Reflection on HAES from a Dietetic Intern Perspective

Blog written by Elyse Hodgins, Master of Applied Nutrition Candidate

As a dietetic intern and future registered dietitian, I recognize the importance of nutrition professionals having an understanding of body image and a skill set in this area, as these two topics can be often linked. My knowledge of body image frameworks was expanded much more in the past 2 months throughout my public health placement with Student Wellness Services at the University of Guelph and specifically working with Lindzie O’Reilly, RD, who practices dietetics with a weight-inclusive approach, specifically through the HAES framework. If you are unaware, HAES stands for Health At Every Size and it is a movement specifically in healthcare settings which shifts the focus away from weight management and more towards health promotion. This is important as weight is sometimes assumed to be an indicator of an individual’s health, when this is not reality. Weight is actually a poor indicator of overall health status, and those with an average BMI are not necessarily “healthy”, just as those with an above average BMI are not necessarily “unhealthy”. Furthermore, HAES recognizes that weight cycling and dieting can be linked to compromised psychological well-being and can have an overall negative impact on health, therefore healthcare professionals are encouraged to take the focus off of weight outcomes and emphasize actual health indicators instead.

The HAES movement also encourages body acceptance rather than a focus on weight loss or other weight-related outcomes. This is similar to another recent topic and movement in the body image field that has become popular, and that I have learned more about throughout my placement, which is body neutrality. Body neutrality encourages individuals to accept their body in its current state, and focus on all the functions our body does for us rather than how it looks. For some people the idea of body positivity and loving the way they look can feel like a big stretch, therefore body neutrality is a more attainable way of viewing ourselves, as it falls somewhere between self-love and self-criticism. If you are having a difficult time fully loving the way you look, try a body neutral approach, where you don’t need to see your body in a positive or negative way, but rather you accept and appreciate all the incredible functions your body does for you.

 Working under a preceptor who practices dietetics using the HAES framework has allowed me to reframe the way I communicate nutrition information to the public to ensure I am portraying the correct message. For example, labelling certain foods as “good” and “bad”, or even “healthy” and “unhealthy”, could perpetuate certain issues such as disordered eating by inadvertently sending the message that some foods should make you feel guilty if you eat them. Instead, I learned to refer to foods in other ways such as “nutrient dense” which shifts the focus more towards health promotion and encouraging the public to consume foods that make them feel their best. HAES encourages individuals to recognize how the foods they consume make them feel, and to use these feelings to make decisions on the foods they eat. For example, encouraging the public to select food that makes them feel energized, satisfied and in a good mood, as opposed to restricting or binging on certain food categories for fear of negative weight outcomes. Therefore, the main lesson that I have learned throughout my placement is how meaningful the words we use can be, and nutrition professionals should be aware of the way they communicate with their clients and the public because of this.

 Learning how to practice dietetics using HAES terminology and understanding the topic of body neutrality throughout this past placement has inspired me to continue advocating for these movements and topics in my future career as an RD. I plan to practice dietetics in a non-judgmental and inclusive way, which also means weight-inclusivity, whereby all my clients feel equally supported and their individualized needs are met through nutrition care. I will be aware of the language that I use as a nutrition professional to ensure that I am not perpetuating diet terms and that the goals I have for my clients are based on overall health promotion, rather than weight outcomes. In conclusion, I am grateful for my public health placement which has allowed me to fully embrace the HAES movement and I am excited to bring this knowledge into my future career and share it with my future clients, colleagues, and workplace.

References

1. Bacon, J., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10(9), 1-13.

2. Muenter, O. (2020, Aug 19). 7 Wellness Experts Explain “Body Neutrality” and Why it’s Worth Exploring. Byrdie. https://www.byrdie.com/what-is-body-neutrality-5075038

3. Resnick, A., & Goldman, C. (2021, May 20). How to Practice Body Neutrality. Very Well Mind. https://www.verywellmind.com/how-to-practice-body-neutrality-512091 

An eating disorder disguised in fitness & health

Blog post written by Emily Sanderson

“You’re so fit.”

“I wish I was thin like you.”

“How do you do it?”

“You’re so lucky.”

These are just a handful of the comments I used to receive, when in fact I was actually sicker than ever before. For the most part, these comments came from strangers; people who didn’t see beyond the superficial appearance I hid behind in public.

Those who really knew me, knew better. They saw past the thin, “athletic” disguise I wore.

They saw my personality change; how I never really laughed anymore. How I never had the energy for spontaneous get togethers, or fun nights staying out late.

They noticed how I retracted into myself. How I turned down invites and isolated myself.

And I’m sure they noticed how I carefully picked away at food when I was in front of people… Only to binge later on, because my body and mind were in a constant, animalistic state of starvation.

Those closest to me also witnessed me letting go of some of my most precious relationships… For how could I possibly maintain a relationship, when I was in a full-blown affair with my eating disorder?

And these were just the things people noticed.

Most people didn’t notice the depression, or the extreme anxiety I felt around anything regarding food, exercise or routines. They didn’t recognize the hair loss, the insomnia, or that I hadn’t had a menstrual cycle in over 5 years.

Yet despite my state of illness, people continued to praise me on my appearance and the level of well-being they assumed I was in. Even though they didn’t recognize it, their praise was validating my eating disorder. Validating my sickness.

And so naturally, the loud (obnoxious) eating disorder voice in my head told me to keep going. That I wasn’t thin enough, fit enough, sick enough.

And I don’t want that to sound as though I blame other people for the comments they made. Although my eating disorder thrived off of their approval, many people’s comments were simply a by-product of the diet culture ridden society we live in, and quite possibly, an expression of their own desire to feel accepted.

Ironically, some of the comments people would make were actually true. I am lucky. I’m lucky that I have thin privilege; I have the privilege that my body is accepted in our society (even in a recovered, weight restored state), whether or not my eating disorder tells me so.

And I’m lucky that my thinness didn’t go unnoticed… that I had people close enough to me that could identify that I was, in fact, TOO thin. And those people helped me to get help, when I wasn’t strong enough to ask for it myself.

I was so very fortunate to have some incredible supports and services available to me, when I needed them the most. And I was lucky to have the luxury of financial and job security, which allowed me the ability to access said services.

Realizing how lucky I am has highlighted to me that there are way too many people living in this world who are not nearly as fortunate as I have been… People living in larger bodies, who are suffering with eating disorders that may never be noticed or validated.  People who live in bodies that our society rejects. People who don’t have access to the amazing supports and services that I did, and still do. And even further, many people who don’t even have access to the possibility of “health”.

 So, what is it exactly that I want people to take away from this post…?

I guess it’s for everyone to be more critical.

To question our society’s ridiculous standards of health and wellness.

To stop praising thinness and the “ideal body”, and open our minds to different ways of “healthy living”.

To start recognizing disordered eating and exercise obsession for what it is.

And maybe, most importantly, to lend more compassion to ourselves and others who may never be so lucky.

We as humans are all different. Our bodies are different, our minds are different, and our hearts and souls are different. With that, “health” can and should look different on everyone – physically, mentally and emotionally.

Join us in celebrating International No Diet Day 2021!

Blog post written by Lindzie O’Reilly, Registered Dietitian, MAN, University of Guelph

Every year on May 6th, individuals and organizations around the world recognize International No Diet Day (INDD). The objectives of INDD are to challenge the idea that there is one ‘right’ or ‘ideal’ body, to push back against the industries that sustain diet culture, to raise awareness about the prevalence of weight discrimination and fatphobia, and to reinforce the harms of dieting among people across age, gender, culture, and body size.

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. The common belief in our society is that decreasing our weight is beneficial for our health when that is often not true. In fact, weight is an outcome that we have a lot less control over than we think. According to Set Point Theory, our bodies have a genetically programmed weight range that they like to hang out in, where each individual will feel their best physically and mentally, and where their risk of disease is lowest. When we engage in behaviours that support our wellbeing, our weight tends to naturally settle in the range it likes to be in. The range of natural human set points is much broader than society leads us to believe. Unfortunately, many individuals and health professionals still refer to the Body Mass Index (BMI) as a marker of health. BMI was developed by a statistician with the intention of being applied to a population as a whole, not to individuals. If you’ve ever taken a stats class, you might remember learning about a Normal Distribution. It means that, naturally, within a population, 68% of individuals will fall within the ‘normal’ range on the curve. This means that the remaining 32% of the population will naturally have a BMI that labels them as ‘underweight’ or ‘overweight’. It would be statistically impossible for everyone in society to achieve a ‘normal’ BMI.

INDD in particular and the Health At Every Size (HAES) movement in general are not arguing that every individual is currently at their natural set point. INDD is not encouraging us to use May 6th as a once a year “cheat day” (I hate that phrase, but that’s a topic for a whole other post…) and eat more than what feels good for their body. Instead, it’s encouraging folks to develop a relationship with food that they can feel good about every day. It’s saying that targeting our weight as the measure we would like to change is not helpful and often leads us to engage in very extreme habits that can have risks and side effects for both physical and mental wellbeing. Instead, it’s encouraging folks to experiment with different habits to discover what make you feel best. Everyone is an expert in their own body, and everybody is different – there’s no one ‘ideal’ size and there’s no one size fits all approach to food. In a weight-obsessed society, it can be really hard to tell the difference between what truly makes us feel good as individuals and what makes us feel good because we’re following the ‘rules’ and doing what we feel we ‘should’ be doing. Here are some suggestions to help you spot the difference.

Some things that may be helpful:

• Experimenting to find a way to move your body that you enjoy

• Experimenting with new foods to discover what you like the taste of

• Eating when your body tells you it needs fuel. This doesn’t mean only eating when your stomach grumbles. There are all sorts of other ways our body can tell us it needs fuel, such as feeling sleepy, feeling irritable, having trouble concentrating or focusing, having a headache. Sometimes we need to eat even if our body isn’t giving us cues as it may be our only break in the day, or it may be important prevention for feeling really hungry later.

• Experimenting to discover what portion size feels good for your body. Did you know that portion size and serving size are two different things?? Serving size is listed on a package or box in order to give us information about macro and micronutrients. Portion size is the amount that YOU choose to eat of a food because it’s what satisfies your hunger, energizes you, or tastes good to you. In most cases, that portion size is larger than the serving size.

• Eating for a wide range of reasons including to meet your energy and nutrient needs, for social reasons, for pleasure or for comfort (that’s right, it’s okay to eat for comfort!).

Some warning signs that a behaviour may be risky:

• Exercising to change your body, because you think you ‘should’, or as a way to punish your body

• Labelling foods as “good”, “bad”, “healthy” or “unhealthy”

• Restricting yourself to only eating foods you define as “good” or “healthy” and feeling guilty if you eat a food you define as “bad” or “unhealthy”

• Only allowing yourself to eat at certain times of the day, even if your body gives you cues that it would like fuel at other times

• Limiting yourself to certain portion sizes, even if your body gives you cues that it would like more

• While it is very much okay to eat for comfort, we can get ourselves into trouble if eating more than your body would like or less than your body would like is one of your only coping strategies when emotions are high. It’s helpful to get support and build additional tools in your toolbox.

As we enter the fourteenth month of a global pandemic, so much unhelpful emphasis has been placed on appearance and weight. Weight is so much more than calories in and calories out. It’s a reflection of where we are at, and the past fourteen months have been truly challenging for most folks. INDD encourages us to pause and reflect on habits that we can engage in that support our physical and mental wellbeing and that help us care for ourselves, rather than engaging in restrictive or weight-focused behaviours that only make it more challenging to care for ourselves and feel well.

If you’re used to seeing positive affirmations in the windows of Waterloo-Wellington businesses during the first week of May, fear not, the Waterloo Wellington Eating Disorders Coalition is adapting the campaign to go virtual again this year. Check us out on Facebook and Instagram to see positive INDD messages on May 6th. Follow and support your local businesses that will be sharing our virtual window signs on May 6th. Spread the word in your own networks and make a difference today!

Take a self-compassion break

Blog written by Lindsay Rafuse, MSW RSW, Counsellor at University of Waterloo Counselling Services and private practice at The Space Within

We’ve been living in a pandemic for over a year now. For myself, it has felt like the longest and shortest year, all at the same time. For a year, we have been adjusting and adapting to the ever changing reality of our world – with so much uncertainty, never really knowing what the next day, week, or month will hold. For many folks, the past year has brought on homeschooling, working from home, continuing to go to work as an essential worker – facing risk of exposure every day, caring for loved ones young and old, financial insecurity and uncertainty, job loss, further social isolation, and mental health struggles. Of course, we cannot forget other world events occurring around us while in this pandemic state – most noteworthy being the anti-racism movement and protests following the murder of George Floyd in May 2020.

With all of this uncertainty and change, I believe that self-compassion can act as a powerful force in helping us to show ourselves the kindness we deserve and help us navigate these difficult times. For myself, it has been useful in helping me shift my inner narrative when I fall into self-criticism – whether that be with my ability to strike a work-life balance while adjusting to working from home or the fears I face as a mother parenting a toddler through the current state of the world.

We can think of self-compassion as having three main components – mindfulness, common humanity, and self-kindness:

• mindful awareness that we are in a moment of suffering without labeling it as good or bad

• recognizing that pain and suffering is part of what makes us human and connects us with others

• giving ourselves the kindness we would offer a dear friend during a time of need.

A brief practice that I have been using is called the “Self-Compassion Break”, developed by self-compassion researcher Dr. Kristin Neff. This practice helps remind us to apply the three components of self-compassion in a moment of pain or struggle. Written instructions for the practice can be found here:

Self compassion break

Guided version can be found here:

Self compassion break - audio version

INTERESTED IN LEARNING MORE ABOUT Compassion and eating disorders?

Our coalition will be hosting a virtual, one-day workshop on the use of self-compassion in eating disorders featuring Dr. Allison Kelly and Sydney Waring in May 2021. Find more information on our CFT Conference page.

CFT Conference

Managing eating disorders during the COVID-19 pandemic

Blog post written by Peer Health Education volunteers at the University of Waterloo

The COVID-19 pandemic has created psychosocial stressors specific to those managing disorders around eating and/or body image. The disruption of daily routines and the uncertainty of the ongoing public health crisis can heighten stress and anxiety, leading to unhealthy food behaviours. The sharply increasing rates of infection nationwide, concentrated in the most populous provinces, can intensify these feelings. In particular, the social isolation inherent to physical distancing can cause difficulty in maintaining support networks. For those dealing with eating disorders, this can spell out an increase in symptoms.

A few tips for you and your social circle to support your emotional well-being are outlined below.

Tip 1: Remain connected to your providers

To continue providing treatment to their patients, many healthcare providers have switched to operating via phone or video conference.

• Continue to work with your healthcare providers (e.g., psychiatrists, dietitians, therapists) to recover from an eating disorder, if this applies to you.

• Check if there are online options, such as online peer support groups and virtual check-ins.

• Create or revise a relapse prevention plan to share with your healthcare providers. Ask for their advice on the most effective options for supporting your recovery during these difficult times.

Tip 2: Practise strategies to manage anxiety

The uncertainty of the ongoing pandemic and the changes it has brought about across all domains of life can elevate feelings of helplessness, stress, and loss of control. It is okay to acknowledge that. Here are practical, straightforward techniques to abate those feelings:

• Adopt some breathing techniques, such as counting your breaths or nostril switches. Learn more here.

• Practice the 5-4-3-2-1 grounding exercise. Learn more about this exercise here.

  • Name 5 things you can see.

  • Name 4 things you can feel.

  • Name 3 things you hear.

  • Name 2 things you can smell.

  • Name 1 good thing about yourself.

• Use the STOP method for dealing with stress. Learn more about this method here.

  • S = Stop

  • T = Take

  • O = Observe

  • P = Proceed

• Switch off media and social media.

Tip 3: Connect with a support system virtually

As a result of the feeling of social isolation with physical distancing efforts, consider strengthening existing support systems through family and friends.

• Invite friends and family to join you during meals and snacks through video-conferencing platforms (Zoom, Skype, MS Teams, FaceTime, to name but a few).

• Create a system to connect with friends and family after eating, in those especially vulnerable moments.

• Be open with friends and family whom you trust about the difficulties that you are grappling with, and your emotional state.

• Connect with virtual communities, including support groups, peer communities, recovery mentors, and meal support.

  • WWEDC (Waterloo-Wellington Eating Disorder Coalition) has a directory of local supports and services, ranging from support groups, to books and websites, to therapists, dietitians and coaches and trainers.

  • NEDIC (National Eating Disorder Information Centre) offers a live chat on their website (nedic.ca) and a toll-free helpline (1-866-633-4220). NEDIC also has a FAQs (frequently asked questions) webpage discussing the complications and risk about COVID-19 and EDs.

COVID-19 is a stressful time, even more so if managing concerns around eating and/or body image. Please be kind to yourself, and practise self-care and self-compassion. It can be surprising how the littlest of things—petting a cat, smiling at a baby—can be the most uplifting.

References

1. https://medicine.umich.edu/dept/psychiatry/michigan-psychiatry-resources-covid-19/specific-mental-health-conditions/managing-eating-disorders-during-covid-19

2. https://www.emilyprogram.com/blog/advice-for-those-struggling-with-an-eating-disorder-during-covid-19/

3. https://butterfly.org.au/covid-19-tips-advice-for-people-with-an-eating-disorder/

The value of lived experiences

Blog post written by Therese Kenny, MSc, PhD Student Clinical Child and Adolescent Psychology 

Eating Disorder Awareness Week (EDAW) invites us to deepen our understanding and awareness of eating disorders. It is important in doing so however, that we are mindful of where the information comes from. Statistics, research, and treatment protocols all have value, but they tend to miss the human experience of eating disorders. To get this, we must turn to the people who know eating disorders best: the people who have lived them and their loved ones. In looking to folx with lived experience, we can learn from their expertise, gain a more holistic perspective, and diversify our understanding of what eating disorders are and whom they affect.

Expertise

Individuals with lived experience bring enormous expertise in the experience of having an eating disorder. Expertise is defined as ‘expert skill or knowledge in a particular field.’ While we often think of mental health experts as helping professionals or researchers, this overlooks the incredible contributions to be made by folx with lived experience. These individuals can offer valuable and unique insights into what having an eating disorder entails. Equally important, folx with lived experience are able to share what helps and what does not help when treating eating disorders and associated mental health challenges, something that is too often identified by professionals who do not have the experience of being service users. In this way, highlighting lived experience perspectives increases our understanding of eating disorders and how we can best support individuals navigating the challenges posed by these disorders.

The Whole Picture

One thing that is unique about lived experience expertise (versus clinical or research expertise) is that individuals with lived experience understand the experience of being a person with an eating disorder. While clinicians and researchers have an abundance of knowledge about eating disorders, they tend to focus on just that: the eating disorder. The reality, however, is that people who struggle with eating disorders have hopes, dreams, and lives outside of the eating disorder. When we focus on just the eating disorder, we can forget these other aspects and target just symptoms and behaviours. This has resulted in definitions of recovery and treatment approaches that focus on what people should abstain from with little focus on what can be grown and cultivated (Kenny & Lewis, 2021). When we look at people’s lived experiences, however, we find that recovery is about so much more than symptom abatement. Instead, these individuals highlight, resilience, transformation and growth, and alternative coping strategies (Bohrer et al., 2020; de Vos et al., 2017; Kenny et al., 2020).

Diverse Experiences

Perhaps most importantly, lived experience perspectives provide diversity. The overwhelming majority of what we know about eating disorders comes from white, able-bodied, cis women. While this knowledge has propelled our understanding of eating disorders in this population, it is essential that we expand our understanding of eating disorders to individuals inhabiting other social locations. This is particularly important because we know that individuals who experience one or more marginalized identities face additional stressors, some of which are directly related to body and food. For example, policing of Black bodies sends an overt message that these bodies are wrong. Living in a body that does not match one’s gender identity can lead to body dissonance. Having a disability means that one’s body may not be functional in the way that one wants. Understanding the intersection of these experiences with other experiences that contribute to eating disorders (e.g., temperament, life stressors/trauma, diet culture) is essential in being able to offer fair, equitable, and effective care. The only way that we can start to expand our understanding of these diverse experiences is to listen to the people who have lived them.

Though by no means exhaustive, these reasons highlight the importance of centering lived experiences in conversations about eating disorders. Ultimately, if we want to learn about and make change in eating disorders, we need to go to the people who are experts in this experience. This EDAW, we encourage you to seek out, listen to, and/or share diverse lived experiences, so that we can all better understand what it means to have experienced or supported someone with an eating disorder.   

References 

Bohrer, B. K., Foye, U., & Jewell, T. (2020). Recovery as a process: Exploring definitions of recovery in the context of eating‐disorder‐related social media forums. International Journal of Eating Disorders, 8, 1219-1223.

de Vos, J. A., Lamarre, A., Radstaak, M., Bijkerk, C. A., Bohlmeijer, E. T., & Westerhof, G. J. (2017). Identifying fundamental criteria for eating disorder recovery: A systematic review and qualitative meta-analysis. Journal of Eating Disorders, 5, 34.

Kenny, T. E., Boyle, S. L., & Lewis, S. P. (2020). #recovery: Understanding recovery from the lens of recovery‐focused blogs posted by individuals with lived experience. International Journal of Eating Disorders, 8, 1234-1243.

Kenny, T. E., & Lewis, S.P. (2021). Reconceptualizing recovery: Integrating lived experience perspectives into traditional recovery frameworks. Psychiatric Services. Advanced online copy.

Recovery: So what now?

Blog post written by Shannon

So what now?

Over 2 years out where do I go from here?

Am I recovered? Am I sick? Am I over all of this?

I think a bit of all three

My body is healed

My brain is getting there

I think there is being sick, living in treatment and living outside of treatment

I think there is recovery from recovery as well

Learning to not necessarily forget those long 8 years

But to put them in a bag under your bed, know they are there but also understand that its okay to not need them anymore

Recovery is a hard word for me to understand.

What constitutes it?

Will I always be so mean to myself?

Is that just a norm that society has dictated?

I don’t believe in one definition of recovery

So I created my own.

Days without staring contests with my food or the clock

Ice cream for dinner

Long lazy days in bed

Good night sleeps

Pizza with extra cheese

Facemasks

Lots of water

Bubble baths

Then I am recovered

Maybe not all in one day, maybe only a few times a week,

But I created my own new normal life

Where I applaud myself for things that are so mundane but are WINS for me.

So what now?

I take it day by day, sometimes minute by minute

And will continue to practice the amazing power of Self love and positive thoughts.

Utilizing self-compassion in therapy for eating disorders

Blog written by Natalie Doan, MSc, PhD Student in Public Health and Health Systems, University of Waterloo

Self-compassion

Self-compassion, as defined by Gilbert (2005), is an attitude of kindness and acceptance towards personal distress and disappointment. Neff (2003) identified three components of self-compassion: self-kindness, feelings of common humanity, and mindfulness. Self-kindness refers to treating ourselves with care and understanding, rather than being harshly critical and judgemental, and recognizing the common humanity of making mistakes and feelings of inadequacies. The practice of mindfulness involves the intention of being in the present moment. By attempting to live in the present moment in a manner that neither suppresses or exaggerates painful feelings, mindfulness can help abate the tendency to over-identify with painful thoughts and feelings.

Although self-compassion and self-esteem may appear at face value to be similar concepts, self-compassion and self-esteem differ in many ways. For example, self-compassion and self-esteem diverge greatly in their reliance on evaluation and judgement. Contrasting the construct of self-esteem, which is predicated on individuals making self-evaluations and judgements of worthiness based on comparisons to other people, self-compassion does not necessitate appraising or making judgments. Hence, fostering self-compassion instead involves recognizing and accepting the universality of personal inadequacies and mistakes.

Interested in learning more about CFT?

Our coalition will be hosting a virtual, one-day workshop on the use of self-compassion in eating disorders featuring Dr. Allison Kelly and Sydney Waring in May 2021. Find more information on our CFT Conference page.

CFT Conference

Compassion Focused Therapy

Compassion Focused Therapy (CFT) is a treatment modality that is aimed at helping individuals prone to self-criticism and shame to cultivate inner kindness, especially when confronted with personal shortcomings and distress. CFT operates under the theory that criticism and hostility have evolved to stimulate a response from threat systems, leading to anxiety, anger, shame, and sometimes maladaptive self-protective behaviours, whereas warmth, affiliation, and compassion stimulate the system that fosters a sense of calmness and behaviours oriented towards trust and connection. Given the favourable effects that occur when compassion is experienced, CFT focuses on enhancing individual’s capacity for self-compassion.

Self-compassion and Eating Disorders

In the context of eating disorders, researchers have suggested that eating disorder symptoms (e.g., restricting, excessive exercising, bingeing, purging) can sometimes represent attempts to regulate underlying feelings of shame. Eating disorder symptoms may be useful to suppress shame in the short-term, but prolong and intensify shame in the long-term. Specifically, bingeing and purging may serve as a brief distraction from feelings of shame; however, engaging in these secretive behaviours can further contribute to the belief that one is “defective” and/or “disgusting” in the long-term. Restriction may also temporarily lower shame by yielding a sense of pride. Similar to bingeing-purging symptoms, the relief of shame is often short-lived and returns as eating disorder thoughts and urges progress. Empirical evidence in the literature provide support for this framework. Researchers have identified an association between shame and eating disorder symptoms in both clinical and community samples. Additionally, research suggests that self-compassion may be protective against shame and eating disorder pathology.

Compassion Focused Therapy for Eating Disorders

Compassion Focused therapy for Eating Disorders (CFT-E) was developed by Goss and Allan (2010). Briefly, the goal of CFT-E is to address the regulation difficulties, shame, self-criticism, and self-directed hostility experienced by individuals with an eating disorder through the development and practice of compassion. CFT-E puts an emphasis is put on an evolutionary and neuroscience model that highlights the ways in which the human brain and body have evolved to regulate different affects. Special attention is also given to help improve the ability to manage feelings of anxiety, anger, grief, and disgust. Beyond the standard CFT, CFT-E has been uniquely developed to help individuals use compassion to meet the challenges associated with eating disorder recovery.

References

Carter, C. S. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology, 23(8), 779-818.

Gilbert, P. (Ed.). (2005). Compassion: Conceptualisations, research and use in psychotherapy. Routledge.

Gilbert, P., & Miles, J. (Eds.). (2002). Body shame: Conceptualisation, research, and treatment. Psychology Press.

Goss, K., & Allan, S. (2009). Shame, pride and eating disorders. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 16(4), 303-316.

Goss, K., & Allan, S. (2010). Compassion focused therapy for eating disorders. International Journal of Cognitive Therapy, 3(2), 141-158.

Kelly, A. C., Carter, J. C., & Borairi, S. (2014). Are improvements in shame and self‐compassion early in eating disorders treatment associated with better patient outcomes?. International journal of eating disorders, 47(1), 54-64.

Kelly, A. C., Vimalakanthan, K., & Carter, J. C. (2014). Understanding the roles of self-esteem, self-compassion, and fear of self-compassion in eating disorder pathology: An examination of female students and eating disorder patients. Eating behaviors, 15(3), 388-391.

Kirsch, P., Esslinger, C., Chen, Q., Mier, D., Lis, S., Siddhanti, S., ... & Meyer-Lindenberg, A. (2005). Oxytocin modulates neural circuitry for social cognition and fear in humans. Journal of neuroscience, 25(49), 11489-11493.

LeDoux, J. (1998). The emotional brain: The mysterious underpinnings of emotional life. Simon and Schuster.

Neff, K. (2011). Self‐compassion, self‐esteem, and well‐being. Social and personality psychology compass, 5(1), 1-12.

Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and identity, 2(2), 85-101.

Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and identity, 2(3), 223-250.

Panksepp, J. (2004). Affective neuroscience: The foundations of human and animal emotions. Oxford university press.

Navigating recovery during the holidays

Blog written by Lindzie O’Reilly, MAN, Registered Dietitian and Samantha Durfy, MA, MSW, RSW

The holidays are a time to relax – a time to visit with family and friends and enjoy home cooked meals. The holidays can also be a stressful time. Many holiday events revolve around food, and often the types and amounts of food are different than our usual routine. It’s helpful if you’re willing to practice some flexibility over the holidays, while also still prioritizing your own needs around food.

1. Eat often during the day. Many of us have a tendency to eat less during the day to compensate for a larger holiday dinner. This actually puts even more focus on the holiday meal and tends to give it more power than it deserves. It makes it nearly impossible to participate in pre-dinner conversation when all you can think about is when and what will be served for dinner. It makes it a lot more likely that you will feel out of control during the meal, making different food choices than you would if you were well nourished all day. Eating often means having at least a bit of a plan in place that helps you determine where and what you will eat leading up to the holiday meal. It might even mean packing some of your own snacks to have on hand, acknowledging that you may need to eat at times when others around you might not be eating.

2. Can you say ‘yes’ sometimes? The holidays often bring many food options that aren’t a part of our usual food routine. The holidays also often mean meals based around food cooked by others. If you feel able, it can be helpful to reflect on holiday foods that you enjoyed prior to having an eating disorder. Are there one or two things you can give yourself permission to enjoy – truly taste without compensation or guilt – this holiday season?  Consider joining in on meal planning with your family members, whether that be menu planning, grocery shopping, or the meal prep itself. Balance the goal of following a plan by taking some calculated risks.

3. Sometimes it’s important to say ‘no’. While important to practice flexibility, it’s equally important to reflect on choices that will help you achieve your personal recovery goals. Holiday meals often mean we are surrounded by family and friends that we haven’t seen for a while. Many folks feel pressure to ‘prove’ to their loved ones that they are ‘well’; leading to food choices that may push us too far outside our comfort zones. Sometimes it can be helpful to survey all of your food options before you begin to fill your plate. From there, decide on foods and amounts that you feel comfortable with, not what you think someone else would like you to have. Boundary setting with others can be a key skill in protecting your recovery.  If those around you are asking you to push yourself too far past your comfort zone, it’s important to say no.

4. Have a support plan. It’s normal for urges and emotions to arise before, during, and after a holiday meal. It’s helpful to create a plan in advance, which could mean identifying a family member or friend that you can pull aside for a chat or identifying a space you can go to take a break and be alone in an empty room or outside.  Asking for support and accountability with your eating goals can help you to survive the additional stressors which often come with the holiday season.

5. Take time to acknowledge your feelings.  The holidays are not always filled with cheer and joy.   For many people the holidays can be challenging, which can impact your recovery goals with food.  If there are tensions within a family or if there has been a recent loss, the holidays can sometimes highlight what we don’t have or who is not at the dinner table this year.  Take time to journal, cry, or talk with someone about your feelings. Bottling up your emotions can put you at risk to engage in eating disorder behaviours.

6. Engage in self-care.  Because the holidays can be a busy time, it’s important to take time for yourself, whether that be journaling, mindful walking, or creative expressions, such as music, painting, or crafts.  Carve out some time during your busy holiday schedule for you and your self-care routine.  Also make a priority of sleeping well and avoiding excessive alcohol or substance use to limit vulnerabilities to your eating disorder.

Navigating holiday meals with an eating disorder is tricky. Going in with a plan in place, checking in with yourself often, asking for support, and keeping your personal recovery goals in mind can help.  Best wishes to you in your recovery this holiday season!

Coping with loneliness, isolation, and an eating disorder

Blog written by Natalie Doan, MSc, PhD Student in Public Health and Health Systems, University of Waterloo

The holiday season can be a very challenging time for individuals living with or recovering from an eating disorder. Holiday treats, family dinners, and social get-togethers centred around food can make the holiday season a time of heightened anxiety for individuals with a history of an eating disorder. For others, the holiday season can exacerbate feelings of loneliness. This year, with COVID-19 being a global public health crisis, it is understandable that physical distancing, lockdown, quarantine, and social restriction measures will impact people’s psychological well-being in various degrees, including by eliciting feelings of loneliness and isolation.

Research has long demonstrated that social support and a sense of connectedness is strongly associated with multiple indicators of health. Feelings of social isolation and loneliness have detrimental effects on physical and mental health, including being risk factors for depression, anxiety, chronic stress, and insomnia. Furthermore, seeing the role that social support plays in coping with symptoms of mental distress following crises, such as natural disasters and pandemics, means that it is essential to consider how individuals struggling with an eating disorders and other mental health concerns cope during COVID-19.

In the context of eating disorders, researchers have long recognized that loneliness can play a pivotal role in contributing, maintaining, and perpetuating eating disorders. For example, feelings of loneliness can trigger bingeing, and bingeing and purging can be used to cope with feelings of loneliness. This introduces implications for eating disorders, especially during a pandemic where maintaining socially connections is a lot more challenging than it would be for many people in other years. Knowing how to cope with feelings of loneliness and isolation is arguably more critical this year than ever before.

Below is a list of some strategies to cope with feelings of loneliness and isolation with social distancing measures in place.

Connect with others

Although it may be increasingly challenging to discover ways to keep connected with members outside your household, technological advances provide many options to explore ways of maintaining connected to others, especially through various virtual platforms.

Build a support system

Whether it is by sharing your thoughts and feelings with your friends or family, joining an online support group, or seeing a therapist, building a support network is helpful in keeping socially connected and coping with loneliness. Sharing your feelings of loneliness with the right people, who might also understand experiencing similar feelings, may be helpful in coping with feelings of loneliness during these isolating times.

Engage in distraction

Distraction can be very useful to cope with emotions, especially in the short-term. There are many ways to stay distracted during the pandemic. Consider doing more of the things you already enjoy spending time doing or learning a new hobby or skill. Some starting points include reading books or audiobooks, listening to music or podcasts, engaging in creative arts (e.g., drawing, painting, crocheting), learning a new language, writing, and watching a new series or movie.

Participate in meaningful activities

Volunteering your time can be a great way to contribute to the community and foster a sense of collective well-being. Depending on your interests, consider taking on activities that might provide you a sense of meaning and purpose, such as volunteering with a local community, student, social, academic, research, or professional organization.

Practice self-compassion

It’s especially important to be gentle with yourself during this time. It might be useful to follow the news, but if exposure to the media leads to increasing fear and anxiety or exacerbate feelings of loneliness, try balancing time spent on the news and social media with other unrelated activities, such as reading, listening to music, or learning a new skill.

References

American Psychological Association. Keeping your distance to stay safe. Accessed from: https://www.apa.org/practice/programs/dmhi/research-information/social-distancing

Banerjee D, Rai M. Social isolation in Covid-19: The impact of loneliness.

Canadian Mental Health Association. Coping with loneliness. Accessed from: https://cmha.bc.ca/documents/coping-with-loneliness/

Levine MP. Loneliness and eating disorders. The Journal of psychology. 2012 Jan 1;146(1-2):243-57.

National Health Service. What you can do if you feel lonely during the coronavirus outbreak. Accessed from: https://www.nhs.uk/oneyou/every-mind-matters/coping-loneliness-during-coronavirus-outbreak/

Pietrabissa G, Simpson SG. Psychological consequences of social isolation during COVID-19 outbreak. Frontiers in Psychology. 2020 Sep 9;11:2201.

Saltzman LY, Hansel TC, Bordnick PS. Loneliness, isolation, and social support factors in post-COVID-19 mental health. Psychological Trauma: Theory, Research, Practice, and Policy. 2020 Jun 18.

Recovery reflections

Blog post written by Shannon

I’m not truly passionate about anything unless I’m talking about this. It’s the only thing I really care about whole-heartedly. I love my family, my friends, my boyfriend, but I see the world so differently than them, because of my past.

I never mean to preach around my friends, but sometimes I can’t help it

Self-hatred around me

Picking up their shirt in a mirror

Talking about calories

I can’t hear or see these things and not put in my two cents

Do my friends have eating disorders? No, not necessarily

But you don’t have to be sick to make self-love a new priority in your life

But damn it’s hard

It’s easier to tell others then to practice it on your self

But

What if me saying something makes someone think differently, or second-guess their mentality even for a moment

I wish someone had done that for me

When I would check my body

When I would skip dinner

My ED has changed me forever, for better and worse

I don’t think the specifics or details of my eating disorder are important or helpful

My lowest and highest weight aren’t either

Because my insecurities started way before there was the eating disorder title placed on it

I was never made fun of, called names or put down as a little girl.

It was the demon in my head that just made existing seem too hard.

It needed something to attack and blame for EVERYTHING and that was my body.

My parents fight? It’s because I’m too big

I fail a test? It’s because I ate dinner

I get in trouble? It’s because my leg jiggles

Kinda funny and totally ridiculous when you think about it.

But I promise you these thoughts ended, it took therapy, and hospitals, and incredible lows, and fighting and screaming, and laughter, and smiles and hugs and cuddles and so much more...

To get to a place where my weight and my body are no longer to BLAME but are THANKED and CELEBRATED for keeping me alive and fighting so hard to put me in a place where I can maybe help someone else.

It gets so much better I PROMISE you.

YOU ARE WORTH so much more then this.

Why we need to #EndWeightHate: Weight Stigma Awareness Week 2020

Blog post written by Amanda Raffoul, PhD, Postdoctoral fellow at STRIPED

Today is the first day of Weight Stigma Awareness Week, an annual week of advocacy hosted by the National Eating Disorders Association (NEDA). Weight stigma is often called and confused with many other terms, including fatphobia, weight bias, and weight-based discrimination. Briefly, weight stigma captures the stereotyping and discrimination that people with higher weights in our society experience. Considering the role of weight stigma in eating disorders (more on that later!), we’ve decided to highlight why it’s important to #EndWeightHate.

Weight stigma is a social justice issue

Although negative comments, “jokes”, or bullying about someone’s weight are symptoms of a weight-focused culture, weight stigma goes beyond one-off interactions and is a structural, social justice issue. This means that the stereotypes many of us have about higher weights or the treatment of people with higher weights are embedded into every facet of our daily lives. People who live in larger bodies face discrimination on social media, in relationships with family and friends, and at doctors’ offices, school, work, and so on. Again, weight-based discrimination goes beyond rude comments — children in larger bodies are graded lower and evaluated as “less smart” than their peers, adults with higher weights are less likely to receive a promotion, and higher-weight people are often neglected in medical care settings, worsening their health outcomes overall.

Weight stigma is a public health issue

Weight stigma is associated with harmful health consequences, both mental and physical. Since weight stigma is a structural issue that worsens health outcomes for some people more than others, it is also a public health issue. One major problem with this is that public health researchers, practitioners, and policymakers themselves can be the perpetrators of weight stigma. (Side note: As a public health researcher myself, I can unfortunately attest to this…) There are tools out there, such as the STRIPED Roadmap, to help minimize weight stigma in public health work, but much still needs to be done to take the focus of public health interventions off of weight and towards health more holistically.

Weight stigma is important to consider in eating disorders work

So why does our coalition care so much about weight stigma? Weight stigma is directly linked to disordered eating and the risk of eating disorders among people across the weight spectrum. Internalized weight stigma, or the ways in which a person applies negative weight stereotypes to themselves, is associated with harmful food and weight behaviours. The Academy for Eating Disorders recently published this infographic outlining common myths about weight stigma and how it may relate to eating disorder risk.

If you live in the Waterloo-Wellington region and would like to find an eating disorders clinician who is weight-inclusive and/or has training around the harmful impacts of weight stigma, please visit our supports & services page.

How to get involved in Weight Stigma Awareness Week 2020

We won’t be able to eliminate weight stigma in one week, but getting involved in Weight Stigma Awareness Week is a great way to raise awareness of the harmful impact of weight stigma within your circles. You might even be able to teach someone about something for the first time! NEDA has a list of social media graphics and resources for you to share on social media, as well as a series of hashtags so you can connect with other advocates online (#EndWeightHate, #WSAW2020). If you’re interested in learning more, our supports & services page also lists dozens of books and articles on weight stigma.

Groceries during a pandemic

Grocery - Delivery/ Pick up

• You can now get groceries delivered from zehrs.ca; walmart.ca; instacart.ca; pcexpress.ca; Market Fresh Guelph

• You can pick up groceries from the comfort of your car, in the store parking lot: nofrills.ca; grocerygateway.com; www.homefieldorganics.com;

• Most restaurants are offering delivery and pick up options. Some are even now providing grocery options.

Grocery - Senior's/Medically compromised Options

• Shopper's Drug Mart has quiet / assisted hours at 8am-9am

• Some Zehrs locations also have early quiet hours for seniors and those who are medically compromised.

Local Food Bank / Food Programs

• Guelph Food Bank  - 100 Crimea St unit c12 Guelph

• HopeHouse Food Bank - 10 Cork St East Guelph

• The Food Bank of Waterloo Region - 50 Alpine Court Kitchener

• St. John's Kitchen - 97 Victoria St., North, Kitchener

• Ray of Hope Community Centre - 659 King Street East, Kitchener

• Cambridge Self-Help Food Bank - 54 Ainslie St S, Cambridge

• Cambridge Shelter - 26 Simcoe Street, Cambridge

• Trinity Community Table - 12 Blair Road, Cambridge

It’s more important than ever to celebrate International No Diet Day in 2020

Blog post written by Lindzie O’Reilly, Registered Dietitian, MAN, University of Guelph

Every year on May 6, individuals and organizations around the world recognize International No Diet Day (INDD). The objectives of INDD are to challenge misconceptions about dieting, push back against the industries that sustain diet culture, and reinforce the harms of dieting among people across age, gender, culture, and body size. 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. The diet industry often touts products aimed at improving our health and wellbeing while in truth, these products net the Canadian diet industry hundreds of millions of dollars in profit each year at the expense of our health and wellbeing. For more information about INDD and the harms of dieting, check out Break Free From Diet Culture.

This year, in the midst of a global pandemic, even those savvy at spotting and fighting against diet culture have faced new challenges. Like a sneaky virus, diet culture has mutated and introduced a whole new breed of myths and misconceptions that lead us to doubt our bodies and promote body shame. Posts abound suggesting that if we don’t ‘watch our bodies’ while spending more time at home in isolation, they will lead us astray. The diet industry taps into our human desire to find something to control when so much around us is out of our control.

In the midst of a global health crisis, staying healthy, physically and mentally, is very important. Since diet culture equates our weight with our health, it’s no surprise that the internet has exploded with strategies to ‘keep tabs’ on our weight – through monitoring, body checking, tracking our intake, and fixating on a need to move our bodies. At best, these behaviours promote body shaming and negative body image. At worst, they can progress to symptoms of an eating disorder that feel all too familiar to anyone who has ever struggled with one. Many individuals with a history of an eating disorder wisely put a lot of effort into screening their social media to ensure they are following accounts that promote recovery and body acceptance and avoiding accounts that promote dieting, body checking, and body shaming. Right now, information about COVID-19 exists in some form on essentially every social media account and news outlet. Individuals looking for accurate and up to date information on the pandemic can very easily be blindsided with information that serves up a side of diet culture.

In this time when physical and mental wellbeing truly is so important, and diet culture is sneakier than ever, let’s talk about some real things that we can do to support our health.

• In addition to practicing physical distancing and washing your hands, eating an amount of food that is right for your body is the best way to keep your immune system strong. While access to food might be different than usual for you right now, it’s important to continue to do your best to follow the same meal plan or food goals that you were following pre-COVID. There is no ‘diet’ to improve your immunity and most diets lack nutrients and energy, compromising your immunity.

• Our lives have changed a lot in the past two months. It’s likely that everyone has experienced some degree of stress related to these changes. Rather than letting diet culture infiltrate your thoughts and contribute to further stress and body vigilance, it’s helpful to find outlets to manage stress. This can include things like reading, painting, connecting with a loved one, meditation, or even cooking and baking. Contrary to what diet culture tells us, baking and enjoying what you bake does not automatically classify you as a stress eater. It’s perfectly okay to bake, even if you’re baking a little more than you usually would right now. It is helpful to have a wide range of coping strategies so that you are not relying on any one single strategy to help you manage.

• While most of us have a little bit more time at home than usual, now is a great time to try a couple new recipes. They don’t need to be complicated and don’t need to include challenge foods (unless that is a goal of yours). Taking time to learn new go-to staples will give you more meal options to draw from when you return to your regular routine. Variety in your diet can go a long way towards helping you meet your nutrient needs. Trying new recipes when your schedule is packed can feel impossible. If you do have more time right now, getting comfortable with a new recipe or two can help further your recovery in the future.

• Getting some fresh air and moving your body in a way you enjoy can be helpful in managing stress and boosting mood. For someone with an eating disorder, that’s not a simple ask. For many folks, exercise was already a complicated thing and may now be an even more complicated thing in our current situation. It’s helpful to ask yourself what is motivating a given decision about exercise – am I doing it because it truly feels good in my body, or because I think I should? For support in trying to tease this question apart, an upcoming discussion facilitated by Dr. Andrea Lamarre will be helpful - https://www.eventbrite.ca/e/working-it-out-exercise-and-recovery-tickets-103030910226?aff=erelexpmlt

Now more than ever, moving away from diet culture and engaging in behaviours that truly support our mental and physical wellbeing is so important. If you’re used to seeing positive affirmations in the windows of Waterloo-Wellington businesses during the first week of May, fear not, the Waterloo Wellington Eating Disorders Coalition is adapting the campaign to go virtual this year. Check us out on Facebook and Instagram to see positive INDD messages on May 6th. Follow and support your local businesses that will be sharing our virtual window signs on May 6th. Spread the word in your own networks and make a difference today!

Recovery blog: Living alone with an eating disorder during a pandemic

Blog post written by Sarah Braun

I’ve always loved my alone time. I grew up an only child, so I’ve become quite accustomed to it and being alone has always felt somewhat normal to me - I never knew anything else. As an adult I have learned to value, appreciate and prioritize my alone time amidst a busy and chaotic schedule. At times I’ve found myself becoming anxious and irritable when I am in social situations or surrounded by others for an extended period of time. I would look forward to going home to rest, relax and recharge by myself. I needed and enjoyed that solitude, because without it my mental health would suffer. However, time spent alone can be a double-edged sword.

When you live with an eating disorder, you are never truly alone. There is always that voice lingering in the background, sometimes very faint and other times overwhelmingly loud. Over the past couple of years, I’ve learned how to quiet that voice through various means; most of which take place outside of the house or in the company of others. Therefore as this pandemic strengthens, and more measures and restrictions are placed upon us, I find myself isolated and confined alone to my
apartment. As mentioned, I am quite familiar with living and being alone, yet this feels different, daunting almost and at times, quite hopeless. Not only is it just myself trapped inside these four walls, I also have the company of my mental illnesses, only now they are being amplified. My eating disorder is latching on to the isolation and begging to thrive in it. Secrets keep you sick, and it is easy to keep those secrets when you have no physical contact with loved ones and the outside world. Connection is only found through a screen these days; fluctuations in weight can go unnoticed and
behaviours can go unknown.

From my experience, most eating disorders stem from or involve some desire for control; so with the COVD-19 pandemic bringing with it so many unknowns and so much uncertainty, the draw to return to eating disorder behaviours seems more desirable than normal. With countless hours spent scrolling through various social media apps, I’ve noticed a theme among posts in what is meant to be a sort of uplifting perspective. Society and governments have been placing emphasis on focusing on
what we can control; our thoughts, our behaviours and our actions throughout this unprecedented time in our lives. For those with an eating disorder or even those in stable recovery, focusing on what we can control usually involves food; what we do eat and what we don’t eat and that can quite quickly become a very risky scenario. Right now more than ever, the world feels unsafe. We are bombarded with stark numbers and statistics. We are told not to leave the house and if necessary, then to wear a mask, gloves and to maintain a safe distance from others. Personally, my eating disorder has always provided me with a sense of protection and safety, therefore now more than ever, the thought of returning to my illness weighs heavier on my mind than normal. With the isolation, lack of control and feelings of being unsafe these days, my eating disorder has been in the corner smiling warmly and waiting to welcome me back with open arms.

Motivation to continue along my recovery journey throughout this pandemic has come in waves, sometimes few and far between. I would be lying if I said keeping my head above water right now is easy, because it certainly is not. In times like these I think back to advice I’ve received over the past of couple years; when it seems impossible to keep climbing, just pause and enjoy the view - nothing more, nothing less. I’m doing my best to take this new normal day by day and sometimes even hour
by hour. I have been working on putting a daily schedule together to provide some sense of structure and routine. My recommendations would include incorporating designated and specific times for creativity, such as writing, colouring and crafting. Next would be an intellectual activity such as reading or an online course. After that, using caution when engaging physical activity, nothing to intense that an eating disorder will cling to and push to the extreme. Perhaps something a simple as stretching, yoga or a leisurely walk around the neighbourhood. The most important part of my schedule involves safe socialization through online platforms such as FaceTime or Zoom. Staying connected in such isolating times, especially for those who live alone, is crucial to maintaining mental health. I make sure to check in with at least one or two people a day and I find that helps to really keep my mood up and feel a sense of love and belonging. However, some days all of that can feel extremely difficult to accomplish. On those days, I’m trying to be compassionate towards myself and do what I can, rather than beating myself up for what I can’t (even if that means just moving from the bed to the couch to watch Netflix - that is okay too.) There is no handbook, no guideline and no rules on how to live through a pandemic, we are all just out here trying to do the best we can to survive.

Create structure to manage social isolation and maintain recovery

Blog post written by Lindzie O’Reilly, MAN, RD. Student Wellness Services, University of Guelph

We are all adjusting to a new reality amidst COVID-19. While our situation continues to change and many things remain unknown, creating a routine can help you manage physical and mental wellbeing and support your current stage of eating disorder recovery.

1. Create and maintain a consistent sleep schedule – With fewer options to occupy our time, many of us have fallen into a habit of sleeping for much longer than usual. For others, motivation to enforce a bedtime might be low, meaning you are staying up late into the night (or morning) and experiencing a decrease in sleep quality. With fewer obligations, there’s no need to stick to the same sleep schedule you had pre-COVID-19, but it is important to have a schedule. Give thought to what your natural sleep rhythm looks like, the sleep routine that would help you fit in the number of meals and snacks you need, and the amount of sleep that helps you feel your best. Choose a rough time to get to bed by each night. This will also likely mean choosing a time by which you need to start to wind down and get ready for bed, move away from screens, and transition to activities that help you relax. Choose a rough time to wake up each day. This may mean setting an alarm to wake you up, ensure you don’t oversleep, and ensure you get your first meal of the day in at a reasonable time.

2. Decide on times for meals and snacks – Based on your sleep schedule and on the number of meals and snacks you need to include each day to support your recovery, choose eating times throughout the day. For many working on eating disorder recovery, pushing off meals and snacks is a common behavior, and justifying meals and snacks when you haven’t left the house or engaged in many activities can feel really challenging. Based on our current reality, we will all be going fewer places and doing fewer things for the next while. Decide on meal and snack times that are non-negotiable regardless of what you’ve accomplished in a day.

3. Create a list of meaningful activities – social activities and hobbies are going to look different than they did pre-COVID-19, but that doesn’t mean you can’t include meaningful and enjoyable things every day. Create a list of things you enjoy – like listening to music, drawing, practicing a language, reading a book, getting some fresh air or chatting with a friend. Schedule times for activities each day as a way to break up the day. Just as an example, this could mean creative time from 10-11am, self-care time from 3-4pm, and connection time from 7-8pm On this list, also include supports you can reach out to, be they professional supports or friends and loved ones.

4. Stock up on staples – As we all try to limit how often we grocery shop, it’s helpful to purchase a few things with a longer shelf life each time you go to the store. Some folks may be used to writing out a weekly meal plan as a step in their recovery. For those who don’t or who haven’t for a while, it might be good to restart the practice during this time to ensure you get everything you need, can make a grocery list, and can arrive at the store with a purpose. Give thought to items you are comfortable with that have a longer shelf life – perhaps things like rice, quinoa, potato or sweet potato, canned legumes, or meat that you can freeze. Great meal options could be things like chili and toast, a stirfry with meat/tofu, frozen veggies and rice, a tuna melt, or an omelet with toast or potatoes. Give thought to substitutions you can make, such as buying fruits and veggies like carrots, apples, oranges and pears with a longer shelf life, or canned or frozen fruits and veggies. In line with the SPREAD acronym, now is likely not the time to add new food challenges, but it is a really important time to maintain current recovery goals. If part of your recovery includes having a baked good once a day, for example, this means ensuring that you buy enough options each grocery trip to last you through until your next trip.

While we are all adjusting to a new day-to-day, it’s really common for it to feel even harder to create structure and routine. The goal of a routine is not to have a strict schedule that you must follow and that feels rule bound or rigid, but it is really helpful to outline a consistent bedtime, wake up time, and eating times. Creating a list of supports and activities you enjoy and can look forward to can help combat worry, loneliness, and sadness. Planning ahead and creating a meal plan can help you make the most of grocery trips and ensure you have what you need to maintain recovery.

Coping with COVID-19 in eating disorder recovery

Blog post written by Therese Kenny, MSc, PhD Student Clinical Child and Adolescent Psychology 

As more and more precautions are put in place to limit the spread of the novel coronavirus COVID-19, individuals with eating disorders face increased challenges in maintaining their recovery. As a result, we have put together some steps to support eating disorder recovery during a global pandemic. In addition to washing your hands and staying home, we encourage you to use the SPREAD steps to help you manage your recovery.

Support recovery

Because of the chance that you may be stuck at home for an extended period of time, it will be helpful to plan ahead so that you have what you need to support your recovery. For me, this meant having my safe foods and challenge foods at home, so that I am able to maintain my meal plan and incorporate challenges. It also meant finding some alternatives for staples in my diet, like picking up frozen fruit and vegetables in case I am not able to get to the store to get fresh produce. If you are unsure of how to best do this, consulting with a dietitian (via phone) could be helpful. Alternatively, take a look at what your friends and family without eating disorders are doing and follow their lead. It’s important also to remember that all foods fit; right now, your eating may look a little different because of all the changes and precautions and that’s okay!

Press pause

Right now, the world is in flux. You may not know if you have to go to work on Monday or whether you will have in-person supports for recovery. At times like this, when uncertainty is rampant, the idea of progressing in recovery can be unfathomable. Give yourself permission to press pause during this time. You do not have to do anything more or challenge any new foods, but you cannot go backwards. Focus on maintaining where you are to the best of your abilities, understanding that slips may happen (see Ease up for tips on how to manage this). 

Reach out

Continue reaching out to supports whenever possible. If your service providers are equipped, they may be able to offer teleconference or phone sessions. With platforms like Zoom, Skype, and WebEx, your providers may also be able to do videoconference sessions! Organizations like Eating Disorders Nova Scotia and Body Brave Canada have online support groups that will continue running at this time. Alternatively, NEDIC and NEDA have phone and text support for individuals struggling with eating disorders. Loved ones may also be able to provide encouragement and support, especially if they are familiar with your journey.

Ease up

These are challenging times. It is not surprising if you are experiencing increased urges to engage in eating disorder behaviours or have found yourself turning to these behaviours. Meeting yourself with compassion can be helpful in managing shame or guilt associated with these slips. How would you talk to a child who is frightened or uncertain about the state of the world? Once you have met yourself with compassion, you can take steps to get back on track such as reaching out to a friend or professional. As the adage in treatment goes, it is important to do the next right thing.

Manage Anxiety and Depression Symptoms

Because anxiety and depression symptoms can make it harder to stay on track with eating disorder recovery, it is important to also make note of and do your best to manage these symptoms at this time.

Anxiety. Individuals who are predisposed to anxiety are likely experiencing a number of worries and/or anxious thoughts related to COVID-19. This may be heightened for people who already experience health anxiety and/or contamination fears. Staying informed while not becoming over-informed is key to managing these worries. Limiting exposure to social media and news coverage will be helpful in this regard. Checking once per day is likely sufficient. Additionally, strategies like mindfulness, meditation, and relaxation may help to manage anxiety as it arises. The Canadian Psychological Association and Anxiety Canada have compiled a list of strategies and resources for managing these symptoms.

Depression. Social distancing is likely to increase feelings of loneliness, isolation, and sadness or depression. Finding connection where you can is important in managing these symptoms. Consider scheduling a Skype coffee date everyday with a friend or calling a loved one to check-in with them. Engaging in light activity such as walking or yoga (if you have been medically cleared to do so) can help boost your mood. Similarly, just going outside and breathing the fresh air can help to feel more connected. If you know that being alone and having little to do is a trigger for your depression, consider planning something to do a day in advance. That way, when you wake up you will have a plan!

Recovery blog: Jessica’s story

Blog post written by Jessica McAllister

“I am my eating disorder” A mindset I’ve had to and am still straying away from today.  Looking back at my teen years diet culture had, and still sometimes can have a firm hold on me.  Everything I did revolved around food, meal planning, cheat days.  For a while it was dieting, and “healthy swaps” and taking the stairs, and not eating at certain times.  Spending hours online looking for a miraculous “quick fix” that I believed would somehow make all of my problems go away.  I’m now 26, and just finally realizing that my disorder was about more than just a number on the scale, meal plans, calories, and the pursuit of thinness.  Don’t get me wrong, those things are big.  Huge even.  They were my friend as well as my worst enemy. I’ve always felt like the only one who has had this “weird” way about them.  I love food, but it scares me. I believe everyone is beautiful no matter their size… except for myself of course.

“I guess the point that I’m trying to make is that there is a light at the end of the tunnel. Finally, I am in the midst of beginning to see it. My god is it beautiful.”

Why is it that I have struggled to learn what my ED team calls “self compassion”  It almost feels like a foreign concept to me.  Does it mean I am to feel sorry for myself, and or wallow in self pity?  Somehow that doesn’t seem right.  It’s taken until now.. at a ripe age of 26 to realize what my mental health team was talking about when they were trying to tell me to have self compassion.  Really it’s okay! It’s a powerful thing, when you’re able to look at yourself in the mirror and accept that things will NOT be perfect.  Accept that you WILL make mistakes, and to know that it’s okay!  You may have been told this once or twice, but the road to recovery is not linear.  Boy is that the truth.  I’ve struggled on days…weeks, months even. Struggled thinking that I was in a more unstable, fragile place than ever.  Comparing my recovery journey to others, not feeling “sick enough” as if it would earn me some sort of metal badge if I was the smallest and sickest in the room.  

Here I go again,  hesitating to continue writing because I feel like I’m getting nowhere.  I’m distracted, this isn’t good enough, and how could anyone possibly relate to all my “crazy” “muffled” thoughts?  Is there really any point to my writing this?  Well yes, because it doesn’t have to be perfect, or make sense for it to be valid.  This is how I have felt, and this is where my disorder has brought me, and this is all okay.  And guess what, I bet just one person can relate. 

Part of recovery for me has been to realize that things don’t have to be just right to be worth doing, or perfectly in place before I start something.  Not everyone is going to relate to your story, but that doesn’t make yours or theirs any less real, and definitely doesn’t take away from the validity of it. I guess the point that I’m trying to make is that there is a light at the end of the tunnel.  Finally, I am in the midst of beginning to see it. My god is it beautiful.

There is something powerful about food freedom, body positivity, and true happiness.  I found that the first two concepts presented me with the happiness I’ve been searching for my whole life.  I wasn’t happy at my sickest point, but I am truly starting to feel happy now.  I’m starting to feel excitement about the future. I am able to eat socially and actually look forward to events.  Whodathunkit? I’m able to enjoy hobbies and concentrate on other things.  My eating disorder no longer consumes me. My relationships have improved, my quality of life has increased, and it may sound cheesy but I actually kind of feel unstoppable.  Fighting an eating disorder is a lot easier said than done. At the same time, fighting an eating disorder has made me the strong woman that I am today, and knowing that I’ve almost made it through is the best feeling in the world.  Just remember, that if you’re reading this. You are NOT alone, there IS help available to you, you are absolutely BEAUTIFUL, and most DEFINITELY worth it.   

Help-seeking for an eating disorder: Barriers and challenges to receiving support

Blog post written by Natalie Doan, BAH, MSc candidate in Public Health and Health Systems, University of Waterloo

“If you are struggling with an eating disorder, please seek help. You do not need to struggle alone. Please see below for some resources”. Obtaining help for an eating disorder is very straight forward—all you need to do ask for help! However, those who sought treatment for their eating disorder can vouch that the process is a lot more difficult than simply asking for help and receiving the appropriate treatment upon the first request. Compounding the financial and geographic constraints to many eating disorder treatment, the experience with the stigma around eating disorders and mental illnesses can convince individuals that they are not worthy or deserving of treatment—I’m not sick enough. However, folks struggling must know that navigating the healthcare systems can be very tricky for many individuals struggling with an eating disorder but there are strategies and resources that can be helpful. Preparing yourself with some of the challenges to expect can help prepare you for a journey towards recovery. 

Barriers related to shame and stigma

“People won’t take me seriously because I don’t look like I have an eating disorder”.

“I’m embarrassed to admit I have an eating disorder.”

“I’m worried what my family and friends will think, say, or do when they find out I have an eating disorder.”
Concerns with what other people will think, say, or do when you disclose that you need help for an eating disorder have one factor in common— they stem from a misunderstanding about eating disorders. Experiencing a negative response from family, friends, and healthcare professionals because of their misconceptions can elicit immense feelings of shame. However, don’t let this prevent you from getting help. Encouraging your loved ones to learn as much as they can about eating disorders can help your loved ones understand more about eating disorders and how to support you. Some great resources to start with include information from the National Eating Disorder Information Centre, National Eating Disorder Association, Beat, and Butterfly Foundation. Regardless of your weight, shape, or size, your struggle is valid and deserving of help.

Barriers related to attitudes towards help-seeking

“Nobody will be able to help me.”

“I don’t need help—I can handle problems by myself.”

 Sometimes hesitation towards help-seeking can come from our beliefs about mental illnesses and treatment. We may believe that we don’t need help because people with mental illness(es) are weak and we desire to be self-reliant. However, asking for help is not a sign of weakness. By being proactive and accessing support for eating disorder symptoms, you can help prevent them from negatively affecting your well-being.

Barriers related to practical constraints (e.g., time, financial, location)

“I’m concerned how taking time off for appointments might affect my school or work.”
“My local community lack resources and it’s difficult for me to travel to appointments.”

“I don’t have anyone who can help me find support.”

 The practical barriers to accessing support and treatment can be incredibly disheartening. Due to the very real constraints of time, cost, and geography, choosing to preserve in obtaining support can be very challenging. In these situations, leveraging online eating disorder support and services can be especially helpful. Depending on the format you prefer, the Looking Glass Foundation, Eating Disorder Support Network of Alberta, Body Brave, and Eating Disorder Nova Scotia are excellent resources to access regardless of where you live. In addition, the National Eating Disorder Information Centre has a toll-free line (1-866-NEDIC-20) where a support worker can help you figure out next steps.

Rise Up! Advocacy & Eating Disorders Awareness Week (EDAW)

Blog post written by Amanda Raffoul, MSc, PhD Candidate in Public Health and Health Systems, University of Waterloo

In Canada, Eating Disorders Awareness Week (EDAW) is held the first week of February (February 1-7). EDAW is an opportunity to increase knowledge, collect donations, and work to erase the stigma surrounding eating disorders among Canadians. The driving force underlying all of these endeavours is the power of advocacy, which inspires EDAW initiatives from coast to coast to coast.

Approximately 1 million Canadians have a diagnosed eating disorder, and an even greater number are likely undiagnosed and/or struggling with disordered eating that does not meet diagnostic criteria. Eating disorders are among the deadliest psychiatric illnesses and have devastating impacts on the lives of those impacted and their families and friends.

Despite these facts, eating disorders are grossly under-funded and under-researched. Efforts by the Canadian government, research institutes, and health centres often fail to address eating disorders in their mandates and missions.

This underscores the need for advocacy in eating disorders practice — by channelling our efforts into raising awareness around eating disorders, we can advocate for greater research, prevention, treatment, and caregiver support that will better the well-being of all Canadians.

During and beyond EDAW, advocacy for eating disorders can:

• highlight the lived experience of individuals who struggle with eating disorders and disordered eating. One key element of this shining a light on the varieties of experiences of folks with eating disorders, and especially those whose stories are often neglected in mainstream portrayals (like racialized people, higher-weight people, and men and nonbinary folks).

• disseminate research on the impacts of eating disorders on Canadians of all sizes, races, ethnicities, and genders. These impacts may be financial, emotional, physical, and/or social for the person affected and their families and friends.

• raise awareness of services and supports nationally and locally. By promoting services in communities (check out the list of regional services on our site) and nationwide, we can increase awareness of supports for when people need them most.

• decrease stigma surrounding food- and weight-related struggles that affect much of the population. EDAW provides an opportunity for eating disorder practitioners and researchers to dispel prevalent myths around disordered eating and reinforce messaging that eating disorders are not a choice.

Feeling inspired? Good! The Waterloo-Wellington Eating Disorders Coalition (WWEDC) is hosting several EDAW events that aim to tackle the stigma surrounding eating disorders in our region.

• University of Guelph Body Image Expose

  • Feb 4, 2020 - 10:00am - 3:00pm

  • The Wellness Education and Promotion Centre at the University of Guelph will be running an expose aimed at introducing students to the topics of Health At Every Size, body image concerns, and eating disorder prevention and treatment. The expose will feature interactive activities such as cookie decorating and button making, as well as information from on- and off- campus supports.

• Faces of Recovery

  • Feb 7, 2020 - 7:00 - 9:00pm @ Guelph Youth Music Centre (75 Cardigan St., Guelph, ON)

  • A panel discussion featuring individuals on the road to recovery from an eating disorder, as well as family members who supported their journeys. Free admission, donations welcome.

• University of Guelph Body Project

  • Feb 8 & 9, 2020 - 11:00am - 1:00pm

  • The Wellness Education and Promotion Centre at the University of Guelph will be facilitating The Body Project. The Body Project is a workshop that aims to promote positive body image, reduce body shaming and encourage folks to accept themselves as they are. Participants must attend both sessions. Refreshments will be provided! Please register at https://gryphlife.uoguelph.ca/.

• All About Eating Disorders

  • Feb 12, 2020 - 7:00 - 8:30pm @ CMHA Waterloo Office (1 Blue Springs Dr., Waterloo, ON)

  • A community workshop featuring clinicians and individuals with lived experience. Learn about eating disorders and local services and supports. Free admission, donations welcome.

Not free to attend one of our events? No problem! You can search for an event in your local area, join the conversation on social media, or join the #showusyourpurple campaign.

Eating disorders cannot afford to wait! This EDAW, join us in advocating for greater awareness around eating disorders and the millions of Canadians they affect.