Living With Food: The Science Supporting Eating Disorder Treatment

With the upcoming Thanksgiving holiday upon us, we would like to re-post our article for family members on suggestions of what to say and what not to say to loved ones in eating disorder treatment during the holidays.

By Karen Wolf and Sarah Emerman

The holidays, especially Thanksgiving, can be a stressful time for both clients and family members. Clients in eating disorder treatment often worry about what foods will be served for the Thanksgiving meal, potential comments made by family members, holiday-sized portions of food, following their meal plans, and avoiding behaviors. Their loved ones may also have concerns about feeling like they have to walk on eggshells around the client for fear of saying the “wrong” thing. This can make for a tense environment during a time reserved for appreciating family and being together. Therefore, with help from the clients in our day treatment program, we have compiled a list of dos and don’ts on what to say (and what not to say) to loved ones in eating disorder treatment during the holidays.

• Don’t comment on how your loved one looks. Avoid comments such as “you look good”, “you look healthy”, and “you look like you’ve gained/lost weight”. While you may be trying to compliment your family member on all of their hard work in treatment, these comments may be interpreted as “you look fat”, regardless of the intent behind them. It may be best to avoid appearance-oriented conversations altogether.
• Don’t comment on your loved one’s portion sizes at the table. The client most likely has a meal plan or is on a family-based treatment plan and will base their meals off of those guidelines. Drawing attention to portion sizes may result in increased discomfort and anxiety around food choices, and may encourage eating disorder urges and thoughts.
• Don’t discuss your own anxiety about what you’re eating. Making comments about the calories/fat in food, talking about post-Thanksgiving diets, or making plans to exercise the next day can encourage eating disorder thoughts and worries for the client. It also sends a message that being full on Thanksgiving is not normalized or acceptable.
• Don't watch your loved one eat. This may make them feel self-concious, alienated, or singled out.
• Do enjoy the food and model healthy eating behaviors. This means not fasting prior or after the meal and including a variety of foods in your Thanksgiving meal.
• Do tell your loved one how happy you are to see them and, at some point if it feels appropriate, remind them how much you care about them. Eating disorders are isolating illnesses and family support is often appreciated.
• Do plan activities to enjoy with your family. Distractions for the client will be important, both before and after the meal. (Suggestions include board games, football games, movies, conversation, outings…).
• Do ask your loved one if they’re comfortable helping prepare and clean up the meal. Individuals with eating disorders think about food and eating constantly and a mental break can help ease discomfort. Instead of helping with cooking, ask your loved one to help set the table, decorate, and tidy up.
• Do have normal conversations with your loved one that don’t include talking about therapy and treatment. If they are in treatment they are most likely sick of talking about their eating disorder. Allow them to direct the conversation to treatment if they wish.
• Do remember the spirit of Thanksgiving and honor the traditions of spending time with family, togetherness, and enjoying each other’s company.

Please note that these suggestions are not based in research, but rather the experience of our clients. These suggestions may not be appropriate for everyone and every family.

This list is published with the permission of our clients. 

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

With the upcoming Thanksgiving holiday upon us, we would like to re-post our article for family members on suggestions of what to say and what not to say to loved ones in eating disorder treatment during the holidays.

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

We often receive calls from individuals who are concerned about their friend or loved one's eating habits or body image. The most common questions are "What should I say to my friend?" and "How can I approach them with my concerns?" While there is no easy answer to these questions, we do suggest checking out the following links from the National Eating Disorders Association for tips on how to approach a friend who may be struggling with an eating disorder or body image disturbance:

How to Help a Friend with Eating and Body Image Issues 

What Can You do to Help Prevent Eating Disorders?

What Should I Say? Tips for Talking to a Friend Who May Be Struggling with an Eating Disorder

Should you have any questions or comments regarding this post, or if you need further guidance on how to approach a loved one with your concerns, please email blog@eatingdisorderscleveland.org or call (216) 765-0500. 

With the upcoming Thanksgiving holiday upon us, we would like to re-post our article for family members on suggestions of what to say and what not to say to loved ones in eating disorder treatment during the holidays.

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

By Sarah Emerman and our adult day treatment clients

1. Don’t expect your loved one to eat normally right away. For many clients, treatment will be the first time in a long while that they will eat normally. They will be trying foods that terrify them, which they will need to work up to in a manner that is appropriate for them. While you should encourage variety in your loved one’s diet, realize that they may not be ready to try all foods right away.
2. Don’t set a time line on when you expect your loved one to be fully recovered. Eating disorder treatment can take a long time. The time it takes to be recovered will depend on their level of motivation, commitment, and the severity of their behaviors. Know that it is normal for motivation to increase and decrease throughout the recovery process. It does not mean that your loved one isn’t trying or doesn’t care about getting better. Check in with your loved one on how they feel they’re doing, and don’t expect their recovery to take a specific amount of time.
3. Be careful with commenting on your loved one’s food and/or meal plan. Your loved one will be working with a dietitian who is trained to support them in following their meal plan and making balanced choices. If you do have a question about your loved one’s food, ask them outside of mealtime. If you have questions about their meal plan ask your loved one if he or she would sign a release and talk to the dietitian directly.
4. Watch your own judgments about food choices. For example, be careful not to label food as “good” or “bad”. Judging something as “bad for you” or “junk food” can reinforce to the client that they shouldn't be eating that type of food and will most likely be contrary to what their treatment team is telling them.
5. Watch the diet talk and use of diet products. Your loved one’s treatment center will be encouraging the use of non-diet products and trends to foster an environment of normalized thoughts towards food and body shape.
6. Do research. Get education about eating disorders, their causes, their symptoms and evidence based care. The more you know about what your loved one is experiencing and why, the easier it will be to understand and support them in their recovery. If your loved one is in one of our higher levels of care please know that we offer a family support group on Thursdays from 5:30 - 6:30, which is included in the cost of our day treatment and intensive outpatient programs.
7. Be willing to practice normalized eating. Many people without eating disorders struggle with making balanced food choices. Be aware of unbalanced eating and strive to make good choices for yourself. Eating in a normalized way will model for your loved one what balanced eating is and will make it easier for them to practice it themselves.
8. Get involved with your loved one’s treatment team.While their treatment team will not tell you specifics about their care without a signed release, the team can provide you with education about eating disorders and give you ideas on how to support your loved one.
9. Don’t blame yourself. What we know about eating disorders is that they are highly biologically and genetically based. You did not cause your loved one’s eating disorder and you did not make them sick.
10. Get support for yourself. The effect of an eating disorder extends far beyond the person experiencing it. Make sure you are getting care for yourself during a challenging and difficult time. CCED offers a free community support group the second Tuesday of every month from 6:30 -7:30 pm, which is open to anyone who has a loved one suffering from an eating disorder. The next community support group will be Tuesday November 9th.

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

By Anita Federici 

Messages about body image and what is and isn’t acceptable in our society bombard us everyday. We now live in a culture where natural body changes that occur with development, puberty, pregnancy, and menopause are pathologized. We see images of pregnant celebrities being praised for dropping their “baby weight” in a matter of weeks. With advances in technology and Photoshop, models can now be slimmed down, stretched out, and re-touched into unrealistic and unattainable depictions of the female form. While many parents have concerns about what their kids are exposed to on television, its important to realize that the television is not the only place kids learn about body image. Facebook, Twitter, magazines, and Internet sites may all play a part in the types of messages your son or daughter receives about body image and self-worth. 

How do we know that our kids are affected? Recent studies have shown that:

• 42% of 1st, 2nd, and 3rd grade girls want to be thinner
• 81% of 10-year-olds have a fear of becoming fat
• 50% of teenaged girls engage in some sort of disordered eating or unhealthy weight management behavior
• Nearly 1/3 of teenaged boys try to control their weight through unhealthy methods, such as smoking or taking laxatives
• In a 2005 study, 1 in 8 boys ages 12-18 reported using hormones or supplements to change their appearance, improve muscle mass, or gain more strength 
• 1 in 20 teen boys said they used products, including growth hormones or steroids, at least once a week 

So what can you do to help your son or daughter maintain healthy levels of self-esteem, self-assurance, and self-worth?

Educate. Knowledge is power. Talk to your kids about what they're learning and exposed to in the media. Ask them how the media affects them. Challenge what they see by educating them on the way images are manufactured to represent unrealistic and unattainable standards. 

Advocate and get involved. There are now programs, designed for a school's curriculum, that promote and discuss healthy body image and self esteem. These programs focus on helping kids discover a strong and healthy sense of identity and a sense of self. Talk to your children's schools and the resources in your community to learn more and see how a similar program can be offered at your school.

Think outside the box. Get creative with your kids and their friends. Host a monthly cooking party with your child and several of his or her friends where you can teach healthy eating habits, talk to them about healthy body image, and demonstrate that balanced eating is fun and healthy. Or create a "gratefulness" activity into the day. Have the whole family sit in a circle before bed and get everyone to name one (non-appearance) thing that they are grateful for in the day. This is a great way to focus on strengths, even when times get tough, and a nice way to connect as a family!

Be mindful of the messages that get reinforced in your own home. Children and teenagers are more likely to have problems with body image and self-esteem if body issues, dieting, and/or other disordered eating behaviors are prevalent within the family. As a parent, you are one of their strongest role models. Remove the scales from the house and model balanced eating and exercise habits. 

Redefine success. When the dominant message is that success is based on appearance, kids tend to internalize that message and judge their worth based solely on what they look like or what clothes they are wearing. Instead, focus on what your kids are already doing well. Did you know that praising kids for their effort and persistence leads to greater growth and less vulnerability in life that emphasizing whether they succeeded or failed at something? Help your children identify and feel confident in their natural abilities and skills. Shift the focus inward to their strengths and capacities rather than on their outward appearance to help them develop a strong core sense of self.  

Next week: How do we determine level of care for eating disorder treatment? 

Contributions by Sarah Emerman 

This is an article from the Swedish medical data bank on family education and development of Eating Disorders.  It is one the first epidemiological studies of this sort.  The information may not be complete, but it is an interesting addition to the literature.  Check it out below:

Note also that very few patients got any treatment at all.  Hopefully we can change that.