Category Archives: eating disorder

Moms, Food, and Diets

In continuing with the fabulous interviews for the forthcoming book Good Enough Mama: Taking Care of Yourself and Your Recovery During Pregnancy and Postpartum, today I want to introduce you to Lindsay Stenovec, Dietician, Mom, Recovery advocate, and host of The Nurtured Mama podcast

Lindsay+Stenovec

What made you want to become a dietician that specializes in eating disorder recovery?

My own journey definitely led me to this area of specialty. Having suffered from disordered eating and body image distress informed it. In college, as a nutrition major, thought I was doing the “right thing,” eating “healthily” when really it was diet mentality. I thought I was being a good nutrition major. I was following the rules that were given to me. I genuinely thought there was something inherently wrong with myself in my body for not being able to adhere to these recommendations that just weren’t realistic or appropriate for my body. And that would send me into these cycles of struggling with disordered eating. So, long story short, I hit this point in late in my senior year of college where I said:

“Enough is enough. I just I have to let myself eat enough food!”

I started to experiment with this, and realized I could relax around food! And I found it was actually not so scary. And shortly after that I was introduced to intuitive eating as well as the world of eating disorder treatment.

(Intuitive eating can be defined as a nutrition philosophy based on the premise that becoming more attuned to the body’s natural hunger signals is a more effective way to attain a healthy weight, rather than keeping track of the amounts of energy and fats in foods. For ten principles of intuitive eating from authors Evelyn Tribole & Elyse Resch, go to: Ten Principles )

Intuitive eating – and using this approach to eating disorder recovery – fit in very nicely with my own personal experience. I realized there was this whole world of people practicing intuitive eating and “Health At Every Size” (HAES)  who were saying not only “It’s OK to eat,” but also “It’s ok to eat enough and enjoy it! You have permission to do this!” I realized, Oh these are my people and this is my jam! There was no going back.

What is diet-mentality and how did you break out of it?

Diet mentality says that a variety of body shapes and sizes are not OK and that you can’t trust yourself around portions. In my nutrition program at school, they were teaching us that you’re going to have to really work hard to help people not eat too much. It was fear-based: one wrong moved you are going to be out of control.

I remember having a discussion in my nutrition program about portion sizes and all of a sudden I realized “Oh my gosh, the ‘serving size’ on the box is just the unit of measure! No_DietingUnder no circumstances is this like the right amount for everyone to eat, every time they sit down to eat that food.” All of a sudden I had so much validation for myself in struggling with trying to stick with a cereal box recommendation, feeling so hungry, and thinking there was something wrong with me. I could eat more than one bowl of cereal because, even though it said one bowl was a “serving size,” one bowl didn’t fill me up!

I remember raising my hand in class and saying:

“I just realized that this is the unit of measure not the perfect amount everyone is supposed to eat! This is just a unit of measure that manufacturers picked and put on the boxes. It helps their product look good within diet culture, but it really has nothing to do with what you need in that moment.”

Everyone including the teacher just looked at me strangely, and went back to the lecture. But it was a revelation for me. Back in the day, they used to always say a bowl of cereal was part of a complete breakfast. Not your whole breakfast. And if you want to choose to have a cup of cereal, fine. But make sure to give yourself unconditional permission when you get hungry an hour later.

Stay tuned next for part two of this interview, when Lindsay discusses some of the ways she helps moms with the massive food and body changes during pregnancy and postpartum!

2 Ways to Take Care of Your Self During the Holiday Season

The holidays can be hard. They can be especially difficult for people recovering from disordered eating, alcoholism, depression, or anxiety. The intention of this blog is to help you be a bit more fierce with your own self-care and a bit more compassionate with yourself and others. This is not a list to use to beat up on yourself for not doing enough or being imperfect! May it be helpful, useful, and ease some of your suffering during this time.

  1. HALT

Try not to let yourself get too Hungry, Angry, Lonely, or Tired. Getting too tired, hungry/hypoglycemic, resentful, or isolating is a recipe for addictive behaviors and/or haltdepression. Imagine yourself to be a little one (this will not be hard for you parents to imagine) who needs regular meals and snacks, regular emotional understanding, and regular sleep. If little ones get too tired/hungry/emotionally not heard, there will be meltdowns. Be a kind parent to yourself. Pack a self-care bag with protein snacks, water, get to bed on time, make plans with friends and/or providers that “get” you so you can feel nourished and grounded. Practice what a friend of mine calls “aggressive self-care.”

2. Keep 1 Thing Constant

Choose one thing – morning meditation, weekly support group, your meal plan, sobriety, journaling, daily inspirational reading. Whatever it is, just keep coming back to this.

A Word About Kindness and Self-Compassion

The intention here is to help you be a bit more fierce with your own self-care and a bit more compassionate with yourself and others… not to beat up on yourself for not doing enough or being imperfect. So if you HAVEN’T kept one thing constant, just restart it. And when you notice you haven’t kept your thing – whatever your thing is that keeps you grounded and sane – constant (We all fall off the wagon on this. It is part of being included in humanity.), notice with kindness and compassion. Imagine you are a puppy. Gently pick yourself up from the place where you are being unkind to yourself and bring yourself back to the place where you are being kind. Gently bring yourself back to the thing that helps you. Just keep coming back.

 

5 Things Moms Can Do to Prevent Eating Disorders

I recently gave a talk for parents on Eating Disorders and what parents wanted to know most was: How do I prevent my child from developing an eating disorder?

Here are five things you can do (and some you can be conscious of NOT doing) to assist with preventing your child from developing an eating disorder:

  • 1. DON’T Diet. 

Diets don’t work. This has been proven again and again. Here are a few scary statistics:

*95% of all dieters will regain their lost weight in 1-5 years (Grodstein, Levine, Spencer, Colditz, & Stampfer, 1996; Neumark-Sztainer, Haines, Wall, & Eisenberg, 2007).

*80% of 10-year-old girls in America have dieted to lose weight. (Bates, 2016)

And yet

Women who were put on diets as young girls are more likely to struggle with obesity, alcohol abuse and disordered eating as adults. (Keel, 2014).

*35% of “normal dieters” progress to pathological dieting. (Shisslak, Crago, & Estes, 1995).

  • 2. DO eat intuitively.

Intuitive eating can be summarized by: relying on internal cues for hunger and satiety, eating for physiological rather than emotional reasons, having no dietary restrictions/unconditional permission to eat, and body size acceptance (Tribole, and Resche, Intuitive Eating A Revolutionary program that Works, 1995, 2012). Listen to your own hunger and don’t restrict. Give yourself permission to enjoy eating!

  • 3. Take care of your own body image.
body ruffle.jpg

The Onion, Aug 25,2014

Be mindful that you are your child’s mirror. You may be tempted, as I saw in a humourous newspaper wear a “Mom’s Bathing Suit as One Giant, Body-Ecclipsing Ruffle.” You many gaze disgustedly in the mirror at your postpartum muffin top.  Postpartum body image and ageing can be brutal. However, don’t allow yourself to buy into the culture’s message around self-worth being tied to “getting your postbaby body back in shape.”

A) Your postpartum body will never be the same shape. You grew a baby in there.

B) Your worth is bigger now. You have been changed by life. Try and embrace and radically accept that. Be proud of your tummy like your child is proud of theirs. You are beautiful because of the life you have lived and your body reflects that: all the scars, stretches, and wrinkles. A wizened tree does not Botox itself to look like a skinny leaf-sprout. Be the tree that you are proudly (or, on a bad day, good-enough).

  • 4. Follow the “Division of Responsibility” when feeding your child.

FullSizeRender-4 copy 3Briefly, the division of responsibility is: The parent is responsible for What, When, and Where you eat. The child is responsible for How much and Whether they eat. This is based on Ellen Sattyr’s work. To see a handout on this, click here

I know it can be hard to trust that your child WILL choose to eat vegetables. But it CAN and DOES happen. See this amazing transformation in my own little one, who used to only eat anything soft and white. Notice how one carrot and two bits of pepper have grown into a plate almost entirely filled with vegetables!

FullSizeRender-4(By the way, DO respect sensory sensitivities. If your child prefers soft texture, make soft texture food and gradually without a fight and making it fun introduce other textures.) And, remember: there are no bad foods. Kids need carbs and fat, and so do you. They help you have enough energy, they feed your brain.

  • 5. Allow all feelings in your family (especially uncomfortable ones like anger, fear, and shame).

Low tolerance for negative affect has been shown to be one of the factors contributing to eating disorders. What does this mean? It means, in order to create an environment where your child willFullSizeRender-4 copy not feel they have to hide or stuff parts of themselves in order to be loved, you have to allow discomfort. Anger is a tough one. Most people error in one direction (rage at others) or the other (blame self and stuff into depression). Work on expressing anger at the level of irritation before it gets too overwhelmingly big. Have weekly family meetings. If you get in a fight with your partner, make up and show your child you have made up so they can see people re-unite after being mad at each other. When your child is mad, don’t withdraw your affection. Notice: “I see you are mad. I’m going to help you. I love you even when you are mad. You can hit the pillow, but not me. I’m going to stay with you until we work this out.” Allow fear. Allow insecurity, embrace imperfection. When someone makes a mistake in our house, we say “Yay! I made a mistake!” This is not my natural inclination. The natural inclination with shame is to hide it. Sweep it under the rug quickly! Pretend-like-you-know-what-you-are-doing-before-you-get-in-trouble-or-someone-sees-that-you-are-a-fraud! Don’t do this. Turn toward your own and your child’s imperfections and growth edges. Growing requires failing, and failing, and failing before succeeding. Support your child in practicing new skills. When your little one is learning to walk and falls down, you say “Hooray! Try again!” Continue to do this with yourself and your little one. Again and again.

It is possible to prevent eating disorders. And it is also possible to build a strong protective factors so that if your child develops one, they can recover with more ease. Do what you can. Eating Disorders are complex and develop from a unique and individual interplay of many factors. Eating disorders are no-one’s fault, but everyone’s responsibility. Prevention and recovery are possible.

 

I Feel Fat: Breaking the Bad Body Image Legacy

mirror mirror

I’m so excited to have a guest blog today by By Andrea Wachter, LMFT, co-author of The Don’t Diet, Live-It Workbook and the new children’s book Mirror, Mirror on the Wall: Breaking the “I Feel Fat” Spell. I have followed her work for years (since I got into recovery nineteen years ago!) and am honored to share her words of wisdom.

Breaking the Bad Body Image Legacy

I was raised by a mom who was extremely dissatisfied with her body. Sadly, and statistically, there is a good chance that you were too. It’s nobody’s fault. Most of our mothers were handed the same bad body image baton that we were, leaving far too many of us competing in the never ending race of trying to eat a certain way, exercise a certain way and look a certain way in order to feel attractive and loveable.

Fortunately, there is a movement toward health and healing. My hope is that someday, a woman who dislikes or despises her body will be as rare as one who thinks that washing her child’s mouth out with soap is a wise parenting tool. As a culture, we need a massive update on our body image programming and if you are reading this blog, there is a good chance that you are up for the task.

Whether someone inherits a bad body image from their family, or learned it from our crazy culture, it is possible to heal. In my therapy practice, I have worked with women of all ages and from all walks of life and I have found that if there is desire and willingness, there is hope to break the legacy of bad body image.

My earliest memory of body image awareness was when I was about eight years old. I innocently walked into the bathroom and saw my mom soaking in the tub. While I don’t remember her exact words, I do recall her saying something negative and unkind about her body. I silently wondered why she didn’t like her body. And the programming went on from there: negative comments she made about feeling or being fat; certain foods being deemed “good” or “bad;” needing to diet or exercise to make up for what she ate.

Then came the painfully memorable shift when the focus turned to my body: Being told I was “getting a little chubby;” getting served the tasteless diet foods that were kept in a special freezer in the garage, while my dad and brother ate the regular foods from the kitchen; my dad telling me I have “such a pretty face,” if only I would “lose a few pounds;” paying my sister and me to lose weight.

I harbor not an ounce of blame or resentment toward these precious people. They received the same mixed-up messages we all have: If you lose weight, you will be more attractive and loveable. If you exercise, eat lean proteins, vegetables and fruits, you will be “good.” If you eat what have been deemed “bad” foods, you will be out of control and lose the praise and love you so hunger for.

Being a sensitive child who was desperately eager to please, I took my parents’ early teachings to heart. My dieting turned to sneak eating which led to periods of serious restricting which led to major binges which eventually morphed into a hard core case of bulimia. I added massive amounts of drugs, alcohol and cigarettes into the mix and spent decades completely lost in food, weight and body obsession. My self-worth, my social life, my love life, my health and my schooling were all greatly and negatively impacted by my painful and insidious relationship with food and my constant attempts to lose weight. And even when I did manage (countless times) to lose weight, it never once brought the peace of mind and happiness that I was told it would. Instead, my weight losses came with terror of weight gain and the animal-like hunger that accompanies and follows starvation.

I once asked my mom how she became so obsessed with dieting and so unhappy with her body. She told me that her mom and grandmother were both heavy but really didn’t seem to give it a second thought. It was only when she moved out of her poor Brooklyn neighborhood and into a “nice neighborhood filled with thin women” that she began to diet. She said, “I think I learned it from friends and it probably came from watching TV. Plus, your father was always so obsessed with my being thin.”

I then asked my dad how he came to be so obsessed with thinness. His answer was honest and it actually made sense to me. My dad ran a ladies clothing company in Manhattan. He worked tirelessly in the factory and he explained, “I guess I saw that the sewers in the factory were all fat and poor and seemed pretty unhappy. They had hard lives. The models who worked for us in the showroom were all thin, rich and glamourous and they seemed to be so happy.” Seemed being the operative word here. My precious papa took a small segment of the population, made some big assumptions, and based on his profound love for me, led me down a road he thought would bring me goodness. As did my mom. We were all given the same faulty programs.
The great news is that I eventually found my way out. And even better news is that I made a career out of it. My life’s work is now about helping others overcome their battles with food, weight and body issues as well as doing early prevention for kids who are showing signs of body dissatisfaction. Much like drugs, the earlier you intervene, the less entrenched the patterns are and all the more hope there is to change.

I was not a light weight dieter, binger and body hater. (Pardon the pun!) I went hard core. Fortunately, I dove hard core into healing too. It takes hard core dedication to break the legacy that so many of us have been handed: to eat exactly what we want in moderate amounts; to say “no” to food, even when others are pushing us to eat; to say “yes” to moving our bodies in ways we love; to say “yes” to rest when we are tired; to say “yes” to tears and compassion when we are sad, mad or scared; to speak our truth rather than stuff it with excess food; to say “no” to unachievable perfection; to accept and appreciate the size and shape of the bodies we were given, the age we are, the aging process.

Healing from food and body issues is not for the faint of heart, but then neither is starving ourselves, overeating, bingeing, body hatred or constant comparing. Both paths are challenging but thankfully one road leads to freedom and peace. I wish this for you.

Click here to check out Mirror, Mirror on the Wall: Breaking the “I Feel Fat” Spell  by Andrea Wachter and Marsea Marcus.

Andrea Wachter is a psychotherapist and co-author of Mirror, Mirror on the Wall: Version 2Breaking the “I Feel Fat” Spell as well as The Don’t Diet, Live-It Workbook. She is also au
thor of the upcoming book, Getting Over Overeating for Teens. Andrea is an inspirational counselor,
author and speaker who uses professional expertise, humor and personal recovery to help others. For more information on her books, blogs and other services, please visit innersolutions

A Story Aout Eating Disorder Recovery

Once upon a time, a long, long time ago,  

 there was a King who had been away at war and was finally coming home. As he approached the castle, his dog ran up to him looking crazy: his muzzle was foaming and bloody, he was running round and round the King in circles, and then back toward the castle where the nursery was. The king followed the dog to his new baby’s room and, to his horror, found the baby’s crib and wall spattered in blood and a large wolf laying prone in the crib. The King, terrified and then horrified, turned toward the dog and plunged his sword into him, thinking the dog had allowed his baby to be killed by a wolf. Just then, he heard the baby’s cry from under the wolf. The dog had protected the King’s baby.

Now, you may be thinking, like my clients when I shared this, How horrible! What a terrible story! What the heck does this have to do with eating disorder recovery; why didn’t he just pause before killing the dog; and where is the Queen in all this?

In order to see how this relates to recovery, we have to look at it metaphorically and break out of literal mind. In this story,

  • the dog is our body,
  • the wolf is our critical, eating disordered mind,
  • and the baby is our most precious soul-self.

The King could be many things: he could be our Observer-self (if he had paused), he could be the fierce action-oriented part of our self (that is helpful when channeled in the right direction and destructive when not), he could be the part of our self that integrates other parts…

However, the most significant question I have for you is: how is your relationship with the dog? Because your body is not the enemy here. And, in recovery, your IMG_2222body needs to (and has the capacity to) become your greatest teacher, ally, and communicator. What would happen if you listened, with curiosity, again and again?

Many blessings and so much gratitude for Dr. Anita Johnston, author of Eating In the Light of the Moon: How women can transform their relationship with food through myth, metaphaor and story telling (Carslbad: Gurz books, 1996) for this story.  Dranitajohnston.com

It’s Eating Disorders Awareness week!

Before recovery, everybody knows there is a problem except you. After recovery, no-one knows there is a problem except you, and it is your job to live in the solution. It is the challenge and opportunity of every recovering person to acknowledge the problem and live the solution.

It is Eating Disorder Awareness Week. In my mind, that means all the people still struggling with eating disorders or disordered eating are putting their heads in the sand and pretending everything is ok. They don’t want to talk about it, everything is “fine,” let’s get on with the business of being perfect, trying to be perfect, or at least look ok so nobody knows what’s really going on. And all the people who have recovered, are willingly trying to recover, or work assisting people to recover are running around like Chicken Little saying “Hey! Everything is NOT ok and that is ok! Let’s celebrate imperfection! Let’s talk about what’s really going on! Let’s raise awareness! Let’s get our heads out of the sand!”

I never thought I would have an eating disorder. Eating Disorders were for models, popular girls, adolescents or athletes. I was none of these. I was a feminist. I was going to join the peace-corps and go to Africa and save the mountain gorillas from extinction. I was 20 years old and ready to save the world. Except I couldn’t pass the physical exam to apply to the peace-corps due to complications from my eating disorder.

I also never thought I would become a therapist. But life takes us in interesting directions, not always the places we plan.  Ad here I am, 17 years recovered, 15 years working in recovery, still at it. I turned my passion for advocacy to helping all of the actual people suffering with eating disorders, not just the models and athletes, but the feminists, the environmentalists, the men secretly struggling with “a women’s disease,” and the middle aged moms. Because in the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified (EDNOS) (Wade, Keski-Rahkonen, & Hudson, 2011). That means either you or someone you know.

People suffering with eating disorders come in all shapes, sizes, and colors. Emaciated, overweight, “normal” weight, men, women, adolescents, people of all skin colors, children ALL suffer from eating disorders. Though it may seem like it, eating disorders are not about food or weight. Eating disorders are hidden diseases that are notUnknown “a superficial problem with dieting” but deadly and complex diseases that deserve to be treated and eradicated. I’m speaking up for those who are still hiding, who are still suffering, who are not yet ready to “be in the solution” of freedom from shame, but want to know that it is possible. It is possible. You are not alone. Come out when you are ready. We are here for you, in a long lineage of healing, those of us who have recovered, who are recovering, who assist others to recover.

For More information on National eating Disorders Awareness Week and how to get involved: http://nedawareness.org/social

When is it Emotional Eating and when is it Disordered?

I once heard the anecdote that if you eat something and eating more of it makes you even more hungry, it is probably mouth hunger. In eating disorder recovery, the terms “mouth” vs “stomach” hunger are often used, mouth hunger referring to hunger that is more about emotions and stomach hunger referring to hunger that is more about physical hunger. I remember in my eating disorder 16 years ago, I would eat an entire pint of ice-cream and be even more hungry afterward. In clinical research and practice, emotional eating is often defined as eating is response to negative affect (depression, anger, anxiety) and gets correlated with binge eating. For those of us recovered, recovering, or wanting to recover from disordered eating, we know all to well what emotional eating is. Or do we? Emotional eating is not necessarily a pathological symptom to “get rid of,” nor is it limited to those struggling with eating disorder recovery. I tell my recovering clients if eating were devoid of emotional connections, then people would eat food pellets at every meal. Almost all eating has an emotional component to it. Ellyn Satter, Registered Dietitian, Family Therapist, and internationally recognized authority on eating and feeding writes:

“Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good…It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.”  1

What is the difference between normal eating, emotional eating, and disordered eating?

That is the 10 million dollar question! I remember early in my eating disorder recovery, I needed to have some guidelines around meals in order to know what “normal” eating was- I had been so dis-connected from normal eating and it had been so long since I had felt able to trust myself. A “meal” in my eating disorder could be ice-cream with a bag of cookies or a bowl of broth. Neither of those took into account my stomach hunger, my body, or frankly, my emotions. I was either bingeing or starving not only my body but my emotions. It was like I was letting the fearful, angry toddler inside of me prepare all of my meals. In my recovery, I needed to have some guidelines around eating that helped me include my physical and emotional needs. These included guidelines such as: eating every 4-5 hours, eating a variety (at least 3 food groups) of foods at each meal, not eating the same thing every day (variety), and allowing dessert. It also helped me to establish some food recovery “bottom lines” that included: no bingeing, no restricting (skipping meals, avoiding food groups), no isolating while eating, and no purging.

Image

Being a mom of a toddler myself now, I can see firsthand how toddler food preferences don’t necessarily veer toward vegetables and prefer sweet tastes such as cookies or ice-cream. There is a reason for this! As one Nurse Health-educator points out, “newborns are born with innate taste preference for sweet, rich, and fatty flavors and naturally reject sour or bitter flavors. This is mother nature’s way of ensuring that a newborn will accept the sweet and rich flavor of breast milk.” 2 So how does a parent deal with a toddler wanting to eat only cookies? Interestingly, guidelines to eating disorder recovery are similar to those presented to parents feeding picky childhood eaters: eat together, serve three foods, don’t force cleaning one’s plate or eating vegetables in order to get dessert, allow choice while pairing trying new foods with familiar foods. 2

But what about the emotions that I’ve been starving or bingeing?

That is where the good news and the bad news is it’s not about food. That is where no food can attend to the anger, sadness or fear that is crying for your attention. As Geneen Roth’s sign on her refrigerator states “It’s not in there.” That is where moving toward rather than away from those feelings, with tenderness rather than avoidance or aggression, is the only way out. That is where I call in the principle of what in yoga is called “ahimsa,” or non-violence toward the self. In medicine and therapy, it is referred to the principle of do no harm. It is what being a good parent, one that is emotionally aware, does with grace. Geneen Roth, asks the following questions:

“Can you imagine how your life would have been different if each time you were feeling sad or angry as a kid, an adult said to you, ‘Come here, sweetheart, tell me all about it?’ If when you were overcome with grief at your best friend’s rejection, someone said to you, ‘Oh, darling, tell me more. Tell me where you feel those feelings. Tell me how your belly feels, your chest. I want to know every little thing. I’m here to listen to you, hold you, be with you.’  All any feeling wants is to be welcomed with tenderness. It wants room to unfold. It wants to relax and tell its story. It wants to dissolve like a thousand writhing snakes that with a flick of kindness become harmless strands of rope.” 3

     As you are considering emotional eating or disordered eating, I invite you to go deeper with these questions. What would it be like to bring even a tiny bit of kindness and some fiercely advocating compassion to yourself? Even for a moment? Even one moment of kindness can make a timeless amount of difference…Before my very last binge 16 years ago, I stopped before I went into the corner store to buy ice-cream. I thought of all the women struggling with the same feelings of sadness, overwhelm, and fear that I was struggling with in that very moment. I had the visceral experience of compassion. I held my own hand and I said “Honey, it’s not in there.” The tears started flowing, and I finally turned a corner.

Resource references:

1. http://ellynsatterinstitute.org/hte/whatisnormaleating.php

2. http://www.healthy-start.net/

3.  http://www.oprah.com/health/An-Excerpt-from-Geneen-Roths-Women-Food-And-God

 

 

Motherhood, Body Image, and Disordered Eating in Middle Age

I remember going to my first ObGyn visit when I was pregnant. The Doctor put “AMA” in my chart. Having worked in treatment settings for eating disorder recovery for many years, I thought she meant “Against Medical Advice,” the term clinicians use when a client is choosing to leave treatment despite their providers’ recommendations. I quickly said to my Doctor:

“I just want you to know am willing to implement any medical advice that you give me regarding my pregnancy!”

She gave me a blank stare.

I explained that I noticed she had written “AMA.”

She smiled. That means “Advanced Maternal Age.”

“Oh.” Long pause. “Oh.”

Being a mother of “advanced maternal age” is becoming more and more common in developed nations, as women work toward completing higher education, solidifying their careers, finding the right partner, and doing personal growth work prior to having children. The Center for Disease Control and Prevention reports:

Delayed childbearing in the United States is evident in the 3.6-year increase in the average age at first birth between 1970 and 2006…The dramatic increase in women having their first birth at the age of 35 years and over has played the largest role in the increased average age of first-time mothers…many other developed nations have observed increases in average age at first birth with some now averaging near 30.0 years of age. 1

What does this phenomena have to do with disordered eating and body image?

Although data regarding body image in middle aged and older women remains sparse, a study published just this past month in the International Journal of Eating Disorders suggests that body dissatisfaction and drive for thinness do not diminish with age. In a survey of 715 women just out, of which 76.5% were married with children, 4.6% met full diagnostic criteria for an Eating Disorder and 4.8% met criteria for Subthreshold Eating Disorder (SED). 2 Together, that makes roughly 10%. So that means 71 of those women with children are suffering with disordered eating.

And yet the myth persists that eating disorders primarily affect adolescents. Why?

There is a reason why the myth that eating disorders affect young women in adolescence exists. According to the National Association of Anorexia and Associated Disorders (ANAD): Over one-half of teenage girls…use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.3 Adolescence is a huge rite of passage for a woman. When a rite of passage is not celebrated, ritualized, or supported, the growth required to complete crossing the threshold of this rite of passage goes underground. Mary Pipher, author of Reviving Ophelia: Saving the Selves of Adolescent Girls (2005), writes:

“I think anorexia is a metaphor. It is a young woman’s statement that she will become what the culture asks of its women, which is that they be thin and nonthreatening…Anorexic women signal with their bodies “I will take up only a small amount of space. I won’t get in the way.” They signal, “I won’t be intimidating or threatening. (Who is afraid of a seventy-pound adult?)” 4

Similar to adolescence, both parenting and middle age are rites of passage in a woman’s life. When not honored, seen, and embraced, these can also turn into eating disorders and body image distress. Ageing women also face the cultural taboos of not taking up too much space, speaking too loudly, or being seen and valued. They face the task of loving themselves and embracing aspects of the beauty of mortality, power, and wisdom that western media culture is terrified of in women: wrinkles, thick middles, saggy boobs, gray hair. I remember reading one article on “objectification theory” in my doctoral research that linked media and female body image obsession with western culture’s fear of mortality. Female body objectification may veil unconscious existential fears. 5 Other stress factors that affect women in middle age that are similar to adolescence are hormonal changes. However, middle age women also face different stressors such as: medical scares, death of a parent or a spouse, divorce, and career challenges. 6 Margo Maine, co-author of The Body Myth: Adult Women and the Pressure to be Perfect, writes:

Women in their 30s, 40s and beyond face increasing pressure to look slender and youthful despite years of childbearing, hormonal changes at menopause and the demands of careers, parenting and caring for aging relatives…Some researchers call it the ‘Desperate Housewives effect,’ referring to the cultural influence of the hit TV series, in which improbably thin women in their 40s prance around in short shorts. 7

It is an interesting journey being “advanced maternal age.” Sometimes I look at young(er) women or young(er) mothers and I think You look so not tired. Or Wow your stomach looks so not stretched. I remember that. That feels like a long time ago. Or I envy younger moms who are more likely to have their grandparents be present for their children’s growing up. My child will already never meet one of his Grandpas. He died before my baby was born. However, there are gifts I have being “middle aged” that I couldn’t have come by earlier in my journey. I had not yet solidified my eating disorder recovery in my twenties. I had not earned a doctoral degree in Psychology in my twenties. I had lots of ideas and lots of difficulty with follow-through. I thought being earnest would pay the rent. The concept of income needing to match or be greater than outgoing expenditures was not a concept I truly understood or felt applied to me. Because I now have financial clarity, I don’t have to “deprive,” “restrict” or  “binge” or “purge” with money, like I used to do with food in my twenties. Interestingly, though I hated my (flatter) stomach in my twenties, I now love my (stretched) stomach in my early middle age. I also have much more capacity to pause and come back to difficult interactions in relationships rather than avoid, hide, or leave. I would not have been ready for marriage in my twenties. I would not have had the “distress tolerance” skills to go toward a young child and stay emotionally present through individuation-attempting tantrums. I would have been inadvertently shaming or stuffed the discomfort with food. I can tolerate it now. I would not have been a good, or frankly even good-enough, mother in my twenties. I wasn’t ready. I remember studying for the Psychologist licensure exam learning that the executive function of the brain (the part that fully understand cause and effect and is able to therefore pause impulsive actions) is not fully developed until the late twenties, or even 30. Does that mean all women should only have children after age 35? Or that only women over 35 are good (enough) mothers? Of course not. And not all women are able to. One always has the potential to become a good (enough) mother. In fact, the eating disorder recovery process mirrors the journey of becoming a good enough mother to one’s self: allowing and embracing imperfection, listening to and honoring emotions, communicating clearly, getting enough sleep, eating in a balanced way, practicing mindfulness or spirituality, connecting with support. And THAT is always possible and always a work-in-process, regardless of one’s chronological age.

BW-IMG_3876-3132321462-O

Dr. Linda Shanti McCabe is a Mom and Licensed Clinical Psychologist who works with women recovering from Eating Disorders, Body image difficulty, Depression/Anxiety, Perinatal Mood Disorders, and New Mommy “boot camp.”You can read about her work professionally at www.drlindashanti.com

Resources:

1. T.J. Mathews, T.J. and Brady E. Hamilton, “Delayed Childbearing: More Women Are Having Their
First Child Later in Life,” Center for Disease Control NCHS Data Brief, Number 21, August 2009. http://www.cdc.gov/nchs/data/databriefs/db21.htm

2. Mangweth-Matzek, Barbara, Hoek, Hans W. et al, “Prevalence of eating Disorders in Middle-Aged Women,” International Journal of Eating Disorders2014; 47:320-324.

3. National Association of Anorexia Nervosa and Associated Disorders websitehttp://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/

4. Pipher, Mary, Reviving Ophelia: Saving the Selves of Adolescent Girls (2005).

5. Grabe, Shelly, Routledge, Clay, Cook, Alison, Anderson, Christie, and Arndt, Jamie “In defense of the Body: The Effect of Salience on Female Body Objectification”, Psychology of Women Quarterly, Vol 29, 2005.

6. Harding, Anne Eating disorders: Not just for the young, CNNHealth.com, June 27, 2012. http://www.cnn.com/2012/06/26/health/mental-health/eating-disorders-not-just-for-young/

7. Barton, Adriana, “Are middle-aged women succumbing to ‘Desperate Housewives syndrome’?” The Globe and Mail, March 6, 2013.http://www.theglobeandmail.com/life/health-and-fitness/are-middle-aged-women-succumbing-to-desperate-housewives-syndrome/article578178/

8. Tiggemann M., “Body image across the adult life span: Stability and change,”Body Image 2004; 1:29-41. 9. Slevec JH, Tiggemann M., “Predictors of body dissatisfaction and disordered eating in middle-aged women,” Clinical Psychology Review 2011; 31: 515-524.

Aggressive Self-Care

Image

I just bought myself a book light. Yes, I still read actual books. Every night, while lying next to my child (resorted to this- see Confessions of a Failed Sleep Trainer) I read. I have been using a flashlight that is slowly wearing its batteries down and I have to shake it to get it back on. My eyes have begun to strain. Every night, before going to sleep, I have had the thought “I should get a book light.”

Why is it so difficult for Moms to take care of themselves? It is a given that I bring my child to all of his doctor visits, dentist visits, haircuts. I make sure he gets plenty of playtime, fresh air, exercise, organic food, sleep, baths. We have special time during which he gets to decide whatever he wants to do. We play games and make up stories for all of the themes that he is encountering in growth opportunities. The cars learn how to say goodbye and then come back together, share racetrack time, use their words to say when they feel MAD or SAD. The part of me that is just-trying-to-survive-as-a-Mom, however, has no time for being playful, kind, or patient with my own feelings and needs. This part wishes they would “just go away” because I don’t have time! And yet they don’t. We all know what happens when you try to rush a young child to get through feelings quickly because we don’t have time: they get bigger! Time doesn’t exist in the emotional world. Grown-ups need to care for their feelings, too. Or they get bigger. (Or turn into depression, resentment, eating disorders, alcoholism, etc)

I am in a moms-who-are-therapists group in which we spoke about aggressive self-care recently. We shared about our “ideal, but realistic” days as moms. What would we do? The answers weren’t huge changes. They were little shifts internally and externally that made a big difference: getting up ½ hour early in order to write, enjoying cooking instead of trying to just-get-everybody-fed, going OUT to dinner to have a night off from cooking, going for a family hike on the weekend instead of spending so much time on laundry, getting a haircut or a pedicure.

Why the term “aggressive”? I like this because it expresses how much it truly is an opposite action to take care of one’s self first (or at all) for many moms. As moms, we often defend and protect our child/dren’s well-being. How often do we turn this energy toward our own care? It requires attention, intention, and yes, some level of aggression. Because the cultural messages for moms are often about martyrdom and loss of self. And so turning toward, back to the self, honoring and tending to one’s self, requires fierceness. In case you didn’t notice the quote that my new book light is illuminating:

 …every day, the world will drag you by the hand, yelling, “This is important! And this is important! And this is important! You need to worry about this! And this! And this!

And each day, it’s up to you to yank your hand back, put it on your heart, and say, “No. This is what’s important.”

-Iain Thomas

PS By the way, just to name the obvious, you don’t have to be a Mom to practice aggressive self-care. It absolutely applies to eating disorder, codependency, and recovery general good self-care as well. Put on your own oxygen mask first.

 

Bellies

IMG_2079

     This is my son’s belly. He is very proud of it. He is also proud of his poo and pee. He lives in a shame free land (so far). I will protect him from shame for as long as I can. He is in Erikson’s “Shame vs Doubt” stage exploring the question “Is it ok to be me?” He happily runs around, showing off his belly, exploring this question. I will fiercely fight for him to hold onto the truth that lives in his belly that it is not only ok but ESSENTIAL that he be himself.

     I remember 15 years ago very early in my eating disorder recovery thinking in the midst of horrible body image distress “My belly is so fat- it looks like it is pregnant!” It wasn’t pregnant- it was full of shame, anger and unexpressed emotions. It was FAT: Feeling Are Thick. It was also nowhere near the size of a pregnant belly, having lived the reality, I now know. If I were to talk to my younger self now, I would say, with great compassion and fierceness, “Honey, you are nowhere near to having a pregnant belly. You want to see a pregnant belly? HERE. Now. What is in there that needs to be birthed and expressed? Get it out because it is not only ok but ESSENTIAL to your recovery and your life that you be yourself.” My older self has learned that. And my belly is now (mostly) free from shame and anger having receivied many apology letters for how I abused it and having been listened to much more frequently over the past decade and a half.

this belly

I’m not going to say it wasn’t difficult with body image postpartum (see “Dear New Mama” and “Does being a Mommy make me look fat?” previous posts). However, I AM proud of my Mama belly. I grew a child in there. Yes, my belly looks different in a bathing suit because I GREW A CHILD in there. Wow. That is pretty miraculous. Thank you belly.

A friend of mine sent me this video postpartum. It is well worth watching the celebration of a woman’s body and belly.

http://www.youtube.com/watch?v=kfOBGQpG9fA&feature=player_embedded#

%d bloggers like this: