Why I Have a Problem with the New Weight Loss App for Kids

Weight Watchers rebranded last year to “WW”, which was smart branding on their part because old school diets such as Jenny Craig or Nutrisystem are no longer as popular as they once were. Now, we are sold the idea that we can be better, more moral people not by “dieting” but by “eating clean” or “eating whole”, but we fail to see that these “lifestyles” are another version of a diet repackaged and tied up with a new, more green bow. 

What better way to attract us millennials, the lovers of environmentalism, yoga, & self-care, than by convincing us that drinking a green juice or eating an avocado toast, will bring us closer to enlightenment (or at least the “yoga body” that makes people think we look enlightened). And through this all, some company somewhere is making a lot of money. The diet industry was projected to be worth $70 billion in 2018 and that amount is only projected to keep rising with time. 

Speaking of companies looking to make money off our country’s obsession with weight loss, WW has created a new weight loss app for children, called Kurbo.

While I hate that adults have to struggle with diet culture, thinking about young kids being exposed to a weight loss app like Kurbo makes me very, very sad. 

As a therapist who specializes in eating disorders, I can tell you that I have been receiving more and more requests to see kids, ages 12 and under, who are struggling with eating disorders of their own. I have had the experience of visiting a treatment center and seeing a child, that could not have been more than 10 years old, sitting in the audience of my presentation. 

If you’re unfamiliar with eating disorder treatment, when a person  has an eating disorder that is appropriate for a residential or inpatient level of care, that means that person has to live at the facility 24/7. For a child, this means that they have to spend the night, every night, away from their parents, their siblings, their family pet, their favorite books and blanket and live instead with the other patients and staff at the treatment center. Of course, parents and families can visit, but when I think about how scared I was to even go to summer camp as a kid, I can only imagine how terrifying it must be for a young child to have to go to treatment. 

Do you know where most eating disorders start? They start with a diet. Not all dieters develop eating disorders, but for the people that might be genetically predisposed or predisposed via their environment, a simple diet can trigger the thought process that develops into an eating disorder. So why would we sign our children up for a weight loss app that introduces them to the thoughts and behaviors associated with eating disorders? Why would we pay $69 a month for our children to have online coaching to learn what foods are “good” and “bad”, or in Kurbo’s case “yellow”, “red” and “green”? 

I do not expect diet culture to go away any time soon. We can bet that our children will hear about which foods are “good” or “bad” even if we refrain from using that language in our own households. If we want our children to learn to have a healthy relationship with food, why not encourage them to learn instead about tuning into their bodies. We can help them figure out what types of foods make their bodies feel good, that give them energy to play and study and all that good stuff that comes with childhood. And most importantly, why not teach our children that they are loved regardless of what they look like and help them build the self-confidence they need to live in this image-focused world? I do not want another company to profit off our children feeling bad about themselves. 

To learn more about the controversy surrounding the Kurbo app, check out this article from Refinery29:https://www.refinery29.com/en-us/2019/08/240564/ww-weight-watchers-kids-diet-program-kurbo-controversy

To learn more about what to do if you are afraid your child is going to be fat, see this blog by eating disorder expert, Beth Mayer, LICSW: https://more-love.org/2017/02/24/for-parents-who-are-afraid-that-their-kid-is-going-to-be-fat-an-interview-with-beth-mayer/

A Poem on Body Image by Hollie Holden

Today I asked my body what she needed, 

Which is a big deal 

Considering my journey of 

Not Really Asking That Much. 

I thought she might need more water. 

Or protein. 

Or greens. 

Or yoga. 

Or supplements. 

Or movement. 

But as I stood in the shower

Reflecting on her stretch marks, 

Her roundness where I would like flatness, 

Her softness where I would like firmness,

All those conditioned wishes 

That form a bundle of Never-Quite-Right-Ness, 

She whispered very gently: 

Could you just love me like this?

~Written by Hollie Holden, 2016

ED's Promise of Control

“It's funny, in a human kind of way, how we can convince ourselves that we're in control at the very moment we are beginning to lose it.”

― William C. Moyers

Eating disorders promise control.

Can’t control your family dysfunction? You can control your weight instead.

Can’t keep your partner from leaving you? You can get your 18 year old body back.

Can’t prevent you and your loved ones from getting sick? You can “clean” up your eating.

At first, you do in fact feel in control, like you are putting your life in order. But who is really in control when you feel compelled to workout for hours a day, restrict your diet to the point of no longer being able to eat at a restaurant or always follow a dessert with a rush of punitive, hateful thoughts toward yourself?

When we are in the midst of an eating disorder, we feel as if we are in control. We are praised for our “will power” by outsiders but inside our brain is being controlled, not by us, but by the disorder itself, ED. ED has the power to  completely consume our life until everything we once enjoyed feels distant and gray and only ED feels important.

It may seem foreign at first to believe that you are in fact not your eating disorder and that it is possible to reconnect to you, the true healthy you. However, with the proper support, you can begin to develop an awareness of which of your thoughts and behaviors are driven by ED. You can begin to understand how these thoughts and behaviors have helped you cope. With that understanding, you can distance yourself from ED’s voice. You will then have the space to start making your own choices - choices of recovery, not the eating disorder’s choices. Instead of reacting and acting upon every demand of the eating disorder (“You must get to the gym; You must not eat carbs; You must not gain weight.”) you can begin to take back control from the eating disorder by making choices in line with your true values.  Values like being a good friend, being kind (to yourself and others), being honest, etc. When you have the ability to make your own choices, it will then be you who is control of your life, not ED.

Tips for Talking to your Doctor about their Weight Stigma and your Eating Disorder

I often hear from clients that they are afraid to go to the doctor’s office. I don’t blame them when I hear their stories: The doctor told them they were eligible for gastric bypass surgery (even though they had not asked about it and have an active eating disorder); They had a heart rate in the low 40’s and the doctor told them they were perfectly healthy (even though they had a BMI of 17 and an active eating disorder); They went to the doctor’s for a sinus infection and the doctor told them they need to lose weight. The list goes on…

However, it remains important to receive medical care. Although we wish the medical community understood more about eating disorders, we unfortunately have to learn to be our own best advocates until the medical community catches up.

Here are MEDA’s 5 tips for speaking to your doctor about their weight stigma and/or your eating disorder:

1. Don’t be intimidated: Remember, doctors are just people who have gone to medical school. Yes, they have spent years studying the human body, but that does not mean that they are perfect, all-knowing beings. Even though eating disorders have the highest mortality rate of any mental illness (Smink et al, 2012), a 2014 national survey found that out of 637 internal medicine, pediatric, family medicine, psychiatry, and child and adolescent psychiatry programs, 514 did not offer any scheduled or elective rotations for eating disorders (Mahr et al, 2015).

2.  Use your Voice: Doctors are often overbooked, overworked, and rushing to the next appointment. We all know the overwhelming feeling that comes from listening to your doctor rapidly firing off questions while simultaneously directing you to stick out your tongue, say “ahh”, take deep breaths, cough three times, undress, redress, on and on. It may seem impolite to interrupt this process to ask your own questions, but you deserve to be heard, especially when it comes to your health. Speak up and express your questions and concerns about your care and your body until you feel satisfied with the information you have received. It is not your fault that you have an eating disorder. It is a serious mental illness that deserves appropriate care, and you may need to be very upfront with your doctors regarding your ED. Learning to use your voice is an important part of eating disorder recovery - think of it as an opportunity to practice.

3. Confidence is Key: It’s a natural response to respect a person of authority’s opinion, but you are the expert on yourself. If something doesn’t feel right, let the doctor know, including when you feel dismissed. For example, if not seeing your weight is helpful for your recovery, tell the doctor and medical staff directly. If they happen to let that information slip, bring it to their attention. If you feel like your doctor is dismissing your condition due to your body size or eating disorder diagnosis, tell them. Doctors take the Hippocratic oath to “do no harm”. It may be uncomfortable, but if their comment or behavior harmed you, you can let them know. By educating your doctor on how they made you feel, you may be saving another patient from a similar experience.

4. Come Prepared: Have you created a plan with your treatment team for how you will handle your doctor’s appointments? Have you done research of your own on a suspected condition? Bring this information with you. Write your questions and symptoms down in advance. Bring along a friend or loved one if you need support. When you are prepared, you will be less likely to panic and forget your questions. If you have literature to share with your doctor about eating disorders, weight stigma, or any other condition, share it with your doctor and express how important it is to you that they consider the information. They may not have had a chance to learn about these topics in their medical training.

5. Connect them to MEDA: MEDA offers free trainings to the medical community on eating disorders and weight stigma. If you feel like your doctor could benefit from a training, connect them to MEDA at education@medainc.org or at 617-558-1881.

Resources to bring to your doctor’s office on eating disorders and weight stigma:

• MEDA Print out for Doctors: https://www.medainc.org/wp-content/uploads/2018/05/MEDA_doctors_print_8.5-x-11-flat-PROD_11.2.17.pdf

• Ragen Chastain’s Health At Every Size Cards (these are awesome): https://danceswithfat.wordpress.com/2013/04/01/what-to-say-at-the-doctors-office/

• 9 Truth’s about Eating Disorders: https://www.medainc.org/wp-content/uploads/2018/03/Nine-Truths-about-Eating-Disorders.pdf

Citations:

Mahr, F. , Farahmand, P. , Bixler, E. O., Domen, R. E., Moser, E. M., Nadeem, T. , Levine, R. L. and Halmi, K. A. (2015), A national survey of eating disorder training. Int. J. Eat. Disord., 48: 443-445. doi:10.1002/eat.22335

Smink, F. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports,14(4), 406-414.

This blog was originally published at https://www.medainc.org/tips-talking-doctor-weight-stigma-eating-disorder/ and is republished here with permission.

Sugar addiction - is it real or not?

MEDA recently held an exhibit at a local high school’s annual wellness fair. A woman approached our table and expressed concern that we were giving out lollipops. She thought it was wrong for us to be giving out an addictive substance (sugar) to high schoolers, especially when MEDA promotes recovery from eating disorders.

So the question is – is giving out sugar to high schoolers akin to giving them recreational drugs? Is sugar, specifically, an addictive substance?

To answer this question, we first have to define addiction. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, no longer utilizes the term “addiction”. Instead, the DSM 5 outlines Substance Use Disorders – Mild, Moderate, and Severe for each class of substance (Note, food and sugar are not on the list of addictive substances). Substance Use Disorders are defined as:

“…when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.” (SAMHSA, 2015)

Therefore one way in which we can define a problematic substance use disorder is the way in which the substance is affecting our daily functioning.

I can say that I have worked with clients struggling with binge eating disorder (BED) or bulimia whose binge-food of choice involves a heavy dose of sugar. Rightfully so, these clients feel their behaviors involving sugary foods are getting in the way of their everyday lives. However, I have also worked with clients who binge on vegetables and report a similar experience. Furthermore, I have worked with many clients struggling with all types of eating disorders whose fear of sugar, flour, or wheat negatively affects their daily functioning. The restriction of sugar further limits the foods they can eat and often the social interactions they can participate in (hello, birthday cake!). Unfortunately, mainstream media and diet culture propagate the idea that sugar is the new gateway drug to complete loss of control with food.

So is it the sugar or our relationship to sugar that is addictive?

In a study published in Neuroscience and Biobehavioral Reviews (2008), “Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake”, researchers hypothesized that sugar has the potential to be an addictive substance. The study found that “Based on the observed behavioral and neurochemical similarities between the effects of intermittent sugar access and drugs of abuse, we suggest that sugar, as common as it is, nonetheless meets the criteria for a substance of abuse and may be ‘addictive’ for some individuals when consumed in a ‘binge-like’ manner.” (Avena, N. M., Rada, P., & Hoebel, B. G., 2008).   This study, conducted on rats, involved depriving the rats of food for 12 hours at a time and then giving them access to a sugar solution. When finally given access to sugar, the rats would binge.  I hypothesize that the rats would probably binge on any edible object after being deprived of nutrients for 12 hours. The study by Avena et. al. also admitted that it was not able to conclude whether or not a rat would endure pain or face physical obstacles in order to continue to self-administer sugar as rats have done in previous studies involving cocaine (Deroche-Gamonet et al., 2004).

Another study published in Clinical Nutrition, “The plausibility of sugar addiction and its role in obesity and eating disorders” concluded that “there is no support from the human literature for the hypothesis that sucrose may be physically addictive or that addiction to sugar play a role in eating disorders” (Benton, 2010). Based on these studies, the research indicates that there is no evidence to support that sugar is physically addictive in humans. There is research that indicates sugar may be addictive for rats only when consumed in a binge-like manner (Avena et al, 2008), which further implies that it could be the binge behavior, not necessarily the substance, that is addictive.

Although I am not a researcher nor have I done an extensive review of all the literature on sugar addiction,  I can speak anecdotally from the experiences my clients have shared with me. What I hear time and again from clients is that their eating disorder is “about the food but not about the food”. The eating disorder is about the feeling or lack thereof that comes from engaging in an eating disorder behavior: the numbness, the distraction, the dissociation, the comfort.  So often it is not the sugar or the actual food (although, let’s be real, sugary, starchy foods often taste better than other foods) that feels impossible to let go of, it is the cycle of bingeing and restricting/purging that acts like a whirlpool.

After all, a binge can be a maladaptive form of self-care: the only time my client has to be alone; the only time my client chooses what they want to do, not what someone else tells them to do; the only time my client feels grounded.  When food has been your primary coping mechanism for years, of course it is hard to let go of that dysfunctional relationship. The point is, the behavior is addictive, not the sugar. 

We need food to survive. Food gives us energy, pleasure, and something to bond over. I hypothesize that if we did not demonize the way in which food can alter the human form to be outside our society’s current acceptable body size, and if we did not label foods as good or bad (resulting in people feeling morally good or bad based on their food choices), we would be able to have a much more balanced relationship with sugar and food in general.

Everyone wants the forbidden fruit when we are told it is forbidden. When we are told we can’t have sugar, we want it even more. For some people, restricting a certain food group could be helpful in their recovery, and I am in full support of people finding what works for them in eating disorder or addiction recovery. However, I have also seen the nasty underbelly of what happens when someone “falls of the wagon” and starts to eat sugar, flour or wheat again after a period of restriction = shame, embarrassment, guilt and feeling like a failure. This pattern is the same binge-restrict cycle that clients have struggled with in the past but stretched over a longer period of time.

The alternative philosophy we support at MEDA is that “all foods fit” and that the foods you eat have nothing to do with your moral worth. We find that when people can step outside the black and white thinking that diet culture prescribes, previous binge-foods no longer seem like forbidden fruit. Clients can then begin to take steps toward listening to their body and eating intuitively, which might mean having a lollipop and might mean having a salad. Healthy eating is flexible eating.

Citations:

Avena, N. M., Rada, P., & Hoebel, B. G. (2008). Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 32(1), 20–39. http://doi.org/10.1016/j.neubiorev.2007.04.019

Benton, D. (2010). The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical Nutrition, 29(3), 288-303. https://pdfs.semanticscholar.org/6bd7/13a6a6d028a4471cbef1c75597f1379dc6c8.pdf

Deroche-Gamonet V, Belin D, Piazza PV. Evidence for addiction-like behavior in the rat. Science.2004;305:1014-1017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235907/#R55

This blog was originally published at https://www.medainc.org/sugar-addiction-is-it-real-or-not/ and is republished here with permission.

4 Tips for Making it Through the Holidays Binge-Free

For many, Halloween means dressing up in a silly costume, taking the kids in your life trick-or-treating, and marathon watching Stranger Things and for most, Halloween involves in some way, shape, or form a big bowl of candy.

For people struggling with Binge Eating Disorder (BED), Halloween can mark the start of a 2-month long holiday obstacle course with a finish line of January 2nd: navigating an alternate path past the CVS candy aisle, trudging through family and work holiday get-togethers, hurdling over Thanksgiving, Christmas, & New Years with a final face-off against the January 1st“New Year, New you!” weight-loss ads.

This obstacle course takes a heck of a lot of endurance especially if all the while you’re trying to steadily hold your progress in BED recovery like your own Olympic torch – never to be dropped, never to be extinguished, and held high with pride. Don’t be surprised if your metaphorical arm gets tired…It’s not easy to run with a fiery torch in your hand!

All jokes aside, here are some tips for maintaining your progress in BED recovery through the holiday season (You CAN do this!):

• Meet yourself where you’re at: You might be at a place in your recovery where you can attend all of the holiday functions and benefit from exposing yourself to former binge-foods while remaining binge-free. You may also be at a point in your recovery where being surrounded by holiday delicacies is not manageable for you. Be honest with yourself: do you need to avoid the candy aisle? Do you need to set a limit for how long you can stay at your work’s Christmas lunch? Either way – It’s OKAY!

• Practice Self-Compassion: Yes, every time I say “Self-Compassion” in my BED support group, I hear a resounding group sigh. I get it! Self-Compassion is NOT easy, but is the cure to shame and self-judgement. If you slip-up and have a binge (or 2 or 3 or 10), instead of beating yourself up, talk to yourself as if you were a dear friend: “It’s okay. Don’t worry about it. This isn’t worth beating yourself up over. You are a good person. The food you eat has nothing to do with your self-worth. You are worthy, and valuable, and gosh darn-it people like you!” Remember, you are SO much more than your eating disorder.

• HALT: Are you Hungry? Angry? Lonely? Tired? If it’s the holidays, you can probably say yes to all of these questions. Make sure you take a moment to “HALT” when feeling vulnerable to a binge:

  • Hungry? Eat a nutrient-dense snack like a fruit/veggie/or protein. If you’re still hungry, eat another. Wait 10 minutes, and ask yourself if you’re “belly hungry” again (Thank you to the group member who taught me that helpful phrase).

  • Angry? Turn the music up loud in your car and sing at the top of your lungs. Punch a pillow. Do 15 jumping jacks. Yell! Dance like crazy to “Monster Mash”. Release your anger in a way that does not involve pushing your anger down with food.

  • Lonely? Reach out for support. Text a friend. Facetime a family member. Call your therapist. Pet your dog. It’s a lot easier to successfully make it to the end of the holiday season with someone by your side to cheer you on.

  • Tired? REST! Yes, there are presents to wrap, greeting cards to send, and financial reports due by the end of the year, but you will not be able to complete these tasks and maintain your recovery unless you are taking time to rest. Your body and mind can only handle so much without time to reenergize.

• Do Self-Care: When you’re taking care of yourself and feeling good, you are less vulnerable to bingeing or utilizing other self-harming behaviors. Make time and space for YOU this holiday season. Eat regularly throughout the day. Buy yourself a Christmas gift that brings you joy. Take yourself to a gentle yoga class. Make yourself a cup of warm apple cider. Nap by the fire. Walk through the fallen leaves. You deserve it.

And finally, remember that “normal” eating is flexible eating. You are not a good person for eating brussel sprouts, and you are not a bad person for eating pumpkin pie. All foods fit. It is normal to occasionally overeat, and if you do overeat, it does not mean that you need to punish yourself with restriction the next day. Eat breakfast like you normally would and continue holding your eating disorder recovery torch high.

This blog was originally published at https://www.medainc.org/4-tips-for-making-it-through-the-holidays-binge-free/ and is republished here with permission.