Giving Thanks During Thanksgiving

It’s that time of year again – soon many will be gathered around a decorative table to celebrate a holiday that includes festivities, family traditions and traditional feasts. Thanksgiving can be more than just a gathering with your loved ones drinking apple cider and eating delicious foods; it can also be a time to express gratitude and cherish memories. The celebration of Thanksgiving can have multiple meanings and purposes for each individual. Similarly, it may not be a positive experience for everyone and can be triggering for some individuals. It’s important to try not lose sight of the meaning of Thanksgiving as well as making your comfort a priority by keeping your glass full.1 This blog post will work to build a plan of action to ensure this Thanksgiving will be a holiday to remember filled with laughs, love, warm beverages and tasty food.

First and foremost, take a moment to reflect on gratitude and memories.2 What are you grateful for? What does Thanksgiving mean to you? Is there a family tradition that you are looking forward to?2 Who would you like to give thanks to? Is there a person in your life that helped you become the person you are today? What is the most beautiful thing that you saw today? Can you recall a memory or a moment that triggers you to smile to this day? When we really take time to reflect on gratitude, we acknowledge self-development, growth and strength.2

Holiday celebrations can be a chance to practice some of your positive coping skills. Going into this holiday, some individuals may be triggered by their eating disorder (ED), past memories, food thoughts, table talk, social media posts and/or diet culture.1 Individuals who have an ED or are working towards their journey to recovery may face challenging yet common feelings of fear and anxiety. Having a plan in place can help to reduce anxiety and help you to enjoy this holiday.2

Let’s Explore our Coping Skills

Support. Choose a loved one to help support you throughout this holiday celebration.3 Talk to them about your emotions and fears that you are experiencing leading up to the meal so that you won’t feel alone at the table.2 This can be the person that you can lean on if you feel anxious during the holiday. Don’t be afraid to invite them aside, get a breath of fresh air and let them walk you through your coping exercises.3 If you feel uncomfortable with making your plate, let them serve you to reduce the anxiety that may manifest.

Eat as you normally would. Just because this holiday has a great emphasis on “food” doesn’t mean that you should change your intake leading up to the celebratory meal.2 In ED recovery, it’s important to continue with mechanical eating in order to heal and receive the appropriate energy and nutrients that meet your needs.2 Try to avoid skipping a meal and/or shifting your food choices and portion sizes that you consume leading up to this meal.2 Doing so can often trigger negative thoughts and possible binge-like behaviours later on in the day.2

Step away from social media. Media can often be detrimental to those susceptible to diet culture (read: all of us!).2 Don’t pay attention to titles like “Staying on Track Over the Holidays” or “Avoiding Thanksgiving Weight Gain” that often promote fat shaming and restriction. It may be helpful to stay off social media for a few days leading up to the holiday to prevent evoking a negative state of mind and negative food relationships.2 Instead, spend some time journaling and prioritizing self-care.

Use positive talk. It’s very important to consider the language that we use around others.2 Whether it’s you or someone else, words and topics of conversations can be very triggering. Refrain from using the words “diet”, “calories”, “weight loss”, “body image” and “healthy/unhealthy food”. Further, ask others to do the same! If fat shaming or food rules becomes a topic of conversation, excuse yourself and help serve or assist in the kitchen.2

It’s normal to feel slightly uncomfortable and full after a big meal. Try remember not to associate this feeling with guilt or shame. Instead, settle down on the couch with your favourite warm beverage and enjoy the comfort and quality time with your loved ones. Give thanks for how far you’ve come so far and for the journey ahead of you. Happy Thanksgiving!


References

  1. Five Ways To Help Your Loved One Through Thanksgiving Dinner. In Walden Eating Disorders. Retrieved from https://www.waldeneatingdisorders.com/5-ways-to-help-your-loved-one-during-the-thanksgiving-meal/
  2. ED Recovery: Tips Too Enjoy Thanksgiving Dinner. In Recovery Warriors. Retrieved from https://www.recoverywarriors.com/eating-disorder-recovery-tips-to-enjoy-thanksgiving/
  3. Tips for Surviving Thanksgiving in Recovery. In National Eating Disorders. Retrieved from https://www.nationaleatingdisorders.org/blog/tips-surviving-thanksgiving-recovery

Animal-Assisted Therapy

Animal-assisted therapy can be used as a complementary practice in eating disorder recovery, providing a sense of calm and comfort in healthcare appointments. Animal-assisted therapy often involves a dog, cat, horse, or another animal, and is usually used in addition to other practices along the recovery journey. Animals show love and affection unconditionally , providing comfort and support that is readily accepted and trusted1. Having positive emotions associated with the animal can steer clients away from any negative thoughts that we may be having, as it is challenging to focus on both the positive and the negative ones at the same time. Additionally, the animal can act as a buffer during uncomfortable conversations, making it easier for clients to open up, and to cope with certain feelings1. It helps bring forth feelings of trust while providing a distraction, lessensingthe burden of a serious conversation and helping clients to feel more comfortable. Animals can provide a warm, comforting feeling that one doesn’t’ necessarily get from speaking with a healthcare professional alone.

These feelings of trust, love, feeling calm, and positive emotions are beneficial in the recovery process. Clients can sometimes feel reserved or guarded, and an animal helps them to feel more at ease. Often the presence of an eating disorder can lead to a negative impact on one’s relationships with others as loved ones tend to be shut out. With the addition of animal-assisted therapy, clients can start to experience those feelings of love, acceptance, affection, and support again, which can potentially have a positive impact on healing other relationships in their lives. Petting a dog while talking to a healthcare team member can help clients to feel more protected and less stressed or overwhelmed. It also gives clients something to look forward to that brings them joy and adds fun to an otherwise potentially stressful situation or uncomfortable task, helping to motivate them to continue attending sessions. 

Just as petting a dog can be a positive distraction during a conversation, it can also be beneficial after a meal to distract clients from eating disorder behaviours or feelings. A therapy dog can help to keep clients in the present moment and help them to step away from restrictive thoughts that may be going through their minds1. Animals do not hold a false sense of what beauty should look like, and are a great reminder that everyone is deserving of love and compassion. Having therapy animals around to help support clients is a beautiful addition to the many aspects of recovery and brings forth many positive benefits for one’s emotional well-being. 

Longbottom, our therapy dog-in-training, accompanies our Lead Dietitian Jillian in all her sessions with clients. In November, Longbottom will be evaluated and officially become certified as a therapy dog! Until then, Longbottom stays close to Jillian and gives everyone a high five on their way out of the office (as seen in the photo).


References

  1. Patricia Flaherty Fischette (2017). Animal-assisted therapy (AAT) as an adjunctive treatment for eating disorders: exploration of AAT through the lens of attachment and affection regulation. Retrieved from: https://search-proquest-com.proxy1.lib.uwo.ca/psycinfo/docview/1957279631/477AF25A9BE04DC9PQ/1?accountid=15115

Relapse Prevention

Recovering from an eating disorder is a huge achievement, but it often involves a few setbacks along the way. Relapse occurs when an individual who has recovered from an eating disorder reverts back to some of their old disordered cognitions and behaviours, such as negative thoughts about food or their body. Relapses are completely normal, but there are some things a person can do to prevent them or make them less destructive to their overall recovery. This blog post discuses common signs of a relapse as well as some prevention strategies that can help facilitate a smoother recovery.

It is important to be able to recognize a relapse budding in order to make use of some of the strategies below. Some possible warnings signs are: frequent weigh checks, skipping meals, avoiding certain foods, an increase in exercise, looking in the mirror often, social isolation, wearing loose-fitting clothes, difficulty coping with stress, avoiding situations that involve food, desiring more control, and/or striving to be perfect.

Strategy 1: Develop a Strong Support System: Find people who support you and encourage your recovery in a way that makes you feel comfortable. These people can be professionals, family members, or friends. Once you find a good support system, be sure to use it when you need to. Reaching out for the very first time may be difficult, but it will get easier. Remember that these people want to help you! It may also be helpful to generate a contact list that includes everyone on your support system so that if you feel yourself slipping, you can reach for the list and connect with someone. 

Strategy 2: Identify Your Triggers & Develop A Coping Plan: Identify all of the triggers that bring you negative emotions or thoughts and lead you towards your old disordered eating habits. Planning to avoid any of the triggers is not a realistic and sustainable plan. Instead, identify a coping mechanism that will work to combat each of the triggers. Some examples of coping mechanisms include: reaching out to your support system, finding a peer support group, using positive affirmations, or distracting yourself with an activity you enjoy. Making a list of coping mechanisms that you can quickly access when you feel triggered can also help keep you on track with your recovery. Most importantly, be honest with yourself if you feel any eating disorder symptoms returning as the faster you address them, the easier you will find your way back towards recovery.

Strategy 3: Identify & Reduce Negative Influences: A negative influence is anything that is not helpful to your recovery. It may bring about negative and unsupportive comments, thoughts, comparisons, or emotions. Some examples of potential negative influences are people, social media, television, certain websites, magazines, a scale, mirrors, old clothes, and certain social settings. If the negative influence is a loved one, try to talk to them about the situation. If the negative influence is electronic, get rid of it. It may be useful to unfollow accounts on social media that stir up negative emotions and replace them with inspirational and motivating accounts. In addition, stop watching shows or movies that are triggering; instead, replace them with entertainment that makes you smile and laugh. You are able to choose your surroundings to a certain extent. Take care of yourself and do what is right for you.

Strategy 4: Eat Regularly: When trying to prevent a relapse, it may be useful to develop a meal and snack plan that helps you to eat regularly. Sometimes, returning to mechanical eating is very helpful in relapse prevention and involves planning what you will eat and when you will eat it. Be sure to choose meals and snacks that you enjoy so that you can look forward to eating. Alternatively, In addition, it may be helpful to prepare some meals and snacks in advance incase life gets busy or you find yourself reverting back to old habits. 

Strategy 5: Do What Makes You Happy: It may be difficult to find the motivation and strength for recovery if one does not take care of themselves. It is helpful to engage in activities that promote physical and mental well-being. Try to fill your life with joy and happiness by spending more time with loved ones or participating in activities/clubs that you enjoy. It is also important make time for yourself to relax and unwind when you need it. This can mean taking a bath, painting your nails, putting on a face mask, getting a massage, meditating, doing yoga, listening to music, reading, writing, drawing, or anything else that brings you serenity. 

When recovering from an eating disorder and trying to prevent a relapse, believe in yourself and try to find your inner strength and courage. Recognize how far you have come already! Relapses may feel like a step in the wrong direction, but they can just be a minor slip if you are determined to find your way back towards recovery. Each relapse can teach you something new about your triggers and strengthen your coping skills. Recognize that your journey will not be perfect, but the slips along the way will guide you towards a full recovery. 


References

  1. Relapse Prevention. (2019). In Kelty eating disorders. Retrieved from: https://keltyeatingdisorders.ca/recovery/relapse-prevention/.

Pregnancy and Eating Disorders

Growing a baby and becoming a parent requires a lot of physical, psychological, and emotional strength. The journey before, during, and after pregnancy can be difficult at times, especially for individuals struggling with an eating disorder as pregnancy can magnify negative feelings towards one’s body and towards food. Other the other hand, pregnancy can also be a healing experience for some as it gives a woman responsibility for another life. Either way, becoming pregnant with an eating disorder may be associated with morecomplications for both mom and baby if mom’s body is not adequately prepared and nourished before, during and after pregnancy1.

During pregnancy, there are many important nutrition and energy requirements that must be met in order to grow a healthy baby and maintain mom’s wellbeing. Nutrition and energy requirements become greater at each trimester and they continue to be elevated up to one year post-birth, especially if mom is breastfeeding. In the first trimester, the most important nutrients that the baby needs for proper growth and development are adequate energy, folate, vitamin A, vitamin B6, and iron.2This is when the heart, brain, bones, and placenta are developing.1During this time, there are also several critical periods of development that require a sufficient amount of specific nutrients. If these needs are not met, the baby may miss an important developmental stage and the damage will be difficult to be reversed. An example of this is a baby born with an open neural tube due to insufficient folate intake. In the second and third trimesters, energy needs increase along with protein, carbohydrate, vitamin C, and vitamin D.2This is when the brain, nervous system, muscles, tissues, fat storage, and facial features are developing.2Mothers who breastfeed continue to have increased energy and nutrient requirements in order to maintain breastmilk quantity.

Weight gain during pregnancy is a natural biological process that signifies a healthy pregnancy. Individuals with eating disorders may find this weight gain distressing, however it is important to remember that maintaining a stable weight or losing weight during pregnancy can have detrimental effects on the fetus. Even people who have recovered from an eating disorder may feel triggered during pregnancy. It may be helpful to know that not all of this weight gain is due to increasing fat stores; a lot of it comes from the baby, breast tissue, increased blood volume, uterine muscles, fluid retention, the placenta, and amniotic fluid2. It is common for disordered eating behaviours to emerge after the baby is born.During this time, try to focus on the health and development of your baby, while keeping in mind that breastmilk quantity suffers with inadequate nourishment. Further, celebrate the amazing process of creating and nourishing a child with your strong and powerful body!

There are several potential health risks associated with pregnancy when a woman is living with with an eating disorder. Poor nourishment during pregnancy can cause a woman to experience malnutrition, dehydration, cardiac irregularities, premature birth, labour complications, difficult recovery, difficulties nursing, preeclampsia, increased risk for cesarean birth, and pre/post birth depression.3,4Mothers who do not gain adequate weight during pregnancy can also experience low blood pressure, weakness, fainting episodes, anemia, miscarriage, and/or a complicated delivery.2,5Binge-eating during pregnancy can cause high blood pressure and/or gestational diabetes.2Babies who do not receive adequate nutrition have an increased risk to be born with a low birth weight and have long-term developmental delays.2They can also experience feeding difficulties and respiratory distress.4However, it is possible to have a healthy pregnancy if proper treatment and care is taken prior to and during pregnancy. 

Women who struggle with an eating disorder during pregnancy may display some of the following symptoms: food restriction, little to no weight gain, extreme exercise, purging, chronic fatigue, headaches, dizziness, difficulty concentrating, social isolation, depression, and/or anxiety.4Please seek professional help if you or someone you know is experiencing some of these symptoms. Corrective action must be taken immediately to avoid negative consequences for the developing fetus and for the mom.

If you or someone you know is struggling with an eating disorder and wants to become pregnant, it is very important to see a doctor and a registered dietitian in order to properly prepare the body for pregnancy. Furthermore, being informed about all the expected body changes, possible complications, and common struggles associated with pregnancy is essential for adequate mental preparation. It is also imperative that mom finds a strong support system that can help her when times get tough. Strengthening the body, mind, and environment can help set a woman up for success. Most importantly, mom should try to embrace the natural changes that her body is programmed to go through in order to enjoy the experience and grow a healthy baby.


References

  1. Brown, E. J. (2016). Nutrition through the lifecycle: Boston, MA: Cengage Learning. 
  2. Fleming, K. (2018). Eating Disorders & Pregnancy. In Centre for Clinical Interventions. Retrieved from: https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Eating%20Disorders/Eating%20Disorders%20-%20Information%20Sheets/Eating%20Disorders%20Information%20Sheet%20-%2011%20-%20Eating%20Disorders%20and%20Pregnancy.pdf.
  3. Pregnancy and eating disorders. (2018). In National eating disorders. Retrieved from: https://www.nationaleatingdisorders.org/pregnancy-and-eating-disorders.
  4. Eating disorders and pregnancy. (2013). In Eating disorder hope.Retrieved from: https://www.eatingdisorderhope.com/treatment-for-eating-disorders/special-issues/pregnancy.
  5. Eating disorders & hormones. (2018). In Centre for clinical interventions. Retrieved from: https://www.cci.health.wa.gov.au/Resources/~/media E8EFAD2E7A224E708BDDA78998ABC8F0.ashx.

Prebiotics & Probiotics

Probiotics and prebiotics are growing in popularity as research is discovering their relationship with the microbiome and human health. The microbiome is a term used to describe the dynamic collection of microbes (eg. Bacteria) found in the human intestines. Many of these microbes have a symbiotic relationship with humans; this means that both species benefit from one another. For example, bacteria can produce vitamins, aid with digestion, and destroy disease-causing microorganisms.1However, harmful microbes also exist and may contribute to some health problems. The reason why probiotics and prebiotics are becoming popular is because they have been shown to support the growth of beneficial microorganisms in the intestines, which may in turn improve our digestion.

Prebiotics and probiotics work together to foster a healthy digestive system in the human body. Prebiotics are non-digestible parts of carbohydrate foods that feed beneficial microorganisms in the large intestines. Probiotics are live beneficial microorganisms that are also naturally present in the large intestine. You may be thinking, if they are naturally present, then why do people consume them? Probiotics are consumed because the microbiome is a dynamic system, meaning that different factors such as stress, certain foods/beverages (eg. alcohol), and some medications (eg. antibiotics) can decrease the presence of beneficial microbes. Probiotics simply help bring the microbiome back into balance. The positive effects of probiotics will vary between individuals and they will depend on the quantity eaten and the type of probiotic; however, more does not necessarily mean better.2It is still unknown how many probiotics are needed in order to reap any health benefits, however, it is suggested that they should be consumed regularly as part of a balanced diet for a long period of time to support the microbiome.2Although probiotics are safe for most individuals, they may cause gas, bloating, and diarrhea in some people.

Prebiotics and probiotics are naturally found in many foods. Some food sources of prebiotics include: garlic, leek, onion, psyllium husk, wheat bran, bananas, whole grains, tomatoes, and potatoes. Food sources of probiotics include: yogurt, cheese, kefir, and fermented vegetables such as sauerkraut. Foods such as juice, cereal, chocolate, and ice cream may also be fortified with probiotics.2It is important to read food labels to make sure that these foods contain live bacteria, otherwise the pasteurization process destroys them and they are not added back in. The types of probiotics that are often added to food products are Lactobacillusand Bifidobacterium.2  Both prebiotics and probiotics can also be found in a supplement form, but they are not necessary for good health and there is no guarantee that they are effective.2Consult a doctor or dietitian if you would like to take such supplements. 

Research shows that the consumption of probiotics may support the gastrointestinal tract. Probiotics may improve the symptoms of both irritable bowel syndrome and inflammatory bowel disease.2They may also help lessen diarrhea associated with antibiotic consumption.2Furthermore, probiotics may help some individuals with their lactose intolerance, but more research must be done to confirm this.2

Multiple direct and indirect pathways have been discovered between the gut and brain, which has led to a new phenomenon referred to as the gut-brain axis.3The gut-brain axis is a term used to acknowledge the relationship between the health of the intestinal microbiome and the health of the brain. For example, an unfavourable microbiome composition may be associated with anxiety and depression.3Therefore, it is suspected that probiotics may potentially benefit mental health as they can rebalance the microbiome by reducing the number harmful microbes and increasing the number of beneficial microbes.4The microbiome also appears to have an effect on immune function, behaviour, and stress response.3,4

More research is needed to fully understand all of the health benefits associated with consuming probiotics and to determine appropriate dosages but we can assume that probiotic-containing foods are safe for most people.2These foods also contain other micronutrients that are needed for good health. The bottom line is that it is not necessary to consume probiotics to be nourished, but they are not harmful in moderation and they may be even be helpful in certain situations. Here at change.creates.change, our dietitians often recommend a probiotic to help with the digestive issues that arise with the refeeding process!


References

  1. Hibberd, P., Duffy, L., & Shurtleff, D. (2018). Probiotics: in depth. In National centre for complementary and integrative health. Retrieved from: https://nccih.nih.gov/health/probiotics/introduction.htm.
  2. Dietitians of Canada. (2018). The Pros of Probiotics. In Unlockfood. Retrieved from: http://www.unlockfood.ca/en/Articles/Digestion/The-Pros-of-Probiotics.aspx.
  3. Rieder, R., Wisniewski, P. J., Alderman, B. L., & Campbell, S. C. (2017). Microbes and mental health: A review.Brain, Behavior, and Immunity, 66, 9-17. doi:10.1016/j.bbi.2017.01.016
  4. Dinan, T. G., Stilling, R. M., Stanton, C., & Cryan, J. F. (2015). Collective unconscious: How gut microbes shape human behavior.Journal of Psychiatric Research, 63, 1-9. doi:10.1016/j.jpsychires.2015.02.021

Am I Covered for RD Services?

Did you know that many employers cover (or partially cover) services by a Registered Dietitian through their employee health benefits plan or employee assistance program? Additionally, if your employer does not cover dietitian services, you are encouraged to request your employer to add them. Many health insurance companies have this option, but sometimes employers opt out of adding these services to your plan1. There are also government-funded services that may be available to you such as those through Family Health Teams, Community Health Centres, Diabetes Education Programs, Hospitals, and Long-Term Care Residences2. It’s always a good idea to find out what is available to you and explore your options. You may be able to get assistance through a variety of avenues that you weren’t previously aware of.

We looked into some common places of employment in the London area that offer a health benefits plan that includes coverage for Registered Dietitians. There is also coverage available to students. Firstly, we have Western University. Health coverage plans are different for both undergraduate students and graduate students, as well as for staff and faculty members3. This also includes Western’s affiliates. The undergraduate health benefit plan is through USC and covers 100% of costs for Registered Dietitian services up to a combined maximum for various health practitioners of $500 per student year4. There is also a convenient button to link to resources to find a local dietitian on the USC benefits webpage. For graduate students, their health benefits are through Society of Graduate Students (SOGS) and cover 80% of costs but have a maximum of $500 per year solely for dietitian services5. For staff and faculty members, we found that it varies by department, but we can imagine there would be reasonable coverage in these plans as well. You can check your specific coverage based on your department by visiting https://www.uwo.ca/hr/benefits/your_benefits/index.html. International students and employees have separate coverage through UHIP, and supplementary coverage can also be purchased6. We encourage looking into precisely what is covered in your specific plan, and what is available through supplemental health insurance as well. Contacting the university can shed some light on the particular options that are available.

We also found some excellent health plans that although the exact details are confidential, might have coverage as they seem to be competitive and sufficient. These include benefit plans through the Ontario Hospital Association (OHA), which has health insurance through Desjardins, the London Health Sciences Centre, which has an extended health care plan that includes counselling services and health and wellness programs, and the Ontario Secondary School Teacher’s Federation. We also found that the Elementary Teachers Federation of Ontario offers coverage for dietitian services7, and an accurate description of benefits for the Ontario Teachers Insurance Plan can be accessed by signing in to the member log in available online8.

Lastly, the Consulting Dietitians Network completed a poll in 2015 that gave insight to companies that they believed to their knowledge included dietitian services in their plans, and the following, among a few others, were included in the list9.

  • Banks – TD, CIBC, RBC
  • Canada Post
  • Global News
  • Loblaw Companies Limited
  • Sobeys
  • Telus

There are surely other employers out there in addition to the ones mentioned here that also offer this type of coverage. Of course, it is always best to view your particular health coverage plan through your school or employer for the most up to date information, but we hope that upon reading this we can help make more people aware that there are coverage options to be explored, and that there are resources available to them.


References

1. Dietitians of Canada (2018). Retrieved from: https://www.dietitians.ca/Your-Health/Find-A-Dietitian/Search-for-a-Dietitian.aspx

2. College of Dietitians Ontario. Retrieved from:https://www.collegeofdietitians.org/public/nutrition-services.aspx

3. Health and Wellness at Western University. Retrieved from: https://www.uwo.ca/health/shs/services/insurance.html

4. USC Student Benefits. Retrieved from:https://studentbenefits.ca/my-coverage

5. Society of Graduate Students. Retrieved from: https://sogs.ca/healthplan/

6. University Heath Insurance Plan. Retrieved from: http://uhip.ca/Enrollment/PlanDetails

7. ETFO Employee Life and Health Trust. (2018) Retrieved from: http://etfo-elhtbenefits.ca/wp-content/uploads/2018/12/ETFO-2018-19-BAAG-ENG-FINAL-1.pdf

8. Ontario Teachers Insurance Plan Login.  https://planmemberlogin.otip.com:4433/login/Account/Login

9. Dietitians of Canada (2017). Retrieved from: https://www.dietitians.ca/Downloads/Public/Case-for-Extended-health-care-coverage-f.aspx

To Exercise or Not To Exercise

When considering whether it’s a good idea to add or re-introduce exercise into the recovery process, it’s important to reflect on a variety of things. These include: a)what the motive is for wanting to exercise?, b) are we are in a physical state that can handle exercise?, and b) what our experience has been with it in the past? Is exercise something we have used previously as a way to compensate, burn calories, or avoid feelings, and if so, how does this relate to how we feel about it currently? What kind of exercise are we interested in trying?

Perhaps we view exercise as s a variety of methods of movement, all of which we enjoy doing, or maybe we long for structure and control and think we ‘have to’ exercise. Of course, being active can relate to wellness and an overall nurturing lifestyle, but it ultimately depends on our relationship with it. It can also be a hindrance to eating disorder recovery if we don’t recognize that exercise is sometimes used as a tool to compensate for something else1. Becoming more aware of how we feel about exercise and what drives us to want to participate in it can help us to discover whether it is something positive in our lives or whether it is something that is negatively affecting us. Our team here at change.creates.change created an algorithm as a starting point to guide you through the decision process.

Algorithm.png

Remember that this is just a guideline. In any case, it is important to discuss options with your healthcare team and decide together what is best for your individual needs. We might all need something different. Generally, it’s good to focus on movement that brings us joy, as opposed to a structured regime. Finding an activity that involves a group social setting can be beneficial to our well-being and foster connections, and also helps if we’re at risk of over exercising and in need of support from others, as well as a timeline of when it’s appropriate to stop.

Alternatively, participating in an activity with a friend or loved one that can help to support our needs might also be beneficial. We want to encourage listening to our bodies’ cues (such as when we are tired,) as opposed to exercising for prolonged periods of time. If this is something that is still difficult to do then perhaps you can establish a (short) time frame with your team and set a timer for when to stop2. It can also be helpful to focus on activities that are more mindful such as going for a walk outside in nature or practicing gentle yoga. Finding a variety of activities that are truly enjoyable is key, as well as learning to let go of the activities that aren’t.

It’s crucial to determine that it is medically appropriate to exercise before trying to implement any new activities. If an adequate body weight is not being maintained or signs of heartbeat irregularities are present, exercise should not be introduced as it can put us at risk3. We must make sure that we are cleared to exercise by our doctor and talk about it with our treatment team before beginning any form of physical activity. Additionally, we need to ensure that we are consuming enough calories to support exercise. Putting out more energy for movement requires that we put more in to fuel our bodies so we want to be sure that we are at a stage where we are consistently meeting our nutritional needs. Allowing others to help and support us in this process can enable us to create a safety net of trusted people that we can turn to if we need help. Overall, if iexercise is something that is going to be fun, like trying new activities or engaging in activities in a group setting, then this type of movement can be a good thing and improve overall wellbeing and quality of life. Just remember that every individual is different, and how exercise fits into our own lives is not going to be the same for everyone. Each journey is unique and should be treated as such.


References

1. Danielsen, M., Rø, Ø., Bjørnelv, S. (2018) How to integrate physical activity and exercise approaches into inpatient treatment for eating disorders: fifteen years of clinical experience and research. Journal of Eating Disorders, Vol. 6Retrieved from: https://www-ncbi-nlm-nih-gov.proxy1.lib.uwo.ca/pmc/articles/PMC6154924/#CR16

2. Cruze, R. (2016) How to find balance with exercise in eating disorder recovery. Retrieved from: https://www.eatingrecoverycenter.com/blog/2016/08/24/how-to-find-balance-with-exercise-in-eating-disorder-recovery-robyn-cruze

3. Murray, E. (2018) Eating disorder recovery: when can I exercise again? Retrieved from: https://themighty.com/2018/03/eating-disorder-can-i-exercise/

The Body’s Built-in Safety Nets

Our bodies are capable of amazing things, and there is a lot going on in there to keep us alive and attempt to make sure that we are functioning at our best. When we upset the optimal levels that our body needs to function, there are coping mechanisms that take place as built-in safety nets to help us survive. There are also specific things that happen in the presence of an eating disorder, and some of these can be exhibited as signs or symptoms to warn us of the underlying issues. For example, in times of starvation or malnutrition, when we are not getting enough energy through calories consumed, our bodies attempt to slow down metabolism in order to conserve energy1. One of the ways that the body accomplishes this is by lowering its’ body temperature. Blood circulation is decreased, and blood is conserved around the internal organs for protection, which causes a lack of warm blood flow to the extremities of the body such as the hands and feet. The blood that is sitting in the extremities gets cold due to the lack of circulation, and thus causes the hands and feet to feel especially cold. Another reason for always feeling cold is the loss of the body’s insulating layer of fat, which is normally used to keep the body warm2. Individuals with eating disorders sometimes explain feeling cold often and this is why it occurs. If this is something that is happening for you or a loved one, it’s important to speak with a health care professional to let them know. Our bodies have a specific temperature range where they function optimally, and a lower temperature range can lead to dangerous health complications.s

Other adaptive changes that the body makes in times of stress can include a reduced respiration rate or hypotension (low blood pressure), which are both also due to the slowing down of the body’s metabolism to conserve energy3. There can also be growth of a fine hair on various parts of the body in an effort to keep the body warm and insulated and try to regulate temperature. This hair growth is referred to as lanugo4. With all of this being said, when these warning signs appear it is extremely important to seek help from a professional before trying to reintroduce a higher calorie intake. The reintroduction process needs to be gradual to avoid refeeding syndrome, where your body cannot adapt quickly enough to the change and cannot cope properly. After prolonged starvation, the body shifts to get energy from different places, and is potentially deficient in essential vitamins and minerals. When refeeding, the metabolism can overwork itself trying to make up for lost tissues and it can be difficult to adapt again to a new change5. Consulting with a physician or dietitian first can help to make personal recommendations while also monitoring nutrient levels and maintaining safety above all in the recovery process.


References

1. Gaudiani, J.L. 2015. Why feeling cold can be a dangerous sign in anorexia nervosa. Retrieved from: http://www.gaudianiclinic.com/gaudiani-clinic-blog/2015/12/21/why-feeling-cold-can-be-a-dangerous-sign-in-anorexia-nervosa

2. Eating Disorders Glossary. Hypothermia (low body temperature). Retrieved from: http://glossary.feast-ed.org/3-treatment-medical-management/hypothermia

3. Ahacic, J.A. 2016. Nursing made incredibly easy! Vol 14-2Retrieved from: https://www.nursingcenter.com/cearticle?an=00152258-201603000-00007&journal_ID=417221&issue_ID=3331856

4. Mascolo, M. 2018. Anorexia recovery and overcoming physical side effects of an eating disorder. Retrieved from: https://www.eatingdisorderhope.com/information/bulimia/anorexia-recovery-and-overcoming-physical-side-effects-of-an-eating-disorder

5. Grubiak, K. 2018. Restoring nutritional health in anorexia nervosa recovery. Retrieved from: https://www.verywellmind.com/restoring-nutritional-health-in-anorexia-nervosa-recovery-4115081

 

What is Thin Privilege?

Thin privilege, related to weight bias, stems from the unrealistic ‘ideal’ of a thin body type for everyone, or for a preferred thin body type. It supports the idea that those with a thin body type have more advantages than those who do not. These advantages can be represented in scenarios such as easily finding your size while shopping at trendy stores, being offered help versus being told that nothing will fit you, not being judged by what you choose to eat, finding a place to sit on a bus or an airplane, and even finding a seat that properly and comfortably supports you. Others include not being associated with labels such as “lazy”, having more employment opportunities, receiving unbiased healthcare, and being accepted by peers, colleagues, and family members1. The adverse effects that result from those who lack these advantages can be detrimental to one’s well-being and include less engagement in self-care behaviour2. These unjust social advantageslead to not only unequal access to resources or health inequity, but also poor interpersonal relationships4.

This is not to say that judgment can’t be felt by thin individuals as well. Just because someone has thin privilege, does not mean that they feel accepted, have high self-esteem, find clothes that fit them, or necessarily have all of the said advantages noted above. This is why thin privilege can be such a contentious topic. It’s important for us to remember that no one is immune to hardship and we are each fighting our own battles. In addition, those who are thin due to serious health issues or poverty, are most definitely not privileged5. However, recognizing that thin privilege exists can help to bring awareness to the topic, and hopefully end the stigma that surrounds it. It’s crucial for us to be aware of how such biases can be harmful to those of any body weight.

One way in which we can combat this is by educating ourselves and others about the existence of thin privilege, because being aware of it can help us to be more aware of our own actions and biases as well. We can also educate ourselves and others about dated information regarding health, such as the use of BMI as a determinant of health. Fortunately, with the help of the HAES® movement, education regarding Health At Every Size is making it’s way around. It’s about time! Every body is deserving and should be treated with equal respect.

The more we know, the more capable we are of standing up to unfair practices. It’s essential that we talk to each other about circumstances like this so that we can support each other and prevent them from happening in the future. We are all deserving of equal opportunities and body equity is something that is to be celebrated. So let’s rise above and instead of judging, remember to practice love and compassion to others but also to ourselves.


References

  1. Bruce, K. (2018). What exactly is “thin privilege”? Retrieved from https://www.kristinabruce.com/blog/what-exactly-is-thin-privilege
  2. Kater, K. (2015). Hope for the future: transforming the destructive assumptions of thin privilege and weight stigma. Retrieved from: http://nedic.ca/conference/closing-keynote-%E2%80%93-april-17th-2015
  3. Bacon, Linda. (2010). Health at every size : the surprising truth about your weight. Dallas, TX :BenBella Books
  4. Nutter, S., Russell-Mayhew, S., Arthur, N., Ellard, J.H. (2018). Weight bias and social justice: implications for education and practice. Retrieved from: https://link-springer-com.proxy1.lib.uwo.ca/content/pdf/10.1007%2Fs10447-018-9320-8.pdf
  5. Nash, M., Warin, M. (2017). Squeezed between identity politics and intersectionality: a critique of ‘thin privilege’ in fat studies Feminist Theory Vol. 18. Retrieved from: https://journals-sagepub-com.proxy1.lib.uwo.ca/doi/pdf/10.1177/1350506812456461