Instagram to make Diet Ads viewable for ages 18 and over—Why They should Remove Them Altogether

by Carolyn Hersh, LCSW

Instagram to make Diet Ads viewable for ages 18 and over—Why They should Remove Them Altogether
Photo by NeONBRAND on Unsplash

On September 18th, 2019 Instagram instituted an official policy that all ads promoting diet and weight loss products would only be able to be viewed by users 18 and over. Any ads that have false claims can be reported and subject to removal. This is a huge victory in the world of challenging diet culture. For years, celebrities and social media influencers have been advertising diet and weight loss products that, for the most part, are bogus, promise false results and can be just downright dangerous to someone’s physical and mental health.

Most celebrities who promote these products are doing so for a paycheck and not because they are actually finding these products useful. Unfortunately, advertisements like these can impact impressionable viewers, especially those struggling with poor body image, disordered eating and eating disorders. And while the celebrities may say, “Take this and look like me,” the reality is that these products have no true evidence that they can change anyone.

Emma Collins, Instagram’s public policy manager, made a statement after this policy went into effect, “We want Instagram to be a positive place for everyone that uses it and this policy is part of our ongoing work to reduce the pressure that people can sometimes feel as a result of social media.” While this is a great step forward, it does feel like the next step should be eliminating diet and weight loss products altogether.

There are some major problems with advertising weight loss products. As a Health at Every Size® activist and promoter of body positivity, I can tell you that these products merely reinforce the idea that your body isn’t good enough. They teach that there is only one ideal body, and usually, it is the body of the celebrity promoting the product. It can be really dangerous to tell people that tea will flatten their stomachs or a lollipop will give them curves in the “right” places.

These advertisements put people at risk for developing eating disorders. They promote the very behaviors that are symptoms of eating disorders. These products try to normalize appetite suppression or compensating for what one has eaten via a laxative pill or tea. The messages are not health-promoting. They reinforce diet culture beliefs of certain foods being bad and needing to atone for eating.

A major issue is that there is absolutely no evidence that the products being advertised actually help with weight loss, detoxing your body of toxins, or changing the shape of your body. Most of these products are not even approved by the United States Food and Drug Administration (FDA). The FDA is charged with regulating medications and while there are a few that have been approved, most that are advertised on social media are not. Most of these products carry false claims and use ingredients that can be more harmful than helpful. And that is a huge problem.

We do not often see celebrities sharing disclaimers of potential side effects from using these products. Diet pills may increase heart rate, heart palpitations, the likelihood of a stroke, and even death. The detox teas carry the risk of dehydration, electrolyte imbalance and stripping our guts of the nutrients we need. Side effects can also include an increase in stomach cramping, bloating, and diarrhea. Our bodies were designed to naturally flush out toxins. It is why we have a liver. And for those users of the products looking for a way to lose weight, well the weight “lost” from these teas are usually just water or stool mass. These products place a huge toll on the body and put vital organs at risk.

For these reasons, we should not only be protecting social media users who are under 18. We should be protecting everyone from viewing these ads. Adults are probably more likely to purchase these products and adults are just as susceptible to false promises as adolescents. It is great that places like Instagram are giving us a choice if we want to view these ads. It is definitely a step in the right direction. But, there is nothing safe about these products. From taking a physical toll on our bodies to mentally placing shame on our bodies there is no room for diet pills, detox teas, or any other weight loss product.

If you are currently struggling with how you feel about your body, help is available through support groups, therapy, and even body-positive accounts and groups on social media. The wonderful thing about social media is that there is a community for promoting Health at Every Size® and working on self-love and acceptance. Most of these groups do not cost anything and can have to have positive effects on your mind and body.

Parents, Don’t Let Your Kids Download Kurbo!

Parents, don't let kids download Kurbo appA disclaimer: I have no vested interest in Weight Watchers’ new Kurbo app. This app will in fact create more work for me. But let me be clear: I do not want this kind of work!

I know that you mean well and are merely concerned about your child’s health, but I can assure you that Weight Watchers does not share your concern. They are a commercial enterprise interested in making money and their business model is based on preying upon insecurities.

You would only need to spend a short time in my waiting room to hear from other parents who were once like you—moderately concerned (or maybe unconcerned) about their child’s weight and happy when their child committed to “eating healthier.” The story is nearly always the same. This child has been in what I would call a larger body—you might have called them “overweight”, pediatricians might have labeled them “obese”. It starts with them giving up sweets and then progresses. They start to restrict meat and starches and exercise more. It looks healthy. Over time, some switch gets tripped, and with very little warning the kid has anorexia, a lethal mental illness.

While most cases of anorexia are triggered by dieting, unintentional weight loss can be a trigger as well. It appears that people predisposed to anorexia respond to a negative energy balance in a way that flips this switch and they cross a dieting point of no return. Many of the teens I work with have been hospitalized for life-threatening low heart rates and electrolyte imbalances.

I cannot adequately express the guilt that parents feel from having allowed their teens to start these diets. I don’t blame them. I understand the pressure they are under.

Two of my three children grew out before they grew up. They had gained the weight their bodies needed to fuel puberty and impending growth spurts. I too received the warning from my well-intentioned pediatrician about their weights and weight gain. I knew enough to ignore the implied suggestion of helping them trim down. I cringe to think what might have happened if I had followed it. My children grew just fine and became more proportional according to their genetic predisposition.

My other child was lauded by the same pediatrician for growing up before growing out. It was only years later when I plotted her growth that I realized she had totally fallen off her expected weight curve at the time the pediatrician praised her weight. Yet, I did notice that she didn’t seem to be eating enough. (For more information on the intervention I did with her, read this post.)

The Kurbo app should come with the following warning:

“This app may trigger an eating disorder
from which your child could take 22 years to recover.”

Yes, 22 years! The most rigorous longitudinal study we have of anorexia has shown that at 9 years, only 31% of individuals with anorexia nervosa had recovered. Almost 63% had recovered at 22 years. If this is the path you follow, you may be facing many long years in and out of costly treatments to help your child recover.

Incidentally, Kurbo has made my job tougher. It classifies foods as “green”, “yellow”, or “red”. “Red” foods, such as ice cream, fried chicken, and pizza are “bad” — Kurbo advises kids to avoid them.

I work with children who suffer from anorexia, may be hypermetabolic, and may require ingesting upwards of 6000 kcal per day for several years to recover. I can’t express the difficulty of convincing an anorexic child to eat highly caloric foods to recover, when they immediately parrot back all the health messages they’ve received about these foods being dangerous. It’s terribly confusing to be told that the foods they’ve learned are bad for them are in fact the medicine that will cure them. This is but one reason why we cannot take a one size fits all approach to foods.

Back in my waiting room, maybe you would hear from some of the adults with eating disorders. They might tell you that years of dieting have contributed to weight gain, weight cycling, binge eating, and misery. They will typically remember that this pattern started in childhood with a diet. Dieting disconnects people from their own internal regulatory system (as does tracking calories and exercise).

What Can Parents Do Instead?  The following advice is for parents of kids of all sizes.

I suggest teaching kids that bodies naturally come in all shapes and sizes and that body size is largely genetically determined. I recommend viewing the Poodle Science video from ASDAH. This video does a great job illustrating body diversity and the risks of subjecting everyone to a single body standard. I suggest teaching kids that fat bodies are great too. We have to make it safe for people to be fat in order to prevent and treat eating disorders. Eating disorders are a more lethal problem. Parents can avoid judging or criticizing their own or other peoples’ bodies.

I suggest giving kids access to a range of foods — prohibiting “fun” foods leads kids to overvalue and overeat them. We don’t need to label foods as good or bad. Parents can serve nutritious food as well as fun food and model that they are of equal moral value. They can also model that food is supposed to be pleasurable and offers the opportunity for social and cultural connections.

Parents can also help children to move in ways that are fun, rather than teaching that exercise is penance for eating.

For more specific advice on helping kids develop as strong intuitive eaters with healthy body images, I suggest the work of dietitian Ellyn Satter and my psychotherapist colleagues, Zoe Bisbing and Leslie Bloch, The Full Bloom Project.

To Learn More

I recommend reading the statement from the National Eating Disorders Association: NEDA Statement on Kurbo by WW App.

And also The New York Times Op-Ed by dietitian, Christy Harrison: Our Kids Do Not Need A Weight Watchers App.

 

Do I Need to Quit X to Stay in Recovery?

Do I Need to Quit X to Stay in Recovery?
Image by Zorro4 from Pixabay

By Carolyn Hersh, LCSW, Staff Therapist

A difficult concept in recovery is knowing when to let go of an activity or even a job that could potentially re-ignite the eating disorder. As a therapist I find myself guiding my clients towards the realization that the sport or career path they had loved so much might be the very thing that holds them back and sets them back up for relapse. It isn’t always an easy decision.

Letting go of something that may have predated the eating disorder can lead to questions as to why it cannot remain in someone’s life in recovery. Many clients in the early stages of eating disorder treatment have to face the fact that they have to stop their sports if they are trying to regain weight or are working on eliminating behaviors that could leave the body physically weak. It is no surprise that once stabilization begins there is an urge to return to previously enjoyed activities. However, returning to these activities could potentially hinder full recovery.

Sports like gymnastics, running, figure skating, wrestling, and dancing are incredibly wonderful. As a figure skater myself, I can attest there is no greater feeling than gliding over the ice. But these same sports, especially at the elite level, can be incredibly demanding on the body. Behaviors required for full recovery can go against what a coach may be preaching to athletes to be in top physical form. What is expected of top athletes could look like disordered eating and poor body mentality from an outside perspective. The eating disorder itself may take what is used to condition a top athlete and manipulate it for its own gain.

It can be difficult to find the balance between a recovered mindset and meeting the demands of a sport or career. With some of my clients in the entertainment industry, there are pressures to look a certain way and fit a mold that their bodies may not be meant to fit. It can be difficult to navigate knowing they need to eat a certain amount of times a day and then have an agent say, “Lose five pounds for this role.”

The hardest decision is when there is a realization that staying in either the sport or career is just too detrimental to your health. It is certainly not easy to walk away from something you’ve put work into. And that can also be said about your recovery. Are you willing to give up a healthy body and mind for a potential chance at a gold medal or lucrative career even if it means killing yourself along the way? I’ve worked with a client who was a dancer who recognized as she was going through treatment that going back into a dance studio would be too triggering. She knew that staring at herself in a mirror and comparing herself to her classmates would lead to restricting her meals. It wasn’t an easy decision to walk away, but she knew there was no way she was in a place to be able to dance without being triggered.

In some circumstances, you may not have to completely quit your previous passion.  You might be able to approach the activity differently. You may not be able to return to a sport as an elite athlete, but you could still engage in the activity at a more recreational level. I’ve seen some of my clients shift from being an athlete to being a coach. Actors going from television and movies to doing local theater.  Sometimes you can still do what you love but it just needs to be re-configured to fit into your recovery lifestyle. For many, it can be comforting to know they can still act or model or run, but just do it less intensively.

You may also have the option of challenging what a sport or career emphasizes as far as body image and diet pressures. There are many models and actors who are embracing bigger bodies and not letting the pressures to lose weight define them. With this option, there is a risk of rejection along the way as we do still live in a culture that overvalues thinness. With that being said, this may be a safe option primarily for those who feel stable in recovery and are able to actively use coping skills to fight urges. If your recovery has reached a place of advocacy this definitely could be a path to take.

Leaving a passion behind or re-defining how it fits into your life can be a huge change. You may feel sad or mad. That’s okay. Ultimately, the decision you make will be the one that supports you in your recovery. If staying in the activity is going to trigger calorie counting, weekly weigh-ins or criticism for not looking a certain way, is it worth it? If you know where the eating disorder thrives then why play with fire? Ultimately, the decision will be based on what will make you healthy and happy and not allow you to compromise with the eating disorder.

Seven Reasons You Should Eat When You’re Not Hungry

challenging diet rules
Representation Matters

One of the cardinal rules of dieting is “Eat only when you’re hungry.” I often find that the fear of eating when not hungry is one of the most difficult bits of dogma to overcome. People with eating disorders and good dieters everywhere have been taught that this is all that stands in the way between us and complete loss of control and utter disaster in our lives. Many don’t even see it as an actual choice or symptom of the eating disorder.

Successful recovery from an eating disorder or disordered eating or chronic dieting requires overcoming and challenging this rule.

Just off the top of my head, I can think of a lot of reasons to eat when not hungry. Here are a few related to disordered eating:

  1. You have overridden your hunger cues for years from cycles of dieting, bingeing and purging. You don’t recognize normal hunger cues or satiety. Your treatment team has told you to eat regularly—three meals and two to three snacks per day. You feel like it is too much food and you’re not hungry. Should you follow their meal plan? Yes! Eating regularly is a crucial step in recovering from any eating disorder and it helps to regulate your hormones and circadian rhythms so you can regain your hunger and satiety cues and become a more intuitive eater.

 

  1. You are in recovery from a restrictive eating disorder and rarely feel hunger. You are told you need to eat more, but you don’t believe it. Isn’t it better to delay eating until later in the day? Should you really eat breakfast and lunch at the times scheduled by your dietitian? Yes, absolutely! Regular meals are critical to getting all of your body functions to work properly again. One of the reasons you may not be feeling adequate hunger could be delayed gastric emptying, which occurs when someone is undereating and food remains in the stomach far longer than it should. One of the consequences is low appetite. The solution: eat regularly as prescribed, even if you’re not hungry.

 

I can think of many more situations that apply to all of us, not just those with eating disorders:

  1. You normally eat dinner at 7 pm and your circadian rhythm is conditioned to get hungry then. But your sister has scheduled a family dinner at 5:30 to accommodate her children so they won’t be cranky at the table. Should you eat at 5:30 before you are hungry? Absolutely! Adjusting our schedules allows us to have meaningful social interactions that typically revolve around eating.

 

  1. You have a meeting that is scheduled from 12 to 3 pm. You’re not hungry at 11 am; breakfast was only at 8:30. You have the option to have a proper lunch at 11:30. Should you? Of course! Be practical—it’s better to eat before your meeting. Then you’ll be properly fueled and will be better able to concentrate during the meeting. Our brains don’t function as well when they’re low on glucose. Planning ahead and adjusting mealtimes accordingly is an important act of self-care.

 

  1. You are traveling to another country. You arrive at your destination and it’s dinnertime. Your circadian rhythms are all thrown off. You feel like you’ve been eating constantly. Should you eat? Yes! Acclimation to a new time zone is ushered along by institution of regular eating at the times appropriate to the destination. You will adjust faster if you get your body in synch.

 

  1. You just had a rough breakup. You’re eating meals, but sad. Your friends show up and want to take you out for ice cream to cheer you up. You’re not hungry. Should you go and eat ice cream with your friends? Absolutely! Food is not solely about nutrition – it’s also about bonding and comfort, and you should let the ice cream and your friends soothe your broken heart.

 

  1. You’re stressed and preparing for a presentation tomorrow. You’ve eaten adequately throughout the day and are not truly hungry. But you know that crunching on some popcorn will soothe your nerves. This is an old behavior that you’ve overused in the past. Contrary to popular belief, emotional eating is not itself a problem. Food is our earliest comfort and humans are designed to find food to be rewarding. If it were not, we would have died out as a species. There is no shame in using food as comfort—what can be problematic is if there are no other tools in your emotional toolkit. If eating is your only coping skill then I encourage you to learn some other strategies for managing negative emotions to give you a broader range of alternatives.

 

So, not eating when you’re not hungry is a rule that should be confronted. How can you start to challenge this rule and, if you have one, the eating disorder that uses it as an excuse?

You must face it head-on with new behaviors, deliberately defying it. If you have been instructed to follow a meal plan: follow it. If you have been told you are undereating: practice eating one thing per day when you are not hungry. The next time you have something in your schedule that interferes with a normal meal time: eat beforehand. Accept invitations to eat at times to which you are unaccustomed. Eat something spontaneously when it shows up, even if you are not hungry.

By practicing these behaviors, you will become less fearful of eating when not hungry. You will learn that this, too, is a normal part of being a human. You will be more relaxed around food and you will see that nothing horrible happens if you eat when you’re not hungry. You do not have to continue to be a victim of diet culture.

Nana’s Poundcake, Food, and Cultural Connection

Nana's PoundcakeFood for us comes from our relatives, whether they have wings or fins or roots. That is how we consider food. Food has a culture. It has a history. It has a story. It has relationships. –– Winona Laduke

Food is about more than sustenance. It is about pleasure and joy and connection. Food is one of the ways we connect with our cultural traditions and our ancestors. This is one of the reasons I am so passionate about my work to help people with eating disorders. When someone has an eating disorder and they are fearful of eating or of eating certain foods, they miss out on the pleasures of food and they miss out on the opportunities to connect with others through food. They also miss out on their own connection with their relatives and their cultural heritage.

In my own family, my 103-year-old Nana has always been known for her piano playing and her delicious poundcake. While her prized Steinway piano now stands in my home, I did not inherit her piano-playing her abilities. I did, however, learn her poundcake recipe.

From the time I was a young girl, I have memories of “Nana’s poundcake.” Simple to make with only 5 ingredients, buttery and yummy. During visits to Kansas City, I looked forward to making it with her. And when she visited us in New York we would make it together. And, occasionally my mom and I would make it without Nana. My kids have had the experience of making poundcake with my Nana, their great grandmother. And they have made it with me. After she eventually passes, we will retain this connection to my Nana and my kids will hopefully continue to make and share her recipe with future generations.

 

 

 

 

 

Photos of my daughters making poundcake with Nana back in 2012 at her apartment (she was 96)

I am glad to have this connection to Nana and to be able to fully enjoy making and eating poundcake with all its rich butter and sugar. What joy and connection I would be missing out on if I were afraid of eating it. To be able to make it and eat it with enjoyment enriches my life and allows me to have a shared experience through four generations of my family. I will always have joyful memories of baking and eating poundcake with the different generations in my family.

Bonus Feature — Nana’s Poundcake Recipe

  • 1/2 pound salted butter (2 sticks) – softened
  • 1 3/4 cup sugar
  • 5 eggs
  • 2 cups sifted flour
  • 2 T vanilla

 

  • Cream butter and sugar
  • Add eggs one at a time while beating constantly
  • Add flour and flavoring
  • Pour into well-greased loaf pan (or bundt pan)
  • Bake at 350° for 90 minutes

Photos from a poundcake I made with my daughter in 2019.

Sweatin’ for the Wedding: Say, “I don’t.”

Sweating for the Wedding? Say: I Don’t.
Image by rawpixel on Pixabay

by Carolyn Hersh, LMFT

In November of 2018, my boyfriend proposed to me. It was one of the most exciting days of my life thus far. With a proposal comes the next exciting chapter: wedding planning. For many brides-to-be, this entails finding that perfect gown.

Sadly, although not surprising, once I got on bridal mailing lists, I learned I was also being targeted by gyms for “Bridal Boot Camps” and “Sweatin’ for the Wedding.” The weight loss industry found yet another way to weasel their way into a life event that should have nothing to do with changing one’s body.

Why is it that you could be with someone who you love for a certain amount of years, and suddenly the moment they place a ring on your finger you need to change your body? Why does looking beautiful equate to weighing less?

Unfortunately, it has become the norm in our culture to experience pressure to lose weight for special events. A friend once shared that when she was dress shopping her consultant actually wrote down smaller measurements because “all brides lose weight.” When my dress consultant mentioned letting her know if I lose weight, my initial thoughts were, “Are you telling me I need to lose weight? Am I supposed to lose weight? What if I like my body where it is? What if I want to gain weight?”

Granted, our bodies can change. But, hearing about weight loss, exercise programs, and diets specific for the big day can be detrimental to our physical and mental health. The diet industry has found another market and doesn’t care how it impacts the people getting married.. Wedding planning can be stressful enough with trying to create a special day without the added pressure to create a “perfect” body.

But, here is the thing. Your fiance asked to marry you not because of what you’ll look like on that one specific day, but because they are in love with you and everything about you. Getting married is about making a commitment of love to one another. Your wedding day should be a celebration of that.

As brides or grooms, we should dress up and present ourselves the way we want to on this day but, it should not be at the expense of our health and well being. Remember what this day is about. Your wedding is not about the celebration of the size of your body but about the love between you and your significant other and making a commitment to one another.

What to do Instead of “Sweatin it”

Here are some tips I have developed to use myself and also with my clients who were wedding dress shopping:

  1. Buy a dress that fits you now. Don’t buy something a size smaller. Don’t use words like “my goal size” or “I’ll be pretty when I fit into this.” Fighting your body to go to a size it isn’t meant to be is only going to add more frustration, stress, and sadness. If the person selling you a dress keeps harping on “when you’ll lose weight” or “all brides lose weight” speak up and tell her that isn’t your plan. You do not have to be a victim of diet culture. Buy the dress that makes you feel pretty right now. Also, do not forget that many dresses you try on are just sample dresses. It’s okay if it doesn’t fit perfectly when you try the dress on. The one you get will be tailored to your already beautiful body,
  2. With that, remind yourself of the things that not only make you look beautiful but what makes you feel beautiful. One of my bridal consultants asked me when picking out a dress, “Do you want to feel whimsical? Do you want to feel like a princess? Do you want to be sexy vixen?” Wedding dress shopping became ten times more fun when I could close my eyes and imagine what style of dress would make me feel the most beautiful.
  3. Write down what you want to feel on your wedding day. Write down your hopes and excitements for this day. Think about what memories you want to hold onto.  While the idea of “looking perfect” in your wedding photos may be a strong drive to engage in diet culture, think about what those photos are truly capturing. Most likely, you’ll want to remember this as a day of celebrating love and new beginnings with your partner.
  4. It’s okay to exercise and it is okay to eat. It’s okay to follow your normal routine, As you plan for your wedding continue to follow your intuitive voice. For many people, weddings take months if not years to plan. Do not remove fun foods out of your diet for the sake of just one day. Listen to your body when it comes to exercise. Exercise because you want to give your body the gift of movement, but know it is okay to take days off too. Exercise should not be a punishment to your body.

In Conclusion

You do not need to lose weight for your wedding day. Ultimately, remember what this day means to you and your partner. Your wedding dress should be the accessory to the already amazing you. You know, the person that your partner wants to spend the rest of his or her life with. So, when it comes to “sweatin’ for the wedding,” say, “I don’t.”

Weight Gain in Bulimia Recovery

by Elisha Carcieri, Ph.D., a former associate therapist at EDTLA

Weight Gain in Bulimia RecoveryOne of the hallmark features of eating disorders is placing a high value on body weight and shape in determining one’s self-worth. In addition, people with eating disorders often believe that body shape and weight can be controlled through diet, exercise, or, in the case of bulimia nervosa, purging. Individuals with bulimia nervosa purge in an attempt to eliminate calories consumed (which is actually ineffective), empty or flatten the stomach, modulate mood, or as a self-imposed negative consequence for binging. Bulimia carries serious mental and medical health risks. The road to recovery from bulimia usually involves (at least) outpatient therapy with a qualified mental health professional such as a psychologist.

Bulimia Treatment

Cognitive behavioral therapy (CBT) is the most well-researched and effective treatment for bulimia. Therapy begins with an initial goal to immediately stop purging, monitoring weight and food intake and implementing regular eating, which usually looks like three meals and two snacks spread out over the course of the day. Over the course of therapy, the patient and therapist address the various factors that keep the eating disorder going including the over-evaluation of weight, shape, and one’s ability to control these factors, dietary restraint and restricting food intake, and mood and anxiety-related factors associated with the eating problem.

Most patients with bulimia nervosa present to treatment at a weight that is in a “normal” range for their height. This is in contrast to those with anorexia nervosa, who are typically underweight. Despite being at a normal weight, the characteristic weight and body dissatisfaction associated with bulimia is strong at the beginning of treatment, and patients believe that they are controlling their weight via their purging behaviors. People with bulimia often restrict food intake in various ways, only to eventually binge and purge. Because treatment involves eating meals at regular intervals without purging, a common fear at the outset of treatment is whether changing eating patterns will result in weight gain. The answer is…maybe.

For most patients with bulimia nervosa, treatment will not result in a significant change in weight. However, some patients may gain weight and a small percentage of patients will lose weight as a result of eliminating binge eating. It is not advisable for patients in recovery from an eating disorder (or anyone, for that matter) to have a specific goal weight in mind. Focusing on weight loss is incompatible with CBT strategies to eat balanced and sustaining meals at regular intervals. Weight may fluctuate over the course of treatment, and, when a person is eating normally, the body naturally gravitates toward a biologically determined weight that is largely out of our control. Indeed, learning to focus less on body weight as a determinant of achievement or self-worth is a valuable treatment goal.

What is Weight Suppression?

Some patients with bulimia may start treatment at a weight that is in the normal range for their height or even on the high side but low in the context of their adult weight history. Weight suppression is maintaining a body weight that is lower than an individual’s highest adult weight. Recent research has begun to shed light on the effects of weight suppression on eating disorders, especially bulimia. Bulimia is often kick-started with a desire to lose weight and attempt at weight loss through dieting. Research has demonstrated that living at a suppressed weight has a significant impact on bulimic behaviors, increasing the likelihood of binge eating (potentially through a brain-based biobehavioral self-preservation mechanism), and subsequently purging. Relatedly, and counterintuitive to what people with bulimia believe about their ability to control their weight, weight suppression is associated with weight gain over time, which further promotes dieting and purging given the strong aversion to weight gain that most sufferers experience.

Will I Gain Weight?

So, what does this mean for treatment and recovery? For patients seeking treatment, this means that yes, you may gain weight, especially if your weight is lower than a previous higher adult weight. This may feel scary, especially at first. Clinicians may even feel uncomfortable having this discussion and feel tempted to reassure patients that they will not gain weight. However, this message is inconsistent with what we now know about weight suppression and reinforces the idea that gaining weight is to be feared and avoided at all costs. Gaining some weight may actually be the key to breaking the cycle of binging and purging, which is much more valuable than maintaining a lower weight.

Greater weight suppression is associated with persistent bulimia symptoms and relapse, so gaining some weight may actually increase the likelihood of recovery from bulimia and also serve as protection against future eating disorder relapse. Weight gain may not just be a side effect of treatment, but it may be an appropriate treatment goal if you have bulimia and are living at a suppressed weight, just as it is an important goal for someone recovering from anorexia.

In Conclusion

If you have had previous treatment, but are still binging and/or purging, it is important to explore whether weight suppression might be a contributing factor. You can discuss whether gaining some weight might be appropriate with your clinician. Understanding the role of weight suppression on maintenance of the eating disorder should serve as motivation to continue treatment and work toward managing negative feelings related to weight gain. Indeed, it is helpful to explore the motivation behind the importance of thinness or maintaining a certain weight and challenging fears associated with gaining weight. You may find that living at a slightly higher weight, once acceptance is achieved, can be much less stressful and time-consuming than forcing your body to weigh less than it is biologically programmed to.

References

Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford.

Juarascio, A., Lantz, E. L., Muratore, A. F., & Lowe, M. R. (2018). Addressing weight suppression to improve treatment outcome for bulimia nervosa. Cognitive and behavioral practice, 25(3), 391-401.

Lowe, M. R., Piers, A. D., & Benson, L. (2018). Weight suppression in eating disorders: a research and conceptual update. Current psychiatry reports, 20(10), 80.

 

Elisha Carcieri, Ph.D., is a licensed clinical psychologist (PSY #26716). Dr. Carcieri earned her bachelors degree in psychology from The University of New Mexico and completed her doctoral degree in clinical psychology at Saint Louis University. During her graduate training, she conducted research focused on eating disorders and obesity and was trained in using cognitive behavioral therapy (CBT) for eating disorders and other mental health disorders such as anxiety and depression. Dr. Carcieri completed her postdoctoral fellowship at the Long Beach VA Medical Center, where she worked with Veterans coping with mental illness, disability, significant acute or chronic health concerns, and chronic pain. In addition to cognitive behavioral strategies, she is also a proponent of alternative evidence-based approaches such as mindfulness, and acceptance and commitment-based strategies, depending on the needs of each client. Dr. Carcieri has experience working with culturally diverse clients representing various aspects of diversity including race/ethnicity, gender, age, disability, and size. She is currently living in Charleston and working as a full-time mom to her two sons, ages 3 and 1. Dr. Carcieri is a member of the Academy for Eating Disorders (AED). She can be reached via email at dr.elishacarcieri@gmail.com.

A Better Resolution For Exercise

joyful movement
Representation Matters

by Kristen Wright, LMFT

Did you make a New Year’s Resolution to start a new fitness routine? Those “thirty days of push-ups or sit-ups” or “do 15 of this and 12 of that a day to your ideal body in no time,” might sound appealing. But you may have already discovered it’s just another commitment that has left you feeling depleted and disheartened. What if this didn’t have to be a failure but the start of a new experience?

No, you are not lazy, inadequate, or hopeless. There! I said it and I firmly believe it. It is very easy to slip into a cycle of unhelpful thoughts. If you were talking to your friend that way, would your friend listen to you? Of course not! Saying “Get off that couch, you lazy cow” is no way to get it done. I used to think beating myself up would help me work out, and I had no excuse for not exercising. I now know that is not the solution.

Here are some strategies that may be helpful.

Rethink Exercise as Simply Movement

Exercise is often viewed as something unpleasant or punishing or even penance for eating. It shouldn’t be! Movement is much broader. It may be a dance class, a walk on the beach with your partner, a hike with a friend, or shooting hoops with your child. It could be jumping around to good music or playing on the ground with our pets or kids. It might even be just walking back and forth or stretching. Workouts come in many forms and all movement counts. Movement should be fun and have some freedom.

We need to reject the idea that a workout has to be 30 minutes to an hour, requires sweat, requires a shower, and must involve so many sets of different things. What if movement didn’t have to be so structured? If you are still trying to understand why workouts are difficult, it may be because in the past you only exercised when you also dieted. I find that many people with a history of repeated dieting have a very negative association to working out. Reframing it as movement helps with removing that association.

Welcome Those Rest Days

Balance is important. Sometimes rest is more important than exercise. Learn to listen to your body and all its needs. You may have had a bad day at work or you may be dehydrated. Everyone needs days off. When taking care of bodies, we have to take care of our mental health. And sometimes the workouts won’t happen. But instead of thinking of “I missed a day, and everything is ruined,” think instead, “Today I took care of my body by resting.”

Stop the Inner Critic

Become aware of your negative thoughts: “I can’t do this; I am lazy; I am a failure. I am too out of shape.” All of these jumbled thoughts weigh us down. We just can’t expect to operate under these conditions. You should talk to your body as you would talk to a friend. And when you do start being kinder to your body, pay attention to the peace and freedom that will follow. Remember: don’t push yourself to the point of negative self-talk. If the negative inner critic pops up, it is time to evaluate the workout and listen to your body.

Challenge Your Perfectionism

Not all workouts will be better than or even equivalent to the last. Watch and challenge that urge to make each bout of exercise more intense or more successful than the previous one. Try to remove performance measures from your exercise. You do not need metrics to measure the success of your movement. Try focusing instead on how your body feels. As well, after having a great week of workouts you might find that the next workout is barely anything. Don’t despair. Your body might be reacting to fatigue, stress, or just screaming for a break. Remember movement is still movement.

Recognize You are not Obligated to Move

In the words of Christy Harrison, MPH, RD, CDN: “Health isn’t a moral obligation, and you don’t owe *anyone* the pursuit of health. Too much of the wellness world is caught up in healthism, and equating our worth to how much we pursue health goals. But the truth is that your value as a person and as a member of society doesn’t lie in whether or not you value your health.” Now how can this apply to you? Your worth as a person does not correlate to your fitness achievements. You are not a moral failure if you don’t exercise. You are not required to exercise!

In Conclusion

You are the only one who can know what your body needs. Different bodies appreciate different activities. Just because your favorite fitness guru on Instagram says that “this” or “that” will get you in shape, does not mean it is something you must do. You are the leader and guru of your own body. So, let your body tell you what it enjoys. Find the movement that makes your body say “Ahah! That felt good, let’s do this again.” It took me many different workout classes and videotapes to find out what I liked. I had to invest and become the explorer and expert of my own body. Be your body’s best friend and explore what your body likes to do. Please don’t give up on a movement style your body enjoys because it doesn’t look like it is making a difference. Rather spend time enjoying how the movement makes you feel. Do you feel better afterward?

AT EDTLA we can help you improve your relationship with food and exercise.

Curate Your Feed with Diverse Body Positive Accounts on Instagram

Photo, Resilient Fat Goddess Instagram

by Sarah Thompson, Resilient Fat Goddess and Lauren Muhlheim, Eating Disorder Therapy LA

“Body positivity can’t be just about thin, straight, cisgendered, white women who became comfortable with an additional ten pounds on their frame.” —Stacey Rosenfeld, Ph.D., Shape magazine (July, 2018).

Eating disorders are about so much more than body image, but the current diet culture, idealization of the thin ideal, and “war on obesity” make it much harder for people with eating disorders to recover. We are barraged on a daily basis by media images of people who represent only a small portion of the population.

As Dr. Muhlheim discussed in a previous post about fat photography, the mainstream media images we see are not diverse, and the images we do see of larger bodies are often portrayed in a particularly negative and stigmatizing way, adding fuel to the fire.

Thus, an important exercise for people of all sizes in recovery is to curate their social media feed by removing accounts that perpetuate the thin ideal and expand the range of body sizes and types to which one is exposed. Adding diversity to your social media feed isn’t only important for people in recovery, it can be just as important for partners as Sarah Thompson wrote about here. It would even be useful for parents and family members of those recovering.

The term used to describe the absence of representation in media was coined by George Gerbner in 1972. This phenomenon is “symbolic annihilation.” Gerbner was a Hungarian Jewish immigrant and communications professor who researched the influence of television trends on viewers’ perceptions of the world. According to Coleman and Yochim, Gerbner explained that “representation in the fictional world signifies social existence; absence means symbolic annihilation.” Representations, or lack thereof, lead to assumptions about how the world works and who holds power.

Gerbner did not assign symbolic annihilation to any particular group, so it has since been applied to many different identities. We can apply the concept to non-dominant systemic identities, such as larger bodied people, people of color, trans and gender-expansive people, disabled people, etc. If we don’t see bodies like our own represented, we may come to believe “my body doesn’t matter”. Often, this can turn into “I don’t matter”. This means that for people whose bodies are marginalized in any way, it is essential to see images of people that look like them.

We have developed a roundup of Instagram accounts to help you on the journey. While it is not comprehensive, it is a starting point. What follows are some Instagram accounts that show body-positive images that celebrate diverse bodies in ways that mainstream media does not.

At the time of this posting, these accounts are free of body shaming, fat shaming, food shaming, and disordered eating. Some are people in recovery from eating disorders. If we missed one of your favorite accounts that consistently publishes photos of bodies at the margins, please email us and let us know!

Larger-bodied women

@madeonagenerousplan

@iamdaniadriana

@themilitantbaker

@fatgirlflow

@fatwomenofcolor

@cosmiccollette

@bampowlife

@danielle_bex

@fatlippodcast

@shesallfatpod

Larger-bodied men

@bigboysarecute

@johnasavoia

@abearnamedtroy

@chubstr

@bear_skn

@zachmiko

@300poundsandrunning

People of color

@iamivyfelicia

@onebeautifulyes

@thefriendineverwanted

@nalgonapositivitypride

@sonyareneetaylor

@virgietovar

@genizeribeiro

@ihartericka

@diannebondyyoga

@mynameisjessamyn

@biggalyoga

@sassy_latte

@adydelvalle_

@melissadtoler

Gender diverse people

@transfolxfightingeds

@comfyfattravels

@chairbreaker

@thirdwheeled

@alokvmenon

@nonnormativebodyclub

@shooglet

@resilientfatgoddess

@thefatsextherapist

@watchshayslay

Older people

@efftheiragingstandards

@idaho_amy

@lamplight.space

@gidget3304

@glitterglama

@fruitbat5150

@26kleisen

@finally_bopo

People with disabilities

@the_feeding_of_the_fox

@dietitiananna

@theonearmedwonder

@rollettes_la

@disabilityisdiversity

@the_hapless_roller

@spookyfatbabe

@disabled_fashion

@princesscakep0p

@everybodyisworthy

Multiple Identities

@thebodyisnotanapology

@decolonizingfitness

@subversesirens

@fatkiddanceparty

@adipositivity

@underneath_we_are_women

@lkt_consulting

@flourorchalk

Other body positive accounts to follow

@sweetamaranth

@iamannachapman

@nolatrees

@bopolena

@bopo_watercolour

@shoogsart

@shelby.bergen

@neoqlassicalart

@lovefromdanica

@bopo.boy

Source

Coleman and Yochim. The Symbolic Annihilation of Race: A Review of the “Blackness” Literature. Perspectives. Spring 2008. http://www.rcgd.isr.umich.edu/prba/perspectives/spring%202008/Means%20Coleman-Yochim.pdf

Fat Positive Photography

Fat Positive Photography
Representation Matters

I’ve recently returned from the Association for Size Diversity and Health (ASDAH) Conference and I’m reflecting on all I’ve learned. I’ve wanted to share and further explore Substantia Jones’ keynote, “Fat Visibility Through Photography: the Who, the How, and the Hell Yeah.”

Jones is a photographer, a “Fat Acceptance Photo-Activist,” and the proprietor of the Adipositivity Project.  She started Adipositivity in 2007 to “promote the acceptance of benign human size variation and encourage discussion of body politics” by publishing images of women, men, and couples in larger bodies. Substantia is passionate about the fact that fat people don’t see a balanced representation of themselves in the media—as she says, “Humans need visibility. Positive and neutral visibility is being denied to fat people.”

So many of the media images we see of larger-bodied people portray them in negative and stereotyped ways: unkempt, unhappy, eating fast food, and often headless—as if they are ashamed to show their faces. At the same time, the range of body types provided by media images does not really represent most bodies. The media typically culls the thinnest or fittest sliver of the population, and then proceeds to photoshop the images of these bodies.  According to the Body Project, “Only 5% of women have the body type (tall, genetically thin, broad-shouldered, narrow-hipped, long-legged and usually small-breasted) seen in almost all advertising. (When the models have large breasts, they’ve almost always had breast implants.)”

In September 2009, Glamour included a photo of Lizzie Miller, a model who is a size 12-14. The photo showed Lizzie nude and looking joyful while displaying a roll of belly fat. The response was overwhelming—American women were thrilled to see a woman who looked more like them and was happy to boot.

While this was groundbreaking, the average American woman is a size 16. So where are the images of the upper half of the weight spectrum? It should be noted that it is not only larger bodies that are marginalized; other bodies are often not portrayed in mainstream media. These include bodies that are darker-skinned, disabled, aging, and gender diverse.

It is important that people in larger bodies see images of people that look like them. It is also important for all people to broaden their aperture on what people should look like. This includes viewing images of fat people who are happy, sexy, desired, and beautiful and engaging in all the activities that make up a fulfilled life.

Those working in the field of body acceptance confirm the therapeutic value of seeing attractive images of larger-bodied people. Unfortunately, these images can still be hard to find. One must look outside of the mainstream media. With that in mind, I thought it would be useful to provide resources for beautiful, artful photos of people living in larger bodies.

During her keynote, Substantia shared photos from several of her favorite fat-positive photographers, including those that inspired her. Below I list some of the photographers she shared and where to find their photos and information about them.

  • The photography of Patricia Schwarz can be found in Women of Substance – Portrait and Nude Studies of Large Women, published in Japan in 1996 by The Kiyosato Museum of Photographic Arts. Little has been published about her aside from this article, which states that Schwarz, who belonged to the fat liberation community in the 1980s, specialized in full-color photography of fat women. The book features women posing in domestic, natural and urban settings in various stages of clothing and nudity.
  • Laura Aguilar is known for her photographs of people from various marginalized communities (including fat, lesbian, and Latina). She is particularly known for portraying her own nude body as a sculptural element in desert landscapes.
  • Leonard Nimoy (yes, that one) published The Full Body Project, a collection of black-and-white nude photos of members of a burlesque troupe called the Fat-Bottom Revue. According to Nimoy, the purpose of the book was to challenge the harmful beauty ideals promoted by Hollywood.
  • Catherine Oakson was described in an obituary as a creator of “artistic self-portraits—some playful, some sensuous—and messages of body positivity.” Unfortunately, since her death, her photographs are extremely hard to find. Her website, “Cat’s House of Fun,” is only available via web archives (web.archive.org). Search for the website, http://catay.com and look at screen grabs prior to 2017
  • Shoog McDaniel, an artist and photographer living in Florida, was also present at the ASDAH conference, and their art was used in the conference program. Shoog was featured in this article in Teen Vogue which described them as “the photographer pushing the boundaries of queer, fat-positive photography.” Shoog states “the work that I do is about telling the stories of people who are marginalized and not usually put on the forefront, and whose lives are beautiful and important.”

Although Substantia’s presentation did not touch upon it, it’s worth mentioning Representation Matters, the world’s first website providing high-resolution, royalty-free, stock images of diverse bodies for commercial use. (The image in this post is from Representation Matters.) They specifically include larger bodies portrayed in a positive light. These photos are available for purchase.

Unfortunately, diet culture and thin privilege are alive and well, and those in larger bodies remain marginalized and excluded from most mainstream media. I hope you’ll check out these resources and come to appreciate the vast diversity of the human body. I purchased some photography books to share at my office. Together we need to work to challenge the notion that there is a best way to have a body and learn to celebrate the beauty of all bodies.

On a closely related topic, I’m thrilled to see that Meredith Noble has a great list of body positive artists to follow.

Source

Baker, Cindy. 2013. “Aesthetic Priorities and Sociopolitical Concerns: The Fat Female Body in the Photography of Patricia Schwarz and Jennette Williams A Review of Patricia Schwarz: Women of Substance, by Patricia Schwarz, and The Bathers: Photography by Jennette Williams, by Jennette Williams.” Fat Studies 2 (1): 99–102. https://doi.org/10.1080/21604851.2012.709447.