The Harmful Effects of Dieting on Mental Health: Insights for International No Diet Day

By Izabelle Rocha, University of Guelph

Every year on May 6th, people worldwide observe International No Diet Day, a day dedicated to promoting body acceptance and raising awareness about the harmful effects of diet culture. Why is a day like this necessary?  In a society where the pursuit of ideal body image is often celebrated and diet culture has been deeply engraved into our society, spread through various mediums such as social media, advertising, social norms, and even healthcare practices, International No Diet Day serves as a reminder of the importance of embracing diverse body shapes and sizes.

The Psychological Impact of Dieting

Dieting takes a significant toll on individuals' psychological well-being. The constant pressure to adhere to strict dietary rules and achieve weight loss goals may lead to increased stress, anxiety, and depression. The obsession with food, calories, and body weight consumes one's thoughts, making it difficult to focus on anything else.

Restrictive eating patterns not only harm physical health but also contribute to negative body image and self-esteem issues. As individuals strive to attain unrealistic beauty standards, they often develop a distorted perception of their bodies, leading to dissatisfaction and low self- esteem. Additionally, the fear of food that accompanies dieting can result in social isolation and loneliness. Meal times become sources of anxiety rather than opportunities for enjoyment and social connection. The stigma surrounding certain foods and the pressure to adhere to strict dietary norms further perpetuate feelings of shame and guilt.

The pervasive nature of diet culture in our society leads to the internalization of harmful messages about food, weight, and beauty. From a young age, we are bombarded with images and narratives that equate the perfect body with success and happiness. This constant exposure to diet culture reinforces negative beliefs about ourselves and others, fueling disordered eating behaviors and perpetuating the cycle of dieting.

Promoting Mental Well-Being and Body Acceptance

There is an urgent need for a shift away from diet culture and towards promoting mental well-being and body acceptance. This involves embracing self-care practices such as intuitive eating, mindfulness, and self-compassion. Intuitive eating encourages individuals to listen to their body's hunger and fullness cues, rather than following strict diet rules. Mindfulness teaches us to be present in the moment and cultivate a non-judgmental attitude towards ourselves and our bodies. Self-compassion involves treating ourselves with kindness and understanding, especially when we make mistakes or face challenges.

What can you do to get involved in international no diet day this year?

• Share posts or articles that resonate with you that promote body diversity and spread the message of international no diet day.

• Challenge diet culture and reduce the stigma by having open conversations with family and friends about the importance of embracing body diversity.

• Consider volunteering or donating to support organizations that are dedicated to promote body inclusivity, eating disorder awareness and mental health advocacy, such as organizations like Body Brave (Donate Here).

• Dedicate some time to engage in self-care activities that promote mental well-being, such as meditation, journaling or spending time in nature. If you're looking for more ideas on how to implement self care practices, don't forget to check out our other recent blog posts on self-care practices.

As we embrace International No Diet Day, let us challenge societal norms, reject the dieting mentality, and celebrate the diversity of body shapes and sizes. Instead of striving for an unattainable ideal, let us focus on nourishing our bodies and nurturing our minds. Together, we can create a world where everyone feels valued and accepted, regardless of their size or shape.

References

Crego, A., Yela, J. R., Riesco-Matías, P., Gómez-Martínez, M.-Á., & Vicente-Arruebarrena, A. (2022). The benefits of self-compassion in mental health professionals: A systematic review of Empirical Research. Psychology Research and Behavior Management, Volume 15, 2599–2620. https://doi.org/10.2147/prbm.s359382

French, S. A., & Jeffery, R. W. (1994). Consequences of dieting to lose weight: Effects on physical and mental health. Health Psychology, 13(3), 195–212. https://doi.org/10.1037//0278-6133.13.3.195

Winter Wellness: Embracing Self-Care Amidst Seasonal Challenges

Written by Izabelle Rocha, University of Guelph BA Honours, Psychology Undergrad

As the winter season unfolds, it's essential to prioritize practical self-care that nurtures emotional, physical and mental wellbeing. As days become shorter and the weather becomes colder it's common to find ourselves facing unique challenges in our mental health and recovery process. In eating disorder recovery these seasonal shifts may present additional hurdles highlighting the importance of self-care at this time. 

Here are three self-care suggestions that can be implemented at any time of year to support the recovery process.

Journaling for Emotional Wellbeing

Self-care tends to focus heavily on physical aspects of wellbeing and neglect the necessary care of emotional and mental health. Journaling can be a great way to self-reflect, reduce stress and enhance overall mental wellbeing. Journaling can be about anything you'd like, here are some prompts to keep in mind.

• Gratitude: 3 things you are grateful for today

• What have been strengths in my recovery?

• What do I need to feel emotionally supported (spend time in nature, call a loved one when stressed, setting boundaries, etc.)?

To stay consistent with journaling, it can be helpful to set a time where you do it every day such as before bed or as part of your morning routine. Setting a realistic amount of time that you will journal each day will help the activity seem less daunting as you start out. Journaling apps such as Day One and Diarium can be used for easy access wherever you are.

Mindful Technology Use for Mental Wellness

Social media is a prominent part of many of our lives and concerns have been raised that what we consume on our phones can influence our perspectives, feelings and even decisions. With many social media platforms being embedded in an engagement seeking orientation it creates a nature of best foot forward in which social media becomes a highlight reel of people's lives. Although there are benefits to media such as a sense of community and support and information sharing, media can also progress toxic ideals and lead to comparison and negative body perception. In light of this, check in with yourself, take a look at the accounts and people you follow and ask yourself the reason you follow them; How does their content make you feel? Does it add value to your life? Prioritize following people who make you feel good and who are adding value whether it's through reliable information or just comedic relief. Creating a feed that is diverse and includes healthy positive role models that help you feel empowered and confident is a way to ensure your time spent on social media is supportive. In addition, being mindful of your screen time and setting healthy boundaries with technology, although hard, can make a difference.

Embracing Holistic Movement

Find joy in movement outside the constraints of structured exercise and participate in activities that allow you to connect with yourself and reap the psychological benefits that come with it. This could include activities such as exploring nature for grounding through hikes or walks in your neighborhood. In addition, practicing yoga can offer a space to explore self-compassion and practice mindfulness. These activities promote a more intuitive and joyful approach to movement focusing on the individual experience rather than the rigid routine that can come with fitness. Equally important is allowance for rest, embracing rest is a key aspect of self-care.

Amidst the winter season it's crucial to maintain healthy practices that provide support for emotional, physical and mental wellbeing. It is important to also seek support from therapists or dietitians with specializations in eating disorders as consistent sessions with your support team is a practice of self-care. Embracing various forms of self-care, celebrating small victories and prioritizing rest can set a well-balanced foundation for the cold months.

References

Jepsen Trangsrud, L. K., Borg, M., Bratland-Sanda, S., & Klevan, T. (2020). Embodying experiences with nature in everyday life recovery for persons with eating disorders. International Journal of Environmental Research and Public Health, 17(8), 2784. https://doi.org/10.3390/ijerph17082784

Marks, R. J., De Foe, A., & Collett, J. (2020). The pursuit of Wellness: Social Media, body image and eating disorders. Children and Youth Services Review, 119, 105659. https://doi.org/10.1016/j.childyouth.2020.105659

Binge Eating Disorder: Breaking the Silence

Submitted by Cheryl Laird, RP. 

What is Binge Eating Disorder? 

Binge eating disorder (BED) is a serious mental health condition that is frequently overlooked and poorly understood. It is a chronic pattern of eating objectively large amounts of food at one time, often in a rushed and secretive way followed by a deep sense of shame. It is estimated to affect about 70 million people worldwide (Keski-Rahkonen, 2021). Although it is not a new phenomenon, there's a lack of awareness and discussion about BED, leading to stigmatization and barriers to seeking help. 

To be clear, two cookies is not a binge. Sometimes guilt can arise from eating a small amount   of food, especially if you consider it to be a “bad” food.  Volume is the key to distinguishing between a subjective binge and objective binge. As a general guideline, an objective binge is an amount of food that the general population would agree is a lot to consume in one sitting. Binge eating is different from occasional overeating such as feasting during the holidays or celebrating important events. To qualify as BED, binging must occur at least once a week over a period of at least three months and includes a feeling of being out of control.  

BED can make you feel very alone because you think you are the only one in the world to have this out-of-control problem with food.  A standard reaction would be to hide what and how much you eat out of shame and embarrassment. BED often leads to eating only small portions of food around others, skipping meals, or going for long periods of time without eating to then binge when you are alone.  During a binge, which can happen once a week or more than once a day, you will eat quickly until uncomfortably full. Binging can be triggered by either negative or positive emotions and is frequently followed by emotional numbness. 

Genetic and Environmental Factors 

Research shows there is a genetic component to eating disorders including BED. If a family member struggled with food or body image, or other mental health issues like anxiety or depression, there is a greater likelihood of developing an eating disorder. Environmental factors such as social media, fashion, beauty, and the health and fitness industry place great emphasis on body image, which increases vulnerability to BED. Psychological factors such as perfectionism (pressure to achieve) and social comparison (comparing what you eat and how you look to others) also play a big role, as does the pressure to conform to cis-gendered body types. 

BED alienates you from vital sources of support like loved ones or healthcare professionals because it can be distressing to share the details of your relationship with food. Depression and misuse of substance or alcohol are often found concurrently with BED.  Onset of BED can begin in adolescence or adulthood. While some people can talk about it, most go for years without telling anyone in the hope that they will be able to solve the problem on their own by increasing their willpower. Typical self-help strategies to get over binging include different forms of food restriction which only exacerbates the problem. Finding someone you trust is a key place to start. Talk to your doctor and seek out other mental health professionals like a counsellor, registered dietitian, or eating disorder support groups like Body Brave or CMHA-WW. 

Therapeutic Approaches 

If you are looking for treatment for BED, there are a variety of therapeutic interventions shown to be effective like cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and interpersonal therapy (IPT) (Iacovino, et al., 2012). CBT addresses negative thought patterns and feelings that result in coping with binging eating. DBT promotes emotional self-regulation, stronger interpersonal skills, mindful self-awareness, and stress management to reduce likelihood of binging. Interpersonal therapy improves interpersonal functioning by addressing relational challenges. 

Healthy Coping Strategies 

While BED is marked by feelings of helplessness and frustration, there are things you can do that help. Engaging in daily self-care is a primary strategy that reduces vulnerability to binging.  Self-care is different for everyone, but it starts with the basics like taking care of your physical needs by showering, eating regularly, and getting enough sleep. Self-care also involves building interpersonal skills like setting boundaries and being more assertive. When you feel the urge to binge, try different coping skills such as self-soothing with smelling essential oils, applying a scented lotion, or lighting a scented candle. Resting, stretching, reading, calling a friend, or doing a hobby are other ways of quelling the urge to eat.  Of all these tools, doing a hobby can feel the most difficult because hobbies and interests are often the first thing to go with eating disorders. To get back into your hobbies, spend some time remembering what you once loved to do in your free time. If you can’t recall, develop new leisure time activities altogether. If you have been putting your life on hold because of your body image concerns or your relationship with food, start with small steps to built confidence. Some realistic goals for yourself might be going to a movie with a friend or joining a book club.  Ultimately, becoming involved in your interests will give you more ways to deal with the feelings that trigger binge eating.  

Start Your Recovery Journey 

Binge eating disorder can be overcome, and breaking the silence is an important factor in helping yourself and others. By fostering open conversations, reducing stigma, and encouraging those affected to seek help, we can create a supportive environment for healing and recovery. 

Remember, BED flourishes in silence. Seeking help is a courageous step towards regaining control and improving mental and physical well-being. The first step is to reach out to someone you trust. Connect with your primary care provider or an eating disorder specialist for guidance and support.  

References 

Keski-Rahkonen, A., (2021), Epidemiology of binge eating disorder: prevalence, course,  

comorbidity, and risk factors, Current Opinions in Psychiatry, 34(6), 525-531. Retrieved on  

December 10, 2023 from https://pubmed.ncbi.nlm.nih.gov/34494972/ 
 

Iacovino,  J, M., Gredysa, D. M., Altman, M., & Wilfley, D. E. (2012). Psychological treatments for  

binge eating disorder. Current Psychiatry Reports, 14(4), 432–446. Retrieved on December 12,  

2023 from doi: 10.1007/s11920-012-0277-8 
 

Iqbal, A. & Rehman, A., (2022), National Library of Medicine: National Center for Biotechnology  

Information. Binge Eating Disorder. Retrieved on 2023, December 17 from 

https://www.ncbi.nlm.nih.gov/books/NBK551700/  
 

National Eating Disorders Information Centre. Affirming Care for Every Body. Retrieved on 2023,  

December 10 from https://nedic.ca/2slgbtq/  

Breaking Stereotypes: Exploring eating disorders beyond body image

Written by Izabelle Rocha, University of Guelph BA Honours, Psychology Undergrad

When you think of eating disorders what is the first image that comes into your mind? For most people they see someone struggling with body image, fears of gaining weight, distorted perception of weight and as a result disordered eating. But eating disorders can go beyond body image and stem from a range of experiences and causes. Avoidant/ restrictive food intake disorder (ARFID) is a non body image based eating disorder and is less widely known.

Avoidant/ restrictive food intake disorder (ARFID) is characterized by selective eating habits and/or disturbed feeding patterns leading to malnutrition, failure to gain weight/weight loss and energy deficiencies. Although ARFID occurs more often in childhood it has no age limitations and can develop at any time. ARFID is commonly described as more severe picky eating. ARFID involves severe sensory sensitivities and impact to nutrition and psychological well being whereas picky eating is a behavior phase with mild and temporary impact. ARFID has many possible causes including triggering events such as choking or vomiting, gastrointestinal issues, witnessing a traumatic choking event, lack of interest in food and issues with sensory characteristics of food.

The diagnostic process for ARFID involves an evaluation of the patients' eating habits, assessment of attitudes towards body image to rule out body image based eating disorders and symptoms related to malnutrition such as fatigue, dizziness, hair loss, dry skin, cold intolerance and abdominal pain. A clinical interview will be done to confirm diagnosis in which a mental health clinician will ask about a typical day of eating and foods that are usually accepted and avoided. Treatment can include cognitive behavioral therapy, and for more severe cases hospitalization may be required to ensure nutrition is given.

Early intervention for ARFID is the most effective approach to ensure successful treatment. Knowing the signs of ARFID is important to connect people with resources when needed. If you or someone you know is struggling with ARFID there are a range of resources and supports available to help. In addition to contacting your primary care physician to learn about next steps and inquire about diagnosis and assessment options, you may find valuable resources on the FEAST and NEDIC websites. These sites offer additional insight, tools and self assessment resources such as this short ARFID screening https://nedic.ca/media/uploaded/Short_ARFID_Screen_-_Self_fillable.pdf and more information on ARFID on the FEAST website. https://www.feast-ed.org/arfid-avoidant-restrictive-food-intake-disorder/. In addition registered dietitians and therapists with specialization in eating disorders can help create meal plans and provide guidance through food exposure therapy. Education and awareness around ARFID is important to reduce stigma, hold empathy and ensure individuals struggling with eating disorders get access to the support they deserve.

References

Zimmerman, J., & Fisher, M. (2017). Avoidant/Restrictive Food Intake disorder (ARFID).  Current Problems in Pediatric and Adolescent Health Care, 47(4), 95–103. https://doi.org/10.1016/j.cppeds.2017.02.005

Todisco, P. (2021). Avoidant/restrictive food intake disorder (ARFID) in adults. Hidden and Lesser-Known Disordered Eating Behaviors in Medical and Psychiatric Conditions, 103–121. https://doi.org/10.1007/978-3-030-81174-7_10

Body Confidence Outside the Gender Binary: Gender Dysphoria and Eating Disorders

Written By: Mari Del Monaco, UofG BA Honours, Psychology Undergrad (they/them)

Living as a nonbinary person is equal parts liberating and confusing. Grappling with my gender identity has caused deep, inherent body image dissatisfaction. Yearning for a masculine, more androgynous appearance increased the severity of my already existing eating disorder. As an assigned female at birth nonbinary person, I will share some information on the relation between gender dysphoria and eating disorders, along with my story regarding these themes.

What is Gender Dysphoria?

            Discussing gender outside the normative binary is still relatively new today. Chances are you’ve heard the terms transgender and nonbinary, but the phrase gender dysphoria may remain unknown to you. For context, gender dysphoria is a chronic sense of discomfort one may experience regarding their body image due to feeling misalliance between their biological sex and gender identity. The spectrum as to how gender dysphoria is expressed is expansive and usually depends on the person’s transition journey. Transgender people may feel discomfort in features such as (but not limited to):

·      Height

·      Body hair

·      Body fat distribution

·      Chest

·      Genitalia

Gender dysphoria can cause extreme discomfort and anxiety. As a result, this may increase the likelihood of low self-esteem, depression, self-harm, and self-neglecting tendencies in those identifying outside the gender binary.

The Gender Dysphoria and Eating Disorder Correlation

            Bodily dissatisfaction coupled with increased anxiety and depression rates in transgender individuals can cause eating disorder likelihood to rise in these demographics. In fact, transgender college students are four times more likely than cisgender, heterosexual female college students to be diagnosed with an eating disorder (Banasiak, 2022). The onset of secondary sex characteristics in transgender individuals during puberty usually triggers disordered eating habits, such as food restriction, excessive exercise, or regular purging. Weight loss may attribute to the slowing of breast development or period loss (amenorrhea); this may be seen as desirable in those experiencing a female to male transition.  Those transitioning from male to female may experience body dysmorphia, developing extreme concern with body shape (Banasiak, 2022).

Additional social standards in queer communities surrounding thinness also add pressure to teens and young adults in the community. There is undoubtably a pressure to be constantly attractive; consistently “slaying” in the community. With often less opportunity for queer individuals to find partners, they may try their best to look attractive in the case that they do find a potential partner. Unfortunately, some may equate extreme thinness or low body fat percentages to achieve this unrealistic ideal leading to increased disordered eating rates (Bonell et al., 2023).

My Story

            Eating disorders and gender dysphoria are extremely difficult to deal with, and my story reflects this. I struggled with food since I was about 13 years old, enduring several eating disorders during my teenage hood. I used food restriction, exercise addiction, and binge-purging behaviours as coping mechanisms for other pre-existing mental health conditions I was unaware of at the time. In twelfth grade, I came out to myself as genderfluid; using she/they/he pronouns. I cut my hair and expressed myself in more masculine ways through my clothing choices. I felt increasingly confident and comfortable in myself, excluding one undeniable fact. I naturally have a larger chest; I found this detrimental to my gender expression and self-identity. To me, my chest was a glaring symbol of femininity. Everyone would know I was born as a “girl”. It destroyed me. I overexercised and restricted in attempt to lose my breasts. Unfortunately, I genetically lose fat everywhere but my chest when I diet; restriction was to no avail. After coming out, my gender dysphoria triggered an eating disorder relapse for about a year thereafter, intensifying my bout of depression at the time. However, there are ways out of this, and I can share my story and information about this as well.

            Nearing the end of my high school experience, I went through intense amounts of therapy and consolidation from loved ones. I am very privileged and lucky to have a strong support system. I have my parents and best friends to thank for much of my recovery; they helped me through such a low point. My parents saw my struggle and took me to a psychiatrist where I was diagnosed with EDNOS (eating disorder not otherwise specified) and generalized anxiety disorder. A combination of CBT (cognitive behavioural therapy) and anxiety medications helped to reduce my disordered behaviours. My amazing friends also bought me my first binder. Binders are tightly fitting undergarments meant to flatten the chest and provide a masculine appearance for nonbinary or transmasculine individuals. They measured my chest size one day (without telling me, bless their hearts) and ordered my binder; cutting the size tag before my first try-on to prevent any eating disorder-related triggers. The first time I wore a binder was unreal; I felt so much closer to my self-identity.

However, chest binding is nowhere near perfect. My goal is to attain gender-affirming top surgery to increase my body confidence and gender affirmation. Even today, my body image is not perfect, but regardless, I am self-assured in my identity as a nonbinary person, and binding really helps with my body image. Though I cannot speak on the male-to-female transition experience, this is my personal story; one of so many ongoing transition tales.

Feeling Confident without Disordered Mechanisms:

There are many resources on how to deal with gender dysphoria and eating disorders. For those outside the gender binary, here are some tips that others (and myself) use to feel confident in their appearance and expression:

·      Find a hairstyle that aligns with your identity and makes you feel attractive.

·      Wear clothes which accentuate your favourite body features and align with your self-identity.

·      Bind your chest within safe time ranges.

·      Talk to your general practitioner about acquiring estrogen, testosterone, or surgeries necessary for your transition.

·      Wear what you want and look cool while doing it! Buy that silly bag, dye your hair that funky colour, get those tattoos and piercings! Gender expression is uniquely individual, and always yours to customize.

I know, this is a lot of information about gender expression, dysphoria, and eating disorders. Whether you’re currently transitioning, a loved one of someone currently struggling, or just someone looking for accessible information, I hope this aided in your understanding. For anyone struggling, don’t hesitate to consider these tips and reach out for help. Know dieting unhealthily is not the way to achieve some “body goal”. You can attractively express gender in your own, unique, fantastic way.

References

Banasiak, E. (2022). The Role of Gender Dysphoria in the Development of an Eating Disorder. The American Journal of Psychiatry Resident’s Journal 18(1), 1-2. https://doi.org/10.1176/appi-rj.2022.180104

Bonell, S., Wilson, M. J., Griffiths, S., Rice, S. M., Seidler, Z. E. (2023). Why do queer men experience negative body image? A narrative review and testable stigma model. Elsevier Ltd 45(1), 2,5. https://doi.org/10.1016/j.bodyim.2023.02.005

Five Skills to Help You Maintain Your Eating Disorder Recovery After the Holidays

Written by Jenna Matisz, MSW, RSW

January can be a tough time of year to be working on eating disorder recovery. Many people experience a dip in mood due to the dark and cold weather. Life can feel more mundane after the excitement and the busyness of the holiday season. Some may have had challenging times with family or food during the holidays that have left them feeling guilty or drained. On top of all that, diet talk is in full-swing with unrealistic promises that starting a new diet or changing our exercise routine is going to make us feel better about ourselves.

So, how can you focus on maintaining your recovery after the holidays?

Consider if you would benefit from implementing one or more of the following skills:

1.     Weigh the pros and cons of making a change

It can be easy to get caught up in whatever the new, shiny diet or fitness craze happens to be this January – a sign of great marketing!

If you’re thinking about making a change that you think could impact your recovery, make a pros and cons list. Consider the advantages and the disadvantages that change might have on your recovery in the short-term (1-12 months) and the long-term (1-5 years). Be honest with yourself, talk about it with your supports, and sit on it for a few days. Then decide how you want to move forward.

2.     Build in a new, healthier habit: daily check-ins

Diet culture teaches us to rely on external rules and pressures rather than listen ourselves. As a result, learning how to reconnect and be mindful of your mind and body may be an important part of recovery for you.

Consider setting aside a few moments each day to check-in by asking yourself the following questions:
1. How am I feeling emotionally right now?
2. How am I feeling physically right now?
3. Is there anything my body or my mind needs?
4. How can I give myself what I need?

3.     Keep a credit list

As a protective measure, our minds naturally focus on the negative. This is adaptive in many ways, but not so helpful when it comes to feeling good about the progress you’re making in recovery!

Consider starting a credit list where you track one (or more!) recovery wins from each day. Keep the list in your phone or in a notebook you use often. Watching the list grow throughout the month can feel motivating and being able to look back on it when you’re doubting yourself can be a good reminder to keep going.

4.     Build mastery

Building mastery is a skill from Dialectical Behavior Therapy that can help improve self-esteem and confidence. Choose a task or activity that you want to make progress in; perhaps it’s something recovery related (like tackling a feared food) or a new hobby you want to try out. Take frequent, small steps to engage in the task or activity on a regular basis and watch yourself progress and build mastery in it.

Seeing yourself make progress in something that’s important to you can give you a sense of competency and make you feel confident and capable. These are important feelings to foster at any time, but particularly after the holidays when we might not be feeling our best.

5.     Make a plan for coping ahead

Diet talk is a constant obstacle in eating disorder recovery but is particularly loud after the holidays. Consider practicing the cope ahead skill to help you navigate diet talk this month.

Ask yourself:
1. What diet talk situations might I have to navigate over the next month or two? How do these situations typically make me feel? What do I find challenging about them?

2. What skills will I need to be intentional about using before, during, and after these situations?

3. Take a moment to imagine yourself applying those skills in the situation. Do you feel any more prepared for navigating the situation? If not, what else do you need to consider?

Maintaining a Recovery Mindset Throughout the Holiday Season: Making a List and Checking it Twice!

Written By: Mar Ratanadawong McM

Marked by glistening white snow and early sunsets, the holiday season brings much wonder to the world around us—

Sometimes things can feel a little less magical than we’d like them to during this time of year when battling an eating disorder or disordered eating behaviours. The winter holidays can bring extra high levels of stress and anxiety for those who are already having trouble navigating their eating and feeding habits.

It takes some preparation, but with some planning and support, the holidays can be made to feel a little less daunting! By challenging yourself to continuously work in maintaining recovery, you are showing incredible strength and resilience that will prove beneficial in your own healing and growth.

My biggest tip for those navigating disordered eating during the holidays: make a list and check it twice! Write down a list noting all the things you need to prepare for this holiday season. (Really, write it down!!)

Things to include on this list include:

-          A personal goal or objective

Make note of something you’d like to accomplish this holiday season. Maybe you want to read a book before the new year begins or learn a new craft! It can be anything and doesn’t need to be related to your recovery.

-          Your Appointment Schedule

This time of year is notoriously busy and it can tempting to cancel appointments during this season citing the colder weather and shorter days. Sticking to your regular appointment schedule will ensure you have support from your care team during these times of potentially heightened stress.  Using a day planner or keeping a calendar is a great way to schedule your day-to-day activities and commitments.

-          Contact Information for your Support Person

Write down the name and number for a reliable support pal that you can lean on for extra support during holiday festivities. Having an accessible contact makes navigating anxiety-inducing situations much less stressful.

These are just a few ideas of things to write down and come back to over the next few weeks. Having a hard-copy version of your list makes it easy to reference when you’re in need of a little guidance. If there’s somebody you would be comfortable sharing your list with, let them know you’d appreciate the extra support in sticking to your plan. What other things would you include on your list?

Wishing everyone a warm and cozy holiday season!

Body Brave Letter Template

Send the letter by email to michael.tibolloCO@pc.ola.org

Dear Minister Tibollo,

 We are a community coalition comprised of health care professionals/students/community members/family members and those with lived eating disorder experiences. Our mission is to increase awareness, provide professional development and training in the prevention and treatment of eating disorders. Eating disorders are one of the most dangerous of all mental illnesses. 

Body Brave, one of our community partners, is a community-based organization which we refer many community members to. They provide much-needed first line treatment and support for people with eating disorders.  Their trained clinical staff are providing services for more than 3000 people per year, filling an important gap in the continuum of care. People on waiting lists for hospital-based programs across Ontario access Body Brave’s services. They also access services after discharge, to prevent relapse.

Body Brave is saving the government millions of dollars by providing these evidence-based services. However, the organization is currently facing a financial crisis which may result in significant reduction in services.

Minister Tibollo, you know how important community-based organizations are for mental health care. 
As a coalition, we ask you to address Body Brave’s funding needs on an urgent basis.

Sincerely,

[Your Name]

Five ways of ‘Be’ing a mindfulness-based, anti-oppressive eating disorder practitioner

Written by Carrie Pollard, MSW RSW

A client has been referred to you that struggles with rigid rules around eating and exercise to the point that it has caused significant weight loss and interferes with this client’s day-to-day life. What do you picture in your mind? What assumptions did you make about this client’s age? Sex? Gender expression and identity? Race?  Religion? Body size?  Did you imagine this person to be able-bodied? Eating disorders do not discriminate, yet marginalized populations are not only higher at risk, but they also have differential access to care, are underrepresented in research and are often misdiagnosed in clinical and medical settings.[i]

When we have biases about the folx we work with, we can cause significant harm and distrust. Engaging in our own inner work to examine and challenge our implicit biases and beliefs, and acknowledging our privileges is critical to providing informed, compassionate care.

Before moving forward with my ‘Top 5’ list, please recognize that this is a simple list about serious and important work and is, by no means, comprehensive enough. It has also been written from my lens as a cisgendered, heterosexual, white, able-bodied, registered social worker that has a parent that is an eating disorder warrior in ongoing recovery. The suggestions I make on how to work from a mindfulness-based, anti-oppressive practice in eating disorder care are reflections of this and will continue to change as I grow as a person. I hope they provide some guidance on how to do your own work.

1.       Be vulnerable. Dig deep and explore how your identity (and all the intersections that inform it) and experiences have shaped your beliefs about yourself, others, and the world. Acknowledge your privileges and how it informs hurtful beliefs, biases, and actions. This includes blindness to our differences and silence in response to injustices and discrimination of others. [ii]

2.       Be mindful. Take time to pause and reflect on the language you use and how it guides questions and assessment. Learn about ways to neutralize your clinical language and be more inclusive. [iii] Acknowledge microaggressions and other harmful assumptions that present themselves in session. Mindfully slowing down this process will increase awareness and reduce defensiveness. Mindfulness also helps us recover if we’ve made an error or caused harm, so that we can compassionately be accountable, apologize, and if possible, repair.

3.       Be curious. Take courses, read books, participate in group discussions and debates, and listen and learn from the experiences of others[iv] so that your knowledge and understanding of the diverse and complex relationships folx have with food and their bodies expands.

4.       Be compassionate. We’re all imperfect and shaped by the biases of the world we exist in. In the journey to providing mindfulness-based, anti-oppressive care to our clients, we’re going to fail and feel uncomfortable… repeatedly. When this happens, we need to ‘pause for compassion’[v] (rather than shame or defensiveness) as this will better foster accountability and nurture change.  

5.       Be brave. Have courage to address your own harmful beliefs and behaviours, as well the willingness to challenge others in their practice.  Moreover, work to create a safe space for your clients and/or patients to correct and question you.

Let’s try this again…

Pause for a moment. Notice the sensation of your feet on the ground and focus on your breath. With a clearer mind, read this again:

“A client has been referred to you that struggles with rigid rules around eating and exercise to the point that it has caused significant weight loss and interferes with this client’s day-to-day life.”

Now what did you picture in your mind? I’m hoping that these practices, which help me, allow you to make less judgements and assumptions of who struggles with disordered eating and body shame.

References

[i] Doan, N. (2021). Socially Driven Inequities and Disordered Eating Experiences. Retrieved from WWEDC October 20, 2022, from http://www.eatingdisorderscoalition.ca/blog/2021/11/5/socially-driven-inequities-and-disordered-eating-experiences

NEDA. Eating Disorders and Identity. Retrieved October 20, 2022, from https://www.nationaleatingdisorders.org/identity-eating-disorders.

NEDIC. Affirming Care for Every Body. Retrieved October 24, 2022, from: https://nedic.ca/2slgbtq/

NEDIC. Eating Disorders and BIPOC Communities. Retrieved October 24, 2022, from https://nedic.ca/bipoc-initiative/

[ii] Saad, L.F., (2020). Me and white supremacy. Sourcebooks.

[iii] Millyard, A., Gilbert, C., & Liss, K. (2021). Neutralizing clinical language: Working with gender and sexual diversity. Retrieved October 20, 2022 from, https://cyndigilbert.ca/wp-content/uploads/2020/05/Neutralizing-Clinical-Language.pdf

[iv] NEDA. The Marginalized Voices Project. Retrieved October 20, 2022, from https://www.nationaleatingdisorders.org/marginalized-voices

[v] Magee, R. (2021). The inner work of racial justice: Healing ourselves and transforming our communities through mindfulness. Tarcherperigee.

Grounding Ourselves

Blog Post by Mar Ratanadawong McM | BScH, Wellness Educator and Science Communicator

Autumn is a season of reflection, a time for us to look back on the year thus far and determine what has and has not worked for us in terms of self-care and recovery. It is a time to release that which does not serve us and open our hearts to new ways of doing.

The transition from summer to autumn brings many welcome changes to the world around us—crisp and cool air, bright crunchy leaves, and shorter days ahead. These seasonal changes bring all sorts of new sights and scenes for us to enjoy, but sometimes this shift in the environment brings about an increase in stressors for those navigating recovery from an eating disorder or disordered eating behaviours. 

              The recovery process involves much thoughtfulness and planning, but that doesn’t mean you’re not allowed to live in the moment! Being present and grounding oneself is a great way to check-in on your mood, and the sensations in and around your body.

              One great method of bringing your attention back to the present is to take a few intentional, slow, and deep breaths. Try to expand your lungs fully by opening your chest and relaxing your shoulders. Once you’ve found your breath, another great method for tuning into the world around us is the 54321 technique1.

First, acknowledge five things you can see in your surroundings. Describe them. What colours do you see? What shapes?

Second, acknowledge four things you can touch around you. Is the object soft? Hard? What about its texture? How does it feel in your hand?

Third, acknowledge three things you can hear. Focus on things outside of your body. Is there a dog barking in the distance? Can you hear the breeze blowing by?

Fourth, acknowledge two things you can smell. Describe it. Do you enjoy the scent? What sort of profile does it give off?

Finally, acknowledge one thing you can taste. What does the inside of your mouth taste like? Minty fresh? Coffee breath?

Whenever you’re feeling overwhelmed, it’s important to recognize that this feeling is temporary, and that it is possible to learn practical skills to quell your anxieties.

By checking in with our surroundings, we are able to ground ourselves and sooth what may be anxious or overwhelming thoughts. Living in the moment allows us to experience the beauty of the world around us in a fashion free of the judgement that often comes with comparisons of our pasts, and concerns for our futures.

What are some ways you’re looking forward to healing your body and mind this season? Write it down! Tell your dog! Share your joys and excitement with a close pal! Involving your community in your practices allows for both the experience of mutual joy, as well as accountability for activities that make you and your body happy.

Wishing you all a healing season of reflection.  

References

1.      Smith, S. (n.d.). 5-4-3-2-1 coping technique for anxiety. BHP Blog - Behavioral Health Partners (BHP) - University of Rochester Medical Center. Retrieved October 11, 2022, from https://www.urmc.rochester.edu/behavioral-health-partners/bhp-blog/april-2018/5-4-3-2-1-coping-technique-for-anxiety.aspx 

Navigating Body Image in the Summertime

Harkamal Samra, Biomedical Science Student and Body Project Facilitator at the University of Guelph

The arrival of warmer weather paired with increased sunshine is highly anticipated, yet, often also accompanied by unwanted, negative feelings that pertain to body image. For many of us, the summer months may lack the structure and routine we were comfortable following throughout the rest of the year, which may naturally offset our internal dialogues and mental health. 

The summer months are also a time for airbrushed commercials advertising everything from clothes, diets, and workout plans, to vacations that fit a specific summer aesthetic. During this time, everyone is vulnerable to negative self-talk in the context of body image, regardless of gender, age, and ethnicity. It may be helpful to figure out a guideline for navigating thoughts about body image during the summer.

1.     Spend less time consuming media that negatively weigh on your mental state. 

Actively practicing mindful consumption can equip us with the ability to use our time online in valuable ways that align with our personal goals. This one seems intuitive enough but is easily overlooked given the accessibility and prevalence of social media. A 2017 RSPH survey of young people aged 14-24 found that apps like Instagram are the most detrimental to mental health as they can cause increased anxiety, loneliness, and comparison (RSPH, 2017). The ability to apply self-awareness and recognize the thin line between the benefits and the detrimental aspects of our engagement online requires an established intent to protect oneself from harmful media influences. 

Therefore, begin with internalizing this intent. Vigorously limit your interactions with any form of media that makes you feel uneasy or that you notice leads to episodes of negative self-talk. Over time, these thoughts can seep into our subconscious, and it will require additional effort to recognize their presence. Eventually, you'll build a rapport with the version of yourself that refuses to permit harmful engagement with content online, and your internal dialogue will become as simple as, "I don't like the way that made me feel, so I'll stay away from it for a bit." 

Obviously, social media's very much the 8th wonder of the world, and its perks remain true. The disadvantages mentioned above are also valid, and the two truths coincide. Limiting your use will ultimately limit your comparisons, so use it to connect, not to compare. 

2.     Be mindful of your internal dialogue. 

This one coincides with the idea of being mindful in your daily life of how you interact with the world and, more importantly, with yourself. Sometimes, it can be helpful to slow down and recognize our thought patterns from a third person's perspective. You can even go as far as to think about whether or not you'd support the dialogue you're noticing if you saw it in a friend. This perspective can often help us realize whether or not our feelings are objectively true or if they're merely feelings with no concrete justifications. 

You can keep a journal, record yourself, meditate, use your notes app, talk to a friend, or use whichever methods of reflection work for you. In the end, understanding the way in which you think can help you figure out why you think that way and whether or not you'd like to change something.

3.     Wear what makes you feel good. 

Summer doesn't have a dress code, and you're more than welcome to don whatever outfit you'd like, whenever you'd like. It’s okay to be less covered up and wear more revealing clothes, if that's what makes you feel comfortable in your own skin. It is also acceptable to not necessarily update your reveal-o-meter according to the weather, as long as the latter point about comfort remains true. So long as you feel good about what you're wearing and it’s a reflection of the choices you've made for yourself instead of what you think is supposed to be the right way to go about dressing, you’re good to go. 

4.     Maintain a restorative support network. 

Don't be afraid to check-in with your close friends and family in order to offer your support or just an ear to share concerns, experiences, or perspectives. Also don't hesitate to personally reach out to your network if it’s you who's in need of their support. If you were seeing a therapist, dietiteian, or counsellor, continue following your regular meeting schedule, as these people are avenues to a healthy internal dialogue. 

The onset of summer can encompass many opportunities for increased connections, introspection, and growth. With respect to the influences of warmer weather on our thoughts surrounding body image, we can ease our experience through mindfully consuming social media, preserving a healthy internal dialogue, wearing clothes that make us feel good, and maintaining a restorative support network. 

RSPH. (2017, May 19). Instagram ranked worst for Young People's Mental Health. RSPH. Retrieved from https://www.rsph.org.uk/about-us/news/instagram-ranked-worst-for-young-people-s-mental-health.html

Ditch the Diet for Good - Here are 5 Ways to Participate in International No Diet Day

Written by Leanne Richardson, Registered Dietitian, MPH, Upper Grand Family Health Team & Lindzie O’Reilly, MAN, Registered Dietitian, University of Guelph

Join the Waterloo Wellington Eating Disorders Coalition on May 6 as we advocate against dieting on International No Diet Day. This day is about challenging the idea that there is one “acceptable” body size or shape, and pushing back against the industries that promote and benefit from harmful diet culture.

Dieting can be defined as any intentional change to our lifestyle (modifying food habits, exercise routine, supplements) for the sole purpose of changing our weight or shape. Although the word diet, or declaration, "I'm on a diet," is approached by many with good intentions, dieting can be harmful to our physical and mental health - we know that dieting is generally the first behavioral step towards developing an eating disorder. The act of dieting normalizes disordered eating behaviours such as preoccupation with “good vs. bad” food, calorie counting and measuring portion sizes, and can make food seem like the enemy. And let’s face it, diets don’t always improve (and often actually impair) your health. People who repeatedly lose and gain weight (also known as weight cycling) have a higher risk of heart disease than those who have a stable weight. Diets can rob you of energy, time and money and weight loss industries are the ones making the profit. The global market for weight loss products and services is set to reach $377.3 billion by 2026. If you're bending over backwards to be on a diet, it might be time to think about a more sustainable approach.

On this International No Diet Day, let this be a reminder to folks that there is no one-size-fits all approach, and everyone’s path and journey towards health and well-being will look very different.

Here are five ways you can participate in International No Diet Day (and beyond):

1.     Experiment with different activities to find one you enjoy doing! Moving your body is meant to be enjoyable and should not be grueling, painful or used as a form of punishment.

2.     Eat when your body tells you it needs fuel. You may feel stomach grumbles, but other signs may include feeling tired or irritable, having trouble concentrating, or having a headache.

3.     Notice how your body responds to food and eat a portion size that satisfies you, energizes you, or tastes good to you. Portion sizes are different from serving sizes, which are listed on a food package or box in order to give us information about macro and micronutrients. Your body may need more than the “serving size” amount.

4.     Refrain from labeling foods as “good”, “bad”, “healthy” or “unhealthy”. Call food what it is and accept that all foods can fit within your daily eating routine.

5.     Unfollow social media accounts that promote restrictive diets, weight loss supplements or an “ideal” body type. Follow accounts that promote joyful movement, nourishment and body acceptance for all shapes and sizes. Unsure where to start? Some of my personal favourites on Instagram are @lizzobeeating, @aliciamccarvell, and @thebirdspapaya.

If you are engaging in risky behaviours such as exercising to punish or change your body, limiting yourself to certain foods or portion sizes even if your body gives you cues that it wants more, or regularly under- or over-eating as an emotional coping strategy, you’re not alone. Reach out for support and build additional tools in your toolbox. See the Resources section of our website for support.

Check us out on Facebook and Instagram to see positive INDD messages on May 6th. Spread the word in your own networks and make a difference today!

Source: www.NEDIC.ca

Speaking the Language of Eating Disorders: Understanding Acronyms

Written by: Vanessa Hart, OT Reg. (Ont.) (she/her/hers)

AX completed by MRP, and RN. 28M meets the DSM DX criteria for AFRID, and OCD. Client has HX of MDD, and has completed outpatient CBT and CPT in the past. ECG was normal. TX plan is for client to complete DBT groups, as well as meet with OT for RTW intervention. SW will support for D/C planning including navigation of NEDIC resources, and to schedule appointment with GP.

Was reading that paragraph difficult? It is for most people. Professionals that are involved with eating disorder treatment, from therapists to doctors, often communicate in what seems like an alien language. Acronyms or short forms are used to more easily and quickly communicate ideas. Unfortunately, for those who do not have much experience within the medical world, these short forms are confusing and can make information difficult to understand.

For this reason, I (Vanessa, an Occupational Therapist working in an inpatient eating disorder rehabilitation program) have created a handy list of common acronyms that are found in eating disorder related treatment information and professional notes. We hope that this helps to make more sense of the alien language that surrounds you!

P.S. Send us an e-mail if you think we missed something :)

ACT: Acceptance and Commitment Therapy

AN: Anorexia nervosa

ADD: Attention Deficit Disorder

ADHD: Attention Deficit Hyperactivity Disorder

ARFID: Avoidant/Restrictive Food Intake Disorder

ASD: Autism Spectrum Disorder

AX: Assessment

BDD: Body Dysmorphic Disorder

BED: Binge Eating Disorder

BMI: Body Mass Index

BMR: Base Metabolic Rate

BN: Bulimia Nervosa

BPD: Borderline Personality Disorder

CBT-E: Enhanced Cognitive Behavioral Therapy (for eating disorders)

CPF-E – Compassion focused therapy for eating disorders

CPT: Cognitive Processing Therapy

CHSP: Chewing and spitting

DBT: Dialectical Behavior Therapy

DOC: Drug of choice

DSM: Diagnostic and Statistical Manual of Mental Health Disorders

DX: Diagnosis

D/C: Discharge

ECG: Electrocardiogram

ECT: Electroconvulsive Therapy

ED: Eating Disorder

EDNOS: Eating Disorder Not Otherwise Specified

ERP: Exposure and response prevention therapy

FBT: Family-based Therapy

GAD: Generalized Anxiety Disorder

GP: General Practitioner (Family Doctor)

HX: History

IOP: Intensive outpatient program

IP: In-patient

IT: Interpersonal Therapy

Inpatient: Treatment within a hospital or residential setting

MDD: Major depressive disorder (depression)

MET: Motivational Enhancement Therapy

MI: Motivational Interviewing

MP/MRP: Most responsible physician

MSE: Mental Status Exam

NEDIC: National eating disorder information center

NG: Nasogastric Feeding

NP: Nurse Practitioner

OCD: Obsessive-compulsive Disorder

OP: Out-patient

OT: Occupational Therapist

OTC: Over the counter (medication)

OSFED: Other specified feeding and eating disorders

Outpatient: Treatment outside of the hospital

PHP: Physician health program

PRN: As needed (often in reference to medication)

PT: Physical Therapist or patient (pt.)

PTSD: Post-traumatic stress disorder

RD: Registered Dietician

RP: Registered Psychotherapist

RT: Recreation therapist

RTW: Return to work

RTS: Return to school

RN: Registered Nurse

SI: Suicidal ideation and/or self-injury

SH: Self harm

SIB: Self Injurious Behavior

SW: Social Worker

TIB: Therapy interfering behavior

TW: Trigger warning

TX: Treatment

UFED: Unspecified feeding or eating disorder

Try reading the paragraph from the beginning of the article again. Does it make more sense? Learning the language of the health care system takes time. I am hoping that this reference guide can be a helpful start. Please comment below if we missed anything! Thanks for reading.

When it comes to eating disorders, everyone has a role to play

Written by Natalie Doan, MSc, PhD candidate at University of Waterloo in Public Health Sciences

Whether that someone is your friend, colleague, patient, student, or loved one, it can be a challenge to decide how you can best support someone with an eating disorder.

The theme of this year’s Eating Disorders Awareness Week 2022 is “everyone has a role to play”. In collaboration with Body Brave, Bulimia Anorexia Nervosa Association, Eating Disorder Support Network of Alberta, Hopewell Eating Disorder Support Centre, National Initiative for Eating Disorders, and Sheena's Place we have developed a conversation guide outlining tips and consideration that we hope you find helpful!

Providing support as a friend of colleague

Before approaching a friend or colleague

-       Become informed: learn about the signs and symptoms, risk factors, myths, and where your friend/colleague can go for support (visit nedic.ca).

-       Avoid making assumptions: you can’t tell if someone has an eating disorder, or what symptoms they have, based on why they look like.

-       Be prepared: your friend/colleague might react with denial or anger when you approach them due to stigma and feelings of shame.

While approaching a friend or colleague

-       Choose a private and comfortable setting (e.g., not during a meal).

-       Speak from the “I” perspective (e.g., “I am worried about you”).

-       Let them know that you are willing to help, while keeping your limits in mind

-       Encourage them to seek support if they are ready.

Other tips for supporting a friend or colleague

-       Avoid commenting on weight or appearance- theirs, yours, or other’s. Doing so validates unhelpful beliefs about physical appearance being a reflection of a person’s worth. Instead, compliment them on personality, skill, and non-body traits

-       Don’t force them to eat and avoid commenting on their food choices. Instead, offer to eat with them or ask them how you can be supportive around food.

-       Keep the relationship alive – engage in activities and conversations that are unrelated to food and exercise

-       Examine your own attitudes about food, weight, size, and shape. What biases might you have and how might you be conveying them to others? How does these impact your own well-being?

Providing support as an educator

Focus on nourishment

-       When teaching about food and nutrition, explain that food provides physical, emotional, social, and cultural nourishment.

-       Encourage students to eat a variety of foods that provide them with fuel and make them feel satisfied.

Highlight the complexity of food and eating

-       Encourage students to explore how family, culture, identity, and life experiences influences their relationships with food.

-       Hold space for diverse experiences and avoid making assumptions.

-       Avoid placing moral value on food, or labelling food as “good” or “bad”.

Focus on enjoyment associated with movement

-       When teaching physical activity, highlight the importance of moving in a way that makes you feel good, as opposed to moving for appearance-based reasons

Emphasize non-appearance-based changes when highlighting concern

-       If you’re worried about a student, speak to behavioural changes you observe (e.g., increased withdrawal and isolation or decreased mood and energy). Avoid commenting on perceived changes in weight.

Provide options when connecting students to resources

-       Acknowledge the courage and strength associated with asking for help.

-       Provide students with options and ask them where they would like to start.

Providing support as a medical provider

Screen for disordered eating

-       Eating disorders are dangerous and prevalent. You will encounter patients with eating disorders so it’s important to screen for them.

-       Remember that people of all demographics can develop all types of eating disorders.

-       Useful tools include the Screen for Disordered Eating (SDE), SCOFF, and EDE-Q.

Provide validation not judgement

-       Eating disorder behaviours can serve as ways of coping with distress – so for your patient, the idea of getting free of the eating disorder can be frightening.

-       Using a motivational interviewing approach can help to address ambivalence and build motivation for recovery.

Medically monitor

-       Ask about symptom frequency and severity and note any changes.

-       Monitor postural vital signs and ask about episodes of dizziness, fainting, chest pain, health palpitations, and GI symptoms.

-       Assess for psychiatric risk (depression, anxiety, substance abuse, and self-harm, and suicidality)

Collaborate and refer

-       Do not wait until your patient becomes unstable, early intervention results in better outcomes.

-       Do not underestimate the severity of an eating disorder. The patient may have a “normal” weight yet may be suffering. People of all body shapes and sizes can experience the detrimental physical and mental health consequences of an eating disorder.

Providing support as a mental health professional

Assess

-       Ask about eating and exercise habits (you won’t know unless you ask!).

-       Use formal assessments (e.g., SCOFF, EDE-Q) or informal questions (e.g., “what does an average day of eating look like?”).

-       Go beyond physical nourishment; explore your client’s social, emotional, and cultural connections to food.

Provide validation, non-judgement and trauma informed care

-       Help your client feel safe, understood, and that their distress/experiences are real.

-       Don’t make assumptions based on your client’s identity – people of all demographics experience all types of eating disorders.

-       Use trauma-informed practices (e.g., providing choice).

-       Emphasize strengths and support your client in seeing themselves as more than their eating disorder.

Apply harm reduction principles

-       Recognize eating disorder symptoms as coping strategies. It may be impossible or unrealistic for your client to give these up, as they are serving to protect them.

-       Support your client in minimizing the harm associated with symptoms.

-       Work with your client to develop safer, alternative coping strategies.

Use a weight inclusive approach

-       Reflect on your own beliefs and biases about food, bodies, and health

-       Learning about frameworks including Body Liberation, Body Neutrality, and Health at Every Size, and apply these to your practice.

-       Advocate for office seating that accommodates all bodies.

-       Use language that does not apply morality to food, eating, or movement.

Collaborate

-       Communicate with physician, dietitians, and external treatment organizations to support your client’s recovery (you don’t need to support your client alone).

-       If desired by your client, engage their family members and loved ones, as they can be a vital part of recovery.

-       Know your limits and refer to providers who have more training in EDs when necessary.

Providing support as a fitness professional

If you notice undereating, try saying:

-       “I’ve noticed that you’re really tired and I’m wondering if you may not be getting enough energy to support your workouts. Are you open to talking about this with me?”.

If you notice overexercising, try saying:

-       “I’ve noticed that you’ve been spending a lot of time at the gym lately. Rest is such an important part of working out. Maybe we could talk about incorporating some rest days into your routine?”.

If you notice over-fixation on weight, try saying:

-       “I’ve noticed that you’ve been worried about your weight and/or shape. I want you to know that weight does not represent your health. Let’s focus on exercises that improve your strength, flexibility, mobility, and overall well-being.”.

If you notice an interest in supplement and diet products, try saying:

-       “I’ve noticed that you’ve been really focused on experimenting with different supplements lately. Let’s talk about some things to look for with supplements – it can be tricky to navigate the many health claims made by companies!”.

Other reminders:

-       If you notice that someone is spending more time exercising, less time eating, and is acting less like themselves, voice your concern empathically and non-judgementally.

-       Ask how you can support them and learn about additional resources that you can offer them if they’re ready to seek external support.

Receiving support as a person with lived experience

Reach out for help

-       Acknowledge the strength it takes to recognize that you are struggling.

-       Asking for support makes you stronger and can help restore your willpower to overcome your eating disorder.

-       Find a safe space and time to discuss your experience.

-       Find a person (or people who you trust).

Talk to someone you feel comfortable with

-       Be open to the fact that they might not understand right away.

-       Don’t place blame on anyone – eating disorders are no one’s fault.

-       They may have questions, and this is normal; try not to be dismissive.

-       Involve health care professionals if it feels supportive to your recovery.

Learn about how you can access support

-       Visit nedic.ca for information about treatment and support options across Canada.

-       Many publicly-funded programs will need a referral; talking to your family doctor is a great place to start.

-       There might be a community-based eating disorder organization near you!

Practice self-compassion

-       While EDAW can spark hope and celebration of healing, it can also promote comparison. If you find yourself comparing your recovery journey to others’, try to invite self-compassion

-       Remember that change takes time, recovery is not linear, and each journey is deeply personal.

For more EDAW resources, visit nedic.ca/edaw/ and https://bana.ca/magazine/.

The benefits of group therapy for an eating disorder

Blog post written by Samantha Durfy, MA, RSW, MSW and Lindzie O’Reilly, RD, MAN

Together we work at Student Wellness Services at the University of Guelph where we see University of Guelph students for one-to-one appointments and offer a variety of groups and workshops on campus. Since Winter 2017, we have worked together to co-facilitate a Meal Support Group for University of Guelph students. That means that this semester (Winter ‘22) we are celebrating our ELEVENTH semester running this group!

Participating in group support in general and a Meal Support Group in particular can feel like an overwhelming thing. Past participants in our group have told us that this is true (it’s hard!), and they’ve also told us that it is helpful and so worth it. We wanted to take some time to discuss the challenges of group attendance as well as why going out on a limb and giving group treatment a try might be beneficial for you.

Seeking support for an eating disorder is hard. It means acknowledging harmful behaviours, asking for help, showing up and being vulnerable. Folks often delay seeking help for a number of reasons – maybe you’re afraid, you’re not sure who to ask, or what to ask for. Maybe you’re not sure what help will look like or the changes you will be encouraged to make. Many of the folks we see worry that they aren’t sick enough or that asking for help means taking away a place from someone else.

While taking the initial steps towards deciding to make changes and asking for help is hard, some folks can find it even harder to wrap their head around the idea of participating in group treatment. Attending a group that occurs at a regular time each week can be challenging to balance amidst a busy schedule and a busy life. It means prioritizing your well-being and recovery goals each and every week and fighting against an eating disorder that will tell you that there are many other things that you should be doing instead with your time. Attending a group also usually means active participation. In a group like Meal Support Group, not only do you have to show up, but you also have to participate (i.e., eating a full meal with others). Attending a group means convincing yourself that you are deserving of support and deserve to take up space in a group. Perhaps most challenging of all, attending a group can bring up strong thoughts of comparison making (“what if I’m eating too much?”, “what if I’m eating the wrong thing?”, “what if I’m not sick enough?”), and we all know that eating disorders are experts at comparison.

Despite the above challenges of attending a group, Meal Support Group attendees overwhelmingly report that attending the group was worth-while and something they are glad that they did, so much so that many of our group members have attended Meal Support Group multiple semesters.  One of the most significant positive experiences in attending a group is the feeling that you are not alone.  A former Meal Support Group member shared that going to group was a validating experience and that “knowing that others are going through or have gone through something similar to what I am experiencing” was extremely helpful.   Another member stated “attending group helps me to know I am not alone” even when their eating disorder tries to tell them otherwise. Group members have shared that attending Meal Support Group has helped them to stay accountable to their recovery goals and to take on challenges that might feel too daunting or scary on their own. A former Meal Support Group member shared that the group kept them accountable to their goals and allowed them to join in on the group food challenge, which they were unsure they would have done without the support of the group.  Eating in a group setting can also help group members work on their pacing, whether that’s to slow down or quicken their pace. 

For folks with an eating disorder, meals with others can feel challenging due to fear of judgment from others; however, group members noted that the Meal Support Group was without judgment and was a safe space to work on their recovery goals.  While still challenging to eat in front of others, we aim to create a safe space in group that allows participants to practice eating in a social situation so that perhaps it might become easier in time to participate in meals with family members, friends and loved ones. Group members shared that the conversation during the meals amongst the group members and leaders helped to distract from any anxiety or difficult thoughts.  Group members also found it helpful to discuss a plan for skills to use before, during and after the meal to manage any difficult urges. 

Research in eating disorders recovery strongly supports and recommends that in addition to individual supports that folks working on recovery from an eating disorder also attend group supports.  It’s what is considered to be best practice.  Former Meal Support Group members have told us countless times that coming to group and eating their full meal is hard AND it’s worth it! If you’re having doubts about attending a group, we hope that you will give groups a try – we believe that in a group you will learn that you are deserving of recovery, you are not alone, and recovery is possible!

Navigating Recovery while Pregnant and Lessons Learned along the Way

Blog post written by Kendra

For the longest time I felt as though I had my recovery under control; I felt a sense of calm and stability in regards to my relationship to food and self. I was however, always cautious when speaking to my recovery and very intentional about situating myself as “in recovery” as opposed to “recovered” because I knew all too well that the small voice in my head never really went away for good. It was quiet, almost non-existent for months on end, however there were also times when it came back full force and made every effort to make its presence known, and take over control. It was something I learned to expect, or moreover just to be on alert for, knowing that when it came, I had the skills and resources to lean on and get my recovery back on track.

But then I got pregnant. I had a beautiful baby boy and then had a second pregnancy and a beautiful baby girl. This is when everything I thought I knew about myself and my recovery got flipped upside down and turned inside out. While I thought I was super aware of myself and equipped to face challenges, I don’t think I could have ever prepared myself for the journey pregnancy and my eating disorder were about to take me on.

Before I get any further, I think it’s so important to acknowledge that having a family of my own was one of my biggest motivators for recovery. I knew more than anything I wanted to be a mom one day and more often than not this was a dream I leaned on when facing some of the biggest challenges in those initial years of recovery.

So to be honest, when it reached the point that my husband and I were ready to discuss growing our family, I did not give two thoughts to the role my eating disorder would play in this journey. I was so thrilled to know I had reached so many of my goals and that one of my dreams was feeling like it could soon be a reality.

Here is where I typically pause in my story. And it’s not because I am choosing to deny the challenges, I actually feel very open to discussing them, but it is because I am worried about what others might perceive of me. Pregnancy is such a beautiful gift and full of so much joy, yet this is not always the full picture and honoring that felt hard at times. I wanted to be glowing, I wanted to take weekly bump photos, I wanted to wear nice maternity clothes, I wanted to get a maternity photo shoot but my eating disorder had other plans. In every effort to take care of myself and the sweet gift growing inside of me, I had this awful voice in my head trying to steal the joy and take control. It was hard. I felt shame. I felt discouraged. And I truly had moments where I didn’t think I would make it through the nine months. But I did, and that is something I am so very proud to say. And while there is a part of me that really wishes this was not a part of my pregnancy journey, I accept that it was, and would love to share some of the things I learnt through all of this.

First and foremost, my eating disorder does not define me. This was a hard one to navigate and one I constantly went back and forth thinking about. I worried that if I accepted some of the challenges I was having it would translate to me not being a good mom. That I wasn’t caring enough and too selfish, and that people would tell me to get over it. I smile as I write this now and being on the other side of things because of how twisted this sounds now, but at the time I felt it. What I know now is that my eating disorder was and still is a small part of me. And while it felt as though its presence was so powerful through this season of life, it did not define me as a person and definitely not as a mom to be.

The second thing was recognizing that for the first time in my life, my body was now needing nourishment for more than just myself. This was hard and something I lost sight of quite often, almost daily, thinking that I was just different than everyone else. The emotions that came with this were huge. I felt guilt for not thinking differently, and questioned my morals and values as a human being. I worried that I was not able to put the needs of another person first and I would get angry with myself for even thinking it was ok to engage in eating disorder behaviours. But again this was the eating disorder talking and not me. And in fact the eating disorder was very wrong every time it came to nourishing my body. I did need more energy than I ever had in the past and this didn’t make me out of control (as my eating disorder would often try and convince me) but instead it allowed me to create a safe and nurturing home for my sweet babies to grow.

Another thing is that with pregnancy comes changes to your body and there is no way to avoid this. I spent so much time worrying about how I could get my body to change as little as possible and worrying about where I would be after delivering my baby. Truth is, pregnancy changes our bodies and everyone’s body changes differently and there is absolutely no way to control this. Gosh, this was hard to wrap my mind around and challenged so many of my thoughts around body image, but it was unavoidable. As I look back, I wish I spent more time celebrating the changes my body went through as opposed to hiding away hoping they wouldn’t happen.

Lastly, it was so important that I reach out for support. Like I said, I always felt fairly confident in my recovery skills and felt as though I had a solid support system around me but at this time, I needed to grow it. I needed to include my midwives. I needed to include my doctor. I even reached out to a therapist that specializes in pre and post-partum care to talk through some of the feelings I was having. I had to ask my family for more support than I typically did. And while I know reaching out for support is something that is talked about so often, it was crucial I embraced this and leaned on whoever I could to get through these times.

I feel as though I could go over for pages on this topic and I am hopeful this is a topic we can begin talking more about. But as I leave today the one piece I hope stands out to everyone is that, struggling with an eating disorder, during pregnancy or not, does not define you as a human being. Recovery is not linear, and even when you feel like things are going well, it is okay to fall back and struggle again. While this journey was hard to walk through, now that I am on the other side I hope that my experience can bring hope, compassion and perspective to someone else.

Navigating diet talks at holiday events

Blog post written by Therese Kenny, MSc

As we near the transition from 2021 to 2022, many of us will be spending more time with friends and families. After what has undoubtably been a challenging 21 months, this may be the first time that some of us are seeing certain people in person. Of course, for many, this may bring up concerns about changes in appearance; we are all familiar with the unsolicited weight, body, and food comments that come up this time of year, and the increased time apart may seemingly invite more of these.

              Although it would be fan-freaking-tastic if everyone were knowledgeable about the negative impacts of comments about weight, bodies, and food, this is not the reality. We may then need to set boundaries with family members or friends in order to keep ourselves feeling safe. One way to do this is to set guidelines ahead of time. You may want to reach out to people who are closest to you and express the desire to avoid diet talk this year. It is up to you how much you share about why this is important to you, but letting people know ahead of time can help them understand that (and why) you may change the subject or leave a conversation.

              Unfortunately, asking to avoid these topics often does not prevent all diet talk and so we need to be prepared to respond to unsolicited comments or advice in or after the moment. There are many approaches to doing this and it will ultimately, depend on your level of comfort addressing this topic with people around you. Before attending a function, take a moment to consider who will (or may) be there and your level of comfort with these individuals. Then, you can plan ahead to have some of these strategies in your back pocket.

1.       Ignore: If I am at an event with people that I do not know super well and someone makes an offhand comment, I often choose to ignore it. For me, I do not feel that a public setting is the time or place to have a conversation with someone I do not really know and may not see frequently. If however, the comments persist, I may take a different course of action. An example of when you may want to ignore could be an extended family member commenting on your appearance when you first see them.

2.       Change the subject: If the comments continue and you are feeling uncomfortable (or even if the single comment was enough to send you spinning), you may want to change the subject. You can do this by subtly redirecting the conversation or by making an obvious statement to indicate that the conversation is over. I was once at a training where we were practicing derailing diet talk, and a colleague used the example of, ‘So what about the political climate in America?’ Depending on who you are with, you may choose a less inciting statement, but you get the idea! If you are uncomfortable with shifting the topic, you may want to confide in a trusted friend or family member who can redirect the conversation for you when it gets into unhelpful areas.

3.       Ask for something to change: You may also choose to have a conversation with someone about how their comments are affecting you and what they can change to support you. Depending on the situation, you may want to have this before, during, or after the event. A good acronym to help you structure this conversation is DEAR:

Describe: First, you want to describe the facts of the situation (not your feelings or interpretation). For example, you might say, ‘Last night at the dinner table, you made a comment about needing to go to the gym after having eaten.’ This statement describes what happened in a non-judgmental way.

Express: You will then express how the situation made you feel. While our inclination may be to tell the other person how they made us feel, it is often more effective to express our own feelings without blame or judgment. In the example above, I might say, ‘When I hear statements like these, it triggers thoughts of needing to lose weight, which makes it harder to engage in my recovery journey’ as opposed to ‘Your comments make me feel crappy.’

Assert: A is the most important step. It is what we are going to ask for in our conversation. Before you enter into the conversation, it is helpful to know what you are asking for. Would you like everybody at the party to avoid all diet talk? Do you want your friend to be more mindful of what they say? Being clear about our ask is important in that it helps us get our needs met or to determine that our needs cannot be met in a particular situation. For example, a friend who is deeply invested in diet culture may have difficulty shifting conversation and thus, you may need to think of other strategies for interacting with this person. In the current situation, an example of an assertion could be, ‘I would appreciate if you could not talk about diets, weight, food, or exercise around me.’

Reinforce: Finally, we want to reinforce what we are asking for. We are asking for something from someone else and want to demonstrate or highlight how this will also benefit them. Sometimes this could be a tangible benefit (e.g., a worker asking for a raise who will do better work if they are appropriately compensated). Sometimes this could be appreciation or gratitude (e.g., appreciating someone’s attempts to be more mindful of triggers). Here I might give examples of both, ‘I would really appreciate if you could do this as it will make me feel safer. I also think that you may notice some benefits from not always talking about these subjects!’

4.       Have a conversation: With certain relatives and friends, you may feel open to having a conversation about the ways in which these comments affect you. Engaging in this dialogue in an open and honest way can be helpful in supporting others to understand you. It however, also carries risks in that another person may not be able to see your perspective or may not understand why this is so upsetting to you. You are the best judge of your own tolerance of this risk, as well as of your friends’ and family’s openness to difficult conversations. Depending on your stress levels, the middle of a party may not be the best time to have this conversation; however, the next day over coffee may feel manageable. Your level of comfort dictates how much or little you want to share about your personal experience. If you are not feeling comfortable disclosing, you may choose to share a resource, such as this article (https://www.self.com/story/body-talk-consent) about the impact of these statements.

5.       Leave: Sometimes, despite our best efforts, openness, and willingness to engage in dialogue, people are not ready to change how they talk. Other times, we may just feel exhausted by all the diet and body talk and not have the energy to redirect, ignore, or comment on it. This is your annual reminder that it is okay to leave! You can leave the conversation, the room, or the event. Having a supportive friend who can help you with this can be beneficial.

This time of year can be challenging for many reasons. Planning ahead for possibly triggering, harmful, or uncomfortable statements can be helpful in managing your mental health this holiday season.

The Forgotten Origins of the Body Positivity Movement

Blog written by Tamanna Nijjar, Arts and Science Student at the University of Guelph

#beautifulasis #bodypositivity #loveyourbody #effbeautystandards #bodyacceptance #allbodiesarebeautiful 

I’m sure you have read these hashtags at some point while scrolling through social media. What a great way to empower individuals to embrace their true selves. Isn’t it? But it’s common to see these hashtags thrown around by brands and social media influencers to gain followers and a positive image on social media rather than promote the true message behind the movement. 

So, what are the origins of body positivity?

 It began with Fat Activism in the 1960s when the women’s liberation movement and Black Civil Rights were gaining momentum. It was common to see Black women labeled as fat, ugly, and sluggish in the media which allowed the movement to focus on fatphobia as the product of misogyny and racism. Those with marginalized bodies were given a voice to advocate for body acceptance in colored individuals and those who identified as LGBTQ+. These individuals strived to create a safe and accepting environment for those who did not fit the strict beauty standards of that period.

The issue in modern society is that the movement has caused those with marginalized bodies to become more marginalized. Mainstream media is constantly overlooking the fact that there are women that don’t classify as white, hourglass-figured, and a US size 12 and are learning to love their bodies as well. It is common to see white fitness influencers and celebrities promote hashtags by showcasing their flaws on social media. But these bodies have always been accepted by the media, and now they are used to erase the roots of a movement that promoted appreciation towards colorism and gender identity regardless of body size and shape.  As we see more white women embracing their bodies while promoting the hashtag, we don’t see many colored women in the media embracing their beautiful organic bodies. This is due to the fear of being compared to their white counterparts and facing backlash. 

Hence, society has whitewashed the body positivity movement. 

This raises the question of what Black women are doing to take back the movement. Many Black women are using social media platforms to redefine and expand the body-positivity movement. It is encouraged to support these Black influencers and amplify their voices to create a movement that is more focused on diversity. Many of these influencers can be found Instagram, a popular social media platform.

«  @StephanieYeboah posts great content on fatphobia and moving towards fat acceptance.

«  @TiffanyIman, her content focuses on separating body weight and confidence to empower individuals to believe that they are more than the number on the scale.

«  @laurenleavellfitness posts fitness content for all bodies and discusses ways to dismantle diet culture while still embracing the body positivity movement.

«  @itsmekellieb created the #FatatFashionWeek series to emphasize that fashion can be enjoyed by anyone, especially those living in bigger bodies.  

Overall, body positivity cannot be recognized without its fat activist ancestors that paved the way for body acceptance regardless of gender identity and color in a society that strongly favored those with unmarginalized bodies. A body-positive movement without fat people, Black people, and those with marginalized bodies isn’t truly a body-positivity movement. 

Cheers to #BodyPositivityInColor – BIPOC individuals are encouraged to use this hashtag to restore the roots of the body positive movement.

References

BBC. (2021, October 26). The history of the Body Positivity Movement. BBC Bitesize. Retrieved from  https://www.bbc.co.uk/bitesize/articles/z2w7dp3.

Johnson, M. (2019, March 5). If you ever felt like body positivity wasn't for you, here's why. Healthline. Retrieved from https://www.healthline.com/health/beauty-skin-care/body-positivity-origins#9.

Johnson, R. (2021, May 3). Has the body positivity movement forgotten its roots? THE UNTITLED MAGAZINE. Retrieved from http://untitled-magazine.com/has-the-body-positivity-movement-forgotten-its-roots/.

Miller, K. (2020, June 22). How whiteness killed the Body Positive Movement. Medium. Retrieved from https://elemental.medium.com/how-whiteness-killed-the-body-positive-movement-4c185773101e.

Socially driven inequities and disordered eating experiences

Written by Natalie Doan, MSc, PhD candidate, School of Public Health Sciences

Eating disorders are increasingly understood to affect people of any weight and size, as well as a diverse range of people with different racial and cultural backgrounds, gender identity, sexual orientation, and socioeconomic status. Given the diversity in which eating disorders can present, it is important to highlight the heterogeneity in disordered eating experiences and identify the links to systems of power and oppression. When discussing the social determinants related to eating disorders, it is important to highlight the systems of power that undergird inequities. For example, when discussing disparities related to socioeconomic status, we can shift our language to explicitly identify income inequality as the driver of inequities, rather than socioeconomic status.

Racism

In many ways, the bodies we have been taught to value have been coloured by white supremacy. To understand the origins of fat phobia and its consequences on our prevailing attitudes towards body size, it is necessary to understand its roots in anti-Black racism. During the period of the transatlantic slave trade, body size was violently used as a marker to characterize people who were deemed to not deserve freedom. Although this period of time has passed, our attitudes towards body size continue to ascribe to the notion that it is okay to objectify certain bodies, in particular fat bodies.

Weight stigma

In recent years, research has highlighted the pervasive impact of weight stigma, discrimination, and bias. It is important to note, although individuals of any BMI and weight may experience weight-based discrimination, weight bias affects individuals classified as “overweight” or “obese” by Body Mass Index (BMI) standards differently than individuals whose bodies are not classified using these labels. Weight-based stigma is associated with multiple psychosocial experiences that are often seen alongside disordered eating, including depression, body dissatisfaction, and low-self esteem. Although weight-based stigma is associated with disordered eating behaviours, such as binge eating and purging, it can also serve as a barrier to seeking help for an eating disorder due to the stereotyping of eating disorders as only affecting people who are thin.

Gender identity and passing

Research has found that individuals whose gender identity falls outside the gender binary (e.g., transgender individuals) report more disordered eating behaviours (e.g., use of diet pills or laxatives) than compared to cisgender individuals. To conform more closely with their gender identity, non-binary individuals may engage in behaviours in an effort to influence the shape of their bodies. For example, transgender individuals may attempt to delay or suppress the development of secondary sex characteristics, such as breast and genital growth, to mitigate body dissatisfaction.

Food insecurity

It is important to consider the influence of experiencing food insecurity on one’s relationship with food. Emerging research has demonstrated the importance of considering the experience of the ‘feast or famine cycle’ in which food intake oscillates as food availability fluctuates between periods of food scarcity and relative food abundance. For example, individuals may experience fluctuations in food availability that can align with an influx of funds for food at the beginning of a pay period and limited food availability when funds are exhausted. This cycle can result in a cycle of restriction and relatively high intake that may be inadvertently amplified by some approaches to alleviate food insecurity, such as the U.S. Supplemental Nutrition Assistance Program.

In summary, disordered eating experiences can sometimes reflect responses to disordered social conditions. It is crucial that we intentionally discuss socially-driven inequities in eating disorder spaces. Creating space for these conversations is vital to support social justice for all.

References

Becker, C. B., Middlemass, K., Taylor, B., Johnson, C., & Gomez, F. (2017). Food insecurity and eating disorder pathology. International Journal of Eating Disorders, 50(9), 1031-1040.

Diemer, E. W., White Hughto, J. M., Gordon, A. R., Guss, C., Austin, S. B., & Reisner, S. L. (2018). Beyond the binary: differences in eating disorder prevalence by gender identity in a transgender sample. Transgender Health, 3(1), 17-23.

Dinour, L. M., Bergen, D., & Yeh, M. C. (2007). The Food Insecurity–Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play. Journal of the American Dietetic Association, 107(11), 1952–1961.

Friedman K. E., Reichmann, S. K., Costanzo, P. R., Zelli, A., Ashmore, J. A., & Musante, G. J. (2005). Weight stigmatization and ideological beliefs: relation to psychological functioning in obese adults. Obesity research, 13(5), 907-916.

Hazzard, V. M., Loth, K. A., Hooper, L., & Becker, C. B. (2020). Food Insecurity and Eating Disorders: a Review of Emerging Evidence. Current Psychiatry Reports, 22(12).

O'Brien, K. S., Latner, J. D., Puhl, R. M., Vartanian, L. R., Giles, C., Griva, K., & Carter, A. (2016). The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite, 102, 70-76.

Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: a review and update. Obesity, 17(5), 941.

Puhl, R. M., Moss‐Racusin, C. A., & Schwartz, M. B. (2007). Internalization of weight bias: implications for binge eating and emotional well‐being. Obesity, 15(1), 19-23.

Puhl, R., & Suh, Y. (2015). Stigma and eating and weight disorders. Current psychiatry reports, 17(3), 1-10.

Strings, S. (2019). Fearing the Black Body. New York University Press.

Taylor, S. R. (2021). The body is not an apology: The power of radical self-love. Berrett-Koehler Publishers.

Natalie’s research focuses on applying an intersectional approach to address socially-driven dietary and health inequities.

Making the Transition to College or University

Written by Carla Giddings OT Reg. (Ont.), Canadian Mental Health Association, Eating Disorders Program

It’s that time of year! Within the context of the COVID-19 pandemic disruptions, we find ourselves at the beginning of another school year. As an occupational therapist, I’ve worked alongside students to transition to College and University for the first time, re-adjust plans along the way, and return after taking a leave of absence for eating disorder (ED) treatment. Over the years, College and University students have taught me much about the many paths to and through school.

1. Assess your school readiness:

Is this the right time for school? If you’re already in school, does it make sense to return this year or take a break?  Is your recovery at a place where you can take on new experiences and stressors? How do you want to engage with school? Lauren Muhlheim and Katie Grubiak (2015) recommend being symptom-free from an ED for six months before attending post-secondary. They offer a checklist to think through when deciding if school is the best option for your recovery and education/career goals. For many people, this might mean deferring (i.e., delaying the start of school) or taking a break to focus on recovery. Most Universities/Colleges have options for deferring from one semester to one year, and supports for a leave of absence.  

Be mindful of “all or nothing” or perfectionist thoughts about school like “I need to attend University full-time living in residence or not at all”. You have options! You might want to test out College or University by taking 1 or 2 courses through distance education. Maybe you keep your living situation consistent for the added structure and support. If this is where you’re at, that’s completely ok.

If after careful consideration, you think it’s the right time for post-secondary, read on for more ideas.

2. Match your school schedule to your recovery needs:

I know as a student, I was completely unaware of options for taking part-time or a partial course load. I thought I needed to be enrolled in a full-time program taking 5 courses each semester. This is not true! There are lots of options for taking fewer courses. Going to school at your own pace that supports your wellbeing will mean you have space to engage in the process more fully like making new friends, getting to know a new city, and exploring new interests. It also means you reduce your likeliness of relapse.

So how do you know the right balance of school and recovery? When planning out your weekly schedule, start with recovery-related activities: your “non-negotiables”.  For many people, these are your meals, snacks, meal planning/preparation, sleep, therapy and medical appointments, and support groups. After you fill in your “non-negotiables” for treatment/recovery work, consider self-care, leisure/recreation and other responsibilities (childcare, family support, community obligations, etc.). Many students also have financial considerations to take care of and may have work schedules to navigate. For these reasons, some students find it helpful to have a full day off school each week for catching up on rest, time with friends or family, meeting new people, exploring new interests, and doing things they enjoy outside of school.

Now take a look at your schedule. How many courses can you reasonably take while prioritizing your wellbeing?  For many people, a part-time or a reduced course load makes sense. Students with eating disorders can register with the school’s Accessible Learning and a reduced course load is a common accommodation. A reduced course load is when you take fewer courses and are still considered a full-time student. That means your OSAP (Ontario Student Assistance Program) funding can remain at the full-time amount for ongoing financial support. This accommodation recognizes that recovery is work – it takes time, energy, and resources!

3. Access accommodations: Academic accommodations are arrangements put in place to create equitable access and opportunities for all students to succeed at school. It is your right to have the accommodations you need: you are not asking for a favour – you are deserving of the same opportunities as any other student to learn.

Academic accommodations are based on your specific needs and can include reduced course load, preferential seating, more frequent breaks (e.g., for meals and snacks), extensions on assignments, a separate location for exams, and others. All Universities and Colleges across Ontario have Accessible Learning Services (although they may have a different name) and Counselling Services. Register as soon as possible so your academic accommodations are in place if/when you need them – there will be information on their website, or you can call them directly.

To register with Accessible Learning, your school may ask for documentation. In Ontario, it is your choice if you want to disclose information related to mental health. Your information will be kept confidential, and your Instructors will not know your diagnosis. The only thing your Instructor will receive is a letter from Accessible Learning saying what accommodations you need. This is your private information and it’s your choice if, what, when and how you share. Typically, it’s up to you to follow-up with your Instructors to put your accommodations in motion. For example, Accessible Learning works with you to determine an accommodation like having an extension on assignments then sends a letter to your Instructor. You will then tell your Instructor if you need the use that extension. Your Accessible Learning Advisor will have more information about the process.

4. Build your support networks:

With times of transition, it’s important to consider the formal and informal supports available to you while at school. Formal supports might be your Nurse Practitioner / Family Doctor, Therapist, Dietitian, or Academic Advisor. This might also include your Accessible Learning Advisor or Counsellor through your University/College. Make sure to have your local crisis line and ED helpline/instant chat on your phone and another place you can easily access it.

Good2Talk: Free and confidential 24/7 Helpline for Post-Secondary Students across Ontario

·       Phone: 1-866-925-5454

·       Text: GOOD2TALKON to 686868

·       Website: https://good2talk.ca/

HERE24/7: Addictions, mental health and crisis services in Guelph-Wellington.

·       Phone (Toll Free): 1-844-437-3247 (HERE247)

·       Phone (Local): 519-821-3582 TTY: 1-877-688-5501

·       Website: https://here247.ca/

National Eating Disorder Information Centre (NEDIC): Information about EDs, finding providers and support groups, or speaking to someone directly through their instant chat/Helpline.

·       Phone (Toll Free): 1-866-633-4220

·       Phone (Toronto): 416-633-4220

·       Website: https://nedic.ca/

·       Instant chat: Monday – Thursday 9:00am – 9:00pm and Friday 9:00am – 5:00pm

Informal supports are family, friends, peer support groups, housemates, classmates, and others. These are people and services that are supportive of your wellness that you can contact when you need help. Each support will have a different function and it makes sense to build a robust network. Your informal supports might also include podcasts, blogs, online groups, and recovery websites.

Throughout your school journey, it is common to encounter oppressive messaging or behaviours about bodies, food, and diet culture (ACHA-NCHA-II, 2019). Many students find it essential to build their skills in identifying unsafe situations / triggers, setting clear boundaries, thinking critically about intersecting forms of bodily oppressions (Crenshaw, 1989) and diet culture, connecting to positive role models and/or peers, and strengthening (self-)advocacy strategies such as challenging stigmatizing language/beliefs (Venturo-Conerly et al., 2020; Rice et al., 2020). There may be spaces and supports on your campus such as advocacy groups for International No Diet Day and organizations for gender empowerment + diversity. Online communities can also be an important space that pushes back against toxic diet culture such as Recovery Warriors or The Eating Disorder Recovery Podcast. You might also find it helpful to check out an intersectional social justice approach such as the work of Sonya Renee Taylor’s online community The Body is Not An Apology: Radical Self-Love for Everybody and Every Body and/or the Body Justice Podcast – BIPOC & Eating Disorder Recovery with Julissa Minaya. Students who identify as LGBTQ2IA+ may want to connect with student organizations on campus or find online supports such as Fighting Eating Disorders in Underrepresented Populations (FEDUP)’s website and blog or thirdwheelED: Two Queer Perspectives on ED Recovery. Be sure to see WWEDC’s Supports and Services and NEDIC’s Resources to find supports that represent your multi-faceted lived experiences and treatment/recovery process.

5. Reinforce your skills

Reflect on what is working well in your treatment and/or recovery. It can be helpful to write out a list of skills and strategies as a reminder. Keep it somewhere where you will see it often while still maintaining your privacy (e.g., journal, on your locked phone, etc.). As a quick reminder, some students find the acronym PLEASE helpful. It’s grounded in Dialectical Behavior Therapy (DBT) (Linehan, 1993, 2015), and I’ve modified this Emotion Regulation skill so it is specific to ED recovery:

·       P – Plan your meals, sleep, and daily activities

·       L – Look out for triggers / high stress situations

·       E – Eat regular meals and snacks according to your meal plan to give your body and mind nourishment

·       A – Assert boundaries and advocate to prioritize your wellbeing

·       S – Seek support from informal supports (e.g., friends, family) and formal services (e.g., therapists, dietitian, Doctor or Nurse Practitioner, group therapy, counselling services, Accessible Learning, etc.)

·       E – Express your feelings / emotions (rather than act them out through ED behaviour)

Additionally, there are Apps that can help remind and reinforce your recovery work. You may want to try Recovery Record or Rise Up & Recover.Treatment and recovery will not always go as planned as you get ready for school and work to find a balance.  There will be days when something might not happen in the way you want or expect. Start again. Return to what works. Access your supports.

References:

American College Health Association – National College Health Assessment (ACHA-NCHA-II) (2019) Canadian Reference Group Data Report: Spring 2019. Available from: https://www.cacuss.ca/files/Research/NCHA-II%20SPRING%202019%20CANADIAN%20REFERENCE%20GROUP%20DATA%20REPORT.pdf

Centre for Innovation in Campus Mental Health (CICMH). (June 11 ,2020). CICMH webinar: Increasing capacity to support students with an eating disorder. Available from: https://www.youtube.com/watch?v=sqdZ_6Htm_k

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. University of Chicago Legal Forum, 1989: 139-167.

Muhlheim, L. and Grubiak, K. (2015). If your young adult with an eating disorder ready for college? Available from: https://www.eatingdisordertherapyla.com/wp-content/uploads/2015/10/Is-your-ya-ready-for-college_-_11_23.pdf

Rice, C., Pendleton Jiménez, K., Harrison, E., Robinson, M., Rinaldi, J., Lamarra, A., and Andrew, J. (2020). Bodies at the intersections: refiguring intersectionality through queer women’s complex embodiments. Signs: Journal of Women in Culture and Society, 46(1): 177-200.

Venturo-Conerly, K., Wasil, A., Shuingleton, R., and Weisz, J. (2020). Recovery as an “Act of Rebellion”: a qualitative study examining feminism as a motivating factor in eating disorder recovery. Eating Disorders, 38 (3): 265-271.

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