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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