Pet Peeves. Just in Time for Eating Disorder Awareness Week.

We will all rest more easily if we air
these 'pet' peeves.

Radio show host, Brooklyn Kitchen store owner and foodie Harry Rosenblum wants to know my food related pet peeves. He'll be interviewing me on March 16th on Feast Yr Ears about eating disorders and recovery with a particular interest in Cate and my book, Food to Eat: guided, hopeful & trusted recipes for eating disorder recovery. Pet peeves. Funny he should have asked; 'Thursday's patient' was just suggesting this for a blog post.

We all have them. Pet peeves are those things that drive us crazy that people and companies say and do that make us want to scream. But most of you don't scream, or even express your outrage. You might be annoyed, infuriated even, but you just keep it quiet and say nothing. Maybe you ruminate about it, or binge eat or don't eat at all. "I'll show them" may be your thinking. So readers, here's your prompt to share those things that piss you off. Ok, ok, not so fast. Let's narrow the focus to food and eating disorder related topics, okay?

I'll start us off with a few.

• People who ought to know better, that assume weight loss is a good thing. Think doctors and nurses. Just 2 days ago a pre surgical nurse interviewing a family member asked if there was weight loss of more than 10 pounds in the past month. Yes, was the reply. "That's great!" she  moronically responded, naive to any underlying vomiting, pain, growing cancer, or depression that might have contributed. Brilliant. Or the pediatrician who praised the boy's weight drop from his high BMI, failing to ask the critical questions that would have diagnosed his eating disorder.

• Food companies that sneakily shrink their packaging, thinking we just won't notice. 1/2 gallon of ice cream? Nope. Now it's just 1.5 quarts (vs 2 quarts). Kashi cereal boxes--same height, just a fraction of the content, with skinnier boxes. Call a spade a spade. Increase the darn price but keep the package size the same. Don't insult my intelligence, please! I'm waiting for them to fill my dozen eggs with just 10. Just you wait. 

Stop insulting my bread.
And please call it bread, not carbs!

• Nutrition misinformation that people can't let go of--belief that gluten, or carbs make you fat. Not so my friends! There's no evidence to support this. It's like global warming for a particular US political party. They hold on to these beliefs in spite of all the science to the contrary. Ughh!

• Food labels that shout out "high protein" or "low fat" or "gluten free" as if we should care. (If you  need to watch your gluten since you have celiac you'd better look for more that the shout out gluten text; you'll need a legitimate stamp identifying foods that have a measured low gluten level through careful factory testing).

• People that think their food choices or diet type raises them to a higher moral ground. Choose to be vegan if you are concerned about the planet or animals or both. But don't wear it like a designer label because quite simply, I'm not impressed.

This is steak. It contains protein.
And fat. And other nutrients.

• Calling food by its nutrient. As in "I'll have some protein with that" referring to meats or fish, for instance. Can't we appreciate and select foods for their other characteristics, too? For their flavor, or texture, their smoothness or crunch? The simple pleasure they give us?

What are your pet peeves? Let's put them out there and circulate them. And maybe we will raise awareness and create change.

What doctors must know about eating disorders.

I want your input. I need to hear your voices. For EDAW 2015, I have volunteered to present to two medical residency programs—one in Boston, MA and one in Providence, RI on what doctors need to know about eating disorders.  I've incorporated recommendations from twitter responders and from Aspire, but I welcome more input. Here's what I have to share with new doctors so far:

• Avoid the ‘Don’t ask, don’t tell’ approach. Patients rarely volunteer behaviors they feel ashamed of—bingeing, purging, diet pill and laxative abuse.  So providers need to ask. Nicely. Casually. Non-judgmentally. Include basic ED screening questions at routine visits.

• Early action is not just for college admissions. Eating disorders are best identified early and treated promptly. We wouldn’t simply wait it out to see if blood sugars simply turn around in a patient with type 1 diabetes. Take eating disorders as seriously as you would cancer, or

  

  The time is now for improving medical management
  of eating disorders.

  diabetes, or heart disease. Because like these medical conditions, they cause physical damage, and impact emotional wellbeing. And did I mention that left untreated they can be fatal?
• Relying on size is a seismic mistake. People of all sizes suffer from eating disorders. And because eating disorders in those of “normal” weight are often missed, they may be more chronic and challenging to overcome. Patients with anorexia can have high BMIs; they severely restrict their intake, are ruled by food rules and fear weight gain; their restriction impacts their ability to function, their mood, their blood pressure, body temperature, blood counts and thyroid level, fertility, bone density, and GI function.
• ED sufferers want help. People with eating disorders ultimately want to be free of their disorder. They are not just being difficult. They may also be struggling with depression, anxiety and OCD making recovery more challenging. They are
  
  suffering with their symptoms making day-to-day life unbearable. In fact, the risk of suicide is higher in those living with eating disorders and is a major cause of death in this population.
• Be careful what you ask for. Before recommending that your ‘overweight’ patients lose weight, do some assessing.  Has their weight or weight percentile been normal for them? What behaviors might be better addressed versus focusing on their weight? Diets can be the tipping point, precipitating an eating disorder. Striving to achieve and maintain a lower than usual weight contributes to maintenance of eating disorders.

  

  You can't simply tell by appearance that
  someone is suffering.

• Guys (yes even straight guys) get eating disorders. Seemingly healthy, fit, guys, and overweight boys and men live with eating disorders. Like girls and women, they may restrict and be fearful of gaining, binge eat, purge, and compulsively over exercise. EDs have no gender limits.
• Eating disorders may start in preadolescence, or at age 20, or in the 40s.  Eating disorders don’t expire when kids reach adulthood, or when adults mature. Individuals with EDs may first present for care after decades living with their ED or may have a late adult onset during a transition period in late adult hood.
• Read between the lines and ask the right questions. Please don’t praise a patient’s weight loss. Would you say great job if they lost due to cancer? Do focus on reinforcing healthy actions, not numbers. Rather, ask:
•  "What kinds of changes have you made?" 
• "How do you feel?" 
• "What percentage of your thoughts are spent thinking about food and eating?"
• "How’s your energy level?" 
• "How are you managing with these changes?"And note that healthy eaters are not always so healthy. Ask why your patient became a vegetarian/vegan. Why are they following a gluten-free or low carb diet?

Families play a critical role in
supporting a child's recovery.

• Parents are necessary supports for recovery. Overwhelmingly, parents need to be brought in to assist recovery. And the only thing we can blame parents for when it comes to eating disorders is their genes. 
• Eating disorders are serious mental health conditions. They have genetic, environmental and nutritional underpinnings. They don’t just “run their course” or become “out grown”. They require treatment by experienced providers. ASAP. Waiting may be lethal.
• If you don’t know, please ask! Check out AEDs medical resource guide and this. Seek out providers to collaborate with who are part of national or regional eating disorder organizations like AED, NEDA, iaedp and MEDA.

Please share this with your medical providers. And with your friends. And twitter followers. And with your Facebook friends.

Eating disorders require education and a break from the commonly help practices and beliefs. And you can help make it happen.

Thanks again to those who have already shared their ideas that were incorporated into this post.