Living With Food: The Science Supporting Eating Disorder Treatment

This post was written by Christina Scalese, a registered, licensed dietitian here at the Cleveland Center for Eating Disorders.

Picture this: While waiting in line at the checkout counter at the grocery store, you glance at the magazine rack and scan the headlines. As you browse, you are hard-pressed to find one that isn’t telling you how to lose weight with a no- or low-carb diet, or maybe it’s telling you which carbs you should or shouldn’t eat.

With all of the conflicting information out there, it’s very difficult to distinguish between what is true and what isn’t — adding to the confusion about what is right for your body. In the mix of all the different fad diets, carbohydrates are notoriously picked on. All of this misinformation has led some people to eliminate or drastically decrease intake of one of the body’s most essential nutrients.

It’s easy for consumers to buy into clever marketing of what they should and shouldn’t eat. This is why it’s important to understand what carbohydrates do for the body, and why we need them to function properly.

So, what are carbohydrates? To get scientific, there are three types: monosaccharide, disaccharide and polysaccharide. They all differ in their molecular makeup. Most commonly, we break down carbohydrates into simple and complex. Simple carbohydrates, monosaccharides and disaccharides, are the most rapidly absorbed in the body and the quickest source of energy. The sugar in fruit and milk fall under this category.

Complex carbohydrates, polysaccharides, include starch and fiber. They have a slow release, keeping blood-sugar levels more stable. Common foods that fall under this category are potatoes, peas, corn, beans and different grains.

This brings me to another source of common confusion — grains. Grains, such as oats, wheat, barley, rice and products derived from these grains, are categorized either as refined or whole grains. A grain has three parts to it: bran, the outer part of the shell that provides the fiber, germ, the nutrient-packed second layer, and endosperm, the innermost part that contains the starch.

When you purchase a “whole grain” product, this simply means the food product contains, simply as it states, the entire grain kernel and all of its great nutrients. A product that is a refined grain only consists of the endosperm. Since refined grains only contain the starchy part of the grain, oftentimes they get a bad rap. However, it is recommended by the Academy of Nutrition and Dietetics that half of your grains should be whole, contrary to what many believe to be 100 percent. So, there is most definitely room for refined grains, such as white flour, breads, pastas, bakery, etc.

Now that you understand the different types of carbohydrates, it’s important to know exactly what they do for you. Being one of the main macronutrients required by the body, carbohydrates are vital to proper functioning. Carbohydrates are the body’s No. 1 source of energy! In fact, the majority of your caloric intake should be coming from carbohydrate sources.

In the body, foods that contain this nutrient are broken down into glucose, one of the monosaccharides. Glucose is very important to your body because it is the primary source of energy for cells, especially in the brain. Since the brain has no storage capacity for glucose, it needs a constant supply.

So, where does the low-carb diet come from? The body stores glucose as glycogen in the liver and muscles. Glycogen holds onto water. If the body is deprived of carbohydrates, the glycogen stores deplete, as does the water it is holding onto. This is where the initial weight loss comes into play. Unfortunately, many people are unaware of what is happening in the body that is promoting the weight loss.

So, the next time you are in line at the store, don’t be misled by clever marketing. Balanced eating is the key to a healthy lifestyle. Carbohydrates come in many different, satisfying and delicious forms. Be sure to include this great nutrient into all of your meals, and enjoy them — guilt-free!

CCED is very proud to announce our very own Lucene Wisniewski, PhD, received the 2013 Outstanding Clinician Award from the Academy for Eating Disorders “for her contributions to the clinical care and well-being of individuals with eating disorders through clinical contributions to the field.”

“I feel really lucky to be part of this community of experts in eating disorder treatment,” Dr. Wisniewski said during her acceptance speech. “On a day-to-day basis, if I feel stuck with a patient, I can call people literally all over the world because of this group. I have learned so much from being a part of the AED, and it is just an honor to receive this award.”

Dr. Wisniewski was honored during an award’s ceremony at this year’s International Conference on Eating Disorders, Crossing Disciplinary Boundaries in Eating Disorders, held in Montreal, May 2 – 4. During her acceptance speech, she joked that the irony of this award is the fact that she never wanted to be a clinician. So, she offered the audience one piece of advice: Take the opportunities that come to you, even if you don’t think they will lead you down what you think is your desired path.

Watch Dr. Wisniewski receiving her award live at the AED’s award ceremony below. Her acceptance speech begins at timestamp 5:45.

By, Samantha Mishne, LISW-S, LICDC

How do you move from a willful place to a willing place? I remind myself willingness is not a thing or a place; it is instead a view on life. Life is happening all around and I can either be willing to accept the change or feedback I receive, or I can be willful and in turn stay miserable, or say "yes, but". I think about this often with the clients I sit with who are asked or sometimes forced to make changes that are often times reinforced by the world we live in. The strength that they exhibit to move to a willing place is inspiring. I say to the young people who participate in family based treatment, your parents are going to reefed you, so you can either stay willful or move to a willing place. The nourishment that food provides often increased people’s ability to a move to a willing place along with parents resolve to care for their children.

When trying to increase willingness the first thing I do is really try and listen to what it is that someone thinks or wants me to do, then I pro and con making the changes vs. staying the same. Ultimately what moves me to a willingness place is being witness to the change my clients make daily and my acceptance that change is constant. Though I say often that I do not like change the older I get the more I am realizing it is constant. You can only push a way for so long before you need to be willing. It is important to note that there are no shades of gray when it comes to willingness. Currently I am pushing away the water stain on my ceiling because I know I have a leak which I need to become willing to have someone come out and fix. Yes this is not as big an issue (no pun intended) as gaining weight, increasing meal plan compliance, not exercising . . .but it is an example of how every day we are faced with a
choice to be willing or willful and we must accept the consequences. I will let you know if my ceiling falls in because I have yet to move to a willing place.

Should you have any questions or comments regarding this post please email blog@eatingdisorderscleveland.org.

CCED is excited to have the opportunity to participate in this year's Academy for Eating Disorders (AED) conference May 1st to 4th. Dr. Lucene Wisniewski will be a speaker at the plenary symposium speaking on Mindfulness, a key concept of DBT and the work we do at CCED. Dr. Mark Warren will be the discussant for a symposium on males with eating disorders, as well as a participant in the symposium on translating research into practice. As always, many CCED staff will be attending this cutting edge conference and we will be reporting back the many things we learn there.

Should you have any questions or comments regarding this post please email blog@eatingdisorderscleveland.org.

CCED and John Carroll University are hosting, “Dialectical Behavior Therapy Skills Training,” on Friday, May 17, from 9 a.m. to 4 p.m. at JCU’s Lombardo Student Center Conference Room. Join us as we instruct professionals, students, parents and community members alike on how to use creativity to teach DBT skills in therapy.

Prior to the workshop, CCED is hosting a breakfast Eat and Greet at 8 a.m. to mingle with participants, answer questions, and offer resources on DBT skills and eating disorders. Be sure to stop by for a cup of Joe!

CCED clinical psychologist and JCU professor Denise Ben-Porath, PhD, will present in this workshop creative techniques, such as role play, video and experiential exercises, as a way to teach DBT skills. Participants will learn how to structure a DBT group, including providing guidelines to the group and managing group interfering behaviors.

“Change-based” skills, interpersonal effectiveness and emotion regulation will be presented in the morning session. Interpersonal effectiveness skills teach clients how to assert themselves appropriately in interpersonal interactions and emotion regulation skills teach clients how to regulate intense emotions.

In the afternoon, “acceptance-based” skills, mindfulness and distress tolerance will be presented. Distress tolerance skills teach clients how to tolerate a situation without making it worse. Mindfulness skills teach clients how to cognitively defuse from negative thoughts, emotions, and beliefs.

Learn more about this workshop and register today. We hope to see you there!

The cost is $25 for students, parents and community memebers (non-CEUs); $120 for professionals (6 CEUs). All proceeds from this workshop will benefit Eating Disorder Network, a nonprofit organization dedicated to the prevention, treatment, and education of eating disorders.

This workshop provides 6 CEUs approved by Ohio Counselor, Social Worker, and Marriage and Family Therapists Board; the Ohio Board of Nursing; and the Ohio Psychological Association – MCE Program for psychologists.

CCED Dietitian Christina Scalese once again appeared on WKYC Channel 3’s “Live on Lakeside” morning show on Monday to discuss the different nutrients our bodies need as we age.

“Through each decade in our life, our bodies have an increased need for certain nutrients because our bodies are always changing,” Christina said. “It’s important to know what’s going on in our bodies so we can support that nutritionally.”

She walked co-hosts Hollie Strano and Michael Cardamone through the various decades of our lives, highlighting vital nutrients — and which foods are rich in them — for each one.

In our 20s, we need to think about bone building. The critical age for bone mass development is between nine and 18, but in our 20s our bones hit peak strength. So, we need to supply them with about 1,000 mg a day of calcium to get started on the right foot. Christina pointed to dairy products, broccoli, and juices fortified with calcium as important foods to incorporate into our diets.

More and more women are having babies well into their 30s. One very important nutrient during this time is folic acid. It helps prevent neural tube defects in the unborn baby. Christina even suggested moms should have a sufficient amount of folic acid (about 400 mg daily) even before becoming pregnant. Strawberries, asparagus, Cheerios are all rich in folic acid.

In our 40s, the aging process begins. Christina suggests a wide variety of fruits and vegetables to get the full benefits of their antioxidants, along with lots of fiber. Fiber is important here because of its ability to reduce the risk of certain cancers and heart disease. She points to whole wheat spaghetti, lentils, apples with the skin on, and raspberries, which are all loaded with fiber.

In our 50s our hormones dramatically change and our metabolism tends to slow down. Balanced calorie counting here is appropriate, but Christina stresses balanced because people shouldn’t be too strict with what they eat, nor should they be restrictive of what they’re eating. Vitamin D in our 50s also is important to help sustain bone health. Mushrooms and milk are rich in vitamin D, she says.

In our 60s, protein is essential because as people age, they tend to lose muscle mass. It’s important to retain that muscle mass to remain active in our everyday lives. Eggs, meats, seafood, and beans are rich in protein. She also points to vitamin B12 as an important nutrient because it helps with red blood cell formation.

But for every decade of our lives, Christina said, it’s important to get a balance of the macronutrients: carbohydrates, protein and fat.

Watch the full "Live on Lakeside" segment. 

This post was written by Christina Scalese, RD LD, a CCED dietitian.

Registered dietitian and University of Akron instructor Kathy Schupp invited me to my alma mater recently to educate her students on eating disorders and the role a dietitian plays in treatment and recovery. A lecture on eating disorders is a set part of the curriculum for the nutrition and dietetic students in Kathy’s Medical Science class.

Kathy began the discussion with an eating disorders video entitled, “Dying to be Thin.” I began my talk with an introduction to the Cleveland Center for Eating Disorders and the services we provide. I differentiated between the different eating disorder diagnoses, but spent most of the time discussing the role of the dietitian in eating disorder treatment and recovery.

I primarily work with our adult Day Treatment Program, but I also provide nutrition support to one of our adolescent programs. Upon admission, I provide a nutrition assessment to each patient in order to discover his/her current behaviors and discuss any medical complications that I need to be aware of.

Through each assessment, I create a personalized meal plan, tailored to meet the specific needs of the patient. The meal plans are based off of the exchange system to avoid a focus on calories and promote the balanced use of food groups. They are adjusted accordingly. The nutrition therapy in eating disorders can present the patient with many challenges, including increased food and beverage intake, incorporating a variety of foods, and practicing appropriate portions.

The dietitians at CCED help patients prepare their meals and snacks during treatment hours to ensure they are meeting their meal plans. Along with providing nutrition education, we also help patients plan appropriate meals and snacks as they begin to introduce new foods.

After the lecture, I opened up the discussion to questions from the students.

“The students felt that the presentation identified the role of the dietitian in counseling clients with eating disorders, to which they were unaware,” Kathy said. “The students found the medical complications to be more involved than they expected and found the interventions the dietitian provided to be very interesting.”

I very much enjoyed educating these students on how nutrition therapy impacts those suffering from this devastating illness. I was invited back to give this presentation again to next year’s class. I am very excited about this on-going opportunity to bring awareness to the community!

If you’re interested in CCED therapists or dietitians speaking to your students or organization about eating disorders and treatment programs, please contact Christina Scalese. She can be reached at 216.765.0500 or cbarth@eatingdisorderscleveland.org.

By, Dr. Mark Warren

Harriet Brown, well known to readers of this blog and to the eating disorder community for her book Brave Girl Eating, recently published an article in the New York Times on why evidence based care is so rarely used in the field of mental health and psychology. Her article is the latest in what has become a very important conversation about the translation of evidence based research into the treatment of mental illness. This topic was also discussed at great length at the recent eating disorder conference in London, organized by Drs Bryan Lask and Rachel Bryant-Waugh. The keynote of this conference, which echos Harriet’s article, shows that the number of practitioners in the community using evidence based care is shockingly low.

Unsurprisingly the response to this article, the presentation in London, and other articles of this nature has been twofold. Many people and clinicians are excited and hopeful that there is effective treatment for historically difficult to treat illnesses. On the other hand, some practitioners are responding by challenging the notion that evidence based care should be the standard of care. The reasons for this vary from the notion that the evidence is weak (possibly, but it is the best we have), to the assumption that the evidence doesn’t apply to every practice (unclear why not), to the criticism that the evidence doesn’t acknowledge cultural and clinical realities (it does). Many criticisms are based on the anecdotal experience of the provider.  One provider referred to the evidence as “weak tea.”

It is very difficult when scientific evidence challenges our own personal experiences and beliefs. However, if you happen to have an eating disorder, or a loved one has an eating disorder, and if you’re aware of the last 20 years of eating disorder treatment, you would want to know that since the advent of evidence based care we have started to get better outcomes.  If I, or a loved one, had an eating disorder, I would far prefer a glass of weak tea to no tea at all.

For more information: Looking for Evidence That Therapy Works 

Should you have any questions please email blog@eatingdisorderscleveland.org

Contributions by Sarah Emerman

The Cleveland Center for Eating Disorders now has a YouTube Channel: CCEDCleveland! Be sure to check out our latest videos on eating disorder treatment.

Mark Warren MD and Lucene Wisniewski PhD are featured in the video, “About the Cleveland Center for Eating Disorders.” Together, they discuss our center’s mission to spread access to high-quality care to all individuals suffering from an eating disorder in Northeast Ohio, along with CCED’s evidence-based treatments.

In addition, Dr. Wisniewski put together a video blogging series, “The Diagnosis, Management and Treatment of Eating Disorders.” In this three-part series, she discusses critical issues from the co-morbidity of eating disorders associated with other mental illnesses, to the causes of eating disorders and their prevalence in our society, to what empirically founded treatments for adults have been shown to be effective.

Be sure to visit often for new videos on the latest in eating disorder treatment.

You can watch all of our videos at CCEDCleveland. Or, check out our About CCED video here or watch Dr. Wisniewski’s video blogging series here.

CCED is very happy to report that Cleveland will be having its first annual National Eating Disorders Association (NEDA) walk on Saturday June 23 at 8:00 a.m. at the Cleveland Metroparks Zoo. This walk is organized by members of the eating disorder community along with NEDA. We are extremely pleased to be able to both sponsor and participate in the walk itself. We encourage everyone who is able to attend the walk, to donate to people who are walking, and to participate if they are able and medically cleared to do so. NEDA walks have become one of the primary ways of getting visibility for eating disorders nationwide. We congratulate those who have organized this walk and thank them for their efforts. We hope there will be a large and enthusiastic turnout for this very important event. To learn more about the walk and how you can participate please go to The National Eating Disorders webpage.

Should you have any questions or comments please email blog@eatingdisorderscleveland.org