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Is ‘National Nutrition Month’ a Recovery-Positive Campaign?

Written by nutritiousthoughtsblog on . Posted in Eating Disorder Recovery, Education.

As registered dietitians dedicated to the prevention and evidence-based treatment of eating disorders and disordered eating, we found ourselves asking the following questions leading into National Nutrition Month®:

  • Does National Nutrition Month® (NNM) align with Eating Disorder/Disordered Eating (ED/DE) recovery?
  • As Health At Every Size® (HAES) informed professionals, to what extent might we ethically support participation in this month-long campaign focusing on nutrition and physical activity to our clients, our peers, friends, loved ones…ourselves?

The quick answers?

  • A little bit, kind of, sorta…
  • Proceed with caution

Here’s a more in-depth look at our perspective:

Let’s begin by explaining a little bit more about NNM!  NNM was created by the Academy of Nutrition and Dietetics (AND), the largest organization of food and nutrition professionals in the United States. AND defines NNM as follows:

What is National Nutrition Month®?

National Nutrition Month® is an annual nutrition education and information campaign created by the Academy of Nutrition and Dietetics. The campaign, celebrated each year during the month of March, focuses on the importance of making informed food choices and developing sound eating and physical activity habits.

– Academy of Nutrition and Dietetics (AND)

We’ve done a thorough review of the National Nutrition Month website for 2019 and wanted to share some thoughts with you.

What we appreciated about this year’s theme:

  1. The 2019 NNM theme is self-titled (“National Nutrition Month®”) which makes it more inclusive of many different topics of discussion – including eating disorders and disordered eating! Win!
  2. Many of the educational materials encouraged making sustainable changes towards achieving balanced food and movement routines that are individualized. We love this approach!
  3. Mental health and motivation for change (which are totally intertwined with eating and moving our bodies) were not excluded from the conversation!

What we could have done without:

  1. The language! Reviewing the NNM website brought up a much larger conundrum – the way we speak about nourishment in our society. The language we use to address nutrition and movement is morally charged. The “good/bad” or “right/wrong” polarization is not recovery-positive and continues to drive us farther away from seeing food as just food and moving our bodies as joyful and drives the shame wagon. Shame does not motivate people to adopt health-promoting behaviors.
  2. Weight management. Encouraging weight management through portion control and calorie tracking is not an approach that is respectful and accepting of all body shapes and sizes and promotes the message that larger bodies are inherently in need of “fixing” or must be controlled in some manner. Nah, nah, nah. Not buying it. Weight management is not weight neutral. It’s not HAES-informed. It’s not recovery-positive. It’s oppressive and unethical to prescribe disordered eating behaviors to people living in larger bodies. Also, there is a body of evidence against it.

*Caveat: National Nutrition Month was not created specifically for those in recovery from ED/DE, but for the general United States public.  However, even so, language equating terms such as “weight management” and “portion control” as being “right” can be harmful for at-risk populations and creates unnecessary vulnerability to developing ED/DE behaviors.

Suggestions for observing NNM in ED/DE recovery:

  1. Celebrate how far you’ve come! Take this opportunity to reflect on how eating and movement patterns have become more sustainable and balanced.
  2. Set goals. How might you propel your recovery forward this month? What would it look like to take steps to strengthen our relationships with ourselves and with food, movement, and recovery?
  3. Increase your food variety – try some new foods this month!
  4. Take up space and use your voice. Be in a larger body. Be fat. Exist as you are.

We love our field, our colleagues, and the wealth of valuable knowledge provided by AND, and we hope to continue to shift the way nutrition and wellness are presented to the general public to be more inclusive and less stigmatizing!

Check out what other ED/DE clinicians have said about NNM over the years:

https://marcird.com/my-take-on-national-nutrition-month/

https://veritascollaborative.com/blog/blog-national-nutrition-month/

https://www.sovcal.com/recovery/having-an-eating-disorder-during-national-nutrition-month/

 

 

 

What is “Health At Every Size”?

Written by nutritiousthoughtsblog on . Posted in Education.

THE HEALTH AT EVERY SIZE® APPROACH:

Weight does NOT define Health.

The framing for a Health At Every Size (HAES®) approach comes out of discussions among healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES® model is an approach to both policy and individual decision-making. It addresses broad forces that support health, such as safe and affordable access. It also helps people find sustainable practices that support individual and community well-being. The HAES® approach honors the healing power of social connections, evolves in response to the experiences and needs of a diverse community, and grounds itself in a social justice framework.

The Health At Every Size® Principles are:

Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.

Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.

Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.

Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.

Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

OSFED & Additional Eating or Feeding Disorders: The Signs, Symptoms, & Impact

Written by nutritiousthoughtsblog on . Posted in Education.

Other Specified Feeding or Eating Disorder

According to the National Eating Disorder Association…

Formerly described at Eating Disorders Not Otherwise Specified (EDNOS) in the DSM-IV, Other Specified Feeding or Eating Disorder (OSFED), is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.

Examples of OSFED Include:

  • Atypical anorexia nervosa (weight is not below normal)
  • Bulimia nervosa (with less frequent behaviors)
  • Binge-eating disorder (with less frequent occurrences)
  • Purging disorder (purging without binge eating)
  • Night eating syndrome (excessive nighttime food consumption)

The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school or relationships. If something does not seem right, but your experience does not fall into a clear category, you still deserve attention. If you are concerned about your eating and exercise habits and your thoughts and emotions concerning food, activity and body image, we urge you to consult an ED expert.

Symptoms associated with anorexia nervosa include:

  • Inadequate food intake leading to a weight that is clearly too low.
  • Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain.
    • Self-esteem overly related to body image.
    • Inability to appreciate the severity of the situation.
    • Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.

Restricting Type does not involve binge eating or purging.

Symptoms associated with bulimia nervosa include:

  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge-eatingepisodes.
  • Self-esteem overly related to body image.

Symptoms associated with binge eating disorder include:

  • Frequent episodes of consuming very large amount of food but without behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge eating episodes.
  • Feelings of strong shame or guilt regarding the binge eating.
  • Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior.

 

Additional Eating or Feeding Disorders

Avoidant/Restrictive Food Intake Disorder

  • Failure to consume adequate amounts of food, with serious nutritional consequences, but without the psychological features of Anorexia Nervosa.
  • Reasons for the avoidance of food include fear of vomiting or dislike of the textures of the food.

Pica

  • The persistent eating of non-food items when it is not a part of cultural or social norms.

Rumination Disorder

  • Regurgitation of food that has already been swallowed. The regurgitated food is often re-swallowed or spit out.

Unspecified Feeding or Eating Disorder

  • When behaviors do not meet full criteria for any of the other feeding and eating disorders, but still cause clinically significant problems.
  • Alternatively, when clinician is unable to assess whether an individual meets criterion for another disorder, for example, when there is a lack of information in an emergency situation.

Binge Eating Disorder: The Signs, Symptoms, & Impact

Written by nutritiousthoughtsblog on . Posted in Education.

Binge Eating Disorder

According to the National Eating Disorder Association...

Binge eating disorder (BED) is an eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. Binge eating disorder is a severe, life-threatening and treatable eating disorder. Common aspects of BED include functional impairment, suicide risk and a high frequency of co-occurring psychiatric disorders.

Binge eating disorder is the most common eating disorder in the United States, affecting 3.5% of women, 2% of men,1 and up to 1.6% of adolescents.2

The DSM-5, released in May 2013, lists binge eating disorder as a diagnosable eating disorder. Binge eating disorder had previously been listed as a subcategory of Eating Disorder Not Otherwise Specified (EDNOS) in the DSM-IV, released in 1994. Full recognition of BED as an eating disorder diagnosis is significant, as some insurance companies will not cover an individual’s eating disorder treatment without a DSM diagnosis.

BED Symptoms and Diagnostic Criteria
The DSM-5, published in 2013, lists the diagnostic criteria for binge eating disorder:

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
  2. The binge eating episodes are associated with three (or more) of the following:
    • Eating much more rapidly than normal.
    • Eating until feeling uncomfortably full.
    • Eating large amounts of food when not feeling physically hungry.
    • Eating alone because of feeling embarrassed by how much one is eating.
    • Feeling disgusted with oneself, depressed, or very guilty afterward.
  3. Marked distress regarding binge eating is present.
  4. The binge eating occurs, on average, at least once a week for 3 months.
  5. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Characteristics of BED
In addition to the diagnostic criteria for binge eating disorder, individuals with BED may display some of the behavioral, emotional and physical characteristics below. Not every person suffering from BED will display all of the associated characteristics, and not every person displaying these characteristics is suffering from BED, but these can be used as a reference point to understand BED predispositions and behaviors.

Behavioral Characteristics

  • Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
  • Secretive food behaviors, including eating secretly (e.g., eating alone or in the car, hiding wrappers) and stealing, hiding, or hoarding food.
  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting; and developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, not allowing foods to touch).
  • Can involve extreme restriction and rigidity with food and periodic dieting and/or fasting.
  • Has periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling uncomfortably full, but does not purge.
  • Creating lifestyle schedules or rituals to make time for binge sessions.

Emotional and Mental Characteristics

  • Experiencing feelings of anger, anxiety, worthlessness, or shame preceding binges. Initiating the binge is a means of relieving tension or numbing negative feelings.
  • Co-occurring conditions such as depression may be present. Those with BED may also experience social isolation, moodiness, and irritability.
  • Feeling disgust about one’s body size. Those with BED may have been teased about their body while growing up.
  • Avoiding conflict; trying to “keep the peace.”
  • Certain thought patterns and personality types are associated with binge eating disorder. These include:
    • Rigid and inflexible “all or nothing” thinking
    • A strong need to be in control
    • Difficulty expressing feelings and needs
    • Perfectionistic tendencies
    • Working hard to please others

Physical Characteristics

  • Body weight varies from normal to mild, moderate, or severe obesity.
  • Weight gain may or may not be associated with BED. It is important to note that while there is a correlation between BED and weight gain, not everyone who is overweight binges or has BED.

BED Population and Demographics
Binge eating disorder is the most common eating disorder in the United States; it is estimated to affect 1-5% of the general population.1 BED affects 3.5% of women, 2% of men,1 and up to 1.6% of adolescents.2

Demographic Information

  • Binge eating disorder affects women slightly more often than men—estimates indicate that about 60% of people struggling with binge eating disorder are female and 40% are male.
  • In women, binge eating disorder is most common in early adulthood. In men, binge eating disorder is more common in midlife.
  • Binge eating disorder affects people of all demographics across cultures.

Physical and Psychological Effects of BED
Binge eating disorder has strong associations with depression, anxiety, guilt and shame. Those suffering from BED may also experience comorbid conditions, either due to the effects of the disorder or due to another root cause. Comorbid conditions can be both physical and/or psychological.

Physical Effects

  • Most obese people do not have binge eating disorder. However, of individuals with BED, up to two-thirds are obese; people who struggle with binge eating disorder tend to be of normal or heavier-than-average weight.
  • The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:
    • High blood pressure
    • High cholesterol levels
    • Heart disease
    • Type II diabetes
    • Gallbladder disease
    • Fatigue
    • Joint pain
    • Sleep apnea

Psychological Effects

  • People struggling with binge eating disorder often express distress, shame and guilt over their eating behaviors.
  • People with binge eating disorder report a lower quality of life than those without binge eating disorder.
  • Binge eating disorder is often associated with symptoms of depression.
  • Compared with normal weight or obese control groups, people with BED have higher levels of anxiety and both current and lifetime major depression.

BED Treatment
Effective evidence-based treatments are available for binge eating disorder, including specific forms of cognitive behavioral therapy (CBT), interpersonal therapy (IPT), dialectical behavioral therapy (DBT), and pharmacotherapy.

All treatments should be evaluated in the matrix of risks, benefits, and alternatives. Decisions regarding treatments should be made after consulting with a trained medical professional and eating disorder specialist.

To find a treatment provider who specializes in binge eating disorder, please visit NEDA’s Treatment Referral database.

Social Stigma of BED
Many people suffering from binge eating disorder report that it is a stigmatized and frequently misunderstood disease. Greater public awareness that BED is a real diagnosis—and should not be conflated with occasional overeating—is needed in order to ensure that every person suffering from BED has the opportunity to access resources, treatment, and support for recovery.

NEDA’s shareable binge eating disorder infographic offers an easy way to spread the word about BED. It is important to underscore that BED is not a choice; it’s an illness that requires recognition and treatment.

Sources
1. Hudson, J.I., Hiripi, E., Pope, H.G. et al. (2007)The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol.Psychiatry, 61, 348–358.
2. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry. 2011;68(7):714–723

Registered Dietitians and Nutritionists: Similarities and Differences

Written by nutritiousthoughtsblog on . Posted in Education.

Registered Dietitians (RDs) and Nutritionists have a similar professional passion – to help guide others in living their best lives through individualized and balanced eating patterns, movement routines, and overall self-care. However, there are stark differences in the education, training, and legal certification processes between Registered Dietitians and Nutritionists that are important to recognize when choosing the nutrition professional that is best suited to meet your needs.

Education and Training
All RDs must complete a formal education program resulting in a minimum of a 4-year baccalaureate degree from an accredited university. These degree programs include extensive coursework in the following areas:

  • Biology and Microbiology
  • Organic chemistry and Biochemistry
  • Human Anatomy and Physiology
  • Foodservice systems management
  • Food and nutrition sciences
  • Computer science and Business
  • Sociology and Psychology
  • Economics

Dietitians have also participated in a rigorous practical internship (minimum of 1,200 hours of hands-on experience) and are qualified to provide medical nutrition therapy (MNT) for chronic illnesses such as diabetes, kidney disease, cancer, metabolic disorders, and many other disease states. Nutritionists may have certificates and/or degrees in nutrition-related fields but are not required to complete the same formal education programs as RDs and cannot legally or ethically provide medical nutrition therapy.

Legal Certification
To become a registered dietitian, one must pass a comprehensive national exam and will likely need to acquire a license to practice in their individual locations. These certifications are upheld through renewal processes and by completing ongoing continuing education requirements. Non-licensed Nutritionists do not have to uphold national or state credentials and do not have to complete continuing education activities. “Nutritionist” is not a regulated title, so anyone can call themselves one regardless of their educational background, work experience, or services offered.

When embarking on your journey to balanced nutrition, ensure that you are choosing the nutrition professional that has the qualifications, experience, and ability to meet your individual needs and to help guide you in reaching your health and wellness goals!