Wednesday, October 22, 2014

Weight Stigma and Binge Eating: What's the Connection?

My article appeared originally on Recovery Brands Pro Corner site.
Karina, a 42-year-old obese woman, put off her annual doctor’s appointment again. The reason for her reluctance? Karina fears her doctor’s judgments and admonitions about her weight. Several years back, her doctor read her the riot act about her weight and since that visit, Karina’s weight has climbed even more.
Karina is not alone. Research indicates that higher weight individuals report experiencing weight stigma and negative stereotypes across a variety of situations and at the hands of family members, friends, doctors, bosses, teachers, and often, strangers.
Last month marked the second annual Weight Stigma Awareness Week. The annual event, hosted by the Binge Eating Disorder Association (BEDA), seeks to raise awareness around weight bias and offers tools for addressing weight discrimination in various settings, including schools and doctors offices. This year’s event was replete with contributions from diverse voices in the weight stigma community, and their messages trended powerfully online.
According to BEDA, biased behaviors include “bullying, hate-speech, and exclusions that limit the ability of a person to gain employment, healthcare, and education.”
BEDA defines weight bias as “judgment or stereotyping based on one’s weight, shape and/or size.” According to BEDA, biased behaviors include “bullying, hate-speech, and exclusions that limit the ability of a person to gain employment, healthcare, and education.” Weight bias is an unfortunate byproduct suffered by many who struggle with binge eating disorder (BED). BED, now a standalone DSM-5 disorder, affects approximately 2 percent of menand 3.5 percent of women. The majority of those with BED are overweight or obese.
Unlike their counterparts who struggle with bulimia nervosa, those with BED do not engage in any compensatory behaviors following binge episodes, such as vomiting, over-exercising, or restricting their intake. The result, for many, is weight gain over time. The DSM-5 notes that BED is more common in individuals pursuing weight-loss treatment than in the general public (APA, 2013).
The experience of weight stigma can contribute to the ongoing presentation of the BED. As with any psychiatric disorder, symptoms can intensify during times of emotional and situational stress. Encountering discriminatory and prejudicial comments, gazes, and practices can contribute to the emotional unrest that triggers a binge episode. So, while the public may criticize those at higher weights in an attempt to bully them into smaller sizes, these efforts often backfire. One study of 2,400 overweight and obese adults found that 79 percent responded to weight bias by eating more.
And thus the cycle continues…
The media presents significant information about the health consequences of being overweight. What it fails to do, though, is parse out the impact that weight discrimination has on patients’ physical health. In addition to increasing binge eating, weight bias can cause negative health outcomes through various pathways. First, higher-weight individuals may avoid doctor appointments due to fear of disrespect from their healthcare providers or shame around being weighed. Large bodies may not be adequately accommodated with respect to certain medical equipment, such as blood pressure cuffs, exam tables, and CT/MRI scans.
Additionally, research has shown that the experience of weight stigma is correlated with reduced exercise motivation, resulting in decreased fitness as a function of stigma and body dissatisfaction. Finally, experiencing stigma and prejudice can result in a chronic, elevated stress response, negatively impacting physical and mental health.
…research has shown that the experience of weight stigma is correlated with reduced exercise motivation, resulting in decreased fitness…
Weight bias can also impact those who don’t meet full criteria for BED. Many individuals, fearing judgments and bias around weight, have internalized their own weight stigma. They are preoccupied with their bodies and may engage in disordered eating in an attempt to manage their weight. Some may fall prey to the diet-binge cycle, in which they attempt to lose weight by dieting, only to gain it back by compensatory overeating. They may be searching for the latest fix – low-carb, gluten-free, low-fat, cleanses, juicing – whatever they believe might help them to control their weight. Some develop problems with compulsive exercise. Many others spend the majority of their lives with the nagging feeling that their bodies simply aren’t right.
So, what can you do to fight weight bias?
  • Adopt a Heath at Every Size® (HAES) approach, focusing on health, rather than weight. Learn to eat and exercise intuitively and to respect your body’s natural size – along with body diversity in the community.

  • If you struggle with BED, get help that allows you to address the behavioral aspects of the disorder without condemning you for your weight. Choose your providers carefully, as even health providers can be weight-biased. Ensure they, too, are proficient in the principles of HAES.

  • Become an activist, even if you aren’t heavy. As Isabel Foxen Duke writes, “When we fight for ‘fat acceptance,’ we fight for our sanity around food and weight, regardless of whether or not we ‘qualify’ as ‘fat.’”
You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Wednesday, October 15, 2014

Practicing Self-Compassion with Jenni Schaefer

Thanks to Jenni Schaefer, who recently featured an excerpt from my book on her blog!

Jenni recently celebrated the tenth anniversary of Life Without Ed, so be sure to check out her book's new edition and to congratulate her when you stop by her site.

Like the excerpt? Read more! You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Wednesday, October 08, 2014

How to Parent Healthy Body Image and Why it Matters

Check out my recent article on parenting and body image on recovery.org.

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com


Wednesday, October 01, 2014

How Much Do We Know About Purging Disorder?

I'm posting this on behalf of K. Jean Forney, a graduate student who studies eating disorders at Florida State University. She's researching purging disorder and looking for support for her project.

The Diverse Presentations of Eating Disorders

K. Jean Forney, M.S.

Typically, when people hear “eating disorder,” they think of anorexia nervosa, the eating disorder characterized by low weight. People sometimes think of bulimia nervosa, which is characterized by binge eating (eating a large amount of food while feeling out of control) and compensatory behaviors, like self-induced vomiting or intense exercise. Awareness is growing about binge eating disorder, the eating disorder characterized by recurrent binge eating without any sort of compensatory behavior.

It turns out a significant portion of people with eating disorders don’t meet criteria for these disorders, but still have clinically significant eating disorders. These clinically significant eating disorders cause distress, impairment, and medical complications. These individuals typically fall into the “eating disorder not otherwise specified” or “Other specified feeding or eating disorder” group. This is problematic, because that group is pretty heterogeneous. Some of those people engage in binge eating, some people eat most of their food at night, others only exercise excessively but aren’t underweight or binge eating. Because it’s heterogeneous, it’s hard to generalize any research findings on this “other specified” group. Things that are true of someone who excessively exercises without binge eating probably aren’t true of people who eat most of their food at night. Without naming and separating these conditions, it’s hard to study and develop treatments, because they are too diverse.

Another member of this “other specified” group is purging disorder. Purging disorder is characterized by purging behaviors, such as self-induced vomiting or laxative abuse, in people who do not experience binge-eating episodes. Estimates range from .5% to about 5% of women experience purging disorder in their lifetime, and there are few estimates available for men. The research available right now suggests that individuals with purging disorder have a higher mortality rate than the general population. It’s a serious condition to have.

Problematically, because purging disorder isn’t a “full” diagnosis like anorexia nervosa or binge eating disorder, no one has studied treatments for it. We are starting to collect evidence about how purging disorder is different from other disorders, but we need to know more about the prognosis and course of the illness, and factors that influence prognosis, in order to better develop treatments.

That’s why I am raising funds to study the long-term outcome of purging disorder and to compare it to the outcome of bulimia nervosa. I will identify what factors (attitudes about shape and weight, feeling out of control while eating, and hormones related to eating) predict outcome, providing clues as to where we can intervene. Please consider taking a moment to share my project and consider donating.

https://experiment.com/projects/long-term-outcome-of-women-with-purging-disorder


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com





Wednesday, September 24, 2014

The Innateness of Movement


I've been spending a lot of time with kids and babies these days, and one thing I've noticed is that little people love to move. Babies and toddlers like to wiggle and jump. Grade-school kids love to tumble and climb. They dance and scoot and swim and ride bikes. Left unattended, kids will naturally choose movement over stagnation on many occasions throughout the day. In fact, they'll voluntarily run down the sidewalk if you let them. But most adults won't.

Many adults don't like to move. We view exercise (even the word sounds challenging) as a chore. We set up contingencies around movement that render it a chore.

Can you return to your innate love of movement? To the baby who jumped from the door frame for 30 minutes because he could, to the little girl who bopped in her bedroom to her favorite songs because why wouldn't she dance, to the boy who chased his buddies down during a hearty game of tag?

If movement isn't this natural, this inspiring to you, then find another way. Moving our bodies should be invigorating, not depleting, and can uniquely connect us to the earth and our most innervated selves. Make fitness fun.


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com


Wednesday, September 10, 2014

Bad Research

In May, The New York Times posted an article about a research study that found that it's possible to lose 11 pounds in four days. I'm disappointed in The Times for featuring this study, and if you're a budding researcher or at all interested in debunking weight-loss myths, follow along with me as to why.

First, the study consisted of 15 participants, an embarrassingly low sample size. Let's just say we can overlook that fact for a second. The article reports that the participants were "healthy but overweight Swedish men." Ask yourself: "Am I a healthy but overweight Swedish man?" If not, the sample doesn't represent you.

You'll also notice that the sample doesn't represent women, Swedish men of different health- and weight- statuses, non-Swedish men - you get the picture. It's a homogenous sample, and that's not the goal of good research.

Next, let's take a look at the experimental condition (note: there was just one condition and not a control group, further decreasing research validity). During the study, participants ate about 360 calories a day and exercised for almost nine hours. Like The Biggest Loser on steroids. . . When we think of research, we like to choose conditions that can be replicated in the real world, to increase the study's internal validity. How likely is it that most people could drop down to such a caloric deficit and exercise for so many hours in their "real lives?" If not, then the results we see could somehow be an artifact of the experimental conditions.

Finally, let's talk about the conditions themselves. To repeat, these men consumed approximately 360 calories a day and exercised for almost nine hours. This sounds more disordered than some of the most serious eating disorders I've encountered. Will these men go on to develop a disordered relationship with food or exercise? Who knows? But, I'm not sure where we draw the line with ethical research and what type of research review board approved this study's intervention. I could argue that infecting research participants with some sort of food poisoning could also result in such rapid and significant weight-loss, but that would obviously be unhealthy. But would it be any more unhealthy than what these researchers prescribed?

And if we're to generalize from this research and start prescribing a few days of extreme caloric restriction and over-exercise to treat those who are overweight, do we want to run the risk of some patients going on to develop disordered eating? Did the researchers look at the participants' attitudes toward food and weight as a result of the intervention? I'm reminded of the Minnesota Starvation Experiment. What happens after a year? Is weight loss really the ultimate goal?


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com


Wednesday, September 03, 2014

Body Commodity

When did your body become anything other than a carrier for you?

When did your body become something to. . .

-think about

-judge

-criticize

-dissect

-change

-punish

-abuse

When did your body become some thing?

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com