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Archive for the ‘Dietitian’ Category

Libero: by Jessica

How many of you who are battling an eating disorder have ever thought to yourself “I’m not ‘sick enough’ or ‘thin enough’ to have an eating disorder?” I’ve definitely been there.

Eating disorders are the deadliest mental illnesses, and yet the nature of an eating disorder is to view one’s health, body, and even the disorder itself in an irrational way. This often leads to people who are slowly killing themselves being in denial about how ill they are, causing the eating disorder to spiral even more out of control.

In my recovery, I was not able to truly make progress until I was able to believe that I had an eating disorder that warranted treatment.
Overcoming my denial and recognizing that I had a problem happened slowly and over time.

This is so much easier said than done. Everyone needs to find their own path to recovery, but here are the top ten ways I have been able to overcome my denial about my eating disorder:

1. I started seeing a dietitian who specializes in eating disorders and put my trust in her expertise.

My dietitian is fantastic, and she has a ton of scientific evidence to back up her recommendations of how I should be eating. Sometimes I still argue with her and accuse her of “just wanting me to be fat,” but I have to remind myself the accusation is ridiculous. She has a degree for a reason. She is an expert on nutrition and she wouldn’t have gone into this field if she didn’t have patients’ best interests at heart.

2. I educated myself on eating disorders and body dysmorphia.

Knowledge is power. When I started reading about the symptoms of eating disorders and what experts say, I was able to realize why I thought the way I did about food and my body. I acquired knowledge I could use to oppose eating disorder thoughts and beliefs.

I went from thinking “I must need to lose weight because my reflection says so” to learning my convictions about my body could not be trusted. I learned you can die from an eating disorder at any weight. I learned eating disorders are more complex than the images shown in the media, so I shouldn’t compare my experience to those images.

I even educated myself on how denial is one of the top symptoms of an eating disorder, so I came to recognize that not feeling like I had a problem didn’t mean I didn’t have a problem.

3. I stopped comparing.

Eating disorders thrive on competition, and your eating disorder will always tell you that you don’t measure up. In reality, your eating disorder is feeding you lies to keep you sick.

There is always going to be someone with an eating disorder that is “sicker” or “thinner” than you. It doesn’t mean you aren’t sick. This includes people who write memoirs about their eating disorders.

I realized early on in my recovery that eating disorder memoirs only served as a source for comparison. There are also always going to be people who don’t have eating disorders who make unhealthy decisions about food, and seeing those people engage in unhealthy behaviors isn’t a free pass for you to engage in them as well.

Common behaviors are not necessarily healthy behaviors, especially since we live in a culture encouraging a thin ideal body image and where disordered eating is rampant.

4. I made a list of everything I lost to my eating disorder.

It is easy to romanticize one’s eating disorder since it serves as a coping mechanism. It can be helpful to take the time to sit down and reflect on the ways in which having an eating disorder detracts from happiness, health, relationships, goals, etc. Whenever I start to romanticize my eating disorder, I look at my list and remind myself of how destructive and serious my eating disorder is.

5.  I identified the difference between my disordered thoughts and my healthy self, and I have an open dialogue between the two.

This is definitely a process, and it takes time. I learned to create a separation between my healthy self and my eating disorder by reading Jenni Schaefer’s Life Without Ed. The separation allows me to “talk back” to my thoughts from a disordered place and disobey them.

For example, if I find myself thinking I have to restrict in order to feel better about a social rejection, I can take a step back and realize the thought is coming from my eating  disorder – not from the part of me that has my best interests at heart.

 

http://www.liberonetwork.com/eatingdisorders/overcoming-denial/?utm_source=Libero+Network+Updates&utm_campaign=1e0c740516-RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_9104c3fc1f-1e0c740516-314271793

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family therapy

As confronting and difficult as it is, getting 3 people in a room to talk about the past, feelings, where things are at the moment for them, is a good thing.

That was us this week. One mum, 2 kids and our counsellor. Sophie found it difficult, she is used to having the space all to herself and didn’t want to share. Will found it also confronting as he isn’t ready yet to talk. I no longer have anything to hide but found it hard to listen to my kids.

No one wanted to talk about dad, but we did get to talk a bit how anorexia stalled our family, and what it meant for brother and sister to live through that. With Will teetering on the edge of an ED it is was more poignant.

However as our counsellor said (and she is right), it’s about hearing, really hearing what is going on for other members of the family. We are all affected by the same events but see and feel them differently. By opening up, we can share, empathise and journey towards wholeness as a family.

It’s never about wiping out the past, but harnessing it and using it for growth and wholeness.

Our counsellor was so thrilled, we all get to do group therapy again next week!

Today Sophie sees the psychiatrist and tomorrow Will sees her. The psychiatrist has rung the dietitian Sophie saw, he has txt me. Our counsellor already knows this. Clearly a lot of phone calls and talking has gone on this week. Meaning, Will is not in a good spot and possibly his bloods have problems. Get those results tomorrow. Once Will is settled on his new medication, we will bring the dietitian into the mix of appointments. Yes it is back to the days of early recovery with Sophie, with rounds of appointments, medications and supplements.

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This letter from the yourfairyangel blog is one of the most beautiful I have ever read. Everyone in the weight-loss and diet industry should read this and reflect seriously on their own behaviour and ethics. The letter made me cry, for those who got harmed, for the honesty of the woman behind it, for a world that is still caught so tightly by diets and thing thin, for the never ending cycle dieting.

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Stop DietingI worked at a popular weight loss company for 3 years. I loved my job there. I LOVED my clients. I loved making a connection and sharing my knowledge. And I learned a lot about nutrition, about dieting and weight loss and what works and what doesn’t. My job was to be a weight loss consultant, and I learned that job very well. I can design a 1200 calorie meal plan, tell you which activities are most likely to make the number on the scale go down, and how many carbs are in a cup of rice. I can talk the diet game like it’s my business…because it was. Volumize with vegetables. Don’t go too long in between meals. Start with a bowl of broth-based soup. Are you drinking enough water? Did you exercise enough? Did you exercise too much? Let’s look at your food journal…

This is not an anti-weight loss company post (although I could write that too). It’s a letter to each and every woman that I unknowingly wronged. My heart is beating a little bit faster as I write this, and so I know this needs to be said. The words have been playing in my head for months. Sometimes it just takes time for me to get up the courage to say the right thing.

So here goes:

Dear Former Weight Loss Clients (you know who you are): 

I’m sorry. 

I’m sorry because I put you on a 1200 calorie diet and told you that was healthy. I’m sorry because when you were running 5x a week, I encouraged you to switch from a 1200 calorie diet to a 1500 calorie diet, instead of telling you that you should be eating a hell of a lot more than that. I’m sorry because you were breastfeeding and there’s no way eating those 1700 calories a day could have been enough for both you and your baby. I’m sorry because you were gluten intolerant and so desperate to lose weight that you didn’t put that on your intake form. But you mentioned it to me later, and I had no idea the damage you were doing to your body. I’m sorry because I think I should have known. I think I should have been educated better before I began to tell all of you what was right or wrong for your body. 

I’m sorry because I made you feel like a failure and so you deliberately left a message after the center had closed, telling me you were quitting. I thought you were awesome and gorgeous, and I’m sorry because I never told you that. I’m sorry because you came in telling me you liked to eat organic and weren’t sure about all the chemicals in the food, and I made up some BS about how it was a “stepping stone.” I’m sorry because many of you had thyroid issues and the LAST thing you should have been doing was eating a gluten-filled, chemically-laden starvation diet. I’m sorry because by the time I stopped working there, I wouldn’t touch that food, yet I still sold it to you. 

I’m sorry because it’s only years later that I realize just how unhealthy a 1200 calorie diet was. I stayed on a 1200-1500 calorie diet for years, so I have the proof in myself. Thyroid issues, mood swings, depression, headaches…oh and gluten intolerance that seemed to “kick in” after about a month of eating the pre-packaged food. Was it a coincidence? Maybe. 

I’m sorry because you had body dysmorphic disorder, and it was so painful to hear the things you said about yourself. You looked like a model, and all of my other clients were intimidated by you, asked me why you were there because clearly you didn’t need to lose weight. And yet you would sit in my office and cry, appalled that a man might see you naked and be disturbed by the fat that didn’t actually exist. I’m sorry because you should have been seeing a therapist, not a weight loss consultant. 

I’m sorry because you were young and so beautiful and only there because your mother thought you needed to lose weight. And because there were too many of you like that. Girls who knew you were fine, but whose mothers pushed that belief out of you until you thought like she did. Until you thought there was something wrong with you. And the one time I confronted your mother, you simply got switched to a different consultant. I think I should have made more of a stink, but I didn’t. I’m sorry because you were in high school and an athlete, and I pray that you weren’t screwed up by that 1500 calorie diet. Seriously, world? Seriously? A teenage girl walks in with no visible body fat and lots of muscle tone, tells you she’s a runner and is happy with her weight…but her mother says she’s fat and has to lose weight and so we help her do just that. As an individual, as women, as a company, hell, as a nation, we don’t stand up for that girl? What is wrong with us? There ain’t nothing right about that. Nothing. 

I’m sorry because every time you ate something you “shouldn’t” or ate more than you “should,” I talked about “getting back on the bandwagon.” I cringe now every time someone uses that phrase. When did the way we eat become a bandwagon? When did everyone stop eating and become professional dieters? I’m sorry because I get it now. If you’re trying to starve your body by eating fewer calories than it needs, of course it’s going to fight back. I used to tell you that then, when you wanted to eat less than 1200 calories a day. The problem was, I thought 1200 was enough. I thought that was plenty to support a healthy body. Why did I believe that for so long? I’m sorry because I wasn’t trying to trick you or play games to get your money. I believed the lies we were fed as much as you did. 

And it wasn’t just the company feeding them to me. It was the doctors and registered dietitians on the medical advisory board. It was the media and magazines confirming what I was telling my clients. A palm-sized portion of lean chicken with half a sweet potato and a salad was PLENTY. No matter that you had “cravings” afterward. Cravings are a sign of underlying emotional issues. Yeah, sure they are. I’m a hypnotherapist with a past history of binge eating disorder. I KNOW cravings are a sign of underlying emotional issues. Except when they’re not. Except when they’re a sign that your body needs more food and you’re ignoring it. Then they’re a sign that your 1200 calorie diet is horseshit. Then they’re a sign that you’ve been played. 

And that’s mostly why I’m sorry. Because I’ve been played for years, and so have you, and inadvertently, I fed into the lies you’ve been told your whole life. The lies that say that being healthy means nothing unless you are also thin. The lies that say that you are never enough, that your body is not a beautiful work of art, but rather a piece of clay to be molded by society’s norms until it becomes a certain type of sculpture. And even then, it is still a work in progress. 

I owe you an apology, my former client and now friend, who I helped to lose too much weight. Who I watched gain the weight back, plus some. Because that’s what happens when you put someone on a 1200 calorie diet. But I didn’t know. If you’re reading this, then I want you to know that you have always been beautiful. And that all these fad diets are crap meant to screw with your metabolism so that you have to keep buying into them. I think now that I was a really good weight loss consultant. Because I did exactly what the company wanted (but would never dare say). I helped you lose weight and then gain it back, so that you thought we were the solution and you were the failure. You became a repeat client and we kept you in the game. I guess I did my job really well.  

And now I wonder, did I do more harm than good? When I left, you all wrote me cards and sent me flowers. I still have those cards, the ones that tell me how much I helped you, how much I cared. But I’m friends with some of you on Facebook now, and I look at your photos and you look happy. And beautiful. And not because you lost weight since I saw you last. But because I see YOU now. You. Not a client sitting in my chair, asking for my assistance in becoming what society wants. But you, a smart and lovely woman, who really doesn’t need some random company telling her there’s something wrong with her. 
  
So I’m sorry because when you walked in to get your meal plan, I should have told you that you were beautiful. I should have asked you how you FELT. Were you happy? Did you feel physically fit? Were you able to play with your kids? There were so many of you who never needed to lose a pound, and some of you who could have gained some. And maybe sometimes I told you that. But not enough. Not emphatically. Because it was my job to let you believe that making the scale go down was your top priority. And I did my job well.  

I am sorry because many of you walked in healthy and walked out with disordered eating, disordered body image, and the feeling that you were a “failure.” None of you ever failed. Ever. I failed you. The weight loss company failed you. Our society is failing you. 

Just eat food. Eat real food, be active, and live your life. Forget all the diet and weight loss nonsense. It’s really just that. Nonsense. 

And I can’t stop it. But I can stop my part in it. I won’t play the weight loss game anymore. I won’t do it to my body, and I won’t help you do it to yours. That’s it. End game.  

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(I use daughter in this post, but please know it is for both sons and daughters)

What is it with dad’s and responding appropriately to their daughter’s eating disorder?? Would you treat her differently if she had another illness?
What little research has been done, is showing father’s have a bigger impact than mother’s in the development of ED’s.

Interesting how up til now no one has even bothered to include father’s in the research. Yet research abounds of how important fathers are in the development of a daughters stability, sexuality, femininity and emotional health. It is obvious that father’s would have to impact on eating disorder development. Again, let me make the very clear point, you cannot give your daughter an eating disorder nor is the blame the parents. Your daughter could have developed depression, addictions, run away or not did any negative behaviour. It is the genetic tendencies that decide how your daughter is going to react to family situations.

Do fathers ignore/deny eating disorders because:

  • you don’t know anything about eating disorders?
  • you don’t know what to say or do?
  • you feel helpless when you see your ‘little’ girl?
  • you think this is your wife’s area?
  • you think men don’t do sickness?
  • you think women should look after women?
  • you think mother’s are more responsible?

Daughters NEED their father’s support and input during eating disorder recovery. Your wife NEEDS your help and support for both your daughter and herself. Without you being on the same page as everyone else in the household, you are only creating divisions and bitterness.

One mum recently said how she went away for a week for work. Her husband had to do all the eating disorder therapy appointments with their daughter. One session with our dietitian (we all share the same male dietitian) and he now gets how important it is for him to be there and understands why his daughter behaves like she does. Maybe we could hire our dietitian out – he makes it damn clear fathers need to understand exactly what ED’s are about and how to interact with their daughters. He also makes it damn clear that fathers must be involved in the recovery process. Another friend said how our psychiatrist helped clear some of the misconceptions and unhelpful remarks her husband was guilty of.

Father’s are just as much needed in the care role as mothers. Every part of recovery is for both parents: refeeding, therapy sessions, communicating, listening … . It means learning about not just the physical symptoms and treatment of eating disorders, but the psychological, emotional and behavioural issues that eating disorders bring. It means learning to relate appropriately. It means not trying to fix things – just be there and listen and be supportive.

Caring for someone with an eating disorder is not just a women’s role. The whole family is involved from the inception of the ED to it’s diagnosis, treatment, recovery, relapses etc. You may have to learn how to communicate, you may have to learn how to be a father a teenager daughter can relate to. Is that too much? Seriously how much do you value your daughter’s life and her freedom from an eating disorder illness.

Next post, I will have a whole pile of links and resources that are there for fathers to help them relate to their teenagers, young adult children and how to understand eating disorders.

 

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early intervention for eating disorder recoveryResearch is looking at into the very early stages of recovery  with the thought there may be very little ability on the part of the sufferer to respond to psychological treatment. This train of thought has also been voiced by others. Some of those raising this point of view are hospitals and medical centres – it always comes down to dollars. If an eating disorder sufferer is not suitably nourished enough for the brain to work, why bother spending money on giving psychological therapy to them at this stage.

Fair point. BUT. I have watched our team from the onset of hospitalisation with many girls start the full process right from day one. Most in-patient treatment centres do too. Our team didn’t and still doesn’t consider it too early to start psychological therapy, when both body and brain are malnourished. Within the depths of the eating disorder, the person is still there. And that is who they are trying to reach. You  get glimpses of the person during early treatment. The constant, drip-feed and small seeds of thought laid by either a psychiatrist or psychologist (even a social welfare worker) are incredibly invaluable. Each little seed takes root and very slowly knowledge about the eating disorder illness  prepares the sufferer for deeper treatment later. I watched my daughter and others, slowly see a light turn on – even though their brains and body were still malnourished and weak. They could start to understand a little that this wasn’t normal, that this illness was something bigger than them, and that it would destroy them if left alone.

Also just as invaluable, is the trust groundwork that is laid. Though the girls didn’t make great leaps in recovery in hospital (apart from weight gain), they learned to start slowly trusting the medical team. The team didn’t give up. They didn’t run away when the girls were sneaky, rude, defiant etc. The team kept turning up and believing in them. This constant show of belief and strength started the building of trust for an ongoing relationship.

By the time Sophie was released from hospital she knew enough the team wasn’t going anywhere in the short-term. She continued to test the teams ability to stay with her, and accept her as she was, to save her even when she didn’t want to save herself. It took 18mths on average with each team member for her to finally trust. But the seeds of trust and knowing her team took place in hospital – again while she was still malnourished. Even those following Maudsley or FBT have therapists, dietitians etc on board from the very start of the recovery period.

Unless there is trust in the relationship of therapist and patient, there will never be any real openness, honesty and intimacy. To gain recovery you have to believe and trust your team.

It is never too early to start therapy with an eating disorder sufferer. Early intervention is not just about weight restoration. It is about bringing the whole person back, slowly, carefully, and wholly.

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urlIt is official. We no longer need the dietitian. He considers himself sacked. It is a good feeling all round. To know that Sophie has managed to stay stable weight, eats from every food group with a wide variety, has conquered her fears (or in the process of) is nothing short of a miracle. And one of her own making.

Our dietitian’s motto for all his patients is: “Keep them alive until they are ready to get better”. He is right – as always. You cannot force someone to become better, the decision is ALWAYS theirs, and theirs alone.

Every support teams job is keeping sufferers alive until they are ready to make the choices and decision themselves. Eating disorders destroy and cause so much misery and pain, that many sufferers would prefer to just die. This is why death is never to be an option. The person is not in their right mind, nor are they able to form an informed or logical decision. The illness takes that completely from them. The depth of darkness and depression only want oblivion. Support teams are there to fight this and keep the sufferer alive til they are able to recover. The support team of course suffer abuse, hate, dis-interest, and dis-association because the ED fights them all the way. But for those who make it back, their support teams have their gratitude.

But once a stable healthy weight is achieved and the longer you can keep at that stability the body and mind change. They become functioning again. With therapy and help, understanding of the illness and tools to fight back are learnt. You learn to make decisions and choices and trust yourself to take them.

From Sophie’s journey there was the time her team just kept her alive and suffered her abuse. She went back into severe relapse not wanting to get better but found her team still there keeping her alive. And they kept doing that, until that magical day, when Sophie was ready. She was ready to make a decision to live. She had no idea how to fight back nor how hard or long the journey back would be. But her team kept her alive so she could make that decision, and her team then walked the road back with her until they are now able to pull back and let her walk unaided. Because she can.

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professional diagnosis of eating disordersThis post from The Guardian highlights my previous post about professional care for eating disorder treatment. The points listed are below are critical and give a good indication of what to look for when searching for professional help. It is far too true that many don’t receive respect and aren’t believed. All this does is entrench the ED further and delay seeking further help.

Over the course of two years, I have met with 40 young women and men who have shared on film honest details about their experiences of eating disorders. Their hope is that sharing their stories will help other people who are similarly affected to feel less alone and encourage them to seek help.

The research shows that common myths about the illness have prevented many young people from getting the treatment and support they needed, from family, friends and even the health service.

During the course of their eating disorder, young people came into contact with many different types of health professionals including GPs, nurses, counsellors, psychologists, psychiatrists, dieticians, social workers and other support workers.

There are some things that health professionals should know when dealing with a young person living with and recovering from an eating disorder.

Anyone can have an eating disorder

Anyone can become ill with an eating disorder. Eating disorders affect people of all ages, backgrounds, sexualities, both men and women. You can’t tell if a person has an eating disorder by just looking at them.

First point of contact is often critical

This first contact with services was often a huge step for a young person. People often found it very difficult to talk about what was going on, trying to hide their problems and it could take months, even years, to seek help. The way they were treated at this point could have a lasting, positive or negative, impact.

Young people hoped that the health professionals would realise just how hard asking for help was and to help nurture and support their confidence to stay in contact with services.

Early intervention is key

Young people often felt that people struggled to recognise the psychological symptoms of eating disorders as well as the range of different eating disorders.

If those who haven’t yet developed a full-blown eating disorder could be recognised, they can also be helped earlier. This is critical, as the longer eating disorders are left undiagnosed and untreated, the more serious and harder to treat they can become.

Effective, early intervention could be achieved when health practitioners were knowledgeable, well trained, sensitive and proactive.

Eating disorders are about emotions and behaviours, not just about weight

A common myth that many of the young people had come across was the thought that people with eating disorders were always very underweight. This idea had made it harder for some to get treatment and support or even to be taken seriously by their doctor.

In some cases, young people felt that the only way for them to be taken seriously and be able to access eating disorder services was to lose more weight. This could have serious consequences; the more weight they lost, the harder it was for them to be able to seek or accept help.

See the whole person, not just the eating disorder

Once in contact with health services, above all else, young people wanted not just to be seen “as an eating disorder” but to be treated as a whole person. It was important that they felt treated as individuals and for health professionals to realise that everyone responded differently.

A good health professional also tried to engage young people on other things than just the eating disorder, hobbies or interests.

Respect the person regardless of age

Feeling respected, listened to and being given the space to explain things from their perspective was important for young people during treatment and recovery.

Professionals should take their time and find out what was going on for that particular person, not act on assumptions. Health professionals shouldn’t patronise or dismiss issues that were important to the person in front of them.

Ulla Räisänen is a senior researcher with the health experiences research group at University of Oxford, and was responsible for conducting the study published on Youthhealthtalk.org

http://www.guardian.co.uk/healthcare-network/2013/feb/12/eating-disorders-health-professionals-key-points

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