Blog

Our blog “Eating Disorders News” covers interesting developments in eating disorders treatment, research and patient advocacy, and updates readers on what we are doing. You can read our latest posts both on the PsychologyToday.com site and on Monte Nido's Eating Disorders Blogs. We welcome comments and suggestions for future blog posts.

A testimony.

July 6, 2016

 

My story, I remember believing not so long ago, was bound to end in tragedy. Another life lost to the death grip of anorexia. Another fatal statistic. Another hopeless cause.
Initially my battle with eating disorders began the summer I turned 13. What started out as an innocent, half-hearted diet quickly spiraled into an out of control obsession with weight, calories, and food. Or more specifically, how to avoid them. A life that should have revolved around middle school crushes, going shopping with friends or worrying about what to wear to a dance was instead consumed by a distorted view of my body and the dangerous behaviors I participated in to change it.
It didn’t take long before I ended up being hospitalized. Overall, I spent a total of five years in both inpatient and intensive residential treatment centers. My entire adolescence was lost—spent fighting a war between mind and body while attempting to regain my health. The sole focus of my treatment programs was weight gain which is undoubtedly important, but there was very little coaching from a nutritional perspective. When I left my last treatment center the day after my 18th birthday, I was at a healthy weight, but rather than feeling like I was on the right path to recovery, I had the feeling that my eating disorder was simply lying dormant for the time being.
I was right.
For the first year and a half out of treatment, I managed my weight. For that time frame, I was able to keep my eating disorder at bay. Looking back now I think it was sheer luck. Finally I lost that feeble grip I had on my health and experienced a relapse that would bring me lower than I’d ever been before—physically and emotionally. Being 20 at this point, no one could legally force me to seek treatment so I didn’t. One day in October, my therapist called on a Saturday morning and asked that I come in, bringing my family with me. I knew it wouldn’t be a pleasant session.
It turns out my support system had arranged an intervention for me, and it was by far the most painful experience I’d endured (and I had endured many painful experiences over the course of battling my eating disorder). First, my grandparents, younger sister and therapist each read letters they’d written for me, explaining their concern and begging me to accept the help I was being offered. Then I was given one of three options: 1) I could admit myself to a residential treatment center that agreed to take me as a patient. My grandparents already had a suitcase packed for me in the trunk of the car (without my prior knowledge), and were ready to drive me to the facility four hours away from home. If I didn’t choose that path, then 2) I would agree to meet with a dietician/eating disorder specialist by the name of Marcia Herrin, or 3) I would be kicked out of my house and my therapist would not continue to work with me. I was devastated. Thankfully I was in a right enough state of mind to know Option #3 needed to be taken off the table. After crying and fighting with the people who just wanted what was best for me, I reluctantly chose to meet Marcia.
I went into my first appointment convinced there wasn’t going to be anything about this woman that was different from all the other professionals I worked with over the years. By the time I left, I remember thinking that just maybe, Marcia had the potential to my life. Not only does Marcia have solid credibility and two books regarding the nutritional treatment of eating disorders, but she herself has a personal history with eating disorders as well. Seeing how successful she is has given me genuine hope that recovery, real recovery, is possible. Many people were giving up on the idea that I could get better but Marcia never saw me in a despondent light. There have even been times when my insurance wouldn’t cover her services, and yet she continued to work with me anyway. Her dedication and confidence in me has instilled a confidence in myself. Without it, I know I wouldn’t be here today. She’s tough on me when I need it—doesn’t put up with any excuses or cop-outs. She holds me accountable when I’m wrong, and provides ovation when it’s earned. Of course the process is never easy, and there are times I’m convinced it’s easier to be sick, but because of Marcia, I’ve been given a taste of what my life can be untainted by eating disorders, and let me tell you—it’s something I’m simply not willing to give up.
Thank you, Marcia, for all you’ve taught me in the last 19 months. I didn’t know this kind of freedom could exist…and the journey isn’t over yet.

The New Improved BMI

March 28, 2015

Body Mass Index (BMI) is a number calculated from your weight and height which makes it an inexpensive and easy screening for weights that may lead to health problems. Go to the National Institutes of Health website for a  BMI calculator.

Calculating BMI is easy, but figuring out what your BMI means is the hard part. First BMIs are not meant to be a stand-alone diagnostic tool. Assessing health at a particular weight for an individual requires evaluations of diet (undereating or overeating), physical activity, muscle development (high muscle density increases body weight), family history (genetics explain about 70% of body weight), and heart rate (too low body weight is associated with low heart rate), hormone status (too low body weight interferes with menses and lowers testosterone), blood pressure, and other health measures.

The US has adopted the World Health Organizations (WHO) BMI categories which I believe are set too low to be applied to most Americans. A number of researchers agree that the current NIH BMI weight categories for adults are problematic in many areas, particularly, if applied indiscriminately to ED patients. These BMI categories underestimate the presumed health consequences of lower weights and overestimate the presumed health consequences of higher weights. Recent studies of mortality rates in US find that people in the overweight and obese categories according to the standard BMI categories have lower mortality rates than have been previously estimated. In fact the lowest mortality rates are in the standard BMI “overweight” category (BMI 25–29.9. The standard categories below are sometimes helpful in evaluating weights of people of Asian descent.

Here are the current standard US BMI weight categories:

Screen Shot 2015-03-26 at 8.41.15 PM

Never willing to wait around until governments see the light, I have revised the standard BMI categories and added several new categories. My revisions are based on a thorough review of the literature and account for gender and musculature. (References on request.) I have used these revised BMI categories for over 15 years in clinical practice with great success.

I defined a minimum safe weight as the lowest weight at which a person can maintain healthy function (including regular periods for women and normal testosterone levels for men), meet nutritional needs, and not engage in eating disordered behaviors and thinking.

To use my revised BMI categories go to the BMI calculator for adults and then find your category in the chart below:

Screen Shot 2015-03-26 at 8.40.51 PM

Marcia

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders. Marcia is also author of Nutrition Counseling in the Treatment of Eating Disorders.

Copyrighted by Marcia Herrin and Nancy Matsumoto

Proposed French Ban on Too-Skinny Models Bites the Dust

March 27, 2015

In 2010 a French model and actress Isabelle Caro died as a result of anorexia. At one point she had weighed only 55 pounds. Concern over her death led the way to a proposed French law that would impose minimum weight standards for women and girls working as models, and criminal penalties for violators.

Sadly, despite predictions that the legislation—backed by President François Hollande’s Socialist government—would pass, the French Parliament rejected the proposed legislation last week, an event completely ignored by the American media. Parliament’s concern? Worries about discrimination against skinny job seekers, a laughable qualm when you consider the glorification of hollow-cheeked models and trend-setters that is the norm in the global popular culture.

While the proposed law was the most stringent of its kind to be considered so far in any country (a fine of about $83,000 and a prison sentence of up to six months would have been imposed on the modeling houses and fashion agencies in violation of it), it wasn’t the first: Israel has already banned underweight and underage models, while in Italy and Spain, less sweeping bans have taken place. Italy relies on voluntary pacts with the industry, and Madrid back in 2006 banned too-skinny models from the runways of Madrid fashion week.

The Madrid ban followed the death of two severely underweight Latin American models in 2006. Their BMIs were less than 13. In 2007, the Council of Fashion Designers of America adopted a voluntary initiative setting 16 as the minimum age for models and requiring snacks (!) be made available during New York Fashion Week. Vogue magazine, meanwhile, adopted some voluntary guidelines that promised to not “knowingly” use underweight models and models under 16 years old. But we think that’s not nearly enough.

Before I tell you why, though, let’s first put these BMI numbers into perspective. The New York Times noted that an 18.5 index, the minimum level the proposed French law would have allowed working models, “suggests that a women who is 5 feet 7 inches tall should weigh at least 120 pounds.” Although the proposed French legislation allowed leeway for health officials to adjust that standard “for factors such as bone size,” as an overall guideline, does 120 pounds for a woman or girl who is 5 feet 7 inches tall no matter what her bone size is sound normal and healthy to you?

My co-writer Marcia notes that so dominant is the focus in schools, among public health officials, and in the media on the dangers of being overweight that her patients “have a hard time seeing that these models aren’t healthy.” And yet the truth is that a body mass index (BMI) of 18.5 is considered the very low end of normal weight by the World Health Organization and by the National Institute of Health. And, Marcia points out, an 18.5 BMI is also “too thin for most women to have regular menses and eat normally.”

To see Marcia’s carefully researched and reasoned recommendations for what she considers appropriate BMI categories for risky low weight, low weight and minimum safe weight, click here.

 

 

 

 

Read the rest of this post at Psychology Today.com »

Eating Disorders, Body Image and the Women’s Rights Movement

March 25, 2015

Twenty years after the landmark Beijing conference on gender equality, the UN this week issued a depressing report(link is external) that details the uneven, and in some cases backward, direction the fight for women’s rights has taken since then.

It brought to mind a similar tale of promises dashed, Debora Spar’s book Wonder Women: Sex, Power and the Quest for Perfection(link is external). In it, Spar, who is the president of Barnard College and a political scientist, notes that despite being essential to the advancement of women, the feminist movement also added more items to our already-staggeringly long to-do list: to be enlightened, empowered women on all fronts, including fighting for equal rights and competing with men in the marketplace.

Speaking before an audience of eating disorders professionals at the last Renfrew Center Foundation Conference(link is external), Spar said, “Before, we raised girls to be wives and mothers, but now we’ve expanded the realm of what we want them to do.” That realm stretches from soccer and scholastics to baking and writing briefs, all while “we’re sexualizing the heck” out of them, she added

“I see them at the back end, at seventeen or eighteen, the perfect girls, the ones who have done everything right, and they’re exhausted,” Spar said, adding (I hope hyperbolically), “I haven’t seen a girl apply to Barnard who hasn’t started an NGO.”

 Instead of putting a stop to women being evaluated on appearance alone, Spar argues the opposite has happened, with the ideal size of women thinner and less realistic than it’s ever been. We’ve “upped the ante,” she asserts, making women feel they have to starve themselves, spend more hours at the gym and then go run their NGO. There’s even a modern equivalent of the corset, she pointed out: Spanx.

There’s Photoshop now, too, and even though young girls know it exists, they still believe that with just a little more effort they can look like those digitally (we won’t say enhanced) altered models. Although magazine editors and advertisers will periodically make an effort to portray more diversity of shape and size (the Dove Campaign for Real Beauty(link is external) comes to mind, now already a decade past), she calls those efforts “about a minute-and-a-half”-long trend. And the saddest part? Editors are aware of the fables they’re telling and Spar claims “it kills them.” It’s just that super-thin models are what readers want to see. Really?

Spar also questioned what has come of the sexual liberation movement: today’s hookup culture, which she views as “the greatest thing to happen to young men ever,” but not the “committed, long-term relationship” that most women want.

Her solution: to not tell young women that they can have it all, that inevitably there will be trade-offs. In other words, “to give up on the idea of perfect,” to “change the narrative so we’re not trumpeting perfect people, but real people.” This will resonate with many eating disorders sufferers, since as Spar says, “eating disorders are the disease of perfect girls, the girls who are trying to do everything right.” When you can’t control everything, you can always control your body, a sort of malignant mutation of the feminist ideal of women controlling their own reproductive systems. Patients suffering from anorexia can do that, too, shutting it down completely.

But how, in the face of a culture that is in love with impossible ideals, do we “trumpet real people,” and how can we change the perception that what readers want to see is paper clip-thin spokesmodels?

I’ve written about a few people who are doing their part, including a Pittsburgh artist who created his own real-sized doll, the founder of an online positive body image magazine, even two 13-year-old girls in Colorado who made a powerful short video about a girl their age suffering from an eating disorder. And if you’d like reminder of what Photoshopped images do to our self-esteem and how we can protect ourselves, check outthis post with advice from my co-author Dr. Marcia Herrin(link is external). Come on, in the spirit of true feminism, let’s effect some change here.

 

Read the rest of this post at Psychology Today.com »

Feeling Stuck in your Battle Against an Eating Disorder?

February 20, 2015

ACT can be another tool to jumpstart your recovery.

Imagine a kind of eating disorder treatment where how many times you binged or purged, or how much weight you gained this week, or how well you stuck to your meal plan was not important.

Imagine that instead, what mattered is how well your actions throughout the week were in service to your true values. Those could include improving family relationships, imagining yourself in a committed, loving relationship, or getting back to school or work. Imagine what it would be like if your primary focus was to reject actions that serve your eating disorder:  engaging in “fat talk” avoiding social events involving food, or keeping your eating habits secretive, for example.

This, in a nutshell, is the heart of a therapeutic approach called ACT, which stands for Acceptance and Commitment Therapy. I’ve written about it before, but it’s been gaining new supporters in the eating disorders world. ACT can be an especially helpful tool for the long-term patient, or for someone who feels stuck and unable to progress.

ACT was one of the workshop topics at the last annual Renfrew Foundation Center conference in Philadelphia. Although sessions are aimed mostly at professionals, I’m continuing what I’ve done in the past, culling practical takeaways both for those battling an eating disorder and the people who care about them.

ACT, as speaker Danielle Doucette, PsyD, a Chicago-based psychologist, explained, challenges the DSM (Diagnostic and Statistical Manual of Mental Disorders)-based approach to treating eating disorders, “in which you check off a list of symptoms, and have to eliminate them” so that a patient is symptom-free and can be declared “recovered.”

Dr. Doucette explained that ACT doesn’t make eating-disordered symptoms or behaviors the enemy. Instead it encourages patients to identify the values they most would like to live by, and helps them actively pursue those. Whether symptoms abate or disappear is not the issue; a patient can become much happier and engaged in life while still purging two or three times a week, for example. It’s a battle between values: those of your own true self and those of the eating disorder, or as Jenni Schaefer famously named hers, “Ed.”

Patients come in, Dr. Doucette explained, wanting to fix their problems, whether they involve panic attacks, overeating, or body image issues. “At some point, we made pain a problem to be solved, like a math problem.” Only pain can’t be solved, she adds, “any more than a sunset can.”  According to ACT, pain “just is.” Dr. Doucette exhorted her audience of practitioners to “bear witness to that pain, don’t try to problem solve it.”

ACT, Dr. Doucette, said, also “challenges the notion that treatment gains can only be made in an outpatient setting,” and described a number of practical exercises anyone can try to employ:

“Creative Hopelessness,” for example, asks the question, “How did I get to be in this place that’s so far from where I want to be?” Eating disorder patients are skilled at being able to “problem solve themselves out of difficult or painful feelings,” Dr. Doucette explained. Want to stop feeling fat, or stop the anxiety you feel around food? Solutions might include compulsively exercising, cutting, or bingeing and then purging.

In the Creative Hopelessness exercise, which is designed to make clear how destructive those strategies are, Dr. Doucette will ask the patient three questions:

  1. What have you tried to do to get rid of the thoughts and anxieties about feeling fat?
  2. What makes those values unworkable?
  3. When you engage in these behaviors are you moving toward your values or away from them?

Another approach illustrates the value of moving from “fusion” with powerful eating-disordered values (“I feel fat therefore I must starve today”) toward “diffusion,” or the ability to see those thoughts as mere thoughts, tricks of the mind that might or might not be true, thoughts that are cutting you off from the life you want to live.

The exercise, which Dr. Doucette calls “The Hands as Thoughts Metaphor,” asks patients to put their open hands in front of them like a book. The hands are the eating-disordered thoughts that they are rigidly fused with and compelled to follow. Then the therapist asked them to slowly bring their hands up to their faces, almost touching their nose. Notice how the room looks different. What’s it like to talk to someone when you can’t see their emotional response, or gesture back to them? Can you play with your children with those thoughts right in front of your face? Now, can you bring your thoughts down to your lap? You’re not throwing them away, but you are gaining distance from them. Do you notice how you can see what’s going on around you, how it changes what you are able to see, do and say?

The idea is to imagine being able to distance yourself from the negative loop of self-talk and behaviors and to see more clearly what your strengths are, where you want to be going in life, and what actions you need to take to get there.

I hope post has helped you begin understand what ACT is and how you might be able to employ it in your own life, or keep it in mind when you are talking to a loved one who is locked in battle with an eating disorder. For more information, here’s a link to some of Dr. Doucette’s graphic presentation on ACT and eating disorders. Here, you’ll find an interesting Q&A with author and psychologist Emily Sandoz, PhD, who has written books on ACT and eating disorders and body image.

 

 

How the Asian Pop Culture Boom Is Feeding Eating Disorders

September 29, 2014

In our book, Marcia and I wrote about the “Western toxin effect,” in which developing countries begin to experience a rise in eating disorders, often spread through exposure to TV and western emphasis on appearance and physical beauty. Now, however, that phrase seems quaint. In Asia, for instance, pop culture has been completely co-opted by western ideals of beauty, and the epidemic of eating disorders is full-blown.

I realized this when I came across a chapter in Euny Hong’s new book, The Birth of Korean Cool: How One Nation is Conquering the World Through Pop Culture.

Hong tells the story of how South Korea, with head-spinning rapidity, rose from a poor, much-invaded nation to a pop culture supernova, dominating the world through its film, K-pop style of girl and boy bands, movies, electronic products and video games. But along with rise to prominence has come an obsession with appearance and plastic surgery.

South Korea is now the world’s plastic surgery capital, accounting for more procedures per capita than the U.S. or Brazil. The most popular procedures are double eye-lid surgery (adding a crease in the eyelid to make it look larger, rounder and more western) and rhinoplasty, often to make the tip of the nose pointier.

The most disturbing part of this trend, though, writes Hong, is “the increase in the number of young children requesting surgery.” Plastic surgeon Dr. Sewhan Rhee says it’s common to see Seoul “middle-school children get plastic surgery during their winter school break. It’s not considered weird. It’s considered normal. “

Peer pressure and the desire to conform, those animating values of adolescent life, have resulted in “a surgical arms race,” Hong writes, “a one-upmanship among schoolchildren to look prettier.”

So it’s no big surprise to learn that South Korea has for some time now been seeing a rapid rise in eating disorders. Way back in 1997, in fact, Los Angeles Times reporter Sonni Efron reported this article on the rise in eating disorders in Asia. In 2012 Georgia Hanias, in a Marie Claire article,“Anorexia: The Epidemic Japan Refuses to Face Up To,” reported that eating disorders were increasing more rapidly in Japan than anywhere else in the world.

The “toxin effect” has spread to young women of all socio-economic levels in other parts of Asia, including South Korea, Singapore and Hong Kong, even in countries where hunger is still an issue, such as India, Pakistan, and the Philippines.

In this YouTube video on eating disorders and thinness in South Korea, an American vlogger who covers the global invasion of Korean culture (or as it’s known in Korea, hallyu), notes, “K-pop has been hugely influential in the whole diet scene because people want to look like their favorite K-pop stars.” Many of these stars are known for their extreme diets. Popular looks include “chopsticks legs” or “lollipop head,” a big head fronted with a cute face and westernized eyes on top of stick-thin legs.

Korean culture is also one in which commenting and even bullying others about their size, shape, and appearance is not taboo. Japan is no different. During my time living there, I got used seeing friends or relatives greet one another with the comment, “Oh, you got a little fat, didn’t you?” Steph, the waif-like vlogger and host of the series “Hallyu Back,” recounts how she has been picked on by fellow teachers or students. “Any day I looked a little bloated,” she says, comments would range from, ‘Oh, fat teacher,’ to ‘Are you having a baby? ’”

The comments on her post are plaintive and alarming: A viewer, likely Japanese, whose handle is Taeyu95 writes, “I really want to go to Seoul next year but my body is holding me back. I’m short and very fat. 159cm (5’2.5″) and 49kg (108lbs). I want to drop to 39kg… And K-pop is very influential to me starting dieting. I just don’t wanna be called fat in Korea.” Note how objectively normal sized, even thin, this person is.

Another comment, from “Kpoping,” reads, “I’m 4’11 and weigh 102 pounds. I would call myself fat. So I try to do the kpop diets and ulzzang diets. I’m the biggest out of my friends but I’m also the tallest. Also my parents say that I’m big boned. And I have been influenced so bad by Koreans and kpop idols.” “Ulzzang,” by the way, describes the pale skin of certain K-pop stars; fans follow their diet tips (“Don’t eat too much meats! Meats turn u brown!”) in the hopes of turning as pale as their idols.

As you can see, the toxin has breached the hazmat suit. I wonder how soon it will be in our globalized world when even the farthest reaches of the globe are no longer immune?

Read the rest of this post at Psychology Today.com »

Why We Disagree with the Film “Fed Up”

September 16, 2014

Some of you may have seen the documentary Fed Up, which tells us “everything we’ve been told about food and exercise for the past 30 years is dead wrong.”

We respectfully disagree.

Before we well you why, here’s the premise of the film in a nutshell: Made by director Stephanie Soechtig, executive producer and narrator Katie Couric, Laurie David and Regina Scully, the film points to our increased sugar consumption as a major cause of skyrocketing obesity rates. The reason for this dramatic increase in sugar (and other refined carbs found in “junk,” fast and processed foods), they say, has to do with fat. Beginning in the late ’70s and early ’80s, saturated fat was implicated in conditions ranging from cancer to heart disease. People wanted to cut fat from their diets, and the market responded. But in order to make foods with little to no fat in them taste palatable, processed food manufacturing companies turned to sugar, resulting in a doubling of Americans’ sugar consumption between 1977 and 2000.

The solution to the obesity epidemic, we’re told, is to jettison refined carbohydrates and cook at home with “whole foods,” meaning whole grains, whole fruits, and whole vegetables.

So here’s why Marcia and I disagree with Fed Up. Although it is obvious that obesity rates have risen steeply over the last 30 years, Marcia’s own clinical experience and a review of the literature doesn’t support the conclusions of Soechtig, Couric, and their assembled team of talking heads. Thirty years ago Americans were much thinner and there were virtually no eating disorders, even though the American diet included refined carbohydrates—in the form of white bread, white sugar, and processed foods—at most meals. To say that obesity rates increased because we are eating more sugar and white flour is like claiming, as one researcher has, that because there is a historical correlation between increased bottled water consumption and obesity, drinking bottled water causes obesity.

The more important difference in our diets between then and now is not the increase in refined carbs, but that meals have taken a back seat to snacks and that both have suffered from “portion creep,” becoming larger and larger over time.

In Marcia’s clinical practice, she advises her overweight patients to move to eating just three meals a day, making sure each meal contains a high-quality protein and some sort of complex carb (white bread, rice, and potatoes are okay, and so are whole grains and legumes), some fat, some veggies, and to save room for dessert. Her patients also learn how to tell what a single portion size should look like (usually between half to a whole cup); a restaurant portion for one in America often is actually enough for two or more. Her patients slowly and permanently lose weight because they are able to stay on this diet without falling back on snacking and bingeing.

Fed Up also makes the case that sugar is an addictive substance. One of the film’s experts, Dr. David Ludwig, tells us that “sugar is eight times more addictive than cocaine,” while another prominent medical figure, Dr. David Kessler, notes that “our brains are constantly being hijacked” by the irresistibly seductive qualities of the junk and processed foods that surround us.

The thing to know is that such research is in its infancy, and there are no evidence-based research findings to back up Drs. Ludwig and Kesssler’s claims. Marcia has noticed that high-sugar foods eaten alone do seem to charge people up and often initiate the urge to binge. On the other hand, high-sugar foods (in other words, dessert) consumed at the end of the meal add to a feeling of satisfaction and well-being and decrease the urge to snack later. This is why with her patients she recommends that high-sugar foods be eaten only at the end of meals and not as snacks. This allows the sugar to be “diluted” by the other nutrients and food components, and its absorption slowed.

Although Drs. Ludwig and Kessler may be right about an addictive element to sugar eaten alone and in between meals, sugar is not like cocaine. We need sugar in our blood stream for our central nervous system to function. Most of us know how bad and impairing low blood sugar feels.

Lest you think that we disagree with everything about Fed Up, there are things to commend the film for, such as the concern we share about the onslaught of processed food advertising aimed at children. We also agree on the need to shift from blaming children, teens, and adults who battle obesity every day to providing them with constructive nutrition counseling.

But the bottom line is that all of Marcia’s patients have tried and failed to stay on the kind of diet Fed Up recommends: a whole foods-only diet that involves reading labels and banning refined carbohydrates and processed foods from their homes. They can do it for a while, but feel deprived and eventually return to overeating, snacking, and bingeing. And while in an ideal world we would all cook at home and eat healthy meals together, that’s not going to happen every day.

Yet we can strive to eat balanced meals and normal portion sizes, whether at McDonald’s or at Grandma’s house, and choose the path of moderation over an obsession with nutrition labels and grams of added sugar. After all, look what happened last time we vilified an age-old element of our diet, saturated fat?

Read the rest of this post at Psychology Today.com »

Healthy Cooking in a High-Risk Profession

June 9, 2014

In my last post, I wrote about the special challenges that face dancers who are at-risk for eating disorders. As promised, here I will tell you about how former professional ballet dancer and current chef Andrea Bergquist-Zamir returned to her former company, Dance Theatre of Harlem, and led a workshop on cooking natural, high-energy and healthy foods that help maintain weight without breaking a professional dancer’s budget.

Having been one herself, she notes, “Dancers don’t know how to cook.” The first time her Dance Theatre of Harlem roommate cooked her dinner, she recalls, she invited Berguist-Zamir to share a spaghetti dinner. ‘To me that means pasta and tomato and meatballs, but for her it was boiled pasta with nothing on it. That was ‘cooking.'”

While many professional dancers can eat normally and maintain their weight, Bergquist-Zamir notes that there are also many who adopt unusual and restricted diets, “whether it’s eating green apples all day, only steamed vegetables or rice cakes. We were big fans of rice cakes with raisins on top as a filler.” Though there is a “general desire to be healthy,” she adds, many dancers just don’t know how to eat a balanced diet.

Budget is a factor, too. She compares the young dancers she taught to some of the clients she sees who shop at the grocery store-style food pantry where she now teaches professional chef training classes, West Side Campaign Against Hunger: Some may feel “they don’t have enough money to eat well because even at the semi-professional level, some weeks you get paid and some weeks you don’t. It’s a lot cheaper to buy a slice of pizza than some fruit salad. If dancers knew how easy it was to make cheap, easy meals that give you energy,” Bergquist-Zamir points out, “they wouldn’t have to do that.”

Bergquist-Zamir taught her students how to make homemade muesli or granola for breakfast, a quinoa salad that could serve as a high-protein lunch or dinner, and for dinner, poached fish, brown rice and kale or other vegetables high in vitamins and minerals. “They loved it,” she recalls of the students’ reaction to the workshops. “They were really excited about learning how to cook.”

Whether you are a dancer, an athlete in a “thinness-demand sport” like gymnastics, diving or figure skating, or just someone who wants to eat a healthy, balanced diet, you’ll want to check out Bergquist-Zamir’s guide to nutritious foods and her recipe for quinoa salad.

Andrea Bergquist-Zamir’s Nutrition Workshop Basics

1. Whole Grains- Rich in antioxidants, folate, vitamins B6 and E, magnesium, and a host of other vitamins and minerals

Brown rice, wild rice, whole wheat pasta, quinoa, barley, whole wheat couscous, bulgur, whole grain breads and cereals, and oats (oatmeal).

2. Vegetables- source of fiber, antioxidants, folate, iron, calcium, potassium, and vitamins A, B, C, E, and K,

Choose seasonal vegetables to obtain optimum nutrient content and flavor, such as asparagus and artichokes in the spring, tomatoes and corn in the summer, butternut squash and kale in the fall, and potatoes and turnips in the winter

3. Fruits- rich in antioxidants, potassium, magnesium, iron, folate, vitamins A and C, and fiber, among other nutrients

Seasonal fruits have the greatest nutrient value and flavor: strawberries and rhubarb in the spring, peaches and blueberries in the summer, apples and pears in the fall, and oranges and grapefruit in the winter.

4. Milk & Dairy– Yogurt, milk, and cheese are all good sources of calcium, protein, vitamin D, and riboflavin (vitamin B2) Choose nonfat or low-fat dairy products over their whole-fat counterparts.

5. Protein-Fish, seafood, eggs, poultry, and lean meat are all great sources of protein. Plant-based sources include nuts and seeds, beans and legumes, tofu and edamame, and grains such as quinoa and millet.

6. Fats-Healthy fat options include olive oil, canola and grape seed oil, avocado, nuts, flaxseed, and cold-water fatty fish like wild salmon and sardines

Andrea’s Quinoa Salad

2 cups water

1 cup quinoa

1/4 cup olive oil

1/4 cup lemon juice

Zest of one lemon

1 apple cored and diced

¼ cup dry cranberries

Spinach (Arugula or any leafy green) to taste

1 cup fresh parsley, chopped

¼ cup toasted almonds

Sea salt to taste, fresh ground pepper

In a saucepan bring water to a boil.

Add quinoa and a pinch of salt.

Reduce heat to low, cover and simmer for 15 minutes.

Allow to cool to room temperature; fluff with a fork.

Meanwhile, in a large bowl, combine the remaining ingredients add cooled quinoa

What is quinoa?

While quinoa is usually considered to be a whole grain, it is actually a seed, but can be prepared like whole grains such as rice or barley. It takes less time to cook than other whole grains – just 10 to 15 minutes. Of all the whole grains, quinoa has the highest protein content, so it’s perfect for vegetarians and vegans. Quinoa provides all 9 essential amino acids, making it a complete protein. Quinoa is a gluten-free and cholesterol-free whole grain. Quinoa is especially well-endowed with the amino acid lysine, which is essential for tissue growth and repair.

Quinoa is a very good source of dietary fiber, manganese, magnesium, iron, copper and phosphorous.

 

Read the rest of this post at Psychology Today.com »

What You Need to Know if your Child is Involved in Ballet

May 11, 2014

In our book, Marcia and I advise parents to be especially vigilant if your childespecially one who is genetically predisposed to an eating disorderis involved in a “thinness-demand” sport or activity such as gymnastics, figure skating, ballet, dance, diving, or distance running. These are activities that place emphasis on or favor a specific body type, usually thinness or small stature.

Last fall, I happened to write two articles that involved dancers. Knowing about the high-risk nature of dance when it comes to eating disorders, I asked my subjects about their experience with eating disorders. Both told me they had lots to say on the topic.

Andrea Bergquist-Zamir danced for six years with the Dance Theatre of Harlem in New York City before becoming a successful chef, working alongside famous names such as Floyd Cardoz and Marcus Samuelsson. She now leads a chef training program at a Manhattan food pantry. Marla Hirokawa trained as a ballet dancer, danced professionally in Hawaii and New York, and worked as a teaching artist for the New York City Ballet Education Department. For the past 25 years, she has headed her own dance school and ballet company, Covenant Ballet Theatre of Brooklyn.

Newly enrolled at the University of North Carolina School of the Arts boarding school in Winston-Salem, Andrea’s dreams were crushed when she was told that she was too big—not so much in weight as in size—says, the 5’-8” former dancer. Instead of ballet, she was placed in the modern dance department. Getting over that setback, she recalls, “took me years.”

In the dance world, Andrea says, disordered eating is a part of life, and her school was no exception. Eating in the cafeteria “where everybody is watching you,” she recalls, was one of the most difficult times of the day. She was lucky in that she didn’t have to constantly diet to meet her teachers’ approval; instead, she exercised as a way of staying fit. While some students suffered from anorexia, the most prevalent disordered-eating behavior was purging. Yet “there wasn’t any type of discussion about it, no help or anything like that,” says Andrea.

Ironically, when she began auditioning for a position with a dance company in New York in the early ’90s, she couldn’t land a modern dance job. Instead, she was selected for the Dance Theatre of Harlem, at last fulfilling her dream of dancing classical ballet. The director at the time, Arthur Mitchell, was known for hiring tall women. There, she was again fortunate; “I wasn’t one of the people they picked on about weight,” she says.

Before launching her professional career, though, Andrea was part of the merit scholarship program at The Ailey School (a part of the Alvin Ailey American Dance Theater that was underwritten by large corporate donors). Since one of the conditions of keeping one’s scholarship “was to maintain your weight,” she explains, weekly weigh-ins were conducted. Marla, too, mentions that one of her students, who later became an instructor at Covenant, was in the certificate program at The Ailey School and “was constantly having to take what she called ‘the fat class,’ which was focused on nutrition and aimed at getting students to lose weight.

As someone who has both danced and taught ballet professionally, Marla notes, “there are some balletic institutions where there’s very strong pressure to maintain a body type. It’s tough because you’re talking about girls in particular whose bodies are changing and whose hormones are raging.” The years between 15 and 18 are also when young female ballet students audition for and are selected by the larger, better-known dance programs. The combination of the athletic demands of dancing and the pressure to maintain a low weight is such that Marla encountered one dancer who did not begin menstruating until after she stopped dancing in their 20s—a serious threat to bone density that can lead to painful and debilitating bone fractures.

Marla says that it wasn’t until she arrived in New York in the early ’80s that she began to notice signs of eating disorders. “It just started to become a lot more visible,” she says. In classes, she saw “girls, women, looking absolutely emaciated. They moved so slowly, and I thought, ‘Wow, what is that?’”

Her first close encounter with an eating-disordered ballet student came in about 2003. She noticed one of her students, who was about 16, picking at her food or not eating. Marla was concerned enough to broach the subject when they were alone. “She was incredibly honest with me,” she recalls. Although the student’s relationship with her mother was strained, Marla knew her condition was serious and that she had to tell the parents. At one point, the student came to live with Marla. The student did eventually move beyond her disorder, and the last time she visited Marla, her relationship with her mother was greatly improved. Today, Marla says she wished she had known about the Maudsley method, also known as Family Based Treatment, and had been able to suggest a trained professional to help involve the family in her student’s recovery.

Since then, several other students battling an eating disorder have come through her school. In one case she recalls, her student was being fitted for her sweet 16 dress. When she was told, “this dress fits you to a T, and you’d better not gain an ounce,” the young dancer started to restrict her food intake and Marla noticed a drastic drop in weight. She talked to the girl and her parents, and with appropriate care, the student regained her equilibrium.

There have been cases at Covenant where some of the company’s instructors or a parent have alerted Marla to a possible problem. In the case of the parent approaching her, the parent did not want her daughter to know she had alerted the school. In order to protect her confidence, Marla casually initiated a conversation and gave her student some advice on healthy eating.

In contrast to the harsh weeding-out approach of the pre-professional academies, explains Marla, Covenant Ballet Theatre Dance Academy accepts all students without an audition process. Its mission is to foster a holistic appreciation of dance, introduce young generations to the art form and in some cases act as a bridge to the city’s larger and better-known dance schools. The many Covenant graduates who have continued dance through college and beyond attests to the success of this approach, yet it is an anomaly among serious dance schools.

Students who don’t have the narrowly defined body type typically considered suitable for ballet are encouraged to continue dance, says Marla. If the student is intent on dancing professionally, she notes, “there is a point where reality will hit, and we can have that conversation then, but talk about it in a more healthful way.” She cites the example of one former Covenant student “who, when I first met her as a kid, had the least going for her as a body type. Yet of her class, she’s the only one who went on, graduated with a degree in modern dance, went on to dance with small modern companies and continues because she loves it.” Marla concludes, “If you have a realistic perspective, are very open, and love the art form, you can find a way to continue doing it.”

In my next post, I will tell you about how Andrea Berquist-Zamir returned to her old company, Harlem Dance Theatre, and taught a class in cooking and nutrition. As a former professional dancer and a chef, Andrea will pass on her tips for healthy cooking and eating for dancers.

 

Read the rest of this post at Psychology Today.com »

Hello, Real-Sized Doll, Goodbye Barbie

March 6, 2014
Lammily is sporty.

Lammily is sporty.

Some of you may have seen the widespread coverage of Pittsburgh artist Nickolay Lamm‘s digital rendering of a real-size Barbie. Lamm checked the CDC’s Web site to get the measurements of the average 19-year-old woman, then used those as the basis for his creation.

Well, response has been so positive that yesterday Lamm, 25, launched a crowd-funding campaign to help him start manufacturing his doll. He’s dubbed her “Lammily,” and the tag-line of his campaign is “Average is Beautiful.” Instead of blonde, she’s brunette. She wears minimal make up and dresses in sporty shorts, workout clothes and one belted dress.

So far Lamm is off to a good start. On the second day of his fundraising campaign he’s already comfortably exceeded his goal of $95,000 To make sure he gets his first foray into doll making right, Lamm is in touch with former Mattel Vice President for Manufacturing Robert Rambeau, who’s helping him identify reputable manufacturers.

“Barbie has been critiqued a lot,” Lamm notes. “My thought was rather than critique her, why not make a proof-of-concept to show that a real-life doll would appeal to people? Normal Barbie doesn’t exist and likely never will. Lammily is my attempt to make what I feel should exist.”

“Every single one of us has something they’d want to change about their body,” says Lamm. “For example, I’m only five-five. I’d rather be six feet but I’m perfectly happy the way I am…I feel like every one of us has gone through something like that.”

While others have tried to market real-sized dolls, no one has yet succeeded. Lamm suspects it’s because “they made a big deal about this doll being average.” He explains, “That appeals to parents, but girls don’t care abou that. They just want a fun doll to play with.”

A sense of humor would probably help sell Lammily, too, and Lamm seems to have one. He imagines a future add campaign in which Lammily is doing pushups and other “fashion dolls” are breaking apart because their emaciated bodies aren’t made to demonstrate physical fitness and health.

To those that have requested that Lamm do for Ken what he’s doing for Barbie, he says that (the rise in male-eating disorders notwithstanding) he’d like to concentrate on Barbie because he believes far more girls than boys and women than men suffer from body image problems. What do you all think?