Beyond Broccoli Archives - Beyond Broccoli

Eating Problems: Get Answers…Today!

Posted on February 23, 2016 by gliffen

Do you worry constantly about what and how much you eat?
The Struggle
Are you afraid that eating “the wrong foods” will make you fat?
Does it seem like you spend too much time thinking about food and eating?
Do you fast, diet, use laxatives, diet pills or “cleanses” to make up for eating too much food (or the “wrong” kinds of foods)?
Do you eat in secret or feel like you don’t deserve to eat?
Do you feel out of control when you start eating or when you eat certain foods – as if you cannot stop until the food is gone or you feel physically sick?
Is figuring out what and how much to eat really stressful for you?
Do you ignore hunger and/or fullness cues? Or is it hard for you to tell if you are hungry or full?
Do you avoid entire food groups or specific foods out of fear they will make you fat or unhealthy?
Does stress lead you to either avoid food or overeat?
Do you exercise to “earn” your food?
Do you exercise even if you are sick or injured?
Is exercise mainly a way to burn calories and something you don’t otherwise enjoy?

Many of these statements are common thoughts, beliefs and behaviors that we don’t think are a problem. In fact we live in a culture that promotes many of these things. We don’t hear much about healthy eating or exercise that become problems when taken too far. For some people however, many of these statements can be clues to problem eating or even full-blown eating disorders.

Food is often used to comfort, numb or distract from uncomfortable feelings or problems that seem overwhelming. If this is a once-in-a-while thing you may be fine. But when this is the main way you cope (or don’t cope) it can be a serious problem.

How do you know if what you are experiencing related to food is “simply” emotional eating vs. a full-blown eating disorder? This year’s Eating Disorder Awareness Week promoted by the National Eating Disorder Association (NEDA) can help you explore this question. The theme this year is:

3 Minutes Can Save a Life. Get Screened. Get Help. Get Healthy.

The NEDA website (http://www.nationaleatingdisorders.org) has a free, confidential screening tool and lots of information about eating disorders both for people who may be suffering with an eating disorder and for friends, family and others who are concerned about someone who may have an eating disorder.

Whether what you (or a loved one) are struggling with is an eating disorder or other eating issues that is causing physical or emotional distress, you are not alone. And, there is support and guidance available. Don’t wait – act right now.

I Had No Idea: a “healthy” passion can become a problem

Posted on February 26, 2015 by gliffen

Passion drives many athletes and outdoor enthusiasts here in Jackson Hole, Wyoming. Surrounded by rugged mountain ranges and access to raging rivers, this recreational Mecca is a sort of proving ground for athletes who want to push their limits skiing, rock climbing, boating, biking, running and more. There is a strong subculture here that sets a high bar for “normal” exercise.

More than 20 years ago during my early years in Jackson a friend and I did a 24-mile day hike up in Grand Teton National Park, a major feat for us east coast transplants. We got an early start and crested the top of the divide feeling pretty good about our accomplishment until a couple of local friends came jogging up the trail and passed us wearing fanny packs with water. If you climb or ski something here someone has climbed or skied it faster, or as part of a multi-peak day, or they first biked from town, swam across a lake, and were heading down to reverse their route after passing you. Seriously.

This Uber-athlete mentality makes it difficult to define “excessive exercise.” Disordered eating patterns that often accompany problem exercise are also normalized here. Sometimes eating takes obvious disordered forms such as severely restricting all food intake or bingeing and purging food. Less obvious disordered eating can be adhering to rigid food rules such as “eating clean” or following any number of fad diets that are socially accepted. This does not mean anyone who is consciously eating well to improve health or athletic performance has an eating disorder but points to the difficulty in identifying problems in subcultures like ours where extreme behaviors are normalized.

A group of friends on a long backcountry ski tour together may have no idea one member of the group has not eaten for 12 hours because she “ate too much” yesterday. Or she needs to hike, skin and ski first to “earn” her next meal. Or she “feels too fat” to eat. Or the food available doesn’t meet her strict guidelines of acceptable food. And with the exercise itself, if someone works out despite illness or injury or never takes a rest day, she is badass, dedicated, someone to be admired.

Excessive exercise as a form of purging in Bulimia Nervosa was added to the DSM-5 (the manual that outlines criteria for a variety of mental illnesses including eating disorders) in June of 2013. Exercise has long been recognized as a problem in a variety of eating disorders but it was not previously defined as a form of purging in place of other purging behaviors such as self-induced vomiting.

Unfortunately, the general public health messages that encourage people to “move more and eat less” don’t acknowledge any downsides to either of these mandates. “Earning” meals or treat foods with exercise is commonly encouraged and the fine line between balancing calories and physical activity or obsessing about these habits is often blurred. Exercise habits can’t be adequately assessed based simply on the number of hours or days each week, the type of activity, or even the intensity, we must look at what drives the exercise.

Is it enjoyable?

What happens if you miss a day of working out?

Has exercise replaced time you spend doing other things you enjoy or time you spend with friends and family?

Do you fuel and hydrate to support your activities?

Do you feel better afterwards or do you just feel relief that you exercised?

All of these questions must be considered in the context of the whole person. An elite or professional athlete may have to train on days conditions are less than ideal and training can appear compulsive to an outside observer and a recreational athlete who sometimes overdoes it may not have a problem. The point is we need to know that despite all of the positive benefits associated with physical activity, exercise can have a dark side. People who exercise while malnourished and underweight can experience accelerated bone loss and exercising after food restriction or other forms of purging can cause dangerous electrolyte imbalances.

If you suspect someone you care about has no idea that their passion may have crossed a line into dangerous territory – seek support. NEDA has a free Coach and Athletic Trainer toolkit with ideas that may apply to recreational athletes who are not being coached. Also from the NEDA website are the following risk and protective factors for athletes that may be helpful to consider in the broader context of appropriate or “healthy” exercise.

Risk Factors for Athletes:

Sports that emphasize appearance, weight requirements or muscularity. For example: gymnastics, diving, bodybuilding or wrestling.
Sports that focus on the individual rather than the entire team. For example: gymnastics, running, figure skating, dance or diving, versus teams sports such as basketball or soccer.
Endurance sports such as track and field/running, swimming.
Overvalued belief that lower body weight will improve performance.
Training for a sport since childhood or being an elite athlete.
Low self-esteem; family dysfunction (including parents who live through the success of their child in sport); families with eating disorders; chronic dieting; history of physical or sexual abuse; peer, family and cultural pressures to be thin, and other traumatic life experiences.
Coaches who focus primarily on success and performance rather than on the athlete as a whole person.
Three risk factors are thought to particularly contribute to a female athlete’s vulnerability to developing an eating disorder: social influences emphasizing thinness, performance anxiety and negative self-appraisal of athletic achievement. A fourth factor is identity solely based on participation in athletics.

Protective Factors for Athletes:

Positive, person-oriented coaching style rather than negative, performance-oriented coaching style.
Social influence and support from teammates with healthy attitudes towards size and shape.
Coaches who emphasize factors that contribute to personal success such as motivation and enthusiasm rather than body weight or shape.
Coaches and parents who educate, talk about and support the changing female body.

Beyond Broccoli’s Response to Article: “6 Things I Don’t Understand About the Fat Acceptance Movement”

Posted on December 29, 2014 by gliffen

This morning I read a blog post by Carolyn Hall entitled “6 Things I Don’t Understand About the Fat Acceptance Movement.” I realize that as with so many contentious current issues, people on all sides are so entrenched in their own views they struggle to step back and look at the whole picture. We all do this – we judge what we see and hear based upon our own life experiences. The bigger problem occurs when we are not open to changing our preconceived notions. As I tell my university students – if we want to be part of the solution to our current problems we must learn to communicate with people who don’t think like we do. This post is an attempt to do just that.

Though I felt frustrated reading this article I recognize Hall’s questions are shared by many who are unfamiliar with the nuances of the HAES (Health at Every Size) approach and provide an opportunity to respond with my take on these questions. I assume this author genuinely wants to hear a different view point and respond to her 6 points accordingly. Each response is based on my 14 years of work as a Registered Dietitian with a major focus on a non-diet approach to health, and a specialty working with problem eating all along the continuum, including eating disorders.

**1. America is extremely accepting of fat.**

Only someone who has not lived in America in a fat body could make this statement. To be clear, despite feeling fat most of my life starting in preadolescence, and going through periods of being 20-25 pounds or so above what is considered “healthy” for my height, my work with clients in larger bodies has shown me that I do not really know what it is like to be fat in our culture. I am haunted by their life stories however, and I can assure you this statement is not accurate.

I do agree with Hall that our culture accepts and even encourages many of the factors that contribute to unhealthy lifestyles, including excess weight and inadequate physical movement. As a whole (with some very vocal exceptions) we accept a food system that produces and promotes a plethora of unhealthy foods and makes them cheap, convenient, and accessible 24/7 for most of us. We accept that our “busy lives” don’t include time to prepare and eat health-promoting food at regular intervals and without distractions. We don’t encourage people to connect with their internal cues of hunger and fullness or with how their physical and mental health is linked to their eating habits. We accept a fear-based approach to education about virtually everything, including nutrition, and then blame people who don’t make sustainable changes based on fear (a topic for another post).

2. “Body positivity” should include health.

I cannot speak for every member of the Fat Acceptance or Health At Every Size Movements but I can tell you as a longtime advocate of a non-diet approach to health, and an eating disorder professional, my motivation to do this work is a focus on health. As with all social “movements” I suspect there are advocates with extreme and more rigid views than mine but having read many books by HAES proponents, any suggestion that health is not a key part of this movement is a misinterpretation.

The problem I see is that weight and health are so intertwined we overlook the fact that many lifestyle changes related to food, exercise, stress resilience, and more, can improve health with little or no change in body weight. Even if weight loss can increase health benefits, which is likely to be true in the extreme cases of morbid obesity the author refers to throughout her article, as long as positive lifestyle changes are tethered to weight loss, we encourage yo-yo dieting and unsustainable changes linked to metabolic mayhem that are not likely to yield long-term health benefits.

Body positivity does not mean you love being fat or want everyone to be fat. Accepting that you are a human being with worth that extends beyond your appearance is body positivity. In my experience working with people who struggle with food, weight and body image, the preoccupation with body weight, shape and size occurs in underweight, overweight and healthy weight individuals, male, female and transgendered. Shifting the focus toward what Connie Sobczak calls “intuitive living” in her excellent book Embody, is about self-care in every aspect of our lives. As long as we are only focused on a number on the scale we are not truly engaged in sustainable self-care.

3. “Health at every size” seems physically impossible.

Again, Hall is hung up here on the extremes – as many critics of the HAES approach are. As stated above, the main idea is that we need to shift the focus from weight to health, for everyone. Weight gain, or loss, may be part of the bigger health picture for people at the extremes of anorexia and morbid obesity. However, I see clients on a regular basis who are within a “healthy” weight range and routinely engage in unhealthy behaviors in an attempt to change (or maintain) the way they look.

I cannot count the number of times clients report compliments about how “good” they look or how much weight they’ve lost after days of erratic eating, purging, starving themselves, or exercising in dangerous ways. They not only hear this positive feedback from friends and co-workers but health professionals – doctors, personal trainers, and yes, sadly, nutritionists. All of us can be blind to the physical and emotional health consequences of a weight-focused vs. health-focused culture.

4. People are allowed to not be attracted to certain body types.

I have no issue with this statement. Attraction is thankfully diverse and individualized. My issue is that the fat shaming prevalent in our culture is an accepted form of discrimination and prejudice. Though I don’t believe we are anywhere near “post-racial” or beyond any other form of discrimination widely accepted earlier in my lifetime, I see examples on a regular basis of serious discrimination based on weight that is totally accepted in mainstream culture. Even people who still believe race, ethnic background, sex, gender, or religious preferences are undesirable, don’t express such views widely (except of course on the internet). Yet somehow there is a general acceptance of negative comments made about someone’s weight. As a society we allow fat to be a code word for lazy, stupid, weak, and other harmful judgments.

Promoting the idea that people come in different shapes and sizes does not mean we all suddenly have to be attracted to fat people. This is more of a social justice issue than a personal attraction or general health issue.

5. Food addiction is a real medical problem.

A complete response to this point is easily an entire blog post unto itself. In brief however, the concept of “food addiction” is controversial, particularly if we attempt to address this “diagnosis” as we do addictions to other substances. There are many issues that contribute to both what and how much we eat on a regular basis. While biochemistry and neuroscience can explain pieces of this complex puzzle, any attempt to reduce problem eating to “simple addiction” is not helpful.

Foods that are highly processed and bypass our internal cues of hunger and fullness are a problem. As stated previously these foods are cheap, convenient, and accessible. They are also heavily promoted using results from billions of dollars of food psychology research. I fully agree we need to address these issues.

To understand eating problems more completely however, we need to include the biochemical aspects of our response to food, along with our long-established neural pathways or habits, various influences in our food environments, and other aspects of human behavior. Evolutionary psychology can also help us better understand our currently maladaptive tendencies with the curiosity and compassion we need to make significant and sustainable changes to our behavior.

Like it or not, eating habits are complicated and reductionist “solutions” must be recognized as such. The HAES movement may not focus on all of the points I mention here but it does recognize the “answers” to the “obesity crisis” are not simple.

6. Childhood obesity is something we can’t be accepting of.

I could not agree more on this point. I know many health professionals who endorse non-diet and HAES approaches and none of them are “pro-obesity” of any sort, especially among children. Raising children to eat based on fear – don’t eat this or that because you will get sick, or worse, get fat, is not helpful. Continuing to advocate a weight-focused vs. overall health-focused paradigm will not help our children. They need to know that eating nutritious foods and moving their bodies daily is good for their brains, bodies, mood, energy levels, and overall health. But they also deserve to know that thin does not equal healthy; that as they transition from childhood to adolescence and then into adulthood, their bodies will grow and change, and these changes don’t mean they are unacceptable when they don’t fit narrowly defined ideals of beauty.

Our children need to know there is no “perfect body” or “perfect diet.” In fact it would be great if they abandoned the notion of perfection altogether. Striving to do the best they can is awesome. Chasing the illusion of perfection can be dangerous.

It is our responsibility as adults to provide an environment for our children that supports good health and a sense of well-being. In our current culture this is no easy feat. It is clear however, that what we have been doing for the past few decades is not working. Focusing on short-term fad diets, succumbing to the trappings of modern society that support unhealthy lifestyles and then blaming people who gain weight or don’t exercise enough, using fear-based tactics in an attempt to change people’s habits, are not helpful strategies to produce the changes we want to see.

I don’t like the phrase “fat acceptance.” I prefer “human acceptance” which gets more to the core of our various health problems linked to weight. In fact we know that the statistics related to weight and health also apply to socioeconomic status and health. This doesn’t mean we don’t pay attention to these relationships but hopefully it means we try harder to understand the complexity of the issues beyond what we see on the scale.

There is no single way out of the mess we are in related to poor health as a society. Blame, shame, fear, anger, and a lack of compassion for ourselves and others are not working to make us healthier physically or mentally. What I am drawn to in alternate paradigms such as Health at Every Size (HAES) is the refusal to reduce our current health problems to weight alone, nor to continue clinging to approaches that don’t work. It is time for a fresh perspective and frankly I don’t care what we call it as long as it takes us in a more positive direction.

Find Willpower in Self-Compassion and Calm

Posted on December 4, 2014 by gliffen

Have you ever tried to change a habit related to food or eating?

What I’m going to share with you today applies to any behavior change. I’m going to use a food example that most of us can relate to as eaters entering the holiday season.

Imagine this scenario:

You decide this year that you are going to take it easy on sweet treats throughout the holidays. Not only do you feel better on a daily basis when you keep sweets in balance, but this change is consistent with your long-term health goals.

You go to work and shortly after you arrive a co-worker walks in with a plate of home-baked cookies – your favorite kind. And there are a lot of them. You graciously accept a cookie then immediately start criticizing yourself for eating it. That voice inside starts in: “Not even an hour into the workday and you’ve eaten a cookie, so much for that healthy eating goal.”

Then you have a second cookie. The voice gets louder, and harsher. By the time lunch rolls around you’ve lost count of how many cookies you ate. You go out to lunch and order dessert after your cheeseburger and fries because at this point you have “blown” your healthful eating plan for the day.

You have just experienced a well-known behavioral psychology phenomenon called the “What-the-Hell Effect.” This cycle of indulgence-regret-greater indulgence was first described by psychology researchers Polivy and Herman.

Now I want you to think about what happens in these “What-the-Hell” situations for you. What are some of the things you tell yourself?

The most common response I hear from my clients is “I have no willpower.” They believe they “cave in” to temptation because somehow they just don’t have enough willpower or their love of food is so powerful they cannot resist that first cookie. They are convinced that first cookie paves the way to “What-the-Hell.”

The reality is that the initial decision to revert back to an old habit, to eat that first cookie, is NOT what leads to the What-the-Hell behavior. It is our feelings of guilt, shame, loss of control, or loss of hope that follow the first relapse that lead us to continue the path away from our longer-term goals.

According to Kelly McGonigal, a psychology researcher at Stanford who studies Willpower, to break this “What-the-Hell” cycle of indulgence-regret-greater indulgence we need self-forgiveness. We may think guilt motivates us to correct our mistakes but it’s just one more way that feeling bad leads us to give in.

Now here is where things get really interesting. There is another important factor in this scenario: your brain.

Some of you may be familiar with neurobiologist Dan Siegel’s “Hand Model of the Brain” (if not click here). The limbic area of the brain is where our “fight/flight” response starts when we are faced with a potential physical or emotional threat. Dr. Siegel calls this the “lower brain”.

The cortex, including the prefrontal cortex or the “upper brain,” covers the limbic area, and enables us to reason and to see the bigger picture –specifically our longer-term goals. Decisions from our lower brain are impulsive, short-sighted and reactive.

When we berate ourselves for eating the cookies, we engage the stress-response in our lower brain and set ourselves up to continue not acting in accordance with our longer-term goals. Blood actually diverts away from the cortex or upper brain.

When we beat ourselves up mentally, our brain works against us!

Study after study of adults shows that self-criticism is consistently associated with less motivation and worse self-control.

Self-compassion – being supportive and kind to yourself, especially in the face of stress and failure, is associated with more motivation and better self-control.

Psychologist Kristen Neff describes 3 core components of self-compassion:

Self- kindness (treat ourselves as we would a loved one who is struggling)
Recognize our shared humanity (we are all imperfect –connects us)
Mindfulness of our inner critic and our discomfort (to respond differently we first must be aware of what is happening)

Going back to our example of the cookie, what if your initial response is “wow, that cookie is delicious” and you eat it slowly, savoring the taste, appreciating that your co-worker made this cookie from scratch?

Afterwards when you are tempted to have another cookie (or 5), you take a few deep breaths instead. You gently remind yourself that enjoying a cookie here and there is consistent with your longer term health goals, but wolfing down 4 more cookies right now probably isn’t. You don’t beat yourself up for eating that first cookie. You are human and many humans like cookies!

When your inner critic kicks in and starts screaming: “You idiot! Why did you eat that cookie? What were you thinking?” you calmly respond, “I wanted the cookie and it was delicious.” End of story. If you stay calm, blood continues to flow to all parts of your brain and you are able to remember your longer-term goals.

This self-compassionate and calm response takes away the driver of the “What-the-Hell” (WTH) effect– if there is no guilt and self-criticism, then there is nothing to escape.

As we enter the holiday season filled with all kinds of ways to tempt us away from our health-promoting self-care habits, a time when we are prone to the “What-the-Hell” effect and to impulsive decisions made by our “lower brain” due to stress, let’s think about sharing some of the compassion we give freely to others, with ourselves as well.

In addition to the many holiday stresses, alcohol, sleep deprivation and distraction can also trigger our “lower brain” and cause us to abandon our longer-term goals. In these situations we need to be extra kind to ourselves. We also need a strategy to help calm our stress response and promote resilience.

One of the simplest stress relievers is to take 3 deep belly breaths. LET’S TRY THIS – 3 deep belly breaths, each followed by a long, slow exhale. ONE, TWO, THREE.

If you were stressed and your limbic brain was threatening to take charge, those 3 deep breaths just redirected the blood flow to your whole brain. Now your cortex has a chance to be part of your decision making.

This calmness in combination with self-kindness may be your most enjoyable holiday treats ever –ones you can look back on in January with a smile on your face!

Gratitude: Antidote to “Not Enough”

Posted on November 25, 2014 by gliffen

I didn’t get enough sleep

I don’t have enough money

I need to exercise more

There is never enough time to get everything done

I’m not ___________ (thin, fit, attractive, rich, strong, smart, etc.) enough

Does your day start or end with any of these thoughts? What about throughout your day? Is there enough? Do you do enough? Are you enough?

Regardless of the abundance that surrounds us we often perceive a “culture of scarcity” – a mindset that can lead us to focus on what we lack versus what we have. A couple of years ago I was introduced to the work of Brene Brown, a psychology researcher who studies shame and vulnerability. Through her work she observes ways this “culture of scarcity” plays out in our everyday lives. The observation that struck me most is that people who struggle with emotional eating or binge eating, sometimes use food in response to these feelings of “not enough.” Brene suggests one possible antidote to subconscious and conscious feelings of scarcity and inadequacy: a gratitude practice.

“Piglet noticed that even though he had a Very Small Heart, it could hold a rather large amount of Gratitude.” ― A.A. Milne, Winnie-the-Pooh

While it may be naïve to think a simple gratitude practice is the solution to behaviors as complex as binge eating, I am intrigued by the idea that focusing attention on what we have versus what we lack can help us feel more fulfilled in our everyday lives. Many clients struggling with emotional eating issues describe food as a way to “fill” some type of void that has nothing to do with biological hunger. Despite their “knowing” this is a reason they eat, they struggle to stop such behaviors. I often encourage clients to identify what is driving the eating because if it is not physical hunger then no amount of food will “fill” them. The idea behind this strategy is that whatever the real need is that drives this eating cannot be met if it goes unidentified. Unfortunately the process of unraveling underlying needs is not simple and takes time.

Is it possible that focusing more on what we are grateful for may help us feel more “full” in a positive way? Can we “fill up” on gratitude to replace mindless activities that don’t serve us well?

I decided to try a gratitude practice myself, just to see what would happen. Though I don’t currently struggle with eating issues, I definitely fall into that scarcity mindset with respect to time, money, and many other things I wish I had more of. When I learned about the scientific studies related to gratitude I wondered if this practice could impact other behaviors that distract my daily life and keep me feeling “busy.”

Last fall shortly after my return to Jackson, I was sitting at my desk with Ginny curled up next to my chair. I glanced at my favorite wedding picture propped on my desk beyond my computer, and then out my front window toward Snow King Mountain bathed in afternoon sunlight. Overwhelmed with gratitude, I wanted to freeze that moment. I was home in Wyoming with Dave and Ginny, I re-launched my dream career at Beyond Broccoli, and I was surrounded by mountains, a community I care deeply about, and immediate access to so many of the things I love to do. I knew that at some point the proverbial “honeymoon phase” of this new chapter of my life would fade, so I decided to start a gratitude practice. My hope was that at some point when the mundane aspects of everyday life replaced my bursting enthusiasm for all-things-Jackson, I could retrieve a few of these strips of paper and remind myself of all the aspects of my daily life that provide richness beyond measure.

I already journal regularly so I chose to try a gratitude jar instead. I got a Mason jar from the kitchen and removed the steel lid. I cut a piece of paper into small strips and wrote a few of the things I was grateful for in that moment. I continued to do this daily for a while, savoring simple moments that made me feel joy and contentment. Dog walks and puppy kisses, random acts of kindness, playing in the snow, sunshine on cold winter days, feeling love and support. It didn’t take long to notice moments of gratitude everywhere I went. Now I don’t even have to read my little scraps of paper – I glance at the jar on my desk and am filled with gratitude.

I don’t know if this gratitude strategy can decrease general thoughts and feelings of scarcity for everyone. I do know this has been a powerful practice for me. I am more aware when I start down the scarcity mind set path and can stop myself or at least recognize what is happening. Though things are going pretty well right now, as with most years the past 12 months included moments of fear, pain, and discomfort, and there were losses. I can’t say I felt less of these uncomfortable emotions, but I do think I was a bit more resilient. The way I see it there is no downside to a gratitude practice and for me nurturing resilience following life’s inevitable hardships, is enough.

“To love someone fiercely, to believe in something with your whole heart, to celebrate a fleeting moment in time, to fully engage in a life that doesn’t come with guarantees – these are risks that involve vulnerability and often pain. But, I’m learning that recognizing and leaning into the discomfort of vulnerability teaches us how to live with joy, gratitude and grace.”
― Brené Brown, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are

Overweight and in Recovery from an Eating Disorder

Posted on November 17, 2014 by gliffen

Last week following a presentation about eating disorders to a group of mental health professionals a participant stood up and shared that a relative of hers had just returned from eating disorder treatment and was overweight. What should she (the relative in recovery) do?

Each time I hear this question my heart sinks. We live in a culture where the primary metric for health is weight. If someone does not meet clinical criteria for a “healthy” weight range she is encouraged by everyone around her, often including her health providers, to “diet.” It astounds me that even when a person has struggled with a full-blown eating disorder the focus remains on weight, and too often “dieting” is the recommendation. Keep in mind that a “diet” for someone with an eating disorder is like a drink for someone addicted to alcohol.

Responding to the question about what to do next is difficult for many reasons. First, I know nothing about this person’s eating disorder journey – how it began, the form it took, the treatment she received, current support, etc. What I do know is that no matter what her journey looks like, working with a combination of outpatient therapist and dietitian with training and experience in eating disorders is the ideal next step. I’d like to say this type of follow up care is essential based on the many stories I’ve heard from my eating disorder clients about working with professionals not experienced with eating disorders. Unfortunately the reality of living in areas where specialized services are not available makes this an ideal scenario rather than an essential one.

The long term nutrition goal is to create a positive relationship with food (body and emotions too but these are more in the psychotherapy realm). Here are my top 3 next steps for nutrition in eating disorder recovery after some type of residential or inpatient treatment:

Seek support related to a more intuitive and mindful approach to eating. There are several books and websites on these topics. For Intuitive Eating resources Evelyn Tribole’s website is great http://www.evelyntribole.com/resources/intuitive-eating-articles-studies-support-groups/10-principles-of-intuitive-eating and for Mindful Eating guidance Michelle May, MD has some really good resources http://amihungry.com/resources/about-the-mindful-eating-cycle/
Be aware of any type of food restriction – especially if your eating disorder includes binge eating. This is one of the most counter-intuitive aspects of eating disorder recovery for those who struggle with binge eating. This is also commonly ignored among dietitians and other health professionals not experienced in eating disorder treatment. The focus is too often on the binge rather than the food restriction that can begin a cycle of disordered eating. Skipping meals and snacks, avoiding certain foods or food groups, only allowing yourself to eat at certain times, or arbitrarily determining portions sizes rather than relying on your body to tell you what and how much you need, are all forms of food restriction that can be harmful in eating disorder recovery.

Watch for “always” and “never” thoughts and statements. These words are red flags for “black-and-white” “all-or-nothing” types of thinking that support disordered eating behaviors of all kinds. These words are rarely true when it comes to food and can help you identify struggles that lurk beneath the surface during your recovery journey.

There are many more issues to address in support of long-term, sustainable eating disorder recovery and a positive relationship with food. If you are overweight as you face the next stage of your recovery these steps can help you stay focused on health and well-being while you support your body’s return to a healthy weight range tailored to your individual needs.

It Takes a Team to Support Eating Disorder Recovery

Posted on November 13, 2014 by gliffen

Earlier this week a colleague and I gave a presentation on eating disorders to a group of mental health professionals in Idaho Falls. It was a whirlwind of information crammed into a relatively short span of time but it felt important. I welcome opportunities to share what I’ve learned about eating disorders – including the treatment process and recovery journey, with both the public and other professionals. Each time I engage with a group about this work, I walk away wanting to do more, wishing we had more time and more resources to empower more mental health, nutrition and medical professionals to identify patients and clients who need support around the most basic of human needs: food and connection.

As we prepared for the eating disorder talk I also realized how powerful it is to partner with a colleague with both experience and a deep understanding of this difficult work we do. I have struggled since my return to private practice to recreate some of the magic I experienced as an integral part of a cohesive multi-disciplinary team in an outpatient clinic devoted to eating disorder treatment.

I now realize that what was special about being part of such a team was that in addition to our increased effectiveness in treating our patients in an environment of ongoing team communication and a strong foundation of knowledge surrounding these complex disorders, we knew innately how to support each other in our work. Whether it was tears, laughter (that could seem inappropriate to an outsider at times), a well-placed hug, or a simple nod of understanding, I felt a little less alone in the often tumultuous sea of treatment and recovery we were helping our patients to navigate.

The outpatient setting presents many challenges for both clients and practitioners. The amount of services covered by insurance is often inadequate and there are many environmental factors that make eating, exercise and body image a daily struggle. Though clients who are appropriate for this more minimalistic level of care are less acutely sick, patching together adequate support for them is often difficult. For those of us committed to working with eating disorders in this less-than-ideal outpatient setting, recognizing when we need support ourselves and being good models of self-care for our clients is essential. I am grateful for my new colleague and friend in this work and look forward to what we can offer our community as a team.

“The Jungle Effect” as Antidote to Fad Diets

Posted on February 14, 2014 by gliffen

Many of you have heard me rant about various fad diets. I lament how easily these temporary promises of a better, thinner, healthier version of ourselves take hold in our often anxious and preoccupied minds. I know humans innately crave a mix of new experiences (and foods) as well as the comfort of familiar routines (and foods), so I get why at least some of these fads are appealing. We know at some level we will never look like the celebrity du jour touting this fad as the secret to her success. We understand that no matter how much we long for simple solutions to our problems, it is unlikely the complex layers of our issues will be unraveled simply and with minimal effort.

Yet we can’t help ourselves. The power of our imagination is so great that we enter each new fad wide-eyed with possibility. Maybe this time we will lose weight, gain health and self-confidence, and all of the problems we think are tied to our weight and appearance will magically melt away.

I am reminded of my favorite nickname of a hockey teammate in Seattle – “Dream Crusher.” Though I understand very well the myriad reasons all of us are attracted to different fads at some point or another (this extends beyond fad diets for those who think this post doesn’t apply to you), I am here to crush that dream. There are no quick fixes to solve complex problems related to weight and health.

Lucky for you I am not particularly comfortable with the moniker “Dream Crusher,” as appealing as it is for a defensive partner on the ice in the context of a hockey game. I prefer to inspire hope and to support the process of change that leads my clients toward their goals and whatever it takes for them to live in harmony with their values. So I have put together a class called “The Jungle Effect” to appeal to your sense of adventure while honoring your need for comfort and the familiar.

“The Jungle Effect” is a phrase coined by integrative physician Daphne Miller. Miller observed several patients who experienced health problems when they transitioned away from their traditional way of eating and adopted the ways of our modern, industrialized society. One client in particular spent time in a traditional community in the jungle as a child and when she returned to this place for an extended visit years later, many health issues she developed as an adult resolved.

Intrigued by this idea that returning to a simpler way of eating and living could reclaim health, Miller explores five areas in the world where populations still follow a mainly traditional way of life, including eating habits, and enjoy an unusually low incidence of various chronic diseases and conditions that plague much of the developed world.

There are many aspects of Miller’s approach that appeal to me. First, she uses stories of real people to introduce us to these exotic places and to give us ideas about how we can integrate traditional ways into our modern lives.

Next, there is a lot of nutrition myth-busting that occurs throughout the book, especially related to our annoying tendency to reduce nutrition to specific nutrients as a guide to a “healthy diet.” While she does introduce information about components in foods that have powerful health benefits like the omega-3 fats found in fish, she presents a broader picture of nutritional benefits. Popular ideas such as simply eating “too many carbs” is a general problem vanish as we learn that the people of Copper Canyon, Mexico eat a traditional diet that is composed of roughly 80% carbohydrates and enjoy one of the lowest rates of diabetes in the world.

Perhaps the best part of the book for me though, is that Miller provides a picture of each culture that extends beyond what they eat. There is no doubt the “what” is important, yet through Miller’s presentation of cultures as diverse as Crete and Iceland we are encouraged to look beyond what is eaten and contemplate how food is produced, prepared and shared, along with many other aspects of daily life in these communities that benefit their health.

“The Jungle Effect,” and more specifically the idea of pursuing more traditional ways of eating, is the closest thing I think we will find to a “simple solution.” By definition a culture that continues its way of life, including eating habits, over centuries is going to have a more simple approach than our post-industrial modern society. The challenge then becomes reclaiming simplicity in a complex society, no small feat as many of you know.

Next week’s class through our local branch of Central Wyoming College is based on some of the important concepts from Miller’s book, complete with foods that represent these special places – Copper Canyon, Mexico, the islands of Crete and Okinawa, Cameroon, West Africa, and Iceland. We will explore some of the key concepts common to this diverse collection of cultures that contribute to good health and longevity. Best of all, we will embrace the excitement that comes with trying something new while uncovering the comfortable, familiar aspects of this simple approach that require no special talents beyond our own inner wisdom.

What Do You Mean “It’s Not About the Food?”

Posted on January 29, 2014 by gliffen

Next week I begin a new series of Beyond Broccoli classes called Food & You: Exploring Beyond the “What.” I am excited about this unique option for nutrition education and support for the many people in our community who struggle with food, weight, and body image, using a behavioral nutrition approach that recognizes in many cases – “it’s not about the food.”

Not long after I started Beyond Broccoli back in 2001 I remember thinking that so much of my formal training and education in nutrition focused on what to eat (or not eat) for a variety of outcomes, and yet the most important work I did with individual clients came down to something we spent relatively little time studying: behavior change.

I remember learning about the “Stages of Change” model that describes the process most people go through to make changes. I was fascinated by this process, though I had no idea at the time this would be some of the most important information to my practice with individual clients. It didn’t take long for me to realize that struggles with food, weight and body image add layers of complexity to changing habits. If I want my clients to be successful in making sustainable changes, together we need to explore well beyond the “what” of their eating habits. So I have devoted much time and energy over the past dozen years to learning more about this whole process.

I suspect some find this idea of a nutritionist not focusing on the “what” confusing. Aren’t nutritionists supposed to be the experts on what to eat (or not eat)? Isn’t that why we consult with them?

As a Registered Dietitian it is important that I know about Medical Nutrition Therapy, or how nutrients can prevent or manage disease and illness. Here in Jackson it also helps me to know about sports nutrition to help my clients optimize food as fuel. Educating clients about the links between food and mood is important for both long-term health and how they feel on a daily basis, often a much more compelling reason to make changes. So yes, what we eat, and don’t eat, is definitely important and a major focus of my ongoing work (and continuing education requirements).

I am also passionate about the need for nutrition education to go beyond just spewing information. I enjoy helping clients acquire tools and build skills to actually apply this information in the context of their individual life situations – or more simply, the “how” related to eating habits.

However, I now know that actually making changes often goes way beyond needing to change, wanting to change, and knowing what to do. I can put together the best meal plan ever for someone, based on all the current research and my clinical experience, but if she isn’t engaged in the process of making the plan and it doesn’t fit into her lifestyle, isn’t compatible with her life goals and values, or doesn’t take into account where she is in the readiness for change process, this “ideal plan” is likely to fail. This leads me to the real crux of changing habits – the “why.”

As I see it, my area of expertise is food and nutrition while my clients and patients are the experts on themselves, even if they are not conscious of this fact. They know why they want to change, or think they want to change, and more importantly what they are willing to do. Sometimes it takes a bit of effort to uncover the layers of “why” and sometimes for clients who struggle with food, weight and body image (which is many of my clients) this process works better with the with additional guidance and support from a skilled therapist using a team approach.

This idea of enlisting additional support for the often challenging process of changing habits is why a group situation can be really helpful. The “Food & You” classes are a way to apply some of what I do with individual clients in a group setting. I offer nutrition education and support using this behavioral nutrition approach rather than dictating “eat this” or “don’t eat that.” Together we explore the myriad factors that influence what we eat, as well as how, when, where, and why. Each class includes a different relaxation or mindfulness technique to get things started, creative and interactive class activities to spur discussion, and a host of ideas, tools and a chance to practice building skills that can help participants move forward in their journey toward a better relationship with food.

Beyond Broccoli Holiday Nutrition Tips:

Posted on December 10, 2013 by gliffen

Tired of the same old holiday nutrition tips that promote a focus on calories, fat grams, weight gain, and other negative consequences of dietary indiscretion, here are some ideas that fit more with the Beyond Broccoli nutrition philosophy and approach.

Be kind to yourself. This does not replace the giving to others we emphasize during the holiday season – compassion for others is linked to self-compassion. You cannot give what you don’t have and you take the best care of what you love. You do the best you can and that is enough.
Check in with why you are eating. The holiday season presents endless opportunities to graze mindlessly. Sometimes the simple question “what do I really need/want right now?” can stop or at least make you aware of eating for non-hunger reasons (emotions, environment, peer pressure).
Eat slowly and intentionally. Identify pleasing flavors and textures in the food you eat and give your brain the 20 minutes it needs to identify fullness. It helps to eat sitting down with minimal distractions (not an easy task for many of us!).
Notice how your body feels after you eat. This primitive instinct once let us know which foods (or amounts of food) caused digestive discomfort so we could avoid (or eat less of) the food the next time. Understanding which foods nourish our bodies best can empower us to make better choices.
Eat regularly throughout the day. When we go too long without eating we set ourselves up to overeat. This is basic biology – part of our hard-wired survival instincts, now mismatched with our abundant food supply. If you are going to a holiday dinner or party in the evening you can make healthier food choices during the day, but skipping meals and arriving at your special occasion ravenous is not a good idea.
Stay hydrated. Our need for fluid increases with many environmental extremes including hot, cold, dry and high altitude. Many of us are conscious about drinking more water when it’s hot but forget we need more when it’s cold and/or dry too. Soups and hot tea are great ways to increase fluid on cold days.
Strive to include joyful movement in your busy holiday schedule. Physical activity can take many forms – find ways to move that you enjoy and you are more likely to keep this as part of your holiday self-care regimen. Forcing yourself to squeeze in a gym session can create more stress than it relieves. Dance at holiday parties, acknowledge that holiday shopping and cleaning are opportunities to be active and “count” as physical activity.
Savor food you perceive as special treats. Choose your special treat foods, knowing that in our modern world most foods are available any time of year so identify the truly special foods for you. Notice that when you give yourself permission to eat and savor these foods you may “need” less of them to feel satisfied.
Shared meals provide benefits beyond physical nourishment. Food connects us as humans – we all must eat to live. There is research that supports many benefits of family meals. Taking time to share meals during the holiday season can help us feel grounded, connected to each other, and in charge of our lives vs. stressed out about how out-of-control this season can get.
Remember to breathe. Deep breathing has many benefits, especially related to stress resilience. Stress is an inevitable part of life and our ability to work through stressful moments or events is important for many reasons, including the ability to not use food as an antidote. Just 3 deep “belly breaths” can change the blood flow in your brain from your “fight or flight” response to your more “rational” thinking.

Category: Beyond Broccoli