a mental health issue and speak openly about it, at least to family and friends. However, airing health issues in general and mental health issues in particular outside of the home is frowned upon in cultures with a focus on presenting a strong and proud family front in society – often families who have faced racialization in society. The threat of “losing face” in a society that asks us to be our best at all times is significant, particularly when you have faced systemic racism or other discrimination.

These are only two examples of how looking at eating disorders from a social justice perspective can help us to identify factors beyond the individual person that impact people with eating disorders and their families. If our analyses are social justice based, of course, so too must our solutions be social justice based – we need to take this understanding and work not only on helping individual people but on building more comprehensive supports for those who struggle.

What does systems level change in the service of social justice look like, in practice? It can take many shapes, but a few examples include:

  • Join in on events like March Against ED, an annual rally taking place at provincial legislative assemblies (check out the National Initiative for Eating Disorders (NIED) recap of this past year’s event here, including a video I created about the event: http://nied.ca/media/)
  • Use social media outlets like Twitter to break down stereotypes about eating disorders either in Tweet form or by providing links to resources like blogs or statistics
  • Micro-advocacy can involve speaking up if someone says something about eating disorders that you know to be untrue or stigmatizing

Of course, never feel that you have to be the one to correct all of society’s ills – all of these strategies (and others!) are best achieved together. 

- Andrea Lamarre

 

 

Eating Disorder ‘Family-Interfering’ Behaviours

As a professional with a career as a school psychologist and a parent whose daughter developed an eating disorder (anorexia) in her late teens, I have remained active in retirement, including supporting families struggling with the devastating effects of eating disorders. One such activity for me over the last ten years has been the facilitation of a twice-monthly Family and Friends Support Group through the Canadian Mental Health Association (CMHA).

On September 30, I was fortunate to be invited to attend a day-long conference at Homewood Health hospital organized to celebrate the 25th anniversary of their establishment of the Eating Disorders treatment program. The focus of this excellent conference in September was managing ED Therapy-Interfering Behavours within a DBT Framework. I agree with Samantha Durfy (a therapist and the main organizer of this conference) that the presenter, Dr. Anita Federicic, PhD, is such a helpful resource person that you would want to have her in your ‘back pocket’ when facing the complexities of treating ED.

My framework when listening to the presenter was frequently that of the ‘family’ which I think often parallels what therapists need to attend to. Of the many parallels I saw, the following are highlights:

A) ‘interfering’ behaviours exist both in the client/loved one as well as the therapist/family and need to be addressed openly. This means that parents must talk with their loved one and not ignore behaviours such as non-responding, lying, not following thru on agreements. Parents must discuss how some of their own behaviours such as over-emotional reacting and lack of skills in communicating interfere. The intention is not to blame but rather to openly deal with such behaviours while respecting the person; the goal is to move towards making a collaborative plan to reduce these 

B) the assumptions within DBT treatment ring true for ‘successful’ treatment as well as ‘successful’ family functioning. Read ‘loved ones’ for ‘clients’ into the following key DBT assumptions: -

  • Clients are doing the best they can 
  • Clients want to improve 
  • Clients need to do better, try harder, be more motivated 
  • Clients may not have caused all their problems, but they have to solve them anyway 
  • Clients’ lives are currently unbearable 
  • Clients must learn new behaviours  

So what does this mean for families?

As difficult as it is at times, rather than staying angry at loved ones, the family needs to embrace the notion that their loved one is doing their best; finding out as much as possible about eating disorders is one way families can achieve this shift; increased understanding underlines that, in fact, anorexia is considered THE most difficult mental health disorder to recover from; anger may reduce and turn to compassion when learning that their loved one is struggling with overwhelming issues. 

At the same time, believing that their loved one does indeed want to improve, despite behaviours like denial and refusing to follow through on helpful strategies, is a challenge for the family but important to do; in our Family and Friends Support Group, we often reinforce with families the small cues their loved one gives that indicate this desire; understanding the stages of change also helps to see that even when a loved one moves away from denial there are still many stages before they will take action; and we often comment that if it were easy for their loved one to make those significant steps to recovery, eating disorders would not be the devastating disease it is known to be.

The apparent opposite assumptions that clients/loved ones are ‘doing the best they can’ and that they also need to ‘try harder/be more motivated’ reflect the many opposites that exist within the complexities of an eating disorder. Indeed, loved ones’ lives are ‘unbearable’ but that doesn’t mean they will naturally want to leave their eating disorder behind (as rational thought would suggest). In our F & F’s Group, we regularly advocate seeking therapy for their loved one (if not already involved), and especially therapy with a specialist in eating disorders – given the huge hurdles a loved one experiences in order to become more motivated to ‘do better’; we also advocate parent(s) seeking help to deal with the huge stress of supporting their loved one wrapped up in so many contradictions. 

Another of the major hurdles is for the loved one to begin taking some responsibility for making their recovery happen, even despite having little responsibility for the contributing causes; in our Family and Friends Group, we have regularly discussed Emotion Focused Family Therapy (EFFT) as a treatment strategy which focuses on strategies to deal with emotions which drive an eating disorder; part of EFFT teaches critical communication strategies (for families) which reduce our typical tendency of advice-giving and increase our recognition / affirmation of our loved one’s feelings before any problem-solving follows; with this affirmation, the loved one may not only feel more capable and but is often freed to do their own problem-solving.

We all do things that can sometimes get in the way of recovery. The main thing is to be aware and talk about them, whether in therapy, within the family or in a support group. If you are located in the Wellington-Duffering area, feel free to access CMHA’s Family and Friends Education and Support Group regarding eating disorders. Regular Meetings are held on the 2nd and 4th Thursday of the month from 6:30 to 8:30 p.m. at CMHA WWD, 130 Weber St. West (at Breithaupt Street) Suite 201, Kitchener. Enter from back parking lot to take elevator to 2nd floor. More information can be found here.

-Barbara Arthur

Medical Complications: Part 1

As many as 600,000 to 900,000 Canadians meet diagnostic criteria for an eating disorder. 80% of these individuals are women and girls. Eating Disorders also affect men and boys. Weight is not always the clinical marker of an eating disorder. People that have normal weights can also have an eating disorder. Eating disorders, such as Anorexia Nervosa, Bulimia Nervosa, Other Specified Feeding and Eating disorders, Binge Eating Disorders are serious illnesses that can be deadly. Individuals can develop life threating medical complications and often have other debilitating illness. The devastating symptoms of an eating disorder lead to serious consequences and risks to an individual’s mental and physical health and can compromise other parts of their lives such as personal relationships, current and future education and employment and overall quality of life. The mortality rate for individuals struggling with anorexia nervosa is estimated between 10-15% and Bulimia Nervosa is about 5%.

Health Consequences of Anorexia Nervosa

The body is denied the essential nutrients that it needs to function normally. There may be depletion of nutrition stores, vitamins, minerals, electrolytes or malabsorption. The body attempts to accommodate this by slowing all of its normal processes to conserve energy which can result in medical consequences such as:

·       Slowing of the heart rate and lowering of the blood pressure; symptoms such as chest pain, heart palpitations, irregular beats or arrhythmias, shortness of breath or edema

·       Muscle loss and weakness. The heart is also a muscle so it is affected significantly and can cause heart failure, heart arrhythmias, cardiac arrest and death

·       Severe dehydration can occur which can cause the kidney function to be altered

·       Liver function alteration

·       Decreased metabolic rate

·       Poor healing and alteration in immune system functioning

·       Bone mineral density loss or osteoporosis which can result in dry, brittle bones with poor bone healing or mineralization

·       Fainting, fatigue and overall weakness can be caused by poor nutrition, anemias, dehydration, low blood pressure, slow heart rate or other heart problems

·       Hair loss is very common, dry skin is also very common, development of lanugo or a downy layer of hair all over the body can develop in the body’s attempt to keep itself warm

·       Intolerances of the body to cold or marked sweating or hot flashes

·       Loss of menstrual cycle or amenorrhea, irregular menses, loss of libido, infertility

·       Gastrointestinal effects such as pain, bloating, acid reflux, constipation or hemorrhoids

·       Seizures, memory loss, poor concentration, insomnia, depression, anxiety, obsessive behaviours, self-harm, suicidal ideations or attempts

Health Consequences of Bulimia Nervosa

Many of the above consequences can be present in Bulimia Nervosa. The recurrence of binging and purging can affect the digestive system and can also lead to electrolyte and chemical imbalances in the body affecting the heart and other major organs. Some of these include:

·       Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death

·       Electrolyte imbalances and loss of potassium, sodium and chloride because of purging behaviours can also lead to dehydration

·       Possible rupture of the esophagus or inflammation or erosion or ulceration of lining from vomiting

·       pancreatitis

·       Changes in the gastrointestinal system, diarrhea, constipation, incontinence and chronic problems with the misuse of laxatives

·       Tooth decay, dental enamel erosion, discoloration, loss of teeth, gum recession or oral lesions, lacerations from the stomach acids during frequent vomiting

·       Parotid gland enlargement

Health Consequences of Binge Eating Disorder

Many of the associated clinical risks are similar to the health risks of obesity and they can include:

·       Hypertension

·       Dyslipidemia or high cholesterol and triglycerides

·       Heart disease as a result of elevated cholesterol and triglyceride levels

·       Development of type II diabetes

·       Gallbladder disease

·       Development of varicose veins

·       Hiatal hernia

·       Arthritis, sciatica or other mobility issues related to the wear and tear on major joints

Eating disorders are complex illnesses that can have harmful consequences on an individual and impact their physical health. They do not discriminate about any body system. They can compromise all regulatory systems of the body including the immune system, digestive system, skeletal system, cardio vascular system and reproductive system.  The effects on physical health can occur rapidly or may deteriorate over a longer period of time. Chronic illnesses can be a direct outcome from the harmful effects of an eating disorder. Some medical complications can resolve quickly as an individual recovers from their eating disorder and others such as osteoporosis can have lasting effects. However recovery is possible and is also complex requiring nutritional, psychological and often vocational or relational treatment.

Written By: Catherine Miller

References:

Mehler, Philip & Anderson, Arnold (2010). Eating Disorders: A guide to medical care and complications, 2nd edition.

Report of the Standing Committee on the Status of Women: Eating Disorders Among Girls and Women in Canada (November 2014) Available at: http://www.parl.gc.ca/content/hoc/Committee/412/FEWO/Reports/RP6772133/feworp04/feworp04-e.pdf

Putting Eating Disorders on the Radar of Primary Care Providers (CWEDP-2010) Available at https://www.haltonhealthcare.on.ca/site_Files/Content/Documents/PDFs/Eating_Disorders_Tool.pdf

Eating Disorders, Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders, 2nd edition (AED Report 2012) Available at: http://www.aedweb.org/web/downloads/Guide-English.pdf

What’s Wrong with Canada’s Food Guide?

What’s wrong with Canada’s food guide?

Eating Well with Canada’s Food Guide (originally called Canada’s Official Food Rules) has been around since 1942 and is meant to provide guidance when it comes to making healthy and nutritionally adequate food choices. There has been much talk recently about the state of the Food Guide and many calls for an update.

As a science, nutrition is not new. Nutrition is, however, constantly evolving. Additionally, because we all eat, we all have our own opinions about food and nutrition. Combined together, this has created a very complicated and, in my opinion, often toxic food environment.

How is the average person supposed to make sense of all of this information? Is the Food Guide still a useful tool for Canadians?

In many ways, the Food Guide can serve as a source of guidance, but in my opinion, should not stand alone.

I believe that Health Canada will always struggle to develop a Food Guide that depicts the natural variety of a healthy diet. We eat for many different reasons, we all have different likes and dislikes, and we have each been raised in a unique food environment (i.e. the foods you were exposed to and the messages you were provided with as a child). From the Food Guide, one can learn that a serving of meat and alternatives could be two eggs or 75g of chicken, but what if you have never cooked an egg before, or are terrified of purchasing and touching raw chicken? I believe that in order to bring about healthy change in our society, we need to spend a little more time looking at issues such as busy schedules or lack of cooking skills, rather than debating whether to include 75g or 100g of chicken with dinner or feeling guilty if we include three tablespoons of peanut butter instead of two.

We have forgotten about balance, and instead have begun an unrealistic pursuit of perfection

I will admit that, when building a meal plan for clients, I typically include a bit more protein and a bit less carbohydrate than the Food Guide suggests. I also believe that the Food Guide does tend to emphasize more processed grains (i.e. cereals, granola bars, and breads) and neglects the awesome variety of tasty and unprocessed whole grains (have you tried millet, amaranth, buckwheat or teff??). That said, following the Food Guide “as is” will certainly not make you unhealthy and I work very hard to fight against many of the extreme approaches that continue to pop up in the media and in social circles. 

Cutting out entire foods or food groups and labelling foods as “good” and “bad” has the potential to have a very harmful effect on health and a very destructive effect on one’s relationship with food. Instead, if I feel that an individual is consuming more carbohydrate or processed food than is ideal for their health, I believe in giving them the knowledge and skills necessary to increase their intake of fresh healthy food, rather than shaming them for eating processed food or establishing rules against it. 

The Food Guide focusses on individual food choices, rather than the overall picture

All in all, I believe that debate around the content of the Food Guide has led us to become caught up in the nitty gritty details. We look to the Food Guide to provide rules and guidance and, in doing so; have forgotten the importance of enjoying delicious real food. When working with clients, I often keep the Food Guide in the back of my mind, but would almost never pull it out and use it in a session. Instead, I am more likely to talk with clients about trends in their intake and set specific and individualized goals around variety and balance at meals and snacks.

I believe that we should always have a Food Guide that provides guidance regarding balanced and nutritionally adequate choices. I believe that our current Food Guide could use some updates to reflect a greater variety of fresh whole foods. I also believe, however, that the Food Guide should never serve as a stand-alone document and that, if you have concerns about your food habits, you should work with a qualified health professional to find a routine that works for your body, that you enjoy, and that you can maintain long term.

Questions, thoughts or concerns? Feel free to contact me at lindzie.oreilly.nutrition@gmail.com