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            <title><![CDATA[ What Is Bigorexia? Signs, Causes, and When Muscle-Building Becomes a Problem]]></title>
            <link>https://equip.health/articles/food-and-fitness/bigorexia-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/bigorexia-eating-disorder</guid>
            <pubDate>Thu, 03 Sep 2026 22:10:00 GMT</pubDate>
            <content:encoded><![CDATA[Bigorexia (also known as muscle dysmorphia) can be tricky to spot. After all, working out regularly, paying attention to what you eat, or wanting to build muscle aren’t inherently concerning—and in fitness culture, pushing yourself hard is often celebrated. In fact, in Equip’s May 2026 survey of more than 1,000 men, 65% said that working out for hours a day is a sign of discipline. But there’s a point where the drive to get stronger or more muscular becomes something more concerning. Bigorexia is a form of body dysmorphic disorder (BDD) in which someone becomes preoccupied with the belief that they aren’t muscular enough, according to the International Journal of Clinical Practice. That can start to shape how they eat, exercise, socialize, and cause negative and harmful feelings about themselves. And because many of these changes can look like dedication from the outside, people may not realize they’re struggling or deserve help. Fortunately, understanding what bigorexia actually looks like can make it easier to recognize when fitness goals go too far and deserve attention and support. What is bigorexia? “Bigorexia is an informal term used to describe the overlap between muscle dysmorphia (a type of body dysmorphic disorder) and anorexia or bulimia nervosa,” says Michael Kowalski, MS, a therapist at Equip. “This intersection combines the distorted view of an individual's muscle mass and the compulsive food- and exercise-related rituals created to change or reduce the obsessive thoughts about their body.” In someone with bigorexia, this might look like intense anxiety about missing a workout, following rigid food rules, or skipping plans that interfere with their exercise routine. Even as they build muscle, they may continue to see themselves as too small. These harmful patterns can be especially difficult to spot because many are normalized in fitness culture. Some are surprisingly common: Equip’s survey found that 76% of respondents felt anxious about missing a workout, while 59% had exercised to compensate for eating. Although bigorexia can affect people of any gender, it’s more common among boys and men, especially teens and young adults. One reason for this may be the cultural pressure for men to look strong and muscular, according to Zoe Ross-Nash, PsyD, CEDS, a licensed clinical psychologist and certified eating disorder specialist.  Is bigorexia an eating disorder? Bigorexia isn’t an official eating disorder diagnosis in the DSM-V. Instead, muscle dysmorphia (aka bigorexia) is classified as a form of body dysmorphic disorder, though it can overlap significantly with eating disorders and disordered eating behaviors. “Body dysmorphia is defined as an extreme disparagement of some aspect of one’s appearance,” says Equip therapist Jalia Henry, MA, LMFT. “While people with eating disorders may have body dysmorphia as a symptom, body dysmorphia is not a type of eating disorder.” Still, someone with bigorexia may engage in disordered eating patterns, like restricting foods, exercising to compensate for eating, bingeing, and purging. That overlap is why treatment for bigorexia often needs to address body image, eating, and exercise together.  Bigorexia vs. related terms Bigorexia is the informal name for muscle dysmorphia, but you may come across a few other terms when reading about it. Here’s what they mean: Reverse anorexia: An older, informal term for muscle dysmorphia, referring to the perception of being too small or not muscular enough. Vigorexia: Another informal term sometimes used interchangeably with muscle dysmorphia. Drunkorexia: A separate term for skipping meals, exercising more, or using other behaviors to “make up” for drinking alcohol. Male anorexia: Anorexia nervosa in boys and men, which often centers on leanness, muscularity, or performance rather than a desire to be thin, per research from the Child and Adolescent Psychiatric Clinics of North America.  What are the signs and symptoms of bigorexia? Bigorexia can show up in how someone exercises, eats, thinks about their body, and moves through life. Not everyone will experience the same signs, but these are some to look out for. Behavioral signs Changes in exercise and eating habits are often among the most noticeable signs. According to Henry and Equip registered dietitian Stephanie Kile, MS, RDN, these signs may include: Compulsive exercise: Working out even when sick, injured, or exhausted, or having trouble taking rest days. Rigid food rules: Cutting out foods or food groups or feeling like you have to eat in a very specific way. An extreme focus on protein intake is also common. Frequent bulking and cutting: Repeatedly cycling between eating more to gain muscle and restricting food to lose body fat. Body checking: Frequently looking in the mirror, measuring muscles, weighing yourself, or checking how your body compares with others. Missing out on everyday life: Skipping social plans, school, work, or other activities to maintain workout or eating routines. Supplement or steroid use: Relying heavily on supplements or using steroids or other substances to change muscle size or appearance. Physical signs You can’t tell whether someone has bigorexia by looking at them. But overtraining, not getting enough nutrition, or using certain muscle-building substances can sometimes lead to physical changes, which Kowalski says can include: Frequent injuries, soreness, or pain Fatigue, weakness, or trouble recovering from workouts Signs of low energy availability or relative energy deficiency in sport (RED-S), such as changes in hormones, bone health, or immune function Side effects related to supplements, steroids, or other muscle-building substances Psychological signs Some of the biggest changes may be in how a person feels about their body or fitness routine. According to the Equip experts, these can include: Feeling “too small”: Continuing to believe you aren’t muscular or big enough, even as your body changes. Anxiety or guilt: Feeling distressed about missing workouts, eating certain foods, or not meeting fitness goals. Low self-esteem: Tying your confidence or self-worth closely to your body or muscularity. Persistent comparison: Regularly comparing your body with people at the gym, on social media, or elsewhere. Depression or isolation: Withdrawing from other people or activities as concerns about food, exercise, and appearance take up more time and energy. What causes bigorexia? There’s no single cause of bigorexia. Instead, “[it’s] a complex mix of genetic, psychological, and social factors,” says Kowalski. He says factors that may play a role include: The influence of social media and fitness culture: Constant exposure to highly muscular or edited bodies can make it easy to feel like you don’t measure up. Pressure to look muscular: Cultural messages often link muscularity with strength, attractiveness, and masculinity. Ross-Nash notes that these expectations can shape both how people feel about their bodies and the ways they try to change them. Perfectionism and personality: People who are highly achievement-oriented, perfectionistic, or anxious may be more vulnerable, Kowalski says. Body image and past experiences: Negative body image, bullying, or teasing about weight, size, or appearance may also contribute. Biology: Genetics may play a role, and the hormonal and physical changes of puberty may be particularly relevant for eating disorders in young men and boys. None of these factors alone means someone will develop bigorexia. More often, the condition develops when several different factors converge. Understanding these complex roots can help shift guilt and blame away from the person who’s struggling. What are the health risks of bigorexia? Bigorexia can take a toll on both physical and mental health. The risks often come from the behaviors that can accompany it, like not eating enough, exercising compulsively, or using supplements or steroids. Physical health risks Exercising intensely without enough food or recovery time can take a toll on your body. According to Kowalski, potential risks include: RED-S and malnutrition: Not getting enough energy to meet the body’s needs can affect bone health, hormones, immunity, cardiovascular health, and other systems. Injuries: Exercise addiction can lead to strains, overuse injuries, and pain. Effects of bulking and cutting: “The extreme cycle of bulking-cutting can lead to chronic health impacts such as difficulty building more muscle, type 2 diabetes, hormonal imbalances, and cardiovascular strain,” says Kowalski. “[It] can cause potentially permanent damage to an individual's metabolic rate, which makes it easier to gain and more difficult to lose weight in the future.” Supplement and steroid risks: Heavy supplement use can cause nutritional imbalances, while anabolic steroids can affect hormones and put the heart, liver, kidneys, and other organs at risk.  Mental health risks Bigorexia can also make someone’s world feel increasingly centered around their body, food, and exercise. Per Kowalski, Kile, and Henry, this can lead to a cascade of mental and emotional effects, including: Body image distress: Feeling persistently unhappy with your body or like you’re never muscular enough. Preoccupation: Spending more and more time thinking about workouts, food, muscle size, or appearance. Anxiety and depression: Bigorexia can contribute to increased anxiety, depression, and low self-esteem. Social withdrawal: Turning down plans or pulling away from friends and family to make room for workouts or eating routines. These effects can build gradually, which is another reason bigorexia isn’t always easy to recognize. But if concerns about muscle, food, or exercise are starting to affect health, relationships, or daily life, they’re worth taking seriously. What does treatment for bigorexia look like? If you or someone you love is struggling with bigorexia, know that support is available. Treatment usually looks at the whole picture, which is why care often involves a team of multidisciplinary providers. Depending on your needs, Kowalski says that team may include: A therapist: Therapy can help you understand what’s driving compulsive behaviors, challenge distorted thoughts about your body, and find other ways to cope with distress. Cognitive behavioral therapy (CBT) can be especially helpful, according to research in Pharmaceuticals. A dietitian: An eating disorder-informed dietitian can help you move away from rigid food rules and make sure your body is getting enough energy and nutrition. A medical provider: A doctor can check for physical complications and monitor your health as you recover. For some people, more intensive treatment may be needed to safely address any severe medical concerns. Ultimately, the right level of support will look different for everyone. If you’re wondering whether your own or a loved one’s relationship with food, exercise, or body image may be a problem, Equip’s five-minute eating disorder screener can be a low-pressure place to start.  How to support someone with bigorexia If you’re worried about someone you love, one of the most helpful things you can do is approach them with curiosity rather than confrontation. They may not realize their relationship with food, exercise, or their body has become a problem, especially when many of the behaviors you’re concerned about are celebrated in gym culture, says Kile. Here is what the experts recommend: Start with a non-judgmental conversation: Focus on how the person seems to be feeling or how their routines are affecting their life, rather than commenting on their body, weight, or appearance. And don’t be discouraged if one conversation doesn’t change things. It may take time for someone to recognize they’re struggling. Model flexibility yourself: Ross-Nash suggests practicing body acceptance and showing that taking rest days from movement is a normal part of caring for yourself. Break the stigma: “Normalize that eating concerns or body concerns are a valid issue and that there are doctors, dietitians, and therapists who are trained to assist in these difficulties,” says Henry. Encourage professional support: An eating disorder specialist can help assess what’s going on and what kind of care may be helpful. If you’re concerned about a child or teen, Kowalski also recommends involving their doctor to address any potential physical complications. Stay involved: Support doesn’t end once treatment begins. Kowalski recommends learning about bigorexia, participating in family sessions when appropriate, and simply continuing to show up. You don’t need to have all the right words—listening and reminding your loved one that you’re there goes a long way.  The bottom line Bigorexia can be easy to miss in a culture where intense workouts and strict eating are seen as signs of dedication. But when those habits become rigid, distressing, or interfere with daily life, they’re worth taking seriously. You don’t have to wait until things feel “serious enough” to seek help. With the right support, it’s possible to build a more flexible relationship with food, movement, and your body. Frequently asked questions (FAQs) How do you know if you have bigorexia? Bigorexia may be a concern if thoughts about getting bigger or more muscular take up a lot of your time or lead to rigid behaviors around food and exercise. Feeling unable to miss workouts, frequently checking your body, or skipping other parts of life to stick to your routine can also be signs. What do people with bigorexia believe? Someone with bigorexia may feel like they’re too small or not muscular enough, even when others see their body differently. These thoughts can be hard to shake and may drive increasingly strict workout, eating, or body-checking routines. What are the related conditions to muscle dysmorphia? Muscle dysmorphia is a form of body dysmorphic disorder that can overlap with eating disorders, OCD, anxiety, depression, and substance use disorder, per a study in Behavioral Sciences.]]></content:encoded>
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            <title><![CDATA[My Loved One Has an Eating Disorder But Refuses Treatment. What Should I Do?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/what-to-do-if-your-child-resists-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/what-to-do-if-your-child-resists-eating-disorder-treatment</guid>
            <pubDate>Thu, 07 Aug 2025 22:26:00 GMT</pubDate>
            <content:encoded><![CDATA[Helping someone with an eating disorder can be difficult, to say the least. You have to wade through the noise to find high-quality treatment, and even then, your loved one may resist your help. While you’re focused on their best interests, the eating disorder may have caused cognitive changes that make your loved one see their behaviors as normal, or even positive. Getting them help as soon as possible, however, is important. Earlier intervention is associated with better outcomes and fewer complications. At the same time, the harder you push, the harder they may resist. But don’t despair and, above all, don’t give up. If your loved one refuses eating disorder treatment, keep reading. First, we’ll explain why they might resist treatment. Then we’ll discuss various strategies to help encourage your loved one to seek the care they need. Whether you’re supporting a child, a teen, or an adult with an eating disorder, these tips will help you help them, even if that’s not initially what they want. Understanding why someone might refuse treatment Two words help explain why people with eating disorders may resist treatment: anosognosia and egosyntonia. Both terms are tongue-twisters, but their straightforward definitions shed light on why eating disorders are not a matter of choice or stubbornness. Instead, they are serious and complex mental illnesses.  Anosognosia: when someone doesn’t know they are sick Anosognosia is a medical condition in which someone is unaware of their mental or physical illness. The condition typically results from complex brain changes. “Anosognosia is a common eating disorder symptom,” says Lainy Clark, MA, LPC, lead therapist at Equip. “It’s also referred to as a ‘lack of insight,’ and results in a person’s inability to recognize the need for help.” “Without any intention to do so, many patients automatically go to minimizing symptoms and the need for intervention,” says Jenna Robinow, LMSW, another therapist at Equip. She adds, “Part of anorexia, for example, is ambivalence toward its negative impact on a person’s health. Malnutrition gets in the way of clearly seeing the urgency of getting treatment. In that sense, it can be unfair to assume that someone in the throes of an eating disorder is going to be on board from the start.” Someone with anosognosia isn’t trying to be difficult. Instead, the eating disorder can cause regions in their brain to actually change, impairing their ability to see themselves objectively. This can help explain why approaches like family-based treatment (FBT)—in which the person with the eating disorder doesn’t need to be aware of their condition in order to benefit from the treatment—are particularly effective.  Egosyntonia: alignment with the eating disorder Eating disorders can sometimes be egosyntonic, which means they feel aligned with a person’s self-image, values, and feelings. While your loved one’s true values may be completely opposed to those of their illness, eating disorders are brain disorders, and brain distortions can make them feel aligned with the values of their disease. If egosyntonia is present, your loved one might know that they have an eating disorder, but not want to recover from it. Given the stranglehold an eating disorder has on the mind, the alignment of eating disorder behaviors with personal values can be quite powerful. Additionally, society tends to praise weight loss and thinness, and this praise can reinforce the idea that eating disorder behaviors are healthy and desirable. How treatment resistance might show up Resistance to eating disorder treatment can manifest in many ways. You may notice emotional, behavioral, physical, or psychological signs and symptoms, or some combination of several or all of these. In some cases, your loved one may have outbursts, try pleading, or give the silent treatment in response to attempts to help them seek treatment. While these responses can be difficult to encounter and navigate, you’re not alone in facing them. “The most common form of resistance is emotional dysregulation, which can result in pushback, outbursts of anger or rage, and crying,” Clark says. She adds that your loved one might also show an unwillingness to participate in treatment sessions or display aggression or increased hostility toward others. Many patients may plead to get out of treatment by promising to attempt recovery on their own, says Tanya Hargrave-Klein, MS, RDN, lead eating disorder dietitian at Equip. Others may throw food, curse at their support network, or shut out concerned loved ones completely. “This might include not returning text messages, not answering their phone, or not acknowledging support people in person,” she adds. This type of opposition occurs quite often. “It’s expected for someone with an eating disorder to experience resistance to engaging in treatment,” she says. “It’s also very typical for them to want treatment one moment and then be opposed to it the next moment.”  How to talk to someone who doesn’t want help: a communication toolkit Trying to talk to someone who doesn’t want help for their eating disorder can be a difficult and delicate endeavor. The most important things to prioritize in these conversations are compassion, patience, and nonjudgment. Here are some tips to communicate gently and effectively: Educate yourself. Lean in to resources like the Equip blog, F.E.A.S.T. and Project Heal to empower yourself with critical information and facts about what your loved one may be going through and how you can most effectively help them. Use kind, compassionate language. Approach your loved one with “I” messages, which can help you communicate your concerns, feelings, and needs without putting blame on the listener. Such statements typically follow this structure: “I feel (emotion) when (situation/behavior) because (impact)” and may also include “I would like (need or request).” Avoid confrontations or ultimatums. Rather than abruptly or unexpectedly confronting your loved one or using accusatory statements, express what you’ve noticed and why it concerns you. Gently offer treatment resources. Let your loved one know that help is available if they are willing. Offer your own support and guidance in making those connections, but don’t force or shame your loved one into taking advantage of your assistance. Model a healthy and enjoyable relationship with food to set an example as something to strive towards.  Myth vs. facts Before approaching your loved one, it can be helpful to reframe your mindset and dispel any myths you may have heard about eating disorders. Knowing these facts may also help you communicate to your loved one that they deserve help: Myth: All people with eating disorders are visibly thin or emaciated. Fact: Eating disorders can affect people of all shapes and sizes, including those in “average” and larger bodies. You cannot tell if someone has an eating disorder by looking at them. Myth: Eating disorders are a choice. Fact: Eating disorders are complex psychological illnesses influenced by a combination of genetics, environment, and psychosocial factors. There is no single cause of eating disorders, and they have nothing to do with choice, vanity, or attention-seeking. Myth: Eating disorders only affect young girls. Fact: Eating disorders do not discriminate. They affect people of all ages, genders, sexual orientations, ethnicities, etc.  Practical steps to encourage treatment Understanding eating disorders is the first step in communicating to your loved one that they need help; having that conversation is next. So what do you do if someone you love refuses eating disorder treatment? You won’t find a one-size-fits-all strategy, but some tried-and-true tactics can help you gently encourage someone who is struggling. Acknowledge their feelings and concerns “It’s helpful to acknowledge what you are observing and validate your loved one’s feelings,” Hargrave-Klein says. “That might sound something like, ‘I can see that you don’t want to start treatment. That makes sense because it feels scary, and because you don’t know what to expect, and because it isn’t something your friends are having to do.’” You can empathize with their experience while still encouraging eating disorder treatment. Express that you care about them and their feelings, and validate how hard it must be. Use open and honest communication Talking about eating disorders can be difficult, but treatment requires ongoing conversation. To open up the discussion, come prepared. Educate yourself about the various eating disorder treatment options, as well as the psychological components of eating disorders that can make treatment feel scary. “Help your loved one fact-check or reframe some of their greatest fears about stepping into treatment,” Robinow advises. “Processing and getting curious about their resistance may diffuse some of their fears, which feel enormous in their head but may be broken down into more manageable hurdles that can be overcome with support.” As your loved one talks, listen without judgment. This strategy increases the likelihood they’ll continue talking to you or even initiate a conversation with you on another day. Remember, this kind of talk isn’t a one-and-done discussion—you may need to have several conversations together, so don’t get discouraged if the first few c don’t go far, and keep the lines of communication open. It can also be useful to share something your loved one always used to love before the eating disorder, but is no longer engaging in. This can help illuminate other values outside of the eating disorder, especially for people who are experiencing egosyntonia. Problem-solve collaboratively Work with your loved one to come to a solution rather than trying to force them toward treatment. Do so by expressing your concerns in a nonjudgmental way and allowing unconditional space for them to express their feelings. Then work together to find a plan you both feel better about. “Don't assume you know how your loved one is feeling,” Robinow says. “Using ‘I’ statements, tell them what you are noticing in their behavior and allow them to tell you what their internal experience is like. This may support a more collaborative effort.” It’s also important to note that if your loved one is a minor, they do not have to be fully on board with treatment for you to get them help. Often, young people begin treatment with resistance, and may even refuse to participate once care begins, but with an evidence-based approach like family-based treatment (FBT), treatment is still effective regardless of patient buy-in. Learn more about FBT and what it looks like at Equip. When your loved one is an adult: navigating legal and medical crises When you’re helping an adult loved one who refuses eating disorder treatment, you may need to consider a variety of unique legal obstacles. According to Equip’s Director of Psychiatry, Maria C. La Via, MD, adults are able to consent to treatment for themselves and, conversely, are able to refuse treatment as well. “This includes refusing to see a primary care or other medical provider as well as a mental health provider for assessment and/or treatment,” she says. “Adults are able to refuse recommendations provided regarding treatment, which can often be frustrating for loved ones.” Anyone navigating this situation may wonder what the legal options are for helping an adult who refuses treatment. Dr. La Via says she always recommends speaking with an attorney who works with adults who may not be making good decisions about treatment. “This may include issues around competency,” she says. You can look at your state’s bar association website to find a local attorney who can help. The National Alliance on Mental Illness (NAMI) can also assist you with finding the right legal resources. “There is also the option of pursuing involuntary treatment,” Dr. La Via says. “This goes by different names in each state, and it involves submitting paperwork through the court system to have an individual evaluated for an involuntary hold and decision about involuntary treatment.” If an adult loved one is on the verge of, or is experiencing, a medical crisis as a result of their eating disorder, you have options. “Your first course of action would be to reach out to their primary care provider to express concern and to ask for recommendations,” she says. She adds, “You can also encourage your loved one to make an appointment to see their PCP. While the loved one’s primary care office may not be able to share specifics on their particular situation, you can always share your concerns, even without a release of information from the identified patient.” In the event of an urgent or emergent health crisis, encourage your loved one to go to either urgent care or the ER, and ideally accompany them to either. “If your loved one refuses to go voluntarily and you are still concerned, you should call 911 and explain the immediate concerns,” says Dr. La Via. Dr. La Via emphasizes the importance of patience and empathy when supporting an adult loved one who is resistant to treatment. “Let them know that you understand how difficult it can be to pursue treatment and that you are there to support them in any way that you can,” she says. “Ask or offer to speak with members of their treatment team or to help them find a treatment team if they don't have one,” she adds. “Get educated about eating disorders, read about risks and treatment options, reach out to providers to get information. Consider therapy for yourself to help you manage the distress of supporting a loved one who is struggling with an eating disorder.”  Understanding the importance of early intervention No matter how reluctant your loved one may be about treatment, keep trying. Research shows that the sooner someone enters treatment, the less likely they are to struggle long-term with an eating disorder. Early intervention also increases the odds of a full recovery and encourages help-seeking behaviors. Preventing caregiver burnout Caregiver burnout is also a recognized concern that can lead to anxiety, depression, fatigue, and a decrease in quality of life and overall well-being. The following strategies and resources can help. You cannot pour from an empty cup: support for the caregiver In many cases, caregivers give everything they have to their loved ones, often at the expense of their own well-being and the well-being of the rest of their family. Caring for someone with an eating disorder who refuses treatment can be mentally, emotionally, and physically draining, and it’s absolutely okay and expected that you might feel difficult emotions like anger, exhaustion, and frustration. While you may feel guilt or shame for needing a break, or feel helpless if your efforts are met with resistance, your well-being is just as critical as that of your loved one, and you deserve help and support too. Equip understands the stress that many caregivers are under, which is why we provide care and resources for the entire family system. Family members receive their own support through caregiver coaches (people with lived experience supporting a loved one), support groups with others navigating similar experiences, and helpful content for overcoming recovery challenges (like supporting a loved one through meals). Advocacy and support networks You don’t have to go through this alone. Advocacy and eating disorder support groups can provide education and help you realize you’re not the only one facing resistance while helping someone with an eating disorder. Also, many people find it beneficial to hear what worked for others. Here are some resources for ongoing support and education: Eating Disorder Foundation (EDF) F.E.A.S.T. National Alliance for Eating Disorders You can also sign up for the Equip newsletter to learn about support group opportunities and get information and resources on helping someone with an eating disorder.  The bottom line: have hope When your loved one refuses eating disorder treatment, you may feel scared, frustrated, or unsure what to do next. But know that resistance is common, and it’s important not to give up. Your support is key to helping them recover. Keep the conversation about treatment open. You can validate their experience and concerns while also educating them about the very real risks of eating disorders and the various treatment options available. You can also help them find providers, make appointments for them, or give them rides to appointments to help reduce any friction or excuses for not getting help. No matter what, be persistent, because the sooner your loved one enters treatment, the better.  FAQ What are common reasons why someone might refuse treatment for an eating disorder? Someone might resist treatment for an eating disorder for a number of reasons. These may include that they don’t think they are ill, or they believe the eating disorder aligns with their self-image, values, and feelings, so they want to keep it. They might also have fears around entering treatment. What should I say to someone who refuses eating disorder treatment? You can start by maintaining open and nonjudgmental communication. Use an “I” message: “I feel (emotion) when (situation/behavior) because (impact),” and “I would like (need or request).” Can someone recover from an eating disorder without professional help? Although rare, recovering from an eating disorder without professional help is possible. The best chances of recovery occur with professional treatment from a knowledgeable care team. Additionally, the health risks are greater for someone trying to go it alone. Are there effective treatments for eating disorders that don’t require patient buy-in? The most effective treatment that doesn’t require patient buy-in is family-based treatment for eating disorders (FBT). In this modality, which is developed for children, teens, and young adults with eating disorders, a professional teaches the caregivers how to help their child regain weight (if necessary) and reduce their symptoms. This empowers parents to be active in their child’s recovery and take the reins initially to decide what their child eats and to stop disordered behaviors. In some cases, FBT-TAY, a related modality that focuses on transition-age youth, is more appropriate for teens and young adults. Can I legally force my adult child into eating disorder treatment? In most cases, you cannot legally force an adult child into eating disorder treatment, but there are exceptions. Depending on their mental and physical state and local laws, you may have the option to pursue involuntary treatment, which involves submitting paperwork through the court system to have an individual evaluated for an involuntary hold and to make the decision about involuntary treatment. How should I handle mealtimes when they are refusing to eat what I've served? Remain calm but firm when offering your loved one meals. Communicate that you are not intending to fight with them or make them angry or upset; you are doing what you know will help them fight their illness. Ensure that you have the support you need to navigate difficult mealtimes by seeking out a therapist with eating disorder knowledge and experience, and/or support groups. What if my loved one agrees to treatment but then doesn't fully participate? Ambivalence is a common component of eating disorder recovery. Because eating disorders can be egosyntonic, those affected may not want to recover. While this feeling is a symptom of the eating disorder itself, it feels real and legitimate to the person struggling. It’s important to acknowledge your loved one’s efforts but to let them know you’ve noticed their lack of participation and you worry it might undermine their recovery. If possible and allowed, consider communicating with their treatment team to find out additional ways you can offer your support and guidance. ]]></content:encoded>
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            <title><![CDATA[How Coaches Use Lived Experience and Hands-On Coaching to Power Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/mentorship-in-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/mentorship-in-eating-disorder-recovery</guid>
            <pubDate>Thu, 20 Apr 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[In the early days of her eating disorder treatment, Maris Degener wasn’t sure if true recovery was really attainable. Her own research led her down rabbit holes of misinformation and misconceptions about who gets eating disorders and what life on the other side of treatment supposedly looked like—and it didn’t look good. She resigned herself to the idea that full recovery simply might not be possible or worth the effort. “The biggest message I received time and time again was that things might improve a little bit, but there would always be a ceiling,” she says. “This made it hard for me to sustain motivation towards recovery or know what was truly possible.”. Luckily, Degener persisted in her treatment and eventually met others who’d walked the same path. “It wasn't until I started finding others who were a bit further along in their recovery that I could start having these, ‘that's possible?’ moments,” she says. “Like, ‘you can really eat that sandwich with real bread and not worry about it?’ and ‘you can really go out to a restaurant spontaneously and not scour the menu beforehand?’” For a long time, Degener believed that she’d gone as far as she could in recovery, and accepted that her eating disorder would always have at least some sort of hold on her. But seeing examples of others thriving and fully free from the shackles of their illnesses made her wonder if she could be that liberated too. “It was scary to think that there might be more work for me to do,” she says. “And at the same time, it was a push I needed to continue to challenge the eating disorder voice even more, and pursue new challenges and chapters in my recovery. There was hope there, even if it was scary or uncertain at times.” Today, Degener serves as Equip’s Director of Coaching, leading some of our most valuable team members: Coaches. At Equip, each family or patient is matched with a dedicated multidisciplinary team that includes a licensed therapist, registered dietitian, medical provider, and a coach or coaches. There are two types of coaches:  Recovery Coaches: Those who have personally recovered from an eating disorder  Caregiver Coaches: Those who have supported a loved one through eating disorder recovery  Both roles are invaluable in treatment and, according to research, may make a significant difference in a patient successfully achieving lasting recovery. What the research says about the importance of coaching While many studies have demonstrated the profound impact coaching can have on mental health conditions like depression and anxiety, few eating disorder treatment programs integrate lived experience the way Equip does. But both first-person accounts and research confirm the value of coaching for eating disorders specifically. According to a 2019 study published in The International Journal of Eating Disorders, peer coaching was shown to be effective in addressing cognitive and behavioral eating disorder symptoms. Out of sixty outpatients with anorexia, bulimia nervosa, or binge-eating disorder (BED), those who received mentorship and coaching from peers in recovery had greater reductions in body dissatisfaction and anxiety than those who received support from people without lived experience or those who were placed on a waiting list for support. Real-life experience bears out this research. “Working with someone who had been through the whirlwind of recovery allowed me to feel truly seen,” says Equip Recovery Coach Stacy Jones. “I could finally talk to someone who spoke the same language, and modeled that it was possible to get through it. It provided an energy and hope to my recovery that I didn't realize I was missing.” Degener says that in her experience, she’d felt limited to only discussing “surface-level” elements of her eating disorders like body image concerns with those who hadn’t experienced an eating disorder themselves. “Eating disorders are highly complex and nuanced experiences,” she says. “It’s very hard to relate to or fully understand how greatly they can impact someone's life until you've had an intimate experience with one, whether in yourself or someone you love.” When she connected with peer coaches, however, she finally felt able to open up about deeper issues. “I definitely didn't feel comfortable sharing with most people that when my eating disorder was loud, I acted far outside my values, even being physically violent with my family members or hurling insults at them,” she says. “So much of recovery can be tethered up in shame and secrecy, and to have someone who can meet you with true non-judgment and compassion can allow you to talk about the deepest challenges of an eating disorder in a new, supportive way.” Coaching is also a powerful way to overcome the stereotypes that may prevent some people from seeking treatment. There’s a pervasive myth that eating disorders tend to affect thin, white, affluent girls—when in reality, they affect people equally across genders, races, ethnicities, socioeconomic status, and body sizes. This misconception can be incredibly alienating for those struggling who don’t fit the mold of what society thinks an eating disorder looks like—and coaches can help with that. Being able to connect with someone who shares your experience or identity can be incredibly powerful in instilling hope and a belief that treatment will work.  Caregiver coaching matters too The value of coaching isn’t limited to patients: research has also indicated that the role can have a positive impact on loved ones of the patient as well. According to a 2020 report conducted by F.E.A.S.T. in collaboration with Project HEAL, there is often a steep learning curve for loved ones attempting to understand the complex terrain of eating disorders. In addition to requiring educational materials, parents and caregivers need specialized strategies for managing care, as well as treatment resources. F.E.A.S.T. and Project HEAL’s research revealed that parents greatly benefited from their own peer support—especially the education and compassion it provided them. “Serving as a coach gives new meaning to everything I’ve learned the really hard way about helping a child through eating disorder recovery,” says Equip Caregiver Coach Kristi Humston. “The gift of hindsight, however, is seeing how the experiences we didn’t ask for but survived can result in hope and lived ‘expertise’ that helps to make the journey for others a little easier.” Among the many important takeaways Humston hopes to drive home as a Caregiver Coach, there are two essential points she covers in her first conversation with families: “First, letting them know that they did not cause the eating disorder,” she says. “And second, that they may as well throw logic out the window. Letting go of the guilt and logic allows space for real conversation and real progress to be made.” While the expertise of trained clinicians—including a medical provider, therapist, and dietitian—is essential to eating disorder recovery, these kinds of empathic insights can often only come from someone who has been through it themselves. And when you’re in the thick of eating disorder treatment, overwhelmed and unsure of what the future holds, these can often be the pieces of wisdom that give parents the strength and motivation they need to keep going. Forging a deeper connection that reinforces recovery “There are many small but highly impactful moments in recovery that can be hard to go through alone,” Degener says. “I'll always remember an Equip Recovery Coach supporting a patient through sorting out some old clothes that they were having a difficult time parting with. The Recovery Coach could offer jokes or distraction when needed, hold space while the patient cried, or simply be there quietly as a gesture of support. Recovery can be so lonely and hard to describe at times. To just have someone to walk alongside you can be incredibly meaningful.” Jones adds that coaches also play a critical part in reducing the stigma around eating disorders and helping patients and loved ones reframe their perspective. “Coaching can be an incredible place for reducing shame—and eating disorders are often fueled by shame,” Jones says. “The shame can even become one of the main ways we relate to ourselves, developing into a deep-rooted belief that dictates how we live our lives. Coaching is a place of compassion and acceptance because coaches get it. And this creates a pathway for shame to unravel.” To illustrate how her relationship to coaching has truly come full circle since her days as a patient, Degener says her role as a coach has also benefited her own long-term recovery. “I find it to be a healthy source of accountability,” she says. “If I'm going to be ‘talking the talk’ with patients, I'm going to need to ‘walk the walk’ in my own recovery. I get to talk to individuals every day about the benefits of recovery and the value in challenging the eating disorder, and in that, I'm reaffirming those truths for myself, too. At its best, coaching can be a wonderfully meaningful relationship for everyone involved.”]]></content:encoded>
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            <title><![CDATA[ARFID in Adults: Symptoms, Causes, and Treatment Options ]]></title>
            <link>https://equip.health/articles/understanding-eds/ARFID-in-adults</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/ARFID-in-adults</guid>
            <pubDate>Wed, 26 Aug 2026 23:19:00 GMT</pubDate>
            <content:encoded><![CDATA[For a lot of us, food is a source of joy and pleasure. But it isn’t fun for everyone. For those with avoidant/restrictive food intake disorder (ARFID), formerly called “feeding disorder of infancy and childhood,” food can be a serious source of anxiety and distress. ARFID isn’t like other eating disorders, even ones that also involve food restriction, like anorexia. “ARFID is often misunderstood,” says Pam Skop, LMHC, CEDS, RPYT, an eating disorder specialist and the founder of EveryBody Psychotherapy NYC. “I explain it as an eating disorder not driven by body image or weight concerns, but by fear, sensory sensitivity, or distress related to food.” She adds, “For some, that fear stems from a past choking incident or gastrointestinal pain. For others, it’s rooted in sensory overwhelm. Certain textures, smells, or temperatures can feel intolerable.” While ARFID is more commonly diagnosed in children and adolescents, it can affect people of any age. Adults with ARFID may have struggled with this eating disorder since childhood, or develop it later in life. In this article, we explore ARFID in adults, ARFID types, signs of ARFID, causes of ARFID, ARFID diagnosis, ARFID treatment, and more. What is ARFID and how does it present in adults? ARFID is a recognized eating disorder in which your food intake is limited because of sensory sensitivities, fear of aversive consequences from eating certain foods, or a lack of interest in food or eating in general. ARFID in adults may look like having a short list of “safe” foods, while severely limiting others based on “texture” or “food sensitivity” issues, or it can show up as a fear of eating or low appetite or motivation to eat. If you have, or suspect you have, ARFID, you’re not alone. The condition, which can seriously impact your health and quality of life, affects up to 5% of the general population. It affects both males and females, though some research indicates a slightly higher prevalence in people assigned male at birth — another difference from other eating disorders, which are more commonly diagnosed in those assigned female at birth. ARFID isn’t as well-known as other eating disorders, like anorexia. But awareness seems to be increasing: searches for information on ARFID have grown by 400% since 2022, according to Google Trends data. Additionally, health insurance claims for the diagnosis and treatment of ARFID increased by 305% from 2018 to 2022.  So what is ARFID? To understand ARFID, understanding what it is not is helpful. It’s not picky eating, which isn’t an eating disorder. When considering ARFID vs. picky eating, says Michelle Jones, PhD, a licensed clinical psychologist and clinical instructor at Equip, “a common misconception…is that individuals with ARFID are choosing to be picky or limit their intake out of stubbornness or oppositionality.” But that’s not the case. “Many elements of how individuals with ARFID experience food are outside of their control and can have a significant impact on their social functioning, academic and work performance, and physical and mental health,” Dr. Jones adds. People with ARFID may even have misconceptions about themselves, as well. “Adults with ARFID often describe their eating patterns as ‘picky’ or ‘childish,’” Skop says. “But that language hides the real issue, a nervous system stuck in a loop of avoidance and fear.” And while both diagnoses involve food restriction, ARFID is vastly different from anorexia nervosa, an eating disorder with much more public awareness. Characteristics of anorexia include a strong fear of gaining weight and using extreme efforts to prevent or counteract weight gain, such as severely restricting food, excessively exercising, and more. When considering ARFID vs. anorexia, it’s important to understand that people with ARFID restrict food intake, but they aren’t doing so because of a distorted body image or concerns about size, weight, or shape. Instead, people with ARFID avoid or restrict foods for other reasons, such as fear of discomfort after eating, aversions to food texture or taste, or a lack of interest in eating. Understandably, these issues can be highly distressing and affect your overall health, happiness, and everyday life. Thankfully, working with a knowledgeable care team can help you cope with and recover from ARFID so that you feel more empowered regarding food and situations that involve eating. What ARFID looks like in adults vs. children ARFID may present a little differently in adults than it does in children. Here are some key differences.  Dr. Jones expands on these differences with a few points: ARFID symptoms typically show up at an early age and can persist through someone’s whole life. Sensory sensitivities and lack of interest in food typically begin in infancy or early childhood—but may be more normalized at that time, too. “For example, a child with sensory sensitivity may have socially acceptable access to ‘kid-friendly’ foods that feel safe and may have less understanding of the negative impacts of a limited variety,” Dr. Jones explains. Fear of aversive consequences can develop at any point in time. On the other hand, an adult who only eats limited or specific foods “may not have access to preferred foods at social events and work functions,” Dr. Jones says. This may lead to them limiting their social engagements “due to concern about judgment.” She adds that adults with ARFID may also “ have greater insight into potential health consequences of a limited variety of food intake” than children with the condition. Within each presentation of ARFID, symptoms are often similar regardless of age, but the impact of the symptoms can vary based on age. The three types of ARFID ARFID shows up differently from person to person, but there are three types, or presentations. Each set of symptoms is associated with various mental health and neurodevelopmental co-occurring conditions, and people often have symptoms of more than one type. “Each of these reasons represents a presentation of ARFID: sensory sensitivity, lack of interest, and fear of aversive consequences,” Dr. Jones says. “And people diagnosed with ARFID can experience one, two, or all three of these presentations.”  Sensory sensitivity/avoidant People with this set of ARFID symptoms have food aversions based on sensory input. For example, textures, tastes, smells, colors, temperatures, or the appearance of some foods can cause disgust. Common comorbidities include autism spectrum disorder (ASD) and sensory processing disorder (SPD). Although different, both these conditions can feature big reactions to sensory input—like certain clothing textures, or loud noises. Fear of aversive consequences Fear of aversive consequences is the most common type of ARFID in adults. People with this set of ARFID symptoms experience food anxiety or fear of eating certain foods. They may fear negative consequences, such as choking, pain from eating or digesting food, or nausea or vomiting. In some cases, this type can arise from a food-related traumatic event, like a previous choking incident, allergen exposure, or food poisoning that led to illness. But it can also develop over time after repeated negative experiences with food, such as in response to chronic gastrointestinal pain or discomfort. Common comorbidities include anxiety disorders and obsessive compulsive disorder (OCD). Lack of interest People with this set of ARFID symptoms have a lack of interest in food. They may miss hunger cues, forget to eat, take little pleasure in eating, or have a low appetite in general. A common comorbidity is attention deficit/hyperactivity disorder (ADHD), which impacts executive function, the mental skills you use to manage everyday tasks, problem-solve, and adapt to changes. Food aversion in adults: when is it ARFID? We all have foods we dislike, a completely normal phenomenon, but a food aversion is a pattern that restricts nutrition, causes significant distress, and drives the avoidance of eating in certain situations. If you’ve been searching for a “food aversion disorder” to name what you or a loved one might be experiencing, ARFID is the clinical term. Keep in mind that a temporary food aversion can come on suddenly as a result of illness or a gastrointestinal issue, such as getting diarrhea after eating a certain food. ARFID involves a consistent and ongoing pattern that often generalizes to multiple foods or affects eating more globally. What causes ARFID in adults? “While there’s no singular cause of ARFID and we are still learning about causes of ARFID,” Dr. Jones adds, “there are some biological and environmental factors that can contribute to ARFID developing.” That’s true of both children with ARFID (the most common group) as well as adults with ARFID. Genetics and biological factors Genetics appear to play a significant role. A study looking at Swedish twins, ages 6 to 12, found that inherited factors accounted for 79% of the propensity toward the condition, while other factors (not shared between twins) accounted for about 21%. Other studies have linked appetite regulating hormone abnormalities to ARFID. Genetic factors that might contribute include differences in taste processing and interoceptive awareness, which is your sensitivity to internal body sensations. For example, your body has mechanisms that tell your brain you’re hungry, but some people are more sensitive to those cues than others. “There is some evidence of genetic influences of taste preferences and that having heightened sensitivity to sensory properties of food may run in families,” Dr. Jones says. “Individuals with sensory sensitivity and lack of interest often experience ARFID symptoms as early as the infant or toddler years and may find that their symptoms are exacerbated by childhood experiences.” As an example, children whose preferences are routinely accommodated may be more likely to have difficulty trying and accepting new foods as they get older, she adds. Without intervention, ARFID symptoms that appear in early life tend to persist or worsen over time. A traumatic event ARFID may stem from a traumatic food-related event. Perhaps you endured a choking incident. Understandably, such a scary situation can lead to anxiety surrounding food and eating. Or maybe you have food allergies and faced a severe allergic reaction to a specific food. Again, this experience may have caused intense fear, and you might worry about it happening again, especially in situations where you don't have access to a list of food ingredients. Avoiding an allergen, such as nuts, doesn’t mean you have ARFID, but you may be avoiding food in general out of fear of another allergic reaction. That behavior is consistent with ARFID. “Individuals predisposed to anxiety may be more likely to experience ARFID symptoms following these types of events compared to those who are not predisposed to anxiety,” Dr. Jones says. If these situations apply to you, that doesn’t mean you’re being picky or overly fearful. When a child undergoes a traumatic event or situation, researchers call it an adverse childhood experience (ACE). ACEs have links to disordered eating behaviors. An ACE could then lead to having ARFID as a child, or the eating disorder could manifest in adulthood. Likewise, any food-related traumatic experience in adulthood could lead to ARFID soon after or down the road. Social and environmental factors Trauma surrounding food isn’t limited to events such as choking or allergic reactions. Some social and environmental factors related to food can lead to a trauma response that then contributes to ARFID. Food insecurity, such as not having enough money to buy food or having limited access to it, is an example. Nearly 15% of households in the United States experience some form of food insecurity. And it’s an issue that may have affected you as a child or as an adult, leading to ARFID at any age.  Other possibilities include having been shamed or mocked for eating or pressured to eat foods that you didn’t like. Adult ARFID may stem from aversive experience with food in childhood that led to the formation of negative attitudes towards specific foods or eating in general. An underlying physiological condition Many disorders affect the gastrointestinal (GI) tract, including irritable bowel syndrome (IBS), gastroesophageal disease (GERD), and inflammatory bowel disease (IBD), just to name a few. With these conditions, certain foods, or even eating in general, can cause discomfort. Often the treatment for these conditions requires people to go on special diets. These special diets may actually increase your fear of foods or eating, leading to the development of ARFID. The correlation doesn’t just apply to just GI issues. Conditions that feature chronic pelvic pain, such as endometriosis, also share associations with eating disorders. Regardless of when you were diagnosed with a condition, whether in childhood or adulthood, the situation can lead to disordered eating. Many clinicians believe ARFID rates are higher in adult GI clinics compared to pediatric ones; one hypothesis is that ARFID develops after years of accumulated negative experiences with food or eating. Psychological and developmental factors As noted above with the different types of ARFID, this eating disorder sometimes coincides with other mental health or neurodevelopmental conditions, including generalized anxiety disorder (GAD), major depressive disorder (MDD), autism spectrum disorder (ASD), sensory processing disorder (SPD), obsessive compulsive disorder (OCD), and attention deficit/hyperactivity disorder (ADHD), as a few examples. Symptoms of these conditions may contribute to ARFID. For example, food texture aversion is associated with both ASD and SPD, and common concerns with ADHD include skipping meals or forgetting to eat. Both depression and anxiety can also lead to low appetite, general food disgust, or a specific texture aversion in adults or children. Another way that these mental health and neurodevelopmental conditions may exacerbate ARFID symptoms is through medication side effects. Some medications, especially for ADHD, can cause a reduced appetite, which can worsen existing ARFID symptoms.  ARFID symptoms in adults The symptoms of ARFID in adults “can vary significantly depending on the presentation or presentations the individual is experiencing,” Dr. Jones says. Additionally, some ARFID symptoms typically show up in childhood rather than adulthood, or vice versa. The following are some potential signs and symptoms of ARFID in adults: Eating behaviors Avoidance of certain food textures, colors, smells, or temperatures Low food intake not motivated by body-image concerns Difficulty eating in social settings or with others watching Food neophobia (reluctance or refusal to try new foods) Forgetting to eat Low interest in eating or poor appetite Refusal of entire food groups (e.g., fruits, vegetables, meats) Reliance on supplements or nutritional drinks instead of meals Restricted range of accepted foods (often fewer than 20 items) Physical signs Dizziness or faintness from poor nutrition Dry skin or brittle hair and nails from nutrient deficiencies Fatigue or low energy Headaches related to undernutrition or dehydration Low body weight Malnutrition or micronutrient deficiencies Nausea when eating Physical discomfort when eating Trouble concentrating or cognitive slowing from poor nutrition Weight loss Emotional and social signs Anxiety about eating or food-related situations Anxiety about or refusing to try new or unfamiliar foods Fear of choking, vomiting, or gastrointestinal distress/pain Irritability or mood changes due to inadequate intake Preoccupation with “safe” foods or meal rituals Rigidity about the types of foods eaten and how they are prepared Social withdrawal due to food-related embarrassment or anxiety If these symptoms seem familiar to you, you can assess whether you might have ARFID by taking Equip’s clinically validated ARFID self-assessment.  How is ARFID diagnosed in adults? Working with a clinician who has expertise in eating disorders, and specifically ARFID, is crucial. To diagnose ARFID, your clinician will ask you several questions or give you questionnaires or assessments. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) lists four criteria for an ARFID diagnosis: Criterion A: Difficulty eating associated with at least one of the following: Significant weight loss or failure to maintain expected weight (although ARFID can be present and serious whether or not someone is underweight) Nutritional deficiency Dependence on supplements or tube feeding Marked interference with psychosocial functioning Criterion B: The disturbance is not due to lack of available food or culturally sanctioned practice, such as a fasting period or holiday. Criterion C: The disturbance does not occur exclusively during anorexia or bulimia nervosa, and a body-image disturbance isn’t present. Criterion D: The eating disturbance is not due to a medical condition. (Or if one is present, the severity of restriction exceeds what’s expected from that condition). Your doctor will ask you questions about the following: Your medical history and your family’s Your history of mental health and neurodevelopmental conditions Your history of traumatic feeding experiences, if any Your history of GI conditions or abdominal and pelvic pain complaints Your symptoms and eating habits, including any changes and when they first began Treatment for adults with ARFID “Treatment often includes a multidisciplinary approach: therapy, nutritional support, and sometimes medical monitoring,” Skop says. “In therapy, we work to expand food flexibility through gradual exposure, nervous system regulation, and addressing underlying trauma or anxiety, rather than forcing compliance.” Dr. Jones adds, “By utilizing a multidisciplinary team, the various ways in which ARFID can impact an individual’s social, emotional, and physical health can be fully addressed.” One caveat: “It is important that the members of the care team have knowledge of and experience in treating ARFID to ensure that effective techniques are being implemented to adequately and appropriately address symptoms,” Dr. Jones says. Keep in mind that treatment for children with ARFID differs from that of adults. For children, treatment involves working with parents or guardian caregivers alongside the child. For adults, the focus is on empowering you. Here are a few treatment possibilities for adults: Cognitive behavioral therapy for ARFID (CBT-AR) CBT in general focuses on identifying and challenging negative thought patterns and behaviors with the intent of developing healthier coping mechanisms. CBT-AR focuses on thoughts, feelings, and behaviors surrounding food and eating. You’ll work closely with a therapist to learn more about ARFID and how it manifests. CBT-AR also typically involves self-monitoring between sessions, to help increase awareness of your eating behaviors and make changes. CBT-AR also includes different treatment approaches specifically designed to address the three different drivers of ARFID—so the treatment can be personalized to address your unique set of symptoms. At Equip, your therapist will administer CBT-AR, but you also have access to a medical provider and dietitian to help with weight restoration (if needed) and a recovery coach who can provide support based on lived experience. Exposure and response prevention (ERP) This type of therapy is often a component of CBT-AR. It focuses on gradual exposure to foods and settings related to eating. This treatment is usually used to address ARFID symptoms associated with a specific fear of eating. You and your therapist will identify a list of foods and situations that trigger your fears and create a hierarchy of these situations. Then, you and your therapist will work on gradual exposure to these things, starting with the least distressing first and building exposure from there. The goal is to help you learn that these foods and situations are actually safe or that you can tolerate distress. A key focus of ERP is the response prevention component. Your therapist will guide you on how to resist your usual avoidance behavior, such as seeking reassurance or checking labels. As you progress, you learn healthier coping mechanisms to deal with anxiety or distress surrounding meals. And you can even continue the process on your own after initial treatment. Virtual care for ARFID Virtual care can be particularly valuable for those dealing with ARFID, and is often a more accessible and convenient option. For busy adults juggling the demands of work and families, virtual care can accommodate already-packed schedules and eliminate the need to commute. Evidence-based modalities like CBT-AR and ERP can be delivered virtually. Peer support In addition to one-on-one therapy, you may also find it helpful to join support groups with other people who have ARFID. Equip features a wide range of ARFID-specific support groups for patients of all ages.  Medications The Food and Drug Administration (FDA) has not approved any medications to specifically treat ARFID. However, your provider might prescribe medications to treat underlying issues that are contributing to the disorder, such as anxiety, depression, and more. In some cases, they may prescribe a medication off label (meaning for a use other than originally intended). There are a number of medications, such as Periactin or cyproheptadine, that have been used to help increase appetite. When to seek help “People should seek help when avoidance begins to interfere with health, social connection, or emotional well-being,” Skop says. “Healing isn’t about eating ‘normally.’ It’s about rebuilding safety and trust in the body’s relationship with food.” “If someone suspects that they or their loved one has ARFID symptoms,” Dr. Jones says, “it is important to seek evaluation from a professional who is experienced in diagnosing eating disorders, including ARFID.” “At Equip, all providers are trained in the best clinical practices for treating ARFID and use these approaches to target the specific symptom set each individual identifies during the intake process,” she says. “We utilize a patient-centered approach backed by research to support patients in achieving their physical, nutritional, and psychosocial goals.” You should seek urgent help if you are experiencing any of the following related to ARFID: Abnormal heart rate, such as slow, fast, or irregular Dizziness or fainting Dehydration Dependence on supplements or liquid nutrition options Frequent illness due to poor nutrition Low body weight Low blood pressure Low body temperature Nutritional deficiencies Seizures Suicidal thoughts  The bottom line ARFID recovery will be different for everyone, and adults typically need different treatment approaches than children. Although recovery may not lead you to crave all foods or to love all situations related to eating, it can help you expand your options, ease anxiety about food, and improve your nutrition, overall health, and well-being. Most importantly, anyone, adult or child, who is dealing with ARFID or another eating disorder should know that recovery is possible at any age, regardless of how long you've been struggling. Recovery is not always straightforward, and it can be difficult, but it’s worth the effort to achieve the healthy and fulfilling life you deserve. FAQ How do you treat ARFID in adults? In adults, avoidant/restrictive food intake disorder (ARFID) requires a multidisciplinary approach. Cognitive behavioral therapy for ARFID (CBT-AR) is currently the top recommended approach; this treatment helps you recognize and challenge negative thoughts, feelings, and behaviors surrounding specific foods and eating and develop better coping mechanisms. A component of CBT-AR is exposure and response prevention (ERP), which is a step-based approach to expanding your food options and more. Group support, medications, and working with a dietitian to establish regular eating patterns and expand variety may also help with your recovery.  What are the three types of ARFID? The three types of avoidant/restrictive food intake disorder (ARFID) include sensory sensitivity, fear of aversive consequences, and lack of interest. People with the sensory sensitivity type have food aversions based on sensory input, such as texture or taste. People with the fear of aversive consequences type may fear choking, pain from eating or digesting food, or nausea or vomiting. People with the lack of interest type may miss hunger cues, forget to eat, or have a low appetite in general. People can have one or more types of ARFID at a time. Is ARFID a mental illness? Yes, avoidant/restrictive food intake disorder (ARFID) is an eating disorder, and eating disorders are considered mental illnesses.  Can you develop ARFID as an adult? Yes, you can develop avoidant/restrictive food intake disorder (ARFID) as an adult. Many factors may play a role, including traumatic experiences related to food, genetics, underlying mental health or neurodevelopmental disorders, and more. How do I know if I have ARFID? Ask yourself if you have a restricted range of foods you eat, distress regarding food and eating, health symptoms related to food restriction, and social issues because of your food restriction. If so, you might have ARFID. You can also take a free ARFID screener to learn more. How do you deal with ARFID as an adult? You can seek treatment for ARFID with an ARFID-experienced clinician. Treatment might include evidence-based methods such as cognitive behavioral therapy for ARFID (CBT-AR) and exposure and response prevention (ERP), medications, peer support, and practical coping strategies, such as meal planning for social situations.  ]]></content:encoded>
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            <title><![CDATA[Signs of Anorexia: How to Spot Changes in Yourself or Someone You Love]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/signs-of-anorexia</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/signs-of-anorexia</guid>
            <pubDate>Tue, 16 Dec 2025 00:43:00 GMT</pubDate>
            <content:encoded><![CDATA[When people start skipping meals and limiting food groups out of fear of gaining weight, it’s rarely a good sign. And for some, like one teenager named Emily, these behaviors were the first signs that she was developing an eating disorder. Emily’s mom Kristen began noticing that her daughter, who was a dancer, was becoming smaller and smaller in her leotard. Soon, she saw that Emily was barely packing any food in her school lunch box each day—and the food she did bring to school would often return home at day's end, largely uneaten.  "Over the span of time, I noticed she was restricting what she was eating and the amounts [of food]," says Kristen, who later learned from a dietitian that her daughter had an eating disorder. That disorder turned out to be anorexia nervosa, a condition that can be life threatening if left untreated.  Anorexia nervosa is a complex eating disorder that involves restricting food and intense fear of gaining weight, to name a few of the signs and symptoms. There are many others, as well, linked to exercise habits, food behaviors, body image, socializing and more.  In this article, we'll take a closer look at what anorexia nervosa involves as well as the warning signs of anorexia nervosa, so you can know what to watch for in a loved one (or yourself) as well as how and when to seek help. What is anorexia nervosa? Anorexia nervosa, often just called anorexia in non-medical terms, is a serious eating disorder and mental health condition in which a person restricts the amount of food they eat because of an overwhelming fear of gaining weight and a distorted perception of their body.  "It’s not about vanity; it’s a complex illness that can become a person’s way of coping with difficult emotions, trauma, or a sense of life feeling out of control," says eating disorder and body image expert Cherie Miller, LPC-S, CEDS-C, IEDS, clinical director and CEO of the Nourished Soul Center for Healing.  According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) there are three key criteria for anorexia nervosa: Restricting intake of calories enough to cause low body weight for someone’s age, sex or development trajectory Intense fear of gaining weight or becoming fat Inability to recognize the seriousness of the condition  In addition, there are two different subtypes of anorexia nervosa. The two types are anorexia nervosa restricting type (AN-R) and anorexia nervosa binge/purge type (AN-BP). Both of these types of anorexia nervosa involve engaging in severe food restriction, along with significantly low body weight and the fear of weight gain. Anorexia nervosa binge-purge type, however, also includes episodes of purging food and sometimes binging on food.  Atypical anorexia, on the other hand, is categorized as an “other specified feeding and eating disorder” (OSFED), a diagnostic category for all eating disorders that don’t fit neatly into the other diagnostic criteria. People who have atypical anorexia nervosa have significant weight loss from restriction of food or purging behaviors and are at risk of all the same medical complications as those with anorexia nervosa, says Barbara Kessel, DO, a psychiatrist at Equip. "Atypical anorexia is really not atypical at all," adds Kessel. "Atypical AN is actually more common than AN-R or AN-BP and has all other diagnostic criteria for typical anorexia nervosa with the exception of low body weight."  Underscoring Kessel's point, a meta analysis published in 2021 in the International Journal of Eating Disorders found that atypical anorexia nervosa actually occurs more than anorexia nervosa, but fewer people with this particular condition are referred to or admitted to a facility to receive the care needed for an eating disorder.  Anorexia nervosa has a lifetime prevalence of up to 4 percent of females and 0.3 percent of males, according to data published in 2024 by the National Alliance for Eating Disorders. In addition, anorexia nervosa has the second highest mortality rate of any mental disorder, after opioid use disorder. About 5-10 percent of people with AN will die within 10 years, and 18-20 percent may die within 20 years.  But those statistics are far from the full story: It’s crucial to know that anorexia nervosa is a treatable condition. There are so many effective approaches available to help those who are struggling regain a healthy weight and establish healthy eating habits. What are signs of anorexia nervosa? There are many signs of anorexia nervosa, ranging from physical to behavioral, emotional, and social. While some of the signs of anorexia nervosa are observable, just as many aren't. Often, the symptoms may be internal or may even be subjective. In still other cases, signs of anorexia nervosa may be something a person does in secret.  "Eating disorders can be tricky to spot in a loved one because so many signs and symptoms are culturally sanctioned or even praised as 'disciplined.'" says Kessel.  In addition, many of the signs of anorexia nervosa may appear together or impact each other. "Anorexia nervosa affects people emotionally, physically, socially, and behaviorally, and those four areas constantly influence one another," says Miller. "Emotional distress often shows up first, feelings like anxiety, fear of weight gain, perfectionism, or pressure to be in control. Those emotions then lead to changes in behavior, such as skipping meals, cutting out foods, being rigid about ingredients, or needing to know every calorie."  Once the body becomes undernourished, physical symptoms begin appearing, and those physical effects, such as brain fog, irritability, and slowed thinking, can make the emotional distress worse, adds Miller.  Here's a closer look at the various signs and symptoms of anorexia nervosa. Physical signs of anorexia nervosa There are a variety of physical signs of an eating disorder like anorexia nervosa. Some are outwardly obvious examples(think: weight loss or thinning hair) while others are less immediately apparent, such as reduced bone mass. All of the physical symptoms are tied to the same issue.  "The physical and emotional changes involved in AN are a direct result of malnutrition," explains Kessel. "As the body becomes malnourished, there is fat and muscle loss throughout the body. This includes important fats that help our brains and neurons function (myelin) and muscles that make up our heart and gastrointestinal systems. Having an eating disorder takes an enormous emotional and physical toll on individuals."  The following are some of the potential physical signs of anorexia nervosa:  Rapid and/or substantial weight loss Lethargy or extreme fatigue Feeling weak Lightheadedness Fainting Irregular heart rhythm Constipation Stomach or abdominal pain Regularly feeling cold Thinning hair Fine, downy body hair known as lanugo Dry, yellow-colored skin Brittle nails Irregular menstruation or no periods Swelling of arms of legs Reduced bone mass Behavioral signs of anorexia nervosa Behavioral signs that someone has anorexia nervosa can often start subtly, but over time, they may escalate and become more obvious. Moreover, many of the behaviors associated with this illness may be practiced when others are not watching, such as secretive eating. In addition, the impacted individual may lie about their actions. For instance, they may say they've eaten, when in reality they have not had any food.  The following are some of the potential behavioral signs of anorexia nervosa:  Excessive exercise Dieting Obsession with appearance Fear of gaining weight Food rituals such as cutting food into small pieces or using excessive spices Focus on making own food Eliminating entire categories of food Counting calories Use of laxatives or appetite suppressants Hiding food Going to the bathroom after eating to purge Trouble sleeping Emotional signs of anorexia nervosa  Anorexia nervosa can also take a significant emotional toll, even impacting relationships, work performance and many other areas of our daily life. Here too, there are signs to be alert for, or emotional indicators that a person may be struggling with an eating disorder. Mood swings, depression or increased anxiety are additional red flags or signs of the disorder.  "For example, skipping a workout leads to significant distress. Or individuals are exercising in spite of injury or illness, or they're having anxiety about food," says Kessel.  "People with anorexia nervosa will become increasingly anxious, obsessive, and emotionally blunted or depressed as they fall deeper into their illness," adds Kessel. People with anorexia nervosa may also struggle with suicidal ideation or self-harm behavior. Importantly however, none of these emotions are personality flaws, but are symptoms of an illness that requires treatment and care.  The following are some of the potential emotional signs of anorexia nervosa:  Increased anxiety Feeling angry or irritable Obsessive thinking Loss of interest in sex Mood changes Depression Perfectionism Difficulty expressing emotions Focus on appearance Lack of emotion Social signs of anorexia nervosa Anorexia nervosa not only affects a person's relationship with food, but many other areas of life as well, including their social life and behavior around others. Often, this involves distancing from others.  "So much of what we experience in life focuses around food, so changes in a relationship with food with in itself lead to isolation and removal from social experiences," says Kelsey Latimer, PhD, CEDS-S, APRN, PMHNP-BC, a psychologist, psychiatric nurse practitioner and CEO KML Psych Services. "In addition to that, we need to realize that there is often depression, anxiety and trauma that accompanies this disorder and those things in themselves also change the way someone moves through the world."  Indeed, anorexia nervosa may limit where someone is willing to go, what they're willing to do and even how they interact with others. This is often because anorexia nervosa impacts a person's sense of physical well-being and also their self-worth.  "They may stop going out, lose interest in hobbies, or seem distracted and disconnected," explains Miller. In addition, she says "relationships become strained because the eating disorder starts making decisions for the person."  Some of the potential social signs of anorexia nervosa include:  Withdrawal from social activities Concerns about eating in public or around others Lack of spontaneity Focus on controlling their environment Anxiety about participating in holidays or other events Finding it hard to relate to others Feeling detached If you're wondering if any of these signs of anorexia are preventable, this article is a great place to learn more about what is and isn't controllable.  When and how to seek help If you or someone you love may be impacted by an eating disorder, it’s crucial to get help as soon as possible. It is never too early to act. In fact, the research is clear that early treatment leads to better outcomes; eating disorders don't go away on their own, and often get worse over time.  "Research has shown that the sooner someone gets help, the more likely they will be to make a full recovery from their eating disorder," says Kessel. "Waiting to seek help can lead to worsening of the illness, increasing need for hospitalizations or higher levels of care."  Equally importantly, there is no such thing as needing to be “sick enough” to get care. Treatment can help at any point in the disorder journey, no matter how long the illness has been present. "All people with an eating disorder deserve evidence based treatment, like that offered at Equip," says Kessel.  The first step is to reach out to a healthcare professional, whether the illness is impacting you or someone you love. You can talk through your concerns on a free, no commitment consultation with an eating disorder expert at Equip. For yourself If you're struggling with anorexia nervosa, it's not unusual to feel shame or fear about your illness and be embarrassed to seek help. But it's important to understand that obtaining treatment for anorexia nervosa is critical.  Waiting to get help can lead to a worsening of the eating disorder—and a potentially increased risk for inpatient care or hospitalization for medical stabilization. For someone you love If you're worried that someone you know or love may have anorexia nervosa, it's important to talk about those concerns with the individual. Discussing some of the objective behaviors you've observed can be an effective approach to initiate this type of conversation without making it seem like an attack.  "Being specific with things you are noticing that might be related to food and beyond takes away the personal attack and focuses on objective reality," says Latimer. "It is always best to come from a place of caring compassion instead of anger, shaming, or aggressive angles."  "These conversations are very difficult to maneuver at times and will often lead to a person denying the issues even with evidence presented," Latimer adds. "That's a part of the process and does not mean you've done something wrong or that the person isn't listening."  Some techniques to consider include: Name some objective behaviors and emotions you've noticed Let the person know you're concerned about them Avoid commenting on the person's weight or appearance  Some phrases to consider: "I've noticed you are avoiding eating around other people and have been acting more anxious around meal times." "I want to help support you.” “I care about you, and I’ve noticed some things that worry me." “I want to understand what you’re feeling.” As difficult as it may be to initiate a conversation, helping someone suffering from anorexia nervosa is an important first step on the road to getting them treatment. It's also important to be prepared for pushback, defensiveness or denial. Often, a person with an eating disorder may not want help. The key is to avoid being discouraged by their response or give up. It may take more than one conversation to make progress.  And one more important point for parents: if your child is a minor, their signoff is not required to get them into treatment. Moreover, it's not only common, but expected that a young person with anorexia nervosa might be defensive or wholesale resist the idea of needing any sort of treatment at all. The critical takeaway is that it's important for you to seek help for your child anyway. The sooner someone begins treatment, the better the odds of a full recovery. What to expect If you or a loved one is ready to seek help from a healthcare professional, it's important to know what to expect. The evaluation process is not all that unlike visiting a primary care doctor for an annual checkup.  That means the healthcare professional will conduct a complete physical exam. But there will also likely be questions about mental health history, eating habits and exercise patterns.  Tests are also typically conducted and they could range from basic steps—like getting the patient's weight and blood pressure and heart rate in different positions—to more extensive options like ordering blood tests including electrolytes,thyroid, kidney and liver function tests,bone density tests, an electrocardiogram (EKG), and potentially a urinalysis.  The good news is there's a variety of treatments available and a practitioner may even discuss some of these during an initial exam. The conversation may cover some of the evidence-based treatments that are available for people of all ages with anorexia nervosa and atypical anorexia nervosa.  Some of the common treatments include family-based treatment (FBT) for children and adolescents and enhanced cognitive behavioral therapy (CBT-E) for adults are manualized treatments that are backed by scientific evidence. These therapies are often supported by a registered dietitian (RD).  Equip treats all types of eating disorders and patients of all ages, providing 100 percent virtual care with a multidisciplinary team. Our evidence-based treatment is accessible immediately, without a waitlist, covered by insurance, and has been proven to support lasting recovery.  Conclusion Anorexia nervosa is a serious, sometimes life-threatening condition. There are many signs and symptoms, some of which are visible, while others happen in secret. Being aware of the signs, whether in yourself or someone else, is the first step to getting the necessary help. Most importantly, seeking assistance sooner rather than later is key, and recovery is always possible. FAQ  What are the beginning stages of anorexia nervosa? Initially, anorexia nervosa may include significant weight loss over the course of a few weeks or months, as well as an intense focus on certain types of food or quantities. The early phases may also include obsession with exercise and use of appetite suppressants. As anorexia nervosa worsens, it may also include abnormal heart rhythm, dizziness, fatigue and constantly feeling cold, among other symptoms.  What are signs of anorexia nervosa? Some of the signs of anorexia nervosa include significant weight loss, fear of becoming fat, focus on food types and quantities, excessive exercising, use of appetite suppressants or laxatives and denial of hunger and abnormal eating behaviors. Thinning hair, brittle nails and lethargy are still more signs, as is social isolation.  How does anorexia nervosa affect the body? Anorexia nervosa can have a variety of serious consequences for your body. That includes becoming malnourished, as well as impacting all of your body's organ systems. It can cause kidney problems, heart problems, low blood pressure, bone loss, and even death.  Does anorexia nervosa cause hair loss? Yes, anorexia nervosa can cause hair loss. It is one of many common symptoms of the eating disorder, along with the development of what's known as lanugo, which is a type of soft, downy hair growth that appears on the sides of the face, the back, and arms and legs.]]></content:encoded>
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            <title><![CDATA[Warning Signs of an Eating Disorder: What to Watch For in Yourself or a Loved One]]></title>
            <link>https://equip.health/articles/understanding-eds/subtle-signs-of-an-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/subtle-signs-of-an-eating-disorder</guid>
            <pubDate>Mon, 24 Nov 2025 20:27:00 GMT</pubDate>
            <content:encoded><![CDATA[When a friend insists they’ve just “gotten healthy,” starts skipping group dinners, or cuts out entire food groups overnight, it can be hard to know what’s normal and what’s cause for concern. Early signs of an eating disorder often look like “healthy habits”—especially in a culture that praises restriction, discipline, and “clean eating.” I know that firsthand. When I developed an eating disorder as a teenager (anorexia nervosa), it was easy to pass my behaviors off as self-control. I told myself I was being mindful, long before any physical changes appeared.  But eating disorders aren’t lifestyle choices. They’re serious, complex mental health conditions. Common types of eating disorders include: Anorexia nervosa: Restriction and fear of weight gain. Note that there are two types of AN, anorexia nervosa, restricting type (ANR), and anorexia nervosa, binge/purge type (AN b/p). Both types involve restriction, leading to a significantly low body weight, and fear of weight gain, but b/p type will also engage in regular episodes of purging and sometimes even binging. The hallmark of both types of AN having is a dangerously low body weight and fear of weight gain. Bulimia nervosa: Cycles of bingeing and compensatory behaviors like purging or excessive exercise Binge-eating disorder (BED): Recurrent binges accompanied by loss of control and distress Avoidant/restrictive food intake disorder (ARFID): Food avoidance due to sensory sensitivities, fear of negative outcomes, or lack of interest/low appetite, not body image concerns Other specified feeding or eating disorder (OSFED): Disordered patterns that cause severe distress but don’t fit neatly into the other categories. These can be just as dangerous. In this guide, we’ll break down the most common eating disorder symptoms, how they can look different from person to person, and what to do if you notice these signs in yourself or a loved one. What are signs of an eating disorder? While every eating disorder looks a little different, many warning signs overlap, says Heather Rosen, PhD, director of the Eating Disorders Program at Psychology Partners Group. Because these signs often develop gradually—and can look like “healthy choices”—they’re easy to miss. Eating disorders also thrive in secrecy, with many behaviors happening in private, adds Rosen. Below are some of the most common physical, behavioral, and emotional signs of an eating disorder. These can appear across conditions like anorexia, bulimia, binge-eating disorder, ARFID, and OSFED. Physical signs Eating disorders affect the body in many ways, and those changes aren’t always obvious. You can’t tell if someone has an eating disorder just by looking at them—research shows less than 6% of people with eating disorders are medically underweight. According to Rosen and Melodie Simmons, DHA, LPC, CEDS-C, a clinical instructor at Equip, you might notice: Noticeable weight or growth changes Fatigue, dizziness, or weakness Feeling cold all the time Dry skin, brittle nails, or hair thinning Missed or irregular periods Stomach pain, bloating, or constipation Behavioral signs Changes in behavior often appear before any physical symptoms do. According to Rosen and Simmons, these signs can include: Avoiding meals with others or eating alone Strict food rules or rituals (cutting food into tiny pieces, eliminating food groups) Frequent moralizing of food (categorizing foods as “good” or “bad”) Overexercising or exercising when injured or sick Hiding or hoarding food Withdrawing from social activities involving food   Emotional and cognitive signs These internal shifts can be easy to miss but are often the strongest indicators that something deeper is happening. According to the experts, signs may include: Anxiety, irritability, or depression Guilt or shame after eating Perfectionism or rigid thinking Distorted body image Denial or defensiveness about eating behaviors What are signs of anorexia nervosa? Anorexia is marked by restrictive eating and an intense fear of weight gain, but the emotional and behavioral signs usually appear long before any physical changes. “Anorexia often starts with subtle shifts families might initially interpret as healthy habits,” says Simmons. “All of these behaviors are not choices—the eating disorder has taken over.” Here's the breakdown of signs of anorexia to look for. Physical signs Physical changes vary widely and aren’t always visible. Some people with anorexia aren’t underweight, and weight alone isn’t part of the diagnosis. In fact, people with atypical anorexia nervosa (AAN)—individuals living in larger bodies who become preoccupied with losing weight and yet remain or end up in a range typically considered “healthy”— experience nearly all the same symptoms but maintain a “normal” or higher weight. According to Simmons and Rosen, you may notice signs such as: Rapid or unexplained weight loss, or slowed growth in children and teens Fatigue, dizziness, or fainting from low blood pressure or inadequate nutrition Feeling cold all the time due to reduced metabolism Brittle hair, nails, or dry skin from nutrient deficiencies Missing or irregular menstrual cycles caused by hormonal imbalance Slow heart rate or low blood pressure as the body conserves energy Appearance of fine body hair or lanugo Behavioral signs Many behavioral signs happen in private or get mistaken for admirable “discipline.” In a culture deeply influenced by diet culture—which often praises restriction, willpower, and shrinking one’s body—these patterns can be overlooked or even encouraged. That can make it harder for people to get help early, even as the eating disorder begins to take priority over relationships, school, or work. Per the experts, symptoms can include: Cutting out entire food groups or drastically shrinking portion sizes Claiming to have eaten already Pushing food around the plate Exercising excessively, even when ill or injured Restlessness or anxiety around meals; leaving early or avoiding shared eating Frequent weighing or body checking Losing interest in hobbies or socializing as diet and exercise take over Emotional and cognitive signs Anorexia often heightens perfectionism and emotional distress, creating a cycle of guilt and control. Simmons and Rosen say this can look like: Intense fear of weight gain or “losing control” Irritability or withdrawal Black-and-white thinking around food (“good” vs. “bad” foods) Preoccupation with body image or perceived flaws Denial about the seriousness of symptoms or need for help Increasing rigidity around food, where rules and routines around eating become inflexible Check out this resource on the parts of anorexia that are preventable, and how to avoid them.  What are signs of bulimia nervosa? Bulimia nervosa involves cycles of binge eating—consuming large amounts of food in a short time—followed by compensatory behaviors like vomiting, fasting, or overexercising. “Bulimia often hides beneath normal eating and sometimes even normal weight, which can make early detection difficult,” says Simmons. Here’s what to look out for. Physical signs Physical effects usually stem from the binge-purge cycle, not from weight alone. According to Simmons and Rosen, you might notice: Puffy cheeks or jaw swelling from enlarged salivary glands (“bulimia jaw”) Dental enamel erosion or increased cavities from stomach acid Sore throat or hoarse voice due to repeated vomiting Scars or calluses on knuckles or hands (known as Russell’s sign) Frequent stomach pain, bloating, or digestive discomfort Fluctuating weight caused by alternating restriction and overeating Behavioral signs Bulimia thrives in secrecy, and many behaviors are mistaken for stress or digestive issues. Per the experts, common patterns include: Going to the bathroom immediately after meals Eating large amounts of food quickly or in secret; hiding wrappers or containers Using laxatives, diuretics, or diet pills to compensate for eating Exercising excessively after meals to “undo” food intake Skipping meals or fasting after binges Emotional and cognitive signs The emotional experience of bulimia often centers on shame, secrecy, and loss of control. Here’s what Simmons and Rosen say to look out for: Guilt or self-blame after eating Emotional highs and lows around meals Distorted body image and constant dissatisfaction with appearance Perfectionism and harsh self-criticism Defensiveness or secrecy when asked about eating habits What are signs of binge-eating disorder? Binge-eating disorder is the most common eating disorder in the U.S. It involves recurring episodes of eating unusually large amounts of food in a short period of time while feeling out of control during the episode. It’s then followed by distressing emotions such as guilt, shame, or frustration, but without purging or other compensatory behaviors. “BED can appear as emotional or stress-related overeating, but with BED, the loss of control becomes distressing and repetitive,” says Simmons. “Oftentimes, people describe feeling ‘numb’ during a binge.” Here are the other signs to look out for. Physical signs BED doesn’t have a “look.” It can affect people in any body size. Physical symptoms are often related to inconsistent nourishment or digestive strain rather than weight alone. According to Simmons and Rosen, here’s what that can look like: Fluctuating weight due to cycles of overeating and restriction (known as the binge-restrict cycle) Frequent stomach pain, bloating, or digestive discomfort Fatigue or low energy from blood sugar spikes and crashes Sleep problems linked to nighttime eating episodes Behavioral signs Behavioral symptoms often revolve around secrecy, shame, and attempts to hide binge episodes, says Simmons. Signs can include: Eating large amounts of food quickly, even when not hungry Eating alone or in secret to avoid judgment Hoarding or hiding food in bedrooms, cars, or bags Frequent dieting or restricting after binges, which perpetuates the binge-restrict cycle Avoiding social events involving food due to embarrassment or anxiety Emotional and cognitive signs The emotional toll of BED often centers around guilt, shame, and a painful sense of loss of control, according to Simmons. This can look like: Guilt or embarrassment after eating Feeling “numb” or detached during binges Low self-esteem or negative body image Stress, boredom, or sadness triggering binge episodes What are signs of avoidant/restrictive food intake disorder (ARFID)? ARFID is a restrictive eating disorder defined by extreme avoidance of certain foods or a limited overall intake—whether in amount, variety, or both—due to sensory sensitivities, fear of negative consequences (like choking or vomiting), or a general lack of interest in food, says Rosen. “ARFID isn’t driven by body image concerns and goes beyond ‘picky eating,’” says Simmons. “Eating becomes a source of anxiety rather than nourishment.” ARFID can affect people of all ages, although it’s more commonly diagnosed in children. While mild food selectivity is common, ARFID causes significant anxiety, nutritional deficiencies, or interference with daily life. Physical signs Physical effects of ARFID often relate to nutrient deficiencies or inadequate calorie intake. Because the cause isn’t weight-focused, people may not recognize that the issue is an eating disorder. According to Simmons, signs can include: For children, slow growth or falling off the growth curve Weight loss or failure to gain expected weight Fatigue, low energy, or trouble concentrating Digestive issues like constipation or stomach pain Pale skin, brittle hair, or weak nails Behavioral signs Behavioral patterns in ARFID often center on avoidance, rigidity, or distress related to specific foods or eating environments. Here’s what to look out for, according to Rosen: Avoiding foods because of texture, smell, or appearance Fear of choking, vomiting, or getting sick Extreme pickiness that disrupts family meals or social life Eating very slowly or only small amounts at a time Relying on supplements or smoothies instead of solid foods Emotional and cognitive signs “Emotionally and cognitively, there’s genuine fear or disgust surrounding certain foods, which can cause mealtimes to feel tense,” says Simmons. That can look like: Fear or disgust around specific foods Tantrums or anxiety before or during meals Little interest in food or pleasure from eating Avoidance of social situations involving food Feeling misunderstood or embarrassed about eating difficulties What are signs of other specified feeding or eating disorder (OSFED)? “OSFED is a category for eating disturbances that cause significant distress but don’t fit neatly into other categories,” says Simmons. Because OSFED can take many forms, the signs and symptoms often overlap with those described in the previous sections, such as changes in mood, food rituals, or secrecy around eating. The main difference lies in how these symptoms combine and present. For example, some people might eat restrictively but not be underweight; others might purge without bingeing or experience distressing nighttime eating patterns. Below are some of the most common OSFED subtypes and the signs to look for in each. Atypical anorexia nervosa People with atypical anorexia experience almost all the same symptoms as those with anorexia, but are not underweight. Still, AAN is just as serious and even more common than AN. Symptoms can include: Restricting food despite hunger due to fear of weight gain or a need for control Preoccupation with calories or “healthy” eating that causes anxiety or guilt Distress about body size or shape even when weight is stable or below average Purging disorder People with purging disorder, engage in purging behaviors without binge eating. Signs include: Going to the bathroom right after meals to induce vomiting Misusing laxatives, diuretics, or diet pills as “cleansing” or “detoxing” methods Guilt, shame, or anxiety after eating that triggers purging Night eating syndrome Night eating syndrome involves consuming a significant portion of daily calories after dinner or during nighttime awakenings. It’s often tied to emotional stress or disrupted sleep cycles, and can look like: Eating late at night or after waking from sleep, often feeling unable to stop Little or no appetite in the morning due to shifted hunger cues Shame, secrecy, or embarrassment about nighttime eating Unspecified or mixed patterns Some people experience a blend of symptoms from multiple eating disorders that don’t match a single diagnosis. For instance, someone might alternate between restriction and bingeing, or cycle through different disordered behaviors at various points in time. Common patterns include: Fluctuating control around food and eating behaviors Persistent anxiety about food, exercise, or body image Feeling like something is “off,” even without fitting a specific label  Why do some eating disorder signs go unnoticed? Despite how common eating disorders are, they often go undetected for months or even years. “Eating disorders are deceiving and camouflage themselves as ‘healthy’ changes such as cutting out carbs, becoming vegan, tracking macros, or exercising more,” says Simmons. “Culturally, these habits are often praised, which can delay recognition.” This can be especially true for athletes, whose intense training schedules and rigid nutrition routines are often viewed as dedication or even required for performance. Behaviors like pushing through injuries, restricting food for weigh-ins, or obsessively tracking calories or macros can be dismissed as part of the sport, making it harder for coaches, parents, and teammates to recognize when these habits cross into disordered or dangerous territory.  Below are a few reasons these warning signs are easy to overlook—and what to pay attention to instead. They hide behind diet culture Diet culture normalizes restriction, calorie counting, and the pursuit of thinness as signs of health. When disordered behaviors—like skipping meals or avoiding food groups—are socially rewarded, it becomes harder to recognize them as red flags, says Simmons. Over time, this makes it easy to dismiss early symptoms as “just being healthy.” They don’t always look the way people expect Many people still associate eating disorders with extreme thinness, but that stereotype is inaccurate and harmful. Research shows that most people with eating disorders are not underweight, and symptoms can occur in bodies of all sizes. This misconception prevents countless people—especially those in larger bodies—from being diagnosed or taken seriously. Eating disorders are also underrecognized in people who don’t fit the narrow cultural stereotype of who gets them, including boys and men, people of color, LGBTQ+ individuals, and those with limited access to care. Bias in healthcare, stigma, and cultural assumptions about who is “at risk” can delay or block diagnosis, leaving many people without the support they need. They happen in private Many symptoms—like purging, bingeing, or overexercising—happen in private spaces, making them difficult to spot even for close friends and family, says Rosen. That’s why it’s so important to trust your gut if something feels off, adds Simmons. Subtle changes in routine, personality, or social engagement can be just as revealing as visible physical signs. They overlap with mental health symptoms Anxiety, perfectionism, and depression often accompany eating disorders. Because these symptoms can exist on their own, it’s easy to focus on the emotional distress and overlook the disordered behaviors driving it. “When anxiety increases and flexibility decreases, that’s a red flag,” explains Simmons. How to help someone showing signs of an eating disorder Reaching out to someone you’re worried about can feel uncomfortable, but it can make a meaningful difference. Many people with eating disorders don’t recognize the severity of their symptoms or may feel too ashamed to ask for help, and early intervention is linked to better outcomes and a shorter, less severe course of illness. Your voice may be one of the first signals that something is wrong and that they don’t have to navigate it alone. “If something feels off, it’s important to approach your loved one with care by staying calm, nonjudgmental, and compassionate,” says Rosen. Here’s what she and Simmons recommend: Start with curiosity, not confrontation: The goal isn’t to diagnose or force someone to eat—it’s to open the door for support. Express what you’ve noticed in a caring, factual way, and focus on how they’re feeling, not how they look. You might say something like, “I’ve noticed you’ve seemed anxious around food lately, and I’m concerned because I care about you.” Avoid commenting on appearance, weight, or willpower: Even well-meaning remarks like “You look great” or “I wish I had your discipline” can reinforce harmful beliefs. Keep the focus on emotional well-being instead. Offer tangible support: Once the conversation is open, help make next steps easier and help them find professional care. Focus on feelings, not food: Eating disorders aren’t really about food—they’re about emotional pain and a need for control. Ask how they’ve been coping with stress or change rather than focusing on what or how much they’re eating. Know what not to do: Even with good intentions, some reactions can make recovery harder. For young people with eating disorders, parents do play a role in supervising meals during recovery, but it's important to do this with the support of a treatment team. Keep showing up: Recovery is rarely linear, and relapse doesn’t mean failure. Keep checking in, sharing meals when appropriate, and reminding them that you care, regardless of what they eat or weigh. “The most important message to anyone suffering is that recovery is absolutely possible, especially when families act early, stay connected, and hold hope when their loved one cannot,” says Simmons. For parents and caregivers of children and teens, that sometimes means seeking an evaluation or treatment even if your child is not ready or doesn’t believe they need help. Caregivers play a critical role in early intervention, and taking action sooner rather than later can be lifesaving.  How to seek help If you’re wondering how to know if you have an eating disorder, or if you’re worried about someone you care about, there are clear, supportive paths to finding the right care: Start with self-reflection or a screener: If you’re unsure whether what you’re experiencing “counts,” try Equip’s free eating disorder screener. It can help you identify patterns in your or your loved one’s relationship with food, exercise, or body image and suggest next steps for support. Talk to your primary care provider or a mental health professional: Be open about what you’ve noticed. A clinician familiar with eating disorders can evaluate your symptoms and connect you to specialized care. Look for eating disorder–specific treatment programs: Evidence-based care often includes a team of professionals—such as a therapist, dietitian, and medical provider—working together. Involve trusted family or friends: Recovery is hard to face alone. If possible, share what you’re going through with someone you trust. Loved ones can help with accountability, meal support, and emotional encouragement. If you’re supporting someone else, seek help for yourself too: Parents, partners, and friends often benefit from professional guidance on how to navigate communication, boundaries, and self-care while supporting someone with an eating disorder. Reach out early: You don’t need to wait until symptoms are “severe enough.” Early intervention is linked to faster recovery, lower relapse rates, and better long-term health outcomes. The importance of early intervention Recognizing the signs of an eating disorder is an important first step, but getting help early is what truly changes outcomes. In one study, 53% of young adults with anorexia nervosa who received early intervention made rapid improvement, compared to just 18% of those receiving standard treatment. Acting quickly can shorten the course of illness, reduce hospitalizations, and restore healthy behaviors before they become deeply ingrained.   If you notice even subtle warning signs—whether in yourself or a loved one—don’t wait for symptoms to worsen or become “serious enough.” Seeking support early is not overreacting; it’s proactive care. Equip’s free eating disorder screener can be a first step toward understanding what’s going on and connecting to evidence-based treatment.  The bottom line Eating disorders can look different for everyone. What often unites them is the silence, shame, and secrecy that make them hard to spot (and even harder to talk about). Awareness is the first step toward change. Paying attention to emotional shifts, subtle behavioral patterns, and your gut instincts can help you recognize when something isn’t right. Whether you’re noticing these signs in yourself or someone else, responding with compassion is a critical step in getting the support needed to recover from this serious illness. Early, caring intervention can make all the difference. Frequently Asked Questions (FAQs) Is forgetting to eat an eating disorder? Occasionally skipping a meal due to stress or distraction isn’t necessarily an eating disorder. But regularly “forgetting” to eat, ignoring hunger cues, or feeling disconnected from your body’s needs can be early signs of disordered eating or restrictive patterns. Can you have an eating disorder without knowing? Yes. Many people don’t recognize that their eating or exercise habits are disordered, especially if they seem “healthy” or are praised by others. Because eating disorders develop gradually and thrive in secrecy, it’s common for people to realize something is wrong only after symptoms worsen. What is the difference between dieting and an eating disorder? Dieting typically involves short-term changes to eating habits for a specific goal, like weight loss or fitness. An eating disorder, on the other hand, is a mental health condition that involves persistent, distressing thoughts and behaviors around food, body image, and control. ]]></content:encoded>
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            <title><![CDATA[What Is Food Noise? Causes, Signs & How to Quiet It]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/food-noise</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/food-noise</guid>
            <pubDate>Wed, 19 Aug 2026 01:50:00 GMT</pubDate>
            <content:encoded><![CDATA[While everyone thinks about food here and there, food noise refers to persistent thoughts about food that feel difficult to ignore. It isn't an eating disorder itself, but it can be a symptom of one—particularly when those thoughts are constant, distressing, or interfere with daily life. Although the experience isn't new, the phrase "food noise" is. It exploded into the mainstream after Oprah Winfrey's TV special “Shame, Blame and the Weight Loss Revolution,” in which several people—including Winfrey herself—described how GLP-1 medications reduced the constant mental chatter around food. Since then, the term has appeared in advertisements and other conversations about weight loss medications. But food noise is much more nuanced than those messages might suggest, and it's especially complex for people with eating disorders. "My food noise was always on," says Equip Lead Recovery Coach Makailah (Mak) Dowell. "It never turned off, even after meals and snacks. My food noise served as a bully to ensure I aligned with my eating disorder, not with myself." For Dowell, restricting food only made the problem worse. "For some folks, when they step away from the food, the food noise becomes quieter," she says. "For me, it would only turn up more." Below, learn the true definition of food noise, how to spot it, and how to get support when the noise becomes too loud.  What is food noise? Food noise refers to persistent thoughts about food that feel unwanted or distressing, or cause social, mental, or physical problems, according to Nutrition & Diabetes. “[It’s] the persistent and unwanted thoughts, feelings, and beliefs about food and eating that take up excessive mental, physical, and emotional space,” agrees Tanya Hargrave-Klein, MS, RDN, LD, lead eating disorder dietitian at Equip. “This may include obsessive thoughts about food rules.” One common example is the belief that you shouldn't eat between meals, a rule that Hargrave-Klein says can create a cycle of self-judgment. "This becomes part of food noise when a person 'shoulds' themself about never breaking this rule," she says. "Then it becomes difficult to not have obsessive thoughts about eating snacks: 'What would I have?' 'What would it taste like?' 'When would I have it?'" Many of Hargrave-Klein's patients describe this internal dialogue as a tape playing on repeat. "[This] crowds out space for other thoughts, making them unable to be truly present in the moment and fully engage in other activities," she says. For Dowell, food noise was a constant loop of thoughts like "you don't deserve this meal," "that's too much food," and "that food is too scary right now." "I would describe it as the isolated events where the eating disorder, anxiety, or stress of a meal/snack/food is loud," Dowell says. "These thoughts would continually show up in my mind to the point where I would step outside of my values and into my eating disorder." What causes food noise? Food noise doesn't have a single cause. It is often triggered by factors like physical hunger and undereating, chronic dieting or food restriction, stress, and differences in the way the brain processes hunger and fullness cues. Often, more than one of these factors is at play. And while food noise can interfere with quality of life and signal an underlying problem, it's important to remember that thinking about food isn't inherently a bad thing. “People have thoughts about food throughout the day,” Hargrave-Klein says. “We think about which foods are in our pantry, what foods taste good, and which foods would satisfy our hunger. These recurring thoughts help us plan ahead so that we can nourish adequately. It’s when these thoughts become more persistent that they can be problematic.” One of the biggest drivers of food noise is restriction, according to Alyssa O’Connell, RDN, registered dietitian at Equip. “When the body or mind senses a lack of adequate nourishment or freedom around food, it hyper-focuses on it as a survival mechanism, generating persistent thoughts about eating,” she explains. One classic study from 1944 illustrates just how powerful the role of restriction can be. In the Minnesota Starvation Experiment, researchers placed 36 healthy young men on a calorie-restricted diet that caused them to lose about 25% of their body weight. As the study went on, many participants developed obsessive thoughts about food, irritability, unusual eating behaviors, anxiety, and depression. “If someone gets too hungry or restricts their intake of food, this may trigger food noise and lead to out-of-control eating when they finally give themself permission to eat,” adds Hargrave-Klein. This can result in the binge-restrict cycle: Restriction leads to intense hunger and overeating, which triggers guilt and another attempt to restrict, which then leads to hunger, food noise, and more overeating. Stress can also turn up the volume on food noise, per research in Nutrients. For some people, difficult emotions like anxiety, uncertainty, or shame make food thoughts more persistent even when they're not physically hungry. Dowell says that in her case, the thoughts weren't simply about eating. They were rooted in guilt, shame, and the belief that certain foods made her "good" or "bad." "My food noise would deem me worthy or not every single day," she says. "It controlled me." Food noise can also look different for neurodivergent people.  For example, some people with ADHD have differences in interoception (the ability to recognize internal body signals like hunger and fullness). This can make it harder to distinguish physical hunger from other sensations, according to research in Biological Psychology. As a result, some may have a harder time recognizing when they're truly hungry or full, which can make thoughts about food feel more frequent or difficult to interpret. Others may find that impulsivity, hyperfocus, or sensory sensitivities influence how often they think about food. These experiences don't necessarily mean someone has both ADHD and an eating disorder, but they can overlap. Food noise vs. hunger: how to tell the difference It's common to assume that food noise means you're hungry all the time. But in reality, hunger and food noise are two different things, says Cay Schubert, LICSW, a social worker and therapist at Fields That We Know Psychotherapy. Physical hunger is your body's way of signaling that it needs nourishment, per Endotext. Food noise, meanwhile, is often fueled by restriction, dieting, rigid food rules, stress, or disordered eating, says Schubert. So how can you tell which one you're experiencing? “Physical hunger typically presents with bodily cues. This can be a rumble in the stomach, low energy, or lightheadedness that can fade when one eats,” says O’Connell. “Food noise, on the other hand, tends to present as a repetitive, intrusive, or anxious thought about food, even when not physically hungry.”  Is food noise a sign of an eating disorder? Food noise isn't an eating disorder itself, but it is a common symptom of many eating disorders, per Nutrition & Diabetes. While everyone experiences thoughts about food from time to time, persistent, distressing food noise—especially when it's paired with restriction or rigid food rules—can be an early sign that something deeper is going on. The Minnesota Starvation Experiment offers one explanation why, by showing what happens when you don’t eat enough: after months of calorie restriction, the participants (who did not have eating disorders) developed obsessive thoughts about food. Those changes resemble the thought patterns Hargrave-Klein says she regularly sees in people with eating disorders. “Some report not being able to stop thinking about what food looks like, smells like, or tastes like,” she says. “Others report overwhelming urges to view photos of food, scroll Pinterest for recipes, or report an inability to stop thinking about their next meal or snack.” While everyone's experience with food noise is different, Hargrave-Klein says one pattern stands out: "While individual experiences with food noise vary from person to person, it's rare that food noise is not present with an eating disorder." When to be worried about food noise Persistent food noise can sometimes be a symptom of an underlying issue that needs to be addressed, like an eating disorder, chronic food restriction or dieting, or prolonged stress. While thoughts about food are a normal part of life, they shouldn't crowd out everything else or leave you feeling distressed, says Hargrave-Klein. Here are some signs food noise is cause for concern: Thoughts about food negatively affect your performance at school, work, or daily responsibilities You find yourself thinking about food when trying to engage in activities that used to make you happy You plan your meals and snacks far in advance, and repeatedly think about what you’re going to eat (even after you’ve already decided) You ruminate about food you’ve eaten You spend an abnormal amount of time consuming food-related content Thoughts about food feel more important than all or most other thoughts  If more than one of these signs sounds familiar, it's worth reaching out for support or taking our free eating disorder assessment. An eating disorder-informed professional can help you better understand what's behind your food noise and whether treatment might help. [GRAPHIC: Signs your food noise may signal an eating disorder] Food thoughts interfere with work, school, or daily life You can't enjoy activities without thinking about food You constantly plan or replay meals and snacks You obsess over food you've already eaten You spend excessive time scrolling food content or recipes Food thoughts crowd out everything else How to quiet food noise If food noise makes it hard to enjoy daily life, there are several evidence-backed ways to turn down the volume—without dieting or ignoring your hunger: Prevent extreme hunger. "Eat regularly throughout the day, which means eating a meal or snack every two to four hours during waking hours," Hargrave-Klein says. "When the body doesn't receive what it needs, it turns on food noise to encourage you to eat. It is a pretty cool system designed to save you." Lean on supportive people. Eating with loved ones can make meals feel less overwhelming and interrupt eating disorder thoughts. "I would ensure that after school, I had plans to eat lunch at someone's house or be around folks," Dowell says. "By not isolating myself, I ensured a protective barrier from the eating disorder." Add more variety to your meals. "Rigid or repetitive eating can trigger food noise," Hargrave-Klein says. "Adding variety and satisfying foods can turn down the volume of the food noise." Challenge negative or self-punishing thoughts. “Are the messages you hear accurate and truthful?” Hargrave-Klein asks. “Talk to a dietitian to debunk any misinformation wrapped up in the food noise.” Dowell encourages anyone struggling with food noise to remember that recovery is possible.  "I thought I was going to live my life every day like this," she says. "Then my first therapist told me, 'Hey, did you know that it can be silenced?' I cried. I didn't know that I could even work my way to that form of peace." To that point, it’s time to seek professional support if food noise is interfering with your ability to work, enjoy relationships, or meet your body's needs, Hargrave-Klein says. Do GLP-1s like Ozempic quiet food noise? For many people, yes. GLP-1 medications like Ozempic and Wegovy suppress appetite, which can make food noise less frequent or intense, according to research in Cureus. But if you have (or are at risk for) an eating disorder, quieter food noise doesn't necessarily mean the eating disorder itself has been treated. That’s because reducing food noise isn't always the same as addressing what's driving it. If the thoughts stem from restriction, rigid food rules, anxiety, or an eating disorder, lowering your appetite may make them less noticeable without resolving the underlying issue. It's also important to remember that while GLP-1s may decrease appetite and food noise, they don't decrease your body's nutritional needs. "Your body still requires adequate energy, macronutrients, micronutrients, and hydration," says O'Connell. "Working with a registered dietitian is helpful when on these medications to ensure you are still reaching your daily nutrition prescription, regardless of how quiet the noise becomes." That doesn't mean GLP-1s are inherently good or bad. They're simply one piece of the puzzle. For many people, lasting eating disorder recovery means addressing what's driving the food noise—and that often takes more than medication alone. The bottom line While thoughts about food are a normal part of life, persistent food noise is worth paying attention to. It can be driven by factors including hunger, restriction, stress, or an eating disorder, and understanding what's behind it is the first step toward finding relief. If food noise is making it hard to enjoy your daily life, you don't have to figure it out alone. Start with Equip's free, 5-minute eating disorder assessment to see if an eating disorder may be present, or schedule a call to connect with an eating disorder-informed professional. Frequently asked questions (FAQs) What are the different types of food noise? There’s no official food noise disorder, so the phenomenon doesn't have specific subtypes. Still, the experts say it can show up in different ways. For some people, it looks like constant thoughts about their next meal. For others, it's rigid food rules, guilt after eating, or obsessive thoughts about what they should or shouldn't eat. Is food noise part of ADHD? Food noise and ADHD don’t always go hand in hand, but some people with ADHD do experience food noise. Differences in attention, impulsivity, and interoception can all affect how someone experiences food and eating. Does food noise ever go away? For many people, yes. Getting enough nourishment and working through the thoughts, emotions, or behaviors contributing to food noise can quiet the mental chatter. If food noise is related to an eating disorder, working with a treatment team can help you address the underlying cause rather than simply trying to silence the thoughts.]]></content:encoded>
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            <title><![CDATA[ARFID and Autism: Understanding the Overlap]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-and-autism</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-and-autism</guid>
            <pubDate>Fri, 14 Aug 2026 13:55:00 GMT</pubDate>
            <content:encoded><![CDATA[Maybe you've spent years wondering why eating feels so much harder for you than it does for other people. Or perhaps you're worried because your autistic child's list of safe foods keeps getting shorter. As you search for answers, it may help to understand the relationship between ARFID and autism. Autism and avoidant/restrictive food intake disorder (ARFID) are two distinct conditions, but they often overlap. Recognizing that connection can help explain why eating feels so hard—and remind you that these challenges are not your fault. People with ARFID aren’t just stubborn picky eaters, nor is it some kind of parenting failure. ARFID results from underlying factors beyond anyone's control. In this article, we'll explore why ARFID and autism overlap, how to tell if food aversions are driven by more than autism alone, and what supportive, neurodiversity-affirming care can look like. What is the connection between ARFID and autism? ARFID is an eating disorder that involves avoiding or restricting food to the point that it affects nutrition, growth, health, or daily life, according to StatPearls. Unlike other eating disorders, ARFID isn't motivated by concerns about body weight or shape. While ARFID and autism are separate conditions, an overlap between the two is fairly common. According to the International Journal of Eating Disorders, about 16% of people with ARFID are also autistic, compared with roughly 3.2% of the general population, per the National Institute of Mental Health. Likewise, about 11% of autistic people have ARFID. Estimates from the European Eating Disorders Review suggest ARFID affects between 0.5% and 15.5% of the general population, though prevalence varies widely across studies.  "Sensory sensitivity is a big connection here," says Lily Thrope, LCSW, founder of Thrope Therapy. "People with autism and other neurodivergence often struggle with sensory sensitivity related to color, texture, smell, and taste, which can relate to fear around certain sensory experiences of food." Differences in awareness of internal body cues like hunger and fullness, anxiety, and a preference for predictability can also make eating more challenging for autistic people, per research in Current Opinion in Psychiatry. Remember: Not every autistic person has ARFID, and not everyone with ARFID is autistic. Autism also doesn’t cause ARFID. However, experts believe the characteristics outlined above can make eating distressing or restrictive enough for some autistic people to develop the eating disorder. Why do ARFID and autism often overlap? There's no single reason why ARFID and autism often overlap. Instead, experts believe a combination of sensory differences, interoception (the ability to perceive internal signals, like hunger and fullness), anxiety, and a preference for predictability can contribute to autistic food aversions and make eating more stressful. Here’s the breakdown. Sensory differences For many autistic people, food is a full sensory experience, not just something that tastes good or bad. With autism, food textures, temperatures, smells, colors, appearances, or even sounds can make eating feel either totally comfortable or completely overwhelming, explains Thrope. This goes beyond simply disliking certain foods. A slight change in texture, a different brand, or even food prepared in a new way can make a previously safe food feel impossible to eat. For example, someone may happily eat one brand of chicken nuggets but have a sensory food aversion to another brand's breading, smell, or texture.  Interoception and hunger cues Another piece of the puzzle is interoception, which is the ability to notice what's happening inside your body. This includes recognizing signals like hunger, fullness, thirst, nausea, or discomfort. Many autistic people experience interoceptive differences, making these signals harder to recognize or interpret, per the European Eating Disorders Review. They may not realize they're hungry until they're ravenous, or have difficulty telling when they're full. In some cases, people with autism forget to eat entirely. Anxiety and fear around eating According to Allison VanGordon, LMHC, a therapist at Equip, some people with ARFID struggle to eat because they associate food with fear rather than sensory discomfort alone. They may avoid foods because they’re afraid of choking, vomiting, an allergic reaction, or stomach pain. These fears may begin after a distressing food-related experience or build gradually over time. For autistic people, differences in interoception, emotional awareness, or tolerance for uncertainty can further intensify that fear, says VanGordon. If someone can tell that a food feels wrong but has trouble identifying why, avoiding it may feel like the safest option. Predictability, routines, and safe foods Many autistic people find comfort in routines, according to research in the Journal of Autism and Developmental Disorders. And food is no exception. Knowing exactly what a meal will look, smell, and taste like can reduce uncertainty and make eating feel more manageable. This is one reason why many people with ARFID rely on "safe foods,” or foods they know they can eat without significant distress. These foods are often very specific: a particular brand, preparation method, or serving temperature may feel safe, while a seemingly minor change can make the food feel completely different.  Having preferred foods or routines isn't inherently a problem. It’s only concerning when the range of foods becomes so limited that it affects someone’s nutrition, health, growth, or everyday life. How autism shows up alongside ARFID ARFID can show up in different ways. Experts generally describe three main presentations, though many people experience a combination rather than fitting neatly into just one category. It's also common for these presentations to change over time. Someone might have both strong sensory sensitivities and a fear of choking, or a low appetite alongside a very limited range of safe foods, for example. You can learn more in our guide to the different types of ARFID. ARFID subtypes and autism overlap  Is it ARFID, autism, or both? Many autistic people have strong food preferences without having ARFID. The difference is that ARFID affects a person's health or daily life. If someone eats such a limited variety or amount of food that it leads to nutritional deficiencies, weight or growth concerns, or reliance on supplements, or makes school, work, relationships, or everyday activities harder, ARFID may also be part of the picture. Why ARFID is often missed in autistic people One reason ARFID can go unnoticed in autistic people is something called diagnostic overshadowing, per a study in Autism Research. In simple terms, this means eating difficulties are assumed to be "just part of autism," without digging deeper. This overshadowing can also go both ways—meaning, autism could be missed in a person with ARFID. That’s why VanGordon says that when she's evaluating someone with ARFID, she looks beyond their eating habits to see whether similar patterns appear elsewhere in their life. "If they have sensory sensitivities, do they also prefer certain textures of clothing? Are they overwhelmed or underwhelmed by their environment?" she says. "If the answer is yes, then I move forward with assessing [for traits of] autism." Why identifying both matters Recognizing ARFID doesn't change the fact that someone is autistic (or vice versa). It simply puts a name to eating challenges that should be treated, not brushed aside. Understanding both conditions can also help guide personalized care plans. Someone with autism and ARFID deserves eating disorder–specific care tailored to their neurodivergence. What does neurodiversity-affirming treatment for ARFID look like? When ARFID and autism overlap in adults or children, treatment focuses on helping them meet their nutritional needs, reduce stress around eating, and build more flexibility with food—all while respecting their sensory needs, communication style, and autonomy. A multidisciplinary team ARFID is a complex eating disorder, which means treatment often involves more than one type of healthcare provider, per StatPearls. Depending on someone’s needs, their care team may include a therapist, registered dietitian, medical provider, and sometimes an occupational therapist, psychiatrist, or other specialist. Each team member brings a different area of expertise. Their therapist can help address anxiety and food-related fears, their dietitian can support nutrition and meal planning, and their medical provider can monitor physical health and nutritional status. Gradual food exposure Trying new foods is often part of ARFID treatment. But food exposure doesn’t mean forcing someone to eat foods that feel frightening or intolerable—that can actually make things worse. Sustainable recovery begins by gradually building confidence with foods in a way that's collaborative, and respectful of their sensory and emotional needs, per research in Current Opinion in Psychiatry. "Overall, if someone has ARFID (with or without also being autistic), you have to help find their why,” says VanGordon. “Just like any eating disorder, it has to make sense for them to engage and to want to do the scary thing of facing the food." Sometimes, this looks like incorporating their interests into their food. "If someone finds it helpful to relate [autism and ARFID], it can be meaningful to take something they enjoy and build exposures around it," says VanGordon. "If the person likes history, find a historical cookbook from the time period they enjoy. If they enjoy fantasy, find recipes to make based on their favorite storylines." Family and caregiver support For ARFID in children and teens, parents and caregivers play an essential part in treatment, according to a study in the Journal of the Canadian Academy of Child and Adolescent Psychiatry. Their ongoing support makes lasting recovery possible. “Stay focused on validating, supporting, and understanding those with complex eating disorders like ARFID,” says Thrope. She also encourages families to honor safe foods, trust the treatment process, and avoid commenting on eating behaviors. What to look for in a provider or program Not every eating disorder provider has experience treating autism, and not every autism provider is trained to address eating disorders. Additionally, not every eating disorder provider has specific expertise treating ARFID. When looking for the right fit, you should prioritize providers or programs that: Have experience treating ARFID Have experience supporting autistic and other neurodivergent patients Use a multidisciplinary team Adapt care to each person's sensory needs and communication style Take a collaborative, non-shaming approach Monitor nutrition, growth, and overall health throughout treatment Use evidence-based approaches, such as cognitive behavioral therapy for ARFID (CBT-AR), family-based treatment for ARFID (FBT-ARFID), or exposure and response prevention (ERP), per Pediatric Reviews and Nutrients  Equip’s multidisciplinary team provides evidence-based ARFID treatment that adapts to each patient's unique needs, including those who are autistic or otherwise neurodivergent. Equip also has the ability to work alongside ASD specialists when clinically indicated. Learn more about our ARFID treatment program and schedule a consultation here. What to do if you think you or your loved one may have both ARFID and autism If you think you or your loved one may have both ARFID and autism, the next step is to seek an evaluation from a pediatrician, primary care provider, therapist, or eating disorder specialist who understands both conditions. If this isn’t available, finding one specialist for each condition could be an alternative first step. The sooner you get answers, the sooner you can get the support you deserve. While waiting for an appointment, it’s helpful to keep track of patterns, such as: Which foods feel safe or unsafe Whether eating causes anxiety, fear, or sensory distress Physical symptoms, such as weight loss, nutritional deficiencies, or slowed growth (in children) How eating challenges affect school, work, social activities, or family life If you're ready for the next step, try our ARFID screener or learn more about Equip's ARFID treatment program. Equip is the largest ARFID treatment provider in the U.S. and has a proven track record of helping people, including children, recover gradually and safely from ARFID. The bottom line Autism can impact the way someone experiences food, but it doesn't mean significant eating challenges should be dismissed as "just part of autism." When an autistic person also has ARFID, recognizing both conditions helps explain why eating feels so difficult and shape a more cohesive—and effective—care plan. Frequently asked questions (FAQs) Does every autistic person have ARFID? No. While autism and ARFID often occur together, not all autistic people have ARFID. Many autistic people have strong food preferences, rely on familiar foods, or avoid certain textures without those eating patterns affecting their nutrition, growth, health, or daily life. How do I know if my autistic child's eating is severe enough to need treatment? The lines between ARFID, autism, and picky eating are sometimes blurry. But if your child's eating is affecting their growth, nutrition, physical health, or everyday life, it's worth talking with a healthcare provider. You don't have to wait until they're eating only a handful of foods or become medically unstable to ask for help—early support can make a meaningful difference. What should I tell a doctor if I think my child has both ARFID and autism? Share specific examples of what you're noticing, such as which foods feel safe or unsafe, whether meals cause anxiety or distress, any weight or growth concerns, and how eating affects school, family life, or social activities. The more concrete information you can provide, the easier it is for a provider to understand the full picture.]]></content:encoded>
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            <title><![CDATA[Anxiety After Eating: Why It Happens and How to Cope]]></title>
            <link>https://equip.health/articles/understanding-eds/anxiety-after-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/anxiety-after-eating</guid>
            <pubDate>Thu, 26 Feb 2026 15:41:00 GMT</pubDate>
            <content:encoded><![CDATA[Sara McKelvey was 15 years old when she began experiencing feelings of anxiety after meals. This often happened when she ate food she had deemed "unhealthy"or when she felt she had eaten too much. "If I had eaten something that didn't fit into my idea of what I should be eating, it would cause body distress and comparison to others," says McKelvey, who is a peer mentor with Equip. She shares that she often found herself looking around the dinner table to see what others had eaten and how their bodies looked. Experiences like McKelvey’s are commonly reported among individuals struggling with body image concerns or disordered eating. If eating a meal triggers feelings of anxiety or panic for you or a loved one, identifying underlying patterns- whether psychological, behavioral, or medical- is an important first step. Read on to learn more about some potential root causes of post-meal anxiety and distress, as well as how to seek long-term solutions and get the help that you or your loved one need. Common symptoms of anxiety after eating Some people experience a range of emotional and physical responses after eating. Physical responses can include a rapid heartbeat, stomach discomfort, sweating, or shortness of breath, while emotional responses may include racing thoughts, dread, or irritability. These symptoms are often related to anxiety, though they can also overlap with other medical or physiological conditions. It’s important to remember that if you experience severe, persistent, or unusual physical symptoms—such as chest pain, fainting, or difficulty breathing—you should seek prompt medical evaluation to rule out other health conditions. Physical symptoms Rapid heart rate Stomach discomfort or nausea Shortness of breath Sweating Feeling/looking flushed Sensation of throat tightness Tightness in the chest Trembling Lightheadedness Emotional symptoms Shame Guilt Racing thoughts Inability to focus on other things Irritability Dread For many people, though, post-meal anxiety can be distressing but manageable with appropriate support and strategies. What causes anxiety after eating? There are many potential causes of anxiety after eating, and triggers can vary depending on the individual and context. Often, more than one factor may contribute, including physical, psychological, and behavioral causes.    Anxiety after eating is often influenced by multiple factors rather than a single cause. It may not be related to just one issue or cause. Sometimes, there may even be overlapping physical, psychological, and behavioral causes.  1. Disordered eating patterns Anxiety after eating can arise if you or a loved one is struggling with disordered eating. This can include a range of eating behaviors: rigid or distressing beliefs about food that cause "uneasiness around food" and feeling unsure about food-related decisions, says Francesca Emma, LMHC. Disordered eating refers to problematic eating behaviors or beliefs that may not meet criteria for a diagnosable eating disorder but can still cause significant distress.” Examples of disordered eating include:  Dieting, restricted eating, or irregular eating Hyperfocus on “clean” or “healthy” eating (sometimes described as orthorexia) Compensatory behaviors intended to ‘make up for’ eating (skipping the next meal, limiting calories the next day, exercising post-meal, or purging behaviors like vomiting or laxative misuse) Binge eating Misuse of diuretics, laxatives, or weight-loss medications Dieting is strongly associated with the development of disordered eating patterns. “Despite usually starting with good intentions around health, it can lead to intense anxiety before, during, or after eating," emphasizes Kate Ringwood, LPC, a psychotherapist and owner of Serendipity Counseling Services. Management or treatment options Treatment for anxiety related to disordered eating varies based on the specific cause, but it often involves working with a dietitian and therapist who specialize in this issue. Ringwood says you don’t need to be diagnosed with a specific condition to work with either of these professionals. 2. An eating disorder An eating disorder is not the same thing as disordered eating. While there are some similarities between the two, eating disorders are recognized mental illnesses and serious mental health conditions that require professional assessment and treatment. There are several different types of eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant restrictive food intake disorder (ARFID), other specified feeding and eating disorders (OSFED), PICA, and rumination disorder.  "People experiencing eating disorders often feel very anxious after meals," says Carol Brown, MSW, an Equip therapist. "They often describe loud and intrusive thoughts and fears around weight gain, deep shame about what they should or should not eat, mental calculations about what food they will permit themselves to eat for the rest of the day, and mental fixation on whether their food choices were ‘healthy’ or ‘good’."  Treatment typically include a multidisciplinary care team of eating disorder experts who follow evidence-based treatments.  3. Related disorders Obsessive-compulsive disorder (OCD), is a mental health condition characterized by persistent, intrusive thoughts, images, or urges (obsessions) that cause significant anxiety, along with repetitive behaviors or mental rituals (compulsions) performed in an attempt to reduce that distress. Although OCD is categorized separately from anxiety disorders, anxiety is a central feature of the condition. In some cases, obsessions may involve fears about contamination, illness, or food safety, which can contribute to stress around eating or food preparation.  Generalized anxiety disorder (GAD), which involves persistent and excessive worry about a range of everyday concerns, may also heighten anxiety before, during, or after meals. "When someone is generally anxious, it can be taken out in a variety of ways—food being one of them," says Emma. "There is a sense of control around food, and so the decision-making process can contribute to emotional and physical responses around food. Food becomes the mechanism for the anxiety." Management or treatment options Treatment options range from talk therapy—such as cognitive behavioral therapy or exposure-based approaches—to medication when appropriate and prescribed under medical supervision. 4.Trauma-related anxiety If you or a loved one has experienced a distressing or traumatic event related to food in the past, it's not unusual to experience ongoing feelings of anxiety around eating. Food-related trauma might include experiencing a severe allergic reaction, choking on food, or having a serious episode of food poisoning. Trauma-related fear of adverse consequences—such as choking or vomiting—may contribute to avoidant or restrictive eating patterns. For some individuals, this may develop into Avoidant/Restrictive Food Intake Disorder (ARFID), a diagnosable eating disorder characterized by significant restriction of food intake due to fear of negative consequences, sensory sensitivities, or low interest in eating, along with nutritional or psychosocial impairment.  Highly distressing experiences that occurred during or around meals—such as intense conflict or humiliation may also become associated with particular foods or environments. Over time, these associations can trigger anxiety in similar settings.. These events can then lead to negative emotions tied to a particular food or location, which may then cause anxiety before, during, or after eating. Management or treatment options Speaking with a licensed therapist can help you or a loved one navigate trauma-related food anxiety. Treatment often includes gradual, structured exposure to feared foods or eating situations when clinically appropriate. "Slow exposure and incorporation of feared foods or situations around food," can be helpful, advises Brown, who also recommends practicing deep breathing and grounding strategies and slowly facing the fear or trigger. Exposure to feared foods or situations should always be guided by a therapist trained in trauma-informed care and exposure techniques, following appropriate assessment and stabilization when needed. What can make anxiety after eating worse It's possible to unknowingly worsen the feelings of anxiety you or a loved one may be experiencing after eating. A variety of behaviors can cause this to happen, including any of the following:  Skipping meals: Skipping meals may seem like a way to manage food-related anxiety, but it often perpetuates the cycle. Undernourishment and food restriction can heighten physiological and emotional responses, including irritability, guilt, shame, and increased anxiety. "We are not our best emotional selves when we are undernourished," explains Brown. "So, as challenging as it is, making sure that you're completing meals really does help with anxiety management long-term." Ensuring you're well nourished helps to stabilize the nervous system, while skipping meals, on the other hand, often leads to heightened anxiety, irritability, guilt, and shame.  Eliminating foods: While avoiding foods that cause you fear may provide temporary relief from anxiety, this approach often maintains the anxiety cycle. "People who struggle with food-related anxiety also often find that avoidance grows, and what started as cutting out specific foods can spiral into cutting out many foods over time," explains Brown. Trying to navigate the anxiety alone: This is a key point to understand: Food-related anxiety is a complex challenge, and addressing it alone can be very difficult. Anxiety often feels more overwhelming and isolating when you try to tackle it by yourself, which can increase distress. If you or someone you know is struggling, support is available.  Following online eating trends without professional guidance: Social media is oversaturated with nutrition tips, tricks and hacks, shared without appropriate credentials or individualized context. There are plenty of downsides related to that influx of information; it can lead to restrictive eating patterns, heightened worry, and increased distress. "This is especially true in our diet- and health-focused culture," Brown explains. "And it can be especially exhausting trying to find and follow the right advice."  Engaging in compensatory behavior: People may feel immediate relief when engaging in compensatory behaviors like purging, excessive exercise, or fasting to manage anxiety after eating. However, these behaviors are associated with greater psychological distress, anxiety symptoms, and maintenance of eating disorder behaviors over time, rather than long‑term anxiety reduction. These patterns can increase the overall severity of emotional symptoms and make recovery more challenging.  When anxiety after eating may be a sign you need more support It’s normal to feel anxious at times, especially during periods of stress. But if you're noticing any of the following issues arise, then it may be a signal that you need more support:  You have frequent or ongoing anxiety. This includes frequently worrying about food or eating, noticing the anxiety show up daily, and being unable to find any relief from the anxiety. Your anxiety impacts your ability to eat meals and nourish your body. This shows up as skipping meals, cutting out numerous foods, or lacking variety in your diet due to anxiety. It’s impacting your quality of life. Do you find yourself skipping out on important social events because there may be food present? Or are you unable to concentrate on important things such as school, work, or relationships because of your food-related anxiety? This is another sign that it might be time to seek help. You’re experiencing health-related consequences. Physical symptoms like fatigue, dizziness, significant weight loss, and difficulty sleeping due to stress around food are all indicators that you need additional support The anxiety is worsening. If anxiety increases to the point where most mealtimes become stressful, or anxiety dictates all food choices, it’s time to seek help. "If most meals feel stressful, filled with anticipation or regret rather than nourishment, it’s an important signal not to ignore," says Emma. These are just some of the common indicators that you might need more support, but it's not an exhaustive list. If overall, you're feeling like your anxiety is becoming unmanageable, reach out for support. "Catching this early, before it worsens, can make a huge difference," says Brown.  And one more important point: If you find yourself wondering whether you're sick enough to need support, that 's usually a good indicator that support is indeed needed. "When in doubt, reach out. You deserve to have support to help you find freedom from anxiety around food," adds Brown. The bottom line Anxiety after eating is a common and understandable experience that impacts many people and can have a variety of different causes. But avoiding food can cause real issues and potentially affect your health. Eating a nutritious, well-balanced diet is important to overall health and well-being.  If you find yourself experiencing frequent bouts of anxiety after eating, the good news is there's no need to solve this challenge alone. There are many forms of help and treatment available, depending on the underlying cause. Many people are able to reduce anxiety and improve their relationship with food with appropriate support. Disclaimer This content is for general informational and educational purposes only and is not a substitute for professional medical, mental health, or nutritional advice, diagnosis, or treatment. If you or a loved one are experiencing persistent or severe anxiety, distress, or physical symptoms related to eating, please consult a licensed healthcare provider or mental health professional. Content is based on current research and expert opinion as of 2026, but medical knowledge and recommendations may change over time. If you experience severe or life-threatening symptoms—such as chest pain, fainting, difficulty breathing, or a serious allergic reaction—seek emergency medical care immediately. Frequently asked questions (FAQs)  Why do I feel anxious after I eat? There are many potential reasons why someone might experience anxiety after eating, including, but not limited to: disordered eating patterns (which often involve rigid food rules), to food-related trauma in your past. Other reasons for anxiety after meals include an eating disorder and food sensitivities or allergies.  Can eating cause anxiety? Yes, eating can trigger anxiety for some people. This may be due to a variety of factors, such as disordered eating patterns, trauma related to a meal or particular food, food allergies, an eating disorder, and much more. If you're frequently experiencing anxiety around eating, you may benefit from seeking guidance from a healthcare professional.]]></content:encoded>
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            <title><![CDATA[Anorexia Treatment: What Works, What to Expect, and How Recovery Begins]]></title>
            <link>https://equip.health/articles/understanding-eds/anorexia-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/anorexia-treatment</guid>
            <pubDate>Fri, 07 Aug 2026 14:15:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’re looking into treatment options for anorexia nervosa (AN) for yourself or a loved one, the possibilities can get confusing. And taking the first step toward seeking treatment can feel scary, simply because you may not know what to expect—and change can be hard. Let’s reflect on that second part for a moment. Neuroscience shows that malnutrition directly impacts the brain, increasing cognitive rigidity and making disordered thoughts and behaviors around food, exercise, and body image deeply entrenched. This is why professional treatment is so crucial: Disordered thoughts and behaviors around food, exercise, and body image become so ingrained that they’re hard to change without help from experts who understand the psychology and underlying causes of eating disorders. Despite these challenges, change is necessary because anorexia nervosa is a serious mental health condition, as noted in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). A common misconception regarding eating disorder care is that you have to wait for serious health effects to show up before seeking help. You don't need to reach a medical crisis to deserve care—anorexia nervosa is a serious condition from the moment symptoms begin. It can take a heavy toll on mental health and well-being long before physical signs show up, and symptoms tend to worsen and become more entrenched the longer they go on. Plus, anorexia nervosa has the second highest mortality rate among all mental illnesses. However, the condition is treatable and recovery is possible. Help is available, and it can be tailored to your needs. In this article, we explore anorexia treatment, anorexia therapies, the different levels of care, and how treatment differs for teens and for adults. What does anorexia treatment involve? Treatment for anorexia nervosa, or atypical anorexia (a presentation where a person meets all the criteria for anorexia but is not clinically considered "underweight"), involves a combination of approaches. Typically, this multifaceted treatment is delivered by a multidisciplinary care team that includes a therapist, dietitian, and medical provider. Treatment often includes evidence-based therapy approaches and nutritional rehabilitation, as well as medical monitoring, family or loved one involvement when appropriate, and weight restoration (which means returning the body to its natural, biological growth curve or set point). Another factor to consider is what level of care you or your loved one needs. “Level of care” refers to the intensity of treatment a person will most benefit from. These levels of care exist on a spectrum ranging from inpatient hospitalization to outpatient options, including virtual care where it makes sense. The level of care you or a loved one needs will depend on individual factors, such as medical status, geographic location, level of outside support, and more. Equip is a fully virtual treatment model that integrates into your daily life and can adjust to match different levels of care depending on patient needs. What happens before anorexia treatment begins? Not everyone with anorexia nervosa requires the same type or level of care, and care should be customized to your (or your loved one’s) specific needs. “Before treatment begins,” says Kelly Wakeland, LCSW, a therapist at Equip, “you’d want to have an evaluation by a trained eating disorder specialist or, at the very least, a screener from your primary care physician.” She adds, “You may also be requested to get a medical exam and certain labs drawn to ensure if someone is medically stable enough for outpatient treatment or if their symptoms are so severe they warrant medical stabilization in a hospital setting.” An evaluation might include: A physical exam, including orthostatic vitals (checking heart rate, blood pressure, and temperature while resting and standing) to assess cardiovascular health. Lab work (blood or urine samples) and medical testing, such as an electrocardiogram (ECG/EKG) to monitor heart function. A comprehensive review of eating disorder symptoms and behavior patterns. A review of co-occurring mental health conditions (such as depression, anxiety, OCD, trauma, self-harm, or suicidal ideation). An evaluation of the home environment and available family or social support. A review of personal and family medical history. A review of any prior eating disorder treatment or psychiatric interventions. What levels of care are available for anorexia? The levels of care for eating disorders exist on a spectrum from the least intensive to the most, and they depend on individualized needs. Plus, you or a loved one may start with one level and then “step up” or “down” in care as needed, since treatment doesn’t necessarily follow a straight line.  Inpatient hospitalization is the highest level of care, occurring in a general or psychiatric hospital setting. It is designed for acute medical stabilization (e.g., addressing life-threatening heart rhythms, dangerously low blood pressure, or refeeding syndrome risk) or acute psychiatric crises. Residential treatment is a 24/7 live-in program for individuals who are medically stable but require 24-hour structure, meal supervision, and intense psychological support to interrupt eating disorder behaviors. Partial hospitalization programs (PHPs) offers a high level of structure without requiring overnight stays. Patients typically participate 5 to 7 days a week for several hours a day (including multiple supervised meals and group therapy) before returning home at night. Intensive outpatient programs (IOPs) are more intensive and structured forms of outpatient care with time commitments of typically 3–5 days per week, 3–4 hours per day (usually including one supervised meal). This allows patients to practice recovery skills while maintaining work, school, or home life. Outpatient treatment is the most common and flexible level of care, consisting of 1 to 2 weekly sessions with individual care team members (such as a therapist, dietitian, and physician). Outpatient care is appropriate for patients who are medically stable and are either catching symptoms early or continuing their progress after stepping down from higher levels of care. The following table shows how the levels of care stack up, starting with the least structured and least time-intensive to the most structured.  As noted, in many cases, virtual care is an option. Virtual care is not a type of treatment, but rather a way of delivering anorexia treatment at home. It can equate to multiple different care levels, depending on the program. “Virtual treatment can be an amazing option for anorexia nervosa if a patient is medically stable enough to not require 24/7 monitoring by a medical team,” Wakeland says. “Virtual treatment allows a patient to recover in their own home, avoiding the challenge of adjusting back to their environment after receiving treatment elsewhere.” In-person monitoring at a doctor’s office may still be necessary at times, but with the overall adaptable nature of virtual care, you or your loved one might be able to continue school or work. “The flexibility of virtual treatment often allows patients and families to retain some semblance of normalcy and can save considerable time and money compared to in-person treatment,” Wakeland adds. What are the main treatment approaches to anorexia? Treatment approaches for anorexia nervosa vary, depending on your (or a loved one’s) age and individual needs. But they tend to include evidence-based therapy, nutritional support, and medical monitoring. These options can sound a bit abstract, so let’s take a look at what they mean. Evidence-based therapy Evidence-based therapy for eating disorders refers to therapeutic approaches that have been proven to help people who are specifically dealing with an eating disorder. A number of different evidence-based modalities for anorexia nervosa exist, but the two with the largest body of research behind them are family-based treatment (FBT) and enhanced cognitive behavioral therapy (CBT-E). Family-based treatment (FBT): FBT is the gold standard for treating eating disorders in young people (children, adolescents, teens, and young adults). In this therapy approach, parents or caregivers take an active role in helping a loved one restore weight and normalize eating behaviors. It may be a part of outpatient, IOP, or PHP care. Sometimes FBT is part of residential programs for adolescents, through family sessions. Enhanced cognitive behavioral therapy (CBT-E): CBT is a part of many different types of therapy, though CBT-E is an enhanced form developed specifically to target eating disorders. It is a structured psychotherapy that focuses on identifying and changing unhelpful thoughts, beliefs, and behaviors that contribute to an eating disorder or disordered eating patterns. It is used as part of outpatient, IOP, PHP, and residential care. Sometimes it is even a part of inpatient stabilization. Other modalities include dialectical behavior therapy (DBT), a type of therapy that incorporates mindfulness and emotional regulation skills; exposure and response prevention (ERP), which helps address eating-related fear and anxiety; and temperament-based therapy with support (TBT-S), in which individuals and their family members participate in group support for several days. Nutrition support Nutrition support is led by a registered dietitian on a multidisciplinary treatment team, but it’s more complex than just “eating more.” “This often looks like identifying a patient’s caloric needs to support weight restoration, setting a target weight range for recovery, and providing psychoeducation and support to families who may have their own preconceived notions about food, dieting, and weight,” Wakeland says. She adds, “Dietitians also review labs alongside medical providers in order to assess specific nutrient needs, inform frequency of weight checks, and help families generate ideas for creating meals that support their loved one’s recovery.” Medical monitoring and stabilization Medical monitoring helps assess how treatment is working based on regular physical and mental health assessments. This type of monitoring is partly for safety reasons, but also to help practitioners and patients assess how treatment is going and decide whether changes in care are necessary. Again, eating disorder care doesn’t always follow a straight line. You or a loved one may need additional care at some points or less during others. Who might be on an anorexia care team? You might be wondering which types of medical professionals and other supports you might find as part of a multidisciplinary care team for treating anorexia nervosa. They may include some or all of the following people: A licensed mental health professional (such as a therapist) specializing in eating disorders A registered dietitian to help navigate complex nutritional needs A medical provider to monitor health status and stabilization A psychiatrist (if necessary) for medication management or treating multiple mental health conditions A coach with lived experience with anorexia nervosa who can offer peer support Family support system consisting of trusted family or other support members  How does anorexia treatment differ for children and teens? Anorexia nervosa treatment differs between minors and adults. This is partially because children and teens with anorexia are still under the care of a parent or guardian and may need additional support. It’s also because these patient populations have different needs. Anorexia treatment for teens and children Loved-one involvement, especially for teens and children, helps support treatment and recovery, according to research in the journal European Eating Disorders Review. For this reason, FBT is often the best approach for young patients. Families usually need coaching on how to implement FBT at home and in daily life, including for meals, school, general routines, and more. Anorexia treatment for adults Adults with anorexia nervosa may have a complex history, including a longer span of living with the eating disorder, co-occurring mental health conditions, and preconceived notions about recovery. For these reasons, a multidisciplinary care team that is adept at collaboration is the most beneficial. Treatment typically focuses on maintaining your autonomy, building a support system, and managing life’s everyday demands, especially those that may be triggering. CBT-E is a key therapeutic focus for adults, though other modalities might also play a role, according to research in the journal Clinical Therapeutics. Despite the fact that adults often have a more complex history with anorexia nervosa, treatment and recovery is absolutely possible, no matter how long you’ve been struggling. Is anorexia treatment covered by insurance? Insurance coverage for anorexia nervosa treatment will vary by plan, provider, diagnosis, medical necessity, and the level of care required. Here’s a list of questions you can ask your provider/program and your insurance company: Is the program in-network with my insurance? What levels of care are covered? What documentation or evaluation is required? What out-of-pocket costs should I expect? Equip is an in-network provider for most commercial insurance plans and a growing number of Medicaid plans. The admissions team can help you understand factors related to cost and coverage before you or a loved one starts treatment. You can also take Equip’s insurance screener to see if Equip is in-network with your health plan. The bottom line You might be wondering what recovery from anorexia nervosa looks like on the other side of initial treatment. It varies from person to person, but in general, it involves a restoration of health, improvements in overall well-being, and more. “Recovery for someone with a diagnosis of anorexia nervosa, beyond the initial medical concern, typically includes returning to their body's natural growth trajectory or biological set point, the ability to eat normally and with age-appropriate independence without restricting the variety or volume of food, a healthy relationship with movement, and a neutral body image,” Wakeland says. She adds, “Recovery can look different for everyone. It doesn’t mean never having an eating disorder thought again or being perfect. Eating disorder recovery is possible, and this diagnosis does not need to be a life sentence.” FAQ Can adults fully recover from anorexia? Yes, adults can fully recover from anorexia nervosa. Adults sometimes have a longer history of living with the eating disorder, along with co-occurring mental health conditions, but help from a multidisciplinary care team can make recovery possible. How do I know if someone needs inpatient treatment for anorexia? The best way to learn whether you or a loved one needs inpatient treatment or a different level of care, such as outpatient (which can sometimes be virtual), is to undergo an initial assessment with a medical professional. What type of therapy is most effective for anorexia? The type of therapy that is most effective for treating anorexia nervosa will depend on factors unique to you or a loved one, including age, medical status, location, and more. CBT-E and FBT are evidence-based therapy methods for treating eating disorders, including anorexia nervosa. But they aren’t the only options.]]></content:encoded>
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            <title><![CDATA[What Causes Eating Disorders?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorder-causes</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorder-causes</guid>
            <pubDate>Wed, 25 Mar 2026 22:09:00 GMT</pubDate>
            <content:encoded><![CDATA[In my 20s, a therapist diagnosed me with “eating disorder not otherwise specified (EDNOS),” now called otherwise specified feeding or eating disorder (OSFED). On the outside, I looked healthy and fit. But a closer look would have revealed a person restricting her food while also engaging in extreme endurance exercise. To anyone unfamiliar with eating disorder causes, my behavior probably suggested I wanted to lose weight, even though I was already thin.  But that was not the driver of my disordered behavior. I had been diagnosed with several chronic illnesses at a young age and was in and out of the hospital, including the intensive care unit. Then in early adulthood, I received another diagnosis: endometriosis, a condition that’s associated with an increased risk of developing an eating disorder.  Chronic pain and a host of other unpredictable symptoms disrupted my life to the point where I felt I had no control. So I attempted to exert control by restricting food well below what I needed to support my physical activity level.  This is just my experience, but my situation illustrates how complex eating disorders can be. Although body image can play a role, it doesn’t always, and many different factors are usually at play. In this article, we explore causes of eating disorders, eating disorder triggers, and more. The biopsychosocial model of eating disorders Each of us has a unique set of life experiences, personality traits, and genetics. And all these factors (and more) can contribute to developing an eating disorder.  Researchers have come up with a basic model for explaining what causes eating disorders, called the biopsychosocial model. It illustrates that eating disorder causes are not one-size-fits-all and that multiple factors overlap, creating a perfect storm that leads to the illness developing.  This model suggests that eating disorders are caused by an interplay of three categories of factors: Biological contributors: These relate to yours or a loved one’s biology, and include factors like genetics, brain chemistry, health vulnerabilities, and more. Psychological contributors: These relate to personality traits, stress responses, coping mechanisms, and more. Social, cultural, and environmental contributors: These include cultural norms, interpersonal relationships, and other environmental influences. We explore each of these categories in depth below. But first, let’s bust through a few myths about eating disorder causes.  Eating disorder causes vs triggers Before we explore the causes of eating disorders, it’s important to differentiate between causes and triggers. “Causes are the deeper vulnerabilities someone may carry, while triggers are the moments that turn up the volume,” says Dr. Melodie Simmons, a licensed professional counselor and certified eating disorder specialist-consultant at Equip.  For example, you might have certain personality traits that increase your vulnerability to developing an eating disorder—but just because you’re more likely to develop one doesn’t mean you will. The eating disorder only “switches on” when there is a trigger, such as trying an overly restrictive diet. And if you or a loved one already has an eating disorder, then triggers may exacerbate it.  Although I’m recovered, I still consider myself to have OSFED. I used to try to control the number on the scale, so I know that weighing myself is triggering for me. For this reason, when I go to the doctor and the intake nurse asks me to step on the scale, I decline unless my current weight is necessary to determine a medication dosage. Even then, I ask for the nurse not to tell me my weight. Biological and genetic contributors Now let’s explore the three elements of the biopsychosocial model, starting with biological causes of eating disorders. Based on genetics and other biological factors, you or a loved one may have inherited a vulnerability to developing an eating disorder. Additionally, chemical messengers in the body, such as neurotransmitters and hormones, can play a role, as can structural differences in brain regions. Plus, how your body manages energy balance also factors in.  Remember, none of these factors make you or a loved one flawed, and they are out of your control. Genetics and family history Various studies have looked at twins and other family members and have explored whether certain gene variants contribute to eating disorder vulnerability. Through these studies, research shows that inherited factors account for 28% to 84% of eating disorder risk. Although more research is needed, some studies have found that variations in our family genes can make us more likely to develop an eating disorder.  Brain chemistry and hormones Neurotransmitters and hormones act as chemical messengers in the body and brain. Differences in these chemical messengers can be inherited or may develop for other reasons, and they can play a role in eating disorders. Here are some examples. Serotonin: This hormone and neurotransmitter helps regulate mood, appetite, and cognitive flexibility, or the ability to adapt your behavior to changing needs. Research shows that serotonin dysregulation and gene variants that affect serotonin pathways are both associated with eating disorders. Additionally, malnutrition, which can be an outcome of some eating disorders, can cause serotonin dysregulation and reinforce food restriction, creating a vicious cycle. Dopamine: This hormone and neurotransmitter is involved in motivation, reward, and other processes. Gene variants in the dopaminergic system may reinforce binging and/or purging cycles that are common with some eating disorders. Energy balance Your hormones also impact appetite, including whether you feel hungry or satisfied. Dysregulation with these hormones, including leptin and ghrelin, may contribute to eating disorder development. Leptin is a hormone that is produced in fat cells. It sends signals to the brain that you are satisfied when full. But leptin resistance can occur with high leptin levels. Leptin resistance means your brain ignores leptin's signals. Higher leptin (and potentially leptin resistance) is linked to binge eating disorder, though this is just one example. Ghrelin is “the hunger hormone.” It’s produced in your gastrointestinal tract and signals to your brain that you are hungry. Higher ghrelin is potentially implicated in several eating disorders. Structural differences in brain regions Our brains are made up of different regions and networks that work together, or separately, in complex ways. Although, as humans, we all have similar brain structures, no two brains are the same. Genetics, our experiences, and our behavior patterns all influence our brain structure.  Some structural differences contribute to various eating disorders, and these may be genetic or develop over time. Examples include gray and white matter changes, cortical and subcortical thickness differences, and network connectivity changes.  Our brains are made up of various networks. These networks connect different parts of the brain and help them work together. This connectivity is ever changing depending on which networks you’re using in a given moment. And if you were to compare your brain with mine, our networks would look a bit different. I like to think of it as no two snowflakes are the same. If you have an eating disorder, you may have enhanced connectivity in some areas and reduced connectivity in others. Psychological contributors Some underlying mental health conditions, personality traits, and even differences in cognitive processes can make you or a loved one more vulnerable to developing an eating disorder. Again, none of these psychological causes of eating disorders make you or a loved one flawed. These are some of the very factors that make us all unique. In fact, some of the personality traits that lead to an ED can, when channeled into something more productive and healthy, lead people to be extremely successful and happy. Co-occurring mental health conditions Eating disorders are mental health conditions themselves. But having a mental health condition—such as anxiety, depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), substance use disorders, and more—can increase risk for developing an eating disorder. Personality traits Certain personality traits, including impulsivity, perfectionism, novelty-seeking, obsessive-compulsiveness, neuroticism, and avoidance are associated with eating disorders.  Dr. Simmons says these traits come up often. “But I’m careful not to pathologize those qualities,” she adds. “I’ll tell patients that nothing is wrong with their personality. The eating disorder just learned how to use their strengths in a rigid way. That shift helps reduce shame and builds compassion.”  As an example, although I’ve never had a formal diagnosis of OCD, I do have the trait of obsessive-compulsiveness. Though I didn’t have a term for it at the time, I first noticed this trait when in the ICU as a child. I feared for my life and thought that if I prayed a lot and “the right way,” I’d survive. I would start my prayers over if I did not do the sign of the cross perfectly.  When I developed disordered eating behaviors, my obsessive-compulsiveness traits “helped” me lock in on my rigid behaviors of doing everything I could to control the number on the scale. Neurocognitive processes How we navigate life is rooted in our neurocognitive processes. Neurocognitive processes include how we intake new information, store it, and retrieve it, and how we use that information for our thoughts and behaviors. Our neurocognitive processes include our executive function. This is the way your brain handles tasks and regulates your behaviors.  Everyone has unique ways of navigating life’s challenges, and your methods are likely a bit different from your best friend’s. However, some people are neurodiverse, which means their brain functions differently than what’s considered “normal,” usually referred to as neurotypical.  The conditions of attention-deficit hyperactivity disorder (ADHD) and autism are examples of neurodivergence, which can make you or a loved one more vulnerable to developing an eating disorder.  “Texture sensitivities, strong need for predictability, or difficulty sensing hunger and fullness can make eating feel genuinely overwhelming,” Dr. Simmons explains. “I frame neurodiversity as a difference, not a deficit, and adjust treatment so it honors how that person’s brain and body naturally work.” Social, cultural, and environmental contributors Social, cultural, and environmental factors are all interconnected. Here are few to consider. Trauma Eating disorders are more prevalent in people who’ve experienced trauma. Trauma at any time, including and especially in childhood, alters your stress response. These alterations can affect your brain chemistry and neurocognitive processes.  Trauma includes many things, such as sexual assault, any form of abuse, military combat, harrowing experiences such as surviving a natural or manmade disaster or a severe car accident, facing food insecurity or poverty in general, experiencing systemic racism in your community, severe illness, and more.  “Trauma can shape how someone experiences safety and control in their body,” Dr. Simmons says, “and sometimes eating disorder behaviors become ways to cope with overwhelming feelings. Trauma isn’t always part of the picture. Eating disorders are complex, and effective treatment usually means addressing both the nervous system and the behavioral patterns that keep it going.” Living environment and upbringing Do families cause eating disorders? This is a common question. And the answer isn’t straightforward. The short answer is, no, families do not directly cause eating disorders. But parents and other caregivers can influence a child’s relationship with food, exercise, and more. Negative associations can increase a person’s vulnerability to developing an eating disorder. However, the blame game isn’t useful and can even impede recovery. Culture The cultures you’re exposed to can also increase susceptibility to developing an eating disorder. The influences are many. Sports: Engaging in sports or physical activity is generally a healthy thing. And sports don’t directly cause eating disorders—however, the culture at play in sports can. For example, wrestlers may be encouraged to reach or maintain a certain weight by any means necessary, and the same is true of ballerinas or other dancers. That said, athletes in non-weight-sensitive sports are also at increased risk for eating disorders. Media: Eating disorders have existed for thousands of years. So media, including social media, isn’t a direct cause. However, media can certainly influence eating disorder development. Media often portrays whatever society considers the “ideal body” of the moment, and these portrayals can be an eating disorder catalyst. Diet culture: Related to media is the general concept of diet culture, in which society tends to champion thin bodies and assign morality to food, with certain foods being “good” and others “bad.” This culture sometimes links self-worth to body size and what’s on your plate, and it is associated with eating disorder development. Keep in mind that culture doesn’t just occur on TV, movies, social media, or glossy magazines—it’s everywhere, including conversations with friends and loved ones. You might be wondering, “Do diets cause eating disorders? The answer is no. They don’t directly cause them. But they are a major risk factor, especially dieting in adolescence or frequent dieting throughout life. Being in negative energy balance (aka a calorie deficit) can trigger an eating disorder in someone vulnerable. Is recovery possible if you don’t know what caused it? You might be wondering if you need to know the exact causes of yours or a loved one’s eating disorder to achieve recovery. The answer is no.  “Patients often want to figure out why,” Dr. Simmons says, “but I let them know that understanding patterns is helpful without needing to solve every piece of the past. Recovery isn’t dependent on having the perfect insight into what started everything.”  For example, family-based treatment (FBT) for eating disorders is agnostic. This means that it doesn’t focus on rooting out the cause. Yet it is one of the most effective approaches for eating disorder treatment.  She adds, “What matters more is restoring nourishment, rebuilding flexibility with food and movement, and strengthening relationships and support. Healing often comes from doing recovery, not just understanding it.” The bottom line I want to end on a hopeful note: eating disorder recovery is possible. I’m certainly living proof.  Although I now have a better understanding of why I developed disordered eating behaviors, the causes weren’t initially clear to me until more recently.But, even at the time, I was able to work with a wonderful therapist who helped me reframe my thought patterns related to food and exercise, using cognitive behavioral therapy (CBT).  Now exercise, specifically running, is something I love for how it makes me feel during and after, not a tool to punish my body for betraying me. And food is what provides me the nourishment to get out in the woods and on the trails or to fuel my brain while writing.  Recovery doesn’t mean perfection, and it looks different for everyone. I still experience triggers. But now I have the tools to recognize them and reframe my thoughts or ask for help when needed.  If you or a loved one are looking for recovery options, know that help is available. Talk with a trusted doctor or schedule a call with Equip to talk through your concerns and explore treatment options. FAQ What causes eating disorders? Several factors can cause eating disorders. Researchers have landed on what’s called the biopsychosocial model to illustrate this. It means that a mix of biological, psychological, and social factors play a role. Do you ever fully recover from an eating disorder? Yes, you can fully recover from an eating disorder. However, even once recovered, triggers can still arise. Recovery teaches you the tools to manage these triggers to reduce your risk of relapse. Can eating disorders be genetic? Yes, family and twin studies show that inherited factors account for 28% to 84% of eating disorder risk. 
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            <title><![CDATA[Does Virtual Eating Disorder Treatment Really Work?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/virtual-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/virtual-eating-disorder-treatment</guid>
            <pubDate>Wed, 10 Apr 2024 14:10:00 GMT</pubDate>
            <content:encoded><![CDATA[Considering eating disorder treatment for yourself or your loved one can be overwhelming. You might be uncertain about which level of care you need or who should be part of the treatment team. Depending on where you live, you could struggle to find experienced providers within a reasonable distance. And of course, you have to consider all this alongside the cost and time involved. One option that could ease your anxiety is virtual eating disorder treatment. This type of care can be more accessible and just as impactful (if not more so) than traditional in-person treatment. “Not having to leave home—or school, the office, whatever—to access medical, therapeutic, and nutrition support and skill-building is a game changer,” says Equip’s Director of Lived Experience, JD Ouellette. "No longer is a one-hour appointment actually three hours with driving included. No longer is it a logistical impossibility to get multiple family members to be able to participate in sessions at an appointed hour. No longer is it necessary to access a residential or partial hospitalization program for coordinated team care.” Read on to learn more about virtual eating disorder treatment, including what the current evidence says about it and how to decide if it’s the right fit for you or your loved one. How effective is virtual eating disorder treatment? What the research shows “The research is clear that virtual care is as effective as in-person care and has benefits that make it easier to access,” Ouellette says. To point to one example, in a study published this year in the Journal of Medical Internet Research, patients who received virtual intensive outpatient (IOP) treatment had similar improvements in eating disorder symptoms as patients who received in-person IOP care. Additionally, the virtual group had greater improvements in depression scores and suicidal ideation and reported higher satisfaction, likely due to the convenience. The researchers concluded that virtual care improves access to treatment without sacrificing quality. Importantly, research shows that virtual eating disorder treatment isn’t just an alternative to lower levels of care, like IOP. According to a study of 109 adults published in the International Journal of Eating Disorders in 2024, patients who received virtual day treatment and those attending in-person day treatment (such as a partial hospitalization program, or PHP) both reduced disordered eating attitudes and behaviors and gained weight. And earlier research published by Equip researchers in Eating Disorders: The Journal of Treatment & Prevention found that not only does virtual eating disorder treatment work, it’s just as effective as traditional treatment. After 16 weeks of treatment, 80 percent of patients with weight restoration goals achieved their weight goals, eating disorder symptoms were reduced by half, and symptoms of depression and anxiety lessened by a third. During the Covid-19 pandemic, virtual treatment became the default out of necessity, and the shift was somewhat haphazard in some instances. But after seeing the promising results of virtual care, many treatment providers began deliberately structuring care to work in a remote environment, leading to even better outcomes. A 2025 peer-reviewed “intentionally remote” program helped patients of all ages reduce eating disorder and depressive symptoms, gain weight, and improve their quality of life. (Equip treatment is a pioneer of treatment that is “virtual design,” offering an approach that fully leverages all of the advantages of remote care.) All of this evidence underscores the fact that families can recover in the comfort of their home, which also offers added benefits, Ouellette says: “A recovery that happens at home, and in one's life, has significant staying power over one that can only be achieved and maintained in an artificial environment.” Who virtual care works best for Although virtual eating disorder care is proven to be effective, it's not the best option for everyone. Here's a look at which patients typically are and aren't a good fit. Virtual care works best for patients who: Are medically stable Have the capacity to engage virtually Have caregiver support (for minors) Benefit from home-based exposures and flexible scheduling Patients may need to pursue in-person treatment (at least temporarily) if they fit any of the following criteria: Medical instability (abnormal vitals, electrolyte abnormalities, syncope, EKG changes) Acute suicidality or self-harm risk Need for 24/7 monitoring and/or hospital refeeding The bottom line is that in the majority of cases, virtual care is an appropriate and effective eating disorder treatment option. And when patients require in-person care due to certain risk factors (like having medical instability or exhibiting suicidality), they can generally transition to virtual treatment once those acute issues have been addressed. Virtual vs. in-person: Pros, cons, and outcomes Both virtual eating disorder treatment and in-person eating disorder treatment have advantages and disadvantages. This table can help you compare the two. (Keep in mind: every program is unique; this is a general comparison.)  In the end, both types of care can be effective. You need to make the best choice for you or your family based on a number of different factors, including medical safety, level of structure needed, and life logistics. That said, given its accessibility, remote eating disorder treatment can be a life-saving option for those who may not otherwise be able to obtain care. It also comes with the significant benefit of allowing people to recover in their day-to-day life—rather than a clinical setting—which can help them build real-world skills and coping strategies that protect against relapse. Virtual treatment can also adapt to be equivalent to different levels of care (including IOP and partial hospitalization program, or PHP) based on patient needs. The intensity of sessions titrates up or down depending on individual needs and progression toward recovery. This may mean more or less frequent sessions, and it's the same thing that would happen if you attended an in-person program. Licensed clinical psychologist Jessica L. Van Huysse, PhD, explains that in certain cases, a patient who starts with virtual care but needs more structure or support might change to in-person sessions and then step back down to virtual treatment when appropriate. At Equip, our virtual treatment incorporates multiple evidence-based modalities proven to lead to recovery in those with eating disorders. We pull from these different approaches to tailor treatment to each patient and their support network, and use a multidisciplinary care team to provide wraparound care that mimics more intensive in-person care. Our treatment model is proven to work; and, conveniently for patients and their families, the place where that model happens is your own home. Virtual treatment for kids & teens (including ARFID) Virtual treatment works for patients of all ages. For children, adolescents, and young adults, family-based treatment (FBT) is the gold standard treatment for eating disorders. And because FBT is based on the idea that healthy family members should take the central role in their child’s recovery, it doesn’t just work when delivered virtually—it needs to be delivered virtually in order to be effective. “When patients are able to continue their care in their home environment, it helps families be integrated throughout the treatment process if they're using family-based treatment,” says Van Huysse. “Virtual treatment helps the caregivers know how best to support their child, rather than having a disconnect where the child goes somewhere to stay for a few months for treatment, and then they come home and the family is not equipped with the same skills that the adolescent was learning while at treatment. And the patient can practice things that come up in their home environment with the support of their treatment team, versus not having to navigate those challenges until they come home and are on their own. This helps recovery be more sustainable.” In FBT, often the entire family joins weekly virtual sessions as well as group therapy. The focus is on empowering parents or other caregivers to take the lead in helping renourish their child. FBT allows families to build a recovery-supporting environment at home, and the patient to learn to use recovery skills in real life. Studies show that virtual FBT leads to weight restoration and reductions in eating disorder behaviors and thoughts, depression, anxiety, and caregiver burden. It also results in similar outcomes as in-person PHP, according to a study published in the International Journal of Eating Disorders in 2022. Additionally, research shows that telehealth delivery of leading treatments for avoidant/restrictive food intake disorder (ARFID, which is most commonly seen in kids) can be effective. In a study published this year in the International Journal of Eating Disorders, Equip provided virtual cognitive behavioral therapy for ARFID (CBT‐AR) or virtual family‐based treatment for ARFID (FBT‐ARFID) to almost 800 youth and adults. Both therapies led to weight gain for those who needed it; improvement in ARFID, anxiety, and depression symptoms; and increased willingness to try new foods. How to evaluate a virtual program When considering virtual eating disorder treatment programs, it’s important to make sure it meets certain criteria. The checklist below provides a good overview of the factors you should consider when deciding on a virtual provider. What to look for in a program: Evidence-based care: FBT, CBT-E, DBT and/or ERP Multidisciplinary team: Medical, therapist, dietitian, peer/family support Published outcomes or ongoing quality metrics Medical monitoring plan: Vitals, labs coordination Family involvement (for youth) and/or caregiver coaching Insurance and coverage transparency Licensure by state Waitlist status and start timelines Safety and privacy practices, including HIPAA and secure platforms Age and diagnosis fit Testimonials and reviews can also be extremely helpful and important when it comes to choosing a program. Hearing what the experience was like for others in similar situations provides a different perspective that can help you assess whether the program is right for you. However, it’s important to prioritize patient outcomes and clinical fit over star ratings, which can be subjective. Costs, insurance, and access As with any eating disorders treatment, the cost of care and whether insurance covers telehealth varies from program to program and insurance plan to insurance plan. Still, virtual care can reduce non-medical costs (like travel and time), and generally has a much lower price tag than in-person care if you are not covered and choose to pay privately. Equip accepts most major insurance plans, and offers zero interest payment plans to make any out-of-pocket costs more affordable. You can check your Equip coverage through our insurance screener. When you schedule a consultation, we’ll also verify that you’re in-network and verify the details of your coverage. Benefits of virtual care While many people still think of in-person care as the go-to model for effective treatment, there are some distinct advantages to going the virtual route. Some of these factors can make or break a patient's ability to initiate and maintain participation in evidence-based care: A lower time commitment, as there is no need to commute to appointments More flexible scheduling, allowing sessions to fit into school or work schedules Less stress around the logistical challenges of accessing treatment Ease of accessing items for specific therapy interventions (i.e., items for family meals or exposure therapies) Ability to have multiple family members join from different locations Access to providers experienced and trained in evidenced-based modalities Ability to learn and practice skills in real life, rather than recovering in a “treatment bubble” For patients who are medically stable, Van Huysse recommends exploring virtual treatment. “It tends to be just as effective as in-person care,” she says. “Some people worry about what it will feel like connecting with a therapist virtually versus in person. But if they're willing to give it a try, oftentimes people find it goes better than anticipated.” For those still on the fence, Ouellette suggests first considering any specific reservations about the path and then evaluating each concern one by one. “Oftentimes whatever challenges there are can be mitigated with some creative thinking and planning,” she says. “Aside from deciding between virtual and in-person care, it's most important to define the treatment model you want to use and the evidence that supports its use, and go from there. A lot of people click with this when I say, 'Residential treatment is a place not a treatment model; oncologists don't prescribe an infusion center, they prescribe a specific chemotherapy protocol that is available at infusion centers.'" Getting ready for virtual sessions: privacy, tech, and setup If, after reading all of this and comparing your options, you choose virtual care for an eating disorder, congratulations! Just by making that choice, you've taken the next step toward recovery. To help your sessions go as smoothly as possible and set you up for success with virtual treatment, follow these tips: Create a quiet, private space. Think beyond your bedroom. A closet, bathroom, or even a parked car works. If you’re a parent or caregiver of a child, consider having separate locations for your child and any adults involved in treatment, as the therapist may want to speak with each of you individually at some point during appointments. Check your device. Test your internet connection, camera, microphone, and speakers or headphones before sessions. Ask how your provider would like to coordinate weigh-ins. They may ask you to have a family member assist with a blind weight, have you position the scale so they can see it but you don't look, or something else. In some cases, you may need to make an in-person appointment with an external provider, who can send your weight and vitals to your virtual team. For meal support, set up the camera so the other person(s) can see your face and your plate. Keep any comfort items nearby to use if emotions become intense. Have a backup plan. If your internet drops or your screen freezes, try immediately to reconnect. If you can't, see if it's appropriate to switch to the phone or reschedule. Be sure you have your provider's number (or another way to contact them) and discuss ahead of time how you’ll reach out if you lose them over video. FAQ Is virtual IOP as effective as in-person? Yes, virtual IOP is as effective as in-person care and leads to similar eating disorder symptom improvements, according to research. Some studies also show that telehealth programs result in greater reductions in depression scores and suicidal ideation and higher levels of satisfaction. Can virtual care treat all types of eating disorders—anorexia, bulimia, BED, ARFID? Yes, virtual care has shown to be effective for most eating disorders, including anorexia and bulimia. Evidence for binge eating disorder (BED) and ARFID are promising. No matter the diagnosis, the key is to choose a program that provides the necessary level of care and ensures medical monitoring so the intensity of treatment can be adjusted if necessary. How do virtual programs check medical safety? For patients who need medical monitoring, most virtual eating disorder programs have patients visit their local primary care provider on a regular basis to have their vitals checked and any other tests done to confirm medical safety. Then that provider sends the patient's results to the virtual care team via a secure portal. How quickly can we start? How quickly someone can start virtual eating disorder treatment varies. You may need prior authorization, and in general it's smart to confirm with your insurance provider that the program is in network and what your copays will be. The program may also put you on a waitlist until space opens up. In that case, ask them about interim supports they offer or can refer you to. At Equip, there is no waitlist, and our admissions team confirms coverage and any out-of-pocket costs on your behalf. Generally, patients begin treatment within two weeks of their initial outreach. Does insurance cover virtual treatment? Many major health insurance companies cover virtual eating disorder treatment. However, coverage varies from plan to plan and may also be state specific. Before you enroll in a program, call your insurance member services to verify your benefits, if you need prior authorization, and if the program you're interested in is in network. What if my child denies a problem or refuses treatment? If your child or loved one denies a problem or refuses eating disorder treatment, don't give up. Rather than ultimatums or pressure, be compassionate. Express your concern using “I” statements, telling them what you've noticed and how that makes you feel. At the same time, validate their feelings and how hard this must be for them. Then listen without judgment. It may take several conversations, but don't give up. You may also have to use your leverage as a parent to make sure they receive the treatment they need, Van Huysse says. “If your child had a medical diagnosis and was refusing to go to appointments or take their medication, what would you do?” she asks. You may need to say, 'you have to do this,' in a firm but loving way. ]]></content:encoded>
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            <title><![CDATA[Real Recovery Happens in Real Life, Not a Treatment Center. Here’s Why]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/real-recovery-real-life</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/real-recovery-real-life</guid>
            <pubDate>Thu, 19 Feb 2026 18:21:00 GMT</pubDate>
            <content:encoded><![CDATA[Residential treatment may have helped jump-start Brittany Sharma’s eating disorder recovery, but according to the Equip peer mentor, lasting recovery happened at home. Back in “the real world,” Sharma says, “healing had to be practiced daily within my routines, relationships, and responsibilities.” Although Equip hadn’t yet been created at the time of Sharma’s treatment and she didn’t formally go through family-based treatment (FBT), she and her parents followed a similar model. “I worked with a therapist, dietitian, psychiatrist, and recovery support group, but my parents were the ones with me every day,” she says. “On days I wasn’t motivated, they were motivated for me. Together, we expanded my safe bubble—learning how to navigate recovery through grocery shopping, eating out, travel, movement, illness, and everyday unpredictability. Eating disorders thrive in secrecy, and recovering at home made that nearly impossible. Recovery wasn’t theoretical; it was practiced in real time.” According to Equip therapist Jalia Henry, LMFT, there’s a good reason “real life” recovery is so uniquely impactful: “When you’re in residential care, your total focus is on treatment. You don’t have outside influences impacting you, and treatment sometimes goes quicker due to fewer day-to-day stressors. When you’re getting virtual care at home, you have your family, school, work, and relationships to balance—but you have the support of a treatment team to assist you on how to maintain recovery while navigating these stressors.” While in-person treatment can help patients feel protected from the distractions and triggers of everyday life—and can feel like a relief for parents or other family members who worry they won’t be able to support their loved one at home—that insulated experience can make it tough to transition back into the real world. “But doing virtual care in the real world gives you the opportunity to learn strategies to overcome these stressors while recovering from the eating disorder,” Henry says. Read on to better understand the different eating disorder treatment options available, when virtual treatment is an appropriate choice, and why at-home care can be such a powerful way to achieve lifelong recovery. Understanding different eating disorder treatment options There are five common levels of care for eating disorder treatment: inpatient hospitalization, residential, partial hospitalization program (PHP), intensive outpatient program (IOP), and outpatient. Here are the basics of each, from least to most intensive: Outpatient care involves meeting with one or more practitioners (often including a dietitian, therapist, and medical provider) several times throughout each month, usually for an hour each. “Outpatient can be fully virtual or in-person. A patient will usually see their therapist or nutritionist one to two times a week,” Henry says. “In addition, appointments with a physician or psychiatrist may be needed less frequently to monitor status.” Intensive outpatient program (IOP) combines individual and group treatment in a structured program. IOP typically meets two to three days per week for two to five hours a day, usually including at least one meal or snack in the program. It can also be done virtually, but in-person is more common. Partial hospitalization program (PHP) also combines group and individual work, but usually occurs in a hospital setting and is a bigger time investment. “PHP is a structured program that’s usually three to five days a week for six or more hours a day,” Henry says. “This typically includes counseling, dietary and group therapy, and multiple meals with support.” It is usually in-person but virtual programs are available. Residential treatment takes place at a live-in facility (not a hospital) and also combines individual and group treatment in a structured program. “Residential care is a 24/7 in-person treatment option with length of stay varying between 30-90 days on average,” Henry says. Inpatient treatment is the most intensive level of care with a primary focus on medical stabilization. “Inpatient hospitalization is a 24/7 in-person treatment option with an average length of stay being less than four weeks,” Henry says. How Equip fits into the treatment landscape While these are the conventional treatment modalities, Equip offers something entirely unique by adapting the level of care and treatment intensity depending on each patient’s needs. Equip is an appropriate treatment option for medically-stable patients needing varying levels of care, including PHP and RTC (over 90% of Equip patients qualify for PHP level of treatment or higher, and 13% of Equip patients enter Equip care directly from inpatient hospitalization). Other traditional levels of care, like PHP and IOP, can be done virtually, but Equip is not a virtual IOP or PHP—unlike one of these programs, which require prescribed hours of at-home computer time per day, Equip is flexible and accommodating to real life. “This flexibility also allows treatment to be the right dosage for every family,” Henry says. “Treatment intensity depends purely on the patient's wants, needs. and availability. Equip’s virtual platform and app means patients can access recovery exactly where and when they’re needed. Equip allows not just the patient but family members to gain access to the treatment team and the skills needed to navigate treatment.” Sharma believes flexibility to be one of Equip’s most impactful features. “Recovery isn’t linear, and people need different levels of support at different times,” she says. “Instead of rigid levels of care, Equip meets patients where they are—adjusting treatment intensity without disconnecting them from their lives. This mirrors how recovery actually works and makes it more sustainable.” What the research says about virtual care vs. in-person care While virtual care may seem like a relatively new concept, there is already a strong body of evidence that demonstrates how effective it is. “Based on research, patients say that treatment is just as valuable virtually as it is in-person, and that virtual care is on par with in-person treatment,” Henry says. As an example, she cites one randomized controlled trial of 128 adults, which found that outpatient cognitive-behavioral therapy for bulimia nervosa was comparable whether delivered face-to-face or via telehealth. A more recent study from 2025 of 49 adults found similar results, indicating that virtual therapy resulted in comparable improvements in eating disorder symptoms, weight gain, and patient satisfaction when compared to in-person outpatient treatment for patients with various eating disorder diagnoses. Additional research has shown that telehealth is a viable solution to the geographic barrier in eating disorder treatment (meaning it helps people who don’t live near treatment centers), and that virtual FBT for eating disorders can expand access to evidence-based treatment. The benefits of recovering in real life While virtual treatment is often touted as being more affordable and convenient than in-person care, it has benefits far beyond this. In fact, the nature of virtual care makes it uniquely suited to helping people achieve lasting recovery and avoid the so-called “revolving door” of treatment. If you’re still weighing the pros and cons of at-home eating disorder treatment, consider these documented benefits of real-life recovery: You can access it from anywhere. In-person, evidence-based eating disorder treatment can be difficult to access. In fact, many locations are considered “treatment deserts,” meaning they completely lack the appropriate care for many people struggling. With at-home virtual care, anyone can get the treatment they deserve, no matter where they live. “Eating disorder treatment isn’t readily available in many areas,” Sharma says. “I limited my own options to stay close to my parents. Virtual care removes geographic barriers and makes specialized treatment accessible to more families.” It’s flexible. With virtual treatment, sessions can fit in between school, work, and other obligations and activities, so there’s no need to put life on pause. This isn’t just nice, it’s essential for many people who can’t miss work or school or other responsibilities, like taking care of children. This flexibility also helps people stay in treatment longer, which strengthens recovery by ensuring they feel confident and ready when they discharge. “Being able to do sessions between meetings, right after school, directly after work, or on your lunch break gives extra flexibility,” Henry says. “It can be so difficult to make it to an outpatient treatment center. Say that’s 30 minutes away, three to four times a week, versus being able to work with Equip and meet all of your providers virtually from wherever is most comfortable for you.” You can bring your village. Unlike other forms of eating disorder treatment, virtual at-home care means loved ones can join the process, strengthening support for lifelong recovery. Not only has research indicated that involving loved ones significantly increases the chances of reaching full remission and drastically reduces the risk of relapse, but involving loved ones also means they’re empowered to better understand the eating disorder and how to provide support. “My recovery anchors were my family, my dog, and passions,” Sharma says. “Being separated from them during the first part of my journey made recovery feel disconnected from real life. Healing alongside loved ones made a profound difference.” Henry adds that for a patient, having their support system learn how to navigate treatment and the eating disorder can be a huge asset that often isn’t a part of the inpatient experience. “Having access to specialized support for your family and loved ones while you’re in treatment is another benefit that you don’t get when you’re inpatient,” she says. “While families have designated days they can visit, they don’t have the day-to-day access to the treatment team that virtual care provides.” You practice real life. Rather than recovering in a treatment “bubble,” those who recover at home face daily, real-world challenges with the support of a multi-disciplinary team. This eliminates the drastic transition from treatment life to real life, because patients are consistently practicing and overcoming real-world triggers and challenges throughout treatment. “Recovering at home means learning how to cope while grocery shopping, eating out, traveling, socializing, and navigating stress—where recovery is truly tested and strengthened,” Sharma says. You stay connected to what matters. Recovering at home means patients are able to remain involved with the people and activities that matter most to them, including family, friends, hobbies, and work. This means the reasons to recover are always front of mind—versus the experience of being in a treatment center where the focus is exclusively on the eating disorder (which can, for some people, only reinforce the importance and prominence of the illness rather than helping patients build up their identity and life outside of it). “Recovering at home allowed me to rediscover who I was beyond my eating disorder,” Sharma says. “I found joy in concerts, community, friendships, and learning how to exist in my body in public spaces. Over time, recovery stopped being separate from my life.” This constant connection to meaningful parts of life also makes it easier for patients to choose treatment and stay committed to the recovery process. “People delay treatment out of fear of missing work or missing school or missing important life events,” Henry says. “The ability to do treatment virtually while still being able to attend important life events allows you to maintain that connection and maintain the important things in your life, while also treating the eating disorder.” By integrating evidence-based clinical care into real life, virtual platforms like Equip offer unique advantages that make it easier to achieve lifelong recovery. Not only does at-home treatment eliminate the transition shock between an insulated treatment "bubble" and everyday reality, but by involving loved ones as active participants and removing geographic barriers, virtual care ensures that healing is practiced in the context of actual routines, stressors, and relationships. If you think virtual care might be the right fit for you or a loved one, consider scheduling a free, no-obligation consultation to learn more about Equip.]]></content:encoded>
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            <title><![CDATA[What Is ARFID? Understanding Avoidant/Restrictive Food Intake Disorder]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-ARFID</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-ARFID</guid>
            <pubDate>Tue, 14 Apr 2026 18:48:00 GMT</pubDate>
            <content:encoded><![CDATA[Avoidant/restrictive food intake disorder (ARFID) is an eating disorder where someone eats a very limited amount or variety of food (or both). Unlike with most other eating disorders, these symptoms don’t show up because of body image or weight concerns. Instead, they are due to factors like low appetite, sensory sensitivities, or fear of negative food-related experiences like choking or vomiting. ARFID can affect kids, teens, and adults, and over time, it can take a real toll on physical health, emotional well-being, and everyday life. The good news: With the right, evidence-based support, those with ARFID can expand their diet, reduce anxiety around food, and build a more flexible, nourishing relationship with eating. Read on to learn what ARFID is, what causes it, common symptoms to look for, how it’s diagnosed, and how treatment works.  What is ARFID? Avoidant/restrictive food intake disorder (ARFID) is an eating disorder. But unlike many other eating disorders, body image or weight concerns are not the main driver here. ARFID is typically diagnosed when someone consistently eats too little food, too narrow a range of foods, or both, in a way that affects their nutrition, health, and/or daily life. In real life, that might look like relying on a short list of “safe” foods, avoiding entire food groups, or struggling to eat enough to meet basic needs. Under the surface, these patterns are driven by underlying factors—like how someone experiences hunger, sensory input, or fear—but what you tend to see day to day is a very limited range of foods, avoiding certain meals or situations, or feeling anxious around eating (we’ll break this down more below). ARFID is most commonly diagnosed in children and is often thought of as a childhood condition. And much of the research we have focuses on kids and teens—estimates suggest that anywhere from 0.3% to 15.5% of children and adolescents meet criteria for ARFID. But it can affect people of any age and body size. While there’s far less research on adults, what we do have suggests that ARFID affects roughly 0.3% of the general population. Indeed, while it often begins in childhood, ARFID can persist into adulthood. It can even show up later in life: For instance, after a stressful or frightening food experience (like choking or getting sick). ARFID is a relatively new diagnosis, only appearing in the DSM since 2013, so it’s still lesser known than many other eating disorders, and many providers aren’t as knowledgeable about it. This can contribute to people going undiagnosed—especially adults, since the common misconception is that ARFID only affects kids. And while it’s not as widely recognized as other eating disorders, ARFID is more common than many people realize—some studies estimate that as many as 15.5% of people will experience ARFID. It also doesn’t have a specific “look.” Someone can be underweight, at a typical weight, or in a larger body and still be dealing with ARFID. What matters is how much their eating patterns are impacting their health and their life.  What ARFID Is — and What It Isn’t What ARFID is A real eating disorder The restriction or avoidance of food Influenced by sensory sensitivities, low appetite, or fear of eating A cause of nutritional deficiencies An influence on daily life, routines, and relationships A disorder that affects any age and any body size What ARFID is NOT A diet or lifestyle choice Just picky eating Driven by a desire to lose weight or change appearance Always obvious or visible from the outside A phase that someone will grow out of What are the three subtypes of ARFID? ARFID Subtypes at a Glance  ARFID doesn’t look the same for everyone. Clinicians often group it into three main “presentations,” but these aren’t rigid categories. Many people experience a mix of presentations, and symptoms can shift over time. Here are the three types of ARFID. Lack of interest in food and low appetite Some people with ARFID simply don’t feel very interested in food. They may forget to eat, feel full quickly, or find eating more like a chore than something enjoyable. Meals might get skipped without much thought, or a few bites may feel like enough. In some cases, this pattern starts early in life, with ongoing feeding challenges or low hunger cues. It can also be influenced by other factors, like certain medical conditions or medications. For example, some people with ADHD struggle to notice hunger signals, and stimulant medications can further reduce appetite. Selective eating due to sensory sensitivity For others, the issue isn’t how much they eat—it’s what they can tolerate eating. Strong sensitivities to texture, smell, taste, temperature, or even how a food looks can make many foods feel overwhelming or “unsafe.” This can lead to a very short list of acceptable foods, often ones that feel predictable and consistent (like specific brands, plain foods, or foods prepared in a very particular way. Small changes (like a different texture or brand) can make a food suddenly feel impossible to eat. This kind of sensory sensitivity is common in people with ARFID who are also on the autism spectrum, though it can affect anyone. Avoiding eating due to fear of an adverse outcome In this presentation, eating is tied to fear. Someone may worry that eating will lead to choking, vomiting, an allergic reaction, or another painful or distressing experience. Often, this is triggered by a specific event, like choking or getting food poisoning. Other times, the fear builds gradually. Either way, the result is the same: avoiding more and more foods, or eating less overall, to try to stay “safe.” Severe cases of this food aversion disorder can lead to significant weight loss or medical complications. What are the symptoms of ARFID? It’s not always easy to tell when eating habits have crossed the line from “picky” into something more serious. A helpful benchmark to remember: If someone’s eating is starting to affect their physical health, emotional well-being, or ability to live their day-to-day life, there is likely a problem. Below are some common ARFID symptoms and warning signs to look out for. Physical symptoms Low weight or noticeable weight loss Faltering growth in children or teens Nutritional deficiencies Dizziness or lightheadedness Stomach cramps Constipation Irregular menstrual cycles Delayed puberty in preteens Behavioral symptoms Difficulty concentrating Sleep problems Lethargy Social withdrawal Irritability Food-related symptoms A general lack of interest in food and eating Not enjoying eating, finding eating to be a chore, or feeling like eating is not worth the effort Being highly sensitive to specific characteristics of foods (like texture, smell, or taste) and avoiding foods with those characteristics A small list of “acceptable” or “safe” foods that gets smaller over time Fear of something bad happening after eating, such as choking, vomiting, or having an allergic reaction Rigid habits or rituals around eating (eating foods in a certain order, keeping foods a certain distance from one another) Lack of appetite Anxiety around mealtimes Anxiety and fear in particular often play a significant role in ARFID. Someone with ARFID might be nervous to eat and become extremely upset or worked up around mealtimes, especially if new or challenging foods are on the table. “This might look like anything from a lot of arguing with their loved one to having a full-blown tantrum,” says Jessie Menzel, PhD, vice president of clinical programs at Equip. Warning signs Beyond the symptoms above, these broader warning signs can help you spot when something more serious may be going on. Keep an eye out for these behaviors or situations: Regularly feeling stressful or tense around meals Avoiding social situations because of food (like restaurants, events, or eating at others’ homes) Being willing to eat only in very specific settings or when food is prepared a certain way Eating a shrinking list of foods over time. Cutting out entire food groups Noticing that eating feels harder than it should Exhibiting increasing rigidity around brands, preparation, or who makes the food Plateauing growth in children (height or weight not increasing as expected) Ultimately, Menzel emphasizes the importance of trusting your gut. If eating feels harder than it should—for you or your loved one—that’s a sign it’s time to seek support. How is ARFID diagnosed? ARFID is diagnosed by a qualified healthcare professional—like a physician, psychologist, or psychiatrist who is particularly knowledgeable about ARFID—often as part of a broader, team-based evaluation. You can start by taking a simple self-screening as a first step. Clinicians first look at how someone’s eating patterns are affecting their health and daily life. This can include things like weight changes, nutritional deficiencies, reliance on supplements, or difficulty participating in school, work, or social situations. Providers also look closely at what’s driving the restriction and rule out other possible explanations. This includes determining whether eating patterns are related to body image or a desire to lose weight (which would point to a different eating disorder), or whether they’re better explained by a medical condition or another mental health diagnosis. If those causes don’t fully explain what’s going on, providers consider whether the pattern fits ARFID—where restriction is driven by things like low appetite, sensory sensitivities, or fear around eating. In younger children, clinicians may also consider pediatric feeding disorder (PFD) as a diagnosis. This is a condition that can look similar to ARFID, but is related to development/skills-based factors rather than psychological factors. PFD includes feeding difficulties related to medical, developmental, or skill-based challenges. An ARFID diagnosis, on the other hand, is a mental health condition specifically tied to patterns of food avoidance or restriction without body image concerns. Because ARFID can show up in different ways, it’s important to understand the full picture so you or your loved one can get the right support. What are the health risks of ARFID?  How ARFID Affects the Body Brain: fatigue, difficulty concentrating Heart: low blood pressure, dizziness Bones: reduced bone density Blood: anemia, nutrient deficiencies Hormones: delayed puberty, irregular menstrual cycles Energy: chronic fatigue ARFID can impact the entire body. When someone isn’t getting enough calories, nutrients, or variety in their diet, multiple body systems can be affected. How severe those effects are depends on how restrictive the eating pattern is and how long it’s been going on. It’s also important to remember that these risks aren’t always obvious right away, and someone doesn’t have to look visibly underweight to be struggling. Even subtle or gradual changes in eating can have real effects on the body over time, which is why early support and treatment matter. Potential health complications of ARFID include: Malnutrition Dehydration Electrolyte imbalances Anemia Low blood pressure Bone loss or reduced bone density Delayed puberty Poor growth in children Fatigue or low energy Social isolation What are the causes and risk factors of ARFID? At this time, there’s no single, clear-cut cause of avoidant/restrictive food intake disorder. Like most eating disorders, ARFID tends to develop from a mix of biological, psychological, and environmental factors, and that mix looks different from person to person. Some factors that may contribute to the development of ARFID include: A family history of eating disorders Sensory processing differences (for example, heightened sensitivity to taste, texture, or smell) Neurodivergence, such as ADHD or autism Differences in how the brain regulates appetite and hunger cues Anxiety disorders or high baseline anxiety A traumatic food-related experience, such as choking, vomiting, or a severe allergic reaction ARFID vs. picky eating: what’s the difference?  “This is the number one question I get from parents and other providers,” says Menzel. And for good reason—on the surface, picky eating and ARFID can look very similar. The difference comes down to severity and impact.  Picky eating is common, especially in childhood. And while it can be frustrating, it usually doesn’t affect someone’s health or daily life. What sets ARFID apart is “the extent to which they narrow what they eat and the persistence with which they narrow,” explains Menzel. With ARFID, eating patterns are more extreme and don’t tend to improve over time. The range of foods a person eats may continue to shrink, and that restriction can start to affect multiple areas of life. For example: Nutritional needs aren’t being met, or there’s a risk of deficiencies. Eating interferes with school, work, or social life (like skipping lunch, avoiding birthday parties, or feeling unable to eat at restaurants). Meals become a major source of stress or conflict. In children, growth (height or weight) may slow or plateau. Flexibility is another key difference. Someone with picky eating may have preferences, but they can usually adapt when needed, like trying something new at a restaurant or when eating at a friend’s house. With ARFID, that flexibility is much lower. According to Menzel, someone may only eat a specific food prepared in a very specific way and not tolerate even small changes. Over time, that rigidity can make everyday situations feel overwhelming or even impossible. What are the best treatments for ARFID? ARFID is highly treatable, and benefits most from a team-based approach that addresses both the physical and psychological aspects of eating. Here are the most effective treatment strategies. Medical care Medical providers help monitor health and make sure the body is getting what it needs to recover. This may include: Tracking weight and growth (especially in children) Restoring weight Identifying and treating nutritional deficiencies Monitoring co-occurring conditions (like anxiety, ADHD, or GI issues) Managing medications, if needed Patients may also work with specialists that can help address underlying or co-occurring conditions that could be contributing to ARFID symptoms. These include: Gastroenterologists Allergists Neurologists Psychiatrists Nutritional counseling Dietitians play a key role in helping people expand what and how much they eat at a pace that feels manageable. Support may include: Building balanced, realistic meal plans Increasing food variety gradually Teaching strategies to manage food anxiety Addressing specific challenges like texture sensitivities or fear foods Food bridging, where someone starts with a “safe” food and slowly makes small changes (like shape, brand, or preparation) to expand their comfort zone Therapy Therapy helps address the underlying drivers of ARFID, like anxiety, fear, or past traumatic experiences with food. Common therapeutic approaches include: Family-based treatment for ARFID (FBT-ARFID): Considered the gold standard of care for young people with anorexia nervosa, FBT empowers family members to take a central role in treatment to stop disordered behaviors and nourish their child. Cognitive behavioral therapy for ARFID (CBT-AR): This specialized type of CBT involves several phases. First, it focuses on teaching the patient about ARFID and how it manifests. Then, it helps patients notice and challenge the thoughts and behaviors of ARFID. Exposure and response prevention (ERP): Food exposures are a central component of ARFID treatment, and this method has been shown to be highly effective. It provides a safe, supportive space for the patient to face challenging or anxiety-provoking foods and experiences. Over time, they gradually become accustomed to and more comfortable with those foods and are able to expand overall food variety. However, it’s important to note that ERP is really only an appropriate treatment approach for individuals with the fear of aversive consequences presentation of ARFID. It unfortunately does not effectively target the other two presentations. Treatment settings Treatment can happen in different settings depending on the level and type of support a person needs. Common options include: Outpatient care: This involves regular sessions with a therapist, dietitian, and/or medical provider while continuing daily life. Intensive outpatient or day programs: These offer more structured support with multiple sessions per week, usually involving at least one meal at the program during each session. Inpatient or residential care: These options provide higher-level support that involves living in a clinical or non-clinical treatment setting and getting 24/7 care. Inpatient hospitalization is generally used to address any acute medical concerns. Virtual care: Many levels of care—including outpatient, IOP, and PHP—can now be delivered virtually. This allows individuals to receive structured, multidisciplinary support from home. For people with ARFID who are medically stable, virtual programs (like Equip) can be an effective option across a range of severity levels. How to find professional help ARFID is highly treatable, but it’s important to get the right support from a team of ARFID-informed specialists. A pediatrician or primary care provider is often a good place to start, however, many general providers are not knowledgeable about ARFID, so if yours is not, seek out an expert, like those at Equip—the largest ARFID treatment provider in the country—to talk through your concerns and next steps. When evaluating providers or treatment options, look for: A multidisciplinary team (medical, nutrition, and mental health support) Experience treating ARFID specifically—not just eating disorders in general A treatment plan that addresses both nutrition and the psychological side of eating Once you’ve booked an initial appointment, a little prep can go a long way. Taking these steps beforehand can help ensure a productive conversation: Write down symptoms or changes you’ve noticed Track patterns (foods avoided, mealtime stress, weight or growth changes) Bring questions about the treatment approach and what to expect next How to support your loved one through recovery If someone you love is showing signs of ARFID, it’s important to know this: it’s not your fault, and it’s not theirs. Eating disorders aren’t a choice. With the right support, recovery is possible, and getting connected with experienced professionals is the first step. Once your loved one is in treatment, here are a few ways you can support them: Be patient: Progress can be slow, especially at the beginning. It may feel like a lot of effort for small changes, but those small wins matter and add up over time, according to Menzel. Stay open to what progress looks like: Someone with a very limited diet isn’t going to suddenly love every food. Try to let go of specific expectations and focus on gradual progress instead. Create a non-judgmental environment: Your loved one’s experience with food may be very different from yours. Reactions like pressure, frustration, or surprise can backfire. What helps most is supporting their willingness to explore, not whether they like a food right away. Build a support system: ARFID can feel isolating, especially if it’s new to you. Connecting with others—whether through support groups or mentorship—can make a big difference for both you and your loved one. The bottom line ARFID is more than just picky eating. It’s an eating disorder that can make food feel stressful, overwhelming, or even scary—and it can impact health and daily life in real ways. It doesn’t look exactly the same for everyone. For one person, it might mean eating the same few foods every day. For others, it might look like avoiding restaurants and social events or skipping meals without realizing it. None of it is a choice or something someone just “grows out of.” The good news: With the right support, people really do get better. Over time, eating can feel easier, less stressful, and a lot more flexible. Frequently asked questions (FAQs) What is the difference between ARFID and picky eating? Picky eating is common (especially in childhood) and usually doesn’t affect health or daily life. People may have preferences, but they can still meet their nutritional needs and adapt in different situations. ARFID is more severe and persistent, and people affected tend to eat a much narrower (and often shrinking) range of foods that can lead to nutritional deficiencies, anxiety around eating, social avoidance, and, in children, stunted or delayed growth. What are the health risks of ARFID? ARFID can affect multiple body systems over time. Possible risks include malnutrition, dehydration, fatigue, dizziness, nutrient deficiencies, low bone density, delayed puberty, and social isolation. Can adults have ARFID? Yes. While ARFID often begins in childhood, it can continue into adulthood or develop later in life. This is especially common after a stressful or traumatic food-related experience (like choking or food poisoning). Learn more about ARFID Looking to go deeper? These resources can help you better understand how ARFID shows up and what effective support can look like: ARFID in children (coming soon) ARFID screener ARFID in adults ARFID symptoms ARFID causes (coming soon) Types of ARFID ARFID treatment What is ARFID? How Equip is leading treatment Deep dive recommendations If you want to learn more or find additional support, these trusted resources can help: Equip: In-depth articles, treatment information, and support options Feeding Matters: Resources on feeding challenges, including ARFID and pediatric feeding disorder F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders): Guidance and support for families National Eating Disorders Association (NEDA): Education, screening tools, and support resources]]></content:encoded>
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            <title><![CDATA[What Is Family-Based Treatment (FBT) for Eating Disorders?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/why-fbt-is-effective</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/why-fbt-is-effective</guid>
            <pubDate>Thu, 15 Jan 2026 20:36:00 GMT</pubDate>
            <content:encoded><![CDATA[When your child is struggling with an eating disorder, finding a treatment option that feels like the right fit can seem daunting and overwhelming. As a parent or caregiver, you may also be hesitant to send your child away to a residential treatment facility that distances you from the recovery process. The good news is there is another option: Family-based treatment (FBT) One of the leading evidence-based approaches available, FBT is the gold standard treatment for young people with eating disorders, including anorexia nervosa, bulimia nervosa and other specified feeding or eating disorder (OSFEFD). This form of therapy allows children to remain living at home throughout the recovery process and actively engages parents or caregivers in treatment. For JD Ouellette, a San Diego mom and Equip's Director of Lived Experience, FBT played a critical role in saving her daughter Kinsey who developed anorexia nervosa in late 2011, as a senior in high school. While Ouellette says her daughter’s eating disorder was “a terrifying situation,” the family was heartened and relieved that there was an available, proven successful treatment modality “that did not involve sending our daughter away." "This was critical for us, because our strong instinct was always to lean into our closeness as a family and stand united when tough things happened," says Ouellette. "I knew that treatment for anorexia would be incredibly hard and that meant we needed to do it together." But what exactly does FBT involve? In this guide we'll provide a comprehensive look at FBT, including a clear breakdown of how (and why) it works, what participants can expect, and how Equip builds upon the FBT model.  What is family-based treatment (FBT)? Family-based treatment, or FBT, is an approach to treating eating disorders that's proven incredibly successful in helping children, teens and young adults to gain weight. This approach to treating eating disorders is also often referred to as the Maudsley Method because the treatment was developed at Maudsley Hospital in London, England.  Considered the gold standard for eating disorder treatment, FBT can be used in cases of anorexia nervosa, bulimia nervosa, bulimia, binge eating disorder (BED), avoidant restrictive food intake disorder (ARFID) and other specified feeding or eating disorder (OSFED). Caregivers play a key role in this approach to treatment—in fact, they’re the primary change agent in the outpatient treatment process.  "Family-based treatment is a collaborative approach to care that brings the whole family into the healing process," says Samantha Bickham, LMHC, CEDS, QS, owner and certified EMDR therapist at Calming Tides Counseling. "Treatment works best when the people who have the most consistent influence and connection with the [patient] are actively involved."  This line of thinking is a significant break from past theories about treating eating disorders, which often placed blame for the disorder on family dysfunction.  Equally importantly, families come in all shapes and sizes and FBT is not limited to traditional nuclear families. It can be successfully used with a variety of different family make-ups including members of blended families, separated families, or any caregiving system involved in a child’s daily life.  "Supports can be parents, but supports can also expand to extended family, friends and neighbors. Each family is different and the treatment can be adapted to fit the individual family and patient's needs," says Carol Brown, an Equip therapist. While experts have widely endorsed FBT as the best treatment approach for young people, a variation of this treatment known as family-based treatment for transition age youth (FBT-TAY) is also available for older patients (ages 18 to 26) who can benefit from their family’s or caregiver's support in recovery.  There's also a specific FBT approach that's been adapted for children impacted by Avoidant/Restrictive Food Intake Disorder (ARFID). This treatment includes many of the same methods and interventions as standard FBT, but also includes various departures such as allowing a child struggling with ARFID to be a more active participant in their own treatment and doing so earlier on during the treatment process. Beliefs underlying FBT There are several key beliefs or tenets that form the basis for FBT and its method of supporting your child's recovery from an eating disorder. They include: An agnostic view of the causes behind the illness: The central idea behind this first tenet is that FBT "does not focus on exploring causes of the illness, but instead aims to engage the family as a resource to bring about early behavioral change," says a 2022 article on the tenets of FBT published in the Journal of Eating Disorders. One of the most important takeaways about the agnostic approach is that it does not blame you, the parent or caregivers, for causing the disorder, which is a notable and important difference from historic ways of treating eating disorders. Therapists take a non-authoritarian stance in the treatment: Another core element of FBT is that the therapist or medical professionals involved typically act more like expert consultants who are the eating disorder and treatment experts. While these professionals are of course, actively engaged, they do not tell parents or caregivers what to do. Instead, "decisions about how to implement treatment are left up to the parents," explains the 2022 Eating Disorders article.. Parents are empowered to bring about the child's recovery: Adding to the previous point, it's you as the parent or caregiver who's empowered to spearhead your child's recovery during FBT. After all, you are the expert when it comes to knowing the patient and your family. The eating disorder is separated from the patient and externalized: Another important feature of FBT is that the eating disorder or illness is separated from the child. What does this mean exactly? When a child does not eat, it's not because they are trying to be difficult or stubborn. Nor are they even really doing it on purpose. The behavior is the result of the fact that the child is still controlled by a powerful eating disorder. And that disorder has the power to influence thoughts, feelings and actions. Treatment takes a pragmatic approach: During FBT, the treatment is focused on eating and weight restoration first, knowing that ED behaviors naturally resolve as patients become nourished.  What’s the difference between family therapy and family-based treatment?  Given how similar the terms FBT and family therapy sound, there's (understandably) confusion surrounding the difference between these two treatment models. While there are some similar elements, these two forms of treatment are not the same. As the table above illustrates, there are different goals, methods and even focuses for FBT and family therapy.  "Family therapy is a broad term and encompasses many different styles and approaches to build communication skills, explore family patterns and improve family relationships. In traditional family therapy, the family is viewed as the patient and therapy focuses on strengthening the family as a unit," explains Carol Brown.  FBT, on the other hand, has a very targeted and specific goal of improving eating disorder symptoms. While the therapy does incorporate the family, the treatment sessions are highly structured and goal-oriented. That includes following a behavior-focused, agnostic approach that doesn’t prioritize getting to the root causes behind the illness, but instead works to return your child to a nourished state—knowing that behaviors related to the disorder will resolve as recovery takes place. Which eating disorders can be treated with FBT? FBT supports young people of all body sizes, identities, and family structures. And while it was initially developed specifically to treat anorexia, it has since been shown to be effective in treating all types of eating disorders, including:  Anorexia nervosa Bulimia nervosa Binge eating disorder (BED) Avoidant restrictive food intake disorder (ARFID) Other specified feeding or eating disorder (OSFED).  How does FBT work?   With families or caregivers taking the lead, the FBT approach to treating an eating disorder moves through three key phases: Reduction of symptoms and weight restoration (when needed) Development of skills and independence Identity formation and relapse prevention Let's take a closer look at what each of those phases involves. Phase 1: Weight restoration and symptom reduction During phase 1 of FBT, the patient's parents, caregivers, or supports are in charge of plating and monitoring meals and supporting the patient in reducing eating disorder symptoms.  During this phase, the family will attend sessions with a trained health professional. Here, you’ll focus on empowering the patient’s support at home—that means managing symptoms as well as providing skills to cope with challenges that show up during or after mealtimes. Weight restoration is also a key focus of this phase when needed—along with resolving any other health concerns that might be related to the patient’s eating disorder symptoms. Phase 2: Development of skills and independence Moving on to phase 2, at this point, the patient should be ready to start building their independence surrounding eating. Also during this phase, support sessions with a trained health professional focus on building skills to help the patient slowly regain independence around eating with the continued support of parents or caregivers. "This can look like the patient practicing independently plating or preparing meals with initial oversight from supports that is slowly phased out," explains Carol Brown. Phase 3: Identity formation and relapse prevention This is the final phase of FBT. At this point in treatment, if the patient has reached a healthy weight and eating disorder behaviors have subsided, the family or caregivers are often encouraged to be completely hands-off when it comes to managing meals, explains Sharonda Brown, MA, BS, LPC-S, NCC, who specializes in eating disorders and FBT.  "This allows the adolescent or young adult an opportunity to build trust and learn who they are by making dietary choices that are best for their health and well-being," explains Sharonda Brown.  "We also discuss creating a space of normalcy for the family where the eating disorder is no longer the focus," Brown adds.  Additional central features of phase 3 include identity formation and relapse prevention. Identity formation involves the patient exploring their identity beyond the eating disorder that has defined their daily life. This might include engaging in hobbies, reconnecting with friends, and even patients choosing their meals based on their own tastes and desires, rather than calories.  This phase might also include having a meal with friends (instead of family), especially if friends were missed during treatment.  Relapse prevention, meanwhile, involves therapists working with you and your child to develop long-term strategies that can be used as a guide to get back on track, should recovery become compromised at any point.  This typically includes establishing a formal plan that's written and can be referred to if there are slip-ups or challenges after treatment ends, says Sharonda Brown.  "So, this looks like identifying triggers and stressors beforehand, as well as thoughts, beliefs, or habits that can potentially provoke a binge, purge, or restriction," Brown explains. "Alongside those, would be remedies or solutions to suppress urges or decrease the use of eating disorder behaviors." What to expect as a parent or caregiver For the parents or caregivers who play a key role in FBT, the journey can be daunting, marked by a rollercoaster of emotions ranging from fear to grief, exhaustion, and frustration. FBT also involves a significant time commitment, along with strict meal structure and regular, ongoing attendance of appointments with a healthcare professional.  It's not unusual for caregivers to be overwhelmed or even surprised at how much commitment and work is involved. It's a process that can feel daunting and difficult because dealing with illness is hard, but remember: it's not permanent and the process becomes less intense and time-consuming as your loved one moves toward lasting recovery.  "It was without a doubt the hardest thing I, and we, have ever done," says Ouellette, who (along with her husband, as often as was possible) spent 12 hours a week participating in an outpatient treatment program with their daughter.  The FBT process and renourishing her daughter also required that Ouellette learn to cook in ways that ensured every meal and snack had maximum possible fat and calories. Even harder than meal preparation was getting her daughter (who was terrified of eating anything), to consume the food Ouellette was preparing day after day.  "It started with a level of supervision of her that was reminiscent of the toddler years, and required my own strong will, skill, finesse, and ultimately raw determination to get her to eat," Ouellette recalls. "Her reaction to food was very much a 'fight' reaction in the 'flight, fight, freeze' response to terror. Her brain was literally processing food as a threat to her life."  The key takeaway for parents or caregivers however, is that the effort is always worth it, as recovery is entirely possible. What's more, FBT gets less daunting after the initial push. And finding and maintaining a support network is a critically important way for families or caregivers to navigate the ups and downs of the process.  "It can be demoralizing so it is vital to connect with other families so you know this is normal and can be temporary if you keep going," says Ouellette. "Hope is critical and that's why you need to hear from parents and people in full recovery." What makes FBT so effective?  There are a variety of reasons why FBT is so incredibly effective, not the least of which is the psychological benefits of family or caregiver involvement in the treatment process. FBT combines the most recent evidence-based clinical research with the sheer power of family.  "​​FBT is effective because it takes those who love you and makes them your treatment providers," says Sharonda Brown. "So often, families are separated from their loved ones’ treatment. With FBT, families get firsthand knowledge of what an eating disorder really is and how it affects everyone involved. It’s almost like healing from the same wound together."  In addition, eating disorders are biological, brain-based illnesses, and FBT’s focus on nutritional rehabilitation and symptom reduction acknowledges that fact. Armed with the knowledge that food is medicine, families can start to renourish their loved one even when the eating disorder is causing resistance and lack of motivation. FBT also helps patients stay in recovery because treatment is happening in the midst of the stressors and challenges of everyday life. Recovering at home means that patients are actively and continually building the tools and coping skills they need all along the way, reducing the risk of relapse that can occur during a transition from a separate treatment setting back into real life.  Still, as a parent or caregiver who is charged with leading what can be an often difficult recovery process, it's natural to worry that the process may harm your relationship with your child. The resistance a child exhibits however, is normal and has nothing to do with feelings about the parent or caregiver. Ouelette says the eating disorder can cause your child to behave outside their values. "You are pouring everything into fighting for your child, and what you often get back in the beginning is sneering and snarling and name calling," explains Ouelette. "I had to remind myself all day that this was not my actual daughter and my actual daughter was depending on me to save her. And over time that is exactly what happened." Not only did Ouellette's daughter fully recover (she now loves food more than before she got sick and eats with gusto), the family is even closer than before. The bottom line: Eating disorder recovery is hard work, but undergoing treatment can be that much easier when surrounded by family members, friends, and the comfort of home. What are common misconceptions about FBT? There continues to be confusion, misconceptions or myths surrounding FBT and what it involves. Here are some of the most common myths.  Myth #1: Only specific types of families can benefit or use FBT This is not true. Families and caregivers come in all forms and FBT can be used effectively by any type of household. That includes single-parent homes, blended families, divorced households, foster care families and more. An Equip study published in 2025 underscores this point. It found that FBT works effectively for families of all different configurations and demographics.  "While FBT literally stands for family-based therapy, we believe that the word family can be interchanged for supports, and supports are individualized for each person in recovery," explains Carol Brown. "As an FBT therapist, I've worked with extended families, grandparents, cousins, aunts, schools, in-home mentors, friends, neighbors, and partners. All of these supports can help support patients navigate challenging meals. FBT is just as effective when working with these supports. We believe it really does take a village."  Myth #2: FBT does not address the cause behind the eating disorder FBT is known as an "agnostic" approach to treatment, meaning it works no matter what is causing the patient's eating disorder. But that doesn't mean it ignores the factors that might be contributing to the disorder.  However, FBT is based on the belief that an eating disorder can be effectively treated: 1) without knowing the exact cause, and 2) by first renourishing the patient and reducing active engagement in disordered behaviors. When a patient's body and brain are undernourished it makes addressing other issues harder, including the causes behind the eating disorder.  "Once the first two phases of family-based treatment are completed, the third phase can allow space for other areas of concern to be looked into," says Bickham. "Research has shown that psychological symptoms such as feelings of depression improve once weight is restored."  Myth #3 FBT “only focuses on weight” While FBT initially does focus on weight restoration, the purpose of this approach is to help support patients in processing some of the more challenging aspects of their eating disorder after their body is fully nourished, says Brown.  "As a therapist I often liken trying to challenge eating disorder thoughts in a malnourished body to trying to write a complex science research paper while sleep deprived—it doesn't work very well," Carol Brown explains. "FBT helps the patient tackle the challenges related to malnourishment as an initial focused goal."  Once there is a significant and noticeable improvement in the rigid, obsessive thoughts, mood dysregulation and motivation associated with eating disorders, and are fully nourished, patients are better able to tackle the other issues associated with eating disorders, adds Brown.  Myth #4: Recovery isn’t possible unless treatment takes place in a dedicated treatment facility Because FBT allows patients to recover in the comfort and familiarity of their own environments, it eliminates the need to remove patients from their everyday lives and empowers loved ones to play an active role in supporting treatment. Additionally, through FBT, parents and caregivers get the opportunity to build confidence in their ability to care for their child, which can help ensure success in recovery. In many ways, FBT is effective because it doesn’t happen in a dedicated treatment facility. Check out these tips for parents in FBT.  When might FBT not be a good fit? While FBT is an incredibly effective evidence-based approach to treating EDs, it may not be right for everyone. There are some situations when this type of treatment may not be the best option, including when there may be safety concerns related to the patient and when there is limited capacity among families or caregivers to participate in treatment.  "FBT might not be a good fit if the patient is medically compromised and needs high levels of medical oversight/hospitalization," explains Carol Brown. Know that inpatient hospitalization is generally a short-term solution to help stabilize a patient; then, they’ll move into longer-term ED treatment, with FBT as a solid next step after inpatient.  There are also occasionally times when significantly high levels of internal family conflict (unrelated to the eating disorder) can be a barrier to successful implementation of FBT. However conflict itself does not necessarily mean FBT cannot be implemented.  The time commitment that this type of treatment involves may also not be possible for every family. Particularly during the beginning phases of treatment, it is important that family members are able to stay present at home in order to reestablish weight and regulate meals, notes Bickham. This type of intensive commitment can lead to financial stress and the needs of other family members being overlooked.  When there are questions about whether FBT can be effective, it's best to consult an eating disorder therapist in order to help make an informed decision. Determining that FBT is not right in your situation does not imply any sort of failure or that the treatment approach you proceed with is somehow less effective or promising. How has Equip built upon FBT? Helping a loved one recover from an eating disorder is no small feat. Many families find they need more support than weekly sessions with an FBT therapist in order to achieve full recovery. Equip builds on the foundation of FBT by making treatment fully virtual and adding the wraparound support of a dedicated 5-person care team, which includes a substantial mentorship component. Each family participating in Equip's process gets both a peer mentor for the patient and a family mentor for the parents. In addition, because body image can be such a challenge for someone recovering from an eating disorder, Equip enhances traditional FBT by offering an evidence-based body image program for patients. Building body image resilience and body empowerment strengthens recovery and reduces the risk of relapse. With virtual treatment, patients and families have more time to focus on life outside of the eating disorder, because we know that lasting recovery comes from building a life worth living. If you'd like to learn more about how FBT could work for your family, schedule a consultation. The bottom line Eating disorders are a life-threatening condition, but the good news is that recovery is entirely possible—for children and teens as well as adults. FBT offers one of the most effective approach for young people in achieving this critical goal. It does so by combining evidence-based clinical research with the power of family, offering families or caregivers a path to renourish their loved one, help them escape from the grip of their eating disorder, and reclaim their life. If you have questions about FBT, reach out to Equip for a consultation to learn more about how we can help.  Frequently asked questions (FAQs) Is FBT evidence-based? Yes, FBT is evidence-based. There is a great deal of research confirming the effectiveness of FBT in treating eating disorders. It has consistently been shown to be a first-line evidence-based treatment (EBT) that can help interrupt eating disorder behavior in young people.  What are the three phases of family-based treatment? With families or caregivers taking the lead, the FBT approach to treating an eating disorder moves through three key phases. They are reduction of symptoms and weight restoration (when needed); development of skills and independence; and identity formation and relapse prevention.  Does FBT work for anorexia? Yes, FBT was initially developed specifically to treat anorexia. It has since been shown to be effective in treating all types of eating disorders, including bulimia nervosa, binge eating disorder (BED), Avoidant Restrictive Food Intake Disorder (ARFID) and Other Specified Feeding or Eating Disorder (OSFED). ]]></content:encoded>
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            <title><![CDATA[How to Stop Binge Eating at Night — and Why Willpower Isn't the Answer]]></title>
            <link>https://equip.health/articles/understanding-eds/how-to-stop-binge-eating-at-night</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/how-to-stop-binge-eating-at-night</guid>
            <pubDate>Wed, 29 Jul 2026 01:04:00 GMT</pubDate>
            <content:encoded><![CDATA[Many people grab a late-night snack now and then to satisfy a craving, enjoy a favorite treat while catching up on a show, or calm unexpected hunger that crops up post-dinner. Late-night snacking, whether in response to factors like this or even as a general habit, (like always having something specific right before bed), is completely normal. Nighttime binge eating is different. It involves eating large amounts of food quickly, feeling out of control around food, and experiencing distressing emotions, such as shame or guilt, afterward. This is a disordered eating pattern, but it isn’t about a lack of willpower or a personal shortcoming. And it’s not something you or a loved one can “just stop,” because underlying physiological and psychological mechanisms typically override any efforts to avoid or stop the behavior. The good news is that when these underlying causes get addressed, recovery from nighttime binge eating is possible. In this article, we explore how to stop binge eating at night, what binge eating disorder is, and more. What is nighttime binge eating—and is it the same thing as late-night snacking? Nighttime binge eating means eating large amounts of food in a short period of time late in the day, whether after dinner, before bed, or in the middle of the night. Intense urges bring on nighttime binge eating, and feelings of distress typically accompany an episode. “Everyone has had an evening where they reach for a late-night snack,” says Jen Simmons, PhD, lead therapist at Equip. “This might be due to stress, trouble falling asleep because of excitement, or genuine hunger.” She adds, “Late-night snacking is a completely normal part of life. It can cross the line into disordered eating when it begins to cause emotional distress, such as feeling an absolute need to eat every single night just to fall asleep. When food starts creating that kind of mental anxiety, it is well worth checking in with a professional.” Nighttime binge eating is a disordered eating pattern. It has characteristics of binge eating disorder (BED) and could be a sign of BED or another eating disorder. BED is a recognized mental health condition, as noted in the Diagnostic and Statistical Manual of Mental Disorder 5th Edition (DSM-5). The following table explores the key differences between nighttime snacking, binge eating episodes, and binge eating disorder.  Why does nighttime binge eating happen, and what can you do? Nighttime binge eating occurs because of underlying physiological and psychological mechanisms, not out of a lack of willpower. The potential drivers include daytime food restriction, stress and other emotional factors, disrupted hormones or processes that regulate hormones, and habits and environmental cues. These factors may sound a little abstract, but they can explain why you may feel like you can’t stop eating at night. Let’s explore them in more detail. Addressing those potential causes can help you prevent binge eating at night without restricting food. But remember, stopping can be hard to do on your own because of what’s triggering the issue. Getting support from a multidisciplinary care team can help.  Restriction and undereating during the day Your body needs adequate nutrition to support all it needs to do, including keeping your heart pumping, lungs breathing, and cells performing their functions. These are just some of the things your body does continuously, even at rest. It also needs an adequate amount of nutrients for you to perform household chores, walk your dog, or do any additional exercise. Restricting food, whether by skipping meals or not eating enough during them, puts you in an energy deficit, meaning you’re burning more calories than you’re taking in. “The body will do whatever it takes to provide what we need to make it through,” Dr. Simmons says, “but by the end of the day, there is simply no gas left in the tank. The body recognizes this deficit and intensely wants to replenish.” Energy deficits can place your body in survival mode by kicking off hormonal processes that send signals to your brain that you need food, stat. These hunger signals can become so powerful that they’re impossible to ignore, leading to binge episodes. This may be more common for you at night because of restriction during the day. Unfortunately, many people try to “compensate” for a nighttime binge by restricting the next day—falling into a harmful pattern known as the binge-restrict cycle. “Waking up the morning after an episode often means having no appetite,” Dr. Simmons says. “If guilt and shame are present, a person might feel like they shouldn't eat breakfast because of what they ate the night before. What happens then is they restrict food until lunch or even later, which actually creates the perfect opportunity for another binge the following night due to a lack of daytime nutrition.” Another factor is when foods get tagged morally as “good” or “bad.” “After bingeing on a food labeled as ‘bad,’ shame and guilt quickly reinforce that perceived ‘badness,’ making the patient feel even worse,” Dr. Simmons says. “This drives them to restrict their meals following this episode, which inevitably leads right back to another binge.” What you can do: Eat regularly and enough during the day Aiming for three satisfying meals per day, as well as a couple of snacks if you get hungry between meals, can help reduce the likelihood of late-night hunger or nighttime cravings. Stress and emotional eating Stress or other emotions can also drive binge eating. For example, stress eating is emotional eating that we sometimes engage in when stressed, worried, scared, or anxious, according to research in the journal Proceedings of the Nutrition Society. It’s a normal process when it occurs on occasion. “Food has always been a fundamental source of comfort for humans,” Dr. Simmons explains. She says that babies are a great example: They cry when hungry, but after they eat, they relax and inevitably drift off to sleep. “Food literally alters our neurochemistry to make us feel good,” Dr. Simmons explains. “It makes complete sense that one of our first and easiest ways to find happiness and comfort comes from food. Where this can lead to issues, however, is when food becomes the primary mechanism we navigate toward during times of stress or high emotion.” Repeated emotional eating at night, especially if you feel out of control around food (eating a lot in a short period) and significant distress, may actually be binge eating episodes. These episodes may be more likely to occur at night after a stressful or emotional day. What you can do: Build stress management into your routine If stress or difficult emotions trigger binge eating episodes, reducing these triggers can be helpful. Stress and anxiety activate your fight-or-flight response, driven by your sympathetic nervous system. You can activate your parasympathetic nervous system (which drives your “calm” response) to get out of fight-or-flight mode. Breathwork is a great strategy in the moment. Try box breathing, for example: Inhale, hold, exhale, and hold, each for a count of four. These two nervous system branches (sympathetic and parasympathetic) tend to work mostly in opposition to each other, almost like flipping a switch. Engaging in any activity that you find calming, such as knitting, reading, taking a bath, or stretching, can help. However, sometimes with a history of trauma or ongoing anxiety, your fight-or-flight system gets chronically set to “on.” If this feels like the case for you, activating your calm response can be more challenging. You may need assistance from a licensed mental healthcare professional who can help you develop additional strategies. Hormonal and circadian patterns Hormones impact hunger and eating in complex ways, but we know that dysregulated patterns can lead to nighttime binge eating. Likewise, nighttime binge eating can lead to dysregulated hormonal patterns, creating a self-perpetuating cycle. For example, leptin is a hormone produced in fat cells that tells your brain you’re full. However, with weight gain, your cells may produce excessive leptin, which can lead to leptin resistance, according to research published in European Eating Disorders Review. This means your brain fails to receive the fullness signal, increasing hunger and making binges more likely. Leptin resistance is associated with various eating disorders, most commonly BED. But even if you (or a loved one) don’t meet the full criteria for a BED diagnosis, leptin resistance could be driving nighttime binge eating. Another hormone that may play a role is cortisol. This stress hormone gets a bad rap, but when it’s regulated, it’s a good thing. It follows a pattern tied to your circadian rhythm, or sleep-wake cycle. The typical pattern is for cortisol to reach its highest point in the morning (helping you wake up) and to decrease as the day progresses. Chronic stress can dysregulate cortisol, however, and dysregulated cortisol is linked to emotional eating, binge eating, and BED, according to research published in the journal Appetite. Cortisol dysregulation, along with the dysregulation of other hormones, can also disrupt your circadian rhythm. Higher cortisol at night is associated with delayed sleep, which may disrupt natural mealtimes, for example. This disruption can lead to eating after dinner, before bedtime, or even in the middle of the night. Another recognized mental health condition and eating disorder is called night eating syndrome (NES). Criteria include eating more than 25% of your daily calories after dinner, according to research in the journal Current Obesity Reports. In the DSM-5, NES is listed under an umbrella term called otherwise specified feeding and eating disorder (OSFED). What you can do: Prioritize a regular sleep schedule If hormonal issues are driving your binge eating at night, they can be hard to address on your own. Working with a multidisciplinary care team can help. However, one thing you can do is set and stick to a regular sleep schedule as much as possible and ensure you’re getting seven to nine hours of sleep per night. Habit and environmental cues Nighttime binge eating can also become a habit that’s hard to break because of environmental cues. Attentional bias is the tendency to pay attention to specific stimuli in your environment while ignoring others. Research shows that people with BED have an attentional bias toward food cues, according to a review published in the journal Appetite. Although you might be gone or busy during the daytime, the nighttime is generally a calmer, quieter time. Food cues (like even just walking into the kitchen), might be harder to ignore and drive evening binge eating. Additionally, sometimes certain cues or habits trigger other habits. For example, if watching TV before bed triggers binge eating because the two usually go together, your brain can associate the two paired habits. If your brain finds them rewarding, it will motivate you to continue doing them. What you can do: Reduce environmental and situational cues As mentioned, sometimes, one habit triggers another. If this sounds familiar, you might be able to interrupt the cycle by forming different habits. For example, if scrolling on your phone before bed triggers nighttime binge eating, putting your phone in a different room while you prepare to sleep might help. Changing ingrained habits can be difficult on your own. Again, working with a mental health professional can help you discover the strategies that work best for you.  What to do after a nighttime binge After a nighttime binge, one of the most important things you can do is be kind to yourself. That can start with interrupting any restriction. “The absolute best advice I can give someone recovering from a night eating or binge eating episode the night before is to eat breakfast the next day, even if you are not hungry,” Dr. Simmons says. Although easier said than done, absolving yourself of guilt and shame is also important. “Just because this happened last night doesn’t mean it has to continue happening,” Dr. Simmons says. “A single instance does not define you as a person, nor does it doom your future progress. We all deserve kindness and compassion, especially when we are struggling.”  When is nighttime binge eating an eating disorder? Binge eating episodes, whether they occur at night or another time, are a disordered eating pattern. Binge eating is different from late-night snacking in that it feels uncontrollable and causes distress, such as feelings of shame or guilt. Binge eating episodes can also indicate that you or a loved one are dealing with an eating disorder. You can take Equip’s free five-minute screener if you’re concerned that you may have an eating disorder, whether BED or another type.  Treatment for eating disorders usually involves a multidisciplinary approach, including therapy, nutritional guidance from a registered dietitian, eating disorder programs with peer support, and more. A common misconception about eating disorder care is that it always involves inpatient or residential treatment, but that’s not the case. There are several levels of care for eating disorder treatment, including virtual options. What’s best for you or a loved one for binge eating treatment will depend on individual factors, such as symptoms and their severity, diagnosis, current health status, and more. The bottom line Nighttime binge eating episodes can signal a disordered eating pattern, especially if you’re feeling like you have no control around food and are dealing with significant shame or guilt regarding this. “If you are experiencing any amount of distress around food,” Dr. Simmons says, “please know that you are not alone. It is always better to talk to a doctor, a loved one, or call a specialized treatment center like Equip. Our trained staff will listen to you without judgment and help advise you on the best next steps.” As a final takeaway, she says, “Recovery is entirely possible! We see it every day here at Equip, and we can help provide you with the support and tools you need to work through whatever food difficulties you are facing.” Speak to your medical provider or schedule a consultation with an Equip team member. FAQ Can eating more during the day actually reduce nighttime eating? Yes, eating more during the day to meet your body’s nutritional requirements can reduce nighttime eating that typically occurs after dinner, before bed, or in the middle of the night. Restrictive diets during the day can lead to binge episodes or strong urges to eat, simply because your cells need nourishment to perform their functions, even at rest. Should I skip breakfast after binge eating at night? Skipping breakfast after binge eating at night can perpetuate the binge-restrict cycle, meaning that more restriction might lead to more binging. Eating breakfast the next day after a nighttime binge, along with lunch and dinner later, can actually help you interrupt the binge-restrict cycle. It’s also important to remember that your body needs food each day to function, regardless of what you ate yesterday. Does nighttime binge eating go away on its own? Nighttime binge eating, although not always related to an eating disorder, is a disordered eating pattern. Such patterns can be challenging to break without interventions. This is because complex underlying physiological and psychological factors trigger binge eating episodes. A multidisciplinary care team that specializes in disordered eating patterns can help you develop strategies to break the nighttime binge eating cycle.]]></content:encoded>
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            <title><![CDATA[How ARFID Is Treated: Therapy, Nutrition, and Support]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-treatment-what-it-looks-like</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-treatment-what-it-looks-like</guid>
            <pubDate>Mon, 27 Jul 2026 18:13:00 GMT</pubDate>
            <content:encoded><![CDATA[If you're looking into ARFID treatment for yourself or a loved one, you may be feeling overwhelmed, confused, or unsure where to start. That's understandable. ARFID (avoidant/restrictive food intake disorder) looks different from person to person, which can make finding clear information about treatment especially challenging. Unlike most other eating disorders, ARFID isn't driven by concerns about body weight, shape, or appearance, according to StatPearls. Instead, eating difficulties are often related to sensory sensitivities, fears about eating (such as choking or getting sick), or a lack of interest in food. That’s why ARFID treatment often looks different from treatment for other eating disorders—and why it's important to seek care from providers who understand ARFID specifically, according to Lily Thrope, LCSW, founder of Thrope Therapy. That said, ARFID is treatable, and people of all ages can benefit from support. In this guide, we'll explore what ARFID treatment can involve, how it may vary depending on a person's symptoms, and what recovery can look like in real life.  What ARFID treatment is designed to do ARFID treatment is designed to help people eat enough, feel safer around food, and participate more fully in daily life, according to Jonathan Levine, LCSW, therapist lead at Equip. ARFID can affect nutrition, physical health, emotional well-being, relationships, school, work, and social activities, which is why treatment often focuses on several goals at once. Depending on the person's symptoms and needs, experts say treatment may aim to: Improve nutrition and address any nutritional deficiencies or medical concerns Support healthy growth and development in children and adolescents Reduce fear, anxiety, distress, or avoidance related to food and eating Expand food flexibility and variety Regulate hunger and fullness cues Increase enjoyment of food Build confidence around eating situations that feel difficult or unsafe Address co-occurring mental health conditions Help loved ones respond in ways that support recovery Improve quality of life, including participation in school, work, relationships, and social activities  What ARFID treatment typically includes ARFID treatment is often multidisciplinary, meaning it brings together different types of support to address the person's unique needs. The exact plan will depend on someone’s symptoms, age, medical needs, and goals. Here’s what to know about the most effective ARFID treatment options. Therapy For many people with ARFID, therapy is one of the main components of treatment. It's typically provided by a therapist, psychologist, or other mental health professional with experience treating ARFID. The goal of therapy is to help people understand what makes eating feel difficult, distressing, or unsafe, and then gradually build more confidence and flexibility around food, says Thrope. Depending on the person's symptoms, therapy may focus on: Reducing anxiety and avoidance Building coping skills Navigating social eating situations Increasing motivation to engage in treatment and work towards recovery Addressing co-occurring conditions (like anxiety, OCD, or depression) ARFID counseling approaches may include: Cognitive behavioral therapy for ARFID (CBT-AR): According to the Journal of Behavioral and Cognitive Therapy, this type of therapy helps people understand the thoughts, feelings, and behaviors that maintain ARFID, and develop behaviors that allow for more flexibility around eating. Exposure is the primary mechanism of change in CBT-AR, and it aims to use repeated exposures to increase volume and/or variety of dietary intake. Family-based treatment for ARFID (FBT-ARFID): FBT is the gold standard treatment approach for children and adolescents with anorexia nervosa, and can help caregivers support meals, nutrition, and recovery at home, per Behavioral Sciences. FBT-ARFID is a specialized version of FBT tailored to ARFID. Exposure-based therapy or exposure and response prevention (ERP): This approach helps people slowly build comfort and confidence around foods, physical sensations, or situations they've learned to avoid, per a study in Nutrients. It is primarily utilized for fear of aversive consequences ARFID and isn’t applicable to or appropriate for use for the other two presentations. Nutrition support Treatment often involves working with a registered dietitian who understands ARFID and how it differs from other eating disorders. They help patients get the nourishment they need while also building a foundation for recovery based on the person’s safe foods list.  According to research in Healthcare, nutrition support may focus on: Improving nutritional intake Establishing consistent eating patterns Addressing nutritional deficiencies Supporting growth or weight restoration when needed Increasing food flexibility Nutrition support also looks different depending on the person's ARFID presentation. For example, someone with sensory sensitivities may work on expanding foods within textures or flavors that already feel safe. Dietitians might support patients with low appetite with meal planning and incorporating easy-to-prepare meals and snacks. Support for a patient with fear of aversive consequences might involve brainstorming calorically dense options to support weight restoration or maintenance while the therapist is targeting fear through exposures. Fear of aversive consequences support might also involve the dietitian helping reincorporate previously feared foods that were addressed through exposure work with the therapist.  Medical care and monitoring ARFID can affect physical health, so medical care is often an important part of treatment, per StatPearls. This support may come from a pediatrician, GI doctor, or another medical provider who understands ARFID. Medical providers help ensure a person's body gets what it needs to stay healthy. Depending on the situation, they may monitor things like: Growth Weight trends Vital signs Hydration Nutritional deficiencies Any physical symptoms that make eating more difficult It’s also important to target other conditions that can make eating harder. “Things like functional GI disorders, food allergies and sensitivities, or sensory processing disorders need to be addressed,” says Jessie Menzel, PhD, Equip’s vice president of clinical programs. “It's important that we do everything we can to make eating an easier or less painful experience for a person with ARFID.” Finally, know that someone can need medical support for ARFID even if they don't appear underweight or "look sick." Medical monitoring ensures treatment supports both physical health and recovery. Psychiatric support (when needed) Some people with ARFID also have co-occurring mental health conditions, such as anxiety, OCD, depression, or ADHD, per research in JAMA Pediatrics. In these cases, a psychiatrist or other mental health provider may be part of the treatment team. A psychiatrist can evaluate whether medication may help manage symptoms of a co-occurring condition that makes eating and recovery more challenging. While medication isn't a standalone fix for ARFID, it may help some people better engage in their treatment overall. Family, caregiver, or loved one support Family members, caregivers, partners, friends, and other trusted people can play an important role in ARFID therapy. For children and teens, loved ones often provide structure for the child's eating schedule, support exposure exercises at home, and help manage food-related anxiety, per a review in Frontiers in Pediatrics. They also practice positive modeling by showing their child that eating a variety of foods is enjoyable. For adults, treatment is generally more self-driven. Some adults choose to involve a partner, friend, or chosen family member in treatment, according to the Journal of Eating Disorders. Regardless of age, involvement of loved ones should aim to reduce stress and increase support, not create pressure or shame. Coaching and lived-experience support ARFID can feel isolating, confusing, and difficult to explain to other people. That's why some treatment programs, including Equip, incorporate coaches with lived experience of eating disorder recovery. “ARFID can be an isolating and confusing experience, even within the eating disorder treatment community,” says Kelsey Gilchriest, an Equip recovery coach who is in recovery from ARFID. “Coaches offer their lived experience to surround patients and families with the message that they are not alone and that recovery is possible.”  How ARFID treatment is personalized While many ARFID treatment plans include the same core components, the specific approach should be tailored to the individual. That's because ARFID generally presents in one (or more) of three ways, and each type of ARFID can require a different treatment focus: Low interest in food or low appetite: Some people rarely feel hungry, become full quickly, or find eating more like a chore than a source of enjoyment. Sensory sensitivity: Some people experience intense aversions to certain textures, tastes, smells, temperatures, colors, or other sensory aspects of food. Fear of aversive consequences: Some people avoid eating because they're afraid of choking, vomiting, having an allergic reaction, experiencing pain, or becoming ill.  What exposure work can look like in ARFID treatment Exposure work is a common part of ARFID treatment. In simple terms, it involves gradual and safe exposure to foods, sensations, or eating situations that feel difficult, says Levine. The keyword here is “safe:” Exposure work doesn’t involve forcing someone to eat foods they fear, tricking them with hidden ingredients, or pushing them faster than they're ready to go. What exposure work looks like ultimately depends on what's driving the ARFID. For someone with sensory sensitivities, “it could be just picking up a small amount of food, or even having it on your plate with no expectation of eating it,” says Levine. “From there, maybe we move into holding it, smelling it, and describing it neutrally. When someone feels ready, maybe we take one small bite, which another day becomes two, and so on.” For people with fear-based ARFID, on the other hand, exposures may focus on building confidence around physical sensations or feared outcomes. "Our goal is to gather new data to see if the fears are reality-based or not," Levine says. "This shows people that they can survive the distress more than they realize and that their fear may not come true after all." How ARFID treatment changes with age and life stage ARFID can affect people of all ages, and treatment can be effective no matter how old you are. However, treatment goals and approaches can vary based on your stage of life. According to Levine, here’s the breakdown of how care differs depending on a patient’s age: Children: Treatment often requires caregiver involvement, which is why family-based approaches are commonly used with younger children. Parents and caregivers may support meals, nutrition, exposures, and routines at home. Younger children also may not understand why they need treatment in the first place, which is why some providers recommend reward systems to make treatment more engaging and incentivize behavior change. Teens: Treatment typically balances caregiver support with increasing independence, making CBT-AR is an effective approach for many teens. Therapy may address challenges related to school, social eating, identity, and motivation, while helping teens build skills they'll need to manage recovery more independently over time. Adults: CBT-AR is also commonly used to treat ARFID in adults. Adults may work on longstanding eating patterns, social and work situations, meal planning, and daily routines. Some adults choose to involve partners or other loved ones in treatment, while others prefer to navigate recovery more independently. Regardless, treatment should respect the person's autonomy and individual goals.  How loved ones can support someone in ARFID treatment Watching someone you care about struggle with eating can be frustrating, confusing, and frightening. Many parents, partners, and caregivers respond by trying to encourage, persuade, or push the person to eat more out of genuine concern and compassion. But with ARFID, these approaches often do more harm than good.  Instead, experts recommend focusing on creating a sense of safety, consistency, and support around food. "Be patient, loving, and kind, and seek education on what ARFID looks like so you can better understand exactly why and how your loved one is struggling," says Levine. "Avoid putting pressure or force on your loved one. This is often the worst approach for ARFID," adds Thrope. "It is most important to prioritize trust and safety with those who are struggling."  When to seek ARFID treatment—and what getting started can look like There’s no need to wait until ARFID becomes severe to seek support. In fact, getting help earlier can reduce the physical, emotional, and social damage that builds up over time. According to experts, it may be time to seek professional support if you or your loved one: Eat a very limited range of foods or avoid entire food groups Experience significant anxiety, fear, or distress around eating Avoid social situations because of food or eating concerns Experience weight changes, nutritional deficiencies, growth concerns, or other health issues related to eating Struggle to meet nutritional needs or maintain regular eating patterns Find that eating challenges are affecting school, work, relationships, or daily life Feel stuck, even after trying to make changes Getting started with ARFID treatment can feel overwhelming, but the process is usually more straightforward than many people expect. It often involves: An evaluation: A provider will ask about eating patterns, symptoms, medical history, and what's making eating feel difficult. A medical and nutritional assessment: The treatment team will evaluate nutritional needs, physical health, and any other concerns that may need support. A personalized treatment plan: Together, you'll identify treatment goals and determine which types of support are likely to be most helpful. Beginning treatment: Depending on the person's needs, treatment may include therapy, nutrition support, medical care, exposure work, and support for loved ones. The most important thing to remember is that ARFID is treatable, and you don't have to figure it out alone. If you're concerned that you or someone you love may have ARFID, consider taking Equip's ARFID screener or scheduling a no-obligation call to explore your options. The bottom line ARFID treatment is most effective when it's tailored to the person's specific experiences with food, eating, and safety. Depending on the individual's needs, treatment may include therapy, nutrition support, medical care, exposure work, and support from loved ones. The good news is that ARFID is treatable, and recovery is possible. People of all ages can start feeling safer, more flexible, and more confident around food with specialized care and the right support system. Frequently asked questions (FAQs) Can ARFID be cured? ARFID is considered a treatable eating disorder, and many people experience significant improvements in their eating, nutrition, and quality of life with the right support. Recovery looks different for everyone, but treatment can help people feel safer around food. What is the role of family in ARFID treatment? Family members, caregivers, partners, and other loved ones can play an important role in recovery. For children and teens, loved ones often help support meals, exposures, and treatment goals at home. Adults may also choose to involve trusted loved ones in their treatment. In all cases, the goal is to create an environment that feels safe and supportive. What's the difference between treatment for ARFID and treatment for other eating disorders? Unlike many other eating disorders, ARFID isn't primarily driven by concerns about body image. As a result, treatment often focuses on addressing the specific factors that make eating difficult (like sensory sensitivities, fear of negative consequences, or low appetite). This is why it's important to work with providers who have experience treating ARFID specifically. ]]></content:encoded>
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            <title><![CDATA[New Equip Research: The Experience of Caregivers in Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/news-and-research/caregiver-burden-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/caregiver-burden-eating-disorders</guid>
            <pubDate>Mon, 11 Aug 2025 18:43:00 GMT</pubDate>
            <content:encoded><![CDATA[Caring for a loved one with an eating disorder is often a full-time job, but one that’s rarely recognized. Research shows that the strain of caring for a person with an eating disorder is higher than that of caring for someone with depression or schizophrenia, with most caregivers reporting a constant sense of worry. At Equip, we work closely with caregivers and strive to support them through the difficulties of eating disorder recovery—but we also know that more research is needed to better understand their experience and what they need during this challenging journey. Our latest survey is a first step toward deepening this understanding. Research goals We conducted this survey with several distinct goals in mind. We wanted to: Quantify the impact of eating disorders on caregivers Our research aimed to assess the emotional, physical, and logistical toll of supporting a loved one through eating disorder treatment. We also sought to unpack how the impact varies by caregiver role (i.e., mothers vs fathers, parents vs. siblings), and throughout the duration of the eating disorder. Explore gaps in support Where do caregivers struggle? Are there areas in which they feel unsupported, excluded, or confused? Our survey looked to identify these gaps, exploring how factors like financial pressure and access to treatment shape caregiver experience. Inform tailored interventions As with all Equip research, our ultimate goal is for our findings to have practical implications that make the treatment experience better for everyone. With this survey, our goal is to use our findings to inform better care models that support caregivers directly, including training, therapy access, peer support, and role-specific guidance. Our survey In order to get a better sense of what the caregiver experience looks like—and what caregivers need to feel supported and successful during the recovery journey—we conducted a survey of over 1,000 people who had helped someone recover from an eating disorder. Here are some more details on our respondent population: 1,075 respondents who reported being a caregiver for someone recovering from an eating disorder within the past seven years 57% of respondents were 40-49 years old, white, cisgender, and caring for a person over 25 Gender was almost evenly split among respondents, with 51% female and 48% male The primary caregiver roles were friend (27%) and parent (21%) Among those being cared for, the most common diagnoses were binge eating disorder (BED) and anorexia Our survey included a wide range of questions meant to bring to light various aspects of the caregiver experience. These questions included those specifically about the challenges of supporting someone with an eating disorder, as well as broader questions about how this experience impacts the caregiver’s mental health. Some notable questions included: How has caregiving impacted your mental health? Did you hide your caregiving responsibilities from your employer due to fear of stigma or career consequences? What were/are your biggest challenges in supporting your loved one? Did you receive education or guidance on how to support someone with an eating disorder? Did your loved one’s eating disorder treatment provider offer mental health support for you as a caregiver? Key takeaways While we already knew that the caregiving experience is challenging, this survey revealed new perspectives, quantitative takeaways, and eye-opening insights that better illustrate the reality of helping someone through recovery. These learnings will also help shape our support for caregivers going forward. It challenges who you are More than 7 in 10 caregivers (74%) say their role taking care of their loved one has reshaped their identity: 41% report that this task has adapted their existing identity, while 33% say they have developed a distinct caregiver identity. This new identity comes with challenges, with 80% of caregivers reporting that they feel overwhelmed at least sometimes, and over half (51%) reporting that they struggle with stress and anxiety. They’re on their own Almost two-thirds (65%) of caregivers are deeply involved in treatment, and 94% believe their support is key to recovery—but they are often left to navigate the journey by themselves. Most lean on friends and family (51%) for support, but about 1 in 8 feel totally alone. While about half of respondents receive some mental health care from providers, many want more, citing burnout, exhaustion, and lack of emotional support. Many emphasized the need for affordable, ongoing mental health care to help them cope with the demands of caregiving. They need more resources Caregivers are hungry for knowledge and help: 57% want more education about eating disorders, and 45% need caregiver-focused therapy or support groups. Nearly 1 in 5 have had to navigate the recovery journey without guidance, and almost half (48%) feel unprepared for managing relapses. Money is tight too: 44% say treatment costs strain their finances. Balancing caregiving with work and family is a daily struggle for 50%, and 30% find treatment options confusing and hard to navigate. There’s a strong desire for centralized, easy-to-find resources, including financial help, structured programs, and step-by-step guidance, especially early in the caregiving journey. They want a seat at the table Caregivers are heavily involved in the recovery journey: 71% report preparing meals, 60% monitor their loved one after eating, and 55% provide regular emotional support throughout the day. And yet, many report feeling left out of the treatment process and want to be included as valued partners. Respondents asked for consistent updates, transparency, and tools to build trust and effectiveness in their role. Self-care is still a priority 1 in 3 caregivers suffer from anxiety, depression, or disordered eating themselves. Many caregivers expressed the need to prioritize their own well-being, by doing things like managing their mental and emotional health, taking breaks, and practicing self-care to avoid burnout. They advised reaching out to others for support, whether through family, friends, support groups, or mental health professionals—highlighting that caregivers are not alone and should never hesitate to ask for help. Where we go from here As our survey results make clear, caregiver strain is real and significant, and they aren’t getting the support they need. This is important not only for the mental health of the caregivers, but also because they play a vital role in their loved one’s treatment journey—and if they are exhausted, burned out, or feeling confused and unsupported, it can make eating disorder recovery much more difficult, if not impossible. To help improve the caregiver experience—and, as a result, likely improve patient outcomes—providers need to foster a nonjudgmental environment and proactively screen for caregiver stress, offering referrals to counseling, groups, or other resources as appropriate. It is also essential for eating disorder providers to give caregivers clear eating disorder education, relapse management tools, and regular check-ins to empower them as the active members of the care team that they already are. Lastly, programs should integrate caregiver well-being into care management, an effort that will improve treatment success. At Equip, we’re proud that caregiver involvement and support is a core part of our treatment program, with extensive caregiver education, dedicated support groups for loved ones, and family mentors on each provider team. Our survey results confirm that these resources are crucial—and compel us to consider new ways that we can provide even more support to everyone helping a loved one overcome an eating disorder.]]></content:encoded>
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            <title><![CDATA[ARFID Safe Foods: Common Examples and How to Build Your Own List]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-safe-foods</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-safe-foods</guid>
            <pubDate>Wed, 15 Jul 2026 20:33:00 GMT</pubDate>
            <content:encoded><![CDATA[If you have ARFID (avoidant/restrictive food intake disorder), figuring out what to eat can feel exhausting. Maybe you have a list of ARFID safe foods, while everything else feels overwhelming. Or if you're caring for someone with ARFID, you may be struggling to understand why foods that seem nearly identical can feel completely different to your child or loved one. For people with ARFID, safe foods serve a practical purpose: they provide a reliable way to stay nourished while navigating the sensory, emotional, and physical challenges of ARFID with minimal anxiety or distress, says Tanya Hargrave-Klein, MS, RDN, LD, lead eating disorder dietitian at Equip. Below, we'll cover common examples of ARFID safe foods, explain why certain foods feel safe, and explore how safe foods can serve as a starting point for expanding food variety. What are ARFID safe foods? ARFID safe foods are foods that a person can eat consistently with minimal anxiety, distress, or discomfort, says Hargrave-Klein. While there’s no universal ARFID safe food list, these foods often share specific characteristics, like a consistent texture, flavor, temperature, or appearance. Safe foods aren't the same as "favorite foods" or "comfort foods." Someone with ARFID may genuinely enjoy a food but still avoid it because of a past negative experience, says Hargrave-Klein. And unlike comfort foods, which people often seek out for pleasure or emotional support, safe foods are typically the foods that create the least amount of anxiety or uncertainty. Safe foods can also be highly specific. For some people, a food only feels safe if it's prepared a certain way, comes from a particular restaurant, or is a specific brand. “Bland, highly consistent foods tend to feel less overwhelming because there are fewer surprises from one bite to the next,” explains Rachel Levine, LMFT, a certified cognitive behavior therapist for ARFID and clinical supervisor of intake and operations at Guidelight Health.  Common ARFID safe foods: a practical list Safe foods serve an important purpose. They can make eating feel less stressful and help people meet their nutritional needs when other foods feel too difficult. So if you or someone you love has ARFID, the lists below can be a helpful starting point for planning meals and identifying foods that may feel more manageable. At the same time, safe foods aren't meant to be the endpoint of recovery. The goal of ARFID treatment is to gradually build flexibility, confidence, and variety over time using safe foods as the foundation. What’s more, ARFID safe foods vary from person to person: what feels safe for one may feel impossible for another. Still, clinicians who treat ARFID do see some patterns. So if some of the below foods feel familiar, you're not alone—and if none of them do, that's okay too. By meal type Here are common safe foods by meal type, according to Hargrave-Klein and Levine. Breakfast Cheerios or Rice Chex (often a specific variety) Toast with butter or peanut butter, prepared the same way each time Frozen waffles Plain oatmeal Yogurt cups or drinkable yogurt (often a preferred brand and flavor) Applesauce Plain bagels with butter or cream cheese Granola bars Protein shakes (often a preferred brand and flavor) Lunch Peanut butter sandwiches prepared the same way each time Plain buttered noodles Plain white rice Macaroni and cheese, often a boxed variety from a specific brand (like Kraft) Chicken nuggets from a specific brand or restaurant (like Tyson or McDonalds) Grilled cheese sandwiches Plain quesadillas Cheese pizza Deli meat sandwiches with limited ingredients Crackers with cheese Dinner Plain or buttered pasta White rice with a preferred protein Chicken nuggets and french fries from a specific restaurant (like McDonalds) Frozen meals from a trusted brand (like Tyson) Plain hamburgers prepared a specific way Simple tacos with predictable ingredients Mashed potatoes Fish sticks or breaded chicken products Snacks Goldfish crackers Ritz crackers or Saltines Dry cereal String cheese Applesauce pouches Yogurt cups Granola bars Pretzels Potato chips Oreos Vanilla ice cream Fruit snacks or gummies By sensory profile Safe foods can look different depending on what type (or types) of ARFID someone has. Some people avoid foods because of fears about eating or a lack of interest in food. Those with sensory-based ARFID find that certain textures, temperatures, flavors, or mouthfeels feel safer and more manageable than others. Here are some common examples of safe foods for ARFID driven by sensory sensitivity, according to Hargrave-Klein and Levine.  Smooth and creamy These foods provide a consistent texture with few surprises: Yogurt (often a specific brand and flavor) Applesauce or applesauce pouches Smooth peanut butter Vanilla ice cream Pudding Smooth mashed potatoes Protein shakes Smoothies made with familiar ingredients Crunchy and dry Many people with ARFID prefer foods that provide a predictable crunch or crisp texture, like: Goldfish crackers Ritz crackers or Saltines Pretzels Potato chips Dry cereal, such as Cheerios or Rice Chex Crackers with minimal seasoning Toast Certain brands of chicken nuggets with a consistent breading Plain and bland Foods with mild flavors and minimal ingredients often feel more predictable and less overwhelming, including: Plain pasta or buttered noodles White rice Plain bread Frozen waffles Macaroni and cheese Plain bagels Grilled cheese sandwiches Cheese pizza Soft and uniform Some people prefer foods with a soft, consistent texture that reduces the risk of unexpected sensory experiences, such as: String cheese Yogurt Applesauce Plain oatmeal Mashed potatoes Buttered pasta White rice Soft bread products By energy level On days when anxiety is high, executive functioning is low, or eating feels harder than usual, many people with ARFID rely on foods that require minimal preparation or decision-making, says Hargrave-Klein. According to Levine, low-prep, low-decision foods may include: Applesauce pouches Yogurt cups Protein shakes that the person already trusts Granola bars String cheese Dry cereal Goldfish crackers, Ritz crackers, or Saltines Frozen waffles Frozen chicken nuggets Microwaveable macaroni and cheese Peanut butter sandwiches prepared the same way each time Why do certain foods feel safe with ARFID? The foods that feel safe with ARFID are often shaped by the reason someone avoids or restricts eating in the first place. Here’s the breakdown.  Sensory sensitivity For people with sensory ARFID, safe foods often have predictable textures, temperatures, flavors, or appearances, according to a study in the Journal of Eating Disorders. “Foods that are soft, uniform, dry, or crunchy tend to be easier to tolerate because they provide a predictable sensory experience,” says Levine. “On the other hand, foods with mixed textures, visible ingredients, inconsistent temperatures, or strong smells can feel extremely overwhelming.” It’s important to understand that these reactions are genuine sensory experiences, not choices or defiance, she adds.  Fear of aversive consequences For some people with fear-based ARFID, certain foods feel unsafe because of what they fear could happen after eating them, per a study in Nutrients. This fear can develop after a distressing experience, such as food poisoning or choking. The specific safe foods will vary depending on the fear and any triggering accident that led to the fear developing. For example, someone with a fear of choking may rely on softer foods (like applesauce, mashed potatoes, or shakes) while avoiding foods that feel harder to chew or swallow (like hot dogs, nuts, or raw vegetables). Low interest in food or eating Some people with ARFID avoid food because they simply don't experience much hunger or have a lack of interest in eating. As a result, they gravitate toward foods that are familiar, convenient, and easy to eat consistently (think: protein shakes, granola bars, crackers, and frozen foods), says Levine. Why brand and preparation matter — and why that's not "being difficult" Maybe your kid only eats a specific brand of chicken nuggets, or you find yourself cringing at an unfamiliar pasta shape. While eating highly specific safe foods can look like stubbornness from the outside, it's actually a recognized and common symptom of ARFID. “This preference is deeply logical, as these individuals typically crave absolute consistency in a food's texture, temperature, appearance, and taste,” says Hargrave-Klein. “Because those with ARFID can detect even the most minute variations, any discrepancy often leads to escalating distress and anxiety.” This is one reason why highly processed or packaged foods often become safe foods. Foods like Oreos, Kraft Mac & Cheese, and Tyson chicken nuggets deliver the same experience every time, whereas naturally variable foods—such as fruit, vegetables, or homemade meals—can feel much less predictable, says Hargrave-Klein. This need for consistency may also help explain why ARFID commonly co-occurs with neurodivergence, particularly autism and ADHD, per research in the Journal of Eating Disorders. For people who experience heightened sensory sensitivities or find unpredictability especially stressful, knowing exactly what a food will look, feel, and taste like can make the difference between a meal that feels manageable and one that feels overwhelming. Safe foods can look different in children and adults In children, safe foods are often shaped by sensory preferences, routines, and a need for predictability. That’s why a child may only eat foods from a specific brand, reject a food if it's prepared differently than usual, or become distressed when asked to try something new, according to a study in Nutrients. Because parents and caregivers are usually responsible for meals, safe foods can also become a source of confusion, stress, and conflict within the family. It’s also important to note that there’s o a difference between ARFID vs. picky eating. Unlike picky eating, which many children gradually outgrow, ARFID does not get better with time and can interfere with nutrition, social experiences, and family life. In adults, safe foods are often tied to routines and coping strategies that have developed over many years—sometimes before a person even realizes they have ARFID. For instance, an adult may avoid restaurants, bring their own food to social events, or rely on a small set of ARFID-friendly meals they know they can tolerate, per research in the Journal of Eating Disorders. Using safe foods as a bridge, not a ceiling Instead of working against safe foods, ARFID treatment often uses them as a foundation for introducing new foods and experiences. Here’s what to know.  What is food chaining? Food chaining is a common ARFID treatment strategy that helps people expand their diets by making small, manageable changes to foods they already consider safe, says Hargrave-Klein. For example, someone who only eats one brand of chicken nuggets might first try a similar brand before working toward home-cooked chicken. Or a person who feels comfortable eating potato chips might try similarly textured plantain chips before eventually eating a banana. "The goal is to build on success rather than overwhelm the nervous system," says Levine. "It's about helping them slowly expand flexibility while respecting the genuine sensory and emotional challenges that come with ARFID." Food chaining involves carefully balancing nutrition, sensory preferences, and anxiety. That’s why it's generally most effective when done with the support of an ARFID-informed dietitian or treatment team. It’s important to work with an ARFID-informed dietitian to try food chaining. That's why Equip's ARFID treatment model brings together therapists, dietitians, physicians, psychiatrists, and peer and family mentors to help people expand their diets while working from the foods that already feel safe. If you're wondering whether your eating patterns could be related to ARFID, taking Equip’s ARFID screener is a helpful first step. Building your own safe foods list A safe foods list can be a helpful tool to reduce decision fatigue, simplify ARFID meal plans, and provide a starting point for expanding food variety. This, too, it’s best to do with the support and care of an ARFID-informed dietitian. If you're an adult or teen with ARFID, consider writing down the foods you can reliably eat, along with any details that make them feel safe. If you're caring for a child with ARFID, creating a safe foods list alongside their dietitian can help you better understand their eating patterns and reduce some of the stress and guesswork around meals. More specifically, it can help to track: 
What to include in your safe foods list  It’s also helpful to organize foods into categories, such as "always," "sometimes," and "not yet." According to Hargrave-Klein, clinicians sometimes refer to these as green, yellow, and red foods. This framework can help people with ARFID maintain adequate nutrition while also identifying opportunities to gradually expand food variety.  The bottom line Safe foods are a valid and important part of living with ARFID. They help people stay nourished, reduce distress, and create predictability when food feels overwhelming. At the same time, safe foods don't have to define what someone can eat forever. With the right support, they can become a foundation for building more flexibility and confidence around food. If eating feels like a daily struggle or a safe foods list has become so limited that it's affecting health or quality of life, know that effective treatment for ARFID exists and you don’t have to navigate it alone. Talk to your doctor, or schedule a call with Equip to start the recovery process. Frequently asked questions (FAQs) What foods are most commonly safe for people with ARFID? While safe foods vary widely from person to person, some common examples include buttered pasta, chicken nuggets, french fries, crackers, dry cereal, yogurt, applesauce, white rice, macaroni and cheese, and certain packaged or processed foods. Many people with ARFID prefer foods that are consistent in taste, texture, temperature, and appearance. That’s why a safe food may need to come from a specific brand, restaurant, or be prepared in a particular way to feel manageable. Is it okay to only eat safe foods if you have ARFID? Safe foods play an important role in helping people with ARFID stay nourished. However, if someone's list of safe foods becomes so limited that it's affecting their health, growth, daily functioning, or quality of life, it may be time to seek help. In ARFID treatment, safe foods are often used as a starting point for gradually expanding food variety. Why does the brand or preparation method matter so much for ARFID safe foods? For many people with ARFID, even small changes in a food's taste, texture, appearance, or preparation can make it feel like an entirely different food. That's why someone may only eat chicken nuggets from a particular brand or toast that’s prepared a specific way. These preferences often reflect a need for predictability and consistency that helps eating feel safe and manageable.]]></content:encoded>
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            <title><![CDATA[How to Stop Stress Eating: Practical Strategies for When Food Becomes a Coping Tool]]></title>
            <link>https://equip.health/articles/food-and-fitness/how-to-stop-stress-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/how-to-stop-stress-eating</guid>
            <pubDate>Tue, 14 Jul 2026 23:19:00 GMT</pubDate>
            <content:encoded><![CDATA[Stress eating is a common human experience. Maybe this sounds familiar: You’re nervous about a school or work project. You know you need to get started, but you find yourself in front of the pantry, rooting around for a snack. You’re not necessarily feeling hungry, but the crunch feels nice while you’re brainstorming. Or maybe you’re at a social gathering, feeling slightly awkward without something for your fidgeting hands to do. You hit up the buffet, even though you ate a full meal before arriving. These scenarios are normal and not a cause for concern. We all feel stressed out or nervous from time to time, and eating can provide comfort since it’s involved in brain reward systems. However, it’s possible for stress eating to cross the line into something more concerning, and you may be wondering how to know when it has become an issue. We delve deeper into the science of emotional eating and how to stop stress eating. It isn’t a personal failure. It’s truly about biology. Let’s dig in. Why stress eating happens Stress eating is a type of emotional eating that we sometimes engage in when stressed, worried, scared, or anxious, according to research in the journal Proceedings of the Nutrition Society. Stress eating can occur in the face of a major life event, such as a difficult breakup. Or it can occur as a way to cope with everyday stressors that life throws at you, whether related to work, school, family, the news cycle, or something else. Research in the journal Nutrients indicates that emotional eating like this is not a matter of willpower. Instead, they write, “It is a neurobiological, psychological, and environmental phenomenon.” Indeed, our instinct to turn to certain tasty foods during times of stress is, at least, in part, driven by biology: according to research in the journal Advances in Pharmacological and Pharmaceutical Sciences, comfort foods increase levels of mood-related transmitters. Physical hunger vs. emotional hunger: how to tell the difference in the moment We have several different types of hunger, and understanding them helps you understand stress eating. We have physical hunger, which is when hormones signal to your brain that you should eat. And we have emotional hunger, which is eating because of stress, boredom, sadness, or even joy. With physical hunger, the sensation typically builds slowly, and you might feel the telltale signs, such as having an empty or “gnawing” stomach or feeling low energy and reduced focus. With emotional hunger, the sensations come on suddenly as an urge to eat (usually something specific), but physical hunger signs are typically lacking. You can also experience both types of hunger at once, according to Dani Castellano, RD, at Equip. “With food, it’s important to consider that you need to eat regularly and adequately,” she says. “You’re physically hungry and you’re stressed, and in this case, eating is a perfectly normal response.” We also have other types of hunger—five in total—which Castellano breaks down in the table below. 5 types of hunger  Why dieting and restriction usually make stress eating worse Dieting and restriction may drive stress eating, especially in the face of negative emotions, according to research published in Nutrition Reviews. “One factor to consider, " Castellano says, “is that eating regularly and adequately helps to support meeting your body’s energy needs, stabilizing blood sugar, fueling your brain, etc.” In the face of food restriction through dieting, she adds, “the body typically will ramp up cues for high-energy foods to make up for what it needs. Because of this, stress eating may increase or feel unavoidable as a coping mechanism in a high-stress situation—because the body simply needs food.” Another consideration is that diet culture can lead to feelings of shame or guilt, which can also drive stress eating. “The types of food you eat when stressed may have value or judgment placed on them,” Castellano explains. If you eat a food that you or society labels as “bad,” negative feelings about what you ate can lead to additional stress, followed by guilt-driven restriction, which then leads to more stress eating, creating a harmful cycle. Again, stress eating is not about a failure of willpower. “Food is more than fuel to many people,” Castellano says. “It’s normal to want to engage in something that is comforting.” And in the face of restriction, you may feel even more compelled to eat your favorite comfort foods. How to stop stress eating: strategies that actually help First, let’s just acknowledge that eating is something we all need to do to keep our bodies healthy. However, if stress eating itself is causing you distress, you might be looking for ways to reduce it. The following strategies can help you manage stress eating, but they aren’t about restriction. They’re about learning coping strategies, ensuring you’re getting plenty of nutrients to support all that your body needs to do—and being kind to yourself. Reduce the conditions that make stress eating more likely Step one of reducing stress eating is to make sure your body has regular fuel. That might look like eating three regular meals and a couple of snacks throughout the day. “Basically, if you want to work towards reducing stress eating, you have to make sure that you’re eating adequately and regularly at a baseline,” Castellano says. If you’re physically hungry, you might have a hard time focusing on other skills you might use to cope with stress (another strategy for mitigating stress eating). Additionally, getting adequate sleep on a regular schedule can help. Poor sleep ramps up stress and makes shaking off life’s mild irritations and frustrations even harder, according to research in the journal Emotion. And research in the journal Nutrients shows that poor sleep also increases physical hunger and cravings. Pause and name what you’re feeling When stress strikes, taking a beat to put a name to your specific feelings may help you regulate your emotions, according to an article in the Journal of Psychiatric Research. Emotional regulation is your ability to control your feelings, and it can aid with emotional reappraisal, or changing the way you think about specific feelings. Cognitive behavioral therapy (CBT) can also help. CBT helps you identify your thought patterns and feelings that drive certain behaviors and reframe ones that are unhelpful or distorted. For example, maybe before hanging out with friends, you think, I always say the wrong thing. You can identify this as “all-or-nothing thinking” and reframe the thought pattern as follows: Sure, everyone, including me, says the wrong thing sometimes. But also, I have good conversations. Naming and reframing feelings (as necessary) helps you rewire your thought patterns over time. And as you reduce the thoughts that lead to certain harmful behaviors, those behaviors lessen as well.  Build a short list of non-food coping alternatives to stress Chances are you have some other ways you like to cope with stress that don’t involve food. Having a list of them handy can help you remember that you have alternatives to stress eating. Again, this is not about skipping lunch or ignoring your hunger when you need a snack. It’s about calming your nervous system so that you can make a mindful choice in the moment. Stress activates your fight-or-flight response, driven by your sympathetic nervous system. Anything that helps you activate your parasympathetic nervous system (which drives your “calm” response) will reduce sympathetic nervous system activity, bringing you into a calmer state. You can use the following tips in various situations to stimulate your vagus nerve, which runs from your brainstem to your large intestine and helps regulate your parasympathetic nervous system. Quick nervous system-regulating tips: Cold face test: Place a cold compress on your cheek or splash cold water on your face. Box breathing: Inhale, hold, exhale, hold—each for a count of four. Hum: Hum a tune for a few minutes.  Practice self-compassion after a stress eating episode If you do stress eat, be kind to yourself. Feelings of shame, guilt, or anxiety may crop up, but these feelings can also lead to a complex cycle that drives additional stress eating. Self-compassion is a tool that can reduce negative feelings, according to research in the American Journal of Lifestyle Medicine. Breaking the cycle of negative self-talk can help you heal from emotional eating.  A therapeutic approach to self-compassion is acceptance and commitment therapy (ACT). It involves six steps: Acceptance: Accept the thoughts and feelings that occur. Cognitive diffusion: Recognize thoughts and feelings for what they are, but know they are not truths about you. Being present: Focus on the present moment (without judgment) rather than on what just happened. Self as context: Recognize that you are more than your thoughts, feelings, and past behaviors. Values: Identify what matters to you, or how you want to live your life, including not being controlled by your emotions. Committed action: Set actionable goals and take steps toward your values, such as by using some of the other techniques listed above to cope with stress.  When stress eating becomes something more serious You might be wondering when stress eating morphs into something more serious, such as binge eating disorder (BED). BED is a recognized mental health condition, as noted in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5). BED is an eating disorder involving feeling as if you have no control around food and having recurrent binge episodes followed by intense distress. BED is not defined by body size, nor is it about a lack of willpower. BED diagnostic criteria: You have recurrent binge eating episodes. Binge eating episodes are defined as eating in a discrete period of time (e.g., within any two-hour period) an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances—and feeling a lack of control over eating during the episode. The episodes are associated with at least three of the following: Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of feeling embarrassed by how much one is eating Feeling disgusted with oneself, depressed, or guilty after overeating You feel distress regarding binge eating. Binge eating occurs at least once a week, on average, for three months. Binge eating is not associated with compensatory behaviors, such as purging, fasting, or overexercising, and is not related to anorexia nervosa or bulimia nervosa. Think of stress eating and BED as existing on opposite ends of a spectrum, with many people falling somewhere in the middle. Castellano notes three factors that might indicate you’ve escalated from the occasional emotional eating nearly everyone does to a more concerning spot on the spectrum: Stress or emotional eating is causing you significant distress. Stress eating has become your only coping mechanism. Stress eating leads to loss-of-control eating or binge eating regularly  What professional support looks like and when to consider it If you are concerned about yourself or a loved one, you might be wondering how stress eating is treated when it has become a frequent experience, or how BED is treated. “At Equip,” Castellano says, “we use enhanced cognitive behavior therapy as the main treatment for our adult patients. Part of this includes using a self-monitoring tool, which allows someone to gain further insight into the patterns that are happening over time in regard to thoughts and context around eating.” Another method is dialectical behavior therapy (DBT), a form of CBT. DBT helps encourage focusing on the present moment and learning to manage complex or challenging emotions without judgment. The bottom line Stress eating is common and normal when it occurs occasionally. Specific foods or just the act of eating can provide comfort by impacting the brain’s reward pathways and chemistry. However, frequent stress eating or feeling a loss of control around food might indicate something more serious. If stress eating has become a concern for you or a loved one, a consultation with a knowledgeable care team can help. Equip offers individualized, evidence-based treatment and can coordinate with external clinicians as needed. Schedule a call here to get started.  FAQ Why do I stress eat even when I’m not hungry? Stress eating, even when you’re not physically hungry, happens because food and the activity of eating provide comfort. Stress eating is common as a way to cope with anxiety or complex emotions. Most people stress eat from time to time, but if stress eating has become more frequent or you feel a loss of control around food, talking to a knowledgeable healthcare provider can help. Is stress eating an eating disorder? Stress eating, when it occurs occasionally, is a normal experience and not considered an eating disorder. However, if stress eating is causing you significant distress, has become your main method of coping with difficult feelings, or makes you feel out of control around food, then your stress eating may be associated with something more complex. Binge eating disorder, for example, is a diagnosable eating disorder. What should I do immediately after a stress eating episode? After a stress eating episode, the most important thing you can do is to be kind to yourself. Acknowledge your feelings and what happened, but try to avoid negative self-talk, which can drive further stress eating. How do I stop stress eating at night? Stress eating at night sometimes occurs because of food restriction during the day. One way to reduce the likelihood of stress eating at night is to stick to regular meal times. Another strategy is to engage in calming activities as part of your bedtime routine and to acknowledge, without judgment, any negative feelings that crop up.]]></content:encoded>
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            <title><![CDATA[More Accessible, Just as Effective: New Equip Research on Virtual CBT-E for Adult Patients]]></title>
            <link>https://equip.health/articles/news-and-research/virtual-cbt-e-adult-outcomes-research</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/virtual-cbt-e-adult-outcomes-research</guid>
            <pubDate>Mon, 20 Oct 2025 16:31:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders are serious mental illnesses that require equally serious intervention. For years, enhanced cognitive behavioral therapy (CBT-E) has been considered the gold standard for adult eating disorder treatment—but almost all studies of CBT-E have focused on in-person delivery. At Equip, we know that virtual treatment is essential, making care accessible to countless people who wouldn’t have an opportunity to recover otherwise. That’s why in our latest peer-reviewed study, published in the Journal of Medical Internet Research, we set out to evaluate the efficacy of Equip’s virtually delivered CBT-E. The results were compelling, and provided insights that will drive us forward on our mission to make treatment that works available to everyone who needs it. Read on to find out what we learned. Why we conducted this study Virtual care has become a critical tool in expanding access to mental health services, especially for people living in rural areas, those with limited transportation, or anyone who might otherwise struggle to find a specialist near them. For eating disorders in particular, virtual care helps patients develop skills, learn to manage triggers, and build a recovery-supporting environment in the real world, which can strengthen recovery and protect against relapse. There have been a number of studies showing the efficacy of virtual eating disorder treatment, including our own research on the remotely delivered FBT. But there is not a large body of data on the efficacy of virtual care for CBT-E, which is the leading evidence-based treatment modality for adults with eating disorders. The research that does exist on virtual CBT-E looks at programs that shifted to virtual care due to circumstance—i.e., the pandemic—rather than intentionally designed, virtual-first programs, like Equip. Our study aimed to help fill that gap. The study looked at 1,629 adult patients (18+) at Equip, all of whom received CBT-E through a treatment model specifically designed to be delivered remotely. Our goal was to understand how effective virtual CBT-E is for helping patients achieve weight restoration (when needed), reduce eating disorder symptoms, and improve co-occurring symptoms of depression and anxiety (both of which often go hand-in-hand with eating disorders). Who we studied (and how) This was a retrospective, real-world study based on data from adult patients treated through our standard care pathways. The patient population represented all eating disorder diagnoses except for ARFID: anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorder. CBT-E is a transdiagnostic therapy, which means that it’s meant to treat all types of eating disorders, rather than just one specific diagnosis. It does this by taking a highly individualized approach that addresses the underlying beliefs and distortions that maintain an eating disorder. Patients in the study met with their providers weekly (which is the clinically recommended cadence) and all sessions were virtual. Our analysis focused on how symptoms changed over time, especially around the 20- and 40-week marks, which align with the typical length of CBT-E in existing clinical trials. What we found Our findings show that virtual CBT-E can drive meaningful improvements in eating disorder symptoms, as well as in common co-occurring conditions like depression and anxiety. The results below show outcomes after 40 weeks of treatment. Weight restoration Among patients needing weight restoration 50% of patients achieved at least 95% of their expected body weight Eating disorder symptoms 34% improvement in eating disorder symptoms 48% of patients achieved subclinical levels of eating disorder symptoms (among patients who began treatment with clinically significant levels of eating disorder symptoms) Depression Among patients who began treatment with clinical levels of depression 32% improvement in depression symptoms 55% saw their symptoms drop below the clinical threshold Anxiety Among patients who began treatment with clinical levels of anxiety 26.5% improvement in anxiety symptoms 56% saw their symptoms drop below the clinical threshold To put these numbers in context: published clinical trials for in-person CBT-E report weight restoration rates between 41% and 53%; eating disorder symptom improvement of 31–36%, and depression and anxiety improvements of 21% and 17%, respectively (all measured at the 40 week mark). That means Equip’s virtual outcomes are not only within the expected range, they often exceed it. What this means for virtual care These findings provide strong evidence that remote, evidence-based eating disorder care can be just as effective as in-person treatment. That’s an important and promising takeaway—not just for Equip, but for the future of eating disorder treatment. Our paper, taken together with the existing body of research, shows that when CBT-E is adapted for virtual settings and delivered with intention, it can be a powerful tool for eating disorder recovery in adults. Because in-person care can be impractical, inaccessible, or simply overwhelming to many adults—not only those in rural areas or treatment deserts, but also those with children they need to take care of or jobs they can’t put on pause—virtual treatment is often the only pathway to recovery. And, as our study shows, it can be an effective and efficient route. The bottom line Eating disorders don’t go away on their own, and often get worse over time—making access to timely, evidence-based treatment essential for the countless adults struggling. Our latest study reinforces that virtual CBT-E can deliver real, lasting results for adults with a wide range of different eating disorder symptoms. It’s a powerful validation of the work we do at Equip every day, and a reminder that recovery can begin right where you are, in your own life, today. Note: While our study included a large number of patients (over 1,600), the group wasn’t as diverse as we’d like: the majority were white (71.5%) and cisgender women (86.1%), with a mean age of 30. That reflects broader trends in research, where underrepresented groups are often excluded—intentionally or not. We recognize that, and are committed to continuing to diversify our sample groups, improve our outreach, and ensure that everyone—particularly those historically left out of treatment—has access to the care they deserve.]]></content:encoded>
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            <title><![CDATA[There’s No Such Thing as "Not Sick Enough” to Get Eating Disorder Treatment]]></title>
            <link>https://equip.health/articles/understanding-eds/not-sick-enough-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/not-sick-enough-eating-disorder-treatment</guid>
            <pubDate>Wed, 08 Feb 2023 16:00:00 GMT</pubDate>
            <content:encoded><![CDATA[When Equip Peer Mentor Rachel Myers decided to seek treatment for her eating disorder, she was confronted by an all-too-common response: “You don’t look like you have an eating disorder.” Myers says that because she did not present as extremely thin or meet the body mass index (BMI) criteria to be considered “underweight,” medical professionals brushed off her mental illness and disregarded the damage her disorder was causing. Myers’ experience is not at all uncommon. Even though there has been increasing awareness around “atypical anorexia,” a diagnosis for people who exhibit all the symptoms of anorexia but without the classification of being underweight, countless people go undiagnosed because of false assumptions around what eating disorders look like. In reality, fewer than 6% of people with eating disorders are medically diagnosed as “underweight,” but despite that statistic, individuals in larger bodies are half as likely to be diagnosed with an eating disorder than “normal weight” or “underweight” individuals. What’s more, eating disorders wreak havoc on a person’s physical and mental health regardless of their weight; the eating disorder is not less serious because a patient’s weight is higher. So why are so many people slipping through the cracks, and why does the medical community—and society at large—still seem to think individuals have to reach a specific, arbitrarily defined level of “sickness” in order to receive help for their eating disorders?  Why so many people don’t get the help they need It’s clear that the diagnostic criteria historically used to define eating disorders and decide who gets treatment is part of the problem. But what other factors contribute to the mythology around being “sick enough” to receive help and be taken seriously? Is it a lack of accurate media representations? Social stigma? Fatphobia? Experts believe it’s all of the above, and more. Myers, for her part, believes that fatphobia is at the root of many misconceptions around eating disorders. “Society believes that if you’re fat, then you can’t possibly have an eating disorder,” she says. “This is something I was told by multiple doctors throughout my lifetime. I convinced myself that this was true, because all of the media depictions of eating disorders in general showed only a certain body type.” “I absolutely think media depictions of eating disorders are partially to blame,” agrees Equip therapist Ashley Isenhower, AMFT. “We almost always see anorexia characterized by extremely thin, white, affluent, cisgender females. Meanwhile, we almost always see binge eating disorder characterized by people in larger bodies.” Equip registered dietitian Dani Castellano says the tendency to measure yourself against others—both physically and mentally—can also contribute to a person’s denial of their own eating disorder. “Comparison can be a big part of eating disorders and a huge maintaining mechanism of them is the belief that things aren't ‘bad enough’ or ‘could be worse,’” she says. “I’ve seen that thought process get in the way of taking steps toward recovery for people who need treatment.” There’s also the fact that it can be hard for people to admit the severity of their suffering when the culture they live in constantly reinforces and rewards the very behaviors that are hurting them. “The diet culture we live in glorifies disordered eating and exercise patterns every day, and depending on body size, that gets in the way of seeming ‘sick enough,’” says Castellano. Myers experienced this herself, explaining that “dieting is so validated within our society that for a long time, I was convinced I didn’t have a problem because most people I knew tried dieting in one form or another, and it was labeled as ‘wellness.’” Who actually deserves help for an eating disorder? The short answer to the question above is everyone. But when it comes to deciding if you or a loved one is “sick enough” to merit treatment, it can be tricky to tease out the true psychological symptoms of an eating disorder from the outdated diagnostic criteria that so many medical institutions and care facilities still lean on. “If you're questioning if you're ‘sick enough’ or if your family member is ‘sick enough,’ I would recommend you reach out for help,” Castellano says. “Equip's website has a wonderful checklist of signs to look out for in determining if someone is struggling with an eating disorder. Early intervention is crucial and anytime thoughts about food, body, or exercise are getting in the way of living life, there is room for healing.” It’s also important to understand that eating disorders have serious health consequences regardless of a person’s weight. People of any weight who engage in eating disorder behaviors can experience significant, potentially life-threatening health problems, such as heart irregularities (including heart failure), electrolyte imbalances, severe dehydration, digestive problems, and psychiatric issues like anxiety and depression, among other complications. Isenhower believes that by asking a few key questions, you can learn far more about your own or you loved one’s need for intervention than you could by looking at any single number or diagnostic marker: How much time do you or your loved one spend fixating on food, calories, or exercise? How much is this “diet” or “lifestyle choice” affecting you or your loved one’s ability to make/sustain friendships or relate to family members at home? Are food/exercise/body concerns negatively affecting you or your loved one at school or work?   How much distress are food/exercise/body concerns causing you or your loved one? “Someone’s mental state is a more accurate way to determine someone’s need for treatment than their weight,” Myers says. “It’s important to be aware of your relationship with food, your body, and movement. If you feel the need to constantly manipulate your body size or diet, this could be an indicator that you’re in need of eating disorder treatment. Body size alone should not be a prerequisite for whether you’re worthy of treatment, because catching eating disorders early is key to preventing them from getting worse. It is never too soon to start reflecting on your relationship with food, especially if you're making drastic changes to your diet or starting to have ritualistic behaviors around food.”  What to do if a medical professional dismisses a patient in need With so many people routinely experiencing the same disregard for their symptoms that Myers did, it’s imperative that individuals and families know when and how to advocate for themselves. When Isenhower encountered harmful dismissal upon seeking treatment for her bulimia, she had to do just that. “I was very engaged in my disorder and attempting to check myself into treatment so I needed my primary care provider to order labs and check my vitals,” she says. “She looked at me, looked at my chart, and exclaimed ‘Oh wow—you’ve lost quite a bit of weight. Good job!’” Luckily, when Isenhower relayed the story to her therapist, she was reminded of the instinct she’d had that something was not right about the way she was living. She ignored her doctor’s comments and continued on to treatment. “So I'd say: trust your gut,” she says. “Doctors don't have adequate training in eating disorders but you are the expert on yourself or your child. You've seen the light disappear behind their eyes and you've watched them struggle with food and body image.” Castellano believes that the attitudes behind Myers’ and Isenhower’s experiences create a huge barrier to equitable treatment. Her advice to people who find themselves in these situations, which she calls “infuriating” and “unjust,” is this: “Take a moment and breathe, know that you are not alone and this doesn't mean that you cannot get help. Do not give up, but know that it can be difficult to find providers who get it. Equip is of course an amazing resource and place to seek treatment for families. The National Alliance for Eating Disorders also has extensive resources and search tools to help you connect with experienced practitioners.” Having navigated this road herself, Myers also has some guidance for those who have been met with misinformation or ignorance in their pursuit of treatment. “Families and patients should feel comfortable finding eating disorder-specific clinicians such as dietitians, therapists, or treatment centers,” she says. “It can be helpful to look up phrases like ‘eating disorder-informed,’ ‘HAES (health at every size),’ and ‘intuitive eating.’ I’ve learned over the years of visiting my primary care doctor that it’s okay to ask for more specialized help, and it isn’t always going to come from your medical doctor.” Isenhower also offers some wisdom from her own personal and professional experience. “Hitting ‘rock bottom’ in eating disorder recovery simply means you don’t want to get yourself in any deeper,” she says. “You can always go further, get sicker, get smaller—but you don't have to. You can simply choose to stop digging.” ]]></content:encoded>
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            <title><![CDATA[What Happens If You Don’t Eat Enough? 9 Ways Undereating Affects Your Body and Mind]]></title>
            <link>https://equip.health/articles/food-and-fitness/what-happens-if-you-dont-eat-enough</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/what-happens-if-you-dont-eat-enough</guid>
            <pubDate>Wed, 29 Jan 2025 21:03:36 GMT</pubDate>
            <content:encoded><![CDATA[I spent several years of my life living in an energy (calorie) deficit. At the time, I never stepped back to wonder what happens if you don’t eat enough. I didn’t understand how my entire being—mind, body, and emotions—were being affected by living that way. I’m not being dramatic when I say that every part of me was drastically and negatively impacted by undereating. Today, as an eating disorder dietitian, I see how the effects of undereating touch every facet of my clients’ lives. Undereating is a main symptom of most eating disorders, and it can have a variety of different causes and triggers, from shame and guilt to body image distress, trauma, and beyond. People without eating disorders can also experience the negative effects of undereating. Recent research shows a high prevalence of undereating in certain populations, like athletes who don’t eat enough to fuel their training, resulting in a negative energy imbalance. “Some people find themselves in chronic deficits unintentionally—their lives are busy, schedules are packed, perhaps their physical activity is high, or they’re struggling with a low appetite,” says Caroline Burkholder, MS, RD, CEDS. “Others may find their chronic deficit has deeper roots: body image concerns, pressure from others, or an internalized list of rigid food rules.” Let’s look at what actually happens if you don’t eat enough, and how it can significantly impact you mentally, emotionally, and physically. 1. Emotional struggles In my practice, I notice heightened anxiety is one of the main consequences of not eating enough. Undereating, which often comes with malnutrition and excessive weight loss, can also cause or worsen depression due to changes in brain chemistry. Kristin Grimes, RDN, LD, explains that is due, in part, to the fact that not eating enough can lead to tissue damage in the brain, as well as a lack of nutrients—specifically vitamin B12, folate, and zinc—that may cause depression, cognitive decline, and irritability. Also, lifestyle medicine physician Nneoma Oparaji, MD, DipABLM, DABOM, says that undereating disrupts mood-regulating neurotransmitters like serotonin and dopamine, which can worsen symptoms of anxiety and depression. “Emotional resilience decreases and small stressors become overwhelming, [and there’s] reduced patience, mood swings, and difficulty regulating emotions,” she explains.  2. Food obsession and poor concentration It’s one of the first concerns clients who are undereating share with me when we start working together: they believe they’re uniquely obsessed with food, when in fact their bodies are simply trying to survive. “Your body doesn't understand that this ‘famine’ is self-inflicted, so it's going to be on high alert to increase its ability to survive and find food,” explains Equip Nutrition Director Erin Reeves, RD. “You might be thinking about food more or feel more out of control when you do eat because your body can't trust there won't be a famine again.” In one famous landmark study (called the Minnesota Study on Human Starvation by researcher Ancel Keys), a group of men were intentionally underfed over an extended period and reported the following symptoms: Fixation on food Decreased concentration Slower rate of learning Poorer judgment Eating faster than normal Dreaming of food Watching others eat These negative effects on thinking ability don’t have anything to do with intelligence or intellectual ability—they’re natural consequences of not giving your brain enough fuel. “When our brain is underfed, it leads to excessive worry, restlessness, difficulty relaxing, decreased concentration and productivity, and brain fog,” says Oparaji. According to a 2021 meta-analysis of adults with anorexia and those without, those with anorexia (which involves undereating as a core symptom) did a worse job on cognitive tasks, and showed significantly impaired memory.  3. Personality changes When you aren’t eating enough food, Burkholder says, “much of the ‘airtime’ in your mind is consumed by thoughts of food, leaving little room for other things.” And when you don’t have the space or energy for anything besides food or your body, it’s almost impossible to stay connected to your core values and authentic self. In the landmark Minnesota Study on Human Starvation, the underfed men reported “dramatic personality changes,” like: Increased irritability Loss of sexual interest Decreased self-initiated activity Lethargy Underfueling can also lead someone to become a more rigid thinker than they are when they’re eating enough, as well as to social withdrawal, which Equip peer mentor Jamie Drago experienced firsthand. “I was so focused on the amount I was eating—and deviating from what I thought was ‘right' brought about such anxiety—that I ended up isolating myself from family and friends,” Drago shares. “This took a toll on my emotional and mental health because I had fewer and fewer avenues for joy and community.” 4. Slowed metabolism Other signs of undereating include a decreased basal metabolic rate (BMR), which is the energy your body needs to perform basic functioning. The body is focused on survival, so if you’re not adequately fueling it, it slows down all its processes to conserve energy and survive with less food. “There are no tricks around this by eating a certain spicy food or doing a certain workout,” explains Reeves. “Your metabolism will slow down if you aren't giving it enough." This is one of the reasons that so many people who spend years yo-yo dieting to lose weight often end up at higher weights than when they started: their bodies get thrown off by undereating and try to recalibrate by adjusting metabolic speed, only to get confused again, and the cycle continues. Signs of a suppressed metabolism can also include: Fatigue Dry skin Feeling cold often On a related note, when you don’t have enough blood sugar circulating in your blood, (which can occur when you’re regularly undereating and have depleted all the sugar stores in your liver and muscles), you can experience hypoglycemia, or low blood sugar. This can cause symptoms like sweating, fatigue, dizziness, and in severe cases, loss of consciousness. 5. Reproductive problems Amenorrhea (losing your period for more than three months) is a common side effect of undereating. It can lead to a long list of serious health issues, according to The Journal of Clinical Endocrinology & Metabolism Clinical Practice Guidelines. These include: Infertility Osteoporosis Anxiety Depression Malnutrition One 2022 research review of women showed that eating too little can disrupt hormone signals from the brain, causing decreased reproductive hormones and disrupted reproductive function. Essentially, when you don’t eat enough, your body prioritizes vital functions (like breathing and keeping your heart beating) and shuts down processes it deems non-essential (like reproduction). “Your body downregulates to conserve as many calories as possible, and that means forfeiting reproductive function,” Burkholder explains. 6. Nutrient shortage and muscle loss Reeves says another serious side effect of undereating is nutrient deficiencies. Being deficient in certain nutrients can lead to a wide variety of health conditions, like: Anemia Cold intolerance Hair loss Skin problems Insomnia Bone issues Undereating can also cause catabolism, or when the body breaks down lean tissue like muscle for fuel, which can lead to loss of muscle mass and muscle wasting. This may be particularly noticeable for athletes who are undereating. “Your muscles will get broken down faster because they have neither the energy nor the building blocks—amino acids and protein—available to maintain themselves,” Reeves explains. Plus, if you’re engaging in physical activity while undereating, your muscles will have a harder time recovering and you’re likely to experience decreased athletic performance, according to Burkholder. Since the heart is largely made of muscular tissue, it will also start to weaken, and vital signs like blood pressure and heart rate can fall dangerously low. “This weakening of the heart reduces the ability to pump blood throughout the body, which can lead to fatigue and shortness of breath,” Grimes explains. “Malnutrition also disrupts the electrical activity of the heart, the power behind the heart’s contractions, which can be fatal.”  7. Digestive issues Malnutrition can also break down tissue in the digestive tract, and over time, this can weaken muscles in the stomach and intestines. In fact, research shows that malnutrition and weight loss from undereating can slow down the gastrointestinal (GI) tract, which can cause issues like: Gastroparesis (slowed movement or motility of stomach muscles) Constipation Reflux Heartburn Bloating Diarrhea Reeves explains that undereating will also decrease the number of enzymes your body makes to break down food, leading to further GI symptoms. In my practice, I’ve observed that undereating-related GI issues cause significant disruptions in clients’ day-to-day functioning and overall quality of life.  8. Feeling out of control In the eye-opening Minnesota Study on Human Starvation, the men subjected to undereating reported that once the restriction period ended, they felt an initial loss of control around food. Some of them said they wanted to eat continuously, while others said they binge ate (and never had before the experiment). More than half of them reported overeating. In my work, I’ve noticed that most of my clients are surprised when they realize their bingeing or overeating is often rooted in undereating. The thing is, when we’re underfed, our bodies will do everything possible to get us to reclaim a state of equilibrium, and that can sometimes manifest in out-of-control eating, binge eating, or an inability to listen to and honor your hunger and fullness cues. Undereating followed by binge eating can become a vicious cycle (known as the binge-restrict cycle), and is often accompanied and enforced by feelings of guilt, shame, and frustration. 9. Weakened immune system Eating enough is like putting on a strong suit of armor each day, and when that armor disappears or is weakened, it compromises every system in your body, including your immune system. “When the body is underfueled, the immune system is one of the first systems to suffer,” Oparaji explains. “A person may notice more frequent colds or infections, and slower wound healing.” According to a 2022 research review, good nutritional status is strongly linked to optimal immune function. This is likely due to the fact that undereating can cause deficiencies in key immune-supporting nutrients, like: Protein Fat Vitamins like A, C, and D Minerals like zinc and selenium How to stop underfueling your body If you’re experiencing any of the signs and symptoms discussed above, you may be undereating. To better understand if you’re not giving your body enough food, ask yourself these questions: Do I… Feel heightened anxiety and depression? Feel more irritable than usual? Have obsessive food thoughts? Isolate myself socially because of food? Feel out of control around food? Have a missing period? Experience significant digestive discomfort? Get cold or sick often and easily? Regardless of your symptoms, once you’ve found yourself in a pattern of chronically undereating, it’s tough to restore balance on your own—whether or not you have an eating disorder. That’s why re-establishing healthy eating habits and reversing the effects of undereating usually takes professional guidance from a team of providers (generally at least a therapist and a dietitian). “Learn from a non-diet dietitian how much your body really needs. It's difficult to use online calculators or providers that endorse weight loss, because you will likely get a calorie goal that is far too low,” Reeves says. “Stay in your lane: don't compare yourself to others or ask your friends how many calories they eat. Your body is its own unique machine, and looking at a snapshot from a peer or someone's 'what I eat in a day' video is not going to give you the personal guidance you need to thrive.” With your dietitian, you’ll learn how to nourish yourself to meet your specific energy and nutrient needs, which usually means eating balanced meals and snacks every few hours throughout the day. You may also learn other practices as necessary, like intuitive and mindful eating and flexible meal planning. Check out more skills and insights on how to stop undereating here. Undereating effects are widespread and have serious impacts on mental, physical, and emotional well-being. But there’s good news: most can be reversed with adequate and balanced nourishment. While the road there can be challenging, trust that your hard work and commitment will pay off in powerful ways for the rest of your life.  Frequently Asked Questions (FAQs) What are the side effects of not eating enough? There are several symptoms of not eating enough, including food obsession, loss of control around food, amenorrhea (loss of period for more than three months), personality changes like increased irritability, lethargy, and digestive issues like constipation and bloating. What are the long-term effects of not eating enough? Chronic undereating can lead to a variety of negative health consequences, including reproductive problems, musculoskeletal issues like osteoporosis, and digestive problems. It can also have long-term effects on your emotional health, relationship, and quality of life. How does undereating affect metabolism? Undereating can suppress your metabolism by decreasing your basal metabolic rate (BMR), which is the energy your body needs to perform basic functioning. Without enough calories, your body will slow all its processes to try and save energy and survive with less food. Can undereating cause digestive issues? Yes, undereating can include digestive issues, like general GI dysfunction, gastroparesis (or slowed movement or motility of stomach muscles), constipation, reflux, heartburn, bloating, and diarrhea. Such digestive issues can significantly impact overall health and quality of life.]]></content:encoded>
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            <title><![CDATA[Beyond Picky Eating: What Parents Need to Know About ARFID in Kids]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-in-children</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-in-children</guid>
            <pubDate>Wed, 24 Jun 2026 14:20:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’re a parent, maybe this scenario sounds familiar: Your child has been consistently refusing to eat any foods that make a “crunch.” At first, you chalk it up to the “picky eating” you remember from your own childhood, something that resolved over time as you tried more foods. But then your child starts refusing to eat any foods that aren’t white or beige. And as the list of things they’re willing to eat grows shorter and shorter, your child starts losing weight or falling off their growth curve. That’s when you wonder if something else is going on. You worry about rotating the same five “safe” foods, which you know are not enough nutritionally, but your child’s distress when you encourage them to try new flavors feels unmanageable. Behaviors like the ones described above indicate that something else is going on aside from typical picky eating. Yes, picky eating is a common childhood behavior, according to the Proceedings of the Nutrition Society—but it often fades as kids gain new experiences with food, whether at home, at school, or on playdates. Sometimes, though, seemingly picky eating can be an indicator of a serious condition. Avoidant/restrictive food intake disorder (ARFID) is a recognized eating disorder in which a person eats a very small amount or variety of food (or both). Body image or weight concerns do not drive ARFID, though these issues often play a central role in other eating disorders. Many factors can contribute to the development of ARFID in kids. But ARFID is not “just a phase,” and it is not your fault as a parent or caregiver, nor is it your child’s fault. And recovery is possible with the right support. In this article, we explore ARFID symptoms in children, ARFID vs. picky eating, ARFID diagnostic criteria, and more. What is ARFID? ARFID is an eating disorder that is not driven by body image concerns or fear of weight gain. It develops out of sensory sensitivities, a lack of appetite or interest in food, or a fear that something bad will happen from eating or drinking certain items. “Each of these reasons represents a presentation of ARFID,” says Michelle Jones, PhD, a licensed clinical psychologist and clinical instructor at Equip. “And people diagnosed with ARFID can experience one, two, or all three of these presentations. Importantly, individuals with ARFID do not restrict their intake due to body image distortions or a desire to lose or avoid gaining weight.” ARFID was first defined in 2013 in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which provides criteria for mental health diagnoses. The four ARFID diagnostic criteria: Your child has an eating or feeding disturbance (e.g., sensory sensitivities, lack of food interest, or food fear) that leads to at least one of the following: Significant weight loss Significant nutritional deficiency Dependence on nutritional supplements (either orally or through a tube) Noticeable issues in social functioning The eating disturbance does not result from a lack of available food or a cultural practice. The eating disturbance does not involve body image or weight concerns. The eating disturbance is not explained by another mental health concern or medical condition. ARFID is distinct from picky eating. It’s also not about stubbornness on your child’s part, nor is it some sort of parenting failure. Instead, ARFID results from underlying factors that are out of your control.  Determining the prevalence of ARFID in children is tricky. But, according to the Journal of Eating Disorders, it affects up to 15% of the population and often develops in childhood, though it can show up later in adulthood. Is it ARFID or picky eating? If your child is a difficult eater, understandably, you might be worried. Like many other parents and caregivers, you might find yourself in the position of having to determine whether what you’re picking up on is ARFID or more along the lines of normal childhood picky eating. The following table offers some clues. Picky eating vs. ARFID in toddlers, children, or teens  ARFID and picky eating can look similar, especially at first, but the differences become clearer when eating patterns affect nutrition, growth, daily functioning, or overall well-being. For a more detailed breakdown, read our article on ARFID vs. picky eating. Dr. Jones offers further insight to help illustrate the basic differences between the two. “When differentiating between ‘normative’ childhood picky eating and selective eating in ARFID,” she says, “I consider the child’s range of preferred foods, how stable those food preferences are over time, whether the child is becoming more limited in variety over time, and the impact of the limited variety on the child’s health and functioning.”  With picky eating, children typically eat at least a few foods from each of the five food groups, though they may have favorites or preferences for how those foods are prepared or presented. “A child with selective eating associated with ARFID may not be able to tolerate even minor changes in preparation or in sensory properties of foods without intervention,” Dr. Jones says. Another key difference involves negative effects on health. “Generally, picky eaters will not experience significant negative impacts in terms of weight, health, or psychosocial functioning as a result of their eating habits,” Dr. Jones explains. However, children with ARFID eventually experience one or more of these health concerns. What are the three presentations of ARFID? ARFID shows up in three distinct ways, but many people with ARFID display characteristics of more than one. Sensory sensitivity: Your child avoids foods because of specific textures, tastes, smells, colors, temperatures, or general appearance. Maybe your kid dislikes when any of their foods touch on their plate. Or maybe they gag when you serve anything green. Low interest in food: Your child says they aren’t hungry or doesn’t show interest in food. In teens, low interest may show up as forgetting to eat. Younger kids may not show any pleasure in foods that kids typically enjoy, and dinnertime might always feel like a battle where you’re trying to get them to eat anything. Fear of aversive consequences: Your child might fear throwing up or choking if they eat specific foods or eat in general. This presentation of ARFID may develop after a frightening experience with food. For example, after an incident in which food got stuck in the back of their throat at a birthday party, they may refuse to eat anything that isn’t pureed or liquefied.  What are the signs of ARFID in children? ARFID can have both behavioral and physical symptoms. As a parent or caregiver, you might be more aware of the behavioral signs of ARFID in your kid, while other signs might show up at the doctor’s office. Here’s a breakdown of ARFID symptoms in children. Behavioral signs The behavioral signs of ARFID in kids might show up at home, school, or during social events, such as playdates, birthday parties, or larger family gatherings. Often, they occur in all these settings. Your child might have ARFID if they: Eat only a small number of foods, refusing all others Continue to adamantly refuse certain foods even after gentle encouragement to try new flavors or textures Reject entire food groups (such as fruits or dairy) Get upset when designated “safe” foods aren’t available Display fear of choking or throwing up from eating Have emotional reactions to food, whether crying or panicking, especially when pressured to eat Eat noticeably slower than other people Refuse to eat at restaurants or in social situations Require you to bring “safe” foods to events Routinely skip meals or refuse to eat altogether Physical signs You might also notice physical signs that are consistent with ARFID. These symptoms could also come to light during a visit to your pediatrician. Your child might have ARFID if they experience: Poor weight gain for their age Unexplained weight loss, especially when they should be gaining as part of their development Vitamin, mineral, or other nutrient deficiencies that show up through testing Thinning hair or pale skin Low energy or unusual fatigue from not eating enough Delayed puberty Digestive issues, such as constipation from not getting enough fiber Dependence on nutritional supplements, such as meal-replacement drinks Dehydration symptoms How does ARFID affect a child’s health? ARFID can affect both physical and mental health in a variety of ways. Nutritional deficiencies are just some of the potential impacts that may show up, while others result from extreme anxiety about food. Common nutrient deficiencies in ARFID and what they might look like:  Growth and development risks Growth and development disruption is one of the key factors that help healthcare providers distinguish ARFID from picky eating. If your pediatrician has concerns, they may evaluate your child for ARFID or other conditions. However, if you notice issues with growth or development, you can always talk to your provider about what might be going on. Growth and development concerns include: Height and weight percentiles may drop on growth charts Puberty may be delayed, which can delay other types of development Muscles do not develop, leading to difficulty with everyday activities and play Bone health suffers, leading to potential fractures Immune system issues may lead to more frequent or severe illness or trouble with wound healing Energy levels can be low, causing trouble with general functioning Social and emotional effects The rigidity around food that is present in ARFID, and the resulting nutritional deficiencies, can also lead to social and emotional issues. Social and emotional effects include: Poorer performance in school Difficulty concentrating or paying attention Low energy for participating in activities Social avoidance, including for birthday parties, playdates, school outings, extracurriculars, etc. Anxiety when eating in public Trouble engaging with family at meals What conditions commonly occur alongside ARFID? Several conditions are associated with ARFID, though just because your child has one of the following conditions does not automatically mean they have ARFID, or vice versa. The conditions just share similarities, and may drive one another. For example, sensory concerns are sometimes a symptom of autism spectrum disorder (ASD), which may lead to food-texture aversions, according to the journal Current Opinion in Psychology. Likewise, a lack of hunger cues is associated with attention deficit/hyperactivity disorder (ADHD), according to Current Psychiatry Reports. This is partly because of how the condition affects the brain, and also because treatment medications can suppress appetite. Additionally, obsessive-compulsive disorder (OCD) may contribute to the fear of certain foods, according to the journal European Eating Disorders Review. Common ARFID comorbidities: Anxiety disorders Attention deficit/hyperactivity disorder Autism spectrum disorder Gastrointestinal disorders (e.g., irritable bowel syndrome or gastroesophageal reflux disease) Obsessive-compulsive disorder Sensory processing disorder How is ARFID diagnosed in children? ARFID is diagnosed in children after a thorough evaluation from a pediatrician or other clinician. When you take your child to see their doctor, here’s what might occur. They may: Ask about your child’s symptoms or how they act around food. Ask about or reflect on your child’s medical history to see if their symptoms could be attributed to another medical concern. Ask about your child’s life experiences, such as whether they’ve experienced trauma or a traumatic food-related incident. Ask about your child’s overall mental health, since anxiety or another condition may be a contributing factor to their behavior surrounding food and eating. Ask about family medical history, since ARFID can have a genetic component. Evaluate whether your child’s growth and development are consistent with other children their age. Perform a blood draw to test for nutrient deficiencies. Perform allergy testing to confirm or rule out food allergies or sensitivities. Keep in mind that ARFID is a lesser-known eating disorder, despite how common it is. So a provider might not notice the condition or might even dismiss your concerns as being just “normal picky eating” that your child will recover from with age. That’s why seeing an ARFID-informed provider is crucial if you continue to have concerns that your child has the condition or another potential eating disorder. Equip’s free ARFID quiz can be a helpful place to start. When to contact your child’s doctor If you have concerns about your child’s eating habits, whether you suspect picky eating or ARFID, never hesitate to reach out to their pediatrician or other provider for an evaluation. “If symptoms that are associated with ARFID are causing a child significant problems in daily life, it’s a good time to seek help,” Dr. Jones says. “Specifically, professional guidance and treatment would be warranted if a child is experiencing weight loss or lack of appropriate growth or weight gain, problems functioning in daily life, significant distress, or any concerning medical symptoms related to poor nutrition.” How is ARFID treated in children? ARFID treatment in children usually involves family members and takes a gradual approach to addressing specific ARFID symptoms. “Most treatment approaches start with helping the child and their caregivers understand what ARFID is and why it’s important to work on eating enough food and a wider variety of foods,” Dr. Jones says. “For children who are selective eaters, they will practice trying small tastes of new foods several times before gradually working on incorporating new foods that they are able to tolerate into their regular diet.” Treatment may look a bit different if your child has low interest in food rather than specific aversions. “Interventions will involve making food more interesting and eating on a more regular schedule to ensure the child is eating an appropriate volume of food,” Dr. Jones explains. Finally, if your child has fears around food, your care team may take another approach. “Children who are afraid of something bad happening during or after eating, such as vomiting or choking,” Dr. Jones says, “will practice facing their fears in small, achievable ways that gradually increase in difficulty until their fears decrease and they no longer interfere with the ability to eat.” Working with a multidisciplinary care team helps set your child up for recovery. An ARFID-informed care team may use specific treatment methods, such as the following, some of which Dr. Jones described above: Exposure and response prevention (ERP) gradually exposes your child to triggers and helps them alter their response. Family-based treatment-ARFID (FBT-ARFID) actively includes parents and caregivers, empowering them to help manage their child’s nutritional recovery, while helping to remove stigma or feelings of blame and guilt. Cognitive behavioral therapy-ARFID (CBT-ARFID) addresses underlying food, sensory, or fear triggers while helping to normalize eating routines and expand food variety and overall intake.  The bottom line ARFID is a recognized eating disorder that often develops in childhood or may show up later in life. One way it is distinct from pick eating is that it leads to negative health issues with growth and development and everyday functioning. If you are concerned about your child’s eating habits or are wondering why they won’t eat and are losing weight, talking to a knowledgeable provider is a good idea. The hopeful news is that help is available and recovery is possible. Equip offers individualized, evidence-based ARFID treatment for kids and can coordinate with external clinicians as needed. Schedule a call here to get started. FAQ Can a child have ARFID without autism? Yes, a child can have ARFID even if they do not have autism spectrum disorder. The two conditions are associated with each other, but they also occur independently. Can a child outgrow ARFID without treatment? ARFID is a recognized eating disorder. It is not something a child will simply “outgrow” without treatment. ARFID is different from picky eating, which typically resolves as children try new foods over time. Can ARFID cause a child to lose weight or stop growing? Yes, ARFID can cause a child to lose weight or hinder their growth and development. The condition can lead to not eating enough to support developmental needs, and it can lead to nutritional deficiencies that impact overall health and well-being.]]></content:encoded>
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            <title><![CDATA[Understanding ARFID Symptoms in Children, Teens, and Adults]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-symptoms</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-symptoms</guid>
            <pubDate>Tue, 23 Jun 2026 18:43:00 GMT</pubDate>
            <content:encoded><![CDATA[At first glance, avoidant/restrictive food intake disorder (ARFID) can look like picky eating. But ARFID is a serious eating disorder that goes much deeper than food preferences. Unlike other eating disorders, ARFID isn't driven by body image concerns or a desire to lose weight. Instead, food avoidance and other ARFID symptoms are typically linked to sensory sensitivities, fear around eating, or a lack of interest in food (or a combination of these factors). "My ARFID is driven by a fear of vomiting, or emetophobia, due to having a history of chronic nausea and health issues as well as significant anxiety," says Equip Peer Mentor Kelsey Gilchriest, who has experienced ARFID firsthand. Her story highlights an important reality: ARFID manifests in complex and unique ways, and doesn't always look the way people expect it to. And because symptoms vary from person to person, it’s often mistaken for picky eating, anxiety, digestive issues, or something else entirely. Below, we'll cover the most common signs of ARFID, how symptoms can present across ages and life stages, and when it may be time to seek support. What are the symptoms of ARFID? ARFID symptoms affect more than eating habits alone. It can also impact physical health, emotional well-being, nutritional status, and social functioning. While every person's experience is unique, ARFID symptoms generally fall into three broad presentations: sensory-based ARFID, fear-based ARFID, and low-interest ARFID. Some people fit clearly into one category, while others experience a combination of symptoms from multiple presentations. Here’s a breakdown of the different behavioral, emotional, physical, and social signs that occur across each type of ARFID. 
ARFID Symptoms at a Glance  Behavioral signs The behavioral signs of ARFID often center around avoiding, limiting, or struggling with food in ways that go beyond typical food preferences. "What this [can] look like in practice is a kiddo who is beyond what parents might consider typical 'picky eating,' or a young adult or adult who eats a very limited range of foods, often foods that might be associated with younger ages," says Cait Scafati, MA, MSW, LCSW, virtual mental health clinical director at Clear Behavioral Health. While not everyone experiences the same symptoms, common behavioral signs include: Eating a very limited range of foods: Some people with ARFID feel comfortable eating only a small number of "safe" foods or avoid certain food groups altogether. “Oftentimes, it’s easier to ask what a client will eat rather than what they won’t,” says Scafati. Avoiding foods based on sensory characteristics: Certain textures, smells, tastes, temperatures, colors, or appearances may make foods feel intolerable. Needing foods prepared in a specific way: Small changes to a recipe, brand, packaging, or preparation method may make a food feel impossible to eat. Eating very small portions: Some people become full quickly, have little interest in food, or struggle to eat enough throughout the day. Taking a long time to eat: Meals may feel overwhelming, stressful, or physically difficult to complete. Avoiding eating after a negative experience: Food poisoning, an allergic reaction, or another traumatic food-related event may lead someone to restrict foods they perceive as unsafe, or food generally. Continuing to avoid food despite hunger: ARFID is not simply a matter of refusing food until hunger wins out. “Clients will not eat despite significant hunger," says Scafati. Relying on nutritional supplements or meal replacement drinks: Some people use supplements to help meet nutritional needs when eating enough food feels difficult. Emotional signs ARFID can also affect how someone feels about eating. According to Scafati and Equip therapist Carol Brown, MSW, common emotional signs include: Anxiety around food or eating: Some people feel intense worry before meals, especially when they aren't sure whether preferred foods will be available. Fear of negative consequences: People with fear-based ARFID may worry about unpleasant or dangerous outcomes. Distress when routines change: Unexpected changes to meals, restaurants, brands, or food preparation can feel upsetting. Feeling overwhelmed by certain foods: Foods with unfamiliar textures, smells, tastes, or appearances may trigger strong feelings of discomfort or disgust. Little interest in food or eating: Some people rarely feel hungry, forget to eat, or view eating as a chore rather than something enjoyable. Frustration around eating challenges: Many people recognize that their eating habits are limiting, but feel unable to change them on their own. Shame or embarrassment about food preferences: Older children, teens, and adults may feel self-conscious about eating differently from their peers. Feeling misunderstood by others: ARFID is often dismissed as "just picky eating," which can leave people feeling judged or isolated. Stress around mealtimes: Meals may become a source of tension, conflict, or worry for both the person with ARFID and their family. Brown notes that for younger kids with ARFID, “ the emotional impact is often felt most by their caregivers who work hard to mitigate the impact of ARFID.” Physical signs ARFID can make it difficult to get adequate nutrition, which can affect physical health. According to the experts, physical signs of ARFID can include: Weight loss or difficulty gaining weight as expected: This may be especially noticeable in children and teens who are still growing. That said, it’s important to remember that someone can have ARFID—and be struggling significantly—without losing weight. Delayed growth or development: Similarly, inadequate nutrition may affect normal growth and development in kids and teens. Nutritional deficiencies: Restricting certain foods or food groups can make it harder to get enough vitamins, minerals, and other nutrients. Low energy levels: Not getting enough nutrition can leave people feeling fatigued. Dizziness or lightheadedness: Inadequate nutrition can affect energy levels, blood sugar regulation, and overall physical functioning. Feeling cold frequently: The body may have difficulty maintaining temperature when it isn't getting enough energy. Gastrointestinal issues: Stomach pain, constipation, nausea, or other digestive symptoms may occur alongside ARFID. In some cases, these symptoms can both contribute to and result from restrictive eating. Difficulty concentrating: The brain needs adequate nutrition to function optimally, so it's harder to focus when those needs aren't met. Changes in hair, skin, or nails: Nutritional deficiencies can sometimes show up as brittle nails, hair thinning, dry skin, or other physical changes. Social signs For many people, some of the most noticeable effects of ARFID happen outside the kitchen, impacting their social functioning and relationships with others, says Scafati. The social signs of ARFID can include: Avoiding social events that involve food: Parties, school events, dates, or work functions may feel stressful when preferred foods aren't available. Spending significant time planning around food: Some people check menus in advance, bring their own food, or avoid situations where safe foods may be hard to find. Feeling isolated or left out: Repeatedly declining invitations or having different eating habits than peers can make it harder to feel included and connected. Embarrassment or self-consciousness around eating: Some people worry about being judged for their eating habits. Family life revolving around food concerns: Parents and caregivers may spend considerable time negotiating meals, accommodating food restrictions, or avoiding certain activities or events because of eating challenges. Difficulties at school or work: Eating challenges may interfere with field trips, sleepovers, business meetings, workplace lunches, travel, or other activities involving food.  How ARFID can look different in kids, teens, and adults “Although the DSM criteria for ARFID is the same no matter what the age group, ARFID presentation differs in kids, teens, and adults,” says Brown. Here’s how.  ARFID symptoms in young children First things first, if you’re concerned a young child in your life may have ARFID, it’s important to note that ARFID is different from pediatric feeding disorder (PFD), although the two conditions can sometimes overlap. PFD involves feeding challenges caused by medical, developmental, or oral-motor difficulties. ARFID, on the other hand, is a mental health condition in which food restriction affects nutrition, growth, or daily functioning.  ARFID in kids is often noticeable during everyday moments like family meals, school lunches, birthday parties, or trips to the grocery store. According to Brown, parents may notice their child: Eats only a small number of foods and strongly resists trying new ones Refuses foods based on their texture, smell, color, temperature, or appearance Becomes upset when foods touch each other or aren't prepared in a specific way Insists on certain brands, packaging, or presentation of foods Experiences significant distress around unfamiliar foods Struggles at playdates, birthday parties, or other activities where preferred foods aren't available Has difficulty gaining weight, growing as expected, or meeting nutritional needs ARFID symptoms in teens As children get older, ARFID can become less visible—but no less challenging. Teens are often more aware of how their eating habits compare to those of their peers, and many become skilled at hiding their struggles. “The emotional impact increases with age and independence,” explains Brown. In practice, she says a teen with ARFID might: Eat the same small group of "safe" foods day after day Skip school lunches because they don't feel comfortable with the available options Feel anxious about eating at restaurants, friends' houses, or social gatherings Avoid activities like sleepovers, camps, or team events where food is less predictable Feel embarrassed or self-conscious about their eating habits Spend significant time planning ahead to make sure safe foods will be available Experience low energy, difficulty concentrating, or other effects of inadequate nutrition ARFID symptoms in adults Although ARFID often begins in childhood, many people aren't diagnosed until adulthood. By then, many have developed routines that help them navigate around their symptoms. As a result, symptoms of ARFID in adults may not be obvious—even when eating still takes significant mental energy and planning. According to Brown, adults with ARFID might: Rely on the same handful of foods they've eaten for years Rely heavily on takeout Order from a limited menu when dining out Avoid social events or travel that involve unfamiliar foods Spend significant time planning meals around safe foods Feel embarrassed about eating differently Experience ongoing nutritional deficiencies or other health concerns related to restrictive eating Realize that food takes up more mental space than it seems to for other people Experience financial burdens due to ARFID-related food waste How autism, ADHD, and other conditions can shape ARFID symptoms ARFID can affect anyone. But “neurodivergence and ARFID have high levels of overlap, and can also make recovery more complex when individuals are experiencing both simultaneously,” says Brown. Indeed, research shows ARFID is more common among people with certain conditions, including autism, ADHD, anxiety disorders, and obsessive-compulsive disorder (OCD). These conditions don't necessarily cause ARFID, but they can influence how symptoms show up. For example: Someone with ARFID and autism may experience intense sensory sensitivities that make certain textures, smells, or flavors difficult to tolerate. Someone with anxiety may be more likely to develop fears around food. Someone with ARFID and ADHD may struggle to notice hunger cues, forget to eat, or find meal planning challenging. Someone with ARFID and OCD may avoid certain foods because of contamination fears. At the same time, not everyone with ARFID is neurodivergent, and not every neurodivergent person develops ARFID, says Scafati. Understanding what's driving the food avoidance—and any underlying conditions that may be shaping it—can help point the way toward effective ARFID treatment. Why ARFID symptoms are often misunderstood If you've recognized yourself or your child in some of the examples throughout this article, you may be wondering why you didn’t consider ARFID sooner. That’s common, and it’s not your fault. The truth is, ARFID often flies under the radar because it doesn't look like what many people think an eating disorder “should” look like. But that doesn’t make your challenges any less real or deserving of support.  According to both experts, ARFID is commonly overlooked for a variety of reasons, including: It's mistaken for picky eating: ARFID goes beyond food preferences. According to Scafati, people with ARFID may continue avoiding foods despite significant hunger, and the eating challenges often affect nutrition, health, or daily life. It's attributed to anxiety alone: Fear of negative experiences with food is a common ARFID presentation that’s easy to mistake for anxiety by itself. It's confused with digestive issues: Symptoms like nausea, stomach pain, or constipation can overlap with ARFID, sometimes making the eating disorder harder to recognize. It's explained away as sensory differences: Sensory sensitivities are common in people with autism and ADHD. But when food avoidance begins affecting nutrition or daily functioning, ARFID may also be part of the picture. It's overlooked in adults: Many adults have spent years adapting to their symptoms, making their struggles less obvious to others (and sometimes even to themselves). When to seek help—and what treatment looks like If these symptoms sound familiar and you think you or a loved one may be struggling with ARFID, it’s worth getting an evaluation. There’s no benchmark for being “sick enough” to deserve care, and when left untreated, ARFID can lead to serious physical and mental health complications, and interfere with relationships and everyday life. Talking to a trusted doctor or seeking an ARFID-informed eating disorder specialist is the first step toward getting the care you or your loved one deserve.  Treatment typically begins with a comprehensive evaluation to better understand a person's eating patterns, nutritional needs, medical history, and the factors contributing to food avoidance. Care should always involve a multidisciplinary team of AFID-informed individuals, including a therapist and dietitian, and often a physician if nutritional deficiencies or other health complications are present. From there, treatment often focuses on helping people expand their range of foods, improve nutritional intake, reduce fear and anxiety around eating, and build confidence during meals, she adds. For children and teens, caregivers also play an important role in the recovery process. Depending on a person’s needs, treatment may include evidence-based approaches like: Cognitive behavioral therapy for ARFID (CBT-AR): A type of therapy that helps people gradually expand their range of foods and address unhelpful thoughts or fears around eating. Family-based treatment for ARFID (FBT-ARFID): This is an ARFID-specific variation of family-based treatment (FBT), which is the gold standard for treating eating disorders in young people. It empowers caregivers to support nutritional rehabilitation and recovery. Exposure and response prevention (ERP): This type of therapy helps people gradually face feared foods, eating situations, or sensory experiences. No matter your situation, know that ARFID is treatable, and recovery is possible. If you're concerned about yourself or a loved one, our clinically validated ARFID screener is a good place to start. You can also schedule a consultation with Equip—the largest ARFID treatment provider in the U.S.—to explore treatment. The bottom line ARFID is a serious eating disorder that can affect nutrition, physical health, emotional well-being, and daily life. Because symptoms can look different from person to person, ARFID is often overlooked or mistaken for anxiety, digestive issues, or picky eating. If you recognize symptoms of ARFID in yourself or a loved one, it's worth paying attention to them. ARFID is a real and treatable condition, and with the right support, you can build a healthier relationship with food and feel less limited by eating challenges. Frequently asked questions (FAQs) What does ARFID feel like? The experience varies by person. Some people feel intense discomfort around certain textures, tastes, or smells. Others experience fear related to eating. Some simply have very little interest in food or eating. Many people with ARFID describe meals as stressful, exhausting, or something that requires far more planning and mental energy than it does for other people. Can ARFID develop suddenly? Sometimes. ARFID can develop after a distressing experience involving food, such as choking, food poisoning, or an allergic reaction. In other cases, symptoms emerge gradually over time, often beginning in childhood. Some people aren't diagnosed until years later, even though they've experienced symptoms for much of their lives. Does ARFID last into adulthood? Yes. While ARFID often begins in childhood, many people continue experiencing symptoms as teens or adults. Some adults don't realize their eating challenges may be related to an eating disorder until they learn more about ARFID later in life. The good news is that support is available at any age, and it's never too late to seek help.]]></content:encoded>
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            <title><![CDATA[Not Eating Enough? Here’s How (and Why) to Fuel Your Body Properly]]></title>
            <link>https://equip.health/articles/food-and-fitness/how-to-stop-undereating</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/how-to-stop-undereating</guid>
            <pubDate>Wed, 03 Sep 2025 16:46:00 GMT</pubDate>
            <content:encoded><![CDATA[In our culture, there’s an underlying fear of eating “too much.” This fear has led to the normalization of disordered behaviors that are supposed to prevent that from happening, like fretting over portion sizes and fixating on nutrition labels. This type of restrictive eating tends to be praised, but in reality, undereating is a major issue that carries life-altering and sometimes life-threatening side-effects—but that fact is rarely talked about. Undereating is a symptom of most eating disorders, but it can also show up in those without an official eating disorder diagnosis. It can stem from a wide variety of causes and triggers, including maladaptive coping mechanisms, feelings of shame and guilt, or simply life circumstances. Recent research shows that undereating is especially prevalent in certain groups, such as athletes experiencing low energy availability (a condition where energy intake does not meet the demands of energy expenditure, leading to an imbalance). Some people may fall into chronic energy deficits unintentionally due to hectic schedules, high levels of physical activity, or naturally low appetites. For others, undereating may be driven by deeper issues, like body image concerns, external pressure from family or coaches to maintain a low weight, or strict internal beliefs about food. Unfortunately, undereating—and even setting goals to eat less—is often normalized and praised, with little recognition of its negative consequences. Today, we’ll define undereating, identify its health risks, and explore strategies to help you or a loved one stop. What does it mean to “undereat”? Undereating happens when you don’t eat enough food to give yourself the calories or essential nutrients—or both—to function properly. “It's essentially a state where your body isn't receiving enough energy and nourishment to support its basic metabolic processes, physical activity, and overall mental and physical health,” explains dietitian Crystal Fox, MS, RDN. Humans require a significant amount of energy daily simply to stay alive, and in fact, the basal metabolic rate (the energy your body uses to maintain basic life-sustaining functions like breathing and cell repairing at rest) accounts for most of it. Then, people use additional energy—generally somewhere around a quarter of calories for a healthy person—for any sort of physical activity, whether it’s structured movement or tasks of daily living. Plus, there’s the thermic effect of food, or the energy it takes to digest and process food, which accounts for around 10 percent of a healthy person’s energy. Energy and nutrient needs vary from person to person, and depend on several factors like gender, age, activity level, genetics, and body composition. Health status is another factor that impacts energy and nutrient needs. For instance, a person with an eating disorder is often going to have higher energy and nutrient needs than a healthy person. It may help to think of energy needs as different buckets, with some people having more or different buckets than others, depending on their circumstances. For example, a child without an eating disorder has a couple of energy need buckets: one for meeting everyday needs to support proper physiological and cognitive functioning, one for physical activity, and another one for meeting growth and development needs. A child with an eating disorder has all of those buckets along with a third bucket to support eating disorder recovery, which often requires weight gain. It’s important to note that there are many energy need calculators available online, but these tend to be oversimplified, inaccurate, and a faulty measure of how many calories a person actually requires. They apply a one-size-fits-all formula to something that’s actually much more nuanced and complex than one equation can account for. Dietitian Erin Kuta MPH, RD explains that undereating can “involve both intentional restriction and unintentional patterns, often influenced by the brain-gut connection,” she says. “For example, stress, overwhelm, and living in survival mode can suppress appetite and blunt hunger cues, making it hard to rely on stomach hunger alone, so I look for other signs like low energy, brain fog, headaches, mood fluctuations, and digestive issues as indicators that the body may not be getting enough nourishment, even if someone doesn’t ‘feel’ hungry.” The best way to determine whether you or your loved one is undereating and assess personal energy needs is to work with a registered dietitian who can help you both understand and meet them. The health risks of undereating People with and without eating disorders can experience the harmful side effects of undereating. When you don’t eat enough, it can negatively impact mental, emotional, and physical health in a number of significant ways, including: Emotional dysregulation Undereating can contribute to anxiety and depression due to brain chemistry changes and nutrient deficiencies. In fact, research shows low levels of B vitamins, Vitamin D, magnesium, zinc, selenium, iron, calcium, and omega-3 fatty acids can have a significant impact on the brain and nervous system, leading to depressive symptoms. Undereating can also reduce dopamine and serotonin production, making emotional regulation even harder. In my work as a dietitian, clients often report feeling more irritable, emotionally reactive, and less resilient when undereating. Food obsession and cognitive issues Many of my clients say they feel obsessed with food—but in reality this is not an innate “food obsession,” but the body’s survival instinct kicking in because it isn’t getting enough to eat. In the landmark study known as the Minnesota Starvation Experiment, men who were intentionally underfed became fixated on food and experienced poor concentration, slower learning, impaired judgment, and intense preoccupation with food. Additionally, one 2021 meta-analysis on anorexia shows undereating can also make daily tasks harder, contribute to brain fog, and is linked to memory issues. Personality changes Undereating can cause major personality shifts, showing up in ways like emotional instability, low energy, mental rigidity, social isolation, and a disconnection from your authentic values and identity. When you're not eating enough, thoughts of food take up most of your mental space, leaving little room for anything else. Decreased metabolism Undereating can lower your basal metabolic rate (or the energy your body needs for basic functions). When fuel is low, the body slows down to conserve energy, prioritizing survival over efficiency. Reproductive issues Losing your period for over three months—known as amenorrhea—is a common sign of undereating and can lead to serious issues like infertility and osteoporosis. One 2022 research review concluded that low energy availability from undereating can suppress all reproductive hormones. This is because the body conserves calories by prioritizing essential functions and shutting down other processes like reproduction Nutrient deficiencies and muscle breakdown Undereating can lead to nutrient deficiencies that cause a range of health issues, such as anemia, hair loss, skin problems, insomnia, bone loss, cold intolerance, and a weakened immune system. It can also slow heart rate, reduce oxygen flow, and increase fatigue, dizziness, and illness risk. Also, when the body lacks energy, it begins breaking down muscle for fuel, leading to muscle loss. Since the heart is a muscle, chronic undereating can weaken it, lower blood pressure and heart rate, and even disrupt heart rhythms, which can be life-threatening. Digestive problems Research shows that weight loss and malnutrition from undereating can slow the digestive tract, weakening the muscles in the stomach and intestines and slowing down digestion. This, in turn, can lead to gastrointestinal issues like gastroparesis (or slowed motility of stomach muscles), constipation, reflux, bloating, and diarrhea. Undereating also reduces enzyme production, making it harder to break down food and worsening symptoms.  Feeling out of control When you’re underfed, your body works hard to restore balance, which can show up as intense hunger, binge eating, or feeling disconnected from hunger and fullness cues. This can create a frustrating cycle of restriction followed by overeating, often reinforced by guilt and shame. Lowered immune system When you undereat, every system is affected, including your immune system. While occasional illness is normal, undereating can suppress immunity, making you more prone to getting sick, slowing recovery, and delaying wound healing. It also leads to deficiencies in key nutrients that support immune function, such as protein, healthy fats, vitamins A, C, and D, and minerals like zinc and selenium.  How to stop undereating Starting to eat enough food after a period of undereating can be challenging—especially if you have an eating disorder—because there are often several factors at play. However, eating enough food is a necessary and foundational step towards restoring your health and well-being, and with the right tools and support, it’s completely possible. Here are ten expert-backed ways to stop undereating: Identify the underlying issue “It’s important to identify the root cause of the undereating and address it accordingly,” Fox says. If you have an eating disorder, undereating likely serves an emotional purpose, such as numbing or indirectly expressing difficult feelings, and is probably driven by intense eating disorder thoughts. If this is the case, it’s best to work with a therapist and dietitian to help you understand what’s driving your food behaviors. Sometimes, it’s not until after you’ve started eating enough food that you can fully understand why you weren’t eating enough. If you don’t have an eating disorder, perhaps undereating is caused by external factors like an overpacked schedule, appetite-suppressing medication, a condition like attention deficit hyperactivity disorder (ADHD), or a combination of issues.  Understand that everyone has different needs As I explained above, energy needs vary from person to person and depend on several factors. “To better fuel your body, you really need to stop listening to all the noise out there of ‘only needing X amount of calories,’ because bodies are individual and each requires different levels of fueling to feel their best,” explains Equip Lead Dietitian Stephanie Kile, MS, RDN. Comparing what’s on your plate to your friend, mother, or sibling may be tempting, but isn’t helpful to getting your unique energy and nutrient needs met. Eat consistently throughout the day “Stick to the idea of getting in three full meals and two snacks a day, aiming to have something to eat every three to four hours during waking hours,” Kile suggests (some people may need fewer or more snacks). If you’re not able to get in all meals and snacks yet, start by eating at least something every few hours and work your way towards enough. For example, if you’re not eating breakfast regularly, start with a snack that includes carbohydrates, protein, and fat (like a banana with peanut butter) and then work towards eating a complete breakfast (like having bread and a latte or yogurt with the banana and peanut butter). “Consistency matters more than perfection,” Kuta adds. Shoot for a relatively balanced plate First, identify the meal’s carbohydrates, since “most of your intake should be from grain-based carbohydrates, like bread, pasta, and rice, which are the top fuel source your body needs to function optimally,” Kile explains. Then, include a protein source, like meat, beans, or fish. Next, make sure there’s some fat. “This can be in the sauce or dips you add to a meal, butter on bread, the oil you cook with, avocado, nuts, cheese, and so on,” Kile shares. Finally, include some fruits or veggies that you enjoy. “Making sure to get all of these aspects in your meals and snacks will help to make sure you’re not undereating during the day,” Kile says. “If you’re skipping one of these nutrients, that would most likely cause you to undereat.” Keep in mind that it’s not necessary that every meal is perfectly balanced and that shooting for a relative balance is just fine.  Lean on meal plans or mechanical eating when necessary After periods of undereating, hunger and fullness cues are often absent or unreliable at first. And if you have an eating disorder, chances are high that your eating disorder thoughts get louder as you start to eat more. If this is the case for you, a meal plan or mechanical eating (or both) could be the best route for now. “Prescriptive meal plans can be a tool to help one begin to learn their needs when they are unable to regulate it naturally,” Fox explains. Mechanical eating, or eating by the clock, is a helpful and often temporary tool to get your body out of an energy deficit and into a regular eating rhythm. Have back-up meals and snacks “Keep go-to meals and snacks on hand that feel doable when energy and appetite are low,” Kuta suggests. In my practice, my clients find it helpful to create a list of such meals and snacks, and then make sure they have those items or ingredients stocked in their kitchen (or stashed in a purse or bag when on the go). Some examples of simple back-up meals include peanut butter and jelly sandwiches with a side like chips and salsa or veggies and hummus, or a snack plate of cheese and crackers, grapes, cashews, and turkey or ham slices. Some snack ideas are yogurt with granola or trail mix with peanuts, chocolate and dried cranberries. Consider logging your food Sometimes, keeping track of what you eat can be helpful for identifying physical, emotional, or mental barriers to getting your needs met. Many of my clients like to use apps like Recovery Record or Nourishly, while others like to simply jot down their intake and insights in a journal (avoid weight loss- and calorie-focused tracking apps, like MyFitnessPal). However, be mindful about this strategy and pay attention to how it makes you feel—for some people with eating disorders, logging food can cause anxiety and distress. Check in with yourself Take a couple of minutes throughout the day to take some inventory of your body and mind. “Check in with your body for signs you might need food, like fatigue, foggy thinking, or irritability, even if traditional hunger isn’t present,” Kuta recommends. Perhaps you are connected to your hunger cues, and you realize you’ve been ignoring them. It can also help to notice what thoughts and beliefs are present when it comes to getting energy needs met, because sometimes societal or familial conditioning can contribute to undereating. “Remember, your body needs nourishment even when you don’t feel hungry, productive, or ‘deserving,’” Kuta adds. Use tools during and around mealtimes Whether or not you have an eating disorder, using nervous system regulation tools can help you slow down and feel safe enough to eat enough. “Consider pairing eating with nervous system grounding, like placing your feet firmly on the floor or taking a few slow, deep breaths to minimize overwhelm and support digestion,” Kuta says. If there are mental and emotional barriers at play, bringing coping tools from therapy in and around mealtimes can be helpful. Some examples are self-compassion, challenging black-and-white thinking, and mindfulness. Work with a registered dietitian Working with a non-diet dietitian is the best way to have a clear understanding of your body’s nutrient and energy needs, and to help you remove barriers to eating enough food every day. A dietitian will guide you and support you through the process, taking into account your reasons for undereating, medical and health status, and personal preferences. If you have an eating disorder, it’s best to work with an eating disorder trained dietitian as well as a therapist to help tackle emotional and mental challenges that often arise once you’re eating more food. Eating enough food is an essential action to support your mental, emotional, and physical health and well-being, whether you’re in recovery from an eating disorder or not. Putting a stop to undereating and fully meeting your energy and nutrient needs is often nuanced and challenging, and usually requires professional guidance and support. When you’re ready, reach out to a non-diet dietitian or Equip to help you get there.]]></content:encoded>
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            <title><![CDATA[Are "What I Eat in a Day" Posts Harmful or Helpful? Red Flags to Look For ]]></title>
            <link>https://equip.health/articles/food-and-fitness/what-i-eat-in-a-day-videos-eating-disorder-risk</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/what-i-eat-in-a-day-videos-eating-disorder-risk</guid>
            <pubDate>Fri, 31 Oct 2025 15:18:00 GMT</pubDate>
            <content:encoded><![CDATA[For over a decade, “What I eat in a day” (WIEIAD) videos have stayed relevant across social media platforms—from YouTube, to Instagram, and now TikTok. It’s an unusual feat for most social media trends, which typically fade out within months at most. The videos showcase the creator’s meals and snacks throughout a single day, and are created by many different types of people, including dietitians, personal trainers, and wellness influencers. WIEIAD videos seem to offer a clear and correct way to eat—which can seem incredibly attractive in a social media landscape full of confusing and excessive nutrition information. “Nutrition science is complicated and nuanced, and we often look for simplified advice on social media of what we should be eating,” explains dietitian Ana Pruteanu, MS, RDN, CEDS-C, LDN. “These videos seem to answer that question in a simple and easy-to-understand format: a video of all the foods someone ate in a day, and what’s implied in the video is that we should be doing the same.” Oftentimes, WIED videos are aesthetically appealing with perfectly curated meals and created by people who fit diet culture’s thin body ideal, which adds to their appeal. “Lots of these videos are made by people who are traditionally attractive—thin, strong, young-looking folks,” says Equip clinical supervisor and therapy lead Jonathan Levine, LCSW. The underlying message of these videos is, if you eat like me, you’ll look, feel, or be like me, “It’s human nature to want to model behaviors that seem to work for someone else, especially when those behaviors are wrapped up in aesthetics, wellness, and quick fixes,” says Tracy Colin, MS, RDN, LD. “The problem is, what looks good online doesn’t always translate to what’s balanced or sustainable in real life.” Read on to explore how WIEIAD videos can be harmful (and the red flags of harmful content), green flags that indicate content may be helpful, and how to use social media for food and nutrition content in a healthy way. Why “What I eat in a day” videos are harmful It’s no secret that social media can negatively influence the way people view their bodies and food. In fact, a 2023 research review showed that social media usage is associated with the development of eating disorders or disordered eating and poor body image, due to factors like social comparison, self-objectification, and internalization of the thin ideal body. Another review from 2024 found a relationship between exposure to eating-related social media content and increased body image issues and disordered eating behaviors. When it comes to the WIEIAD trend specifically, a 2024 research analysis showed that WIEIAD videos on TikTok contain eating disorder and body-focused themes (including calorie counting and dieting tips), as well as promotion of weight loss and the thin ideal and eating disorder behaviors. Aside from containing problematic and triggering messaging, WIEIAD videos often breed unhealthy comparisons, deliver inaccurate nutrition information, and fail to take individual differences into account. These posts generally portray one person’s day of eating, and that person usually fits into diet culture’s definition of attractive. Then, Prutaneau says, the viewer is left comparing their own eating to that portrayed in the video, and often feeling as if they aren’t eating “healthy” enough. “That comparison can make us lose sight of the fact that different people have different bodies with different needs,” Levine cautions. “It can make us feel like we should be eating certain things in certain ways or not eating things at all.” If you have an eating disorder or are in recovery, WIEIAD videos can be particularly triggering and reinforce the eating disorder’s food rules and beliefs. But even without an eating disorder or a history of one, they can have a negative impact on your relationship to food. “Constant exposure to these curated ‘perfect day of eating’ clips can erode trust in your own hunger cues and create unnecessary food guilt,” Colin explains. WIEIAD videos shift your focus to someone else’s food and body, making it harder to honor your own needs.  Signs that a WIEIAD post is harmful “What I eat in a day” content on social media can take many different forms, but it can often have negative effects on the view. Here are some red flags to look out for that indicate a WIEIAD post may promote unhealthy beliefs or behaviors: There’s diet culture language. Any talk of weight loss, detoxes, cleanses, “clean eating,” extreme dieting, “good” or “bad” foods, or body shaming is a clear indicator of harmful content. They promise quick fixes or blanket recommendations. If the creator is suggesting you eat how they eat or promising some kind of silver bullet, it’s not a scientifically-sound video. Every person has varying needs and nutrition is not one-size-fits-all. They include body objectification. “These videos also tend to include body checks, subtle or not-so-subtle shots showing off physiques, which can send the message that if you eat like them, you’ll look like them,” Colin says. “That’s not how nutrition or bodies work.” The creator is not a credentialed expert. A 2025 study showed that an abundance of nutrition content on TikTok is created by non-experts (like wellness influencers) who are often influenced by diet culture. Meanwhile, credible, accurate videos unfortunately get fewer views than sensational or less accurate ones, since social media platforms typically prioritize engagement over accuracy. Could “What I eat in a day” videos ever be helpful? While there’s not substantial research showing any benefits of this type of content, one 2024 study of 250 WIEIAD videos showed that about half of them included healthy, intuitive eating behaviors and some provided neutral or positive examples of eating and body acceptance. However, the same study found that most of the videos portray negative body image practices like body checking. So while some healthy versions do exist, they’re unfortunately few and far between. As an eating disorder dietitian, I appreciate some fellow dietitians’ recovery-focused renditions of WIEIAD content, where they document a day’s meals and snacks highlighting imperfect eating, intuitive eating skills (like honoring hunger and fullness cues), and recovery-oriented eating patterns and foods (like eating dessert regularly). “They can be healthy when done responsibly,” Colin explains. “There are creators, including dietitians, who use WIEIAD videos to show balance, variety, and flexibility in eating—the difference is in the intention and the message.” Signs that a WIEIAD post may be truly healthy Here are a few green flags that indicate a WIEIAD video is health-promoting and credible: They include disclaimers. “When these videos include context, like reminders that everyone’s needs are different, or that these meals are simply ideas and not prescriptions, they can actually inspire people to nourish themselves more intuitively,” Colin says. “The key is transparency, emphasizing that food isn’t one-size-fits-all, and removing the comparison piece that makes so many of these videos harmful in the first place.” They challenge diet culture. “People modeling a normative pattern of eating, and discussing the nuances of body types, the risks of dieting, disordered eating, and diet culture can change our perspectives of food and dieting on large scales,” Levine shares. Look for videos that promote an all-foods fit mentality, honoring your body, and flexible, imperfect, and non-restrictive eating practices. It’s also a good sign if they address mental and emotional aspects of eating, advocate for eating disorder recovery, and celebrate body diversity. “I love content that focuses on balance, culture, and real-life nourishment, not perfection,” Colin shares. “The healthiest nutrition content shows meals being created with intention, variety, and enjoyment in mind, all without the pressure to “eat perfectly.” They’re created by credentialed, non-diet experts. While there are likely non-expert creators of WIEIAD videos sharing truly healthy eating practices and beliefs, your safest bet is to stick to nutrition experts, like non-diet dietitians, who promote healthy eating practices and share the science to back them up. Look for terms like, “intuitive eating,” “anti-diet,” and “weight-inclusive” and credentials like “RD” or “RDN” when reviewing creators. Finally, keep in mind that following nutrition- or food-related social media accounts is not always the best or healthiest decision for you. Sometimes, a break or complete discontinuation of viewing food and nutrition content is what’s healthiest, especially if you’re in eating disorder recovery. In fact, one 2023 study of women in recovery from an eating disorder or disordered eating found that, even in the case of accounts claiming to be recovery-oriented, social media can be both beneficial and detrimental to recovery, and called for a nuanced approach to social media use. In my practice, clients have found it helpful to broaden the types of accounts they follow to better align with their values and subjects that bring them joy or inspiration (like animals, travel, or poetry). This practice aligns with research from 2025, which showed that viewing art content on social media could protect against eating disorder risk, while watching WIEIAD videos may increase risk for eating disorder behaviors and beliefs. According to Levine, taking a prolonged break or leaving social media entirely is what’s best sometimes.  Take some time to ask yourself if following food- or nutrition-related content feels healthy or harmful to you, even when it’s free of diet culture. Ask yourself questions like: Why am I or why would I view food or nutrition content? What feelings or thoughts do I notice while I’m viewing food or nutrition content, and afterwards? What kind of impact does seeing such content have on my relationships to food, my body, and my behaviors? If you decide following food and nutrition content on social media is healthy and helpful for you, here are some examples of credible, non-diet culture accounts to follow: @platebyplateapproach @karalydonrd @dietitian.rachelhobbs @rachaelhartleyrd @tapintonutrition @thethicknutritionist @eatingdisorder.dietitian @wholeselfnutrition @nutritionbykylie @carolinegreennutrition]]></content:encoded>
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            <title><![CDATA[Understanding the Symptom: Eating in Secret]]></title>
            <link>https://equip.health/articles/understanding-eds/secret-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/secret-eating</guid>
            <pubDate>Tue, 21 Jan 2025 18:24:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders thrive in secrecy. One of the trickiest things about treating these illnesses is that often, the person affected hides their symptoms and disordered behaviors, either because they’re ashamed or because they actively don’t want to get better. This doesn’t mean that people with eating disorders are inherently sneaky or dishonest; rather, it shows how effectively eating disorders hijack the brain and do everything they can to stay in control—which often means being secretive. This secrecy applies to a wide range of eating disorder symptoms, but a big one is eating in secret. Read on to learn more about why many people with eating disorders eat secretly, what conditions secret eating is associated with, why it can be harmful, and how to stop. What does secret eating look like? Secret eating is when someone eats in a furtive, covert way, which includes concealing the evidence of eating. It’s different from just eating alone, which can be totally normal—the difference is that someone engaged in secret eating has purposely and carefully planned their eating to make sure nobody will witness it, while someone might simply eat alone for any number of different reasons. A good question to ask is, “would I be upset or ashamed if someone walked in on me eating right now?” If the answer is yes, it’s secret eating. Secret eating can take many different forms: it can mean eating a small amount of food or a large amount of food, and can involve a loss of control or not. “Secret eating can look like saying, ‘I already ate,’ rarely eating with other people, or eating late at night,” says Equip therapist Pepper Snider, MA. Secret eating is a form of disordered eating, and it can be both a symptom of an eating disorder and an early warning sign that an eating disorder is developing. It can happen at any age, though research shows that secret eating can often emerge in childhood and, among young people, it’s associated with eating disorder psychopathology.  What causes some people with eating disorders to eat in secret? There are a number of reasons why someone with an eating disorder might eat in secret. Some of the most common reasons are: A desire to protect the eating disorder. Eating disorders are self-protective illnesses, and one of the ways they protect themselves is through secrecy. A lot (most, in fact) of disordered behaviors occur in private as a way to protect or keep hidden the eating disorder. People with eating disorders might exercise in secret, purge secretly, or engage in body checking behaviors secretly, as well as eat in secret. Shame or fear of judgment. “Eating in secret can be a common symptom of an eating disorder, as people can experience feelings of guilt and shame for their behaviors,” says Snider. According to research, secretive eating may reflect eating- or body-related shame, and is associated with both depression and binge eating behaviors. Some people who eat in secret may have been previously judged or shamed by what or how or how much they eat, and so they’ve come to prefer to eat in secret. To cope with negative emotions. Food can be a source of comfort for people. This isn’t necessarily a bad thing, but it can become a disordered behavior, especially if food is a person’s only coping technique, or if they can only find that comfort and release when eating alone. In fact, research shows that children with symptoms of depression are five times more likely to eat in secret. What eating disorders are associated with secret eating? The research on secret eating mostly focuses on its relationship to binge eating: according to studies, 54% of people with binge eating disorder (BED) report secretive eating distinct from objective binge episodes. However, secret eating isn’t always associated with BED, and it’s common for people with anorexia, bulimia, or OSFED to also eat in secret. “Eating in secret can be a symptom in all eating disorders,” says Snider. Negative consequences and risks of secret eating Eating in secret can harm both physical and mental health as well as quality of life. Research shows that adults who engage in secret eating have more eating disorder pathology (i.e., more severe symptoms) and worse overall mental health, and tend to place more value on their shape or weight. In young people, secretive eating is associated with a higher risk of developing an eating disorder, and a greater risk of depression. Eating in secret can also take a toll on relationships, emotional well-being, and daily life. When a person will only or mostly eat in secret, it disrupts their life: they withdraw socially (often making up lies for why they can’t attend events with food), their relationships suffer, and their dysfunctional relationship with food gets more entrenched. “Feelings of guilt and shame can keep the secretive eating cycle going,” says Snider. “It can impact connection with others and prevent people from getting help.”  How is secret eating addressed in eating disorder treatment? The first step of eating disorder treatment is almost always to normalize eating habits, which means sticking to a regular schedule of balanced meals and snacks throughout the day. Usually, these meals and snacks are eaten with others—either treatment providers or supports—which naturally minimizes both the opportunity and the urge to eat in secret. Secret eating can also be addressed more directly if necessary. Says Snider, “eating in secret can be addressed with exposure, practicing eating in front of others and processing the emotions or thoughts that come up when breaking the secretive eating cycle.” Check out these tips for eating in restaurants while in recovery.   What to do if you or a loved one is struggling with secret eating If you find that you’re frequently hiding your eating or finding ways to eat in secret—or have noticed someone in your life is doing this—it could signal an eating disorder. And even if an eating disorder isn’t the underlying cause, secret eating can still damage your mental and physical health, and disrupt your relationships and quality of life. Regardless of the root cause of secret eating, you need help to stop this harmful behavior. Talk with your doctor or an eating disorder-informed dietitian about your concerns, and they can guide you toward resources and strategies to help shift this behavior. You can also schedule a consultation with the Equip team to talk through your concerns and what treatment options are available.]]></content:encoded>
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            <title><![CDATA[Is Wellness Culture Making Us Unwell? How Influencers, Marketers & Celebrities May Promote Disordered Eating ]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/wellness-culture-making-us-unwell</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/wellness-culture-making-us-unwell</guid>
            <pubDate>Fri, 30 Dec 2022 17:39:00 GMT</pubDate>
            <content:encoded><![CDATA[When journalist, anti-diet registered dietitian, and certified intuitive eating counselor Christy Harrison set out to write her upcoming book, The Wellness Trap, she looked no further than her own complicated health journey for inspiration. “This book is deeply personal to me, as someone with a whole host of chronic health conditions that wellness culture constantly pushes me to ‘fix’ with food, supplements, and various alternative practices that I’ve come to realize are at best unproven and often downright dangerous,” the Food Psych Podcast host wrote in a recent newsletter. But based on her own personal experience and scores of interviews with other health seekers, Harrison ultimately concluded that “wellness practices often cause more damage than the conditions they’re meant to prevent or cure and the conventional approaches they’re intended to replace.” As Harrison explores in her book, the $4.4 trillion global wellness industry certainly seems to be built on dubious claims and plenty of phony promises. At the core of all this is the troubling definition of “wellness” in our current social media-obsessed world, a definition that keeps millions on a constant and impossible quest for “better health” and seems to be making us anything but well. And for people vulnerable to or in recovery from eating disorders, this misinformation and false hope can be particularly damaging. What is “wellness” anyway? And what is “wellness culture”? “Wellness” is one of those words we hear so often that we may not even realize it’s been co-opted and redefined by a variety of industries. While the dictionary definition alludes to “the quality or state of being in good health especially as an actively sought goal,” anti-diet advocates like Harrison define “wellness culture” as “a set of values that equates wellness with moral goodness, and posits certain behaviors — and a certain type of body — as the path to achieving that supposed rectitude.” In other words, “wellness culture” adopts many of the tenets of thin-worshiping “diet culture” elevates “natural” healing over conventional medicine, and emphasizes individual choice and responsibility over social determinants of health. This overall approach often leads to the cultural appropriation of certain practices, favors anecdotal evidence over scientific fact, and places blame on individual people rather than systemic issues. “Wellness culture as we are sold it today is the idea that we are solely responsible for and able to significantly change our health, and that pursuit of health through rigorous focus on diet and exercise confers moral superiority to those who pursue it,” says Equip Director of Lived Experience JD Ouellette. “There is a lot of judgment of others in wellness culture, and wellness culture rarely acknowledges that it requires a lot of money and privilege to meet the standards and obligations it has defined. Thinness is a primary focus in wellness culture.” Like Ouellette, many anti-diet advocates consider there to be serious dissonance between the basic definition of “wellness” and the way “wellness culture” has interpreted the term. “True wellness culture to me would be acknowledging people come in all shapes, sizes, interests, ability levels, and that we cannot ‘just’ overcome genetics and environmental influences through strict diet and exercise — even if we want to,’” Ouellette says. “Wellness would include satisfaction with oneself and life and community ties and intellectual endeavors and pursuit of hobbies. It would prioritize rest and connection-building along with eating and moving joyfully. It would have absolutely nothing to do with body size.”  How has social media impacted the rise of wellness culture? While wellness culture predates the existence of social media, the proliferation of apps like Instagram have certainly spread the ethos of the modern movement like wildfire. From celebrities endorsing diet supplements to influencers recommending questionable workout regimens, social media is rife with problematic examples of “wellness” that many experts say are simply thinly veiled versions of diet culture. “Social media tends to present wellness culture as an approach to a ‘healthier’ lifestyle without the ‘diet’ word attached to it,” says Equip Registered Dietitian Gabriela Cohen, MS, RD, LDN. “However, if you consider the word ‘diet’ to include any form of restriction and rigid rules, dieting is all over this new wellness culture in my opinion.” Cohen points to a few specific examples of the blurred line between dieting and wellness, including the promotion of fasting, the moralization of foods (which she says inherently ends up moralizing the individuals eating or not eating these foods), and putting certain foods (example: celery juice) on a pedestal. “It’s clear that restrictive diets don't work, and moreover, the long-term harmful effects are both physical and mental,” she says. “But we have to always remember that the diet industry is worth billions of dollars, so what wellness culture is doing is shifting the vocabulary to keep the business going.” Equip Regional Therapy Manager Kristen Nichols says the social media influencers at the center of modern wellness culture often have body types that are considered “socially acceptable” and “desirable,” which can have an impact on consumers. “These wellness influencers are often depicted engaging in behaviors, such as starting their day with meditation or drinking their favorite green juice,” Nichols says. “Through these portrayals, wellness is equated with moral goodness and an aspirational set of values is born.” Just as diet culture can invoke feelings of guilt and shame in those who interpret their lack of weight loss as a “failure” (when in reality, diets themselves are based on a false premise), wellness culture can prompt the same shame response in hopeful followers. “Wellness culture is incredibly privileged and assumes everyone has the time and resources to meditate, journal, do yoga, make green juice, cook every meal from scratch, get eight hours of sleep, go to therapy, spend time outdoors, etc. daily,” Nichols says. “This is just not realistic or achievable for the vast majority of people. But nowhere in wellness culture is this unrealistic expectation acknowledged, leading, once again, to the idea that the individual has failed when they can’t live up to this ideal.” (Check out this guide on how to protect your kids from social media.) How “wellness” culture relates to disordered eating Nichols doesn’t just have clinical experience with the problematic side of wellness; she’s witnessed the negative effects of it firsthand. “Unfortunately, I can think of countless examples of clients, friends, and family members who have fallen victim to wellness culture at one point or another,” Nichols says. “One of the most prominent examples of this is a good friend who is convinced that doing Crossfit and altering her diet will be the answer to all of her concerns in life. After joining a costly Crossfit gym, my friend went on to try one fad diet after another because someone at her gym had recommended it to her.” While Nichols says the intention behind these diets was never to lose weight, her friend was told these restrictive food plans would help her cultivate a “health-centric” lifestyle. “I watched my friend beat herself up for not following the diets to a T or missing a day at the gym,” she says. “It made me wonder how much this pursuit of health and wellness was actually worsening my friend’s mental health and wellbeing—the exact opposite of what she hoped to achieve in the first place. With her, there was no reasoning; the ideal of being the perfect Crossfitter and subscribing to this particular brand of wellness culture was all that mattered.” Cohen says that—just like diet culture—wellness culture lures individuals with the promise of a fresh start that will transform their bodies and their lives. “And it’s even more convincing because it’s promoted as a lifestyle change rather than a quick fix,” she says. “The problem with this lifestyle change is that it is still based on the principle of you needing to change something—whether it’s your eating habits, body size, muscle tone, skin—because you’re not fine the way you are, or you're doing something you shouldn’t. This often leads to increased anxiety and body image struggles, and the feelings of defeat when you slip up or are not successful in maintaining this lifestyle change. These same feelings are ones that often lead to cycles of restricting food. We could say that wellness culture is a slippery slope to diet culture, which is a slippery slope to disordered eating.” What to watch out for when it comes to wellness culture While “wellness” itself certainly isn’t an inherently bad state of being to strive for, it’s important to know how to differentiate between truly healthy behaviors and problematic ones. “There are many wellness practices that can enhance an individual’s emotional, physical, or spiritual health on a standalone basis,” Nichols says. “For anyone intrigued by the many offerings of wellness culture, there are several ways to be a mindful consumer.” Understand your intentions. Nichols first recommends anyone setting health goals to check in with themselves and get clear on what they are hoping to get out of adopting a certain wellness practice. “Keep an eye out for magical thinking or unrealistic expectations,” she says. Have realistic expectations. She also encourages individuals to do their research to ensure their expectations are aligned with reality. “If you’re hoping to achieve a certain benefit, make sure you understand how often you need to practice a certain behavior in order to achieve your desired result,” she says. “Meditation is a great example: most people require regular, sustained practice before they’re able to embody the stereotypical image of someone sitting cross legged and serene.” Don’t expect “perfection.” Lastly, Nichols adds that it’s essential to normalize fallibility in the pursuit of well-being. “Many people decide to try out a new practice and decide they either don’t find it useful or enjoyable or they don’t have the time or energy to make it a regular part of their life,” she says. “It’s normal to fall in and out of habits given the different seasons of our lives. Discontinuing a practice doesn't make anyone a failure, it makes them self-aware. Know that there is no moral superiority connected to forcing yourself to remain tethered to a practice that’s not serving you.” Have some healthy cynicism. Cohen believes it’s also essential for consumers to keep in mind that “wellness” means big business to influencers and other supposed health advocates pushing products. Rather than investing full trust into a stranger encouraging restrictive eating habits or particular workouts, tune inward and educate yourself on the true facts of well-being. “Focus more on what you can add, rather than what you can take away,” Cohen says. “Think about your hydration, your sleep, your anxiety levels. And always remember there is no need to change anything — you are more than fine the way you are. Do the work and define what being ‘well’ and ‘healthy’ means to you, taking into account that there are more aspects to health besides your food intake and the way you move your body.”  Helpful resources to navigate the world of “wellness” Even with all these tips in mind, the wellness world can be completely confusing—particularly when it comes to weeding out diet culture rhetoric or disordered eating messages. Ouellette, Nichols, and Cohen have compiled some of their favorite resources below to help separate fact from fiction when it comes to “wellness”: Books: Anti-Diet by Christy Harrison (note: The Wellness Trap by Harrison will be published in April 2023) Body Kindness by Rebecca Stritchfield The Body is Not an Apology by Sonya Renee Taylor Intuitive Eating by Evelyn Tribole and Elyse Resch Fearing the Black Body by Sabrina Strings Social Media Accounts: Alexis Conason, Psy.D., @theantidietplan Zeynep Demirelli, MSc., @realistic.body.therapist Sarah Dosanjh MSc CTA MBACP, @the_binge_eating_therapist Saskia Carr, @intuitively.eaten Gaudiani Clinic, @gaudianiclinic Colleen Werner, LPC-MHSP(temp), @colleenmwerner Aubrey Gordon, @yrfatfriend Kara Lydon, RD, LDN, @karalydonrd Alissa Rumsey MS, RD, CSCS, @alissarumseyrd Anna Sweeney MS, RDN, CEDS-S, @dietitiananna Food Science Babe Isabel Vasquez, RD, @isabelvasquezrd Virginia Sole-Smith, @v_solesmith Podcasts: Food Psych with Christy Harrison Eat the Rules with Summer Innanen Maintenance Phase Podcast]]></content:encoded>
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            <title><![CDATA[Did You Know that Nervous System Regulation Can Help with Recovery? Here’s How.]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/nervous-system-regulation-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/nervous-system-regulation-eating-disorder-recovery</guid>
            <pubDate>Wed, 02 Jul 2025 17:12:00 GMT</pubDate>
            <content:encoded><![CDATA[As a young dietitian working in an eating disorder treatment center, I often heard patients being described as “stuck” or “non-compliant.” Their providers (including myself) were frustrated because they couldn’t follow their meal plans or kept going back to eating disorder behaviors— despite endless support groups and therapy and nutrition sessions. When asked about their inability to progress in their recovery, they were often as confused as we were, because rationally they knew what was going to help them heal (in short, eating enough food and using coping tools), yet it felt impossible. Once I was introduced to the role of nervous system regulation in recovery, these patients' struggles suddenly made sense to me. It became obvious that they were experiencing physiological, protective responses to perceived frightening threats that were impossible to rationalize away—and this was all happening outside of their conscious awareness. I realized that the missing piece to these patients’ progress was a felt sense of safety, both within their bodies and surrounding them, especially around mealtimes. Without this sense of safety, they were unable to take any more steps forward. Research shows that nervous system dysregulation is common in people with anorexia, as well as among those with other eating disorder diagnoses. By becoming aware of what’s happening in your own nervous system, you can understand why and how dysregulation can lead to eating disorder behaviors, and use tools to regulate your system and find safety. “If someone has the tools to regulate their nervous system, they’re then able to make decisions about how they will respond in a certain situation, rather than feeling hijacked and simply reacting beyond conscious awareness,” explains dietitian Annyck Besso, MSc., RD, LDN. Read on to learn more about what the nervous system is, how it impacts eating disorder recovery, and how you can harness nervous system regulation to make mealtimes and other challenges easier. What exactly is the nervous system? The nervous system is complex: it’s a complicated network of specialized cells that coordinate all sorts of functions of the body, and there are two different parts of the nervous system—the central nervous system and the peripheral nervous system—both of which are further subdivided into more parts. In this article, I’ll be using the phrase “nervous system” to refer to the autonomic nervous system (ANS), a part of the peripheral nervous system that regulates involuntary bodily processes like heart rate, blood pressure, and digestion. Besso, who describes the ANS as “our personal surveillance system,” says the ANS is “constantly scanning our inner and outer environments and asking, ‘Is this safe?’ This scanning occurs beyond conscious awareness and control.” According to polyvagal theory, a concept developed by neuroscientist and psychologist Stephen Porges, there are three branches of the ANS: the sympathetic nervous system (SNS), the dorsal vagal pathway of the parasympathetic nervous system (PNS), and the ventral vagal pathway of the PNS. If this all sounds extremely complicated and confusing, don’t worry—you don’t need to memorize the different parts of the nervous system to be able to reap the benefits of nervous system regulation. Let’s break down what these different parts do, and what it means for you. The three nervous system states: fight-or-flight, freeze, and safety First, let’s look at the SNS, otherwise known as your fight-or-flight system. The SNS triggers hyperarousal, which is when you’re super responsive and hypervigilant, meaning you’re extremely sensitive to potential threats or dangers. This can manifest in symptoms like clammy hands and feet, increased heart rate and blood pressure, flushed skin, anxiety, trembling, heightened senses, agitation, and aggression. “Think about how your body feels if you were to witness a car accident,” Besso explains. “Your heart rate would increase and you’d probably feel this strong urge to act.” On the other hand, the dorsal vagal branch of the PNS causes hypoarousal (also known as the “freeze” response), which is when you feel shutdown or frozen and may experience symptoms like disassociation, flatness, numbness, isolation, exhaustion, or memory loss. Hypoarousal typically happens when a person feels extremely overwhelmed or chronically stressed, or following a traumatic event. Both of the above states (fight-or-flight and freeze) are nervous system responses in reaction to a real or perceived threat. The third branch of the PNS, the ventral vagal branch, is the branch that helps us find safety—and the key to nervous system regulation. As Besso explains, the ventral vagal pathway is “responsible for bringing us back into an engaged, calm way of being. It’s what allows us to feel a sense of safety and connection.” This state is also described as being in your ”window of tolerance,” which is when you feel safe, present, stable, and connected, and are better able to function well and manage emotions. When you’re inside your window of tolerance, your heart rate, blood pressure, digestive processes, and breathing patterns are stable and running well. Generally, when you’re not regulated (so, either hyper- or hypo-aroused and not operating in your window of tolerance), your nervous system tries to protect you the best it can. When you’re regulated (inside of your window of tolerance), you feel safe and connected with yourself and others. In this latter state, your body can tell the difference between an actual threat (like a speeding car approaching you) and a threat that’s only in your mind (like eating enough at breakfast, or a fear food). How nervous system dysregulation can impact eating disorder recovery In my practice, there's a common denominator in clients who have dysregulated nervous systems: they don’t feel safe living in their bodies. In eating disorder recovery, food is frequently associated with difficult emotions or trauma, so eating (often along with other factors like weight gain) can feel like a real threat. People with eating disorders often have weakened interoception (or the ability to understand how or what your body is feeling), so signals like hunger and fullness may be perceived as threats, too. In the face of these perceived threats, people with eating disorders often turn to disordered behaviors that provide momentary relief and safety (a false window of tolerance). Besso explains that these behaviors “serve as ways to temporarily regulate the nervous system. They’re protective responses that help manage and respond to the discomfort.” But in reality, the relief they provide is short-lived, and this pattern only helps strengthen the eating disorder and sabotage recovery. Remember, your nervous system’s threat responses bypass the logical thinking processes in your brain’s prefrontal cortex—which is why just having conversations about harmful food and body beliefs and behaviors often aren’t enough to let them go. “It’s so important to remember that rationalizing with someone who is in recovery from an eating disorder is typically not effective,” Besso adds. “The ANS perceives a threat where there isn’t one, but the response is as if someone asked you to walk alone at night in a dark alley.”  How hyperarousal leads to disordered behaviors When you’re hyperaroused, behaviors and tendencies like restriction, eating past fullness, excessively exercising, rigidity and rules, obsessive thinking, purging, and bingeing may be present, along with physical symptoms like diarrhea, malabsorption and constipation. “Decreased production of saliva and digestive enzymes accompanied with a fight-or-flight state can make eating even harder for clients in recovery, and can potentially lead to more discomfort in the digestive system like bloating, gas, distention, and irregular bowel movements,” explains dietitian Maura Fowler, MPH, RDN, CPH. “Having anxiety about body, food, or movement can then exacerbate the fight-or-flight state, feeding into the cycle.” How hypoarousal leads to disordered behaviors When you’re hypoaroused, on the other hand, typical responses look like checking out and numbing through behaviors and feelings like only wanting “safe” foods, a desire to disappear, food avoidance, difficulty making food-related decisions, disassociation, flatness, or people-pleasing around meals. Fowler adds that being hypoaroused can also make it hard to engage in recovery groups, therapy, and nutrition counseling. Physically, it can lead to slowed digestion, exhaustion, and prolonged disconnection from hunger and fullness cues. “Pairing a low appetite with intense fatigue and purchasing, prepping, and eating five-plus times a day can be a big challenge,” Fowler says. “Dissociation can really complicate food procurement, prep, and eating, including the potential danger of cooking and leaving the stove on.” She also explains that being in either dysregulated state can make it difficult to connect with others and build safe relationships, which are an important part of recovery. The good news is that learning how to regulate the nervous system and live in your window of tolerance can lead to lasting recovery. Besso says that when she works with clients on nervous system regulation, her goal is to help them “recognize and understand signals in their body that indicate their nervous system is dysregulated, and incorporate strategies to help them feel more regulated without engaging in disordered behaviors.” When I’ve witnessed clients being in their windows of tolerance, I notice they’re better able to access their “wise mind” and act in alignment with their values. It’s easier for them to affirm themselves, eat adequately, digest well, self-soothe, and use tools we developed together. How to regulate your nervous system during and outside of mealtimes In eating disorder recovery, having the awareness and ability to tend to your nervous system is like having a superpower, because it helps you understand why you use behaviors and how to help yourself find real safety within your skin. According to dietitian Gina R. Mateer, RD, some of the benefits of regulating your nervous system during eating disorder recovery include: Improved digestion (leading to an easier time with eating) increased ability to connect with others and improve relationships Increased ability to move your body in a way that supports your nervous system Less difficulty letting go of eating disorder behaviors Improved ability to nourish your body adequately (and maybe even pleasurably) Building a more trusting relationship to food and your body Plus, understanding that your nervous system has been trying to keep you safe can soften any judgement towards yourself for past or current behaviors.  9 strategies for nervous system regulation Nervous system regulation can be a journey, just like recovery, but it’s worth it. Beyond the recovery-supporting benefits above, having a regulated nervous system can also help you throughout life, improving your ability to manage life’s challenges and connect with the people around you. Below are some expert-endorsed ways to begin regulating your nervous system: 1. Get to know your own system. First, take some time to explore what it feels like within your own system to be hypoaroused, hyperaroused, and regulated—a process typically best guided by a therapist. They can help you identify eating disorder behaviors and physiological reactions that occur when you’re dysregulated and explore ways to find safety and help you connect to how this feels physically, emotionally, and mentally. My favorite book to help you get to know your nervous system is Anchored by Deb Dana. 2. Embrace co-regulation. In my practice, co-regulation (where two or more people support one another’s emotional regulation) is often one of the first ways clients learn to find safety around mealtimes. Being in safe relationships with your providers and people in your personal life can significantly support nervous system regulation. So, lean on your trusted providers and loved ones when you’re feeling dysregulated, and ask them for what you need during and around meals. Perhaps it’s a listening ear, a dining companion, help with naming emotions, a hug, or simply their nonjudgemental presence. 3. Increase external safety. Your body has an unconscious surveillance system, called neuroception, that’s constantly assessing risk and safety around you, according to polyvagal theory. By bringing soothing elements into mealtimes, you can increase your sense of safety during a time when your nervous system is likely to sense a threat. Some examples include discussing soothing topics, listening to calming music, bringing objects that evoke safe and comforting memories (like a rock or shell from an experience in nature or a souvenir from a recent trip) to the table, having a beloved pet within petting distance, wearing a soft piece of clothing or weighted blanket, or looking at photos of things or people you love during meals. Besso also recommends “being in an environment that is visually calming and appealing” by decluttering the table and setting it with a nice tablecloth or cutlery. 4. Use mindfulness practices. Mindfulness practices, including breathing techniques and meditations, can be effective ways to regulate your system. When you're hyperaroused, try using an extended exhale breath, where you exhale about twice as long as your inhale. Fowler recommends diaphragmatic breathing (or belly breathing), as it “slows down breathing that may have become quick or rapid during peaking anxiety, helping regulate the nervous system.” When you’re hypoaroused, try an energizing breath practice (my favorite is breath of joy). For overall regulation, Mateer recommends starting with five minutes of meditation using guided resources (see below), and considering yoga nidra, or yogic sleep, which is a deep relaxation technique using guided imagery and body scanning. 5. Incorporate mindful movement. Before sitting at the table, it could be helpful to try some activating movements like shaking, jumping, pushing your hands together, dancing, or singing, all of which can help you upregulate from a state of shutdown or expel extra energy from fight-or-flight. Practicing yoga can also foster a sense of safety within your mind and body. 6. Try grounding practices. Grounding practices help bring you into the moment and back to your body when your mind has taken you away and left you feeling dysregulated. If you’re feeling hyperaroused at the table, help yourself get regulated by engaging your five senses and naming (to yourself or aloud) five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. “Sensory check-ins are another way to focus away from any anxiety you may be having from food,” Fowler adds. If you’re feeling hypoaroused, engage any of your five senses and see what helps you feel regulated. It may be smelling an essential oil like lavender or focusing on your dog’s fur as you pet them. For another grounding practice at the table, try feeling your feet, seat, and back connection to your chair and floor, and from there gently pressing your feet into the ground and your hands into the table. Outside of mealtimes, spending time in nature (and this could be as simple as putting your bare feet in the grass or sand) is another grounding way to nourish a dysregulated nervous system. 7. Use cold water. There’s a reason why some people love cold showers, and it’s likely because of the regulatory effect cold water has on the nervous system. In fact, cold water directly stimulates the vagus nerve, supporting physical, mental, and emotional regulation. Try using an ice pack or splashing cold water on your face if you, like me, aren’t a fan of cold showers. 8. Look for glimmers. According to polyvagal expert Deb Dana, glimmers are micro-moments that signal safety and connection to the nervous system, which can help build bigger foundations of safety and regulation over time. They’re joyful moments you intentionally seek out throughout your day, such as watching a sunrise, listening to birdsong, stopping to smell a flower, or savoring your first sip of coffee or tea. 9. Check in often. When you’re learning your nervous system, checking in regularly helps you gain awareness and understanding of what’s happening inside you. Take a few minutes before, during, and after each meal to see where you are in your nervous system. Start by putting your feet on the ground and noticing your breath, then ask yourself a few questions: “Am I regulated, hyperaroused, or hypoaroused? If I’m dysregulated, what do I need to do to find safety?” Go at your own pace as you get to know your nervous system and learn which tools help and don’t help you, and know that it takes time and repetition to show your nervous system new ways of approaching eating experiences. Eventually, practicing your tool (or tools) regularly will greatly improve your ability to regulate in hard moments. Remember, nervous system regulation in eating disorder recovery is about finding what helps you feel safe enough to nourish your body, make choices that support your well-being, and move forward on your recovery path. Resources for nervous system regulation If you’re interested in learning more about nervous system regulation to support your eating disorder recovery, or the recovery of a loved one, here are several resources to explore: Anchored: How to Befriend Your Nervous System Using Polyvagal Theory by Deb Dana Polyvagal Card Deck by Deb Dana Free Nervous System Meditations on Insight Timer Safe & Sound Protocol Podcast Episode 20: “An embodied Approach to Eating Disorders with Rachel Lewis Marlow” The Embodied Healing Workbook by Catherine Cook-Cottone]]></content:encoded>
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            <title><![CDATA[Are Extreme Texture Preferences a Problem? Understanding Sensory Sensitivities in ARFID]]></title>
            <link>https://equip.health/articles/understanding-eds/sensory-sensitivity-arfid-extreme-texture-preferences</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/sensory-sensitivity-arfid-extreme-texture-preferences</guid>
            <pubDate>Wed, 19 Nov 2025 19:28:00 GMT</pubDate>
            <content:encoded><![CDATA[Imagine the crunch of biting into a perfectly crisp apple, or the creaminess of rich chocolate ice cream. Now imagine your teeth hitting a soft spot on your fruit or discovering a hard nut in your dessert. It would likely be unpleasant, but probably wouldn't upset you for too long. For some people, though, the texture, taste, smell, or even color of certain foods can be extremely upsetting and intolerable. If this is something you’ve noticed in yourself or a loved one, it may be a sign of avoidant/restrictive food intake disorder (ARFID) due to sensory sensitivities. People with this eating disorder have extreme preferences and aversions when it comes to the sensory qualities of food; for example, they might say that certain textures feel overwhelmingly slimy, specific smells trigger immediate revulsion, or particular colors make food seem completely inedible. This can lead to a very limited number of “safe” foods that they consume, which can cause developmental problems in children and overall health problems in anyone. It also can shrink a person's life, as they often avoid normal activities—like going to a friend's house for dinner or eating lunch at school—because they can't consume anything offered in those places. If you think you or your loved one may have sensory sensitivity ARFID, know that recovery is possible. With the right support and evidence-based treatment, you can expand food variety, reduce distress around eating, and reclaim the experiences you’ve been missing out on. Read on to better understand this type of ARFID, what causes it, and how to get help. The three ARFID presentations Avoidant/restrictive food intake disorder (ARFID) is an eating disorder where a person significantly reduces how much food they eat, the diversity of foods they eat, or both. Unlike eating disorders rooted in body image concerns or weight preoccupation, ARFID stems from other underlying factors that make eating feel challenging, uncomfortable, or unsafe. There are three presentations, or subtypes, of ARFID, and people may have one or a combination of two or all three of these types. 1. Sensory sensitivity People with this presentation experience specific foods as genuinely unpleasant or intolerable based on the texture, aroma, appearance, taste, or temperature. Some people also strongly favor foods with particular sensory characteristics—for example, if they have food texture sensitivity, they may prefer only crunchy foods or those with smooth textures. This results in a very short list of "safe" foods that they will comfortably consume. 2. Lack of interest and low appetite For some people, the drive to eat is fundamentally muted. They may not experience hunger signals the way others do, or they might find eating to be boring and joyless. Hours can pass without them thinking about food, or they may feel satisfied after consuming only a small amount. 3. Fear of aversive consequences Concerns about choking, vomiting, becoming ill, having an allergic reaction, or other negative outcomes keeps people with this presentation of ARFID from eating certain foods or food groups. This often, but not always, sets in after a traumatic food-related event.  Understanding ARFID due to sensory sensitivity “People who have the sensory sensitivity subtype of ARFID are especially sensitive to different sensory properties of food,” explains Michelle Jones, PhD, licensed psychologist and clinical instructor at Equip. Basically, their window of tolerance is a little bit narrower for certain sensory input, she says: for example, they may interpret bitter tastes as extremely harsh, or crunchy textures as jaw-breakingly hard. While people with sensory sensitivity most commonly can't tolerate certain tastes or textures, specific smells, colors, temperatures, and other sensory properties of food may also cause strong aversion. This sensory sensitivity may lead to excluding entire food groups, such as fruit or vegetables, or only eating one or two types of a food group, such as a certain brand of chicken nuggets but no other protein sources. People of all ages can have ARFID due to sensory sensitivities. However, it often appears before a child turns 10 and can last throughout adulthood. “It can start very early, even as early as infancy, such as if a baby only tolerates certain types of formula, struggles when solid foods are introduced, or struggles to transition from purees to solid food,” Jones says. (Note that if a very young child is having trouble eating, it may be pediatric feeding disorder, which is a feeding disorder related to developmental issues, and not an eating disorder). Teens and adults who have this presentation of ARFID have likely had the eating disorder since childhood, but didn’t realize because they were accommodated, adds Rollyn M. Ornstein, MD, clinical professor of pediatrics at UNC School of Medicine. “This doesn't come on later in life,” she explains. “People may go along their merry way, and accommodate themselves or others accommodate them. Then when they become upset about it, either as an adult or an adolescent, they start to address it, so it looks like they're presenting at 16. The fact is, they always had it, and now it's impacting them more.” ARFID vs picky eating “A lot of times, people think about this version of AFRID as being extreme picky eating,” Jones says. However, it's not exactly the same thing. Picky eating typically presents between the ages of 3 and 5, but by the preteen or adolescent years, most kids grow out of this developmental phase. “With ARFID, this is not something people grow out of,” Jones says. It’s an eating disorder that requires evidence-based treatment to address. Signs and symptoms of ARFID due to sensory sensitivity If you or a loved one has ARFID due to sensory sensitivity, you may notice symptoms such as: Eating a limited number of the same foods Eating two or fewer foods from one or more major food groups (i.e., grains, proteins, vegetables, fruits, fats, dairy) Eating only certain brands of specific foods (since they are predictable) Strong hesitancy to try new foods Strong reactions (gagging, pushing away, distress) to non-preferred foods Eating rituals: Needing food to be prepared or served in specific ways Avoiding activities, social events, traveling, and other things because of food anxiety or fears Stunted growth (in children) or weight loss (in adults) Nutritional deficiencies Gastrointestinal problems, such as stomach pain or constipation  What causes ARFID due to sensory sensitivity? The cause of food sensory sensitivity is a bit unclear, but a few factors appear to be at play. Differences in brain function First, a region of the brain called the insula may function differently in people who have ARFID. The insula helps with sensory processing by interpreting signals that the body receives (such as a certain taste) into feelings (such as disgust). Research suggests people with sensory sensitivity may have an intensified perception of tastes, so things they like taste amazing, while things they dislike taste absolutely repulsive. In one study, people with ARFID—and especially those with the sensory-sensitivity presentation—self-report heightened sensitivity to taste and smell. However, lab tests showed their actual sensitivity was no greater than people who don't have ARFID. Genetics Second, “we suspect this is pretty heavily based in genetics and biology,” Jones says. Often, one or both parents of patients with this type of ARFID are picky eaters, she adds, which suggests a genetic factor. There may also be an environmental factor that doesn't cause ARFID but can heighten susceptibility in those who are genetically predisposed. “If a child has a parent who is a picky eater, they're not seeing a wide variety of foods in the diet being modeled for them. And maybe they're not presented with as much variety in foods because that parent is only eating a limited variety of foods,” Jones explains. “For example, if the parent doesn't eat any vegetables, they may be less likely to be providing vegetables to their child.” Neurodivergence There is also a strong link between ARFID due to sensory sensitivities and neurodivergence. According to a 2024 study in the Journal of Eating Disorders, 15 to 30 percent of patients diagnosed with ARFID also have autism spectrum disorder (ASD), and sensory sensitivity is the most common presentation. About 90 percent of children and 95 percent of adults with ASD have sensory hypersensitivity to specific food textures, tastes, smells, or appearances. This means they have faster, more intense, and longer responses to these sensory characteristics. Some may also have hyposensitivity, which can make certain foods very bland and lead them to seek out foods with strong flavors or textures. At Equip, 36% of ARFID patients identify as neurodivergent, and our providers are experienced in working with this unique population. The 2024 study also points out that people with ADHD tend to be easily distracted and agitated, which may lead to less interest in food and heightened arousal levels at mealtimes. Both of these things can lead to selective eating patterns. Rigid thinking “In addition, there can be some cognitive rigidity that can make it more difficult for someone who has ARFID to expand their dietary variety,” Jones says. “They may be less likely to be successful in doing so or less willing to do so without a lot of support from family and providers to help them with that process.” To be clear, though, sensory sensitivity is a trait; on its own, it doesn't mean someone has ARFID or autism, emphasizes Ilana Brodzki Pilato, PhD, a licensed clinical psychologist at Duke Center for Eating Disorders. Anxiety Anxiety is also associated with sensory sensitivities in children and adolescents with ARFID. This could contribute to increased awareness of the sensory characteristics of foods, but more research is needed on this theory. How is sensory sensitivity addressed in ARFID treatment? In general, ARFID treatment typically begins with psychoeducation to help the patient understand the eating disorder, what they're experiencing, and treatment. For patients with sensory sensitivity, “we want to help them connect their feelings—usually a lot of disgust in response to trying food, sometimes paired with anxiety—to what they want to be different in their life, and then we plan exposures based on that,” Jones explains. These exposures start small and, in the case of cognitive-behavioral therapy for ARFID (CBT-AR), explore all of the sensory properties of a food—sight, touch, smell,and taste—before finally chewing it. During all of this, the therapist works with the patient to help them manage any anxiety and describe the food objectively. “We don't rely on emotionally charged language like 'gross' or 'nasty.' Instead, we focus on things like, 'This food is smooth, this food is brown, this food smells like chocolate, first it's solid and then it melts and is creamy in my mouth, it tastes sort of sweet,'” Jones says. Once the patient is ready to take a bite, it might be as small as the size of a pea or a grain of rice at first. Then they gradually work up to larger portions. The types of foods used in exposures will also gradually increase in difficulty: If they like potatoes, for example, and can't tolerate hard foods, they might work their way from experiencing mushy mashed potatoes all the way up to super crunchy chips. One goal is to add more foods to the list of things they eat on a regular basis. Still, “there's never any expectation that they're going to incorporate all foods that they try,” Jones says. “It's about practicing having these experiences of trying foods. Maybe they're not as bad as they would have expected, or they tolerate it better than they thought they would.” Every exposure progression is unique to the patient, who gets to select which foods to try, with the guidance of their treatment team. For example, if the patient doesn't eat any foods that provide significant protein—which is necessary for growth and development for kids and daily activities for adults—their therapist might point that out and ask which sources of protein they might be willing to learn about. Or they may discuss foods that would help them psychosocially, such as dishes commonly offered at parties, served in restaurants, or that are easy to take with you and eat before sports practice. By trying these foods, the hope is that the patient can begin to add those social activities back into their life. In one small study of adults, 20 to 30 sessions of CBT-AR helped patients add an average of 18 foods to their diet and significantly reduce sensory sensitivity—to the point where almost half of the patients no longer met the criteria for ARFID. In another study of CBT-AR, adolescents had significant reductions in sensory sensitivity and ARFID severity after treatment, and 70 percent no longer met ARFID criteria. CBT-AR is most beneficial for those 10 and older. For children younger than 10, Feeling and Body Investigators (FBI) shows a lot of promise. This treatment is similar to CBT-AR in that exposures help the patient slowly work through a hierarchy of sensory aspects of food so they can get used to those sensations. To help children use nonjudgemental language to describe food, there are characters that each align with a different sensation. “This helps them be more specific about what they do and don't like about food, and can help guide them in what foods they may be more likely to accept,” Pilato explains. “It also helps them decouple that negative emotional valence that's tied to trying a food by being more neutral about it.” So rather than “disgusting”, a smoothie is mushy, not as liquidy as they like, and has more banana than they prefer. Again, kids try foods in session and out of session, with the goal of working up to taking a bite by the end of session and more bites at home. Family-based treatment (FBT)—the gold standard for treating eating disorders in children—can also incorporate exposures during sessions. At Equip, we use FBT-ARFID, a version of FBT designed specifically for ARFID that includes exposures and other aspects of the evidence-based treatment approaches described above.  What to do if you or a loved one are struggling with sensory sensitivity ARFID If you believe that you or a loved one may have sensory sensitivity ARFID, Jones recommends seeking treatment with providers who are knowledgeable about ARFID, have experience treating people with sensory sensitivity, and who use evidence-based interventions. All of these criteria are crucial: Since ARFID is a newer diagnosis, it's less understood than other eating disorder diagnoses, even by eating disorder professionals. “There is also such diversity within the ARFID diagnosis that somebody who has very limited experience may not have worked with someone who has the presentation of ARFID you do or may not have experience working on the ways in which ARFID affects you,” Jones says. ARFID requires different treatment approaches than other eating disorders, so it’s important to work with providers who understand which evidence-based treatments have been shown to help. Equip is the largest ARFID treatment provider in the United States and has helped thousands of adults and children recover from ARFID. While a robust multidisciplinary care team is ideal, Jones recommends working with at least a therapist and a dietitian. Both can provide education and do different interventions, including exposures. “Having them work together is the foundation of any effective treatment team,” Jones says. You also should include a medical provider, who can monitor your vitals and make sure you don't have any medical complications or nutritional deficiencies. If you’re concerned that you or a loved one may be dealing with ARFID due to sensory sensitivities, our free, five-minute ARFID screener can help you better identify if you should seek treatment. You can also schedule a call with our team to learn more about our comprehensive, evidence-based ARFID treatment program. Whatever treatment route you choose to take, know that recovery is possible, and you’re not alone. “Not a lot of people know about ARFID, so it can feel isolating. Having a sense of community and knowing others are dealing with the same thing can make people feel less alone,” Jones says. FAQ Is sensory sensitivity a sign of ARFID? Sensory sensitivity can be a sign of ARFID. People with this presentation of ARFID have strong negative responses to the texture, taste, smell, appearance, and/or temperature of certain foods. They may also strongly favor foods with specific sensory properties. Note that there are other types of ARFID, including fear of aversive consequences and lack of interest, and some people have symptoms from more than one type. When does food texture sensitivity indicate an eating disorder? Providers use four criteria to determine if someone's food texture sensitivity indicates an eating disorder. Note that a person only needs to be meet one or more of these criteria to be diagnosed with ARFID, not all four: Weight loss: In children, the person is not gaining weight or not growing as expected, and in adults, the person has lost significant weight with no explanation Significant nutrition deficiency: As indicated by blood tests Over-reliance on nutritional supplements: The person consumes half or more of their nutritional intake from products such as Boost or Pediasure Interference with psychosocial functioning: The person skips out on social events due to their sensitivity and/or sensitivity negatively impacts their mood and causes anxiety How can I get over food texture issues or other sensory aversions? Working with a therapist who is experienced in treating patients with ARFID due to sensory sensitivities is the best way to overcome food texture sensitivity or other sensory aversions. They can safely and gradually lead you through exposures to expand the number of foods you consume and also address any food anxiety or other co-occurring mental health concerns. What causes food sensory sensitivity? The cause of food sensory sensitivity is complex. It seems to involve genetics, environmental factors, and changes in the brain. People with food sensory sensitivity are also more likely to have ADHD or autism, and vice versa, though this relationship is not well understood. How is sensory sensitivity addressed in ARFID treatment? Treatment for ARFID due to sensory sensitivity typically includes exposure therapy. During these sessions, the patient identifies which foods they would like to learn about. Over time, they gradually explore all sensory aspects of these foods, including the look, touch, smell, and finally the taste and chew. They also learn to use objective language to describe foods, such as “red”, “smooth”, and “bittersweet”, rather than emotionally charged language like “gross” or “nasty”.]]></content:encoded>
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            <title><![CDATA[Why There Aren’t “Good” and “Bad” Foods: Understanding the All-Foods-Fit Approach]]></title>
            <link>https://equip.health/articles/food-and-fitness/all-foods-fit-reframing-good-and-bad-foods</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/all-foods-fit-reframing-good-and-bad-foods</guid>
            <pubDate>Mon, 29 Jan 2024 20:24:00 GMT</pubDate>
            <content:encoded><![CDATA[“I was so ‘bad’ yesterday—I had dessert twice.” “I’m going to be ‘good’ today so I can eat pizza tonight.” “I’ve eaten so much ‘junk.’” “She is so disciplined—she only eats ‘clean’ food.”
 Do any of the above comments ring a bell? Chances are you’re nodding your head. That’s because we live in a society steeped in diet culture, where these kinds of statements are totally normal and it’s societally acceptable to demonize certain “bad,” “unhealthy” foods or even whole food groups (like carbs) and place a moral stamp of approval on the “healthy” or “good” ones. As an eating disorder dietitian who takes a non-diet approach to nutrition, I’ve had countless conversations with clients who are full of shame about their food choices and feel like they’ve done something terribly wrong by eating a fast food meal or a piece of cake. But it’s not just people who struggle with eating disorders who feel this way. In fact, research shows that the general population also tends to view food through a lens of morality, specifically seeing more energy-dense (aka higher calorie) foods as “impure” and low-energy foods as “pure.” Fortunately, a new approach has been slowly emerging over the last few decades, an approach to eating that removes shame and morality from food and helps us reclaim our power and pleasure from diet culture. That approach is known as “all-foods-fit.” What is an “all-foods-fit” approach? Taking an all-foods-fit approach to nutrition means allowing room for a wide variety of foods in your meals and snacks with nothing off-limits (unless you have a food allergy). This includes foods that society tends to deem “unhealthy,” but I call “fun foods.” It means creating a balance between nutrient-dense foods and fun foods that feels right to you. “Some foods contain specific nutrients that are beneficial for various aspects of physical health, but that doesn’t mean that foods lower in nutrient density are inherently non-nutritious,” explains Aleta Storch, RDN. “All foods contain nutrition, because all foods provide calories, which are converted into energy that fuels your body.” Plus, an all-foods-fit approach recognizes that food can be more than physical sustenance. “Some foods can promote other types of health, like mental, emotional, relational, financial health,” Storch adds. “Often, these are the foods that get labeled by diet culture as ‘bad’ or ‘junk,’ but if we lean into the philosophy that all foods have the capacity to support one or more aspects of our health, then all foods can fit into a diet that promotes health." The slow push towards the uncoupling of morality and food choices began in the 1990’s when heroin chic was in, fat was out, and highly restrictive diets like Atkins and Zone were booming. Perhaps in response to such alarming trends, the all-foods-fit approach arose within intuitive eating and other non-diet movements. “There is room in our diet for pizza and ice cream, just as there is room for kale and quinoa,” says Claire Rifkin MS, RDN. “We can eat any of those foods without shame, guilt, or categorizing them as a ‘good’ or ‘bad’ food choice.”  How an all-foods-fit approach helps in eating disorder recovery Taking an all-foods-fit approach can help anyone who lives in our thin-obsessed, diet culture-warped society. Being intentional about embracing all foods instead of giving into socially normalized rules—like avoiding desserts or skipping carbs or always choosing salad over fries—can make life more joyful, fulfilling, and peaceful for anyone. “All-foods-fit, when adopted by the general population, can be freeing and healing for many, and decrease the fear-mongering about certain foods,” says Rebecca Jaspan, a registered dietitian (RD) specializing in eating disorders. “It allows food to be just food.” Plus, one 2022 study of college females showed that intuitive eating interventions, like allowing consumption of all foods, may help to reduce the risk of disordered eating and increase body appreciation. Research also supports using an all-foods-fit approach in eating disorder treatment. One study that assessed an intuitive eating program at a treatment center found a link between positive treatment outcomes and intuitive eating abilities, like incorporating all foods. Another study, this one looking at college students, showed an association between using intuitive eating principles, like giving oneself full permission to eat all foods, and improved eating disorder symptoms, as compared to using behaviors like self-weighing and calorie counting. Personally, I know that if I never made peace with all foods in my recovery, I’d still be stuck in my eating disorder. In my practice, I find when clients reach a point of neutrality and removal of morality around food, they are then able to truly step into full recovery. If they still keep certain foods off limits or have rules around how or when they can eat them, it makes achieving complete freedom impossible. “The goal when using an all-foods-fit modality in eating disorder recovery should always be to reduce the associated shame and stigma of certain foods,” Rifkin shares. One way to do this is by creating an inventory of off-limits foods and working on integrating each food at a pace that feels doable. Storch also points out the value of incorporating science into the process: “At the end of the day, our bodies cannot distinguish glucose in a chocolate bar from glucose in an apple. Do we get additional nutrients from the apple that we don’t get from the chocolate? Absolutely,” she explains. “But we also get nutrients from the chocolate bar that we don’t get from the apple, and if a chocolate bar is a source of joy and relaxation, but the apple is a source of stress or rigidity, then the chocolate bar is actually the healthier choice.” While it’s hard work, our brains are malleable, and with repetition, time, and patience, they can be rewired to see all foods neutrally.  Benefits of an all-foods-fit approach The all-foods-fit approach has benefits for people across the spectrum of food relationships: those with eating disorders, those struggling with disordered eating, and those who simply eat food and live in our society. Here are some of the benefits of embracing it: You take back your power from diet culture. Dieting and weight loss is a multibillion dollar industry that profits off people feeling shameful and anxious about food choices. Adopting the all-foods-fit approach helps to free you from diet culture and lets you eat what you want without feeling shame or anxiety or the need to compensate afterward. You improve your mental health. When you spend less energy worrying about avoiding foods or what you ate, you have new mental space and energy for more meaningful aspects of life. As Storch says, the all-foods-fit approach “makes life easier and more enjoyable.” In fact, research shows associations between intuitive eating (which applies all-foods-fit) and increased psychological health, including lower preoccupation with your body and fewer depressive symptoms. This approach can also be particularly beneficial in challenging black and white thinking about food, which is a common pattern that often comes up in eating disorder recovery, Rifkin explains. You heal your relationship to your body. With some time under your belt practicing the all-foods-fit approach, you may notice better body image and higher self-esteem. This makes sense, because getting rid of food rules increases your confidence in your ability to make the best food choices for yourself. In fact, a 2021 meta-analysis found a connection between adults who practiced intuitive eating and improved body image, self-esteem, and overall well-being.  You lower your risk of developing an eating disorder. For those without eating disorders, embracing an all-foods-fit approach will act as a protector of sorts and could lower your risk of developing disordered eating behaviors, according to a 2020 study. You improve your physical health. I’m often asked, “But how is eating everything, including pizza and French fries, healthy?” In my practice, I notice when my clients have rules around their food choices, they often find themselves falling into unhealthy patterns, such as the binge-restrict cycle. Counterintuitively, their rules make them preoccupied with the off-limits fun foods, and they become unable to hear their body’s needs clearly. Once all foods are fair game, they’re typically able to find a natural balance between fun and nutrient-dense foods. That’s likely why all-foods-fit practices like intuitive eating are associated with increased diet quality, higher fruit and vegetable intake, and improved metabolic indicators like blood pressure and cholesterol. You connect to your intuition. Food rules create mental noise and sever your connection to your body, which is your intuition’s home. “When you approach food neutrally, you can use internal cues like hunger and fullness to decide what foods make you feel good physically, mentally, and emotionally,” Jaspan explains.    Tips for introducing the all-foods-fit approach into your life Adopting an all-foods-fit approach isn’t as simple as just deciding to do so. For many people, it takes a more deliberate and intentional approach, often with the support of a registered dietitian. Here are some tips for getting started: Consider the “why” for yourself. Take time to explore how adopting an all-foods-fit mentality will benefit your life. “Consider how foods that you label as ‘bad’ or ‘junk’ might support areas of health beyond just the physical,” Storch suggests. Perhaps it’s having more mental space with less food preoccupation, finding more pleasure in life, or having more freedom and less anxiety when traveling or out at restaurants. Take an inventory of thoughts and rules. “I recommend starting to get curious about your thoughts and feelings around food,” Rifkin says. Without judgment, take stock of all your food beliefs and rules that are getting in your way. If it feels helpful, write them down and check in with them as you progress. Give yourself permission. When you’re ready (enough), start to incorporate foods that were previously off limits with full, unconditional permission. “No foods are off limits or saved for special occasions or ‘cheat days,’” Jaspan adds. If you find it feels scarier or more difficult than you imagined, slow down and go at a pace that feels more realistic to you. With some of my clients who have several “fear foods,” we create a fear food hierarchy, with the hardest foods at the top, a bit easier in the middle, and easiest at the bottom. We start at the bottom and work our way up over time. Have coping skills in place. It can feel scary to let go of food rules and start eating foods that were once off limits. Often, such food rules function as maladaptive coping skills to help numb or deal with hard emotions or life situations, so you may need to incorporate adaptive coping tools at eating times to help manage tough emotions that surface. Some examples include breathing exercises, grounding practices, journaling, self-compassion practices, confiding in a therapist or safe person, and listening to music. Stay consistent. Once you begin incorporating foods that you used to restrict, be sure to keep having them often. Because the brain may perceive such foods as a threat, it’s only after eating them regularly that you can make peace and feel in control around them. There’s no hard and fast rule about what defines consistency, but in my practice, I find it’s helpful to have the food at least every other day for a month or so, followed by at least a few times a week for a few months, and eventually whenever you want the food. Get support. “If you find yourself experiencing significant difficulty in introducing new foods, or if feelings of shame become overwhelming, it may be beneficial to seek support from a licensed mental health professional or a dietitian,” Rifkin says. And if your difficulty stems from disordered eating or an eating disorder, seeking this support becomes even more important: challenging the distorted thought and behavior patterns of an eating disorder is not something you can do on your own or through sheer will.  If you’re concerned about your diet and food rules, it’s important to talk to your healthcare provider or an eating disorder specialist to get a professional assessment and the help you need. Scheduling a free consultation with our team at Equip is a quick and convenient way to get started on the road to food freedom.  ]]></content:encoded>
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            <title><![CDATA[What Is the Difference Between Eating Disorders and Disordered Eating?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-vs-disordered-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-vs-disordered-eating</guid>
            <pubDate>Tue, 22 Nov 2022 22:11:00 GMT</pubDate>
            <content:encoded><![CDATA[  Maybe your middle schooler starts coming home with her lunch uneaten, or a friend begins weighing and measuring her food at every meal, or you notice that you’re avoiding food throughout the day and eating most of your calories at night—in any of these cases, you might wonder: are these just eating quirks, or something to worry about? The question can be hard to answer, in part because habits like these are often portrayed as “normal” or even desirable in our society. But the truth is that all of these behaviors (and many others) can be considered disordered, and in some cases, they may indicate a full-blown eating disorder. So how can you tell the difference between disordered eating vs. an eating disorder? And is disordered eating on its own a cause for concern? Read on to learn the difference between disordered eating vs eating disorders, why both can be dangerous, and concrete next steps to take if you believe you or a loved one may be struggling with disordered eating. What is a healthy relationship with food? Before we can begin to understand disordered eating vs eating disorders, it’s helpful to have a baseline for comparison. As a caveat, every person’s eating behavior is unique to them, and there is no universal definition of “healthy” eating. Still, if we look at the research, non-disordered eating tends to include: Consuming a balanced diet that provides the nutrients your body needs Having a positive attitude about food Being flexible with your eating. You eat in response to your hunger, schedule, proximity to food, and feelings, rather than rigid food rules “Optimally, you're using interoceptive and internal cues to guide your hunger and fullness,” says Carol B. Peterson, PhD, Professor in the Department of Psychiatry and Behavioral Sciences at University of Minnesota Medical School. “Eating is also deeply culturally meaningful, from a social and interpersonal interconnectedness standpoint. Eating is a source of community and connection, and can and should be fun.” According to registered dietitian Alix Turoff, balance is a key tenet of true healthy eating. “A healthy relationship with food is one where food takes up a balanced and appropriate amount of space in your life,” she says. “You care about nutrition and the impact it can have on your health and well-being, but it’s not running the entire show. You can make choices that support your health without beating yourself up if things aren’t perfect.” Another important aspect of having a healthy relationship with food is flexibility. “You can honor hunger and fullness cues when possible, but you also know real life exists,” Turoff says. “Sometimes you eat because you’re hungry, sometimes because it’s dinner time, and sometimes because your friend baked cookies and you want one.” One word that doesn’t come up in Turoff’s description of a healthy relationship with food is “shame” or anything related to it. “When you have a healthy relationship with food, eating isn’t constantly tied to guilt, punishment, or morality,” she says. “You’re not having a full internal crisis over eating a bowl of pasta without protein or feeling like you need to ‘make up for’ dessert. It doesn’t mean you never think about nutrition, but your food choices don’t define your everyday decisions and the thoughts that follow.”  What is disordered eating? A closer look at the behaviors Disordered eating is a term used to describe a wide range of eating behaviors that may not warrant an eating disorder diagnosis but can cause physical and psychological harm. “Disordered eating is more of a descriptive term, and not an official psychiatric diagnosis described in the the Diagnostic and Statistical Manual of Mental Disorders,” explains Katherine Hill, MD, former VP of Medical Affairs at Equip. The risk of developing disordered eating habits is a real one: in a systematic review and meta-analysis including 63,000 children and adolescents around the world, 22 percent showed disordered eating. In her clinical experience, Turoff says most patients with disordered eating typically present a pattern of behaviors and beliefs. In addition to having rigid food rules and uncontrollable anxiety around certain eating situations, she says most clients with disordered eating have a level of preoccupation with food, exercise, or body image that goes well beyond simply wanting to be healthy. But in the context of diet culture, this preoccupation can feel like a normal or even positive thing despite causing significant distress. “A lot of people don’t realize they’re struggling, because these behaviors are so normalized,” Turoff says. “They think they’re just being disciplined or health conscious, when in reality their relationship with food is becoming increasingly rigid and stressful.” Some of the most common disordered eating examples include: A rigid approach to eating (tracking calories or macronutrients, inflexible meal times, reduced food variety) Assigning moral value to food (judging good foods vs bad foods) Skipping meals, fasting, or frequent dieting Binge eating Anxiety around trying new foods or eating in different environments GI issues Exercising to compensate for what has been eaten Using diuretics or laxatives Secretly eating Increased preoccupation with food and body and fear of weight gain Turoff says that in addition to labeling foods as “good” or “bad,” some clients with disordered eating habits describe themselves as being “good” or “bad” depending on what they ate that day. For many, there may also be a significant fixation on the scale. “Someone may be weighing themselves multiple times a day or letting the number dictate their mood, their food choices, or whether they feel like they were ‘successful’ that day,” she says. Gastrointestinal issues may also be tied to disordered eating in some cases. “Sometimes they are real, but sometimes people become convinced they can’t tolerate certain foods or ingredients and start eliminating them without a clear medical reason,” Turoff says. “They might adopt diets like gluten free, dairy free, or vegan not because of an allergy or ethical reason, but because it gives them a socially acceptable way to avoid foods they’re afraid of.” Another common characteristic of disordered eating is anxiety around eating food that was prepared by others. “Clients may dread going out to eat, avoid social situations that involve food, or feel intense stress about ingredients or calories they can’t control,” Turoff says. “Sometimes that fear centers around calories, and sometimes it centers around ingredients, which we often see with orthorexic tendencies.” What about orthorexia? Speaking of orthorexia, this relatively new condition merits its own discussion here. While it's not an official eating disorder diagnosis, orthorexia—which is sometimes described as “clean eating disorder” or “eating too healthy disorder”—is another type of disordered eating. According to research on the topic, people with orthorexia become fixated on consuming only foods they believe are “clean” and “healthy,” often leading to very rigid rules about what can and can't be eaten. “Orthorexia often starts with good intentions but can lead to extreme restrictive behavior that can be problematic nutritionally,” Peterson says. “And for some, it can lead to a rebound of binge eating.” Turoff says she sees orthorexic tendencies all the time in her practice. “What makes it tricky is that it usually starts from a very genuine place,” she says. “The problem is that for some people it slowly becomes more and more restrictive.” Orothorexia can also be tricky in that it doesn’t always come with obvious physical signs like weight changes. “Someone can be extremely preoccupied with eating only certain ‘clean’ foods and avoiding others without necessarily eating more or fewer calories overall,” she says. “From the outside, it can just look like someone who is very disciplined or very informed about nutrition. In many cases, these behaviors are actually praised by friends, family, or even healthcare professionals, which can reinforce the behavior and make it harder for someone to recognize that their relationship with food has become unhealthy.” Unfortunately, social media has had an undeniable impact on the prevalence of orthorexia and added further confusion about what “healthy eating” really is. “People are constantly exposed to content that frames certain foods or ingredients as dangerous or toxic, often from influencers who position themselves as whistleblowers exposing the ‘truth’ about the food system,” Turoff says. “That kind of messaging can create a lot of fear around foods that are perfectly acceptable and safe, and it can push people toward increasingly rigid eating patterns while making them feel like they’re simply being responsible about their health.” Causes of disordered eating Many different factors might lead someone to develop disordered eating behaviors, but dieting is a major one. Fad diets that encourage extreme measures like intermittent fasting, cutting out entire food groups, or “cleansing” the body by only consuming certain liquids are all inherently forms of disordered eating in themselves. Although some people may be able to practice these things without any negative consequences, for a lot of people, they can be very problematic, Peterson says. Another contributing factor is the fact that disordered eating behaviors have become increasingly normalized and even praised in our society, making them easy to dismiss. As thin bodies continue to be idealized, and diet mentality shapes our culture, our conversations, and our conscience, habits like skipping meals or exercising for hours each day are often socially accepted. This not only means that harmful behaviors may go unnoticed, but may also encourage disordered eating behaviors in those susceptible to them. Research suggests that disordered eating may also be caused by factors like societal or interpersonal pressure to lose weight, certain personality traits (like perfectionism), and psychological factors such as depression, anxiety, or low self-esteem. What qualifies as an eating disorder? To understand disordered eating vs eating disorders, it’s helpful to know these general definitions: Eating disorders are serious mental illnesses with specific, narrow diagnostic criteria. Eating disorders can cause malnutrition, bone loss, damage to vital organs, and other severe physical health consequences. Disordered eating is a more general, descriptive term that captures a number of different behaviors with varying levels of severity. While disordered eating can show up in a wide variety of different ways, there aren’t distinct “types” of disordered eating. With eating disorders, however, there are five official diagnoses in the DSM, all with different symptoms and risks. Anorexia nervosa: Anorexia is characterized by extreme food restriction and an intense fear of gaining weight, leading to a significant low body weight in the context of age, sex, developmental trajectory, and physical health. BED (binge eating disorder): BED is characterized by recurrent episodes of uncontrollably eating a large amount of food quickly (known as a binge), often followed by distressing feelings, like guilt and shame. The bingeing occurs at least once a week for three months, and is not associated with compensatory behaviors afterward. BED is the most common eating disorder in the United States. Bulimia nervosa: Bulimia is an eating disorder characterized by recurrent episodes of binge eating (eating objectively large amounts of food quickly and with a lack of control) followed by compensatory purging behaviors to try to prevent weight gain. Purging may look like self-induced vomiting, misuse of laxatives or diuretics, or excessive exercise. This pattern occurs at least once a week for three months. ARFID (avoidant/restrictive food intake disorder): ARFID is characterized by eating a very small amount or variety of food (or both), leading to weight loss, failure to meet expected growth targets, nutritional deficiencies, the need for nutritional supplements, or a marked interference with psychosocial functioning. ARFID behaviors are not driven by body image concerns or a fear of weight gain, but rather come from sensory sensitivities, fears around eating, or a lack of interest in food. OSFED (other specified feeding and eating disorder): OSFED is a more general term to describe eating disorders that don't fit into other diagnoses. Some sub-categories of OSFED include atypical anorexia (when someone meets all of the criteria of anorexia nervosa except for low body weight), purging disorder, and night eating syndrome. All of the diagnoses above involve disordered eating behaviors, such as restricting food intake or “working off” meals. However, not everyone who engages in one (or several) of these behaviors has an eating disorder. This makes discerning one from the other that much more difficult—but with some knowledge, it’s possible to identify the differences, and know when it’s time to seek help.  The key differences: Severity, frequency, and life impact While disordered eating habits on their own don’t signify a diagnosable condition, they can easily become a slippery slope into an eating disorder. Thankfully, learning to recognize disordered eating behaviors can go a long way toward preventing harmful habits and ensuring that you or your loved one get the support you need to prevent or address an eating disorder. The differences between disordered eating vs eating disorders lies less in what the behaviors are, and more in how they show up. Specifically, it’s important to consider: How often the behaviors happen How intense the associated thoughts and feelings are How much these behaviors disrupt a person's life “There's a fine line between disordered eating and an eating disorder,” Hill says. “Disordered eating is generally mild without a significant impact on someone’s mental or physical health or self-worth.” Eating disorders, on the other hand, significantly impact all of these things. Turoff agrees, noting that while disordered eating can still be very harmful, eating disorders tend to involve more entrenched patterns, psychological distress, and significant medical or functional consequences. “That said, there’s a lot of overlap,” she says. “The behaviors themselves can look very similar. Someone with disordered eating and someone with a diagnosable eating disorder might both be restricting, bingeing, compulsively exercising, or obsessing over food. The difference is how often it’s happening, how intense the thoughts are, and how much of the person’s life and identity are being consumed by it.” Despite their similarities, Turoff believes it’s important to distinguish between disordered eating and EDs in order to pursue the most effective treatment possible—not because one is serious and the other isn’t. “Disordered eating is not harmless just because it doesn’t meet full diagnostic criteria,” she says. “It can still impact physical health, mental health, quality of life, and it can absolutely progress into a full eating disorder. The distinction can help guide treatment, but it should never be used to minimize someone’s suffering or convince them they’re not ‘sick enough’ to deserve support.” Let's break down the three major differences between an eating disorder vs disordered eating so you can better determine what you or your loved one may be dealing with. Frequency of behaviors To be diagnosed with most eating disorders, the behaviors have to occur at a specific frequency for a certain period of time. For example, binge eating disorder is diagnosed if the person binges at least weekly for at least three months. “We'll also see people engage in bingeing less frequently, say monthly. That would potentially be disordered eating,” Peterson explains. Another example would be a person who frequently yo-yo diets, adopting restrictive eating patterns for weeks and months at a time before going back to more “normal” eating, or even binge-like behaviors. While this would generally be considered disordered eating, it is not a diagnosable eating disorder. Severity of thoughts and feelings What's happening inside someone's mind matters when comparing disordered eating vs an eating disorder. While those with disordered eating habits may think about food more than others, the level of food obsession is far more intense with an eating disorder. Those struggling with an eating disorder are often so fixated on food—what they did eat, what they didn’t eat, what they will eat, how they'll avoid eating—that it impairs focus and makes it nearly impossible to stay present. Thoughts and feelings about self-worth are another distraction. “In Western society, we see a high valuation in appearance and weight and shape, but in eating disorders, it's the number one thing,” Peterson says. “If they were to get an A on a test or lose a pound, the weight loss would have a bigger impact on their sense of self. Or if they got promoted and also gained weight, the weight gain would have a bigger impact.” Life impact While people with disordered eating habits may be preoccupied by thoughts around food and their body, their life generally isn't greatly impacted. With an eating disorder, however, those thoughts and behaviors occur so frequently, and are so intense, that the eating disorder reshapes life. “You can't determine the severity of an eating disorder based on what someone does behaviorally,” Peterson says. “You want to understand what their life is like, and the extent to which these experiences and behaviors impact them. Often, their internal world is torturous." For example, a child who skips her best friend's birthday party out of anxiety around the cake, or a teen who lies to his parents and goes out on a five-mile run despite having a bad cold are both situations where a person is likely struggling with an eating disorder. As an adult, you may be able to maintain a high level of functioning but struggle to pay attention in work meetings or truly engage with your kids. One helpful way to think about it is to ask how often someone thinks about food or their body, and how often they want to think about food or their body. If the gulf between those two answers is significant, it shows that their brain is being monopolized by thoughts over which they don’t have control. This is a major red flag for an eating disorder. “With an eating disorder, it is complete preoccupation,” Peterson says. “If you ask them, 'In a typical hour, how many minutes are you thinking about eating, your shape, or something related?' They'll say, 'Fifty-five minutes.'” This can make it difficult to concentrate at school, at work, and during conversations with friends.
  When disordered eating becomes dangerous: Physical and mental red flags If disordered eating begins to have a negative impact on health, it's probably tipped over into eating disorder territory. “Disordered eating generally does not significantly impact someone's physical or mental health, whereas an eating disorder does,” Hill says. Watch for the red flags listed below that indicate you or your loved one may have an eating disorder. If you notice one or more of them, it’s worth making an appointment with a medical provider for an evaluation. You can also schedule a free consultation with an Equip team member, or take our free eating disorder assessment. Medical red flags Stalled growth in adolescents Menstrual irregularities GI symptoms Decreased bone density Low heart rate Loss of tooth enamel Hair loss Electrolyte imbalances Psychological red flags Mood changes Depression Anxiety Increased social withdrawal and secrecy Body checking Suicidal thoughts Obsessive thoughts that interfere with daily tasks Behavioral red flags Greater tendency to skip meals Being more limited in what one is willing to eat Wanting to watch and see how food is prepared Saying “I ate already” at meals or food-related events Food going missing from the house, or evidence-of binge eating (i.e., excessive food wrappers or takeout containers) The risks of "mild" disordered eating It’s important to understand that even if someone's disordered eating habits don't meet the diagnostic criteria for an eating disorder, they can still cause significant harm. Research has associated disordered eating behaviors with physical and psychological problems such as: Anxiety and depression Struggles with self-esteem and body image Digestive problems (though it's unclear which comes first) Fatigue and difficulty concentrating Poor sleep Nutritional deficiencies and electrolyte imbalances Social isolation and withdrawal And while disordered eating behaviors are harmful on their own (even if they never develop into a full-blown eating disorder diagnosis), someone “just” engaging in disordered eating behaviors for the time being could soon find themselves on the path toward an eating disorder. “People don't set out to have an eating disorder. They try to cut back carbs and increase protein, or skip dessert,” Peterson says. “But for people who are vulnerable—and it's usually unclear who those are until it’s too late—the diet becomes all-consuming, much more rigid, and pervasive in the longer term. This can lead to more and more restrictive eating that results in nutritional problems and unhealthy weight loss.”  What to do if you or a loved one are struggling with disordered eating If you're wondering, “Do I have an eating disorder or disordered eating?” or you're worried that someone in your life is engaging in disordered eating behaviors, there's help and hope. As a first step, consider using an online eating disorder assessment to give you a better sense of what you may be dealing with. “My biggest advice is this: do not wait until it gets worse to take it seriously,” Turoff says. “A lot of people think if they’re not underweight, not bingeing every day, or not doing whatever stereotype they associate with an eating disorder, then it’s not a big deal. But if food is causing significant stress, if your eating feels chaotic or overly rigid, if your body image is affecting your mood and your choices, or if your world is starting to get smaller because of food and exercise behaviors, it’s important to get help before things get worse. You do not need to hit some imaginary rock bottom to deserve help. In fact, getting support earlier is usually what prevents things from escalating.”  If you suspect a loved one may be struggling, talk to them during a private, low-stress time that doesn't involve food. Be mindful of how you approach the issue. Using threats or being the “food police” can make your loved one feel accused or scrutinized—which typically leads to more secrecy, Peterson says. Instead, “approach with a sense of curiosity of wanting to learn more,” she says. Express your concerns from a place of love, focus on how you're feeling and what you've noticed, and encourage professional guidance. Here are some non-confrontational conversation starters that may help: "I’ve noticed that you’ve seemed a little down or stressed lately. Is there anything on your mind that you want to talk about?" "I've observed some changes in your routine lately. How are you feeling about everything?" "I know you’ve been going through a lot. Have you noticed any patterns in your eating habits that have been affecting you?" "I've noticed you seem anxious around food lately. Is there something I can do to help make things easier?" "You know, sometimes people struggle with food and their bodies without even realizing it. Have you ever felt like something might not be quite right with your eating habits?" "I notice you've been avoiding social situations that involve food. Is there something bothering you about those situations?" "You seem to be working really hard to control different aspects of your life. How does that feel for you?" If they're open to it, offer to help them find a professional to talk to. If they're reluctant, emphasize that you love them and want to support them, and that you're there if they ever want to talk. You may have to have several conversations. However, if someone is at medical risk, you need to step in, Peterson says: “You can say, 'This isn't a choice. We have to get you evaluated to make sure you are okay.” And if you’re the parent or caregiver for a minor who you think may have an eating disorder, it’s also important to intervene and help them get care, even if they resist. To help a loved one or yourself get treatment, the first step is to make an appointment with your primary care provider or an eating disorder specialist for a consultation (you can also schedule a call with an Equip team member for a free, no obligation consultation). This advice holds true even if you believe the behavior isn't a full-blown eating disorder. “Early intervention is key to preventing further damage,” Hill says. During a professional assessment, a healthcare provider may: Ask about any history of dieting, changes in eating and exercise habits, and use of appetite suppressants, diuretics, and other medications that can affect weight Perform a physical exam to look for physical symptoms like bloating, lanugo (fine hair all over the body), and knuckle calluses (evidence of purging) Order bloodwork to check electrolytes and other markers Use mental health screenings designed to help diagnose eating disorders Whether the provider concludes you're dealing with disordered eating or an eating disorder, they can help you determine the next steps, including referring you to an eating disorder specialist. “Often people are extremely hesitant to seek treatment, afraid of forced treatment, and feel deep shame or fear of being misunderstood,” Peterson says. “Once they start treatment, they're enormously relieved. They feel understood for the first time.” If you or a loved one are struggling with an eating disorder or any form of disordered eating, you are not alone and you are worthy of help. “We don’t feel ashamed when we need help in other areas of life,” Turoff says. “If you’re struggling with math, you might get a tutor. Working with a dietitian or therapist to improve your relationship with food is really no different. Sometimes having an experienced professional help you sort through the noise and bring some balance back into this part of your life can make a huge difference.” Frequently asked questions (FAQs) What is the main difference between disordered eating and an eating disorder? There are three main differences between disordered eating and an eating disorder: With an eating disorder, the behaviors occur at a specific frequency for a certain period of time. With disordered eating, the behaviors are less regular and less frequent. Someone with an eating disorder has more intense food- and body-related thoughts and feelings, to the point where they're constantly preoccupied. An eating disorder has a significant negative impact on someone's life, where they begin to skip out on social events and can't perform as well at school and work because they're so distracted. Disordered eating generally does not significantly affect one’s life. Can disordered eating harm my health even if it's not a full eating disorder? Yes, disordered eating can be harmful to physical and mental health. It's associated with anxiety, depression, fatigue, difficulty concentrating, poor sleep, nutritional deficiencies, electrolyte imbalances, social isolation, and poor self-esteem. When does dieting cross the line into an eating disorder? Distinguishing a diet vs eating disorder can be challenging, especially since many disordered eating habits have been normalized in our society. However, red flags that dieting may have crossed the line into an eating disorder include stalled growth (in adolescents), menstrual irregularities, GI symptoms, low heart rate, mood changes, increased social withdrawal and secrecy, and obsessive thoughts that interfere with daily tasks. Is skipping meals considered an eating disorder? Skipping a meal here and there isn't an eating disorder. However, skipping meals can become an eating disorder if the person regularly skips meals and/or skips more than one meal a day, and this is affecting their day-to-day functioning. What is a "mild eating disorder?" There isn't such a thing as a “mild eating disorder.” By definition, eating disorders are serious health conditions that can lead to major health problems. Even disordered eating, which may not meet the diagnostic criteria of an eating disorder, can cause potential health complications. If you suspect that you or a loved one may have disordered eating or an eating disorder, see a medical provider for an evaluation as soon as possible.]]></content:encoded>
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            <title><![CDATA[The Fear of Eating in Front of Others: Understanding (and Overcoming) this Common Eating Disorder Symptom]]></title>
            <link>https://equip.health/articles/food-and-fitness/fear-of-eating-in-front-of-others</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/fear-of-eating-in-front-of-others</guid>
            <pubDate>Tue, 16 Jul 2024 19:18:00 GMT</pubDate>
            <content:encoded><![CDATA[Over the course of her eating disorder journey, Equip Peer Mentor Jamie Drago encountered a variety of challenges, but some were more surprising than others. One particular struggle Drago faced is actually pretty common for those with eating disorders, though she was caught off guard by how difficult it was to overcome: the fear of eating in front of others. “At certain times during my eating disorder, I worried what others might think of the types of foods I was choosing, or I’d assume that my own anxiety about the content of food must be what others were thinking as well,” Drago says. “Sometimes being around peers that weren’t eating at that time or seeing them eat certain foods were my biggest struggles, as I had a really hard time with comparison in all areas of my life.” While there are many reasons that a person in the midst of eating disorder recovery might feel anxiety about eating in public, Drago believes her fear was driven by the desire to emulate those around her. “Oftentimes, I felt like I didn’t know what a ‘normal’ or ‘right’ amount of food was for one sitting, which caused me to get in my head with an anxiety spiral, and the fear of having to sit with that anxiety was enough to make me want to avoid it altogether,” she says. While eating anxiety is quite common for those struggling with or recovering from an eating disorder, the fear of eating in front of others can be addressed and overcome with the right support. Read on to learn more about why the fear of eating in front of others can be so common for those with eating disorders, the consequences of living with this fear, and what to do if you or someone you care about is struggling. What is the fear of eating in front of others? According to Equip therapist Adriana Lindenfeld, the fear of eating in front of others is characterized by feeling the following emotions when eating in the presence of others: Fear Discomfort Anxiety “This fear can stem from concerns about being judged, embarrassed, or scrutinized for their eating habits, appearance, or food choices,” she says. This eating anxiety can lead to significant distress and avoidance behaviors, Lindenfeld explains, driving people to go to great lengths to avoid eating in the presence of others—which, in turn, has a negative impact on their social life and overall well-being. “The fear of eating in front of others is intertwined with both social anxiety and eating disorders,” Lindenfeld says. “People with social anxiety often experience an intense fear of negative evaluation, which extends to their eating behaviors in social settings.” Is eating anxiety a sign of an eating disorder? While eating anxiety is not technically considered an eating disorder, anxiety about eating is often associated with, and can be a sign of, an eating disorder. According to research, the following percentages of individuals with EDs also have at least one co-occurring anxiety disorder: About 48% of adults with anorexia 81% of adults with bulimia 65% of adults with binge eating disorder (BED) Anxiety tends to come with an intense fear of negative evaluation, while eating disorders often involve significant concerns about body image, control, and self-worth; and when both occur in the same person, the fear of eating in front of others can feel almost inevitable. “The combination of these factors creates a powerful and distressing cycle where the act of eating in public becomes a source of immense anxiety and avoidance, further isolating individuals and exacerbating their overall mental health challenges,” Lindenfeld says.  While there aren’t specific numbers around how many people struggle with a fear of eating in front of others, Drago speculates that it affects a good proportion of those with eating disorders. “It’s hard to say how common this experience is because it can vary so much from person to person, as can the reasons behind the fear,” she says. “Anti-fat bias also causes very legitimate concerns that someone may make a comment about the food choices a person in a larger body might make. It could also be a fear of not knowing what’s in the food someone else prepared, comparing your eating pace to others, or a fear of judgment—there are really a ton of different reasons.” Lindenfeld says she that in her experience, anxiety about eating in front of other people can be fueled by a number of different reasons, including: Self-consciousness: Many people with eating disorders are highly self-conscious about their body image and eating behaviors. Fear of judgment: Those with eating disorders may fear that others will judge them for what or how much they are eating. Shame and guilt: Feelings of shame and guilt about eating behaviors or body image can also contribute to this fear.  The psychological impact of eating anxiety While consistently choosing to eat alone—and taking sometimes drastic measures to avoid eating with other people—may seem innocuous to those unfamiliar with the nuances of disordered eating, it can have a significant psychological impact over time. According to Lindenfeld, mental health repercussions can include: Isolation: People experiencing a fear of eating may withdraw from social activities that involve food, leading to social isolation. Increased anxiety: The avoidance behavior can reinforce the anxiety, making it more intense over time. Depression: Persistent social isolation and anxiety can contribute to feelings of depression. Negative self-esteem: Constant fear and avoidance can further damage self-esteem and body image. Lindenfeld says eating anxiety can lead to: Increased stress Depression Social isolation “Constant worry and preoccupation about eating in social situations can create chronic stress,” Lindenfeld says. The efforts to avoid eating in social situations can be stressful—planning ways to skip or avoid meals or social gatherings that involve food takes mental and emotional energy—and social withdrawal and isolation can lead to feelings of loneliness and depression.” Lindenfeld also explains that because people with eating disorders often have negative self-perceptions and low self-esteem, anxiety around eating can exacerbate these feelings and lead to a deeper sense of worthlessness and depression. Once again, a vicious cycle is set into motion: “Increased stress and depression can make the eating disorder worse, leading to even greater anxiety about eating in front of others. This, in turn, leads to more avoidance and isolation, further increasing stress and depression,” she says. Drago says that the longer she went out of her way to sidestep eating with others, the harder it became to engage in social meals. “Something I’ve really found to be true for myself is that avoiding doing a scary thing is what keeps it scary,” she says. “So from a mental standpoint, it was something I really needed to challenge.” What are the signs that someone has eating anxiety? While the signs of eating anxiety may look different depending on the person and their specific fears, there are several telltale signs that someone is experiencing fear or difficulty around social eating. According to Lindenfeld, these are some of the most common red flags: Avoidance: The person may consistently avoid meals with others or social events involving food, eating in secret instead Nervousness: They may appear visibly anxious or distressed when faced with eating in front of others. Preoccupation: They express excessive worry about food, eating, and body image. Changes in eating behavior: The person alters their eating habits in order to avoid judgment (i.e. they may eat very little or avoid certain foods). “Signs can vary from person to person, but often you might notice that a person is avoiding social gatherings, consistently avoiding eating in public, or preoccupied with knowing what will be served or if others will be eating,” Drago says. How can someone overcome the fear of eating in public? While the fear of eating in front of others can be a challenging obstacle to navigate—especially in the context of an eating disorder—there are a variety of effective treatment approaches that can help people overcome these fears. Lindenfeld says that three specific types of therapy are particularly effective in addressing eating anxiety and helping people become more comfortable with eating in social situations: Cognitive behavioral therapy (CBT) helps individuals challenge and change negative thought patterns related to eating in front of others. Exposure therapy involves a gradual exposure to eating in social situations to reduce fear and build confidence with the goal of increasing distress tolerance. Mindfulness-based approaches include techniques to increase awareness and reduce anxiety in the present moment. For those in eating disorder treatment, Drago recommends working with your treatment team to identify the feelings that are coming up for you in social eating situations, then exploring reframes or coping skills that might help you manage those feelings. “For me, challenging myself when I was with safe people was a great first step,” she says.  How loved ones can support someone with eating anxiety There are plenty of ways to show up for a loved one who is struggling with social eating, but each person’s specific support needs will vary. “I think it’s really important to ask the person suffering what is most helpful for them in those moments,” Drago says. “Some people prefer if no attention is drawn to eating to help make it feel more ‘normal’ and less of a focus—especially if their fear centers around being surveilled by others. Others may prefer encouragement during the meal or ahead of time along with planning ahead.” While individual needs may vary, Lindenfeld offers a few tips for demonstrating support when someone you love has a hard time eating around others: Provide understanding and empathy. Be non-judgmental and empathetic towards their fears and anxieties. Be loving but firm. Express kindness and compassion, but be candid about how their disordered behaviors may have detrimental effects. Be supportive in social situations. Offer to accompany them to social events and provide reassurance. Use “I” statements. Focus on the behaviors that you have personally observed, such as, “I noticed you’ve been eating dinner in your room alone and not with us at the dining table.” Using the opposite approach—for instance, statements like “you don’t want to eat with us anymore”—may come off as accusatory and provoke defensiveness. Avoid simple solutions. Sometimes, the natural reaction to someone’s eating anxiety is to say something like, “it’s just food,” or “can you just get over it?” But these reactions aren’t constructive, and can actually exacerbate the individual’s suffering. Encourage professional help. The fear of eating around others can be difficult to overcome alone, and this is especially true if it stems from an eating disorder. Try gently encouraging your loved one to seek help from a mental health professional, or consider more intensive, comprehensive treatment from a qualified team of experts. FAQ What does it mean if I’m afraid to eat around other people? While being afraid to eat around others isn’t necessarily an eating disorder, it may be a sign of one. The fear may stem from a desire to hide disordered eating behaviors (like restricting or purging), a preoccupation with body image and weight, or shame related to their food choices. If this fear is persistent and interferes with your life, it’s important to speak with a mental health professional. Why is my loved one afraid to eat around others? Eating anxiety isn’t necessarily an eating disorder, but it is a common symptom of EDs like anorexia, bulimia, and BED, and serves as a way to hide disordered behaviors. For example, a person may have food anxiety about not being able to restrict food as usual, or they may feel shame about their food intake or their body image, making eating in public feel too vulnerable. How can I help someone who has anxiety eating around others? There are many ways to show support for someone experiencing a fear of eating in front of others. While individual needs may vary, offering understanding and empathy can help provide comfort, but it’s also important to be honest about how their disordered behaviors may have detrimental effects. Offer to accompany the person to social events and provide reassurance, and use “I” statements when possible (i.e. “I noticed you’ve been eating dinner in your room alone and not with us at the dining table”). Most importantly, if you believe the person may be experiencing eating anxiety that impacts their daily life, encourage them to seek professional help. What are the negative consequences of always eating alone? Consistently avoiding eating in public can have negative consequences like social isolation. People who have anxiety about eating in public may withdraw from social activities that involve food, leading to increased anxiety, depression, and worsened self-esteem and body image. Is it a problem if someone is afraid to eat around other people? Fear of eating in front of others or anxiety about eating in public can be problematic for a number of reasons. In addition to the potential for social isolation, depression, and worsened self-esteem, eating anxiety can be a sign of an eating disorder, driven by a desire to hide restrictive or otherwise disordered eating behaviors. If the fear is persistent or causes distress, it warrants seeking professional help. ]]></content:encoded>
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            <title><![CDATA[Feeling Addicted to Food? Understanding Symptoms and What Really Helps]]></title>
            <link>https://equip.health/articles/understanding-eds/food-addiction-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/food-addiction-treatment</guid>
            <pubDate>Wed, 26 Feb 2025 20:47:56 GMT</pubDate>
            <content:encoded><![CDATA[  If you've ever searched for food addiction help, food addiction symptoms, or food addiction treatment, you're not alone. In one study, 86 percent of people said they believe certain foods are addictive, and 79 percent said that sugar is addictive. “I often hear clients talk about being addicted to food,” says registered dietitian Caroline Young, MS, RD. “They feel like certain foods have power over their lives, and they can’t trust themselves around them. I hear statements like, 'I better not have X in the house, because I’m addicted.'” If you feel like certain foods have a power over you, it’s not all in your head, but it’s not really “food addiction.” Read on to learn what the science says about food addiction, consider an alternative perspective, and discover solutions outside of food addiction treatment that can help you find food peace. What is food addiction? It's somewhat tricky to define “food addiction”, because it’s not an official condition, and so there isn't a standard definition. But when most people—researchers included—talk about food addiction, they're typically referring to eating habits around highly enjoyable foods (pizza, fries, sweets). This includes cravings for those foods, feeling a lack of control when eating these foods, and perhaps even bingeing on them. It doesn't help that discussions on the news or social media tend to demonize ingredients in these types of foods; you might have even heard the theory that sugar is as addictive as drugs like cocaine and heroin. “It’s not typical for people to feel ‘addicted’ to broccoli or bananas, or other nutrient-dense food,” Young says. “The foods typically named in relation to ‘food addiction’ are the ones diet culture calls 'junk' or 'bad' food—or what I, along with my anti-diet colleagues, call 'fun' or 'play' food. Think high-sugar, high-fat, and high-salt: cookies, cakes, French fries.” “When I work with individuals who feel ‘addicted to food,’ one of the first things we do is gently reframe what’s actually happening because the experience is very real, even if the label can be misleading,” says dietitian nutritionist Heather Ritter, RDN, LDN. “Most people assume ‘food addiction’ works like substance addiction in that certain foods are inherently addictive and cause a loss of control. While this narrative is widespread, current research has not established a single, consistent definition or biological mechanism that supports ‘food addiction’ as a standalone clinical diagnosis.”  The science behind food addiction Ritter is right: like several far-reaching claims made in the nutrition world, the theory of food addiction lacks substantial evidence. A 2022 systematic review concluded that food addiction isn’t a legitimate diagnosis and there is simply not enough research or clinical trials to draw conclusions. This is in part because there's no unanimously accepted definition of “food addiction” or well-defined diagnostic criteria for it. Many studies use the Yale Food Addiction Scale, an assessment created in 2009 that applies substance dependence criteria to food addiction. But there are two major criticisms of the YFAS: This measure is self-reported, meaning it's the person's own perception of their eating, which may not be completely reliable—a medical provider or even the person's friend may have a different take on that person's eating behaviors. The scale assumes that food addition is a neurobiological disease, similar to substance use disorders. But this assumption isn't supported by the research. “What is well supported, however, is the presence of addiction-like eating behaviors,” Ritter says. “In clinical practice, these behaviors are real and distressing but they are more accurately understood as the result of physiological deprivation, learned patterns, and psychological factors, rather than the food itself.” Measurements aside, a handful of animal studies have found that rodents can display behaviors associated with food addiction, such as withdrawal from high-fat foods and persistent seeking of sugar. But studies haven't found that humans behave this way. Additionally, rodents act like this when they're isolated, but when they're put in a cage with other rodents, they don't seek out the sugar as much, says Dana Sturtevant, MS, RD, dietitian and co-author of the book Reclaiming Body Trust. And then there’s the overlooked issue of the impact of dietary restriction. Why it feels like an addiction: the role of restriction and "food noise" Dietary restriction plays an undeniable role in the phenomenon that can feel like food addiction. “A history of dieting can intensify cravings and a drive to eat, mimicking signs of what’s labeled as food addiction,” says dietitian Kristin Draayer, MS, RDN. That’s exactly what happened to the rodents in the study referenced above: they only displayed “addictive” behaviors when given intermittent access to sugar. “When given free access to sugar alongside adequate access to food and water, the rodents did not binge, suggesting that it's the deprivation, not the sugar itself, that triggers this response,” Draayer explains. There's also the famous Minnesota Starvation Experiment, in which healthy young males put on a severely calorie-restricted diet became obsessed with food (experiencing what would be referred to today as "food noise")—and then, when given free access to food again, many engaged in extreme overeating. Subsequent studies on humans also show that intermittent fasting or other types of caloric restriction (particularly of “forbidden foods” high in fat and sugar) causes some people to develop binge eating behaviors. Why restriction fuels addiction-like behaviors Food restriction of any kind—whether that's trying to “cut back” on calories overall, cut out specific food groups, limit certain foods, you name it—can lead to actions that resemble addictive behaviors around food. But that doesn't mean someone has an addiction. “One of the most powerful drivers I see is restriction,” Ritter says. “When the body is under-fueled, whether due to dieting, skipping meals, food insecurity, or rigid food rules, it responds in predictable, protective ways.” According to Ritter, our bodies typically have the following responses to food restriction: Increased levels of the hunger hormone ghrelin Reduced levels of the fullness hormone leptin Heightened attention and preoccupation with food Stronger biological drive for energy-dense foods “Human beings like to feel in control, and the minute we're told we can't have something, we want it more,” Sturtevant explains. “When we engage in restrictive eating patterns and put rules and conditions around our eating, over time our tolerance to that restraint diminishes. We get tired of controlling our food, and our body gets tired of not having enough to eat.” If, as a result, we eat something that we've labeled as “bad” or “off limits,” guilt and shame can flood in. That can lead us to make stricter food rules, Sturtevant says, which we follow until we eventually succumb to hunger and eat the restricted food, often in a way that feels out of control. This is almost inevitably followed by more guilt and shame, then stricter rules, and then rinse and repeat. This is known as the binge-restrict cycle. “This is not a lack of willpower. It is neurobiological survival wiring,” Ritter says. “Psychologically, restriction also creates a sense of scarcity: ‘I can’t have this.’ That perceived deprivation increases urgency, cravings, and preoccupation. Over time, this often leads to a reinforcing cycle. This cycle can feel like addiction, but it is more accurately a biobehavioral response to deprivation, not a substance-driven disorder.”  There's also a primal response to starvation. When our bodies don't get enough calories, our behaviors change: People may find that they become preoccupied with food: thinking about it, watching cooking shows, reading cookbooks, and so on. They may also be sure to get every last bite when they do eat, licking plates or scraping the spoon against the bottom of the yogurt container over and over. This state of biological deprivation is the primary driver of what many call "food noise"—that feeling of constant food obsession. Food restriction and feelings of food addiction may be worse today given diet culture, which tells us that we should or shouldn't eat certain foods. What’s really going on: underlying causes of food addiction Ritter says that in her work, what is often labeled as “food addiction” is typically driven by a combination of other underlying issues: Physical factors: undereating, inconsistent intake, blood sugar variability, inadequate macronutrient balance Psychological factors: rigid food rules, dichotomous (“all-or-nothing”) thinking, chronic dieting history Emotional factors: using food as a coping strategy for stress, anxiety, loneliness, or trauma “Given the culture we live in, there is a crisis of imagination and understanding of what is going on,” Sturtevant says. “It's rare to look at a person's relationship to food prior to these studies. They don't control for food insecurity, and we know that people who live with food insecurity have a higher risk of eating disorders and disordered eating. They're also not considering people's dieting history and history of restricting and restraining food. And if you put people with chronic dieting behaviors in a room with food they think they shouldn't be having, they're going to feel compulsive. But just because that's their experience doesn't mean it's the same thing as being addicted to heroin or alcohol.” And while feeling addicted doesn’t necessarily mean that a person has an eating disorder, there’s often an overlap in symptoms, like: Food preoccupation “Food noise” Loss of control around food Even if someone dealing with addictive-like behaviors around food doesn’t meet the criteria for an eating disorder, usually at least disordered eating is present. “With feelings of food addiction often stemming from a place of deprivation, there’s always the chance there could be a true underlying eating disorder,” explains Equip Dietitian Shira Feldman, MPH, RD.  Other emotional and psychological factors may be at play. “I notice when clients have not yet developed adequate emotional coping or regulating tools, and only go to food to self-soothe and manage hard feelings, they seem more prone to feeling like they are addicted to food,” Young says. We also tend to forget that food itself is emotional. Although emotional eating often gets a bad rep, it's not always a negative thing. It's a normal way to connect and sometimes cope, though it's also important to gain awareness of when we do this and build other tools to manage during emotionally tough times.  Why food addiction treatment based on abstinence fails According to Ritter, the complex combination of physical, emotional, and psychological factors often underlying the known as “food addiction,” an abstinence-based strategy (i.e. entirely cutting out certain foods) simply doesn’t work. “An abstinence-based approach often backfires,” Ritter says. “Restricting specific foods tends to increase their perceived value, reinforce preoccupation, and perpetuate the cycle of restriction and overconsumption.” Despite the availability of so-called food addiction treatment programs, there's no research to support these treatments. Worse, some of these approaches are based on substance abuse treatment protocols, where abstinence is often a necessary goal for healing and health. However, if we treat food or certain foods like a drug and try to avoid them at all costs, it not only makes it challenging to get the nutrients your body needs to function, it also makes it basically impossible to develop a healthy, positive relationship with food. “Avoiding certain foods reinforces your belief that you can't handle them, and this thought gets wired into your brain's neural pathways,” Draayer says. “This creates a self-perpetuating cycle: You might think you're preventing out-of-control eating by staying away, but you're actually reinforcing the idea that you can't trust yourself around that food.” In other words, the rules you make to curb your “addiction” become a self-fulfilling prophecy.  The core flaw: food isn't a drug The basis for abstinence-based food addiction treatment is the idea that certain foods are as addictive as hard drugs. And it’s true that eating specific foods can light up the brain’s reward center, causing a release of dopamine—but it's not that simple. “What’s often left out of the conversation is that other things, like caring for your child or cuddling with a pet, also light up the brain’s reward center—but we don’t pathologize those behaviors,” Draayer says. It's also unclear whether any brain changes lead to the development of a dependence on the food, as drug abuse can. Another important difference is that unlike with substance addiction, we don’t experience withdrawal symptoms when going without certain foods, and repetitively eating a food doesn’t increase our tolerance to it. Regardless, food is a necessary part of daily life (as well as an opportunity for joy, connection, pleasure, and more), not a toxic substance, making abstinence a misguided approach that almost invariably backfires. “Unlike substances where abstinence may be appropriate, food is biologically necessary, and overly restrictive approaches frequently worsen one’s relationship with eating,” Ritter says. The evidence-based path to food addiction recovery Firstly, if you feel like you’re addicted to food, it could be a sign of an eating disorder. Binge eating disorder is the diagnosis most often associated with feelings of food addiction, but it can also be associated with other eating disorders. Food addiction can also be linked to disordered eating, which is harmful on its own, even if you don’t have a full-blown eating disorder. The best way to find out if an eating disorder is driving “addictive” food behaviors is to talk to your doctor or a trusted mental health professional about your concerns. You can also take a self-assessment, or get a free consultation with an Equip team member or professional specializing in eating disorders. Be wary of programs that offer food addiction treatment, as they are likely not evidence-based. If an eating disorder isn't present, it's still important to get support to overcome any feelings of food addiction. Just remember that true healing isn't about how to stop food addiction through willpower, but about overcoming this feeling of additction by breaking the binge-restrict cycle. This is the foundation of effective food addiction recovery, and the strategies below can help you get there. “The most effective, evidence-based interventions focus on addressing the underlying patterns, not eliminating specific foods,” Ritter says. Some key tenets of “food addiction” treatment include: Consistent, adequate nourishment (structured meals and snacks to regulate physiology) Cognitive behavioral therapy (CBT or CBT-E) to address thought patterns and eating behaviors Dialectical behavior therapy (DBT) for emotional regulation and distress tolerance Exposure-based approaches to reduce fear and reactivity around specific foods Trauma-informed care Medication support, when clinically appropriate Here are some other effective, expert-endorsed strategies to explore. Diversify your coping tools Despite what diet culture says, using food as a coping tool is not inherently negative. However, it becomes an issue when eating is your only way to manage hard feelings and it doesn’t feel like a choice. As eating disorder therapist Anita Johnston explains, when you eat without physical hunger, you cross over into emotional symbolism: Food becomes a metaphor for what we’re needing emotionally. For instance, some people will overdo it with sweets when they’re needing love and comfort. Eating this way can satisfy emotional needs in the short-term, but they leave the root problems unaddressed, and this can become a harmful pattern of behavior. With the help of a therapist or trusted friend, you can identify what food symbolizes for you when you’re eating without physical hunger and feeling out of control, and then brainstorm ways to meet your underlying emotional needs. For the example above, people may find that spending time with their partner or pet or wrapping themselves in a blanket with a warm drink provides them the comfort they’re seeking in food. Eat adequate meals and snacks Since restriction is often what’s driving feelings of food addiction and lack of control around food, it’s key to eat consistently. Take stock of your daily eating habits and consider if you’re skipping meals, eating meals that are too small or unsatisfying, regularly missing a main macronutrient (carbs, fat, or protein), or foregoing snacks even when you’re hungry between meals. If you find gaps in your eating, work toward increasing and balancing your intake to meet your body’s needs throughout each day. “Regular meals and snacks that include carbohydrates, protein, and fat help stabilize blood sugar, reduce biological drive to overeat, and rebuild trust with the body,” Ritter says. Learn about food habituation “Habituation is a natural process that occurs when we are repeatedly exposed to the same stimulus,” Draayer explains. “Over time, our previously strong response to that stimulus decreases.” When it comes to foods that feel addicting, the more you casually expose yourself to them (instead of swearing them off), the less emotionally charged your experience becomes—cookies are just cookies, pizza is just pizza, and chips are just chips. “Of course, certain foods will still be enjoyable, but there’s not that intense control and food obsession,” Draayer adds. “Instead, it becomes a more neutral experience, empowering people to regain control and giving them the ability to make food choices that are nourishing and satisfying.” Keep in mind that if a food has been off-limits for a long time, a “honeymoon phase” (where you allow yourself to have however much you want of it) may be necessary before it becomes neutral.  Developing a healthy relationship with food One of the most powerful ways to address any feelings of food addiction is to get curious about your relationship with food. “Much of the time, people need to work on their mindset around the foods they feel addicted to,” Feldman says. “Exploring their relationship with these foods often uncovers beliefs rooted in diet culture, and working on unpacking these beliefs is extremely beneficial.” Consider the following tips to root out harmful diet culture beliefs and develop a positive, balanced attitude toward food. Work with a dietitian If working toward food adequacy, food habituation, and your food relationship seems overwhelming, an eating disorder dietitian can help make the process more manageable. “There isn’t a one-size-fits-all way in which we eat, and dietitians can help people sort through all the information that is out there and find what works and feels good for them,” Feldman says. Eat for satisfaction Feeling full after a meal isn’t the same thing as feeling satisfied. “Satisfaction comes from pleasure,” Sturtevant says. “When we ask people about this in workshops, their most satisfying meals are about who they were with, where they were, the ambiance, the music, the service—it's more than just the food.” She encourages clients to eat for satisfaction at least once a day. Discover what you like “A lot of clients can't tell me if they like what they're eating. Because it hasn't been about liking it, it's about making the ‘right’ choice and how many carbs are in it or whatever external directives,” Sturtevant says. Experiment with new foods, even if that means trying a different flavor or brand of something, and listen to how your body reacts. Let go of limitations Sturtevant suggests making a list of your favorite foods and enjoying as much as you want, as often as you want. This may feel scary at first, but most people find that, over time, this freedom (as well as stopping any overall restriction) eliminates addictive behaviors. “Moving away from ‘good’ vs. ‘bad’ food thinking and practicing flexibility decreases urgency, guilt, and the sense of loss of control around eating,” Ritter says. “Just as importantly, I emphasize removing blame. What often looks like a lack of control is, in many cases, the body and brain doing exactly what they are designed to do, which is protect against deprivation, whether physical or emotional.” Moving forward with confidence If you're concerned that you're addicted to certain foods, you're not alone, and it’s possible to develop a healthy, neutral relationship with all foods. Working with professionals like eating disorder-informed dietitians and therapists disordered can help you unpack what's fueling your behaviors, develop new skills to manage your emotions, and help you change your relationship with food to one that's more pleasurable and positive. You can schedule a call with an Equip team member to get connected with experts who can support you on this path.  “When those underlying needs are consistently met, the intensity and frequency of these ‘addiction-like’ eating behaviors often decrease significantly,” Ritter says. “While the term ‘food addiction’ resonates with many people’s lived experience, the evidence suggests that these patterns are better understood and more effectively treated through a lens of nutrition adequacy, behavioral patterns, and psychological support, rather than the inherent addictiveness of food itself.” By learning the true roots of addictive eating behaviors, being compassionate with yourself, and enlisting professional support, you can build eating habits that feel sustainable, nourishing, and joyful. It can be challenging, but it’s so worth it.  FAQ What is food addiction and is it a real eating disorder? When people discuss food addiction, most are talking about having cravings for highly enjoyable foods and feeling a lack of control when eating these foods, perhaps even bingeing on them. That said, food addiction is not a real diagnosis. There's no standard definition of the term, and research on this issue is inconclusive. Many studies fail to account for people's past relationships with food, including any disordered eating, and just because a food “lights up” the same parts of the brain as drugs doesn't make it addictive (many other things “light up” these brain regions, like cuddling a pet). Food addiction is not an eating disorder diagnosis, but it could be a sign of an underlying eating disorder. What are the main food addiction symptoms? Food addiction is not an official diagnosis, so there is not one set of symptoms. Rather, when people speak of food addiction, they are often referring to an intense preoccupation with food, feeling out of control around food or certain foods, or both. How can I stop my food addiction? The first step toward stopping food addiction is to get evaluated for an eating disorder. If an eating disorder isn't present, you should work with a non-diet dietitian who can help you develop a more positive, balanced relationship with food and unpack any underlying concerns that might be contributing to feelings of addiction. One of the most important parts of treating food addiction is establishing regular eating habits, which helps reduce food noise and stop the binge-restrict cycle. How can dietary restriction lead to addiction-like behaviors? Dietary restriction can lead to addiction-like behaviors because many times people set very rigid rules about what they’re not allowed to eat and, understandably, can't abide by those rules. When this happens, they may feel guilt and shame and then set even stricter limits on what they can and can't eat and in what situations. This continues until a person's primal hunger takes over, and they may binge or eat more than normal, simply because their body needs the nutrition, and then the cycle continues. What are the psychological factors behind perceived food addiction? Factors such as trauma, stress, early-life adversity, and mood dysregulation have been linked to perceived food addiction. In these instances, people may be using food as a tool to cope with their feelings. What are effective alternatives to food addiction treatment? If you’re concerned you may have food addiction, it's best to get screened for an eating disorder. Even if you don't have one, working with an experienced registered dietitian and therapist can help you create an adequate meal and snack plan that prevents compulsive eating behaviors, and also work to develop tools to properly address any underlying emotional needs. How can I develop a healthier relationship with food? Given today's diet culture, many people can benefit from developing a healthier relationship with food. There are many ways you can do this, including: Eating for satisfaction (rather than simply fullness) at least once a day Trying new foods to discover what you like Eating adequate meals and snacks throughout the day Working with a dietitian to help you create a plan that feels good for you]]></content:encoded>
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            <title><![CDATA[Eating Disorders Increase In the Postpartum Period. Here’s Why (and What to Do)]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/postpartum-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/postpartum-eating-disorders</guid>
            <pubDate>Thu, 07 Sep 2023 19:57:00 GMT</pubDate>
            <content:encoded><![CDATA[I’ll never forget the moment I saw my postpartum body for the first time. It was mid-morning, several hours after I’d given birth to my daughter, when I finally made my way from the hospital bed to the small bathroom and was taken aback by my reflection. The big, firm belly where my baby had lived was gone, replaced by loose skin that flopped over disposable hospital underwear; my breasts had swollen to a size I’d never seen before; even my arms and legs looked different: softer, weaker, bigger. I’d been prepared for the bodily changes of pregnancy, but it wasn’t until that very moment that I’d considered my post-birth body. Staring at my exhausted reflection—emotionally and physically overwhelmed by the whole business of childbirth, not having slept in nearly 36 hours—I had an inkling of a thought: this new body might be a problem for me. I’m in recovery from anorexia, and knew that pregnancy could present the opportunity for eating disorder thoughts and behaviors to resurface (luckily for me, they hadn’t). But, as I would soon learn, the postpartum period was a whole different animal, with arguably greater risk for those in recovery from or vulnerable to eating disorders. Ultimately, I made it through okay, with some hiccups along the way. But had I understood the contours of postpartum eating disorders—and what to do to protect myself and my recovery–it would have been made for a smoother, less fraught transition. And I’m far from alone in this experience. How common are postpartum eating disorders? As a whole, research suggests that the postpartum period is a high-risk time for eating disorders. Depending on which study you look at, the rate of eating disorders among those who have recently given birth is up to 13%, as compared to about 5% for pregnant people (and a baseline rate of 9%). And for those who self-reported more eating disorder thoughts and behaviors before becoming pregnant, the risk of disordered behaviors in the postpartum period becomes even greater. It’s important to note that the research here is still somewhat limited. While clinical studies suggest that the postpartum period is a high-risk time for the recurrence of anorexia and bulimia, there are gaps in our knowledge. For instance, not much is known about the recurrence of other eating disorders, like OSFED or binge eating disorder, during the postpartum period, nor the prevalence of net-new eating disorders after giving birth. Still, these numbers are sobering, and an indication that we need to pay closer attention to this brief but consequential period of life. As one paper put it, “seriously disordered behavior during, and especially after, pregnancy may be more common than previously thought.”  Eating disorders in pregnancy vs. the postpartum period Equip Senior Research Manager Jessica Baker, PhD, explains that most of the existing research compares postpartum eating disorders to eating disorders during pregnancy (sometimes referred to as 'pregorexia') rather than pre-pregnancy, and so that’s where we must look to draw any conclusions (at least for now). This body of research, she says, has largely found that for women with anorexia and bulimia, pregnancy leads to a remission of eating disorder symptoms—in one particular study that she cites, 75% of women reported no symptoms by the third trimester. Indeed, while some eating disorder symptoms (like binge eating) can increase during pregnancy, they generally diminish during those nine months. “However,” Baker says, “for the majority, these symptoms return during the postpartum period.” Most studies show that while eating disorder attitudes and behaviors—like restricting, purging, and weight concerns—decrease throughout pregnancy, this reprieve tends to be followed by a backlash. Post-birth, eating disorder symptoms return to baseline levels, or may even be more intense. For me, I saw this exact dynamic play out in my own mind: throughout pregnancy, any lingering body image distress or food anxiety disappeared, only to return with a vengeance once my daughter was outside my body.   Read: Can Pregnancy Trigger an Eating Disorder?  Why the postpartum period is such a high-risk time for eating disorders So why, exactly, do eating disorder symptoms tend to spike during the postpartum period? There’s not one answer, but rather a confluence of different factors that can create, for some, a perfect storm for an eating disorder to surface or resurface. “Bounce back” culture Society puts many demands on new mothers, but one is louder and clearer than others: your body should look like you never had a baby. And fast. This pressure is almost universally felt—according to one study, 75% of women are concerned with weight retention in the first month after delivery, and 70% are attempting to lose weight by four months postpartum—but it can be particularly pronounced for people in eating disorder recovery. After delivery, those with an eating disorder history may struggle more intensely with pregnancy-related weight gain and a desire to lose weight, setting themselves up for disordered eating and rigid food rules that can lead to a relapse. “The drive to be that old you, to have the same old body, can fuel disordered eating behaviors,” says Equip dietitian Stephanie Kile, RD. “Having an eating disorder in my past, I was worried that the urge to ‘bounce back’ would set in, and that seeking the praise of comments like ‘you don’t look like you had a baby!’ would make my eating disorder flare up.” Baker emphasizes the potentially harmful influence of societal pressures, explaining that “physically, post-birth, people experience fluctuations in weight and changes in body shape that don’t align with the thin ideal. One of the most consistent and potent risk factors for an eating disorder is body dissatisfaction, and reports suggest that about 50% of people are dissatisfied with their weight postpartum.” Coming to terms with an unfamiliar body Even putting aside a desire to lose weight and pressure to attain certain body ideals, many people are uncomfortable with their postpartum body simply because it’s completely unfamiliar. I know I felt that way—as if I was looking at someone else’s body when I looked in the mirror. Molly Menton, VP of Clinical Operations at Equip, describes a similar experience: “By the time I got pregnant with my twins, I’d been in recovery for a good 15 years and was really comfortable in my skin. I was excited about pregnancy and not concerned about the weight gain. But the postpartum period was challenging because I expected my body to feel the same as it used to pre-pregnancy, but it didn’t. It felt softer, spongey, loose, and my joints were like jelly. I couldn’t move in the same way that I used to, my bladder didn’t work anymore, and my breasts were giant and leaky. It felt like an entirely new and different body. I thought weight gain would be the ‘thing’ that was hard about the postpartum period, but the hardest part was how different and foreign my body felt. I didn’t recognize my body, not just size and weight but composition, capabilities, and tolerance. I had new pains and aches that I’d never had before, my endurance was low, and it felt like nothing worked right anymore. I had no idea how long this period would last. Would I ever go back to my old body? Would things ever feel normal again?”  Postpartum depression Research shows that people with eating disorders have an elevated risk of developing postpartum depression or anxiety—according to one study, up to 50% of those with an eating disorder history experience postpartum depression. This plays into postpartum eating disorders because eating disorder behaviors can serve to regulate negative mood and emotions. In other words, when a woman experiences depression after giving birth, she may use behaviors like restricting or purging as a coping mechanism, raising her risk of developing or relapsing into a full-blown eating disorder. Psychological stress It’s not a secret that parenting a newborn is hard. On top of recovering physically from labor and delivery, there are sleepless nights, never-ending diaper changes, and crying bouts that you can’t seem to stop or understand. And beyond those immediate demands, there are more nebulous and even existential concerns: who are you, now that you’ve had a child? What does your relationship with your partner look like? Will you be a good parent? What does being a good parent even mean? These questions and concerns are a heavy weight to carry (especially when you’re running on little to no sleep), and, again, the eating disorder can come to the rescue. For those in recovery, it may be tempting to return to behaviors that you know help turn down intense emotions. I remember breastfeeding after a particularly long night, feeling exhausted and irritated at my husband for some long-forgotten reason, and finding comfort in the simple act of opening up MyFitnessPal to log the foods I’d eaten that day. Though I knew how harmful that behavior could be for me, it allowed me to temporarily escape from my emotional and physical distress. This, ultimately, was a blip for me, and not the first step on the road to relapse, but it clearly illustrates how that road is paved. Hormonal shifts Baker explains that hormones play an important role in the fluctuations of eating disorder symptoms during pregnancy and the postpartum period. “During pregnancy, estrogen and progesterone concentrations progressively increase until childbirth, and both hormones abruptly decrease postpartum,” she says. She goes on to explain that research in non-pregnant women has established a strong relationship between ovarian hormones and eating disorder symptoms, showing that the higher someone’s estrogen levels, the lower their eating disorder symptoms (this is particularly true of binge eating). This pattern parallels what’s been observed in pregnant and postpartum samples: as estrogen increases, eating disorder symptoms decrease; and when those levels plummet after childbirth, the symptoms come roaring back. “It makes logical sense that ovarian hormones are involved in the development of disordered eating behaviors, given that decades of animal study research has established that estrogen plays a role in ‘normal’ food intake,” Baker says. Of course, this doesn’t happen to every person who becomes pregnant: it’s thought that a certain subset of biological females may be more sensitive to changes in ovarian hormones, and that this subset overlaps with those who have an eating disorder history or are at risk for developing an eating disorder. Breastfeeding For many, breastfeeding is a big part of the postpartum experience. And while it can be deeply rewarding and meaningful for some, it can be incredibly difficult for others—and it presents its own risks for eating disorder onset or relapse. Perhaps most notably, our culture likes to present breastfeeding as an effective way to lose weight after pregnancy (a claim based on the fact that it takes a lot of calories to produce breast milk). Not only does this mentality reduce a special bonding experience to a weight loss gimmick, but it can also lead down a road to disordered behaviors and negatively impact a person’s ability to breastfeed in the first place. “The idea that breastfeeding will help you lose weight isn’t entirely true due to the increased nutrition needed to help milk production. Plus, the body tends to hold onto some weight to make sure you can continue to produce milk safely—think of it as a reserve for the body to dip into in case of emergency,” says Kile. “Thinking of breastfeeding as a means to weight loss can open the door for an eating disorder postpartum. The eating disorder will want to lose weight on a quick timeline, which isn’t always compatible with breastfeeding. You need adequate nutritional intake from a variety of nutrients to make sure milk composition is what it needs to be for the baby; if intake is too low, it could negatively impact milk supply.” Research seems to bear this out, showing that mothers with a history of anorexia were more likely to stop breastfeeding before six months postpartum—and while this may be for a variety of different reasons, inadequate milk supply is a likely culprit. This was the case with me. While I had no problem meeting my nutritional needs while pregnant, I struggled to meet my high caloric demands while breastfeeding (I remember that little eating disorder voice, having been quiet for so many years, telling me that I didn’t have an “excuse” anymore, because the baby was no longer inside my body). As my food intake dwindled, so did my milk supply. I’d set a goal of breastfeeding for one year: by five months, I needed to supplement with formula; by eight months, I stopped breastfeeding completely. It’s important to note that someone’s choice about whether or not to breastfeed is theirs and theirs alone. Nobody should feel guilt for not breastfeeding, whether it’s by choice or otherwise. However, for those who do want to breastfeed, it’s important to understand the impact that disordered eating can have on the physiological process.  How to protect against postpartum eating disorders Eating disorder relapse is by no means inevitable during the postpartum period—but it’s vital to acknowledge that this is a high risk time for those with an eating disorder history, as well as those who may be vulnerable to a new onset eating disorder. Thankfully, there are things you can do to bolster against the risks and keep eating disorder thoughts at bay after giving birth: Remember that your body just went through a significant ordeal. No matter how your labor and delivery goes, childbirth is, in many ways, a massive physical trauma, and your body deserves both gratitude and grace afterward. “The body needs time to heal. The placenta leaves behind a wound the size of a dinner plate. Your organs need to move back into place, the uterus needs to shrink, and all of that takes proper nutrition to make sure your body is fueled to properly heal,” says Kile. “Give yourself permission to eat, and eat often. Your body just went through a huge change.” Make yourself comfortable. We mean this literally: don’t race to get into pre-pregnancy clothing, or squeeze yourself into items that just barely fit. Continue to wear your maternity clothes if you need to, and focus on what lets your body feel good during this physically taxing time. “Find comfortable clothes, ease back into movement, and accept that your body feels different because it is different: you built a baby!” says Menton. Curate your social media. “Bounce back” messages exist everywhere, but social media may be one of the richest sources. Especially if you’ve been flagged by these platforms as a new parent, you’re likely to be inundated with influencers and content centered around losing the baby weight. Silence this noise by muting, unfollowing, or blocking any accounts that make you feel bad about your body. Talk to your support network. When you’re spending all your waking moments with a newborn, it’s easy to become isolated from friends, family, and other loved ones. This isolation can allow eating disorder thoughts to grow louder and remain unchallenged—so proactively counteract this risk by sharing your experience with others. “Talk to someone about your struggles, the goals you have in mind, and remind yourself that your journey doesn’t need to look like anyone else’s journey,” says Kile. Put the right support team in place. “People with a current or history of an eating disorder should find a licensed provider they’re comfortable sharing this information with, so that they can implement proper monitoring,” advises Baker. “Speak to providers about closed weights. Reconnecting with a previous therapist or dietitian for support throughout pregnancy and postpartum can be useful to develop a plan, work through triggers and stressors, and have an outlet.” Be patient with yourself—and your body. “I wanted to get back to my pre-baby weight, but realized that caring for twin newborns, breastfeeding, sleep, and recovering from birth was a Herculean task all on its own,” says Menton. “I intentionally stayed very focused on being patient and letting my body figure out where it would settle after this major milestone.” These guidelines can make it easier to navigate any eating disorder thoughts or behaviors that may resurface during the postpartum period. But, of course, it’s also possible that these precautions won’t be necessary at all: as research has found, some women with eating disorders during pregnancy actually reach recovery postpartum, reporting that they no longer have the time or desire to engage in eating disorder behaviors, and that they don’t want to negatively influence their children by modeling disordered actions.  While I write this, I’m 37 weeks pregnant with my second child. As with my first pregnancy, I’ve loved watching my body change and grow; but, given where my mind went after my daughter was born, I’m beginning to get nervous about the thoughts that might crop up once the baby is here. This time, though, I know the risks. Having lived through the newborn phase once before, I know how fleeting and precious this time is, and will fiercely protect my ability to be present throughout it, without eating disorder thoughts ripping me out of the moment. Armed with the knowledge and advice above, I’m hopeful that I—and any pregnant or postpartum person who reads this—will be able to do just that. ]]></content:encoded>
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            <title><![CDATA[How Restriction Changes You: Unpacking the Minnesota Starvation Experiment]]></title>
            <link>https://equip.health/articles/understanding-eds/minnesota-starvation-experiment-restriction</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/minnesota-starvation-experiment-restriction</guid>
            <pubDate>Mon, 04 Aug 2025 11:46:00 GMT</pubDate>
            <content:encoded><![CDATA[As a registered dietitian and health writer, I typically rely on recent research to guide my practice and writing. However, there’s sometimes what’s called a landmark study from many years ago that influences the nutrition field significantly enough to guide clinical practice and be a constant in clinician-to-patient conversations. In the field of eating disorders, that study is the Minnesota Starvation Experiment. The Minnesota Starvation Experiment—initially titled The Biology of Human Starvation—was performed by scientist Ancel Keys and his team, and is considered the landmark study that fundamentally shaped our understanding of the wide-ranging and serious effects of food restriction. The purpose of the experiment was to gain insight into the physical and psychological effects of semistarvation (or severely undereating) that occurred in World War II and understand how to help renourish civilians that were malnourished during the war. “The goal was to improve how aid was given to people in Europe and Asia who had suffered from famine after the war,” explains Equip lead dietitian Tucker Reiley, MS, RDN. The experiment revealed jaw-dropping truths about the far-reaching consequences of food restriction, and helped illuminate what’s required to restore health and well-being. Today, we’ll delve into the study and its findings, explore the science of food restriction and its effects, unpack what the study tells us about eating disorders, and see how its findings could help you or your loved one in recovery.  Overview of the experiment and its findings In 1944, Keys and his colleagues recruited 36 male conscientious objectors (those who opted out of serving in the war) to participate in semistarvation. All participants were physically and mentally healthy at the start of the experiment. The study included three phases: Standardization (3 months): The men received a calorically adequate diet, and they reported feeling well-fed, energized, and engaged in their lives and community. Semistarvation (6 months): Participants ate about half of what they needed, with their diet reflecting that in war-torn parts of Europe: items like potatoes, turnips, rutabagas, macaroni, and dark bread. They were also required to walk a significant amount each week and expend a certain amount of energy. “The researchers wanted the participants to lose around 25% of their body weight before they explored renourishment strategies,” Reiley explains. The semistarvation period revealed many drastic changes to the participants’ minds and bodies: Physical changes, like heart muscle mass reduction, decreased basal metabolic rate, decreased cold tolerance, fatigue, hair loss, dry skin, increased hunger, decreased hormone levels and libido, difficulty sleeping, dizziness, and blacking out. Mental side-effects, like decreased alertness and focus, impaired decision-making, increased obsessive thoughts and rigid thinking, and even psychotic episodes. Emotional consequences, like increased depression, dysregulation, anxiety, and irritability. Social changes, like isolation and withdrawal, social insecurity, decreased sense of humor, strained relationships, and declining personal hygiene. Behavioral shifts, like smoking, biting nails, hoarding and stealing food, obsessing over recipes and cookbooks, binge eating, meticulous meal planning, excessive condiment use, and food preoccupation. Rehabilitation (3 months): Men were provided one of four rehabilitation diets with higher, varying energy levels, and results showed the most calorically dense intake was most effective at reversing malnutrition. “When it came time to renourish the study participants, pre-starvation levels of dietary intake did not support weight restoration and recovery of normal functioning. Instead, participants required substantially more food than they had ever normally eaten to restore weight,” Reiley shares. “The process of weight restoration had its own set of discomforts and side effects, such as GI distress, elevated metabolic rate, and refeeding syndrome.” The men also noted that after the restriction period ended, they initially experienced a loss of control around food during refeeding. Some described a constant urge to eat, while others reported episodes of binge eating—something they had never experienced prior to the experiment. Over half of the participants said they engaged in overeating. Estimates of full recovery time ranged from two months to two years, and none of the men believed their participation had any lasting negative effects on their health.  The science of restriction: the "why" behind study participants’ drastic mind-body changes It’s clear that semistarvation caused the men in the study to experience drastic, holistic changes—but you might be wondering why that happened. “Every living cell in the human body requires energy from food to perform its functions, and when the body doesn't get its needs met consistently, the whole system has to make adjustments to prioritize survival,” Reiley explains. “The lack of energy input means that cells responsible for hormone, neurotransmitter, and antibody production cannot do their jobs effectively, which means all sorts of processes in the body and brain are impacted, from immune function to maintenance of bone integrity to emotional regulation and impulse control.” Here’s a breakdown of why food restriction causes such serious physical, mental, emotional, and behavioral side-effects: The physical effects of food restriction Since the heart is primarily composed of muscle, prolonged undernourishment can cause it to weaken, leading to dangerously low blood pressure and heart rate. As the heart's ability to pump blood declines, symptoms like fatigue and shortness of breath may develop. Additionally, malnutrition can interfere with the heart’s electrical system—the force that drives each heartbeat—which, in severe cases, can be life-threatening. Another serious consequence of restriction is nutrient deficiency, which can cause various health problems like anemia (often due to iron deficiency), cold intolerance, hair thinning, skin issues, insomnia, weakened bones, dizziness, persistent fatigue, and a compromised immune system. When the immune system is suppressed, the risk of infections, colds, flu, and other illnesses increases. Furthermore, a 2022 research review found that low energy availability due to restriction can suppress the entire reproductive hormone system. In females, this leads to a drop in estradiol and progesterone—two key hormones for reproductive health. In males, inadequate energy intake disrupts testosterone production, resulting in fatigue, reduced libido, sexual dysfunction, and decreased bone mineral density. In short, when the body doesn’t receive enough fuel, it conserves energy by prioritizing essential functions (like maintaining heartbeat and breathing) while shutting down less critical systems such as reproduction.  The mental and emotional effects of food restriction Food restriction—often accompanied by malnutrition and significant weight loss—can contribute to or intensify depression and anxiety by disrupting brain chemistry. Malnutrition may damage brain tissue and result in deficiencies in key nutrients such as vitamin B12, folate, and zinc, which is linked to depression, cognitive decline, and irritability. Malnutrition can also reduce the production of dopamine and serotonin, two hormones critical for mood regulation, potentially worsening symptoms of both anxiety and depression. In addition to making it difficult to focus in demanding environments such as work or school, food restriction can interfere with managing daily responsibilities and contribute to brain fog. A 2021 meta-analysis found that anorexia—which often involves chronic restriction—is associated with cognitive deficits, including notably reduced memory performance. The behavioral effects of food restriction Food obsession and disordered food behaviors are usually a direct result of food restriction, because “there is an instinct to focus on what we need to survive,” says dietitian Katie Gilder, MPH, RD. “Not having a basic biological need like hunger met is of course going to distract someone from being able to focus on other things, and will lead to a hyperfixation on ways that this need could be met until it is,” she explains. Gilder also points out that when people have the types of food (not just the amounts) controlled, scarcity mindset ensues. “No foods that were simply for enjoyment were provided, so not only were their physical needs not being met, but with the variety of foods being limited as well, it makes sense that the men started to be obsessed with recipes and pictures of food,” she says. “There was even one man who was ‘kicked’ out of the study for sneaking out and bingeing on ice cream, and I think it says a lot that he didn't just sneak out and eat anywhere, but specifically a food that was totally absent in the meals they had been provided.” Another man in the study was so tempted by the delicious smell of a bakery as he walked past that he bought a dozen doughnuts, gave them to children, and watched them eat. Other behavioral issues that may occur because of food restriction include social isolation, decreased engagement in work or school and hobbies, decreased ability for daily functioning, and other disordered food behaviors like hoarding, hiding, or stealing food. “The brain's reward systems become fixated on food and coping with the psychological stress of the threat of starving to death, sometimes through behaviors that further negatively impact the person's health and well-being,” Reiley adds. What the experiment tells us about eating disorders While this study isn’t about people with eating disorders, it offers some profound key points that can be applied to eating disorders and recovery. Restriction is at the root of many disordered behaviors The cause of an eating disorder is often multi-faceted, however restriction is present across diagnoses and often leads to a number of eating disorder behaviors—many of which are mirrored in the study’s semistarvation side-effects. “The men in the study who had no prior predisposition to an eating disorder fairly quickly showed similar signs to those we see with many restrictive eating disorders, like obsessive thinking about food, talking about food constantly, and looking at recipes for foods they aren't able to eat,” Gilder explains, “so we can think about how this is evidence that no one with an eating disorder chooses to become so entrenched in some of the thoughts and rituals with foods.” Rather, the thoughts are a direct result of the restriction. Food restriction is a slippery slope Not only does food restriction lead to disordered behaviors, it can also make it more difficult to see that those behaviors are harmful or undesirable. “The more malnourished the brain gets, the more difficult it can be for the person to recognize the problem or interpret reality accurately and can result in a slippery behavioral slope,” Reiley explains. Nutrition rehabilitation is hard, to say the least Although the men in the study didn’t have eating disorders, many of them said the nutrition rehabilitation period was the hardest part of the experiment. It took many of them a long time to return to baseline and feel like themselves again—which suggests that this process would be even harder for a person struggling with an eating disorder. In addition to healing from the side effects of malnourishment, people in recovery from eating disorders often need to heal from trauma, body image distress, and other emotional issues. The study also highlights the necessity of eating an abundance of food (often more than what many may consider “normal”) to fully reverse side-effects of food restriction. “Consider how difficult it would be for someone who deeply fears eating a normal amount of food or gaining weight to need to eat significantly more than their peers and need to gain significant amounts of weight for their brain to start healing, all while the changes they are making physically feel worse due to the GI side effects and heightened anxiety,” says Reiley. Recovery is entirely possible Although it took them a while to feel normal afterwards, the men in the study emerged from the haze of semistarvation and returned to themselves, their hobbies, jobs, and families. One man said he knew he was healed once his sense of humor fully returned. One of the most rewarding parts of being an eating disorder dietitian is getting to witness people return to their true selves and their full lives, which they wouldn’t be able to do if they were still malnourished and living in energy deficits.  How the Minnesota Starvation Experiment can help you or your loved one in recovery In my practice, I’ve shared the Minnesota experiment and its findings with clients and their families to help them understand how profoundly food restriction impacts their minds, bodies, and emotions, and that changes they’re experiencing are not their fault or something they’re choosing. “An eating disorder is an incredibly interwoven tapestry of the body-wide malnutrition injury and its direct physiological side effects, as well as the way the human brain attempts to adapt to scarcity and the chronic stress of starving,” Reiley explains. “When someone no longer recognizes themselves or their loved one with an eating disorder, it's not the fault of the person with the eating disorder—it is the eating disorder and the havoc it has wrought in that person's life.”  Remember, eating disorders are (maladaptive) coping mechanisms, so the food preoccupation that comes with food restriction and living in an energy deficit often “helps” someone with an eating disorder avoid other issues in life that may be stressful and feel outside of their control. This is why developing healthy coping skills in therapy is critical. Also, to an eating disorder sufferer, obsessively thinking about food can feel like it’s all there is to their personality and existence, which can make recovery feel daunting (“Who am I without my eating disorder?”). However, remembering that the food obsessions are born from restriction can be reassuring and help people to understand that recovery is about reconnecting with their true interests and core values. If you’re a parent with a child or teen, keep in mind that, like the study shows, food restriction causes food obsession and preoccupation with cookbooks or recipes. Gilder cautions against using such thinking patterns and behaviors even if it seems authentic. “We want to have parents take back control over the planning, cooking, and often plating of foods for a period of time, and then if after their child has been re-fed they are still really into cooking, we can be super open to that,” Gilder explains, “but since we know there is a correlation between the underfed brain and the obsession with food, I do want to make sure we interrupt that at first.” Also, keep in mind that your child or teen’s mealtime behaviors (like shredding food, eating very slowly, or becoming very emotional) are in fact results of starvation, not defiant acts.  Another significant point I often share from the experiment is that nutrition rehabilitation and weight restoration are necessary to recover from eating disorders and eventually heal from all their side effects—and it’s impossible to heal mentally and emotionally if you haven’t restored your physical health. “The brain is the slowest organ to heal from the systemic malnutrition injury that restrictive eating disorders wreak on their victims, and being able to get the body out of a weight suppressed state is a critical part of healing the brain to the point that it can effectively engage with the difficult therapeutic work that recovery asks of people,” Reiley says. “My hope is that people are able to recognize that by addressing the restriction, there is a path forward to get back to who they were before the eating disorder took over.” If you or your loved one is struggling with an eating disorder, know that recovery (while often difficult) is possible, and like the Minnesota experiment shows, the system-wide impacts of restriction are reversible. Reach out for help from a professional team who will guide you to restoring your or your loved one’s physical, mental, and emotional health and well-being. ]]></content:encoded>
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            <title><![CDATA[What Is Diet Culture?]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/what-is-diet-culture</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/what-is-diet-culture</guid>
            <pubDate>Thu, 19 Jan 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[ If you’ve spent any time in the world of eating disorders, you’ve definitely come across the term “diet culture” a few times. There’s a reason for that: diet culture is a powerful force that affects all of us, whether we realize it or not, and challenging it is a big part of recovery. But what is diet culture, anyway? Read on to understand what, exactly, we mean when we talk about diet culture and more details about the connection between diet culture and eating disorders. What is diet culture? Research has defined diet culture as a societal norm that considers thin bodies to be more desirable than other body types. Not only are thin bodies deemed “better” in aesthetic terms, they’re also thought of as more “righteous” and “superior” than large bodies, which are thought of as “immoral” and “inferior.” Diet culture is characterized by myths about health and food, like the false notion that weight is equivalent to—and a direct representation of—health. Because diet culture values thinness above all, it also puts the pursuit of thinness on a moral pedestal. In other words, if you’re not thin or aspiring to be so, diet culture works to make you feel guilty, less worthy, or even oppressed. This belief system has been associated with negative outcomes, and, along with other factors, can be a contributing cause of eating disorders. Some of the core tenets of diet culture are: Considering weight loss to be inherently good and desirable for everyone Conflating thinness with health Encouraging external rules about how much, what, or when to eat Deeming certain people more or less worthy based on their body size Holding up thin privilege, which makes it difficult for people in large bodies to access jobs, benefits, basic comforts, and more Positioning exercise as compensation for eating or punishment for being fat Establishing certain foods and ways of eating as “good” and others as “bad” Promoting excessive exercise and judging those who work out less Diet culture is prevalent and appears to be ever-growing. According to the Centers for Disease Control and Prevention (CDC), between 2015 and 2018, ​​17.1% of U.S. adults aged 20 and over were on a special diet on a given day. In 2024, a Marketdata LLC analysis reported that the U.S. weight-loss market was estimated to have grown to a historic peak of $90 billion in the previous year, boosted by sales of GLP-1 prescription weight loss drugs. How to spot diet culture Unfortunately, diet culture is everywhere in the world we live in—and the more you know what to look for, the more you’ll realize how inescapable it is. Equip dietitian Emily Tauschek, RDN, CN, describes some of the ways that diet culture exists in everyday life: “Diet culture shows up as telling someone they don’t look fat—which implies that being fat is a bad thing—and normalizing disordered behaviors like having coffee for breakfast or drinking water instead of eating.” Some more common examples of diet culture in action include: Complimenting someone’s weight loss Food packaging or descriptions that imply a food’s moral value (“healthy,” “guilt-free,” etc.) The idea that food is “earned” by burning calories through exercise or physical activity Restrictive diets masquerading as not being diets (Noom, Whole30, etc.) Photoshopped images on social media Moralizing food (i.e. saying you’re being “bad” for choosing fries instead of salad) Considering “thin” to be shorthand for “healthy” Body policing (i.e. monitoring, commenting on, or judging others’ bodies) Rebranding diet products or behaviors as “wellness” Social media algorithms that promote posts reinforcing the thin ideal  How diet culture relates to “wellness” Since the early 2010’s, a lot of diet culture has morphed into “wellness,” another system of beliefs that says it has nothing to do with weight loss but, in fact, continues to value thinness above everything else. “In recent years, diet culture has been sneakily disguised as a ‘wellness’ or ‘lifestyle’ change,” says Tauschek. “But these ‘new’ diets still promote rigid eating patterns that ignore your internal hunger cues, have long lists of foods to always avoid, and endorse restricted intakes below your baseline energy needs.” How diet culture affects us Diet culture not only has a huge impact on individual people, it also affects the economy. An estimated 45 million Americans diet every year, and our country spends upwards of $30 billion on diet and weight loss products annually. This means that the diet industry is massive, and it benefits by convincing us that our bodies aren’t okay as they are—that we need to continually consume media and products that will help us become smaller. In other words, for the industry to continue being flooded with money, more people need to feel unworthy; and to make people feel unworthy, diet culture needs to spread. The toxic effects of diet culture Dieting rarely works—evidence suggests that most dieters regain the weight within a few years—but it can have serious and long-lasting consequences. For one, repeated cycles of gaining, losing, and regaining weight can increase the risk of heart disease and insulin resistance. Dieting also has negative cognitive effects, resulting in an obsession with food. What’s more, when you’re continually striving for an unachievable body (and being told left and right that you’re a failure for not achieving it), feelings of unworthiness, guilt, and shame aren’t far behind. Because diet culture is rooted in a framework that idolizes thinness, it perpetuates weight bias—i.e. negative attitudes and stereotypes about people in larger bodies. This bias manifests as weight stigma, or discrimination and prejudice against these individuals. Research shows that weight stigma is linked to disordered eating behaviors and avoidance of physical activity, which can create a harmful cycle of further stigmatization. Diet culture also contributes to weight cycling (the repeated pattern of losing and regaining weight, also known as "yo-yo dieting”). Research has shown a significant link between weight cycling and increased risk of cardiovascular disease, high blood pressure, and all-cause mortality. While it’s important to note that there is a strong association between weight fluctuation and these health outcomes, researchers agree that more studies are necessary to determine whether there is a causal relationship. When it comes to weight stigma and cycling, there are some important myths to be aware of: Myth: Diets work long-term. Fact: After initial rapid weight loss, most people experience a plateau and then progressive regain. This is not due to a lack of willpower, but is driven by physiological responses to weight loss that increase appetite and decrease energy expenditure. Myth: Your body is healthier when you weigh less. Fact: Weighing less does not automatically translate to being healthier, and research has shown that being underweight can lead to worsened anxiety and depression, compromised bone health, weakened immunity, impaired digestion, increased risk for developing an eating disorder, and more. Myth: Shame can help motivate health. Fact: Shaming does not make people healthier—in fact, the stigma perpetuated by shame undermines motivation and promotes anxiety, low self-esteem, and a belief that something is fundamentally wrong with the person. Lasting health improvements are better achieved through compassion, self-acceptance, and intrinsic motivation, rather than negative self-talk or external pressure Can diet culture lead to eating disorders? The short answer is, yes. Research has shown that dieting is the most important predictor of new eating disorders and that food restriction can increase the risk of eating disorders in people who are susceptible to developing them. According to a report by the American Academy of Pediatrics, young people who dieted moderately were five times more likely to develop an eating disorder, and those who followed extreme diets were 18 times more likely. This relationship makes sense, given we know that a negative energy balance (expending more calories than you consume) can be a trigger for certain eating disorders. We also have reason to believe that all eating disorders are ultimately rooted in restriction, which means that dieting is a major risk factor for those who are otherwise vulnerable. Additionally, diet culture is a big contributor to poor body image, and body dissatisfaction has been linked to the development of an eating disorder. “While we may never know a singular cause for a person’s eating disorder, we can’t discount the pervasive nature of diet culture,” says Equip therapist Maddie Friedman, LCSW. “Eating disorders are brain disorders, meaning that they don’t take place in a vacuum without genetic influence. So if we imagine that genetics are the match, diet culture is often the spark, or the environmental trigger that sets an eating disorder ablaze.” Here's a guide on how to tell the difference between a diet vs an eating disorder.  Social media, “wellness,” and diet culture today With the rise of social media, diet culture has unfortunately continued to grow and spread in new ways. TikTok in particular has been found to play a significant and often harmful role in perpetuating diet culture through its algorithm and content trends: interacting with weight loss or "healthy eating" content can quickly lead to an endless stream of similar videos, creating a dangerous feedback loop. Additionally, research has shown that TikTok content glorifies weight loss and frames food in terms of achieving thinness, and that the majority of creators are young, white, and female, with average or thinner-than-average body sizes. Expert voices in nutrition and health are often notably absent from these online conversations, and evidence suggests that exposure to these types of videos could lead to disordered eating behaviors and body dissatisfaction among young users. While it may not be possible to completely avoid social media in our modern world, there are some strategies you can use to help you (or a loved one) identify credible nutrition information and filter out triggering content: Look for content creators who are eating disorder-trained psychotherapists, medical doctors, or registered dietitians (RD). If you find yourself engaging with or listening to the advice of an online expert, do a quick Google search to confirm their legitimacy. Be wary of posts that lack scientific backing. Look for information that is supported by clinical studies and comes from reputable health organizations. Look for signs of misinformation, such as claims of guaranteed, effortless, or rapid results. Actively seek out and follow accounts from creators with diverse body types. Use TikTok’s "not interested" button to tell the algorithm to show you less of the types of content that are triggering, harmful, or not factual. If you’re a parent, consider putting parental controls on your child’s social media accounts (if you want more guidance on protecting your child from harmful social media content, this in-depth article is a good resource). Anti-diet culture: practical ways to push back Diet culture is so strong that it can feel like gravity. But unlike gravity, resisting its pull isn’t futile: while the force of diet culture will likely continue to exist for a while (until we, as a society, can dismantle the industries and systems holding it up), there are things you can do to avoid being dragged down by it: 1. Focus inward Remember that only you are an expert on your body and your unique levels of hunger, fullness, and satisfaction. External diet plans or food rules take the power away from your body’s innate wisdom. 2. Take stock of subconscious beliefs Examine the ways that weight stigma and diet culture have shaped your view of health, nutrition, and fitness; look closely, because you’ve likely been impacted even if you think you haven’t. By building an awareness of how diet culture appears in your own life, you can label it when it shows up, and this simple act can strip diet culture thoughts of some of their power. 3. Diversify your social media feeds “There’s so much information on social media about health and weight that’s simply false, and it’s supported by a billion-dollar weight loss industry that depends on diet culture and weight bias,” says Friedman. As a first step to remove this type of content from your life, get rid of “wellness” influencers who post content that makes you feel bad about yourself or guilty; then take some time to follow people of all body sizes and shapes. Seek out opportunities to hear the lived experiences of people harmed by diet culture and anti-fat bias. It’s also important to cultivate healthy skepticism. Remember, it doesn’t take any certification or training to post a diet tip on Instagram. Don’t assume the information you read or hear from friends and family is true; and, even if it is, don’t assume it needs to impact your life or your choices. 4. Seek the right support If you’re looking for more professional support navigating the world of diet culture, there’s a growing number of Health At Every Size experts who can help. 5. Brush up on media literacy By learning more about how to interpret and understand media, you can start to critically analyze and deconstruct the harmful messages and unrealistic body ideals that promote diet culture. Ask yourself critical questions (like, “who benefits from me believing this post?”) and check your sources, and you’ll begin to see all the deceptive tactics (like digital manipulation and persuasive marketing) that show up in both traditional and social media. 6. Find weight-inclusive care Weight-inclusive care promotes health and well-being at every size, shifting the focus from weight loss to sustainable, health-promoting behaviors. Rather than centering health around the number on a scale, weight-inclusive care can help you build a more positive and respectful relationship with your body. 7. Script responses to shut down body talk Creating pre-written responses, or scripts, to shut down body talk, set boundaries, and redirect conversations is a powerful way to push back on diet culture. For example, if someone provides unwelcome commentary on your food or weight, you can script a response like, "I'm working on having a better relationship with food and my body, so I'd appreciate it if we could talk about something else."  When to seek help Diet culture is inherently dangerous and can quickly spiral into disordered eating for anyone who’s susceptible to developing an eating disorder. It’s important to get help as soon as possible if your focus on food, weight, or body shape begins to severely disrupt your daily life, relationships, and emotional well-being. You don’t need to have a clinical diagnosis to deserve help and support. If you feel shame or guilt around eating, engage in secretive eating or purging behaviors, or compulsively exercise to "earn" food, it’s time to get help. If you or a loved one are experiencing any of these issues, speak to a doctor or an eating disorder professional about your concerns, or schedule a call with an Equip team member. So, what is diet culture? It’s a seemingly inescapable force that strives to make us feel bad about ourselves and our bodies every day. But here’s what diet culture is not: it is not a life sentence; it is not an inevitability; it is not the truth. And as more of us become aware of these essential realities, we can continue to make its force ever weaker.  FAQ What does “diet culture” mean? "Diet culture" refers to a societal belief system that values thinness and equates it with health and moral worth. It promotes restrictive eating, calorie counting, and a constant focus on weight loss, often leading to a negative relationship with food and one's body. Is diet culture toxic or harmful? Why? Yes. ​​Diet culture perpetuates weight stigma by making thinness a moral and social ideal, leading to discrimination against people in larger bodies. This mindset also fuels weight cycling—the harmful cycle of losing and regaining weight—which can have negative effects on both physical and mental health. How many people are dieting? An estimated 45 million Americans diet every year. According to the Centers for Disease Control and Prevention (CDC), between 2015 and 2018, ​​17.1% of U.S. adults aged 20 and over were on a special diet on a given day. How big is the diet industry? The U.S. weight-loss market was estimated to have grown to a historic peak of $90 billion in 2023, boosted by sales of GLP-1 prescription weight loss drugs. Does dieting cause eating disorders? Yes, it can. Research has shown that dieting is the most important predictor of new eating disorders and dieting or food restriction can increase the risk of eating disorders in people who are susceptible to developing them.]]></content:encoded>
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            <title><![CDATA[Why “Quasi-Recovery” Is Risky—and How to Move Beyond It]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/quasi-recovery-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/quasi-recovery-eating-disorders</guid>
            <pubDate>Mon, 01 Jul 2024 13:28:00 GMT</pubDate>
            <content:encoded><![CDATA[There was a point early on in my eating disorder recovery where I really thought I was “cured” of my illness. After all, I was eating dietitian-approved meals and snacks, and had significantly reduced my time in the gym. What I didn’t know at the time was that I had actually just reached a strange sort of limbo in my recovery: I was doing the “right” things, and it probably looked like I’d gotten a handle on my disease to the outside world. But inside, I was still obsessing over every bite I ate and every treadmill session I didn’t do, and still feeling massive guilt for “defying” my eating disorder. Though I wouldn’t realize it until later, I had entered a common but risky gray area sometimes called “quasi-recovery.” Equip Peer Mentor Jamie Drago had a similar experience in her own recovery. “For me, quasi-recovery looked like making a lot of deals with myself and negotiations with the eating disorder,” Drago says. “For example, I’d tell myself, ‘I can eat X but only because I did Y,’ or ‘it’s okay for me to do X as long as I do Y.’ I focused so much on things being ‘not as bad as before’ that I wasn’t able to see how much better things could still have been even from that point.” This gray area isn’t talked about very much in the recovery discourse, but it’s common, and more harmful than you might think. Plateauing in eating disorder recovery is risky for a number of reasons, including the physical implication of medical instability and the psychological implication of incomplete cognitive recovery. Read on to learn more about “quasi-recovery,” its associated risks, and how to move past it. What is quasi-recovery? Quasi-recovery in eating disorders, sometimes referred to as “semi-recovery” or “partial recovery,” is a way to describe a state in which someone is no longer in the depths of their illness, but has not yet fully recovered either. For example, a person in quasi-recovery may be able to follow their meal plan but won’t let go of disordered behaviors like body checking. According to Equip Lead Therapist and Clinical Supervisor Brittney Lauro, LCSW, quasi-recovery is essentially the act of picking and choosing parts of the eating disorder that a person decides they’d like to get rid of, rather than challenging all parts of the disorder. To those without an eating disorder, this might seem confusing—but remember that eating disorders are often coping mechanisms gone awry, so someone might feel like they need certain behaviors in order to deal with life. What’s more, toward the beginning of recovery, the eating disorder brain is still running the show, and that brain places a high value on certain aspects of the disorder—like weight, dietary restriction, and exercise—and may refuse to let them go. “When I think of ‘quasi-recovery,’ I’m reminded of some of the things I hear people say when they’re starting treatment,” says Lauro. “Statements like, ‘I really want to stop binge eating or purging, but I don’t want to change my healthy eating habits,’ which often means restriction. Or sometimes it’s, ‘I’m willing to gain a few pounds, but I refuse to go past XYZ number.’ Other times it’s, ‘I want to let go of parts of my eating disorder but I don’t want to stop exercising every day.’” Drago describes this confusing stage as having “one foot in, one foot out” in recovery. For many people navigating recovery, stopping the most dangerous habits associated with their eating disorder might feel like they’ve achieved enough, leaving them clinging to behaviors that are still disordered but aren’t “as bad.” “Maybe eating disorder thoughts are less intrusive and they’re able to live a more flexible life than before,” Drago says. “But there are still some strings attached.” More often than not, living with those attached strings means prolonging the treatment process, increasing the chance of relapse, and impeding true, full recovery.  Why people get stuck in quasi-recovery There are a number of reasons someone may get stuck in quasi-recovery and have trouble moving into full recovery. Some common contributing factors include: Persistent dietary restraint (i.e., continuing to restrict food or follow food “rules” in some capacity) Overvaluation of weight/shape (i.e., lacing a high value on weight and body shape) Compulsive exercise Overvaluation of weight and shape is a major contributing factor for many. While this might not seem like that big of a concern, placing a high value on one’s body and appearance can cause someone to stay cognitively “in the eating disorder, making it difficult for them to move into full recovery, even if they’re performing all recovery behaviors “correctly.” “There’s what feels like a persistent ‘need’ to look a certain way, or control one’s food or exercise a certain way,” Lauro says. “The overvaluation refers to a mindset where these things—weight, food control, etc.—are so highly valued, that nothing much else matters. It’s an intensive mindset, and truly is the driving force that sets people with eating disorders apart from folks who experience periods of disordered eating.” The good news is that overvaluation of weight and shape is effectively addressed in CBT-E, helping patients move into “all-in” recovery. Similarly, both compulsive exercise and dietary restraint correlate with eating disorder severity and relapse vulnerability. Lauro believes that one major reason so many people struggle with quasi-recovery is because diet culture has normalized disordered behaviors around restrictive eating and unhealthy exercise. “I feel for folks,” Lauro says. “There’s so much messaging in our society that supports ‘quasi-recovery.’ Exercise is praised at all costs with little discussion about rest, and there are constantly new fad diets disguised as ‘lifestyle changes’ or ‘wellness plans.’ It is all so confusing knowing what to do and what to trust.” This experience can be especially common in life after eating disorder treatment. It’s important to note that the phrase “all-in recovery” may be subjective, as eating disorder recovery itself can take many forms. Recovery is not necessarily a destination but an ongoing journey that many experts view as a dynamic, evolving process marked by stages, setbacks, and shifts. While traditional treatment has often focused on measurable markers like weight, behaviors, or absence of symptoms, experts now believe that recovery should be rooted in clinician-guided plans that prioritize how patients actually feel and describe their experiences, and what optimizes their entire well-being.  The risks of quasi-recovery “The greatest risk of quasi-recovery is always relapse,” Lauro says. “And we know that relapse and active eating disorders take away from your ability to live life and fully experience joy. Any time we leave any element of the eating disorder unchecked, we run the risk of reigniting the whole thing. I have seen this numerous times in my practice. It is always best to make sure we leave no stone unturned.” The definition of “relapse” varies in scientific literature, as does the definition of “remission.” With that in mind, a systematic review reported that eating disorder relapse rates range from 9 to 52%, and tend to increase as the duration of follow-up increases (i.e., the longer someone has been in recovery, the higher their likelihood of experiencing a relapse). While the definitions may vary, there is a consensus among experts that the risk for relapse in those with anorexia is especially high within the first year following treatment. Relapse risk can spike for a number of reasons, including: Stressful life events Being under your body’s “set point” weight Returning to unsupervised exercise Sustaining ongoing rules around food and exercise Relapse can be of particular concern when someone in quasi-recovery experiences a major or stressful life event. “If someone hasn’t allowed their body to reach its natural weight set point, for example, or still has a disordered relationship with exercise, they could be at risk for relapse prompted by life events like a wedding or having a child,” Lauro says. “On the flip side, I find that those who have allowed themselves to maintain their natural set point, and have done all of the work to eliminate restriction and all compensatory behaviors, don’t end in relapse despite stressful or major life events.” Research also shows that a lower body mass index (BMI) at treatment discharge predicts higher relapse risk in those with anorexia, and there can be physical and mental tolls to lingering food restriction, weight suppression attempts, and compulsive exercise. Drago says that in her experience with quasi-recovery, the biggest risk was succumbing to the slippery slope of increasingly disordered thoughts and behaviors. “As many times as I told myself I would be able to sustain a semi-recovery state, it never stayed that way for very long,” she says. “These are really strong illnesses and even things like ‘cutting corners’ with a meal plan or doing something ‘just a little bit’ eventually sends things downhill every time.” Lauro says that in her opinion, there simply isn’t enough information published about the hope that comes with full recovery. “Most articles focus on life events that trigger relapse and it's usually painted in a hopeless light,” she says. “The truth is, there is hope. And there’s a strong chance you won’t relapse if you reach full recovery and let go of quasi-recovery.”  Quasi vs. full recovery: a simple self-check While there is no clinical definition for quasi-recovery and no diagnostic assessment to determine whether you meet quasi-recovery or full recovery criteria, asking yourself certain questions can help you get a sense of where you fall. If you’re concerned you might be lingering in quasi-recovery, ask yourself: Do I have rules or make “deals” with myself around food, movement, weigh-ins, etc.? Do I experience anxiety if I miss a workout? Do I perform body checking behaviors or avoid looking at myself completely? Do I have an ongoing need to only eat “safe foods”? Do I avoid weight-related medical care? When answering these questions, it’s important to remember that “full recovery” can mean different things to different people. But the scientific literature shows that “cognitive recovery” (i.e. shifting disordered thoughts and mental habits) is an essential part of being fully recovered. In other words, only changing behaviors does not necessarily mean a person is fully recovered, and weight restoration does not equal full recovery—because eating disorder psychopathology can persist even after weight and behaviors have been normalized.  How to get out of quasi-recovery (a step-by-step plan) While it’s relatively common to temporarily land in quasi-recovery, it’s not a place to settle or get stuck. The goal is always to find true freedom from the harmful tethers of the eating disorder—but this can admittedly be a big challenge. “Getting past the hurdle of partial recovery is really tough, because doing that first half of the work is already hard and scary and exhausting, so the idea of having to do even more can sound out of the question,” Drago says. “To make that final push, you need to sit down and really investigate where you are still seeing eating disorder thoughts, urges, and behaviors popping up.” In addition to continuously challenging food fears and anxiety-provoking situations, Drago believes that constant, clear communication with one’s treatment team is essential to achieving full recovery. “With a lot of our society really encouraging and praising a focus on changing our bodies, and many folks experiencing frequent instances of weight stigma, it’s important to process with your providers how you can care for yourself and support your recovery in the face of that,” she says. If you do feel that you or a loved one are stuck in quasi-recovery from an eating disorder, it’s important to take action and pursue full recovery. While there is no single method or timeline for full recovery, the following steps can give you a sense of how to get out of quasi-recovery: Return to regular eating patterns Because restrictive eating predicts eating disorder symptoms and relapse, it’s important to work with an eating disorder-trained dietician to incorporate all food groups with consistency. “Don’t be afraid to go back to basics,” Lauro says. “That includes three meals and two to three snacks eaten at regular intervals of time and inclusive of all food groups. Pay attention to be sure that portion sizes align with what your treatment team would have recommended.” Pause, then rebuild movement carefully Temporarily putting exercise on hold can be an important step in moving from quasi-recovery to full recovery. Working with a clinician or dietitian to plan a graded return to movement can help address any compulsion risk and prevent a slide back into disordered behaviors. Working with a team to plan a safe re-entry into movement may include first getting medical clearance, then putting together an appropriate fueling plan, setting time and type limits, and creating non-aesthetic goals. A few red flags for compulsive exercise include: Anxiety if exercise is skipped Obligatory or rigid patterns around exercise Exercising despite negative consequences Needing to exercise more over time to relieve anxiety Prioritizing exercise over other aspects of life “The most effective way to do this is to go cold turkey for a period of time—at least a week or so—without any exercise,” Lauro says. “If this feels unattainable, try to cut back little by little. When you’re ready to re-integrate exercise and movement, start with activities that aren’t linked to your eating disorder. Consider group classes or walking instead of running, etc. If your eating disorder has rules about how much time you should be on an exercise machine, experiment with intentionally stepping off the machine a few minutes early.” Work the cognitions (CBT-E/DBT skills) Working with a skilled clinician to target persistent issues—like overvaluation of weight and body shape, body checking, rules, and perfectionism—through CBT-E and dialectical behavioral therapy (DBT) can help advance recovery. These two modalities can also help you tackle body image work, which further supports recovery. Expand your clothing options “If you’re still only allowing yourself to wear certain clothing styles or colors, consider experimenting with fashion that you genuinely like without a focus on weight or what your body looks like,” Lauro says. Make a scale strategy It’s important to work with a team to strategize how to approach weight monitoring, and whether doing blind weights or having exposure to the numbers will be most helpful. “For some folks, this might mean removing the scale completely from their home and only having weight checked at doctors appointments when it is medically necessary,” Lauro says. “For other folks, the opposite might be true: it might mean reaching back out to their treatment team to work on exposure to seeing a number on the scale. Some folks tend to choose this option as a means of protecting their future selves, so if they are ever in a situation where they will have to see their weight at a medical appointment, they are less likely to be impacted in a negative way.” Create a relapse plan Making a relapse prevention plan is a core step in the recovery journey. To do so, work with your treatment team, supports, or both, to identify personal triggers and early-warning signs, and plan who to contact and what kinds of prevention skills to practice (urge surfing, opposite action, etc.) in the moment. This is often one of the last steps of treatment, but it can also be done post-discharge, and can be an essential part of reaching full recovery. Seek support It’s important to know that it’s always okay to need more help. Just because treatment didn’t “fully” work in the past doesn’t mean it won’t help now. If you or a loved one experience medical instability, suicidality or self-harm risk, or rapid deterioration, it’s critical to seek additional support and to step up care. And even if you’re not in an acute situation but still want support reaching full recovery, you deserve—and may need—to reach out to professionals for additional help. While the specific ways someone challenges themselves to move out of this gray area may look different from someone else in the treatment process, it’s important to keep the ultimate goal in mind: total recovery. Quasi-recovery is common, but it can be a dangerous place to stay, so recognizing the signs of it and knowing how to move beyond it is essential to achieving true and permanent freedom from an eating disorder. Remember: if you need additional support to fully recover from your eating disorder, that’s not “failure.” Quasi-recovery is a step on the way to full recovery, and most people do get there. Recovery takes time—but it’s always worth it.  FAQs What does quasi-recovery mean? Quasi-recovery in eating disorders, sometimes referred to as semi-recovery or partial recovery, is a way to describe a state in which someone is no longer in the depths of their illness, but has not yet fully recovered either. This state of quasi-recovery can involve both behavioral and cognitive components. Why is weight restoration not enough by itself? Psychological symptoms can persist even when weight is restored or stabilized. Without making intentional cognitive and behavioral changes, the risk of relapse still persists. Is it normal to fear stopping exercise? Yes. Exercise compulsion is common and having fear or anxiety about missing exercise sessions or pausing workouts completely can be anxiety-provoking. Because of that, it’s important to work with your team to pause and re-introduce movement safely. How do I avoid relapse during life stress? Creating a comprehensive relapse plan and building a team of supports can go a long way in helping to prevent relapse. It’s also important to be aware of early relapse warning signs and to maintain structure while recovering. What does “full recovery” involve? “Full recovery” entails making physical, behavioral, and cognitive changes that support your overall well-being. Research has shown that only individuals who were behaviorally and cognitively recovered were comparable to controls on measures of body dissatisfaction, disordered eating, drive for thinness, and endorsement of the thin ideal.]]></content:encoded>
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            <title><![CDATA[When Does Dieting Become an Eating Disorder? ]]></title>
            <link>https://equip.health/articles/understanding-eds/diet-vs-eating-disorder-telling-the-difference</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/diet-vs-eating-disorder-telling-the-difference</guid>
            <pubDate>Fri, 23 Feb 2024 16:50:00 GMT</pubDate>
            <content:encoded><![CDATA[One of the telltale signs of an eating disorder is a change in someone’s eating habits. But changing your eating habits is also the defining characteristic of going on a diet—so when does dieting become an eating disorder? The answer is nuanced, especially because the worlds of dieting, disordered eating, and eating disorders have a fair amount of overlap. Read on to learn the difference between a diet vs. an eating disorder, whether dieting can become an eating disorder, and when to be concerned. Dieting and eating disorder: the basics Before we break down when dieting becomes an eating disorder, let’s define the terms. While the word “diet” can refer simply to what a person eats, here we’re talking specifically about weight loss diets. In this context, a diet can be defined as an eating plan in which someone eats less food, or only particular types of food, in order to become thinner or lose weight. People go on weight loss diets for a variety of reasons, including because they think it will improve their health or “wellness,” or simply because they want to look a certain way. Eating disorders, on the other hand, are mental illnesses characterized by severe and persistent disturbances in eating behaviors, accompanied by distressing thoughts and emotions. Eating disorders are disabling and deadly disorders that have serious consequences on physical, psychological, and emotional health and disrupt a person’s ability to go about their life. There are several different types of eating disorders, including: Anorexia Bulimia Binge eating disorder (BED) Avoidant/restrictive food intake disorder (ARFID) Other specified feeding or eating disorder (OSFED) Unfortunately, dieting is extremely common. According to research, about 17.1% of American adults are on a diet on any given day, and half of adult Americans (about 130 million people) attempted to lose weight within the past year. Eating disorders, on the other hand, are less prevalent: about 9% of Americans will have an eating disorder at some point in their lifetime, and about 5.5 million will develop one this year. So while dieting and eating disorders have similarities—both involve changes in food habits and a focus on making one’s body smaller—clearly not everyone on a diet has an eating disorder. Let’s take a look at the differences.  Diets vs. eating disorders Telling the difference between a diet and an eating disorder can be tricky, especially in the context of diet culture, which tends to praise and normalize disordered behaviors, like fasting or cutting out entire food groups. However, there are specific things you can look for that can signal it’s not “just” a diet. Some of the primary differences between a diet vs. an eating disorder include: How long it lasts: Generally, people go on diets for a finite amount of time. Someone may go on a diet ahead of an event (like a vacation or a wedding, for instance), or in order to reach a certain weight, and then go back to more normal eating afterward. Eating disorders have no natural end; people will continue to engage in their disordered behaviors until they get treatment. How it impacts other areas of a person’s life: “Dieting becomes an eating disorder when it’s associated with significant impairment in physical, emotional, occupational, or social domains,” explains Cara Bohon, PhD, an eating disorder researcher and associate professor at Stanford. Eating disorders can hurt relationships, negatively affect performance at school or work, and make it impossible to keep up with daily responsibilities. How much mental real estate it occupies: “A shift in thought patterns is one of the first red flags I often see,” says Christina Fattore, RD, an eating disorder dietitian. When compulsive thoughts about food, exercise, or body size and shape (sometimes called “food noise”) begin to take up most of a person's brain space, it’s time to be concerned. How important it is: Diets are pretty straightforward: they’re about following food rules and achieving a certain weight, and there is no deeper meaning. Eating disorders may look similar on the surface, but they become about much, much more. For someone with an eating disorder, there are extremely high stakes attached to the rules of their disease. If they “slip up” or ignore their eating disorder voice, they feel intense distress. Whether or not it feels like a choice: In general, going on a diet is a choice someone makes, and they can choose to stop when it no longer serves them. An eating disorder is not a choice, and someone can’t just decide to stop having an eating disorder. “Dieting has solidified its place in our society as a desirable lifestyle choice. However, I think it’s important to remember a diet is just that: a choice,” says Fattore. “With an eating disorder, the disorder itself is in the driver’s seat, not the other way around.”  These differences help to illustrate the different ways that diets and eating disorders affect a person, but they can be difficult to quantify or even to see at all, especially if you’re concerned about a loved one. Below are some more easily identifiable red flags: An extreme rigidity around food rules. “Eating disorders don’t make space for ‘cheat meals’ or ‘days off,” explains Fattore. Preoccupation with body size or shape. This might look like body checking, frequently weighing oneself, or comparing one’s body with other people’s bodies. A fixation on calorie counts and nutrition labels. This can also show up in behaviors like measuring and weighing food, and a need to be extremely precise about the quantities or kinds of food eaten. Mood shifts associated with insufficient nourishment. “Think about the term ‘hangry,’” says Bohon. Physical ailments that appear to be related to a person’s restrictive eating. This could include fatigue, hair loss, brittle nails, always being cold, or getting sick frequently. Social withdrawal. People with eating disorders tend to avoid plans that involve food, or turn down invitations in order to exercise. “Dodging situations that would require one to practice food flexibility is an indication that we’re veering into dangerous territory,” says Fattore. Other disordered weight loss behaviors in addition to the diet. This could include self-induced vomiting or misuse of laxatives. If these signs resonate with you, taking our interactive eating disorder screener could be a helpful next step.  When does dieting become an eating disorder? While diets and eating disorders are decidedly different from one another, one can lead to the other. This doesn’t mean that diets cause eating disorders (otherwise, everyone on a diet would develop an eating disorder, and that’s not what we see), but it does increase risk. “For many years, it has been consistently shown in research that dieting is a risk factor for the development of eating disorders,” says Bohon. She cites research from the early 2000s that found that attempts to restrict eating were “robust predictors” of the onset of eating disorders, findings that were replicated over the following decades. More recent studies have found that the following diet-related behaviors all increase eating disorder symptoms: Tracking food with apps Counting calories Self-weighing Research has also shown that teenage dieting is what usually precedes the onset of bulimia and anorexia, and prospective studies have found that dieting increases the risk of developing an eating disorder by five. Bohon does point out that some researchers suggest that dieting for weight loss doesn’t increase eating disorder risk, citing evidence that weight loss programs result in reductions of eating disorder symptoms. But there are flaws in making this conclusion, she says. “This interpretation of the evidence is short-sighted. As eating is controlled via dieting, concerns about shape or weight or eating are tempered. But when the dieting stops, the concerns elevate. Given that most weight loss efforts fail—weight is either not lost or regained the following year—any reductions in eating disorder symptoms would be expected to be temporary.” Think of these seemingly conflicting data points this way: for some people, dieting itself can be a trigger for an eating disorder—likely because a negative energy balance, or eating fewer calories than you burn, can trigger an eating disorder in people predisposed to developing one. For others, dieting might appear to lessen disordered thoughts or behaviors, but that relief is short-lived: the relief comes from the fact that a person’s body more closely matches society’s thin ideal, and when the weight inevitably comes back, so do the disordered behaviors. It’s also worth calling out that even for people who won’t go on to develop an eating disorder, dieting can have negative consequences. Studies have found that dieting can lead to: Nutritional deficiencies Menstrual irregularity Osteopenia and osteoporosis Stunted growth in kids and teens Irritability Fatigue Distractibility Binge eating As one team of researchers put it, “our results showed that dieting may carry more risks than benefits as a means to lose weight.”  Can I ever go on a diet if I’m in recovery? While every person is unique, most eating disorder experts would advise against going on a diet while in eating disorder recovery. There are, of course, some particular instances in which specific dietary modifications are medically necessary and may be considered healthy. For example, those with conditions like celiac disease or dairy allergies may need to adhere to specific diets that restrict certain foods. While these diets are limiting, they are distinct from weight loss diets because they provide sufficient nutrition and don’t promote explicit weight loss or an energy deficit. In these very specific cases, following a particular diet may be essential for managing a health condition. All that said, weight loss diets are not recommended for people in recovery from an eating disorder. Research has consistently identified dieting as one of the strongest predictors and a significant risk factor for the development of an eating disorder. This slippery slope from a diet to an eating disorder is often the result of the “diet cycle,” or the “binge-restrict cycle,” which starts with restrictive eating, which leads to physical and psychological deprivation. These feelings of deprivation then cause the person to break their diet rules by overeating or bingeing, which typically results in guilt, body dissatisfaction—and the return to dieting. Dieting can also cause a negative energy balance, which can trigger an eating disorder relapse. Perhaps more importantly, weight loss diets put diet culture’s values above a person’s true values or health. Not only is weight loss or thinness not a universal sign of health or morality, but dieting is often ineffective at best, and dangerous at worst. Research has consistently shown that most dieters regain the weight they lose, and that diets themselves often promote the adoption of disordered eating behaviors. Rather than fixating on weight, experts agree that it’s more important to prioritize behaviors that are truly health-promoting, like stress management, adequate sleep, joyful movement, and more. Is dieting inherently bad? Ultimately, it’s up to each individual person to decide what food choices work best for them. For people with celiac disease, that means cutting out gluten; for those who are lactose intolerant, that means eliminating dairy; others might simply find that they feel better when they eat certain foods rather than others. In all of these cases, a person’s chosen diet wouldn’t be considered disordered. But when it comes to diets designed specifically for weight loss, it’s a different story. As the research shows, dieting for weight loss purposes is rarely sustainable and increases your risk of developing an eating disorder, making it a lose-lose endeavor. Fattore sums it up like this: “If ‘going on a diet’ means incorporating a higher volume of nutrient-dense foods, exercising in a way that’s mentally and physically rewarding, and engaging with food in a more mindful manner, then sure, dieting can be healthy,” she says. “But if a diet means depriving your body of necessary calories, cutting out entire food groups, or ignoring physical cues like hunger or exhaustion, then I don’t think we can ever truly classify dieting as healthy.”  FAQ What’s the difference between a diet and an eating disorder? Both diets and eating disorders may include calorie restriction, excessive exercise, weight and food monitoring, and feelings of stress and shame. Generally speaking, diets: Are a lifestyle choice Can be quit at any time Cause some changes to quality of life Have fixed “rules” Eating disorders, on the other hand: Are mental health conditions Require treatment Cause major changes to quality of life Have increasingly stricter “rules” Can I go on a diet if I’m in recovery from an eating disorder? In general, experts do not recommend weight loss diets for those in recovery from an eating disorder. Research has consistently identified dieting as one of the strongest predictors and a significant risk factor for the development of an eating disorder. Dieting can be a slippery slope for those predisposed to developing eating disorders, and diets themselves often promote the adoption of disordered eating behaviors. Rather than focusing on weight, experts suggest prioritizing health-promoting behaviors like stress management, adequate sleep, joyful movement, and more. Is dieting the same thing as disordered eating? No. Dieting and disordered eating are not the same thing, although they can overlap. Dieting is typically an intentional, structured attempt to change eating patterns (often for weight or health reasons). Disordered eating involves harmful, rigid, or distressing behaviors and thoughts about food, body image, or control—whether or not a person has received a formal diagnosis. How can I tell if my loved one’s diet is actually an eating disorder? While a diet is generally an eating plan that limits certain foods or portions with the goal of losing weight, eating disorders are serious mental health conditions marked by persistent, disruptive thoughts and behaviors around food. A diet is a personal lifestyle choice; an eating disorder is not. If you’re worried about someone you care about, our free eating disorder screener can help you figure out what to do next. ]]></content:encoded>
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            <title><![CDATA[Guide for Loved Ones: How to Avoid Triggering Someone with an Eating Disorder]]></title>
            <link>https://equip.health/articles/understanding-eds/how-to-avoid-triggering-someone-with-an-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/how-to-avoid-triggering-someone-with-an-eating-disorder</guid>
            <pubDate>Fri, 28 Mar 2025 16:31:05 GMT</pubDate>
            <content:encoded><![CDATA[I’ve had countless conversations with parents, partners, siblings, and friends of people suffering from eating disorders, and all of them desperately want the same thing: to help their loved one feel supported in their recovery. Yet they often feel overwhelmed, helpless, and unsure how to be there in the way they’d like. Honestly, eating disorders are complex illnesses that are hard to understand unless you’ve been there—but it is possible to learn about what can be harmful to your loved one’s healing, and how to help them feel safe and thrive in recovery. In this article, we’ll explore how you can not only avoid triggering your loved one, but also actively support their recovery. Read on to learn some of the most common food- and body-related triggers, guidance on what to say and do (and what to avoid), along with strategies and resources to help create a safer space for people struggling with eating disorders. What does it mean to "trigger" someone? The word “trigger” has become ubiquitous in recent years, but it’s often used pretty loosely, and in ways that don’t reflect its original meaning. When it comes to eating disorders, however, it’s important to understand that triggers are very real, and can have real consequences. “Triggering someone with an eating disorder means saying or doing something, often unintentionally, that activates thoughts, emotions, or behaviors tied to their struggles with food, body image, or exercise,” says dietitian Meagan Rothschild, RD, LD, CEDS. According to Equip dietitian Stephanie Kile, MS, RDN, eating disorder triggers often cause “thoughts that align more with the eating disorder side of the brain than the recovery side.” Kile describes the eating disorder side as the part consumed by thoughts about food and body image, urges to engage in behaviors like restriction or purging, and black-and-white beliefs, like the idea that certain foods are good and others are bad. It’s the side of the brain a person in recovery is working to quiet, which is why it can be helpful for others to understand how to avoid activating it.  Common triggers for people with eating disorders While each individual will have different triggers, there’s one giant and pretty universal trigger: diet culture. Diet culture is a system of social beliefs and expectations that values thinness above all, and everything about diet culture aligns with and reinforces the eating disorder mindset. It’s in our everyday conversations, gyms, classrooms, social media, mass media, and even doctors’ offices. Here are several specific eating disorder triggers that are rooted in diet culture: Social media “Social media is a huge trigger source for my clients, because they often see unrealistic expectations of how they should look or what they should be eating,” shares dietitian Brianna De la Cruz, MS, RDN. Several of my clients also find it difficult to use social media without their recovery being derailed by food- and body-focused posts, including “What-I-eat-in-a-day” reels, fear-mongering messages by self-proclaimed nutrition experts, and photos showcasing weight loss or body ideals. Moreover, there’s ample research surrounding the negative effect that social media can have on young people’s body image and eating habits. One 2023 systematic review of people ages 10 to 24 showed that social media can promote negative social comparison, thin ideal internalization, and self-objectification, all of which can lead to eating disorders. One 2019 study of adolescents showed a link between a greater number of social media accounts and disordered eating, thoughts, and behaviors. The same study also linked greater daily time spent using Instagram and Snapchat to increased disordered eating behaviors in girls. Other research shows content labeled with “fitspiration” and “thinspiration” (content intended to inspire viewers to achieve fitness or thinness) can trigger young people already struggling with eating disorders. Food language and judgement In my practice, perhaps the largest trigger for my clients are the words of (usually) well-meaning and unaware partners, friends, family, colleagues, coaches, or teachers. Here are several typical examples of triggering food language (all of which are often and unfortunately viewed as normal in our culture): Commenting about the food on someone else’s plate: “Wow, she must be hungry.” Talking about how much you did or didn’t eat today: “I haven’t eaten all day.” Tying morality to foods: “I was so bad today—I had pizza” or “I was good at lunch—I had a salad.” Discussing plans to restrict: “I get one ‘cheat meal’ this weekend and then I’m back to skipping carbs” or “I’m going to save my calories for tonight’s dinner.” Talking negatively about calories: “That must be loaded with ‘empty calories.’” Describing your new diet: “I just started intermittent fasting and feel so much better.” Making claims about food and “health”: “It’s not healthy to eat dessert” or “Sugar is unhealthy.” Such comments are typically triggering for eating disorder diagnoses like anorexia, bulimia, and binge eating disorder. The triggers for ARFID, which is not tied to body image distress, are usually a bit different. De la Cruz explains that triggering someone with ARFID “could look like teasing them for resorting to safe foods at a restaurant or making fun of them for being nervous to try a new food, which validates their fear, causing them to be more hesitant in trying fear foods.” Unfortunately, triggering food comments don’t stop with friends and family—healthcare providers are, in fact, one of the most common sources of harmful comments I see in my practice. Some of my clients leave their medical appointments upset and confused, because their doctors recommend restricting their diets based on their weight or lab work, without asking questions about their relationships to food or knowing about their eating disorder history. “I have had restricting patients being told to limit their sugar intake, which inhibits their progress significantly,” adds De la Cruz. Body language and judgement Body-based comments can also be detrimental. “It could be as simple as a common greeting many people use, such as ‘Wow you look like you lost weight,’” Kile says. Even saying something like “you look so healthy” can activate the eating disorder part of the brain, according to De la Cruz. “This can cause someone to believe they may have gained weight and cause them to overthink or want to restrict,” she explains. Speaking negatively about your own body or other people’s bodies (like “He needs to lose weight,” “She lost weight since I last saw her,” or “I need to lose weight”) can also trigger the eating disorder sufferer. Such comments are examples of weight bias—negative attitudes and beliefs about and towards others because of their weight. Like food language, weight language is an issue within healthcare settings, because many providers also have weight bias. In fact, I have spent many sessions with clients helping to reverse damage after medical appointments, because their doctors are operating from a weight bias lens and making recommendations harmful to eating disorder recovery. Unfortunately, doctors often praise larger-bodied patients for disordered behaviors (like counting calories) and mindsets (like striving for weight loss) that would be concerning for smaller-bodied people. While such treatment is problematic for anyone, those with eating disorders are especially vulnerable. In fact, a 2024 systematic review shows weight stigma, or discrimination against people based on their weight and size, is associated with increased disordered eating outcomes, like binge eating, drive for thinness, unhealthy weight control behaviors, and dietary restraint.  Problematic messaging and behaviors about exercise Unfortunately, diet culture also dominates societal beliefs and behaviors surrounding exercise, often under the guise of health. The term “healthy” is “skewed to mean restrictive and overworked, where someone is praised for working out for hours in the gym and eating as little as possible to achieve weight loss,” Kile says. While it’s everywhere, eating disorder triggers related to exercise are common in gyms, yoga studios, and on social media. Here are some examples of words and actions that could trigger someone in recovery: Using exercise to justify or to punish yourself for eating fun foods (like French fries or cake) Discussing your exercise routine in detail Expressing guilt about not exercising Idolizing someone for being “disciplined” because they exercise every day Talking about burning or “earning” calories Belittling lower-intensity forms of exercise (e.g. “Walking doesn’t count.”) Unexpected plans or surprises Depending on how far along someone is in recovery, spontaneity can be difficult, especially when eating is involved. Here are a few examples of situations that can be triggering: Stopping for ice cream or dessert without talking about it beforehand Surprising your loved one with a meal out at a restaurant Making pancakes for breakfast on a weekday when they’re typically made on weekends While such scenarios are fun, healthy, and normal (and ideally will one day become natural for the person struggling), for people who are still working toward recovery, they can cause significant distress and rouse the eating disorder brain.  How to help your loved one feel safe in recovery While society-at large is steeped in diet culture and you can’t totally protect anyone from it, you can take steps to help create safe environments and relationships that support healing. Here are some strategies to consider as you navigate your loved one’s eating disorder recovery: Be conscious of media On social media, you can’t control what other people post, but you can control what you’re sharing online for your loved one to see. Before posting something, run it through an eating disorder trigger filter. Ask yourself, “Could this cause someone distress about food, body or exercise?” If the answer is maybe or yes, reconsider sharing it. Plus, unfollowing diet culture content from your own feed and following recovery-aligned content can help your own shifting mindset. If you’re a parent or guardian for a young person with an eating disorder who uses social media, have a discussion and set boundaries with them about who they follow and how much time they spend online. Remember, diet culture runs rampant in movies and shows, too, and can impact eating disorder sufferers. For example, one of my larger-bodied clients was struggling with her parents and sister always wanting to watch Friends and laughing during scenes when Monica was wearing a fat suit and was portrayed in a negative light and the brunt of many jokes. Once she got her feelings out in the open, her family understood why it made her uncomfortable and decided to choose another show to watch together. Look at your language As you now know, many eating disorder triggers happen in conversations. “I encourage loved ones to shift from diet talk, body scrutiny, and food moralization to a more neutral, supportive way of discussing food and bodies,” Rothschild shares. Take an honest look at how you talk about food, body, and exercise, especially around your loved one. If you realize you may be adding fuel to the eating disorder fire, work to start learning how to speak about these topics without diet culture coloring everything. Here are some ways to help shift your language and behavior for the better: Resist commenting on other people’s food or body (including your own). Instead, comment on other aspects of them, like their style or personality. Strive for balance in your diet, allowing room for all foods, including more nutritious foods (like veggies) and fun foods (like pizza). If you must adjust your diet for medical reasons (e.g. high cholesterol or diabetes), let your loved one know. If you talk about food, focus on taste, texture, and smell, not nutritional content. Refrain from sharing any dieting plans or talking about disordered behaviors (like counting calories or restricting certain foods). Educate yourself about non-diet nutrition, which is a non-restrictive way of eating that prioritizes mental and physical well-being. If you haven’t already, learn about Health at Every Size, a public health framework that deconstructs the belief that weight equals health, and emphasizes that people of all body sizes are worthy of respect and care. If you talk about exercise around your loved one, do so from a lens of joyful, healthy movement, instead of coupling it with food and calories. Try talking about anything else in life. Kile suggests “leaning into new topics of interest to talk about, [like] hobbies, and other aspects of life such as work or school and what new song they’re listening to these days.” “Focus on neutral, supportive conversations about food and bodies, respect boundaries, and validate your loved one's experiences without trying to ‘fix’ them,” Rothschild recommends. “Educating yourself on eating disorders and diet culture, fostering a non-judgmental food environment, and emphasizing connection over appearance or food-based comments can make a meaningful difference and create a safe space.” If any suggested strategies make you feel uncomfortable or don’t feel realistic, it may be time to look at your own relationships to food, body, and exercise, and to seek professional help if necessary.  Have open communication Not every person with an eating disorder has the same triggers, so it’s important to get to know your loved one’s specific vulnerabilities and what feels helpful to them. Ask them to share what feels supportive and what doesn’t, and ask for permission if you’re unsure about discussing a specific topic or partaking in a certain activity. “Asking permission is also a really helpful way to support an individual going through recovery and avoid causing a triggering moment for them,” Kile says. Additionally, communicating with your loved one’s treatment team can help you build an even deeper understanding of how you could hinder and help their recovery. Advocate outside the home While you can’t control how others speak to your loved one, you can spread awareness and set boundaries in places like schools, gyms, and doctor’s offices. If you’re a parent, consider talking to your child’s school or doctor’s office about their health curriculum and practices (check out free resources for doing so). If your loved one is an adult, advocate for them at doctor’s appointments if necessary and help them to eventually do so on their own (check out these medical self-advocacy cards). Taking such measures will help your loved one feel safer as they go out in the world. Go at their pace While planning food-related surprises or being spontaneous might feel helpful, try to meet your loved one where they are. Perhaps they aren’t ready to try a new restaurant, but they make that a goal with their dietitian for the future, or maybe they don’t want to stop at the ice cream shop, but will have some at home with you. Openly talk about what they are and are not ready for, and discuss it with their dietitian if they have one. “I met with a parent who didn’t realize that forcing her daughter to try new foods was actually inhibiting her progress,” De la Cruz says. “A simple conversation helped make a huge difference in her recovery.” She suggests learning about your loved one’s safe and fear foods. “For parents, this could mean making sure safe food is around, but also supporting your child in facing fear foods and expanding their diet,” she says.  Does this mean I have to walk on eggshells forever? When you’re supporting someone with an eating disorder, all the do’s and don’ts can feel overwhelming and a bit paralyzing—but these guidelines are important, and they not only help your loved one but also potentially help you develop a better relationship with food and body image. What’s more, it’s not forever. “Supporting someone with an eating disorder doesn’t mean loved ones have to walk on eggshells forever,” Rothschild says, “but it does require mindfulness and consideration, especially in the early stages of recovery.” De la Cruz compares learning how to speak and act around someone with an eating disorder to becoming fluent in a new, healthier language and mindset. In fact, many of my clients’ friends and family end up addressing and improving their own food and body relationships in the process. Plus, the further along people are in recovery, the less triggering everyday diet culture comments and actions become. “Those individuals will get to a better, more solid footing in their recovery where those topics are no longer triggering, but that timeline varies for everyone,” Kile explains. Eventually, they become less impacted by triggering, diet culture-based comments, and can even speak up about it. “Hopefully, through counseling and education, those with eating disorders will feel confident enough to correct others or know that those comments do not have to impact their own view of themselves and health,” De La Cruz says. Additional support resources There are an abundance of tools available to help support people with eating disorders. Here are some of my favorite resources: Books How to Nourish Your Child Through an Eating Disorder By Their Side: A Resource for Caretakers and Loved Ones Facing an Eating Disorder Loving Someone with an Eating Disorder: Understanding, Supporting, and Connecting with Your Partner Websites FEAST (Families Empowered and Supporting the Treatment of Eating Disorders) Your Recovery Resource Plate by Plate Groups ANAD Caregiver or Sibling Support Group National Alliance for Eating Disorders Virtual Support for Loved Ones Eating disorder recovery takes a village. If you’re struggling to support a loved one, reach out for professional and personalized guidance. The resources above are a great place to start, or you can connect with an Equip team member to talk through your concerns. ]]></content:encoded>
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            <title><![CDATA[The Role of the Binge-Restrict Cycle in Eating Disorders]]></title>
            <link>https://equip.health/articles/understanding-eds/binge-restrict-cycle</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/binge-restrict-cycle</guid>
            <pubDate>Mon, 23 Dec 2024 18:32:00 GMT</pubDate>
            <content:encoded><![CDATA[Equip Lead Peer Mentor Makailah (Mak) Dowell describes her relationship with her eating disorder as a “toxic marriage” rooted in a cycle of binging and restriction. “There is no way I could eat and not have a ‘consequence,’” she says. “The consequence was deeply rooted in fatphobia, stigma, and a careless lack of love and respect for myself. The cycle led to binges, then discomfort, and then days of restricting, self-hatred, and isolation.” Dowell is only able to reflect so eloquently on her struggles because, by confronting her eating disorder head-on, she achieved full recovery. That confrontation included becoming educated on the binge-restrict cycle, an often misunderstood pattern of problematic behaviors that has unfortunately been normalized in today’s society. While bingeing and restricting may seem like complete opposites, they commonly go hand-in-hand (which ties into the often overlooked truth that food restriction is the root of most eating disorders). Read on to learn more about the binge-restrict cycle, what it looks like, and why addressing it is a key part of eating disorder treatment.  What is the binge-restrict cycle? First, let’s define the terms. Restriction is when a person suppresses or ignores their body’s hunger cues to limit their food intake. Someone who is restricting might eat very little food, or no food at all. Binge eating is when a person eats an objectively large amount of food (more than most people would eat in similar circumstances) in a short amount of time, often past fullness and even to the point of physical discomfort. Someone who is bingeing usually feels like they can’t control what they’re eating, and once the binge is over, they often feel distressing emotions. When a person restricts their food for any reason, their body responds by producing ghrelin, otherwise known as the “hunger hormone,” to try to communicate that it needs nourishment. The longer restriction goes on, the more ghrelin is produced, and this can ultimately cause the hunger to take over, which can—understandably—result in a binge. “The binge-restrict cycle refers to a pattern of restriction that is followed by binge eating, which then triggers more restriction,” says Equip Director of Program Development Tana Luo, PhD. “The pattern of restriction and binge eating becomes a self-perpetuating cycle that can be difficult to break.” Part of that self-perpetuating cycle are the intense feelings of guilt and shame that often come after a binge, which then prompt the urge to restrict, either as punishment for “failing” or to “make up for” the food eaten. “It begins with the binge itself, then a period of self-hatred and body dysmorphia, and then that translates to the act of restricting,” Dowell says.  The four stages of the cycle While the binge-restrict cycle is composed of two main behaviors—bingeing and restricting—the cycle itself is actually broken down into four stages: Restriction. “This can mean skipping meals or snacks, limiting the amount of food being eaten, or restricting the types of foods eaten,” Luo says. Craving. “Restriction is followed by an increased urge to eat,” Luo says. “This can look like an obsession with food, because food intake has been restricted.” Bingeing. “That increased urge to eat can then trigger the third stage, which is a binge episode,” Luo says. Guilt. “Binge eating is followed by feelings of guilt, shame, or embarrassment,” Luo says. “There is also often a desire to ‘make up’ for the binge or to ‘get back on track.’ This is what then drives restriction following a binge, and then the cycle repeats itself.” How the binge-restrict cycle shows up in eating disorders Bingeing and restricting are characteristic of a number of eating disorders, including binge eating disorder (BED), bulimia, some forms of OSFED, and anorexia binge-purge subtype (AN-BP). The binge-restrict cycle may also contribute to other disordered behaviors, like purging. “Restricting can lead to purging and other eating disorder behaviors,” Dowell says. “The cycle itself can include restriction, binge eating, and purging, and it can show up in many kinds of eating disorders. The cycle usually ends with a moment of ‘calm.’ Inevitably, the calm is disrupted by the eating disorder.” Those who haven’t experienced the binge-restrict cycle themselves or observed it in a loved one may be surprised to know that many eating disorders involve both behaviors. While anorexia is typically characterized by restriction and bulimia is commonly characterized by bingeing and purging, there are many other forms of disordered eating, and even these specific diagnoses can present in a variety of ways. “The binge-restrict cycle is really common across eating disorders where binge eating is a feature,” Luo says. “While not always the case, restriction often contributes to the maintenance of binge eating behaviors. Assessing for restriction is therefore an important part of understanding the full picture of someone who struggles with binge eating.”  How to break the binge-restrict cycle Because each phase of the binge-restrict cycle fuels the next, it can be tough—if not impossible—to break on your own. However, with the right professional support, you can stop the continual loop of behaviors and establish a healthier relationship to food and eating. Here are the essential steps to breaking the binge-restrict cycle: Seek expert help “If someone is struggling with the binge-restrict cycle, it is important to get an assessment from a professional and to seek treatment,” Luo says. “Usually, treatment then involves getting onto a regular schedule of eating and stopping restriction. This can feel really counterintuitive—people might wonder why they are being encouraged to eat more frequently throughout the day in order to stop binge eating. But because we know that restriction is often the driver of binge eating, it’s important to tackle restriction first.”  Normalize eating habits This step is easier said than done (and helps illustrate why a multidisciplinary team of experts is so essential), but committing to a schedule of regular meals and snacks can go a long way in breaking the binge-restrict cycle. It’s crucial to keep up this eating pattern even if a binge occurs, because any form of restriction will only perpetuate the cycle. Over time, these eating patterns will help regulate hunger and eliminate the urge to binge. Work to reframe food rules Diet culture is everywhere, but actively working to resist the disordered messages that have become normalized in our society will go a long way in breaking the binge-restrict cycle. “Treatment should also focus on breaking free from diet rules and ensuring a wide variety of foods in the diet,” Luo says. “This means steering away from labeling foods as ‘good’ and ‘bad’ or ‘healthy’ and ‘unhealthy.’” Ensure accountability “As someone who didn’t have access to treatment and had to learn how to combat my eating disorder solo for some time, I know how important it is to make sure you stay accountable,” Dowell says. “Let others know how you are doing, eat meals at a friend’s house, ensure your loved ones have a ‘window’ to your mental health, and do skills work. Dialectical behavior therapy (DBT) skills are some of the most effective interventions for high distress, emotional regulation, and choosing values that resemble yourself, not the eating disorder.” While the binge-restrict cycle looks similar from person to person, we know that each patient’s needs and challenges are unique. That’s why our providers pull from the leading evidence-based modalities to tailor treatment to you and work collaboratively with one another to ensure that you get the support you need to break the cycle. Get in touch with our team today for more information or to schedule a free consultation. ]]></content:encoded>
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            <title><![CDATA[Food Obsession in Eating Disorders: Why It May Feel Like You Can’t Stop Thinking About Food]]></title>
            <link>https://equip.health/articles/food-and-fitness/food-obession-in-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/food-obession-in-eating-disorders</guid>
            <pubDate>Thu, 14 Nov 2024 13:59:00 GMT</pubDate>
            <content:encoded><![CDATA[We often associate eating disorders with certain behaviors around food, like eating too much, not eating enough, or purging after eating. But thoughts about food are an equally significant, if less discussed, part of these illnesses. Food-related thoughts may look different from person to person, but it’s quite common for those struggling with an eating disorder to be abnormally preoccupied and find themselves wondering how to stop thinking about food all the time. In this article, we’ll take a close look at food obsession in eating disorders, including why it occurs, what conditions it’s associated with, how it’s addressed, and more. What does food obsession look like? Food obsession can be defined as persistent, intrusive thoughts about food that impair daily living. If you’re experiencing it, it’s likely that your brain space is taken over with food- and eating-related thoughts and rumination about what, when, how much, and with whom to eat. According to Registered Dietitian Katy Zanville, MS, RDN, food obsession can sometimes be referred to as “food noise,” and is generally considered a subjective term describing a preoccupation with food and difficulty stopping thoughts about eating. “Food obsession differs from general excitement about what to eat for your next meal. It often takes up significant brain space and results in guilt and stress around food,” Zanville says. Alix Turoff, a registered dietitian and certified personal trainer, seconds this. As she explains, “Food obsession is when thoughts about food take up an outsized amount of mental real estate. It goes beyond normal planning or interest in nutrition and is often characterized by repetitive thoughts, heightened anxiety, rigid rules, and difficulty shifting attention away from food-related concerns.” In the context of eating disorders, Turoff says food obsession is typically driven by fear, control, or moralization of food rather than hunger, pleasure, or nourishment. Turoff points out that food obsession can look different for everyone, but offers a few common examples of how it may present: Scrolling menus when you’re at work or doing other important tasks Planning meals hours in advance Mentally beating yourself up over a snack that you ate yesterday Fantasizing about a binge that you're planning to have later Constantly thinking about food can also have behavioral ramifications. People with eating disorders tend to want to be around food, even if they’re not eating it. Some food-related warning signs of an eating disorder include: Making food for others without having any Reading cookbooks or constantly viewing recipes Watching food shows on TV Being excessively interested in what other people are eating Rigidly tracking food intake Adhering to harmful diet culture beliefs about needing to earn or burn off food “The experience of food obsession can be nuanced and vary from person to person,” says Jonathan Levine, LCSW, therapy lead at Equip. “But constant thoughts of food, such as what (not) to eat, when (not) to eat, where (not) to eat and around whom, and what’s ‘safe’ to eat are all examples of how obsessive thinking can show up. These obsessive thoughts can also lead to obsessive behaviors, like only eating certain foods, in certain places, around certain people, at certain times of day.” While on its surface it might not seem like that huge of a deal, food obsession isn’t benign—it can have a real impact on a person’s life. Research shows that it’s common for people with eating disorders to become preoccupied with food, experiencing constant and excessive food thoughts to the extent that they disrupt daily functioning. Food obsession can also affect memory and cognition, with one study showing that people with anorexia are more likely to remember food-related words than those without anorexia. This illustrates the fact that food obsession increases cognitive load, with constant thoughts about food taking up considerable brain space at the expense of thoughts about other things, like work or school or relationships.  Why it happens: restriction, coping, and “sticky” attention So why is it so common for people with eating disorders to become preoccupied and find it hard to stop thinking about food? There are a few possible explanations, but at its core, food obsession is a result of the eating disorder hijacking a person’s mind. “Food becomes the focal point of one’s life when an eating disorder is loud and in control,” explains Levine. Turoff notes that while we often think about food obsession in the context of eating disorders, there are several factors beyond restriction that can contribute to food obsession. “Food insecurity, or when someone doesn't have consistent access to food due to financial instability, living in a food desert, chaotic eating patterns, or past deprivation can lead the brain to prioritize food-related thoughts and planning,” she says. “Individuals with a history of dieting or eating disorders often develop heightened sensitivity to food-related information, too. The brain becomes more likely to notice and ruminate on food cues as a result of past trauma.” To dive deeper into how this works, let’s unpack some of the main drivers of food obsession in eating disorders: Restriction It’s a simple fact that restricting food makes you think about food more. From an evolutionary perspective, this makes sense: when you don’t let yourself eat, your body believes you’re starving and kicks into survival mode. It will do whatever it takes to get the energy it needs—and one way it does this is by sounding an alarm bell in the form of constant thoughts about food. These thoughts are a survival mechanism, meant to motivate you to find the fuel necessary to stay alive. “If you spend all of your time thinking of what to eat without letting yourself eat and receive adequate nutrition and pleasure, your brain will enter a state of vigilance around food and continue that mindset of avoidance and restriction while the body fights back to get the energy it needs,” says Levine. “Your body will fight to get the nutrients it needs by increasing thoughts of food to maintain homeostasis and safety.” Zanville explains further, adding that food restriction triggers the production and release of a brain chemical called neuropeptide Y, which triggers an intense drive to eat carbohydrates, specifically. “Restriction can lead to food obsession and binge eating by triggering our body to think it is in starvation mode,” she says. “Our body is constantly trying to keep us alive and will increase thoughts of food and eating in order to get us out of starvation mode.” There’s a significant body of research backing up this idea. Perhaps most well-known is the Minnesota Starvation Experiment, a 1940s study in which hundreds of healthy men were put on a semi-starvation diet in order to measure and monitor how it affected their physical and psychological health. One key takeaway was that their restrictive diet led to extreme preoccupation with food. Among other behavioral, psychological, and physiological changes, the study participants: Talked about food with one another Dreamt about food Began reading cookbooks and collecting recipes Reported excessive thoughts about food and eating “Dietary restriction is a major contributor to food obsession,” Turoff says. “When access to food is limited either—physically or psychologically—the brain interprets this as a threat, which increases attention toward food and amplifies food-related thoughts. The Minnesota Starvation Experiment and eating disorder literature shows that restriction heightens preoccupation with food, increases cravings, and reinforces rigid thinking patterns.” As Turoff points out, there have been multiple other studies confirming the findings of the Minnesota Starvation Experiment over the years. Research has shown that both starvation and self-imposed diets result in preoccupation with food and eating, and that dieting can lead to increased responsiveness to food signals and a heightened desire for food. One study looking at both dieters and binge eaters found that among both groups, higher levels of dietary restraint were associated with greater preoccupation with food and eating. “The level of restriction doesn't necessarily need to be extreme to contribute to food obsession,” Turoff says. “Even subtle or intermittent restrictions that you might see with a temporary diet, calorie counting, rules around ‘clean eating,’ etc. can lead to obsessive thinking by maintaining a sense of deprivation and uncertainty around food availability.”  Coping and avoidance With or without being in a state of restriction, people may turn to food obsession as a coping mechanism. Thoughts about food—whether it’s planning a binge hours in advance, obsessing over what you just ate, or painstakingly tracking macros—can be a way to escape or numb distressing emotions, or to feel a sense of control over a chaotic situation. “I noticed a significant rise in issues with food during the pandemic and during lock-down,” shares therapist Amanda Marks, LPC, CPCS. “Many of us felt out of control during that time and were scared and overwhelmed, and the focus and obsession with food gave us the sense of control and distraction that we were needing.” Attention or memory bias People struggling with eating disorders tend to have what are called attention or memory biases toward eating-related cues and words, which can make obsessive food thoughts feel intrusive, persistent, and even sticky. Here’s what that looks like: Attention biases in eating disorders are when you focus on information that’s consistent with your eating disorder (e.g. you focus on the calories in the food instead of the flavor). Memory biases in eating disorders are when you remember information aligned with your eating disorder better than other information (e.g. you remember how much your friend ate at lunch instead of a story they told you). Food insecurity Finally, research shows a link between food insecurity and binge eating, which (as you’ll read soon), is one of the primary eating disorders that has food obsession as a main characteristic. Other research shows that food insecurity is associated with general eating disorder pathology, which almost always includes food obsession. Additionally, food insecurity might cause someone to undereat or live in a calorie deficit, which then leads to obsessive food thoughts. Which eating disorders are associated with food obsession? While people with any eating disorder diagnosis could have excessive thoughts about food, Levine says that food obsession tends to be associated with: Binge eating disorder (BED) Bulimia nervosa Anorexia nervosa In one study, those with anorexia and bulimia had higher levels of food preoccupation than those with BED, but people with all three eating disorders had more thoughts about food than people without eating disorders. Typically, when food restriction is at its highest, so are obsessive food thoughts, so there may be some variation in the intensity of food obsession for people with bulimia or BED depending on where they are in the restrict-binge-purge or binge-restrict cycle. Could it be something besides an eating disorder? Constantly thinking about food isn’t always a sign of an eating disorder. People could also experience food obsession for other reasons, such as: Food insecurity can include food obsession in the context of an eating disorder, but it can also include food obsession without eating disorder pathology. When food isn’t reliably available, it’s natural for it to be top-of-mind. Dieting or other disordered eating habits that fall outside of a diagnosable eating disorder can also lead to food obsession. This is because of the effect restriction has on the brain and body. ‌ Research has also shown that both ADHD and OCD can lead to food obsession. Marks explains that those with ADHD may become preoccupied with highly palatable food (aka “fun” foods like ice cream, pizza, french fries), or may unintentionally forget to eat, putting them into a state of restriction that then leads to food obsession. People with OCD, she says, may develop obsessions around food, which can manifest as counting calories, creating complex food rituals, or being fixated on the cleanliness of food, for example. It’s best to seek a professional evaluation to determine if OCD or ADHD is present. Negative consequences and risks of food obsession Excessive food-related thoughts can have a significant negative impact on your cognition and mood, daily functioning, and overall well-being. According to Turoff and Zanville, food obsession can lead to negative emotional and physical consequences, including: Binge eating Guilt and shame around food Blood sugar imbalance Psychological distress Body image concerns Heightened anxiety Reduced cognitive flexibility Impaired concentration Difficulty fully engaging in social, occupational, or academic activities Disruption in hunger and fullness cues over time and increased vulnerability to binge-restrict cycles In the Minnesota Starvation experiment, for example, the subjects showed impaired cognitive abilities and depressed mood across the board. In fact, several subjects were forced to withdraw from university because they became unable to concentrate and lacked the motivation to attend class. A different study found that “successful” dieters (i.e., people who restricted their eating in the presence of food) performed badly on a simple task, whereas “unsuccessful” dieters (those who ate their fill) performed very well. When the “successful” dieters let go of their diets, they did a good job on the task, suggesting that thoughts about dieting and food were taking up too much space to allow them to function to the best of their ability. Additional research suggests that if you have restrictive rules around eating, it can lead to worse cognitive performance even after you’ve eaten: in one study, dieters performed worse on a memory task than non-dieters both before and after eating. The researchers theorize that this is because before eating food they were experiencing obsession due to food restriction, and after eating, they were distracted by guilt and stress about what they’d eaten. Beyond the toll it takes on mental performance, constantly thinking about food can have other negative impacts on your life. “If you’re cutting out activities, people, or plans, or changing your lifestyle to ensure that you’re able to meet the eating disorder’s desires related to food obsession, then you’re losing parts of yourself and parts of your life to that obsession,” says Levine. Marks also points out that if you don’t already have an eating disorder, obsessing over food and using it as a form of control can increase your likelihood of developing one. “We want to make sure we have balance in our life to get all of our needs met, and maintaining an obsession makes that extremely difficult, if not impossible,” she says.  How is food obsession addressed in eating disorder treatment? “The most important component of food obsession to address in eating disorder treatment is nutritional rehabilitation and consistency to reduce deprivation-driven preoccupation,” Turoff says. “This often looks like bringing calories up to maintenance levels or above and creating more structured meal and snack times.” In addition to regular eating, healing food obsession generally involves several other interventions. Here’s what this might look like in treatment: Renourishment and regular eating One of the first steps to stopping food obsession is to eat regular meals and snacks so that the body and brain can feel a sense of safety again and live in energy equilibrium. Specific interventions can vary from person to person, but it may include following a meal plan, or relying on mechanical eating for a period of time. “It depends on the diagnosis, a person’s age, and if they need to restore weight to nourish their brain,” Levine says. Zanville adds that the first line treatment plan for food obsession should be establishing consistent, balanced eating to move a person away from being in starvation mode. “Once nutrition rehabilitation is accomplished, someone struggling with food obsession can work with their therapist and dietitian to explore emotional root causes of their preoccupation with food,” she says. Exposure work If food obsession includes certain foods, planned and supported exposure work is a necessity in treatment. “For example, if someone is obsessed with either never eating cake or eating cake in what feels like an uncontrollable manner, we’ll work to normalize the food by asking them to eat cake regularly,” Levine explains. “It’s hard to obsess over the normal, the routine, the baseline, so if we make something feel normal by experiencing it regularly, that will decrease the obsession in time.” Evidence-based therapies There are several therapeutic techniques effective at healing food obsession, including CBT-E (which targets food rules), DBT (which helps you develop skills to use during urges), and FBT (which helps young people restore health and reduce avoidance). “Eating disorder counseling helps to identify the underlying reasons and concerns about the food obsession,” Marks explains “There’s a saying in treatment, ‘it's about the food, but it's not about the food,’ and therapy can help to identify what’s going on internally that is causing the fixation on food.” In many cases, food obsession goes away on its own during eating disorder treatment. That’s because as you become renourished and adopt regular eating habits, the restriction and other disordered eating patterns that were fueling the food obsession go away. You also learn healthy coping strategies to use instead of turning to thoughts about food to manage emotions.  What you can do now: a safe, two-tiered toolkit Below are a few ways to help yourself if you’re dealing with food obsession. We’re including both quick tools to manage obsessive thoughts in the moment, and strategies to practice regularly that will help mitigate food obsession long-term. In-the-moment skills 5-4-3-2-1 grounding. Name five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. “This is perfect for anyone that needs to come back to the present,” Marks says. “By engaging our senses, we are able to bring ourselves back to the present moment where we aren't fixated on or worried about our next meal.” Urge surfing. Try sitting with an obsessive urge for about 10 minutes. “Urges and feelings don't last forever,” Marks explains. “By sitting with the urge and not acting on it, we can build resilience to these urges and pick safer options to manage our difficult emotions.” For food obsession, this might look like sitting with an urge to replay what you ate for your last meal, plan the calories for your next meal, or track macros in an app. Cognitive defusion. Put some space between yourself and your obsessive food thoughts by placing the phrase “I’m noticing the thought” in front of the thought. From there, you can start to remember that you are not your thoughts—and that you have a choice over how you’ll respond to them. Brief sensory task. Take a few minutes to engage at least one of your five senses to help ground you and interrupt obsessive thoughts. This might look like petting your dog, smelling an essential oil, drinking a warm beverage, or putting your feet in the grass. Text a support person. “Having a support system is so incredibly important, and it can be used to encourage someone to eat when they feel like restricting, or provide comfort and connection when someone is feeling like they want to binge,” Marks says. Sometimes, just sharing your obsessive thoughts can help loosen their grip. Foundational skills Consistent eating and pre-planned, balanced snacks. “Eating regularly and being nourished keeps us regulated, feeling safe, and at peace. If we aren't nourished, we won’t be able to manage the difficult emotions that we experience,” Marks shares. “Consistent food also helps us to gain awareness of our hunger and fullness cues again, which will help reduce disordered eating behaviors.” If your hunger and fullness cues are absent, lean on mechanical eating, or eating by the clock, until they return. Scheduled screen breaks from food content. Constantly viewing food content on your phone or computer can reinforce obsession. “Fill up your social media accounts with things that you enjoy,” Marks encourages. “Just having a screen of difficulties only adds to the preoccupation and rumination.” She suggests following a variety of accounts with various topics that aren’t related to food. Reduce tracking. If you’re tracking your food intake, it may be time to take a break for a while to help reduce obsessive tendencies. If you’re tracking your food intake as a part of eating disorder treatment, talk to your treatment team about your challenges with food obsession, and see if there is a different approach you could try. Practice sleep hygiene and stress management. Just like food, sleep is a basic need, and it contributes significantly to your health and ability to heal from an eating disorder or food obsession. Work with your therapist to find supportive ways to manage stress (like joyful movement or spending time with friends), which will help food obsession become less appealing or useful as a way to cope. Clinician-guided exposures and intentions. Work with your therapist and dietitian to implement any necessary exposures to help you heal from your food obsession. Your dietitian will guide the experience, while your therapist will help you manage any difficult emotions that arise. They’ll also help you implement coping skills, set intentions, and remove barriers that are keeping the obsessive thoughts in place. “Food obsession reflects a brain responding to the perceived threat of deprivation,” Turoff says. “The obsessive thoughts around food aren't the root problem, but rather a signal that an individual’s relationship with food has been shaped by fear, scarcity, or overcontrol. Reducing food obsession requires addressing these underlying drivers rather than attempting to suppress or ‘outthink’ the thoughts themselves.” If you’re struggling with food obsession, it could signal an eating disorder. Reach out to an eating disorder therapist or dietitian, or schedule a consultation with the Equip team to talk through your concerns and what treatment options are available. FAQ Why am I always thinking about food? Always thinking about food is often a result of food restriction or living in an energy deficit, as reflected in the landmark study, The Minnesota Starvation Experiment. It can also be caused by emotional stress and used as a form of distraction or control. What is “food noise”? Food noise is a lay term for intrusive thoughts about food (whether it’s about eating the food, not eating the food, amounts of food, or other food-related topics) that negatively impact daily functioning and keep you from living in alignment with your values. Fortunately, food noise often lessens with renourishment and therapy. How do I stop thinking about food all the time? The most effective ways to stop thinking about food all the time include regular eating, reducing food rules, and developing coping skills. It’s best to get evaluated to determine the source of your obsessive thoughts, and to work with a dietitian and therapist to support your healing. Is my food obsession OCD or ADHD—or an eating disorder? Food obsession can be caused by eating disorders, OCD, ADHD, and other issues like food insecurity. Sometimes, there’s overlap between conditions. Seek a professional assessment to determine which one is driving your food obsession.  Why do I think about food when I’m not hungry? If you can’t stop thinking about food when you’re not hungry, it could be a residual side effect leftover from previous food restriction (called restriction rebound), or a result of emotional or mental stress or food insecurity. Keep in mind that all humans need to think about food on a regular basis to help plan, prepare, and look forward to eating, but it becomes a problem when it’s constant, obsessive, and interferes with your ability to live a full life.]]></content:encoded>
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            <title><![CDATA[Post-Meal Distress in Eating Disorder Recovery: Why It Happens and How to Cope]]></title>
            <link>https://equip.health/articles/food-and-fitness/post-meal-distress-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/post-meal-distress-eating-disorder-recovery</guid>
            <pubDate>Tue, 07 May 2024 21:46:00 GMT</pubDate>
            <content:encoded><![CDATA[Believe it or not, eating the food isn’t always the scariest part of meals in recovery. In fact, for anyone struggling with their relationship to food (whether it’s disordered eating or an eating disorder), the time after the meal can often be even more fraught than the meal itself, bringing difficult emotions and physical discomfort. Those minutes to hours after your last bite may include a storm of difficult thoughts, emotions, and urges that can feel crippling and insurmountable. Read on to learn more about post-meal distress, why it occurs, and how to move through mealtime aftermath in healthy and supportive ways. Why post-meal distress is a normal part of recovery While there are many eating disorder recovery challenges, post-meal distress is one of the most common experiences across diagnoses—and a necessary and natural part of the healing process. “Since eating disorders are characterized by a difficulty with food, it’s very normal to experience distress after eating because of having to do something that has been a significant struggle,” says psychotherapist Amanda Marks, LPC, CPCS. In these moments after meals, it’s as if the disordered part of the brain is trying to do damage control, because eating anything—and especially a full meal—is its biggest threat and worst-case scenario. This means that the period post-mealtime can, understandably, feel unsafe. “Eating disorders are ultimately coping skills for many, and losing that coping skill can cause distress until other, safer coping skills are developed and used regularly,” Marks explains. Though enduring post-meal distress can be challenging, it’s worth it, because it ultimately leads to a safer, more positive relationship with food and increased resilience in recovery. Thankfully, there are supportive, healthy ways to navigate this challenge, which we’ll explore in more detail below.  The physical reasons for post-meal distress While we often think about the emotional component of post-meal distress, it can also include a myriad of physical symptoms, from what some people refer to as the “recovery bloat” to quality-of-life disruptors like constipation. Bloating, stomach pain, and delayed digestion Since the gastrointestinal (GI) tract slows during periods of malnutrition and restriction, it needs time to recalibrate during the nourishment process, which can mean uncomfortable side effects like delayed digestion. GI pain or discomfort often follow meals in recovery, with post-meal fullness and abdominal distension the most typical GI complaints from people with eating disorders, along with bloating. One 2021 systematic review shows that GI disorders like functional dyspepsia (chronic indigestion that comes with bloating and stomachaches after meals) are significantly high in eating disorder patients, and often linked to psychological, hormonal, and functional factors. Early satiety and unreliable fullness cues According to eating disorder dietitian Libby Parker, RD, anyone who has been restricting may experience stomach stretching once they begin eating regular meals or eating more than their typical intake. This is because their body has adjusted to different intake patterns and fullness cues. As Parker explains, “this stretching, which is a normal response to food and fluid intake, sends a signal to the brain that the person is getting full and to stop eating, and when this happens early in the meal, it can make it physically difficult to eat enough.” She says such physical issues can cause the eating disorder voice to pipe up, saying things like, “you're supposed to honor your hunger and fullness cues, and you’re full.” This can be particularly confusing, because while this might sound valid, people in early eating disorder recovery often can’t trust their hunger and fullness cues and need to actively override them. Parker adds that those with binge eating disorder may have different types of physical distress, like delayed fullness if eating too quickly. Constipation, diarrhea, and vomiting Constipation is also common after meals (and in general) during eating disorder recovery (especially in anorexia). This is usually a result of slowed gastric motility—which is caused by malnutrition and dehydration—leading to food backing up in the colon. The same 2021 review from above also shows that irritable bowel syndrome, which often includes constipation or diarrhea, is common in those with eating disorders. It’s likely that such symptoms are caused by malnutrition, prolonged restriction, purging, and other disordered eating behaviors, and exacerbated by mental distress and hard feelings like overwhelm and anxiety (since the brain and gut are interconnected). Those with bulimia may also experience spontaneous vomiting. Nausea, heartburn, and reflux Unfortunately, other GI symptoms like heartburn and reflux can occur after meals in eating disorder recovery following long periods of restriction and malnutrition (and binge eating behaviors can directly cause heartburn and regurgitation, since it negatively impacts the esophagus). Nausea is another common post-meal issue, often caused by delayed gastric emptying and anxiety—and the nausea often leads to even more anxiety, which then worsens the nausea. “These physical discomforts can exacerbate emotional distress, and may contribute to a cycle of negative thoughts and behaviors surrounding food and eating,” explains eating disorder dietitian Jaclyn Leocata, RDN. In my practice, I also see clients who experience other post-meal visceral responses—typically triggered by their nervous systems sensing a perceived threat—such as rapid heart rate, sweating, clamminess, and disassociation. The good news? Research shows that with time, nutrition rehabilitation, and progress in eating disorder recovery, the physical symptoms that come alongside post-meal distress will resolve.  The psychological and emotional storm after a meal It’s also normal to experience emotional and mental distress following meals (and these feelings are typically intertwined with the physical symptoms). Here are some of the most common factors that fuel these challenging emotions: The eating disorder voice Often, there are challenging eating disorder thoughts after meals, with the eating disorder voice telling a story about why eating that meal was the worst thing possible. Those thoughts typically lead to highly uncomfortable emotions, including guilt, anger, fear, and shame about the quantity or types of foods eaten, and feeling a loss of control and safety. “While the specific experiences may vary, the emotional impact can be quite similar across different eating disorder diagnoses,” Leocata says. “For instance, those with anorexia nervosa may struggle with an intense fear of weight gain after eating, whereas people with bulimia nervosa may feel a strong urge to engage in compensatory behaviors like purging, excessive exercise, or future restriction.” Marks says the eating disorder will often “‘tell’ someone that they are a failure or a bad person for eating and not having enough “willpower.” This is because the illness is threatened when rigid food rules and rituals are broken, and so it lashes out as an act of self-protection. Emotional overwhelm There’s a saying in eating disorder recovery, “when food goes down, emotions come up,” which refers to the fact that once you’re eating food in recovery, you’re bound to feel emotions that have been numbed for significant periods of time. Eating disorders and disordered eating often have emotional purposes and function as maladaptive coping tools—so, if someone is using their eating disorder to suppress feelings of sadness by restricting food intake, for example, eating an adequate meal is going to feel exceptionally difficult. “When our bodies are nourished, we experience more feelings and sensations, and that can be incredibly overwhelming and distressing for someone who is used to feeling numb,” Marks explains. Often, those in recovery haven’t yet developed healthy ways of coping with sadness or other tough emotions, and so I describe this phenomenon as being thrown out to sea without a life raft to hold onto. “Emotionally, eating disorders use a fixation on food as a coping mechanism,” Parker says, “and so anything that causes discomfort, whether physical, or against the eating disorder, will create a heightened emotional reaction.” This can look like crying after meals, or feeling depressed or irritable after eating.  Body image distortion and feeling “disgusting” Eating regular meals and snacks can also have a negative impact on body image, at least at first. As Leocata explains, this is because after eating, someone with an eating disorder may be filled with negative emotions, which can lead them to “perceive their body negatively, leading to feelings of disgust and self-hatred. They might catastrophize the consequences of eating or have irrational beliefs about food and its effects on their body.” Additionally, when someone’s trauma is at the root of their eating disorder (which is common), old wounds can become entangled with the eating disorder. This makes it particularly hard to feel safe within the body after meals, since the body may perceive eating as a serious threat. When your body doesn’t feel like a safe place to be, you’re more likely to have a fraught relationship to what it looks like. Navigating meals: practical guidance for what to eat Since every person has unique energy and nutrient needs, it’s best to work with a registered dietitian in eating disorder recovery to develop a meal plan and find the eating pattern that works best for you. However, there are some general guidelines to keep in mind when it comes to learning how to eat normally after an eating disorder. The role of mechanical eating Often, mechanical eating, or eating meals and snacks by the clock at regular intervals, is a helpful but temporary tool used in the beginning of recovery until hunger and fullness cues are back online and the eating disorder voice is quieter. Mechanical eating can help connect the mind back to the body, provide external guidance when internal guidance is buried, disrupt the eating disorder brain, and support weight restoration. From "safe foods" to food neutrality At first, meals and snacks may need to be comprised entirely of foods the eating disorder finds safe or non-threatening. This is okay at first, but over time, it’s critical to increase variety and integrate “fear foods” on a regular basis. This not only helps you eat a variety of foods to help your body get all the nutrients it needs, it also helps you reach food freedom and neutrality, rather than a black-and-white view of “good” or “bad” foods (a mentality that fuels the eating disorder’s rigid rules). Principles of a balanced recovery meal Again, you should work with an eating disorder-informed dietitian to determine what, exactly, meals and snacks look like for you, but here are a few rules of thumb to keep in mind as you create eating disorder recovery meals: Include sources of all three macronutrients (carbohydrates, fat, and protein( at each meal and snack. Include a source of dairy (or a dairy alternative) at most, if not all, meals. Include a mix of nutrient-dense foods (like avocado and broccoli), and “fun foods” like French fries, pizza, or sweets (as you’re able).  How to cope: your post-meal distress toolkit Having challenging moments after eating is an inevitable part of eating disorder recovery, but there are things you can do to make those minutes or hours more manageable, whether it’s for yourself or a loved one. Below are several expert-endorsed eating disorder coping skills that can help you navigate post-meal distress during recovery. In-the-moment coping skills (for immediate relief) The strategies below can be helpful earlier in your recovery, when meals still cause a great deal of distress. You can turn to them as needed when difficult feelings arise after eating. Try mindfulness practices. To develop a more mindful approach to your hard thoughts and feelings after meals, be intentional about choosing a specific practice to support the process. Leocata suggests guided meditations (here’s an example of one you can try when flooded with eating disorder thoughts after meals). Many of my clients like to pick a sense (sight, sound, taste, smell, or touch), and engage with it, to help them get more present in the moment and less fused with their thoughts. Sensory tools like essential oils, weighted items, massage, and rocking chairs can be helpful for connecting with your body’s senses. Work with your nervous system. Since the time after a meal can feel emotionally unsafe in recovery, it can be helpful to create a safer internal environment by regulating your nervous system. Regulating practices include sensory modulation (as mentioned above), using cold water or an ice pack on your face or hands, being with a person who feels safe to you, petting your dog or cat, spending time outside or in nature, and taking several rounds of extended exhale breaths. Parker adds that deep diaphragmatic breathing, which activates the parasympathetic (or rest-and-digest) nervous system, can help calm anxiety. Choose another post-meal activity. Planning an activity for after meals can be helpful: crafting, journaling, listening to music, spending time with a friend—anything that will help take your mind off the meal or snack for a while. Staying occupied and supported after meals can help soften hard thoughts and emotions and prevent compensatory behaviors. It’s important to note that while distracting activities can serve a purpose, it’s best if they aren’t only tool you’re choosing. “Distraction techniques like watching TV should be used minimally, since that can often lead to avoidance,” Marks cautions. Process feelings after the meal. Whether alone or with a support person, identifying and safely expressing your feelings can provide some relief after meals. Depending on what you’re feeling, safe emotional expression can include talking about it, drawing or painting, journaling, crying, yelling into or punching a pillow, or whatever helps you healthfully express yourself. “It can be helpful to name the discomfort and include it in a recovery affirmation such as, ‘This is difficult and I'm choosing recovery,’” Marks says. Foundational strategies (for long-term healing) The strategies below are more long-term, gradual tools to help reduce post-meal distress over time and help you or your loved one develop a less fraught relationship with eating. Eat slowly and limit fluids. During the meal, Parker suggests eating relatively slowly and avoiding drinking excessive fluids. This will minimize physical distress and promote an easier post-meal period. Work with a therapist to learn healthy emotional coping skills. One of the hardest parts of recovery can be learning how to feel the full spectrum of human emotions, after months or years of numbing them through behaviors like restriction. However, it’s critical to learn how to navigate all emotions, including the hard ones that can surface after meals, and to replace unhealthy eating disorder coping skills and recovery ambivalence with life-supportive ones. Be kind to yourself. There are three steps to applying self-compassion to your experience, according to researcher Kristin Neff. First, extend kindness to yourself instead of judgment; my clients tend to find it helpful to imagine they’re speaking to a loved one who is struggling. You can also show yourself kindness through action, like giving yourself a hug or wrapping yourself up in a blanket with a warm cup of tea. Second, tap into common humanity: remember that you’re not alone and that other people are having difficult emotions after meals, too. Here are some coping cards to help you integrate self-compassion into your post-mealtimes. Lastly, remember that you’re not your thoughts or emotions. Try to be mindful of them instead of over-identifying with them, even though they can feel all-consuming. Every meal is a step forward Resolving post-meal distress (and other facets of recovery) requires healing the body and mind together, with the support of professionals. By taking it one meal at a time, and using your tools intentionally and consistently, your brain will build new, supportive neural pathways in place of the destructive ones put in place by an eating disorder. It can be difficult to navigate recovery and struggles surrounding mealtimes, but with support and determination, you’ll one day find that you or your loved one can eat a meal and simply move on with the day, feeling satisfied, comfortable, and renewed.  FAQ Why do I get stomach pain and bloating in eating disorder recovery? Since the GI tract slows during periods of malnutrition and restriction, it needs time to recalibrate during the nourishment process, often causing uncomfortable side effects, including stomach pain and bloating. Keep in mind that stomach pain and bloating (along with other GI struggles) are common across eating disorder diagnoses, and go away over time. Is it normal to cry or feel depressed after eating? In eating disorder recovery, it’s normal to cry or feel depressed after eating a meal or snack. This is for several reasons, including psychological to physical discomfort. Eating disorders function as maladaptive coping mechanisms to numb hard feelings, so it makes sense for hard feelings to surface once you’re in recovery and eating regularly. There’s also the common storm of eating disorder thoughts that cause guilt and shame and can feel extremely overwhelming and all-consuming. Finally, there’s the physical distress that can come after meals in recovery, which can cause emotions to feel even harder to navigate. What should I do if I feel the urge to use behaviors after a meal? It’s normal to feel the urge to use behaviors after a meal. Try to first change your location (e.g. go outside or change rooms) and set a timer on your phone for five minutes, to give yourself a timeframe to choose your way of coping. Then, choose a coping skill or two (like expressing what you’re feeling safely through whatever feels right, like crying or journaling, using healthy distraction, or regulating your nervous system by taking some extended exhale breaths). It’s also often helpful to reach out to at least one person in your support system, like your dietitian or therapist, or a trusted friend. Finally, try planning ahead before meals, so you know how to handle urges that may arise afterwards. How can I learn to eat normally again? Eating disorder recovery is a gradual, non-linear process, which requires resilience and patience with yourself. With repetition of eating regular meals and snacks and using your copping tools, your brain and body will learn that it’s safe now to nourish yourself and even enjoy food. Go one meal and snack at a time and if you’re not already, seek support from a dietitian and therapist. Your dietitian will help you understand your nutrition needs, integrate or re-integrate foods you love into your diet, manage GI issues, and trust your body over time, and your therapist will help you develop critical recovery skills like emotional resilience and self-compassion. They both will help remove barriers to eating normally and provide non-judgmental support on your recovery path. ]]></content:encoded>
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            <title><![CDATA[Is Your Workout Routine Leading to Undereating? Signs For Athletes to Watch For]]></title>
            <link>https://equip.health/articles/food-and-fitness/undereating-in-athletes</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/undereating-in-athletes</guid>
            <pubDate>Thu, 12 Dec 2024 20:38:00 GMT</pubDate>
            <content:encoded><![CDATA[Athletes are often very disciplined. In addition to practicing for hours every week (or even every day), many spend additional time training or doing other workouts to prepare for the big game or competition. They may also be mindful about what they're eating, particularly before and after their sport, to ensure they can perform and recover properly. This is all healthy—until it isn't. There's a fine line between being disciplined and adopting a regimen that actually harms health and performance. All too often, athletes may be undereating and not realize it. Camilla Blanton, RD, Lead Registered Dietitian at Equip, explains that undereating is when “there's a mismatch where the energy demands of the sport or activity are not being matched by the athlete's energy intake.” Essentially, it occurs when you're not giving your body the nutrients it needs to function, let alone perform at its best for the sport. Studies show this tends to be pretty common: according to one meta-analysis, about 45 percent of athletes have “low energy availability” (another term for undereating). Making things more concerning, although not everyone who underfuels has an eating disorder, athletes in general have two to three times the risk of developing an eating disorder compared to their non-athlete peers. Everyone needs a certain amount of calories and the right balance of nutrients for their body to function day in and day out—and athletes need even more because of all the energy they expend. When athletes undereat, it not only has a negative impact on their physical (and mental) health, but also hurts their athletic performance. Whether you're an athlete, parent of an athlete, coach, or trainer, it’s important to understand the causes, risks, and solutions to undereating in athletes. Read on to learn why athletes may not realize they're not eating enough, signs and risks of undereating, and how athletes can ensure they're getting balanced nutrition for peak performance. Why athletes may be undereating without realizing it In some instances—like in the case of an eating disorder—an athlete might know that they’re not eating enough. But in many cases, athletes are completely unaware that they’re underfueling. There can be a number of reasons for this, including the factors below. Pressure to maintain a certain body image No matter the sport, “a lot of the time, the reason for undereating might be cultural messaging from coaches, trainers, and other people of influence,” Blanton says. We know all too well how the media loves to talk when an athlete (or other celebrity) loses or gains weight, and this can cause younger athletes in the same sport to think they need to look a certain way to succeed. Additionally, coaches and trainers might make comments about an athlete's weight, body shape, or something they see them eating. It doesn't matter if the comment is directed at the athlete or one of their peers, if it’s critical or complimentary, or if it’s well-intentioned: the message to look a certain way or eat or not eat certain foods can affect everyone who hears. Social media and the recent change in name, image, and likeness (NIL) rights for college athletes has heightened body dissatisfaction, Blanton adds. “There's an emphasis on leanness and athletic aesthetic, and you see that image through social media, as far as who's getting deals. And that means you need to have a social presence, which means you constantly need to see images of yourself, which is not helpful.” Ignoring body cues “There's a lot of messaging in the athlete world about pushing through. A lot of people hear, 'No pain no gain,'” Blanton says. “It can teach athletes of any age to ignore their body cues.” This may lead them to ignore feelings of hunger, when their body is trying to say, “We're not getting enough nutrition,” she adds.  Misconceptions about energy needs Nutrition is highly individualized. Each of us has different needs. Many athletes may simply underestimate how much they need to eat to support their activity level. Part of this may be due to diet culture and misinformation from social media, where anyone can claim to be an expert and recommend their eating plan. Additionally, not all trainers are well educated about nutrition, and they may share unhelpful tips. Appetite suppression after intense workouts Some athletes may undereat simply because they don't feel hungry after training. Various hormones play a role in hunger and fullness, and research shows that these hormones change after exercise. For example, short bouts of exercise cause levels of ghrelin (the hormone that causes hunger) to fall and levels of peptide YY and glucagon-like peptide-1 (two hormones that increase fullness) to increase. Intense activity may have an even greater effect at reducing ghrelin levels, leaving athletes less hungry after harder workouts. Signs of undereating in athletes So how can you tell if you, your child, or an athlete you work with may not be getting proper nutrition? “It doesn't take a lot for the body to show physical signs and symptoms of low energy availability,” Blanton says. Watch for the below symptoms of under-fueling in sports—if you notice more than one, it's probably time to talk to a healthcare professional. Physical symptoms of underfueling Chronic fatigue and low energy levels Frequent injuries, such as stress fractures Recurring injuries Loss of menstruation Frequent illness Missing practice or training due to illness Trouble sleeping Abdominal pain and constipation Performance-related indicators Overall decreased performance (in power, endurance, strength, speed, coordination, agility, etc.) Plateauing in training Regressing in strength and endurance Struggling to complete workouts Slower recovery times Slower heart rate Psychological and emotional red flags Increased irritability or anxiety Depression Preoccupation with food and exercise Social withdrawal or avoiding meals with others Emotional dysregulation  Risks of chronic undereating for athletes Underfueling in athletes can lead to serious long-term risks, which include physical, psychological, and athletic consequences. This is true for athletes who underfuel consistently as well as those who only do it intermittently, like skipping snacks or nutrition after a workout. Physical health risks Relative energy deficiency in sport (RED-S): RED-S occurs when someone doesn't eat enough to support their level of everyday and physical activity. In one study of elite and pre-elite female athletes, 80 percent showed signs of RED-S. These symptoms include a decline in performance, fatigue, injuries, GI problems, and trouble sleeping and concentrating. RED-S can lead to bone loss, delayed growth, dizziness, slowed metabolism, and loss of menstruation. Hormonal imbalances: Undereating suppresses the release of gonadotropin-releasing hormone (GnRH). This causes the body to produce less luteinizing hormone (LH) and follicle-stimulating hormone (FSH), hormones that regulate reproduction and menstruation. Weakened immune system: Low energy availability boosts production of reactive oxygen species, unstable molecules that can damage cells and impair immune response. Digestive issues: Constipation and abdominal pain can occur if an athlete is underfueling, due to slower digestion. Performance-related risks Loss of muscle mass: Low energy availability reduces muscle protein synthesis, the process where the body repairs and builds muscle. Since working out damages muscle, this can cause you to lose muscle. You need muscle for athlete performance as well as to support bone health. Bone loss: For one, athletes who undereat may not be consuming sufficient calcium, vitamin D, and other nutrients to support bone health. And second, if an athlete loses their period, their body is producing less LH and FSH. These hormones regulate estrogen production, which we need for bone growth. Decreased levels can lead to bone loss and possibly osteoporosis. Injuries and extended recovery times: Because of the effects on muscle and bone, athletes who undereat are more likely to sustain injuries of all kinds. They often keep having the same injury, Blanton adds.  Psychological risks Depression and anxiety: Various nutrients impact brain function in positive and negative ways. So if you're not eating a varied diet or enough of certain nutrients, it may increase the risk of depression and anxiety. Eating disorders: “Sports participation doesn't cause eating disorders, but it can be a contributing factor to maintaining eating disorders,” Blanton says. “We see a lot of problematic eating behaviors in athletes.” For example, having strict rules about food and exercise might eventually develop into orthorexia, and restriction may set someone up to later binge. At the same time, “athletes are less likely to receive a diagnosis and treatment, even though we know they have a higher risk of eating disorder,” Blanton adds. This is at least in part because many disordered behaviors—like controlling food intake and exercising obsessively—can seem normal or even “good” in the context of sports. Practical nutrition and recovery tips for athletes In a world where we're often being told what not to eat, it can be difficult to figure out what to eat—especially what to eat more of if you're an athlete. Although each person's needs are unique to their body and their sport, below are some starting guidelines for athletes to avoid underfueling. Recognize increased energy needs You may need to eat more than you think. “A lot of times, athletes are eating three meals plus snacks throughout the day, but their nutritional needs are so high, that's not enough,” says sports dietitian and eating disorder expert Tara Ostrowe, MS, RD, CSSD. If you increase exercise duration, frequency, or intensity, you also need additional energy, Blanton adds. Lastly, if you notice any of the symptoms of underfueling listed above, there's a good chance your body is saying it needs more food, she says. Build a balanced plate for peak performance Most “diets” advise reducing our intake of certain nutrients, especially carbohydrates. But “we should never cut out food groups, because all of them combined gives our body exactly what it needs to support performance,” Blanton says. “In particular, carbs provide energy, protein supports recovery, and fats help unlock vitamins in certain foods.” So athletes need all the macronutrients (carbohydrates, proteins, fiber, and healthy fats), ideally at every meal, she says. Also, don't neglect fruits and vegetables, which provide micronutrients that play a role in muscle growth, energy production, and recovery. Think food first “A lot of athletes think they need supplements, but we want to take a food-first approach because food is synergistic. Different macronutrients work together to help your body unlock other nutrients at times,” Blanton explains. If you find it challenging to get all the nutrition you need from food, see a registered sports dietitian. They can help you see if you could make any changes to your diet first, and if there are still gaps, discuss supplements. “Even if it's just a one-session assessment to get an idea or framework of what your body needs and what that looks like,” it helps, Ostrowe says. Time it right Most athletes require pre- and post-workout nutrition to properly fuel and recover. “In terms of performance and feeling your best regarding endurance and energy for your workout, pre-workout nutrition is important. You'll notice you get a better workout and reduce the risk of injury,” Ostrowe says. “And post-workout nutrition will help your body recover so you're able to perform at your best day after day and prevent injury.” Understand that recovery is part of training Recovery is part of training. Rest days help your body recover and tend to promote better sleep. In turn, sleep is essential for both physical and mental health. Too little sleep increases stress hormones, negatively affects muscle repair, and leads to fatigue.  What to do if you’re struggling with undereating as an athlete Given all the mixed messages athletes can receive about body shape, weight, exercise, and nutrition, it's understandable that so many athletes grapple with undereating at times. If you think or know you're not consuming enough to fuel your activity, consider the following tips to help you give your body and mind the fuel you need to thrive. Recognize the need for support It's not always easy to determine if you're undereating. Blanton suggests asking yourself questions about your performance and habits like: Am I running out of steam or power during my training or workouts? Do I feel frustrated with my athletic performance? How am I doing now versus the start of the season? Do I feel low energy, weak, or tired all the time? Am I having trouble sleeping? Have I stopped getting my period? Even if you're honest with yourself, “having the insight and understanding that there's a mismatch between your activity level and your eating can be difficult,” Blanton says. That's where professional help comes in. Seek out a sports dietitian, who can help you navigate your personal nutritional needs. And if you need emotional or psychological support, find a therapist who works with athletes and is knowledgeable about disordered eating. Find eating disorder-informed healthcare providers Athletes who underfuel don't necessarily have eating disorders. However, working with sports dietitians, therapists, and other providers who are eating disorder-informed often leads to better outcomes. For example, professionals with a health at every size (HAES) approach take the focus off of someone's weight and body size and instead focus on their health and well-being. “We know if we focus on health-promoting behaviors, such as eating enough food to support our sport performance, we will see a positive benefit to one's health,” Blanton says. “On the other hand, seeing a provider who's heavily weight-focused could negatively impact someone, even if weight has never been a concern for them.” This is especially helpful for athletes in weight-centric sports like wrestling or ballet. Build a positive relationship with food A dietitian can help you shift your mindset about food to be more neutral. “All foods can be included in one's dietary intake,” Blanton says. “We want to have variety and options for macronutrients.” And although you may have heard the saying “food is fuel,” not everyone finds this helpful. “If food is just fuel, it can create a limiting mindset. Food should also be fun, and fueling should also be fun to some extent and include foods that taste good,” Blanton says. Overall, work toward a place where you can be flexible with your eating and honor what your body desires. The Equip takeaway: Honoring your energy needs as an athlete Athletes need proper nutrition to fuel performance and recovery. However, many may be undereating, either because they don’t realize how much they need to eat, because of societal pressures, or because of an eating disorder. “There's a lot out there about what a body should look like for this or that sport, but that doesn't equal performance or how someone will succeed in that sport,” Ostrowe says. Undereating can negatively impact performance and every system of the body, from the skeletal and immune system to the GI tract, cardiovascular health, fertility, and mental health. On the other hand, if athletes forget about a number on the scale or a certain body shape and instead put their focus on consuming a balanced diet, training without overtraining, and giving their bodies time to recover, “they'll have top performance,” Ostrowe says. If you're struggling with undereating as an athlete, know that help is available. We recommend finding a HAES sports dietitian who also understands eating disorders. You can also take this five-minute screener to assess if you may have an eating disorder. Either way, seek out help now, before your performance and your health suffer.  FAQs What are the most common signs of undereating in athletes? The most common signs of undereating in athletes include more frequent injuries, recurring injuries, fatigue, frequent illnesses, and a plateau or decrease in athletic performance. What are the risks of undereating in athletes? The risks of undereating in athletes includes relative energy deficiency in sport (RED-S), a weakened immune system, digestive problems, loss of muscle mass and bone mass, increased risk of injuries and extended recovery times, and the potential to develop depression, anxiety, or an eating disorder. How can undereating affect athletic performance? Undereating typically leads to decreased or plateaued athletic performance. This may mean decreased power, endurance, or strength. “If the body doesn't have a reserve of energy, it's going to need to pull that from the body. That means a breakdown of muscle and bone,” Blanton explains. Undereating also means the brain isn't working as well, so skills and rapid movement may be challenging. Lastly, recovery will be slower, so athletes will be sore longer and unable to perform at their best. What is RED-S, and why should athletes care about it? Relative energy deficiency in sport happens when a person isn't consuming enough nutrition to support their everyday activity and any additional physical activity. Athletes should care about RED-S because it can lead to impaired sports performance, longer recovery times, increased risk of injury, more frequent illnesses, bone loss, and other serious consequences. How can athletes ensure they are eating enough? If someone is concerned they may not be eating enough, working with a registered sports dietitian can help. They can help you understand what nutrients you need, how much you need, how those needs shift based on where you're at in your sports season (for example, pre-season versus before competitions), and what foods work best for you. How can coaches and trainers support athletes struggling with undereating? Coaches and trainers can do many things to support athletes struggling with undereating. Here are some practical suggestions: 1. If you're doing any weight monitoring, Blanton recommends reevaluating. “Do you need to do weight checks? Does the frequency need to be that high? Are you checking in on athletes to see how it's impacting them?” she asks. Then consider working with a HAES provider to find more effective ways to do all of this. 2. Focus on performance over weight metrics. 3. Limit negative food comments. Promote a food-first approach and encourage eating rather than discussing limitations on food, Blanton says. 4. Be mindful that eating disorders affect people of all shapes, sizes, ages, and genders, and athletes participating in any sport. 5. Have sports dietitians and other experts you can refer athletes to for additional support.]]></content:encoded>
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            <title><![CDATA[11 Ways to Help a Loved One with an Eating Disorder through Meals]]></title>
            <link>https://equip.health/articles/food-and-fitness/mealtime-skills-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/mealtime-skills-eating-disorder-recovery</guid>
            <pubDate>Tue, 24 Jun 2025 13:57:00 GMT</pubDate>
            <content:encoded><![CDATA[  Imagine this: You have to face the most terrifying challenge your brain can imagine, and the people you love most are the ones forcing you to do so. You have to do this every day, several times a day, with no end in sight. For someone recovering from an eating disorder, that’s what meals can feel like. It might be hard for anyone on the outside to understand, but when you’re in the grip of an eating disorder, meals and snacks can be the most mentally, emotionally, and physically demanding part of the day. This makes the kitchen table a scary and stressful place not only for the person struggling, but also for those supporting them. And for family members who are concerned about a loved one, it can make the prospect of intervening and providing eating disorder meal support feel completely overwhelming. If you’re in that situation, you’re not alone: it’s extremely hard to know how to help someone with anorexia eat—or any other eating disorder for that matter, since restricting food intake is a core component of all eating disorder diagnoses. “Mealtimes can feel like a war zone,” says registered dietitian Bryn Miller, LPC, CEDS-C, EFFT. The good news is that there are tangible things you can do to make eating easier for someone struggling with an eating disorder, and help bring some peace back to the table. Why are meals so hard in eating disorder recovery? There’s no doubt that meals can bring up a variety of negative emotions for people with eating disorders. Research indicates that those affected by an eating disorder associate mealtimes with guilt, confusion, fear, and distress, and that people with anorexia experience an increase in pre-meal anxiety. “No matter what type of eating disorder you have, there's going to be a lot of fear around food. Knowing that we have to eat, ideally, three meals (especially breakfast) and two to three snacks a day to get all of our nutrition in—that's a lot of times for someone to face the fear,” explains Equip dietitian Dani Castellano, RD, CEDS. “That's going to bring up a lot of distress.” This anxiety can manifest in a number of observable ways, including fidgeting, becoming agitated, not engaging in conversation, and avoiding eye contact, says Lauren Chaffin, MS, RD, LD, a registered dietitian specializing in eating disorders. It might also cause a person to turn to eating disorder behaviors, like food rituals or hiding food. In other cases, she says, someone may struggle to ignore the ever-louder voice of their eating disorder, leading to them bottling up and pushing down their feelings. When you're wondering how to help someone with anorexia eat (or any other restrictive eating disorder), keep in mind that mealtimes can cause physical discomfort, too. Our digestive system is a smooth muscle, and when someone isn't using it in the way it's usually used—because they're restricting or bingeing and/or purging—it's not going to be as strong as it needs to be, Castellano explains. This can cause great discomfort when someone in recovery starts consuming consistent, adequate nutrition on a regular basis, especially since many patients need to eat more than they are used to eating, she adds. With all of this happening inside your loved one, it can be extremely difficult for family members to know how to provide eating disorder meal support. But there are two pieces of good news that might provide some comfort:  First, meals typically get easier over time with support, consistency, adequate caloric intake, intentional meal planning, and (when needed) weight gain. “A hungry brain is operating as a more primal brain, with the amygdala—or fear center—taking prominence,” says registered dietitian Elyssa Toomey, RDN, CED-S. “As nutrition rehabilitation progresses, one is more able to access the prefrontal cortex of the brain, which is responsible for executive functioning and reasoning.” This, she says, helps make mealtimes calmer. And second, there are concrete things you can do to make meals and snacks easier for your loved one—and, in turn, for your entire family.  Tips for providing eating disorder meal support Eating disorder recovery isn’t one-size-fits all, and you know your child better than anyone else. The strategies below are expert-recommended ways to help make mealtimes more manageable, but you may need to pick and choose to find the ones that work best for you, your loved one, and your family. 1. Choose regulating pre-meal practices Soothing the nervous system before sitting down to meals can be very helpful. “This means everyone begins meals in the most emotionally regulated place possible, instead of a state of anxiety or numbness,” explains registered dietitian Caroline Young. Some pre-meal regulating practices include: Connecting with nature (like taking a walk outside) Taking several rounds of extended exhale breaths, which research suggests activates the parasympathetic (aka “rest and digest”) nervous system, prompting relaxation Using cold water or an ice pack on your face or hands Listening to music, which may help with pre-meal anxiety as well as post-meal mood in recovery Doing progressive muscle relaxation, where you clench each muscle really tightly and then release it, gradually moving from head to toes 2. Try pre-meal processing Give your loved one space to share how they’re feeling before eating. “Discuss and name any food-based anxiety. Perhaps a particular food is a challenge, or they’re feeling anxiety because of what else they’ve consumed today,” Toomey suggests. “Reassure your loved one that the foods are safe, and remind them to try and separate meal events: What we ate previously or plan to eat later should have no impact on what we’re having now.” She also suggests taking a few collective slow breaths and setting intentions for the meal, like “Stay engaged” or “Taste the food.” 3. Use healthy distraction Though it might feel counterintuitive (shouldn’t we face this head-on?) sometimes distraction is your best friend at the table, especially early in recovery. “A lot of times, the brain can't focus on two things at once,” says certified eating disorders dietitian Iris Epstein, RD. Because of this, it can be helpful to find ways for your loved one to keep their mind off of eating disorder thoughts during meals. Healthy mealtime distractions can include: Playing board games Telling riddles or jokes Playing 20 Questions Doing a crossword puzzle or Wordle Reading a book Playing with a figure toy Drawing Listening to music Listening to a podcast Watching a favorite TV show Talking  4. Foster a safe environment Eating disorder meal support begins before you sit down. Consider if there's anything overstimulating or negatively distracting in your dining area, such as a fast-paced movie on TV or homework to be done. Also take note of who is around, because certain people may make your loved one feel more or less comfortable eating. “It already feels so wrong to them to be facing the food all of the time. So if we have an environment that feels additionally difficult on top of that, that can make it feel impossible to eat,” Castellano says. “Instead, create a space where you can lessen the distress and difficulty even one percent so they can tackle what's in front of them.” If times you can't control the environment, check out these tips for meal support while traveling. 5. Increase external cues of safety Having a physical object or sensory experience that provides comfort can make a big difference during mealtime, reminding the person struggling that they’re safe and helping them regulate their nervous system. Young suggests clients bring items to meals that evoke a sense of peace—seashells from a beach trip, a calming essential oil, an affirmation, a cherished photo, a piece of jewelry from a loved one—and to look at, listen to, smell, or touch it when necessary. Having pets nearby can also create an internal sense of safety for the whole family. Toomey says homemade placemats can also go a long way. “They can be full of drawings, clippings from magazines, quotes, motivations, goals—whatever will help keep one focused on a peaceful state of being during the meal,” she says. These coping cards, which you can print or save to your phone, can also be good in-the-moment reminders of safety. 6. Use mindfulness while eating Another way to help manage the nervous system throughout meals is by using mindfulness tools—like breathing techniques, sense engagement, and grounding practices—which can help move us out of our heads and into our bodies.“When my clients are struggling in meal sessions, I ask them to pause and name five things they can see, four things they can touch, three things they can hear, two things they can smell, and one thing they can taste,” Young says. “I ask them to feel their feet’s connection to the floor and their body’s connection to their chair. After doing this, they’re typically able to re-center and continue the meal with less distress.” 7. Keep the conversation light Talking about food, weight, bodies, or the eating disorder is off the table during meals and snacks. “The support person should always avoid comments around the type of food, the meal itself, the quantity, or anything related to the eating disorder,” Chaffin says. “Basically, no attention should be drawn to the food a person is eating, whether seemingly positive or negative.” For a deeper dive into what to say and what not to say, you can explore this guide for avoiding triggers. By shifting the conversational spotlight from food and the eating disorder to other topics, the meal becomes more endurable for the person struggling, and prevents the eating disorder from latching onto something said and twisting it in a harmful way. That said, not every non-food-topic is fair game—it’s also important to keep conversations light. Meals aren’t for discussing hard family issues or emotionally charged subjects. Instead, try talking about movies, books, or travel, or using conversation cards to explore interesting, unexpected topics.  8. Communicate clearly Before meals, it can be helpful for everyone to clearly communicate their needs. “Both the person supporting and the person struggling should be open to conversations around what is needed and what to do when those needs are unable to be met, such as getting more support or seeking help from their treatment team,” Chaffin says.Communication can also come in handy during the meal if things become too overwhelming. “Often when someone is struggling to eat their meal, a loved one focuses on the specifics of the food, like how many more almonds they need to eat,” Toomey says. “This isn’t helpful. Instead, pause and say to your loved one, ‘It seems like you’re having a really hard time, do you want to talk about it?’ This can diffuse the tension and hopefully get to the root of the problem.”It can also help to validate how they're feeling by saying something like, 'This is very hard work you're doing, and I'm here to support you in getting through this,' Castellano advises. Lastly, if you're not sure what would be most helpful for your loved one, ask. “People avoid asking because they’re trying to know it all or do all the right things,” Castellano says. That puts a lot of unnecessary pressure on you, and prevents you from finding out what your loved one might really need or want. Nobody can know everything—so ask.  9. Have compassion Remember that your loved one is not their illness. “We can all behave in ways that aren’t totally ‘rational’ or in alignment with our values when we’re under extreme duress, even if that duress doesn't make sense to someone else,” Miller says. Expect resistance, and try not to personalize it. “It's the eating disorder talking,” Epstein says. Instead of arguing back or becoming forceful, speak with compassion. Depending on your loved one and your relationship with them, Epstein advises saying things like: “I'm here to keep you safe.” “I know this is hard. You don't have to like this, but remember what our goal is.” “Let's take a bite together.” “Take your finger and poke [the food]...Good. Now, try to put a little on your fork...That's it. Now can you put a little in your mouth?” “We both hate this eating disorder, but I know you can do it.” “You did something really hard, and I applaud you for it.” Nothing. Just sitting in silence if they're slowly eating. 10. Be intentional after meals One of the hardest parts of a meal is the period afterward, since this is when the relentless eating disorder voice loves to berate the sufferer about what they ate, evoking shame and guilt. Research shows that staying occupied and supported after meals can help soften these hard thoughts and emotions, and prevent compensatory behaviors. “After a meal or snack, it’s important to stay present with the person struggling,” Chaffin says. “Keep the conversation going, play a game, watch TV, or go outside for some fresh air together.”  11. Take care of yourself “Providing eating disorder meal support can be challenging, so do your best to get rest, food, and your own support,” Toomey encourages. “You can't pour from an empty cup, so be sure to prioritize your own self-care.” You may benefit from seeing your own therapist or joining a support group, or, if you’re in treatment at Equip, sharing your struggles with your family mentor. “Talking with family mentors can be so helpful because they've had that lived experience,” Castellano adds.  ]]></content:encoded>
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            <title><![CDATA[How Gym Culture Can Contribute to Eating Disorders and Disordered Eating]]></title>
            <link>https://equip.health/articles/food-and-fitness/gym-culture-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/gym-culture-eating-disorders</guid>
            <pubDate>Tue, 11 Jun 2024 18:26:32 GMT</pubDate>
            <content:encoded><![CDATA[As a competitive athlete in high school and college, Ashliegh McIntyre thought doing extra workouts outside of practice, tracking her meals, and skipping rest days was normal. “At times, these things were even viewed by my coaches as dedication,” she says. McIntyre began falsely equating the pursuit of a smaller, more muscular body with an ambition for better health and performance. But her commitment to the gym left her constantly injured, sick, anxious, and depressed, and ultimately led to her temporarily abandoning sports altogether. “At that point I realized that it wasn’t normal and I was actually struggling,” she says. When she was later diagnosed with an eating disorder, part of recovery for McIntyre—who is now Equip’s Senior Manager of Scheduling Operations—involved unlearning many of the gym culture norms that she’d internalized. She’s not alone. Gym culture is often framed as motivating or community-building, and sometimes it can be—but toxic gym culture can also drive disordered exercise and eating. Read on to learn how to know when gym culture has become harmful, how you can foster a positive relationship with fitness, and what to do if you’re worried about a loved one’s gym behavior. What is gym culture? Gym culture is a set of behaviors, norms, and ideologies found in gyms and other fitness spaces, both in person and online. Although the cultures of some gyms can be positive, supportive, and encouraging, the unspoken rules of other gym environments can be problematic, promoting extreme, black-and-white, and inflexible mindsets. The risks of toxic gym culture “One of the core reasons why gym culture can be toxic is that it often associates someone’s body and fitness level to their worth,” says Equip Registered Dietitian Rui Tanimura MS, RD, CYT. Some of the unhealthy habits and attitudes that often surround gym culture include: Tracking workouts, weight loss, calories, and other metrics Adopting a “no pain, no gain” mindset, which might mean doing things like working out through injuries or illness Being very rigid or perfectionistic about your workout schedule and each day’s activity Maintaining a strict diet, or other forms of restrictive eating Equating health with a certain lean, muscular body type Forming cliques based on how you look or how strong you are “Gym culture sends so many harmful messages,” says Kim Packebush, Senior Product Operations Manager at Equip. “It’s the idea that if you didn't track it or take a picture, it didn't count. It’s the belief that movement only ‘counts’ if it’s done at the highest intensity and made visible to an audience for approval. It’s the sense that the only thing keeping someone from going to the gym is a lack of motivation—completely ignoring factors like money, transportation, sleep, stress, and more.” One of the most significant ways in which gym culture harms physical and mental health is through the culture of comparison. “People feel pressure to measure themselves against others and strive to attain an unrealistic standard of beauty,” says Kate Georgiadis, a certified personal trainer. She adds that gym culture tends to promote the misleading idea that every person can attain the same body type by following the same workout regimen and eating plan—a myth that feeds into the culture of comparison and leads people to feel shame and distress when they “fail.” It’s not just aesthetics, though; there’s also functional comparison. “There are so many classes now where you see how fast you're riding a bike or going on the treadmill, and you see everyone else's stats and where you're falling during the class,” says Colleen Reichmann, PsyD, licensed clinical psychologist and founder of Wildflower Therapy. “It's rife for comparison—of both how our bodies look today compared to the person next to us, and also performance comparison.” These attitudes and behaviors can have serious negative consequences on mental and physical health: Toxic fitness culture may lead to: Intense anxiety or obsession surrounding fitness Disordered eating habits that cause nutritional imbalances (for example, overconsumption of protein-rich foods) Neglecting other areas of life, like relationships, work, and rest time Body dissatisfaction and body image issues stemming from constant comparison and unrealistic standards Higher risk of developing an eating disorder  The relationship between disordered eating and gym culture There’s a well-researched connection between gym culture and disordered eating. In a recent study, 232 gym members in Norway answered a survey that included an eating disorders screening. The results showed that nineteen percent were at risk of disordered eating, 16 percent reported having secretive eating behaviors, and 12 percent had a history of eating disorders. Research also shows that while fitness instructors may notice unhealthy behaviors in gym members, they often don’t know what to do. In a 2020 study, researchers in Switzerland surveyed 99 gym employees. Three out of four said they had suspected a client of having an eating disorder or exercising excessively. It’s estimated that up to 14 percent of people who exercise experience exercise addiction, or a drive to work out that feels out of control, and about half of the people with this harmful behavior also have disordered eating habits. Gym employees aren’t immune to these pressures either. In a survey of 685 trainers published in 2015, 22 percent of male and 59 percent of female fitness instructors were classified as having disordered eating. And 9 percent may have compulsive exercise behaviors, according to a 2021 study. The study authors of the survey in Norway note how marketing strategies and exercise concepts at gyms tend to focus on appearance and body weight, which may contribute to these risks, and highlights the fact that gym culture and diet culture so often go hand in hand. On its surface, gym culture may be about getting “strong” or achieving certain fitness goals, but underneath, it’s usually rooted in a desire to be thinner or “leaner”—so dieting is an almost inescapable counterpart. Dieting, in turn, can be a very slippery slope into disordered eating because diets are a form of restrictive eating, which is also the root of most eating disorders. This is why gym culture is often associated with "anorexia athletica,” or a pursuit of thinness in athletes.  Additionally, using diet and fitness apps—another common part of gym culture—is associated with disordered eating, body image concerns, and compulsive exercise, particularly for those who frequently use the apps. There’s also growing misinformation about food and nutrition on social media. Many fitness influencers share meal plans and nutrition tips that aren’t informed by a background in nutrition and dietetics, and often make sweeping generalizations that can encourage people to go against their own body’s signals and needs (the opposite of intuitive eating).  How to find a healthy relationship with fitness Gym culture probably isn’t going anywhere, but with the right information, you can avoid its most toxic elements and find a way to incorporate fitness into your recovery in a way that’s truly healthy. If you’re seeking alternatives to traditional gym culture or trying to re-introduce movement after struggling with an eating disorder, consider these tips. 1. Look for a focus on holistic well-being As a fitness professional who has experienced toxic gym culture, Georgiadis encourages finding a coach invested in well-being rather than in fitting certain body ideals at any cost. “I believe that true health comes from being fully and authentically yourself,” she says. “Developing a positive relationship with your body and a deeper understanding of yourself can help you feel more confident and present in all areas of your life, including your relationships and work.” Finding a trainer, instructor, or even influencer who shares these same values can go a long way toward helping you build a healthier relationship with exercise. 2. Look for a gym that values body diversity over “weight loss” If you or a loved one is going to re-enter a gym or workout space after recovering from an eating disorder or disordered eating, take stock of the environment and be honest with yourself about risks. “Pay attention to the people who frequent the gym. This speaks volumes about the owner's approach to movement and food,” Packebush says. “Does that gym ever post before and after pictures of their clients? Do they provide nutritional advice? Do they care more about filling their classes than ensuring their clients are well-rested, fed, and in the right mindset? Find a gym with people of all body types, not just someone's idea of an ‘after’ or a ‘before’ on their way to an ‘after.’” 3. Find a type of workout that works for you For some people, switching up the fitness modality they focus on may help shift their mindset away from potential triggers. “Strive for joy and fun,” Reichmann recommends. “See if you can find a space that incorporates intuitive movement.” Yoga studios that have weight-neutral, trauma-informed practices can be especially helpful for those in eating disorder recovery. “Eating disorders are psychological conditions that can create a separation between mind and body. Yoga can help people feel safe and grounded enough to reveal their innermost needs,” Tanimura says. “It can also teach us to surrender instead of giving into anxiety and fear-ridden thoughts.” Yoga can be especially beneficial for those in recovery. Of course, yoga isn’t the only type of exercise that can be nourishing and health-promoting. It’s less about the type of exercise and more about the mindset behind it and how it makes you feel. Experiment with different formats and types of movement to find what is best for you. 4. Take an honest look at your fitness circle, on- and offline “Surround yourself with people who care more about how you are truly doing rather than the size or shape of your body, how much you can lift, or how fast you can run,” McIntyre says. “Be wary of fitness influencers who shame other body types, idealize a specific one, and don’t share their education and credentials readily. And don’t be afraid to use the block button and eliminate the possibility of specific accounts appearing in your social media feeds.” What to do if you’re worried about a loved one’s gym behavior If you're worried that your loved one's relationship with the gym signals a bigger issue or possibly an eating disorder, don’t ignore it. Reichmann advises approaching the conversation in a curious and non-accusatory way, using “I” statements to describe what you’ve noticed. For example, “I see that you’ve been spending more than an hour at the gym every day, even when you are sick. I’m really worried.” Then let them talk. You could also share this article and similar ones with them, saying something like, “I was reading about gym culture and thought of you. What do you think about it?” Lastly, you can suggest that they see a therapist. “It can feel scary—a lot of people shut down this type of conversation, especially the first time you try to talk to them,” Reichmann says. “So be compassionate, but sturdy, understanding that they may not be receptive.” If they aren’t, don’t give up. Although you can’t control someone else’s behavior, you can bring up the conversation at another time when you are both relaxed (not when your loved one just finished a workout or is on their way to one). If you’re still uncertain what to do, McIntyre recommends seeking out the advice of a specialist, who can provide individualized advice. Above all, make sure your loved one knows that you are open to talking about this anytime. They could surprise you and bring up the topic in the future.  How fitness professionals can help improve gym culture People who work in the fitness industry can tailor gym environments and their social media presences to avoid promoting disordered behaviors and mentalities. Here are some examples of steps fitness professionals can take to build a better future for gym culture: Educate staff about eating disorders and what to do if they suspect a client is at risk Refrain from making nutritional suggestions. Have credentialed resources on hand for clients requesting nutritional advice Shift the focus from appearance and weight loss to overall well-being and the benefits of movement Feature body diversity in your advertising, staffing, and social media presence Foster an environment that encourages rest, modifications, and safety rather than a “no pain, no gain” mentality Offer workshops dedicated to providing body image and mental health tools What to remember about gym culture and your health Although gym culture is simply the values and actions found in a fitness center or related spaces—such as social media accounts of fitness instructors—the messages it sends can significantly impact your mental and physical health. The motivation behind your workout can tell you whether you’ve fallen into a toxic gym culture mentality. If your workout is centered around true health, inside and out, no worries. But if you exercise to look a certain way, burn a certain number of calories, or always push yourself to go harder or be “better” in some way, it’s a red flag. Take some time to step back and reevaluate the role exercise plays in your life. Similarly, if your eating behaviors are tied up with your workouts—for example, you feel the need to exercise to “make up for” something you ate or you’ve adopted a new diet regimen at the advice of a trainer—toxic fitness culture may have gotten a hold of you. In either case, finding support can help. You may have a friend who can suggest a new fitness center, trainers, or social media accounts to follow that foster a positive relationship with your body, exercise, and eating. Or you may benefit from working with a health at every size (HAES)-informed therapist. Remember, movement should feel like a nourishing and energizing choice, not a punishing and exhausting requirement. This can be especially important to keep in mind when recovering from an eating disorder. If you or a loved one are worried about your gym-going behaviors and think an eating disorder may be the root cause, schedule a call with an Equip team member to talk through your concerns. Calls are brief, free, and no-commitment.  FAQ 1. What is gym culture and how can it influence eating disorders? Gym culture is a set of behaviors, ideologies, and norms that shape gyms and other fitness spaces. Gym culture often promotes excessive and ultimately unhealthy habits and attitudes, such as pushing yourself past your body’s limits, equating health with weight loss, restricting your diet, or exercising to “make up” for meals. Many of these behaviors have the potential to lead to an eating disorder. 2. How does social media impact gym culture and related eating disorders? Social media is one of the main ways gym culture is defined and spread in our society. Some examples of gym culture on social media are before-and-after photos, “what I eat in a day” videos, and unlicensed nutritional advice. These types of posts can normalize disordered behaviors, spread misinformation, and promote unattainable appearance ideals. All of this can be triggering for followers who are susceptible to eating disorders. 3. In what ways can gym trainers and environments contribute to disordered eating? Some gym trainers and environments are harmful and could contribute to disordered eating in the way they praise weight loss and instruct clients to restrict their diets. Nutrition is highly individualized, and one-size-fits-all diets that involve strict rules can quickly slip into disordered eating behaviors. These kinds of actions and advice also send the harmful message that you have to look a certain way in order to be healthy. 4. What are some signs that gym culture is affecting someone's mental health? There are many ways to determine if gym culture is affecting mental health or leading to an eating disorder. Some common signs include mood changes, working out very frequently or with a rigid schedule (even when sick or injured), expressing shame about one’s body, and anxiety or inflexibility around food.]]></content:encoded>
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            <title><![CDATA[How to Determine If a Patient with an Eating Disorder Needs Hospitalization]]></title>
            <link>https://equip.health/articles/understanding-eds/inpatient-hospitalization-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/inpatient-hospitalization-eating-disorder</guid>
            <pubDate>Tue, 11 Feb 2025 21:15:40 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders are mental illnesses that also pose significant risks to a patient’s physical health. They affect nearly every part of the body—from the nervous system to the brain to the heart to the digestive tract—and these effects can be quite serious. In fact, eating disorders have the second highest mortality rate of all mental illnesses, behind only opioid addiction. In general, outpatient treatment should be the first line of defense for an eating disorder, as it causes the least disruption to a person’s life and research shows it’s just as effective as more intensive forms of treatment. But because of the effect eating disorders can have on physical health, patients sometimes need medical stabilization in a hospital before they can begin to address the psychological, emotional, and behavioral aspects of their illness through outpatient care. Determining whether or not a patient needs to be admitted for medical stabilization can be a tough call for healthcare providers to make. Use this guide to better understand what to consider when making this decision so you can provide the best care to your patients. Why might a patient with an eating disorder need hospitalization? Eating disorders can put someone in physical danger for a number of different reasons, one of the big ones being the effects of severe food restriction. “The serious physical health risks of eating disorders are often the result of a lack of adequate nutrition—also known as low energy availability, or LEA—and the associated weight loss,” explains Michele Zucker, MD, Medical Director at Equip. These physical consequences include: Abnormal heart rhythms, including very low heart rates (bradycardia) that can lead to death if not managed properly Kidney damage or failure Liver dysfunction or failure Pancreatic dysfunction and pancreatitis Slowing of movement of food through the gastrointestinal system that leads to vomiting and inability to keep in food Low blood pressure, which can lead	to dizziness upon standing, and fainting A weakened heart, and potentially even heart failure Severe malnutrition may also cause a condition called pericardial effusion, where fluid accumulates in the sac surrounding the heart. If this fluid collection becomes large enough, the heart is unable to beat properly and keep blood moving throughout the body. But food restriction isn’t the only eating disorder behavior that can put someone in physical danger—there are several other behaviors that can lead to serious medical complications. Some of the risks to be aware of include: Vomiting to get rid of food may result in bleeding from the esophagus, which can cause a significant amount of blood loss. Excessive vomiting can also lead to potentially dangerous changes in the body’s acid/base status, as well as low potassium. Overuse of laxatives can cause low levels of potassium, sodium, magnesium, and phosphorus, which can affect nearly every organ system. Excessive exercise contributes to low heart rates. Water loading (drinking excessive amounts of water or other fluids in order to influence weight) can cause dilution of electrolytes including potassium and sodium. Very low sodium levels can cause seizures. Avoidance of drinking adequate fluids or overuse of diuretics can lead to dehydration, which can contribute to kidney dysfunction or failure, dizziness, and fainting. Lastly, there is a risk of refeeding syndrome if nutritional rehabilitation isn't done correctly. “When someone starts eating again after a period of very low nutrition, it can result in shifts in fluids and electrolytes,” Zucker explains. “These shifts may affect many organ systems, and can lead to serious complications, including body swelling, double vision, confusion and disorientation, nausea and vomiting, muscle weakness, trouble breathing, abnormal heart rhythms, and even death if not properly managed.”  Medical criteria for hospitalization: key indicators Many providers use the American Psychiatric Association Practice Guidelines and the Society for Adolescent Health and Medicine factors to support hospitalization to determine if a patient may need to be hospitalized for medical stabilization. Their criteria is: Very low weight (<75% of the 50th percentile BMI for age and sex) Dehydration Electrolyte disturbance (low potassium, sodium, phosphorus) Physiological instability Severely low heart rate (<50	beats/minute daytime; <45 beats/minute sleeping) Abnormally low blood pressure Low body temperature (<95 degrees F, <35.6 degrees C) Orthostatic changes in pulse or heart rate Failure to thrive/arrested growth and development Uncontrollable bingeing and purging Medical complications of malnutrition (for example fainting, seizures, heart failure, kidney failure, liver failure, pancreatitis, etc.) Concurrent medical or psychiatric conditions that limit appropriate outpatient treatment (like type I diabetes, obsessive compulsive disorder, or a suicide attempt) If a patient meets any of the criteria above, they may need inpatient hospitalization—however, this checklist alone isn’t enough to determine if a patient needs a higher level of care. “Our bodies are designed to stay alive, so they accommodate malnutrition until they can't, “ says Kara Pepper, MD, East Coast adult medical supervisor for Equip. “People can come to the doctor's office and have normal labs, but that doesn't mean there are no eating disorder behaviors going on. You need to talk to your patients.” She encourages providers to screen everyone for eating disorders. Additionally, keep in mind that weight is only one factor. “You also need to look at how quickly a patient’s weight changed, and the frequency and intensity of their engagement in eating disorder behaviors,” says Heather A. Dlugosz, MD, Medical Director at the Harold C. Schott Eating Disorder Program. Pepper agrees, adding that, “people can have very significant malnutrition if they lose significant weight in a short amount of time, even if their BMI doesn't reflect that they're underweight.” Treatments provided during inpatient hospitalization While inpatient stabilization may sometimes be required, it’s important to understand that this level of care is meant to be short-term and intensive. Patients may remain in a hospital setting for a few days or weeks, then transition to a lower level of care. The exact care provided will vary from hospital to hospital, but effective inpatient treatment for an eating disorder should be tailored to the individual and address multiple different aspects of the illness. It typically involves a multidisciplinary team that monitors the patient and a regular schedule of care that often includes the following: Multidisciplinary team During medical stabilization, patients are often cared for by medical providers, dietitians, and nurses. Many inpatient units also have psychiatrists, who can prescribe medication for any underlying mental health conditions, as well as therapists, social workers, or occupational therapists, who provide support to help manage anxiety and stress related to eating and can assess patients' progress or regression. “It's a collaborative approach to help the whole patient, mind, body, and spirit, and help their support team to understand how to care for them,” Dlugosz adds. Monitored vitals When being stabilized, patients’ heart rate and rhythm, blood pressure, and weight are closely monitored. “Blood is usually drawn at least once daily for up to seven days to monitor for electrolyte changes that can occur with early refeeding, and any abnormal electrolyte levels are corrected through supplementation,” Zucker says. This blood work also checks for underlying conditions that could be causing or contributing to weight loss or preventing weight gain. Psychological support Adjusting to inpatient care can be challenging, and some patients may not want to be there. So in the beginning, therapy may focus on helping people navigate being in inpatient treatment, Pepper says. In addition to individual sessions, group therapy sessions give patients the opportunity to work on interpersonal dynamics and receive and provide support to others. Restricted activity During treatment, it's essential that the patient's body is able to use as much nutrition as possible to grow and repair. Because of this, most are expected to remain restful and may be monitored to ensure they aren't trying to exercise or get more physical activity in secret. Supervised meals Dietitians carefully plan each patient's individual meal plan, and all meals are eaten in group settings. Staff are available to supervise and may eat with the patients to provide support, compassion, and redirection if someone becomes distressed or engages in a disordered behavior like hiding food or cutting it into small pieces, Dlugosz says. If someone can't eat their entire meal, they often drink a liquid supplement after to ensure they consume all the nutrition their plan calls for. Patients may also be supervised after meals in order to prevent purging behaviors. Feeding tube Depending on the treatment center, a nasogastric (NG) tube may be used in different circumstances to provide a liquid meal replacement. This tube goes through the nose and feeds down the throat into the stomach to ensure optimal caloric intake. “It's an option to be used when patients are really struggling,” Dlugosz says. “ If someone has weight restoration to do, they may have a nutrient goal that's hard to reach with solid food alone without a lot of physical or psychological discomfort.” In these instances, patients may choose to use an NG tube, which allows them to focus on eating what they can manage at the meal and still support their goals.  Duration of hospitalization and post-discharge planning It's hard to predict how long any one patient will spend in hospitalized care. “The goal of the inpatient hospitalization is to monitor for and treat any electrolyte changes, halt weight loss, normalize vital signs, treat any other medical complications of the eating disorder, and address any additional medical or psychiatric problems,” Zucker says. “Given these goals, a patient may remain hospitalized for anywhere from several days to several weeks, depending on the severity of their symptoms and how quickly they’re able to make progress. Their length of stay may also depend on additional medical or psychiatric issues, support systems, and insurance coverage.”  After discharge from the hospital, patients may step down to any level of care, including outpatient, intensive outpatient, partial hospitalization, or residential eating disorder treatment. “Typically, the inpatient team collaborates with the patient and their family to determine the best next step, and then initiates referrals for that treatment,” Zucker says. Although some people go straight from a hospital setting to outpatient care, many step down more gradually. “It's hard to go from 24/7 care to only one to two sessions per week,” Dlugosz says. “Depending on the patient, they may continue to require close medical and psychiatric monitoring, weight restoration, or further help with changing behaviors that would be challenging in outpatient treatment alone. We want to give patients the practice of building mastery to do things independently in a way that doesn’t feel too overwhelming.” In an ideal world, the best discharge plan is tailored to support continued recovery. But there are also considerations like insurance limitations, comorbidities, finances (such as if the patient is the breadwinner for their family), proximity to loved ones, and patient autonomy to factor in. “We want it to be something they feel like they can commit to while also ensuring the plan meets the needs of where they are in their recovery journey,” Dlugosz says. The critical role of inpatient care in eating disorder recovery Eating disorders are one of the most deadly mental illnesses, making it critical to help patients get the right level of care to address both the physical and mental health consequences. While outpatient treatment is considered the front-line treatment for most eating disorders, some patients with severe eating disorders may first require inpatient care. Providers can help these patients by being aware of the signs that someone needs hospitalization, and then referring the patient to an appropriate treatment center. “Find out who in your community treats eating disorders, make connections with them, collaborate, and understand what resources are available locally and in your region,” Dlugosz encourages providers, “so if and when you have a patient who needs more support, you a have list of places you feel comfortable referring them to.” It’s also important to remember that even if a patient is resistant to treatment or the idea of hospitalization, it doesn’t mean that it’s the wrong choice—and they may find the motivation to recover only after treatment begins. “At any given time in our inpatient unit, we have patients who are not 100 percent willing to be there and others who really are motivated for change,” Dlugosz describes. “Once they get settled in and build further willingness for support, most individuals start to see how their life can be different outside of their eating disorder. Even if they're not 100 percent committed to recovery, we can see degrees of change in patients while they're here. Most of the patients we work with transition to the next level of care after an inpatient admission that meets their current needs and are able to continue to work toward building a life outside of their eating disorder in line with their goals and values.” If you’re unsure whether a patient of yours needs inpatient hospitalization, you can talk to an Equip team member to determine the best course of action. You can schedule a call, or reach out to us via email, phone, or online form.  FAQ What are the key signs that indicate a patient with an eating disorder needs inpatient treatment? Eating disorder hospitalization criteria includes: Weight <75% of the 50th percentile BMI for age and sex Dehydration Electrolyte disturbance (low potassium, sodium, phosphorus) Severely low heart rate Abnormally low blood pressure Body temperature <95 degrees F (<35.6 degrees C) Slowed or halted growth and development Uncontrollable bingeing and purging Medical complications of malnutrition Suicidal thoughts or attempts How does inpatient hospitalization help stabilize patients with eating disorders? Inpatient hospitalization helps stabilize patients with eating disorders in several ways. First, the patient's vitals are monitored to check that their health is stable and to catch and fix any electrolyte changes. Second, meals are supervised and activity is limited to ensure their nutrition is going toward recovery. Third, therapists, psychologists, and other mental health professionals provide support to cope with any general anxiety or anxiety around eating, as well as to treat any underlying mental health conditions. This holistic approach addresses all aspects of the eating disorder. What happens if hospitalization for an eating disorder is delayed or avoided? Eating disorders can lead to various health risks, including osteoporosis, damage to the liver and kidneys, heart changes that can lead to death, and more. The sooner someone with an eating disorder receives the appropriate level of care, the lower their risk of these complications. So if hospitalization for an eating disorder is delayed or avoided, that person could face serious health issues in the short- and long-term. Can a patient refuse hospitalization, and what are the ethical and legal considerations? Yes. Though the exact laws vary state by state, in general, adult patients (or the parents or guardians of minor patients) can refuse hospitalization. That said, laws about civil commitment (also called involuntary commitment) in some states may give providers the ability to petition a court to commit a patient to inpatient treatment if that patient poses an immediate threat to their own life or others' lives. How can families and caregivers support a loved one during and after eating disorder hospitalization? There are many ways that caregivers can support a loved one both during and after hospitalization for an eating disorder. This can include: Unlearning: “Because of fat stigma, anti-fat bias, and society's view of weight, there's a lot of unlearning about what health and body size mean,” Pepper says. Attending family therapy sessions can help. Avoiding certain language: Keep comments about things like body size, weight, and food—whether yours, theirs, or others—to yourself. Validating their feelings: Eating disorders often cause shame, and inpatient care is a challenging time when someone can't engage in certain behaviors that they find comforting. Work to validate how hard what they're doing is. Challenging them: Set limits when you need to, Dlugosz says. Finding your own support: Support groups for parents and loved ones can give you a place to meet others going through similar things. This can give you a place to talk about your feelings and to feel less alone. Therapy may also help.  ]]></content:encoded>
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            <title><![CDATA[How to Cope with Weight Gain in Anorexia Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/weight-gain-anorexia-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/weight-gain-anorexia-recovery</guid>
            <pubDate>Wed, 21 May 2025 16:44:12 GMT</pubDate>
            <content:encoded><![CDATA[There’s no denying that anorexia recovery, while life-changing and often life-saving, can be a challenging process. Committing to treatment can transform your (and your family’s) life and well-being for the better, but it’s important to be aware of the most common obstacles that can impede or complicate the journey. For many people, the most difficult hurdle to overcome in anorexia recovery is weight gain. Weight gain in anorexia recovery can be incredibly difficult—physically, psychologically, and emotionally. Understanding why weight gain is absolutely critical in anorexia treatment can help ease some of the concerns and discomfort that often accompany the process, as can learning coping strategies. Read on to learn more about the role of weight gain in anorexia recovery and how you can come to tolerate and accept it. Introduction to weight gain in anorexia recovery Without adequate weight gain, full recovery is impossible, making it one of the most important factors in healing from anorexia. “Re-nourishing the body is essential for improving health outcomes and minimizing lasting impact,” says dietitian Ana Pruteanu, MS, RD, who likes to equate weight gain in anorexia recovery to “a process of healing the body and healing ourselves, and regaining the freedom to feel strong again, be able to eat with others, and be able to be ourselves again.” But for those recovering from anorexia, gaining weight isn’t an easy thing to accomplish. It can be challenging for a number of different reasons, including emotional and mental overwhelm, loss of a (maladaptive) coping mechanism, and our weight-obsessed culture. “Gaining weight feels like a loss of control to many of the people I work with,” Prutaneau says. “Societally, we are told that gaining weight is a sign that we are doing something wrong.” The weight gain process can also take a toll physically, and sometimes even be painful because of digestive distress during nutrition rehabilitation. The good news is that there are a variety of ways to manage every part of the weight gain process, like developing new coping tools, surrounding yourself with supportive people, and creating boundaries with diet culture content—all of which we’ll break down together today. Why you need to gain weight in anorexia recovery Commonly known as “weight restoration,” gaining weight during the eating disorder recovery process is crucial to both short- and long-term mental and physical health. While it’s true that people with anorexia who are severely malnourished may need to be admitted to a hospital to receive more intense treatment and monitoring, you don’t need to “look” thin or malnourished to require weight restoration. “It’s important to highlight that not all people need to be ‘medically underweight’ to be sick with anorexia,” says Equip Therapy Lead, Maddie Friedman, LCSW. She explains that for young people, falling off their growth curve is an indication that weight restoration may be required, regardless of whether or not they are “underweight.”  And for adults, it’s crucial to recognize that the marker many providers use to determine whether or not someone needs to gain weight—the Body Mass Index (BMI)—is deeply flawed. A person may fall into a “healthy” BMI range and still be below their body’s natural set point, in which case they would require anorexia weight restoration. Research shows that BMI is a faulty tool for setting target weights, and that if a person is even a few pounds below the weight their body wants to be, this deficit can fuel eating disorder behaviors. Those with atypical anorexia—an eating disorder diagnosis that shares almost all the same characteristics of anorexia, except for low weight—often need weight restoration, despite not falling into the “underweight” BMI category. Being weight-suppressed has a variety of different health risks, including: Heart conditions Low blood sugar Dizziness Fatigue Being cold all the time Gastrointestinal issues Headaches Anxiety Death “Breaking the cycle of restriction is often the first step to treatment, as it allows the brain and body to relearn hunger and satiety cues that align more with nutritional needs outside of the eating disorder,” Friedman says. “Target weights are calculated for folx in need of weight restoration to get back on track with their growth, development, and overall well-being. Malnutrition can impact all of the systems in the body and can lead to infertility, brain damage, and bone loss, and, in some cases, can be fatal.”   Weight suppression can also exacerbate the mental symptoms of the eating disorder, while gaining weight naturally quiets these symptoms. Equip’s Director of Peer Mentorship, Maris Degener, says weight gain was an essential piece of her recovery journey for multiple reasons. “Gaining weight is what the eating disorder feared, and so much of my recovery was continuously facing the eating disorder’s fears in order to overcome them,” Degener says. “If I were to try and avoid gaining weight over the long term, it would have reinforced the eating disorder belief that weight gain was something that must be feared, and would have also meant engaging in the restrictive behaviors I was trying to move away from in order to try and control my body size.” In addition to pushing back against the eating disorder, weight gain enabled Degener to experience an array of physical and mental health benefits. “The more nourished I became, the more fueled my brain and body was to continue to challenge the eating disorder,” she says. “Gaining weight, for me, supported better sleep, more energy throughout the day, and a greater ability to practice regulating my emotions during the ups and downs of recovery.”  Why weight gain can be so challenging Given the fact that diet culture continuously and dangerously conflates weight loss with worth or moral superiority, weight gain can be hard for anyone. But for those in the grip of anorexia, it can be particularly difficult to tolerate. Weight gain during anorexia recovery can be challenging on several different levels: Emotional challenges “Regular eating and weight gain can be so challenging during treatment and recovery because they can feel totally unfamiliar and distressing,” Friedman says. “Gaining weight often requires acting in opposition to the eating disorder, which has usually been driving behavior for a long time.” Degener says that for her, weight restoration was particularly difficult on an emotional level: “I remember explosive meal times where I fought and argued with my parents because of how fearful I was of gaining weight—and the time after meals was difficult, too,” she says.” I carried a heaviness of anxiety, worry, fear, and anger with me for some time, and had to learn strategies for sitting with and tending to those emotions.” As she continued to restore weight, Degener also encountered new emotional experiences in recovery, like parting with clothes that no longer fit. “I look back on these experiences as important moments that ultimately taught me and gave me so much perspective—and in the moment, they didn't feel that way,” she says. “They felt scary and frustrating and difficult.” Social challenges Diet culture plays a harmful role in perpetuating fatphobia and glorifying thinness at any cost, which can make intentional weight gain a challenging proposition. “One element that I don't want to overlook is the role of living in a society embedded with anti-fat bias and diet culture,” Degener says. “We are continuously taught and sold the idea that losing weight or living in a thin body is our obligation and necessary to living a fulfilling life. Gaining weight and experiencing changes in our body in a society that is so often unsupportive of doing so is a challenge we shouldn't overlook in this discussion.” Psychological challenges Restriction itself can have significant deleterious effects on the brain, making it even more difficult to fathom listening to your body’s cues and purposely gaining weight. “The brain has often lost touch with hunger cues due to restriction, and when certain body signals are overlooked for a period of time, they may stop showing up altogether,” Friedman says. “As a result, we often encourage patients to eat by the clock. Eating more regularly will help the brain and body relearn hunger cues. This may initially feel uncomfortable due to most of us learning that feeling hungry is a requirement for eating.” Physical challenges For many, the physical sensations of fullness and eating in a way that supports adequate nutrition can be unfamiliar and uniquely uncomfortable. “Many people recovering from anorexia will get full very quickly during the renourishment process, due to not being used to eating the amount of food that is often required to combat weight suppression,” Friedman says. “This discomfort will improve over time with consistency.” Deneger recalls feeling substantial physical discomfort during the weight restoration process, which took time to navigate. “My body was getting used to a new pattern of eating, and reintroducing foods that the eating disorder had led me to avoid for quite a while, which wasn’t always comfortable,” she says. “I spent a lot of time resting after meals—watching movies, making art, or reading to distract myself from emotional discomfort and allowing my body time to digest and settle.” Strategies for making weight gain more manageable While recovery from anorexia is different for everyone, and you’ll have different challenges at different stages in the journey, there are a few general strategies that can make weight gain more manageable. Here are some expert-endorsed tips for coping with weight gain in anorexia recovery: Cultivate self-compassion and mindfulness Practicing self-compassion can provide relief in the hardest of moments when you’re struggling with weight gain in recovery. According to researcher Kristin Neff (who offers free, guided self-compassion exercises), self-compassion involves mindfulness instead of over-identification with thoughts or feelings, self-kindness instead of judgement, and common humanity instead of isolation. There are many forms of mindfulness practices that can be helpful in building tolerance for the potential emotional and physical discomfort of weight gain, including calming meditations and breathing practices. Pruteanu recommends a nervous system regulating exercise: “Activate the vagus nerve—the main nerve network of the parasympathetic nervous system—by humming for a couple of minutes before eating,” she says. “This can help shift your body into rest-and-digest mode and decrease digestive issues.” Find comfort and safety where you can Gaining weight in recovery can feel uncomfortable and unsafe, so it’s a good idea to bolster your mealtimes and day-to-day experiences with tools that support you and remind you that you’re safe in the most difficult moments. Friedman’s suggestions include applying a heating pad on your belly when experiencing fullness, bloating, or stomach discomfort, bringing a blanket or safe object to the table while eating, and engaging in distraction during mealtime to prevent hyperfocusing on feelings of fullness or discomfort (for example, watching a show, listening to music, petting your dog, talking to a safe person, or playing games). Cultivate a supportive circle It’s also helpful to consider who the people are in your life that make you feel safe, and to enlist them for support during potentially distressing moments. “Having support around you for tough moments like shopping for new clothes or parting with ones that no longer fit can be incredibly supportive,” Degener says. “Having someone with you who can offer validation and support can help make a difficult experience a bit less lonely and a bit more doable.” Start by letting them know that you’re struggling with gaining weight, what your triggers are, and how they can be there for you. Stock your closet with clothes that make you feel good “It’s really important to have clothing available that feels comfortable regardless of size,” Friedman says. “In fact, I often recommend cutting out tags from clothing altogether since sizing is totally inconsistent and tends to just fuel further discontent and stress in the weight restoration process. Removing or donating clothing that no longer feels comfortable can be a very helpful part of this process, and having new clothes that feel good will hopefully decrease focusing on what no longer fits.” (And, as Degener notes above, it’s a good idea to have the support of someone close to you when you’re doing this.) Audit your social media Whether you’re aware of it or not, social media can impact how you feel about your changing body in recovery. “One thing that was impactful for me was switching up my engagement with social media,” says Degener. She found that taking breaks and following accounts that reflected body diversity allowed her to see people of all body sizes living their lives and finding joy. “In recovery, I came to realize that I grew up really only seeing a very narrow representation of body sizes portrayed in the media and this negatively influenced beliefs I held around my own and others' bodies,” she says. Structure your meals One of the most important and helpful tools for weight gain in recovery is a meal plan or structure (developed by a dietitian) tailored to meet your needs and preferences. Generally, some good guidelines to follow are eating regularly throughout the day and including carbs, fats, and proteins at every eating experience. Pruteanu recommends starting with foods that feel safer and to be mindful of how much you drink at meals. “Limit liquids during mealtimes to avoid overfilling your stomach with fluid," she says. “Feeling too full can trigger physical discomfort and bring up urges to restrict or purge.” She also suggests using mechanical eating or eating by the clock. “Don’t wait for hunger cues, as these are often not consistent at the initial phase of recovery and when under-nourished,” she adds. Consider gentle movement Sometimes, gentle movement like walking or restorative yoga can help alleviate distress associated with gaining weight, as long as it’s for the right reasons (and not dictated by the eating disorder brain). For example, taking a walk in nature can be calming and soothing, and a restorative yoga practice can help the body process difficult emotions. However, whether or not you can incorporate movement into your recovery is a tricky topic that requires discussion with your treatment team.  Working with professionals Anorexia recovery requires the support of specialists. Weight restoration in particular isn’t something you should try to accomplish alone, but rather alongside a team of experts who can help you do so safely and in a way that leads to long-term recovery. The role of registered dietitians Registered dietitians are typically the ones who set target weights—and often use weight ranges instead of one specific weight, since bodies fluctuate on a regular basis. Target weights are typically determined by several factors, including pre-eating disorder weight, how much weight was lost, and sometimes growth charts (if the patient is a child or teen and still growing). BMI is sometimes still used to calculate target weights, but it's not a reliable indicator of health on its own and must be used mindfully and in the context of a person’s overall health. Sometimes, a person’s target weight is higher than what seems to be an acceptable weight, according to society’s standards. Keep in mind target weights are estimates and can sometimes change, depending on how a person’s body responds to nutrition rehabilitation and how they’re doing otherwise (medically, mentally, and emotionally). Additionally, dietitians may adjust meal plans or structures throughout treatment depending on how the body responds and needs change. The role of therapy and counseling Since weight restoration can take a toll mentally and emotionally, it’s important to work with a therapist who can hold a safe space for you to express and navigate eating disorder thoughts and difficult feelings (about body image and otherwise) and develop coping skills and strategies to use outside of therapy. There are many therapeutic techniques that can be helpful in the weight gain process, and often a combination of techniques is used, including cognitive behavioral therapy, dialectical behavioral therapy, family therapy, acceptance and commitment therapy, and mindfulness-based therapy. The role of medical monitoring It’s critical that you’re having regular medical visits during the weight gain process where your medical team will review factors (aside from weight), like heart rate, blood pressure, and lab values, to ensure medical safety. Often, people in anorexia recovery are at risk for refeeding syndrome, which is a physical process that occurs when some patients who are malnourished start eating regularly again. Medical providers can help monitor and mitigate this risk.  Tracking progress While we’ve focused primarily on the struggles that come with weight gain in recovery, weight gain also brings so many improvements and benefits, not only in the short-term but throughout life. As you gain weight from anorexia, you’re likely to experience a number of quality-of-life improvements—like improved energy levels, better sleep, more stable moods, increased focus, and healthier vital signs—which are all signs of progress. It can be helpful to journal about any positive changes that occur as you gain weight (even if they’re small), like laughing with a friend, enjoying a slightly better mood, or being able to finish a book. There’s no need for you to track your weight, since this is your team’s job and it can often cause more distress for the one in recovery (since weight and weighing are often a hyper focus of the eating disorder). You can work with your dietitian to decide how you’ll track progress (outside of weight), how (and how often) you’ll discuss weight, and whether open (seeing your weight) or blind weighing (not seeing your weight) is best for you.  Long-term acceptance and body appreciation While gaining weight during anorexia recovery is almost inevitably challenging, any distress it causes is a short-term and necessary part of the journey. As you work toward your body’s set point, you can work toward not only acceptance of your new body, but, eventually, even appreciation. From tolerance to acceptance At first, it may feel impossible to know how to accept weight gain or your changing body, and that’s okay (and common). The first step is tolerance—being able to manage the multi-layered distress that can come along with anorexia weight gain—and that’s enough until you’re ready to move forward. The next step is acceptance of weight gain. To achieve this, your team will ideally meet you where you are and sit with you in each stage of readiness to accept the weight gain process and eventually your recovered body. Building body respect It’s hard to take care of something you hate, so while loving your body is not a necessity in recovery, respecting it is. Here are some of my favorite ways to take steps away from body hatred and toward body neutrality, or taking a neutral yet respectful stance toward your body: Practicing neutrality in the mirror. When you’re standing in front of the mirror, intentionally describe different body parts in a neutral way (e.g. “There are my arms. They have freckles.”) to remind yourself that your body isn’t here to be criticized. Applying mindfulness to negative body thoughts. Start noticing negative body thoughts and put the phrase, “I’m having a thought that,” before the negative thought, which will help put space between you and the thought, giving it less power. Remember, you are not your thoughts and you don’t have to believe everything you think. Celebrating function over appearance. Take stock of all the activities your body allows you to do on a regular basis and focus on that, instead of how your body looks. When you start recognizing all that your body enables you to do, it can feel easier to respect it a little more.  FAQ People navigating anorexia recovery—and their loved ones— often have questions about anorexia weight gain, why it’s necessary, how much is needed, and more. Here are answers to some of the most frequently asked questions on this topic: How much weight will I need to gain? It depends. Your target weight is based on a variety of factors, including your weight history, your growth chart, your symptoms, and your treatment teams’ recommendations. The amount of weight you have to gain may be very different from another person going through recovery. “It makes sense to ask this question—when we begin a journey that's challenging, we want to know the destination,” Degener says. “Ultimately, the answer to this is different for every person, and working with a professional you trust will help you identify goals that support your unique recovery. Something I often say is, I had to gain much more weight than my eating disorder thought was ‘okay,’ and overcoming that belief was actually an essential step in my recovery.” Who decides my target weight? This can also vary, but it’s typically the dietitian on your treatment team who determines your target weight. “For many, determining a target weight means working with a registered dietitian who has a strong understanding of eating disorder recovery,” Degener says. “They have a wealth of knowledge and experience working with others who are navigating recovery, and can offer incredible support.” Why do I have to gain that much weight? Can I still recover if I’m a few pounds short of my target weight? Adequate weight gain is one of the best predictors of reduced eating disorder symptoms. Not gaining enough weight for your unique body (even if you’re technically in the “healthy” BMI range) can make your recovery more fragile, and set you up for a potential relapse. This is sometimes referred to as 'quasi recovery.' “Weight is one data point that the treatment team evaluates to monitor progress, and additional factors such as mood and behavior are evaluated as well,” Friedman says. “Generally speaking, the target weight is thoughtfully identified, and achieving this can be critical for ensuring additional growth, return of menstruation, bone health, brain health, and so much more. When folx are able to exceed their target weight they are often in a more stable place to protect against future fluctuations as well.” What if I don’t think I’ll ever be okay with my weight gain? Fearing weight gain is often an inherent part of anorexia, so it’s not unusual to worry about this. Self-compassion is one important tool that can help quiet the eating disorder voice. “Be gentle with yourself,” Friedman says. “Eating disorders are often very effective in convincing us that weight gain is the worst possible outcome. In reality, malnutrition is more likely to rob folx of their futures and steals joy and hope from them in real time. Focus on taking treatment meal by meal, moment by moment, and day by day.” While it may feel overwhelming or unrealistic to imagine “loving” your body, there are actionable steps you can take to move away from the other extreme on the spectrum and learn to appreciate your body for what it does for you. “It might feel more manageable to start with finding ways to tend to your body's needs with warmth or neutrality—making sure you get enough rest, wearing clothes that feel comfortable, spending time engaging in hobbies or activities you enjoy,” Degener says. “Don’t expect yourself to accept body changes overnight. This is a process that takes time and has its ups and downs.” How do I accept the emotional impact of weight gain? Gaining weight in recovery often causes intense, difficult emotions, which can feel overwhelming and everlasting, but once emotions are fully felt and processed, they can be released. Additionally, the emotional backlash of weight gain can be an opportunity to get curious about any conditioned beliefs you may have about weight, learn how to safely feel the full spectrum of human emotions, and build more emotional resilience. It’s important to work with a therapist to help you develop coping tools to manage your emotions and create safety within yourself, and to provide a compassionate space for processing anything that surfaces during your weight gain process. What if I fear relapse due to gaining weight? Fear of relapse is common in recovery at any point, but it can be particularly strong while gaining weight, so know that your feelings are valid and you’re not alone. The good news is that you can treat this fear like any other hard emotion. Be sure to voice your concern to your treatment team and safe people in your life so you can process the fear and find effective coping skills to help you build more emotional tolerance. It can also be helpful to create a relapse prevention plan with your team. How long does weight restoration usually take? The timeline of achieving weight restoration is different depending on many factors including initial weight, target weight, and severity of eating disorder symptoms. For most people who need weight restoration, they can expect to start gaining weight in the first few weeks of treatment. At Equip, for example, 86% of patients are gaining weight by week 8, and 70% have achieved full weight restoration after one year. Can gentle exercise help me feel better without risking relapse? Gentle movement can be one of several coping tools to help manage weight gain distress in recovery when it’s done safely and for the right reasons. For example, yoga can help to process big emotions and cultivate body appreciation, which can certainly be helpful while gaining weight. However, it’s important to work with your treatment team on deciding whether to integrate movement or not, and if so, which types and how much. How do I discuss weight gain with loved ones? If you feel the need to discuss weight gain with loved ones, or it comes up in conversation, how you respond depends on how safe you feel with them. It’s likely that some people will be supportive, and others may not, depending on their own weight biases and perspectives. If they’re questioning your weight gain, you can let them know that you and your treatment team are working together to make sure you’re as healthy as possible. It may also be necessary to set boundaries in case their opinions are making the process harder for you. It’s best to discuss weight gain with the people in your life that are supportive and understanding and help you along on your road to full recovery.  ]]></content:encoded>
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            <title><![CDATA[When Is Low Appetite a Problem? Understanding Lack-Of-Interest ARFID]]></title>
            <link>https://equip.health/articles/understanding-eds/low-appetite-lack-of-interest-arfid</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/low-appetite-lack-of-interest-arfid</guid>
            <pubDate>Fri, 21 Mar 2025 16:15:46 GMT</pubDate>
            <content:encoded><![CDATA[While it may be hard for many of us to believe, some people find little pleasure in eating. And this disinterest isn't only for less “fun” foods, like spinach or plain chicken breasts—these people feel the same way about cake, French fries, mac and cheese, and any other delicious or exciting food you can think of. For them, the vast majority of foods simply aren’t appealing. This is often an indication of an eating disorder called lack-of-interest avoidant/restrictive food intake disorder (ARFID). Someone affected by lack-of-interest ARFID doesn’t often feel hungry, and when they do, a few bites of food is all it takes to make them feel satisfied. Since they often eat a limited number of foods and small amounts of food, people with lack-of-interest ARFID tend to be underweight and experience nutritional deficiencies, which can increase the risk of health problems. Luckily, there are effective and evidence-based treatments for this type of eating disorder, which can help anyone struggling turn up their hunger cues, comfortably eat more, and recover. If you’re concerned that you or a loved one may be dealing with lack-of-interest ARFID, read on. What is ARFID? ARFID is a somewhat newly recognized eating disorder. It was introduced into the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) in 2013. It’s used to describe an eating disorder where people limit how much they eat, the variety of foods they eat, or both— but unlike other eating disorders, ARFID feeding behaviors aren't driven by a desire to lose weight or control how one's body looks. There are three presentations of ARFID. People may have one or more of these: Selective eating due to sensory sensitivity Some people find certain food textures, colors, smells, and tastes highly repulsive or, on the other hand, have a strong preference for foods with particular characteristics. Because of this, people with this ARFID presentation eat only a very limited number of “safe” foods, which often includes specific pre-packaged foods, since those foods are predictable. Fear of aversive consequences Concerns about choking, vomiting, allergic reaction, illness, or pain keep people with this presentation of ARFID from eating. This commonly occurs after one or more traumatic eating events, such as choking or getting food poisoning. It can also be common in people with valid food allergies or a history of gastrointestinal disorders. Lack of interest and low appetite In this instance, people have little desire to eat and often find little pleasure in eating. Their hunger cues tend to be muted, and when they do eat, they feel full after a small amount of food.  Understanding lack-of-interest ARFID Also called low appetite or low hunger ARFID, lack-of-interest ARFID is when someone has a very low innate drive to eat, explains Equip’s VP of Clinical Programs, Jessie Menzel, PhD. “They don't enjoy food that much or derive little pleasure from food or eating,” she says. Because of this, children with lack-of-interest ARFID may have “failure to thrive,” meaning they're well below the weight and height of other children their age and sex. Similarly, some but not all adults with lack-of-interest ARFID may have low weights. Symptoms of lack-of-interest ARFID Lack-of-interest ARFID can be tricky to identify. Knowing the common symptoms can help you spot this disorder in yourself, your child, or another loved one. People with this eating disorder: Restrict their food intake Go long periods of time without eating (because they're not hungry) Feel full quickly after eating small amounts of food May take small bites Eat smaller meals Often take a long time to finish a meal Don't enjoy food that much Have a hard time tolerating fullness Experience stomach pain or discomfort if they eat larger meals Feel like they have to push themselves to eat Are lower in weight May have some sensory sensitivities to foods What causes lack-of-interest ARFID? Although research about ARFID is still in its infancy, from what has been studied, lack-of-interest ARFID is associated with hormonal abnormalities, Menzel says. Young women with lack-of-interest ARFID have lower levels of ghrelin. Often called the “hunger hormone,” ghrelin increases appetite, which triggers us to seek out food and eat. “In people who have anorexia nervosa, levels of ghrelin increase substantially. It's like the body turning up the volume to tell a person to eat because they're starving,” Menzel explains. “But in people of similar weight who have ARFID, the body isn't turning up levels of ghrelin. It's not trying to compensate for low weight by driving the urge to eat.”  Genetics may also play a role in the development of lack-of-interest ARFID, with one twin study showing that inherited factors contributed approximately 79% to the diagnosis, and unshared environmental factors accounted for 21%. Lastly, although not necessarily a cause, lack-of-interest ARFID is associated with autism, anxiety, and depression. “Early challenges with eating are associated with later developing other psychiatric disorders, but it's unclear which causes which,” Menzel says. The risks of lack-of-interest ARFID Any presentation of ARFID can affect someone's physical and mental health, as well as their quality of life. Here's how lack-of-interest ARFID can impact a child or adult. Physical health risks Failure to thrive and stunted growth Delayed onset puberty Nutritional deficiencies Gastrointestinal pain and discomfort Low bone mineral density Mental health risks Anxiety Depression Quality of life risks People with ARFID may lack social connection, which can contribute to the development of anxiety and depression. “Eating is so central to the way people relate to their worlds. It's social: we eat at family gatherings, school, and other times,” Menzel says. “If you don't enjoy food or struggle with it, that can be isolating. You may avoid those gatherings because you can't relate or you worry about putting your food challenges on display. That prevents the opportunity for social connection, which is huge for resiliency.”  How is lack-of-interest ARFID treated? Treatment for lack-of-interest ARFID starts by trying to establish regular eating, Menzel says. “In this instance, we focus a little more on increasing the volume of what they can eat as quickly as they can tolerate.” The most common types of therapy to help with this are variations of cognitive behavioral therapy (CBT) and family-based treatment (FBT). Cognitive behavioral therapy for ARFID (CBT-AR) Many clinics and professionals use CBT-AR, a type of cognitive behavioral therapy specifically for ARFID and appropriate for people ages 10 and up. In this protocol, the patient progresses through four stages over the course of about 20 to 30 sessions. In the first two stages, the patient eats three meals and two to three snacks a day at set times. “This normalizes eating, which helps prompt the body to start giving some hunger cues,” explains Evelyna Kambanis, PhD, clinical research fellow at the Massachusetts General Hospital Eating Disorders Clinical and Research Program. As part of this, the provider may ask the patient to self-monitor their eating, providing food logs of what they consume on a daily basis. Additionally, the patient rates their hunger and fullness on a scale of one to seven before and after every meal and snack. “This helps bring greater awareness of hunger cues, because they've learned to ignore those cues,” Kambanis says. The third stage, which has different modules for each presentation of ARFID, is the “heart of treatment,” Kambanis says. For lack-of-interest ARFID, this stage uses interoceptive exposure: “The exercises we use help patients see that the internal bodily sensations—like bloating, fullness, and nausea—are temporary, tolerable, and not associated with long-term consequences,” Kambanis says. Because of this, over time, the patient can eat more food in terms of both volume and variety. Though different exposures may be used, some common ones are: Having the patient push their belly out as far as possible for 30 or more seconds (to simulate bloating) Gulping two to three large glasses of water in as few sips as possible (to simulate fullness) Spinning in a chair for 30 seconds (to simulate nausea) For each exposure, the patient rates their levels of stress, anxiety, and fear before, during, and after the exposure. Providers also may ask the patient how similar the physical sensation they felt during the exposure was to the feelings they have or are trying to avoid when eating. “We coach them to sit with—rather than avoid—that anxiety and uncomfortable feelings and notice any reduction in their feelings during the course of each exposure,” Kambanis explains. Then, whichever exposure feels most distressing, the provider assigns that as homework for the next week. Treatment also prepares patients and their families for life after ARFID treatment, including how to continue facilitating exposures.  Lastly, providers work with patients to help them develop a greater awareness of the rewarding aspect of foods, using an exercise called “the five steps.” “You mindfully describe a preferred food using sensory exploration,” Kambanis says. One at a time, the provider asks the patient what the specific food looks, feels, smells, and tastes like and what its texture is like. To emphasize the positive aspects of the food, the provider will also ask things like what the patient likes about their preferred food and what special events it reminds them of. “Then we ask them to incorporate those into their regular meals and snacks in the upcoming week to help them drive more pleasure in eating,” Kambanis explains. Family-based treatment for ARFID (FBT-ARFID) Most often used for children, this collaborative therapy gives parents a key role in recovery. It aims to “help parents feel more competent and empowered with the skills they need to manage their kid's eating challenges,” Menzel says. Providers work with parents to identify strategies to increase the volume of meals, the refueling process, and help parents manage behaviors that may come up around mealtime. Over time, as the patient progresses, the treatment shifts to help the patient feel more comfortable managing eating on their own to the extent that they're able, Menzel adds. Preliminary research has found that FBT-ARFID leads to weight gain and reduction of symptoms for the patient, as well as increased self-efficacy for parents.  Medication for lack-of-interest ARFID ARFID can co-occur with attention deficit hyperactivity disorder (ADHD), and some stimulant medications prescribed for this condition reduce appetite. In these instances, eating disorder professionals may recommend an appetite stimulant to help patients experience hunger cues and eat a higher volume of food, Kambanis says. Other treatments In addition to ADHD, people with any type of ARFID may have other diagnoses, such as autism spectrum conditions. If that is the case, healthcare providers may prescribe medication or other treatments to address these co-occurring conditions.  What to do if you’re worried that you or a loved one have lack-of-interest ARFID If you think you or a loved one may have lack-of-interest ARFID, trust your gut and find help. ARFID is an eating disorder—it's not something that people just “grow out of”—and at any age, it poses health risks and can harm your quality of life. You deserve a full, happy life, so take action. The following tips may help you: Educate yourself By reading this article, you're one step ahead. “A lot of pediatricians are learning about ARFID,” Menzel says. “So come armed with knowledge of what it is and the symptoms.” This can help you advocate for your child—or yourself, if you’re concerned about your eating and your doctor isn’t knowledgeable about ARFID. Seek out professionals specifically trained in ARFID Since ARFID is a newer eating disorder, some providers still aren't aware of it. Because of this, if you see a medical professional who isn't trained in ARFID, you may be misdiagnosed, which could delay proper treatment. “Because the main presentation is restriction and patients are likely to be underweight, this presentation of ARFID can be misdiagnosed as anorexia nervosa, even if the patient denies having body concerns or fear of gaining weight,” Menzel says. This can happen because providers may not be well-versed in ARFID, and patients may not be able to articulate reasons for not eating other than, 'I'm not hungry,’ ‘It hurts,’ and ‘I don't like food,’” she adds. Lean into preferred foods You or your loved one likely have a short list of foods you enjoy. Work with that. “Treatment always addresses volume before diversity,” Kambanis says. “If ice cream is one of the only things they look forward to, and they need to gain weight, it's okay for them to eat a lot of it.” Try Equip If you can't find a doctor or mental health professional in your area who knows about ARFID and can help you navigate it, schedule a call with Equip. Equip is the largest ARFID treatment provider in the United States, and our team includes providers with specific clinical expertise treating ARFID, as well as those with lived experience recovering from ARFID. That means we can provide treatment that works, as well as the wraparound, comprehensive support you need to recover.  
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            <title><![CDATA[What Is Mechanical Eating, and Why Is It Helpful in Eating Disorder Recovery?]]></title>
            <link>https://equip.health/articles/food-and-fitness/mechanical-eating-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/mechanical-eating-eating-disorder-recovery</guid>
            <pubDate>Wed, 16 Apr 2025 20:21:00 GMT</pubDate>
            <content:encoded><![CDATA[I remember hearing the term “mechanical eating” for the first time when I was studying nutrition. It was presented as a rather dry medical term that’s only applicable to acute eating disorder patients, and taught as a rigid practice that must be approached in a very specific way for progress to occur. However, I’ve discovered during my practice as an eating disorder dietitian that mechanical eating can actually be a powerful and adaptable tool for people across the eating disorder spectrum and levels of care. In fact, it can help people meet their nutrition needs in a variety of situations—both within and outside of eating disorder recovery. Today, we’ll explore what mechanical eating is, who it’s for, its pros and cons, how it compares to intuitive eating, and how to get started. What is mechanical eating? Simply put, mechanical eating is “eating by the clock,” according to Equip dietitian Tanya Hargrave-Klein, MS, RDN. “Meals and snacks are scheduled at specific times throughout the day instead of relying on hunger and fullness cues to prompt eating,” she explains. In my practice, I often describe mechanical eating as “eating for self-care,” because even when you’re disconnected from your body’s cues, your body still needs energy (calories) to function properly and for you to thrive. Mechanical eating provides structure when cues aren’t available. That structure comes not only from designated times to eat, but also designated things to eat at those times. A dietitian provides meal and snack recommendations, which are tailored to each patient’s needs and include suggestions on both type and amount of food, according to Elizabeth Davenport, MPH, RDN, LD. Often, mechanical eating includes meal plans as tangible (and often temporary) tools for meeting energy and nutrient needs. “Meal plans often reduce and even eliminate the stress associated with deciding what and how much to eat,” Davenport says. “Using a meal plan also takes power away from the eating disorder: if the person in recovery has a meal plan and their eating disorder thoughts are prevalent, the meal plan is the guide and not the eating disordered thoughts.” In eating disorder recovery, meal plans come in a wide variety of forms depending on your specific needs. But you can also practice mechanical eating without a meal plan at all—for example, it can mean simply eating at certain times of the day or eating every few hours. Davenport says, “There’s a spectrum of mechanical eating, which is useful for a variety of needs.” Who can benefit from mechanical eating? After periods of malnutrition, under- or imbalanced eating, and mind-body disconnection, mechanical eating can help people with eating disorders know when, what, and how much to eat. Eating disorders often disrupt interoception, or awareness of internal body states like hunger and fullness, so having external guidance from an approach like mechanical eating is necessary until cues are reconnected and reliable. For these reasons and others, it’s a helpful practice for a wide range of eating disorder patients with different needs and at different stages of recovery—as well as those without eating disorders. This includes: Those in early recovery “People in the early stages of recovery often aren’t able to tune into their internal cues and are also navigating loud eating disorder thoughts, and using mechanical eating gives them the structure and support to set aside the eating disorder thoughts,” Davenport explains. When I was working in an eating disorder treatment center, most of my patients were using mechanical eating as a tool to help them to restore weight and vital signs, normalize eating at regular intervals, and challenge the eating disorder brain. Research also supports its use as a re-nourishment tool and behavior change strategy to disrupt eating disorder routines. Those stuck in the binge-restrict cycle “For those who restrict after binging, mechanical eating is part of caring for themselves, as it offers the support and structure to remind them it’s important to eat the next scheduled meal or snack after a binge,” Davenport says. One 2024 study of eating disorder patients showed “real-time skills” like mechanical eating and planning ahead are linked to lower likelihood of engaging in binge eating or purging.  Those navigating transitions Transitions or stressful life events can be a trigger for eating disorder relapse, and mechanical eating can protect against this risk. In my outpatient practice, I’ve found mechanical eating to be a helpful tool for clients further along in recovery when they’re going through transitions or hard periods, or if they’ve begun to slip into old, harmful patterns. Neurodivergent people Neurodivergent people (e.g. those with autism spectrum disorder or attention-deficit hyperactivity disorder) with or without eating disorders can benefit from using mechanical eating on a regular basis. Many neurodivergent folks forget to eat because of issues like medication side effects, hyperfocus (or complete absorption in tasks), and decreased interoception. “Some neurodivergent individuals report being unable to tune into their internal hunger and fullness cues,” Davenport says. “In cases like this, mechanical eating is essential to helping people eat enough food at regular intervals throughout the day.” Decision fatigue (or mental overload hindering decision-making abilities) and reduced executive functioning skills necessary for everyday tasks, like planning and remembering, are also common in neurodivergent folks. So mechanical eating can help by creating structure with personalized meal plans including pre-selected menus with simple and accessible foods. Also, research shows children with autism are more likely to have food sensory sensitivities, and can benefit from following individualized meal plans including foods with specific textures and preparations. Performers Anyone participating in a performance-based activity (e.g. athletes, actors, and dancers) can use mechanical eating to support balanced and stable energy levels. “They need to eat based on when they have a game, meet, match, or performance, and they need to eat enough to be at their best during those events,” Davenport says. “They may not actually be hungry when it’s time to eat, but they know they need to fuel themselves to get through their match or game.” It can also come in handy after training, practicing, and performing, according to Stephanie Militano, RD, who works with athletes. She says that intense exercise and exertion can blunt hunger signals, making it “easy to under-fuel, so sticking to a schedule keeps energy levels steady, powers performance, and supports recovery.” Anyone needing temporary, circumstantial support Unexpectedly, everyone can use mechanical as a temporary tool when various circumstances make it hard to stay connected to bodily cues and present a challenge for meeting nutrition needs. For example, you may travel overseas and change time zones, and then eat according to the new time zone’s clock (rather than your hunger) to help your body get on track. Or maybe you get sick with a cold or flu and use mechanical eating by eating bland foods without hunger, since such illnesses typically disrupt appetite and the mind-body connection. Or perhaps a pregnant woman is nauseous, and she uses mechanical eating by eating small amounts by the clock every hour or two. You may also find it challenging (like many of my clients and me) to stay connected to the body on emotionally charged days—when emotions are running high— and eating may look like eating simple foods every few hours. Finally, Davenport says new college students can also use the tool, as “it can be helpful to go through their new schedule and plan out when, where, and sometimes what they’ll eat,” she explains. “Putting the information in their calendar and eating based on their schedule and what’s close to their classes is one form of mechanical eating.”  What are the pros and cons of mechanical eating? Now that we know how mechanical eating can benefit different groups of people—including those with and without eating disorders—let’s explore some of its advantages and drawbacks. Pros of mechanical eating Mechanical eating can be helpful and supportive in a variety of different circumstances. The benefits of mechanical eating include: Helping with body reconnection. In my practice, I often describe mechanical eating to my clients as like picking up the phone to call an old friend you haven’t talked to in a long time. Though it might feel awkward or unnatural at first, over time, mechanical eating can help you re-establish your connection to your body after it’s been lost due to an eating disorder, illness, or another life situation. It’s often a temporary tool used until you recreate interoceptive awareness and rebuild safety and trust in your body. “Mechanical eating can be instrumental in helping people reconnect with, rebuild, and begin to trust their internal cues,” Davenport adds. Offering tangible external guidance when you need it. As outlined above, there are many scenarios when the body’s cues aren’t reliable for guiding daily nourishment. Mechanical eating offers the necessary guidance during such times. “If someone needs guardrails to guide and prompt their eating, mechanical eating is a helpful tool,” Hargrave-Klein explains. “Setting up a schedule for eating helps people understand precisely how to adequately nourish their body.” Disrupting the eating disorder brain and supporting weight restoration. In eating disorder recovery, mechanical eating can be a necessary part of weight restoration, which is often required for medical safety and full recovery. Mechanical eating can also help patients directly challenge the eating disorder brain’s rules at meals and snacks—when listening to hunger and fullness cues is basically impossible (since the eating disorder brain will likely be shouting to eat far less, or far more, than a person needs). In fact, research shows that mechanical eating can help to normalize eating regularly, and decrease fear and rituals around food. It can also help patients clarify eating disorder triggers, thoughts, and underlying emotions, which can be addressed and processed with a dietitian and therapist. Cons of mechanical eating Though mechanical eating can be extremely helpful—even essential—in certain situations, it’s not a perfect approach in all situations. Some of the potential drawbacks of mechanical eating include: Excessive rigidity. Mechanical eating can become overly rigid and be taken to unhealthy extremes for some groups of people, like neurodivergent folks or those with eating disorders. According to Hargrave-Klein, it can limit a person’s ability to be flexible with what and when to eat, which can make certain experiences difficult, like social outings, holidays, and traveling. For some people, “it’s easy for them to become so obsessed with sticking to the schedule and meal plan that any deviation from the plan causes troubling distress and anxiety,” she says. Discomfort, especially in recovery. Honestly, eating is most enjoyable when you’re hungry for the food you’re eating. Eating without feeling hungry can feel frustrating and physically uncomfortable at best, and even maddening and painful at worst. It’s especially hard for those in eating disorder recovery, since the eating disorder brain is often at its loudest during mealtimes, and intestinal conditions (like gastroparesis, which is slowed stomach motility) can develop after periods of malnutrition, which can make the act of eating physically painful. Potential alignment with the eating disorder brain. Mechanical eating can become disordered when it’s used in an overly structured way for unnecessary periods of time—sort of like an abuse of power by the eating disorder. Davenport says it can become a “crutch,” especially for those with restrictive eating disorders, who might use their mechanical eating plan to justify eating less than their body wants or needs. “The eating disorder can misuse the structure, and people can stay stuck using the clock, the amounts of food recommended to eat, and the foods suggested,” she explains. “So mechanical eating, like any tool, can end up being misused by the eating disorder.” Mechanical eating vs. intuitive eating Fundamentally, mechanical and intuitive eating—a way of eating that emphasizes listening to the body—are opposites. The former includes following external guidance, and the latter emphasizes letting internal cues take the lead. “Intuitive eaters rely on hunger cues to know when to eat, they rely on feelings of fullness to know when to stop eating, and they select foods and beverages that will satisfy them in the moment,” Hargrave-Klein explains. “Mechanical eating is prescriptive and provides clear guidance on when to eat, sometimes despite the absence of hunger.” But despite this opposition, mechanical eating can also be a step towards intuitive eating. “Mechanical eating can be a powerful tool in eating disorder recovery if you are working to get your hunger cues back,” Militano explains. “Over time, structured eating supports the goal of trusting your body's hunger signals.” In fact, the two eating styles can be used simultaneously, because, sometimes, it’s possible to practice the freedom of intuitive eating within the structure of mechanical eating. For example, one of my clients finds it helpful to set alarms to remind her to make enough time to eat lunch amid a busy workday, and she lets her body tell her when she’s full and ready to move on from the meal. Or perhaps you have structured mealtimes but give yourself a few options to intuitively choose the contents of your meals. In truth, you can be an intuitive eater and still spend whole days or weeks mechanically eating because you’re sick or going through a hard time. Frequently, intuitive eating is the desired outcome once someone reaches full recovery, and research shows it’s possible for eating disorder patients to eat intuitively eventually. However, it’s important to approach it with awareness, intention, and patience, because it takes time to reconnect with and heal the body, and to be mentally ready for full-on intuitive eating. It’s also important to note that intuitive eating isn’t for everyone and doesn’t always need to be the end goal—for example. neurodivergent people may understandably need the guidance of mechanical eating indefinitely, to help them stay healthy and thrive.  How to get started with mechanical eating Whether you’re in recovery from an eating disorder (or supporting a loved one who is), traveling, sick, or think mechanical eating could help you for a different reason, there are a number of different ways you can begin this practice. Some strategies and approaches to consider include: Setting phone alarms to help remember meals and snacks. Joining virtual meal support groups for common humanity and encouragement. Using (non-calorie-focused) food logs or apps like Recovery Record for identifying barriers and patterns. Building mealtime coping skills for enduring discomfort. Working with a dietitian to create a meal plan for structure. This last bullet point is perhaps the most crucial one, since having the regular support of a dietitian can help significantly in your mechanical eating practice. Registered dietitians not only provide eating structure and guidelines, but also help clients navigate the inevitable barriers to getting nutritional needs met, and offer safe spaces to share about physical or emotional discomfort.  “I help clients with mechanical eating first by meeting clients where they are and explaining the support and structure mechanical eating can offer, including helping them restore their internal cues and working to trust their body and those cues,” Davenport says. “I want them to know it’s a tool that is tailored to their individual needs and that the tool will be in their back pocket anytime and in whatever form they need it, whether that’s a very structured meal plan with amounts and times to eat, or using the clock to plan to eat when they know there’s a long day ahead and lunch won’t be at the usual time.” If you need help establishing or maintaining a mechanical eating practice, reach out to an eating disorder-informed registered dietitian. You can also schedule a call with an Equip team member if you think you could benefit from more comprehensive eating disorder support alongside mechanical eating. ]]></content:encoded>
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            <title><![CDATA[Getting Your Period Back: Healing Hypothalamic Amenorrhea in Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/amenorrhea-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/amenorrhea-and-eating-disorders</guid>
            <pubDate>Wed, 11 Oct 2023 20:05:06 GMT</pubDate>
            <content:encoded><![CDATA[I had just finished a marathon, was newly married, and was about to start graduate school—from the outside, I looked like a “healthy” and “successful” 25-year-old woman. But one thing was missing—my period—a vital sign of a woman’s health. In fact, my gynecologist said I had reproductive lab values of a menopausal woman. At that point, I was living in what I now consider quasi-recovery from an eating disorder. While I wasn’t engaging in eating disorder behaviors and thought it was all behind me, my missing period said otherwise. After several tests to rule out other potential causes like polycystic ovarian syndrome or brain abnormalities, I was diagnosed with functional hypothalamic amenorrhea (HA). The good news is that HA is reversible—I know from my own healing journey and those of my clients as an eating disorder dietitian. Ample research also supports that hypothalamic amenorrhea is a treatable condition. If you think you might be experiencing it, know you’re not alone. HA affects over 1.5 million women and people assigned female at birth in the U.S. Here’s what you need to know about HA, and the steps you can take to get your period back.  What is hypothalamic amenorrhea, exactly? With hypothalamic amenorrhea, periods are absent for over three months due to the hypothalamus—the control center of your brain—not working properly. Ordinarily, the hypothalamus is in communication with your ovaries via what’s called the hypothalamic-pituitary-ovarian (HPO) axis. HA occurs after the HPO is disrupted, leading to hormonal imbalance, anovulation (ovulation doesn’t happen), and no periods. Let’s break down the process known as the hypothalamic-pituitary-ovarian (HPO) axis:. The almond-sized hypothalamus releases the reproductive hormone gonadotropin-releasing hormone (GnRH). In turn, GnRH regulates key hormones in your menstrual cycle: follicle-stimulating hormone (FSH), and luteinizing hormone (LH). FSH and LH prompt the ovaries to produce estrogen, and estrogen causes a uterine lining to form each month eventually resulting in a period. “Excessive exercise, disordered eating, and high levels of stress can cause the hypothalamus to secrete an abnormal amount of GnRH, which causes a reduction of LH and FSH,” explains Equip dietitian Gabriela Cohen, MS, RD, LDN. “When there is not an increase in LH production in the menstrual cycle, there’ll be a lack of follicular development, the body won’t be able to ovulate, and there’ll be a low level of estrogen. Ultimately, this results in a lack of a period.” What are the risks of hypothalamic amenorrhea? As you might guess, functional hypothalamic amenorrhea can lead to infertility, since ovulation is necessary for natural conception. But you might be surprised to learn how many other aspects of your health can be impacted. “Beyond the reproduction effects, HA is a critical warning sign that the hypothalamus is overstressed and lacks the energy for proper functioning,” says Erin Decker, RD. Decker explains that “An improperly functioning hypothalamus means not only problems for the reproductive system, but also for many other body systems such as the gastrointestinal, psychological, metabolic, and immunological systems.” Decker explains that hypothalamic dysfunction manifests across said systems in several ways, including the following symptoms: Low resting heart rate Low bone density and increased risk for fractures Increased susceptibility to illness Low sex drive Disconnected hunger cues Poor sleep quality Food and body obsession Anxiety or depression. Decker also advises, “Keep in mind that these symptoms and an overstressed hypothalamus can show up in a person of any sex and age—not just those who menstruate.” When it comes to bone health, chronic hypothalamic amenorrhea “can lead to bone loss and decreased bone mineral density, and eventually osteoporosis,” according to pediatrician Katherine Hill, MD, and Vice President of Medical Affairs and Care Delivery at Equip. Plus, HA can negatively impact your heart since normal estrogen levels help protect it.  Why is hypothalamic amenorrhea a side effect of eating disorders? Several symptoms and behaviors of eating disorders, such as food restriction, anxiety, depression, emotional stress, excessive exercise, energy (calorie) imbalance, and malnutrition are associated with HA development, according to The Journal of Clinical Endocrinology & Metabolism. Decker says weight loss “below someone’s expected weight for their body” can also contribute to HA. “Though keep in mind this might not present in the stereotypical ‘thin’ body you might expect.” We know that people of all body sizes experience eating disorders, and the same goes for HA, including those who appear underweight, “healthy,” or who live in a larger body. Furthermore, research shows that attitudes common in people with eating disorders are linked to hypothalamic amenorrhea. One 2023 review showed disordered beliefs like hyperfocus on diet, excessive exercise, and fear of weight gain in patients with HA, but not in control groups without HA. Another 2020 study showed common eating disorder traits, like dietary rigidity, need for social approval, and drive for thinness, were also more apparent in women with hypothalamic amenorrhea. In my practice, I often observe the cause of HA to be an energy deficit driven by restriction, overexercise, and stress. However, sometimes it only takes one of these factors to signal to the body that there’s not enough energy for reproduction. If the body is in an energy deficit (which happens often with eating disorders), it goes into survival mode, including the hypothalamus. “The body is going to have to put certain processes on hold, such as ovulation,” Cohen explains, “in order to focus on more important ones for survival, like breathing and heart pumping.” Both eating disorder and functional hypothalamic amenorrhea recovery go hand in hand. “If HA isn’t resolved, it often indicates that you haven’t completed full weight restoration, and physical, emotional, and mental recovery is almost impossible to achieve without full weight restoration,” Cohen says. Regular periods are a sign that there’s a healthy energy balance in your body, and according to Hill, restoring balance is essential “so that the hypothalamus is able to produce all the necessary hormones again.” How to get your period back: hypothalamic amenorrhea recovery  HA is usually reversible through making lifestyle adjustments, however—just like eating disorder recovery—it takes commitment and hard work. It can be frustrating, so practice patience and gentleness towards yourself, and consider taking these steps towards healing: Clarify the source First, work with a doctor or dietitian to pinpoint the source of your HA, so you know where to put your focus. Maybe it’s across all three categories (stress, exercise, and food) or maybe it’s one or two of them. According to a 2020 review, addressing the underlying factors (like inadequate food intake or overexercise) is the best approach to reversing hypothalamic amenorrhea. Make sure you have a team  Healing from HA requires professional support from a team, often including a medical provider, dietitian, and therapist, ideally with HA experience. Your doctor will help you understand your hormone lab values and provide any necessary procedures, like ultrasounds. Your dietitian can help you understand and work towards meeting your nutrition needs and address eating disorder thoughts or beliefs. Your therapist can help you through the inevitable uncomfortable emotions that come with making necessary changes. In fact, scientific evidence shows cognitive behavioral therapy could help restore periods.

For those who experience gender dysphoria, HA can be more complicated, and Decker recommends finding a team that “can meet you where you're at, understand and validate how menstruating might make you feel, and be able to have those difficult conversations around risks versus benefits with you,” she says. Schedule a free consultation to learn more about Equip's virtual program that includes a 5-person treatment team.  Eat enough, especially carbs and fat My clients with HA are usually not eating enough food to support all bodily functions, including ovulation and menstruation. Unsurprisingly, the two macronutrient groups that are typically lacking most are carbohydrates and fat, both of which diet culture demonizes. Without enough calories, fat, protein, and carbohydrates, the hypothalamus can’t do its job.

Since calorie and nutrient needs are never one-size-fits all, I suggest working with your dietitian to develop a flexible meal structure of meals and snacks (that includes all food groups) and take steps towards meeting it daily. Chances are, it’s going to require more food than you think to get your period back, especially if undereating drives your HA. Work with your dietitian and therapist through obstacles and struggles that arise and trust that it’ll be worth it. Assess your exercise  Often, scaling back or stopping exercise for an extended period is necessary to restore energy balance. I had to take an honest look at my relationship to exercise and significantly decrease the frequency and intensity of my workouts to get my period back. Although it was hard, it pushed me to develop more coping skills and treat my body with more respect. Healing from hypothalamic amenorrhea eventually allowed me to transform my rigid, obsessive relationship with exercise into a free, joyful one.

If exercise is part of your HA puzzle, a therapist and dietitian can help you figure out what needs to change and support you through discomfort that comes with it.  Check on your stress Since one of the causes of hypothalamic amenorrhea can be stress, take an inventory of your life stressors and ask yourself a few questions: Is everything on my plate right now completely necessary? Is there anything I can let go of for now? How can I put my self-care first? Simplifying and prioritizing may be necessary to lower your stress levels.

A 2021 review article concluded that healing from HA should include working on daily stress, along with addressing food and exercise. Researchers suggest trying relaxation techniques (such as meditation or breathing practices) and to prioritize adequate and high-quality sleep. If your sleep is lagging, try a sleep hygiene routine to help your nervous system slow down, such as a warm shower, reading a book, and a bedtime meditation or yoga nidra practice.  Work towards your body’s healthy weight Decker points out that eating more and scaling back on exercise when healing HA may result in weight gain (and the Endocrine Society agrees). “This is a sign to me that weight gain was necessary for this person. Bodies come in different sizes and often aren’t what our culture (or even medical community) want or expect them to be,” Decker explains.

Despite what diet culture says, the BMI scale doesn’t determine your healthy weight. Instead, your healthy weight is whatever weight your body needs to be to support your health and well-being, which includes a regular cycle.

“Sometimes, patients may get their menstrual period occasionally before being fully weight restored, but they often need to meet their full target weight range in order for consistent, regular periods to return,” Cohen adds. Weight gain can be difficult since we’re conditioned to believe it’s always a negative outcome, but it’s often necessary to get your period back. Your team can help you determine your healthy weight range, challenge weight stigmatizing beliefs, and work through weight gain discomfort.

Healing from hypothalamic amenorrhea was what took me from quasi- to full recovery from my eating disorder. “Many think of eating disorder recovery as being the achievement of a ‘normal’ body weight or absence of disordered eating behaviors,” Decker adds. “While this is a step in the right direction, there are multiple other factors that could still require healing that we can’t necessarily see, and HA is one of them.” ]]></content:encoded>
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            <title><![CDATA[Understanding Extreme Hunger in Anorexia Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/extreme-hunger-anorexia-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/extreme-hunger-anorexia-recovery</guid>
            <pubDate>Tue, 04 Nov 2025 19:18:00 GMT</pubDate>
            <content:encoded><![CDATA[Going through treatment for anorexia nervosa can feel scary for many different reasons: your body is changing, you’re eating regularly for the first time in a long time, and you’re facing the discomforting thoughts and emotions that you had been numbing with disordered behaviors. Another factor that can cause a lot of distress and anxiety? Extreme hunger in anorexia recovery. Though not everyone goes through this, many people recovering from anorexia report wanting to eat all the time, even shortly after finishing a meal. Some become concerned that they've swung from one end of the eating disorders spectrum to the other, going from restricting to bingeing. Though it can feel unfamiliar and alarming, this extreme hunger during anorexia recovery is a normal biological response as the body replenishes and renourishes itself—and it's actually a positive thing. “Your body is resetting, it's healing, and you're getting closer to that baseline metabolic state that your body needs to get back into,” says Equip Lead Dietitian Stephanie Kile, MS, RDN. “From a clinical standpoint, that's the goal you're working toward. We want to honor and allow that healing to happen.” Read on to learn about the link between anorexia recovery and extreme hunger, as well as how to manage both the hunger and any emotional distress it causes you or a loved one. What counts as “extreme hunger”? “Extreme hunger” in recovery doesn’t have a precise definition or specific criteria. “It's kind of a colloquial term used in treatment settings or among patients to describe what feels like constant hunger that shows up during treatment and recovery,” explains registered dietitian Erin Decker, MS, RD, LDN. This hunger can present in many ways, including: Feeling hungry within an hour of eating a balanced meal Needing to eat larger servings of food to feel satisfied Being so full your stomach is distended, yet still thinking about food and wanting to keep eating “Food noise”, or intrusive, insistent thoughts about food All of this can cause fear and confusion. “It's such a scary feeling,” Kile says. “The patient never wanted to honor hunger, and now they have this overwhelming sense of hunger.” Anxiety, guilt, and shame are also common emotions. “The patient is coming from a place of, 'I used to have control around food, and now I'm eating all this food,'” Decker says. Signs of extreme hunger If your loved one in anorexia recovery experiences extreme hunger, you may notice signs such as the following, Kile says: Taking larger portions of foods Eating seconds or thirds Eating a greater variety of foods, including those they had stopped eating Requests for foods they enjoyed in the past Increased distress after eating If you observe changes like these, it’s important not to comment on them. “Let the person do what they need to do to fuel their body so they can keep feeding themselves,” Kile recommends. And if they express any negative emotions or seem troubled by how much they’re eating, you can tell them, “Your body is healing. We are trying to honor that, and so that's why you ate that food. It's not bad or good, it's what you needed.” Is extreme hunger the same as binge eating? Many patients who report extreme hunger in anorexia recovery express concerns that they are now binge eating. That's perfectly understandable—and it's also not what's going on. “Binge eating is not always but more often diagnosed under emotional aspects,” Kile says. “We lean toward food due to past comforts and things like that.” For those who binge eat, the behavior is often a coping mechanism, or a physiological response to short-term restriction. But for those recovering from anorexia, eating in response to extreme hunger is driven by a biological need for nourishment and for healing the body after a long period of malnourishment. “You are fueling your body in the way it needs to be fueled during this timespan of increased healing and increased needs,” Kile explains.  Why does extreme hunger occur in anorexia recovery? As with many things related to eating disorders, there isn't one reason why extreme hunger occurs in anorexia recovery. Instead, several factors appear to be at play, including hypermetabolism, hormonal changes, an altered perception, and a person’s original body composition. Hypermetabolism: Some patients experience increased metabolism when they shift from undereating to giving their body the nourishment it needs. “Your body is trying to heal and repair any damage previously done while also keeping you alive. It's saying, 'We need to replenish stores that were lost during your time of extreme restriction,' so your needs and your hunger increase,” Kile explains. Your body needs fuel so your brain, heart, digestive system, muscles, and everything else can return to optimal functioning. In response to getting more nourishment, your body is turning on systems that may have been turned off or in low power mode, which increases your energy needs. Hormonal shifts: Anorexia leads to changes in the levels of different hormones that regulate hunger. Then, during recovery, these hormones reregulate: leptin increases, ghrelin decreases, and peptide tyrosine tyrosine (PYY) decreases. As these levels normalize, “typical” hunger signals re-emerge. But at first, these signals may seem louder to someone who has been restricting and ignoring their body's messages to eat for some time. Altered perception: “Coming from a restriction background, your hunger during recovery might feel really extreme compared to what's been your baseline hunger,” Decker says. “This is normal.” Over time and with support from your care team, what seems extreme now may begin to seem more normal or acceptable. Body composition: According to some studies, how much fat and muscle mass you lose during restriction may dictate your hunger. Your body wants to get back to your original levels of both, and sends signals to the brain to eat enough to achieve this goal.  How long does extreme hunger last in recovery? Extreme hunger can last anywhere from a couple weeks to more than a year, Kile says. It all depends on the individual. “In my experience, it's variable,” Decker says. “The longer you've been restricting, and if you are not fully committing to your recovery plan, the more it will be drawn out. You will be in that space of extreme hunger as you are gradually restoring your nutrient needs. Generally speaking, the sooner you dive into your recovery plan, the faster you will get through it, because you're giving your body what it needs.” Is extreme hunger associated with any other eating disorders? While extreme hunger is most associated with anorexia, it can occur after any long-term restriction. Since most eating disorders are ultimately rooted in restriction, this means it can show up in any eating disorder diagnosis.  How to manage extreme hunger Although having extreme hunger can be overwhelming, there are ways to manage both the actual hunger and any emotional distress (or to support a loved one dealing with extreme hunger). 1. Follow your meal plan This typically includes eating three meals a day and anywhere from three to five snacks. “Eating every three to five hours will help you stay on top of that hunger and make it less daunting to eat the volume of food you're consuming,” Kile says. Having balanced meals and snacks—with a mix of carbs, fat, and protein—will also help you feel fuller. 2. Give yourself permission to eat If you want ice cream, have it, even if you haven't in years. Since that may stir up a lot of anxiety, you might work with your registered dietitian or therapist to explore why you haven't had it in so long, why it feels scary to eat it, and how you could incorporate it into your meal plan. 3. Talk it out Work with a therapist or dietitian who is informed about anorexia and can explain what is going on, Kile suggests. They can also help you address any guilt, shame, anxiety, or bad feelings about your body. And have a support system—like your parents, a partner, or a friend—who can listen when you simply need to get the thoughts out of your head. This can help your emotions feel less overwhelming—or even silly. 4. Distract yourself Puzzles, playing games, watching TV, reading a book, and drawing are all healthy ways to take your mind off of any anxiety during a meal. Afterward, a hot shower, walk in nature, or dancing to your favorite music may help. 5. Practice mindfulness Many people find deep breathing to be helpful when emotions have their mind abuzz. Others like meditation or progressive muscle relaxation. See what works for you. 6. Be patient If you honor your body’s biological need for more nutrition, this extreme hunger will lessen as it recovers, Kile says. Be compassionate with yourself and give yourself the grace to feel all that you feel while exploring a freer way of eating. Anorexia recovery and extreme hunger don't have to be feared As scary as it might seem, extreme hunger is a natural and expected part of anorexia recovery. After a period of restriction, your body needs to repair and replenish, so your nutritional needs are greater. “Your body is kind of making up for lost time,” Decker says. In turn, it turns up the volume on your hunger so you get the message: “I need more food!” This isn’t weakness, or failure—it’s healing. You can get through this, and the sooner you can respect your own hunger and follow your meal plan, the sooner it will quiet down. If you don't already have support, working with both a therapist and a registered dietitian who understand and have experience helping patients with anorexia can be a gamechanger. A therapist can help you work through the emotional and mental challenges, and a dietitian can help you identify balanced meals and snacks and set a regular eating schedule to get ahead of extreme hunger. Recovery is possible, and before you know it, your hunger won’t seem as scary. ]]></content:encoded>
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            <title><![CDATA[Online Eating Disorder Treatment: What Recovery Looks Like at Home ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/online-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/online-eating-disorder-treatment</guid>
            <pubDate>Fri, 02 Feb 2024 19:53:00 GMT</pubDate>
            <content:encoded><![CDATA[  If you’re worried that you or a loved one may be struggling with an eating disorder but feel discouraged by traditional treatment options, you’re far from alone. Traditional, in-person eating disorder treatment can be expensive and inconvenient, and often these programs have long waitlists. For these reasons and others, more and more people are exploring virtual alternatives. Not only is it just as effective, virtual eating disorder treatment can also have unique benefits, like keeping patients connected to their communities and teaching them to use new coping skills in their everyday lives. This is the foundation of our model at Equip: to provide virtual, evidence-based eating disorder treatment that leads to real results and lasting recovery at home. But since virtual eating disorder treatment is a recent innovation, people seeking care are understandably curious about what it would actually feel like in practice. If you’ve never experienced it before, it can be hard to picture how virtual treatment can make a real, tangible impact in your day to day life. Considering eating disorder treatment can be a daunting process, but knowing what to expect can help you make an informed choice as well as alleviate anxiety. We spoke with Cara Bohon, Senior Vice President of Clinical Programs at Equip, to give a simple breakdown of what you can expect from our at-home treatment program.  The first week: Starting treatment at Equip Before a patient can begin treatment at Equip, it’s important that they’re determined to be medically stable. The Equip team works with the patient, and their family if needed, to obtain medical clearance from their doctor. Our team also verifies insurance coverage. This can all happen immediately after your free consultation—Equip has no waitlist. Once a patient is cleared for treatment, they can begin sessions with their care team. At the beginning of treatment, each patient is matched with a dedicated five-person care team that includes a therapist, a registered dietitian, a medical provider, a peer mentor (someone who has recovered from an eating disorder) and a family mentor (someone who has supported a loved one through recovery). For younger patients: In the first week, younger patients will meet with their therapist, dietitian, and medical provider alongside their family members. This family involvement is key, because Equip uses family-based treatment (FBT), which studies show is the leading treatment modality for young patients. FBT is based on the radical idea that healthy family members are the people best-suited to help their loved one recover. Because of the virtual format, patients and family members can join in from different locations if needed. “During these initial appointments, the patient’s therapist, dietitian, and medical provider will learn more about the history of the eating disorder and assess for other mental health or medical conditions,” says Bohon. The patient will also meet with their peer mentor individually, someone who has lived experience recovering from an eating disorder. Family members will also meet independently with their family mentor, which is someone who has experience supporting a loved one into eating disorder recovery. For adult patients: For adult patients, the first week is typically more of an independent experience. The patient has initial one-on-one sessions with their therapist, dietitian, medical provider, and peer mentor in order to get to know their care team and share more in-depth information about their eating disorder history and symptoms. While adult patients aren’t required to involve loved ones in treatment, doing so can be incredibly helpful. Supports, which could mean family members, spouses, colleagues, or friends, are welcome to join patient sessions, and they can also be matched with their own mentor who has helped a loved one recover from an eating disorder. If an adult patient doesn’t want to involve loved ones at first, their treatment team can help them identify who to incorporate in their recovery journey—and how to do so—later on in the treatment process.  The first 1-6 months of treatment: What a typical week looks like “After the first week, care becomes individualized to meet the needs of each patient,” says Bohon. For the first few months of treatment, most patients continue with weekly sessions with their therapist, dietitian, and mentor, and schedule one-off sessions with their medical provider as needed. These sessions with different providers range from 25-50 minutes each. Groups and classes are also available to patients and their loved ones to provide additional support and skills. For example, Equip offers identity-specific support groups such as BIPOC, gender non-conforming, and athlete groups, which allow patients to connect with others who share similar experiences. There are also groups for caregivers and siblings of varying ages, as well as groups for learning new skills, such as nutrition or dialectical behavioral therapy (DBT) skills, which research shows can help reduce eating disorder behaviors and co-occurring anxiety or depression. During the first few weeks or months in treatment, a patient may meet with every member of their team and attend a group or two, but as treatment progresses and the patient begins to be more engaged in their outside life and less controlled by their eating disorder, they might attend fewer sessions. The care team and patient work together collaboratively to decide when to taper down sessions, — or increase sessions again if necessary. 6 months and beyond: Progressing through treatment “At Equip, we measure how a patient is progressing through treatment based on how their symptoms change,” says Bohon. As eating behaviors change and improve, treatment adapts to meet the patient’s needs at the time. This can look a bit different depending on the patient’s age. For younger patients: For younger patients going through FBT, there’s typically a process of gaining more independence as treatment progresses. Family is typically quite involved for them in the first few months of their treatment journey, often plating and supervising meals and snacks throughout the day. Research shows this initial hands-on approach can improve long-term treatment outcomes. This amount of involvement starts to reduce as time goes on and the patient feels more confident navigating meals on their own. Similarly, a younger patient may not have as many individual sessions with their therapist at the start of treatment. This is because a malnourished brain isn't as receptive to therapy as a nourished one, so eating disorder therapy is generally much more effective once eating habits are normalized. So at first, treatment focuses more on addressing eating disorder behaviors (such as restrictive eating, bingeing, or excessive exercise) than the thoughts and feelings surrounding those behaviors, and family members may be more present during sessions. As time goes on, the patient may meet more one-on-one with their therapist and care team, and goals may shift to deal with other aspects of the eating disorder, such as emotional or relationship triggers. For adult patients: Adult patients typically do more individual sessions from the beginning. As the patient becomes more comfortable in their treatment, they may decide to invite more of their loved ones into the process. It can be helpful for loved ones to receive education from support groups and their family mentor so they can better understand eating disorders and how to support someone who’s recovering. This involvement of supports can be crucial to protecting against relapse, as it helps patients build a safety net of knowledgeable loved ones. Like younger patients, treatment for adult patients typically focuses more on behavior earlier on, and then shifts to more psychological and emotional issues such as body image, interpersonal relationships, and co-occurring conditions like anxiety or depression.  The unique benefits of at-home treatment No two recovery journeys are exactly alike, as treatment is tailored to each person’s needs. And in the same vein, each patient may experience unique benefits to getting treatment at home. This is something Bohon has witnessed in her time at Equip. “I’ve seen patients be able to better understand what making nourishing meals look like in their own kitchens. Providers learn more about patients' interests by seeing art and posters in their rooms. Families get specific guidance for adjusting mealtime environments,” says Bohon. Still, some benefits are universal. Studies have shown that virtual eating disorder treatment can help increase access to care. It saves patients and their families from having to relocate for treatment, take time off of school or work, and from countless hours commuting or sitting in waiting rooms. Patients can get treatment while staying connected to the things and people that matter and build a sustainable, recovery-supporting life from their own home.  ]]></content:encoded>
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            <title><![CDATA[Eating Disorders in Children: What Parents and Caregivers Need to Know.]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-in-children</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-in-children</guid>
            <pubDate>Tue, 03 Feb 2026 23:33:00 GMT</pubDate>
            <content:encoded><![CDATA[Kelly (name changed to protect privacy) first noticed something was going on when her 9-year-old daughter came back from a trip and had lost weight. Then “things really took a downward spiral,” Kelly says. Her daughter, now 10 years old, wasn’t eating her lunch at school. She was cranky all the time, and she was always asking if she had to eat things.  After her daughter hadn’t eaten for about 48 hours, Kelly’s family took her to the ER, where she was officially diagnosed with anorexia. Since her daughter was so young, eating disorders hadn’t been on Kelly’s radar yet—but the diagnosis explained all of her daughter’s sudden changes. Treatment was really rocky at first, and it was intense for the whole family. “You as the parents are the treatment for the child,” Kelly says.  As hard as it was to recognize her daughter had an eating disorder and to go through treatment, Kelly’s daughter made a lot of progress. Within three weeks, “things turned around really fast,” Kelly says. “We could see her light start to come back.”  Unfortunately, Kelly isn’t the only parent who has had to help a young child overcome an eating disorder. If you’re concerned about your child, know that you’re not alone and recovery is possible. In this article, we’ll cover how eating disorders show up in kids, what’s often missed, why early help matters, and what effective treatment looks like for young children. We’ll focus on children under the age of 12 years old rather than teenagers, because eating disorders look different in young kids. Understanding eating disorders in children While people often associate eating disorders with teens and young adults, eating disorders in young children are more common than you might think; an estimated 22% of children and adolescents worldwide have an eating disorder or disordered eating patterns.  Since 2020, eating disorders have been increasing in young people, starting at 6 years old. Research also suggests that eating disorders are starting earlier in life.  Eating disorders that young children may have include the eating disorders:  Avoidant/restrictive food intake disorder (ARFID): Avoiding food because of low appetite or disinterest, sensory sensitivities, or fear that something bad might happen while eating. Up to 22% of children will develop ARFID. Anorexia: Restricting food intake alongside a fear of gaining weight. An estimated 0.6% of children will develop anorexia. Bulimia: Binge eating followed by purging behaviors to compensate, such as vomiting or excessive exercise. An estimated 0.1% of children have bulimia. Binge eating disorder: Repeated episodes of binge eating while feeling a loss of control and shame or guilt about the behavior. An estimated 1% of children worldwide develop binge eating disorder. Other specified feeding and eating disorder (OSFED): OSFED is an umbrella term for eating disorders that don’t fully meet the diagnostic criteria of other specific eating disorders, and it includes diagnoses such as atypical anorexia and purging disorder. Eating disorders in children vs. teens Eating disorders in children will often look different compared to teens, which could contribute to the misconception that young kids don’t get eating disorders. For example, according to Carly Poynter, PsyD, post-doctoral fellow at Eating Disorder Therapy LA, “younger children may present with more behavioral changes. “Behaviors are often less secretive when compared to teens or young adults with eating disorders.”  You’re also more likely to notice early physical changes in younger children with eating disorders compared to teens. Your child may fall off their growth curve or they may show symptoms such as an abnormal heart rate, dizziness, or fatigue. Keep in mind that falling off the growth curve—even if your child isn’t underweight—is a major red flag. How young can someone be diagnosed with an eating disorder? Eating disorders can be diagnosed at any age. The most common eating disorder in children and often the earliest diagnosed is ARFID. According to Jonathan Levine, LCSW, therapy lead for Equip, children as young as 3 years old may show symptoms of ARFID, though it’s commonly diagnosed closer to 5 years old.  Keep in mind that ARFID in children is different from pediatric feeding disorder. Pediatric feeding disorder occurs when a child lacks the developmental skills to properly feed themselves. ARFID, on the other hand, is an eating disorder that occurs when a child chooses to restrict certain foods due to disinterest in food, lack of hunger, sensory sensitivities, or fear of eating.  Anorexia can also be diagnosed under the age of 10 years old. Bulimia and binge eating disorder may occur in younger children, though they’re more commonly diagnosed in older children, according to Levine.  Kids may not fit neatly into one of these eating disorder categories, but they can still be diagnosed with OSFED—another serious eating disorder that requires treatment. What are warning signs of eating disorders in children? While you should keep an eye out for sudden shifts in a child’s behaviors, keep in mind that EDs can show up in many different ways. You may notice drastic changes, but that’s not always the case.  “You really want to be monitoring for any type of drastic shifts in diet, as well as in a hyperfocus on ’healthy’ stuff,” Levine says. “A lot of that can be developmentally appropriate, especially in the culture we live in, but a rapid shift in hyperfocus is a really clear warning sign that something may be brewing.”  If your child has an eating disorder, it can show up in a number of different ways, including behavioral, physical, cognitive, and emotional symptoms. While some of these symptoms are similar to older teens, keep in mind eating disorders look different in children. You’re more likely to notice behavior and physical changes, even though some of them can be subtle, because kids are less likely to hide these signs. Behavioral signs Behavioral signs are some of the most common indications of eating disorders in kids, according to Poynter. These can include: Refusal of foods that they previously enjoyed Refusal of food all together Hiding food Social withdrawal Avoiding meals and snacks with other people New eating behaviors, such as a new diet or a fixation on healthy eating Eating significantly different portion sizes Eating more slowly Cutting food into small pieces Obsessive exercise Interest in comparing bodies Describing parts of their body in a more negative way Hyperfocus on having muscles, especially in boys Spending more time looking in mirrors Placing a high value on weight, weight loss, and body shape or size Physical signs You or your pediatrician may notice the physical signs of an eating disorder first. Common physical signs of eating disorders in kids include: Weight or height falling off of their growth curve Weight loss Decreased muscle mass Low heart rate Low blood pressure Dizziness Fatigue Digestive issues Complaints about stomach aches Delayed puberty or early puberty Being cold all the time Dry skin Thin hair Lanugo (fine hair on the body) Cuts or callouses on knuckles from vomiting (Russell’s sign) Poor immune function (getting colds frequently) Electrolyte imbalances Emotional and cognitive signs Emotional symptoms of a child not eating enough or having an eating disorder can include: Irritability due to lack of food consumption Anxiety or emotional dysregulation around meal times More emotional dysregulation in general Mood changes that may include anxiety, depression, or even euphoria Shorter attention span Flat affect (lack of emotion) Tantrums Trouble at school due to difficulties concentrating from lack of food intake  If you’re unsure about any of your child’s symptoms, take Equip’s free eating disorder screener. It can help you understand if your child is at risk for an eating disorder. Which types of eating disorders are most common in children? The most common eating disorders in children are ARFID and anorexia, though kids can also be affected by binge eating disorder, bulimia, or OSFED. Let’s take a closer look at each of these. ARFID ARFID is the most common eating disorder in children. ARFID involves limiting food intake because of sensory sensitivities, low interest in food, lack of appetite, or fear of bad things happening while eating. These behaviors aren’t driven by body image issues or fear of weight gain, though children with ARFID may have body image concerns like any other child.  Children with ARFID may dislike certain textures, smells, tastes, or colors of foods, or simply have little to no interest in eating. They may also be afraid of food because they believe it could cause pain, choking, or vomiting. These fears can be triggered by a traumatic event, such as feeding problems as an infant, having choked in the past, or getting sick from food due to food poisoning, food allergies, or something else. Anorexia Anorexia is an eating disorder that involves restricting food intake along with an intense fear of gaining weight. Levine says he more commonly sees anorexia and food restriction in young children compared to binge eating.  Keep in mind with anorexia in children, the fear of gaining weight and body image issues may show up more subtly. “Children may or may not verbalize negative body image/body dissatisfaction,” Poynter says. “However, some may demonstrate a greater interest in comparing bodies or describe some parts of their body in a more negative way.” Binge eating disorder Some young children will develop binge eating disorder, where they consume large amounts of food in a short period of time. They may feel out of control while bingeing and experience guilt and shame afterward.  Binge eating disorder can be an easy eating disorder to miss, according to Levine, since eating lots of food can be a normal part of development for growing children. Bulimia Bulimia is the least common type of eating disorder for this age group, though it can occur. This eating disorder involves binge eating followed by purging behaviors, such as vomiting, laxative use, or excessive exercise, to “make up for” the food eaten. OSFED Some children may have an eating disorder that doesn’t fit into the other categories. In that case, they may be diagnosed with OSFED, which can affect children of any age. Atypical anorexia—where a child is a normal weight but still restricting their food—falls under OSFED. Why are eating disorders in children often missed? There are a number of reasons eating disorders in children are often missed, so if you’re blaming yourself for missing a potential eating disorder in your child, “try to relinquish any guilt and shame,” Levine says.  “Most parents I meet with are often like, how could I miss this? How did I not know this was happening?” Levine adds. “These things are subtle, they're insidious. They're adept at maintaining power and control of the child and an adult, and they really thrive in the shadows. So it's not an indication that a parent or a trusted loved one failed.”  Below are some of the most common reasons eating disorders in children are missed.  Signs can be subtle “Some parents have said that they have not noticed the more subtle changes or have thought that these changes were related to their rapid development,” Poynter says.  For example, children with eating disorders may complain about stomachaches or have a lack of interest in eating. They may also be cranky or have tantrums because they’re not eating enough. Weight changes can look different In children, you might not always notice rapid weight loss. Eating disorders might instead cause your child to fall off their growth curve for height and weight gain. In the case of young children, not gaining weight can be a subtle but early sign of an eating disorder. In fact, it’s the number one warning sign of an eating disorder to look for in children.  “Some pediatricians also do not monitor a growth curve as closely and do not point out when a child has dropped off their growth curve, especially when the child’s growth curve is above the 50th percentile,” Poynter adds. Body image issues look different Young children with eating disorders may not show as many direct signs of body image issues and a fear of weight gain compared to older children. They may, however, compare bodies or have negative things to say about certain parts of their body, such as their hips or chin, Levine says. Weight stigma For children in larger bodies, weight stigma can lead to an eating disorder being missed—in fact, these children may be praised for losing weight. Or, they may fall off their individual growth curve, and pediatricians may not flag it as a potential issue to investigate.  Similarly, pediatricians may rely too much on the BMI to measure a child’s weight. “BMI is a faulty metric,” Levine says. “It's an oversimplification of looking at a complexity.” Diet culture When a child suddenly starts focusing on their health and “healthy” foods, it can be a sign of an eating disorder. But this can be missed because diet culture tells us that focusing on healthy foods is a good thing. “Adults suffer from the same diet culture as kids do,” Levine says. “It’s just picky eating” “ARFID is frequently played off as ‘picky eating’ and often left undiagnosed and untreated until the child begins to experience significant impairment in development,” Poynter says.  ARFID is different from picky eating. Picky eaters will still be hungry and want food, but children with ARFID may avoid food altogether. If you’re not sure about your child’s behaviors, take Equip’s screener that can help you tell the difference between ARIFD and picky eating. “It’s just a phase” In developing children, eating disorders can sometimes be missed because the symptoms are labeled as “just a phase.” It can be normal developmentally for kids to have body image concerns or go through periods of eating more or less. But eating disorders are not a phase and will get worse over time. What are the health risks associated with eating disorders in children? Eating disorders can cause serious health risks for children, but treating them as early as possible can help prevent many of these issues from taking hold. “Luckily kids are resilient, so if you catch it quick enough, you can shift those [health risks],” Levine says.  Here are some of the most common health risks of eating disorders in kids.  Falling off their growth chart: “When children are malnourished, their height can be stunted,” Poynter says. Low bone density: Eating disorders put children at risk of not reaching their peak bone density, which can lead to stress fractures and osteoporosis when they’re older. Digestive issues: Children with eating disorders may complain of stomach aches, and they can experience other digestive issues such as constipation. Heart problems: Restricting food can cause cardiovascular issues like low heart rate, abnormal heart rhythms, and low blood pressure. Mood issues: Kids who aren’t eating enough can become malnourished, which can lead to irritability, mood issues like depression, or tantrums. Mental health risks: Children with eating disorders have a higher risk for mental health conditions such as depression, anxiety, and suicidal thoughts. Delayed puberty: Eating disorders can lead to delayed puberty in children. What causes eating disorders in children? As with eating disorders at any age, eating disorders in children aren't caused by one single thing. “All mental health diagnoses, eating disorders included, are a biopsychosocial phenomenon,” Levine says. This means they’re caused by a number of interconnected factors.  Factors that contribute to eating disorders in kids include: Genetics Eating disorders have a genetic component, meaning a family history can increase a child’s risk of also developing one. And even if there's not a known family history of an eating disorder, there may still be genetic factors that predispose someone to one. Traumatic experiences Experiencing trauma, especially in childhood, can be a trigger for an eating disorder. Traumatic events include things such as physical or sexual abuse, a major loss, parental divorce, or being in an accident. Other mental health conditions Children with anxiety may be at higher risk of developing an eating disorder. ARFID also overlaps with neurodivergent conditions. So children with ADHD or autism may be more likely to develop ARFID. Personality characteristics Some personality characteristics may put a child at higher risk of developing an eating disorder. These traits include: Perfectionism Impulsivity Seeking to avoid stress or discomfort Compulsive behaviors Social media and media Even for young children, what they hear or see on social media or in the media can influence eating disorders. “With social media and media in general, there's just a really big push for thinness right now that feels quite dangerous,” Levine says.  Seeing extremely thin people and diet culture celebrated in the media can steer children towards disordered eating habits. “They don't have the capacity to realize that that person looks sickly, and they think that's what a ‘normal’ body should look like when it's not,” Levine says. Parents aren’t to blame Keep in mind that caregivers are not to blame for a child’s eating disorder. “If your child develops an eating disorder, it doesn't mean you've failed,” Levine says. “There's nothing wrong with you as a parent or a family.” What are the treatment options for children with eating disorders? Treatment for an eating disorder in a young child should involve the whole family. This might feel overwhelming, but the good news is, this approach is highly successful for young kids.  “Younger children are more amenable to behavioral interventions, and when we can apply these strategies early, we can prevent the eating disorder from becoming more insidious,” Poynter says.  The best approach for most eating disorders in children is a treatment called family-based treatment (FBT). The role of family-based treatment (FBT) FBT “is the gold standard for recovery in eating disorders,” Levine says. It’s an evidenced-based treatment that puts parents and caregivers in the driver’s seat of the recovery process, with the support and guidance of eating disorder professionals. It occurs in three phases.  During the first phase of treatment, “the parent is in charge of all things food, exercise, and supervision,” Poynter says. “This phase asks a lot of parents as they are to provide all meals and snacks and supervise them.”  While this may sound intimidating, it’s done with the support of an expert treatment team—which usually includes a therapist, dietitian, and medical provider–who will support your entire family through the process. Since FBT happens at home, it works well with virtual programs like Equip, allowing you the flexibility and convenience while still getting the support you and your child need.  As your child’s weight gets restored if needed and eating disorder behaviors lessen, FBT begins to return the responsibility of eating to your child at a developmentally appropriate level during phases two and three of FBT. “This is done in a gradual process to ensure the eating disorder does not creep back up,” Poynter says.  For children with ARFID, there’s a specific version of FBT designed to address the unique nuances of ARFID.  FBT can also include other evidence-based therapies like cognitive behavior therapy (CBT) and exposure and response prevention (ERP) to support your child’s recovery. Levels of care and medical support You may be concerned that your child may need hospitalization for an eating disorder, but keep in mind that not all children with an eating disorder need to be hospitalized—if they are medically stable enough to start outpatient treatment instead. Outpatient care should be the first-line treatment in most cases, since it lets the child stay at home and integrates well with FBT. That said, some children may need immediate medical intervention and will therefore start their treatment journey at the hospital.  Signs a child may need hospitalization, according to Levine and Poynter, include: Acute food refusals, that's going 24 hours without eating Significantly low weight or rapid weight loss Significantly low caloric intake Low blood pressure Low heart rate Electrolyte imbalances Fainting or significant dizziness  Hospitalization, however, is only for short-term care. After that, it’s best to transition to a lower level of care that supports lasting recovery. If your child has been hospitalized, they will step down to an outpatient treatment program. This can be an in-person treatment program or a virtual treatment program such as Equip. What to do if you’re worried about a child If you’re worried about your child or a child you love, there are steps you can take right away.  1. Get an evaluation “Have your pediatrician complete a medical evaluation,” Poynter says. You can also reach out to a trained therapist for an eating disorder evaluation. You can easily and quickly schedule a call with Equip to get answers to your questions and start the treatment process.  Even if you’re not sure but you suspect something could be going on, get your child seen as soon as possible.  “If you're curious, if you're concerned, if you're uncertain, go to a trusted professional and get a screening just to make sure there's not something amiss,” Levine says. 2. Get into treatment as soon as possible If your child does have an eating disorder, get them into treatment as soon as possible. This will help prevent their disorder from getting worse and get them on the road to recovery faster.  “If there is something amiss, get them in treatment immediately, because we know that there really isn't stagnation with eating disorders. There is progress and recovery or there's regression where it gets worse,” Levine says. 3. Learn about eating disorders “Educate yourself about eating disorders and identify how to help,” Poynter says. This can help you feel more empowered on the journey to get your child well. 4. Ask for help “There's no shame asking for help,” Levine says. You don’t have to take this journey alone, so reach out to loved ones, your child’s treatment team, or an eating disorder support group for help along the way. The bottom line Eating disorders can develop in children as young as 3 to 5 years old and are more common than many families expect. In young children, these disorders often look different than they do in teens, with symptoms showing up as behavioral changes, growth concerns, or physical and emotional shifts rather than obvious body image distress. Because signs can be subtle, eating disorders in children are frequently missed or mistaken for picky eating, phases, or healthy habits. Early identification and treatment are essential, as eating disorders can affect growth, physical health, and emotional well-being. The good news is that children are highly resilient, and with early intervention and family-based treatment, recovery is possible. Frequently asked questions (FAQs) What are the most common eating disorders in children? The most common eating disorder in children is ARFID, with 5% to up to 22% of children having the disorder. Children can also develop anorexia, binge eating disorder, and less commonly, bulimia. Will my child “grow out” of an eating disorder? Children don’t “grow out” of eating disorders. Without treatment, eating disorders get worse and can lead to dangerous health outcomes like a lack of growth, low bone density, heart issues, digestive problems, and other mental health issues. Early intervention and treatment are the best course of action for young children with eating disorders. What age can eating disorders start? Eating disorders can start at any age. ARFID can start as young as 3 to 5 years old while other eating disorders like anorexia often occur a little older, as young as 9 or 10. 
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            <title><![CDATA[Eating Disorders in Boys: Signs Parents Shouldn’t Miss]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-in-boys</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-in-boys</guid>
            <pubDate>Wed, 17 Dec 2025 19:05:00 GMT</pubDate>
            <content:encoded><![CDATA[When her son was 14 years old, Jenny (name changed to protect privacy) noticed his approach to food patterns didn’t feel right. “He had all the common symptoms of anorexia,” Jenny explained.  Eating disorders in boys—or boys and men of any age—are not uncommon. Despite the misconception that eating disorders mainly affect girls, research suggests at least 1 in 4 people with an eating disorder are male. But the number may be higher due to how many boys go undiagnosed. We also know that rates of eating disorders in males are increasing at a faster rate than in females. However, eating disorders in males and females can look different, which is one reason they are typically underrecognized.  On top of his food patterns, “he's a high performing athlete,” Jenny said of her son. “He was just exercising like crazy.” By the time her son turned 15, Jenny decided it was time for an intervention.  Jenny turned to Equip for her son’s treatment. The journey to get her son back to a healthy weight range took a lot of effort for the whole family. But her son was willing to do the work. “He did everything that we asked him to do in terms of refeeding,” Jenny said.  Now, Jenny’s son on his way to recovery. Jenny said he doesn’t like to talk about his eating disorder, but he’s made a lot of progress.  Here’s an at-a-glance snapshot of how eating disorders in boys look different from eating disorders in girls.  In this article, we’ll break down what eating disorders look like in boys, why they’re often missed, what signs to look out for, how to talk to your child if you’re concerned, and what to expect from treatment.  One thing to note. We’ll use terminology like “boys” and “men” throughout this article. Just remember that gender isn’t binary, and people of any gender can and do develop eating disorders. We’re opting to use “boys” and “men” to support an overlooked group of people with eating disorders. What types of eating disorders affect boys? Boys can experience any type of eating disorder, even those typically associated with girls. The most common eating disorders in boys include:  Anorexia: Restricting energy intake along with an intense fear of gaining weight. Bulimia: Binge eating and then compensating using purging behaviors such as vomiting or excessive exercise. Binge eating disorder: Recurring episodes of binge eating accompanied by feeling out of control and ashamed of bingeing behaviors. ARFID (avoidant/restrictive food intake disorder) : Avoiding food due to a lack of interest or low appetite, sensory sensitivities, or fear of something bad happening while eating. Muscle dysmorphia: Also called bigorexia, being preoccupied with a perceived lack of muscles that leads to distress and attempts to change body size and shape. Muscle dysmorphia isn’t an official eating disorder diagnosis, but it can be a symptom of eating disorders or lead to developing one.  Keep in mind that boys may appear to be a “healthy” size, but that doesn’t necessarily mean everything is fine. “Looks are not a great indicator of health,” Levine says.  Let’s take a closer look at each of these. Anorexia in boys Anorexia is an eating disorder that causes food restriction along with an intense fear of weight gain. Boys with anorexia, however, may be more preoccupied with building muscle, having a low percentage of body fat, and developing certain physical features rather than losing weight.  “What I'll often hear in teenage boys is they desire to have a six pack or to have a really chiseled jawline or really pronounced features,” says Jonathan Levine, LCSW, therapy lead for Equip. In fact, in one study, up to 60% of boys said they changed their diet to build bigger muscles.  Below are other signs to look for that could point to male anorexia.  Physical signs of anorexia in boys include:  Weight loss or slower growth Muscle weakness Delayed puberty Digestive issues like constipation Low blood pressure, which can lead to dizziness and feeling faint Fatigue Low heart rate Getting cold easily Brittle nails and hair Fine hair on the face and body (lanugo hair)  Emotional signs of anorexia in boys include:  Intense fear of gaining weight Distorted body image Denial of the seriousness of their symptoms Perfectionism  Behavioral signs of male anorexia can include: Restricting food intake Cutting out entire food groups Compulsive exercise or excessive weight lifting Obsessing over “healthy” foods or certain food groups Having strict food rules Withdrawal from others Excessive body checking or weighing themselves Bulimia in boys Bulimia—episodes of binge eating followed by behaviors to compensate for the binge, known as purging—often looks similar in boys and girls, Levine says. Purging behaviors may include vomiting, overexercising, and laxative use. But again, boys are typically more focused on building muscle rather than losing weight.  Physical symptoms of bulimia in boys include: Sore and inflamed throat from vomiting Enlarged salivary glands that cause puffy cheeks or jaw swelling Scars or scrapes on the knuckles or hands from vomiting Loss of enamel on teeth Acid reflux and other digestive issues Dehydration Electrolyte imbalances  Emotional signs of bulimia in boys include: Excessive focus on body weight, shape, or size Fear of weight gain or preoccupation with muscularity Guilt, shame, or disgust about eating habits Depression Anxiety  Behavioral symptoms of bulimia in boys include: Binge eating followed by vomiting, excessive exercise, or restricting calories Going to the bathroom after meals Exercising more than usual Fasting Taking laxatives, diet pills, or diuretics Using supplements or performance-enhancing drugs (like steroids) Eating in secret Hiding food wrappers Binge eating disorder in boys Binge eating disorder occurs when people eat a large amount of food in a short amount of time. They may feel out of control when bingeing and then experience distress and feelings of shame or guilt.  Physical signs of binge eating disorder in boys include: Weight changes Sleep issues Digestive issues, including bloating, acid reflux, and diarrhea Fatigue  Emotional signs of binge eating disorder in boys include: Feeling guilt, shame, or distress after bingeing Having a negative body image Low self-esteem Difficult emotions that trigger binge episodes  Behavioral signs of binge eating disorder in boys include: Eating a large amount of food quickly in a short period of time Eating even when already full or not hungry Eating to the point of discomfort Hiding evidence of binge eating Avoiding eating with others Hoarding or hiding food Withdrawing from friends and family Dieting  Binge eating behaviors in boys can also hide in plain sight, because “it is normalized for men to eat more food,” Levine says.  “When a boy is eating a large amount of food, you'll often hear adults, coaches, teachers be like, ‘Oh, you were so hungry,’ or ‘You must be growing,’” Levine adds. “[Adults aren’t] really diving deeper into the possibility that maybe there is an eating disorder going on.” ARFID in boys ARFID involves restricting food intake due to sensory sensitivities, being uninterested in food, having a lack of appetite, or fearing negative consequences from eating. It’s not driven by body image concerns like other eating disorders. But people with ARFID may have body image concerns just like anyone else.  ARFID can be caused by childhood feeding issues and sensitivities. It also commonly occurs alongside other mental health issues and neurodivergences such as:  Major depression Generalized anxiety disorder Obsessive-compulsive disorder (OCD) Autism Sensory processing disorder Attention deficit/hyperactivity disorder (ADHD)  Boys are just as likely as girls or even more likely to have ARFID.  Physical symptoms of ARFID in boys include:  Weight loss or not growing as expected Malnutrition Fatigue Digestive issues such as stomach pain or constipation Pale complexion, brittle hair, or weakened nails  Emotional signs of ARFID in boys include:  Feeling anxious about eating or being around food Fear of choking, throwing up, or experiencing stomach discomfort Fear of trying new foods Irritability Mood changes Difficulty concentrating  Behavioral signs of ARFID in boys include: Restricting types of food eaten Refusing to try new foods Avoiding certain foods based on their smell, texture, or what they look like Narrowing their range of preferred foods Forgetting to eat Refusing to eat entire food groups Severe pickiness that makes shared meals or social events difficult Choosing supplements or meal replacement shakes instead of foods Muscle dysmorphia in boys Muscle dysmorphia, which is a form of body dysmorphia, is most common among males. Muscle dysmorphia occurs when someone is preoccupied building muscle and reducing body fat. It causes significant distress and leads boys to engage in behaviors to fix their perceived “flaws.” It’s also referred to as bigorexia, though this isn’t an official eating disorder diagnosis.  Physical signs of bigorexia in boys include: Changes in weight or body shape Extra muscle definition  Emotional signs of bigorexia in boys include:  Obsession with looks Intense dissatisfaction with body appearance Depression Comparing bodies with others  Behavioral signs of bigorexia in boys include:  Compulsive exercise and excessive weight lifting Rearranging activities to exercise instead An intense focus on diet and a desire to “burn off” meals Dieting and strict food rules or focus on “clean” eating Fixation on protein intake Using “bulking and cutting” cycles to build muscle Overusing or feeling compelled to use supplements Using steroids Frequent body checking Avoiding mirrors Asking for reassurance about appearance Hiding parts of the body in their clothing Rigid rules around food or body What are warning signs of eating disorders in boys? There are some common symptoms of eating disorders to watch for in boys regardless of the type of eating disorder someone may have. Keep in mind that you can’t tell someone has an eating disorder by looking at them. Many eating disorder behaviors also happen in secret.  If you’re unsure about your son’s symptoms, Equip’s free eating disorder screener will help you determine whether your son’s behaviors indicate an eating disorder. Physical signs Look for these common physical changes that could mean someone has an eating disorder:  Weight loss Lack of weight gain, especially in developing children and teens Fatigue Dizziness Weakness Getting cold easily Digestive issues like nausea, constipation, or acid reflux Brittle nails and hair  “Weight loss in a growing child should always be a situation to explore,” says Lauren Muhlheim, Psy.D., FAED, CEDS-S, certified eating disorder specialist at Eating Disorder Therapy LA. “Because growing children are supposed to be regularly gaining weight, sometimes lack of weight gain is an even earlier sign.” Behavioral signs Watch for behavior changes around food and exercise. Behavioral signs of eating disorder in boys include:  Compulsive exercise Using supplements and other performance-enhancing substances Eating alone or avoiding eating with others Body checking Restricting food intake Cutting out entire food groups from their diet Having strict food rules Hoarding or hiding food Withdrawal from activities that involve food Emotional signs Not all signs of an eating disorder are physical or easy to observe. But these emotional signs of an eating disorder in males are just as important to pay attention to:  Fixation on muscularity and low body fat Fear of weight gain Shame or guilt after eating Anxiety Irritability Depression Perfectionism Distorted body image Difficulty acknowledging or openly discussing symptoms “Hidden-in-plain-sight” signs Boys with eating disorders may experience subtle symptoms that hide in plain sight. These are often associated with diet culture and behaviors sometimes considered “normal” or “healthy.” But “just because society is normalizing our behavior doesn't mean it's normal,” Levine says.  Watch for behaviors that might be praised as “healthy” or being “disciplined,” including:  Clean eating Fixation on protein consumption Excessive fitness tracking Cycles of bulking (eating a lot) and then cutting (restricting food) Calling restriction “shredding” or “cutting” Avoiding rest days Macro or meal timing obsession Extreme loyalty to sports-related dieting trends  Eating disorders in boys can also hide in athletics, where getting muscular, focusing on certain food groups, or exercise are praised. Depending on an athlete’s sport, there may also be pressure to maintain a specific weight or a certain look such as leanness. Eating disorders in male athletes are more common in weight-sensitive sports like wrestling, gymnastics, diving, and running. Why are eating disorders in boys often missed? “Quite simply, eating disorders in boys are often missed because of the stereotyped image of who gets eating disorders,” Muhlheim says. Eating disorders are typically associated with girls.  “Consequently, parents and health professionals may be less likely to recognize an eating disorder,” Muhlheim adds. “This leads to later diagnosis of eating disorders in boys.”  Men may not recognize their eating disorder is a problem because of the stigma that these conditions only affect women. Their disordered patterns may also not fit the stereotype of what an eating disorder looks like, further delaying diagnosis and treatment.  Boys with eating disorders will typically focus on building muscle and reducing body fat to increase muscle definition. They want to get bigger with more muscle. Girls with eating disorders, on the other hand, focus on getting smaller and losing weight.  Boys and men also may learn to hide their feelings or minimize their symptoms due to male gender norms. “We're not supposed to talk about our feelings. We're not supposed to dive deeper. It's not safe to share and sharing is vulnerable. Vulnerable is weakness,” Levine says. “Because boys and men are socialized not to talk about the problems, [eating disorders are] often not diagnosed until later.”  By the time boys seek treatment, their symptoms are usually more severe than when girls first seek treatment. We also know women are 1.5 times more likely to get treated for an eating disorder compared to men. What causes eating disorders in boys? There isn’t a single cause of eating disorders, “but they are believed to be caused by a combination of genetic and environmental factors,” Muhlheim says.  Common causes of eating disorders in boys include the following. Genetic predisposition Eating disorders have a genetic risk, meaning if someone else in their family has an eating disorder, someone may be more likely to develop one too. Personality traits Certain personality traits are associated with developing an eating disorder, including:  Perfectionism Impulsivity Tendency toward compulsive behaviors Wanting to avoid stress or discomfort Anxiety Having other mental health conditions Boys with other mental health conditions like depression, generalized anxiety disorder, OCD, or social anxiety disorder have a higher risk of also having an eating disorder. About 70% of people with an eating disorder have at least one other mental health condition.  For eating disorders like ARFID, boys with neurodivergence have a higher risk of also having an eating disorder. ARFID often overlaps with autism and ADHD. Trauma or high stress Experiencing trauma or high stress, especially in childhood, can trigger an eating disorder. Traumatic events include things such as physical or sexual abuse, a major loss, parental divorce, or being in an accident. Cultural and media pressures around muscularity Boys are exposed to cultural and media images that show muscular men as the ideal body. Think superhero movies and fitness influencers with six-packs, big muscles, and unrealistic body standards. Comparing against these unrealistic ideals can lead to body dissatisfaction and disordered eating patterns. Social media “Social media can impact whether they're looking at other people's bodies, like gym goers, fitness influencers, actors, or just hearing people talk about what makes a man a man,” Levine says. These comparisons can contribute to body dissatisfaction and eating disorder patterns.  Pro-eating disorder content on social media is also a problem, Levine says. “We're seeing a rise in pro-eating disorder content, pro-anorexia content, and people who look truly, deathly thin being celebrated for their beauty,” Levine says. Peer comparisons Just as boys may compare their bodies with things they see in the media or on social media, they may also compare with their peers. These comparisons can lead to body dissatisfaction and eating disorder behaviors. How do sports and fitness culture contribute to risk? “We know that athletes are at a very high risk of developing an eating disorder,” Levine says. Young athletes are up to three times more likely to develop an eating disorder compared to their peers who don’t play sports.  Many sports, especially weight-sensitive sports, put pressure on boys to look a certain way or stay a specific size. In wrestling for example, athletes need to maintain a certain weight, while in running the emphasis is on leanness.  Boys in sports may feel pressured to work extra hard to meet these weight and shape standards. They may also experience pressure from their coaches or peers. Levine says the intense focus on body image and “really scrutinizing your body and finding weak points to develop” can trigger an eating disorder.  Even boys who don’t play a formal sport but just like to work out can have an increased risk of developing an eating disorder. This is especially true if they spend time at a gym with rigid ideas about fitness like restrictive eating and excessive exercise. These toxic gym culture ideas can contribute to eating disorder patterns or trigger an eating disorder. What are the health risks for boys with eating disorders? Eating disorders can take a serious toll on boys’ physical and emotional health, especially during the years when their bodies and brains are still developing. Below are health concerns to watch for if your son or another loved one is struggling with an eating disorder. Hormonal changes Eating disorders can lower testosterone levels and delay normal puberty, affecting development, mood, and energy. Testosterone is also important for developing muscle, reducing injury risk, and building endurance. Growth suppression Inadequate nutrition may slow or halt height and weight gain during critical growth periods. During the developmental years, a child should regularly be gaining weight. But an eating disorder and restricting calories can slow growth and normal weight gain because the body doesn’t have enough energy. Bone density loss Disordered eating can make bones weaker, which can lead to stress fractures and increase the risk of osteoporosis. Over time, osteoporosis makes bones thinner and more fragile, so they’re more likely to break. Gastrointestinal distress Restriction, bingeing, or purging can lead to stomach pain, constipation, bloating, acid reflux, diarrhea, and other digestive issues. Heart risks in severe restriction Extremely low calorie intake can slow the heart rate and cause heart rhythm problems. When the heart rate gets too low, boys may experience fatigue, dizziness, and they could faint. In severe cases, these heart issues can lead to heart attacks. Injuries due to overtraining Excessive exercise can lead to muscle strains, stress fractures, and chronic injuries. Mental health risks Boys may face depression, anxiety, and chronic feelings of guilt and shame as their eating disorder progresses. Those with eating disorders also have a higher risk of suicide. Call the national suicide hotline at 988 if you’re concerned your child may be at risk for suicide. Effects of supplement or steroid misuse Overuse of supplements or anabolic steroids can damage many organs in the body, including the liver, kidneys, and heart.  Serious effects of anabolic steroids in particular include:  High blood pressure Blood clots Artery damage Low sperm count Baldness Infections Agression Severe acne Long-term health risks if untreated Without treatment, boys with eating disorders may experience lasting impacts on physical development, fertility, bone health, and overall well-being. How can you start a conversation about eating or body concerns? The best way to start a conversation is to speak up as soon as you suspect something is wrong. From there, “if your child is showing signs of eating or body concerns, it’s always a good idea to mention what you notice and ask them about it,” Muhlheim says.  Start the conversation with support but be straightforward and present just the facts. For example:  “I’ve noticed you’re lifting weights a lot more than you used to. Can you tell me about this?” “You used to love ice cream, and now you’ve cut it out completely. Can you talk to me about why?” “You’re really exercising a lot right now, but I noticed you’re not eating as much as you used to. Do you think you’re fueling enough for your level of activity?”  You can also ask about what media they are watching to get a better idea of their body ideals.  Keep in mind that someone may not be ready to admit they have an issue, or they may not recognize that their food and fitness behaviors are harmful.  “If they deny it, it may not mean that they don’t have an issue,” Muhlheim says. “A lack of awareness is often a symptom of an eating disorder in children and teens. Keep watching and trust your judgement.” What are treatment options for boys with eating disorders? The sooner you’re able to get someone into eating disorder treatment, the better. “Early intervention matters because it reduces the potential for medical complications, delayed puberty, and stunted growth. It also leads to better outcomes,” Muhlheim says.  The good news is there are several evidence-based treatment options that get boys with eating disorders the help they need. In most cases, treatment will require a team of professionals who can support your son’s recovery journey. At Equip, for example, boys with eating disorders work with a medical provider, therapist, registered dietician, family mentor, and peer mentor.  Here’s what to look for in an eating disorder treatment program and other ways to find support for your son and your family. Family-based treatment (FBT) The gold standard for eating disorders “for anyone 18 and under is called family-based treatment, or FBT,” Levine says. “That's what I would recommend for anyone who has family support.”  FBT puts parents and loved ones in the front seat of the eating disorder recovery process. During the first phase of treatment, the family is in full control. You make all the food and exercise choices for your child in order to get their physical health back on track. This means making decisions about, preparing, and supervising everything your child eats for a period of time until they start recovering physically.  As treatment progresses, you’ll gradually return food choices and eating back to your child until they’re in full developmentally appropriate control again. You’ll complete the whole process with the support of a specialized therapist and the rest of your son’s treatment team. Cognitive behavioral therapy (CBT) Cognitive behavioral therapy—enhanced (CBT-E), also referred to as enhanced CBT, is another effective tool for treating eating disorders.  During CBT-E, a therapist may address topics such as restoring a healthy weight, body image, restriction, or eating and moods. Over time, the goal is to help boys get a handle on the factors that cause their eating disorder so they can fight against it. Dialectical behavior therapy (DBT) Dialectical behavior therapy (DBT) is a type of therapy that focuses on four major sets of skills: mindfulness, distress tolerance, emotion regulation, and interpersonal skills. The goal is to help boys shift away from problematic coping mechanisms—like disordered eating and compulsive exercise—to more adaptive skills to manage difficult emotions and situations. Medical care Treatment for eating disorders includes medical care to monitor a child’s physical health. Your medical provider will help develop a plan for safe recovery, track weight and vital signs, monitor any health issues, and manage prescriptions if needed. Tailoring treatment for boys Treatment should include elements that highlight the unique aspects of having an eating disorder as a male. “It's really important to look at gender norms and what is expected of anyone,” Levine says.  This could include examining the role models boys look up to on social media, discussing how stigma affects their feelings about their disorder, and talking about what society considers “normal” for men versus the reality. Family support “Family support is really everything,” Levine says. “Eating disorders really thrive in isolation and secrecy, [so] getting other people in the mix … can be really critical.”  Support can come directly from immediate family, but don’t rule out other support people. This could include extended family, other trusted adults, and friends who understand what’s going on. Levine says even checking in with boys via FaceTime, Zoom, or text can go a long way. Support groups Eating disorder support groups can help reduce the stigma of having an eating disorder and let boys know they’re not alone. It offers them the opportunity to talk with other boys and young men going through the same thing, which is important.  Support groups are an important component of treatment for caregivers too, because it’s not easy having a child in recovery. That’s why treatment providers like Equip offer support groups specifically for boys and men and for caregivers of boys. Virtual eating disorder care Virtual treatment can be especially helpful for families with a medically stable son who has an eating disorder. It’s just as effective as in-person care, while offering flexibility and convenience. Virtual care—like Equip’s virtual eating disorder program—makes it easier for families to balance work and other responsibilities alongside treatment. When and how to seek help “If a parent or a loved one notices a shift in someone’s eating habits, I would always recommend they get screened for an eating disorder really soon,” Levine says.  Specific signs that mean it’s time to talk with a professional include:  Hyperfocus on health Desire to lose weight Hyperfocus on getting “jacked” and building muscles Shifts in how much they’re eating, such as suddenly skipping breakfast or they start fasting Cutting out foods they used to love entirely  Keep an eye out for things that are often considered “healthy” in our society, such as cutting out all sugar. While these shifts in food intake are often celebrated, they can point to an eating disorder in boys. “Any drastic shift with the goal of changing your body should be really scrutinized,” Levine says.  You can also take Equip’s free eating disorder screener if you’re concerned about yourself, your son or another loved one. It can help you determine potential risk for an eating disorder and whether it’s time to talk with a professional.  And don’t be afraid to reach out to a professional even if you’re not sure. Seeking help early is protective. “Early intervention is the most effective thing for long-term recovery,” Levine says.  Document any changes you notice in behavior around eating and exercise. Even if they seem like small shifts, it doesn’t hurt to make note of them. This way when it’s time to speak with a professional, you’ll be able to lay out all the signs you’ve noticed. Who to contact first If you’re worried, reach out to your primary care provider (PCP, which for pediatric patients would be their pediatrician) first, Levine says. That’s usually your first point of contact because your PCP can refer you to other providers. You can also reach out to a mental health professional like a therapist or psychiatrist as your first point of contact.  However, you want to make sure your child is seen by a qualified healthcare professional who understands eating disorders and what they look like in boys. Otherwise, your doctor may dismiss your son’s disordered behaviors as “healthy,” or as “nothing to worry about,” which can make the problem worse.  To assess whether your PCP, pediatrician, or any healthcare professional is qualified, Levine says to ask them:  Have you heard of the health at every size movement? Are you familiar with eating disorders?  Keep asking providers until you find one who has the right experience. Most healthcare professionals will be honest about their expertise. And if your provider dismisses your concerns, trust your gut and look for another provider who will take you seriously. “One more extra appointment may be a hassle, but it's really worth getting ahead of this,” Levine says. What to do if your child resists help You’re not alone if your son resists treatment. “That's a feature of the disease, not a bug,” Levine says. The best thing you can do is ask for help. “Finding a way to get additional support from professionals, from specialized eating disorder providers, from support groups is really critical,” Levine says. “No one can do this alone.”  Equip, for example, offers eating disorder support groups specifically for boys, men, and caregivers. Specialized eating disorder providers will also be able to give you guidance on how to manage your child’s resistance. The bottom line Despite the misconception that only girls get eating disorders, at least 25% of people with eating disorders are male. However, eating disorders often look different in boys compared to girls. Boys with eating disorders typically focus on leanness and gaining muscle compared to losing weight. Their eating disorder may also hide behind diet culture trends like a fixation on protein, restricting certain food groups, or “bulking and cutting.”  If your child or another loved one shows signs of an eating disorder, getting them help as soon as possible will help put them on the road to recovery faster. With a knowledgeable medical and mental health treatment team and evidence-based therapies like FBT and CBT-E, it is possible for anyone to enter and sustain lasting eating disorder recovery. And best of all, it’s always worth it.  Remember, you don’t need to do it alone—ask for help when you need it.
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            <title><![CDATA[The Different Eating Disorder Diagnoses: Understanding Signs, Symptoms & More]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorder-diagnoses</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorder-diagnoses</guid>
            <pubDate>Thu, 23 Sep 2021 16:46:00 GMT</pubDate>
            <content:encoded><![CDATA[Diagnosing eating disorders isn't straightforward. For one thing, eating disorders don't look how many people think they look, allowing them to hide in plain sight. For another, there are several different eating disorder diagnoses, and some of them aren't widely known about or understood. There's been increasing awareness, visibility, and discourse around eating disorders, but societal stereotypes and preconceived notions still abound. “The stock photo on most media articles about eating disorders is a sad, thin, white woman on a scale, and the image that comes to mind is a skeletal body damaged by severe malnutrition,” says Equip’s VP of Clinical Programs, Cara Bohon, PhD. “But those images only represent one segment of a population and a single eating disorder diagnosis. Not only that, but viewing eating disorders this narrowly does real damage to the people struggling with these illnesses who do not look like those images—and that's actually most people with eating disorders!” Bohon explains that while anorexia—which is characterized by severe food restriction, malnutrition, and a fear of weight gain—is the disorder that most often comes to mind for people because of those pervasive media images, binge eating disorder (BED) and bulimia nervosa are actually more common, and there are also other, lesser known eating disorders like Avoidant Restrictive Food Intake Disorder (ARFID). In fact, according to the National Eating Disorder Association (NEDA), BED is three times more common than anorexia and bulimia combined, and it’s also more common than breast cancer, HIV, and schizophrenia. “It's important to highlight the dangers of these other illnesses because failing to do so means that people live with dangerous disorders and don't seek treatment,” Bohon says. “Doctors miss eating disorder diagnoses in people who aren't visibly malnourished or aren't white. And behaviors that characterize illnesses like bulimia nervosa or binge eating disorder—like binge eating and purging—are commonly kept secret, so they often won't come up in a doctor visit, even if a patient is explicitly asked." This is deeply concerning given that, left untreated, the health repercussions of these other eating disorder diagnoses are significant and include potential death, either as a direct or indirect result. To provide a better sense of the complex and nuanced ways that eating disorders show up in the world, we're taking a close look at the five eating disorder diagnoses currently in the The Diagnostic and Statistical Manual of Mental Disorders (DSM), the clinical tool published by the American Psychiatric Association that medical professionals use to formally diagnose mental illnesses. But remember, even these five diagnoses can't paint the full picture of the eating disorder spectrum; people can exhibit symptoms of an eating disorder or disordered eating in countless different ways. If you're concerned about yourself or a loved one, seek out help from a professional. Avoidant Restrictive Food Intake Disorder (ARFID) ARFID is an eating disorder diagnosis that was introduced in the most recent version of the DSM, which was published in 2013. Prior to the publication of the DSM-V, ARFID was known as “Selective Eating Disorder” because it involves limiting the amounts or types of food a person will eat. While ARFID is similar to anorexia in that it involves restriction, that restriction is almost never tied to the body image distress or fear of fatness that is characteristic of anorexia. There are many diagnostic criteria for ARFID, but at the basic level, it involves an avoidance of food and eating. There are three subtypes of ARFID, which are related to the particular reason that a person avoids food: General lack of interest in eating (often with an inability to feel hunger cues) Sensory issues (i.e., avoiding certain textures, colors, or smells) Fear of an averse consequence from eating (like choking, vomiting, or an allergic reaction As with all eating disorders, there are many biological, sociocultural, and psychological risk factors that may make a person more susceptible to developing ARFID, making it difficult to pinpoint one cause. However, experts do know that people with autism spectrum conditions are much more likely to develop ARFID, as are individuals with ADHD and intellectual disabilities. Unfortunately, the potential long-term complications of ARFID can be severe, since the body is not receiving adequate nutrients and may shut down in an effort to conserve energy. People with ARFID may also be at risk for electrolyte imbalances, which can lead to sudden death. Signs of ARFID include: Significant weight loss Constipation, abdominal pain, and other gastrointestinal distress Will only eat certain textures of food Dramatic restriction in types or amount of food eaten, and the list of acceptable foods grows smaller over time Lack of appetite or interest in food Fear of vomiting Anorexia nervosa Anorexia nervosa is perhaps the most well known eating disorder diagnosis, but far fewer people are diagnosed with it than with other eating disorder diagnoses described here. That said, as the diagnostic criteria for anorexia has evolved over time and researchers have started relying on broader definitions that more accurately reflect the range of symptoms, more recent studies indicate a higher prevalence of anorexia (and all eating disorders). In general, anorexia involves an intense fear of weight gain, even when an individual is considered medically underweight. Although it’s characterized by weight loss or lack of appropriate weight gain in growing children, anorexia can affect people of all body sizes. It also affects people across ages, genders, sexual orientations, races, and ethnicities. That means you cannot tell if a person is struggling with anorexia (or any eating disorder) just by looking at them. According to the DSM-V, people with anorexia nervosa restrict their food intake in a way that leads to significantly low body weight and have an overwhelming fear of gaining weight, as well as distorted body image. Individuals who are at a weight that’s considered at or above an “average” range for their age, sex, and height, but who exhibit the other symptoms of anorexia, may be diagnosed with an eating disorder known as “atypical anorexia.” It is important to remember, however, that atypical anorexia carries almost all the same health risks as anorexia, including cardiac arrest and death, and that medical definitions and parameters around “average” weights can be flawed, problematic, and stigmatizing, so weight alone is never a reliable or accurate way to diagnose an eating disorder. According to NEDA, between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa at any point during their lifetimes. One study indicated that the lifetime prevalence by age 20 for atypical anorexia in females is 2.8% (compared to 0.8% for anorexia in the same population of 496 adolescent girls). Signs of anorexia include: Extreme weight loss or not making expected developmental weight gain Soft, downy hair covering the body Constipation, abdominal pain, and other gastrointestinal distress Loss of period in those who have menses Severely restricting food intake through dieting or fasting Exercising excessively Frequently skipping meals or refusing to eat Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them Adopting rigid meal or eating rituals, such as spitting food out after chewing Not wanting to eat in public Bulimia nervosa Bulimia nervosa is characterized by episodes of uncontrolled overeating, otherwise known as binges, followed by episodes of purging to "get rid of" the calories consumed. There are a variety of methods people with bulimia use to purge what they’ve consumed during a binge, but vomiting and/or the misuse of laxatives are the most common forms of purging. During a binge, a person often eats a much larger quantity of food than they normally would in a short amount of time—usually less than two hours—and feels unable to stop or control the behavior. People with bulimia may binge and purge several times a week or even multiple times throughout the day, but there are nuances and exceptions in a variety of cases. According to NEDA, 1.0% of young women and 0.1% of young men will meet diagnostic criteria for bulimia at some point in their lives. Unlike many (but not all) individuals with anorexia, those with bulimia often maintain what is labeled by society as an “average” or “above average” body weight which can make diagnosis much tougher. It’s also important to know that not all individuals with bulimia use self-induced vomiting, laxatives, or enemas to purge: “non-purging” bulimia may involve behaviors like fasting or excessive exercise. Signs of bulimia include: Frequent visits to the bathroom, particularly after meals Excessive exercising Preoccupation with body image Intense fear of gaining weight Using laxatives, diuretics or enemas after eating when they're not needed Fasting, restricting calories or avoiding certain foods between binges Using dietary supplements or herbal products excessively for weight loss Feeling guilty or shameful about eating Withdrawing socially from friends and family Binge eating disorder (BED) Binge eating disorder is characterized by recurrent binges accompanied by a feeling of a loss of control, as well as shame, distress, or guilt after the binge. Unlike those affected by bulimia, individuals with BED don’t purge after binge eating. According to NEDA, BED is the most common eating disorder in the United States. A 2007 study found that 3.5% of women and 2.0% of men had binge eating disorder during their lifetime. Some of the medical complications of BED include physical ailments like diabetes, heart disease, and some types of cancer, as well as an increased risk for psychiatric illnesses, especially depression. BED was only recently introduced in the DSM and is now officially recognized as an eating disorder diagnosis in the DSM-V. Prior to the publication of the DSM-V, BED was listed as a subtype of Eating Disorder Not Otherwise Specified (EDNOS), a diagnosis that has now been replaced by Other Specified Feeding or Eating Disorders (OSFED). The recognition of BED as a separate disorder is significant because in many cases, insurance companies in the U.S. will not cover the cost of treatment for an illness if it's not one of the official DSM eating disorder diagnoses. People who struggle with BED are often considered what is labeled by society as “average” or “above average” in weight, but anyone can struggle with the illness, regardless of the number on the scale. Signs of binge eating disorder include: Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food Appears uncomfortable eating around others Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism) Fear of eating in public or with others Steals or hoards food in strange places Creates lifestyle schedules or rituals to make time for binge sessions Withdraws from usual friends and activities Shows extreme concern with body weight and shape Fluctuations in weight, both up and down Feelings of low self-esteem Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) Other Specified Feeding or Eating Disorder (OSFED) OSFED is diagnosis that used to be called Eating Disorder Not Otherwise Specified (EDNOS) prior to the publication of the DSM-V. This diagnosis is considered a general “catch-all” classification for eating disorders that may not fit the exact diagnostic criteria of other formally recognized eating disorder diagnoses. According to NEDA, the majority of individuals with eating disorders treated in community clinics were historically diagnosed with EDNOS. While it may be a more general diagnosis, OSFED can be just as serious as other eating disorders and can result in hospitalization for the same types of medical complications prevalent in anorexia and bulimia. In fact, individuals with OSFED are just as likely to die from their illness as people with anorexia or bulimia. Because OSFED is such a variable condition, there are a vast array of symptoms and warning signs and the illness can look different from person to person. In general, however, people with OSFED exhibit behaviors and attitudes that suggest dieting, weight loss, and/or control of food are major concerns and sources of anxiety. Some people with OSFED experience dramatic changes in weight, but not all, and it is impossible to diagnose an eating disorder of any kind based on appearance alone. Eating disorders are serious, life-threatening mental illnesses, but lasting recovery is possible with the right treatment. Of course, the difficulty of diagnosing eating disorders often means that many people go without treatment—so we're hopeful that educational articles like this will open more eyes to the variety of different eating disorder diagnoses and the different ways they might show up in the world. If you think you or someone you love is struggling with an eating disorder, early intervention is critical. Schedule a consultation to get a professional assessment and learn about treatment options.]]></content:encoded>
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            <title><![CDATA[ARFID vs. Picky Eating: Understanding the Difference]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-vs-picky-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-vs-picky-eating</guid>
            <pubDate>Fri, 03 Apr 2026 14:06:00 GMT</pubDate>
            <content:encoded><![CDATA[Picky eating is common, especially in toddlers and young kids. Most of the time, that’s developmentally typical. But sometimes, what looks like extreme picky eating is actually avoidant/restrictive food intake disorder (ARFID)—an eating disorder that goes beyond preferences and begins to affect health, growth, nutrition, and daily life. But where’s the line between ARFID vs. picky eating? “ARFID is often misunderstood as ‘just picky eating,’” says Christine Ruberti-Bruning, LPC, a certified eating disorder specialist at Ruberti Counseling Services. “The major difference is ARFID behaviors are highly disruptive to someone's quality of life and can have significant impacts on physical health.” Maybe dinner turns into a standoff, or maybe your child’s list of “safe” foods keeps shrinking to the point that they’re not growing normally. If you’re an adult, you might be realizing that your limited range of foods isn’t just a quirky preference—it’s something that’s quietly shaped your life for years. Below, we’ll walk through the difference between ARFID and picky eating, the warning signs to look for, and how to find ARFID-informed care that helps you (or you child) find lasting recovery. What is picky eating? Picky eating is a common part of childhood development, especially between the toddler and early elementary years (that’s about two to six years old). It can be frustrating for parents, but it’s usually driven by typical developmental factors, like a growing desire for independence or a heightened sensitivity to taste and texture that softens over time. According to Michelle Jones, PhD, a licensed clinical psychologist and clinical instructor at Equip, signs of typical picky eating may include: Preferring familiar foods over new ones Avoiding certain textures or flavors but tolerating others Eating from most food groups, even if options are limited Gradually expanding foods with low-pressure exposure Continuing to grow along their expected height and weight curve Participating in social meals, even if they eat selectively Importantly, picky eating doesn’t usually interfere with a child’s overall growth, health, or day-to-day life, she adds. In other words, food preferences can be strong, but they’re not shrinking someone’s world. Picky eating can absolutely test your patience. But in most cases, it peaks in the toddler years and slowly improves as children gain exposure, confidence, and maturity.   What is avoidant/restrictive food intake disorder (ARFID)? ARFID is an eating disorder, but not the kind most people picture. Unlike anorexia or bulimia, ARFID isn’t driven by body image concerns or a desire to lose weight (although people with ARFID can still experience body image concerns, just like anyone else). Instead, it’s typically fueled by things like sensory sensitivities (for example, intense food texture aversion), fear of something bad happening while eating (like choking or vomiting), or a low interest in food altogether. Over time, this pattern of restrictive eating can mean someone isn’t getting enough food variety or volume to meet their body’s needs. And that’s where one key difference between ARFID and picky eating becomes clear: ARFID leads to meaningful impacts on health, nutrition, growth, or daily life. According to the DSM-IV-TR criteria, a person can be diagnosed with ARFID if their eating disturbance leads to at least one of the following: Significant weight loss (or failure to gain expected weight in children) Nutritional deficiencies Dependence on nutritional supplements or tube feeding Eating interfering with daily life (for example, avoiding school, social events, restaurants, or travel because of food). ARFID in children can show up earlier than many people expect. According to Ruberti-Bruning, children can develop ARFID as early as four years old, though it tends to be more commonly diagnosed between 10 and 12 years old. Early symptoms of ARFID may include: A lack of interest in food Low appetite Eating only a very limited number of foods Needing foods prepared in highly specific ways And although ARFID is more commonly diagnosed in kids, it can affect people of any age. Teens and adults experience ARFID, too, either as an eating disorder that begins later in life, or one that developed in childhood and was never treated. If you’re recognizing long-standing restrictive eating patterns in yourself, know that ARFID in adults is real, even if the diagnosis wasn’t widely discussed when you were younger. ARFID vs. picky eating at a glance On the surface, ARFID and picky eating can look similar: limited foods, strong preferences, pushback at meals. The key difference is how much that pickiness affects health and life, according to Jones. “The primary distinguishers between ARFID and picky eating are the degree of selectivity and the impact of the selective eating. An individual who is a picky eater will often still eat at least a few foods in each of the basic food groups,” she says. “Someone who has selective eating due to ARFID often has few or no foods represented in at least one of the basic food groups.” And over time, their list of accepted foods generally shrinks, rather than expanding. Here’s a side-by-side comparison to help you tell the difference between ARFID and picky eating, in yourself or a loved one:  
Warning signs that suggest ARFID (not picky eating) It’s normal to second-guess yourself. Many parents wonder if they’re overreacting—or, on the flip side, if they’ve missed something important. The clearest signal for when to worry about picky eating is impact: is your child’s eating affecting their health, growth, or ability to participate in everyday life? According to Jones and Ruberti-Bruning, here are some red flags that may suggest ARFID rather than typical picky eating: Significant weight loss or stalled growth: When someone isn’t gaining weight as expected, is losing weight, or has dropped off their growth curve. Nutritional deficiencies: Bloodwork shows low levels of key nutrients, or there are physical signs of malnutrition. Reliance on supplements: When someone depends on nutritional drinks or supplements to meet basic calorie or nutrient needs. A very limited (and shrinking) list of safe foods: Only a handful of foods feel acceptable, and that list gets smaller over time. Extreme distress around meals: Intense anxiety, tantrums, or panic when presented with certain foods. Gagging when exposed to certain foods: Strong food texture sensitivity or food aversion that triggers a physical reaction. Fear of choking or vomiting: Avoidance driven by worry that something bad will happen if they eat. Avoidance of social eating: Skipping parties, school lunches, sleepovers, or travel because of food. Little to no interest in food: Eating feels like a chore; hunger cues are low or absent. Sleep issues: Difficulty falling or staying asleep, poor sleep, or fatigue may be linked to inadequate nutrition. If you’re noticing several of these signs in yourself or your child, it doesn’t mean you’ve done something wrong. It doesn’t mean you should have “fixed it sooner.” It simply means it may be time for more support than home strategies alone can provide. Types of ARFID Not everyone with ARFID struggles with food in the same way. In fact, there are three primary types of ARFID, and many people experience a mix of more than one. Here’s the breakdown. Sensory-based avoidance This type of ARFID is often what people picture when they think of extreme picky eating. Here, eating is limited because of heightened sensitivity to the sensory properties of food: taste, texture, smell, temperature, or even color, says Jones. Certain textures may trigger gagging. Mixed foods may feel unbearable. A slight change in preparation can make a once-safe food suddenly feel impossible. It’s also important to say this clearly: Sensory sensitivity on its own does not equal an eating disorder. Many neurodivergent individuals, such as those with autism or ADHD, experience sensory processing challenges. ARFID only becomes a concern when that sensitivity leads to nutritional gaps, weight changes, or major disruptions to daily life. Fear-based (aversive) avoidance In this type of ARFID, restriction is driven by fear rather than food preference. “[Someone] limits the volume and/or variety of food out of fear that something negative will occur as the result of eating, such as vomiting, choking, allergic reaction, or pain,” explains Jones. “This response often begins following a food-related traumatic experience, such as an illness or choking incident.” In these cases, anxiety is in the driver’s seat—and simply telling someone to “just try it” doesn’t address the fear underneath. Lack of interest or low appetite This type of ARFID can be harder to recognize because it doesn’t always involve strong dislikes or panic. Instead, “there is little interest in food and a lack of appetite,” explains Ruberti-Bruning. “A person can go a long time without eating and experiences little to no joy in eating.” Lack-of-interest ARFID can also include low hunger cues and early fullness, so the body doesn’t send strong signals to eat and feels full sooner than it should, adds Jones. Even without dramatic food refusal, this pattern can still lead to weight loss, stalled growth, or nutritional deficiencies over time. Mixed presentation Many people don’t fit neatly into one category, says Jones. Someone might have sensory sensitivities and fear of choking, or low appetite combined with intense texture aversion. The important takeaway is this: ARFID isn’t one-size-fits-all. The common thread is the impact on health and daily functioning. When should you seek professional support?  One of the biggest differences between picky eating and ARFID shows up over time: With typical picky eating, you generally see gradual improvement. A child might go through a phase of refusing certain foods, but their overall growth stays on track. The list of accepted foods may be limited, but it usually stays stable or slowly expands with low-pressure exposure and maturity. Social eating can be selective, but it doesn’t consistently prevent participation. With ARFID, the pattern tends to intensify instead of soften. According to Jones and Ruberti-Bruning, here are some signs it may be time to seek professional support: Ongoing weight loss or slowed growth: Your child isn’t gaining weight as expected or has fallen off their growth curve. Nutritional deficiencies: Bloodwork or physical symptoms suggest gaps in essential nutrients. Heavy reliance on supplements: Nutritional drinks or supplements are needed to maintain weight or meet daily needs. Escalating anxiety around meals: Panic, meltdowns, or intense fear show up consistently at mealtimes. A shrinking list of safe foods: Variety decreases over time instead of expanding. Avoidance of social eating: School lunches, parties, restaurants, or travel are skipped because of food. Low appetite with medical impact: Persistent lack of hunger or early fullness is affecting weight, growth, or energy. You don’t have to wait until things feel extreme to get support. Seeking an evaluation isn’t overreacting; it’s gathering information. And getting support early can protect you or your child’s health, ease family stress, and create a clearer path forward. How is ARFID evaluated? A thoughtful ARFID evaluation should feel thorough, collaborative, and specific, not dismissive. Here’s what to expect: Talking through eating history: A provider will ask about current safe foods, how the list has changed over time, portion sizes, appetite patterns, mealtime behavior, sensory sensitivities, and any fears related to eating. Reviewing growth and medical history: For kids and teens, providers will look at the bigger picture: how height and weight have changed over time. They may also order lab work to check for nutritional deficiencies or other health concerns, just to make sure the body is getting what it needs. Assessing psychosocial impact: Food doesn’t exist in a vacuum. A good evaluation will explore how eating is affecting everyday life. Is your child avoiding school lunch? Skipping birthday parties? For adults, is work travel stressful because of food? If eating is shrinking someone’s world, that matters. Screening for co-occurring conditions: ARFID can overlap with conditions like anxiety, ADHD, autism, or gastrointestinal conditions. Your provider will consider the full picture in order to guide the right kind of support. Determining what kind of support is needed: If someone’s health is at risk—like significant weight loss or dehydration—your doctor may recommend inpatient treatment at first to address any acute medical issues. For many people, though, treatment can happen through regular outpatient appointments. Either way, a thoughtful provider will make sure the level of support matches what the body and brain need right now.  Because ARFID is a relatively newer diagnosis, not all providers are trained to recognize it. That’s why it’s important to work with an ARFID-informed clinician or team who understands the nuances of restrictive eating that isn’t driven by body image. If you’re unsure where to start, this ARFID self-assessment can help clarify next steps. ARFID treatment also requires collaboration, says Ruberti-Bruning. A registered dietitian who specializes in ARFID, a therapist, and a doctor or pediatrician are all key members of the team. What does treatment for ARFID look like? The good news is that ARFID is treatable. Equip is the largest ARFID treatment provider in the U.S., and has a wide variety of ARFID-specific support. And rest assured, treatment doesn’t require forcing foods, issuing ultimatums, or turning meals into battles. Instead, it’s structured, gradual, and tailored to the specific reasons behind the restriction. According to Jones and Ruberti-Bruning, here’s what that support usually involves: A team approach: Most people work with a multidisciplinary team that includes a therapist, a dietitian, and a medical provider. The therapist helps address anxiety, fear, or rigidity around food. The dietitian helps make sure nutritional needs are met and guides the process of expanding foods. A medical provider keeps an eye on growth, labs, and overall health. Everyone works together. Gradual exposure to new foods: One of the core parts of treatment is slowly, carefully expanding the range of foods someone can eat. That might mean trying a new version of a familiar food. Or taking one small bite of something new. The pace is slow and steady to help someone build confidence around new foods. Support for anxiety or fear: If eating feels scary, therapy focuses on helping the brain feel safer around food. Over time, that fear response can soften. Cognitive-behavioral therapy for ARFID (CBT-AR) is one evidence-based approach specifically designed for this. It helps identify the patterns keeping avoidance in place and gently challenges them through small, supported steps. Over time, that fear response can soften, and eating can start to feel more manageable. Caregiver involvement: For children and teens with ARFID, parents or caregivers play a central role in treatment. In family-based therapy (FBT), caregivers are supported and coached to take an active role in helping their child eat more consistently and gradually expand their range of foods at home. Rather than placing the responsibility on the child alone, FBT empowers families with tools, structure, and guidance—making them a key part of the recovery process. Building structure around meals: Sometimes eating has become so unpredictable that the body’s hunger cues are out of sync. That’s why treatment may include setting regular meals and snacks to help the body relearn when to expect food. Addressing the whole picture: If anxiety, ADHD, autism, or medical issues are also part of the story, those are addressed too. Progress is usually gradual. Expanding food variety takes time. But many families begin to notice something shifts before the food list dramatically grows: The stress decreases. Meals feel less explosive. Fear loosens its grip. ARFID isn’t a character flaw. It’s a real eating disorder with real physical and emotional impacts. Treatment centers on helping someone feel safe around food again, supported through the process, and adequately nourished so their body and brain can grow and thrive. The bottom line Picky eating is common, especially in young kids. ARFID, on the other hand, is restrictive eating that affects health, growth, nutrition, or daily life—and it often becomes more restrictive over time. If you’re worried, trust that instinct. ARFID is treatable, and early, informed support can reduce stress and protect both physical and emotional health. You don’t have to wait until things feel extreme to reach out for clarity and next steps. Frequently asked questions (FAQs) What is the difference between being picky and having ARFID? Picky eating usually involves strong preferences but doesn’t significantly affect growth, nutrition, or daily life. Many picky eaters still eat from most food groups and gradually expand their foods over time. ARFID is an eating disorder involving restrictive eating that leads to meaningful consequences. That includes weight loss or stalled growth, nutritional deficiencies, reliance on supplements, or avoidance of social situations because of food. Put simply, the biggest difference between ARFID and picky eating is impact. What are the three types of ARFID? There are three main types of ARFID, though many people experience a mix of more than one type: Sensory-based avoidance: Restriction driven by heightened sensitivity to taste, texture, smell, or other sensory qualities. Fear-based (aversive) avoidance: Restriction driven by fear of choking, vomiting, allergic reactions, or other negative outcomes. Lack of interest or low appetite: Limited intake due to low hunger cues or minimal interest in food. Do kids grow out of ARFID? ARFID usually doesn’t fade on its own the way typical picky eating often does as a child matures. Without support, eating patterns can become more rigid over time, not less. The earlier someone gets help, the easier it is to expand foods, lower anxiety around meals, and prevent bigger health concerns in the future. What do people with ARFID usually eat? People with ARFID often rely on a limited number of foods. ARFID safe foods may be very specific in brand, texture, or preparation. For example, someone might only eat a certain type of pasta prepared in a particular way, or avoid entire food groups because of sensory discomfort or fear. Over time, the list of safe foods may shrink without treatment.]]></content:encoded>
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            <title><![CDATA[Binge Eating Disorder Isn’t About Willpower. Here’s What It Is About.]]></title>
            <link>https://equip.health/articles/understanding-eds/willpower-binge-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/willpower-binge-eating-disorder</guid>
            <pubDate>Tue, 24 Oct 2023 21:30:00 GMT</pubDate>
            <content:encoded><![CDATA[ For a large portion of her illness, Equip Peer Mentor Stacy Jones blamed herself for her eating disorder. “I spent several years thinking I just had a problem with willpower,” Jones says. “I read so many books about developing willpower and became more and more discouraged—I figured I must've been the problem.” Jones describes a feeling many people with eating disorders are familiar with—particularly those who struggle with binge eating disorder (BED). Despite the fact that BED is the most common eating disorder in the United States, it’s arguably one of most misunderstood and stigmatized. There's often a misrepresentation of binge eating disorder facts.  The uncontrollable urge to eat large amounts of food (bingeing) characteristic of BED is often considered a personal failure in our diet culture-entrenched society, though we know it’s almost always a biological response to food deprivation. And because BED is more common among people in larger bodies, those with the disorder may feel even more exposed and vulnerable to fatphobia—including in doctor offices. People with BED might be used to hearing that binges — a symptom of their eating disorder — are the result of a lack of willpower. Not only is BED not an issue of willpower, but it’s a complex neurobiological mental illness, just like all eating disorders. The physiological, psychological, and emotional components of the disease are powerful and can’t be overlooked. Here’s what everyone should know about binge eating disorder facts. Binge eating disorder facts: Why BED has nothing to do with willpower Here’s what BED is: the most common eating disorder in the U.S., affecting about 2.8 million people; an illness that, unlike other EDs, affects males and females fairly equally; a brain disorder influenced by myriad genetic and environmental factors. Here’s what BED is not: the manifestation of any sort of personal shortcoming. “Let's remember that eating disorders provide a ‘false sense of control’ over our lives, starting with what we choose to eat or how our body looks,” Equip Dietician Gabriela Cohen says. “That ‘high’ or feeling of ‘pride’ from restricting gives a false sense of success. Ultimately, you are failing to actually take care of your body. Depriving the body of nourishment often leads to binge eating behaviors which are simply the response to that restriction.” Cohen is describing one of many potential root causes at the heart of all eating disorders: restriction. While food deprivation is considered one of the hallmark symptoms of anorexia, restriction is also a significant component of binge eating disorder because of something known as the “binge-restriction” cycle. According to research, most binges are preceded by a period of restriction, because the physical hunger and mental exhaustion of food deprivation is unsustainable. In BED, the never-ending list of food “rules” and attempts to “be good” (i.e. restrict) result in inevitable “slip-ups” (i.e. binges), leading to a frustrating and potentially dangerous cycle of restricting, bingeing, feeling shame, and restricting again. “That idea that binges are due to a lack of willpower can cause feelings of guilt, defeat, and anxiety, which in turn trigger even more binge eating disorder behaviors and the continuation of the binge-restriction cycle” Cohen says. Jones agrees that any form of restriction can contribute to the difficulties of BED. “Oftentimes people address physical restriction but not mental restriction,” she says. “Labeling food as ‘good’ and ‘bad,’ avoiding ‘unhealthy’ foods, and other forms of mental restriction are also likely to increase binge urges.” Equip Therapy Lead Brittney Lauro also says the willpower mindset goes against our primal human need for nourishment. “In truth, our brains haven’t evolved all that much,” she says. “So when we apply the willpower mindset to something like cutting out sugar or carbs, it activates the deprivation fear in our brain. We were designed to operate this way because it’s what helped us survive: we would increase our intake of food when resources were available so we could survive when resources weren’t, like in a harsh winter. Even when we can intellectually understand that food is available, this primal fear of deprivation gets activated, leading us to binge eat, or feel out of control with our eating.” It’s also possible for BED to serve as a form of emotion regulation. “For some, it might be a form of grounding, for others it might serve as a way to check-out or desensitize ourselves when painful memories or experiences are prompted,” Lauro says. “For those who are neurodiverse, binge eating might be associated with ‘stimming,’ or self-regulating.” How diet culture creates an illusion “Diet culture loves to moralize foods, thoughts, and behaviors, such as how restricting ‘bad foods’ should be viewed as a sign of strength that one should be proud of,” says Equip Dietician Gabriela Cohen. “When you restrict your diet, the body craves an influx of food. Giving in to this natural response through compulsive overeating or binge eating, is then is looked at as ‘failure’ in the eyes of diet culture.’” Because this diet culture mentality is woven in the fabric of our modern society, it plays an undeniable role in the shame spiral. “We live in a society where we are conditioned to believe that if we just work harder we can do anything, like losing weight,” says Lauro. “The reality is that life isn’t that simple. The myths around willpower generate billions of dollars in revenue to the diet industry.” When willpower is marketed as the solution to everything, those with BED can be consumed with shame that their eating disorder behaviors are the result of their own lack of discipline. Lauro adds, “In nearly all instances where I have professionally treated BED, as well as when I worked in the fitness industry, I have seen folks come in with the idea that their willpower will change it all,” she says. “I can see so clearly how this idea is normalized. We see it in the media, written on the walls of workout centers, and we hear it from healthcare professionals, colleagues, friends, and family.” How to overcome the “willpower” mindset and actually heal BED Considering the diet culture we’re all immersed in, separating from this mindset might be difficult — but it’s possible. Accepting and understanding the need for self-compassion and actionable steps toward treatment will help ensure long-lasting recovery from any eating disorder. “The good news is, nearly all effective strategies for coping with and treating binge eating don’t require or involve willpower,” Lauro says. “Moreover, they don’t involve removing certain food groups from your life or home—in fact, this is often a surefire way to increase the probability of binge eating in the future.” Establishing regular eating patterns Because the restrictive behaviors at the root of BED inevitably perpetuate the cycle of disordered eating, experts say establishing or re-establishing consistent patterns around food is critical to recovery. “First and foremost, I can’t emphasize enough the importance of a regular pattern of eating,” Lauro says. “What that means is three meals and two to three snacks eaten at regular intervals of time throughout the day, making sure to never go more than three to four hours without an instance of eating.” While the contents of those meals and snacks may differ from person to person, the goal is to adequately satiate the body and brain to prevent the fear of deprivation. “For some people, having consistent eating instances as well as dietary variety will resolve or quiet down the binge eating,” Lauro says. Cohen agrees that the primary treatment strategy for BED must focus on building regular eating patterns with the support of a team. “Yes, you actually need to eat to overcome BED,” she says. “With the support of a team, you’ll also be challenged to break your food rules and restrictions, and eat your fear foods consistently, because if restriction persists, the binge-restrict cycle will continue.” Working with a team using enhanced cognitive behavioral therapy Another effective strategy experts used to treat BED in an evidence-based modality called enhanced cognitive behaviora; therapy or CBT-E. This modality is a multi-stage, highly individualized approach that includes monitoring and noting thoughts, which is vastly different from a typical food log or what you might see in a fitness app says Lauro. Monitoring is designed to be completed in the moment, which in and of itself serves as a way to slow down, or disrupt, the process of binge eating. Oftentimes, folks describe feeling like they get into a ‘spiral’ during binge episodes that leads to feeling out of control. By utilizing an evidenced-based tool like a monitoring record, you can intervene with the spiral and create an ‘in the moment’ pause.” Establishing distress tolerance techniques While binges can often occur as a result of longtime restriction, there are other potential psychological and emotional factors at play that people should be aware of as they move toward recovery. “Many people end up binge eating as a way to avoid emotions—and this can even serve as a survival technique, like in cases of trauma,” Lauro says. “Healing from binge eating involves learning to sit with discomfort and tolerate distress. You can certainly practice this on your own if you feel it’s accessible and safe, but if you’d like more support, or binging is tied to more intense experiences, I highly recommend working with an eating disorder specialist to assist creating a strategic guide to building up distress tolerance.” Jones says it’s imperative to explore the emotions that arise in the moments leading up to, during, and after a binge from a place of curiosity to help better understand the causes behind it. To truly work through the challenges of the illness, confronting and navigating the unpleasant feelings underlying the disorder is paramount. “One of the foundations for recovering from BED is working through shame and learning binge eating disorder facts,” she says. “If you experience shame, know that society has placed it on you and it’s not yours to carry. When we relate to binges from a place of compassion it holds less power. This creates space for healing and moving beyond BED.” Here are more tips on how to stop binge eating.  If you or someone you love might be struggling with binge eating disorder, know that there’s support available. Schedule a consultation with our team to learn more about virtual eating disorder treatment at Equip.]]></content:encoded>
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            <title><![CDATA[Binge Eating Disorder Treatment: Understanding Your Options and Finding Help]]></title>
            <link>https://equip.health/articles/understanding-eds/binge-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/binge-eating-disorder-treatment</guid>
            <pubDate>Thu, 10 Oct 2024 16:23:46 GMT</pubDate>
            <content:encoded><![CDATA[Binge eating disorder (BED) is the most commonly diagnosed eating disorder, affecting an estimated 2.8 million Americans at some point in their lives. Binge eating disorder is characterized by recurrent episodes of binge eating (where someone eats a large amount of food in a short period of time while feeling out of control), and it can do significant harm to a person’s mental and physical health, increasing the risk of diabetes, cardiovascular disease, nutritional deficiencies, and sleep disorders. BED is also linked with anxiety and depression. To make matters worse, misconceptions about BED can lead to misguided—or even harmful—treatment approaches for those who seek help. “Much of my early binge eating disorder treatment was focused on being more controlled around food, which led to further confusion and tension around food,” says Stacy Jones, a peer mentor at Equip. Luckily, effective binge eating disorder treatment options exist and are accessible. Read on to learn what treatment involves, the different options available, and how to treat binge eating disorder in a holistic way that leads to long-lasting recovery.  Recognizing the need for professional help Many people still don’t recognize BED as a true mental illness. People struggling mistakenly believe it’s a matter of willpower, that they have an issue with “food addiction” or “overeating,” or that their behaviors are a personal failing rather than a serious mental health problem. All of this can prevent them from reaching out for help. But the reality is, binge eating disorder is just as serious as other eating disorders, and recovery requires professional support. If you notice yourself or a loved one engaging in some or all of the following behaviors, it may mean it’s time to seek treatment: Regularly eating past the point of fullness Eating large amounts of food in short periods of time Hiding or stealing food Being highly critical of your weight or body shape Experiencing shame or guilt after eating Feeling fearful or uncomfortable eating in front of others Gastrointestinal issues Weight gain What does binge eating disorder treatment involve? Binge eating disorder treatment often involves a combination of therapy, nutritional counseling, and sometimes medication. This multidisciplinary approach treats the whole person rather than just symptoms, which leads to better outcomes and lasting recovery. Perhaps contrary to many misconceptions about BED, experts say the treatment for binge eating should be rooted in addressing the urge to binge, not by suppressing or ignoring hunger. “A big component of treatment is identifying the binge triggers—besides restriction—such as specific places, situations, or people that may need to be put on hold until regular eating patterns are established,” Equip dietitian Gabriella Cohen says. Therapy for BED Binge eating disorder treatment employs many of the same therapeutic approaches as other eating disorders. This includes cognitive behavioral therapy for eating disorders (CBT-E), exposure and response prevention (ERP), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), and family-based treatment (FBT). Cognitive behavioral therapy for BED works to identify and change the patient’s distorted thoughts about eating and their body and weight. Unlike regular CBT, CBT-E also provides education about BED so patients can better understand their eating disorder and the treatment process. Research shows that CBT-E helps reduce bingeing. Exposure and response prevention involves exposing the patient to thoughts, situations, and objects that cause them distress. At first the exposure is brief, and with time, the exposure becomes longer. During the exposure, the patient can’t engage in their coping behavior—in this case, binge eating—and must engage in other skills to cope. With repeated exposure, the patient no longer views the “threat” as a threat. Dialectical behavior therapy teaches coping skills, such as mindfulness practices, to help them accept and better manage difficult emotions. According to one study, DBT led to similar improvements as CBT did, though results were faster in the CBT group. Acceptance and commitment therapy is an action-oriented approach that focuses on accepting thoughts and feelings without judgment. This helps patients continue to pursue the life they desire, even though they still will face negative experiences. Family-based treatment is widely considered the gold standard of evidence-based treatment for children, adolescents, and young adults with binge eating disorder. “A support system can be essential in supporting the structure necessary to regulate eating patterns and reduce urges. FBT can also be important for accountability and emotional support,” Cohen says. Equip’s research has found that our FBT+ approach is effective for treating binge eating disorder in young people. Whatever specific treatment modality is used, “targeting feelings of shame is often at the core of binge eating disorder treatment,” says Jenna Robinow, LMSW, a therapist at Equip. “Folks with BED, or those around them, may associate binging with stigmatizing and exaggerated themes like gluttony, laziness, or poor self-control. Those associations are harmful and unfounded, as BED is a serious mental illness and its symptoms should not be mistaken for the content of someone's character.” Nutritional counseling for BED A solid nutrition plan from a registered dietitian is one of the most important starting points for binge eating disorder treatment. An experienced dietitian for eating disorders can help patients challenge their beliefs about foods, binge less often, and teach them how to reduce their desire to control their eating (because, paradoxically, the desire to control eating often fuels future binges). A dietitian can also create a personalized meal plan that helps the person struggling consume all of the nutrients they need, which can reduce the biological urge to binge. Often, the structure of a meal plan also helps reduce stress around eating. Medication for BED For some people with binge eating disorder, medication—often in combination with therapy—can help reduce binge episodes. Medications for binge eating disorder may include: Selective serotonin reuptake inhibitors (SSRIs): These antidepressants decrease binge frequency and depression scores. Lisdexamfetamine: The only medication FDA-approved to treat moderate to severe BED, this stimulant improves binge eating symptoms. BED treatment options: choosing the right setting Comprehensive binge eating disorder always involves a number of different specialists, as outlined above, but where and how you meet with them can vary. Today, help for binge eating disorder can be found in person or online, as well as in outpatient and inpatient settings. In-person vs. virtual treatment In-person treatment means the patient travels to an office or clinic to meet with their provider, who may be a physician, dietitian, therapist, or other specialist. Virtual treatment for binge eating disorder involves seeing these same healthcare providers over a video or phone call on a personal computer, tablet, or phone. Research shows that virtual eating disorder treatment is as effective as in-person treatment, but each person and their care team should thoughtfully decide what’s best for them personally. It can help to consider the pros and cons of each setting. Benefits of in-person care The provider can do a physical exam No risk of technical difficulties Some people feel a stronger connection when seeing their provider face-to-face Downsides of in-person care It can be more difficult to schedule, as you need to account for travel time You often wait for long periods of time in the waiting room, losing time that could be spent doing other things Many people don’t live near specialists It is often more expensive Benefits of virtual care It’s convenient. You don’t have to take the time and gas money to travel and then sit in a waiting room. Being in the comfort of your home may help you open up more during sessions. The connections are secure and private, and nobody else needs to know you’re meeting with your provider. You may have better access to specialists who don’t offer in-person care in your area. Downsides of virtual care Not all health insurance plans cover virtual eating disorder treatment. Internet connection issues could disrupt your session. If that happens, you may not get that time back. Some people may feel less connection with their provider when they meet virtually. Virtual providers may need to coordinate with in-person providers for any sort of physical monitoring, like checking weight or vitals. Outpatient vs. inpatient care Both outpatient and inpatient care can help with binge eating recovery. The main difference between these two is where the patient lives. With outpatient care, the patient lives at home and meets with their providers, in-person or virtually, in individualized sessions. Outpatient care can include intensive outpatient (IOP) programs and partial hospitalization (PHP) programs, which take up more time than just seeing individual providers. However, outpatient care generally allows the patient to continue to live their lives while receiving the support they need. Inpatient care includes both residential treatment and inpatient hospitalization. With inpatient care, patients live at the treatment facility where thye get 24-hour care, support, and medical monitoring. Supporting recovery: Beyond clinical treatment Care from medical doctors, dietitians, therapists, and other eating disorder specialists is crucial to treat BED. With this multidisciplinary clinical support, those struggling with BED can also begin to make lifestyle changes and build their support network in a way that supports long-lasting recovery. Lifestyle modifications and self-help strategies Before engaging in any of the below, it’s important to talk with your professional care team. They can help you decide what is best for you. Be active: Finding ways that you enjoy moving may help reduce binge eating symptoms. This isn’t about weight loss; it’s about appreciating what your body can do for you. Don’t skip meals: Not eating leads to more hunger, and can trigger the biological urge to binge. Eating regular meals and snacks is key to BED recovery. Practice meditating: Mindfulness meditation has been shown to decrease binge eating and emotional eating. Make a plan for triggers: It may be best to keep certain foods out of your house or to work with a therapist to create a plan for social situations where you may feel the urge to overeat. Building a support system Having friends and family who you can turn to can remind you that people love you and want what’s best for you. Eating disorders also thrive in secrecy, so surrounding yourself with loved ones can help prevent the social withdrawal that often allows for eating disorders to tighten their grip. Consider making regular dates to see loved ones and asking one or two people specifically if you can call or text them when you’re having a tough day. They can help you commit to your care plan. As great as your friends and family are, they may not be able to fully understand what you’re going through. There are many binge eating support groups that meet in-person or virtually and can connect you with others who can relate to your situation and share their own experiences. You’ll feel less alone and may learn a few new coping strategies. The Equip takeaway: Binge eating disorder recovery is possible Despite common misconceptions, binge eating disorder isn’t a matter of willpower or food addiction. It’s a serious mental illness, and it requires professional treatment to recover. Usually BED treatment involves a multidisciplinary approach including therapy, nutritional counseling, medication, or some combination of these three components. Many of these BED treatment options can be done in person or virtually, giving patients flexibility in their care. Additionally, support from loved ones and care groups can make a big difference in reducing symptoms and getting back to a life worth living. If you think you or a loved one has BED, reach out for help now. Eating disorders don’t go away on their own, and the sooner you start care, the better your chances of recovery. Talk with your doctor or a mental health professional, or schedule a call with an Equip team member. FAQs What are the most effective treatments for binge eating disorder? The most effective treatments for binge eating disorder are cognitive behavioral therapy for eating disorders (CBT-E) or other types of therapy. Working with a dietitian who can create a personalized meal plan is also essential. In some cases, medications can help, such as selective serotonin reuptake inhibitors (SSRIs) and the stimulant lisdexamfetamine. Can binge eating disorder be treated without medication? Yes, binge eating disorder can be treated without medication. For many people, psychotherapy alone helps. The main types of therapy shown to reduce binge eating symptoms are cognitive behavioral therapy for eating disorders (CBT-E), interpersonal psychotherapy, and dialectical behavior therapy (DBT). Exposure and response prevention, acceptance and commitment therapy (ACT), and family-based treatment (FBT) may also help. How do I find the right therapist or support group for BED? To find the right therapist, seek out someone who received eating disorder education and has experience working with patients with binge eating disorder. Also check that they regularly work with other providers, such as medical providers and dietitians. Lastly, see how you feel when you talk with them; many providers offer a short, free intake call, which can give you a sense of what they’d be like to work with. You can schedule a free, no-obligation call with Equip to talk through your concerns and determine if Equip is a good fit for you. To find the right support group for binge eating disorder, first ask your healthcare team if they know of any in-person or virtual groups. You can also search online. We recommend choosing a group with a trained moderator, a schedule that works for you, and that lets you participate as much or as little as you wish. As with therapists, it may take a few sessions to determine if the group aligns with your needs. What role does diet play in the treatment of binge eating disorder? The first step of binge eating disorder is to establish regular eating habits, which often means eating three meals and two snacks a day. In this way, diet is a core part of BED treatment. When seeking treatment for binge eating disorder, it’s important to work with an anti-diet, eating disorder-informed dietitian who can provide you with a personalized meal plan. Following a structured meal plan can reduce binge behaviors as well as stress around eating.]]></content:encoded>
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            <title><![CDATA[Is “Compulsive Overeating” an Eating Disorder?]]></title>
            <link>https://equip.health/articles/understanding-eds/compulsive-overeating</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/compulsive-overeating</guid>
            <pubDate>Tue, 12 May 2026 16:22:00 GMT</pubDate>
            <content:encoded><![CDATA[Diet culture often champions the idea of eating as little as possible to prevent weight gain or to lose weight. The problem with intense restriction is that it disrupts the natural hormonal signals that tell us we’re full or hungry. In what seems like a paradox, a pattern of eating too little can then lead to eating too much. Maybe you’ve noticed a pattern of overeating and you don’t know how to stop, or maybe you’re concerned about this type of behavior in a loved one. The pattern might look like continuing to eat well beyond when you’re full, eating even when you’re not hungry, or eating large quantities in secret. Perhaps you’re wondering, “Is compulsive overeating disorder a real thing? And what can I do?” Indeed, compulsive overeating is a real behavioral pattern. But it’s not classified as an eating disorder. Instead, overeating can be a symptom of one (most often binge eating disorder, which is diagnosed based on specific criteria). Before we unpack the specifics, keep in mind that compulsive overeating is NOT about having a lack of willpower. It occurs because of a combination of factors, including your genetics, potential underlying mental health conditions, and social or cultural influences. Equally important is knowing that help is available and compulsive overeating recovery is possible. In this article, we explore what compulsive eating is and is not, signs of compulsive overeating, psychological reasons for overeating, the difference between binge eating and compulsive overeating, compulsive overeating treatment, and more. What is compulsive overeating? “Compulsive overeating” is not a clinical diagnosis. Instead, compulsive overeating is a behavioral pattern of continuing to eat when you’re already full or eating even when you’re not hungry. It can be a way of self-soothing. “Individuals who engage in compulsive overeating may rely on food as a maladaptive coping mechanism to manage difficult internal experiences, including trauma-related distress, such as post-traumatic stress disorder, anxiety, depression, or even boredom,” says Hannah Bishop, a licensed professional counselor at Equip Health. She adds, “Over time, this pattern can weaken the individual’s ability to recognize and respond to internal hunger and fullness cues, reinforcing a cycle of emotional reliance on food.” Compulsive overeating can dramatically affect quality of life and overall health and well-being by leading to issues including: Type 2 diabetes Metabolic syndrome High blood pressure Gastrointestinal issues Emotional distress That’s why recognizing the pattern is crucial. But again, this pattern is not about willpower, and it’s not your fault. Likewise, if you’re concerned about a loved one who might have adopted this behavior pattern, know that it isn’t something they can just stop or control.  Compulsions are irresistible and persistent impulses that drive compulsive behaviors, actions done against your will. Is ‘compulsive eating disorder’ a real diagnosis? Compulsive overeating is not an eating disorder itself. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) lists specific criteria for diagnosing eating disorders, and compulsive eating is not included. Instead, the term “compulsive eating” refers to a type of behavior. However, these behaviors can be signs or symptoms of eating disorders that are listed in the DSM-5, especially binge eating disorder (BED) and bulimia nervosa. However, some people may casually refer to BED as compulsive overeating. What are the signs of compulsive overeating? Compulsive overeating involves a mix of behavioral, emotional, and physical signs that you might notice in yourself or a loved one. “A patient struggling with compulsive overeating may recognize several characteristic signs,” Bishop says. “These can include using food as a primary and ongoing coping mechanism for emotional distress, feeling disconnected from internal hunger and fullness cues, and cycling between episodes of overeating and subsequent feelings of intense guilt or shame.” Here are some more specific examples of what you might notice. Behavioral signs Some signs involve specific behaviors surrounding mealtimes or food in general. They include the following: Eating large amounts of food in a short period (often beyond fullness) Eating rapidly or mindlessly Eating when not physically hungry Grazing constantly throughout the day, even when not hungry Eating alone or in secret because of embarrassment Hiding or hoarding food Feeling unable to stop or control eating during episodes Continuing to eat despite discomfort or pain Structuring daily routines around food (planning, access, concealment) Alternating periods of overeating with periods of restricting food Emotional signs Some signs involve the specific emotions you or a loved one might feel regarding food or eating behaviors. They include the following: Experiencing intense feelings of guilt, shame, or disgust after eating Using food to cope with stress, anxiety, boredom, or sadness Feeling preoccupied with food, weight, or body image Feeling out of control while eating Experiencing emotional numbness or like you are “out of your body” while eating Having low self-esteem tied to eating behaviors or body image Experiencing anxiety around food availability or in eating situations Noticing all-or-nothing thinking (Example: “I already messed up, so it doesn’t matter how much I eat.”) Physical signs Some signs show up as physical sensations in your body. These include the following: Developing high blood pressure Developing high blood sugar Developing high cholesterol Eating to the point of uncomfortable fullness or pain Experiencing frequent gastrointestinal discomfort (bloating, nausea, etc.) Noticing weight gain Feeling low energy or fatigue after eating episodes Not noticing when you are hungry or full Having trouble sleeping after eating late at night What causes compulsive overeating? Social and other forms of media sometimes talk about how we eat as a matter of self-control. But compulsive overeating is not caused by a lack of willpower. Instead, several factors can play a role. The binge-restrict cycle One of the most common aspects of disordered eating and clinically diagnosed eating disorders is the binge-restrict cycle. Research has shown that most binges, or incidences of “overeating,” are both preceded by and followed by a period of restriction. Our bodies need food to sustain their functions, including everything from simply breathing to rushing to catch the bus. Restricting food puts you in an energy deficit, which causes psychological and hormonal changes. Your body is trying to ensure your survival, so your hormones send signals to your brain that you need to eat more food, making you extremely hungry. T Hence, you might not be able to get your mind off food. The urge to eat then becomes intense.  Eventually, your hunger becomes nearly impossible to ignore. Then, after a period of restriction, you may eat much more than usual because your brain is trying to get you to correct the energy deficit you’re in. But binging can then lead to feelings of shame, which can then lead to more restriction, followed by more binging, and so on. Biology and hunger regulation This binge-restrict cycle, over time, disrupts your natural hunger and fullness cues. Hunger and fullness cues involve hormonal signals sent to the brain, which are supposed to help us eat intuitively. Intuitive eating isn’t always perfect. But it looks a bit like this: “I’m hungry. I should take my lunch break now.” And as you’re nearing the end of your meal, you might think, “Okay, I’m getting full and I feel much better.” Then you go about your day until you next notice that hunger signal. But with the binge-restrict cycle, that intuition gets removed. Part of the problem is that the cycle overrides it. Another concern is that physical changes, including weight gain, can further disrupt these natural hormonal hunger and fullness signals. For example, leptin is a hormone produced in fat cells. It tells your brain that you’re full. However, with weight gain, your cells may produce excessive leptin, which can lead to leptin resistance. This means your brain fails to receive the fullness signal. This increases your hunger even more. Leptin resistance is associated with various eating disorders, most commonly BED. Emotional coping Eating can also become a coping mechanism. Foods high in sugar, fat, and sodium can trigger dopamine release, giving you a sense of reward. This pleasurable feeling might temporarily distract you from anxiety, depression, or negative feelings in general, including anger or boredom. The reward then motivates you to repeat the behavior, and more repetition reinforces the pattern. But over time, the same pattern doesn’t produce as big of a reward. You may even feel numb instead. Yet your brain encourages you to eat even more, even though doing so is not as satisfying.  Learned patterns and environment Finally, sometimes overeating is a pattern learned from family, cultural practices, or environmental considerations. Experiencing food insecurity is an example that may apply to all of the above. Perhaps your parents or grandparents experienced food insecurity. So they may have encouraged you to always “fill your plate” or “clean your plate” even when you’re full. Or maybe you have directly experienced food insecurity, a factor associated with binge eating disorder, of which compulsive overeating can be a symptom. One study provides the “food stamp cycle” as an example. The government typically distributes benefits, such as from the Supplemental Nutrition Assistance Program (SNAP), at the beginning of the month. Near the end of the month, however, food may become scarce. The process may perpetuate the binge-restrict cycle. Having to make do with less food at the end of the month leads to increased hunger signals that can lead to bingeing when the benefits finally arrive again at the start of the month. Why can it feel so hard to stop eating? We’ve said it before, and we will say it again: Compulsive overeating is not about a lack of self-control or willpower, and it is not a personal failure. It truly is a compulsion, and that’s why stopping can feel so difficult. Compulsive overeating places you or a loved one on an emotional-relief loop of binging, feeling shame, restricting, feeling hunger, and repeating the pattern. Willpower is no match for this loop. Overeating is a compulsive behavior, meaning you can’t stop doing it without disrupting the pattern. You might recognize these questions and phrases in your self-talk: Why can’t I stop eating? I’m so full, but I can’t stop. I cannot control myself around food. I shouldn’t have eaten that. I should be ashamed of myself. I won’t eat anything tomorrow. I can’t stop thinking about food. I’m so hungry. Compulsive overeating vs binge eating disorder (BED) Compulsive overeating is a behavioral pattern rather than a formal diagnosis of an eating disorder. BED is a formal clinical diagnosis listed in the DSM-5. “BED is characterized by recurrent episodes of consuming unusually large amounts of food within a discrete period of time, accompanied by a subjective sense of loss of control,” Bishop says. “These episodes are often associated with emotional distress and may or may not follow periods of dietary restriction.”  What does support or treatment look like? Treatment under the guidance of a knowledgeable care team can help you recover from compulsive overeating behaviors. “Compulsive overeating is often treated alongside co-occurring conditions such as post-traumatic stress disorder, anxiety disorders, or depression,” Bishop says. “In treatment, patients work to address the underlying sources of emotional distress while simultaneously developing healthier coping strategies to replace maladaptive eating behaviors.” The same evidence-based modalities that help treat eating disorders can help treat compulsive overeating. Bishop notes that dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT), and interpersonal therapy (IPT) are commonly used to improve emotional regulation, challenge unhelpful thought patterns, and strengthen interpersonal functioning. “In addition,” she says, “collaboration with a registered dietitian supports the development of balanced, consistent eating patterns and helps interrupt cycles of restriction and overeating. Treatment is often most effective when it includes multiple layers of support, such as individual therapy, group therapy, and community-based resources.” The bottom line If you or a loved one is experiencing emotional distress around food or feelings of not being able to control eating habits, never hesitate to reach out for help. Remember, compulsive overeating isn’t a personal failure. It’s a real compulsion that can disrupt your natural hunger and fullness signals and hijack your reward pathways. Speak to your medical provider or schedule a consultation with an Equip team member. FAQ Why can’t I control my eating? You may not be able to control your eating if eating has become a compulsion. Although not a clinical diagnosis, compulsive overeating is a recognized pattern of disordered eating. It can occur from disrupted hunger and fullness signals, as an emotional coping mechanism, or from environmental factors, such as food insecurity. Is compulsive overeating the same as binge eating disorder? Compulsive overeating can be a symptom of binge eating disorder, but the two are not the same. Compulsive overeating is a pattern of behavior regarding food. Binge eating disorder is a mental health diagnosis that requires meeting specific criteria. What causes binge eating disorder? Eating disorders in general, including binge eating disorder, are caused by a mix of genetic, social, cultural, and environmental issues. 
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            <title><![CDATA[Understanding Binge Eating Disorder: Signs, Triggers, and What Recovery Can Look Like]]></title>
            <link>https://equip.health/articles/understanding-eds/binge-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/binge-eating-disorder</guid>
            <pubDate>Tue, 13 Jan 2026 14:15:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’ve ever thought, “I can’t stop eating—what’s wrong with me?” you’re likely carrying a lot of confusion and frustration about food. For many people, binge eating disorder (BED) involves eating past comfort, feeling out of control around certain foods, or hiding how much they ate, followed by heavy feelings like guilt, embarrassment, or shame. Over time, this can turn into a draining cycle. You promise tomorrow will be different, blame stress or emotions, or try another diet, only to feel discouraged when nothing changes. Despite what pervasive diet culture and the weight loss industry may lead people to believe, binge eating disorder is a real mental health condition, not a failure of willpower. It often involves intense urges to binge, feeling unable to stop once you start, and emotional distress before or after eating. And it can affect people of any body size, age, gender, or background. Here, we’ll explain what BED is, what it looks like, and how to get the right support, whether you’re seeking answers for yourself or someone you care about.  What is binge eating disorder (BED)? The definition of binge eating disorder is “repeatedly eating unusually large amounts of food in a short period of time, accompanied by a sense of loss of control,” says Jen Simmons, PhDc, LPC, therapy lead at Equip. “During a binge, a person may feel unable to stop eating, may disconnect or dissociate, may eat much faster than normal, and often continues eating even after becoming uncomfortably full.” According to the DSM-5-TR, a binge has two key parts: Eating an objectively large amount of food in a discrete period (usually within two hours) Feeling unable to stop or control what or how much you’re eating. To meet the criteria for BED, these episodes happen at least once a week for three months, cause significant distress, include several common features (like eating rapidly or eating when not hungry), and occur without regular purging or other compensatory behaviors. This is different from everyday overeating or emotional eating. Most people occasionally eat more than they meant to or turn to food for comfort during stressful moments, according to Sharon Batista, MD, assistant clinical professor of psychiatry at Mount Sinai Hospital. With BED, the pattern is more compulsive and distressing. BED is also very common: about 1 to 3 percent of adults in the U.S. experience it at some point, making it the most common eating disorder (for comparison, anorexia nervosa affects an estimated 0.6 percent of adults). Still, it often goes unrecognized or untreated. Diet culture plays a big role in that. Many people are taught that struggling with food means they lack discipline or willpower, and that stricter diets or exercise plans should fix it. So when binge eating continues despite those efforts, people tend to blame themselves. But ironically, restriction can actually make binge eating more likely. Over time, deprivation raises cravings and thoughts about food, making binge urges stronger. That can lead to the familiar cycle of restricting, bingeing, feeling ashamed, then trying to restrict again. If you’re experiencing BED, know that it isn’t a sign of weakness. It’s a pattern shaped by stress, emotions, brain chemistry, deprivation, and shame—patterns that are treatable with the right support. What are signs and symptoms of binge eating disorder? “People with binge eating disorder often experience a painful and complex internal world marked by shame, guilt, disgust, anxiety, and depression,” says Simmons. “These emotions are frequently connected to fears of gaining weight or deep dissatisfaction with their body image.” Here’s a breakdown of the most common signs of binge eating disorder. Behavioral signs According to Simmons and Batista, behavioral signs of BED include: Recurrent binge episodes that involve compulsive overeating Eating in secret Eating very quickly Eating past discomfort Planned binges or rituals around binges Skipping meals or “starting over” (like restricting food as soon as a binge ends) Avoiding food-centered situations Psychological signs Keeping the behaviors associated with binge eating disorder a secret can create a profound sense of isolation. And “as isolation grows, so does the emotional distress that often triggers another binge, creating a cycle that becomes increasingly difficult to break,” says Simmons. According to both experts, other emotional and psychological symptoms may include: Loss of control around food Food “noise” (aka constant mental chatter about eating) Shame, guilt, or harsh self-talk Anxiety or depression All-or-nothing thinking (like labeling foods or days as “good” or “bad”) Fear of judgment Physical signs The body often reflects the binge-restrict cycle too, even if these symptoms are easy to overlook or dismiss as “just digestion issues” or “stress.” Physical symptoms can include: Painful fullness or bloating Digestive issues Fatigue or energy swings Symptoms linked to irregular blood sugar levels, like shakiness, lightheadedness, irritability, or brain fog Weight fluctuations Beyond day-to-day physical symptoms, binge eating disorder is also associated with several longer-term medical conditions. Some people develop blood sugar dysregulation or type 2 diabetes, high blood pressure, elevated cholesterol, sleep apnea, or cardiovascular strain over time. These complications aren’t inevitable, but they do highlight why BED deserves medical care and support, not self-blame or “toughing it out.” What does binge eating disorder feel like? For people living with BED, the hardest part is often what’s happening on the inside. “Many individuals feel embarrassed about their relationship with food, avoiding meals with others and hiding binges in private because they fear being judged,” says Simmons. “The cycle of isolation, bingeing, and self-criticism feeds on itself, making recovery seem even further out of reach.”  According to Simmons and Batista, people with BED often describe a constellation of internal experiences that repeat over time, including: Food noise and obsessive thoughts: Food can start to take up so much mental space that it becomes hard to focus on anything else. Loss of control: Once a binge begins, it often feels impossible to slow down or stop, even when you want to. Dissociation or “checking out”: Many people report mentally disconnecting during binges, feeling numb, zoned out, or detached. Secrecy, shame, and guilt: People may go to great lengths to conceal food, clean up evidence of binges, or lie about their compulsive eating. Planning rituals: Binges may become highly planned, with specific foods, routines, or “rules” around when and how they happen. The relief-remorse cycle: Many people experience brief emotional relief in the middle of a binge—a numbing of stress, sadness, or anxiety—followed by a heavy crash of guilt, shame, or fear once it’s over. Isolation and fear of being “found out”: Worry about others noticing eating patterns or body changes can lead to social withdrawal and eating alone. All of these experiences can exist at the same time, and none of them mean you’re broken or weak. They reflect how the nervous system, emotions, and brain are trying to cope with distress. With the right support and treatment, this internal landscape can grow smoother, more nourishing, and less overwhelming over time. What causes binge eating disorder? There’s no single cause of binge eating disorder. Instead, it’s often triggered by a combination of biological, emotional, and environmental factors. Biological factors Some people are more biologically vulnerable to developing BED based on how their brains and bodies respond to food and stress. A few of the most common biological risk factors include: Genetic predisposition: Having family members with eating disorders, mood disorders, ADHD, or substance use disorders increases risk. Brain chemistry, reward pathways, and neurodivergence: For some people — especially those with ADHD or other neurodivergent traits — dopamine systems (which regulate mood, reward, and impulse control) may become tightly linked to eating for comfort or relief. That means food can trigger deeply rewarding experiences, which may reinforce binge patterns over time. Effects of restriction: Skipping meals or under-eating can intensify cravings, making binge urges stronger and harder to resist. Psychological factors For many people, binge eating becomes a way to cope with emotions that feel overwhelming, unmanageable, or hard to put into words. Common psychological factors include: Emotional regulation challenges: Food may temporarily soothe anxiety, sadness, anger, loneliness, or emotional overload when other coping tools feel unavailable. Trauma or chronic stress: Past trauma, ongoing caregiving stress, financial strain, or high work pressure can dysregulate the nervous system and make bingeing more likely as a numbing or self-soothing response. Perfectionism and shame: All-or-nothing thinking (“I messed up, might as well binge”) and intense self-criticism feed both restriction and bingeing. Avoidance patterns: Binge eating can offer escape from uncomfortable feelings or situations, even if that relief is short-lived. Environmental and cultural factors The world we live in can fuel BED, even when people are trying hard to “do everything right.” Contributing factors can include: Restriction: Skipping meals, cutting out foods, following rigid food rules, or trying to “make up for” eating can push the body into intense hunger and increase mental preoccupation with food. This physical and emotional deprivation is one of the strongest triggers for binge urges. Diet culture: Messages about “good” and “bad” foods, ideal body sizes, or the belief that thinner is “better” or more attractive can reinforce shame, drive restrictive eating, and deepen the binge–restrict cycle. Weight stigma: Experiencing judgment or pressure around body size can intensify shame, secrecy, and emotional distress. Disrupted routines: Long workdays, inconsistent meals, or chaotic schedules can push the body into intense hunger states that lower emotional resilience. Co-occurring conditions BED often overlaps with other mental health conditions that affect emotional regulation, impulse control, or stress response, including: Attention-deficit/hyperactivity disorder (ADHD) Anxiety disorders Depression Post-traumatic stress disorder (PTSD) or trauma-related conditions Obsessive-compulsive disorder (OCD) These conditions don’t cause BED on their own, but they can make binge urges stronger and recovery more complex without targeted support. What are the long-term health risks of binge eating disorder? BED can slowly wear down both emotional and physical well-being, making everyday life feel smaller, harder, and less fulfilling. Without support, BED can gradually impact mental health, physical well-being, and daily functioning in many key ways. Mental and emotional health effects Worsening anxiety or depression Increased shame and self-criticism Social withdrawal Increased secrecy or avoidance Emotional dysregulation Difficulty with routines or concentration Heightened impulsivity around food Physical health effects Interestingly, although people may believe that some of these physical health effects of BED are due to weight gain that comes from binge eating, such as blood sugar problems (including Type II diabetes), these problems are actually related to the binge eating rather than weight. It's estimated that 30% of people with BED are in a "normal" BMI range, and they have these issues too. Digestive problems (including reflux, bloating, constipation, nausea, or chronic stomach discomfort) Sleep disruption and fatigue Blood sugar irregularities Cardiovascular strain What’s the difference between binge eating disorder, bulimia, emotional overeating, and stress eating? These experiences are often lumped together because they all involve eating past hunger or eating in response to emotions. But there are key differences in the behaviors, related emotions, and what happens after eating. Binge Eating Disorder vs. Emotional Eating vs. Stress Eating vs. Overeating  Binge eating disorder vs. overeating Everyone overeats occasionally, like at holidays, celebrations, or during especially busy or stressful days. What separates overeating from BED is pattern and distress, says Simmons. With BED, binges happen repeatedly and are associated with a loss of control and emotional distress afterwards. Overeating, on the other hand, is occasional, more controllable, and not linked to intense guilt. Binge eating disorder vs. emotional/stress eating Emotional and stress eating involve using food to cope with feelings or stress, according to Simmons. That could look like rewarding yourself after a hard day, eating to cope with stress or sadness, or reaching for food during difficult life events, she explains. However, emotional eating is occasional and not associated with the same levels of distress or everyday disturbances as BED, adds Batista. Binge eating disorder vs. bulimia Both BED and bulimia include binge episodes. The key difference is what happens afterward. “Binge eating disorder (BED) involves repeatedly eating unusually large amounts of food in a short period of time, [but] there are no regular purging behaviors,” says Simmons. “Bulimia nervosa also includes episodes of binge eating, but it is followed by … vomiting, laxative or diuretic use, excessive exercise, or any behavior aimed at getting rid of food or preventing weight gain.” How is binge eating disorder diagnosed? Binge eating disorder is diagnosed using standardized clinical guidelines from the DSM-5-TR, the manual mental health professionals use to identify and treat eating disorders. Rather than focusing on body size or appearance, diagnosis looks at patterns of behavior and emotional distress. According to Batista, a medical or mental health professional will check for: Recurrent binge episodes that include eating rapidly, eating until physically uncomfortable, eating when not hungry, eating alone due to embarrassment, or feeling guilt or disgust afterward Ongoing distress and loss of control Binges occurring at least once a week for three months No regular purging It’s also important to know that you don’t have to meet every diagnostic criterion to benefit from binge eating disorder treatment. Many people seek support because binge eating feels distressing or out of control, even if it hasn’t reached the formal frequency threshold yet. Early care can help interrupt the cycle before it becomes more deeply ingrained. Finally, it’s important to understand that BED can occur at any body size. Weight is not part of the diagnostic criteria, and how someone looks has no bearing on whether their eating struggles are real or deserving of care.  What does binge eating disorder treatment look like? There isn’t a single “one-size-fits-all” solution for binge eating disorder treatment. Here’s a look at the core evidence-based approaches commonly used in treatment for binge eating disorder and why they help, according to Simmons and Batista. First line therapies: Cognitive behavioral therapy (CBT) and enhanced CBT (CBT-E): CBT identifies thoughts and behaviors that drive binge cycles and teaches practical skills to regulate eating, challenge shame-based thinking, and interrupt habitual patterns. CBT-E is a specialized version designed specifically for eating disorders. Interpersonal psychotherapy (IPT): This treatment addresses relationship stress, grief, life transitions, or social conflicts that may trigger binge eating and reinforce isolation. Supplemental therapies: These are typically integrated alongside the above modalities. Dialectical behavior therapy (DBT): This type of therapy focuses on learning skills for emotional regulation, distress tolerance, and impulsivity—key building blocks for managing binge urges when emotions feel overwhelming. Integrative cognitive-affective therapy (ICAT): This therapy combines emotional processing with behavior change, helping people recognize emotional triggers in the moment and respond with healthier coping strategies. Acceptance and commitment therapy (ACT): In this type of therapy, you learn skills to tolerate uncomfortable thoughts or urges without acting on them, while strengthening your connection to personal values and long-term goals. Family-based treatment (FBT): When BED occurs in young people, FBT can be an effective approach. Treatment for co-occurring conditions: Addressing related challenges like ADHD, anxiety, depression, trauma, or sleep disorders can make binge urges easier to manage and support long-term stability. Other treatment methods: Medications: Vyvanse is FDA-approved for adults with BED. Other medications, such as SSRIs or treatments for ADHD, anxiety, or depression, can support recovery when co-occurring conditions are present. Nutrition therapy (non-diet, non-restrictive): Registered dietitians help patients establish consistent, nourishing meal patterns and remove rigid food rules. Regular eating reduces physical deprivation and steadies hunger signals, which lowers vulnerability to binges. Mentorship and lived-experience support: Peer mentors offer encouragement, normalization, and practical guidance from someone who has walked the recovery path themselves. Feeling understood can reduce shame and isolation. What does binge eating disorder recovery look like? “Recovery from BED is a process, not a single event,” says Batista. “Clinically, recovery means a significant reduction or cessation of binge episodes, improved emotional regulation, and a healthier relationship with food and one’s body.”  In treatment, recovery often begins with something that can feel counterintuitive: learning to eat regular, consistent meals and snacks to normalize eating patterns. This steady nourishment helps interrupt the binge-restrict cycle, says Simmons: When the body is fed consistently, urges begin to soften, and binges naturally decrease over time. As you start to settle into recovery, Batista says many people begin to notice small but meaningful shifts, such as: Quieter food thoughts and fewer intrusive cravings Eating when hungry and stopping when comfortably full without fear or guilt Fewer or no binges Turning to emotional regulation tools instead of food when stress or big feelings arise Feeling more comfortable eating socially and re-engaging in daily life without secrecy Recovery is often described through everyday wins, like keeping all foods in the home without anxiety or no longer planning entire days around potential binges. “It’s important to note that recovery does not always mean weight loss,” adds Batista. “The focus is on reducing binge behaviors and distress, not on achieving a specific weight.” When and how to reach out for help You don’t need to “hit rock bottom” to deserve help for binge eating disorder. If food, weight, or eating behaviors are taking up a lot of mental space, that’s reason enough to talk to someone. According to Simmons and Batista, it may be time to reach out for help if you find yourself: Binging regularly (even if it doesn’t feel “often enough” to count) Feeling out of control around food or stuck in cycles of bingeing and restricting Thinking about food, eating, or weight most of the day Eating in secret or feeling intense shame after binge eating Using food to cope with emotions Avoiding social situations because of eating-related anxiety Getting support can start small. You might begin by talking with your primary care provider, a therapist, or a registered dietitian who specializes in eating disorders. If you’re unsure whether what you’re experiencing qualifies as an eating disorder, this quick screening tool can help clarify your next steps. “Most importantly, eating disorders are never your fault,” says Simmons. “You didn’t cause them, and you’re not doing anything wrong by struggling. They are real mental health conditions that deserve care, compassion, and effective treatment. With the right support, full recovery is absolutely possible.” Conclusion Binge eating disorder is a real, treatable mental health condition, not a failure of discipline or willpower. With evidence-based care, including regular eating, therapy, and emotional support, you can break the binge-restrict cycle. Food thoughts soften, you’ll rebuild trust in your body, and daily life begins to feel steadier again. If any of this resonates with you, support is available, and reaching out can be the first meaningful step toward recovery. FAQ What happens to your body when you binge eat? When you binge eat, you often eat very quickly and past the point of comfort, which can cause bloating, stomach pain, nausea, fatigue, and reflux. Blood sugar can spike and crash, leading to feeling shaky, foggy, or irritable afterward. Emotionally, many people feel ashamed or upset, which adds stress and keeps the binge cycle going. How common is binge eating disorder? Binge eating disorder is the most common eating disorder. About 1 to 3 percent of adults in the U.S. experience it at some point. It affects people of all genders, ages, and body sizes, and many struggle for years before realizing what they’re dealing with or getting support. Why can’t I stop binge eating? Binge urges are driven by the body and brain, not a lack of discipline. Dieting or skipping meals makes hunger and cravings stronger, and stress or emotions can make food feel like a quick relief. Over time, your brain learns to rely on bingeing to cope, which is part of what makes it hard to stop binge eating. That’s why treatment focuses on eating regularly and building emotional coping skills, not trying harder to control food. 

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            <title><![CDATA[5 Eating Disorder Thoughts You Might Not Realize Are Disordered]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorder-thoughts</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorder-thoughts</guid>
            <pubDate>Mon, 20 May 2024 21:27:00 GMT</pubDate>
            <content:encoded><![CDATA[When it comes to defining and diagnosing eating disorders, many people tend to focus on problematic behaviors: skipping meals, frequent post-meal bathroom trips, excessive hours at the gym, evidence of binge eating. While it’s impossible to ignore the significant role that disordered behaviors play in these illnesses, eating disorder thoughts can be just as harmful. In fact, detrimental or maladaptive thoughts are central to the multilayered nature of anorexia, bulimia, binge eating disorder (BED), and other eating disorders. What are eating disorder thoughts? Put simply, eating disorder thoughts are thoughts that align with and contribute to the eating disorder mindset. They’re thoughts that arise not from your own mind, but from the logic of the illness, thoughts that fuel the values, choices, and actions desired by the eating disorder. This sounds quite sinister (and it is), but unfortunately, it can actually be kind of tricky to identify eating disorder thoughts. That’s because many of the same thoughts that are characteristic of eating disorders have also become normalized in our society, thanks to diet culture. Constant self-monitoring, questioning, and shame around eating and exercise behaviors are, in some ways, expected and encouraged in our society. Meanwhile, we’re constantly told that only certain bodies have value, and that we should all be working toward attaining one of those bodies by becoming smaller. When our thoughts seem to align with these societal values, it’s easy to dismiss them as “normal,” or even good, when they’re quite the opposite. To better understand how many of the “normalized” thoughts in our diet-centric world are actually disordered—and how to counter them—I asked Equip Therapist Lead Jonathan Levine, LCSW, to share five common examples from his clinical work. Here, Levine helps break down why certain thoughts are anything but “normal,” how to start changing cognitive patterns, and when to seek expert help. Eating disorder thought 1: "I shouldn't eat all day so I can eat freely at the restaurant with my friends tonight." According to Levine, one common thought that is often written off as a rational way to “save up” calories revolves around all-day restriction. In reality, minimizing or completely eliminating food during the day in an effort to “earn” an evening meal isn’t healthy or sustainable; on the contrary, it can set the stage for all types of eating disorders. “So many people feel as though they need to ‘earn’ their food or calories, and that in order to enjoy eating out, you need to be ‘good’ the rest of the day by not eating,” Levine says. “This transactional thinking and hyperfocus on controlling what, when, and where we eat is sadly normalized in our society, and is a sign that you may be struggling with disordered eating.” Eating disorder thought 2: "I need to go for an extra long run/workout because of what I ate yesterday." The flipside of “earning” food by restricting beforehand is “making up” for food by exercising away the calories afterward. But contrary to nearly all the messaging we encounter on a daily basis from social media, influencers, and fitness brands, you don’t need to pay penance for eating through physical activity. Not only is the “calories in, calories out” view on weight loss considered outdated, overly simplistic, and completely inaccurate, but there are also a slew of health benefits related to exercise that have nothing to do with calorie burn or weight. When you view workouts solely as compensatory measures for consuming food, you increase your risk of developing eating disorders like bulimia by using exercise as a form of purging. “Having a meal or food item connected to compensatory behavior, like exercise, is a warning sign of disordered eating,” Levine says. “Food is not earned, it is required.” Eating disorder thought 3: "I can't eat in front of people because they might judge what or how much I'm eating." Many people who (even unknowingly) struggle with disordered eating harbor a lot of fear and shame around eating around other people. There are various reasons different people might dread or avoid eating in front of others, but fear of judgment or rejection for food choices or eating behaviors are two big ones. Because eating disorders thrive in isolation, opting out of social situations that involve food can be a slippery slope, leading to increasingly disordered thoughts and habits. “Deep anxiety around eating in front of others is a warning sign that your eating is regimented, controlled, rigid, or compulsive,” Levine says. Eating disorder thought 4: "I can't eat it if I don't know the calories or can't log the calories." The ubiquitousness of calorie counts on restaurant menus and the proliferation of food tracking apps has unfortunately normalized obsessive counting, tracking, and logging when it comes to eating. While some people may find nutrition information helpful or empowering, those prone to disordered eating can quickly become overwhelmed by the onslaught of numbers, and feel compelled to know and record the nutritional content of anything they consume. This desire to control every bite of food can spiral into an obsession and ultimately manifest in an eating disorder. “Calorie counting in and of itself is a massive warning sign of disordered eating and possibly an eating disorder,” Levine says. “If you or someone you know struggles to eat something without specific nutritional info, or they compulsively log all that they eat into an app or note, that's a sign that there is disordered eating or an eating disorder present.” Eating disorder thought 5: "I need to be a certain weight and definitely don't want to be a certain number." For many people, numbers—on the scale, on clothing tags, on BMI charts, and more—have erroneously become barometers of health or self-worth. In reality, reaching or maintaining a specific weight has nothing to do with achieving or sustaining overall well-being, and striving for an arbitrary number can provoke unnecessary and detrimental stress, anxiety, and compulsive behaviors. “A hyperfocus on one's weight as a metric of value is, sadly, normalized in this society where we equate thinness and beauty,” Levine says. “However, this value is also deeply related to eating disorder pathology and thoughts. If you are extremely concerned about being a certain number or fearful of going over a number, it's a good time to assess if you're struggling with disordered eating or an eating disorder.” If you or someone you know grapples with any of these thoughts or similar preoccupations around food, exercise, or body size, it’s time to reach out for help. There’s no such thing as “not being sick enough” to deserve support, and seeking out expert guidance sooner than later can help prevent an eating disorder from developing or becoming more entrenched. Working with a multidisciplinary team, including therapists, dietitians, medical doctors, and support members can make all the difference in permanent recovery and true health—both in your body and your mind.]]></content:encoded>
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            <title><![CDATA[Eating Only (or Mostly) at Night: Why It Happens, How to Stop, and When It Signals an Eating Disorder]]></title>
            <link>https://equip.health/articles/food-and-fitness/only-eating-at-night</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/only-eating-at-night</guid>
            <pubDate>Thu, 26 Dec 2024 20:56:00 GMT</pubDate>
            <content:encoded><![CDATA[When we think about food-related behaviors in eating disorders, we often focus on the “what” and the “how.” What are they eating? Is it too much, too little, not enough variety? And how are they eating? Have they adopted rituals around food, do they eat in secret, do they lose control when they eat? But one important factor that tends to get ignored is the “when.” For those with eating disorders, disordered behaviors often involve the timing of meals and snacks—and for many, this means only (or mostly) eating at night. When someone eats (or doesn’t eat) can be a sign of an eating disorder, and can perpetuate certain disordered patterns. This tends to show up as restricting food during the first part of the day, and eating all or the majority of one’s calories later in the day or at nighttime. Only eating at night can pose a variety of physical and psychological risks and challenges to recovery. Read on to learn more about why many people with eating disorders develop the pattern of only eating at night, what conditions the behavior is associated with, why it can be harmful, and how to stop. What is night eating (or only eating at night)? Night eating or only eating at night is exactly what it sounds like. The specifics will look different from person to person, but the general pattern remains the same: routinely skipping breakfast and eating nothing or very little throughout the rest of the day, then, as evening approaches, allowing food. For some people, this might mean engaging in a binge; for others, it may mean eating a relatively small amount of food that still accounts for most of their daily intake. What is night eating syndrome (NES)? While people with several different types of eating disorders may engage in night eating, it’s worth noting that there is a specific eating disorder characterized by this pattern, known as night eating syndrome (NES). According to the Cleveland Clinic, those with NES typically wake up several times during the night to eat, and find it difficult to fall back asleep without feeling full. According to the DSM-5, NES involves recurrent episodes of night eating either after dinner or after waking up from sleep. Some vital stats on NES criteria and prevalence: NES is a type of other specified feeding or eating disorder (OSFED). NES is defined by excessive food intake in the evening or nighttime (i.e. consuming at least 25% of a person’s daily calories after dinner, or waking up throughout the night to eat). About 1.5% of people in the United States have NES, but many people with other eating disorders tend to eat only or mostly later in the day without meeting the criteria for NES. NES is different from sleep-related eating disorder (SRED), which can cause individuals to eat uncontrollably while mostly or completely asleep and have little to no memory of the episodes the next morning. Those with NES, on the other hand, are aware of their night eating and can recall it the next day, but the behavior can’t be explained by factors like: Sleep-wake cycle changes Social norms Substance or medication use Other mental or physical disorders “For individuals with NES, the nighttime eating pattern is driven by a circadian rhythm disruption,” says registered dietitian and certified personal trainer Alix Turoff, RD. “People may have a suppressed appetite in the morning, combined with increased hunger or a compulsion to eat in the evening or overnight. While NES can co-exist with eating disorders, its drivers are more rooted in sleep-wake rhythm dysregulation than in weight-control behaviors. Still, NES can overlap with eating disorder symptoms, and the two can reinforce each other.” While the DSM doesn’t include criteria for how often night eating must occur or how long these behaviors should persist in order to receive an NES diagnosis, those with NES typically have at least two episodes per week. A diagnosis also includes meeting at least three of the following criteria: A lack of desire to eat in the morning and/or skipping breakfast four or more times per week The presence of a strong urge to eat between dinner and sleep onset and/or during the night Trouble falling or staying asleep four or more times per week Holding the belief that one must eat in order to initiate or return to sleep Having a frequently depressed or worsened mood in the evening Because a pattern of waking up to eat can significantly impair daytime functioning and negatively affect mental health, treatment for NES is essential and may include a variety of different therapies, including those used to treat general night eating. What causes some people to only eat at night? There are a number of different reasons why someone with an eating disorder might develop this eating pattern. “Eating predominately at night is a common symptom in eating disorders because it can reflect a combination of physiological, psychological, and behavioral factors tied to the disorder’s underlying dynamics,” says Adriana Lindenfeld, LMHC, a therapist at Equip. Daytime restriction “From a physiological standpoint, irregular eating patterns or prolonged restriction during the day can disrupt hunger and fullness cues, leading to increased cravings and overconsumption later in the day.” (This underscores the notion that most, if not all, eating disorders are rooted in restriction). Turoff explains this phenomenon further, adding that people with restrictive eating disorders such as anorexia often develop night eating as a response to calorie restriction during the day. “When someone spends the entire day suppressing hunger or adhering to rigid food rules, the body and brain eventually override those restrictions,” she says. “As the day goes on, the hunger gets stronger and nighttime often becomes the point where the biological drive and physiological need to take in calories breaks through. Patients will often say they feel ‘fine’ or ‘not hungry’ all day, which can also be a result of eating at night and the guilt that comes with it the next morning leading to more restriction—and, eventually, they become overwhelmingly hungry in the evening because their energy needs haven’t been met.” In other words, eating at night can be one version of the binge-restrict cycle. Marriage and family therapist Alyssa Mass, LMFT, agrees that night eating is often a consequence of not providing the body with enough calories during the day. “My first question to people with eating disorders who are eating at night is, ‘what have you been eating during the day?’” she says. Registered dietitian nutritionist and certified intuitive eating counselor Katy Zanville, RDN, says that restriction during the day can show up in a few different ways, like skipping meals, undereating carbohydrates, or eating small portions that aren’t sufficient for your nutritional needs. “Another form of restriction during the day can be psychological—like eating foods that you label as ‘good’ during the day and allowing foods labeled as ‘bad’ at night,” she says. “This sets you up to eat past fullness on foods that are restricted during the day.” Calorie “banking” Those with anorexia or other restrictive eating disorders might “save” calories for later in the day as a way to exert some control, both over their food intake and their emotional state. “Eating later in the day might reflect an attempt to delay or minimize caloric intake as long as possible, potentially as a way to ‘earn’ the right to eat,” says Lindenfeld. “This pattern might also reflect rigid, ritualized eating behaviors or avoidance of eating in social settings.” Managing difficult emotions Night eating can also be a response to distressing emotions, like stress, anxiety, and loneliness, Lindenfeld explains. “The evening hours—often quieter and less structured—can create a vulnerable window for compulsive eating, especially if restriction or emotional suppression occurred earlier in the day,” she says, adding that eating at night can be a way of managing anxiety or avoiding feelings of guilt that they know they would feel after eating earlier in the day. Mass adds that nighttime might carry particular emotional resonance that leads to eating. “If daytime restricting isn’t in play, then it’s a discussion around what nighttime means,” she says. “For some it may be a time where stressful thoughts have the space to come in and food may quiet or mute that noise. For others it may feel like a more relaxed time when the world around them is quiet, and eating at night may feel relaxing or like a treat for a hard day.” Fear of judgment For those with binge-type disorders such as binge eating disorder (BED), nighttime eating can be less related to biological starvation and more emotional or related to environmental factors, according to Turoff. “People may eat exclusively or primarily at night because it feels private, they’re less likely to be observed or judged, or they associate nighttime with relief from stress,” she says. “I frequently see patients who feel ashamed eating during the day but describe nighttime as the only time they ‘allow themselves’ to eat freely. These patients might also find that they’re able to go hours without food during the day because they’re still full from the night before so they may actually not feel hungry during the day but it’s because of the pattern of overeating at night which ultimately fuels the cycle.” Hormonal factors From a physiological perspective, hormonal imbalances that throw off a person’s hunger and fullness cues can also play a role in some cases. Which eating disorders involve only eating at night? Lindenfeld says that eating only (or mostly) later in the day can be a symptom of a number of different eating disorders, including: BED Anorexia Bulimia OSFED “Although binge behaviors aren’t exclusive to nighttime, BED often involves episodes of consuming large quantities of food during the evening hours, especially if the person has restricted their intake earlier in the day,” Lindenfeld says. Research also demonstrates this pattern: in a study of people with BED, researchers found that breakfast was the least commonly consumed meal, with dinner being the most common meal and evening the most common time for snacking. Night eating can also be a symptom of bulimia: “While binge episodes in bulimia can occur at any time, they often happen at night due to emotional triggers, physical hunger following restriction, or feelings of isolation,” Lindenfeld says. As mentioned above, people with anorexia might eat primarily at night to minimize overall caloric intake, and OSFED, which encompasses a wide range of disordered eating patterns, can also include eating at night. Could eating only at night be a sign of something besides an eating disorder? “While night eating in restrictive eating disorders is often a physiological rebound from inadequate calorie intake during the day, it can also show up outside of clinical eating disorders. This can be related to factors like diet culture, diet history, or lifestyle,” Turoff says. “For example, chronic dieters may unintentionally undereat earlier in the day and then find themselves hungrier at night and in other cases, people who work irregular hours—like a nurse who works nights three days per week—might have a dysregulated appetite rhythm independent of an eating disorder.” Some other factors that might lead someone without an eating disorder to eat only (or mostly) at night include disrupted sleep patterns, emotional distress (which can trigger emotional eating), and diet culture. Unfortunately, it’s extremely common for people without eating disorders to adopt pretty disordered eating habits in an attempt to lose weight, look a certain way, or meet certain “healthy” standards around diet or fitness. One prime example is intermittent fasting, which might be appropriate for some people for a certain amount of time, but often does more harm than good (and may eventually lead to an eating disorder). “Eating only at night does not automatically mean a person has an eating disorder, but the context of the behavior is what matters,” Turoff says, noting that nighttime eating can indicate an eating disorder if: There’s intentional restriction during the day to “bank” or “save up” calories for later, or to avoid eating in front of others. The night eating feels compulsive, out of control, or driven by intense hunger that results from not eating enough during the day. Nighttime eating is associated with shame, secrecy, or emotional distress around or after eating. Night eating is paired with compensatory behaviors like restricting food the next day, overexercising, or purging to compensate. Night eating is a result of a rigid belief system or “rules” created around when someone is “allowed to eat. “Whether or not the behavior is a result of an eating disorder or something else comes down to whether that person feels their night eating causes distress, lack of control, and whether the behavior is rooted in restriction or emotional avoidance versus physiology or schedule,” Turoff says. What if I’m only hungry at night? Certain people struggle to feel hunger at any time of day other than night. For some, breakfast can be a challenge, and for others, a busy schedule might mask hunger cues throughout the day. While many of us have been told to “only eat when you’re hungry,” that rule isn’t helpful for people with suppressed or unreliable hunger cues, and it can perpetuate the cycle of disordered eating. “People’s bodies can and do have different rhythms and that’s okay,” Mass says. “For people who have a harder time eating during the day, we may talk about ‘breaking the fast’ instead of breakfast. What’s the first meal of the day and how many hours are between the last meal of one day and the first meal of another? From there, we might discuss the reality of their daily schedule and how we get a certain amount of calories in by a certain time.” While different people have different cues for hunger and fullness (some may feel a stomach rumble when they are hungry and others may get a headache or feel weak, for example), eating disorders can make it difficult to feel those cues at all. Food restriction is at the core of most eating disorders—not just anorexia—so it’s important to understand that skipping meals and snacks throughout the day, even if you don’t feel hungry, can worsen eating disorder symptoms. Those with bulimia or binge eating disorder, for example, tend to binge after periods of restriction, and the biological hunger that results from that restriction is what triggers the binge and contributes to feeling out of control. Getting adequate nutrition throughout each day is essential for overall health and for treating a variety of eating disorders. That’s why at Equip, patients and loved ones work closely with a registered dietitian to prioritize regularly timed meals and snacks, diversifying the types of food a patient eats, and challenging and breaking established food rules.  The risks of only eating at night Eating only (or mostly) at nighttime can have negative effects on a person’s physical and mental health, as well as their relationships and quality of life, regardless of whether or not they have an eating disorder. “Physically, nighttime eating disrupts the body’s natural circadian rhythm, which governs digestion and metabolism,” Lindenfeld explains. “Consuming large amounts of food late at night can lead to gastrointestinal issues, and increased risk of conditions like insulin resistance, type 2 diabetes, and cardiovascular disease.” She adds that it can also affect sleep quality, because your body’s efforts to digest all that food can make it tough to fall or stay asleep. Here’s a snapshot of the potential negative consequences of only eating at night: Increased risk of diabetes. Research has shown that regularly eating very large meals late in the day is linked to elevated levels of glucose and insulin, which decreases insulin sensitivity and increases the risk for type 2 diabetes. Cardiovascular risk. Habitual night eating has been associated with the progression of arterial stiffness, which is a significant predictor of heart disease. Acid reflux or gastroesophageal reflux disease (GERD). Eating within two to three hours of bedtime can trigger increased acid production in the stomach, and lying down soon after eating can encourage this acid to flow into the esophagus, causing acid reflux and heartburn. Hormonal imbalance and intense cravings: Restricting food during the day can disrupt the balance of hormones involved in the hunger-fullness cycle. In terms of psychological impact, Lindenfeld notes that nighttime eating is often associated with feelings of shame, guilt, and loss of control, which can amplify anxiety, depression, and low self-esteem. Only eating later in the day can also impact social functioning, as people might avoid situations during the day that involve eating. This can hurt relationships, which can worsen the other negative psychological effects of nighttime eating. According to Turoff, night eating can cause: Increased shame Guilt Preoccupation with food, “especially when the nighttime eating feels ‘sneaky,’ secretive or out of control” Reinforcement of a binge-restrict cycle Social isolation “Over time, these patterns can disrupt metabolism, perpetuate guilt and shame cycles, and exacerbate the psychological and physical toll of an eating disorder,” says Lindenfeld. How night eating impacts sleep One of the most significant ways that night eating negatively affects overall health is by disrupting sleep. “People don’t sleep well when they eat at night,” Mass says. “During sleep, our body should be at rest, but food can take up to six hours to digest. That means you really have to subtract six hours from your sleep time. So, eight hours of sleep will feel like two because even though you were asleep, your body was working.” Here are some of the ways that disordered eating patterns (including only eating at night) can negatively impact sleep: While a lack of nutrition can result in fatigue during the day, it can actually lead to insomnia at night, and hunger can also cause obsessive thoughts about food, making it more difficult to sleep. Because those with eating disorders may be undernourished or underweight, they may have trouble regulating their body temperature, which makes it difficult to feel physically comfortable and fall asleep. If a person binges (and/or purges) at night, physical side effects (like acid reflux, bloating, and digestive discomfort) and emotional effects (like shame and guilt) can make it hard for them to fall asleep. The possible malnutrition that may result from only eating at night can cause sleep cycle disruptions, including reduced rapid eye movement (REM) sleep This can have a significant effect on mental health and cognitive function. Restricted or poor quality sleep, in turn, can cause a significant increase in ghrelin (the "hunger" hormone), which may perpetuate the cycle of disordered eating. How is night eating addressed in eating disorder treatment? According to Turoff, the first step in getting help for night eating is evaluating whether nighttime eating is a response to inadequate calorie intake or something else. “More often than not, people who ‘aren’t hungry’ earlier in the day have unintentionally conditioned their bodies to expect food only at night,” she says. “Over time, hunger cues become blunted and untrustworthy. At first, this usually requires a more structured approach, especially for individuals with eating disorders who aren’t able to ‘intuitively eat,’” With the help of a team, individuals who struggle with night eating can begin to learn “mechanical eating” during the day. Mechanical eating is when someone eats on a schedule, such as every three to four hours, independent of hunger cues,” Zanville says. “Modifying the texture of foods, eating safe or comfort foods, or relying on smoothies and nutrition shakes can also help with poor appetite during the day.” According to Lindenfeld, addressing this pattern of eating involves a multidisciplinary approach that targets the behavioral, psychological, and physiological factors contributing to the behavior. “A key focus is restoring regular eating patterns throughout the day to regulate hunger and satiety cues,” she says. “This often involves structured meal planning with the guidance of a registered dietitian, and encouraging balanced meals and snacks spaced evenly to prevent daytime restriction.” Treatment might also include cognitive behavioral therapy (CBT) to address distorted thoughts and feelings that tend to lead to nighttime eating, as well as helping people develop healthier coping strategies for dealing with triggers and distressing emotions. What to do if you or a loved one are struggling with eating only at night If you find that you’re eating all (or the majority of) your food in the evening and are restricting throughout the day, or have noticed someone in your life doing this, it could signal an eating disorder. And even if an eating disorder isn’t the underlying cause, eating only at night can be harmful to your mental and physical health, as well as your relationships and quality of life. Either way, it’s important to reach out for support. Talk with your doctor or an eating disorder-informed dietitian about your concerns, and they can guide you toward resources and strategies to help shift this behavior. You can also schedule a consultation with the Equip team to talk through your concerns and what treatment options are available.]]></content:encoded>
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            <title><![CDATA[What's the Connection Between OCD and Eating Disorders?]]></title>
            <link>https://equip.health/articles/understanding-eds/ocd-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/ocd-and-eating-disorders</guid>
            <pubDate>Wed, 27 Mar 2024 23:08:00 GMT</pubDate>
            <content:encoded><![CDATA[Lauren Gerber, Equip’s Head of Brand & Comms, says she always considered herself to be a fairly obsessive person. But she never identified as someone with obsessive-compulsive disorder (OCD), a mental illness characterized by uncontrollable and recurring thoughts (obsessions), repetitive behaviors (compulsions), or both. She was also never formally diagnosed with the condition—until 15 years after she’d recovered from her eating disorder. Her story is unique, but far from rare, as the overlap between OCD and eating disorders is bigger than many people realize. “Looking back, I believe OCD absolutely helped fan the flame for my eating disorder,” Gerber says. “I remember not being particularly mentally interested in food or my body or dieting during my eating disorder. I was instead absolutely fixated on the number on my scale—specifically it being an even, flat number—or a precise ratio of certain ingredients. I know this now to be indicative of 'symmetry' or 'perfectionism' OCD, but for years, I just thought I had a strange version of an eating disorder and the rigidity that came with it.” What is obsessive-compulsive disorder (OCD)? Obsessive-compulsive disorder, as the name implies, is a mental illness that’s characterized by uncontrollable obsessions and compulsions. According to the DSM-V, obsessions are defined as “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.” These obsessions go hand-in-hand with compulsions, which is when a person with OCD attempts to ignore, suppress, or neutralize an obsession by performing a certain action or thinking a certain thought. While the hallmark symptoms of OCD are these obsessive thoughts and the compulsive behaviors meant to manage them, this can manifest in a number of different ways. While some people may have obsessions that revolve around germs or contamination (with accompanying compulsions like excessive handwashing, for example), others may obsess over fear of losing control, which could be accompanied by a compulsion like calorie counting or intense food monitoring. OCD presents differently from person to person, but research suggests that the illness may be classified into several broad categories, including: Checking, in which the person engages in safety checking compulsions Indecisiveness, in which the person becomes obsessed with making the correct decision Contamination, in which the person’s obsessions are related to both realistic and unrealistic contagions or contaminations Just right, in which the person has uncomfortable feelings that things are not “just right” (symmetry and order falls under this category) How are OCD and eating disorders connected? Eating disorders are complex, multifaceted brain disorders rooted in biological, psychological, and social risk factors and triggers. For some people with eating disorders, obsessive thoughts around food, weight, or body size may lead to levels of anxiety that can only be quelled by compulsive behaviors, like restriction, purging, over-exercise, and more. In these ways, the symptoms of certain eating disorders can look almost identical to the symptoms of OCD. “There is a high rate of comorbidity between eating disorders and OCD,” says Equip’s Director of Program Development, Tana Luo, PhD. She explains that while prevalence estimates tend to vary widely, lifetime prevalence of OCD in people with eating disorders has been found to be as high as 60%, and lifetime prevalence of an eating disorder in people with OCD is as high as 17%. While some studies indicate that rates of OCD are higher in those with anorexia than in those with bulimia, Luo says other research indicates no difference from diagnosis to diagnosis, particularly when looking at lifetime prevalence. There's also a strong connection with OCD and the lesser-known diagnosis of ARFID.  “There can be many similarities in how OCD and eating disorders present,” Luo says. “For example, both OCD and eating disorders may be characterized by obsessive, distressing thoughts. For those with an eating disorder, those thoughts tend to center on things like weight, food, and body image, whereas for those with OCD, the content of the thoughts may focus on things like contamination and harm, among many other things.” Eating disorders and OCD tend to share other common characteristics as well, like repetitive or compulsive behaviors. “For those with an eating disorder, the behaviors may include ritualistic eating behaviors, exercising, or purging,” Luo says. “And for those with OCD, there’s a range of compulsive behaviors that may be present. In both cases, the compulsive behaviors function to reduce a person’s fear and anxiety.” OCD that focuses on symmetry and order can also contribute to an eating disorder, as this type of OCD involves obsessions over numbers and counting. In someone predisposed to an eating disorder, this can manifest as a fixation on weight, body measurements, calories, or other food- or body-related numbers. Does OCD cause eating disorders—or vice versa? As with most mental health conditions, neither OCD nor eating disorders have a single or straightforward cause. Both illnesses can result from a multilayered interaction of family history, environment, biology, and more. Because of these complicated roots, neither condition is thought to “cause” the other—but the symptoms of both can occur simultaneously, or one diagnosis may follow the other. Some researchers suggest that certain personality traits and cognitive styles may increase vulnerability to both OCD and eating disorders, which Luo says may explain why there’s such an overlap between the two. “Perfectionism, for example, is one trait that has been found to be associated with both eating disorders and OCD,” Luo says. “Perfectionism refers to the drive to meet a high standard, being highly critical of oneself, and experiencing significant distress in response to perceived failure. This trait may make a person more vulnerable to developing both an eating disorder and OCD.” Additionally, Luo points out that eating disorders and OCD are both marked by cognitive inflexibility and challenges with set-shifting, the ability to move back and forward between different tasks or mental sets. “These cognitive styles may increase susceptibility to both disorders,” she explains. While OCD and eating disorders can co-occur, Luo says it’s not uncommon for people with eating disorders to demonstrate obsessive-compulsive behaviors in the absence of true clinical OCD. “That is, someone who is struggling with an eating disorder may have many distressing obsessions about food, weight, and their body, and they may engage in ritualistic or compulsive eating-related behaviors,” she says. “But if all of those symptoms are occurring exclusively within the context of the eating disorder, the person wouldn’t meet criteria for OCD, too.” Even though obsessions and compulsions around food or weight may not merit an OCD diagnosis if those behaviors are all associated with an eating disorder, it’s important to note that low weight and malnutrition can actually increase obsessive-compulsive symptoms. This triggers what Luo calls a “vicious cycle” that starts with disordered eating behaviors leading to weight loss. “Then that weight loss increases the person’s cognitive rigidity, which leads them to engage in more disordered and compulsive eating behaviors, which leads to further weight loss, and so on and so forth,” she says. This doesn’t mean that OCD causes eating disorders, but rather indicates how the former might come before the latter in a person who is genetically vulnerable to both disorders. In order to properly diagnose and treat people, Luo says it’s critical for providers to assess the nature and timeline of the onset of obsessive-compulsive behaviors, as well as those of the eating disorder and any weight loss. “That way, providers can determine whether the patient truly has a comorbid eating disorder and OCD or if the obsessive-compulsive symptoms are occurring only in the context of the eating disorder,” she says. How treatment addresses eating disorders and OCD concurrently Just as eating disorder treatment requires a multidisciplinary approach, OCD may also require various forms of therapy, medications, or both to address and manage symptoms. Because there’s so much variability within these illnesses, there isn’t necessarily a one-size-fits-all treatment to tackle both, and expert-led, individualized care is typically recommended. “There isn’t strong evidence to support the use of just one treatment modality for both diagnoses,” Luo says. “Cognitive behavioral therapy (CBT) principles can be effective for both, although the specific applications will vary. More specifically, cognitive behavioral therapy for eating disorders (CBT-E) is an evidence-based treatment for eating disorders, and exposure and response prevention (ERP), which is a type of CBT, is the gold standard for OCD.” The absence of one standard treatment protocol to address both disorders at once doesn’t mean that they can’t be treated effectively at the same time. While Luo explains that CBT and ERP share the same underlying principles and thus work well together, other treatment modalities can also be successful in treating OCD and eating disorders together. “Even if a treatment other than CBT is being used to treat the eating disorder—say, family-based therapy (FBT)—it’s still possible to introduce ERP alongside that treatment,” shes says. “In any case, people struggling with both an eating disorder and OCD should work closely with a treatment provider to determine the best way to treat both disorders and the timeline for treating each.”]]></content:encoded>
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            <title><![CDATA[Different Types of ARFID: Understanding The Three ARFID Presentations]]></title>
            <link>https://equip.health/articles/understanding-eds/types-of-arfid</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/types-of-arfid</guid>
            <pubDate>Mon, 11 Aug 2025 16:56:00 GMT</pubDate>
            <content:encoded><![CDATA[Sixteen-year-old Jeremy was surviving on just three foods—mostly frozen, pre-packaged snacks he could eat immediately or throw in the microwave. He ate twice a day at most, his disinterest in food severely impacting his nutrition and development. "He would essentially choose not to eat most of the day," Michelle Jones, PhD, licensed psychologist and clinical instructor at Equip, recalls. "It was very difficult for his parents to support him in eating more." Jeremy’s case illustrates what avoidant/restrictive food intake disorder (ARFID) can look like—but his story is just one example of the way this eating disorder shows up. ARFID is an extremely varied and individualized diagnosis, and it can manifest in three distinct ways, known as “presentations.” Certain individuals avoid foods due to sensory issues like texture or smell, others restrict eating out of fear that something bad will happen, and some, like Jeremy, simply lack interest in food altogether. People with ARFID may experience one, two, or all three presentations. Each type of ARFID has different causes and symptoms, and requires different treatment approaches —making real understanding and identification crucial for recovery. Read on to learn more about the different types of ARFID, how to identify them, treatment options, and more. What is ARFID? ARFID is an eating disorder where a person consistently avoids or restricts food so much that it harms their health. The disorder affects between 0.3% and 15.5% of the general population and can lead to problems like significant weight loss, nutritional deficiencies, and developmental delays. While ARFID is often associated with children or adolescents, it can occur at any stage of life, and adults experience ARFID too. Unlike other eating disorders like anorexia nervosa or bulimia nervosa, ARFID behaviors aren’t driven by body image concerns or fear of weight gain. Instead, their food avoidance comes from other factors. The reasons behind their food avoidance—whether it’s a fear of choking, extreme selectivity around food texture, never feeling hungry, or something else—determine which presentation (or presentations) a person is experiencing. What are ARFID “presentations” or types of ARFID? The DSM-5 identifies three main types of ARFID, also known as “presentations.” “The three ARFID presentations are like three different roads leading to the same place. In this case, that destination is an individual not eating enough variety or quantity of food to support their health and development,” says Janessa Slatky, RDN, and eating disorder-informed dietitian. The three different presentations or ARFID types are: Lack of interest or low appetite: When someone has little natural drive to eat, doesn't find food particularly enjoyable, and often feels full very quickly or simply forgets to eat. Sensory-based avoidance: When someone finds certain textures, smells, tastes, temperatures, or appearances of food overwhelming or disgusting, leading them to eat only a narrow range of "safe" foods. Fear-based avoidance: When someone avoids foods due to worry about negative consequences like choking, vomiting, having an allergic reaction, or experiencing pain, usually caused by a past traumatic event.  
While ARFID is more commonly diagnosed in children than adults, it affects people of all ages, and certain presentations tend to show up at different times in the lifespan. “It's more about the timing at which they first present,” says Jones. “For example, we typically see the fear-based presentation in older children, adolescents, and even in adults. That’s because symptoms typically don't emerge until later, because some kind of traumatic event or perceived trauma precipitates it. Signs of sensory sensitivity and lack of interest, however, can appear as early as infancy.” Lack-of-interest ARFID Lack-of-interest ARFID is when someone doesn’t have a natural drive to eat. "They don't have the natural, biological hunger cues that normative eaters get,” says Michelle. “For these people, eating becomes a chore, something that requires a lot of effort and doesn't have a lot of payoff." While this type of ARFID can be tricky to identify, people with this eating disorder often: Experience weak or absent hunger cues throughout the day Get little to no pleasure from eating experiences Express that eating feels like a waste of time Feel full quickly after eating small amounts of food Take an unusually long time to finish eating when they do eat May need to "push themselves" to eat or require external motivation Often, parents wonder if their children’s lack of interest in food is due in part to other underlying issues, like depression or ADHD. “With depression, loss of appetite comes with other mood symptoms, like sadness and irritability. ADHD usually involves impulsivity and forgetfulness, but not a long-standing disinterest in food itself,” explains Jones. Sensory sensitivities ARFID The most common subtype, ARFID driven by sensory sensitivity involves avoiding foods based on how they look, smell, taste, feel, or sound. While preferring certain textures of food can be normal and appropriate, ARFID related to sensory sensitivities is much more acute. "We refer to people who have this presentation as 'super tasters,' because they have a greater ability to differentiate between different flavors and textures of food compared to normative eaters. So, when they dislike a food, it feels very intense for them," says Jones. Symptoms of this type of ARFID often include: Strong reactions (gagging, pushing away, distress) to non-preferred foods Loyalty to brand-name foods because they're predictable Avoidance of entire food categories (all vegetables, all meat, anything "wet") Very specific preparation requirements (cut a certain way, specific temperature) Severe anxiety and distress around eating Because of these ‘super taster’ abilities, trying new foods can be a bit of an overwhelming experience for people with this presentation. “People who have this presentation will limit themselves to foods that they've tried before and can accept—we call them ‘safe foods,’” says Slatky. “In turn, kids might appear difficult at mealtimes, refuse to get school lunch, or not want to go out to eat.”  Fear of aversive consequences ARFID The third type of ARFID, fear of aversive consequences, involves someone avoiding food because they're worried that something negative might happen when they eat. The specific fear can take a variety of different forms, but according to Jones, fears of choking and vomiting are most common. This type of ARFID can co-occur with certain mental health conditions like anxiety and obsessive-compulsive disorder (OCD). Unlike lack of interest and sensory sensitivities, this type of ARFID commonly occurs after one or more traumatic eating events, such as choking on something, experiencing food poisoning, or having an allergic reaction. “For example, someone might have had a really terrible stomach bug once. That experience then causes them to avoid foods associated with that experience in order to prevent themselves from becoming sick and vomiting again." People with this type of ARFID may: Avoid foods (often called “fear foods”) associated with a past negative experience Show anxiety symptoms (rapid heartbeat, sweating, panic) around fear foods Express specific worries about choking, vomiting, allergic reactions, or pain Only eat foods they perceive as "safe" Have a sudden onset of eating restrictions rather than long-term pickiness Avoid eating in certain situations or around other people While this type of ARFID often starts after someone experiences a traumatic event firsthand, it can also develop or get worse just by watching something scary happen to someone else. “I've had patients who maybe have always been a little bit afraid of vomit. Then they watch a movie where there's an intense vomiting scene, and then they start to worry it's going to happen to them," says Jones. “A child's world is so small, so a fear like that...it's their whole world." It’s also important to note that sometimes, people can have this presentation without experiencing a triggering event either firsthand or secondhand. Is it possible to have multiple presentations or types of ARFID? While symptoms of only one type of ARFID are required for diagnosis, having multiple types is quite common. "More than 50% of the time, we'll see multiple presentations, with fear of aversive consequences and sensory sensitivity being the most common pairing,” says Jones. “If parents are noticing that their child is picky in terms of variety, but also really seems uninterested in even foods that they're willing to accept, that's a good indication that they have multiple presentation types.” What does treatment for each type of ARFID look like? While treatment for each type of ARFID usually depends more on the individual person than the specific subtype, there are some common treatment approaches for each—all of which tend to focus on helping people get proper nutrition, build coping skills, and improve their daily life. Treatment for lack-of-interest ARFID “In treatment for lack-of-interest ARFID, it’s often not going to be possible or realistic to have all of the symptoms go away completely because patients are limited by their biology,” says Jones. “So treatment becomes more about reducing the impact of symptoms on everyday life, health, and functioning.” Often, that involves teaching parents (or adult patients) how to create structured eating routines and building interoceptive awareness. According to Slatky, this external structure helps patients actually tune into their own hunger and fullness signals. Treatment for sensory sensitivities ARFID When treating this type of ARFID, the goal is often to expand the variety of foods a person eats. To do this, providers often use systematic desensitization, where the goal isn't to force foods, but to help the patient slowly get used to different textures and smells in a non-threatening way. This is a form of exposure therapy, which is a core component of all ARFID treatment. Food exposures are individualized, gradual, and introduced in a thoughtful and safe way. “In extreme cases,” says Slatky, “We'll spend many, many days just looking at the food, or being in the room with the food. So, one day we smell the food, the next day we touch it to our lips. The next day, we lick it. The next day, we might put it in our mouth and take it out.” Fear of aversive consequences ARFID Addressing ARFID related to fear of aversive consequences typically involves cognitive behavioral therapy (CBT), an approach that has been shown to have fairly high success rates: in a recent study, 85% of children who received CBT for ARFID improved their food variety and anxiety after just 12 weeks. Exposure-based therapy can also be an effective intervention here, allowing patients to face their fears in small, safe steps. “I tend to think of exposure-based therapy as a typical bell curve. The more exposures you do, anxiety is going to rise, but then over time that anxiety will eventually come back down,” says Slatky. Providers might also teach coping strategies for anxiety, like deep breathing techniques, and work with families to encourage positive food experiences, like involving children in meal planning.  What to do if you or a loved one is struggling with ARFID If you think you or someone you care about might have ARFID, it's important to get professional help. However, because ARFID is a relatively new diagnosis, not all providers are familiar with its presentations and treatment approaches. “Working with a professional without ARFID specialization can put parents or patients in a difficult position of feeling like they’re educating providers instead of the other way around,” says Jones. At Equip, we provide expert, individualized ARFID treatment through multidisciplinary teams specifically trained in evidence-based approaches. As the leading U.S. provider of ARFID care, we adapt our treatment to address sensory sensitivities, lack of interest in eating, fear of aversive consequences, or combined presentations—so you can get the exact care and help you or your loved one need to feel better. If you're unsure whether you or your loved one might have ARFID, consider taking this free ARFID quiz—this can help guide conversations with a trusted doctor or mental health. You can also schedule a call with Equip to learn more about our specialized ARFID treatment options.]]></content:encoded>
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            <title><![CDATA[Food Allergies and ARFID: What's the Connection?]]></title>
            <link>https://equip.health/articles/understanding-eds/food-allergies-and-arfid</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/food-allergies-and-arfid</guid>
            <pubDate>Mon, 17 Jun 2024 18:14:00 GMT</pubDate>
            <content:encoded><![CDATA[If you or someone you know has a food allergy, then you understand the anxiety that can accompany meal and snack times. A certain level of apprehension is, of course, understandable, considering that some food allergies can cause severe or even life-threatening reactions. But while a degree of concern and advanced planning is undoubtedly warranted when it comes to food allergies, intense fear and rigid rules around food can, in some instances, contribute to the development of avoidant restrictive food intake disorder (ARFID). People with ARFID typically struggle to eat because of extreme sensory sensitivities, fear of a bad outcome from eating, or lack of interest in food (as opposed to other types of eating disorders, in which disordered behaviors are driven by concerns around the body and weight). People with ARFID usually eat very little food, very few types of food, or both, but it’s much more than just extreme picky eating. It’s a psychological illness with serious mental and physical health consequences, and it affects people of all ages, races, genders, and body sizes. Like all eating disorders, ARFID doesn’t have a single cause, but it can be helpful to understand potential contributing factors, including food allergies. Here’s what experts know about the connection between food allergies and ARFID. How common are food allergies in people with ARFID (and vice versa)? Overall, food allergies are quite common: in fact, almost 6% of adults and children in the U.S. have one. While food allergies are most common in babies and kids, they can develop at any age. The prevalence of ARFID is still largely unknown, but it’s most common in children (although adults can develop it as well), affecting approximately 3.2% of children and between 14-22.5% of children being treated for eating disorders. While prevalence estimates vary widely, there does appear to be a strong connection between food allergies and ARFID. “Research shows that there is likely a very high overlap between ARFID and food allergies,” says Equip’s VP of Program Development, Jessie Menzel. “Two studies—one with children and one with adults— found extremely high rates of ARFID symptoms—over two thirds!—among those with food allergies. In ARFID samples, rates are lower but still significant.” Why might some people with food allergies develop symptoms of ARFID? As mentioned above, people with ARFID don’t restrict their food intake out of a desire to lose weight or change their body. Rather, they typically restrict the types of amount of food they eat for one of three reasons: Sensory sensitivities (issues with taste, texture, smell, etc.) Lack of interest in food Fear of something bad happening if they eat (choking, vomiting, contamination, etc.) For people with food allergies and ARFID, it’s typically reason #3. “ARFID is a very diverse eating disorder and food allergies are most commonly associated with the fear of aversive consequences, meaning that they usually cause someone to avoid food or restrict their eating due to fear of bad outcomes,” Menzel says. ARFID doesn’t have one specific cause, but experts do believe that in some cases, food allergies may play a strong role in influencing the development of the eating disorder. “We think that food allergies place someone at higher risk for developing ARFID because of the necessary changes a person has to make to their diet to avoid allergic reactions,” Menzel says. “People with food allergies have to follow restricted diets and have had previous bad—even traumatizing—experiences with food. They are taught that they need to avoid certain foods for their own safety.” While this behavior is often necessary for people with food allergies, this learned behavior can create negative associations with food. Over time, these feelings can develop into an increased caution or distrust of food in general. “If that wariness becomes too extreme, people may start avoiding foods even though they’re safe simply due to the chance that it might be contaminated by an allergen,” Menzel says. “Sometimes these fears become so intense that people start to develop extreme fears, like fear of breathing air that might be contaminated by food allergens. When fears start to cross the line from reasonable to extreme and cause someone to avoid foods even though they’re safe, that’s when you’re dealing with ARFID.” Can you prevent ARFID in people with food allergies? Anyone with food allergies, or anyone who parents a child with food allergies, is familiar with the inherent obstacles in navigating meal and snack options. “Food allergies present many challenges for individuals and parents because it is necessary to exercise a certain amount of caution around food,” Menzel says. “Food actually can be dangerous for a person with food allergies.” While there’s certainly some amount of caution and preparation that is required when living with a food allergy or parenting a child with one (or more), there are strategies for reducing the amount of anxiety or fear that may result from food monitoring. For parents in particular, Menzel recommends being mindful of two things: How you express your own anxiety around your child’s food allergies. The most important way parents can demonstrate a reasonable amount of ease around food is to model sensibly cautious but calm behavior. “As a parent, it’s important to show confidence to your child,” Menzel says. “They will pick up on cues from you. Take only the absolutely necessary steps to ensure that food is safe and resist the temptation to do more.” The lengths you go to reassure your child that food is safe. “Going to great lengths to assure your child that a food is safe can quickly become a slippery slope,” Menzel says. “Even though it might make your child feel better in the short term, this behavior can actually increase your child’s fears over time. Before you know it, your child will begin to question or fear even safe foods, a hallmark of ARFID in kids with food allergies.” If you’re an adult living with food allergies and are worried that you’re developing rigid or extreme behaviors that might lead to ARFID, your best bet is to talk to a professional. With the right support, you can develop tactics for safely managing your allergy without slipping into an eating disorder. Are certain food allergies more likely than others to lead to ARFID? Any food can cause an adverse reaction in someone who is allergic to it, but there are eight foods or food groups that account for most serious allergic reactions in the U.S.: Milk Eggs Wheat Fish Soy Crustacean shellfish Peanuts Tree nuts That being said, there is no reason to assume any one of these foods or food groups is more likely to lead to ARFID than any others. “There isn’t a lot of data linking specific types of allergies to increased risk of developing ARFID,” Menzel says. “But ARFID has been associated with IgE-mediated food allergies and eosinophilic esophagitis (EOE)—but it likely can occur with any type of food allergy.” Otherwise known as Immunoglobulin E, IgE are antibodies produced by the immune system in response to an allergen. These antibodies are what are responsible for allergic reactions. Someone with IgE-mediated food allergies experiences an abnormal immune response when exposed to certain foods, such as milk, eggs, wheat, nuts, and more. Certain food allergies can contribute to EoE, an inflammation of the esophagus, but researchers are still unclear on which specific foods could be the cause. “Research is very clear, though, that anytime someone is asked to follow an exclusion diet—a common recommendation when a food allergy or sensitivity is suspected—risk for developing ARFID is substantially increased,” Menzel says. What to do about food allergies and ARFID Knowing that food allergies may increase the chances of developing ARFID can empower you to be on the lookout for telltale signs and symptoms, whether it’s in yourself or your child. In addition to behavioral changes like food restriction or limitation, ARFID can also show up in physical symptoms, including significant weight loss, abdominal pain, constipation, and more. “The presentation of ARFID that food allergies are associated with is the one that is most likely to result in rapid, significant weight loss, which can lead to hospitalization,” Menzel says. “Therefore, it is extremely important to be on the alert for signs of ARFID development.” While food allergies may require lifelong monitoring and treatment, ARFID is an eating disorder that can be effectively treated with the support of a multidisciplinary team of experienced clinicians. “The good news is that ARFID in the context of food allergies is very treatable!” Menzel says. “If you’re concerned about ARFID and food allergies, speak to a mental health professional who specializes in anxiety or eating disorders for help.”]]></content:encoded>
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            <title><![CDATA[Can Eating Disorders Cause Infertility?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-infertility</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-infertility</guid>
            <pubDate>Mon, 09 Sep 2024 19:09:00 GMT</pubDate>
            <content:encoded><![CDATA[Last year, I wrote an article for Vogue that was potentially the most vulnerable thing I’d ever put out into the world. My husband and I were embarking on an in vitro fertilization (IVF) journey in order to—hopefully—freeze embryos. My doctor had suggested the proactive measure as a sort of insurance policy in case we wanted a second child. In retrospect, this all sounds a bit presumptuous because we hadn’t even had a first child. But because of my “advanced maternal age,” we were planning ahead—after all, we didn’t know what the future might hold for us given my history of an eating disorder and the repercussions from that. I lost my period in high school following significant anorexia-fueled weight loss. For many people, restoring weight in eating disorder recovery is enough to resume regular menstrual cycles and ovulation. For me, it wasn’t. The Vogue story was published before we discovered that the IVF was unsuccessful—we didn’t get any viable embryos from the process. This only escalated my fears around fertility and my guilt that I had caused all of this with my eating disorder. I’ve written it before and I’ll write it again here—both as a reminder to myself and an important point for everyone reading—eating disorders are not a choice, and neither is infertility. About 14 million people worldwide experience an eating disorder each year, and 1 in 6 worldwide experience infertility. But those facts didn’t necessarily make me feel less alone, or stop me from worrying about whether my own eating disorder had cost us our potential future as a family. Writing this now, it’s surreal to admit that I’m currently eight months pregnant and expecting a baby girl next month. Getting here wasn’t easy and it certainly wasn’t without stress, tears, and serious recommitment to all the strategies and principles I learned in recovery. And even writing these facts out is somewhat uncomfortable because I know that luck was also on my side—not every person who struggles with infertility will get to this point. But what’s essential to know is that while a past or current eating disorder diagnosis can pose fertility challenges, it doesn’t need to dictate whether or not you can get pregnant. Here’s everything I wish I’d known about the relationship between eating disorders and fertility, and what to do if you’re concerned that an eating disorder is standing in the way of you becoming a parent. Why can eating disorders negatively impact fertility? According to one study on the long-term effects of eating disorders on fertility and pregnancy, 21% of women with anorexia and 20% of those with anorexia and bulimia had been seen by a physician for lifetime fertility problems, compared to just 11% of the general population. Women with eating disorders were also more likely to have received medical assistance in becoming pregnant and had lower rates of intentional pregnancies. In a recent survey conducted by Equip, we found that 45% of women with a history of an eating disorder or disordered eating struggled with infertility. But why this connection? “At the very root, eating disorders cause hormonal imbalances that negatively impact menstruation and ovulation—both of which are required to conceive,” says Equip physician assistant Alicia Karagianes, MHS, PA-C. According to reproductive endocrinologist Dr. Aimee Eyvazzadeh, MD, MPH, eating disorders can significantly impact fertility through several mechanisms: Menstruation and ovulation disruption: “Low body weight, malnutrition, or excessive exercise can lead to hypothalamic amenorrhea, where menstruation stops due to hormonal imbalances,” Eyvazzadeh says. Nutritional deficiencies: “Deficiencies in essential nutrients such as iron, folic acid, and vitamin D can affect ovulation and implantation,” Eyvazzadeh says. In addition, Karagianes adds that eating disorders can also deplete vitamin B, zinc, copper, selenium, and calcium, which are all necessary for healthy pregnancies. Hormonal imbalances: “Conditions like polycystic ovary syndrome (PCOS), which is common in patients with binge eating disorder (BED), can further complicate fertility,” Eyvazzadeh says. That eating disorders would decrease fertility also makes sense from an evolutionary perspective. In many cases, eating disorders can disrupt or halt the systems necessary to conceive because the conditions for conception aren’t adequate or safe. In other words, eating disorders force our bodies into survival mode, and reproduction just isn’t an essential function for survival, so it’s pushed to the back burner. In its infinite complexity and wisdom, your body not only prioritizes its own survival, but is also aware of the safety of any potential offspring. If you’re not adequately nourishing your body, it receives the message that there’s not enough food to go around, and it wouldn’t be wise to bring a baby into a famine. Similarly, the anxiety and dysregulation that often goes hand-in-hand with eating disorders can signal to your body that your environment is not safe, and thus not a good place to introduce a brand new life. Indeed, research shows that stress and anxiety can impair fertility, and that fertility rates drop during times of famine. It’s also worthwhile to call out the psychological component: many people struggling with eating disorders may be—consciously or subconsciously—scared of the body and lifestyle changes that pregnancy will require, and delay trying to conceive because of those fears. In the survey we conducted, we found that in 10 women delayed trying to conceive due to disordered eating habits, such as intermittent fasting, eating in a calorie deficit, or skipping meals Do certain eating disorders impact fertility more than others? So it’s clear that eating disorders have an effect on the body’s ability to become pregnant, but do the specific eating disorder behaviors matter? Are some diagnoses worse than others? In general, no—but there are some nuances. “Overall, eating disorders can impact hormone production and therefore fertility,” Karagianes says. “Though this is done through various mechanisms depending on the specific eating disorder type, the extent of impaired hormone production has more to do with the severity of the eating disorder and less to do with the specific type of eating disorder.” There are, however, some slight differences in just how different eating disorders impact fertility. “Anorexia primarily impacts fertility through significant weight loss and malnutrition, leading to amenorrhea and anovulation,” Eyvazzadeh says. “While patients with bulimia may maintain a ‘normal’ weight, repeated purging can lead to electrolyte imbalances and hormonal disruptions that affect ovulation.” Eyvazzadeh also adds that BED’s association with PCOS and other hormonal conditions can reduce fertility, and those with avoidant/restrictive food intake disorder (ARFID) may also experience nutritional deficiencies that affect overall reproductive health. When talking about the effect that eating disorders can have on fertility, Karagianes divides them into “low energy intake” disorders and disorders not associated with low energy intake. Low energy intake (i.e., not eating enough) is the primary cause of low energy availability (LEA), a state when the body doesn’t have enough calories to support all of its functions. “In low energy intake eating disorders, your body is in a state of malnutrition,” Karagianes says. “This causes the body to begin to shut down systems in an attempt to save energy expenditure and make sure vital organs, like your heart and lungs, continue to run. During this process, the reproductive system and hormone production from the brain is often turned down or off, causing lack of menstrual cycles and inhibiting ovulation.” But even when the body is not deprived of essential energy, eating disorders can still have a significant impact on fertility. “Eating disorders that aren’t associated with a low energy intake state can still create a state of stress, impacting the brain’s hormone production,” Karagianes says. “This is often seen in irregular menstrual cycles and lack of ovulation.”  Is it possible to become pregnant if you've had an eating disorder? While every single person and situation is different, it’s important to know that women who’ve had eating disorders can, in fact, become pregnant. In my case, because I’d been missing my period and not ovulating since high school, I knew I would require some kind of medical intervention whenever I was ready to try to conceive. And, luckily, the medications my doctor prescribed were actually effective. While that may not be the case for every single person who experiences an eating disorder, it’s a myth that all women who have experienced these illnesses will never be able to conceive. “The majority of people fully recovered from an eating disorder will not face infertility as a result of their eating disorder,” Karagianes says. “Ideally, patients will have sought eating disorder treatment, be in recovery, maintain weight restoration and thus have their regular ovulation and menstrual cycles reinstated.” Even with an infertility diagnosis—which is defined as failure to achieve pregnancy after 12 months of trying to conceive—there are options. “Typically, an initial medical workup will be done, which varies based on individuals,” Karagianes says. That initial workup generally involves a number of different tests and labs to get to the root of the problem, and then identifying next steps based on the results. Those next steps might be medications, intrauterine insemination, or IVF, among other interventions. Eyvazzadeh agrees that it is possible to become pregnant after having an eating disorder, but points out that those in recovery may require specific interventions to ensure a healthy pregnancy, including: Nutritional rehabilitation and counseling: Working with a registered dietitian trained in eating disorders may be necessary to help achieve a healthy weight and nutritional status before becoming pregnant. Psychological support. Ongoing therapy can be critical to address any residual or persistent body image issues or disordered eating behaviors. What to do if you’re struggling with infertility and an eating disorder (past or present) Both infertility and eating disorders can be incredibly sensitive issues to discuss with others, but being open and honest with loved ones and medical professionals can pave the way for permanent recovery. “Seeking help for an eating disorder is a critical first step when struggling with infertility,” Karagianes says. “There are such unique stressors that exist when eating disorders and infertility intersect, causing an increased medical, emotional and psychological demand. Being in eating disorder treatment before or during fertility care can mitigate some of the potential complications from eating disorders that can so drastically impact infertility.” The type of treatment you or a loved one seeks out matters too. While I came across plenty of social media influencers who promised they could help women recover their lost periods and become pregnant in months, I only really moved the needle on my own recovery when I sought out a team of experts who deeply understood the nuances of eating disorders and their impact on fertility. “If someone is struggling with an eating disorder and infertility, it's essential to seek support from a multidisciplinary team that includes a reproductive endocrinologist, a dietitian with expertise in eating disorders, and a mental health professional,” Eyvazzadeh says. “This team can provide a comprehensive approach to both fertility treatment and eating disorder recovery, ensuring the best possible outcomes for both mother and baby. Encouraging open communication and seeking early intervention can help manage both conditions effectively.” There are so many individual differences when it comes to eating disorder recovery and infertility, but it’s important to know that there is hope for those who have experienced an eating disorder and wish to become parents one day. My personal journey hasn’t been easy or predictable, but committing to recovery opened up a world of possibilities that may not have been available otherwise—including the chance to meet my daughter next month. If you or a loved one are facing fertility challenges and think a past or current eating disorder might be contributing, don’t wait to get the help you need to build the family you want.]]></content:encoded>
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            <title><![CDATA[Recovery in a World of Diet Culture]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/recovery-in-a-world-of-diet-culture-kristina-saffran</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/recovery-in-a-world-of-diet-culture-kristina-saffran</guid>
            <pubDate>Thu, 30 May 2024 20:01:00 GMT</pubDate>
            <content:encoded><![CDATA[The eating disorder field has long debated the definition of “recovery.” It was once believed that you could never fully recover from an eating disorder: while behaviors might abate or even go away completely, those of us who’d been afflicted would always have to suffer with the monster in our heads. We were doomed to fight a lifelong battle to keep the disease at bay. That’s why when I finally achieved recovery —eating freely and flexibly, making peace with my healthy body, and finally having brain space for more interesting things than food and weight—I wanted to shout it from the rooftops: full recovery is possible, and it’s worth it! Period. As I founded Project HEAL and then Equip to ensure that everyone had access to the full recovery that I had found, I was humbled by the large and diverse community of eating disorder sufferers that joined, people of all ages, races, genders, classes & body shapes and sizes. Many told me that the message I’d thought was so inspiring — that everyone can achieve “full recovery, period.” — actually felt alienating to them. It was confusing to me at first, but as I spoke with more people whose recovery journey had been different from my own, it began to make sense. I started to understand why many were more comfortable with the phrase “in a strong and active recovery.” The phrase “full recovery” can imply a sense of ease, complete freedom from the worries about body and food that define an eating disorder, and achieving this state is challenging in a world filled with diet culture myths. We know that eating disorders have strong neurobiological underpinnings and that what turns an eating disorder on in the brain is insufficient calories. As strong as one’s recovery may be, eating less than your body needs can set off a strong biological cascade that plunges you into the world of the eating disorder, and that’s difficult to pull out of. In fact, weighing even five to ten pounds less than your body naturally wants to weigh significantly increases anxiety and depression. Weighing more makes it easier to counteract the neurobiological wiring some people have that sets them up to develop eating disorders. And yet, weighing more is really hard in a society where diet culture is thrown at you every single day. Never skipping a workout, cutting out entire food groups, intermittent fasting, and dangerously low-calorie diets are totally normalized and even prescribed (including the much-discussed GLP-1 medications). And we’re continually given the message that only certain bodies have value and that we should all be striving to achieve those—smaller—bodies. Weighing more is really hard in a culture that idealizes thinness and loathes fatness. When I expressed worry about weight gain in treatment, well-meaning providers and family members assured me that they’d “never let me get fat.” When I recovered, the message was clear: gain weight but not too much weight. Looking back, I wish that my high school treatment team had stressed that weight gain over the next decade of my life wasn’t just normal but critical to maintaining a strong recovery. Diet culture—this idealization of thinness and everything it takes to achieve it—and fatphobia–stigma, bias, and discrimination against folks who are in large bodies–are rampant in our culture, making recovering from an eating disorder hard. It’s hard for me in a smaller body that society accepts, and even harder for the five million Americans who struggle with an eating disorder today, most of whom are in average or higher-weight bodies and don’t get access to treatment because of it. The societal idealization of thinness and everything it takes to achieve it has significantly impacted how many people are diagnosed with an eating disorder, especially those in high-weight bodies, as disordered behaviors have been both normalized and encouraged. It is no wonder that 40-60% of elementary school girls are afraid of becoming fat, and hospital admissions for eating disorders have skyrocketed. It makes sense that people identify with a living recovery that is “strong” and “active” because, in order to protect it, they need to constantly push back against a culture that might enable—or even encourage—harmful behaviors. But if we can begin challenging and divesting from diet culture, we can build a culture founded on healing, joy, community, and peace. This Mental Health Awareness Month, I encourage you to examine your own views about weight and health. Read about Health at Every Size, Intuitive Eating, and the Fat Acceptance Movement. Familiarize yourself with content creators challenging the status quo, like Sharon Maxwell (@heysharonmaxwell), Virgie Tovar (@virgietovar), Corissa Enneking (@fatgirlflow), Jessamyn Stanley (@mynameisjessamyn), and Dr. Rachel Millner (@drrachelmillner). Notice where you may be holding judgments around food and bodies. Begin challenging those thoughts and invite others to join alongside you. In doing so, you might also heal yourself.]]></content:encoded>
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            <title><![CDATA[The Link Between Social Media and Eating Disorders: What Parents Should Know]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/eating-disorders-and-social-media</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/eating-disorders-and-social-media</guid>
            <pubDate>Thu, 18 Dec 2025 17:13:00 GMT</pubDate>
            <content:encoded><![CDATA[The connection between social media and eating disorders can feel scary for any parent. You see your child scrolling, hear about trends like “thinspo” or “what I eat in a day,” and start to wonder: Is this just normal teen behavior, or something that could hurt them? “Social media increases the risk for eating disorders because it turns comparison into a constant, 24/7 passive activity,” says Adriana Lindenfeld, MA, EdM, a therapist at Equip. “Teens are exposed to filtered bodies, curated diets, and extreme fitness routines that are presented as ‘normal,’ and the brain begins to interpret those repeated images as truth.” In this guide, we’ll walk through how social media influences body image and eating, which kids are most vulnerable, early warning signs to watch for, and what you can do right now to help your child navigate the online world more safely and confidently. How are social media and eating disorders linked? Research consistently shows a clear connection between eating disorders and social media, especially for kids and teens. Studies have found that higher time spent on platforms like Instagram, TikTok, and YouTube is linked to increased body dissatisfaction, dieting behavior, appearance comparison, and symptoms of eating disorders. This doesn’t mean social media causes eating disorders on its own. But it can significantly increase risk for children who already have underlying vulnerabilities—which, during adolescence, includes a lot of kids. The teen brain is especially sensitive to social feedback, comparison, and belonging, according to Michael Wetter, PsyD, ABPP, FAACP, a clinical psychologist who specializes in eating disorders. At the same time, many kids are still learning how to spot edited images, sponsored posts, or unhealthy “wellness” content. When likes, comments, and views become a kind of social currency, teens can start tying their self-worth to how they look on and offline, he says. Weight stigma and diet culture amplify this pressure. Social media is filled with messages linking thinness to health, discipline, success, or morality, says Wetter. Over time, these subtle cues can quietly shape how kids think about their bodies and eating. “What a child sees is not simply ‘someone looking good in a photo,’ but an implicit message about what is normal, expected, and valued within their peer group and the broader culture,” says Wetter. When those messages center on narrow, edited beauty standards, it becomes harder for teens to develop a realistic, positive,, compassionate body image. Why social media can increase eating disorder risk Certain features of social platforms interact with the developing teen brain in ways that can quietly increase vulnerability to eating disorders. These risks often build gradually, through everyday scrolling rather than through obviously harmful content. “What begins as mild curiosity can become a highly reinforcing digital loop where the platform continuously provides material that shapes the child’s beliefs about their body, their value, and what they must do to be accepted,” explains Wetter. Here are some of the most important mechanisms behind that process. Comparison loops Social media invites constant comparison, often right at the moment when teens’ bodies are already changing quickly and unevenly because of puberty. As some peers develop earlier or later than others, those natural differences can feel magnified online. Teens see carefully chosen photos and videos of peers, influencers, athletes, and celebrities—almost all filtered, posed, or edited to present a highly unrealistic version of what bodies “should” look like, says Wetter. “Young people begin to believe that their natural appearance is abnormal or inferior, even though the images they are comparing themselves to are digitally altered,” he explains. “This comparison can become automatic, leading to chronic dissatisfaction with one’s body, withdrawal from social activities, avoidance of situations involving food, and an escalating internal narrative of shame.” Filters, editing tools, and AI-generated bodies Today’s filters and editing tools—now powered by increasingly advanced AI—can dramatically change faces and bodies with the tap of a finger. Waistlines shrink, muscles sharpen, skin smooths, and proportions shift toward narrow “ideal” standards that don’t reflect real bodies. When kids are repeatedly exposed to these altered images, their sense of what bodies normally look like gets distorted, says Wetter. This makes it easier for young people (both children and teens) to believe they should look different than they do, even when their bodies are healthy and developing exactly as expected. That gap between “real me” and “online bodies” fuels frustration, shame, and body dissatisfaction. Algorithm amplification One of the most concerning aspects of social media is how quickly algorithms intensify content exposure, often without a teen realizing it’s happening. Platforms are designed to feed users more of whatever keeps them engaged, so one harmless click can rapidly shift a teen’s feed toward more extreme or appearance-focused material. Research suggests this is especially true on Instagram and Snapchat.  For example, a teen might start by watching a video about a “healthy recipe.” Soon their feed fills with more recipe content, which gradually shifts toward low-calorie or weight-loss meals, fasting tips, and body transformation posts. Over time, this can lead to exposure to thinspo, pro-ED messaging, or videos comparing body shapes, even though the teen never searched for this content intentionally. “Algorithms don’t just show content but funnel users into narrower tunnels,” says Lindenfeld. “One innocent click on ‘healthy recipes’ can quickly spiral into weight-loss hacks, extreme dieting, and even pro-ED messaging.” That can be the spark that triggers restrictive eating, calorie fixation, bingeing, purging, or compulsive exercise, adds Wetter. Hidden or coded pro-eating disorder content Some online communities that promote eating disorder behaviors actively evade detection. Hashtags shift constantly, wellness-coded language replaces direct mentions of restriction, and accounts frame disordered behaviors as discipline, “clean eating,” or self-improvement. Because this content doesn’t always look obviously harmful, teens—and even parents—may not realize they’re being exposed to messaging that encourages starvation, purging, or compulsive exercise. What appears on the surface as motivational or healthy can quietly reinforce eating disorder thinking underneath. Diet, fitness, and “healthy lifestyle” trends Many popular trends feel harmless—some are even genuinely well-meaning—but still pose risk for vulnerable teens. According to the experts, common trends include: “What I Eat In a Day” videos (WIEIAD) that document every meal Intermittent fasting challenges Aesthetic body transformation videos Workout content taught Fitspo and thinspo (fitspiration and thinspiration) content also focus heavily on achieving certain body shapes rather than supporting overall well-being, reinforcing the idea that appearance is the ultimate marker of success or worth. “Teens can internalize these ideas quickly, adopting patterns that look like clean eating, fitness motivation, or lifestyle optimization but are actually early manifestations of eating disorders,” says Wetter.  Who’s most at risk? Any child can be affected by social media pressure. But some kids are more vulnerable than others due to developmental stage, personality traits, or life experiences. Lindenfeld and Wetter recommend staying attentive to changes in eating, body image, or emotional well-being for the following groups: Teens and preteens: Adolescence is the most common time for eating disorders to emerge. Rapid physical changes, a need for peer approval, and constant exposure to appearance-focused content can shape body image. Girls: Girls are diagnosed with eating disorders more often than boys, in part due to stronger cultural pressure to be thin and appearance-focused content on social media. Boys may also be more likely to go undiagnosed due to stigma. Perfectionistic or high-achieving kids: Kids who hold themselves to very high standards may be more vulnerable to messages that frame food restriction or extreme exercise as discipline, control, or self-improvement. Diet culture ideals can blend easily with perfectionistic thinking. LGBTQIA+ youth: LGBTQIA+ teens have higher rates of body dissatisfaction and eating disorder symptoms, often due to stress, identity pressures, or feeling unsafe expressing themselves offline. While social media can provide community, it can also amplify appearance comparison. Neurodiverse youth: Autistic and ADHD youth may be more prone to rigid routines, hyperfixation, or repetitive content loops, especially when combined with sensory sensitivities or anxiety around food. Athletes and dancers: Performance cultures that emphasize appearance, leanness, or weight loss in teens can normalize restrictive eating or compulsive training. Social media adds constant visual comparison to already high-pressure environments. Kids experiencing major transitions: Children navigating puberty, school changes, or family stress may turn to social media for comfort, control, or validation. During these vulnerable periods, appearance pressure and diet culture content can have an even stronger impact. What are early warning signs parents should watch for? Eating disorders are often hidden illnesses. Many kids and teens work hard to conceal their behaviors—they may sneakily skip meals, exercise in private, or change their eating habits away from home. You may not see obvious red flags at first, and that doesn’t mean you’re missing something or doing anything wrong. The most important tool you have is your intuition. If something about your child’s relationship with food, movement, or their body feels off, it’s worth paying attention even if you can’t point to a single dramatic change. Subtle shifts that persist over time are often more telling than one big sign. Here are some common early warning patterns to watch for. Behavioral signs Keep an eye out for changes in daily habits or routines that weren’t there before. According to Lindenfeld, that can look like: Skipping meals or suddenly avoiding family meals Cutting out entire food groups without a medical reason Creating rigid food “rules” (only eating certain foods or at specific times) Obsessively reading nutrition labels or tracking calories Exercising excessively, secretly, or feeling intense guilt for missing workouts Frequently watching diet, fitness, or WIEIAD content Frequent body checking (constant mirror checking or body pinching) Visiting the bathroom immediately after meals Emotional signs These are changes in mood or thought patterns related to food or body image, including: Increased anxiety or irritability around meals or food events Strong fear of weight gain or intense dissatisfaction with their body Talking negatively about their appearance Perfectionistic self-criticism or all-or-nothing thinking Withdrawn mood, low energy, or increased secrecy Social signs These show up in how your child interacts with others. For instance: Pulling away from friends or family Avoiding social situations centered around food Skipping parties, practices, or outings they once enjoyed Increased isolation or time alone in their room or on social media If you’re noticing several of these patterns and aren’t sure what they mean, taking Equip’s free eating disorder screener can be a helpful way to gauge next steps and options for support. Can social media be a positive or supportive space, too? Social media isn’t all harmful. For many kids and teens, it can also offer creativity, community, education, and connection—especially those who feel isolated or misunderstood in their offline lives. “Following body-neutral or recovery-oriented creators, accounts that promote diverse body types, and evidence-based mental health content can counter the pressure of idealized images,” says Lindenfeld. “A curated feed can help replace harmful messages with compassion, realism, and connection.” Social platforms can be particularly meaningful for LGBTQIA+ and neurodivergent youth. Online communities often provide safe spaces to explore identity, find validation, and connect with peers when in-person support feels limited or unavailable. That sense of belonging can reduce loneliness, one of the emotional drivers frequently tied to disordered eating. How parents can keep their kids safe on social media You don’t have to become a tech expert or monitor every scroll to help protect your child online. What matters most is building trust, staying involved, and creating an environment where your child feels safe talking about what they’re seeing and feeling. Here are evidence-informed ways to help keep kids safer while they navigate social media: Build media literacy together Lindenfeld recommends guiding—not restricting—your child’s digital world. Talk openly about how social media works, scroll their feed together, and ask gentle, curious questions, such as: “Do you think that image might be edited or filtered?” “What do you think the goal of this post is?” “How does watching this make you feel about yourself?” When kids learn to pause and reflect on what they’re seeing, it gives them space to decide what values they want to absorb instead of letting algorithms choose for them. Curate their feeds intentionally Going through feeds together can be surprisingly powerful. Encourage teens to unfollow or mute accounts that promote extreme dieting, body shaming, or comparison and replace them with creators who celebrate body diversity, recovery, creativity, and real-life interests unrelated to appearance. Remind your child that algorithms follow engagement. What they watch, like, and linger on shapes what they see next, so choosing healthier content can slowly change the tone of their feed. Use parental controls and other tools that reduce exposure Most platforms offer tools that can limit certain topics, block harmful keywords or hashtags, set daily screen time boundaries, and monitor who kids interact with. While these tools aren’t perfect, they can offer important guardrails—particularly for younger children—and reduce exposure to explicit pro-eating disorder content on social media. Reduce overall screen time Less scrolling means less exposure to appearance-focused messaging. Set tech-free zones or times in your household (like during meals, family activities, or before bed) to create natural breaks from constant online input. Encourage offline interests that build identity and joy outside of screens, such as art, sports, volunteering, music, or simply spending time with friends in person. Create a supportive home environment What kids hear at home matters. Avoid diet talk, weight commentary, or labeling foods as “good” or “bad.” Model balanced eating and positive body respect, including toward your own body, says Lindenfeld. Check in regularly with curiosity, not criticism Your tone is as important as your message. Instead of confrontational questions like “Why are you watching that?” try gentle check-ins: “What kind of stuff has been showing up on your feed lately?” “Is anything online making you feel stressed or weird?” “Do you ever compare yourself to what you see?” The goal isn’t to open up a conversation. When kids feel safe being honest, they’re far more likely to share concerns before those concerns deepen into harmful patterns.  When and how to seek support It’s easy to worry about overreacting, but you don’t need to wait for a crisis to ask for help. If concerns about social media start to overlap with ongoing changes in eating, weight, mood, or daily functioning, it’s time to consider professional support. According to Lindenfeld, it’s time to reach out if you notice: Food restriction, bingeing, purging, or compulsive exercise Rapid or unexplained weight changes Intense fear of eating or weight gain Increasing secrecy, social withdrawal, or mood changes Growing fixation on body image or diet content online Missed periods Fainting or dizziness Early support is linked to better outcomes, and getting help sooner can prevent symptoms from worsening. Look for providers or programs that specialize in treating eating disorders in kids and teens and use a team approach (including medical, therapy, and nutritional care). When reaching out, you can ask: Do you specialize in adolescent eating disorders? How involved are families in treatment? How do you coordinate care across specialties? Most importantly: You are not alone, and this is not your fault. Eating disorders are complex medical conditions, not parenting failures. Getting support is a powerful step toward recovery. Not sure where to start? Equip offers a free eating disorder screener to help guide next steps and admissions specialists who can talk through options with your family. The bottom line Social media can powerfully influence how kids see their bodies and their worth, but parents are far from powerless. Understanding how online content shapes comparison, recognizing early warning signs, and having open, compassionate conversations can make a real difference. Eating disorders are serious, but they are also highly treatable, and recovery is possible with the right support. If something doesn’t feel quite right with your child, trusting your instincts and seeking help sooner rather than later can protect their health and set them on a path toward healing. FAQ How is social media affecting eating disorders? Social media increases eating disorder risk by fueling constant body comparison, normalizing diet culture trends, and exposing kids to restrictive or appearance-focused content. Algorithms often intensify this exposure by serving progressively more extreme posts related to weight loss or food control, even when they don’t seek it out. Does social media cause eating disorders? Social media doesn’t cause eating disorders on its own. Eating disorders develop from a mix of genetic, emotional, and environmental factors. However, social media can significantly increase risk by amplifying appearance pressure, diet messaging, and comparison that can trigger or worsen symptoms. What role does media play in the development of eating disorders? Media helps shape body image by promoting narrow beauty standards and linking thinness to worth or success. On social platforms, algorithms magnify these messages, making harmful content more common and harder to avoid. While media isn’t the sole cause, it contributes to an environment that raises eating disorder risk.]]></content:encoded>
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            <title><![CDATA[Is Outpatient Eating Disorder Treatment Right for You? Understanding Different Levels of Care]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/outpatient-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/outpatient-eating-disorder-treatment</guid>
            <pubDate>Thu, 04 May 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[When you’re searching for eating disorder treatment, the options can feel overwhelming—just the acronyms alone (IOP, PHP, FBT?) are dizzying. Often, the first decision you need to make is whether to choose inpatient or outpatient eating disorder treatment. In most cases, outpatient is the right choice, but what exactly does that entail? In this in-depth guide to outpatient eating disorder treatment, we take a closer look. Levels of care in eating disorder treatment: a quick primer Before we dive into outpatient eating disorder treatment, it’s important to zoom out and look at the whole spectrum of treatment choices. We’ll mention them briefly here, but for a more complete look, check out our guide to the different levels of care for eating disorders. From least to most intensive levels of care, these are generally the choices you have for eating disorder treatment: Low-touch outpatient care: Sometimes referred to as routine outpatient treatment or just outpatient treatment, this approach involves meeting with one or more practitioners on a weekly basis, usually for an hour each. That might mean seeing a dietitian, therapist, and medical provider, for a total of three hours of care per week. Intensive outpatient program (IOP): An IOP combines individual work with group treatment in a structured program. It meets anywhere from two to five times a week, usually for about two to three hours each time. Since many IOPs meet in the evenings or mornings, patients can often attend without disrupting school or work. Partial hospitalization program (PHP): A PHP is another structured program that combines group and individual work. It usually occurs in a hospital setting, and generally meets five days a week for at least six hours a day, meaning that patients will eat the majority of their meals and snacks at the treatment center. Though patients spend evenings and weekends at home, it’s generally not possible for them to continue participating in school or work at this level of care. Residential treatment: With residential treatment, patients receive 24-hour care at a live-in facility (not a hospital). They receive both individual and group treatment in a structured program, eat and sleep at the facility, and are supervised around the clock. Inpatient treatment: The most intensive level of care, inpatient treatment is 24-hour care at a hospital. The primary focus of inpatient treatment is medical stabilization, and stays are typically relatively short (three weeks or less). Inpatient treatment is often necessary for people experiencing some of the most dangerous health effects of eating disorders, like electrolyte imbalances. Equip is redefining the traditional treatment landscape, which provides a fragmented experience through each level of care and pulls patients out of their community and away from their support system. Instead, we provide individualized treatment with a dedicated, multidisciplinary provider team that supports patients through different acuity levels and into lasting recovery. 
Our providers are experienced and successful in treating highly acute patients who would otherwise need to seek residential treatment, a partial hospitalization program (PHP), or intensive outpatient program (IOP), as well as low or medium acuity patients looking for outpatient alternatives. Instead of "stepping down" between care levels, patients are able to stay with the same care team as their treatment evolves.  What counts as outpatient eating disorder treatment? Though people may say “outpatient treatment” when referring to low-touch outpatient care, outpatient eating disorder treatment technically encompasses any kind of treatment in which the patient lives and sleeps at home. That means it includes routine outpatient care, IOP, PHP, and anything in between. It also includes virtual treatment, which can take a number of different forms across IOP, PHP, and individual treatment settings. While Equip is "outpatient" in the sense that patients live and sleep at home, it breaks the mold of traditional outpatient programs, treating high acuity patients who might otherwise seek inpatient environments.  With all forms of outpatient treatment, patients get more autonomy and independence and—depending on the level of care—can often continue to participate in their everyday life. One outpatient approach that’s somewhat distinct from the others is family-based treatment (FBT). With FBT, the gold standard for treating eating disorders in young people, families are tasked with helping their loved one recover from their eating disorder with the support of an outpatient treatment team. This means family members plate and supervise meals, monitor and prevent eating disorder behaviors, and set any other boundaries recommended by the treatment team. FBT, by definition, brings in the family and occurs in real-life settings, so it’s always an outpatient treatment. Because of the wide range of treatment levels under the outpatient umbrella, outpatient eating disorder treatment will look different depending on which approach or program you choose: It might mean simply seeing a dietitian on Tuesdays and a therapist on Fridays, or it might mean attending a PHP from 7 a.m. to 4 p.m. every weekday. At Equip, treatment is highly individualized based on patient needs, and generally begins with frequent (virtual) appointments, which might require adjusting regular activities temporarily. But as treatment progresses, sessions usually decrease in frequency, allowing for a full return to normal life while continuing the recovery process. Does outpatient eating disorder treatment work? “Research shows that all types of eating disorder treatment can be effective,” says Jessie Menzel, Equip’s VP of Program Development. “What does differ is how far these programs can get you in recovery. More intensive, inpatient treatments usually can’t take you all the way to the finish line—they’re shorter-term treatments—whereas once a week outpatient treatment can take you from the beginning all the way to the end of your eating disorder.” Research shows that outpatient treatment leads to good outcomes for many patients, and is usually the best format for early intervention, even in acute cases. In one study comparing inpatient and outpatient eating disorder treatment for patients with anorexia, researchers found that those in outpatient treatment had better adherence and were twice as likely to express positive views of their care. Parents were also much more satisfied with outpatient treatment. According to the American Academy of Pediatrics, FBT—which is always an outpatient treatment—is the most effective treatment for children and teens with eating disorders. Time and again, research has found not only that FBT works, but is also cost-effective and decreases the need for hospitalization. Equip’s own research has also found that FBT works just as well when delivered virtually. Inpatient care is more disruptive, more expensive, and generally has longer waitlists than outpatient eating disorder treatment. Despite the fact that many practitioners continue to turn to inpatient treatment as the default for adolescents with eating disorders, it’s neither more successful nor more cost-effective than outpatient treatment. (Here's a guide for understanding insurance for eating disorder treatment.)  How can I determine whether outpatient treatment is right for me or my loved one? “Outpatient treatment should almost always be a first-line treatment for eating disorders. It causes the least amount of disruption to your life and can be just as effective as more intensive forms of treatment,” says Menzel. “Outpatient treatment keeps you connected to things in life that are meaningful—like friendships, hobbies, activities, school, jobs, and family—and those connections can help keep you motivated in treatment.” Menzel also recommends outpatient eating disorder treatment to those who have tried more intensive treatments in the past but have always relapsed afterward. “Recovering in outpatient treatment can be more challenging in some ways, but it gives you the chance to deal with the things in your life that trigger your eating disorder head-on,” she says. However, outpatient eating disorder treatment isn’t right for everyone. In order for outpatient treatment to be a safe choice, patients must be medically stable, so it’s important to be medically cleared before beginning any sort of outpatient program. “If you or your child are experiencing serious or urgent medical complications from your eating disorder, you need a higher level of care,” says Menzel. “Eating disorders aren’t something to mess around with—they have the second highest mortality rate of any psychiatric disorder.” At Equip, all patients are medically cleared before beginning treatment. If they need medical stabilization, they are admitted to an inpatient program, and can then begin Equip treatment once they've been discharged. Outpatient eating disorder treatment has a lot of things going for it: it’s the least disruptive approach, it’s backed by research, most experts recommend it as the best place to start, and there are several different outpatient options to choose among. Outpatient treatment also buffers against relapse by treating the eating disorder in a patient’s everyday life: eating disorders happen in the real world, after all, so shouldn’t recovery as well? If you want to learn more about what Equip’s eating disorder treatment model looks like, we’re here to answer any questions you might have.]]></content:encoded>
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            <title><![CDATA[Inpatient Eating Disorder Treatment: When It's Needed, What to Expect, and What Happens After ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/inpatient-eating-disorder-treatment-what-to-expect</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/inpatient-eating-disorder-treatment-what-to-expect</guid>
            <pubDate>Fri, 22 Aug 2025 14:19:00 GMT</pubDate>
            <content:encoded><![CDATA[Admitting to a hospital for inpatient eating disorder treatment can feel scary and overwhelming. But it’s important to remember that a medical or psychiatric hospital stay may be necessary, and can be a crucial first step toward recovery. As a provider considering hospital admission for a patient (or if you’re concerned that you or a loved one need hospitalization), it’s important to understand not only eating disorder hospitalization criteria, but also the role of a hospital level of care in the recovery process. “A hospital stay may be needed as a vital first step to your recovery,” says Amy Rapaport, MD, Equip's Medical Director. “A hospital stay can ensure medical and psychiatric stability, improve a patient’s nutritional status, and jumpstart the recovery process." Inpatient eating disorder treatment can also help patients gain weight more quickly, which may be important: some studies indicate that significant weight gain in the first month of treatment leads to a greater chance of sustained recovery. If you're still hesitant to refer a patient (or loved one) to the hospital, read on. Learning about hospital treatment for eating disorders can help you better understand what it entails, how it can help patients, and what comes after to help support lasting recovery. What is inpatient eating disorder treatment? Inpatient eating disorder treatment refers to 24-hour care in a hospital setting, and is usually a relatively short-term step in the treatment process. The patient receives medical and psychiatric care, support, and supervision from a team to help them achieve medical and psychiatric stabilization. Inpatient hospital treatment is most often used when someone is experiencing serious medical complications due to their eating disorder (such as low heart rate or electrolyte imbalances), is at risk of self-harm, or has co-occurring conditions. Inpatient hospital treatment is the most intensive level of care on the continuum of eating disorder treatments. Therefore, it's typically acute, short-term care, lasting only until a patient is medically and psychiatrically stable to transition to a less intensive level of care. Other levels of care, from most to less intensive, include: Residential treatment: Patients in residential care are medically stable but continue to engage in eating disorder behaviors. Similar to inpatient hospital treatment, they are supervised and receive care 24 hours a day; however, they often live in a home-like facility rather than a hospital. While in residential treatment, they often receive psychiatric care, therapy, nutritional counseling, and other support to help them with long-term recovery. Partial hospitalization program (PHP): A PHP is a structured treatment program, however it's not 24 hours a day. Instead, patients participate five to seven days a week for anywhere from five to 10 hours a day, but sleep at home each night. This means they eat the majority of their meals and snacks at the treatment center. They also receive individual and group therapy as well as nutrition counseling to help them work on recovery skills and then practice them at home. Intensive outpatient program (IOP): Generally for patients who are ready to step down from more intensive levels of care but still need support reducing their eating disorder behaviors or thoughts, IOP programs meet about two to five days a week for about two to three hours at a time. The sessions may be held at hospitals or treatment centers, or virtually. In addition to individual and group therapy and nutrition counseling, IOP may include family therapy and supportive meals. IOPs often meet in the evenings or mornings, allowing patients the flexibility to attend work or school. Low-touch outpatient care: The least intensive level of eating disorder care, low-touch outpatient treatment involves meeting with individual providers, rather than providers who are part of a multidisciplinary program. The patient may meet with a therapist and potentially also a psychiatrist, dietitian, and other providers on a weekly basis, usually for an hour each. They may also see their medical provider on a regular basis. This support helps them stay on track for recovery and identify any red flags of a potential relapse early on. As an adaptable, virtual treatment provider, Equip is an appropriate level of care for all patients who are medically stable, and is an alternative to residential, PHP, IOP, and outpatient care. Our model is built to adapt to the intensity of care each patient needs, and titrates up or down depending on patients’ progress. Many Equip patients discharge to our treatment directly from inpatient hospital care, and 75% of our patient population are considered high acuity.  When should a patient be admitted to the hospital for inpatient treatment? Hospitalization is generally for patients who need medical and/or psychiatric stabilization. It may be that less intensive treatments haven't helped and a patient’s health has deteriorated, they're at risk of harming themselves or others, or they have a co-occurring condition that is causing significant complications. Whatever the case, inpatient hospital criteria for eating disorders is determined by a patient’s physical and psychiatric symptoms in addition to evaluating medical data. “Parents may be scared to have their child go into the hospital. They may not understand the urgency of close medical monitoring or the dangers of refeeding their malnourished child at home,” says Rapaport. This can be exacerbated by the fact that many people with eating disorders who appear to be functioning “fine” are actually extremely medically compromised. That's why it is important to look at blood work and other tests to determine if a patient should be admitted. Low blood pressure, low heart rate, and electrolyte abnormalities in the setting of significant weight loss and/or eating disorder behaviors can place a patient at high medical risk. “There are a lot of things parents can't see only by looking at their child. Rapaport explains. When to hospitalize for an eating disorder: key medical criteria Because of all of the factors described above, no single test can indicate that someone should be admitted for inpatient eating disorder treatment. Rather, when deciding when to hospitalize for an eating disorder, many providers consider a list of factors from the American Psychiatric Association Practice Guidelines and the Society for Adolescent Health and Medicine. These eating disorder hospitalization criteria include: Very low weight (<75% of the 50th percentile BMI for age and sex) Dehydration Electrolyte disturbance (low potassium, sodium, phosphorus) Physiological instability Severely low heart rate (<50 beats/minute daytime; <45 beats/minute sleeping) Abnormally low blood pressure Low body temperature (<95 degrees F, <35.6 degrees C) Orthostatic changes in pulse or heart rate Failure to thrive/arrested growth and development Uncontrollable bingeing and purging Medical complications of malnutrition (for example fainting, seizures, heart failure, kidney failure, liver failure, pancreatitis, etc.) Concurrent medical or psychiatric conditions that limit appropriate outpatient treatment (like type I diabetes, obsessive compulsive disorder, or a suicide attempt) Regardless of someone's weight, significant weight loss over a short period of time is a concern. “The refeeding process is a delicate one, and they need to be very closely monitored to avoid refeeding syndrome,” says Sam Cares, PhD, Supervising Psychologist for Rogers Behavioral Health. What happens during inpatient eating disorder treatment? Although every hospital’s treatment protocols are unique, the majority include the same basic components, all with the goal of medical and psychiatric stabilization to allow the patient to progress to a lower level of care. Treatments provided during inpatient care Regardless of a patient’s diagnosis or specific concerns, inpatient treatment plans tend to include the following. 1. Medical monitoring Weights, vitals, and blood work help physicians know if, for example, a patient's caloric intake should be adjusted or if their electrolyte levels are improving. This information helps shape a patient's recovery plan and also keeps an eye out for potential health complications like refeeding syndrome. “Even if you have regular levels of electrolytes and other nutrients on your blood tests upon admission, when your body is malnourished, your cells are not using those nutrients. And as soon as you start to refeed, the cells reactivate—they need these nutrients to metabolize the food they're getting now—and all those nutrients are pulled into the cell, and electrolyte levels in the bloodstream drop. That's what causes refeeding syndrome,” Rapaport explains. 2. Supervised meals Inpatient eating disorder programs provide three meals and often two to three snacks a day, all tailored to each patient's nutritional needs. In most cases, each patient eats with one person in the room supervising them. This is for a few reasons: Nurses or other support staff monitor their patients' intake. If necessary, patients may need supplemental drinks or a feeding tube to ensure they consume all the nutrients they need without raising the risk of refeeding syndrome. They help patients work through any distress and other mental and physical challenges that arise before, during, and after eating. They acknowledge their distress and are supportive but firm about the fact that the patient needs their meal, Rapaport says. Depending on the patient's symptoms, they may sit with them after the meal to ensure they don't purge and aren't exercising in their room. 3. Psychiatric and medical care When appropriate, a psychiatrist or other medical provider may prescribe medications to help treat mental health conditions, such as depression and anxiety, as well as other health conditions that can co-occur with eating disorders. Psychiatrists can also provide psychoeducation about the eating disorder. 4. Enrichment activities Some hospital programs may include additional therapies, such as support groups, art, or music. “A lot of times when someone struggles with a psychiatric diagnosis, they get away from the valuable, enjoyable activities of daily living. We want to help people reach back into that,” Cares says. This option is more common in hospitals with eating disorder programs, Rapaport notes. How long do patients stay in inpatient treatment? The length of inpatient care varies from patient to patient, depending on their current condition and medical history, Cares says. Some may only need two or three days to stabilize their vitals and be able to step down to a lower level of care. Others may need more intensive nutrition rehabilitation and stabilization, which may take up to two weeks or longer, Rapaport says. Can you have visitors during inpatient treatment? Yes. Most inpatient treatment programs not only allow for visitors, they encourage it. “The role of support people is paramount to eating disorders treatment,” Cares says. “Studies show the level of support someone has within and outside treatment is correlated to their ability to maintain any gains they make in treatment. For that reason, we have daily visitation time when family, friends, and loved ones can come to an adjacent unit and meet with patients. It helps people still live their lives even though they are very much removed from it at that time.” However, as a general rule, patients are not permitted to leave the hospital during their care. “The idea behind inpatient treatment is that someone so acutely sick, they need 24/7 monitoring. So they are there until they're discharged,” Cares explains. What happens after inpatient eating disorder treatment? Inpatient eating disorder treatment is usually fairly short-term and the first step in acute cases. Once a patient is medically and psychiatrically stabilized, less intensive treatment can begin. “Inpatient doesn't address the underlying issues that are maintaining the eating disorder,” Cares explains. “Other levels of care help address those, so the patient has a better chance of recovery.” Before a patient leaves the hospital, their inpatient treatment team will generally work with them or their caregivers to identify an appropriate treatment program for them to enter after discharge. “We look at things like how stable their weight, labs, and vitals are; what's ideal versus what's necessary; and their access to resources, including what their insurance will cover,” Cares says. “We also consider, do they need to continue working or go back to school?” Depending on all of this, the patient may step down to: A residential program PHP IOP A virtual program, such as Equip “We always recommend stepping down to one of these higher levels of care,” Cares says. “You very rarely go from inpatient to outpatient because too much of a drastic shift in support can lead to relapse. We aim to connect people with resources that are going to help them ease back into their life.” Equip can effectively treat patients who might otherwise seek residential or other higher levels of care after inpatient hospitalization. In fact, 30 percent of Equip patients were previously in higher levels of care, and 75 percent are high acuity (meaning they frequently engage in eating disorder behaviors). “Once you are medically stable and no longer at risk of refeeding syndrome, it is very important to continue the recovery process,” Rapaport says. This means continuing weight gain if needed, decreasing eating disorder behaviors, and addressing body image concerns.” A team including therapists, dietitians, and medical and psychiatric providers are needed during recovery, all of which are offered at Equip. Additionally, Equip offers many group sessions that patients can attend daily (or more than once a day), peer mentors, and virtual meal support. “At Equip, patients can bring their entire support system to treatment, allowing them to receive all of the individual and group treatments and medical monitoring available in residential treatment while remaining at home,” Rapaport adds. The Equip takeaway: the role of inpatient treatment in eating disorder recovery Inpatient eating disorder treatment is necessary when a patient requires medical and/or psychiatric stabilization—but it's just one step along the journey to recovery. Once stable, the patient can step down to a less-intensive level of care. It's essential to work with patients and their loved ones to determine what level of care is best, because lasting recovery requires a multidisciplinary, long-term treatment approach. If you’re concerned a loved one or patient may need inpatient treatment, schedule a call with Equip. We can guide you through next steps and help connect you with the appropriate resources.]]></content:encoded>
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            <title><![CDATA[What Is Anorexia Nervosa and How Is It Treated?]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-anorexia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-anorexia</guid>
            <pubDate>Fri, 29 Jul 2022 13:49:25 GMT</pubDate>
            <content:encoded><![CDATA[ Anorexia nervosa is a complex eating disorder that can be challenging for patients, loved ones, and even healthcare providers to understand. It's not a choice or a phase—it's a serious, brain-based mental illness that can significantly harm someone's physical and mental health, and be life-threatening. And, despite common misconceptions, anorexia nervosa affects people of all body sizes, genders, ages, and backgrounds. In general medicine, “anorexia" can also mean loss of appetite. This article covers the eating disorder anorexia nervosa, which is often referred to as simply “anorexia.” People with anorexia restrict their food intake and have an intense fear of weight gain and a distorted body image. Anorexia has two subtypes: restricting type, in which a person limits their food intake, and binge-purge type, in which a person not only restricts but also has episodes of binge eating and then purging through behaviors like vomiting or laxative use. Learning about what is anorexia—including the causes, symptoms, health consequences, and treatment—can help you recognize when you or a loved one may need support, and take the first steps toward recovery. What is anorexia nervosa? Anorexia nervosa is an eating disorder characterized by restricted food intake and an intense fear of weight gain. “Someone with anorexia is not getting enough nourishment, and that impacts their brain in a way that makes it hard to make good judgments around food and their body. It also impacts their ability to understand the severity of the illness,” says licensed clinical psychologist Andrea Seefeldt, PsyD, CEDS. The most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes three criteria for anorexia: Restriction of caloric intake to the point where the person isn't getting the nutrients their body needs and they lose weight Intense fear of weight gain, or behaviors that prevent weight gain Body image disturbance or lack of recognition of the seriousness of their symptoms Past editions of the DSM included amenorrhea—when someone stops getting their period for at least three months—as part of the criteria for anorexia nervosa. Per the DSM-5, a patient's menstrual status is no longer a factor to consider when diagnosing anorexia. Types of anorexia Although restricting what and how much someone eats is a key element of anorexia nervosa, people with this eating disorder may also engage in other behaviors and show other symptoms. When diagnosing patients, healthcare providers often identify one of the following subtypes of anorexia, depending on the dominant eating disorder symptoms someone is experiencing: Anorexia nervosa, restricting subtype (AN-R): The person restricts their food intake and does not engage in bingeing or purging. They may, however, exercise excessively. Anorexia nervosa, binge/purge subtype (AN-BP): In addition to restricting food, the person regularly binge eats (consuming a large amount of food in one sitting) and then purges (attempting to “get rid of the calories” with compensatory behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Atypical AN (AAN): “Atypical anorexia,” which actually falls under the OSFED diagnosis, is a somewhat misleading label for someone with all of the symptoms of anorexia except for low weight. “Really, it's the same disorder with the exception of occurring in people who may start out in larger bodies and lose a significant amount of weight but their weight isn't considered dangerously low,” explains Barbara Kessel, DO, CEDS, a psychiatrist at Equip. She explains that those with atypical anorexia face the same health risks due to their behaviors, such as malnutrition. There is a growing movement among eating disorder professionals to do away with the term “atypical anorexia” because it is so imprecise and misleading, and implies that AAN is less serious than other types of anorexia. Due to stigma and stereotypes, many healthcare providers fail to diagnose patients with AAN, who often don't enter treatment until later in their illness. Plus, so-called “atypical anorexia” is not atypical at all; in fact, most people with anorexia are not medically underweight. Note that not everyone with anorexia fits neatly into one category or another; many eating disorder diagnoses can overlap, and someone may experience different symptoms at different times. Causes and risk factors It's difficult (if not impossible) to identify a specific cause for any type of eating disorder in any one person. However, research tells us that anorexia is a complex, neurobiological mental illness with a strong genetic component, and is influenced by social, environmental, and cultural factors, as well as one's temperament. Here are some factors that place a person at a higher risk of developing anorexia: Having a parent or sibling with anorexia Experiencing teasing or bullying Perfectionistic tendencies Being more anxious or sensitive than most people Life stressors, such as moving, changing jobs, or losing a loved one Engaging in dieting or increased activity without properly refueling, which leads to an energy deficit (that is, they're burning more calories than they’re consuming) Dieting—or striving for “healthy eating,” “clean eating,” or a “lifestyle change”—can be particularly risky. “Because we have such a diet-focused and weight-obsessed world, a parent, friend, or loved one might think, 'My child is just dieting' or 'Look, they're trying to be healthy, it's a good thing,'” Seefeldt says. But limiting or eliminating food groups in the name of “health” can quickly lead someone to take in an insufficient amount of calories. Even a shift to a plant-based diet for environmental or animal welfare reasons can result in an energy deficit that ultimately triggers an eating disorder. While anorexia is so much more than a “diet gone wrong,” dieting—by any name—is a significant risk factor for developing an eating disorder. Intentional dietary changes aren't the only way someone can end up in an energy deficit. Illness, surgery, medication, or an increase in physical activity without sufficient refueling can all lead to someone unintentionally consuming insufficient calories. It’s important to note that decades ago, experts often blamed parents—especially mothers—when a child developed anorexia. Although we now know that families are not to blame, this harmful belief persists in our culture, and can sometimes prevent people from seeking treatment. Who does anorexia affect? Anorexia nervosa doesn't discriminate. It can affect people of all ages, genders, body sizes, socioeconomic status, and races. Research shows that eating disorders equally affect females of all ethnicities; however, non-whites may be half as likely to receive treatment as whites. This is due to a variety of factors, including the fact that minorities may face stigma and limited access to care. Although research suggests that women and girls are about 10 times more likely than men and boys to be diagnosed with anorexia nervosa, this number may not be accurate, as we don’t know how many males with anorexia go undiagnosed. Males with eating disorders face a double stigma—not only do they have a psychiatric disorder, they have a “female” disorder—and this can keep them from seeking treatment. Signs and symptoms Anorexia can be difficult to spot because the eating disorder usually doesn’t want to be seen. Many anorexia behaviors happen in secret, and the ones that happen publicly can sometimes go unnoticed, or even be perceived as being “healthy.” Rather than raise alarm bells, weight loss or showing “discipline” around food and exercise tend to garner praise. “Usually an eating disorder is going on for a while before anyone notices, and sometimes eating disorder behaviors are even praised,” Kessel says. “It may not be until weeks, months, or even years later that people realize that it’s problematic and has taken over the person's life and become more of a disorder than a healthy behavior.” Knowing the symptoms of anorexia outlined below can help you stay informed and alert to concerning signs in yourself or someone you care about. Overall, if someone is unable to fully participate in life because of fears around food or not being able to exercise, or they’re being too rigid about those things, it's a red flag, Kessel says. Food-related symptoms Contrary to myths, having anorexia doesn’t mean not eating at all; most people with anorexia eat. Their behaviors or attitude around food, however, may indicate they are struggling. Here are some common warning signs: Studying nutrition labels (without a medical reason) and counting calories Turning down foods or food groups they previously enjoyed Using the bathroom (including taking showers) right after meals in order to purge (e.g., vomiting, exercising, or using laxatives) Cooking or baking for others, but not eating the food themselves Dining alone, and avoiding eating with family or friends Avoiding going out to eat or social events with food Engaging in food rituals, such as cutting food into tiny pieces, smearing food on the plate, needing to eat foods in a certain order, or adding an unusual amount of mustard, pickles, or other low-calorie condiments Refusing to drink anything but water or non-caloric beverages Saying they already ate or making other excuses for not eating Physical signs Because anorexia can affect every organ system in the body, it often comes with physical and physiological symptoms, including: Weight loss, or lack of expected weight gain or height growth in children Feeling cold all the time, even in warm environments Frequent illness or injuries (such as stress fractures) Loss of a period in those who would normally be menstruating Hair loss or growth of fine hair on the body (called lanugo) Dizziness or fainting Constipation, abdominal pain, or other GI issues Exercise red flags Many people with anorexia develop a disordered relationship with activity. Below are some warning signs that a person’s exercise behaviors may be related to an underlying eating disorder: Working out in a compulsive or secretive way Rigidly quantifying and tracking physical activity, such as with a fitness app Feeling compelled to complete an exact amount of exercise each day Never taking a day off—even if sick or injured—and feeling guilty if not able to exercise Exercising in order to “earn” or “burn off” food Obsessively emulating fitness influencers on social media Concerns about appearance Someone with anorexia often suffers from an unhealthy preoccupation with their body size. Common signs of serious body image problems include: Having a distorted perception of their body size Wearing oversized clothing Avoiding social activities because of appearance worries Weighing themselves frequently Engaging in body-checking behaviors, such as pinching their flesh, checking their appearances in mirrors, trying on specific clothing items to assess the fit, or measuring body parts, such as wrists, thighs, or waist Changes in mood When someone is malnourished from anorexia, it usually affects their mood and relationships, leading to: Symptoms of new or increased anxiety, depression, or obsessive-compulsive disorder Irritability Withdrawing from friends and family Losing their “sparkle” Intense perfectionism Rigid black-and-white thinking Struggling to name or express emotions Difficulty concentrating How anorexia affects the body The physical symptoms of anorexia only hint at what's going on at a deeper level inside the body. The malnutrition caused by anorexia can lead to body-wide issues, triggering a cascade of both short- and long-term health consequences. Cardiovascular effects: Inadequate nourishment can result in bradycardia (a slow heartbeat), hypotension (low blood pressure), and decreased heart rate variability (HRV, or a variation in the time between heartbeats). All of this increases the risk of sudden cardiac death. Endocrine effects: In women, underfueling your body can lead to functional hypothalamic amenorrhea (FHA), which is characterized by irregular or absent periods. This happens due to changes in levels of various hormones, including estrogen. FHA can lead to infertility and harm bone, heart, cognitive, and mental health. Skeletal effects: Estrogen promotes the growth of new bone cells and inhibits the breakdown of old bones. When estrogen levels decrease due to a restrictive diet, bone mass decreases. More than half of women who have anorexia also have osteopenia, or low bone density and weak bones, and about one-third have osteoporosis, which is more severe bone loss that makes you more susceptible to fractures and breaks. Neurocognitive effects: Imaging studies have shown that, in some patients, anorexia causes brain atrophy. This is more common in severe and chronic cases, and may cause challenges with decision-making and memory. Anorexia treatment: What works and how to get help Although anorexia is a serious illness that comes with various health risks, it's also treatable, and several types of evidence-based care exist for patients of all ages. There are different levels of care depending on how much support and supervision a patient needs. For patients choosing in-person care, the treatment options (from most to least intensive) are: Inpatient hospitalization: Patients who are medically and/or psychologically unstable need 24/7 care. Inpatient eating disorder treatment at a hospital allows medical providers to keep a close eye on the patient's vitals and to supervise and lend support during meals until they are stable. This stage of treatment tends to last a few weeks, then the patient steps down to a less-intense level of care. Residential treatment: This is most often used by patients who are medically stable but continue to engage in eating disorder behaviors. Residential treatment provides 24-hour care and supervision in a home-like facility. In addition to medical care, patients often receive psychiatric care, therapy, nutritional counseling, and other support. Partial hospitalization program (PHP): As the name implies, patients in PHP spend part of their time (often five to seven days a week for five to 10 hours a day) at their treatment center. This allows most, if not all, of their meals and snacks to be supervised. They also typically attend individual and group therapy and nutrition counseling sessions. However, they sleep at home. Intensive outpatient program (IOP): Most patients in IOP need support reducing their eating disorder behaviors or thoughts. IOP programs offer individual and group therapy, nutrition counseling, and often family therapy and meal support. Patients typically come two to five days a week for about two to three hours at a time. Low-touch outpatient care: The least intensive level of eating disorder care, outpatient treatment calls for medically stable patients to meet with their own individual providers on a regular basis. The majority of patients see a therapist and many also meet with a dietitian as well as a medical provider. This way someone is monitoring their vitals while they continue to receive support to stay on the path to recovery. Another option is to pursue virtual treatment, which doesn’t neatly fit into the traditional level of care model. Virtual treatment is appropriate for all medically stable patients, and research shows that it’s just as effective as in-person care. It can also be more accessible, removing barriers to care and helping more people get treatment sooner. Plus, recovering in “real life”—as opposed to in a clinical setting—can offer additional benefits: patients practice coping skills and learn to manage triggers in their day-to-day life, with the support of their team, rather than not having to face these challenges until they’ve been discharged from treatment. Equip’s virtual model is built to adapt to the level of care each patient needs, with treatment becoming more or less intense depending on where a patient is on their recovery journey.  Tenets of effective care Like treatment for any eating disorder, anorexia treatment should be personalized to the patient. Still, there are some fundamental elements that have been proven to make recovery more likely. Multidisciplinary care team: Anorexia nervosa impacts every aspect of a patient's life. It makes sense, then, to find professionals who can support all of those aspects. A care team often includes a physician to monitor physical health, mental health professional to address the thoughts and behaviors, and a dietitian to provide nutritional counseling and support. Some patients also benefit from a psychiatrist, who can prescribe medication for co-occurring conditions like anxiety and depression. At Equip, patients also work with mentors who have lived experiencing recovering from an eating disorder. Evidence-based modalities: Research shows that family-based treatment (FBT) is the gold standard for eating disorder treatment in children, adolescents, and young adults. For adults, several modalities may work. Enhanced cognitive behavior therapy (CBT-E), dialectical behavior therapy (DBT), and Maudsley model of anorexia nervosa treatment for adults (MANTRA), have the most evidence for this age group. Weight restoration: Gaining weight is often, though not always, a critical part of anorexia treatment—and can be the hardest part. Like every other organ, the brain needs proper nutrition to function at its best—so weight restoration benefits a patient's ability to think clearly, process thoughts, and, in turn, do the work required in therapy. “Once the brain is better nourished, we can work on the cognitions and distorted thoughts,” Seefeldt says. Research shows that weight gain predicts psychological improvement and reduced eating disorder symptoms. Plus, patients who are discharged from treatment at higher weights have lower odds of relapse. Body image work: Therapy can help patients who have distorted views of their bodies. They might work on stopping body checking, tolerating body changes during recovery, finding enjoyable ways to move their body, and practicing gratitude for what their body can do. This can be especially important given the prevalence of fatphobia in our society and how intensely critical people can be about others' bodies. Medication: There's no FDA-approved medication that treats anorexia. However, some medications have been shown to help with weight restoration. “At the beginning of treatment, if a patient is very malnourished and underweight as compared to their target weight, we might use medication to help turn down the volume on the eating disorder cognitions and rigidity,” Kessel explains. “They don't do the work for you—you still have to show up and challenge the eating disorder—but they make it more doable.” Once someone is closer to their target weight, other medications may help treat comorbid disorders such as depression or obsessive compulsive disorder. “If we treat those comorbid conditions, folks are less likely to relapse,” Kessel says. Relapse planning: Many patients write a relapse prevention plan as part of anorexia treatment. This document often outlines skills and strategies to manage triggers, signs of potential relapse, a plan for what to do if you start to slip up (including when to return to a treatment provider and who else to turn to for support), and motivation for recovery, such as a list of reasons to recover. These plans help patients stay on track toward recovery and ensure that, if they do take some steps back, a slip-up doesn’t snowball into a full-blown relapse. When to get help If you or your loved one is medically unstable due to anorexia, go to the emergency room. Otherwise, if you’re at all concerned about yourself or a loved one, it’s important to reach out for help now, as early intervention is associated with better outcomes. Make an appointment to see a physician or mental health provider, or schedule a free, no-obligation consultation with an Equip team member. We offer tailored treatment plans according to your unique needs, goals, and challenges. Whatever type of anorexia treatment you seek, don't delay. True healing and lasting recovery is within reach. “It's not an easy road, but with the right treatment, recovery is possible for anybody,” Kessel says. This is true even if you tried treatment in the past and it didn’t help, or you’ve relapsed. “It may be that you were in a different place back then or the treatment team wasn't right for you,” Kessel says. “There's always hope. The medical complications are almost all reversible, and you can feel better.” FAQ What’s the difference between “anorexia” and "anorexia nervosa”? The definition of “anorexia” is “loss of appetite”. In fact, in general medicine, “anorexia” is considered a symptom. “Anorexia nervosa” is an eating disorder that's characterized by insufficient caloric intake and an intense fear of weight gain. However, the meaning of “anorexia” often depends on the context of your conversation. Many people refer to “anorexia nervosa” as simply “anorexia”. Why do people with anorexia lose their period? In short, people with anorexia lose their period and develop functional hypothalamic amenorrhea (FHA) because of insufficient nutrition. The long answer is that caloric restriction, excessive physical activity, and psychological stress combine to disrupt the hypothalamic-pituitary-ovarian (HPO) axis. This leads to reduced secretion of gonadotropin releasing hormone (GnRH) from the hypothalamus in the brain, which in turn leads to reduced production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Without enough LH and FSH, the ovaries can't function properly, estrogen levels fall, and ovulation and menstruation don't occur. What is lanugo and why does it happen? Lanugo is fine, soft hair that grows all over a fetus's body. However, people with anorexia nervosa may also experience lanugo. In those instances, experts believe that lanugo is a sign of malnourishment and the body's attempt to conserve heat. Since weight loss often results in a loss of insulating fat, the downy hair acts in some ways like a blanket to keep the person warmer. What are the two types of anorexia nervosa? The two types of anorexia nervosa are restricting type and binge-purge type. People with restricting subtype severely limit their food intake and may engage in excessive exercise. In addition to restricting their food intake, people with binge-purge subtype also have episodes of binge eating and purging. How is anorexia treated? Anorexia treatment varies based on the severity of the eating disorder and often what resources the patient has access to. Generally speaking, some patients need hospitalization in order to become medically stable; then they can step down to less-intense levels of care. However, many patients can get better without ever leaving home, and virtual treatment can be just as effective as in-person treatment. In terms of types of therapy, family-based treatment (FBT) is the gold-standard treatment for anorexia in children, adolescents, and young adults. For adults, first-line therapies include cognitive behavioural therapy for eating disorders (CBT-E), dialectical behavior therapy (DBT), and Maudsley Anorexia Nervosa Treatment for Adults (MANTRA). Is anorexia a choice? “Nobody chooses to have anorexia, and it's no one's fault,” Seefeldt says. Anorexia is a serious brain-based mental illness that affects a person's mental and physical health and can even be life-threatening. That's why it's essential to seek professional help. Treatment, which often includes psychotherapy, nutritional counseling, medical monitoring, and sometimes medication, can help patients achieve lasting recovery.]]></content:encoded>
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            <title><![CDATA[Eating Disorder Symptoms Explained]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorder-symptoms</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorder-symptoms</guid>
            <pubDate>Thu, 07 Jul 2022 14:38:16 GMT</pubDate>
            <content:encoded><![CDATA[With eating disorder rates on the rise, you're not alone if you're worried that someone you love may be struggling. While it's always best to seek out an eating disorder professional for an official diagnosis, family and friends are usually the ones who first notice potential eating disorder symptoms. This noticing is an important first step to getting your loved one the support they may need. Unfortunately, the symptoms of an eating disorder aren't as cut-and-dried as the symptoms of other conditions, like, say, strep throat. Eating disorder behaviors vary widely from one person to another—even within the same eating disorder diagnosis—and many signs and symptoms of eating disorders can be perceived as "healthy" or praised by others (an unfortunate effect of diet culture). The good news is that by learning about the type and range of various eating disorder symptoms, you can better notice red flags and help determine if your loved one needs treatment. Below are common symptoms of eating disorders, broken out by category. Food-related eating disorder symptoms One common red flag for many eating disorders is a change in the way someone eats. This might mean avoiding foods they used to enjoy, or other food-related symptoms like: Counting calories Limiting or avoiding entire food groups Studying nutrition labels (without a medical reason) Having rigid rules about when, where, and what to eat Eating alone (avoiding meals with family or friends) Using the bathroom (including taking showers) right after meals Cooking or baking for others, but not eating the food themselves Eating slowly Cutting food into tiny pieces or smearing food on the plate Adding an unusually large amount of low-calorie condiments, such as mustard, hot sauce, or pickles Physical eating disorder symptoms Eating disorders can affect every organ system in the body, so physical symptoms are often present. While weight loss or weight fluctuations are probably the eating disorder symptom people are most familiar with, there are a number of other physical signs (and someone can have an eating disorder without any weight loss). For growing children or teens, weight loss might be replaced by a lack of expected gain in height or weight. Additional physical symptoms to watch out for are: Feeling cold all the time Frequent illness or injuries (such as stress fractures) Loss of a period in those who would normally be menstruating Hair loss Growth of fine hair on the body Puffy cheeks Scabs or scars on fingers (which might be a sign of purging associated with bulimia) Dizziness or fainting Insomnia Constipation or other GI issues Exercise-related eating disorder symptoms Even though eating disorders, by definition, refer to a problem with eating, exercise is a common component of these illnesses. Some warning signs of potentially problematic exercise include: Working out in a rigid, compulsive, obsessive, or secretive way Obsessively tracking physical activity, such as with a fitness app Feeling compelled to complete an exact amount of exercise each day, regardless of illness, injury, or other negative effects on other areas of life Compensating for food through exercise (i.e., feeling that they need to “earn” or “make up” for food eaten) Appearance-related eating disorder symptoms Not everyone with an eating disorder has body image concerns (for instance, those with ARFID generally do not), but for those who do, intense dissatisfaction with physical appearance can interfere with daily life. Some signs that someone is having body image struggles that may be tied to an eating disorder include: Wearing oversized clothing Avoiding social activities because of body image worries Weighing themselves frequently Frequently judging their appearance in mirrors Trying on specific clothing items to check the fit Body checking (e.g., pinching their flesh, measuring body parts) Mood-related eating disorder symptoms When someone is suffering from an eating disorder, it can affect their mood and relationships. New or increased anxiety, depression, or obsessive-compulsive symptoms are very common in those with eating disorders. However, changes in mood can also be more subtle, and might include: Increased irritability Social withdrawal Intense perfectionism (i.e., feeling like anything less than an "A" is a failure) Black-and-white thinking (things are either "good' or "bad," with no in-between) Mood swings If any of the above sounds familiar to you, your loved one could very likely be struggling with an eating disorder and it's time to get them the support they need. If you aren’t sure but have a gut feeling that something just doesn’t seem right, listen to your intuition—eating disorders can be very secretive and sneaky, so if you’re picking up on any warning signs, odds are that you are right to be worried. It can be scary to recognize signs and symptoms of an eating disorder in someone you love. But remember that eating disorders tend to get worse over time, and so acting now, rather than avoiding the issue due to fear or discomfort, or hoping it will get better, is the best thing you do. Your loved one is still the same person they always were. Their eating disorder symptoms are just that—symptoms—and with the right diagnosis and treatment, they can return to the life they deserve to live, unencumbered by a debilitating disease.]]></content:encoded>
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            <title><![CDATA[How One Family Is Recovering from Anorexia with Equip]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/family-story</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/family-story</guid>
            <pubDate>Mon, 01 Apr 2024 23:38:00 GMT</pubDate>
            <content:encoded><![CDATA[  The following story is from Deana A., a mother helping helping her teen recover from anorexia. Our daughter is an artist and musician to the core of her soul. She can see things in a way that’s beautiful and unique. As a family, we have always loved that about her. She’s always made us proud without any effort. After she turned 13, we saw she was struggling with feelings of angst and anxiety. We initially thought it was typical for her age. Since she’s our oldest, it was our first time parenting a child entering their teenage years. Looking back we saw she’d been losing weight as well—but it was very slow, so we didn’t attribute it to something serious. We realized she had an eating disorder while our family was visiting grandparents. She was numb with emotion. She was sad and very frustrated. At this point we were forcing her to eat a certain amount of food—but hadn’t realized yet that she literally could not eat. On that trip I started to ask her more pointed questions—are you drinking water? Are you able to drink water? The answers revealed the seriousness of what we were up against. We started researching everything we could. In an online support group I came across JD, another parent who had helped a child through an eating disorder and now helps other families get help, who recommended looking into family-based therapy (FBT). The fog I was in was so dense. I still didn’t know how sick our daughter was or how long the treatment would take. I just knew I had to make her gain weight. Life was really difficult in that time. I took it hour by hour and focused on making her to eat, supporting her through every bite she took. When I wasn’t feeding her I was researching anorexia, Family-Based Therapy, and reading other parents’ experiences. We started to recognize the seriousness of the situation—that an eating disorder is a life threatening illness, like a child with cancer. How an eating disorder affected our family Our family had become divided through this diagnosis. Before this we’d been pretty unified at the dinner table. It was hard to see us not have meals together and see our younger son not get the attention he needed. My husband is an incredible father but our daughter wasn’t responding to his efforts to help. She trusted me, and only me, with her most raw thoughts and emotions. I was so grateful for her trust—and it was also very isolating since I was the only one to see her at her worst. Because my husband didn’t experience the scariest moments with our daughter, it felt like it was on my shoulders. It felt like I couldn’t breathe. I was unraveling but trying not to. Advice for other families Early on I heard from other parents that it gets worse before it gets better. That’s true. You feel like you’re drowning—but know there is a way out. Parents are often worried their child might not like them if they’re enforcing all these rules about eating and behavior. They might want to be more of a friend. Through our treatment and recovery we saw just how much kids need good family support and strong parental guidance to get better. Evaluating treatment options We saw our pediatrician as soon as we returned home. She’s an incredible doctor but was not an eating disorder specialist—and referred us to the eating disorder clinic in our area. It was likely the clinic would treat our daughter at a residential facility at some point; and I really did not want to send my daughter away to be treated. Before we found Equip we had tried a therapist for our daughter. She was a great therapist but I felt I got more support from the mentors in my online support group. With eating disorders, there’s something powerful about learning from those who have been there before. I shared all the research about family-based treatment with our doctor, who was very supportive of our decision to go with that option and treat our child at home. It empowers you to take the best care of your child—better than anyone else can. Family-based treatment made sense to us—it felt intuitive. Give your child a full plate. Learn what’s normal to eat—and what’s average. Stop making it about numbers and points, which will eventually need to be unlearned anyway. Initially I was skeptical since I’d found Equip through a stranger on the internet. As I dug into them more, I saw a lot of the research behind the program and realized it was worth a try, especially if we could help our daughter get better without sending her away. I recognize that sometimes a kid is so sick they need to go away to a treatment center to get stable. Even when they come home they’ll still be ill—just less ill than before. So you still have to do the work. Our experience with family-based treatment at Equip We were such a priority to our care team. The team was available when we needed it—and we needed them a lot. One week I booked two appointments with the therapist instead of one, and the team made themselves available for more if we needed it. When someone is struggling with an eating disorder—you don’t know what it’ll be like one minute to the next. Once during a camping trip, our daughter was having a really hard time. I got in touch with our family mentor, Lisa—on a weekend—who talked to me for 15 minutes to guide me through the situation. I really felt like I was a priority and her reassurance was enough to keep me steady on the path. I also loved how our Equip care team was unified in our treatment plan and communicated with each other. Usually, even if you find great providers on your own—the therapist, psychiatrist, and dietician will be in separate places. They might email each other now and then, but the quality of care and coordination wouldn’t be like it is with Equip It was a time commitment, but when you’re going through an eating disorder that amount of time is necessary. If our daughter had gotten treatment at the clinic we were referred to, it would have meant commuting to the facility three days a week for three hour sessions. And the treatment wouldn’t have been as thorough. Now that our first phase of more intensive treatment is over and we’ve learned how to maintain our daughter’s health, our time commitment is a weekly support group with other parents. Our therapist told us from the start that parents will always do the heavy lifting. Kids will look back and remember this as a rough patch; parents will remember the vivid details. Our Equip team educated us about what to do for our daughter and how to get her to the other side of this.. Equip also treats not just the whole person—but the whole family. As a couple, we didn’t understand what each other was going through. Our care team really respected us as parents and as a couple. They met with us individually and together as needed, helping us become a unified front and giving us the same information. Our daughter also grew to love her time with her peer mentor. Initially she acted like she hated it but every time after that appointment she has been built up mentally. Five months after starting this journey I can say everything is changing for the better. Both our kids are sitting at the dinner table playing a game over dinner and I trust our daughter will finish her meal while my husband and I step away to take a phone call. Parenting a child through an eating disorder is like diving into the deep end of a pool blind folded without knowing how to swim. But with Equip and Family-Based Therapy, it’s as if there’s friends on the edge of the pool telling you how to move your arms and legs, and where to swim to get to safety. It’s scary to get your child through this but it was my only option to save her. So that’s what I had to do. We really loved the Equip program so much. We almost wish we still engaged with our care team like we did during treatment. We felt it was the holy grail of treatment. ]]></content:encoded>
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            <title><![CDATA[Family & Festivities: Supporting a Family Member in Eating Disorder Recovery During the Holidays]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/navigating-eating-disorder-recovery-during-holidays</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/navigating-eating-disorder-recovery-during-holidays</guid>
            <pubDate>Mon, 11 Dec 2023 18:14:36 GMT</pubDate>
            <content:encoded><![CDATA[For many, the start of the holiday season may evoke a spectrum of different emotions: the joy of quality time with friends and family, the stress of planning, and gratitude for a new year. But for those navigating eating disorder treatment, another emotion may arise: panic. As Equip’s Director of Mentorship JD Ouellette describes it, dinner on an average weeknight can be a challenge, but a holiday meal may feel like an insurmountable challenge. “When it’s hard to eat or feed your child on the best of days,” JD says, “having these holidays coming at us in a culture that’s organized around eating and people can feel overwhelming. At various stages of eating disorder recovery, we have to weigh the impact of all the people and food, and how we’re going to navigate through that.” How to stay mindful of recovery during the holidays As you begin to make decisions about how your family will participate in this year’s holiday festivities, stay aware and present of where you or your loved one is in their recovery process. Think about what steps you can take to ensure your family stays focused on recovery: Decide which holiday gatherings you’ll be attending this year. Remember that it’s okay to skip events that may be overly stressful! Make a plan (and even share it with loved ones!) for managing challenges and triggers if you choose to attend or host a holiday get together. Recognize which beloved family traditions may need to be adapted or avoided, and which activities may help your family redefine the focus of the celebrations. Get creative by planning some non food-focused holiday activities. It's totally okay to have your own traditions and spend time with friends - and even strangers! Reflect on what the holiday season means to your family. Focusing on your cultural traditions and values can make celebrations less stressful and more joyful. How to show up to holiday gatherings in a recovery-supportive way Should your family choose to attend a holiday gathering, here are some practical tips to do so in a way that is supportive of recovery: Provide your family with education and information on eating disorders to help empower them to support you. and the person navigating recovery. Sharing this article might be an excellent way to get buy-in from extended family! If you’re anticipating, like many families, a lot of “diet talk” at the dinner table, try sending out an email to attendees in advance of the holiday explaining how and why these topics should be avoided. Provide your family with education and information on eating disorders to help empower them to support you. Provide clear, tangible examples such as asking family members to avoid labeling foods as “good” or “bad,” or making comments like “I’m starting my diet tomorrow,” during dessert. Email your loved ones to outline your boundaries in a respectful way and provide suggestions for how to honor them. Find your allies to run interference with you. Appoint a trusted friend or family member to interfere or redirect “diet talk” throughout the gathering. Get creative with tables, and choose to sit with loved ones who you feel will be supportive during difficult moments. Or, find a quiet spot away from the main dining area to give your loved one a calmer space to eat a potentially challenging meal. Help them print or download to their phone these coping cards that can provide in-the-moment reminders of encouragement. Uphold routine to stay grounded and reduce stress Holidays are not the time to deviate from your meal plan. Ensure adequate nutrition throughout the day to support recovery and normalize acting against diet culture norms like skipping meals before a holiday dinner. Model by eating at regular intervals throughout the day for your loved one. Eat breakfast, lunch, and snacks together as a way of establishing normalcy. Stick to your meal plan to provide the powerful learning experience of having consistent energy during a busy day of activities by taking the time to nourish and fuel Check out these expert tips on how to navigate body image stress during the holidays.  Be flexible If attending food-focused events is too much of a challenge or if your loved one simply needs a break, remember that you can always shift the celebration off of the dinner plate. There are many other ways to honor the spirit of the holiday season through connection, gratitude, and joy. Try a quiet family evening at home with a board game, movie, or crafts. For those for whom movement is a safe choice, suggest a gentle walk or bike ride through the neighborhood to look at holiday decorations. Consider volunteering to observe the spirit of the season in a way that inspires community and connection. Changing the focus of the holidays doesn’t mean having to avoid food-centered activities altogether. After all, food isn’t simply fuel – food represents culture, love, and community. But for those working towards recovery, holiday meals can also be stressful and overwhelming during this time. Finding the balance between both can be a nuanced, ever-changing process, but figuring out what choices are right for your family this year can help make room for many more years of holiday celebrations in the future.  ]]></content:encoded>
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            <title><![CDATA[ARFID Might Not “Feel Like” an Eating Disorder. It Absolutely Is.]]></title>
            <link>https://equip.health/articles/understanding-eds/is-arfid-an-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/is-arfid-an-eating-disorder</guid>
            <pubDate>Wed, 14 Feb 2024 17:31:00 GMT</pubDate>
            <content:encoded><![CDATA[  Equip Peer Mentor Kelsey Gilchriest began having issues with food at an early age. But at the time—and even to this day—many of the people in her life downplayed the severity of her problems. “What I often experience is people believing I'm ‘just a picky eater,’” she says. “My father was also labeled a picky eater, so my avoidance of certain foods was more normalized in my household.” Gilchriest didn’t develop an aversion to specific foods due to body image issues, a fear of weight gain, or emotional distress, all of which might have signaled that she was dealing with an eating disorder. Rather, her main motivation to limit her intake came from a fear of vomiting, otherwise known as emetophobia. Reflecting on her experience now, Gilchriest knows that a history of chronic nausea and gastrointestinal issues, compounded by significant anxiety, contributed to her food habits. But what she didn’t know all those years she was labeled a “picky eater” was that her symptoms were actually characteristic of an eating disorder known as ARFID (avoidant restrictive food intake disorder). What is ARFID—and is it an eating disorder? “ARFID is an eating disorder that is not defined by a fear of gaining weight or dissatisfaction with how one looks,” says Equip VP of Program Development, Jessie Menzel, PhD. “Rather, ARFID is driven by one or more things: extreme sensitivity to the sensory properties of food, a fear of a bad outcome after eating, like vomiting or choking, or a lack of interest in food.” While ARFID can result in serious physical and psychological consequences, it’s often misunderstood—or missed completely—because of how different it looks from other eating disorders. This can be true for the people who are struggling, their loved ones, and even experts in the field. “I've had medical professionals tell me that I don't have an eating disorder simply because I don't struggle with body image or have a desire to change my body,” Gilchriest says. “This was damaging for many years, as I only had a handful of foods that I would eat and yet my therapist and doctors didn't think I had a problem.” (It’s important to call out that many people with ARFID do have body image distress—we all exist within diet culture, after all—but ARFID behaviors don’t stem from a desire to lose weight or change one’s body.) Pervasive confusion and lack of information about ARFID may lead many people, like Gilchriest, to doubt if they really have an illness at all. But the truth is, ARFID is a very serious eating disorder, even though it can differ significantly from more well-known eating disorders, like anorexia and bulimia. Read on to learn why ARFID is absolutely an eating disorder—and how to advocate for proper treatment. Why doesn’t ARFID “feel” like an eating disorder to some? “There are so many reasons why I think some people do not see ARFID as a ‘real’ ED,” Menzel says. “First, we as a society still associate ‘eating disorder’ with ‘body dissatisfaction,’ even though some eating disorders—like binge eating disorder—don’t even require body dissatisfaction as part of the diagnostic criteria.” Another common reason many people—even those experiencing it—tend to disregard ARFID as “not that serious,” is the same reason Gilchriest’s restrictive habits were often ignored. “ARFID is commonly confused with picky eating and I think people often dismiss picky eating as ‘normal’ or ‘just a phase,’” Menzel says. “While a degree of pickiness certainly is normal, ARFID is not run-of-the-mill pickiness. It is restricted eating that has gone so far that it negatively impacts health, growth, and social and emotional well-being.” Finally, ARFID is also often dismissed as a less-than-serious issue because many consider the symptoms to be characteristics of developmental growing pains. “People incorrectly assume that ARFID is a childhood problem and many don’t think that children get eating disorders,” Menzel says. When people view ARFID in children as developmentally normal behavior, and ARFID in adults as mere picky eating, it’s easy to understand why they’d fail to associate it with other eating disorders. ” Some people with ARFID actually prefer to acknowledge the difference between ARFID and other diagnoses by referring to ARFID as a “feeding disorder” rather than an “eating disorder.” This categorization feels better to some people, while others prefer to call it an eating disorder. Regardless of the categorization, ARFID is a very real condition that should be taken seriously. The dangers of not recognizing ARFID as an eating disorder One real risk of not recognizing ARFID as an eating (or feeding) disorder is the possibility that the illness goes unchecked for far too long, leading to worsening symptoms that impact a person’s health and quality of life. “I work with adult patients who have struggled their entire lives with debilitating anxiety around food and eating without receiving any support professionally or interpersonally,” Gilchriest says. “As with any eating disorder, there can also be medical consequences if it goes untreated.” For growing children, letting ARFID go undiagnosed or untreated can have particularly dire physical consequences. Children and teens need proper nutrition in order for their bodies to develop in a healthy and normal way, and the nutrient deficiencies and malnourishment that comes with ARFID can lead to stunted growth and delayed puberty, among other issues. Why ARFID requires the same comprehensive treatment as other eating disorders “ARFID needs the same multidisciplinary treatment approach that we know works well for other eating disorders: a therapist, a dietitian, and a medical provider,” Menzel explains. But many people with ARFID aren’t directed toward such treatment, largely because awareness and understanding of ARFID still isn’t widespread in the medical community. This makes sense, given that the illness was only added to the The Diagnostic and Statistical Manual of Mental Disorders (DSM) within the last eleven years, while anorexia and bulimia have been in it for many decades. “It's important to look for providers that have training and experience specifically in treating ARFID,” Menzel says. “Just because a provider treats eating disorders doesn’t mean that they’re able to treat ARFID. Look for treatment modalities, too, that have been specifically developed and tested with ARFID, like family-based treatment for ARFID (FBT-ARFID) and cognitive behavioral therapy for ARFID (CBT-AR).” Gilchriest points out that there is significant variability among those living with ARFID, and the way the illness presents itself can be very specific to the individual. “In my three years of working with ARFID patients, I have not met two people whose presentation of ARFID is exactly alike,” she says. “Effective treatment for ARFID uplifts the lived experience of the patient, as they are the experts in their experience and can collaborate on and define what recovery looks like for them.” Given how different ARFID can look from person to person, it’s natural to question whether your or your loved one’s symptoms are “bad” enough to merit treatment. But according to Menzel, if you have any suspicion that there’s a problem, it’s time to seek support. “I always tell anyone with ARFID to trust their gut—no pun intended!” she says. “If you’re unhappy with the way you’re eating, if food is getting in the way of you finding joy in life, if food is causing you pain, distress, or anxiety—talk to someone about it. Eating disorders are not just about wanting to lose weight or change the way you look. You may be struggling with ARFID.” If you’re concerned that you or a loved one may be struggling with ARFID, don’t ignore it. Speak to your doctor or schedule a consultation with someone on our team to get a professional assessment.]]></content:encoded>
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            <title><![CDATA[When Picky Eating Goes Awry: Understanding the Difference Between Selective Eating and ARFID]]></title>
            <link>https://equip.health/articles/understanding-eds/equip-academy-picky-eating-arfid-selective-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/equip-academy-picky-eating-arfid-selective-eating</guid>
            <pubDate>Wed, 15 May 2024 18:13:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. ARFID is often dismissed or left undiagnosed because it’s viewed as “just” picky eating — and it’s true that in a lot of cases, picky eating is normal and completely harmless. The tricky part for parents and healthcare professionals is finding the line between developmentally appropriate pickiness and a concerning problem. So how picky is too picky? Knowing that many children may tend towards pickiness during childhood, at least for a time, how, as a pediatrician or provider do you know when it is time to intervene? It’s an important question to answer: a study published in Pediatrics in 2015 provided evidence that even moderate levels of picky eating in toddlerhood were associated with adverse physical and mental health outcomes. Defining Selective Eating One of the most well-operationalized definitions of picky eating severity that I’ve found was published by Dr. Will Sharp, PhD, who runs the feeding disorders program at the Marcus Autism Center in Atlanta. While his definitions of picky eating severity weren’t used in the studies I’ll be discussing here, his methods of defining picky eating have high clinical utility. He breaks down picky eating severity based on both selectivity and mealtime behavior and their associated risk for nutritional deficiency and food rejection. Put very simply, a child with low levels of pickiness is one who eats from all five food groups (starches, fruits, vegetables, proteins, and dairy) on a daily basis and who eats at least three items from each of these food groups. Children with low levels of pickiness might still have some negative impact on family functioning, in that they still may be a bit difficult to please, but risk to physical development is minimal. Children with moderate levels of pickiness have at least one food group in which they accept a low number of items on a weekly basis. In other words, they eat from all five food groups, but at least one of those food groups is consumed infrequently and has little variety. So think here of a child who might eat two vegetables, but definitely not daily and maybe only once or twice a week. Children with high levels of pickiness completely reject one or more food groups (for instance, refusing to eat any fruits and any dairy), and accept five or fewer total food items. They also may eat slowly, feel full early, and/or experience significant distress at mealtime. Moderate and high levels of pickiness are both associated with more significant mental and physical health risks than low-level pickiness, including risks of micro- and/or macro-nutrient deficiency (scurvy, iron deficiency anemia, kwashiorkor).  How does ARFID fit into all this? First, let’s define ARFID. ARFID stands for avoidant/restrictive food intake disorder, and it’s an eating disorder characterized by problems with either volume or variety of food intake (not eating enough food or enough types of food) that are not driven by a desire to lose weight, a fear of gaining weight, or a desire to change one’s body. The selective eating behaviors associated with ARFID cannot be explained by an existing medical or mental health condition. ARFID can stem from several different causes. The primary presentations are: Fear of adverse consequences from eating (like choking or getting sick) Selective eating due to sensory sensitivity (i.e., disliking certain textures, smells, or tastes) Lack of interest in food and eating ARFID is a serious eating disorder that can cause a variety of impairments to patients’ mental and physical health as well as their daily life. ARFID can lead to: Weight loss or failure to grow Nutritional deficiency Dependence on enteral feeding or oral supplements Problems in daily living Another condition to be aware of is DSM-IV-TR Feeding Disorder Diagnosis, which is similar to ARFID in many ways but differs in that the diagnostic criteria doesn’t include a weight loss or growth impairment requirement, and it can exist within the context of another medical condition.  When to intervene in picky eating Eating preferences are unique, and selective eating can be normal. So when do we worry? When, as healthcare providers, should we do something? Thankfully, there are some clear signs that can indicate it’s time to take action. Red flags in a patient include: Not eating at least one food from all five food groups on a weekly basis Losing weight or falling off the growth curve Struggling to eat enough food, period Refusing to try new foods Tantrums or intense emotional distress when presented with non-preferred food Not responding to intervention There are a number of different measures you can use to determine if a patient’s eating has become too selective. One option is to look at nutritional adequacy through blood tests and/or food frequency assessments. Food frequency is a measure of how frequently a person consumes different types of food, and there are a few different options for measuring this, including The Primary Food Groups Building Blocks (in CBT-AR manual), food recall (food eaten over a 48-hours or four-day period), and always-sometimes-never lists (foods they’ll always eat, foods they’ll sometimes eat, and foods they’ll never eat). You can also look at the characteristics of their selective eating to determine if it’s a problem. Picky eating Strong preferences for specific types of foods, brands, or preparations May try new things, eats from all five foods groups on a regular basis (even if it’s not a lot of foods) Growing okay, eating doesn’t cause too many problems ARFID Strong and narrow preferences for types of foods, brands, or preparation Excludes whole food groups or eats certain types of food on an infrequent basis, refuses to try new foods Growth impairment, health & social consequences, distress Treatment of selective eating When treating selective eating, it’s important to remember that it arises out of a variety of different contributing factors, including: Early exposure to foods Genetics Personality factors Cultural norms Innate dispositions Familiarity/modeling Physiological factors Neurodiversity can also play a role—up to 89% of children with autism have feeding differences. Neurodiversity especially shapes eating preferences when it comes to: Sensory sensitivity: Hypo- or hyper-sensory processing differences with respect to taste, texture, smell, temperature, look, and sounds related to eating (or the eating environment) Cognitive rigidity: Strong preferences for sameness, consistency, and predictability. Impacts food choice, willingness to try new foods, other preferences (like meal preparation, location, etc.) Gastrointestinal issues in autism: Painful or negative experiences with food or eating related to underlying gastrointestinal disorders Selective eating and ARFID are best treated by neither overly accommodating patients’ preferences (preparing alternate meals, not persisting with new foods, not offering foods again, allowing escape) nor pressuring them to eat (focusing on liking versus trying, using of judgmental language, overwhelming them with new foods). It’s best to keep an agnostic frame of reference in mind when approaching patients and caregivers about these factors. The treatment of selective eating can be broken down into three broad steps.Before completing this plan, it’s important to address any other factors that might be impacting eating before addressing variety: Step 1: Establish weight gain or regular eating. Make sure the patient is getting enough to eat first. Step 2: Make a plan for dietary expansion. Step 3: Start dietary expansion. There are a number of different evidence-based modalities for treating ARFID and feeding difficulties. These include: Feeding therapy Could include any of the following: Behavioral intervention (ABA; large evidence base) Sequential Oral Sensory (SOS) approach to feeding Responsive feeding or Division of Responsibility Family-Based Treatment for ARFID (FBT - AR) Family approach Evaluated in children ages 5-12 No specific approach to expanding dietary variety Cognitive Behavioral Therapy for ARFID (CBT - AR) Individual or family-based Suitable for ages 10+, only manual treatment for adults Incorporates SOS + mindfulness for dietary expansion Conclusion: What to remember about selective eating and ARFID Here’s what providers should know about differentiating ARFID, selective eating, and picky eating from one another, as well as how to treat ARFID or selective eating. Picky eating is transient; selective eating is persistent. It will not get better with time. Both involve eating a narrow range of foods, difficulty trying new foods, and are difficult to please. ARFID differs from selective or picky eating in that the eating has resulted in: Weight loss or poor growth Nutritional deficiencies Dependence on supplements Impairment in social/emotional functioning Taste is complicated. Sensory perception is involved, but cognitive rigidity and disgust also influence persistence of selectivity. Providers should set fair expectations for treatment, work with caregivers to modify behavior as needed, and expand diet through exposure. For more in-depth information on diagnosing and treating selective eating, including strategies for setting expectations, modifying caregiver behaviors, introducing new foods, systematic desensitization, and more, watch my recorded Equip Academy presentation on the topic. To refer a patient or learn more about Equip’s evidence-based eating disorder treatment for ARFID, schedule a call with our team. ]]></content:encoded>
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            <title><![CDATA[ADHD and ARFID: Why Eating Can Feel So Hard — And What Actually Helps]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-adhd</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-adhd</guid>
            <pubDate>Wed, 10 Jun 2026 16:54:00 GMT</pubDate>
            <content:encoded><![CDATA[If you've been searching for answers about ADHD and ARFID, chances are eating feels harder for you than you think it should. Maybe you've looked up at the clock and realized it's 4 p.m. and you haven't eaten all day. Maybe your child will eat only a handful of foods because certain textures, smells, or tastes make eating feel overwhelming. Or perhaps meal planning and food prep feel impossible to keep up with. If that sounds familiar, you're not alone. Many people with attention-deficit hyperactive disorder (ADHD) struggle with eating. They may forget meals, hyperfocus through hunger, lose their appetite on stimulant medications, or find the daily task of feeding themselves surprisingly difficult to manage. For some, those challenges are related to ADHD itself. For others, they may be signs of avoidant/restrictive food intake disorder (ARFID), an eating disorder characterized by restrictive eating that's not driven by body image concerns. The overlap between ADHD and ARFID can be confusing. Many people spend years wondering whether they're just picky eaters, bad at feeding themselves, or somehow lacking willpower. In reality, these struggles often stem from differences in how the brain processes hunger, sensory input, food, and daily tasks. In this article, we’ll explore where ADHD and ARFID overlap, how they're different, and what effective treatment can look like. Understanding ADHD, ARFID, and why they're often connected ADHD is a neurodevelopmental condition that affects attention, impulsivity, activity levels, and executive functioning (the mental skills that help us plan, organize, remember, and follow through on tasks). It affects as many as 32% of children and 21% of adults. When it comes to eating, ADHD can make it harder to: Notice hunger cues Remember meals Plan and prepare food Shift attention away from a task long enough to eat ARFID is an eating disorder characterized by restrictive eating that isn't driven by body image concerns. People with ARFID eat a very small amount or variety of food (or both), and this can lead to nutritional deficiencies, weight or growth concerns, distress around food, and difficulties in everyday life. There are different types of ARFID, but common reasons for food avoidance include sensory sensitivities, food-related fears, and a lack of interest in eating.  Although ARFID is often thought of as a childhood condition, it can affect people of all ages. Research suggests it may affect up to 15.5% of children and teens, while an estimated 0.3% of adults have the disorder. That latter number doesn’t tell the whole story, though: ARFID is often overlooked in adults, so many adults with ARFID have spent years struggling with food without realizing there's a name for what they're experiencing. At first glance, some ADHD and ARFID symptoms can look similar. And an overlap between the two conditions is fairly common: One study found that nearly 17% of children with ARFID also had ADHD, while another reported rates closer to 1 in 4. “It’s not always possible to differentiate between eating challenges associated with ARFID and those associated with ADHD,” says Michelle Jones, PhD, a clinical instructor at Equip. “However, it’s important to be aware of the challenges that can arise when individuals experience symptoms of both ARFID and ADHD, and adjust treatment goals and approaches to manage both.”  ADHD vs. ARFID: How to tell the difference ADHD and eating disorders like ARFID are not the same thing. But because of their similarities, telling them apart isn't always easy—and many people experience both at the same time. For example, someone might forget meals because of ADHD while also avoiding certain foods because of sensory sensitivity ARFID. Still, there are a few ways they often differ, including: The reason why eating feels difficult: ADHD food issues are often tied to distraction, hyperfocus, executive functioning difficulties, or appetite changes. ARFID-related eating challenges are more often driven by sensory sensitivities, low interest in food, or fear of choking, vomiting, or other negative consequences. Consistency of symptoms: Not eating with ADHD tends to be more situational. You might forget to eat one day and eat normally the next. ARFID-related food avoidance is usually more persistent. The reason behind food avoidance: People with ADHD may stick to familiar foods because they're convenient, predictable, or easy to prepare. People with ARFID often avoid foods because they feel overwhelming, distressing, or unsafe. Response to structure and support: Eating with ADHD may feel easier with the help of consistent reminders, routines, or easy-to-access meals. Someone with ARFID may continue struggling even with structure because the food itself feels difficult to eat. Impact on health and daily life: ADHD eating habits don't always cause significant nutritional, medical, or social consequences. ARFID is more likely to affect nutrition, growth, physical health, or participation in everyday activities. ADHD Eating Challenges vs. ARFID vs. Both  Why ADHD and ARFID often occur together ADHD doesn't cause ARFID. But some ADHD traits can make restrictive eating more likely (or make existing eating challenges harder to manage), including: Sensory sensitivity: Certain textures, smells, tastes, or appearances of food can feel intensely uncomfortable or overwhelming, which is why ADHD and food aversions sometimes overlap. Executive functioning challenges: Planning meals, grocery shopping, preparing food, and remembering to eat all require executive functioning skills. Because ADHD can make these skills more challenging, food-related tasks may require more effort and mental energy than people realize. Differences in hunger and fullness cues: Many people with ADHD struggle to consistently recognize or respond to these cues, making it harder to keep up regular eating patterns. (This is one reason why ADHD and binge eating disorder can also overlap.) Anxiety and food-related fears: People with ADHD are more likely to experience anxiety, which can amplify concerns around eating. At the same time, a negative experience with food, intense sensory discomfort, or fears around eating can lead to increasing food avoidance over time. Appetite suppression from medication: ADHD and appetite changes can go hand in hand, especially for people taking stimulant medications. These medications can reduce hunger, making it harder to eat enough throughout the day. Neurodivergence: ADHD, autism, and other neurodevelopmental differences are more common among people with ARFID, which may help explain why so many people see themselves in both experiences. Signs it may be time to seek help Many people with ADHD, ARFID, or both spend years wondering whether their eating challenges are "serious enough" to deserve support. But you don't have to wait until things feel extreme to ask for help. If eating is causing stress, affecting your health, or getting in the way of daily life, then it's worth talking to a healthcare professional. Some signs it may be time to seek support include: Weight loss or poor growth: Restrictive eating can make it difficult to get enough energy and nutrients to support growth, development, and overall health. Nutritional deficiencies: A very limited diet can increase the risk of missing important nutrients, especially when you avoid entire food groups. Fatigue, dizziness, or fainting: These can be signs that your body isn't getting the nutrition it needs. Increasing food restriction: The list of foods that feel "safe" continues to get smaller over time. Distress around eating: Meals, snacks, restaurants, social events, or trying new foods regularly cause anxiety, frustration, or overwhelm. Social or family impact: Eating challenges are affecting relationships, school, work, travel, or social activities. Reliance on supplements or meal replacements: Nutritional supplements can be helpful in some situations. But relying on them because eating feels too difficult may be a sign that it’s time to seek support. Most importantly, trust your experience. You don't need to prove that your struggles are severe enough to deserve help. If food, eating, or nutrition feels like a constant source of stress, that's reason enough to start a conversation. What treatment for ADHD and ARFID can look like The good news is that support is available, and you don't have to figure it out on your own. Because ADHD and ARFID can affect eating in different ways, treatment often works best when it addresses both the eating challenges and the reasons behind them. Many people benefit from working with a multidisciplinary team of professionals—like a therapist, dietitian, physician, and psychiatrist—who can help address different aspects of recovery. Depending on a person's needs, treatment may include: Therapy: Therapy can help you better understand your relationship with food, manage anxiety, build coping skills, and gradually work through food-related fears. Nutrition support: A dietitian can help you build a more varied diet, address nutritional deficiencies, and develop eating strategies that fit your needs. Medical monitoring: Regular medical care can help identify and address complications such as nutritional deficiencies, weight loss, growth concerns, or other health issues. Exposure-based approaches: ARFID treatment often includes gradual exposure to feared or avoided foods. Over time, this can help food feel less overwhelming or distressing Sensory accommodations: Treatment may include honoring safe foods, adjusting food preparation methods, or finding ways to reduce sensory overwhelm while gradually building flexibility. Executive functioning supports: Reminders, visual schedules, easy-to-prepare foods, and other practical tools can make eating feel more manageable for people with ADHD. Family involvement: For children and teens, caregivers often play an important role in creating a supportive, low-pressure eating environment and helping treatment strategies carry over into daily life. Medication coordination: For people taking ADHD medication, treatment may involve working with healthcare providers to address appetite suppression or other medication-related eating challenges. “It may [also] be necessary to eat at times when you don’t feel hungry to ensure that you are eating enough and helping your body regulate hunger cues as much as possible,” adds Jones. Treatment is most effective when it meets you where you are. With the right support, many people are able to expand their food options, reduce stress around eating, and feel more confident navigating meals, social situations, and everyday life. The team at Equip—the largest ARFID provider in the U.S.—can help you start on your ADHD and ARFID treatment journey (as a first step, it may be helpful to take Equip’s free ARFID self-screener). Tips for daily life “Managing ARFID symptoms when you have ADHD may require specific strategies or supports to manage challenges related to executive functioning, sensory processing, or interoceptive awareness,” says Jones. Just remember: What works for someone else may not work for you. The best approach is often the one that feels realistic, sustainable, and supportive of your individual needs.  Here are some strategies Jones recommends: Optimize your environment: Eating can be easier when your environment works for you. That might mean reducing sensory distractions, such as loud noises or visual clutter, or adding sensory input that helps you stay engaged, such as listening to music or sitting in a more comfortable position. Use external reminders: Visual timers, phone alarms, calendar notifications, meal guides, or other cues can help if you tend to forget meals or lose track of time. Ask for support when you need it: Friends, family members, or caregivers may be able to help with meal planning, grocery shopping, food preparation, or creating a more supportive eating environment. Don't rely on hunger alone: If your hunger cues are inconsistent or medication suppresses your appetite, you may need to eat on a schedule (sometimes referred to as “mechanical eating”) rather than waiting until you feel hungry. Build awareness of hunger and fullness: Checking in with your body before and after meals, practicing mindfulness, or tracking hunger and fullness cues can help strengthen interoceptive awareness over time. Accommodate sensory needs: Small adjustments—such as changing a food's temperature, texture, or preparation method—can sometimes make meals feel more comfortable and approachable, even if they don’t include an ADHD food fixation or ARFID “safe” food. Practice self-compassion: Struggling with food isn't a personal failure. Approaching your food-related challenges with curiosity rather than criticism can make it easier to identify what helps and advocate for the support you need. The bottom line For people with ADHD, ARFID, or both, eating challenges are often about much more than food. Sensory sensitivities, executive functioning difficulties, inconsistent hunger cues, and food-related fears can all play a role, among other factors. Whatever the reason, struggling with food is not a personal failure. You deserve support that helps you understand your needs, meet your nutritional goals, and feel more confident around food. Frequently Asked Questions (FAQs) Can adults have ADHD and ARFID? Yes. While ADHD and ARFID are often discussed in children, both conditions can affect adults as well. Some adults have lived with eating challenges for years without realizing there may be an underlying explanation, and the same can be true of ADHD. Others may develop ARFID later in life after a negative food-related experience, illness, or an increase in sensory sensitivities. Do ADHD medications make ARFID worse? For some people, stimulant medications can reduce appetite, making it harder to eat enough throughout the day. While ADHD medications don't cause ARFID, appetite suppression can sometimes make existing eating challenges more noticeable or more difficult to manage. If you're concerned about changes in appetite, talk with your healthcare provider. Is ARFID a lifelong condition? Not necessarily. Everyone's experience is different. With appropriate support, many people are able to expand their food variety, reduce anxiety around eating, and improve their nutritional intake. Progress often takes time, but treatment can absolutely help make eating feel more manageable.]]></content:encoded>
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            <title><![CDATA[The Hidden Link Between Video Games and Body Image]]></title>
            <link>https://equip.health/articles/news-and-research/video-games-body-image-research</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/video-games-body-image-research</guid>
            <pubDate>Mon, 08 Jun 2026 16:56:00 GMT</pubDate>
            <content:encoded><![CDATA[There are over three billion video game players worldwide, making gaming one of the most popular cultural and social forces on the planet. These virtual worlds serve as a sanctuary for connection, creativity, and community.  However, as next-gen graphics make virtual environments increasingly lifelike, the boundaries between a player’s digital identity and their real-world self-perception are blurring. And while gaming remains a powerful source of joy, the hyper-idealized bodies on our screens are leaving an impact on player well-being. To explore this dynamic, Equip conducted a comprehensive research project surveying 983 adult video game players, ranging in age from 19 to 78, with a roughly even split between males (54%) and females (46%). Our findings reveal insights that can help us understand how gaming culture shapes our body image and even our eating habits—and where these effects cross the line from casual to concerning.  The rise of "digital perfection" in gaming culture Modern gaming environments are flooded with physically "ideal" aesthetics. However, our research found a double standard in how male and female characters are designed: Over 75% of players agree that both male and female characters frequently display an "ideal" appearance. However, female characters are pushed to an extreme: 43% state that women in games are almost always portrayed with an idealized physique, compared to just 24% for male characters. Many gamers recognize that these standards are disconnected from reality. In fact, 15% of respondents flag male characters as "very unrealistic," and 27% say the same about female characters. With billions of people engaging with video games daily, this disconnect has triggered a growing mandate for change. Over 28% of players expressed outright dissatisfaction with the lack of body diversity in current games. When asked for the single thing they would change about the industry, 30% called for more realistic and diverse body types, while 28% demanded an end to the sexualization and objectification of characters. As one 25-year-old male daily gamer expressed: "If you never see a person that looks like you in any media (regardless of if it's a video game or not), you start to get the idea that you're undesirable or not meant for the public eye. I know deep down that video game characters are not meant to be realistic depictions of people... but that doesn't mean it doesn't get exhausting never seeing yourself in anything." These archetypes don't stay behind the screen—they often translate into real-world body anxiety: Roughly 42% of all players experience negative thoughts about their body or appearance at least several times a week. Gender disparities Women in the gaming community experience a disproportionate amount of appearance-related distress. Over 80% of female respondents report having negative body thoughts daily, weekly, or a few times a month, compared to roughly 50% of men. For women, these thoughts are primarily centered around weight or not feeling “attractive enough.” A 51-year-old female daily gamer highlighted how this exhaustion builds up: "I'm already bombarded in other media with 'perfect' or ideal women, now I get it here too, with the bonus of totally unrealistic top-heavy, tiny-waisted, childlike characters. It just drags your self-esteem down..." While men reported fewer negative thoughts overall, their distress is tied to cultural pressures around masculinity and body standards. They are significantly more likely than women to report feeling that their bodies are "not muscular enough" or "too skinny/small". This pressure extends even to how characters are styled, as a 28-year-old male daily gamer noted: "There seems to be an absence of tall, slender, and asymmetrical facial features in most game characters (male). Or they are designed in such a way that clothing fits absolutely perfectly and frames their body in amazing ways. It sometimes affects the way I dress since I compare myself to the way clothes fit on their bodies." Avatar psychology: escapism vs. idealization One of the most fascinating aspects of the study was how avatar customization influences player confidence. Nearly three-quarters of respondents customize their avatars moderately to extensively, often modifying their digital selves to look more attractive, muscular, or leaner. According to our data, the type of avatar a player chooses can skew their real-world self-perception: Gamers who primarily play with male avatars often experience a protective boost, reporting higher real-world confidence and fewer negative body thoughts. Conversely, those who primarily play with female avatars report significantly lower confidence, more frequent negative body thoughts, and a much higher tendency to compare their physical selves to game characters. Players who explicitly design avatars to be a "better version" of themselves report significantly higher rates of daily or weekly negative body thoughts. When virtual influences lead to harmful real-world behaviors  Perhaps the most striking takeaway from the research is how digital influence prompts real-world behavioral changes. One in four players has considered altering their appearance, eating habits, or exercise routines due to gaming, and 55% of those individuals followed through, primarily focusing on weight loss or muscle building. Alarmingly, the study also highlighted a hidden intersection with gaming and eating disorders. Out of the entire sample, 6.5% of players had been diagnosed with an eating disorder, and another 9.9% suspected they had one. Among those without a formal diagnosis, 26.6% admit to restricting or skipping meals for non-religious reasons, while more than 10% engage in excessive exercise or "water loading" to suppress hunger. Fostering a healthier gaming culture With billions of active users globally, the gaming industry stands at a crossroads. The data show that younger players (under 36) are most likely to compare themselves to characters, while players of immersive genres like RPGs, sandbox games, and simulation games use avatars heavily for identity experimentation. By narrowing the gap between digital "perfection" and human reality, game developers have an incredible opportunity. Embracing authentic, diverse character designs won't just foster a healthier mental environment for players; it will build deeper, safer, and more loyal communities for years to come. If you or someone you love is struggling with body image distress, disordered eating, or an eating disorder, you don't have to navigate it alone. Equip provides evidence-based, virtual care designed to help you heal at home.]]></content:encoded>
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            <title><![CDATA[The Signs and Symptoms of Binge Eating Disorder: What to Watch For]]></title>
            <link>https://equip.health/articles/understanding-eds/binge-eating-disorder-symptoms</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/binge-eating-disorder-symptoms</guid>
            <pubDate>Fri, 05 Jun 2026 18:39:00 GMT</pubDate>
            <content:encoded><![CDATA[Everyone overeats from time to time, whether it’s finishing off a pint of ice cream after a bad day, wanting to sample everything at a new restaurant, or indulging at special occasions where food takes center stage.  If overeating is a regular occurrence for you, however, you may have asked yourself, Is this binge eating disorder or am I just overeating? You may have also asked this question about a loved one.  Binge eating disorder (BED) is different from general overeating. BED involves regular episodes of binge eating, in which a person feels out of control with food and eats a large amount in a short period of time to the point of becoming uncomfortably full. BED also involves intense and distressing feelings around food, often shame or guilt.  In contrast, when general overeating occurs, life goes on as usual. Overeating might lead to temporary gastrointestinal (GI) discomfort from feeling full, but it’s not accompanied by intense emotions or a sense of losing control.  In this article, we explore symptoms of binge eating disorder, how they are different from overeating symptoms, and when to get help. How is binge eating disorder (BED) different from overeating? We all overeat now and then, but BED is different. It is an eating disorder that involves feeling as if you have no control around food and having recurrent binge episodes followed by intense feelings of distress. BED is not defined by body size, and it is not about having a lack of willpower.  BED is a recognized mental health condition, as noted in the Diagnostic and Statistical Manual of Mental Disorder 5th Edition (DSM-5).  Binge eating vs. overeating “Occasional overeating is a universal human experience,” says Jen Simmons, PhD, LPC, lead therapist at Equip Health. “It typically occurs in social or celebratory settings like a holiday gathering, enjoying a favorite dish, or accepting an extra serving from a well-meaning family member.”  She adds, “while it might cause temporary physical fullness or mild stomach discomfort, it lacks a heavy emotional aftermath. BED, which is currently the most prevalent eating disorder, is entirely different. It is defined by a distinct, psychological loss of control.” BED can include compulsive overeating as a symptom, however. What are the signs and symptoms of binge eating disorder? BED features a mix of behavioral, emotional, and physical symptoms, as detailed below.  Behavioral symptoms of BED The behavioral symptoms of BED include regular binge eating episodes. But these behaviors aren’t personal failures; they’re a compulsion and part of a recognized mental health condition.  We all overeat now and then, but BED is different. It is an eating disorder that involves feeling as if you have no control around food and having recurrent binge episodes followed by intense feelings of distress. A binge episode is defined by feeling unable to stop eating (or control what or how much you are eating), and/or consuming an unusually large amount of food in a short period of time (e.g., within 2 hours). BED is not defined by body size, and it is not about having a lack of willpower.  “During a binge,” Dr. Simmons says, “an individual often continues to eat rapidly and long after feeling full, experiencing an out-of-body sensation where they feel unable to stop or pace themselves.”  Behavioral symptoms explained: Eating unusually large amounts of food in a short time: This is not about just eating lots of food in one day. Rather, it is about bingeing, as defined above. Feeling unable to stop or control eating during a binge: Binge episodes don’t have to do with willpower. Instead, physiological and psychological drivers perpetuate the behavior. Eating much faster than usual: Binge episodes typically involve eating rapidly without taking time to chew thoroughly or assess hunger and fullness cues. Eating alone or in secret: Instead of eating large amounts at a gathering, binging typically occurs in private. Binge eating regularly (not just occasionally): In the DSM-5-TR, the required frequency for a BED diagnosis is experiencing binge episodes at least once a week for 3 months Avoiding social situations involving food: Feeling a lack of control around food can make you avoid events or occasions where eating is expected. Emotional symptoms of BED The emotional symptoms of BED involve intense distress and feeling out of control around food. These emotions aren’t your fault—they often have complex roots, and binge behaviors amplify them. Hard emotions can also be binge eating triggers, perpetuating the cycle.  “Unlike normal overeating,” Dr. Simmons says, “BED can be a response to deep emotional distress. When we experience severe stress, anxiety, or painful emotions, our brains naturally search for a way to self-soothe.”  “Eating triggers a release of positive neurotransmitters that temporarily create feelings of comfort and satiety, essentially turning food into an emotional thermostat,” she adds. “This creates a complex, painful cycle. While occasional overeating passes without emotional concern, BED leaves behind a long-lasting wake of distress.”  Emotional symptoms explained: Feeling guilt after eating: Guilt can center on the feeling that you “should” be able to just stop bingeing. But the truth is that BED is a mental health condition with complex physiological and psychological mechanisms at play. Bingeing is not something you can just “stop” by commanding yourself to do so. Experiencing shame or embarrassment: Diet culture perpetuates ideas about how we “should” eat, and BED leads to behaviors that are outside those perpetuated norms. This can lead to negative feelings. But again, BED is not your fault. Feeling distress related to binge eating: Sometimes, BED develops as a result of distress in life and can become a coping mechanism. It also leads to intense distress regarding meals and snacks and social situations that involve eating. Feeling out of control around food: This is a huge factor in BED. Binge eating is a compulsion. While loss of control is also a behavioral symptom of binge episodes, this feeling of being out of control around food can extend outside of binge behaviors and impact other parts of life. Experiencing anxiety, sadness, or frustration related to eating behaviors: Eating is naturally tied to your brain’s pleasure, reward, and motivation mechanisms. Anxiety and depression can trigger binge episodes, and likewise, binge episodes can trigger these mental health symptoms. Having low self-esteem or negative self-image: Intense feelings, such as shame, embarrassment or guilt, can impact how you feel about yourself. Physical symptoms of BED The physical symptoms of BED are somewhat unique to each person, though a few tend to be relatively common, such as feeling uncomfortably full after a binge. Body size, however, is not a commonality. “A harmful misconception is that you can diagnose BED by looking at someone’s body size,” Dr. Simmons says. “Because individuals with BED do not engage in compensatory behaviors like purging, an outdated stereotype persists that BED only affects people in larger bodies. This is absolutely false. BED affects people of all ages, genders, racial backgrounds, and body types.” She adds, “conversely, assuming someone in a larger body automatically has an issue perpetuates harmful weight stigma. A person’s weight does not reveal their health status or their relationship with food. Challenging these visual biases is essential if we want to ensure everyone receives the care they deserve, regardless of their size,” Physical symptoms explained:  Feeling uncomfortably full after binge eating: Since binge eating episodes involve eating a large amount of food in a short period and eating past the point of fullness, your body doesn’t have time to adequately digest the food, leading to discomfort. Experiencing gastrointestinal symptoms: In addition to feeling full, you might also experience GI symptoms, such as nausea, acid reflux, diarrhea, constipation, and more. These symptoms can add to shame and other forms of emotional distress. Weight fluctuations: Although body size or body mass index (BMI) is not an indicator of BED, the recurrent binge eating can result in weight changes. Feeling sluggish or fatigued after binging: Binge eating episodes are sometimes followed by an energy crash because of mechanisms related to blood sugar and insulin or from feeling full. Intense emotions can also contribute to feeling exhausted. Experiencing sleep disruption: Sleep disruption isn’t necessarily a guaranteed symptom, but binge eating prior to bedtime can lead to poor sleep quality, as can ongoing GI symptoms. Metabolic health concerns: Not everyone with BED experiences physical health concerns. But BED increases the risk of high blood sugar, which can lead to prediabetes, type 2 diabetes, and other metabolic health issues. What’s the difference between binge eating disorder and bulimia nervosa? Binge eating episodes can also be a part of other eating disorders, including other specified feeding and eating disorder (OSFED), anorexia nervosa (AN) binge-purge subtype, and bulimia nervosa (BN).  Bulimia nervosa involves binge eating episodes followed by behaviors meant to “get rid” of the food or prevent weight gain, known as purging. Purging behaviors may include throwing up, using laxatives, overexercising, fasting, and more.  What’s the key difference between BED and bulimia nervosa? “The defining difference lies in what happens after the binge,” Dr. Simmons says. She adds, “For individuals with bulimia, purging offers a fleeting sense of emotional relief or control, with some describing a profound desire to feel ‘empty’ inside. Over time, this becomes an addictive cycle, making it incredibly difficult to consume food without feeling an overwhelming urge to get rid of it.” What do you do if you’re concerned about a loved one If you’ve noticed some of these warning signs of binge eating disorder in a friend or family member, you’re right to be concerned. You may be wondering how to talk to them in a loving and caring way about your concerns. This is an important step, albeit a challenging one. “Initiating this conversation is vital because BED thrives on secrecy and isolation,” Dr. Simmons explains. “The disorder grows in the dark, feeding on the belief that one’s struggles must be hidden.”  She adds that while your loved one might initially be distressed or defensive due to the shame associated with binge eating, these conversations also have the capacity to bring profound relief.  “By breaking the silence, you shatter the isolation,” she says. “You aren’t stepping in to police their eating habits, but rather to show them they no longer have to carry the overwhelming weight of this secret alone. Having the courage to start that conversation is truly the kindest thing you can do.”  So how do you start the conversation? “Often, the best approach is rooted in gentle honesty and observation, not judgment,” she says. “You might start by saying something like, ‘I've noticed some shifts lately, and it feels like you’re carrying a heavy burden. I love you. I see you suffering, and I want to help.’”  She adds that “recognizing that a loved one is struggling with BED requires looking beyond the food itself to notice shifts in their emotional and physical well-being.” When (and how) to get help If you’ve noticed BED symptoms in yourself or a loved one, you may be wondering when to seek help or how to encourage someone else to seek care. You can take this free five-minute symptom screener.  “Recognizing when to seek professional help for BED comes down to assessing how much mental and emotional space food is occupying,” Dr. Simmons says. “A primary red flag is a continuous cycle of frequent dieting or restriction followed by binge eating.”  She adds, “other critical signs include finding yourself actively planning out binge episodes, purchasing specific foods solely for a binge, or realizing you can no longer eat comfortably in public or around others.”  Seeking treatment for BED can feel overwhelming, but it is available without judgment, and recovery is possible. When seeking treatment, working with a multidisciplinary team of professionals who are eating disorder-informed is crucial. With BED in particular, treatment should not be weight-loss-focused, as that often backfires.  A care team for BED might include: A licensed mental health professional (such as a therapist) specializing in eating disorders A psychiatrist (if necessary) for medication management or treating multiple mental health conditions A recovery coach with expertise in BED who can offer peer support A registered dietitian to help navigate complex nutritional needs. Equip offers individualized, evidence-based binge eating disorder treatment and can coordinate with external clinicians as needed. Schedule a call here to get started. The bottom line BED is a complex mental health condition characterized by regular binge eating episodes, feeling out of control around food, and emotional distress. But life doesn’t have to be this way for you or a loved one.  “Food should not be a source of constant distress, anxiety, or warfare,” Dr. Simmons says. “It should be an enjoyable part of life that nourishes and sustains our bodies. I often tell families that if someone sits down for a meal and experiences visible discomfort, anxiety, or hypervigilance around food, there is an underlying issue that needs to be addressed.”  She adds, “The most dangerous approach is waiting to see if it just goes away. Eating disorders are progressive. The longer they go untreated, the more deeply entrenched the behavioral patterns and psychological pathways become, making them harder to untangle. Fortunately, you do not have to figure this out alone.” FAQ How often do binge episodes have to occur to be considered BED? In the DSM-5-TR, the frequency criteria for diagnosing BED is having binge episodes, on average, at least once a week for 3 months. Can you have BED without gaining weight? Yes, you can have BED without gaining weight. Body size, weight, and BMI are not part of the diagnostic criteria for this eating disorder. How do I know if my eating pattern is serious enough to get help? If food, food-related social situations, body image, or weight are creating distress for you, then getting help is important. You don’t have to look “sick” or appear a certain way to have an eating disorder or a disordered eating pattern. Eating disorders don’t go away on their own and generally get worse over time, so getting help as soon as you are concerned is essential.]]></content:encoded>
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            <title><![CDATA[What Is OSFED? Understanding this Often-Misunderstood Eating Disorder Diagnosis]]></title>
            <link>https://equip.health/articles/understanding-eds/OSFED-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/OSFED-eating-disorder</guid>
            <pubDate>Thu, 12 Feb 2026 17:22:00 GMT</pubDate>
            <content:encoded><![CDATA[When I was in my teens and early 20s, I knew my behaviors surrounding food and exercise were somehow disordered. But I didn’t have a name for my concerns. Instead, I felt as if my brain had cherry-picked behaviors or criteria from several different eating disorders and created a version all its own.  Not having a term for what I was going through was frustrating. I knew I needed help, but without a clear definition for my behaviors and thought patterns, I didn’t think I was “sick enough” to ask for that care. I delayed seeking treatment until a friend finally recommended an appropriate therapist and encouraged me to make an appointment.  Eventually, that wonderful clinician gave me a name for what was going on. She called it eating disorder not otherwise specified (EDNOS). Nowadays the language has shifted, and EDNOS is referred to as otherwise specified feeding or eating disorder (OSFED).  If you or a loved one is experiencing disordered eating or exercise behaviors that don’t fit under a certain label, you might be searching for answers about what’s going on so that you can get the right care. Know that no matter what you’re noticing, treatment is available, and recovery is possible.  In this article, we explore OSFED diagnostic criteria, OSFED symptoms, OSFED treatment, OSFED vs. EDNOS, and more.  What is other specified feeding and eating disorder (OSFED)? “In simple terms,” says, Rachel Levine, LMFT, LSWA, CEAP, a therapist at Equip,“it means someone is struggling with serious and disordered eating-related thoughts or behaviors that don’t fit neatly into one specific diagnosis, like anorexia or bulimia, but are just as real and have just as strong an impact in their life. It’s not a ‘lesser’ eating disorder; it’s a way clinicians name patterns that fall outside strict boxes.”  OSFED diagnostic criteria: You or a loved one presents with clinically significant symptoms of an eating or feeding disorder. The symptoms cause distress or impaired functioning. The presentation does not meet the full diagnostic criteria for another feeding or eating disorder. Levine makes an important point: OSFED, or EDNOS, as it used to be called, is not a less-severe eating disorder compared to others. But that can be a common misconception, and it was for me. My behaviors and symptoms didn’t fully align with anorexia nervosa or bulimia nervosa, for example, so I didn’t seek help. Yet what I was doing was still dramatically impacting my physical and mental health.  OSFED statistics: Despite not being as well-known, OSFED is a common eating disorder, with an estimated prevalence of up to 11.5% for people assigned female at birth and 0.3% for those assigned male.  OSFED vs EDNOS Eating disorders are mental health conditions outlined in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), the guide that clinicians use to help diagnose eating disorders based on specific criteria. Previous editions of the DSM used the term EDNOS, starting in 1987. But the DSM-5, which was published in 2013, officially retired the term in favor of using OSFED. The goal was to provide more information about the condition and to aid clinicians in diagnosing it so that patients like me could get appropriate care and treatment.  OSFED isn’t a perfect umbrella term, but the DSM-5’s updated language also includes more detail about the eating disorders that fall under it, helping to home in on what might be going on for patients. What types of eating disorders fall under OSFED? Several specific diagnoses fall under the OSFED umbrella. A brief look at these helps showcase why the term is needed to help more patients, especially those of us whose situation doesn’t fit neatly into a different category.  Atypical anorexia nervosa (AAN): This condition shares all the criteria for anorexia nervosa except that people with AAN are not considered underweight. Subthreshold binge eating disorder: This condition shares all the criteria for binge eating disorder except that the binge episodes occur at a lower frequency and/or for less than three months. Subthreshold bulimia nervosa: This eating disorder shares all the criteria for bulimia nervosa except that the binging and purging behaviors occur at a lower frequency and/or for less than three months. Purging disorder: People with this condition engage in purging behavior to control weight or alter body shape but they do not binge. Purging might include vomiting, misusing laxatives, or exercising excessively. Night eating syndrome (NES): This condition involves eating at night, whether after waking up or binge eating after dinner. Clinicians diagnose it when behavior doesn’t align with binge eating disorder or another condition. Other types of OSFED: The five conditions noted above are common forms of OSFED, but they do not make up an exhaustive list. Other conditions that could also fit under the umbrella of OSFED, but don’t always, include the following: Rumination disorder: This disorder involves a pattern of regurgitating undigested food from the stomach to then be spit out, rechewed, or reswallowed, usually within 15 minutes of eating it. Chew and spit disorder: This disorder involves a repeated pattern of chewing and then spitting out food before swallowing. This is also not a formal DSM diagnosis, but symptoms could be diagnosed under the umbrella of OSFED. Pica: This condition involves eating things that aren’t food, such as dirt, cloth, paper, and more. Orthorexia: This condition, though not considered a formal eating disorder, involves obsessing over “healthy eating” or “clean eating,” leading to disordered behaviors surrounding food and exercise. The focus might include eliminating entire categories of food, such as dairy, carbohydrates, gluten, or “white” foods without a medical reason (e.g., a diagnosed allergy, sensitivity, or intolerance). Note, though, that Pica and Rumination disorders are each their own distinctive diagnosis, not OSFED. But sometimes those with symptoms not meeting the full criteria could be diagnosed with OSFED. Keep in mind also that you can have OSFED without fitting neatly into any of these subcategories.  What are common signs and symptoms of OSFED? Pinpointing signs and symptoms of OSFED on your own can be difficult, since you or a loved one might have symptoms associated with multiple eating disorders. For example, if I were to take my own symptoms and treat the table in the section above like a personal bingo card, I would blot the squares for atypical anorexia, purging disorder, and orthorexia.  In this section, we’ve categorized the behavioral, psychological, and physical signs and symptoms associated with OSFED across the board. If you or a loved one is experiencing any of these signs, talking to a knowledgeable clinician is a good idea. These symptoms can dramatically affect quality of life and physical and mental health.  Behavioral signs Avoiding certain food categories (e.g., dairy, gluten, carbs, etc., without a diagnosed medical reason). Binge eating or feeling as if you have no control around food Chewing food and spitting it out before swallowing Compulsive or rigid exercise routines or rules Developing rituals around food (e.g., cutting food into tiny piece or eating slowly) Eating large quantities of food after dinner or in the middle of the night Eating non-food items (e.g., paper or chalk) Eating secretively or having difficulty eating in social situations Following rigid food rules Obsessive focus on eating “clean” Purging behaviors (laxative misuse, self-induced vomiting, exercising excessively) Regurgitating food soon after eating Restricting food intake Skipping meals or eating small portions Psychological signs Anxiety when foods you deem “safe” aren’t available Denial or minimization of serious behaviors Developing rituals around food (e.g., cutting food into tiny piece or eating slowly) Difficulty recognizing hunger or fullness cues Distorted body image Distress related to eating patterns at night Feeling out of control around food Intense fear of gaining weight or changing body shape Perfectionism or rigid thinking Preoccupation with food, meal timing, calories, or ingredients Strong feelings of anxiety, shame, or guilt regarding food or activity level Tying self-worth to eating habits, exercise habits, or body size or shape Physical signs Brain fog Changes in appetite Dental or throat irritation, brought on by vomiting or regurgitating Dizziness or lightheadedness from inadequate nutrition Feeling cold frequently Gastrointestinal issues (e.g., bloating, constipation, or abdominal pain) Significant weight gain Significant weight loss Nutritional deficiencies What are the health risks of OSFED? “The health risks of OSFED can be just as serious as those of any other eating disorder,” Levine says. “Because OSFED covers many patterns, the risks vary, but the potential harm should never be underestimated.”  OSFED can increase the risk for mental health conditions, including anxiety, depression, obsessive-compulsive disorder, substance use disorder, and more. And the list of physical health risks is extensive.  Physical health risks of OSFED Dental issues Difficulty concentrating/brain fog Digestive issues (e.g., constipation, diarrhea, stomach or esophageal damage) Electrolyte imbalances Fatigue Heart problems Infertility Muscle loss Nutrient deficiencies Obesity Organ failure Osteoporosis Slowed growth in adolescents Type 2 diabetes And more Is the term OSFED helpful? “The term OSFED can actually be very helpful when it’s understood for what it is: an inclusive diagnosis,” explains Levine. “It exists to recognize people whose eating disorder symptoms are serious and disruptive but don’t fit neatly into those clinical boxes.”  She adds, “Rather than excluding those individuals, OSFED ensures they are seen, taken seriously, and able to access appropriate treatment and support. When explained clearly to patients and their supports, I think it can be reassuring, communicating that you don’t have to meet a rigid checklist for your experience to be valid or worthy of care.”  For me, landing on the term EDNOS was super helpful. And now with the newer term OSFED and its more robust definition, I have an even better understanding of what I was going through when I was younger. I didn’t fit super clearly into a category, but I needed help, and I’m so glad I got it. I also am now able to recognize if an old pattern or behavior crops up, see it for what it is, and take action for care.  “One important thing to highlight,” Levine adds, “is that you don’t need a ‘perfect’ diagnosis to deserve help. OSFED is common, treatable, and valid. Recovery isn’t about fitting into a label. It is about feeling better, getting support, and rebuilding a healthier relationship with food and yourself.” What does OSFED treatment look like? Appropriate OSFED treatment is tailored to you or your loved one with the condition. It often looks different, depending on your unique set of behaviors, thought patterns, symptoms, and any co-occurring conditions. Plus, multiple forms of treatment may be necessary.   However, Levine notes several common treatment approaches: Cognitive behavioral therapy for eating disorders (CBT-E) Family-based treatment (FBT) Nutrition support through working with a registered dietitian “At Equip,” Levine says, “we do this as a team and make sure patients have access to a holistic approach that meets them where they are at and ensures they have access to the care they both want and need. Treatment focuses on both physical health and the underlying thoughts, emotions, and coping patterns connected to food and body image.” The bottom line OSFED is a serious mental health condition. It’s just as serious as other more well-known eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder and requires personalized treatment for you or a loved one.  But I want to leave you with a huge dose of hope: recovery is possible with a knowledgeable and passionate care team. I wish Equip had existed when I was in my 20s, but I’m happy to report that I’m fully recovered. Triggers sometimes crop up, but I now have the understanding and the tools to navigate them and cope. I’m ever grateful to my friend who connected me to the right therapist and to that therapist for helping me heal. FAQ What does OSFED mean? OSFED stands for other specified feeding and eating disorder. It is an umbrella term for diagnosing and giving name to a clinically significant feeding or eating disorder that does not match criteria for other feeding or eating disorder diagnoses. What is EDNOS now called? Eating disorder not otherwise specified (EDNOS) is now called other specified feeding and eating disorder (OSFED). Can you have OSFED and ARFID? Avoidant/restrictive food intake disorder (ARFID) is a distinct eating disorder, so if you or a loved one meet diagnostic criteria, the diagnosis is ARFID. However, sometimes people meet some but not all criteria for ARFID and may also meet some but not all the criteria for other feeding or eating disorders. In these cases, other specified feeding and eating disorder (OSFED) becomes the diagnosis. Can you recover from OSFED? Yes, you can recover from other specified feeding and eating disorder (OSFED) with the help of a knowledgeable and compassionate care team. Is OSFED serious? Yes, other specified feeding and eating disorder (OSFED) is just as serious as more well-known eating disorders, such as anorexia nervosa, bulimia nervosa, binge eating disorder, and more.]]></content:encoded>
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            <title><![CDATA[Understanding Diabulimia: When Diabetes and Disordered Eating Overlap]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-diabulimia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-diabulimia</guid>
            <pubDate>Fri, 29 May 2026 18:38:00 GMT</pubDate>
            <content:encoded><![CDATA[Managing type 1 diabetes can feel like a full-time job. It requires near-constant daily decisions about food intake, blood sugar and insulin management, activity levels, and more. This constant focus on food can lead to the development of disordered eating behaviors, including “diabulimia.” Diabulimia is a term used to describe restricting or skipping insulin doses to avoid weight gain. It is not a formal eating disorder diagnosis, but it is a dangerous practice that can lead to serious physical and mental health concerns. Because insulin is a life-saving medication for those with type 1 diabetes, abusing it can lead to serious—and potentially fatal—complications. But with the right specialized care, anyone struggling with diabulimia can find lasting recovery and sustainable health. In this article, we explore diabulimia symptoms, diabulimia treatment, and more. What is diabulimia? Diabulimia is a term used to describe insulin-dose restriction or avoidance in people with type 1 diabetes to control weight. Type 1 diabetes is an autoimmune condition in which the pancreas does not make enough or any of the hormone insulin. Insulin is generally required for cells to be able to access and use energy from foods, so those with type 1 diabetes need to take insulin medication in order for their bodies to function. Insulin also promotes energy storage and body mass increases. Restricting insulin means a person’s body cannot access the vast majority of the energy or nutrients in the food they eat, leading to weight loss—alongside serious physical consequences. “For those living with type 1 diabetes, restricting insulin is functionally synonymous with starvation,” says Tanya Hargrave-Klein, MS, RDN, LD, a dietitian at Equip. She adds, “Experts describe insulin as a biological key required to unlock the body’s cells. Without it, glucose remains trapped in the bloodstream, unable to be converted into vital energy. This metabolic breakdown leads to dangerously elevated blood sugar levels, leaving cells effectively famished despite the presence of nutrients.”  What happens in your body when insulin is restricted: When we eat, glucose rises in the bloodstream. In people without diabetes, the pancreas releases insulin. If you have type 1 diabetes, you need to take insulin because your body doesn’t make it—or enough of it. Insulin acts like a key that unlocks cells, allowing glucose to be either stored or used right away for energy. This lowers glucose in your bloodstream. Without insulin, glucose generally cannot get into cells for energy storage or use. With cells not able to use glucose effectively, your body must break down fat and muscle for fuel, leading to weight loss. The breakdown of fat produces ketones in the liver, which can reach high levels in the bloodstream. Ketones are acidic, and a buildup can lead to diabetic ketoacidosis (DKA), a life-threatening issue. Glucose also stays high in your bloodstream, where it can reach dangerous levels that harm tissues and organs.  Is diabulimia an eating disorder? Diabulimia is not an official eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Instead, insulin restriction is classified as a disordered eating behavior. What about type 2 diabetes and diabulimia? Diabulimia can occur with type 2 diabetes as well, but there are distinctions. Everyone with type 1 diabetes needs to take insulin medication; not everyone who has type 2 diabetes needs insulin therapy. But since diabulimia is characterized by purposely altering your insulin administration, people with type 2 diabetes who take insulin can develop diabulimia. The behavior is the same—restricting insulin in an attempt to control weight—regardless of whether a person has type 1 or type 2 diabetes. How common is diabulimia? The prevalence of diabulimia is unclear. However, a 2024 review of 14 studies found that about 10% of people with diabetes restrict or misuse insulin. This is especially true for people assigned female at birth. Another 2024 review article suggests that 20% to 30% of adolescent and up to 40% of adult females with type 1 diabetes have also experienced diabulimia. We also know that people with type 1 diabetes are more likely to develop eating disorders than people who don’t have the condition. How diabulimia works in the body and brain Insulin allows cells to uptake glucose to use as fuel or store for later. In people with diabetes, insulin restriction leads to weight loss because it forces your body to break down fat and muscle to be used for energy. “Whether categorized as dieting, dietary restriction, or restrained eating, the core mechanism remains the same,” Hargrave-Klein says. “An individual consumes less energy than they expend.” Insulin restriction leads to an energy deficit, which leads to weight loss. Diet culture tends to champion any type of weight loss, so weight loss from insulin restriction might feel rewarding. The feeling of “accomplishment” reinforces the insulin-restricting behavior. This causes a psychological loop that leads to more insulin restriction and more weight loss. “As the deficit deepens and weight loss accelerates, the brain is deprived of essential fuel, precipitating fundamental shifts in its chemistry, structure, and function,” Hargrave-Klein says. She adds, “An under-resourced brain gravitates toward rigidity, often manifesting as a preoccupation with food and obsessive, rule-based thinking. This psychological shift compels further restriction, creating a self-perpetuating cycle that is notoriously difficult to break without clinical intervention.” Meanwhile, insulin deprivation drives high blood sugar, which can complicate things further. “When blood sugar remains chronically high,” Hargrave-Klein says, “medical professionals often advise stricter dietary limits to compensate. Such clinical guidance can inadvertently validate and strengthen the existing behavioral cycle.” Additionally, insulin restriction drives high ketone levels, which can cause DKA, a medical emergency.  What are the signs and symptoms of diabulimia? Diabulimia doesn’t always look like disordered eating. The early signs can be subtle and even praised as good behaviors. “The historical emphasis on aggressively controlling diet, activity, weight, and insulin dosage in diabetes management creates a dangerous paradox,” Hargrave-Klein says. “For example, what appears to be a good-faith effort to maintain a healthy blood sugar level—such as fixating on food intake or diligently avoiding sugar—may, in reality, be disordered eating behaviors hidden in plain sight or cloaked in wellness culture.” She adds, “This confusion is compounded when weight loss resulting from insulin withholding is often mistakenly lauded by health professionals as a positive step toward better glucose control, further obscuring the symptom of an emerging eating disorder. This insidious overlap makes it easy for genuine eating disorder behaviors to be explained away in individuals with diabetes.” Here are the most common signs and symptoms of diabulimia. Behavioral and emotional signs Skipping, reducing, or avoiding insulin doses intentionally to lose weight Obsession with body weight, calories, dieting, or body image Fear of weight gain from insulin use Frequently checking weight or expressing dissatisfaction with appearance Hiding diabetes management habits or lying about blood sugar readings Avoiding diabetes appointments or becoming defensive about diabetes care Eating in secret, binge eating, or feeling guilt or shame around food Mood swings, anxiety, depression, irritability, or social withdrawal Perfectionistic thinking or feeling “out of control” with diabetes management Physical symptoms Frequent high blood sugar levels Increased thirst and frequent urination Unexplained weight loss Fatigue or low energy Blurred vision Headaches Dry skin or dehydration Frequent infections, especially yeast infections or urinary tract infections Nausea or stomach pain Fruity-smelling breath caused by ketones What causes diabulimia? As with all disordered eating or eating disorders, diabulimia can have several causes. Here are some common reasons it develops. Body image concerns: Insulin treatment often causes weight gain. This weight gain is healthy and necessary, but it can cause body image struggles, which can then lead to a desire to lose weight. Restrictive diets: Diabetes management sometimes requires dietary restrictions, and those who are predisposed to disordered eating patterns may find this triggering. A desire for control: Having a chronic illness like diabetes can make you feel like you have no control over your body. Restricting insulin can create a feeling of control. A focus on numbers: Diabetes management requires a heavy focus on numbers, whether for blood sugar readings, food labels, or other metrics. This focus can lead to a preoccupation with monitoring weight. Perfectionism: Perfectionism is a trait associated with eating disorders, and diabetes management can exacerbate this trait. What are the health risks of diabulimia? Diabulimia causes serious risks. “The most immediate danger is DKA, a life-threatening acute complication,” Hargrave-Klein says. “A severe lack of insulin forces the body into starvation mode, burning fat for energy and unleashing ketones into the bloodstream. As even a minor pH alteration can shut down organ systems, the resulting blood acidity associated with DKA can lead to coma and, tragically, death.” High glucose also presents complications. “Diabulimia's toll is swift and catastrophic, inflicting severe and often irreversible damage on the body,” Hargrave-Klein says. “When insulin is withheld, the body is flooded with relentlessly circulating glucose, resulting in dangerously high blood sugar levels. This chronic toxicity gradually damages organs.” According to Hargrave-Klein, here’s what that damage could look like: Vision is threatened as blood vessels leak into the eyes, causing irreversible impairment. Nerve damage leads to tingling and numbness in the hands and feet, potentially crippling mobility. Major organs are compromised, precipitating chronic kidney failure and cardiovascular disease. Health risks and complications of diabulimia Recurrent episodes of DKA (DKA is a medical emergency) Hospitalizations related to uncontrolled diabetes Severe dehydration Fainting or dizziness Difficulty concentrating or confusion Neuropathy (nerve damage) Kidney problems Eye damage or vision loss Irregular or missed menstrual periods Muscle loss and extreme weakness How do clinicians ‘diagnose’ diabulimia? If you believe that you or a loved one might have diabulimia, seeking help is vital. The condition carries serious health risks and can be life-threatening. Know that you may need to proactively reach out rather than wait for a doctor to say something, as endocrinologists may not realize what’s going on. If you or a loved one are experiencing any of the symptoms discussed above, talk to a trusted doctor who can help you determine if you’re dealing with diabulimia, another disordered eating behavior, or an eating disorder. Equip offers an easy self-screening tool that can be a helpful start on your journey—or you can schedule a call with an Equip team member. What does treatment for diabulimia look like? If diabulimia is confirmed, then building a comprehensive care team is the next step. “Treating diabulimia demands a dual focus—simultaneously addressing the life-threatening diabetes and the underlying eating disorder,” Hargrave-Klein says. “Effective intervention requires a dedicated, multidisciplinary team to manage the complex, entangled issues facing the patient.” She recommends: An endocrinologist with expertise in eating disorders and diabetes A certified diabetes care and education specialist (CDCES) or dietitian who also has eating disorder expertise A mental health professional specializing in eating disorders who also has diabetes experience A psychiatrist (if necessary) for medication management or treating multiple mental health conditions A recovery coach with expertise in diabetes and eating disorders who can offer peer support Equip Health offers individualized, evidence-based eating disorder treatment and can coordinate with external diabetes specialists for patients navigating diabulimia. The bottom line Managing type 1 diabetes is no easy feat. It requires monitoring your food intake and managing medications, including insulin. Taking insulin properly—which is vital and life-saving for those with type 1 diabetes—can lead to weight gain, which can be triggering. Diabulimia is the dangerous practice of restricting or skipping insulin doses in order to lose weight. But diabulimia is incredibly dangerous because it leads to high blood sugar levels (which damages organs and tissues) and high ketone levels which can cause DKA, a life-threatening medical emergency). If you or a loved one is struggling with diabulimia, help is available and recovery is possible. To start the healing process, it’s important to work with a multidisciplinary team that has expertise in both diabetes management and disordered eating. FAQ What are the long-term effects of diabulimia? The long-term effects of diabulimia include damage to organs and tissues, and diabetic ketoacidosis (DKA), which is a medical emergency. Severe weight loss, malnutrition, and other symptoms can also occur. Is diabulimia an official eating disorder diagnosis? Diabulimia is not an official eating disorder diagnosis. It is a valid term used to describe the practice of restricting or skipping necessary insulin doses to lose weight. It is considered a disordered eating behavior. Why do people restrict insulin? Some people who need insulin will restrict it due to not being able to afford the high cost of the medication or having poor healthcare coverage. Other people restrict insulin to lose weight. Either way, the practice of insulin restriction is extremely dangerous. If you are restricting insulin in order to lose weight, talk to your doctor or an eating disorder specialist immediately. If you cannot afford your insulin, reach out to the manufacturer of the brand you use. They can offer a free 30-day supply. Another resource is getinsulin.org. This site has a tool that can provide you with options when facing a crisis.]]></content:encoded>
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            <title><![CDATA[What Is EDNOS? (Now Called OSFED)]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-EDNOS</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-EDNOS</guid>
            <pubDate>Thu, 31 Aug 2023 00:07:00 GMT</pubDate>
            <content:encoded><![CDATA[Sometimes people experience eating disorder symptoms, but don’t meet the exact criteria for the primary eating disorder diagnoses. You may have seen the term “EDNOS” used to refer to eating disorders that fall into this gray area—but what is EDNOS? EDNOS, an acronym that stands for eating disorder not otherwise specified, is actually a diagnostic term that’s no longer in use, having been replaced by OSFED in 2013 (OSFED stands for other specified feeding or eating disorder). Though EDNOS is no longer an official diagnosis, it’s still used occasionally, so it’s helpful to understand what it means. Read on to learn more about OSFED (formerly EDNOS), what conditions fall under it, and what to do if you’re concerned about yourself or a loved one. EDNOS vs OSFED—what changed? First, it’s important to note that according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the clinically accepted replacement term for EDNOS is OSFED. Both acronyms mean the same thing, but EDNOS is now an outdated term, which is why we refer to the diagnosis as OSFED. EDNOS was a diagnostic category from the DSM-IV, which was used for individuals who had significant eating disorder symptoms but did not meet the full criteria for anorexia, bulimia, or binge eating disorder (BED). In 2013, the EDNOS diagnosis was officially retired and replaced in the DSM-V with OSFED and unspecified feeding or eating disorder (UFED). OSFED is used when a person’s eating disorder symptoms don't meet the criteria of another official diagnosis. It can show up in a wide variety of different ways, but also includes specific examples like atypical anorexia, sub-threshold bulimia or BED, purging disorder, and night eating syndrome, which are all serious but treatable eating disorders. UFED is typically used when there is not enough information to make a more precise diagnosis. Because EDNOS is now considered an outdated term, those who have previously been diagnosed with EDNOS may either now meet the full criteria for one of the other DSM-5 eating disorders, or are assessed as having either OSFED or UFED. The meanings of OSFED and UFED: clear definitions A person with OSFED has significant eating disorder symptoms but does not meet the full clinical criteria for a diagnosis of anorexia, bulimia, or BED. However, just because someone doesn’t meet the criteria for these disorders doesn’t mean their illness isn’t serious; OSFED, like other eating disorders, is associated with significant physical and psychological complications. Similarly, a person with UFED typically has significant symptoms of an eating disorder but does not meet the full criteria for any specific eating disorder. This diagnosis is used in situations where a clinician doesn’t specify the reason why a person doesn’t meet the full criteria for another diagnosis. That might happen in situations where a clinician doesn’t have enough time or information to make a more specific diagnosis, like in the emergency room, for example. The main difference between UFED and OSFED is that an OSFED diagnosis requires a clinician to provide a specific reason why the patient doesn’t meet the criteria for any other eating disorder (reasons might include things like a patient’s weight, or how frequently binge episodes occur, for instance). In the case of a UFED diagnosis, a clinician chooses not to specify the reason, usually due to lack of information or time. Symptoms of OSFED Because OSFED is an umbrella term for conditions that cause significant distress or impairment but don’t meet the full criteria for other specific eating disorders, the symptoms can vary widely. There are, however, some common symptoms that may be present across various subtypes. Eating and behavioral symptoms Dieting, counting calories, reporting new food allergies and/or avoiding food groups Compulsively exercising, even when sick or injured Using laxatives, enemas, diuretics or appetite suppressants Performing body checking Avoiding social activities Eating alone or in secret Hiding or hoarding food Self-inducing vomiting Chewing and spitting out food Making frequent trips to the bathroom during or after eating Showing increased interest in planning, buying, and preparing food for others but not eating it Obsessive rituals around food Cognitive and emotional symptoms Preoccupation with eating, dieting, exercising, or body image Sensitivity to comments about food, eating, dieting, exercise, or body image Increased anxiety or irritability, especially before, during, or after eating Shame, guilt, and/or disgust, especially after eating Distorted body image or body dissatisfaction Low self-esteem, depression, anxiety, and/or suicidality Physical symptoms Significant weight loss or gain Experiencing an absence of periods or change in menstrual cycle (for individuals with ovaries) Getting sick more frequently Showing signs of frequent vomiting, like swelling around the cheeks and jaw, or damaged teeth Experiencing fainting or dizziness  OSFED subtypes There are many subcategories of OSFED. These categories help define the different kinds of eating disorders that might not meet the standards of other official eating disorder diagnoses. A person’s symptoms don’t need to fit into one of these subcategories to have OSFED—no matter the specific label, any eating behaviors that cause significant impairment and distress deserve and require treatment. Here a few of the most common OSFED subcategories: Atypical anorexia nervosa: This term is used when a person meets all the diagnostic criteria for anorexia except low weight. Atypical anorexia is just as serious and carries many of the same health risks as anorexia, which is why, at Equip, we refer to it simply as anorexia. Bulimia nervosa (of low frequency and/or limited duration): Bulimia nervosa is a condition that involves eating large quantities of food (binge eating) followed by purging to get rid of it. Like binge eating disorder, a bulimia diagnosis has certain frequency and duration criteria (i.e., the number of times bingeing and purging occurs in a certain time frame, and how long it’s been going on). If you don’t meet these criteria, you might not be able to receive a bulimia diagnosis, despite experiencing the symptoms. For low-frequency or limited duration bulimia, getting an OSFED diagnosis means that you can still receive the treatment you need. Binge eating disorder (of low frequency and/or limited duration): A binge eating episode is defined as eating an amount of food that is definitely larger than most people would eat under similar circumstances, while feeling a lack of control over eating. For someone to get a BED diagnosis, they must binge a certain number of times per week, and that behavior must have been going on for a certain number of months. When people experience binge eating but don’t meet that frequency or duration criteria, they are diagnosed with this form of OSFED. Purging disorder (purging without bingeing): Purging refers to behaviors that involve intentionally “getting rid of” food from your body. Laxative misuse, excessive exercise, and self-induced vomiting are all common types of purging. Bulimia is another disorder that involves purging, but a bulimia diagnosis is also dependent on the presence of “bingeing” behaviors. When someone experiences purging but not bingeing, their symptoms may align more closely with purging disorder. Purging can start out as a coping mechanism for a different condition, and progress into a harmful habit. Night eating syndrome: This condition is specifically related to disordered eating habits that take place at night. That could mean eating more heavily in the evening or in the middle of the night upon waking. Some people are even still asleep (and therefore not conscious) when they take part in night eating. Is OSFED/EDNOS less serious than other eating disorders? It’s crucial to understand that eating disorders are complex conditions, and so a person’s symptoms don't always line up exactly with the specific symptom profile of a more commonly known disorder. Having OSFED (or EDNOS) isn’t an indication that someone’s condition is any less real or serious. OSFED can be severe and requires professional treatment, just like any other eating disorder diagnosis. In fact, research shows that OSFED can carry similar psychopathology to other eating disorders, and similarly improves with treatment. This is why early diagnosis and intervention are so important—evidence-based treatment can and does help those with OSFED heal and recover. Effective treatments for OSFED As with other eating disorders, treatment for OSFED includes evidence-based modalities like enhanced cognitive behavioral therapy (CBT-E), or family-based treatment (FBT). The specific approach that’s right for you or your loved one will depend on which eating disorder behaviors are present as well as other factors, including age. Whatever treatment is used, it will have a common goal of establishing normal eating routines and building new coping skills. In children, adolescents, and young adults, FBT is considered the gold standard, first-line treatment. It was created for eating disorders involving food restriction, but can also be effective for eating disorders where restriction plays a minimal role (although restriction is a root cause of most eating disorders). FBT is a targeted, structured treatment approach that requires parents and other family members to take on a central role in recovery. In adults, CBT-E—a specialized form of CBT designed specifically for eating disorders—is considered the first-line treatment for OSFED. Dialectical behavioral therapy (DBT) skills are also important for emotion regulation, as is nutrition rehabilitation and, sometimes, medical monitoring. Since it’s not as well known as other eating disorders, having an OSFED diagnosis can be an isolating experience. That’s why support groups can also be a key to recovery for anyone with OSFED. Connecting with others who have received similar diagnoses often helps people feel less alone, and serves as motivation for recovery. Treating an eating disorder promptly and with evidence-based care is vital, even if your or your loved one’s symptoms don’t line up with a traditional diagnosis. At Equip, we provide personalized treatment to all patients, which can be particularly helpful if you’re struggling with OSFED (or have been previously diagnosed with EDNOS), since OSFED symptom profiles can be so unique and varied. With treatment tailored to your needs, your provider team can help you heal your relationship with food, and find lasting eating disorder recovery. FAQs What does EDNOS stand for? What is it called now? EDNOS stands for eating disorder not otherwise specified. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), EDNOS was replaced with two new diagnostic categories to provide more specific and clinically useful diagnoses: other specified feeding or eating disorder (OSFED) and unspecified feeding or eating disorder (UFED). What does OSFED mean? OSFED stands for other specified feeding or eating disorder. It’s a diagnosis for individuals who have significant eating disorder symptoms that cause distress but do not meet the full criteria for a specific diagnosis like anorexia or bulimia. The diagnosis is used when a clinician can specify why the full criteria were not met. Examples include atypical anorexia nervosa (in which all criteria for anorexia are met, but the person is not clinically underweight) and purging disorder (which involves recurrent purging without binge eating). What’s the difference between OSFED and UFED? Both OSFED and UFED are diagnoses for individuals who have significant eating disorder symptoms that don't meet full criteria for other disorders. However, in OSFED a clinician can specify the reason the criteria are not met and in UFED, a clinician chooses not to specify the reason, often due to a lack of information or time (such as in an emergency room setting). Is OSFED a real eating disorder? Yes. OSFED is a real and clinically significant eating disorder that is recognized as a formal diagnosis in DSM-5. The diagnosis was created to ensure that individuals with serious, life-threatening symptoms receive appropriate care, even if they don't meet the full criteria for diagnoses like anorexia or bulimia. OSFED is not considered a less severe form of an eating disorder. What are the OSFED subtypes? OSFED has five distinct subtypes (but people can also be diagnosed with OSFED without falling into one of these subtypes): Atypical anorexia nervosa: All criteria for anorexia are met, but the person is not underweight. Bulimia nervosa of low frequency and/or limited duration: Exhibiting symptoms of bulimia but not meeting all clinical criteria. Binge eating disorder (of low frequency and/or limited duration): Binge eating that doesn’t meet the frequency or duration for BED diagnosis. Purging disorder (purging without bingeing): Recurrent purging behaviors to influence weight or shape, without binge-eating. Night eating syndrome: Recurrent episodes of eating after waking up from sleep. How is OSFED treated? In children, adolescents, and young adults, family-based treatment (FBT) is considered the gold standard, first-line treatment for OSFED. In adults with OSFED, enhanced cognitive behavioral therapy (CBT-E) is considered the first-line treatment.]]></content:encoded>
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            <title><![CDATA[What Is Bulimia Nervosa? Your Guide to Symptoms and Treatment]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-bulimia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-bulimia</guid>
            <pubDate>Mon, 27 Jan 2025 18:55:45 GMT</pubDate>
            <content:encoded><![CDATA[ Many times, people hear about bulimia when a celebrity opens up about their eating disorder history or tabloids make assumptions about a star's appearance. But the fact is, bulimia tends to be quite secretive—people with this eating disorder often try to hide the behaviors due to feelings of shame and guilt, leading many people affected to feel like they’re alone in their struggles. Yet in reality, about 2 percent of women and 0.6 percent of men will develop bulimia at some point in their lives, which equates to hundreds of millions of people worldwide. Although bulimia can be difficult to overcome, help is out there, and lasting recovery is possible with the right treatment. The first step to recovery is learning the facts about bulimia. Here’s everything you need to know—from symptoms to causes to treatment and more. What is bulimia nervosa? Bulimia nervosa, usually referred to as just bulimia, is an eating disorder characterized by episodes of binge eating followed by purging behaviors to “get rid of” the food. During a binge, a person consumes a large amount of food in a short period of time, often with a sense of being out of control. Afterward, someone suffering from bulimia can feel overwhelmed by feelings of guilt, disgust, or fear. These painful emotions then drive them to seek relief in the form of compensatory purging behaviors. Purging is commonly thought of as vomiting—and it can be. But it also includes any behavior that's done to try to get rid of or make up for calories consumed. This may include taking laxatives or diuretics, fasting or meal skipping, or excessive exercise. Unlike with anorexia (including anorexia binge-purge subtype), people suffering from bulimia will purge explicitly to compensate for calories consumed during a binge. Most medical professionals diagnose bulimia nervosa if someone binges and purges at least once a week for three months. Additionally, people with bulimia feel an intense need to try to achieve a certain weight or shape. This striving for a certain body “ideal” often results in food restriction that can lead to insufficient nutrition and, in turn, drive binge eating. Over time, the pattern of bingeing and purging can become compulsive, leaving the sufferer feeling trapped and hopeless. What are the signs and symptoms of bulimia? Like all eating disorders, bulimia often hides in secrecy. However, you may notice changes in behavior as well as physical signs that indicate someone is struggling. Below are some common bulimia nervosa symptoms. Behavioral symptoms Binge eating followed by purging (vomiting, use of laxatives, excessive exercise) Eating in secret and hiding food (you may notice food wrappers or missing food items) Frequently going to the bathroom after meals Avoiding social situations that involve food Exercising more often, even if injured or sick Showering after meals Psychological symptoms Preoccupation with weight and body	shape or size Fear of weight gain Guilt, shame, or disgust about their eating habits Depression Anxiety Substance abuse Physical symptoms Dental problems, such as damage to enamel (due to vomiting) Scrapes, scars, or bruises on hands and fingers (due to self-induced vomiting) Puffy or swollen area around the cheeks (due to vomiting) Irregular menstrual cycles What causes bulimia nervosa? Eating disorders are complex, brain-based mental illnesses. Rather than having one single cause, bulimia has a strong genetic component and is influenced by social, cultural, and environmental factors. Genetic factors Genes play a significant role in a person’s vulnerability to developing an eating disorder. Studies have found that genetics increase the risk of bulimia nervosa, as well as behaviors and attitudes that contribute to disordered eating. Environmental and social triggers Genes are only part of the equation. Someone may be genetically predisposed, but never develop bulimia because nothing in their environment “turns on” that genetic expression; and similarly, someone may not have any genetic vulnerabilities but go on to develop bulimia due to their environment. Everyone faces pressure to conform to society's unrealistic standards of body shape, size, and weight, and this alone can increase the risk of bulimia. These pressures can be even greater for certain people, including those who participate in appearance-based sports like wrestling, swimming, dancing, gymnastics, and figure skating, says Savannah Erwin, PhD, a clinical postdoctoral fellow at UNC's CEED (Center of Excellence for Eating Disorders). Having parents who are very focused on their weight and size may also be a factor. Another potential cause of bulimia nervosa? Your home life and the physical and emotional pressures that you're exposed to. “For many people, weight stigma and experiences of trauma or bullying can exacerbate feelings of inadequacy caused by societal pressures, like unrealistic beauty standards,” says Angela Celio Doyle, PhD, Equip's VP of Behavioral Health Care. “This can create a perfect storm for developing bulimia.” Psychological triggers Studies have found changes in brain activity in people who have bulimia. Additionally, anxiety, depression, perfectionism, and low self-esteem may increase the risk of developing this eating disorder. “Bulimia often co-occurs with anxiety and depression. The cycle of bingeing and purging can increase feelings of shame and isolation, worsening mental health issues. It’s a vicious cycle that can be tough to break,” Celio Doyle says. Risks and consequences of bulimia Bulimia nervosa can affect someone's physical and mental health, as well as their relationships and quality of life. However, almost all of these negative repercussions can be reversed, and the sooner someone is treated for bulimia, the better their chances of reducing or eliminating these consequences. Physical health risks Dental problems, such as cavities, tooth erosion, and pain Cardiac arrhythmias (or an abnormal rhythm of heart beats). This puts you at risk for	cardiovascular disease, stroke, and heart attack. Gastroesophageal reflux disease (GERD) Irregular periods Kidney damage Mental health consequences Anxiety Depression Feelings of guilt, shame, and loss of control Low self-esteem Harm to quality of life Impaired relationships. Having bulimia can make you less engaged when you're around loved ones. For example, “while a person with bulimia might go to dinner and a movie with friends, they might spend the whole time at the movie thinking about how they will purge,” Erwin explains. This type of mental preoccupation can make it impossible to be present with others, which can harm your relationships. Inability to cope. “Builmia can also result in issues with emotional regulation, making it difficult to cope with other stressors in life,” Celio Doyle says. Myths and misconceptions about bulimia Despite increased awareness about eating disorders, certain myths about bulimia persist. Here are three misconceptions—and the reality they obscure. Bulimia only affects young white women “Eating disorders affect people of all shapes, sizes, races, gender, ages, and socioeconomic status,” Erwin says. “They don't discriminate.” For bulimia specifically, research shows that Black and Latinx adolescents have a higher risk but are less likely to be diagnosed (an example of how harmful stereotypes can be). And although the onset of bulimia nervosa peaks in late adolescence, it can occur throughout the lifespan. Bulimia is also more common in girls and women, but boys and men suffer, too. Lastly, transgender and gender non-conforming individuals likely have a heightened risk for bulimia, as data suggest rates of eating disorders for this group are five times higher than for their cisgender and gender-conforming peers. Purging is an effective way to control weight In addition to being incredibly harmful, purging often fails to control weight because the behavior backfires—it often leads to more bingeing and can disrupt metabolism, Celio Doyle explains. “The body can become more efficient at storing calories, and over time, people may end up gaining weight,” she says. “Additionally, purging can cause serious health complications and doesn’t address the emotional and psychological factors driving the disordered eating.” Bulimia doesn't harm the health of people in larger bodies Everyone with bulimia—regardless of their size—is at risk of the health consequences discussed above. People in larger bodies may in some way be at greater risk of harm, because some healthcare providers have a weight bias. They may not consider that someone with a bigger body may have an eating disorder, or they may not be well-educated about eating disorders. Still, even if someone doesn’t appear ill or isn’t medically “underweight”, bulimia needs to be treated as soon as possible. How is bulimia nervosa treated? There's no standard “bulimia nervosa treatment guide.” Rather, treatment for bulimia is personalized to the individual and their circumstances. In general, treatment typically includes a form of therapy, and may also involve nutritional counseling and medication. The goal is to reduce symptoms and behaviors, improve quality of life, and try to reverse or minimize any health consequences, like electrolyte imbalances and dental erosion. Multidisciplinary approach Bulimia impacts various aspects of a person's life, from their physical to their mental and emotional health, and one healthcare provider can't address all of this. To achieve lasting, sustainable recovery from bulimia, you need a team. This often includes: A medical provider who can screen for health complications and monitor those risks on an ongoing basis. A trained therapist who's experienced in treating bulimia to address the mental and emotional health components of the disorder. A registered dietitian to help with meal planning, nutrition education, and normalizing eating habits. Evidence-based modalities Different types of therapy have been proven to help reduce the symptoms of bulimia and improve quality of life. Some of the most widely-used evidence-based approaches to treating bulimia include:  Family-based treatment: With FBT, patients’ family members are empowered to help their loved one normalize eating habits and stop purging behaviors. As eating patterns are normalized and disordered behaviors diminish, the patient begins to work with a therapist to address remaining symptoms, root causes, and any co-occurring conditions. With FBT, bulimia recovery happens at home. “By involving family members, FBT helps to strengthen communication and understanding, reduces secrecy, and fosters a supportive environment,” Celio Doyle says. “Families learn how to encourage positive behaviors and reinforce healthy habits, which can lead to better outcomes in recovery." Dialectical behavior therapy: DBT helps people regulate their emotions and improve their relationships, key factors in managing bulimia. “Individuals learn emotional regulation, which helps them handle feelings that might trigger bingeing or purging,” Celio Doyle says. “They also learn distress tolerance, so they can cope with tough situations without resorting to disordered eating. Lastly, mindfulness techniques help them become more aware of their thoughts and behaviors, making it easier to make healthier choices.” Enhanced cognitive behavioral therapy: Specifically designed to treat eating disorders, CBT-E focuses on changing the negative thought patterns and behaviors that contribute to the disorder, Celio Doyle explains. “Patients learn to identify and challenge distorted beliefs about body image, food, and self-worth. CBT also encourages healthier eating habits and coping strategies, making it easier to manage urges to binge or purge.” Medications In some instances, a physician or psychiatrist may prescribe medication to help treat bulimia. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat depression and anxiety, and they also have been shown to reduce symptoms of bulimia nervosa in adults. Fluoxetine is FDA-approved for this use. Virtual eating disorder treatment These days, a lot of bulimia treatment and recovery can happen at home thanks to telehealth. Virtual eating disorder treatment is convenient since you don't have to take time to commute to an office, and it also makes evidence-based care more accessible. Research also shows that it's just as effective as traditional in-person treatment. Recovery from bulimia nervosa: What to expect  Recovery from bulimia is a multidimensional journey, involving behavioral changes, physical rehabilitation, and emotional work.  The role of nutrition Nutritional balance helps support mental clarity and reduce disordered eating behaviors. “Regular meals and snacks help stabilize mood and reduce urges to binge and purge, supporting overall recovery,” Celio Doyle says. A registered dietitian can prevent you from falling into an eating rut that can undermine recovery. “They can help you come up with different ideas to meet your nutritional needs that don't feel redundant but also don't give the eating disorder room to pick and choose what it wants,” Erwin says. Developing healthier coping strategies “Identifying triggers and developing healthier coping strategies are key components of recovery, helping individuals manage stress without resorting to disordered eating,” Celio Doyle says. Building a positive body image People with bulimia tend to overvalue their physical appearance. Learning strategies to develop body acceptance and self-esteem helps reduce this harmful focus, Celio Doyle says. “It also helps people cultivate a healthier relationship with themselves, which supports long-term recovery,” she adds. How to support a loved one with bulimia If you're concerned that someone you love may have an eating disorder, you can be a source of support and encouragement to help them seek the professional care they need to recover. Although this will likely be a difficult conversation for both of you, you can do this. Here are some strategies to keep in mind. Use “I” statements “Approach the person with care and compassion,” Celio Doyle advises. “Use 'I' statements to express concern and avoid judgment. Let them know you’re there to support them, not to criticize.” Similarly, Erwin suggests sticking with the facts, expressing how you feel, and keeping things open-ended. This may mean saying something like, 'I'm concerned. I've noticed that you use the bathroom a lot after meals. Can you tell me what you're doing in there?' Help them seek treatment Bulimia treatment and recovery requires care from a team of professionals. Even if your loved one says they will stop on their own, it's incredibly difficult to overcome an eating disorder without help—they're simply that powerful and persuasive. So “encourage them to talk to a healthcare provider,” Celio Doyle says. “Offer to help them find resources or go with them to appointments, if they’re comfortable with that.” And don't hesitate to intervene if you notice severe signs of distress, health complications, or if the person is in crisis, she adds. Be there for them “Bulimia can come with feelings of shame and guilt. So continue to show up for your loved one and love them as they are,” Erwin says. “Give them a safe place where they can tell you they're having a hard day or their eating disorder is really loud.” You can also ask what they need, which may mean sitting with them at meals or letting them call you anytime they need support. Lastly, educate yourself about bulimia so you can better understand what they’re going through. If you're concerned that you or someone you love is dealing with bulimia, it's important to reach out for professional support. Talk to your doctor or schedule a consultation with an Equip team member. FAQ What is bulimia nervosa? Bulimia nervosa is an eating disorder. People with bulimia engage in bingeing (eating a large amount of food in a short period of time) followed by compensatory purging behaviors (such as self-induced vomiting, excessive exercise, skipping meals, or using laxatives). They also overvalue how they look and feel compelled to achieve a specific weight or body shape. How can bulimia affect someone's health? Bulimia can affect someone's physical and mental health. It can lead to tooth erosion, gastroesophageal reflux disease (GERD), kidney damage, and abnormal heartbeats called cardiac arrhythmias, which increases the risk of cardiovascular disease, stroke, and heart attack. Psychologically, bulimia often co-occurs with anxiety, depression, and low self-esteem. And overall, it can decrease someone's quality of life. How is bulimia treated? Treatment for bulimia is multidisciplinary. Medical doctors can monitor and treat any health consequences. Therapists often use family-based treatment (FBT), dialectical behavior therapy (DBT), and/or cognitive behavioral therapy (CBT) to help address the thoughts and behaviors associated with bulimia. Registered dietitians can help patients establish regular eating habits and ensure they’re getting the nutrients they need. Additionally, some people benefit from medications such as antidepressants. Treatment can occur in-person or online, and research shows that virtual care is as effective as in-person treatment.]]></content:encoded>
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            <title><![CDATA[What Is Pregorexia? Risks, Causes, and Treatment Options]]></title>
            <link>https://equip.health/articles/understanding-eds/pregorexia-risks-causes-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/pregorexia-risks-causes-treatment</guid>
            <pubDate>Fri, 11 Oct 2024 18:47:00 GMT</pubDate>
            <content:encoded><![CDATA[There are few times in life more emotional, transformational, and—frankly—challenging than pregnancy. Not only is the experience associated with huge life changes, but for those who have struggled with an eating disorder, pregnancy can also be uniquely triggering. While the data varies, the estimated prevalence of diagnosed eating disorders in pregnant women is between 5.1 and 7.5%, but the number of expectant mothers struggling with disordered eating and body image issues is likely higher. In fact, disordered eating among pregnant people is common enough that it’s coined at least one new term: pregorexia. First used in 2008, the term “pregorexia” is not a clinical diagnosis, but a media-created word used to describe pregnant women who reduce their food intake or exercise excessively in order to control pregnancy-related weight gain. While the condition isn’t an official clinical disorder, the phenomenon is very real, and it can have devastating consequences for both the expectant mother and her baby. Read on to learn more about pregorexia, including the warning signs, risks, and treatment options. What is pregorexia? Pregorexia occurs in the peripartum period, meaning the time immediately before, during, and after giving birth. The term refers to a pregnant person’s attempts to counteract the body weight and shape changes that occur during pregnancy by reducing calories, increasing physical activity, or both. “‘Pregorexia’ is a term that was coined to describe disordered eating behaviors and body image concerns that specifically occur during pregnancy,” says Equip Director of Program Development Tana Luo. “More specifically, pregorexia may be characterized by behaviors like restriction of intake and excessive exercise in order to avoid the weight gain and changes to the body that accompany pregnancy.” Pregorexia is not formally recognized by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or by the 11th edition of the International Classification of Diseases, but it is a serious issue and could be considered a clinical eating disorder, depending on the specific symptoms. “While it is not a recognized eating disorder in its own right, those who struggle with pregorexia may meet diagnostic criteria for an established eating disorder,” Luo says. “Furthermore, the risks and dangers associated with pregorexia are very real.” What are the risks of pregorexia? All types of eating disorders and disordered eating in pregnancy can have significant negative effects on both the pregnant person and their child, and pregorexia is no exception, whether the symptoms exhibited qualify it to be an “official” clinical disorder or not. “The behaviors associated with pregorexia may put pregnant people at risk for unstable vital signs, electrolyte disturbances, and dehydration,” Luo says. “Those who struggle with pregorexia may experience concerning symptoms, including dizziness, fainting, and fatigue.” Aside from the physical risks associated with pregorexia, Luo says the condition can also seriously affect the mother’s psychological well-being, increasing the risk of anxiety and depression, social isolation, guilt, and shame. Research shows that there is a significantly frequent co-occurrence of anxiety and mood disorders in pregnant women with eating disorders. Eating disorders in pregnant women have also been associated with an increased risk of postpartum depression, in addition to hypertension, anemia, and other complications. Of course, pregorexia doesn’t just affect the expectant mother—it can have serious negative effects on the unborn baby as well. Risks to the child associated with pregorexia can include everything from low birth weight and preterm labor to seizures, feeding problems, and future attention deficit disorders. “Lack of adequate nutritional intake may significantly impact the growth and development of the baby,” Luo says. “Risks include intrauterine growth restriction and low birth weight, preterm birth, and miscarriage.” How to identify pregorexia Like any eating disorder or form of disordered eating, pregorexia can manifest in a variety of ways, depending on the person affected and their unique circumstances. According to Luo, pregorexia is characterized by behavioral, cognitive, and emotional signs. Behavioral signs of pregorexia Limiting food intake Skipping meals Being overly restrictive or rigid in food choices Counting calories Purging Excessive or compensatory exercise Weighing oneself excessively Cognitive signs of pregorexia Obsessive thoughts about weight, body image, or size Obsessive thoughts about food Emotional signs of pregorexia Extreme fear or anxiety about weight and body image Experiencing guilt or shame related to weight gain In terms of physical signs, Luo says that lack of adequate weight gain during pregnancy can also be a red flag, particularly if it occurs alongside other behavioral, cognitive, or emotional symptoms. What does treatment for pregorexia look like? While there is no specific, one-size-fits-all form of treatment for pregorexia, anyone struggling with disordered eating during pregnancy (or any time) should seek help from a multidisciplinary team of experts offering evidence-based care. There is limited research on treatment strategies specifically for pregorexia, but the same treatment approaches that work for eating disorders outside of pregnancy are likely to be effective. The American Psychiatric Association recommends the use of cognitive behavioral therapy (CBT) and enhanced cognitive behavioral therapy (CBT-E) for pregorexia, which is the leading evidence-based approach for adults with eating disorders. “Given that pregorexia describes disordered eating that specifically occurs during pregnancy, established eating disorder treatments would be recommended,” Luo says. “Ideally, treatment would include a focus on the behavioral and psychological aspects of pregorexia, as well as ensuring adequate nutritional intake.” For the latter, people with pregorexia should work with an anti-diet, eating disorder-informed dietitian as well as a medical provider who can ensure that they’re eating enough—and enough variety—to support themselves and their growing baby. What to do if you or a loved one is struggling with pregorexia All forms of disordered eating tend to be shrouded in shame and secrecy. This can be even more pronounced in the case of pregorexia, as women who are struggling may feel guilt and shame about engaging in disordered behaviors that have the potential to harm their pregnancy. But in order to address pregorexia, it’s important for people dealing with these symptoms to speak up as soon as possible to seek support. “An important first step is to recognize the signs and symptoms of disordered eating during pregnancy and to acknowledge that these struggles are both normal and nothing to be ashamed of,” Luo says. “Society unfortunately puts a lot of pressure and attention on how people look both during pregnancy and postpartum. Validating the experience and reducing guilt and shame are crucial to then taking the next step of getting support.” If you’re dealing with pregorexia, or are worried about a loved one, don’t wait to reach out for support. Getting prompt, evidence-based treatment is crucial to the health of both the pregnant person and their baby. Talk with your doctor or a mental health provider, or schedule a call with an Equip team member.]]></content:encoded>
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            <title><![CDATA[Can You Prevent Anorexia? Here’s What Eating Disorder Experts Say]]></title>
            <link>https://equip.health/articles/understanding-eds/how-to-prevent-anorexia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/how-to-prevent-anorexia</guid>
            <pubDate>Fri, 26 Dec 2025 16:52:00 GMT</pubDate>
            <content:encoded><![CDATA[Anorexia is the second deadliest mental health condition, so it’s understandable to want to do everything possible to prevent it. The reality is that the causes of anorexia are extremely complex, and some of them—like genetic and biological factors—you can’t do anything about. But environmental factors also play a big role, meaning that there are steps you can take to prevent anorexia even in those who are predisposed to it. Read on to learn what everyone should know about how to prevent anorexia, as well as how to catch it earlier, which dramatically improves outcomes. Who is at risk of developing anorexia? Despite pervasive stereotypes that exist around who gets eating disorders like anorexia, they can affect any person, regardless of their demographic. “Anyone of any background, body shape, or age can get an eating disorder. Eating disorders don’t discriminate,” says Equip Therapist Lead Ana Gardner, MSW. Gardner points out that while research on anorexia has focused on young females in Western countries, anorexia occurs globally in all ages and genders. And while anorexia can impact anyone, females are diagnosed at a higher rate: research shows that during their lifetime, up to 4% of females and up to 0.3% of males suffer from anorexia (though many males likely go undiagnosed due to stigma). These numbers may seem small, but they represent millions of people, which is sobering given the seriousness of this illness. “Anorexia specifically has one the the highest mortality rates of mental illnesses and is associated with higher rates of suicide,” says Gardner. The major risk factors for people for eating disorders, including anorexia, include: Family history of an eating disorder/genetic factors. Equip Lead Registered Dietitian Stephanie Kile MS, RDN, explains that those who have another family member (typically a first-degree family member) diagnosed with anorexia or another eating disorder have a higher risk of developing the condition, due to genetic factors.  Losing weight. Gardner explains that for those who are predisposed to developing an eating disorder, significant weight loss in childhood or adolescence can trigger anorexia. In fact, at any age, being in a negative energy balance (aka eating fewer calories than you burn) can “turn on” an eating disorder in someone who is vulnerable to developing one. Other mental health conditions. Those with anorexia often have co-occurring conditions, like depression, anxiety, or neurodivergence. Perfectionistic personality traits. Studies have found that perfectionism is associated with a number of eating disorder diagnoses, including anorexia. Exposure to trauma. About 25% of people with eating disorders have PTSD, and trauma can increase risk. Elite sports. Athletes are at an increased risk of developing an eating disorder due to a variety of factors, including body-based pressures and normalization of harmful behaviors. Use of appearance-focused social media. Research consistently shows that certain types and uses of social media increase body image distress and raise the risk of adopting disordered eating habits. Bullying. Those who have had comments or been bullied about their weight or body, may also be at a higher risk. Internalization of a thin-ideal. ““There are so many messages out there that restricting and smaller bodies are ideal and learning ways to achieve this are everywhere,” Kile says. “The ease of access to the information is always increasing, so learning typical anorexia behaviors is at anyone's hands.” Body dissatisfaction. Poor body image for whatever reason is linked with a higher risk of developing an eating disorder. Diet culture. We live in a society that consistently tells everyone (including impressionable young people) that thin bodies are better, and this can do considerable damage. “The messages we hear can impact how one perceives their body, the foods they consume or don’t consume, and how they move their body,” says Kile. “The culture you are around can also influence anorexia, both native culture of family origins and those you are commonly around, such as a sport, gym culture, or field of work.” Why prevention is key: Understanding the harmful effects of anorexia “Anorexia is a life-threatening illness that can have long-term consequences, up to and including death if not treated,” Gardner says. “If you or your loved one is struggling with anorexia, there is hope! You’re not alone and help is available. Anorexia is treatable. Prevention can reduce some risk factors and increase emotional resilience, and research suggests that earlier intervention is likely to shorten illness duration or improve outcomes in anorexia.” Kile adds that while anorexia is a treatable condition, taking steps to prevent it will help lessen the burden and impact that the condition and treatment takes on a person and their family. “The impact this has trickles into every aspect of the individual and their families lives, making prevention important,” she says. “Treatment can take years for some due to requiring weight regain, learning new coping strategies, learning how to introduce movement back, rewiring the brain to continue to grow and develop properly, allowing the body to heal—and then, if they’re an adolescent, get back on their growth curves.” How to prevent anorexia While there is no single, surefire way to prevent anorexia, there are a number of things you can do to help drastically reduce the risk of you or a loved one developing it. Whether you’re worried about your child developing anorexia, or concerned about your own risk, consider these prevention strategies: Know the genetic risks. Kile advises learning whether you have a family history of eating disorders. If you do, then “as a family, make it key to not allow diet culture to seep in and impact your family’s actions towards food and movement,” she says. Avoid linking exercise with food. “Reduce negative body talk or making connections that movement is needed if you eat a particular food,” Kile says. Even seemingly harmless comments about “deserving” or “earning” foods because of physical activity can send damaging messages. Promote healthy body image. “Educate yourself and your loved one on media literacy, diet culture, the unrealistic thin ideal and health at every size (HAES),” Gardner says. “Practice making affirming statements about others outside of their bodies—comments like, ‘I love your energy’ or ‘your personality really shines when XYZ.’ Compliment yourself and others outside of their appearance. Make your space an ‘anti-diet culture’ zone and redirect conversations when they talk about diet culture.” Know what messages your child is hearing “Check in with your children if they are on a sports team or dance, or any club if coaches or instructors are teaching things about foods or bodies, so that you can provide greater insight on what was shared,” Kile says. “This is a common place where influence happens, and children trust that what people in these roles share are facts and truths, when sometimes it is just that individual's beliefs they are sharing with others.” Have all foods fit. “Diet culture has villanized various foods and called them ‘junk’ or off limits,” Gardner says. “Refrain from demonizing any food, but include a variety of foods into your lifestyle. Aside from allergies, make room for all foods that you enjoy! Another way of saying all foods fit is saying all foods are your friend. This allows freedom with foods instead of a restrictive mindset. Practice regular eating and reach out to a HAES-aligned RD if you’re curious to learn more.” Normalize body changes. “We live in a culture and society that expects bodies to stay the same for decades,” Gardner says. “We live in an anti-wrinkle, anti-aging, diet-culture society that has created unrealistic ideals. Normalize weight gain and body changes as individuals grow, age and develop. Allow, expect and embrace body changes as life happens.” Promote healthy self esteem, coping skills and emotional resilience. “Find purpose, value and identity outside of appearance,” Gardner says. “Ask yourself, ‘What makes me me,’ ‘Who am I outside of my body and body image?’” When to seek professional help for anorexia According to Gardner and Kile, it’s time to see professional help for anorexia when you or your loved one: Have an intense fear of gaining weight or continual behavior to avoid or prevent weight gain Experience increased fatigue, weakness, or tiredness Have a preoccupation with weight and body size Notice shifting mentality around food (e.g. rejecting previously enjoyed foods and preferring “healthy” or low-calorie foods) Adopt strange behaviors around food, like playing with food instead of eating it, hiding food, lying about food, or eating in a ritualized way Engage in excessive or compulsive exercise (exercising when sick or injured, over-exercising, becoming distressed if a workout is missed) Use purging behaviors (vomiting, laxative/diuretic use) Refuse to eat with others or social withdrawal due to food Lose weight or fall off the growth curve Experience menstrual changes or amenorrhea Have anxiety around meals Experience increasing perfectionism, irritability, mood changes, or obsessive thinking about food/weight “While prevention is a great goal, eating disorders impact anyone and everyone, so while you may take all the steps to prevention, don’t be discouraged if you or someone you love does get impacted with anorexia, just remember to take the steps towards care and continue moving forward,” Kile says. If you’re concerned about your own risk of developing anorexia or worried about a loved one, our free eating disorder screener can help you determine next steps. You can also schedule a call with our team to discuss treatment options. Equip has no waitlist and is covered by most insurance. FAQ Who is at risk of developing anorexia? Anyone of any age, sex, gender, race, or ethnicity may be at risk for developing anorexia, but certain factors elevate that risk. Some of these risk factors include genetics or family history of eating disorders, exposure to trauma, perfectionistic traits, other mental health conditions, use of appearance-focused social media, and body dissatisfaction, among others. Can you prevent someone from developing anorexia? While there is no single, proven strategy for preventing anorexia in those predisposed to eating disorders, prevention efforts still matter. Promoting healthy attitudes toward food and body image can reduce risk and knowing the warning signs can help you catch it early, which leads to better treatment outcomes. What are some strategies to prevent anorexia? It may be possible to reduce the risk of developing anorexia by encouraging balanced, flexible eating and an “all foods fit” approach, avoiding dieting and weight-focused talk, promoting body acceptance, and teaching coping skills for stress and perfectionism. It’s also important to continue checking in with loved ones who may be at risk, and consistently discussing the messages they’re receiving from outside sources regarding food, exercise, and body image. What are some signs that my loved one needs anorexia treatment? Some signs that a loved one needs anorexia treatment may include food restriction, fear of weight gain, obsessing over calories or exercise, avoidance of meals, physical changes, and intense distress around eating or body image. If these, or other signs of trouble arise, it’s important to seek professional help right away. You can schedule a call with an Equip team member to talk through your concerns and determine next steps.]]></content:encoded>
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            <title><![CDATA[Eating Disorders in Teens: What You Need To Know]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-in-teens</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-in-teens</guid>
            <pubDate>Wed, 30 Nov 2022 22:11:00 GMT</pubDate>
            <content:encoded><![CDATA[I thought I knew a lot about teenagers and mental health — and eating disorders in teens specifically. I’d studied adolescent development in graduate school, worked as a high school teacher and athletic coach, and knew teens who had struggled with eating disorders. I should’ve been able to spot the early warning signs of an eating disorder in my own teen, right? As it turns out, I wasn’t. Because I believed some common myths about eating disorders — including that someone has to “look sick” to have one — I didn’t realize that one was taking root in my own house. I learned a lot the hard way, but as rates of eating disorders in teens continue to rise, it’s essential for more parents to become proactively educated about these deadly illnesses. Rates of eating disorders in teens Although eating disorders can emerge across a person’s lifespan, the teen years are an especially vulnerable time; research indicates that around 95% of eating disorders begin between the ages of 12 and 25. And since the start of the pandemic, rates of eating disorders in teens have increased significantly, with hospitalizations doubling. It’s worth noting that these statistics don’t even account for the many teens who are never diagnosed. And while anyone can develop an eating disorder, we know that certain teens may be particularly at risk: LGBTQ+ teens have significantly higher rates of eating disorders than their straight, cis peers, and teen athletes are more likely to develop eating disorders than teens who are not in sports. Both parents and health professionals may miss eating disorder symptoms in teens who don’t fit the stereotype of the thin, white, affluent, teen girl, but the truth is that eating disorders affect teens of all body sizes, races, socioeconomic classes, and genders. Causes of eating disorders in teens It’s rare to be able to pinpoint one specific catalyst for someone’s eating disorder, and we lack research that could establish a simple, direct cause. Regardless of a person’s age, eating disorders often develop out of a “perfect storm” of contributing factors, such as genetic vulnerability combined with environmental, social, or cultural factors. (Read more about the different causes of eating disorders.) The teenage years in particular present a host of factors that can fan the flames of an eating disorder, helping to explain the high rates of eating disorders in adolescents. For one, hormonal changes during puberty may play a role in the development of eating disorders, particularly for girls. Social media is at the center of many teens’ lives, and research has shown that these platforms may aggravate existing body image concerns or disordered eating. For older teens, the transition to college can be a high-risk time for the onset of an eating disorder or a relapse in those who struggled earlier in their adolescence. Signs of eating disorders in teens The signs of eating disorders in teens are quite similar to those in other age groups. However, the unique characteristics of the teenage years can mask some signs, making it easier for caring adults to miss them. Indeed, eating disorders at any age can be difficult to identify, but stereotypes about teenagers add a new layer of challenge. Family members, teachers, and coaches often mistake eating disorder symptoms for “normal” teen moodiness or self-consciousness, and the secrecy and isolation that tend to accompany eating disorders can be written off as a developmentally normal desire for more privacy and independence. In addition, if a teen declares they’re adopting a new way of eating, parents can explain it away as them simply going through a phase. Well-meaning adults and peers might even praise and encourage these attempts to “eat healthier.” However, suddenly cutting out entire food groups (like meat, dairy, gluten, or processed foods, for instance) can be an early warning sign of an eating disorder. Becoming more appearance-conscious is also a big part of adolescent development, and body dissatisfaction among teens has become so normalized in our culture that it’s frequently dismissed as a rite of passage. However, while negative body image might (sadly) be increasingly common, it can also be a sign the teen may be struggling with some serious mental health challenges –— especially if any of the other signs are coupled with it. Challenges in treating teens with eating disorders From schoolwork and extracurriculars to college applications and social pressure, the teen years are stacked with challenges even without the addition of an eating disorder. This reality means that prioritizing recovery usually requires a lot of adult support, especially for a high-achieving student or competitive athlete. A teen with an eating disorder may have to adjust their course load, pause participation in sports, or even take a medical leave from school — and they’re unlikely to be able to make these recovery-minded decisions on their own. Even though family-based treatment (FBT) is the evidence-based treatment for eating disorders in adolescents, parents may feel uncertain about having such an active role in their teen’s recovery. Because independence is such a central part of the teen years, parents may feel uncomfortable making the shift to FBT, which requires that family members temporarily make all food decisions and supervise meals. The crucial thing to remember here is that in order for your teen to develop true autonomy and resume their healthy development, they must first become independent from their eating disorder. While it can feel like punishment for a teen to lose certain freedoms or to pause the trajectory of their external achievements, in reality they are being protected from the negative consequences of their eating disorder and given the chance at true freedom in the future. What to do if you are worried your teen has an eating disorder Family members who notice changes in their teen’s attitude toward food, exercise, or their body are often hesitant to say anything; parents may fear drawing attention to the behavior or worry they will end up making things worse. It’s easy for eating disorders to make the rest of the family start walking on eggshells, but staying silent means the eating disorder is thriving, at your teen’s expense. In fact, one of the most powerful things a parent or guardian can do is approach their teen with compassion and curiosity rather than judgment. A conversation starter might sound like, “I’ve noticed you’ve stopped eating dessert. Would you tell me more about that change?” If you’re worried about your teen, have them seen by their primary care physician as soon as possible. Checking their height and weight and ordering any needed lab work or other tests will give you some essential data to help guide next steps. Keep in mind that many primary care physicians lack sufficient training in eating disorders and may not realize how ill a teen is, especially if they are not medically “underweight.” Many doctors may recommend a “wait-and-see” approach, a well-meaning strategy that can lead a teen’s eating disorder to become more severe and more difficult to treat. Remember that eating disorders aren’t a “phase” your teen will “grow out of.” Since early intervention carries a better prognosis with eating disorders, if your gut tells you something isn’t right — even if the primary care doctor says not to worry yet — ask for a referral to an eating disorder specialist for a thorough evaluation. All people with eating disorders deserve timely, effective treatment, but for teens, there are some particular health factors that can make the matter even more pressing. Teens who are malnourished are at risk for losing lifetime bone density during the body’s finite period of bone growth and development. Having an eating disorder also increases the chances of developing substance use disorder, which is particularly damaging for the developing teenage brain, and raises suicide risk in a population that already has the highest prevalance of suicidal thoughts. What families should remember about teens with eating disorders If your teen has an eating disorder, you may be feeling scared, helpless, or even guilty, wondering what you could have done differently. It’s important to remember that families are not to blame but can be a critical source of recovery support, even for a fiercely independent teen. Your teen may be mature in many ways, but they are still your child. And as much as they and their eating disorder may want to push you away, your teen needs you more than ever. Through supporting the hard work of recovery, you are literally saving their life and giving them the foundation they need not only to survive but to thrive. The recovery process is challenging for the whole family, but it’s so worth it. While I may have missed the early signs of an eating disorder in my teenager, it didn’t prevent our family from getting up to speed and learning what we needed to do to support recovery. And my early fears of harming the relationship with my teenager or interfering with adolescent development were allayed when we got to the other side of this illness. With support, eating disorder recovery for your teen is possible.]]></content:encoded>
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            <title><![CDATA[Boys and Men Get Eating Disorders — Here’s Why We Miss Them]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-in-men-and-boys</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-in-men-and-boys</guid>
            <pubDate>Wed, 02 Nov 2022 23:01:00 GMT</pubDate>
            <content:encoded><![CDATA[Stephen Klagholz was an active and athletic elementary school kid when his eating disorder took root. His interests gravitated toward fitness and nutrition, and his increasingly intense preoccupation with his body and food was supported—even admired—by those around him. Klagholz says that consequently, his entire adolescence was spent “honing eating disorder behavior and worsening my body image,” but his problematic thoughts and behaviors were easy to mask. On the surface, he seemed like a dedicated athlete, pursuing a “healthy” lifestyle. While our society may be starting to recognize the warning signs of eating disorders across groups, during Klagholz’s formative years, being a boy meant his eating disorder would slip through the cracks of care. “It wasn’t until I was a sophomore in high school, when I was already years deep into restrictive dieting and over-exercising, that I was diagnosed with anorexia,” Klagholz says. It took until sophomore year of college for Klagholz to be admitted to an inpatient program. “The masculine ideals around me were both fuel for my eating disorder and a diversion for others who couldn’t recognize that I was dealing with a deadly illness,” he says. “Over 20 years later, I still encounter people, including health care professionals, who perpetuate the stereotype that eating disorders only affect women.” While we’ve made strides in understanding that these diseases don’t discriminate, there is still rampant misinformation surrounding eating disorder diagnoses in men and boys. So why are so many individuals who identify as male not receiving the care they deserve—and what can we do to change the landscape of diagnosis and treatment? How common are eating disorders in men and boys? Before diving into the statistics, it’s important to recognize the nuances around gender, sex, and identity. The social pressures, media influences, and body image ideals that burden gay men, trans men, and nonbinary folks may vary from those that impact cisgendered, heterosexual men. But while eating disorders can manifest for different reasons and present in a multitude of ways, the overarching reality is that individuals who identify as boys and men are simply not receiving adequate care. “The biggest misconceptions I’ve seen related to boys and men with regards to eating disorders is that eating disorders are a ‘female disease’ or that men who get eating disorders ‘must be gay,’” says Equip VP of Medical Affairs Katherine Hill, MD. “These stereotypes are not only untrue, but also extremely harmful. Eating disorders are often missed in boys and men until they are extremely ill. We used to think that about 10% of those with anorexia nervosa were male, but now we know it’s more like 25% or even a third, and potentially even higher when taking into account how often the diagnosis is missed in males.” Hill says that research now indicates higher rates of eating disorders like avoidant/restrictive food intake disorder (ARFID) in males than in females, so the notion that eating disorders are a girls’ issue is “patently false.” “Often, the men I work with are ashamed and guilty about struggling with an eating disorder. And while those feelings of guilt and shame are common, boys and men are generally taught to hide their emotions because expressing an emotion that is not anger is a sign of weakness. These extra layers of self-criticism can heighten the obstacles to recovery and help-seeking behaviors,” says Equip therapist Jonathan Levine, LCSW. Klagholz says that he knows he’s not alone as a man who has struggled with an eating disorder. “I’ve been in sports my whole life and worked professionally in fitness for close to a decade,” he says. “I can say, without question, that I’ve encountered a significant number of men who exhibit extremely disordered behaviors around food, exercise, and body image. What I find most interesting is that there seems to be a strong level of reinforcement of these behaviors and accompanying thought processes among men and within society. In my experience, competitiveness among men to be the healthiest, the fittest, or the most ripped abounds and has a huge impact on how men conduct and value themselves.” Why boys and men aren’t getting proper eating disorder treatment With males accounting for a significant portion of people with eating disorders, why are health professionals letting so many of them slip through the cracks? For one, eating disorders may not look quite the same across genders. “Body image concerns in boys and men often present a bit differently than in females and tend to be more focused on gaining muscle or getting ‘ripped’ rather than on thinness,” Hill says. This phenomenon is sometimes referred to say "bigorexia." “So my male patients with anorexia nervosa, for instance, are often going to the gym compulsively and eating a very restrictive diet, often limited in carbs and high in protein, and sometimes using muscle-building supplements or steroids.” Another issue is that experts have long considered lack of menstruation—otherwise known as amenorrhea—one major criteria for diagnosing anorexia specifically. It wasn’t until the publication of the DSM-5 in 2013 that amenorrhea was removed from the mandatory list of diagnostic criteria.  And while eating disorders like anorexia may present in more “traditional” ways in individuals who identify as female, eating disorders in boys and men may hide in plain sight as the “bulking and cutting” dietary technique popular in fitness, which involves alternating between periods of caloric surplus and restriction to increase muscle definition. Hill says that while girls and women tend to present with more straightforward eating disorder signs, like a lack of period or extreme weight loss, “the warning signs can be more subtle in boys and men. We’re much better at picking up on eating disorders in female patients because they tend to fit the stereotype.” Another reason boys and men may not be getting the help they need is that, as Klagholz experienced, society often reveres a male obsession with fitness. “We often forget that boys and men are faced with unrealistic body ideals in popular and social media, just like girls and women are,” Hill says. “Male celebrities often go on extreme diet and exercise regimens for a movie role, for instance, and these behaviors are then mimicked by well-meaning boys and men. And our society praises these extreme behaviors as ‘healthy’ when in reality, they are anything but. Fortunately, some male actors like Zac Efron and Shawn Mendes are now speaking up about their own body image and health struggles.” Another barrier to care may simply be that proper treatment for male eating disorders can be hard to come by. Equip Patient Services Representative Kristen Davis says that when her son received an eating disorder diagnosis ten years ago, it was a challenge to find adequate care; unfortunately, a decade later, she still hears from other parents echoing the same frustration and desperation. “When my son was diagnosed with anorexia, it was almost impossible to find treatment for him, even though he was undernourished and hospitalized for his dire condition. We couldn't find a program, let alone one within our insurance coverage, to accept a male without a lot of challenge and perseverance,” she says. Hill says this gap in awareness and aptitude at the professional level trickles down. “Truthfully, very few people, including many healthcare professionals and even the patients themselves, know that males can get eating disorders too,” she says. “I’ve heard some of my male patients say, ‘I didn’t know guys like me could get eating disorders.’” How can we improve care for male eating disorders? While the intricacies of eating disorders in men and boys are distinct in some ways, the continued lack of understanding and care for this population speaks to a broader issue: our society still has a long way to go in comprehending the complexities of these illnesses. Levine says that initiating and participating in frank conversations may help move the needle on progress. “Normalize all emotional experiences without judgment or criticism,” he says. “Challenge the hidden messages boys and men are shown in movies, TV, social media, and music when you see it. Lastly, stay curious! Curiosity is a powerful mechanism to challenge fear and support healing.” Hill says the most important takeaway is that eating disorders affect everyone and there is nothing shameful about these mental illnesses. “If you or a male loved one develops an eating disorder, the first thing I’d say is that despite how it may feel, you’re absolutely not alone,” she says. “Eating disorders are common in boys and men, and increasing in prevalence. The second thing I’d say is that it’s not your fault, your loved one's fault, or anyone’s fault.” Davis believes early intervention could start in the classroom if educators were properly informed and trained about the warning signs of eating disorders across demographics. “I can't state enough how important it is that schools become trained in eating disorders and how to identify students suffering,” she says. “As someone who worked in a school for 11 years, and a parent whose child deteriorated in front of our and his school's eyes, I know firsthand that there needs to be regular faculty training and a process in place to educate and help students.” Now recovered, Klagholz believes social support and connection are essential—particularly in boys and men who may feel isolated in their experience. “Finding a male peer mentor with lived experience may not sound great to the person initially but, with the right connection, such a relationship can be extremely valuable,” he says. This goes for family members, too. “Consciously challenging your own beliefs about eating disorders and possible stereotypes ingrained in your mind will be very important for anyone supporting a boy or male with an eating disorder,” he says. “You should understand that your loved one may not exhibit all the ‘normal’ signs of an eating disorder. Find a support group of other people with experience of a male loved one having an eating disorder.” And finally, Klagholz reiterates the undeniable impact a simple check-in can have on a loved one’s life. “Don’t risk it—one conversation can go a long way,” he says. “I urge people to simply be aware of the possibility that their male loved one might have an eating disorder. If there’s a concern, it should be talked about, investigated, and observed. ” If you're concerned that you or a male loved one may be struggling with an eating disorder, it's important to get help. Speak to your medical provider or schedule a consultation with one of our team members. ]]></content:encoded>
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            <title><![CDATA[How Eating Disorders Impact Sleep (and What to Do About It)]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-and-sleep</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-and-sleep</guid>
            <pubDate>Tue, 19 Aug 2025 18:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders can wreak havoc on a seemingly endless list of things, from physical well-being and mental health to relationships, family dynamics, and more. But one area that is often overlooked when it comes to the repercussions of these illnesses is sleep. Research has shown that eating disorders and sleep disorders frequently coexist, and behaviors like food restriction, bingeing, and purging can negatively affect sleep quality. Fortunately, with the right support and specialized treatment, it’s possible to effectively address both sleep concerns and disordered eating. Read on to learn how and why eating disorders and sleep affect one another, and what to do if you or a loved one are struggling. The link between eating disorders and sleep The connection between eating disorders and sleep is complex and multifaceted, and in many ways, still being explored. While research has demonstrated worse sleep in people with eating disorders compared to those without, the exact mechanisms behind the sleep problems eating disorders cause remain unknown. That said, experts do know that the relationship seems to go both ways: disordered eating can affect sleep quality and quantity and, in the other direction, sleep plays a critical role in regulating psychological, hormonal, and metabolic balance, and even has an influence on the food choices people make. According to Equip Therapy Lead Jennifer Simmons, eating disorders affect nearly every physical, mental, and emotional system in the body, and sleep is an area that is often disrupted but rarely discussed. “Whether someone is restricting food, binge eating, or purging, their sleep can be impacted in significant and distressing ways,” Simmons says. “Taking a look at the link between disordered eating and sleep is crucial to understanding both.” It’s also important to note that there is a specific type of sleep disorder called sleep-related eating disorder (SRED) which causes individuals to prepare and eat food (or even toxic or non-food substances) while sleeping and leaves them with no memory of their actions when they wake up. While experts aren’t sure of the exact causes of SRED, underlying medical or mental conditions, medications, and routine changes may all contribute.  Why disordered eating affects sleep (and vice versa) There are a number of ways disordered eating can negatively impact sleep—and that poor sleep can, in turn, influence eating behaviors. Feeling hungry One of the most straightforward ways eating disorders can affect sleep is the fact that it’s hard to rest when your body and brain are in need of nutrients. While a lack of nutrition can result in fatigue during the day, it can, somewhat ironically, lead to insomnia at night. The mechanism of action here may have to do with a neuropeptide in the brain called orexin, which is involved in both appetite and wakefulness. High levels of orexin have been associated not only with hunger, but also with increased wakefulness, as well as mood and cognition issues. “When someone restricts food, their body is in a starvation state,” Simmons says. “This can cause restlessness and difficulty settling in at night. Think about what a baby does when they’re hungry: they’re fussy, uncomfortable, and have a hard time relaxing. This is the same thing our bodies go through at every age.” Being hungry can also cause obsessive thoughts about food, making it difficult to turn off your mind and sleep. Poor temperature regulation Body temperature can also be a serious impediment to sleep. Many people with eating disorders are at a low weight or undernourished, which can impair temperature regulation and make it difficult to feel physically comfortable and fall asleep. “You might need two blankets on you when you go to bed, and then kick them all off just to be freezing cold again,” Simmons says. Side effects of disordered behaviors Disordered behaviors like bingeing or purging can have a profound effect on the body’s ability to fall asleep due to physical side effects like acid reflux, bloating, and digestive discomfort, as well as emotional fallout. “Shame and guilt can often arise after these disordered eating behaviors and lead to emotional turmoil, making it more difficult to relax and fall asleep,” Simmons says. “The gut-brain axis is a growing area of research that suggests what we eat or don’t eat directly impacts mood, cognition, and sleep quality.” Malnutrition Simmons also points out that malnutrition itself can be a prime cause of dysregulated sleep because of its potential to cause daytime fatigue and sleep cycle disruptions, including reduced rapid eye movement (REM) sleep. REM sleep is characterized by intense dreams and is associated with mood regulation, mental concentration, and the consolidation and processing of new information—meaning that when you miss out on this phase, it can have a significant effect on your mental health and cognitive function. Co-occurring conditions It’s also important to remember that eating disorders often co-occur with other mood-related disorders such as anxiety, depression, and obsessive-compulsive disorder (OCD), which can all impact sleep. “Anxiety can make going to sleep or staying asleep more difficult if dysregulated thoughts are present,” Simmons says. “Depression can make someone sleep too much or not enough, which can throw off their circadian rhythm, and OCD can cause difficulty relaxing if patterns or routines are not followed.” How poor sleep fuels disordered behaviors Just as eating disorders impact sleep, sleep quality can also have an effect on eating behaviors. On a biological level, sleep deprivation interferes with a variety of hormones that help to regulate appetite, including leptin (which promotes satiety), ghrelin (which increases hunger), and orexin (which is involved in appetite and wakefulness). “With a lack of sleep, these are all dysregulated, which could cause issues with hunger cues,” Simmons says. “Cortisol, the stress hormone, can also rise, and melatonin, the sleep-wake hormone, can be suppressed, which confuses the body’s natural circadian rhythm.” She adds that poor sleep can increase cravings, weaken impulse control, and potentially lead to more disordered eating behaviors. “When someone has not gotten enough rest, recovery can feel even more difficult,” she says. “How do you fight the eating disorder if you don’t have any energy to do so?” How to address sleep issues caused by eating disorders Many people who navigate recovery find that, as they heal the symptoms of their eating disorder, many of their sleep issues also improve or completely resolve. But working proactively to address both the eating disorder and sleep hygiene (i.e. the practices and habits that support good sleep) is the most effective way to see improvement in both arenas. “Having sleep issues can be tiring—no pun intended,” Simmons says. “It is important to address sleep and eating disorder recovery holistically. This means paying attention to both basic sleep hygiene and eating disorder-focused skills to help wind down for a restful sleep.” Here are some of Simmons’ recommendations for addressing sleep issues caused by an eating disorder: Commit to a regular eating pattern A predictable daily meal and snack schedule will not only go a long way toward setting the foundation for eating disorder recovery, but also support healthy sleep. “By eating at regular times, our sleep hormones become more regulated, which will help the body rest peacefully when it comes to bedtime,” Simmons says. Stick to a consistent sleep schedule Choose both a wake-up time and bedtime that you can stick to every day—including weekends. “When you are deciding what time to go to sleep, be sure to give yourself enough time to wind down doing relaxing activities like taking a hot shower or bath, dimming your lights, reading, journaling, meditation, and gentle stretching, or yoga,” Simmons advises. Eliminate distractions Not only can the blue light from digital devices interfere with your ability to sleep, but the mental stimulation of doomscrolling, comparing yourself to others on social media, or watching endless videos can undermine your ability to unwind. “Try to avoid screens, social media, intense conversations, or anything that might stimulate you before bed,” Simmons says. Be mindful of energy-boosters If movement is part of your recovery journey, be sure not to engage in physical activity too late in the day, as this can make it more difficult to fall asleep. Simmons also advises limiting or skipping caffeine during the day, or at least avoiding it too close to bedtime. “Caffeine stays in the system for quite some time so if you are drinking caffeine late in the afternoon this could be one of the culprits keeping you awake.” Create a calming sleep environment Make sure your bedroom is dimly lit and set at a comfortable temperature before you slip under the covers. “And only get into bed when you are ready to go to sleep,” Simmons says. “If you’re tossing and turning in bed and unable to sleep, the best thing you can do is to get up and go into another space for a short time. Think of this as a sleep reset. This time is a chance to try to relax, which means you can read, listen to some calm music—and then, after a few minutes, try going back to bed.”  The Equip takeaway on eating disorders and sleep Interrupted or poor sleep isn’t just an inconvenience; it can seriously affect your overall health and hinder eating disorder recovery. “If you are struggling with sleep during eating disorder treatment, tell your treatment team and let them help you with some skills and tips,” Simmons says. “Getting enough rest is one of the best things you can do for your eating disorder recovery.” And if you are consistently tossing and turning or finding sleep to be stressful, know that there are solutions to help you feel rested, restored, and better prepared to prioritize recovery. “Don’t lose hope if sleep is rough right now!” Simmons says. “Many people notice that as you make progress in your eating disorder recovery, you may also notice your sleep improves gradually and naturally. Your body is designed to function well when it receives what it needs to function, with regular food intake being a great start. Celebrate the small wins as you start to implement changes. Maybe you enjoyed journaling before bed and noticed your thoughts weren’t as loud? Perhaps you did a meditation and felt relaxed and at peace when laying down? Keep working on adding those small changes—they do add up!”]]></content:encoded>
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            <title><![CDATA[Can Menopause Trigger an Eating Disorder?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-and-menopause</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-and-menopause</guid>
            <pubDate>Tue, 21 Nov 2023 23:43:23 GMT</pubDate>
            <content:encoded><![CDATA[The pervasive myth that eating disorders only affect young people (especially girls) eclipses a common reality for many women: eating disorders often actually surface during menopause. Since the International Journal of Eating Disorders published a groundbreaking study that found about 13% of women over 50 exhibit eating disorder symptoms, many more research studies have indicated a significant link between disordered eating and menopause (the time frame 12 months after a woman's last period) and perimenopause (the years leading up to that point). The prevalence of eating disorder symptoms during midlife can be as high as 29%. “While we don’t yet have a reliable data set, it’s thought that about one-third of middle-aged women have a chronic condition, one-third relapse, and one-third have a new onset eating disorder.” says Equip Senior Research Manager, Jessica Baker. Physiological and lifestyle changes related to menopause may explain why many women experience an eating disorder at this time of life. Here’s what you need to know about why and how menopause can trigger an eating disorder. What does menopause have to do with eating disorders? There’s a higher prevalence in eating disorder symptoms among midlife women navigating menopause than those who are pre-menopause, “likely due to a 'perfect storm' of hormone changes coupled with physical and psychological changes that often occur during this time of life,” Baker says. “Further, cultural pressures for midlife women to remain thin and young-looking has steadily increased over the past decade.” Potential weight gain Most of us are well aware of the unrealistic beauty standards and “anti-aging” pressures that impact older women, but menopause-specific physical and psychological shifts are also important to consider. Along with common symptoms like hot flashes and vaginal dryness, weight gain may also occur during menopause, which could be triggering for those prone to disordered eating. Hormonal changes During menopause, women also experience significant hormone changes, namely a reduction of estrogen and progesterone. There’s some research to suggest that a sudden change to estrogen levels can lead to abnormal food intake, increasing the risk of an eating disorder. This may also contribute to why many young women develop eating disorders during puberty. Hormonal changes can also have significant mental health affects, such as anxiety, depression, and loss of control. These symptoms can often exacerbate an eating disorder. Midlife challenges Additionally, many women going through perimenopause and menopause are often concurrently experiencing challenges, ranging from role transitions (like "empty nest syndrome," retirement, and divorce) to increased body dissatisfaction, grief, and loss. These stressors can all play a role in the development or relapse of an eating disorder. It wasn’t until Equip Family Mentor Inga Yanoski helped her own child recover from anorexia that she realized she’d developed her own share of food and body issues in adulthood. “While I was never officially diagnosed with an eating disorder, I believe I could have absolutely had orthorexia in my 20s,” she says. “Even though I have worked hard on healing my relationship with food and body, there is no shortage of diet culture messages around how to navigate perimenopause and menopause that can find their way into my psyche and sometimes make me doubt my choices.” Diet culture pressures Yanoski adds, “In diet culture, there’s an intense pressure to not let our bodies age, change, or grow” she says. “It’s this dangerous space where women could easily start with ‘lifestyle changes’ such as cutting out sugar and carbs, or experimenting with intermittent fasting, and eventually trigger a relapse or an onset of an eating disorder.” Yanoski also points to the hormonal shifts and mid-life stressors that are at play, like putting kids through college, career shifts, relationship changes, and caring for aging parents. “These factors all impact our moods, sleep cycles, and in turn, our appetite.” The warning signs to be aware of While eating disorders can and do manifest in a variety of ways, Baker says many of the hallmark signs and symptoms are consistent in all populations. “The early warning signs of an eating disorder are generally going to look similar across age groups.” These include: Dieting Food restriction Weight loss Frequent weighing behaviors Negative self talk about weight or body Excessive exercising Misuse of diet pills/laxatives “While the warning signs may be similar across age groups,. what is different is that the medical and physical consequences of an eating disorder are exacerbated at older ages due to the body's lessened ability to bounce back from insult and injury, so it is even more important to get help early,” Baker says. Treatment for eating disorders during menopause Despite the increased research exploring the link between eating disorders and menopause, there’s still work to be done to ensure patients receive the most appropriate, targeted care. “Unfortunately, few studies have looked at treatment specifically for patients at older ages,” Baker says. “However, similar to younger age groups, cognitive behavioral therapy (CBT) has shown success in decreasing symptoms for this age group.” Individualized treatment means emphasizing issues that are relevant and significant to the patient. In the case of menopause, that might mean centering CBT and other therapeutic approaches around age-related concerns, life transitions and stressors, and the experience of menopause. “I have seen patients experiencing the stereotypical 'midlife crisis' which can raise questions about the purpose and meaning of life. For this I have seen the benefit of helping the patient identify their values and living life according to those values,” says Baker What everyone should know about eating disorders before, during, and after menopause Eating disorders certainly aren’t an inevitable consequence of menopause, but aging is also not the protective factor against eating disorders that many may believe it to be. “First and foremost, it’s important to understand that eating disorders can occur at any age across the lifespan and that those at older ages aren't 'immune,'” Baker says. “This is especially important if the individual has a history of an eating disorder. This time of transition may be a good time to revisit previous tools and strategies that were helpful in recovery and to reconnect with treatment providers.” Baker is also clear that the medical community must make a concerted effort to better comprehend eating disorders in menopausal women. While self-advocacy is important, patients should be able to depend on their clinicians to offer empathetic, evidence-based diagnosis and care. “Too often, women at older ages have the experience of being brushed off or told they are too old for an eating disorder. This is extremely concerning given that we know the physical and medical consequences of an eating disorder are worse for this group of women.” While there is still a long way to go in better caring for perimenopausal and menopausal women with eating disorders, continuing to have frank, honest conversations and dispelling myths will help people of all ages and backgrounds get the help they need. “We need to continue to spread awareness about eating disorders in midlife,” Yanoski says. “We must stop normalizing or even praising disordered eating. We must continue to address anti-fat bias and stop praising the pursuit of thinness.” Equip is proud to treat patients of all ages with tailored care. Because treatment is virtual, it meets middle-aged patients wherever they are as they navigate the particular responsibilities and challenges of that life stage. If you’re concerned you may have an eating disorder or a relapse, schedule a free consultation with our team.]]></content:encoded>
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            <title><![CDATA[Eating Disorders and Anxiety: What’s the Connection?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-and-anxiety</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-and-anxiety</guid>
            <pubDate>Fri, 01 Mar 2024 17:16:00 GMT</pubDate>
            <content:encoded><![CDATA[The first time I discovered I’d been diagnosed with anxiety was kind of by accident. I was submitting a superbill to my insurance company, hoping to receive modest reimbursement for the therapy sessions I’d been attending for my eating disorder. Filling out the mandatory paperwork, I quickly scanned my therapist’s document to determine my specific diagnosis, and there it was: not anorexia, but generalized anxiety disorder (GAD). I was shocked. Did I have both conditions? And what exactly is the connection between eating disorders and anxiety? Let’s get into it. What does the research say about eating disorders and anxiety? Anxiety, like eating disorders, comes in many forms. While everyone can feel anxious occasionally, those with anxiety disorders experience excessive and intense worry that impacts daily life. The symptoms can range from trouble concentrating and irritability to heart palpitations, sweating, sleep problems, and more. There are also several different kinds of anxiety disorders, including: Generalized anxiety disorder (GAD): characterized by excessive worry regarding daily activities or situations Panic disorder: characterized by recurrent panic attacks and the fear of experiencing them Social anxiety disorder: characterized by a heightened fear and worry that social situations may lead to humiliation or rejection To say anxiety is common is a major understatement: according to the World Health Organization (WHO), about 4% of the global population currently experience an anxiety disorder. In 2019, 301 million people worldwide had an anxiety disorder, making them the most common of all mental disorders. Considering the frequency with which eating disorders co-occur with other conditions (including OCD, substance use disorder, and depression), it may come as no surprise that many people with eating disorders also grapple with anxiety. According to Equip Therapist Lead Jonathan Levine, LCSW, current research indicates that there’s a high prevalence of anxiety in eating disorders, with the anxiety often (but not always) preceding the onset of the eating disorder and persisting after it’s in remission. Rates vary depending on which specific eating disorder someone is struggling with, but Levine says the connection between eating disorders and anxiety is clear. According to research, some 48% of adults with anorexia, 81% of adults with bulimia, and 65% of adults with binge eating disorder (BED) have at least one co-occurring anxiety disorder.  Does anxiety cause eating disorders—or vice versa? There’s no single cause or explanation for why some people develop eating disorders, anxiety, or both, but there are certain risk factors.The development of both eating disorders and anxiety is influenced by a complex interaction of genes, biology, behavior, environment, and more. “Researchers don’t know for sure whether anxiety causes eating disorders or vice versa, as it’s often a chicken-or-the-egg type of situation,” Levine says. “Like so much of mental health, it comes down to the person. Some people develop anxiety, whether it's related to performance, socialization, or generalized, and never experience an eating disorder. Others may develop restrictive eating and experience anxiety that’s below the clinical threshold, or in other words, their anxiety is not a major factor in their day-to-day life experience.” While it’s often impossible to say which illness leads to the other, it’s important to note that starvation—an effect of the restriction that’s characteristic to many eating disorders—affects the brain and can lead to mood changes, rigid thinking, reduced appetite, and, yes, anxiety. “People who are malnourished often develop anxiety that dissipates as the brain becomes nourished via a routine pattern of eating,” says Levine. “Another explanation resides in a behavioral pattern of avoidance, which is frequently seen in those struggling with eating disorders and anxiety,” says Levine. “This can be seen by some people avoiding eating in public, eating around others, or certain foods entirely. Avoidance is a hallmark of anxiety, in that people avoid the catalyst that causes anxiety, which makes them more hesitant to challenge this anxiety in the future, creating a perpetuating see-saw of increased anxiety.” Social anxiety can also play a role, as people may feel a subconscious desire to use eating disorder behaviors as a way of minimizing their anxiety while around others. “This desire may lead to a hyperfocus on what they're eating—type of food, calories, when and where they eat—in response to the anxiety,” Levine says. “In this instance, social anxiety may lead to disordered eating which can then lead to a full onset of an eating disorder.” While bulimia is the eating disorder most associated with anxiety, it’s not entirely clear why that’s the case. There are, however, multiple theories that Levine says he keeps in mind when discussing the issue with patients and families. “One piece to consider is personality characteristics. Neuroticism—which is characterized by worry, anxiety, and hyper sensitivity— has been found to increase the risk of binge eating, a key symptom of bulimia,” he says. How eating disorder treatment addresses anxiety concurrently Regardless of the reason why someone feels anxiety, Levine says how they react to their anxiety determines whether it will improve or worsen. “If we avoid what's causing our anxiety, be it eating, socializing, or anything else, that anxiety will increase because it hasn’t been challenged,” he says. “And the next time you’re faced with the same situation, that anxiety is still high because it was never dealt with—it continuously grows until you face it.” With that in mind, it’s easier to understand why so many forms of eating disorder treatment are also proven to be effective methods for treating anxiety; in both instances, patients are supported in challenging the things causing them distress and developing healthy coping behaviors. One of the main strategies for treating both anxiety and eating disorders is psychotherapy, and most eating disorder therapists are trained to address common symptoms of both through evidence-based treatment. “There are multiple treatment modalities that can treat both eating disorders and anxiety,” Levine says. “The modality that’s used will largely depend on someone's age and diagnoses, but some options include family-based treatment (FBT), dialectical behavioral therapy (DBT), exposure and response prevention (ERP), and enhanced cognitive behavioral therapy (CBT-E). These are all evidence-based, effective treatments for someone struggling with anxiety alongside an eating disorder.” In my case, ongoing therapy has not only been critical in my eating disorder recovery and long-term healing, but in improving my anxiety as well. The tools I’ve learned in treatment to address my eating disorder have naturally helped with my anxiety, and vice versa. Eating disorders and anxiety often go hand in hand, which can feel overwhelming. But it’s important to remember that having more than one diagnosis doesn’t mean that recovery will take twice as long, or that you’ll always be dealing with at least one condition. With evidence-based treatment and comprehensive support, you can tackle both diagnoses at once, and let your recovery from one strengthen your recovery from the other. ]]></content:encoded>
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            <title><![CDATA[When It’s not “Just” an Eating Disorder:  What a Co-Occurring Diagnosis Means for Treatment]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorder-cooccurring-diagnoses</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorder-cooccurring-diagnoses</guid>
            <pubDate>Wed, 20 Mar 2024 15:30:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders are incredibly challenging on their own. The majority of the time, however, patients living with an eating disorder have other medical or mental health conditions as well. At least 50% and as many as 95% of patients with eating disorders have at least one other mental health diagnosis. Eating disorders are also common in people who are neurodivergent and those with certain physical health conditions, such as gastrointestinal disorders. Medical professionals refer to these simultaneous diagnoses as “comorbidities.” This term can be confusing and even frightening to many people (the word “morbid” tends to evoke strongly negative emotions) so the phrase “co-occurring conditions” is often more useful. The existence of co-occurring conditions can make diagnosis and treatment of an eating disorder more complex. Understanding the ways other conditions intersect with eating disorders can help patients and their families better approach the recovery process for all conditions, whatever they may be. What mental health conditions tend to overlap with eating disorders? While there is a range of mental illnesses that can coexist with eating disorders, the most common co-occurring mental health conditions are anxiety, depression, and obsessive-compulsive disorder. The relationship between these diagnoses is complicated and not fully understood. Body image concerns affect many people with eating disorders, and some patients may also suffer from a separate condition called body dysmorphic disorder. Because someone with an eating disorder may struggle with emotion regulation, there is also an increased vulnerability to substance use disorder. Other mental health conditions that often co-occur with eating disorders are post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). When it comes to eating disorders and other mental illnesses, it’s not always easy to tell which came first. Many patients struggle with psychological conditions that can make them more vulnerable to developing an eating disorder. Eating disorders and the accompanying malnutrition can also trigger new mood disorders or worsen any pre-existing conditions. How does neurodiversity intersect with eating disorders? Research shows that neurodivergence — when a person’s mental or neurological function deviates from what’s considered normal — can affect someone's relationship with food and their experience of eating, making them more vulnerable to an eating disorder. Among the most common overlapping diagnoses are Autism Spectrum Disorder, ADHD, and Sensory Processing Disorder. Because neurodiversity can impact the way eating disorder treatment works, honoring a patient’s specific needs is essential for healing. For instance, a neurodivergent patient with a heightened sensitivity to a food’s smells, appearance, or texture often requires a different approach to exposure therapy than would a patient with only a fear of calories or weight gain. The existence of an eating disorder can also have an impact on the treatment of conditions such as ADHD; for instance, a physician may recommend non-stimulant medication options that are less likely to affect appetite. How do physical conditions affect eating disorders? Certain medical conditions can increase the chances of developing an eating disorder. For instance, having diabetes can put someone at higher risk for an eating disorder. This heightened risk may be due to metabolic factors, weight stigma, or the required focus on counting and quantifying nutrient content — calories, sugar, carbs, etc. When a patient who was an eating disorder and diabetes misuses insulin in an attempt to control their weight, it’s known as diabulimia. Patients with gastrointestinal conditions may be particularly vulnerable to eating disorders for a variety of reasons. When the act of eating causes pain, nausea, or other intestinal distress — which is the case with conditions like gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and polycystic ovary syndrome (PCOS) — it makes sense to feel anxious about eating or to avoid certain foods. Having to follow a limited diet because of celiac disease and food allergies can contribute to insufficient nutritional intake or increased fears around food, both of which can contribute to the development of an eating disorder. Because eating disorders themselves can cause GI distress, it’s sometimes difficult to tease apart what is causing which symptoms. For instance, gastroparesis is common in those suffering from anorexia, bulimia, and ARFID, and is generally resolved with nutritional rehabilitation. Eating disorders can affect anyone, so there is a wide range of medical conditions and disabilities that can overlap with an eating disorder. The diagnoses mentioned here are by no means an exhaustive list of possible co-occurring conditions. How do you treat more than one condition at once? Eating disorder professionals are trained to treat the most common co-occuring conditions, such as depression and anxiety. For other overlapping diagnoses, it may be necessary to seek out more specialized providers, ensuring that everyone on the treatment team is aware of the eating disorder so that the patient doesn’t get any mixed messages or contraindicated recommendations. Although treatment plans vary by individual needs, it’s common to prioritize the eating disorder symptoms first before directly targeting mood disorders or other challenges; healing the brain and body through nutrition can often provide significant relief from other psychological symptoms. Being nourished and free of most eating disorder behaviors also allows patients to engage more fully in therapeutic treatments for other conditions. In family-based treatment (FBT), for instance, individual therapy doesn’t usually begin until a patient is renourished. Treatment focusing on renourishment doesn’t ignore the patient’s other medical conditions or mental health challenges. While focusing on the eating disorder, providers also monitor physical health and mood and, when necessary, assess for signs of suicidal ideation. Throughout the recovery process, patients may be provided with therapeutic approaches such as dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), exposure response prevention (ERP), medication, or specific modalities for addressing trauma, substance use disorder, and other mental health conditions that exist alongside the eating disorder. For patients with diabetes or digestive concerns, a registered dietitian (RD) often plays a particularly critical role on the treatment team. An RD can help develop a meal plan or nutrition prescription that addresses both the eating disorder and co-occurring conditions. Coordination with an allergist, gastroenterologist, endocrinologist, or other medical provider can also support eating disorder recovery while managing co-existing health concerns. When should you delay eating disorder treatment to prioritize another health condition? Although it is usually important to prioritize eating disorder treatment ahead of other health conditions, there are certain circumstances that would prompt a shift in focus. One such situation is active risk of suicide. The most life-threatening condition should always be the primary focus of treatment, which means that suicide usually takes precedence over an eating disorder. In cases of suicide risk alongside anorexia nervosa with severe weight loss and medical instability, there are serious concerns about imminent risk to life from both conditions. This means that families and the treatment team should take a two-pronged approach, continuing to support their loved one through meals and snacks with an FBT approach, while using a strong treatment like DBT for suicidality. Clinicians might also choose to prioritize another condition if that condition is interfering with eating disorder treatment. In those cases, it becomes necessary to treat the co-occurring condition first in order to begin to make real progress toward eating disorder recovery. For example, severe depression can be the root cause of maladaptive coping strategies like disordered eating, and so treating the depression can alleviate the eating disorder symptoms. Not addressing the depression first could result in a sort of whack-a-mole situation, where the eating disorder goes away but is replaced by other harmful coping strategies, like substance abuse. This is a tough call for clinicians to make, so it’s generally recommended that they treat the eating disorder first, and shift focus to depression — or another interfering condition — only after it becomes clear that the depression is maintaining the eating disorder. The bottom line is that the priority of treatment will usually depend on which condition is the biggest threat to life and safety. Finding a treatment team with expertise in eating disorders (a less common speciality to be trained in for treatment providers) who can also treat co-occurring conditions is important. Doing so ensures that your loved one doesn’t have to bounce around from one treatment provider to another, receiving mixed messages about how to manage multiple treatment targets. How can you support a loved one with co-occurring conditions? Taking the eating disorder just as seriously as other conditions is an important step in supporting your loved one’s recovery. It can be helpful to remember that eating disorders, like other diagnoses, are not a choice, a phase, or a “cry for attention.” Despite pervasive cultural myths that tend to downplay the severity of eating disorders or even blame the sufferer for their condition, eating disorders are serious, potentially fatal illnesses that require prompt treatment. Someone with multiple diagnoses may be at higher risk for feeling like they are a patient rather than a person. Family and friends can play an important role in helping a loved one continue to build a life worth living outside of their medical conditions. While a specialized treatment team is essential, a strong support network that sees the patient as a whole person can make all the difference in clearing the path toward lasting recovery.]]></content:encoded>
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            <title><![CDATA[Anorexia Nervosa in Children: Signs, Causes, and Treatment]]></title>
            <link>https://equip.health/articles/understanding-eds/anorexia-in-children</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/anorexia-in-children</guid>
            <pubDate>Wed, 06 Aug 2025 13:51:00 GMT</pubDate>
            <content:encoded><![CDATA[Being a parent can often feel like wading through a seemingly never-ending list of concerns. Is your child safe? Are they happy? Are all their needs being met? With all of these questions playing on a constant loop, it may seem unfathomable to consider bigger questions around mental and physical health issues, like eating disorders. But eating disorders like anorexia can and do affect people of all ages, including children. In fact, a recent study found a massive increase—about 40%—in eating disorders among kids ages 6 to 18 since the beginning of the COVID-19 pandemic, and another study found that about 22% of children worldwide show signs of disordered eating. While noticing changes in your child's eating or weight can be scary, there are highly successful evidence-based treatment strategies that work in children with anorexia. Read on to learn the facts about anorexia in children, how to spot the signs, and what the path to recovery looks like. What is anorexia nervosa in children? Anorexia nervosa, commonly referred to as anorexia, is an eating disorder characterized by extreme food restriction and fear of weight gain. While many people with anorexia are at a low weight and appear extremely thin, the illness can affect those in “average-size” or larger bodies as well. It’s important for parents to know that a child does not need to be visibly emaciated to have anorexia; in pediatrics, brighter red flags are things like stalled weight gain or deviation from the growth curve. “Anorexia nervosa is a serious eating disorder characterized by an intense fear of gaining weight, distorted body image, and severe restriction of food intake, often leading to dangerously low body weight,” says Equip Dietitian Lead Tanya Hargrave-Klein MS, RDN. “While the core diagnostic criteria are similar for both adolescents and adults, there are important distinctions in how the disorder presents and is treated in younger individuals.” While many people associate anorexia with simply not eating, it’s important to note that there are actually two different subtypes: restricting type and binge-eating/purging type. “Young people with the restricting type of anorexia primarily achieve weight loss through dietary restriction and excessive exercise,” Hargrave-Klein says. “They might meticulously count calories, avoid certain food groups, or develop rigid rules around eating. In the binge-eating/purging type, children restrict food intake, but also engage in recurrent episodes of binge eating—consuming a large amount of food in a short period, often feeling a loss of control—followed by compensatory behaviors such as self-induced vomiting, or misuse of laxatives, diuretics, or enemas.” Equip Therapist Carol Brown, LCSW, notes that these subtypes aren’t fixed, and can change over time. She also explains that, while anorexia at any age carries risks, the health risks for children with anorexia can be greater: “While the diagnostic criteria in both children and adults are the same, there are heightened medical risks for children, as they are not yet fully developed.” Signs and symptoms of anorexia in children and teens While there are important distinctions in how the illness is treated in young people versus adults, the signs and symptoms of anorexia in children can often resemble those of older patients. “Parents might hear ‘I’m not hungry’ or ‘I already ate’ frequently, and might also notice that their child prepares food for others but doesn’t eat it themselves,” Brown says. “The child may have a new or sudden preoccupation with food and recipes, or have detailed questions about how food is prepared—for instance, asking parents if they used oil, lean meat, low calorie dressing etc.” Parents may also notice their child avoiding social situations due to body image or appearance distress, according to Brown. The most obvious sign of anorexia in children is weight loss, but it’s crucial to understand that weight loss won’t always be obvious—and that it’s not necessary for a child to be underweight for them to be struggling with anorexia. “While weight loss can be a concern and sign of anorexia, this is more complicated in youth since they are developing and their bodies are changing,” explains Brown. “This makes it easier to miss, especially since anorexia is just as risky for youth even if they are ‘within normal BMI,’ which is why it’s important to pay attention to other signs.”  Behavioral signs According to Hargrave-Klein and Brown, behavioral signs of anorexia often include: Calorie counting Meticulous food preparation Skipping meals Hiding food Developing rigid food rituals Eating alone Making excuses to avoid eating Preoccupation with calories/”healthiness” of food Fixation with weight (weighing self frequently) Focus on perceived appearance flaws Extended bathroom time before/immediately after meals Preoccupation with exercise Excessive fluid or caffeine consumption Excessive laxative use Sudden changes in food preferences and restriction of foods that they previously enjoyed Additionally, young people with anorexia may also: Engage in body checking Avoid social events involving food Wear baggy clothing Chew and spit out food Bake without eating Exercise excessively outside of organized sports Emotional and psychological signs “Emotional and psychological indicators of anorexia in a child can manifest as an intense preoccupation with food, eating habits, or exercise,” Hargrave-Klein says. “You might observe heightened irritability during meal and snack times, and a palpable fear of weight gain.” Additionally, Hargrave-Klein says that the emotional and psychological signs of anorexia may include: Extreme mood swings Withdrawal from previously enjoyed activities and friendships An increasing tendency towards secretiveness Social isolation Physical signs “The physical toll of anorexia on young individuals can present in striking ways,” Hargrave-Klein says, noting that common physical signs may include: Dramatic weight loss Persistent gastrointestinal issues like constipation and bloating Irregular or absent menstrual cycles Chronic coldness Hair loss Sleep disturbances Episodes of fainting or dizziness “A telltale sign can also be the appearance of fine, downy hair (lanugo) on the body, along with a compromised immune system,” Hargrave-Klein adds  What causes anorexia in children? Understanding the risk factors There is no single cause of anorexia in children or adults, but rather a combination of genetic, psychological, and environmental factors. “When I work with families, one of the first truths I share as an eating disorder registered dietitian is that parents are not the cause of their loved ones' eating disorders,” Hargrave-Klein says. “There is no single cause.” There are, however, certain risk factors that may increase the chance of developing anorexia, including a family history of eating disorders or other mental health conditions, perfectionistic personality traits, and anxiety disorders. “For children, a close relative with an eating disorder is a significant risk factor for anorexia,” Hargrave-Klein says. “Additionally, low energy availability, or burning more calories than you eat, can increase risk. This is often seen in young athletes who unintentionally burn more calories than they consume, particularly when intense sports training is coupled with inadequate fueling.” According to Brown, additional risk factors for anorexia in children may include a history of bullying (especially if its weight- or appearance-related), dieting, or trauma. “Youth specifically are very easily influenced by their peers, so having peers that are dieting or highly focused on appearance, or following dieting/fitness/’health’ trends on social media,” she says. “Social media usage—specifically following body-focused/diet-focused/appearance-focused content—can have a significant impact on young people’s body dissatisfaction, and children have a more difficult time discerning true vs. false claims related to health and nutrition.” Mental health challenges like depression, trauma, obsessive compulsive disorder (OCD), or generalized anxiety can all also contribute to the likelihood of a child developing anorexia. “Further fueling the fire is weight stigma—the prejudice people face due to their body shape or size,” Hargrave-Klein says. “Constant exposure to damaging messages about weight can breed body dissatisfaction in young people, significantly increasing their risk of developing anorexia. Tragically, young individuals battling eating disorders are up to three times more likely to have endured bullying or teasing about their appearance than their peers.” Brown also notes that another anorexia risk factor for children is engaging in a sport or activity that is appearance- or weight-focused, such as dance, running, gymnastics, or swimming. “All that said, eating disorders are complex mental health conditions with no single known cause,” she adds. Diagnosis: how to get a professional anorexia assessment In order to get a proper diagnosis for children with anorexia, it’s essential to identify signs and symptoms as soon as possible and seek guidance and support from a trained professional. “Early detection of anorexia is crucial; it can significantly reduce the duration of treatment and mitigate the physical ramifications of the illness,” Hargrave-Klein says. “Discuss your observations and concerns with your loved one's primary care provider. Request an eating disorder assessment and, if needed, seek a second opinion. Don't delay.” If you observe any of the aforementioned signs or have any concerns about your child’s eating, it’s essential to listen to your gut and take action. As with all eating disorders, anorexia only tends to get worse over time, and it does not go away on its own. “Early intervention is key, and the earlier it is caught the easier it is to treat!” Brown says. “Do not hesitate if you notice any concerns—early intervention can be life saving.” One small first step toward a diagnosis is Equip’s free, 5-minute eating disorder screener. You can also set up a call with an Equip team member to talk through your concerns, get a professional opinion on whether your child may have anorexia, and discuss potential treatment options. Treating anorexia in children Although anorexia can often present similarly in children and adults, the most effective treatments for both groups are distinct. Family-based treatment (FBT) is considered the gold standard for treating eating disorders in children, adolescents, and young adults. It was specifically developed to treat anorexia, but has shown to be effective for bulimia, binge eating disorder (BED), and other specified feeding or eating disorder (OSFED) as well, and can also be used in conjunction with other treatment modalities to treat ARFID. “While conventional adult-focused treatments have limitations, FBT is an evidence-based approach and is considered the leading treatment for children with anorexia,” Hargrave-Klein says. “Historically, treating anorexia in children involved adapting methods developed for adults. These traditional approaches, which prioritize a child's development of insight and motivation, can be inefficient and risky. Valuable time is lost while the physical effects of the eating disorder worsen. FBT addresses this by offering a more rapid and often more economical route to recovery.” Working with a multidisciplinary treatment team To effectively treat anorexia in children, experts agree on the importance of working with a multidisciplinary treatment team including a doctor, therapist, registered dietitian, and other clinicians. While one or more medical providers may be necessary to help stabilize a patient’s health, a dietitian can provide nutritional rehabilitation to not only support weight gain, but to restore brain and body function in children with anorexia. In the context of FBT, a therapist is essential in helping to target eating disorder symptoms and behaviors first, and then moves on to address psychological, emotional, and relational aspects later. The importance of family support “When a child is battling an eating disorder, it's as if a terrorist has seized control of their mind, making healthy eating choices impossible,” Hargrave-Klein says. “FBT empowers parents to guide their child toward recovery by ensuring proper nutrition until the child is fully weight- and nutritionally-restored. This active family involvement significantly increases the likelihood of recovery.” FBT utilizes a three-phase model that empowers families to actively manage their child's recovery at home. The three phases of FBT are: Reduction of symptoms and weight restoration (when needed) Development of skills and independence Identity formation and relapse prevention “The initial phase focuses on caregivers supervising re-nourishment at home,” Hargrave-Klein says. “This is essential for the child to regain weight, which is a fundamental step in recovery. As the child improves, FBT then assists them in resuming control over their eating and other eating disorder symptoms, providing them with coping strategies for the challenges of recovery.” Brown adds that family support is always valuable in the mental health field and it is even more crucial in pediatric eating disorder recovery, as family support is the main driver of change. “This differs from adult eating disorder treatment, which utilizes an enhanced cognitive behavioral approach to treat eating disorders,” she says. “While supports are very valuable in adult eating disorder treatment, in treating eating disorders in children, the supports are the primary change agents.” One of the unique challenges of anorexia is that it’s egosyntonic, meaning the eating disorder behaviors feel aligned with the person’s beliefs, making it extremely challenging to fight disordered urges. “This only worsens as the child becomes more and more malnourished, creating a cycle that’s really difficult to break,” Brown says. “Our patients often describe the eating disorder urges as a ‘voice’ telling them what to do; these voices become louder and more fixed with malnourishment, and it becomes more and more difficult to differentiate the eating disorder voice from rational thoughts. This is where supports become so valuable; they can provide a supportive counter-messaging voice when the child has difficulty accessing their own internal voice.” Above all, family support in the context of anorexia treatment in children allows patients to maintain some semblance of normalcy as they navigate recovery. “Keeping children at home keeps them with their families,” Hargrave-Klein says. “It keeps them in their real lives. It keeps them developing and on track with peers. It keeps them connected to things that motivate them: basketball practice, school, theater tryouts, and friends.” Anorexia in children: recovery is possible Although anorexia in children can be frightening to consider or alarming to confront, recovery is possible. And remember that you don’t need to go it alone: there are experts available to offer comprehensive, evidence-based, effective treatment, and they can support you as you help your child restore their health and return to themselves.. Because anorexia can have long-term health complications, including bone density issues, heart problems, and more, early intervention and comprehensive treatment are essential. You can also support your child’s anorexia recovery—and help protect against eating disorders in general—by practicing prevention strategies like fostering healthy eating habits and promoting a positive body image at home. Anorexia in children is scary, but it is treatable; and with your help, your child can achieve lasting, lifelong recovery. FAQ How is anorexia different from just being a "picky eater" or not having an appetite? “Eating disorders can be deceptive,” Hargrave-Klein says. “It's easy to attribute changes in a child's eating habits to a passing phase of pickiness or a low appetite. However, there are key distinctions. Picky eaters generally consume sufficient calories by eating larger quantities of their preferred foods. In contrast, children with anorexia restrict both the variety and amount of food they eat, and this rigidity often intensifies as the illness progresses. Furthermore, a child experiencing a loss of appetite simply doesn't feel hungry. A child with anorexia, on the other hand, may feel hunger but actively chooses to restrict food intake due to an intense fear of weight gain and a distorted body image.” Can my child recover from anorexia at home, or do they need to be hospitalized? “Children with anorexia have the best recovery odds at home, rather than in traditional treatment centers,” Hargrave-Klein says. “Residential programs often fall short, with anorexia returning in up to 50% of child and adolescent patients. Hospitalization may be necessary for medical issues, but family-based treatment (FBT) can begin inpatient and continue at home once the child is medically stable.” Brown adds: “Recovery at home is absolutely possible! There are many benefits of at-home recovery, including decreased life disruptions, not needing to constantly shift treatment teams and locations—leading to decreased disruptions and increased stability in overall care—as well as increased patient and family confidence in their ability to maintain recovery at home. However, when heightened medical risks are present, the child may require hospitalization to stabilize these risks; I encourage families to follow their treatment team or medical provider’s guidance when heightened medical risks are present.” What do I do if my child denies having a problem? “This may happen, as eating disorders are egosyntonic so parents can anticipate some—or a lot of—pushback in early recovery,” Brown says. “Recovery is still possible even when the child denies that there is a problem, and the FBT model and treatment team can help guide parents as to how to respond when there is pushback. Therapists and treatment teams who utilize FBT can help guide parents and families in how to renourish their child and manage eating disorder symptoms at home even when the child is struggling and pushing back.” Will my child ever be "normal" around food again? “Full recovery from anorexia is 100% possible and should be the goal of the treatment team,” Hargrave-Klein says. “If not, seek other providers. Once your child is weight and nutritionally restored, they should be able to interact with food as they did prior to the onset of the eating disorder.” “Recovery is absolutely possible!” Brown agrees. “Early intervention and support can be key to recovery. Everyone’s recovery journey is unique and some might notice a re-emergence of old thoughts during periods of heightened stress and may benefit from continued support during stressful times, but overall it is absolutely possible for children to return to regular eating, regular life, and being able to enjoy mealtimes without being overtaken by intrusive eating disorder thoughts.”]]></content:encoded>
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            <title><![CDATA[Anorexia Binge-Purge Subtype Is More Common Than You Think. Here’s What to Know]]></title>
            <link>https://equip.health/articles/understanding-eds/anorexia-binge-purge</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/anorexia-binge-purge</guid>
            <pubDate>Mon, 07 Oct 2024 15:19:00 GMT</pubDate>
            <content:encoded><![CDATA[ Many people associate anorexia with being extremely thin and restricting food. And while those two things are often characteristics of anorexia, it’s not so black and white: for one thing, people with anorexia aren’t always underweight, and for another, anorexia can also involve episodes of binge eating and purging. When the latter occurs, it’s known as anorexia binge-purge subtype (AN-BP). Though it’s less commonly known, anorexia binge-purge subtype is just as dangerous as anorexia that’s purely restrictive. It can negatively affect physical and mental health, leading to issues such as heart attack, osteoporosis, anxiety, and depression, among others. Understanding anorexia and binge-purge can help you identify if you or a loved one may have this condition. Read on to learn about this lesser known (but equally serious) form of anorexia, including its prevalence, symptoms, and effective treatments for binge-purge anorexia. What is anorexia binge-purge subtype? People with anorexia nervosa binge-purge subtype exhibit three main behaviors: Food restriction Binge eating Purging Let’s break this down: Like people with anorexia nervosa restrictive type (the commonly known version of anorexia), people with AN-BP severely limit their food, both in terms of intake and variety. In fact, people with AN-BP may engage in more frequent restrictive eating behaviors compared to people with restrictive anorexia. Where the two differ is that those with AN-BP can also experience episodes of binge eating and purging. This is when someone eats large quantities of food in a short amount of time and then “gets rid of” the food they consumed through purging behaviors like vomiting, excessive exercise, or laxative use. “A person with AN-BP can feel a loss of control when eating or react to a meal by engaging in some kind of purging behavior afterward,” explains Angela Celio Doyle, PhD, Equip’s VP of Behavioral Health Care. The chart below outlines how restrictive anorexia and binge-purge anorexia behaviors compare.  How is anorexia binge-purge subtype diagnosed? To be clinically diagnosed with AN-BP, patients must engage in these three behaviors—restrictive eating, binge eating, and purging—consistently for at least three months. But it’s important to note that most eating disorders don’t fit neatly into one diagnostic box, at least not forever. As Doyle puts it, “although eating disorders can appear very different, at their core they’re very similar in terms of what drives them, and so diagnoses can often overlap or change over time,” Doyle says. “Restrictive anorexia may develop into AN-BP without treatment. Likewise, AN-BP can evolve into bulimia.” So it’s not uncommon to be diagnosed with restrictive anorexia and then eventually start to binge and purge. See more about anorexia vs bulimia to understand the difference.   How common is anorexia binge-purge subtype? It’s difficult to pinpoint the exact prevalence of anorexia binge-purge. Generally speaking, up to 4% of females and 0.3% of males experience anorexia nervosa over the course of their lifetime. Of those patients diagnosed with anorexia, 30 to 50% have anorexia binge-purge subtype. Statistics, however, don’t tell the full story of the severity and detrimental impact of AN-BP. “Even though these rates seem low at a glance, they still represent millions of people who are struggling with a very serious eating disorder,” Doyle says. What are the symptoms of anorexia binge-purge subtype? AN-BP is unique in that patients with this condition experience symptoms from several different eating disorder diagnoses at once. “The most common eating disorder symptoms co-occur with each other in anorexia binge-purge subtype,” says Doyle. “A person with AN-BP has at least two, but sometimes all three, cardinal eating disorder behaviors: dietary restriction, binge eating, and purging.” What makes AN-BP different from other eating disorders with similar symptoms, like binge eating disorder and bulimia, has less to do with behaviors than with the psychology of the illness. Typically, a patient receives an AN-BP diagnosis when their symptoms and mindset more closely meet the criteria for anorexia nervosa, even if they also exhibit the binge eating and purging behaviors characteristics of binge eating disorder or bulimia. Below is a breakdown of the most common symptoms of binge-purge anorexia. Behavioral symptoms Restrictive eating Binge eating (consuming a lot of food quickly with a feeling of being out of control) Self-induced vomiting Misuse of laxatives or diuretics Excessive exercise in order to “make up” for meals Withdrawal from social activities Psychological symptoms An intense fear of weight gain A distorted perception of weight or body shape An overemphasis of the importance of weight or body shape Preoccupation with food Anxiety Depression Physical symptoms Damage to teeth Constipation or other digestive problems Fatigue or weakness Dehydration Electrolyte imbalance (particularly low potassium levels) Slower than normal heart rate Edema (swelling)  The role of the binge-restrict cycle Most people with AN-BP experience something known as the binge-restrict cycle, where a period of restriction leads to episodes of binge eating, which then triggers feelings of shame, in turn resulting in the desire to restrict again (or purge). This cycle is the body’s natural response to limiting food intake. “Restriction—even when it’s just eliminating one food group—takes us out of our body’s biological comfort zone,” Doyle explains. “Our bodies know that we need consistent, well-rounded nutrition, and it fights back with urges to binge.” Because of that hard-wired survival mechanism, Doyle says that restricting food generally or certain foods specifically (unless medically necessary) is usually an unsafe and unhealthy tactic. “There are a lot of restrictive patterns that have been co-opted into the diet culture space that can do more harm than good,” she says. “This includes intermittent fasting, cleanses, elimination diets, and carb cycling.”  Differences from other eating disorders Other eating disorders also involve parts of the binge-restrict cycle. But only anorexia nervosa binge-purge consistently involves all three aspects: restriction, binge eating, and purging. People with binge eating disorder eat a large amount of food in a short period of time, but they don’t purge. People with purging disorder “get rid” of food by making themselves vomit, over-exercising or using laxatives, but they don’t binge eat. People with bulimia nervosa binge and then purge to compensate for the calories they consumed during their binge. People with restrictive anorexia limit what they eat, but they don’t binge and purge. What does treatment for anorexia binge-purge subtype look like? As with all eating disorders, implementing swift, evidence-based treatment is the key to long-term recovery of AN-BP. Anorexia binge-purge subtype is a serious mental health condition that can do significant harm to your mental and physical health when left untreated. People struggling with AN-BP may experience complications such as: Electrolyte imbalances, which can lead to heart attack or stroke Irregular heart beat Heart failure Osteopenia and osteoporosis Anxiety Depression Suicidal thoughts Research also indicates that those with anorexia binge-purge subtype are more likely to drop out of treatment compared to people with other eating disorders, which makes it even more important to intervene quickly, before the eating disorder has time to dig deep roots. Recovery is possible for everyone with AN-BP, regardless of how long they’ve been struggling, but getting treatment as soon as possible can reduce the health risks and also improve recovery outcomes. The most common and effective treatment for binge-purge anorexia is enhanced cognitive behavioral therapy. It’s also important for patients to work with a multidisciplinary care team—which should include a dietitian, therapist, and medical provider—who can support all aspects of their health.  Enhanced cognitive behavioral therapy (CBT-E) “Enhanced cognitive behavioral therapy (also known as CBT-E) is a specific version of cognitive behavioral therapy specifically for eating disorders,” Doyle says. “It’s the first treatment recommended to patients with AN-BP because of its strong evidence for helping the most people.” Considered one of the most effective treatments for eating disorders, CBT-E can be used to treat a variety of diagnoses through a highly individualized plan that helps patients to: Stop binge and purge behaviors Re-establish regular eating habits Confront their distorted perceptions Address their disordered thoughts and behaviors “Stopping binge and purge behaviors can be a huge relief for someone struggling with AN-BP,” Doyle says. “CBT-E also focuses on the thoughts and feelings that drive the eating disorder behaviors so that the person can experience a life that is more and more symptom-free over time.” Multidisciplinary treatment approaches Like eating disorders themselves, each person struggling with disordered thoughts and behaviors is unique. While treatment approaches vary from person to person, experts agree that a multidisciplinary team, as well as social support, gives patients the best chances of achieving long-term recovery. “At Equip, we offer CBT-E, and our patients work with a team that includes a therapist, a dietitian, medical support, and mentorship by people who have lived experience with an eating disorder,” Doyle explains. “Mentorship from someone who has been through something similar, especially for patients with lesser-known conditions like anorexia binge-purge, can provide a lot of much-needed hope.”  The Equip takeaway: understanding and healing AN-BP The anorexia binge-purge subtype is a type of anorexia in which a person engages in episodes of binge eating and purging as well as restricting their food intake. AN-BP can lead to serious health complications ranging from digestive problems and damage to teeth to heart problems and weak bones. Long-term recovery from eating disorders, including anorexia nervosa binge-purge, is possible, but it requires evidence-based treatment. Therapy, especially CBT-E, has been shown to be an effective treatment for AN-BP, especially when delivered while a patient works with a multidisciplinary care team. If you’re concerned that you or a loved one may have AN-BP, seek help now. This harmful eating disorder is fully curable—but it doesn’t go away on its own. Talk to your doctor or a mental health provider about your concerns, or schedule a call with an Equip team member.  FAQs What are the main symptoms of the anorexia binge-purge subtype? The main binge-purge anorexia symptoms are food restriction, binge eating (eating large quantities of food in a short amount of time) and purging (“getting rid of” the food they consumed through behaviors like vomiting, excessive exercise, or laxative use). To be clinically diagnosed with AN-BP, someone needs to exhibit these behaviors consistently for at least three months. How common is the anorexia binge-purge subtype compared to other eating disorders? The exact prevalence of anorexia binge-purge is hard to nail down. Generally speaking, up to 4% of females and 0.3% of males experience anorexia nervosa over the course of their lifetime. Of those patients diagnosed with anorexia, 30 to 50% have anorexia binge-purge subtype. This means millions of people struggle with AN-BP. What is the binge-restrict cycle and how does it affect those with anorexia binge-purge? The binge-restrict cycle is a pattern where a period of food restriction is followed by episodes of binge eating, which then triggers feelings of shame, in turn resulting in the desire to restrict again. People with anorexia binge-purge subtype engage in the binge-restrict cycle, but may also purge after a binge. This differs from those with other eating disorders, who typically only engage in one or two parts of these three behaviors. For example, people with the restrictive subtype of anorexia nervosa only restrict, those with binge eating disorder only binge, and those with bulimia binge and purge. What treatment options are available for someone with the anorexia binge-purge subtype? Enhanced cognitive behavioral therapy (CBT-E) is one of the most effective treatments for binge-purge anorexia. This type of therapy focuses on stopping binge and purge behaviors, re-establishing regular eating habits, and addressing distorted thoughts. Working with a dietitian, medical provider, and mentor—in addition to a CBT-E-trained therapist—can further help someone with AN-BP. How can families support a loved one with the anorexia binge-purge subtype? If someone you love is struggling with the anorexia binge-purge subtype, you can support them by learning about this eating disorder, encouraging open communication, and examining your own beliefs and feelings about food and eating. You can also encourage your loved one to find support, and help them find the providers and resources they need to get better. What are the long-term health risks of the anorexia binge-purge subtype? The long-term health risks of the anorexia binge-purge subtype are serious. They include electrolyte imbalances (which can lead to heart attack or stroke), osteoporosis, suicidal thoughts, irregular heart beat, and heart failure, among many others.
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            <title><![CDATA[Is There a Link Between ADHD and Binge Eating?]]></title>
            <link>https://equip.health/articles/understanding-eds/adhd-and-binge-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/adhd-and-binge-eating</guid>
            <pubDate>Mon, 29 Apr 2024 17:28:00 GMT</pubDate>
            <content:encoded><![CDATA[While eating disorders are complex enough to navigate on their own, research shows that most people with eating disorders are also dealing with at least one other co-occurring condition. For instance, anxiety disorders are common among adults with eating disorders—affecting some 48% of those with anorexia, 81% of those with bulimia, and 65% of those with binge eating disorder (BED)—and the risk of depression is also higher for people affected by eating disorders, especially those with BED or bulimia. More recently, research has also drawn a link between ADHD and binge eating. Attention-deficit/hyperactivity disorder, or ADHD, is one of the most common neurological disorders in children, but it can also affect adults. And while people with any type of eating disorder might also have ADHD, there does seem to be a particularly strong link between BED and ADHD. Read on to understand why binge eating and ADHD often go hand in hand, and how to find the most effective treatment for lasting recovery. What the research says about ADHD and binge eating While not every person with ADHD experiences eating issues, research has shown that the odds of having a clinical eating disorder are higher among the ADHD population. One study found that those with ADHD are more likely to experience binge eating and purging behaviors and to restrict food intake, and several studies have indicated a specific correlation between ADHD and binge eating. “There is evidence that there are greater rates of binge-spectrum disorders, including both bulimia and BED, in people with ADHD, compared to people without ADHD,” says Equip’s Director of Program Development, Tana Luo. She cites one sample that found that 8.3% of adults with ADHD had BED, as compared to a prevalence rate of 2.6% for the general population. And according to some estimates, she says, up to 30% of people with BED experience ADHD symptoms, compared to 5% for the general population. How do the symptoms of ADHD relate to binge eating? There are a multitude of symptoms associated with ADHD, but some of the most common and universal include persistent patterns of: Inattention (i.e. not being able to focus on or complete a task/listen/pay attention, etc.) Hyperactivity (i.e. having an unusually high level of excitement or activity) Impulsivity (i.e., acting on sudden feelings, ideas, or desires). “People with ADHD tend to struggle with executive functioning, things like planning ahead, prioritizing, and managing time,” Luo explains. Meanwhile, BED is characterized by recurrent episodes of binge eating, in which a person consumes a large amount of food while feeling like they can’t control their compulsion to do so. Though the overlap with ADHD may not be immediately obvious, Luo points out that both conditions share some characteristics, which may make someone more prone to one if they’re actively experiencing the other. “It’s possible that the symptoms of ADHD increase risk of binge eating behaviors,” Luo says. “For example, it could be that challenges with executive functioning make it hard for people with ADHD to stick to a regular plan of eating. And we know that skipping meals, whether intentional or unintentional, increases vulnerability to binge eating later in the day. Furthermore, some people with ADHD struggle with awareness of their hunger and satiety cues, and this could also lead to disrupted eating patterns.”  How the brain might explain the ADHD-eating disorder link Like all mental disorders, ADHD doesn’t have one single cause, nor can we point to a clear reason why it correlates with binge eating. There are, however, some theories around the connection between ADHD and binge eating in certain brain processes. “There are a few different hypotheses as to why there’s a link between ADHD and binge eating,” Luo says. “It may be that ADHD contributes to binge eating, or vice versa. Or that certain comorbidities in ADHD, like depression, increase risk of binge eating disorder. And finally, it’s possible that ADHD and binge eating share the same underlying neurobiological vulnerabilities.” One study found that both ADHD and binge eating involve similar processes in the brain. Specifically, both groups had dopamine systems (the reward circuit in the brain) that reacted more positively to food when in a heightened emotional state, and both also showed higher scores for impulsivity and more difficulty processing and regulating emotions. It’s also worth noting that there’s some evidence to suggest a connection between ADHD and anorexia, but Luo explains that this association isn’t as well understood.“While there is evidence to indicate co-occurrence between ADHD and bulimia and BED, the relation between ADHD and anorexia has been shown to be mixed,” she says. “With that being said, people with ADHD tend to experience difficulties regulating their emotions. And, oftentimes, disordered eating behaviors serve as a way to regulate painful emotions. People with ADHD may also experience interoceptive differences, meaning they may have trouble detecting, accurately interpreting, or attending to their body’s cues, including hunger and fullness cues. Challenges with interoception may increase overall risk for developing an eating disorder.” How to treat ADHD and binge eating together When it comes to treating binge eating, a variety of therapeutic strategies, like cognitive behavioral therapy (CBT), integrative cognitive-affective therapy (ICAT), and dialectical behavior therapy (DBT) can be effective, as can certain medications. For ADHD treatment, the standard protocol typically combines medication, skills training, education, and counseling. And importantly, with the right care, it’s possible—even preferable—to treat both conditions at the same time. “Non-pharmacological treatments for ADHD include both behavioral and cognitive-behavioral approaches, both of which can work very well alongside eating disorder treatment,” Luo says. “For example, both family-based therapy (FBT) and enhanced cognitive behavioral therapy (CBT-E) teach patients skills like emotion regulation, mindfulness, identifying triggers and high risk times, meal planning, and structuring home/school/work environments to support regular eating. Many of these skills also apply to symptoms of ADHD.” When people come to Equip with both binge eating and ADHD symptoms, their multidisciplinary care team works collaboratively to create an effective, evidence-based plan of action to address both conditions. “At Equip, providers work with each patient and their loved ones to identify how the patient’s specific symptoms of ADHD may be impacting eating disorder symptoms,” Luo says. “This understanding then informs how different strategies are applied to address eating disorder symptoms. For example, someone with ADHD may benefit from additional tools, like setting alarms or reminders to eat, coming up with a detailed plan of eating before a big event, and extra focus on certain distress tolerance and emotion regulation skills.” Regardless of whether you or a loved one has been diagnosed with ADHD or BED, if you’re worried about specific symptoms or patterns, it’s important to seek immediate expert support. With the right team and plan, both conditions can be effectively treated, making a healthier, happier future possible.]]></content:encoded>
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            <title><![CDATA[Why I Founded Equip]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/why-I-founded-Equip</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/why-I-founded-Equip</guid>
            <pubDate>Thu, 30 Jul 2020 19:00:00 GMT</pubDate>
            <content:encoded><![CDATA[I was diagnosed with anorexia when I was 10. It sometimes surprises people that I was so young, but it’s common—eating disorders are brain disorders—and I come from a family steeped in anxiety, depression, and addiction. When I was 10, my babysitter went on a diet and I decided to try it with her—leading me to a struggle with anorexia that lasted through my teenage years and almost killed me. My eating disorder reached its strongest point during my freshman year of high school. That year, I was hospitalized four times for a total of seven months. And though this may sound bizarre: I loved treatment. It was safe. It was easy. I was with people who understood me. And I didn’t have to deal with freshman year of high school, my parents fighting, or any other real life triggers. The hard part was coming out and maintaining recovery in real life. Unsupervised, I habitually reverted back to old behaviors, lost weight, and ended up back in the hospital—where I wanted to be. My parents lived in a terrified state for years. Quality information about eating disorder treatment is hard to come by, specialist providers remain scarce, and it’s not often reimbursed by health insurers. When I started to relapse after my fourth hospitalization, my parents gave me a choice: you can spend three months at a residential facility out west, or you can stay home and try a treatment where we get involved. At the time, I wanted nothing more than to go to residential. But I remember thinking: I just missed my entire freshman year of high school to be in treatment. If I miss sophomore year too, I might never get better. So I spent my sophomore year of high school doing family-based treatment(FBT), and it saved my life. FBT is an outpatient behavioral treatment where families play a critical role in the recovery process—preparing, plating, and supervising all meals and monitoring for eating disorder behaviors like vomiting or over-exercising.  To be clear, I hated it. Eating disorders are tough to treat because not wanting to get better is part of the illness. Specifically, people with eating disorders are terrified of gaining weight, and weight gain is almost always essential to the healing process. It was one of the most challenging years of my family’s life, and undoubtedly, it was the thing that got me better.  In hindsight, my eating disorder compulsions were so strong that it would have been nearly impossible to do alone. With the support of loved ones, the more I ate three meals and three snacks a day and maintained a healthy weight, the less scary it became. At the same time, because I was back in high school, I started to develop friendships and hobbies to drown out the eating disorder, and there were real consequences to relapsing. Towards the end of that year, as I grew stronger in my recovery, I learned that 77% of the 30 million Americans who suffer with eating disorders never receive treatment. The injustice was as visceral to me then as it is now: eating disorders have the second highest mortality rate of all mental illnesses, yet finances and other barriers prohibit the majority of sufferers from accessing life-saving care. I cofounded Project HEAL in 2008 to raise money to fund eating disorder treatment for those who couldn’t afford it. Two years into our founding, as a psychology major in college, I dug into the research on eating disorder treatment—and learned that much of what is practiced in the community has no basis in research. I learned that residential treatment settings were becoming the go-to treatment for adults and adolescents alike, despite no data on their effectiveness. Over the past 13 years, I’ve watched people that I was in treatment with at age 15 cycle in and out of these treatment centers. The research was also clear that FBT, the treatment that had saved my life, was the gold standard for young people with eating disorders, but it wasn’t accessible to the majority of the population. Most eating disorder therapists have not been trained in FBT, leading to what my cofounder Erin calls “treatment that feels good, but not treatment that works”.  FBT as originally envisioned is also, frankly, pretty burdensome for parents. Preparing and supervising 21+ meals and snacks a week is time consuming, and shuttling your child to multiple appointments a week can be impossible for working parents and those with other kids. FBT hasn’t been rigorously studied or adapted for people of color, people in larger bodies, and LGBTQ individuals,who we know suffer from comparable rates of eating disorders. And insurance almost never covers FBT, so it’s out of reach for most working class Americans. In addition to being inaccessible, it lacks the thing that keeps people engaged in treatment: other people who’ve been there. FBT got me into recovery, but it was peer support that kept me there. I needed someone who could vent with me when I returned to high school and all of my friends were dieting, and then tell me that I absolutely couldn’t go down that road. I needed someone who had been in my shoes and was living proof that recovery was possible and worth it. And my mom and dad needed that too. I started Equip to make gold standard eating disorder care accessible to all people. We took the vital core of FBT—empowering families to feed their loved one and get them into recovery—and expanded upon the model by providing peer and family mentors, along with wraparound medical, therapeutic, and dietary support. We’ve made Equip virtual, so you can arrange treatment to fit your entire family’s schedule and needs—instead of upending your family to fit treatment or sending your child away from home. And we’re partnering with forward thinking payers to cover this treatment, because families shouldn’t have to pay out of pocket. And as Equip has grown, we've expanded our model beyond FBT to include evidence-based modalities intended for adult patients who don't live at home with their families.  I started Equip so that no more parents have to bury a child. It’s unconscionable that one person dies by an eating disorder every 52 minutes when we have treatments that work. It’s unconscionable that so many of my peers have spent the last 15 years of their lives cycling in and out of treatment centers. It’s unconscionable that so many families spend hundreds of thousands of dollars on treatments that don’t work before they learn about evidence-based treatment. I started Equip because neurobiologically-based brain disorders that cause you to act out of your values require assistance from families (blood or chosen)—and families need training. I started Equip because you can’t build a life worth living if you’re away from home, not living life. I started Equip because you can’t get better with talk therapy that doesn’t account for the neurobiological and physiological underpinnings of eating disorders, or with providers who don’t make treatment safe for people of all genders, ethnicities, and shapes and sizes. Most of all, I started Equip because eating disorders are treatable and full recovery is possible. In fact, people with eating disorders share powerful temperament traits that can be channeled in positive and life changing ways when they’re given access to treatment that works. I’m living proof.]]></content:encoded>
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            <title><![CDATA[How Do I Know When to Refer my Patient to Eating Disorder Treatment?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/when-to-refer-a-patient-to-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/when-to-refer-a-patient-to-eating-disorder-treatment</guid>
            <pubDate>Thu, 18 May 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’re worried about a patient who has signs of an eating disorder, the right course of action isn’t always clear. You know the outcome you want—namely, for your patient to get better—but it can be difficult to know what they need to get there. Can you continue to treat them while keeping a close eye on their symptoms, or do you need to refer them to a specialist? Are they “sick enough” to go to a treatment program, or can they get better with light guidance from their regular healthcare providers? Answering these questions becomes even more fraught when you consider how serious eating disorders are (they have the second highest mortality rate of all mental illnesses) and add in the complex emotional, relational, and logistical dynamics at play. After all, eating disorders don’t just affect the patient but also their family and loved ones, and any treatment recommendation you make will have implications on the entire unit. Some good news: with the right treatment, eating disorders are 100% treatable for all people. As a practitioner, how can you know when it’s time to make that recommendation? Dr. Lauren Hartman, Medical Director at Equip, answered some of the most common questions providers have about referring patients to eating disorder treatment. What factors should I consider when deciding whether or not to refer a patient to eating disorder treatment? The most important factor to consider is that early intervention is key. Unfortunately, the longer someone struggles with an eating disorder, the sicker they become and the harder it is for them to recover from it. Connecting them to treatment as soon as you—or they, or their loved ones—are concerned will help them have the best prognosis for recovery. Remember that for someone with an eating disorder, there is no such thing as “not sick enough” for treatment. What are the signs that indicate a patient needs to go to eating disorder treatment? Are there any telltale red flags that indicate, without a doubt, that treatment is needed? Signs of an eating disorder may include changing eating habits, cutting out food groups, and skipping meals. A person may also start hiding or discarding food that is being given to them. Exercise may become more compulsive or excessive. People may also start eating large amounts of food in a short period of time. They may start using the bathroom more frequently, particularly after eating. There may also be mood changes: people struggling with an eating disorder may become more withdrawn, or develop increased irritability, depression, or anxiety. Some physical signs that someone needs eating disorder treatment include rapid or excessive weight loss. For your pediatric patients, this may also include not growing or gaining weight at a time when they should be. Patients may present with syncope or presyncope, bradycardia, hypotension, or abnormal postural pulse changes. For patients with ovaries, there may be irregular periods or loss of the menstrual cycle completely. You may also see stress fractures in patients resulting from no or minimal trauma. One telltale red flag is rapid or severe weight loss. Since eating disorders are a diagnosis of exclusion, I’d always recommend first ruling out other medical causes of weight loss (like thyroid disease, diabetes, inflammatory bowel disease, etc). If there aren’t other causes to explain the weight loss, treatment is indicated. This is particularly true and urgent for a pediatric patient who is at a critical time of growth and development. What level of care should I recommend to my patient and their family? Should I simply refer them to an eating disorder specialist, send them to a program, recommend they’re admitted as an inpatient, etc? There are published guidelines that provide criteria for when a patient should be medically hospitalized (we recommend the guidelines from The American Psychiatric Association and the Society for Adolescent Health and Medicine). If a patient does not meet criteria for medical hospitalization, then I’d recommend a comprehensive outpatient eating disorder treatment program for them. Comprehensive outpatient programs like Equip allow for minimal disruption to the lives of patients and their families, while still being appropriate for patients needing all levels of care (except those who are medically unstable). In fact, four out of five Equip patients meet criteria for residential treatment. If a patient does need inpatient treatment, here's what to expect.  Once I refer my patient to eating disorder treatment, will I continue to be involved in their care? Yes. Most eating disorder programs, including Equip, continue partnering with referring doctors. Of course, since eating disorder programs are providing specialty care and not primary care, you will also continue to be involved to provide primary care to your patient. If you think a patient of yours is in need of specialized eating disorder treatment, you can make a referral or learn more about the referral process.  ]]></content:encoded>
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            <title><![CDATA[Is Virtual Outpatient Treatment Right for my Patient? ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/virtual-outpatient-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/virtual-outpatient-treatment</guid>
            <pubDate>Thu, 15 Feb 2024 22:52:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders are serious illnesses that affect millions of people and require treatment by a team of specialists. If one of your patients has an eating disorder, you have a number of different types of treatment to refer them to, and it can be difficult to parse all the options. One relatively new but increasingly popular option is virtual outpatient treatment. Read on to learn more about virtual outpatient care for eating disorders, and how to know if it’s right for your patient.  The problem As healthcare providers, we’re faced with a serious problem: the extensive reach and acuity of eating disorders, and the need for new ways to help people. Eating disorders are a public health crisis, affecting millions of people each year. In this year alone, 5.5 million Americans will develop an eating disorder, and rates are rising. The COVID-19 pandemic dramatically worsened the problem: there was a 70% surge in reports of eating disorders in the early part of the pandemic. Since the pandemic began in 2020, there has also been a spike in eating disorder acuity, with a 2x increase in hospitalizations and length of stay, and over half of eating disorder patients experiencing increased symptoms. All of this is particularly alarming given that eating disorders can be life-threatening, and negatively impact every organ of the human body. Here are some of the dire physical effects of eating disorders: Heart: Slowed heart rate, low blood pressure, irregular heartbeat Brain: depressed or anxious mood, obsessive thoughts about food or exercise Skin: dry skin, hair loss Gut: abdominal pain, liver inflammation, constipation, bloating Hormones: irregular periods, decreased bone mass Blood: low white blood cells, anemia, low platelets Eating disorders can also lead to fatigue, blood electrolyte changes, and vitamin deficiencies, among other issues. What’s more, despite being completely treatable, most people struggling with eating disorders go without effective care. In fact, just 23% of people with eating disorders will get treatment, and an even smaller fraction will get evidence-based treatment that works. For comparison, up to 77% of people with depression get treatment. There are a number of reasons for this, one of the primary being that many people with eating disorders live in treatment deserts. There are only 5,000 eating disorder providers across the United States, and the average American lives more than two hours away from an eating disorder treatment center, making in-person care inaccessible or disruptive to life. Even for those who live near a treatment center, treatment generally requires patients to take time off from school or work. Some of the other barriers to effective treatment include: Location and transportation limitations: Patients live too far from treatment centers and/or don’t have a way to get to one. Cost and limited insurance coverage: In-person treatment can cost thousands of dollars a day, and is not always covered by insurance. When it is covered, insurance authorization often runs out before a patient is fully recovered. Lack of eating disorder providers and coordinated care: Many patients can’t find an eating disorder provider at all. Among those who do, the care is often not coordinated, with the patient needing to serve as middle man between providers (physician, dietitian, therapist, etc). Lack of family support: In-person treatment generally includes minimal family support, which can increase the risk of relapse once a patient is discharged. Lack of affirming care: Most traditional treatment programs are based on young, cisgender, white females, letting people with marginalized identities slip through the cracks. Missed diagnosis: Because of pervasive stereotypes about who gets eating disorders, many people go without treatment. This includes people in larger bodies, BIPOC populations, LGBTQIA+ folk, and other marginalized identities. Lack of diversity among care providers: When patients don’t see themselves reflected in any care options, it can lead them to not get care at all. Language barriers can also be a problem. The emergence of virtual care for eating disorders Virtual mental health care in general has become more common since the start of the pandemic. In one study of military servicemen and women, telehealth visits made up about 15% of outpatient mental health visits before the pandemic, and increased 275% to their peak in April 2020. Telehealth visits have decreased since then, but still remain above pre-pandemic levels. This increase in virtual mental health care has given us plenty of opportunities to look at its effectiveness, and the research shows that there are equivalent outcomes for telehealth and in-person care. Both telehealth and in-person care resulted in similar reductions in eating disorder and depression symptoms and similar weight restoration rates, and telehealth is feasible and acceptable for patients with eating disorders. Benefits and common concerns around virtual eating disorder treatment Virtual eating disorder treatment is still relatively new, and so many providers understandably have concerns about it. Some of these are addressable, and some might lead you to question whether or not virtual care is right for your patient. Some of the most common concerns providers have include: Issues around privacy: Patients or providers might worry that they will not be able to find a private place. Some homes have lots of people and not enough rooms to afford privacy; workplaces can be hard, too. Lack of full engagement from patients and families: When you are at your computer, there are a myriad of ways to be distracted: other browsers, your cell phone, a delivery person coming to your door, your dog barking. This can be particularly hard when working with a teen who may be reluctant to start treatment. Internet and connection problems: Internet and connection problems can interrupt or completely block sessions Self-view on telehealth platforms may be a concern for some patients: It might be difficult for patients to see themselves on video platforms, like Zoom. Inability to get objective measurements of vitals: You may worry that you will not be able to get objective measures of vitals (weight, blood pressure) or do a full physical exam. Patient safety: Safety can also be a concern. What happens if a patient engages in behaviors in session, or leaves a session when distressed? Many of these concerns can be addressed by following the best practices for virtual eating disorder treatment. Here’s what best practice virtual outpatient care looks like: Follows structure and frequency of in-person evidence-based care: The structure and frequency should align with the type of treatment being used (weekly for FBT and CBT-E, 2x/week for CBT-E when working on weight restoration). It should include multidisciplinary involvement from a therapist, registered dietitian, and medical provider, and psychiatrist if needed. Uses a HIPAA-compliant web conferencing platform: There are many HIPAA-compliant web and video teleconferencing platforms, including Zoom, Doxy, Vsee, and SimplePractice. Includes patient contact information and plan to ensure patient safety: The treatment team collects information including patient address, phone number, emergency contact for someone, and 911 for their local area. Begins with a medical evaluation and includes plans for medical monitoring: Patients are cleared for medical stability before beginning treatment, and a medical provider is part of the treatment team. This could be a fully virtual medical provider on your team, or someone who will have in-person meetings with the patient. Medical check-ins can include weekly weight check, orthostatic pulse and orthostatic blood pressure, and, in cases of purging, serum electrolytes. Takes into account insurance, legal, and regulatory considerations: Ensure that the patient’s insurance covers telehealth codes and that there is appropriate licensure for the state where the patient lives. . Is conducted in a private location with “listening” devices turned off: The patient and provider should both be in private areas and ensure that Alexa, Siri, and other listening devices are turned off. According to the APA guidelines, patients may need to seek a higher level of care if weight control behaviors or eating disorder symptoms are worsening or if progress isn’t seen over 6 weeks (e.g., an average weight gain of 0.5-1 lb/week in patients with anorexia, 50% decrease in purging behaviors for people with bulimia). Careful monitoring is essential in virtual outpatient settings. In addition to the concerns outlined above, virtual eating disorder treatment also has unique benefits: Accessibility and convenience: It’s easier for providers to meet with patients and their supports. It’s easier to schedule appointments (e.g., a provider on the West Coast can see a patient on the East Coast). It’s easier for patients in treatment deserts to connect with specialists. Patients can get care from any location (car, conference room at school or work, private office). Cost and insurance coverage: There is less overhead for families, and more insurance companies are covering telehealth sessions. Overall costs are also much lower for patients paying out of pocket. Integrated with everyday life: Patients may feel less reluctant to go to treatment. Providers get a better understanding of patients’ environments and home life. Patients heal at home while focused on what matters to them in their everyday lives. Considerations for referring a patient to virtual outpatient treatment When deciding where to refer a patient with an eating disorder, there are a lot of factors to think about. Considerations to take into account include: For medically stable patients, outpatient treatment is the best place to start. A higher level of care can be more disruptive and costly. Early intervention predicts better outcomes. Evidence-based outpatient treatments are as effective online as they are in person. Once a patient is deemed medically stable, there are several other things to consider when deciding if virtual treatment is the right choice for them (learn more about assessing medical stability here). In order for virtual treatment to be a smart choice for a patient, they need to have the following elements in place: Access to stable Internet and a device that can support online conferencing Access to a private space Local medical provider who can partner with virtual treatment team Openness to working online with a provider or team of providers No suicide risk, self-harm, psychosis, or aggressive behaviors No co-occurring conditions that would significantly alter treatment needs (like diabetes or substance use disorders) Our 2022 study showed that virtual treatment works for eating disorders. The research found that if vitals were stable and labs normal, most eating disorder patients can be managed as outpatients. Evidence also shows that it’s a myth that more time spent in care is associated with better outcomes. The bottom line is that for medically stable eating disorder patients, virtual outpatient care can be as effective and more accessible than in-person treatment. This increased accessibility means that there’s a greater opportunity to help fill the massive gap in eating disorder treatment, and begin to address this public health crisis.  Each patient has unique circumstances, and it’s important to consider your particular patient’s needs and their ability to use this modality—but virtual eating disorder treatment is an evidence-based, accessible option that has the potential to save many lives. Schedule a call with our team to refer a patient or learn more about Equip’s virtual outpatient eating disorder treatment.]]></content:encoded>
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            <title><![CDATA[The Power of A Story: How Sharing Your Journey Can Support Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/sharing-your-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/sharing-your-eating-disorder-recovery</guid>
            <pubDate>Fri, 25 Jul 2025 12:41:00 GMT</pubDate>
            <content:encoded><![CDATA[When Maris Degener was first diagnosed with anorexia and began treatment, she kept it to herself. But over time, as she moved closer to recovery, she felt a growing desire to share her experience with others. A pivotal moment for her came after a yoga class, when she handed her teacher a letter sharing that these yoga classes had been Degener’s first re-introduction to movement since being diagnosed, and that she’d found great solace and comfort in the space the instructor had created. “She wrote me a letter back and gifted me a book, and it helped me find new community and support that I didn’t know I needed before,” Degener remembers. “Where I’d previously feared being judged or seen differently, I instead saw that it opened the door to something new and meaningful.” After that moment, Degener went on to tell her story in many different ways: she blogged about it, was the subject of a documentary that chronicled her recovery, and now regularly shares her lived experience as Director of Peer Mentorship at Equip. And while most people in recovery won’t share their journey on such a grand scale, doing so in ways both small and large can be an impactful and important part of the recovery process. Read on to learn more about the power of sharing your recovery journey, what to consider when deciding whether to share, and guidance on putting your story into the world. How storytelling can support recovery Research and lived experience support the idea that sharing one’s eating disorder recovery journey can be a helpful and positive part of the process, both during and after treatment. One study of adults who attended monthly eating disorder support groups found that sharing lived experience improved participants’ motivation and treatment engagement while also reducing stigma and isolation; another study, a meta analysis that included almost 1,500 participants, found that disclosing one’s emotional experience in written form helped alleviate eating disorder symptoms and improve body image. “Sharing your story in recovery can be a profoundly cathartic and empowering experience,” says Lainy Clark, LPC, Therapy Lead at Equip. “It not only helps you further process your own healing journey, but can also offer a sense of closure, accomplishment, and meaning.” Degener’s own experience illustrates this, as sharing her story led her to feel “overwhelming support and relief,” while also positively guiding the trajectory of her recovery journey. “For me, sharing my story challenged me to look at life through the lens of recovery,” she says. “When I was consistently writing a blog about my life in recovery, I would sit down almost every day to reflect on the successes, challenges, and ups and downs of my life. But it was always coming from a place of asking, ‘What can I learn from this?’ It helped me take the nonlinear and curving lines of recovery and make sense of patterns, habits, or themes popping up over time.” But when a person tells their recovery story, it doesn’t just support their own journey, it also helps others navigating similar paths. In one study of women who had recovered from an eating disorder, the majority of participants said that hearing other people’s recovery stories increased their motivation to recover—which is especially important given that many people with eating disorders aren’t motivated to get better (at least at first). “There were so many times where, after sharing my story in some way, others would then come to me privately to share, ‘I’ve been through this, too,’” Degener says. “I was saddened to realize that so many of us were struggling alone, but it also emboldened me to continue sharing my story in the hopes that it would help others feel less alone.” Clark adds that when you help others by sharing your journey, it can further strengthen your own recovery in a number of different ways. “In those moments, sharing becomes a way to offer hope and encouragement—not just a personal release, but a generous act of connection,” she says. “That kind of experience can bring a deeper sense of meaning and fulfillment, transforming something once painful into a source of strength and support for others. For many, it also helps reframe their healing journey with greater clarity and purpose.” To share or not to share: factors to consider While it’s clear that there can be real benefits of telling your recovery story, that doesn’t mean that it’s the right choice for every person at every time. Both Degener and Clark offer some important considerations for when you’re deciding whether or not to share your journey. Wait until you’re ready Sharing your story may not be the best choice early in recovery, when you’re still working toward initial goals like weight restoration, normalizing eating habits, and reducing disordered behaviors. For most people, it’s wise to wait until you’ve made enough progress that you—and not the eating disorder—are in control of the narrative. Disclosing too early may unintentionally fuel disordered beliefs, or lead you to explore triggering topics or difficult emotions before you’ve put in place a solid enough recovery foundation. “I believe that if someone is still in the midst of their recovery and feels concerned that sharing their story might be triggering, it may be best to hold off. Sharing your story can be powerful, but it also requires emotional readiness,” Clark says. “In my experience as a provider, the ability to articulate one’s experience often signals a meaningful shift: from being entangled in the eating disorder narrative to gaining insight, perspective, and ownership of it. It’s a sign that the individual is no longer clinging to the identity the disorder once provided, but instead is beginning to see the experience as something that happened to them—and something that has contributed to their growth.” Understand your intention It’s important to think about the “why” behind the desire to tell your story. By asking yourself what you hope to gain from disclosure, you can help ensure that it’s a beneficial experience, rather than a harmful one. “I’d get clear on your intention,” Degener advises. “Is this to inspire others or provide support in recovery? Is this because I’m needing support and to feel connected to a larger community? If the situation doesn’t support your intention, it may not be helpful to share in that moment.” Respect your own wishes If you simply don’t want to share your story, that’s the best imaginable reason not to do so. Holding your personal boundaries is often the most recovery-supporting choice you can make, regardless of any potential benefits from sharing your journey. “I wouldn’t recommend sharing your story if you don’t want to, unless it’s a matter of safety. For example, no one needs to know your medical information—unless they’re your doctor, or someone in your support network who needs to know what’s going on to support you and help keep you safe,” says Degener. “Beyond that, if you feel pressured to share, or uncertain about it, I’d recommend hitting pause and giving yourself some space before jumping into sharing.” Guidance for telling your recovery story If you do decide to share your eating disorder recovery story, there are some helpful guidelines to keep in mind. While your story will be a unique expression of your particular journey, your personality, your creative preferences, and your goals, the advice below can help you share your story in a way that’s most beneficial for both you and others. Be authentic It’s often said that social media is a highlight reel, and this fact leads many of us to feel like we can only show our most “perfect” selves to the world. But the reality is that recovery is messy, and that the most impactful stories—and storytelling experience—come from being honest about that messiness. “At first, I struggled to share the realities of my experience. I wanted everything to be seen as ‘perfect,’ even though recovery is anything but linear,” says Degener. “I got the advice from another yoga teacher one day to challenge myself to be more realistic in what I shared. She said, ‘I like what you’ve been writing—but you need to talk about the sh*t no one talks about.’ And when I took her advice, I heard from others that being more authentic—while still hopeful—about what recovery means and looks like helped them feel more connected to what I shared. And it also helped me feel more accepting of every part of my experience, not forcing perfection where it wasn’t needed or didn’t exist.” Don’t try to fit your story into a mold It would be nice if recovery followed a neat and satisfying plot arc, but this is rarely the case, and it’s not something you should expect from your story. Often, recovery involves steps backward as well as steps forward; there may be lapses or even full relapses; and these things don’t make your journey any less worthy, powerful, or inspiring. As Degener advises, “Don’t feel like you need to have a ‘perfect’ story or one that fits the mold of what you think recovery ‘should’ look like. There is no one way to recover and no one way to tell that story, either.” Know that telling your story looks different from person to person Even for Degener alone, sharing her story took multiple different forms: a letter, a blog, a documentary, and countless conversations with individuals and groups. If you choose to share your story, it might be through one of those mediums, or it might be something totally different: a poem, a piece of art, an essay, an Instagram post, a heart-to-heart with a loved one. You can choose to share your story in whatever way feels most natural, helpful, interesting, or accessible to you. “There’s no single ‘right’ or ‘perfect’ way to share your recovery story,” says Clark. “For some, sharing openly—whether throughout their journey or through platforms like social media—feels natural and empowering. For others, it may feel more meaningful to share privately with a trusted friend, therapist, or loved one.” Degener agrees that eating disorder narratives can take many different shapes, and that’s part of their strength and beauty. “I think it’s powerful to think about storytelling in all its forms. Maybe it’s opening up to a partner so they can support you at that upcoming dinner party. Or maybe you’re a parent, thinking about how you might use your story to help your child build resilience against diet culture,” she says. “All of these relational moments include us asking ourselves: what is the story I want to tell, and how do I want to tell it?” Keep it supportive of recovery When disclosing anything about your eating disorder experience, there’s always the risk that it could do unintentional harm, both to yourself and your audience. It’s important to avoid potentially triggering content, such as before and after photos, specific details about disordered behaviors, or numbers around weight, calories, or body measurements. And while there’s no need to gloss over the difficulties of recovery or shy away from hard truths or emotions, it can be most empowering to look for the lesson, insight, or hope you can derive from these challenges. “Knowing that my story would be read by others challenged me to ask myself, ‘How can I keep this supportive of recovery? How would others feel reading this if they’re struggling, too?’ You can’t control everyone’s reactions, and you don’t want to sugarcoat reality either, but it personally helped me to push myself to try and look at even the hardest parts of recovery in a different light,” says Degener. Don’t force yourself to dwell in difficult moments Telling your story doesn’t mean reliving every detail of your eating disorder experience, especially if some are particularly distressing. “A saying I’ve heard goes, ‘Share your scars, not your wounds,’” says Degener. “I think this depends on the context, but I’ve taken this to mean, you don’t have to dive deep into the hardest, freshest, most painful experiences you’ve had in order to connect with others or share your story.” Have a plan if things get hard Even if you decide to omit the most painful parts of your story, sharing what it was like to struggle with and overcome an eating disorder can be emotionally challenging. To ensure that these challenges don’t have a negative impact on your recovery or mental health, Clark says it’s important to have a solid support plan in place. “In many ways, sharing your recovery story can feel like a form of exposure—it might be uncomfortable or even scary at first, but it can also bring a deep sense of relief and accomplishment afterward,” she says. “It’s important to thoughtfully assess where you are in your journey. Ask yourself: How well can I manage potential triggers? Do I have coping strategies I trust? Who can I turn to for support if it becomes emotionally difficult? Being intentional and prepared can make the experience of sharing your story both safe and empowering.” Remember that consent matters Above all, keep in mind that you are in charge of if, when, and how you share your story—and you can change your mind at any time. “Advice I’ve heard that I cherish is that consent matters in this process,” says Degener. “You should never be pressured into sharing your story, or certain parts of it. You might choose to share your story with some people, and not others. And you might share a detail once and later think, ‘You know, I don’t think I’ll share that specific anecdote again.’ You are allowed to use your story in different ways, forms, and mediums throughout your life, and it is all valuable.” Harnessing the power of your story Ultimately, sharing your story can be a deeply powerful step in the recovery process. It’s not for everyone, and if it feels uncomfortable to you, listen to that feeling—but maybe consider if there is some way—small or large, private or public—that you can share your eating disorder recovery story, whether that’s to help yourself, or someone else. As Degener puts it, “Getting the opportunity to determine how my story was told, and feeling like I was able to bring hope to those struggling with something similar, is an experience I will always be grateful for.” If you’re interested in sharing your recovery story in the form of art, photography, poetry, or another creative format, we’d love to hear from you. Reach out to recoverystories@equip.health to get in touch.]]></content:encoded>
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            <title><![CDATA["Overeating Treatment" vs Binge Eating Disorder Treatment]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/overeating-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/overeating-treatment</guid>
            <pubDate>Thu, 31 Aug 2023 20:59:00 GMT</pubDate>
            <content:encoded><![CDATA[  You might have heard people talk about “overeating” or “food addiction.” These are not clinical terms, but there’s a diagnosable condition that describes similar symptoms: binge eating disorder. So why is this term more accurate, and what does treatment for this condition look like? Binge eating disorder vs. overeating: What’s the difference? Most people, if not all people, overeat from time to time. It’s a completely normal part o f being human to grab that last slice of pizza even if you’re full, or to make yourself a sweet treat after a filling dinner. Binge eating is different. A binge occurs when you quickly eat an unusually large amount of food in a short period of time, past the point of discomfort, and feel like you have no control over yourself while doing so. You may also feel disconnected from your body. Feelings of guilt, shame, or distress usually follow a binge. Binge eating disorder (BED) is diagnosed when a person regularly experiences episodes of “bingeing.” Binges almost always occur after a period of restriction. Why is it essential to use the term “binge eating disorder” instead of “overeating”? When we talk about BED, we’re talking about a diagnosable mental health disorder that goes beyond the occasional indulgence and isn’t about “willpower.” The term reflects the complexity and seriousness of the condition. It’s important to call binge eating disorder what it is, rather than brushing it off as compulsive overeating, for several reasons: It improves clinical understanding: Using the term “BED” can help healthcare professionals better understand the nature of the behavior. It’s a clear label for specific symptoms, making diagnosing and treating it easier. It acknowledges the regularity and severity of the condition : BED is not about eating too much at a family meal or a birthday party. It’s a distinct pattern of regularly restricting food portions and groups, followed by excessive eating accompanied by a loss of control. The term emphasizes the repetitive and compulsive nature of the behavior. It reflects emotional factors: Unlike occasionally eating past the point of feeling full, BED stems from complex emotional and psychological factors. It isn’t just about the food, but also coping with the emotions, stress, or other underlying issues. It brings to light potential medical implications: BED can also have serious medical implications, including cardiovascular issues, sleep issues, and other health concerns. Referring to it by its clinical term points to the condition’s seriousness. Does binge eating disorder treatment work? Absolutely! Binge eating disorder treatment can be incredibly effective. Effective, evidence-based binge eating disorder treatment generally includes: Professional guidance: Seeking help can involve connecting with healthcare professionals like therapists, dietitians, and medical providers. In treatment, you have a team of experts by your side, helping guide you through the journey to your recovery. Therapy options: Therapy is a cornerstone of BED treatment. A common and beneficial approach is enhanced cognitive behavioral therapy (CBT-E). CBT-E is a therapy approach that has the most empirical evidence for treating eating disorders, proving it to be an effective, gold standard–level treatment. Individuals who participate in up to 16 weeks of CBT-E show the greatest reduction in symptoms over those who only do up to eight weeks of treatment. This treatment approach can help rewire your thoughts and behaviors around food. With the support of a trained therapist, you can recognize and change the binge-restrict cycle. Nutrition counseling: Working closely with a dietitian is another key component of treatment to overcome binge eating disorder. A dietitian is a food expert on your team who can help you better understand your eating habits and heal your relationship with food. Medication consideration: When appropriate, your healthcare provider may consider adding medication to address co-occurring conditions like anxiety or depression. Emotional support: Emotional support is crucial to your recovery, serving as a safety net when things get tough. Friends, family, and support groups can provide the ongoing encouragement and understanding you need to push through the ups and downs of treatment. What does binge eating disorder treatment look like? Starting your journey to overcome BED can feel like you are stepping into the great unknown. Here’s a glimpse of what you can expect from your treatment: Evaluation and diagnosis: The recovery process begins with an assessment done by a healthcare professional. This evaluation is the starting point for your medical provider to understand the challenges you’re facing and to make an accurate diagnosis. Personalized treatment plan: Once you have a diagnosis, you and your care team can develop a customized treatment plan that fits your life and needs. This plan will outline the steps and strategies chosen to meet your unique situation—and that plan can change over time. Therapy sessions: Therapy sessions are a central part of your treatment. Regular check-ins with a licensed therapist can help you navigate your challenges and celebrate your victories. Coping skills: Building coping skills is a major focus of eating disorder therapy. These coping skills can help you deal with emotions, stress, and triggers. Nutritional guidance: A dietitian will provide you with nutritional guidance, help you reintroduce or incorporate movement, and promote a positive relationship with food. Supportive environment: Having a supportive environment is crucial and beneficial. Surrounding yourself with people who understand and encourage your journey can play a vital role in providing you with emotional support. At Equip, we encourage patients’ family and friends to be part of the treatment process, and match them with their own mentor who has supported a loved one through recovery. Progress and adjustments: Treatment is a dynamic process; it’s a journey that comes with milestones. As you progress, your provider team may adjust your plan to reflect your evolving needs and goals. It’s important to remember that seeking help for a binge eating disorder is a brave and significant step. Binge eating disorder isn’t not “just” overeating, and it’s not something you can push through on your own. Get in touch with our team today for more information or to schedule a free consultation. About Erin Reeves, RD Erin Reeves, Director of Nutrition at Equip, has 15 years of experience treating patients through all age ranges and levels of care. She received her Masters's Degree in Nutritional Science and completed her dietetic internship through California State University Long Beach. Erin is extremely passionate about helping people improve their relationship with food to live a full and happy life.]]></content:encoded>
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            <title><![CDATA[It Takes More than One Person to Treat an Eating Disorder: The Value of Multidisciplinary Care]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/multidisciplinary-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/multidisciplinary-eating-disorder-treatment</guid>
            <pubDate>Thu, 29 Feb 2024 20:57:00 GMT</pubDate>
            <content:encoded><![CDATA[  With a lot of illnesses, you just need one specialist to help you get better: you’ll see an orthopedist for knee pain, a dermatologist for skin concerns, an optometrist for eye issues. Eating disorders, however, are different. To effectively treat an eating disorder, you don’t just need multiple providers, you also need providers across different disciplines and areas of expertise. This may seem like overkill, but research shows that working with a multidisciplinary care team—aka a treatment team that includes several different types of providers—gives patients the best chances of achieving lasting recovery. Read on to learn about how multidisciplinary treatment for eating disorders works, and why it’s so important. Why eating disorders need multidisciplinary treatment You can’t treat an eating disorder with just one provider because eating disorders don’t just affect one part of a person. They’re complex illnesses that touch many different parts of a person’s body, mind, and life, and each of these parts needs to be addressed. Because of this, experts in the field widely recognize the multidisciplinary team approach to be the best practice for treating eating disorders and disordered eating, with research showing that it’s the most effective approach for weight restoration, among other benefits. To better understand the importance of multidisciplinary treatment and why certain providers are included on the care team, it can be helpful to understand the various different ways an eating disorder can affect someone: Physical effects Eating disorders affect all the major systems of the body, and can come with a multitude of physical and physiological complications. These include: Loss of brain matter Amenorrhea Bone issues, including osteoporosis or osteopenia Constipation, stomach pain, or digestive problems Low blood pressure Low heart rate Heart arrhythmias Organ damage Vitamin or nutrient deficiencies Psychological effects Eating disorders are mental illnesses, and so it makes sense that they have a profound impact on a person’s psychological health. Psychological effects include: Depression, loss of interest in activities, or flat affect Increased anxiety Obsessive thoughts and preoccupations Compulsive behaviors and rituals Suicidal thoughts Poor self-esteem Hopelessness/despair Inability to describe or access emotions Social effects Eating disorders tend to be all-encompassing, having a deep impact on a person’s mood, outlook, and relationships. The emotional effects of eating disorders include: Irritability Social withdrawal Absence from family meals and food-related events Impaired relationships Inability to communicate effectively For a more complete list of the different ways eating disorders can impact a person, explore our eating disorder screening guide. The bottom line is, one single provider can’t address all of these factors on their own. What a multidisciplinary team looks like in eating disorder treatment Not every eating disorder treatment team looks the same; the composition can vary depending on where you seek treatment, your diagnosis, and what your specific needs are. However, a multidisciplinary eating disorder treatment team almost always involves a physician, a therapist, and a dietitian. At Equip, we add to this team by connecting patients with mentors who have lived experience. When a patient begins treatment at Equip, they’re matched with a dedicated care team made up of five providers, all of whom have specific experience treating eating disorders: A physician to stay on top of medical issues A therapist to help build coping skills and work through psychological elements of the illness A dietitian to help meet nutritional goals and build mealtime skills A peer mentor who has been through recovery to provide empathy and motivation A family mentor who has helped a loved one through recovery to support the patient’s family and friends Let’s take a closer look at the role each of these people play in the course of treatment. The role of an eating disorder physician in treatment Because of the potential physical complications outlined above, a physician is a vital part of any eating disorder treatment team. Physicians not only monitor and manage any physical complications of the eating disorder, they can also address any health issues that arise on the road to recovery. Physicians also assess whether a patient is medically stable enough to start outpatient treatment, and continually assess whether they need hospitalization. All Equip physicians have extensive experience treating eating disorders. These physicians work closely with patients and their families, and also coordinate with the referring doctor to keep them updated on their patient’s treatment, their progress, and, eventually, their discharge plan. The role of an eating disorder dietitian in treatment Creating regular eating habits is one of the first and most important parts of eating disorder treatment. Doing this is much easier said than done, so it’s vital that any multidisciplinary team include a registered dietitian (RD) who has experience treating eating disorders. According to the American Dietetic Association, nutritional counseling by a registered dietitian is an essential component of treatment for patients with anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders. Experts in the field have called out the fact that dietitians are often left out of the treatment equation to the detriment of patients, as dietitians are “ideally positioned to assess and advise on the clinical aspects of malnutrition.” These experts also point out that because food is a central focus in eating disorder treatment, dietitians are “key members” of the multidisciplinary care team. Dietitians work with patients and their families in many different ways throughout the recovery process. Some of the things a dietitian might do during eating disorder treatment include: Give a nutrition prescription. Dietitians help patients achieve nutritional rehabilitation, which often means safely increasing calories, food variety, or both. Help with meal plans and recipes. By providing practical food guidelines that include recipes, meal choices, and snack ideas, dietitians give patients and their loved ones the specific and actionable knowledge they need to restore nutrition. This can be especially helpful for patients and parents striving toward a high-calorie meal plan. Provide nutrition education. Scrutinizing nutrition labels and obsessing over calorie counts is a hallmark of many eating disorders, but this is by no means the equivalent of real nutritional understanding. Throughout treatment, dietitians help patients and their loved ones understand the basics of nutrition, helping them better understand their body’s needs, challenge diet culture beliefs, and develop a better relationship with food. Managing activity. Exercise can be a tricky thing for those in recovery to navigate. Dietitians can help patients figure out the best approach toward physical activity and how it fits into their lives in a healthy and sustainable way. Increasing food variety. People with eating disorders often eat a very small variety of foods and have certain foods that they refuse to eat or can’t eat without great anxiety (“fear foods”). Dietitians help them increase food variety and challenge fear foods in a safe environment. The role of an eating disorder therapist in treatment Eating disorders are mental illnesses, and so a holistic treatment plan needs to include someone who can address the mental and psychological components of the disease. Patients can begin with therapy as soon as they start treatment. While certain therapeutic modalities have more or less success depending on a patient’s diagnosis, research shows that therapy, in general, helps improve eating disorder symptoms, with at least one study showing that any type of therapy leads to significantly better outcomes than no therapy at all. According to the American Psychological Association, psychologists or other mental health professionals are “integral members of the multidisciplinary care team,” helping patients to identify factors that maintain the illness and develop a treatment plan that addresses these factors. During treatment, therapists can help patients to: Set goals and track progress towards those goals Become more in tune with their emotions and mood, and how they impact eating Learn coping strategies to replace eating disorder behaviors Challenge eating disorder beliefs and thought patterns Improve relationships and communication Treat co-occurring conditions, like depression, anxiety, or OCD Various different therapeutic modalities have shown to be effective in treating eating disorders. At Equip, our therapists pull from the leading evidence-based approaches to tailor treatment to their patient’s needs. Some of the modalities we use include CBT-E (enhanced cognitive behavioral therapy, or cognitive behavioral therapy for eating disorders), DBT (dialectical behavioral therapy), FBT (family-based therapy), ERP (exposure and response prevention), and more. The role of mentors in eating disorder treatment Eating disorder recovery is hard. Even with all the right support from providers who specialize in eating disorders, it’s normal for both patients and their loved ones to have moments where they feel discouraged, ambivalent, misunderstood, even hopeless. Mentors help combat that. While the research around mentorship is somewhat limited, it’s also quite promising. One study showed that mentorship has value for both mentors and mentees during eating disorder treatment, while another showed that peer mentorship is effective in addressing both cognitive and behavioral eating disorder symptoms. Mentorship can also be crucial for the friends and family supporting a patient through recovery, as research shows that there’s often a steep learning curve for loved ones when treatment begins. Family mentors—people who have been in their shoes and made it to the other side—can provide both education and a listening, understanding ear. Of course, a multidisciplinary approach doesn’t work as well (or at all) if the different parties aren’t communicating with one another. At Equip, the members of a patient’s team are consistently in contact, making sure to share information, concerns, and insights every step of the way. This sort of coordinated care is not only vital for providing the most effective and tailored treatment, but also relieves patients and their families of the burden of serving as a go-between for all of their different providers. We know that you can’t just “white knuckle” eating disorder recovery on your own—and in fact, for the best odds of lasting recovery, you need a multidisciplinary care team of different providers. These illnesses are physical, mental, emotional, and social, and so they require a wraparound treatment approach. By addressing every aspect of the eating disorder, multidisciplinary care makes recovery sustainable, protects against relapse, and empowers patients to free themselves fully from the grip of their eating disorder. Learn more about how Equip’s multidisciplinary treatment works.]]></content:encoded>
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            <title><![CDATA[How to Stop Binge Eating: Spot Your Triggers, Break the Cycle]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/how-to-stop-binge-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/how-to-stop-binge-eating</guid>
            <pubDate>Fri, 15 Aug 2025 15:41:00 GMT</pubDate>
            <content:encoded><![CDATA[Do you feel completely out of control around food, like you can’t stop eating and are trapped in a cycle you can’t break? If so, you’re not alone. In fact, binge eating disorder (BED) is more common than many people realize, as it affects millions of people and is the most common eating disorder in the U.S. Despite that, it’s often misunderstood and mistaken for a lack of willpower around food—but it’s not a matter of personal failure. Rather, binge eating is the sign of a complex condition, one that has proven, effective solutions backed by evidence. Today, we’ll look more closely at binge eating disorder and its criteria, unpack common triggers, identify ways to stop bingeing, and explore resources and next steps in your healing process. What is binge eating disorder? Signs and criteria According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), binge eating disorder is defined as eating an excessive quantity of food in a discrete period of time (e.g., within a two-hour window) at least once per week for three months or more. During a binge episode, it’s common to feel a loss of control, where you feel like you’re unable to stop eating. “People feel out of control and impulsive, unable to stop even if they want to,” explains dietitian Amy Goldsmith RDN, LDN. After a binge, people typically experience significant distress, but don’t engage in compensatory behaviors like excessive exercise or purging (which distinguishes BED from bulimia nervosa). A diagnosis of binge eating disorder typically also requires three of the following criteria: Eating much more rapidly than usual Eating until uncomfortably full Eating large amounts of food when not physically hungry Eating alone due to embarrassment about how much you’re eating Feeling disgusted with yourself, depressed, or very guilty afterward Keep in mind that binges are different from having a big meal or a snack, or occasionally overeating or eating past your body’s fullness signals—which are healthy and important parts of recovery. “Occasional overeating, like having seconds on a holiday or enjoying dessert after a big meal, is a common and often joyful part of normal eating,” adds dietitian Victoria Whittington, RDN. According to the National Institute of Mental Health (NIMH), approximately 2.8 percent of adults in the U.S. will experience binge eating disorder at some point in their lives, which is higher than the prevalence of other eating disorders like bulimia nervosa and anorexia nervosa. BED is more common in women than in men, with women accounting for around 60 percent of those diagnosed with binge eating disorder. Though it can develop at any stage of life, it often begins inlate adolescence or early adulthood. Binge eating disorder is commonly associated with other mental health issues such as depression, anxiety, and substance use disorders.  Understanding binge eating triggers The specific triggers for binge eating can vary from person to person and circumstance to circumstance, but they tend to fall into one of several different categories. “Binge eating can be triggered by a mix of biological, emotional and environmental factors,” Whittington explains. Below, we’ll explore the most common types of binge eating triggers. Biological triggers: the binge-restrict cycle Some form of restriction is usually at the heart of most instances of binge eating and most cases of binge eating disorder. The binge-restrict cycle is a pattern of restriction, followed by binge eating, then another period of restriction, and on and on. “Undereating during the day or restricting certain foods can increase hunger hormones and make the brain more sensitive to food cues, setting the stage for a binge,” Whittington says. Additionally, food restriction often leads to obsessive thoughts about food and extreme hunger, which can contribute to a binge. After the binge, you might find yourself feeling ashamed or guilty, which can lead to more restriction, then another binge, and so on. Emotional triggers: stress and emotions For many, binge eating is a coping mechanism gone awry: when you reach for food in a compulsive and excessive way, you may really be reaching for help and soothing. One 2020 study of men and women with binge eating disorder found that binge eating may function to alleviate unpleasant emotional experiences. Without healthy ways to handle difficult feelings and stressful life situations or process past trauma, you may instead turn to disordered behaviors, like bingeing, to numb the emotional pain. Sometimes, food can become a companion in moments of loneliness or boredom until you’ve found other ways to help get your needs met. Environmental triggers: people and places, times of day, and food insecurity Sometimes, being overwhelmed in social situations with negative body image or pressures to fit in or eat a certain way can trigger binge eating. This can be especially true if you’re around people who are entrenched in diet culture themselves, or are visiting places that feel chaotic or uncomfortable. You might also notice that certain times of day might trigger the urge to binge—for example, 2024 research shows that it’s most common for people to binge around dinner time. Finally, more 2024 research shows that food insecurity is linked to binge eating, with the study revealing that food insecure teens are at risk of developing binge eating disorder in the future. Expert-backed strategies: how to stop binge eating Healing from binge eating disorder is like recovery from other eating disorders in that it requires intention, time, patience, and support. Below are the four key tenets of how to stop binge eating. Foundational step: break the cycle with structured eating Because restriction can lead to bingeing, it’s important to create a structured meal plan and food routine (ideally with the help of a registered dietitian) to avoid going long periods of time without food. “Structured eating is often one of the most impactful tools to support recovery from binge eating,” Whittington explains. “Eating balanced meals and snacks every three to four hours throughout the day can help keep blood sugar stable, reduce food preoccupation, and make it easier to respond to internal hunger cues.” Many people need three meals and two to three snacks each day, but energy and nutrient needs vary from person to person. Whittington says that it’s critical to follow the eating structure even if your hunger cues aren’t present yet. This is an example of mechanical eating—a temporary tool in eating disorder recovery in which people “eat by the clock” rather than by hunger. “This helps to normalize hunger and fullness cues and decrease food thoughts and cravings over time,” she adds. However, it’s important to make sure your eating structure isn’t rigid or restrictive and that it satisfies you, because otherwise, it could still set you up to binge. To do this, it’s best to work with a dietitian on a structure that supports your unique needs and preference. Your dietitian will “assess your nutrition needs and provide recommendations that focus on consistent fuel throughout the day to ensure physiological hunger doesn't create a binge,” Goldsmith says. In the moment: skills to cope with an urge to binge First, understanding what triggers your binge eating can help shine a light on the root of the problem. Once you know your triggers and what causes urges, you can develop healthier ways to cope with them rather than resorting to binge eating. Below are some strategies to turn to when you have an urge to binge, and you can explore more coping skills on our YouTube channel. Shift your nervous system. Goldsmith recommends disrupting the intensity of an urge by shifting the nervous system in the heat of the moment. You can do this with actions like “splashing your face with very cold water, going outside in the cold, or squeezing a frozen orange,” she shares. Other ways to help regulate your nervous system include spending time with a safe person, listening to soothing music, talking about calming topics, holding objects or photos that evoke pleasant memories and feelings of safety, using mindfulness practices like extended exhale breaths, mindfully moving your body, or engaging your senses. Check in. All urges can be an invitation to slow down and turn inwards with curiosity. “It can help to pause and check in with what’s going on internally,” Whittington says. “It's most helpful to do this without judgment. Ask yourself: Am I hungry? Am I feeling something uncomfortable that I’m trying to soothe with food?” Often, the urge is showing you that you have an unmet need that’s not food-related (as long as you’re not physically hungry and you’re not in a calorie deficit). Meet your need. If you conclude that there’s an unmet, non-food need (e.g. comfort, rest, release, safety), try and help yourself meet that need the best you can. If it’s comfort, cuddle with your pet or a cozy blanket or call a close friend or family member. If it’s release, perhaps it feels good to scream into a pillow or dance around your living room. The idea is that the more often you meet your non-food needs without bingeing, the less intense your urges will be to binge. Practice mindful eating. Mindful eating can also be a useful tool to reduce bingeing, as it’s “a practice that encourages slowing down, tuning into hunger and fullness cues, and becoming more aware of the eating experience,” Whittington explains. In a 2024 study, people with binge eating disorder who took part in weekly mindful eating sessions saw significant improvements in how often they binged, how they felt about their bodies, and their overall quality of life. While more long-term research is still needed, these results suggest that slowing down and becoming more aware at mealtimes could be a powerful step toward healing from binge eating disorder.  Cognitive and behavioral skills (from CBT-E) Research shows that enhanced cognitive behavioral therapy (CBT-E) is an effective approach for binge eating disorder recovery. There are some CBT-E skills that are particularly helpful for binge eating disorder that can be used during an urge and at other times. These include: Challenge all-or-nothing thinking. “If you catch yourself thinking, ‘I already messed up today, so I might as well keep eating,’ try pausing and asking, ‘What’s a more helpful way to look at this?’” Whittington suggests. You might shift to a thought like, “I don’t have to be perfect and I can get back on track with my next meal,” for example. “Over time, replacing all-or-nothing thinking with more balanced self-talk helps reduce shame and supports long-term healing,” Whittington says. Self-monitor. Maintaining a detailed journal of food intake and mood can reveal thought patterns, triggers, and feelings associated with binge episodes. You can use an app like Recovery Record, a template from your treatment team, or your own journal—whatever helps you the most. Delay the urge. Once an urge hits, try pausing and setting a timer for five or ten minutes (or however long you feel like you can tolerate) to put some space between you and the urge. Whittington says doing something different once an urge starts can help lessen its power and give you the opportunity to respond instead react. Sometimes, simply walking outside or changing rooms can be enough. Goldsmith also suggests changing your environment by going for a walk or taking a shower. When the five minutes are up, reassess how you’re feeling and see if bingeing still feels like the right solution. Review barriers to recovery and create a relapse prevention plan. Once you’ve started to try new coping skills, notice what gets in the way and makes it hard to resist an urge and choose something else. It could be a physical issue, such as struggling to eat an adequate breakfast so you’re not overly hungry at the end of the day. It could be an emotional issue, like not getting enough time for yourself, so you’re reaching for food to try and fulfill that need through food. Work with your treatment team and other support people to identify such barriers and create a plan that helps reduce or remove them, and make sure to include how you’ll navigate setbacks. Professional treatment options Binge eating help can come in many different forms, depending on how much support you need. It’s always best to work with a team so you get the holistic, multidisciplinary collaboration necessary to effectively address the eating disorder. This team often includes a registered dietitian, therapist, doctor, and sometimes a psychiatrist, who all work together to support your recovery. At Equip, patients also have access to a mentor who has lived experience recovering from an eating disorder. If you’re interested in virtual, evidence-based binge eating disorder treatment at Equip, you can schedule a (free, no commitment) consultation with a team member. A sample 7-Day blueprint for recovery You might be wondering what recovery from binge eating disorder looks like. While the journey will be different for each person, there are certain themes and focus areas that will likely emerge for everyone navigating the path of BED recovery. Here’s a general snapshot of what the first week could include: Day 1: Focus on establishing a regular eating pattern. This may look like shooting to eat breakfast, lunch, dinner, and some snacks around the same time each day. Try to strike a relative balance of food groups at each eating experience and be sure to include foods you love (nothing is off limits). As I mentioned earlier, there’s no need for rigidity, and the goal is to be nourished during the day to feel your best and prevent getting overly hungry later. Day 2: Practice identifying one emotional trigger. Once you’re eating consistently and enough, you can start to notice emotional triggers to binge eat. Is it that you’re feeling lonely at the end of your day? Or perhaps something happened that brought up a painful memory from the past. Use nonjudgemental curiosity to notice what you’re feeling when you get triggered. Day 3: Try one "in the moment" coping skill. Do your best to pick one of the above skills, like checking in or delaying the urge, to practice and see what happens. Keep in mind that it takes time and usually professional help to discover the skills that work best for you. Day 4: Focus on self-compassion after a difficult moment. Recovery always comes with struggles and often self-criticism when things don’t go as planned. When you’re having a tough moment, try being kind to yourself instead, reminding yourself that other people are struggling with binge eating disorder too and that your thoughts and feelings are not you (even though it may feel like it), but something difficult you’re experiencing. Then, take some time to speak lovingly to yourself—like you would a good friend going through the same thing—instead of judgmentally. Days 5-7: Continue practicing these skills, emphasizing consistency over perfection. Notice which combinations of foods feel best in your body and see if there are any tweaks that you need to make to your eating pattern (alongside your dietitian). Take it one day at a time, get to know your triggers, and see which coping tools help you the most and which ones to leave behind. Resources and your next steps Binge eating disorder is a complex illness, not a matter of willpower. Recovery takes time, tools, and support, but it’s entirely possible. If you’re struggling with binge eating disorder, it’s best to get a professional assessment to help you clarify your path forward. When you’re ready, you can schedule a free consultation with Equip to get started. In the meantime, here are some other resources to help you learn more about binge eating disorder and find the support you need: NEDA Helpline NHS Guide to Binge Eating Disorder ANAD free peer support groups EDA meetings Binge Eating Disorder: The Journey to Recovery and Beyond by Amy Pershing Food Psych podcast episode about healing from emotional eating, binge eating FAQ How do I stop binge eating right now? The best way to disrupt the binge-eating cycle is to reach out for professional help to start your recovery process with the support you need. You can schedule a free consultation with Equip to get started. During that call, you’ll get a no-commitment eating disorder assessment, and discuss treatment options and next steps for care. What is the first step to stop the binge-restrict cycle? Aside from reaching out for professional help, the first step to stop the binge-restrict cycle is to make sure you are eating enough food throughout the day and that you’re not restricting (even a little bit). Not eating enough during the day or cutting out specific foods can raise hunger hormones and heighten the brain’s response to food, making a binge more likely. This kind of restriction often triggers intense hunger and constant thoughts about food, increasing the chances of losing control around eating. Afterward, feelings of guilt or shame may set in, which can lead to further restriction—creating a cycle of bingeing and restricting. How can I tell the difference between extreme hunger and a binge urge? Extreme hunger is physiological, while a binge urge is usually emotional. To tell the difference between the two, take a moment and look back at the last 24 hours and ask yourself questions like, “Have I eaten enough food from multiple food groups? Have I restricted at all?” If you are well-fed and haven’t restricted, chances are higher that you may be experiencing a binge urge. However, if you haven’t eaten enough, your body may be simply trying to get you to eat as quickly as possible to get your basic food needs met. Can I stop binge eating without professional therapy? It’s difficult to heal from binge eating disorder without professional therapy, because there are often emotional issues at the heart of the eating disorder that need to be healed. Recovery also requires learning healthy coping skills which a therapist will help you build, and adhering to a balanced and structured meal plan, which a dietitian can help you develop. Why do I binge eat at night and how can I stop it? You may binge eat at night because you’re not eating enough during the day and your body is trying to get you to meet your energy needs (in fact, binge eating most often occurs at night). Alternatively, if you’re getting your energy needs met and getting satisfied at your meals and snacks, but still binge eating at night, it’s likely an emotional or mental issue driving the bingeing. Often, it can be a combination of both physical and emotional issues that drives binges. The best way to stop bingeing at night is to get professional help from a dietitian and therapist. Your dietitian will help you understand your energy and nutrient needs and help you make sure you’re not living in an energy deficit, and your therapist will help you identify emotional or mental concerns that are leading to bingeing at night.  Is it possible to stop binge eating for good? It’s definitely possible to stop binge eating for good, however, it takes patience, support, and commitment to the recovery process. The first step toward stopping binge eating forever is reaching out for professional support.]]></content:encoded>
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            <title><![CDATA[6 Holiday Challenges to Eating Disorder Recovery (And How to Handle Each)]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/holiday-challenges-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/holiday-challenges-eating-disorder-recovery</guid>
            <pubDate>Mon, 09 Dec 2024 21:48:27 GMT</pubDate>
            <content:encoded><![CDATA[While eating disorder recovery can be challenging at any time of year, the holiday season can be especially tough. From the endless marathon of food-focused events to difficult family dynamics and unwanted body- and food-related comments, the holidays present a unique set of potential triggers and hurdles to those affected by an eating disorder. Thankfully, with some mindful preparation, you can learn to navigate these holiday challenges in a way that protects recovery and also allows you to enjoy this special time of year. Whether you’re dealing with an eating disorder yourself or supporting a loved one who is, read on for expert-endorsed tips on managing this festive but fraught time of year. Why are the holidays challenging for eating disorder recovery? The holidays are a source of joy for many people, but they can also be extremely stressful. And for people navigating eating disorder recovery, there are even more stressors above and beyond all the normal anxieties around gifts, social obligations, and other holiday demands. For those affected by an eating disorder, the holidays come with several unique challenges, including: Social and cultural emphasis on food: November and December are often filled with holiday gatherings and events, and almost all of them center around food. Whether it’s a party with a lavish potluck spread, a sit-down dinner with family, or baking cookies with friends, food plays a key role in most holiday activities. Many families and cultures also have specific food-related traditions, which can feel particularly tough to navigate because of the meaning associated with them. When eating already feels like a struggle on a normal day, all of this heightened focus on food adds an additional layer of difficulty (not to mention the fact that holiday foods are often richer or more “indulgent” than the foods we eat during the rest of the year, and many may be fear foods for those with eating disorders). Family dynamics: During this time of year, it’s normal to gather with family members that you don’t normally see, and this can come with complex dynamics and uncomfortable conversations. This might mean spending time with a family member who brings up distressing emotions, like insecurity or anxiety, which can lead to eating disorder urges. Or it could mean navigating conversations and comments around food, body, and diet, which can be extra triggering in these high-stress environments. Disruptions to routine: The normal day-to-day routine often flies out the window during the holidays. Kids are on school break, many offices close for a period of time, and there might be the added complications of traveling or hosting guests. No matter what the specific disruptions are, these changes can make it more difficult to stick to a meal plan, attend groups and appointments, and take care of the other regular demands of recovery. New year, new you messaging: As December winds down, it’s inevitable that we’ll all be bombarded with messages around weight loss, New Year’s diets, fitness goals, and “making up” for the indulgences of the holiday season. These diet culture-informed messaging can be harmful to anyone, but to those in the midst of recovery, it has the potential to do even more damage. All of the above can make the holidays feel daunting to those in recovery. Thankfully, there are some strategies that can help alleviate stress, make difficult moments easier to handle, and even reinforce recovery practices and tactics. So if you’re in recovery yourself or supporting a loved one who is, it’s important to take some time to map out a plan of action before you’re swept up in the chaos of the holidays. Here’s a closer look at six potential holiday challenges to eating disorder recovery and recommended ways to handle each obstacle with grit, grace, and determination. How to handle food-focused celebrations and activities The challenge: It’s no secret that the holiday season is chock full of events with a heavy emphasis on food. And in many cases, for a variety of reasons, the meals and snacks that are served at these celebrations may feel overwhelming to those who struggle with an eating disorder. It can also be hard for those working toward recovery to eat in new, unfamiliar environments or around certain people. The suggestion: “The holidays can come with more food-related challenges than the rest of the year,” says Camilla Blanton, a registered dietitian at Equip, noting that holiday events often include foods that are tied up with emotions, or foods that are only served once a year. “If there are specific fear foods you or a loved one are concerned about eating over the holidays, you can prepare by incorporating these food items more regularly in early December to help you work on food neutrality,” she says. “This could look like adding some holiday cookies to your child's lunchbox or incorporating cinnamon rolls as part of your breakfast a couple times a week. Whatever the food may be, finding a supportive way to incorporate it as a more normalized or neutral food can be extremely helpful.” It can also be helpful to plan ahead for hard feelings that might come up during food-focused events. Mindfulness and grounding practices, like breathing exercises or connecting to your senses, can be an extremely powerful tool for staying calm when a meal or other event begins to feel overwhelming. You might also want to identify a person you can turn to for real-time support when things get challenging, and establish a signal with them that tells them you need some help. If you’re supporting a loved one through recovery, you can offer to be their support person and collaboratively come up with things you can do in the moment to help manage triggers. Managing increased desires to purge The challenge: People who struggle with purging behaviors often find the holidays a particularly hard time. All the big meals and challenging foods can trigger the urge to engage in compensatory behaviors to “get rid of” or “make up for” the food. Many of the foods we eat during the holiday season are foods that someone with an eating disorder might deem “off-limits” or “bad,” and these judgments can intensify the desire to purge. The suggestion: One of the first steps toward stopping purging behaviors is to know the triggers. As the holidays approach, take some time to think about what factors tend to trigger your desire to purge (or, if your loved one struggles with purging, talk through triggers with them). Some common triggers are large meals, not feeling in control of one’s eating schedule, eating fear foods or new foods, and feelings of guilt, shame, or insecurity. Take some time to reflect on previous purging episodes to identify triggers specific to you or your loved one. Establishing a post-meal routine might also be a smart choice. The time immediately after eating is often the most challenging, so putting in place some structure can be really helpful. That might look like taking a mindful walk, listening to music you love while cleaning up, or playing a game with family. Lastly, don’t underestimate the power of distraction. Like almost all urges, the impulse to purge will pass if you simply ride it out. Being able to stay distracted while the impulse is strongest can go a long way toward eliminating purging behaviors completely. Create a personalized list of activities you can turn to after meals or whenever the desire to purge arises, like journaling, watching TV, or calling a friend. Here are some more tips for navigating holiday meals in particular.  Dealing with unsolicited comments on body or food choices The challenge: “One of the trickiest eating disorder challenges during the holidays is the amount of conversations centered around food and appearance,” says Ally Duvall, Senior Program Development Lead at Equip. “There are so many comments on how you should look during holiday get-togethers or how ‘bad’ you are for eating delicious treats that it can feel overwhelming to still choose recovery.” The solution: A helpful first step in combating unwelcome opinions or observations may be to head them off beforehand by telling friends and family to leave body-related talk at the door. In some cases, a person struggling with or recovering from an eating disorder may not want to share their diagnosis with anyone outside their immediate support group, but may be worried those same outsiders will make triggering comments or engage in problematic conversations around diets or body image. Mary Martinez-Schmidt, a family mentor at Equip, says a little planning may go a long way in these situations: “Reach out to family in advance and let them know that you would appreciate it if they avoided these topics of conversation, as you are working on cultivating a positive mindset and building a better relationship with your body and would love others to do the same,” she advises. Duvall says one of her favorite ways to handle the unwelcome comments at holiday gatherings is rehearsing responses to negative body or food talk ahead of time. “You can practice this with yourself or someone you trust by saying a negative statement and then responding to it in a way that challenges the statement or sets up a boundary,” she says. “One example could be: ‘I wish I could eat as much as you do’ and the response you could say is ‘I’d love to talk about something more interesting than how much or little we are eating—let’s change the subject.’” Blanton says another way to draw a boundary around body commentary is to shift the focus entirely. “One strategy is to change the topic. Perhaps you come in prepared with three ‘fun facts’ that you’ve recently heard from a podcast or read somewhere,” she says. “Coming prepared with some ‘change of topic’ prompts can support diverting the conversation to something other than food and body commentary.” If directly confronting triggering comments feels too overwhelming, Blanton says it may be helpful to model the type of neutral language around food and bodies that you’d like others to use (i.e. refusing to label foods as “good” or “bad” or assigning any sort of morality to food choices or body types). And if all else fails, calling in reinforcements is always a great idea. “Ask people in your support network to step in to change the topic,” says Blanton. “This can help in navigating group conversations and table talk.” Coping with travel disruptions and changes to routine The challenge: Abandoning a routine and venturing into a new environment can be stress-inducing for just about anyone, but those in recovery may find the disruption to regular life especially trying. “Travel days are some of the toughest days when working towards eating disorder recovery during the holiday season,” Blanton says. “Many people forget to prepare themselves for a travel day that may push them out of their typical routines, which can throw off eating schedules.” She notes that changing time zones often adds an extra challenge by disrupting appetite signaling, which can make it harder to stick to a meal plan. The solution: While traveling by plane, train, or automobile may make certain aspects of recovery challenging, families can anticipate the potential hurdles and prepare as much as possible. “Pack extra snacks for the plane or car ride—more than what you think you might need, just in case of travel delays,” Blanton says. She also recommends sticking to a timed eating schedule, which can help keep you or your loved one accountable to their planned meals and snacks even if their hunger cues are thrown off from travel. One way to support this goal is by setting phone reminders for meals and snacks; this might feel like overkill, but these external cues can make a world of difference during hectic travel days. If travel-related stress feeds into difficult feelings or eating disorder urges, mindfulness techniques and grounding practices can be a good tool. Deep breathing, meditation, journaling, or simply noticing your physical environment can be good ways to stop a busy mind and ease anxiety. Dealing with clothing- and appearance-related stress The challenge: “Anyone who has been close to someone suffering from an eating disorder can relate to the intense and anxiety-inducing challenge of having to choose what to wear, especially for special occasions,” says Martinez-Schmidt. “This comes up a lot during the holiday season, as we often participate in large family gatherings, special events, school dances, and workplace holiday parties in which we all feel pressure to look our absolute best. This is even more challenging for someone with an eating disorder who suffers not only from body dissatisfaction but also from constant overvaluation of shape or weight.” The suggestion: Just as finding the right Halloween costume or prom outfit can cause anxiety and stress for those in recovery, choosing a look for the holidays can conjure up some intense feelings. But in all these cases, a good rule of thumb is to prioritize comfort: selecting clothes that feel good and inspire confidence will likely eliminate the stress and self-consciousness that can arise from wearing constricting or otherwise uncomfortable clothing. Martinez-Schmidt says it can be tricky for family members to know what to say to boost a loved one’s confidence or self-esteem, but the best strategy may be to maintain a neutral stance when it comes to discussing shape or body image. “Well-meaning friends and family might be inclined to offer compliments like ‘you look amazing,’ ‘you look healthier,’ or ‘you lost weight!’ in an attempt to offer reassurance. However, these statements, even if they’re meant to be positive, only reinforce your loved one’s excessive preoccupation with their body shape and size. The best strategy is to offer compliments and appreciation for qualities that are not related to physical appearance. Saying things like ‘your smile lights up the room’ or ‘you’re always the life of the party!’ will go a lot further in helping your loved one feel comfortable in their own skin.” Navigating Social Pressures and “Performing” Recovery The challenge: “I didn’t anticipate the guilt and shame I would feel around wanting to be the perfect example of recovery, especially during the holidays,” Duvall says. “I spent a lot of time worrying about my ‘recovery status’ if I didn’t challenge a diet culture comment from Cousin Sam or use my coping skills the way I had planned to. This fear of failing recovery, especially around times of high emotions and gatherings centered on food, can feel isolating and intense.” The suggestion: Duvall says overcoming the pressure to be “perfect” requires a lot of patience and understanding that there really is no such thing as “perfect” in the first place — especially when it comes to non-linear journeys like eating disorder recovery. Taking time-outs and consciously reminding yourself of your values, your progress, and your worth can go a long way. “It’s so important to remember that you have the power to meet yourself with compassion and kindness,” she says. “Although shame might be your initial thought, what do you choose your second thought to be?” she asks. Blanton agrees, adding that support networks exist for a reason, and their encouragement may be extra important during this time of the year. “The holidays can be hard for many struggling with disordered eating or an eating disorder,” she says. “Allow yourself some grace and self-compassion as you move through the holiday season, and be sure to have your support network nearby if you need extra support this year.” Affirmations or mantras can be a good tool for practicing self-compassion in the moment. Try finding some sayings or phrases that resonate with you, and write them down or practice repeating them internally when feelings of inadequacy arise. Lastly, remember that recovery is a nonlinear process. For most people, the journey to full recovery involves at least a few steps backward among all the steps forward. What’s most important is to keep a long-term view and remember that perfection is never the goal. Self-care strategies for holiday recovery challenges Throughout the long holiday season, self-care can be your best friend. It’s easy to get wrapped up in all the obligations and pressures, but whether you’re in recovery or supporting a loved one, it’s extra important to take time for yourself. Practicing self-care throughout the holiday season can help you prevent burnout, keep recovery strong, and make this festive time of year more enjoyable in the end. Self-care looks different to everyone, but here are some strategies you might consider adopting this time of year: Prioritize your routine. With all the events, travel, and social demands this time of year, it can feel like your time is no longer yours. Of course, we all have things we truly need to do, but remember that you can say no to things, and that it’s okay to prioritize your own daily needs. Try establishing a structure for your days that gives you guaranteed time for important things like meals, as well as at least 30 minutes a day that you can dedicate to a quiet, restorative activity. Make time for non-food activities. So much of recovery centers around food, and this can feel even more true this time of year. Make sure you carve out time to engage in hobbies and activities you enjoy that have nothing to do with food. That might be reading, knitting, painting, hiking, decorating your home—anything you truly like doing. Try action cards. Action cards, or coping cards, are physical cards you can carry with you to help you stay grounded and connect to your values and goals during triggering moments. You can create your own cards with reminders you know will resonate with you, like an affirmation, a quote you love, or a list of things and people you want to recover for. You can also download a set of coping cards from Equip that you can either print out save to your phone. Find physical comfort. It’s essential to take care of your body in ways that don’t involve eating or exercise. You might take a warm bath, do a face mask, get a massage, or just put on your coziest socks and PJs—whatever helps you feel more comfortable and cozy in your own skin.  Express gratitude. It’s easy to fixate on what you don’t have or what you’re missing out on, and this feeling can intensify when you’re navigating the holidays during recovery. Focusing on what you do have can counteract this tendency, helping you adopt a more positive mindset. This, in turn, makes navigating all the challenges before you significantly easier. Supporting a loved one in eating disorder recovery during the holidays If your loved one is dealing with an eating disorder, it can feel tough to know what to say or do during challenging periods like the holidays—but it’s during these times that your support is most important. Thankfully, there are concrete, actionable things you can do to help make the holidays easier for your loved one to manage as they work toward recovery. Ask how to help them. Sometimes, the simplest solution is the best. If you’re not sure what kind of help your loved one needs or wants, ask them. Find a quiet, private time to talk with them, and ask how they’re feeling about the upcoming holiday season. Listen to their thoughts and concerns, and let them know that you’re there to support them in whatever way they need. If possible, try to collaboratively come up with tangible things you can do or say to support them during this time of year: Running interference with a certain relative? Sitting next to them during meals? Making sure certain foods are (or aren’t) around? Changing the subject when conversations turn to triggering topics? Model neutral language. We all absorb attitudes from the people around us, so one way to support a loved one who might be dealing with negative body image or disordered thoughts about food is to provide a healthy example. Pay attention to your own words, and try to make sure you’re speaking about food and bodies in a neutral, judgment-free way. Don’t refer to foods as "guilty pleasures,” criticize your own body, or talk about “making up for” holiday meals through diet or exercise. Instead, emphasize how a food tastes or smells, how your body feels or what it can do—or just talk about something else entirely. Come up with an escape plan. Sometimes, the best thing a person can do to support their recovery in a tough situation is to get out of there. This, of course, is easier said than done, so your help can go a long way. Before a party or event, create an exit plan that you and your loved one can turn to if things become too overwhelming. This can include a signal you’ll use to indicate it’s time to go, as well as exactly what you’ll say and do to discreetly and safely leave. The Equip takeaway on recovery during the holidays The holiday season can feel daunting for those affected by eating disorders, as well as their loved ones. The good news is that with some thoughtful preparation and communication, you can navigate this challenging season in a way that supports recovery. The holidays might look different this year than they did in years past—and that’s okay. By prioritizing recovery, you’ll not only continue to move toward a life without an eating disorder, you may also create new meanings and traditions that you’ll bring into the years to come. If navigating the holidays feels like too much even with the strategies above, remember that you don’t have to do this alone. Enlisting the help of an eating disorder expert might be the best choice for you or your loved one this holiday season. Talk to your doctor or an eating disorder-informed mental health professional, or schedule a consultation with an Equip team member to talk through your concerns.]]></content:encoded>
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            <title><![CDATA[Parents' FBT Survival Guide: Tips and Strategies for Succeeding with Family-Based Treatment]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/fbt-survival-guide-tips-for-families</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/fbt-survival-guide-tips-for-families</guid>
            <pubDate>Thu, 14 Aug 2025 14:21:00 GMT</pubDate>
            <content:encoded><![CDATA[When JD Ouellette’s daughter was first diagnosed with anorexia, it came as a shock. “But it also made all the puzzle pieces of symptoms and behaviors come together,” Ouellete, Equip’s Director of Lived Experience, says. As her daughter’s health quickly deteriorated, Ouellette and her family sprung into action—but they felt less than prepared for the journey ahead. “All of my understanding of anorexia at that point came from Lifetime TV movies, ABC Afterschool Specials, and Karen Carpenter,” Ouellette says. “So I held all the outdated beliefs about parents and trauma causing eating disorders and controlling your food because you couldn’t control anything else in your life.” Soon, Ouellette realized that the stereotypes she’d been holding onto weren’t necessarily rooted in reality. “Our parenting, our family, our child, and our life was nothing like any of that,” she says. “We were a close, functional family of six and our daughter, until recently, had been happy, healthy, confident, and full of hopes, dreams, and plans.” But this understanding didn’t get her any closer to knowing how to help her child. In her urgent search for support, Ouellette heard about an anorexia treatment known as family-based treatment (FBT) and decided to pursue it. “Doing FBT was experiencing and walking through pain and trauma alongside my child,” she says. “It involved feeling like I was the source of her pain because I was the one feeding her, going through my own heartbreak and grieving—and coming out the other side with a healthy daughter and a bond that was forged in steel.” Today, Ouellette is a passionate advocate for families going through FBT, based on both her own lived experience and the evidence showing that FBT gives children, adolescents, and even young adults the best chance to fully recover. “Eating disorders are incredibly serious, life-impacting, and threatening illnesses,” she says. “FBT is a treatment model that doesn’t put the patient ‘over there’ to be fixed, but instead helps parents or caregivers and the rest of the family to understand the eating disorder, drive treatment progress, and learn how to support their loved one for the long term. FBT makes home—which is after all where life is lived—a place where recovery can be achieved and sustained.” When confronted with the option of FBT, many parents may feel unprepared and overwhelmed, just like Ouellette was at the start of her journey. While some fear and trepidation are common parts of the process, advocates like Ouellette emphasize that FBT is an incomparable treatment option. With the right tools and preparation strategies, all families can confidently navigate FBT — here’s how.  What is FBT? Originally known as the Maudsley Method, FBT is an eating disorder treatment approach that focuses on empowering the family to actively participate in a loved one’s recovery. FBT is considered the gold standard for eating disorder treatment in children, adolescents, and young adults, and is used to treat anorexia, bulimia, binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID) and other specified feeding or eating disorder (OSFED). “FBT is a form of therapy for eating disorders focused on empowering the family to renourish their loved one and interrupt disordered eating behaviors,” explains Equip Therapist Lead Ana Gardner. “Eating disorders have high mortality rates and the potential for lifelong consequences; for this reason, FBT does not focus on what caused the ED, but on early and effective intervention. Time is of the essence, especially in adolescence, as we would like to stop the disorder in its tracks and minimize the chaos the eating disorder can cause in that patient's life.” The primary objective of FBT is to give patients the opportunity to recover in their familiar home environment, with the support of their loved ones. The treatment protocol first targets eating disorder symptoms and behaviors (and weight restoration, if necessary), and then moves on to address psychological, emotional, and relational aspects later. FBT is typically split into three phases that give the patient increasing independence as they move toward recovery: Phase 1: Reduction of symptoms and weight restoration (when needed) Phase 2: Development of skills and independence Phase 3: Identity formation and relapse prevention “It's important to note that the longer the eating disorder is around, the more entrenched it can become in a person's life,” Gardner says. “This is why early action is emphasized. Parental empowerment builds confidence in carers as the primary change agents of the recovery process.” Gardner points out that an important aspect of FBT is that it distinguishes between the patient and their eating disorder, a process known as externalization. “It can be helpful to visualize the patient and the eating disorder as separate entities,” she says. “Many patients name their ED and identify it as a villain. Like a villain or alien—or any other analogy with a negative connotation—this ED is guiding the patient's thoughts, feelings, and behaviors. Externalizing the eating disorder is critical for reducing shame and blame, and gearing up the carers to band together to push out the ED.” Why can FBT be so hard? Because families are the core of FBT, they bear the responsibility for most of the real work of recovery. And while FBT is typically done with the support of trained professionals and follows a specific, structured protocol, this work can still be incredibly challenging—especially in the beginning. “As a parent, doing FBT can feel like counterintuitive parenting,” Ouellette says. “I tell other parents that an eating disorder and FBT require you to be the parent your child needs versus the parent you are comfortable being. Initially, most of us feel terrified and ill-equipped, we’re sometimes in shock, and it feels like we’re being tasked with an impossible endeavor.” Ouellette says that in her case, the most challenging pieces were treating her mature and highly independent 17-year-old “like a toddler” at the onset of FBT, and navigating times when her daughter’s eating disorder defended itself by pushing back against the rules and requirements of treatment. “My daughter’s eating disorder was so clever at making me doubt myself that for a time, I just couldn’t have long or deep conversations,” she says. “I had to stick to being brief, direct, loving, and firm. It felt like being ‘cruel to be kind.’” Gardner says the emotional obstacles Ouellette encountered are not only common, but anticipated as integral parts of the FBT experience. “Discomfort and challenges are normal and expected in FBT treatment,” she says. “FBT directly challenges the eating disorder’s control and autonomy—oftentimes, this means significant monitoring for the patient. The eating disorder is fighting to stay alive and will often push back with tenacious tactics. To be clear, the ED is the one who is pushing back, not the patient.” This pushback from the eating disorder is so common that there’s actually a term for it: “extinction bursts,” which refers to the eating disorder’s desperate attempts to retain control as treatment begins to successfully undermine its power. “When the eating disorder is no longer able to operate as successfully as it had, it will hold on for dear life,” Gardner says. “This may mean more intense tantrums, intense food refusals or sneaky attempts to engage in old behaviors. It can be hard to witness, but it's a sign that the ED is losing its footing and is trying to re-entrench the patient in previous behaviors. Continual monitoring, consistent boundaries and a calm demeanor are some of the most powerful ways carers can help defeat the eating disorder—even during an extinction burst.” Because FBT can feel so counterintuitive, Ouellette says it can be misinterpreted by those who don’t fully understand eating disorders—outsiders may be skeptical, or see it as a violation of children’s autonomy to insist that they eat a certain amount or avoid certain behaviors. “So it can be a very isolating experience, even if you have friends and family trying to understand and support you,” she says. For Ouellette and her family, the payoff for all these challenges went far beyond her daughter’s recovery. “It taught all of us about ourselves and the kind of team we are as parents and a couple, as parents and children, and our children as siblings,” she says. “We don’t have to assume we would do whatever it takes to help one of us in their time of need—we have done it. We will be there no matter the work needed, how hard the work is, or how long the work takes. In addition to cementing our strength as a family, the dialectical behavioral therapy skills that were part of our FBT treatment have made us more effective communicators, better able to emotionally regulate in stressful times, and able to be better in touch with and more direct about our needs with and from one another.” Common FBT challenges and how to overcome them Parents and other caregivers can feel confident in choosing FBT—there’s no doubt that this approach gives patients the best chance of achieving full recovery—but that doesn’t make the challenges go away. “It's not easy, but it’s possible!” says Gardner. “When carers take responsibility for meals and interrupting eating disorders behaviors—like food refusal, selective eating, weight manipulation—it’s common that it will get harder before it gets better.” Thankfully, there are expert-endorsed strategies, tools, and tips to make it easier to navigate the hurdles and challenges that tend to arise. Caregiver alignment Enforcing the boundaries of FBT can be challenging enough on its own, but trying to do so in alignment with a spouse or partner can be doubly tough. “Everyone is stressed, this is hard, and different personalities can struggle more than others with the structure and hard lines of FBT,” Ouellette says. “I am a huge fan of using some therapy sessions just for parents to hash out what things will look like—even when there are separate homes—and what division of labor will be. I don’t think everyone has to do everything and playing to your strengths, while growing and changing to fit the situation, is helpful. I love to have a very brief written document with the schedule and some agreed upon rules and motivators and contingencies. It’s better to make decisions away from the pressure and influence of the eating disorder than in the moment.” Reluctance to take full control over renourishment Taking control of your child’s eating is the central component of FBT, at least during the first phase. But doing this can be extremely hard, and may feel unnatural or even “wrong.” According to Gardner, overcoming this obstacle hinges on understanding why carers are tasked with monitoring and re-nourishing. “Often, patients will attend an in-person higher level of care where they gain weight, stop ED behaviors, and are then discharged home,” she says. “Yet once they return home, the behaviors resurface, leading to renewed weight loss and disordered eating patterns. FBT empowers caregivers to intervene directly in the home environment, disrupting disordered behaviors and supporting a sustained recovery.” According to Gardner, consistent monitoring for weight manipulation, secretive exercise, food avoidance, hiding or discarding food, and more is vital to a child's success. “Supervised meals and limiting time alone after eating can minimize opportunities for ED behaviors to re-emerge,” she says. “Professional support can help coach families through how to manage these behaviors while maintaining compassion and connection.” Gardner adds that it’s also important to arm parents with education on how eating disorders function and what to look for. “Families are encouraged to understand that this is not their child ‘being difficult’—it's the ED speaking. Learning the language, tactics, and patterns of ED behavior can help carers separate the illness from the child and respond more effectively.” Food preparation The actual food prep part of FBT can present its own unique challenges for caregivers who have to make sure each meal and snack is in compliance with the patient’s specific plan. “I encourage thinking of the meal plan as a nutrition prescription and the food as a dose of antibiotics to be dosed at specific intervals and in specific amounts—and understand that skipping doses can make things worse,” Ouellette says. “It’s a different way of thinking about and preparing food, and usually that’s everything society has been telling us not to do.” Ouellette says that a few strategies that helped her were to meal prep while her daughter slept and to simplify what she was offering. “And for those who have friends and family wanting to help out, having them prepare meals for you can allow you to use your energy where it is most needed: getting the food in and the weight on,” she says. “And if you don’t cook, you can still do this, and your dietitian and other caregivers can help!” Pushback from the patient “For many carers, it can feel like a battle with the ED to renourish the patient,” Gardner says. “It can be excruciating to see your child completely entangled in an eating disorder. Any pushback or combativeness from the patient's ED can be frustrating—and also expected. Remember, recovery is not linear,” Gardner says. “Some days may feel endless while others may offer a glimmer of hope.” To overcome this obstacle, Gardner offers the following strategies: Have planned distractions during meals (while carers are still providing ongoing monitoring). Think: music, audiobooks, calming conversation. “Having a distraction after meals like playing a board game or watching a TV show may also be helpful,” Gardner says. Set time limits (e.g., 30–45 minutes for a meal) for each meal. If the meal is not finished when the time limit is up, there may be a logical consequence (such as drinking a nutrition shake). You can talk with your dietitian to figure out the best time limit and how to enforce it. Keep language simple and calm. “At Equip, we often teach the ‘loving and firm’ approach,” Gardner says. This may look like any of the following scenarios: Scenario 1: Child: “I’ve already eaten enough! I don’t want to eat anymore” Example response: “I know this can be scary. Your body still needs this food to heal. I’ll be with you every step as you finish.” Scenario 2: Child: “Why are you doing this to me? You’re ruining my life!” Example response: “I know it feels that way right now. I’m doing this because I love you too much to let the eating disorder stay in control. We’ll get through this together.” Scenario 3: Child: “I don’t want to eat. I feel disgusting!” Example response: “I’m so sorry you're feeling that way. Those feelings are real, but they don’t mean you don’t need food. Let’s take one bite at a time- I’ll be right here.” Scenario 4 Child: “Just let me skip one meal. One won’t matter!” Example response: “I understand that’s what the eating disorder wants you to believe. But every meal matters. We can do this together. Let’s start now.” Limited time and activities In addition to the mental and emotional toll FBT can take, the treatment can also be logistically challenging and take up a lot of time. “Taking full control over plating and meal prepping can be a large time commitment and this may be a shift for scheduling,” says Gardner. “This is an intense treatment for a potentially deadly illness,” Ouellette says. “It will disrupt your life, and the more you lean into that and pare down your life and family’s life and attack the ED head on, the sooner you get back to a more normal life. I encourage parents and caregivers to use the thought exercise ‘What would we sacrifice for treatment if this were curable cancer?’ I use this metaphor with the blessing from several parents who have been unfortunate to deal with both cancer and EDs among their children.” Feeling isolated Eating disorders can be incredibly isolating for the person going through the illness, but they can also leave the caregivers feeling alienated. “Find support where you can—in support groups with other families especially,” Ouellette says. “With such a bizarre, often frightening illness it makes all the difference to see certain behaviors as symptoms and to share with and be supported by people who truly get it.” Self-doubt and burnout FBT positions parents as the primary change agents and the treatment team operates more as consultants, and Gardner says this can cause an increase in self-doubt and burnout. To combat those natural and expected feelings, she offers the following strategies: Respond, do not react. “Before responding to your child, especially if they are refusing a meal or pushing back during meal times,” Gardner says. “Ask yourself: ‘Is this my child or the ED talking? What would the ED want me to do right now? How can I move recovery forward?’ This pause allows you to respond with intention, rather than react out of emotion or exhaustion.” Use mantras. Parents in FBT often benefit from having written reminders or affirmations visible in the kitchen or dining room, such as: “Food is medicine.” “I’m saving their life.” “This is temporary. Recovery is possible.” “I can do hard things. I already am.” Lean on your treatment team. “Utilize your treatment team to troubleshoot, check in, and define progress,” Gardner advises. Attend support groups. Hearing the experiences of others can make a world of difference. If you’re in treatment at Equip, make time to attend one of the many caregiver support groups (many families report these groups are one of the most impactful parts of their experience). You can also find other groups through organizations like F.E.A.S.T. Identify progress. “Recognize that even sitting down for a meal, eating one more bite than yesterday, even showing up after a meltdown—these are wins,” Gardner says. Find small moments of joy or rest for yourself. “Even five minutes a day can matter,” Gardner says. Ouellette agrees, advising caregivers to “look at the things that keep you going—exercise, time with friends, hobbies, etc.—and see what you can do for 10 min at a time vs. an hour or more at a time. You might not be able to walk for an hour, but you can probably get outside for some fresh air for at least a few minutes.” The wrath of the eating disorder “Eating disorders are mean!” Ouellette says. “They’re mean to our kids and often to us. Work on externalizing the eating disorder so you can stay compassionate and consistent; use techniques like visualization to help you with that, and use language like ‘My child’s ED did/said X’ versus ‘my kid did/said X.’ Develop sayings you can repeat in your head. One of mine was, ‘you have to see the beast to slay the beast,’ and later my daughter and I found out we both used ‘this too shall pass’ in our heads.” The Equip takeaway on succeeding with FBT While there’s no doubt that FBT can present a variety of challenges, experts continue to endorse it as the most effective option for children and adolescents with eating disorders—and those who have navigated FBT, like Ouellette, say it’s well worth the effort. “All parents say they would do anything to save their child’s life,” she says. “People who do FBT have done ‘anything’ to save their kid’s life. This isn’t meant to judge anyone who has walked a different path with their child’s eating disorder or to say only FBT parents have had this experience, but to drive home the hard work and distress tolerance that powers FBT. I often say the only thing harder than doing FBT is not doing FBT.” To determine whether FBT is the right fit for you and your family, Gardner recommends talking to an eating disorder specialist or team that can provide you with an understanding of FBT. “Knowledge and research are tools we utilize against the ED,” she says. “I also recommend the book When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating. Ouellette says that while her family has always been close, she believes they achieved a new level of trust and bonding through FBT. “What makes it the most worth it is seeing my daughter happy, healthy and living her dreams that were temporarily interrupted by anorexia,” she says. “She has an incredible career she loves, a wonderful husband, two delightful children, and lives not too far from us. Our whole family—my husband and I, our four kids and partners, and our five grandchildren spend time together every summer and over the holidays and we really have a fantastic time and we gather joyfully and freely around food.”]]></content:encoded>
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            <title><![CDATA[Think Family-Based Treatment Isn't Right for You? Addressing Common FBT Myths]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/fbt-myths-misconceptions</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/fbt-myths-misconceptions</guid>
            <pubDate>Wed, 09 Jul 2025 19:55:29 GMT</pubDate>
            <content:encoded><![CDATA[When Maris Degener stepped down from inpatient treatment for her eating disorder, her care team recommended family-based treatment (FBT). After learning that her parents would be in charge of what she and when she ate—as well as making sure she completed her meals, and, if she didn't, having her drink a nutritional shake—she was scared. “It felt really overwhelming,” she says. “The last thing any teen wants is for their parents to be up in their business for any reason. I didn't understand why my parents needed to be so involved—shouldn't this be my decision?” Once she began FBT, Degener, now Equip’s Director of Peer Mentorship, made progress toward recovery—and also took steps back. This dance continued for some time, but Degener and her parents committed to the process and, like many others, discovered that it works. Still, many patients and families are resistant to FBT, uncertain of what exactly it entails, who it works for, and whether or not they can handle it. Read on to learn more about FBT, the truth behind common FBT myths and misconceptions, and how to find FBT-trained providers for your loved one. What is FBT? FBT stands for family-based treatment, and, as the name suggests, families are key to the process. Based on the Maudsley Method, which was developed at the Maudsley Hospital in London, FBT empowers families to play a central role in their loved one’s recovery. A key premise of FBT is the belief that healthy family members are the ones best equipped to help young people recover from eating disorders, and this allows medically stable patients to recover at home, rather than being sent away from their life and loved ones for treatment. Unlike other eating disorder treatment approaches, FBT doesn't focus on the causes of the eating disorder. Instead, the initial goal is renourishment, and weight restoration if necessary. This is essential, because an undernourished brain has a hard time thinking clearly and rationally, and malnourishment perpetuates psychological symptoms like rigid or obsessive thoughts about food, depression, and anxiety. During the renourishment phase, parents or other family members make decisions about their loved one’s food and eating, ensuring the patient eats regularly, consumes enough food, and avoids disordered behaviors, like purging or otherwise “compensating” for food eaten. During the second phase of FBT, once a patient has been renourished, gained adequate weight (if needed), and shows few or no eating disorder behaviors, they gradually regain independence and control over their eating. Then, during the third and final phase of FBT, the treatment team helps the patient and family develop skills to prevent relapse and build a full life, free of the eating disorder.  Why FBT is the gold standard for treating eating disorders in young people FBT is the gold standard for treating eating disorders in children, adolescents, and young adults because it has more empirical evidence than other treatment approaches, says Renee D. Rienecke, PhD, FAED, Director of Research at Galen Hope. She adds that when compared head-to-head with other treatment approaches for this age group, FBT proves to be much more effective. “Eating disorders compromise a young person's judgment, internal motivation, and ability to self-regulate, plus the adolescent brain is continuing to develop. All of this means that process therapies alone are largely ineffective for this age group,” explains Melodie Simmons, DHA, LPC, CEDS-C, clinical instructor at Equip. “FBT prioritizes restoring health in a way that honors both the urgency of the illness and the family's critical role in recovery.” Various studies show that for patients diagnosed with anorexia, FBT is more likely to lead to full remission after six and 12 months and leads to significantly faster weight gain, compared to other types of treatment. And for patients diagnosed with bulimia, FBT leads to significantly higher rates of abstinence from binge eating and purging episodes compared to other treatment approaches. All of this evidence is why FBT is the front-line choice for practice guidelines in the U.S., U.K., Canada, Australia, and New Zealand, Rienecke says. “We want to try to do FBT for as many families as we can,” she adds.  Common myths and misconceptions about FBT Even though the evidence clearly points to FBT as the best, first-line approach for treating eating disorders in young people, many families are still resistant or hesitant when it comes to trying it. Part of that is due to various myths and misconceptions about this approach—let’s break them down. Myth 1: FBT is only for certain types of families Despite what you may have heard, you don't need to be a “perfect”, functional family for FBT to help your loved one. “I've been doing FBT for more than 20 years, and I've seen hundreds and hundreds of families,” Rienecke says. “There isn't any evidence to show that you have to be a certain type of family to benefit from FBT.” In fact, she co-authored a study that found that single-parent and two-parent families do just as well with FBT, and Equip’s own independent research shows that demographic factors (like socioeconomic status or family configuration) have no effect on FBT success. Other research also found no difference in treatment efficacy between single- and two-parent households and homes with different household income. “FBT fits with so many families, and part of the reason is that so many treatment decisions are left to the family, because they're the expert on their family,” Rienecke explains. “The therapist isn't saying, 'This is what you do’ in every case. Instead, they work with the family to figure out what is going to work best for them. It's flexible in that regard and can be helpful for a lot of different types of families.” Myth 2: FBT is only for certain types of patients FBT can help any young person struggling with any eating disorder. FBT was initially developed to treat anorexia, so that’s where most of the research focuses. However, there's strong evidence that it helps treat bulimia, and it shows promising outcomes for binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified feeding and eating disorders (OSFED). About 90 percent of participants in most FBT studies are cisgender girls. While more research on other populations is needed, so far trials show FBT works for every gender identity. Two small studies found that it helps cisgender boys and transgender, gender expansive, and gender minority youth reduce eating disorder symptoms at similar rates. Myth 3: FBT takes away the patient’s autonomy This is the most common misconception that Rienecke hears. “FBT takes control away from the eating disorder,” she clarifies. “If a child needs treatment for an eating disorder, they're probably no longer in control of their eating—the eating disorder is in control. FBT takes control from the eating disorder and temporarily gives it to parents until the child is strong enough to take that control back.” Myth 4: FBT only focuses on food, not the underlying psychological issues FBT does start off heavily focused on weight restoration, because the brain needs nourishment in order to work properly. “We know from the Minnesota starvation experiment that weight restoration fixes a lot of psychological symptoms,” Rienecke says. “You need to be physically healthy before you can be psychologically, mentally, and emotionally healthy. Get the mind and body nourished, and all these things fall into place—anything the eating disorder brought on tends to resolve.” Research shows that weight gain improves depressive symptoms, eating restraint, eating concerns, and overall eating disorder symptoms. Improvement is greatest during the earliest phases of weight restoration, a phenomenon that Degener experienced firsthand. “Weight restoration brought me out of complete fight-or-flight mode,” she says. “It turned down the volume on the urgency of everything and gave me space to do the hard inner work I needed to do.” Myth 5: FBT will ruin my relationship with my child “This is a common concern,” Rienecke acknowledges. “But I have never once seen a kid stay angry at their parents. Once the eating disorder starts to recede and the kid comes back online, everyone realizes the eating disorder was mad at the parents—and the kid realizes their parent or parents did what they did out of love to help them get better.” That doesn’t mean that there won’t be tension and pushback along the way—there almost certainly will be. That’s because in order for a person to recover, the eating disorder has to be challenged; so if you’re effective in treatment, the eating disorder won’t be happy. And at first, your kid won’t be either. “Kids generally don't like FBT. It's not fun,” Rienecke says. But stick with it, and this will change. In fact, Simmons says she has seen many families report stronger, more trusting relationships after working through the recovery process together. When Degener started FBT, things initially felt harder than when she was in inpatient treatment. “My parents and I had screaming matches and explosive fights,” she says. “There were a lot of moments of 'What are we doing here?' I was frustrated because I felt like I was taking tiny baby steps.” But with consistency and time, things got better, and she went on to recover. Today, she realizes all of the conflict she and her parents went through was her eating disorder trying to maintain control. Myth 6: We won’t have time for anything else if we do FBT It’s true that FBT can be a lot of work. You need to attend therapy and dietitian sessions, and put in the time at home to plan and cook meals to meet your child's nutritional needs. And then there's the emotional work of supporting your child, helping them through eating challenges, pushing them when necessary, and facing their resistance. First, know that if you are in the throes of FBT, you're doing an amazing job. You determined that your child needed help, and you got it for them. Second, remind yourself that even though FBT takes up a lot of time now, dealing with an eating disorder for years, decades, or even a lifetime takes up much more time. “Eating disorders are already all-consuming of a family's time, energy, and peace. FBT provides a roadmap to reclaim your life and have that balance again,” Simmons says. If FBT ever gets to feel too overwhelming, talk to your child’s treatment team. They can help you find other sources of support, whether that means a therapist for you, support groups, or getting help from other people in your life, like grandparents or neighbors who can step in to take care of other responsibilities, like watching siblings or running errands. If you’re in treatment at Equip, there are many support groups for parents going through FBT, and your treatment team includes a family mentor who has lived experience helping their child recover from an eating disorder. Both of these resources can provide you with actionable tips and strategies, as well as much-needed empathy. And if you haven't yet started FBT because you're concerned about the commitment it takes, consider this: “What would you be willing to do if your child had cancer?” Rienecke asks. “Anorexia is a deadly illness, with the second-highest mortality rate of any mental illness. If you were willing to do whatever it took for your child to get better from cancer, this shouldn't be any different.” Myth 7: Shouldn’t experts be in charge of this? The experts are in charge, Rienecke says—you, the parents, are the experts. “A therapist doesn't know all of the family's likes, dislikes, routines, habits, preferences, and cultural, ethnic, and religious practices that impact eating habits. The family knows that,” she explains. “The therapist guides and encourages the parents to figure out what is best for their family. What they come up with is better than the therapist could tell them to do because they know their kid best.” Additionally, you’ll work with an eating disorder-informed dietitian, who will help you develop meal plans that work with your family’s unique habits, preferences, and lifestyle, and will also provide you with skills and tips for getting through tough eating moments. Are there evidence-based alternatives to FBT? FBT is the first-line, gold standard eating disorder treatment for young people. But if for whatever reason FBT is not working for a young person, there are other evidence-based treatment approaches that can work in this age group (note that all of the approaches below can also work in conjunction with FBT). These include: Enhanced cognitive behavioral therapy for eating disorders (CBT-E): Also known as cognitive behavioral therapy for eating disorders, CBT-E is the gold standard	treatment for adults diagnosed with anorexia, bulimia, binge eating disorder, and other specified feeding or eating disorders (OSFED). However, CBT-E is less proven to help children and young adults. Structured around four phases, CBT-E operates on the principle that our thoughts, feelings, and behaviors are interconnected, and modifying any one of these will trigger a change in the others. Dialectical behavior therapy (DBT): This form of talk therapy aims to help people cope with challenging emotions in a healthy way. Rather than turning to disordered behaviors, the patient learns other coping skills. DBT has the most evidence for helping adults with binge eating disorder. Exposure and response prevention (ERP): A type of CBT, ERP helps patients gradually confront and learn to overcome their fears. In the case of eating disorders, this	may mean fears of specific foods, food-related situations, weight gain, exercise, or social events. There aren't a lot of studies on ERP for eating disorders, but the evidence we have suggests it can be effective. How to get started with FBT Even though families play a central role in FBT, it’s generally not something that you’ll want to do entirely on your own—the support and guidance of a multidisciplinary treatment team is almost always crucial. This team should include at the very least a therapist and dietitian, but may also include other team members, like a medical provider or psychiatrist. You can find an FBT therapist by searching the list from the Training Institute for Child and Adolescent Eating Disorders or the Academy for Eating Disorders directory. You’ll also want to work with a PCP who understands eating disorders so they can monitor and manage any physical symptoms. If your child's pediatrician isn't well-educated in eating disorders, ask your FBT therapist if they know anyone in your area. An eating disorder-informed dietitian can help with creating meal plans that support weight restoration; your therapist may also be a good resource for finding a dietitian. Lastly, some patients benefit from teaming with a psychiatrist, who can prescribe medication for underlying mental health conditions, like anxiety and depression, which often co-occur with eating disorders. At Equip, patients have access to a therapist, dietitian, medical provider (which may include a psychiatrist), and mentors for both the patient and the parents. This multidisciplinary team works collaboratively with one another, so caregivers don’t have to worry about communicating and coordinating among different providers. Although it takes effort and time, with the right care team, FBT can be the key to a richer, fuller life for both the patient and their family members. “FBT is harder and messier than anyone can imagine,” Degener says. “But my parents saved my life. They intervened when I wasn't in a position to do that work on my own, and I'm forever grateful for that.” To learn more about FBT treatment at Equip, schedule a free consultation.]]></content:encoded>
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            <title><![CDATA[The Complexity of Binge Eating Disorder: Treatment, Symptoms, and What a Weight-Neutral Approach Looks Like]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/equip-academy-binge-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/equip-academy-binge-eating-disorder-treatment</guid>
            <pubDate>Fri, 12 Jul 2024 11:04:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. Binge eating disorder (BED) is the most common eating disorder in the United States, and yet there’s a lack of awareness about this condition, both in the general population and the medical community. Binge eating disorder is often misunderstood or misdiagnosed, and many people with BED are given medical guidance that, while well-intentioned, can actually exacerbate their eating disorder. Today, we’ll look closely at BED, exploring what it looks like, available treatment options, and the importance of a weight-neutral approach. What is binge eating disorder? Binge eating disorder is an eating disorder characterized by recurrent episodes of binge eating. A binge is defined as eating an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances, accompanied by a sense of lack of control over eating during the episode. Also, binge eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of being embarrassed by how much one is eating Feeling disgusted with oneself, depressed, or very guilty after compulsive overeating Marked distress regarding binge eating A major hallmark of BED is the absence of compensatory behaviors — like exercise or vomiting — that you see in other eating disorder diagnoses, like anorexia and bulimia. Epidemiology of BED: General overview To best treat patients with BED, it’s helpful to understand its epidemiology. Here are some important and eye-opening facts about binge eating disorder: BED is the most prevalent eating disorder subtype in the U.S. BED is more common in females BED affects 3% of U.S. adults over their lifetime (3.5% of women, 3% of men) Estimates across ethnicity vary (some reflecting differences, some no differences) Onset is usually in young adulthood, though it’s not uncommon in adolescence, and persists through midlife Age of onset is older than what is typical for anorexia, bulimia, or ARFID 39% of those with a BED diagnosis report receiving treatment for BED 27% of U.S. physicians did not recognize BED as discrete eating disorder Medical and psychological impact of BED Like all eating disorders, BED has significant medical and psychological consequences for the person struggling. Medical impact Individuals with BED are at greater risk of developing: Type 2 diabetes Hypertension Dyslipidemia Cardiovascular issues Reproductive issues It’s important to note that all of these potential medical consequences are independent from weight status. Psychological impact There are high rates of co-occurring mental health conditions in individuals with BED. 75% of people with BED will have at least one psychiatric disorder More than 40% will experience a co-occurring disorder with BED Common comorbidities include depression, PTSD, GAD, OCD, suicidality, impulse control disorder 2% report current suicidal ideation (adults) Factors impacting the onset of BED There is almost never one identifiable “cause” of an eating disorder, as they emerge out of a confluence of genetic, neurobiological, psychological, environmental, social, and other factors. However, research has associated certain factors with an increased risk of developing BED. Some risk factors for BED include: Greater exposure to negative comments about shape, weight, and eating compared to individuals without BED Environmental factors like growing up in a larger body, family eating behaviors, etc. Genetic component, with heritability estimates of 30-80% Alterations in central and peripheral nervous system associated with regulation of appetite Barriers to accessing BED treatment Many people with binge eating disorder go undiagnosed or misdiagnosed, leaving them without the support they need to get better. Among those who do get diagnosed, some are given treatment advice that actually exacerbates the eating disorder. Provider barriers While providers have the best of intentions for their patients, they may inadvertently prevent those with BED from accessing treatment due to a variety of different unfortunate factors, including: Lack of awareness of BED Taking BED less seriously than other eating disorders Conflating BED with weight Assumptions about who gets BED Ineffective communication with patients Focus on weight or “lack of self-control” vs. focus on helping patients with coping strategies, compulsions, and negative emotions/mood states The underlying reason behind many of these factors is the pervasive weight stigma and bias in healthcare. Weight stigma is defined as discriminatory acts and ideologies targeted towards individuals because of their weight and size. Weight stigma is a result of weight bias, which is defined as negative ideologies associated with obesity. Weight stigma shows up in many different ways. Physicians have been found to have less respect for larger patients and spend less time with their higher weight patients, often making assumptions that higher weight individuals are lazy, weak, or unmotivated. The physical environment of medical spaces can also be an example of weight stigma, as many gowns, chairs, exam tables, and other elements can’t accommodate larger bodies. According to researchers, weight stigma “has direct and observable consequences for the quality and nature of services provided to those with obesity, leading to yet another potential pathway through which weight stigma may contribute to higher rates of poor health. In terms of quality of care and medical decision-making, despite the fact that higher-weight patients are at elevated risk for endometrial and ovarian cancer, some physicians report a reluctance to perform pelvic exams and higher-weight patients (despite having health insurance) delay having them.” Patient barriers Those struggling with BED also come up against barriers themselves. These barriers may prevent them from recognizing that they’re struggling with an eating disorder at all, talking with a doctor about their concerns, or accessing treatment once they realize they need help. Some barriers that patients may face include: Lack of awareness of the potential of a BED diagnosis Shame around eating behaviors, and subsequent reluctance to discuss eating habits with providers Traumatizing prior experiences with providers around weight/eating habits History of multiple attempts to control/manage eating or weight, and subsequent loss of hope Trouble getting insurance coverage Difficulty finding specialists All of these barriers can lead to a delay in seeking care, which can result in more severe outcomes once the individual is connected with a provider. The importance of weight-inclusive care for BED BED is a particularly challenging eating disorder to have and treat in the context of diet culture and our weight-obsessed world. The weight loss industry continues to boom, and there are prevalent societal norms around weight loss. At the same time, growing up in a larger body and negative family attitudes around weight/eating/body shape are risk factors for binge eating disorder. The confluence of these two realities means that some patients with BED and/or their parents seek weight loss instead of or alongside eating disorder treatment. This almost always exacerbates the eating disorder, which is why taking a weight-inclusive approach is essential for BED treatment. In one study, people receiving weight neutral treatment instead of weight loss-focused treatment for BED reported less feelings of shame and had increased levels of resiliency following treatment. What weight inclusive care looks like Weight inclusive care is defined as empirically supported practices that enhance people’s health in care settings regardless of where they fall on the weight spectrum. Weight-inclusive BED treatment focuses on: Reducing binge-eating frequency and disordered thoughts Improving metabolic health Treating underlying mood disorders via psychological and pharmacological treatments Reducing idealized aesthetic evaluations of self-worth Focusing on enhanced quality of life Promoting “normal” versus “optimal” nutrition Creating safe space for the patient in regards to provision of weight inclusive care (and modeling this for parents) Treatment for adults with BED The first-line treatment for adults with BED is CBT-E, or enhanced cognitive behavioral therapy, a form of CBT developed specifically for treating eating disorders. Treatment for adults with BED may also include: Interpersonal psychotherapy (IPT): Identifying and changing the role of interpersonal functioning in causing and maintaining negative mood, psychological distress, and unhealthy behaviors. Dialectical behavioral therapy (DBT): Mindfulness and skill development around emotion regulation, distress tolerance, and interpersonal relationships to help patients respond to stress and negative affect more effectively. Medications: Some medications have proven to be helpful in treating BED, including lisdexamfetamine dimesylate (e.g., Vyvanse), antidepressants, and anticonvulsants. Overview of CBT-E CBT-E targets the thoughts, behaviors, and beliefs that keep an eating disorder going, aiming to reduce negative emotions and undesirable behavior patterns by changing negative thoughts about oneself and the world. CBT-E is tailored to the patient by focusing on problematic eating-related cognitions and behaviors. CBT-E uses a collaborative approach, meaning that it never uses prescriptive or coercive procedures and therefore never asks you to do things that the patient does not agree to do. CBT-E may be therapist-led or self-help (in which a patient follows a manual/book, with or without facilitator), but it’s worth noting that the APA recommends that people with BED seek treatment that uses a team approach with a therapist, dietitian, and psychiatrist when needed, with mentorship as an added bonus. Some important facts about CBT-E: One of the most effective treatments of eating disorders ~ 66% of patients in remission in research sample Transdiagnostic, meaning it treats most forms of eating disorders Time-limited treatment with 20-40 sessions over a span of 6-12 months (on average) Not a “one-size fits all” treatment; varies by patient Goals of CBT-E When used for BED treatment, CBT-E has two primary goals: 1. Reduce binge eating behaviors: Establish regular eating, which means eating every 3-4 hours throughout the day, eating a wide variety of foods, normalizing attitudes and beliefs around eating, and having no “forbidden” foods. 2. Improve emotion regulation and/or overvaluation of weight or shape. This includes teaching coping skills, identifying and defining values, engaging in value-driven behavior, reducing investment in the thin-ideal, and testing body image attitudes & beliefs. This work helps reduce disordered, "emotional eating." CBT-E treatment involves four stages, the scope of which is beyond this presentation, but you can learn more about them here. Treatment for adolescents with BED There are currently no level 1 or level 2 (probably efficacious) evidence-based treatments for youth with BED. Previous research in adolescent BED patients has used CBT, IPT, and DBT, however most are small studies or case studies, and thus findings are hard to extrapolate However, limited findings do show that compared to a waitlist control, CBT did better and in a trial utilizing DBT there was a reduction in binge eating. While it has not been formally tested, for youth with BED, FBT-BN did show a reduction in binge eating episodes in a case study. Family-based treatment (FBT) In the absence of a first-line treatment approach specifically for adolescents with BED, a good treatment option is FBT, which is the leading evidence-based treatment for eating disorders in young people. FBT empowers patients’ families to be active participants in recovery, and research shows that for children and adolescents with eating disorders, FBT has the highest rates of recovery and the lowest rates of relapse. The goals of FBT for BED include: Stop loss-of-control eating episodes (i.e., binge episodes) Regulate eating every 3-4 hours Ensure patient is eating enough at meal/snack times (i.e., not restricting) Exposure to typical binge foods to normalize eating them in appropriate quantities without triggering a binge episode FBT has three phases, the Family Management Phase, Return to Independence Phase, and the Quality of Life Phase. Here’s a quick overview of what each phase focuses on. Family Management Phase Reduce compensatory behaviors Reduce binge/loss-of-control eating episodes Regular eating throughout the day; structured meals and snacks Family support during times of high binge likelihood Return to Independence Phase Return of independence and developmentally appropriate oversight over eating. This will look different for patients depending on stage of development and family dynamics Education on physiological and psychological triggers for loss-of-control eating/binge eating Quality of Life Phase Treatment of co-occurring psychological conditions Reducing appearance and weight-based ideals that influence self-worth Addressing other issues of adolescence You’ll notice what’s NOT a focus of any of these phases: anything to do with WEIGHT. Strategies for working with pediatric population If the family of a pediatric patient with BED is pushing for weight loss, here are a few points to consider discussing with them: Be explicit that the goals of treatment of BED do not include weight loss Goals for younger people focus on eliminating loss-of-control eating rather than focusing on the amount of food eaten Children and adolescents are growing and we do not want to miss any growth opportunity Provide information on Health At Every Size (HAES) if families are asking for weight loss as a way for their child to be “healthier” Provide psychoeducation that engaging in behaviors that promote weight loss could strengthen the eating disorder and thus would not align with health Weight may stabilize once normative eating commences and binge eating stops, however weight stabilization is NOT the same as actively promoting or working towards weight loss Focus on other goals (i.e., self-esteem vs. weight loss) Weight loss medications and BED The rise of weight loss drugs like Ozempic has complicated BED treatment, with some putting forward these GLP-1 antagonists as “cures” for BED. To understand why weight loss medications aren’t a good approach to treating BED, it’s important to understand a bit more about how these medications work. Glucagon-like peptide1 (GLP-1) agonists are medications that have long been used to treat type 2 diabetes, but some GLP-1 agonists have recently received FDA approval for weight loss. A GLP-1 agonist is a type of medication that facilitates the role of GLP-1 (a naturally occurring hormone) and makes the effects of GLP-1 even more pronounced. GLP-1 is a naturally occurring hormone with several important functions, including: Triggering insulin release: Insulin is a hormone that helps the body turn food into energy. When insulin is released, blood glucose is lowered. Blocking glucagon secretion: Glucagon is a hormone that raises blood sugar levels. When glucagon secretion is blocked, blood glucose is lowered. Slowing stomach emptying: Slower digestion means that the body releases less glucose from food into the bloodstream. Increasing feelings of satiety: GLP-1 affects areas of your brain that process hunger and satiety. All of these functions result in lowered levels of blood glucose and increased feelings of satiety. Why are GLP-1 agonists risky for folks with eating disorders? There are a number of different reasons that using GLP-1 antagonists to treat BED might backfire: 1. Interference with the goal of establishing regular eating patterns. Eating disorders impede the ability to notice and respond to hunger cues, which is why eating disorder treatment nearly always involves establishing a pattern of regular eating throughout the day. Medications that lead to decreased hunger cues, such as GLP-1 agonists, can interfere with regular eating and are often contraindicated. 2. Lack of research. There are currently no long-term studies on a diverse patient population that have examined how GLP-1 agonists affect eating disorder behaviors, medical complications, and rates of recovery/relapse. As such, we do not have compelling evidence that GLP-1 agonist medications lead to a sustained reduction in binge eating. 3. Perpetuation of the thin ideal. Using GLP-1 agonists for weight loss can perpetuate weight stigma/idealization of thinness, which is often a core symptom that maintains eating disorder psychopathology throughout the illness. 4. Lack of psychological considerations. Importantly, GLP-1s do not perform any of the functions that therapy does, like changing thinking patterns, working on emotion dysregulation, and addressing concerns about weight. 5. Risk of adverse consequences. Many of the side effects associated with GLP-1 agonists are similar to some of the more serious medical complications associated with eating disorders (e.g., gastroparesis, dehydration). Weight cycling (i.e., gaining and losing weight repeatedly) is associated with an increased risk of depressive symptoms, and those with eating disorders are already at heightened risk for depression. What if my patient with BED wants to take weight loss medications? If you have an adult BED patient who wants weight loss medication as part of their treatment, the points below can be helpful to discuss with them. Weight loss medications should not be taken as a treatment for BED. There isn't any long-term research to suggest that GLP-1s or other medications lead to a sustained reduction in binge eating. Symptoms that are masked by the medication could return if you stop taking the medication. Because GLP-1s and other weight loss medications affect hunger cues, they could be taking away the opportunity to learn how to respond effectively to hunger cues. Weight loss medications may lead to weight cycling, and weight cycling is linked with increased depression, creating more psychiatric challenges. If the medication is prescribed for type 2 diabetes, discuss the possible risks and benefits of treatment for BED while on this medication. Conclusion: A weight-neutral approach to treatment of BED Binge eating disorder is a common and serious eating disorder that affects people across gender, age, race, socioeconomic status, and body size. There are many misconceptions around its diagnosis and treatment, which are often exacerbated by diet culture and weight stigma in the healthcare space. In order to ensure that everyone struggling gets help, it's important for providers to understand the available evidence-supported treatment options. Treatment goals for BED De-emphasize weight loss as an outcome Focus on quality of life and non-weight indicators of health Refrain from setting weight goals Treatment methods for BED Greater emphasis on structured eating and inclusion of regular meals/snacks Mindful and judicious nutrition education (e.g., non-judgmental approach to quality of food) Resources Offer education around HAES and weight stigma, specifically for parents of pediatric patients Connect patients with other providers who provide weight-inclusive care For more in-depth information on a weight-inclusive approach to binge eating disorder, watch my recorded Equip Academy presentation on the topic. You can also explore past Equip Academy presentations and register for upcoming events here.]]></content:encoded>
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            <title><![CDATA[Treatment of Athletes with Eating Disorders: Considerations, Conundrums, and Best Practices]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/equip-academy-athletes-eating-disorders-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/equip-academy-athletes-eating-disorders-treatment</guid>
            <pubDate>Sat, 19 Oct 2024 18:08:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. Participation in sports and athletic endeavors has wide-ranging benefits in both the short-term and the long-term. But athletes are also at an increased risk of developing an eating disorder or disordered eating, and treatment of athletes with eating disorders comes with specific considerations and challenges. In this article, we’ll look at an overview of the research on athletics and eating disorders, signs and symptoms to look out for, and best practices for supporting athletes. Benefits of engaging in sport Research has shown that engaging in sports positively impacts a person’s mental and physical well-being in a number of ways. After controlling for social determinants of health, engaging in athletics has been shown to have the following benefits: Improved physical and mental health (both immediate and long-term) Improved academic performance Motor skill development/coordination Strength and stamina Better self-esteem More positive body image Good sportsmanship Psychosocial development Lower rates of suicide Sense of purpose, identity, and community Delayed onset of substance/alcohol abuse (and fewer risky behaviors overall) Life and occupational skills (leadership, determination, resilience, critical thinking, communication, negotiation, time management) Active kids tend to become active seniors The benefits of engaging in sports were reinforced during Covid-19, which forced worldwide closure of organized sports. During this time, the protective benefits of sports were lost, and mental health issues in athletes skyrocketed. Youth athletes are even more vulnerable than adults to the negative mental health effects of sports restriction, and the residual effects of the pandemic impacted training and performance, with many young athletes losing interest in sports. For adult athletes, the Covid-19 pandemic often led to loss of career and subsequent financial stress. After the world of sports reopened, some Covid-era modifications remained in place. Many organizations began offering at-home training programming and remote check-ins with teammates, as well as incorporating mindfulness into their practices. Athletes returned to sports protocols, and sports psychologists began ongoing discussions about athlete mental health. Problematic eating behaviors in athletes Unfortunately, participation in sports also comes with an increased risk of disordered eating and exercise behaviors. Problematic eating behaviors are two to three times more prevalent in athletes than in any other group, and there’s a higher risk of eating disorders across all sports (not just weight-sensitive sports) relative to non-athletes. Estimates of eating disorder prevalence in athletes vary across the literature, ranging from 2-49%. Among collegiate athletes: Prevalence estimates range from 2-19% One quarter have subclinical eating disorder behaviors (restrictive, binge eating, purging) Among D1 athletes, almost half have subclinical eating disorder behaviors And yet despite this increased risk, athletes are actually less likely to receive a diagnosis and treatment. Prevalence by gender Research shows that eating disorders are more prevalent among cisgender female athletes than their male counterparts. Among distance runners, for instance, one study found that 46% of females screened positively for an eating disorder, compared with 14% of males. In another study, 26% met clinical criteria for an eating disorder, with five times more females (84%) than males (16%) reporting disordered eating behaviors. A study of female athletes found that 91% of cisgender female athletes worried about calorie intake, 50% restricted calories to improve performance or change weight/shape, and 30% were told by a medical professional that it’s normal to miss periods. Contributing factors There are a number of factors that contribute to this increased prevalence of eating disorders and disordered eating among athletes. Some of these factors include: Excessive pressure from parents/caregivers to meet expectations Weight-sensitive sports (like gymnastics, wrestling, ballet) Poor sleep hygiene (which increases anxiety and depression) Child encouraged/allowed to train or perform when unwell (injury, illness) Belief that weight manipulation will improve performance Participation in public/open weigh-ins Sudden increase in training volume Weight/body-related comments by teammates College/high school athletes grappling with a body that is continuing to change, develop, and mature while often simultaneously trying to achieve a specific athletic aesthetic A traumatic sports-related occurrence, like an injury or illness, a change in coach, or retirement from sport Despite this increased risk, athletes are actually less likely to be diagnosed than their non-athlete counterparts. This is because eating disorder behaviors—like excessive exercise, restrictive diets, or obsession with weight—are often normalized in athletic circles. This makes early intervention challenging, and often athletes struggle for a long time before the eating disorder is identified. Body dissatisfaction among athletes Regardless of eating disorder status, athletes often struggle with body dissatisfaction. Some contributing factors to body dissatisfaction among athletes include: Emphasis on leanness (sometimes called the “athletic aesthetic”) Changing bodies (weight or body composition) Growth and development affects other aspects of performance Feeling compelled to change body to improve an aspect of performance These factors can all be amplified by social media, constant viewing of images of themselves, and revealing or tight-fitting uniforms. Barriers to treatment As mentioned above, athletes are often less likely to be diagnosed with an eating disorder and receive treatment, despite their increased risk. And in cases where athletes themselves recognize that they may have a problem, there are additional barriers that prevent them from reaching out for help. These include: Lack of awareness Biases and stereotypes about who gets eating disorders Disordered behaviors being normalized or praised in the sports community Minimization of physical symptoms by coaches High tolerance for discomfort Sense of obligation to team/coach Shame Fear of loss of opportunity/scholarship Concern around performance implications Family prioritizing sports commitments On top of all the above, athletes might also be disincentivized, either explicitly or implicitly, from seeking help when they’re struggling. They may be held back by shame or a sense of loyalty or obligation to their coach and teammates, or they may simply be unaware that their food- and body-related thoughts are disordered. Treatment accessibility is also an issue for many, as getting treatment for their eating disorder might mean being removed from their sport and losing life-altering opportunities like a sponsorship or scholarship. Screening for eating disorders in athletes Eating disorder assessment measures designed for use with general populations (such as the SCOFF questionnaire and EDE-Q) have demonstrated suboptimal psychometric properties in athlete populations. Several measures to assess eating disorder risk among female athletes have been developed and validated. These include: Compulsive Exercise Test – Athlete Version (CET-A). This was developed to assess excessive exercise. It has been found to successfully discriminate between female athletes with and without high eating disorder risk. Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) Female Athlete Screening Tool Physiologic Screening Test Eating Disorder Screen for Athletes (EDSA) Signs, symptoms, and syndromes There are various signs and symptoms to look out for that might indicate an athlete is struggling with an eating disorder: Dieting/mention of diets/orthorexia Sudden unprompted elimination of foods or food groups Weight loss (regardless of weight status) Withdrawal/isolation Frequent injury/re-injury or illness Fainting/lightheadedness/hypoglycemia Weakness/fatigue Anemia/nutrient deficiencies Training beyond what is prescribed Decline/plateau in performance/response to training Refusing to participate in team meals Inflexibility around which foods are consumed Unwillingness to fuel for practice/after practice. RED-S The below diagram is of the retired “female athlete triad”, which was limited to just females being flagged. The Triad at one point in history described the combination of disordered eating, amenorrhea, and early-onset bone loss (noted here as: osteopenia or osteoporosis). The latter two components (loss of menses and osteopenia/osteoporosis) are the body’s response to underfueling.  Relative Energy Deficiency in Sports (REDs) is the new, improved, and more inclusive version of the Female Athlete Triad. Coined by IOC in 2014, REDs describes the root cause of a number of performance-worsening symptoms. It is caused by inadequate energy intake relative to expenditure (regardless of eating disorder status). It is not a “triad,” but a syndrome that affects many aspects of health and athletic performance. REDs acknowledges that the consequences of underfeeding reach beyond bone and reproductive health. All athletes are vulnerable! Some more things to know about REDs: It is difficult to diagnose In a large sample of female athletes surveyed for symptoms of REDs, 80% had one symptom, 50% had two symptoms, and 30% had over five symptoms 20% of studies have included males Consequences of low energy availability take longer to appear in males REDs and eating disorders share many symptoms, including: Fatigue Weight loss Low testosterone Missed/irregular periods Frequent illness Hair loss Depression and anxiety Trouble focusing Irritability Trouble staying warm REDs has serious and far-ranging health consequences, which are illustrated in the diagram below:  Note how these symptoms truly impact the health and well-being of the individual. Here we can see the large variety or combination of symptoms that could present as a full-body syndrome, defined as a group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms. REDs also has consequences for athletic performance, illustrated in the diagram below:  Supporting an athlete with an eating disorder It takes a village to treat an individual with an eating disorder. Guidelines are clear on recommending a team of multidisciplinary providers with training in eating disorders. The eating disorder treatment team typically includes a medical provider, dietitian, and therapist, and often a psychiatric provider as well. When we’re talking about an athlete, that team usually also includes the athletic department, counseling, and family. Everyone on the team shares the goal of returning to sport. Not sure who will be the best supports for an athlete? Ask them! A multidisciplinary care team for an athlete may include: Registered dietitian: helps with nutritional rehabilitation, meal planning, behavioral counseling, education, and weight monitoring. Psychologist: Helps with coping, communication, and psychological evaluation. Family therapist: Helps with evaluation, support, and communication skills. Family/parents: Help with communication, psychological support, and financial support. Psychiatrist: Helps with assessment, monitor safety, and provide treatment. Athletic administration: Help with eligibility, compliance, and financial support. Coach and coaching staff: Help with safe and effective training and competition. Team physician, athletic trainer, and physical therapist: Help with health monitoring and care. Eating disorder treatment for athletes involves a number of different clinical areas of focus. Athlete-specific areas of focus include resolving malnourishment/LEA; return-to-sport considerations; and relationship to self, body, sport, food, and exercise. Practice applications When treating an athlete with an eating disorder, it’s important to understand sport culture and identity within sport. This will vary across sports, teams, age, gender, level of competition, and coaching environment. Providers can learn more about athletes needs and how to support them with exploratory questions, such as: What got you into your sport? What do you love about your sport? Has that shifted at all over time? Can you tell me a bit about the culture on your team? What aspects of being an athlete bring you the most joy? Which do you struggle with the most? What does “sports nutrition” mean to you? What does it look like to “eat like an athlete”? What are the top five words that come to mind when you think about how you feel when you’re training? Competing? How do you tend to tolerate rest days? What do you do instead? Can you tell me about how you handled a time where you had to pause due to illness, injury, etc? How are your expectations different from/similar to your coach/teammates? Target weight assessment When determining a target weight for athletes with an eating disorder, it’s important to take into account a number of different factors, including: How new they are to athletics/training. If they are new, it is difficult to rely on historical growth data, as they may have changes in body composition that warrant a different weight target than what we predict from growth charts. Age/developmental stage Sex hormones. It may take longer for hormones to normalize if weight is advanced too soon (especially for those with propensity toward more rapid muscle development) Bone density. Bone loss may warrant a more conservative (i.e., higher) target, especially when unable to use hormone profile/menstruation as indication. When setting target weights for athletes, be sensitive to their unique circumstances. Consider real and imagined consequences of aiming for a higher end of the weight range, especially in sports that have a particular idealized aesthetic. Remember that they may experience loss of respect, opportunities, and other consequences, and that this is their community, livelihood, and future—their “life worth living” outside of treatment. Remember that frequent re-evaluation of target weight is important, given many moving parts (and is also influenced by injury, off-season, retirement/transition out of sport) Needs assessment through a sports nutrition lens Creating meal plans and establishing energy demands for athletes requires a different approach than with non-athletes. Consider that their energy needs are already high, and will be higher to maintain a higher weight—don’t set patients up for failure with too low of a calorie target. Considerations to keep in mind: Expect a wider range of needs and multiple adjustments More challenging to predict endpoint due to many moving parts Timing of meals and snacks (pre/during/post-season) Hydration needs change Macronutrient needs change (depending on sport/goals) Use of treatment contracts Treatment contracts can be an effective tool when treating athletes with eating disorders. Benefits include helping with clarity, increasing alignment across the board, and appealing to the coachability of an athlete who has traits of being goal-oriented. These contracts can be developed early on in treatment with patients, and can be shared with all people involved in a patient’s treatment. Treatment contracts may be best introduced during transitions, for instance if the patient is making a rapid transition from intensive outpatient treatment and back into the sport, patient is not fully reintegrated, or patient struggles with maintaining adequate intake. Contracts can be extremely supportive to creating alignment between the patient, their supports, and the treatment team. Treatment contracts typically include: Expectations for participating in treatment (session attendance, labs, weight checks) Frequency of meals and snacks Weight/intake goals Consequences/rewards for meeting/not meeting targets Supportive vs. punitive guidelines Clear and firm language Athlete programming at Equip This brings us to Equip’s SAFER protocol, which stands for Safe Approach For Exercise Return. It is a staged approach which was developed in collaboration with the Safe Exercise at Every Stage (SEES) authors and adapted for family-based treatment as well as adult treatment at Equip. Below is an at-a-glance look at Equip’s SAFER protocol.  In addition to our SAFER protocol, Equip also has a variety of athlete-specific resources: Athlete support groups (for supports and patients) Providers with expertise in eating disorders and sports medicine/psychology/nutrition Use of exercise-specific validated measures (CET) Peer/family mentors with lived experience Fully virtual (addressing geographic barriers, privacy concerns) Collaboration with athlete’s support system For more information on treating athletes with eating disorders, watch my recorded Equip Academy presentation on the topic. You can also explore past Equip Academy presentations and register for upcoming events here.]]></content:encoded>
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            <title><![CDATA[How Does Eating Disorder Therapy Work? ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/eating-disorder-therapy</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/eating-disorder-therapy</guid>
            <pubDate>Fri, 16 Jun 2023 13:47:00 GMT</pubDate>
            <content:encoded><![CDATA[When someone is struggling with their mental health, the first recommendation they often get is to see a therapist—and often, that’s just what they need. But with eating disorders, the role of therapy is more complex. Eating disorder therapy is an integral part of treatment, but it’s not the only part, and it often looks different than people might expect. Here’s a look at the unique role eating disorder therapy plays in treatment. Understanding the role of eating disorder therapy in treatment People are often surprised to learn that therapy isn’t usually the initial, primary focus in eating disorder treatment. That’s not to say that those who are struggling can’t get started with therapy right away; but in order for treatment to be effective, they’ll likely need to work with other providers and focus on other areas in the beginning. 
There are a few reasons for this. For one, eating disorders emerge out of a constellation of neurological, genetic, and environmental factors, and so conventional talk therapy isn’t likely to move the needle toward recovery, at least at first. Usually, it makes more sense to begin with behavioral interventions that can help those struggling address some of the physiological and habitual aspects of the eating disorder. This, in turn, paves the way for eating disorder therapy to be more productive.
 Then there’s the reality that therapy just won’t work well on a malnourished brain. Regardless of whether or not a patient is underweight, if their eating behaviors are disordered, their brain is likely malnourished. A malnourished brain doesn’t think clearly or take in new information well, and those who are malnourished are more likely to be anxious and have trouble paying attention. This means it’s extremely difficult to make any real progress in eating disorder therapy until eating habits are normalized. 
Equip therapist Lainy Clark points to another hurdle that comes up in eating disorder therapy: anosognosia. “You might expect that in eating disorder treatment, someone who’s suffering will meet with a therapist on their own for an hour or so every week and after some time emerge all better,” she says. “But history has shown that this is an ineffective—and at times, nearly impossible—way for folks to recover. That’s because of anosognosia, or a person’s lack of insight into their need for help. They don’t believe they’re sick. This ambivalence can make it difficult to engage in on-on-one therapy and even more difficult to implement changes.”
 None of this is to say that therapy doesn’t have a role in treatment—in fact, eating disorder therapy is crucial, it just doesn’t take center stage during the first steps of recovery. At Equip, adult patients will begin seeing a therapist right away, whereas young patients who are doing family-based treatment (FBT), will usually only start seeing an individual therapist after they’ve made behavioral progress. In either scenario, the first focus is always to normalize eating habits, restore weight (if needed), and stop eating disorder behaviors. After those aspects have been addressed, the focus can shift to individual eating disorder therapy. In eating disorder therapy, providers work with patients to continue to improve their symptoms, help them build skills, explore the emotional and psychological aspects of the eating disorder, and address any co-occurring conditions. Says Clark, “one-on-one therapy does become a bigger part of treatment when patients are weight restored and the anosognosia is no longer wreaking havoc.” What are the goals of eating disorder therapy? The end goal of eating disorder therapy is, of course, to help patients achieve recovery. The way therapy accomplishes this goal will shift based on a patient’s individual needs and where they are in their treatment process. At first, eating disorder therapy is often focused on addressing a patient’s struggles with food and sticking to their meal plan. Once eating has become less of a struggle, the scope and goals can both widen.
 Equip Research Intern Bek Urban explains that initially, her eating disorder therapy sessions centered around how she was doing with eating disorder behaviors, but over time, the range of what she discussed with her therapist expanded greatly. “I was surprised at first, because I expected to sit and talk about food and exercise the whole time I was in therapy. Instead, my therapist worked with my dietitian to make sure those things were taken care of, which let us focus on other things in therapy: things like processing trauma, body image, fear of change, and practical day-to-day stuff about how life would be different in recovery.” Some of the potential goals of eating disorder therapy include: Developing skills to manage mealtime distress. There are a wide range of different techniques that people struggling can call on to make eating easier. This might include mindfulness practices, distraction, or writing down negative thoughts, among others. Becoming more in tune with emotions, mood, and how they impact eating. Often, our emotions impact us in ways we don’t even realize. By tuning into the relationship between eating and mental state (for instance, noticing that anxiety sparks an urge to restrict), patients can make more mindful choices in the moment. This often entails regulating your nervous system.  Learning coping strategies to replace eating disorder behaviors. Eating disorder behaviors are often coping mechanisms gone awry. Eating disorder therapy can help patients build healthier coping mechanisms that help eliminate the need for the eating disorder. Spotting unhealthy habits and working to replace them with healthier ones. Therapists can help patients see patterns that are perpetuating the eating disorder or causing distress—like scrolling fitness accounts on social media, or fixating on what other people are eating—and brainstorm healthier alternatives. Improving relationships. Loved ones can’t cause an eating disorder, but tough interpersonal dynamics can be a barrier to recovery. Eating disorder therapy can help patients and their loved ones better understand each other and find healthier ways to communicate. This not only makes life more pleasant for everyone, but also protects against relapse by helping the patient build a strong network of support. Exploring underlying causes. While eating disorders never have just one cause, therapists can work with patients to identify some of the psychological roots of their disorder, like low self-esteem, trauma, or anxiety, for example. They’ll then use evidence-based modalities to help patients address these issues. Treating co-occurring conditions. Eating disorders often come with one or more co-occurring conditions, like depression or anxiety. Therapists can work with patients to tackle these conditions alongside the eating disorder. Discovering life beyond the eating disorder. Therapists can help patients set goals beyond those involving weight or eating behaviors. They work with patients to explore their hopes and dreams outside of the eating disorder—moving abroad, starting a company, writing a book—and help them envision a path to get there. “Therapy provided me a place to practice being me for the first time, and opened doors to a reality I couldn’t imagine before,” says Urban. “So much of my life before therapy was focused on coping through my eating disorder and not being who I am. Therapy allowed me to explore what I wanted to do with the huge part of me that was opening up as the eating disorder shrank.” How eating disorder therapists work with the rest of the treatment team Because eating disorders affect many aspects of a person’s life—physical, nutritional, social, emotional, psychological—effective treatment requires a multidisciplinary care team to address each area. For most people seeking treatment, this means pursuing eating disorder therapy while also seeing a dietitian and having periodic check-ins with a medical provider.
 The coordination between providers depends on the type of treatment a patient is getting. In an ideal world, all of these providers would be regularly checking in with one another to ensure everyone is on the same page about goals, concerns, and the patient’s progress—but unfortunately, in traditional treatment there often aren’t open lines of communication between providers. At Equip, every patient is matched with a dedicated team that includes a therapist, dietitian, medical provider, and mentors who have made it to the other side of recovery. Because all of our providers are Equip employees, they are one cohesive team, allowing care to be both coordinated and collaborative.
 “The value and support of the multidisciplinary care team is immeasurable. It’s a major benefit for therapists,” says Clark. “Eating disorder therapy in many other settings can feel isolating, and therapists often shoulder the burden of a person’s mental well-being and progress, or lack thereof.” She says that being able to work closely with other providers helps therapists feel more supported and leads to better care for the patient. What modalities are used in eating disorder therapy? There are several different effective therapeutic approaches in eating disorder therapy. The specific approach (or approaches) a therapist chooses to use will depend on the patient’s diagnosis, symptoms, age, personality, family dynamics, and more. At Equip, our therapists use a variety of different evidence-based approaches, tailoring treatment to each patient’s unique needs.
 The modalities we most commonly use are: Cognitive behavioral therapy for eating disorders (CBT-E): CBT-E is the leading treatment for eating disorders in adult populations. Using a detailed view of their daily habits, thoughts, and emotions, therapists work with patients to identify behavioral triggers and find more adaptive ways of coping with them. CBT-E differs from regular CBT in that it addresses certain eating disorder-specific challenges, like food and body image. Dialectical behavioral therapy (DBT): “Dialectical” refers to accepting that two opposing realities can exist at once, and DBT focuses on helping people manage this through both acceptance and change. With eating disorder therapy, this means learning skills and strategies to manage big emotions that can trigger eating disorder symptoms. While there’s still research to be done on the effectiveness of DBT for eating disorders, initial studies are promising. Exposure and response prevention (ERP): Originally developed to treat OCD, ERP focuses on helping patients overcome fears and triggers through exposure. For eating disorder patients, that might mean fears around certain foods or food-related situations, social events, exercise, or any other situation that evokes a strong anxiety response. Research is still emerging on using ERP for eating disorders, but evidence suggests it can be effective. Temperament-based therapy with supports (TBT-S): TBT-S acknowledges and treats the brain- and personality-based factors that might contribute to an eating disorder, helping patients identify the temperament traits behind their behaviors and find healthier, more productive ways to channel them. For example, a therapist might work with a patient to redirect their perfectionism toward a creative project or career goals rather than their eating disorder. Initial research has shown TBT-S to be an effective treatment approach.
Often, family therapy is also an important part of eating disorder treatment, especially for younger patients. This is particularly true in family-based treatment (FBT), where family members are at the center of treatment, but it can be equally helpful for all eating disorder patients. Bringing family members—or chosen family, friends, or other important people in the patient’s life—into treatment helps patients address challenging relationships and bolster their support network. This is incredibly important not just during treatment but afterward, when a patient’s friends and family will be the first line of defense against relapse. Eating disorder therapy isn’t one-size-fits-all. A good therapist will work with the patient and the rest of their treatment team to find an approach that works, and change or add modalities based on the patient’s progress and their needs. How to get started with eating disorder therapy If you or your loved one is struggling with an eating disorder, it’s important to get help, whether that means getting an assessment from your doctor or reaching out to an eating disorder treatment provider. If you decide to seek treatment through an eating disorder program, like Equip, you’ll automatically be connected with a therapist who specializes in eating disorders. At Equip, all of our therapists have extensive experience treating all eating disorder diagnoses and co-occurring conditions, and we take care to match each patient with the therapist who we think will be the best fit. If you’re seeking eating disorder therapy on your own, there are few questions you should ask as you choose a provider: What is their training? Most graduate programs for therapists don’t include extensive eating disorder education, so it’s important to find someone who has received additional training. Do they understand the importance of coordinated care? Even patients who aren’t enrolled in an eating disorder treatment program need to be supported by a whole team, not just a therapist. It’s important to find a therapist who not only understands the role of the dietitian and medical provider, but also knows how important it is that they communicate regularly with them. Do they treat co-occurring conditions? Effective eating disorder therapy often requires that therapists address co-occurring conditions like anxiety or depression, so it’s vital to find a provider who is comfortable treating multiple diagnoses at once. How do they make you or your loved one feel? “Be patient, be picky, and advocate for your needs,” Urban advises. “Therapists are humans like everyone else, and you won’t always get along with every therapist you meet. It’s not uncommon to just not mesh well with a therapist, even if they’re a perfect fit for someone else. And that’s okay!” Lasting recovery is possible for everyone struggling with an eating disorder, but it’s hard work. Eating disorder therapy is an essential part of that work—not only for helping to stop destructive behaviors and silence the eating disorder voice, but also to help open the doors to a brighter, bigger, and bolder future. “I wouldn’t live the life I have now without the support of the therapists I had before, during, and after treatment,” says Urban. “Therapy was a space that would welcome all of my fears and all of my joys as I learned to live without my eating disorder.”]]></content:encoded>
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            <title><![CDATA[What Is CBT-E? Understanding Enhanced Cognitive Behavioral Therapy for Eating Disorders]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/CBT-e-enhanced-cognitive-behavioral-therapy-for-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/CBT-e-enhanced-cognitive-behavioral-therapy-for-eating-disorders</guid>
            <pubDate>Fri, 31 May 2024 19:37:00 GMT</pubDate>
            <content:encoded><![CDATA[If you or someone you love has ever sought treatment for a mental health condition like anxiety, depression, or an eating disorder, you’re likely familiar with cognitive behavioral therapy (CBT). But while CBT is widely applicable to many different mental health conditions, in recent years, a new variation meant specifically to treat eating disorders, known as CBT-E, has emerged. CBT-E stands for enhanced cognitive behavioral therapy, but is also sometimes referred to as cognitive behavioral therapy for eating disorders. It shares many similarities with CBT, with some key differences. Read on to learn the details on CBT-E, how and why it’s used to treat eating disorders, and whether you or your loved one may want to explore its benefits. What is CBT-E? Specifically designed to treat eating disorders, CBT-E is rooted in the principles of CBT but considered an “enhanced” modality because of the innovative strategies and procedures implemented in its development. Rather than targeting a single diagnosis like anxiety or depression, CBT-E is designed to be flexible and individualized, so it can adapt to fit a variety of needs. “Enhanced cognitive behavioral therapy is a modular approach to treating a wide range of eating disorders,” says Equip Director of Adult Programs, Lara Effland, LICSW, CEDS-S. “It’s a patient-focused treatment that includes psychoeducation about the mechanisms of a patient’s eating disorder, common triggers, and areas that prevent them from recovery.” Initially developed for adults in outpatient treatment, CBT-E has more recently been used in adolescent populations as well, and is considered a viable treatment option alongside family-based treatment (FBT). CBT-E is notably a “transdiagnostic” model, which recognizes that people with the same diagnosis may present with very different symptoms, and it can be used to treat all types of eating disorders including anorexia, bulimia, BED, and others. “CBT-E has an initial focus on building motivation and engagement in care,” Effland says. “The goal of therapy is to change disordered eating by changing patterns of behavior and problematic thoughts that contribute to disordered eating behavior. Namely, thoughts around the over-evaluation of shape and weight, how weight and shape are associated with self-worth, and the person’s desire to control them.” Effland explains that CBT-E includes four specific stages: Stage 1: “Starting Well”: During the initial stage, the focus is on providing personalized education and guidance to patients and helping them gain an understanding of their eating disorder. Sessions are generally twice a week. Stage 2: “Taking Stock”: The goal in this stage is to establish some processes for monitoring and tracking goals, usually through twice weekly sessions. Stage 3: Individualized modules based on each patient’s specific needs. Stage 3 is the most variable stage, and will look different from person to person. Topics addressed might include body image; weight restoration; mindset and setbacks; moods and eating; and dietary restraint and restriction. Weekly sessions are typically focused on helping the patient understand the processes that are maintaining the eating disorder and beginning to address the concerns and issues underlying the problematic behavior. Stage 4: “Ending Well”: The focus in the final stage of CBT-E is planning ahead for the future and developing strategies for coping with changes and setbacks. According to Effland, CBT-E uses a variety of different interventions depending on patients' unique needs and challenges. Some of those interventions include: The self-monitoring tool, a formalized framework for tracking eating and drinking behaviors and how patients feel about them Collaborative review of a patient’s weight to help dispute eating disorder thoughts about weight. Behavioral experiments and cognitive restructuring to dispute eating disorder thoughts Behavior chaining, or a sequence of behaviors in which one action triggers the next one Education about the relationship between thoughts, mood, and behavior “Unlike FBT, CBT-E has specific treatment recommendations for addressing things like dietary rules and restraint, body image, perfectionism, low self-esteem, and mood, among others,” Effland says.  How does CBT-E differ from traditional CBT? CBT is a popular therapeutic approach designed to help patients become aware of negative or inaccurate thoughts and begin to challenge them. It’s a leading treatment for anxiety, depression, and a variety of other co-occurring issues. CBT-E, on the other hand, is a treatment modality that uses CBT as a basis but is specifically designed to adapt to the needs of different eating disorder diagnoses. Effland explains that CBT is based on the foundational belief that thoughts can lead to emotions and behaviors that are either helpful or unhelpful, and when you intervene in one part of the thought-emotion-behavior cycle, you intervene in them all. “This theory is included in CBT-E as the basis for the treatment. However, CBT-E uses the psychoeducation of eating disorders as the basis for the remaining interventions. It’s CBT through the lens of an eating disorder,” she says. CBT-E also differs from CBT in that it follows a structured, tailored pattern of treatment consisting of the four distinct stages outlined above. While the stages are designed to focus on particular areas, like education and self-monitoring, each one is customized to fit the patient’s unique needs and goals, and the third module in particular may focus on a variety of topics that are specific to the patient’s particular challenges, like body image or mood management. What does the research say about CBT-E for eating disorder treatment? The evidence for the effectiveness of CBT-E has been promising so far, according to researchers. “It’s the most empirically supported treatment for eating disorders, especially bulimia and binge eating, and can be successful for anorexia,” Effland says. “CBT-E is the leading evidence-based treatment for adults with an eating disorder.” According to a 2017 paper on the evolution of CBT for eating disorders, studies have shown that CBT-E may be particularly effective for eating disorder patients having significant difficulty with issues like mood intolerance, perfectionism, interpersonal difficulties, and low self-esteem. When compared with interpersonal psychotherapy (IPT), significantly more people who underwent CBT-E (66%) met criteria for remission compared to 33% for IPT. A slightly older study examining the effectiveness of CBT-E in adults found that by the end of treatment, two thirds of the patients who completed treatment achieved full remission. As for the effectiveness of CBT-E in adolescents, the research is somewhat limited but also encouraging. A 2013 study found that two-thirds of the 49 participants who received 40 sessions of CBT-E over 40 weeks completed the full treatment with no additional input. These patients demonstrated a substantial increase in weight and a marked decrease in eating disorder psychopathology, leading researchers to consider it a viable form of treatment for adolescents. While CBT-E has been shown to effectively treat a range of diagnoses, Effland does point out that patients may also require additional forms of treatment to address all symptoms and ongoing issues. “CBT-E doesn’t treat all conditions or disorders related to an eating disorder and you might need to incorporate other treatments to support co-occurring conditions and disorders,” she says. What should patients and families expect from CBT-E? While the exact format of CBT-E will vary depending on the patient and their needs, the core principles revolve around tackling the underlying mechanisms of the eating disorder, and learning ways to work through the root issues. “Your treatment is individualized and tailored to your specific eating problem and needs,” Effland says. “You, your treatment team, and your support system will become experts on your eating problem and what keeps it going.” In addition to following the four-stage modular format, CBT-E is also conducted in a particular, but personalized way. “CBT-E is a one-to-one talking-type of treatment that focuses primarily on what is keeping the eating problem going,” Effland says. “If needed, we will address things that have happened in the past if they will be helpful on your journey to recovery.” According to Effland, eating disorder treatment with CBT-E can take between 20-40 weeks, depending on various factors including whether or not a patient needs to gain weight. At Equip, our providers pull from a variety of the leading evidence-based modalities to personalize treatment to each patient, and this often includes CBT-E. Whether your treatment plan includes CBT-E or not, here are the general pieces of the treatment puzzle that you can expect from eating disorder treatment at Equip: You will meet with your therapist and dietitian weekly for at least the first ten weeks. You will meet with your peer mentor as often as is helpful. You will meet with your medical provider in the first week of treatment and as often as recommended after that. Your family or supports will meet with their family mentor as often as needed. They can also join you for sessions with your therapist as frequently as is needed. ]]></content:encoded>
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            <title><![CDATA[The Relationship Between Binge Eating Disorder and Depression ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/binge-eating-disorder-and-depression</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/binge-eating-disorder-and-depression</guid>
            <pubDate>Thu, 18 Jan 2024 18:52:27 GMT</pubDate>
            <content:encoded><![CDATA[Anyone who has ever lived with an eating disorder likely understands the fact that illnesses like anorexia, bulimia, and binge eating disorder (BED) rarely exist in a vacuum. That means eating disorders are often accompanied by other psychiatric and medical conditions, including everything from anxiety to cardiac problems. While depression is one of the most common conditions to accompany any form of eating disorder, some research suggests that the symptoms of depression may be more severe in those with BED, specifically. So why do these two conditions tend to overlap—and what are the most effective ways to treat both? How common is it to have binge eating disorder and depression? In a national sample of over 36,000 adults in the United States, 66% of those with BED also had depression. It’s worth noting that even more people, 76%, had co-occurring depression and bulimia. “While depression is more prevalent in bulimia than BED, both diagnoses include binge eating behaviors, so they are very connected.” says Equip’s VP of Research, Dori Steinberg, PhD, RD. Depression is just one of the many mood disorders that are common in these populations; “The data shows that the prevalence of any mood disorder (e.g., depression, anxiety, bipolar disorder) is 70% in patients with BED and 80% for patients with bulimia,” says Steinberg. Reggie Ash, LPCC-S, Therapy Director at Equip recognized these high rates in his own therapy practice, “I have treated a lot of people with BED and it was very common for them to have a diagnosis of depression as well,” says Reggie Ash, LPCC-S, Therapy Director at Equip. “I don't know that I've treated anyone that was only diagnosed with BED. They all had comorbid diagnoses of depression, anxiety, or trauma." Why is BED associated with depression? Comorbidities between eating disorders and other mental health conditions can develop for a variety of biological, psychological, and genetic reasons. “Binge eating is associated with increased feelings of shame and psychological distress, which may be the primary contributing factor to high rates of depression,” Steinberg says. “We also know that depression is statistically most likely to be a key factor in reducing quality of life for those with BED,” she adds. Researchers continue to investigate the specific mechanisms underlying the depression and binge eating link, but some studies suggest that using food to cope with negative emotions may play a role in perpetuating the symptoms of both conditions. Other research indicates that some foods—particularly those high in fat and sugar—are often used to self-soothe because they trigger the release of dopamine, a neurotransmitter associated with feelings of satisfaction and pleasure. This self-soothing behavior (not to be confused with “food addiction” – which isn’t scientifically-backed) may eventually lead some individuals struggling with depression to rely on binge eating as a temporary solution to manage negative feelings. While depression may be linked to BED, it isn’t exclusive to just one type of eating disorder. Depending on an individual’s specific genetic and environmental circumstances, depression can present in different ways. “Symptoms of depression can be overeating or undereating,” Ash says. “For example, if someone finds themselves eating more to cope with difficult feelings, that may be a trigger that leads to BED. The same can be said for someone who finds themselves eating less when navigating negative moods; they’re predisposed to restricting when having a change in mood.”  How to effectively treat binge eating disorder and depression Treating both binge eating disorder and depression requires the introduction of regular eating patterns, establishing distress tolerance techniques, and working with a team of trained professionals who have clinical expertise in both. And according to Ash, there’s one piece of the treatment puzzle that can be particularly beneficial. “Therapy, therapy, therapy,” he says. “Therapeutic interventions help people learn coping skills and triggers, how to manage emotions, and how they’re impacted by their environment.” It's also important that other co-occurring conditions are identified and addressed. For example, there's also a known link between ADHD and binge eating disorder.  While family-based treatment (FBT) is considered the gold standard treatment for young people with eating disorders, adults may benefit from a variety of modalities, including dialectical behavior therapy (DBT) and enhanced cognitive behavioral therapy (CBT-E). According to Ash, Medication can also be helpful, in particular antidepressants. Not all people with binge eating disorder and depression need them, but sometimes people do need medical assistance, and when combined with therapy, it can be successful. Binge eating disorder and depression can often present as a tangled web of symptoms, leaving patients and loved ones confused about which developed first. In reality, identifying the order of events isn’t as important as receiving effective care. When treating an eating disorder and a co-occurring condition, it’s vital you seek care with professionals trained in treating multiple conditions simultaneously. At Equip, patients are matched with a care team who treat the whole person, not just one diagnosis.  ]]></content:encoded>
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            <title><![CDATA[What are the benefits of the HAES approach?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/benefits-of-HAES-approach</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/benefits-of-HAES-approach</guid>
            <pubDate>Fri, 20 Oct 2023 16:08:00 GMT</pubDate>
            <content:encoded><![CDATA[The Health At Every Size, or HAES, approach in healthcare has roots all the way back to the 60s, and has been a growing movement ever since. It’s a framework that shifts from fixating on a patient’s weight to focusing more holistically on their health, pushing back on anti-fat bias and stigma. Most providers today still use weight as an important measure of a patient’s health, but recent studies have found concerning risks to this approach. A study from 2020 showed that putting patients on diets can actually increase the likelihood of weight gain or an eating disorder while another study showed that fat women who purposely lost 15% or more of their weight were two times more at risk of death. Several other studies have indicated that many providers hold biases against patients in bigger bodies, and these patients receive inferior quality care as a result. So how does the HAES approach remedy these longstanding gaps in treatment and what does it look like? Carise Rotach, MA, LMFT, and Equip’s Therapy Manager, answers common questions providers have about the HAES approach and how it can benefit patients. What are the key characteristics of the HAES approach, and why are they important? Perhaps the most important tenet of HAES approach is decoupling weight and health.  Medical weight bias assumes illness for fat people and assumes wellness for thin people. HAES asks us to go beyond the metric of weight when determining someone’s health or illness status. This approach also calls on health care providers to unlearn the pattern of recommending weight loss as a cure-all for illness— a default recommendation that can lead to folks going undiagnosed, misdiagnosed, or in some cases cause proper medical care to be withheld. HAES-aligned providers overwhelmingly provide more robust medical care for patients, regardless of size, and engage in more comprehensive diagnostic measures to ensure they identify the root source of illness.  Why is BMI an unreliable measure of health? What other metrics should providers focus on instead? In the most simplistic way, the BMI is a data scientist’s nightmare. Firstly, the BMI was created to be a basic equation squaring weight and height in order to categorize middle aged white cisgender European men. The creator of the BMI took the bell-curve of the data spread and planted a spot right in the middle calling it the “ideal” size. This metric was then used by insurance companies to identify which members would be too “high risk” to insure, based solely on the equation of their height squared with weight. Of course, we can see that this metric offers no detail about genetics, cultural background, whether this person is a smoker, whether they have vaccines or a skydiving habit. It’s an incredibly poor metric of health. At worst, the BMI has a racist history as described in The Bizarre and Racist History of the BMI. The metric of the BMI was misappropriated by people who believed in eugenics and superiority of folks who fell within the “ideal” category of weight. Because of the over-reliance of the BMI metric, many folks, often of marginalized identities in western culture, are denied medical care, medically-necessary procedures, life-saving medication and specialty care. A world without BMI as a metric would place much more focus on the function of the person’s body and overall wellness. For example, a provider can discuss blood pressure without tying it to BMI by investigating their family history, addressing a person’s sleep habits, taking into consideration any sociological stressors, need for gender-affirming care, or racial trauma. Providers can ensure access to medical care, and ultimately still provide medication as a life-saving measure. In short, providers can choose to see the person in front of them as deserving of full and complete care. What could treatment goals look like under the HAES approach? At Equip, our treatment goals include stabilizing nutrition intake, ceasing eating disorder behaviors, restoring weight to target weight range (some folks won’t have this goal if they aren’t below target), and examining cognitive distortions. Target weight is determined by growth trends, physiological indications of the body functioning, and mental health stabilization. Additionally, we work within cognitive behavioral therapy frameworks to challenge narratives around body ideals and fat-phobia. Outside of eating disorder treatment, goals can reflect a patient’s wishes; sleeping better, feeling better, having better relationships, etc. Removing weight as a focus opens up possibilities for patient-centered and patient-authored care. How can you introduce a patient to HAES after years of them believing an opposite message? Ultimately, we must meet people where they are in a non-judgmental manner. The patient may experience fear and grief as they unpack years of mistreatment. It’s common that people can identify and challenge outside messages easier than they can their own internalized fatphobia and biases. Perhaps they have a recent trigger, such as gaining "pregnancy weight" or going through a co-occurring mental illness. With patience and openness, people can start to question fatphobia and anti-fatness when they encounter it, internally and externally, in the same way that people can become fluent in another language. A common response to HAES is, “Isn't it unhealthy to be fat?”, can you break down why this isn’t true and how people can be healthy at every size? Healthy people come in all shapes and sizes and unwell people come in all shapes and sizes. By over focusing on weight instead of more relevant data points, we aren’t addressing systemic root issues. We can’t operate from a one-size-fits-all definition of health. Fat people are healthy when they are able to have access to comprehensive medical care, access to joy and pleasure, support in relationships, engage with a world that doesn’t wish for their disappearance or “curing” of their body, and generally practice bodily empowerment and autonomy.]]></content:encoded>
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            <title><![CDATA[I'm an Adult with an Eating Disorder. Do My Loved Ones Need to Be Involved in Treatment?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/adult-eating-disorders-family-involvement-in-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/adult-eating-disorders-family-involvement-in-treatment</guid>
            <pubDate>Wed, 13 Sep 2023 15:42:00 GMT</pubDate>
            <content:encoded><![CDATA[When Equip Peer Mentor Stacy Jones entered eating disorder treatment as an adult, she was reluctant to get her friends and family involved in the recovery process. “I was resistant at first to sharing with others what I was going through and that I needed their support,” Jones says. “I felt shame around my eating disorder and wasn't sure how those in my life would react.” The hesitation Jones felt is an unfortunate but common consequence of pervasive stereotypes around who gets eating disorders. Many people associate eating disorders with adolescents and teenagers, but the reality is that they don’t discriminate based on any demographic factor, including age. In fact, according to the National Institute of Mental Health, the average age of onset for binge eating disorder (BED) is 21 years old and the average age of onset for both bulimia and anorexia is 18 years old. Still, many adults continue to feel shame around their struggles, which can impede their ability to seek out the kind of support that experts consider critical to recovery. “Many adults feel isolated and alone when starting in eating disorder treatment, and interpersonal relationships can be such an asset in combating that,” says Equip Director of Adult Programs, Lara Effland, LICSW. “Eating disorders tend to be an isolating and secretive disorder. Bringing loving people into your recovery can break down feelings of shame, loneliness, and isolation.” While loved ones are considered an integral part of family-based treatment (FBT)— the gold standard for eating disorder treatment in children and adolescents—those over a certain age may feel less comfortable seeking support from friends and family members for a number of reasons. And depending on where and how adults receive care, their treatment team may not always prioritize the inclusion of close connections in recovery. But many, like Jones, have found that leaning on loved ones throughout treatment can make all the difference in long-lasting success—and there's evidence to support this. “It took some time, but I finally realized that if I truly wanted my life to be different and to recover, I needed support from those who cared for me,” Jones says. “Once I had those conversations and could lean on the people around me, my recovery started to shift. I became more committed to and involved in my treatment. Receiving compassion and care from my support network allowed my capacity for the uncomfortable to grow.” Why social support can be essential in adult treatment According to Equip therapist Danielle Shlomo, LMSW, the hesitation that many adults feel when it comes to seeking support is often rooted in common fears. “Many people struggling with eating disorders may have a profound sense of shame or distress, making it extremely challenging to seek support from others or openly discuss their experience,” she says. However, Shlomo explains that having a strong support network can be essential for helping someone initiate change, especially if their own internal beliefs still align with those of the eating disorder. Perhaps counterintuitively, external support can also help reduce the feelings of shame that may prevent someone from reaching out in the first place. “A network of chosen supports fosters a positive environment for the person struggling, alleviating the sense of isolation in their journey,” she says. While FBT typically involves a young patient’s close family members or caretakers, adults with eating disorders can bolster their treatment with  a variety of key players, including relatives, friends, romantic partners, and more. The majority of research around social support in treatment has focused on young populations, but many clinicians incorporate the same tenets into adult treatment. That may mean bringing family, chosen family, and friends into treatment while using evidence-based modalities like enhanced cognitive behavioral therapy (CBT-E), acceptance and commitment therapy (ACT), and dialectical behavioral therapy (DBT). Current research on family support in adult eating disorder treatment is sparse. However, the evidence that does exist is promising: one study exploring the topic found that including family members in even just a single therapeutic session could improve odds of recovery. A qualitative analysis found that eating disorder patients in romantic relationships commonly considered certain qualities in their partner to be important to their recovery, including patience, flexibility, and compassion. Another study found social support to be imperative in adult recovery, and that beyond family members, significant figures in a person’s life including friends, colleagues, neighbors, people from religious groups, and others could help the person coping with the disorder. “In my clinical experience, many adults are often surprised by how genuinely supportive the people in their lives are once they take the leap and involve them in their treatment journey,” Shlomo says. “No form of support is too small to make a difference in someone’s recovery. In the context of eating disorder recovery, every bit of support matters in helping someone build a life that is truly worth living.” How loved ones can be involved in adult treatment There’s no single way to offer support to an adult in eating disorder treatment, but there are some critical things that friends, family members, romantic partners, and other connections can do to have a positive impact on recovery. “Some people rely on their loved ones for accountability,” Shlomo says. “This can involve things like sharing meals together in person or virtually, assisting with weekly weight and vital checks, or providing support for any behavior changes they need help with.” It can also be helpful for loved ones to simply foster a safe, encouraging environment that challenges harmful societal norms related to physical appearance, thinness, “healthy eating,” and restrictive diets. “Many adults struggling with eating disorders might not realize that they don't have to confront beliefs stemming from harmful societal norms alone,” Shlomo says. “Receiving support from others in this area can make a significant difference.” Effland points out that unlike in adolescent treatment, a patient’s supports aren’t necessarily considered responsible for their well-being, but are thoughtfully invited to participate. Once invited, however, she says it’s critical for loved ones to educate themselves about eating disorders and how they can show up to help support recovery. “Adult support can positively or negatively affect  treatment,” she says. “So it’s important to include psychoeducation for the supports, and help them learn how to build a supportive and recovery-focused relationship.” Jones agrees, adding, “a support team as an adult is not about having someone telling you exactly what you need to be doing and ensuring you do it. It’s about having others who can help with the tasks that make life more stressful, remind you of  the tools and skills that help, allow you to be seen and heard, and remind you to live life alongside recovery.” At Equip, a patient’s supports are fully integrated into treatment and given a variety of resources—including groups, provider sessions, and a dedicated mentor—to best arm them with the knowledge and strategies they need to provide effective support. Patients can work in collaboration with their treatment team to decide the type of support strategies that work best for them at any given point in their recovery. A few of the most common, actionable ways Effland has seen support members participate in a loved one’s tre​​atment include: Acting as a supportive listener Becoming aware of their own health habits and rules Building a calm and consistent home life for themselves and (if applicable) for their loved one in recovery Seeking their own support or therapy to work through tough dynamics, issues, and stressors in the relationship Continuing to work on effective communication and sharing how they feel Learning what your loved one needs when struggling with shame, anger, anxiety, and other distressing emotions As for any tactics to avoid, Effland says it’s vital to take a nonjudgmental approach and relinquish any desire to control your loved one. “It’s important to refrain from giving advice, counsel, or commentary, or nagging, scolding, or trying to control their recovery,” she says. Creating a support network that works for you The most important thing to know about seeking support from loved ones is that there’s no one-size-fits all template for what that should look like. “Some people feel most comfortable keeping a small support network of one to two friends or family members, while others may feel it’s right for them to extend their circle to include more people,” Shlomo says. “If you’re unsure about who to include in your support network or where to begin the conversation, try approaching it one person and one conversation at a time.” Jones says that while it can be difficult to identify people to include, it’s important to set a high bar.  She advises prioritizing people who  can extend compassion and understanding while holding space for the complexities of recovery and fostering a safe environment, even through hard times. And while receiving support can be vital to recovery, it shouldn’t be rushed. She believes it’s essential to take time to form and nurture authentic, deep connections if your support network is to be truly supportive. “It can bring up a lot of emotions not having friends or family who can support you in your recovery,” Jones says. “Know that whatever it brings up for you is understandable and it doesn't mean you are alone in this. Taking time to explore the support you desire and ways to make those connections can be so powerful.” If you begin treatment at Equip without a support network in place, your team will work with you to identify who might be helpful to include and how to involve them in your recovery. Because the reality is, recovering from an eating disorder is a massive challenge regardless of your age, but it becomes infinitely more possible and sustainable when you bring your village. And if you don’t have that village yet, we’re here to help you build it.]]></content:encoded>
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            <title><![CDATA[New Equip Research Reveals How Fitness Culture Impacts Body Image and Disordered Eating Among Men]]></title>
            <link>https://equip.health/articles/news-and-research/men-fitness-body-image-research</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/men-fitness-body-image-research</guid>
            <pubDate>Mon, 02 Jun 2025 06:50:00 GMT</pubDate>
            <content:encoded><![CDATA[Disordered eating doesn’t just affect women—males account for one in three eating disorders—yet too often, men’s experiences are overlooked or misunderstood. Equip’s latest research, based on a survey of over 1,000 men across the U.S., takes a hard look at how fitness culture, social media, and societal stigma are shaping disordered behaviors in men—and why many are still suffering in silence.  Below, we unpack the survey’s findings, including key takeaways on exercise habits, supplement culture, treatment barriers, and the growing influence of social media. We also share direct insights from men who bravely opened up about their mental health struggles, and offer recommendations for where we go from here. Understanding the goals behind the research This study was designed to explore three critical areas: The relationship between fitness culture and disordered eating behaviors like cutting, bulking, and compulsive exercise. The influence of social media and fitness influencers on male body image and supplement use. The reasons men avoid or delay seeking treatment, including stigma and access issues. Who we surveyed We heard from 1,027 men from diverse backgrounds: Age: 18–29 (27%), 30–39 (36%), 40–49 (25%), 50–55 (11%) Race: 72% white, 17% Black 14% identify as LGBTQIA+ 17% have received an eating disorder diagnosis; 11% are unsure if they have one 25% have sought help for body image or eating disorder concerns What we found We learned a lot from our survey, but there were three main themes. 1. Disordered behaviors often hide in plain sight From skipping meals to “work off” food to obsessively working out despite injury, disordered eating and exercise behaviors are being normalized—especially within fitness culture. 76% of men said they feel anxious about missing a workout 59% exercise to compensate for eating 49% have avoided social situations due to body concerns More than 25% have intentionally bulked or cut These behaviors are often framed as “discipline,” but they signal deeper mental health concerns that too often go ignored. “Pushing yourself too much to the point of fitness/gym obsession can create problems and do more damage than good.” – 30–39 y/o bisexual respondent 2. Social media & supplements are reinforcing harmful ideals Social media is fueling distorted perceptions of what a “fit” male body should look like. This distorted body ideal is pushing men toward unsustainable and dangerous habits—often without questioning the safety or science behind them. Nearly 50% of respondents couldn’t tell when an image was photoshopped 38% said they’ve skipped meals to afford gym memberships or supplements 65% agreed that working out for hours a day is a sign of discipline “There’s a lack of focus on mental health in the fitness conversation. It’s often just about physical appearance.” – 18–29 y/o white respondent 3. Stigma is still a strong barrier to getting help Even as disordered eating behaviors increase among men, most aren’t seeking support. The reasons are complex—but stigma is a clear driver. On a more positive note, almost half of respondents acknowledged that eating disorders don’t just affect girls and women—but society and many providers haven’t caught up: the cultural silence around male body image and eating disorders is leading to delays in care—and missed opportunities for early intervention. Only 25% of respondents have ever sought help More than half who didn’t seek help said they “didn’t think the issue was severe enough” 49% agreed that eating disorders are not just a women’s issue “Men are conditioned by society to not speak of body image issues because it is seen as a sign of weakness.” – 40–49 y/o white respondent Where do we go from here? This research is a wake-up call. Disordered eating among men isn’t rare. It’s just rarely recognized—and even more rarely addressed. To change that, we must: Normalize conversations about male body image: Break the silence and challenge the idea that disordered eating is only a women’s issue. Reframe “discipline” in fitness culture: Encourage healthy habits, not harmful extremes. Help men recognize when “grind culture” becomes a red flag. Regulate supplement marketing and misinformation: With so many turning to unverified online sources, it’s critical to hold influencers and brands accountable for promoting unsafe or misleading content. Expand and tailor treatment options: Men deserve care that acknowledges their unique experiences—including those in the LGBTQIA+ and BIPOC communities. At Equip, we’re proud to not only be conducting research like this, but also to offer inclusive, individualized care that supports patients of all gender identities. If you’re concerned about yourself or a loved one, don’t wait to reach out for help.Schedule a call with an Equip team member today. 
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            <title><![CDATA[Our First Annual Treatment Outcomes Report Is Here—Read the Highlights]]></title>
            <link>https://equip.health/articles/news-and-research/equip-treatment-outcomes-report-2023</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-treatment-outcomes-report-2023</guid>
            <pubDate>Wed, 28 Jun 2023 15:56:00 GMT</pubDate>
            <content:encoded><![CDATA[See our most recent, 2025 outcomes here.  Outcomes matter. As a growing eating disorder treatment provider, we do many things—outreach, operations, IT, marketing—but all of it is rendered meaningless if our treatment doesn’t work. In order to ensure that all of our efforts are moving us toward our  goal of providing effective eating disorder care to everyone who needs it, we must closely and continually evaluate the impact of our work. That’s why at Equip, we’re rigorous about tracking and reporting on our clinical outcomes. We have a dedicated research team who operate independently of our clinical team to ensure objectivity and regularly monitor the effectiveness of our treatment. With combined decades of experience conducting clinical studies, our research team includes industry leaders  in the study of eating disorders, psychology, nutrition, advanced statistical modeling, and more. But we know that just measuring outcomes isn’t enough. In order to best serve our patients—and hold ourselves accountable to our high standards—transparency is key. That’s why we’re proud to share our first annual outcomes report, which provides a close look at Equip’s outcomes data for our patients and their loved ones. We hope to use these findings to inform our care going forward, and are dedicated to bringing you into our journey by publicly sharing a new outcomes report each year. Our 2023 outcomes report Our inaugural report includes outcomes from treatment we provided to children, teens, and young adults from the moment we opened our doors in late 2020 through March 2023. During this time period, we only treated patients aged 6 to 24; we’ve now expanded to treat patients of all ages and our future outcomes reports will include a more diverse patient population. Preview some key highlights below.  Who we treated  Our treatment model is built to be accessible to everyone, especially populations that often slip through the cracks of treatment. During the time covered in this report: ⅓ of patients were BIPOC 10% of patients were nonbinary or transgender 14% of patients were men and boys
  The relatively younger age of the patients covered in the report is reflected in the diagnoses we treated; both ARFID and anorexia tend to set in earlier than other eating disorders. 74% of patients had anorexia 17% of patients had ARFID 9% of patients had other eating disorders, including bulimia, binge eating disorder, and other diagnoses It’s also worth noting that many of the patients we treated came to Equip after trying treatment elsewhere. Eighty-three percent of patients included in the report had received prior treatment without achieving recovery, and 54% had received a higher level of care, which generally means inpatient treatment, a residential program, or a partial hospitalization program.  How we tackled barriers to treatment
 Equip was designed to eliminate financial, geographical, or cultural barriers to treatment. Our outcomes report shows that we’re successfully helping patients clear these hurdles. According to available data, there are no eating disorder treatment centers in nine U.S. states. Equip is available in all of them and treated patients in 8 of them. Traditional care is often cost-prohibitive and many providers don’t take insurance. 94% of Equip patients’ treatment was covered by insurance. 5% of Equip patients experienced food insecurity. Our providers worked with these families to help them find local food banks, determine SNAP eligibility, and create budget-friendly grocery lists and menus.   Did treatment work?  Over the time period covered in the report, most patients saw significant and measurable progress, and many achieved full recovery. Patients with severe eating disorder symptoms saw a 50% decrease in symptoms in their first 5 months of care. As treatment progressed, patients saw more symptom-free days, meaning more days per week without behaviors like restricting, compulsive exercise, binging, or purging. After 6 months, patients with ARFID had an increased appetite and interest in food, ate a wider variety of food, and had less fear of adverse outcomes from eating (like vomiting, choking, or stomach pain). Among patients who needed to gain weight, 81% reached their target weight within a year. The number of patients reporting anxiety or depression decreased by half over the course of treatment. Parents and other family members supporting their loved one also saw positive outcomes and an improved quality of life. 96% of families felt truly cared for by their Equip team After 8 weeks of treatment, 60% of parents/family members experienced less caregiver burden, and 75% felt more confident caring for their child 90% of parents/family members would recommend Equip to another family   We’re grateful for the opportunity to report on and share our treatment outcomes, and are eager to use these findings to continue to make our care even better as we expand to more patients in the year ahead.]]></content:encoded>
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            <title><![CDATA[Equip Now Treats Patients of All Ages!]]></title>
            <link>https://equip.health/articles/news-and-research/equip-adult-treatment-announcement</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-adult-treatment-announcement</guid>
            <pubDate>Mon, 18 Sep 2023 17:12:32 GMT</pubDate>
            <content:encoded><![CDATA[Since day one, our mission at Equip has been crystal clear: to make evidence-based eating disorder treatment accessible to everyone who needs it. From that first day, we’ve known that eating disorders don’t discriminate—they affect people across all identities—including all ages. Today, we are thrilled to announce that Equip treatment is now available to patients of all ages. Until now, we’ve treated patients ages 6 to 24 who live with their parents, as we know this is the age range in which eating disorders normally begin. Over the past few years of treating patients, we’ve built out and validated our treatment model, ensuring that we were able to maintain our industry-leading outcomes at scale before expanding to adults. We’ve been thrilled to see our treatment for 6-24-year-olds yield tremendous results, and we’re confident that our now expanded age range will lead to full healing and recovery for many. Our new, expanded care model takes the best parts of Equip’s family-based treatment and makes them adaptable to patients of all ages and living situations, allowing us to personalize treatment to every patient. Rather than creating separate treatment tracks for young patients and adults, we’ve made a holistic shift that allows for tailored, individualized treatment, regardless of age—without compromising the evidence-based foundation that has yielded strong outcomes for thousands of patients. As always, Equip patients of all ages can expect: A wraparound, multidisciplinary care team that includes a therapist, dietitian, and medical provider, as well as mentors with relevant lived experience and identities 100% virtual care that fits into your life, not the other way around The involvement of your village—whether that means family, chosen family, friends, colleagues, or anyone else you rely on for support. If you don’t have anyone or aren’t sure who to bring into treatment, we’ll help you identify or expand your support system during treatment. Evidence-based care that's focused on getting you the outcomes you want so that you can fully engage with your life Our new approach now leverages additional evidence-based modalities including CBT-E (enhanced cognitive behavioral therapy), DBT (dialectical behavioral therapy), FBT, and ERP (exposure and response prevention), among others. Each patient’s dedicated care team will tailor treatment to best suit their needs—closely monitoring what’s working and what’s not—and will be by their side for every step of the nonlinear journey to recovery. Eating disorders affect 10% of the population, and recovery is possible for each and every one of those people—but only with the right treatment. Our goal is to get treatment that works to every single person who needs it, enabling them to rediscover the beautiful lives that are waiting for them on the other side of these complex, debilitating illnesses.]]></content:encoded>
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            <title><![CDATA[What Is Orthorexia? When “Healthy Eating” Becomes Harmful]]></title>
            <link>https://equip.health/articles/food-and-fitness/what-is-orthorexia</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/what-is-orthorexia</guid>
            <pubDate>Fri, 09 Jan 2026 19:42:00 GMT</pubDate>
            <content:encoded><![CDATA[For a long time, Equip Peer Mentor Rachel Myers struggled with what she calls “health anxiety.” The fear of getting sick or developing a chronic illness consumed her, sending her down a rabbit hole of strategies meant to protect her body. That search eventually led her to veganism, which became the starting point of something more consuming—an obsessive pursuit of “healthy” eating that quietly took over her life. Experiences like Myers’ are more common than many people realize, especially in a culture that praises discipline, purity, and self-control around food. What often begins as an attempt to feel better or safer can gradually turn rigid and anxiety-driven, making meals stressful, social eating difficult, and any deviation from food rules deeply distressing. This pattern has a name. Orthorexia is an unhealthy fixation on eating foods perceived as healthy, clean, or pure. While caring about nutrition is not a problem in itself, orthorexia crosses into dangerous territory when food rules become inflexible, compulsive, and disruptive to daily life and well-being. Part of what makes orthorexia so confusing is that orthorexia nervosa is not currently a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), despite the very real physical, emotional, and social consequences it can have. That gray area leaves many people wondering whether their distress “counts” as an eating disorder, or whether they’re simply being disciplined or health-conscious. But the lack of a diagnostic label doesn’t make the suffering any less real. Orthorexia can seriously affect physical health, mental health, relationships, and quality of life, especially in a culture that praises clean eating, self-control, and wellness at all costs. It can also be a slippery slope to a diagnosable eating disorder. Below, we’ll unpack what orthorexia is, how to recognize it, why cultural pressures make it so hard to spot, and what compassionate, effective treatment and recovery can look like. What is orthorexia? “When we talk about orthorexia, we’re referring to the state of being rigidly obsessed with 'clean' eating patterns in a way that obstructs normal functioning and daily life,” says Equip dietitian Gabriela Cohen, MS, RD, LDN. This can look like eliminating entire food groups without medical need, spending hours planning or researching meals, or avoiding social situations because food feels unpredictable or unsafe. While estimates vary, orthorexia is thought to affect up to about 7% of the population—and it appears even more common in health- and fitness-focused spaces, like some competitive athletics, fitness studios, and weight loss-focused social media accounts. Studies suggest that 28% to 76% of people working in health-related fields show signs of orthorexia, and up to 55% of regular exercisers (think: athletes, weightlifters, CrossFitters, and runners)may experience orthorexic behaviors.  Many people with orthorexia start with positive intentions, like wanting to feel better physically or improve health. “We have an issue when this behavior becomes inflexible,” says Brianna Halasa, LMHC, LPCC, a licensed psychotherapist. “People start to plan their meals to the detail, cutting out entire categories of food groups or compulsively checking ingredient lists or labels.” Because these behaviors are often praised in thinness-focused Western cultures, orthorexia can be difficult to recognize. But when food rules create distress, isolation, or harm to health, that’s a sign your relationship with food may no longer be supportive. Is orthorexia an eating disorder? Orthorexia nervosa is not currently a standalone diagnosis in the DSM. This lack of formal criteria contributes to confusion about whether orthorexia “counts” as an eating disorder. Many clinicians, however, recognize it as a serious and harmful pattern. “Not only do I believe orthorexia is and should be a classified eating disorder, I think it's probably the most dangerous one,” says Ashley Isenhower, AMFT, an Equip therapist. “It’s the embodiment of diet culture and anti-fat bias.” It also often overlaps with diagnoses like other specified feeding or eating disorder (OSFED), anorexia, anxiety disorders, and obsessive-compulsive disorder (OCD). How is orthorexia different from healthy eating?  “Orthorexia is a focus above healthy eating to a point that it becomes more consuming and no longer healthy,” says Stephanie Kile, MS, RDN, lead registered dietitian nutritionist at Equip. “It becomes more than just healthy eating and begins to impact all areas of life.” With healthy eating, food choices are adaptable and leave room for enjoyment and social connection. With orthorexia, food choices are governed by fear and moral judgment. Breaking a rule often leads to guilt or anxiety, and food begins to dominate daily thoughts and routines. Put simply, healthy eating supports flexibility, nourishment, and quality of life. Orthorexia does not. What are the signs of orthorexia? Orthorexia can show up in many areas of daily life, not just at meals. Myers’ experience illustrates how far-reaching the impact can be. “My life revolved around being ‘healthy,’ but I was constantly getting sick because I was not eating enough to sustain my energy needs,” she says. “I lost my menstrual cycle for many years, and orthorexia made me avoid getting help because I feared doctors would try to ‘contaminate’ me even further with medicine or chemicals.” These signs often develop gradually, which makes them easy to overlook or dismiss as “just being disciplined.” One helpful way to understand orthorexia is to look at how it shows up across three areas: behavior, thoughts and emotions, and physical health.  Behavioral signs With orthorexia, “food becomes a source of stress rather than nourishment,” says Halasa. “Think about someone who puts the pursuit of purity over relationships, joy, and overall well-being.” That shift often shows up through patterns like: Rigid food rules that go beyond medical needs, like cutting out entire food groups Compulsive checking of ingredient lists, nutrition labels, or sourcing details Spending excessive time planning meals, researching foods, or preparing food “correctly” Avoiding restaurants, social gatherings, or travel because food feels unpredictable Refusing to eat food others make or feeling the need to control every aspect of meals Exercising compulsively to “balance” or justify eating Increasing isolation as food rules limit daily life Psychological signs According to Kile, orthorexia can also involve “high levels of perfectionism” and “lack of ability to have freedom in eating,” even when body image concerns aren’t the primary focus. Other psychological signs include: Intense anxiety around eating foods deemed “unclean,” processed, or imperfect Guilt, shame, or self-criticism after breaking food rules Black-and-white thinking about food as good or bad Feeling morally superior—or deeply ashamed—based on food choices Constant mental preoccupation with food, ingredients, and eating decisions Difficulty being present or enjoying activities because of food-related worry Physical signs “If you are cutting out entire food groups without medical necessity, you won’t get adequate nutrition, which leads to deficiencies,” says Halasa. You may also notice other physical symptoms like: Unintended weight loss or difficulty maintaining weight Fatigue, dizziness, or low energy from inadequate intake Digestive issues such as constipation, bloating, or early fullness Hormonal disruptions, including missed periods or sleep problems Signs of nutrient deficiencies from restricted variety Worsening anxiety or depression as restriction increases It’s also worth noting that someone with orthorexia may have a "normal" body mass index (BMI) and appear healthy. You can’t always tell from someone’s appearance if they’re struggling with orthorexia (or any other form of disordered eating, for that matter). What causes orthorexia? Orthorexia doesn’t come out of nowhere. It tends to grow gradually, often shaped by a combination of personality traits, stressors, and cultural messages about health and discipline, says Kile. “Orthorexia is complex and shouldn’t be reduced to ‘she or he is obsessed with clean food,’” adds Halasa. For many people, food rules become a way to cope with anxiety, uncertainty, or a need for control. Understanding these factors isn’t about blame. It’s about realizing why orthorexia takes hold—and knowing that support can help with the underlying struggles, not just the eating behaviors themselves. Psychological factors According to Halasa and Kile, certain mental and emotional traits can increase vulnerability to orthorexia, including: Perfectionism and all-or-nothing thinking High levels of anxiety or health anxiety Obsessive or compulsive traits A strong need for control or predictability History of trauma, anxiety, depression, or other eating disorders Poor body image, even if weight loss isn’t the original goal Food rules can temporarily reduce anxiety, which reinforces them…until they start creating more stress than relief. Environmental factors  Orthorexia in Today’s Culture Social media: Algorithms amplify extreme food rules and “clean eating” content. Food purity trends: Foods labeled as clean, toxic, or inflammatory create fear around eating. Moralized eating: Food choices become tied to discipline, worth, or virtue. Unregulated wellness advice: Oversimplified health claims are presented as universal truths. Supplement and detox culture: Products promise control, purity, or quick fixes. Praise for restriction: Rigid eating is rewarded as dedication or self-control. Diet culture in disguise: Weight loss and control are framed as wellness. Lack of nuance: Complex health topics are reduced to rigid rules.  “We live in a culture that praises beauty and discipline, and often confuses wellness with worth,” says Halasa. All of this can encourage orthorexic behaviors. Common examples include: Diet culture and the moralization of food as “good” or “bad” Wellness trends that equate restriction with discipline or virtue Social media algorithms that reward extreme eating patterns Exposure to misleading or oversimplified health claims Certain sports, careers, or communities where “clean eating” is praised Trauma or chronic stress, where control over food becomes a coping tool Biological factors Biology can also influence risk, according to Kile. Some people may be more susceptible to orthorexia due to: A family history of eating disorders Genetic predisposition toward anxiety or obsessive traits Digestive conditions or chronic illness that initially require dietary changes A history of dieting or medically supervised food restriction What are the health risks of orthorexia? Even when food choices look “healthy” on the surface, orthorexia can take a serious toll on both physical and mental health. And these risks don’t come from eating the “wrong” foods—instead, they stem from chronic restriction, stress, and lack of flexibility around eating. Common health risks of orthorexia include: Malnutrition and nutrient deficiencies: Cutting out entire food groups without medical necessity can make it hard to meet basic nutrition needs. Over time, this can lead to deficiencies in protein, fats, vitamins, and minerals that the body needs to function properly, says Halasa. Hormonal disruptions: Inadequate intake can affect hormone production, leading to missed periods, fertility issues, sleep problems, and blood sugar instability, according to Kile. Digestive problems: Restriction can slow digestion and contribute to constipation, bloating, nausea, and early fullness, says Kile. Ironically, rigid “gut health” rules often worsen GI symptoms rather than improve them. Cardiovascular and metabolic effects: Malnutrition can lead to a low heart rate, dizziness, fatigue, and low blood pressure—risks commonly seen in other restrictive eating disorders, too. Worsening mental health: Orthorexia is closely linked to anxiety, depression, and obsessive thinking, according to Kile. The more rigid food rules become, the more food anxiety tends to increase. Social withdrawal and isolation: Avoiding meals with friends, family, or coworkers can strain relationships and reduce social support, which is critical for mental health and recovery, says Halasa. Increased risk of other eating disorders: Orthorexia can overlap with or progress into other eating disorders, including anorexia or binge eating disorder, especially as restriction intensifies. Delayed or avoided medical care: Some people with orthorexia distrust medical guidance, which can delay diagnosis and treatment. “My orthorexia made me really mistrust my own medical provider,” Myers says. “Instead of opting for medications to help with my chronic illness and mental health symptoms, I was determined to use diet, exercise, and supplements to manage them. I believed it wasn’t good to have anything 'artificial' in my body." When should you seek help for orthorexia? Many people hesitate to reach out for support because they worry their struggles with food aren’t “serious enough.” With orthorexia, that worry is especially common, especially since the behaviors are often praised or encouraged. But distress is a meaningful signal, and you don’t have to wait until things feel extreme to ask for help. Getting support sooner can make it easier to untangle fear from food, protect your health, and move toward a more peaceful, flexible relationship with eating. According to Kile and Halasa, it’s time to seek support if you notice: Food taking up a lot of mental space or causing ongoing worry Feeling anxious, guilty, or distressed around meals Pulling back from social plans, travel, or shared eating Experiencing physical changes like low energy, digestive issues, dizziness, or missed periods Struggling to eat enough to feel nourished or function well Feeling stuck in rules that are no longer helpful, even if you want things to change What does orthorexia treatment look like? Orthorexia treatment focuses on rebuilding a safer, more flexible relationship with food and health, says Halasa. This often involves practicing flexibility by doing things like slowly reintroducing foods that once felt off-limits or learning to eat in social settings without fear taking over. Treatment also commonly addresses overlapping concerns like anxiety, OCD, or other eating disorders, which can reinforce rigid patterns. Supporting the whole person—not just changing food rules—is a key part of recovery. That’s why treatment often involves a coordinated team, including: Therapists, who help address the anxiety, rigidity, perfectionism, or trauma that often drive orthorexic patterns. Therapy can support more flexible thinking, reduce fear, and build coping skills beyond food control. Dietitians, who work compassionately to expand food variety, challenge food myths, and restore nourishment without shame. It’s important to work with an anti-diet and/or eating disorder-informed dietitian like those at Equip for the best outcome. Medical providers, who monitor physical health and support recovery if complications like malnutrition or hormonal changes are present. Because orthorexia isn’t a formal DSM diagnosis, providers may recommend using a diagnosis like OSFED, says Isenhower. This helps ensure the seriousness of the struggle is recognized and can make it easier to access appropriate care and insurance coverage. How can I support a loved one with orthorexia? Supporting someone with orthorexia can feel complicated. What matters most is approaching the situation with empathy, curiosity, and care. How to start a conversation about orthorexia You don’t need to have the perfect words. Starting from concern and observation—not criticism—can help a loved one feel safer opening up. Cohen recommends gentle, open-ended questions like: I’ve noticed food seems more stressful lately. How has eating been feeling for you? Do these habits feel supportive, or do they feel heavy or overwhelming? How are you feeling emotionally around food right now? Does anxiety around eating ever feel like it’s getting in the way of your well-being? Avoid reinforcing harmful behaviors Even well-meaning comments can unintentionally reinforce orthorexic patterns, says Myers. Try to avoid: Praising restriction or “discipline” around food Commenting on how healthy, clean, or pure someone’s eating looks Comparing your eating habits to theirs Turning concern into a debate about nutrition facts Instead, center conversations on emotional health, stress levels, and quality of life. Encourage support early and gently If you or someone you love are showing signs of disordered eating or an eating disorder, remember that support is out there. If you’re concerned, encouraging professional support sooner rather than later can help prevent patterns from becoming more entrenched. Equip provides tailored eating disorder treatment that includes a coordinated care team and mentors who have been through similar experiences. In treatment, trained clinicians can help you or your loved one unpack long-held beliefs about what is and isn’t “healthy,” and create space to live a life free from rigid restrictions. Schedule a free consultation to learn more.  The bottom line Orthorexia can be hard to spot because it often looks like “doing everything right.” But when eating becomes rigid, anxiety-driven, or isolating, it can take a real toll on physical health, mental well-being, and daily life. You don’t need a formal diagnosis—or a breaking point—for your concerns to matter. If food feels stressful, controlling, or overwhelming, that’s reason enough to seek support. With compassionate, multidisciplinary care, orthorexia recovery is possible, and you can rebuild a more flexible, peaceful relationship with food and health. FAQ Is orthorexia a type of OCD? OCD and orthorexia are not the same, but the two can overlap. Many people with orthorexia experience obsessive thinking, compulsive behaviors, or high anxiety around food. That’s why treatment often addresses co-occurring anxiety or OCD traits alongside eating behaviors. What happens if orthorexia goes untreated? Over time, orthorexia can lead to malnutrition, hormonal disruptions, digestive issues, worsening anxiety or depression, social isolation, and increased risk of other eating disorders. Because the behaviors are often praised, many people delay getting help, which can make recovery harder. Is orthorexia in the DSM? No. Orthorexia nervosa is not currently a standalone diagnosis in the DSM. However, many clinicians recognize it as a serious disordered eating pattern. Providers may use a diagnosis like OSFED for people struggling with orthorexia to ensure symptoms are taken seriously and treatment is accessible.]]></content:encoded>
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            <title><![CDATA[When Is It Time to Worry About Your Teen’s Weight Loss? ]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/weight-loss-in-teens</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/weight-loss-in-teens</guid>
            <pubDate>Fri, 29 Aug 2025 15:07:00 GMT</pubDate>
            <content:encoded><![CDATA[It seemed to start innocently enough. JD Ouellette’s daughter was a high school senior when she decided to do a “healthy eating makeover” with her friends. “As she explained it to me, now that they were done with their athletic careers, and in anticipation of gaining the ‘Freshman 15’ the next year, they wanted to make changes to their eating,” Ouellette says. “And at that time, it made perfect sense to me.” But the “healthy” experiment quickly spiraled out of control and soon, Ouellette's daughter developed severe anorexia. It took time before Ouellette realized her daughter was in the throes of an eating disorder, however. “All of the food restriction and weight loss were initially seen as strictly gastrointestinal issues,” she says. “That’s what we were working on with her pediatrician before it became clear the answer was anorexia. We went from concerned to terrified in about three months.” While weight loss isn’t always a sign of disordered eating, nor does every eating disorder include weight loss as a symptom, weight loss in teens can be cause for concern. Read on for more information about teen weight loss, how to know if it’s a sign of an eating disorder, and when to seek help.  Weight loss pressures for teens No matter how much progress society makes in terms of eating disorder awareness, teens tend to experience immense pressure to be a certain size and look a certain way. Part of this is due to the innate characteristics of this stage of life: teens live in bodies that are rapidly changing, they are exploring romantic relationships and the need to look “desirable” for the first time, they’re learning to navigate complex (and often appearance-based) social dynamics—and they’re doing all of this with frontal lobes that aren’t yet fully developed. The advent of social media has only amplified these pressures, and a resurgence of “thinspo” and the glamorization of weight loss exacerbates things even more. “A fundamental reason we accept dieting as a rite of passage—and the age it starts at keeps getting younger—is that our entire society is steeped in diet culture,” Ouellette says. Diet culture isn’t just woven into the fabric of the media we consume; Ouellette argues that the promotion of weight loss and dieting is embedded into academics, athletics, social life, and social media—all because of the false but persistent belief that a thinner body is always a better body. “Kids hear from the vast majority of the adults in their lives that dieting is normal and appropriate,” she says. “So while peer pressure is definitely a factor in dieting influence, so are doctors, coaches, teachers, and parents—who are almost always well-meaning.” Indeed, teens experience the pressure to lose weight from a variety of different sources, including: Social media. “Social media algorithms can quickly fill a teen's feed with diet, ‘clean eating,’ and exercise posts—even if they only like one post or share a workout video,” says Equip’s Lead Dietitian Tanya Hargrave-Klein MS, RDN. “For teens predisposed to eating disorders, this constant exposure to hundreds of Photoshopped images of ‘perfect’ bodies, combined with diet messages disguised as health tips, can be dangerous, making it easy for them to fall into unhealthy dieting and exercise habits in the pursuit of ‘health.’” Mainstream beauty standards. “We have the prevailing aesthetic that thin is the only attractive or acceptable body size, which shows up everywhere,” Ouellette says. “Messages that I got once a month from Seventeen Magazine are in the faces of our youth almost nonstop through social media. Social media has supercharged diet and wellness culture influence.” Expectations around growth. “Puberty naturally leads to weight gain, a fact often misunderstood by teenagers,” Hargrave-Klein says. “The rapid changes in their bodies can make them feel disconnected from their new appearance. Additionally, adolescents who experience early or late puberty might feel isolated from their peers, which can intensify self-doubt and shame.” Everyday stressors. “Teenagers often experience a confluence of hormonal shifts and external stressors stemming from social dynamics, academic pressures, and personal insecurities,” Hargrave-Klein says. “This combination can lead to the adoption of maladaptive eating behaviors, including restriction or bingeing, as a coping mechanism.” What are the risks associated with teenage weight loss? While it’s true that losing weight isn’t always a sign of a problem, there are a number of potential risks to be aware of when it comes to weight loss in teens. “Pursuing weight loss during adolescence can have significant negative consequences, affecting physical health, mental well-being, social life, and athletic performance,” Hargrave-Klein says. “As a registered dietitian specializing in eating disorders and a mother whose daughter was diagnosed with anorexia at 14, I have observed the serious effects of weight loss efforts in teenagers. This path can quickly lead to isolation, injury, and the development of an eating disorder.” A few of the most common risks of teen weight loss include: Growth disruption. “When a teenager is underfueled, it can hinder growth and potentially prevent them from reaching their full adult height,” Hargrave-Klein says. “For teen girls, this can disrupt hormonal balance, leading to irregular menstrual cycles and weakened bones.” Increased anxiety and isolation. “Socially, food-related activities, which are typically enjoyable, can become sources of anxiety,” Hargrave-Klein says. “Fear of food can lead to social withdrawal, resulting in isolation and a decline in mood.” Mental, emotional, and physical challenges. “Weight loss always carries risks, but for adolescents, these risks are significantly higher,” Hargrave-Klein says. “Adolescence is a crucial period of emotional, mental, and physical development, where adequate caloric intake is vital for energy and for establishing a healthy foundation for adulthood. The pursuit of a smaller body can have lasting negative impacts, costing teenagers more than just weight. It can affect their health, happiness, and future.” The development of an eating disorder. “For individuals with a genetic predisposition, creating an energy deficit for weight loss can act as a trigger, initiating destructive behaviors and thoughts that can overwhelm a young person's life,” Hargrave-Klein says.” It’s also important to note that for young athletes, pursuing a leaner physique can negatively impact performance and overall physical health, increasing risks for injuries like stress fractures and compromising strength and agility. “I experienced this with my own daughter,” Hargrave-Klein says. “She was enthusiastic about track, but then suffered a foot bone fracture. Her participation in social gatherings diminished, and she became reclusive. These issues escalated, culminating in a severe eating disorder.”  When to worry about weight loss in teens As Ouellette sees it, not only should weight loss in teens be considered cause for concern, but so should any stalled weight or height gain (in the absence of actual weight loss). “Falling off their height, weight, and BMI curves is a huge red flag and more dangerous than them going above previous curves,” she says. “Puberty is an especially vulnerable time because while rapid weight gain is normal and healthy, it is pathologized and many children react to the gain with dieting. Even if they don’t develop an eating disorder, they can still be doing damage in terms of building bone density, future vertical growth, and brain development and maturation.” Hargrave-Klein says that because teenage bodies are still undergoing significant growth and development, weight loss is rarely, if ever, advisable. “Even a modest decrease in weight—as little as five pounds—can have profound effects on a teenager's physical, mental, and psychological well-being,” she says. According to Hargrave-Klein, indicators that weight loss may be negatively impacting a young person include: A departure from the teen's historical growth curve, evident since the age of two years old Loss of menstrual cycle (in teens with a menstrual cycle) Increased anxiety or indecision surrounding meal and snack selection and consumption Social withdrawal or a loss of interest in previously enjoyed activities Hair loss Excessive worry and/or preoccupation about body shape and size Persistent feelings of coldness, fatigue, or dizziness Digestive complaints such as bloating, gas, or constipation Engaging in excessive or secretive exercise  When might a teen’s weight loss signal an eating disorder? Teenage weight loss can lead to a variety of mental and physical health issues, but it doesn’t always signal an eating disorder. However, there are certain signs to look out for that may indicate your teen is struggling with anorexia, or another eating disorder diagnosis. “The signs may be subtle at first, but paying close attention to changes in appearance, eating habits, and mood can be crucial,” Hargrave-Klein says. Here are a few red flags to be aware of: Wearing looser, baggier clothes. “One of the most obvious indicators is a visible change in clothing fit,” Hargrave-Klein says. “Baggy, ill-fitting clothes, or a new preference for oversized hoodies and loose jeans, even on hot days, can be a deliberate attempt to conceal a thinning frame.” Dramatic shifts in their relationship with food. If a teen is suddenly finding excuses to miss meals, pushing food around their plate rather than eating it, or isolating themselves during mealtimes, they may be experiencing difficulties with food. “You might also notice a refusal to eat once-loved foods, or the sudden elimination of entire food groups, like starches, or a newfound obsession with ‘organic’ foods,” Hargrave-Klein says. Significant mood and behavioral changes. “As weight loss progresses, a teen's emotional and mental state can also deteriorate,” Hargrave-Klein says. “Look for increased social anxiety, a consistently low mood, or the emergence of obsessive compulsive characteristics.” “If these warning signs resonate, don't hesitate,” Hargrave-Klein says. “Consulting your child's primary care provider is the crucial first step. It's vital to rule out any underlying medical causes for the weight loss and to seek support for your loved one as soon as possible. Early intervention can make all the difference in addressing disordered eating thoughts, beliefs, or behaviors.”  Is weight loss in teens ever okay? While not all teens who lose weight will end up with an eating disorder, Hargrave-Klein cautions that there is no way to know who will and who won’t. “For that reason alone, weight loss is not recommended for teens,” she says. “Any discussion about wanting to lose weight should be had with the teen’s primary care provider.” From Ouellette’s perspective, weight loss in teens is almost always problematic, for all of the reasons outlined above, and for another. “The vast majority of people who lose weight end up at higher weights than before, and this creates a vicious cycle of dieting leading to weight gain,” she says “I am a fan of focusing on healthy behaviors and letting your body—which is really smart until we impose artificial rules on it—decide where it wants to live size-wise.” In Ouellette’s view, “healthy behaviors” refers not to food restriction or rigid workout routines, but to health-supporting habits like: Eating a wide variety of foods, including foods eaten for pleasure Having a relationship with movement based on enjoyment Getting plenty of rest Limiting technology and social media Maintaining social connections Spending time with family Having hobbies and passions Seeking help for teen weight loss It’s natural for parents to be concerned when their teen experiences any kind of sudden weight loss. And while it may be tempting to wait and see whether their weight stabilizes or the loss can be attributed to some other factor, Hargrave-Klein says it’s best to book an immediate consultation with a primary care provider or eating disorder specialist. “This proactive approach is crucial because unexplained weight loss can signal not only an eating disorder, but potentially an underlying medical condition requiring prompt assessment,” she says. Regardless of whether the weight loss was intentional, Hargrave-Klein explains that a skilled healthcare provider can thoroughly evaluate the teen and collaborate with families to develop a treatment plan and provide a referral to eating disorder specialists, if necessary. The overall goal of this kind of immediate intervention is to guide the teen back to their historical growth curve and to minimize any potential negative impacts on their physical, psychological, and emotional development. For any parents who are hesitant to jump to conclusions and don’t want to assume their teen is struggling with disordered eating, Ouellette says it’s important to follow your instincts and listen to your gut. “Pay attention to what you are seeing and hearing, schedule a doctor’s visit—and I would talk to the doctor in advance about your concerns—educate yourself around weight in general, and eating disorders specifically,” she says.  Challenging diet culture to help your teen Just as diet culture can lead teens to pursue weight loss, it can also make it more challenging for parents to intervene or get help from experts. As Ouellette points out, sometimes medical professionals hold their own biases and beliefs about weight, body size, and dieting that may reinforce weight loss or lead them to miss an eating disorder in those who don’t fit the stereotype of who these illnesses affect. “It’s really important to figure out where your physician stands before they talk to your teen,” she says. Ouellette is also aware that many parents may have their own long-held internalized beliefs around weight. To begin to counter some of that thinking, she recommends reading Harriet Brown’s Body of Truth: How Science, History, and Culture Drive Our Obsession with Weight—and What We Can Do about It. “The information in this article is likely opposite of what you hear in most spaces, and changing your thinking from conventional wisdom is hard and even lonely,” Ouellette says. “As I began to learn more over the last decade, you can imagine my shock at finding the BMI category with the longest life span is actually ‘overweight’! I say this not because I think BMI is a good way to evaluate health, but because this truth is a tangible reason to question everything you’ve ever learned about weight.” If your teen is losing weight (or trying to), it’s important not to ignore it or assume it’s a passing phase. Teen weight loss can be the first step on the path toward an eating disorder, and even in the absence of an eating disorder, it can harm their physical, emotional, and cognitive health, as well as their social life and relationships. Speak to their doctor or an eating disorder professional about your concerns, or schedule a call with an Equip team member. ]]></content:encoded>
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            <title><![CDATA[How to Navigate Social Media During Recovery]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/social-media</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/social-media</guid>
            <pubDate>Fri, 12 Mar 2021 19:40:00 GMT</pubDate>
            <content:encoded><![CDATA[In our modern world, it can be hard—if not impossible—to completely avoid using social media. After all, these apps and websites are how people connect, stay up to date on current events, and get our fill of baby animal memes, any time of day. Social media, like all things, comes with positives and negatives. Along with connection comes comparison, and comparison can be incredibly harmful — and a slippery slope — for those with eating disorders. So how can you know whether social media would be helpful for you in recovery? This is when it’s important to weigh the pros and cons of being online. Looking for a way to help a loved one with an eating disorder? Check out this guide for protecting your child from social media in recovery. The potential pros of social media There are many body positive, pro-recovery accounts out there — on Instagram and other social media platforms. The comments on these accounts can be a reminder that recovery is possible and that there are supportive people out there. Since most of us won’t give up social media entirely, we can at least make the experience more positive by following pro-recovery accounts. It can also be an opportunity to diversify your feed and hear from voices often left out of conversations about eating disorder recovery. Social media can also be a great way to connect with people who you may not be able to see in person, especially during a time like COVID-19, where in-person connection can be challenging. These people may be helpful supports in your recovery journey — and social media can enable this connection. The potential cons of social media Sometimes, it can be hard to find accounts with reliably accurate and helpful info. Even pro-recovery accounts can sometimes veer into problematic territory. Sometimes, it can be hard to accurately figure out which accounts you’re following for pro-recovery content and which ones are part of your feed because they feel “familiar.” These familiar accounts may deliver messages you used to believe in, but you actually realize now are triggering content. Unhelpful accounts and pages do exist, and they spread misinformation and are quite harmful to the recovery process. Since anyone can share anything on social media, there’s always the possibility of bumping into triggering or unhelpful content. This is why it’s always important to be aware of what boundaries you need for your recovery. Actions and suggestions for limiting social media: It’s never a bad idea to take a break from social media. In fact, stepping back from social media to focus on your recovery is often a great idea. This gives you the time to focus on you and what you want from life and those around you. If you can’t step back all the way, it can be a healthy exercise to clear your feed of accounts that are triggering, or that promote diet culture or disordered behaviors. If something isn’t making you happy, is increasing your eating disorder urges, or makes you feel “not enough,” then it’s not a good idea to have it on your feed. Work with your therapist or peer mentor to discuss how social media has impacted your personal recovery journey. In these sessions, you can talk through what actions might be best for you and how to go about achieving those changes. Social media can always become a tool later in your recovery journey if it’s too complicated or overwhelming right now—that’s perfectly fine! Alternately, social media might never play a role in your recovery, and that’s 100% okay, too. Also, here’s a big reminder that you never have to share your recovery journey online. It’s 100000% okay to keep it private if that’s what feels right for you. No matter how many people you see journaling their recovery journey on social media, it is not a prerequisite to recovery success. You and your team get to decide what helps you.]]></content:encoded>
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            <title><![CDATA[Why You Don’t Need to “Make Up” for Anything You Did in December ]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/post-holiday-guilt-diet-culture</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/post-holiday-guilt-diet-culture</guid>
            <pubDate>Tue, 10 Jan 2023 15:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Reflecting on a former job, Equip’s Director of Lived Experience, JD Ouellette, remembers one particularly troubling post-holiday tradition: the company’s “Biggest Loser” contest with weekly weigh-ins and cash prizes for employees who lost the most weight. “Where to start with how problematic this was?” Ouellette says. While this sort of toxicity could rear its head anytime and any place, the fact that it existed (and continues to exist) so casually in a workplace speaks to the normalization of post-holiday repentance in the form of weight loss. From fitness influencers to supplement manufacturers, everyone seems to endorse one to-do item each January: “make up” for the indulgences of the prior month. “The beginning of the year is notoriously full of messaging in the media for weight loss, increasing activity, and ‘starting the year off right,’” says Equip therapist ​​Maddie Friedman, LCSW. “This is so problematic because these messages are rooted in the idea that people are not inherently well and that their bodies are something to fix. It normalizes low self-worth and body dissatisfaction, and perpetuates the false narrative that weight loss will lead to greater happiness and success.” Just as we’re sold the false notion of attaining a “bikini body” every summer, we’re expected to buy into the annual January rhetoric around calorie restriction and/or excessive exercise. Not only is this messaging steeped in fatphobia and diet culture, but it also promotes and normalizes disordered eating behaviors. But in reality, here’s the clear truth: there’s no need to “undo the damage” of making memories and enjoying special foods with loved ones. So before you buy into a fad diet or punishing workout plan, read on for the reasons you definitely do not have to “make up” for the choices you made in December. What’s “normal” new year behavior, and what could be problematic? While it’s certainly true that many of us fall out of our typical routines during the holiday season, there’s no need to snap back to reality through self-punishment. “I think most of us like to get back into our daily routine after the holidays,” Ouellette says. “We’re back to our normal sleeping and eating and movement and work and school patterns, and that does generally mean less fudge and cheese than we've been enjoying during our celebrations.” That said, the prevalence of comments like “the diet starts January 1st!" (usually from the same people who say “calories don’t count during the holidays!”) only exacerbate anxiety around food, exercise, and body size. “Comments like these continue to normalize and endorse societal beliefs that calories need to be limited, some foods are ‘bad’ for us, and bodies need to shrink,” says Equip dietitian Emily Tauschek, RDN, CN. Aside from stirring up stress, the enduring faith so many people put into diets is misplaced anyway, according to Friedman. “Long story short, our bodies have wisdom and diets do not,” she says. “Most diets fail and they maintain their relevance because we are more likely to blame ourselves than diet programs peddling success stories and false hope..” Given the widespread dialogue around dieting and exercising in the new year, it can be tough to pinpoint what kind of post-holiday thoughts and behaviors could be considered problematic—but there are some warning signs to be aware of. “I think where we should get concerned is any time children and adolescents pursue weight loss, or if we see anyone developing rigid rules around their food and exercise that distance them from others,” Oullette says. “Flexibility around food and movement is mentally healthy; rigidity and rules-bound eating and exercise are not.” Ouellette recommends parents and caretakers listen to the ways their loved ones may be speaking about their bodies, food, and movement. “When in doubt, have a conversation from a place of non-judgment: ‘it looks like you have a lot of new rules about your food and exercise. Can you tell me about it?’ is a good place to start,” Ouellette says. “If you’re unsure whether or not to be concerned, go through a list of eating disorder warning signs to see what things may be problems that you are not aware of.” How to navigate post-holiday messaging while staying committed to recovery With so much noise from the outside world—at all times, but particularly at the start of a new year—it can be incredibly tough for those healing from eating disorders to stay focused on recovery. Tauschek believes it’s important to approach this challenge from a place of self-compassion, first and foremost. “It's not easy to exist in a world where restriction and weight loss is normalized and praised,” she says. “Give yourself grace, lean into the support of your treatment team, set boundaries, and remember your ‘why’: why you are doing this and why full recovery is worth it.” Friedman says the power of community and continued education about the dangers of diet culture can go a long way, too. “The diet industry does not exist to help you; it exists to profit off of your perceived ‘failure,’” she says, recommending the podcast Maintenance Phase as an informative resource that dives into research related to weight loss fads, programs, and scams. “Unfollow social media accounts that promote dieting and weight loss, even in seemingly subtle ways, and follow content that supports health at every size, enjoyment of all foods, body diversity, and movement for pleasure..” While New Year's resolutions feed into post-holiday restriction and body manipulation, Ouellette thinks it’s important for people to keep in mind that resolutions do not have to be body-based at all. “New Year's resolutions and looking at the new year as a launching board for a ‘new you’ don't have to be based on diet culture,” she says. “You can resolve to rebel against diet culture. The ‘new you’ can choose to skip the gym without guilt. Getting into and maintaining recovery is bold and brave—stay aware of your risk factors, don't even put a single toe onto the slippery slope, and use your boldness and braveness to build and live a life that celebrates you for being you, without contingencies.”   ]]></content:encoded>
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            <title><![CDATA[4 Ways Parents Can Address Harmful Family Commentary This Holiday Season]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/family-commentary</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/family-commentary</guid>
            <pubDate>Mon, 11 Dec 2023 18:17:06 GMT</pubDate>
            <content:encoded><![CDATA[When your child has an eating disorder, established family norms like discussing diet and weight can impact their recovery in harmful ways. During the holiday season, these often innocent but triggering behaviors may intensify, especially during family gatherings where food plays a central role as a medium through which loved ones bond and connect. As you plan for this year’s holiday festivities, it’s helpful to anticipate and plan for potential landmines. While it may feel initially awkward to ask your family for behavior change, remember the heart of the matter: your child’s health. Start by thinking through what commentary you have heard from your family during family gatherings in the past that were potentially harmful and emotionally taxing. Then, make a plan to reach out to loved ones with a tone that is light, bright, and polite. Keep your request specific, short, and sweet, and avoid blaming the person for their beliefs or behaviors. Of course, some people may feel offended no matter how carefully you craft your request, but that doesn’t mean you’ve done anything wrong. Here are the four most common issues parents who have kids with eating disorders should consider addressing with their families in advance of holiday gatherings, along with suggestions for conversation starters that are compassionate and effective. 1. Say no to body-based greetings It’s very common in our society to greet people with body-based greetings like “you look great,” “have you gained weight?” and “you’re so thin!” While often seemingly positive, all of these remarks harmfully suggest appearance is a person’s most important asset. Eating disorders are highly responsive to social cues about weight and appearance, making it a powerful shift to limit body-based greetings and replace them with greetings that focus on the person’s personality or character. If there are family members who you know will comment on your child’s body, reach out in advance to gently let them know why such comments can be harmful. Try saying something like: “I know how much you love Alex and want her to be happy and healthy. So I’d like to ask if you can avoid talking about her weight and appearance when we see you on Saturday. I’ve been working on this myself, and now instead of talking about how people look I just say things like ‘it’s good to see you.’ It’s a small change but it will really mean a lot to us. Would you consider it?” 2. Eyes on your own plate In many families, there is at least one person who is extremely interested in what other people are eating. For example, you may have a dad who frequently says things like “Wow! You gonna eat all that?!” And while he says this in a joking tone and a twinkle in his eye, it’s inappropriate. Your child who has an eating disorder (and everyone else!) would do much better if your dad could keep these types of comments to himself. To help keep everyone’s eyes on their own plate, let your loved ones know that these types of comments can be harmful – whether they are about eating “too much” or “too little”. Reach out to anyone who needs to hear this stating something like: “I am really looking forward to the holiday meal, and I can’t wait to catch up with everyone. I wanted to ask you a favor, and while it’s a small thing, I think it would be really great if you would consider it. I’ve noticed that you tend to talk about how much food people have on their plates, and I’d like to ask you not to do that. I know you mean it in a joking way, but it can make people uncomfortable, particularly Danny. Do you think you could try that?” If you're looking for more reminders like these, download these coping cards from Equip to keep on your phone or print out. 3. Skip the diet talk Many people are deeply embedded in diet culture. For them, talking about their diet feels like a natural way to bond with others. They may share what they are and are not eating in detail. And they may even add in how many pounds they have lost and why it’s so important to lose weight since they want to be “healthy”. While diet talk is culturally normative, it’s also harmful because it promotes the myth that health is directly tied to weight. It also perpetuates the incorrect assumption that we can and should control our body weight. Since family members who tend to engage in diet talk may be struggling with their own relationships with food and their bodies, try to approach these conversations from a place of compassion. Call your loved ones and say something like: “I am really looking forward to seeing you on Thursday! I wanted to ask you a big favor in advance. I know that your diet and health are really important to you, and I totally understand where you’re coming from. At the same time, we’re working on pursuing health without dieting or weight loss. This is a real challenge we’re facing, and it’s important to us. Would you mind not talking about your weight loss goals? There’s so much else we can talk about, and while I know this is a big request, I’d love it if you would consider it.” 4. Acting on boundaries These initial phone calls are how you can set your family’s boundaries in advance, but keep in mind that people may struggle to meet your boundaries. This is often due to force of habit, and sometimes it’s because people disagree with or don’t understand the boundary you have set. On the day of the event, you might find yourself in a situation where you will need to decide whether and how you will respond when the behavior you’ve asked your family members not to do happens anyway. Keeping this in mind, you may want to think ahead and plan some options beforehand – from mild to assertive. The first option is to ignore the comment. Make eye contact with your child communicating that you know what happened and don’t approve. Then follow up with your child privately and let them know that you are there to support them. This may sound something like: “I noticed that Aunt Trudy couldn’t help herself and commented on your weight. I’m really sorry about that. Is there anything you need from me now? Is there a way you would like me to respond differently in the future when that happens?” The next option is to speak up and divert the conversation if necessary. You can say something like “Hey, mom, remember we aren’t talking about diets today! How’s Uncle Bert doing?” Finally, the most assertive option is to take a break or leave the event. This is something you should do if you sense your child is in distress. Watch them carefully and stay tuned into their emotional state during the event. If you sense they are distressed and you are having difficulty helping them feel better, remember that it is okay to leave. This usually feels awkward, but your child’s safety and care should come first. Family commentary during the holiday season can be a real challenge. But the most powerful approach is to go in prepared. Family dynamics, just like traditions, often repeat year after year, so planning in advance can help make holiday gatherings more relaxed and joyful for the entire family.    About Ginny Jones Ginny Jones is the founder of More-Love.org and a Parent Coach who helps parents who have a child with an eating disorder. Ginny recovered from a longtime eating disorder and has spent the past decade immersed in research regarding child psychology, neurobiology, parenting, and eating disorders. Her unique approach to supporting parents who are facing a child with an eating disorder is based on her lived experience, research, training, and interviews with hundreds of professionals, people who have/had eating disorders, and parents. Her mission in life is to empower parents to help their children recover.]]></content:encoded>
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            <title><![CDATA[It’s Prom Season: How to Deal with Photo-Centric Events in Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/body-image/prom-photos-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/prom-photos-eating-disorder-recovery</guid>
            <pubDate>Mon, 10 Apr 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[I was never exactly excited to have my picture taken between the ages of 14 and 18. But few occasions during my teenage years provoked more stress and general resentment for the invention of the camera than senior prom. It was the spring of 2002 and my first boyfriend had unceremoniously dumped me that New Year’s Day, so I was attending the event solo, wasn’t thrilled about my dress, had been on the receiving end of a pretty unfortunate haircut—and I was just embarking on my first attempt at eating disorder recovery. I felt uncomfortable, anxious, and triggered by every click and flash as family and friends scrambled to document the moment. Young people today arguably have it even worse: everyone has a camera in their pocket or purse, and any picture taken can be immediately shared via various social media platforms. This can make any teen feel self-conscious about their appearance (which is, after all, a hallmark of teenagehood), but it can be doubly difficult for those in eating disorder recovery. Fortunately, there are plenty of strategies available to help young people in recovery handle the stressors of prom generally—picking a dress, body comparison, tough social dynamics, unfamiliar food, etc—and also overcome some of the unpleasant feelings they may have about having their picture taken at this and other majorly photographed events. Knowing how to prepare for the potentially overwhelming experience can go a long way in making it through the night with confidence, humor, and an authentic smile. Understanding why prom in particular can be so triggering 
Pictures are a major part of the anxiety equation when it comes to prom, and today’s teens likely feel this stress more than any generation before them because of social media. “Twenty years ago, a photo was taken and not seen by more than maybe five others and then put in a box and looked at years later,” says Equip Therapy Lead Lainy Clark. “Now, the immediacy of photos and the fact that they’re displayed for hundreds, if not thousands, of others to see and comment on, carries a lot of weight. For those navigating recovery, who are usually hyper-sensitive about their body and others’ judgements, this can cause them to live their prom night in a state of fear and self-criticism.” According to Clark, the constant photo-taking of the night exacerbates another major source of prom season stress: the outfit. “Prom and other events that involve a dress or something not normally worn to school can be anxiety-inducing. While someone can wear sweatpants and a baggy sweatshirt most days to hide or feel more comfortable in their body, they can’t do that so easily on prom night. Finding an outfit for prom is an exciting event for most young people, but for those navigating recovery, it can be really challenging to find something they’re comfortable in.” For a person in recovery, the combination of wearing something they don’t feel comfortable in and having their photo taken constantly can “really increase the volume on the eating disorder’s self-critic station,” according to Clark. Equip’s Director of Lived Experience, JD Ouellette, has firsthand experience with this situation, because her daughter attended senior prom while enrolled in an eating disorder recovery program. While the event was a success and a big step in her healing, it took a lot of effort and support from her friends and family. “I cannot think of many more triggering events for someone with an eating disorder than one that typically reVolves around dressing in way that reveals lots of the body, knowing everyone is evaluating and judging—even if in a positive way—how everyone else looks, going out to a fancy dinner beforehand, and, of course, partaking in a night-long photo shoot,” Ouellette says.” I think prom in general is a fraught event for many high schoolers and an eating disorder will cause every insecurity and self-doubt to be magnified exponentially.” How to prepare for the potential triggers of prom photos While there’s no one surefire method for maneuvering through prom unbothered by the inevitable posing, posting, and poring over of photos, there’s a lot families can do to prepare for the event and maintain a healthy mindset. Here are some of the top tips from Equip experts: Practice as much as possible “Prepare your coping skills ahead of time,” advises Equip Director of Admissions Nicole Mathews. “it's best to practice coping skills when you aren't in a triggered state. If your brain is used to jumping right into finding a new diet to follow after seeing a picture of yourself, for example, you have to work to rewire that auto-response towards something that will move you forward in your recovery. Start practicing as early as you can before the event so when you’re in that stressful state, it's easier to access these newer skills.” One strategy Mathews suggests is thought-stopping with neutral statements. “When you see a picture of yourself and your auto-response is to think something negative about your appearance, try saying a neutral statement to yourself,” she explains. “For example, ‘my body helps me move so I can dance with my friends.’ Neutral thoughts can be easier than positive, especially if you have a long history of negative thoughts about your appearance.” Similarly, Ouellete advises talking through the whole night in advance. “Make a plan for all the bad things that could happen as well as the good ones,” she says. “Maybe you make a list of your favorite coping skills and put them on your phone in case something happens. Think about building in a couple of ‘escape breaks’ where you and a close friend find somewhere to sit and breathe and decompress for a few minutes. Definitely make an exit plan for if it all just becomes too much. I am a huge fan of role plays in advance of events like this. Is there a frenemy who is prone to passive-aggressive comments? Script your comeback in advance and practice it.” Teens can do this alone or role-play with family members, depending on what feels most comfortable to them. Invest time in finding an outfit that feels comfortable Landing on the right outfit can look different for everyone. If mall trips or online shopping prove too stressful or pricey, Ouellette recommends thrifting or borrowing clothes from a friend. If you do go to a store, carefully consider how you approach the issue of sizing, which can be notoriously inconsistent and triggering for many. “One piece of shopping advice I always share is to consider having the person with the eating disorder point to items and you choose the sizes and have them first try on the size that is likely to be too large. You can even cover size tags with painter's tape while you're shopping.This worked well for us,” Ouellette says. Clark echoes the sentiment, adding that it can also be helpful to do dress rehearsals at home leading up to the event. “Buy the outfit early and try it on often,” she says. “Look in the mirror and identify the positive things you see.” She recommends young people work with their therapist and peer mentor to address internal criticisms and see themselves as brave and resilient in their prom outfit. By getting all these negative thoughts out of the way early, it makes it easier for them to feel confident and enjoy the night. Stay connected to your feelings “My biggest tip is to do an internal check-in,” says Equip Peer Mentor Isabella Dean. “Check in with yourself before looking in the mirror, before leaving your room, and before being bombarded by the well-meaning people in your life. Ask yourself: ‘How do I feel?’ ‘How do I want to feel going into this event?’ ‘What can I focus on that brings me joy?’ Get clear on how you're truly feeling, and most importantly, how you want to move forward into the event. By doing this, you're affirming your own resiliency and ability to handle whatever the event brings.” Decide ahead of time how—and when—you want to handle looking at photos “Let people take the pictures, but decide how you want to handle actually seeing the pictures,” Dean says. “For me, I usually opt not to look at the pictures until after the event, when it's become a fond memory that I want to relive. This reduces the urge to body-check in the moment, and also reduces the amount of eating disorder or body distress ‘noise’ that could take away from my enjoyment of the event.” Remember that saying “no” is always an option “It’s okay to decline having your photo taken by others,” Clark says. “In this day and age when your photo can end up anywhere, it’s understandable and acceptable to want to avoid the trigger of seeing a photo of yourself that someone else posted. It can also be a really good idea to avoid social media during the days after the big event. If social media often causes you to compare yourself to others or feel negatively about what you chose to wear and how your body looked, don't get on those platforms. There’s not much anyone is actually missing out on.” While it’s also a perfectly valid option to skip out on prom altogether, Clark encourages families to explore the pros and cons together. “There is likely a tendency to not go to these events due to the discomfort it may bring up—and it may be something you regret later,” Clark says. “Instead, what if you were to lean into the discomfort and look at it as an opportunity for growth? The growth may not come without some pain and tears, but, at the end of the night or in the next year or after 10 years, you may be able to look back on that old picture and see the sparkle in your eyes, the smile on your face, and the joy in your heart, and remember that is what matters.”]]></content:encoded>
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            <title><![CDATA[LGBTQIA+ Folks Often Have More Body Image Distress. Here's Why.]]></title>
            <link>https://equip.health/articles/body-image/lgbtqia-body-image</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/lgbtqia-body-image</guid>
            <pubDate>Thu, 08 Jun 2023 16:49:00 GMT</pubDate>
            <content:encoded><![CDATA[Growing up, Equip Peer Mentor Sean Stanisz felt different than his peers for a variety of reasons. But his physical appearance—and the scrutiny he received because of it—came to define his adolescent experience. “I was made aware of my fat body before my queer identity,” Stanisz says. “Especially when others would bully me about how certain aspects of my body, like my broad chest and hips, aligned more with opposing gender identities.”   Stanisz (who uses he/they pronouns) says the unsolicited commentary on his body made him question his own gender identity. He didn’t feel masculine or feminine enough, resulting in what they call “waves” of gender dysphoria, or severe distress caused by an incongruence between a person's gender identity and the gender they were assigned at birth. But even when Stanisz began embracing his queer identity, he struggled to find relatable body representation in the LGBTQIA+ community. “A lot of the imagery in queer culture depicted the stereotype of effeminate, thin, white men or hyper-masculine white men,” Stanisz says. “Even in a community that was a haven for personal acceptance and that gave my younger self hope, I experienced isolation and pressure to conform to certain body standards.”
 Stanisz is far from alone in this experience. Research has indicated that eating and body issues may impact members of the LGBTQ+ community in ways that are unique and distinct. According to the Trevor Project’s 2022 National Survey on LGBTQ Youth, about 87% of LGBTQIA+ youth reported dissatisfaction with their bodies, and these rates were higher among transgender and nonbinary youth compared to cisgender youth. What’s more, those who expressed body dissatisfaction reported higher rates of depression and anxiety symptoms, self-harming behaviors, and suicidal ideation than those without body dissatisfaction. We also know that LGBTQIA+ folks are at increased risk for developing eating disorders, and body dissatisfaction can play a significant role there. These alarming statistics illuminate the fact that LGBTQIA+ individuals face myriad challenges and risk factors that increase their likelihood of struggling with body image or even developing an eating disorder. Here’s how appearance and gender ideals, norms, and expectations can contribute to body dissatisfaction and disordered eating in the LGBTQIA+ population—and how community members and allies can push back against the rampant pressures and reduce body image struggles. The connection between gender identity, appearance ideals, and body image Unrealistic, unattainable, and super specific (often thin, Eurocentric) appearance ideals can negatively impact just about anyone who doesn’t fit the narrow beauty standards. But those in the LGBTQIA+ community often face additional challenges when it comes to physical appearance, societal expectations, and cultural stereotypes. “Appearance ideals look different for various identities within the LGBTQIA+ community,” says Equip Research Intern Bek Urban. “In my experience as a nonbinary person, I’ve felt a lot of pressure to be ‘nonbinary enough’ for society.  There’s this idea that a nonbinary person's body should look androgynous and have a ‘genderless appearance,’ both of which are often equated with thinness. This unreachable goal exists because of other people’s ideas about what it ‘looks like’ to be nonbinary.” Equip Senior Program Development Lead Scout Silverstein believes the problems that arise from not fitting societal expectations for gender are rooted in something called “desire capital,” or the social power a person accrues as a result of their desirability. “We live in a society where the degree to which a person meets appearance ideals is often directly tied to their desire capital,” Silverstein says. “This impacts how a person is treated—from daily interactions to job opportunities to romance. With LGTBQIA+ people already facing discrimination and bias in these areas, there may be a perceived need to increase desire capital by meeting appearance ideals”
 Silverstein explains that when most people discuss gender dysphoria, they're referring to an “internal distress experienced by a transgender person due to their gender expression and gender identity being in misalignment”—but there’s more to it than that. “It warrants more exploration,” Silverstein says. "Gender dysphoria may also be a response to external pressures, like rigid appearance ideals or gender norms,” Silverstein says. “Screening for eating disorders is necessary and access to gender affirming care is essential for transgender people who desire social or medical transition.” How threats to the LGBTQIA+ community compound body image issues “Body image pressures can be distressing for all people. For folks within the LGBTQIA+ community, however, they can be tied to fear for their safety and can be, quite literally, life or death,” Urban says. “I think some of the most troubling concerns are those facing the trans and gender-expansive community. In a time when violence against trans folks is on the rise and being visibly trans in public is being criminalized, there are often understandable and urgent pressures to make your body fit into a mold of what society expects. Fitting into such molds may be protective and, in many places right now, necessary for safety.” Stanisz adds that for trans and gender non-conforming individuals especially, body image pressures have reached an unprecedented high “as legislation across the country actively sees their bodily existence as a threat on a political level.” Because of the increased attention and vocal social and political prejudice, those who identify as trans or nonbinary may experience particularly intense feelings of distress or dysphoria.
 “There’s the sense of a heightened need to present in a binary-specific appearance in order to navigate society safely and without persecution,” says Stanisz. Silverstein agrees, noting that “those who don’t meet appearance ideals are more often treated as disposable. Additionally, for transgender people, safety may be bound with one's ability to be perceived as their correct gender.”
 How LGBTQIA+ community members and allies can protect and bolster body image Unfortunately, many of the factors that contribute to body image distress and eating disorders in the LGBTQIA+ community are societal and systemic. However, there are concrete actions that allies and community members can take to push back against these challenges. “Finding support from the community can be super helpful for LGBTQIA+ folks who may be struggling with body image concerns, disordered eating, or an eating disorder,” Urban says. “Peer support can help people find community and hear experiences of others who understand some of the unique things that cisgender, heterosexual people may not be able to. Affirming providers are also vital!” Silverstein suggests LGBTQIA+ individuals look for like-minded peers who may also be navigating similar physical and emotional journeys. “Find your local queer beach or swim club, connect with others who are also on the journey of body liberation, curate your social media feed,” Silverstein says. “It can be helpful to think about the concept of gender euphoria: what actions help you to feel recognized, valued, respected, and free in your gender?” Urban seconds the suggestion to explore gender euphoria, sharing that it was integral in their own recovery. Gender euphoria can be defined as a feeling of bliss and happiness that comes when a person feels alignment between their gender identity and their gender expression. Urban says leaning into their authentic identity, regardless of whether their physical appearance “fit” societal expectation was critical to recovery. “Focusing on gender euphoria and joy helped me to decouple my identity from felt pressures and become more authentic to myself—which lets me better care for my body.” When it comes to the kind of support that allies, friends, and family members can offer, Urban says speaking out is especially important and necessary to ensure the safety and health of those who identify as LGBTQIA+. “The most pressing thing right now is to be an active force advocating with the community,” Urban says. “More allies are needed to speak out to protect LGBTQIA+ folks from legislation and widespread oppression. Creating a world that is safe for LGBTQIA+ folks in general creates a world that is less traumatizing and more open to acceptance and inclusion of all bodies, no matter gender or gender expression.”]]></content:encoded>
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            <title><![CDATA[What Causes ARFID? Understanding the “Why” Behind Avoidant Eating]]></title>
            <link>https://equip.health/articles/understanding-eds/what-causes-arfid</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-causes-arfid</guid>
            <pubDate>Mon, 18 May 2026 16:26:00 GMT</pubDate>
            <content:encoded><![CDATA[Maybe your child only eats a small number of foods or reacts strongly to certain textures. Perhaps your meals feel stressful, or eating just doesn’t come easily. If that sounds familiar, you’re not imagining it, and you’re not alone. For some people, these patterns are part of an eating disorder called avoidant/restrictive food intake disorder (ARFID). But what causes ARFID? Like all eating disorders, ARFID doesn’t have a single cause—it typically develops from a mix of biological, environmental, and psychological factors. One thing that makes ARFID different, though, is that it isn’t driven by body image or a desire to lose weight. It’s often shaped by things like sensory sensitivities, differences in appetite, and fear or anxiety around eating. Below, we’ll break it all down so you can better understand what might be driving these eating patterns—and that recovery is possible. What causes ARFID? ARFID isn’t caused by one single thing. Most of the time, it stems from a combination of factors, according to Michelle Jones, PhD, a clinical instructor at Equip. While the research is still evolving, Jones says these can include: Biological vulnerability: Research suggests there may be an inherited component to ARFID, meaning some people are more likely to have traits like heightened sensory sensitivity or a low appetite. For them, eating can feel overwhelming, unappealing, or harder to tune into from the start. Experiences: Experiences like limited exposure to new foods, pressure at mealtimes, or a specific event that made eating feel unsafe can contribute to ARFID. Psychological responses: If eating has felt uncomfortable or scary, the brain can start to interpret food as something to avoid, reinforcing patterns of anxiety and restriction. How your brain functions at baseline can play a role, too. For instance, conditions like autism, ADHD, anxiety, and OCD can make someone more sensitive to food, more rigid in their thinking, or less in tune with hunger and fullness cues. Biological contributors to ARFID “While there are certainly environmental and experiential contributors to the development of ARFID … current research suggests that biological and genetic factors play a significant role,” says Jones. In other words, ARFID isn’t a choice. So if you notice these patterns in yourself or someone you care about, there’s a reason behind them—they’re often rooted in real differences in how the body and brain respond to food. Here’s how that can show up. Genetics Researchers are still learning about the role genetics play in ARFID. What we do know so far is that some people may be more biologically predisposed to developing eating disorders, including ARFID. That’s not to say someone is born with ARFID itself. But it can mean they’re wired in a way that makes them more vulnerable to the condition. From there, other factors can build on that foundation and shape how ARFID develops over time. Sensory sensitivities to food “ARFID is often misunderstood as ‘picky eating,’ but it is much more complex,” says Lily Thrope, LCSW, founder of Thrope Therapy. For some people, that complexity starts with how their body processes sensory input. They may be “biologically predisposed to detect more minute changes in taste, texture, and other sensory properties of foods,” explains Jones. This is especially true with food aversions for people on the autism spectrum, she adds. In practice, sensory sensitivity ARFID means that foods that might seem neutral to someone else can feel intensely unpleasant or even intolerable. For example, a mushy texture, mixed foods, or strong smells might trigger a physical reaction like gagging or a strong feeling of disgust. Differences in appetite and hunger cues Not everyone experiences hunger the same way. For some people, the part of the brain that regulates appetite works differently, which can cause low appetite. These patterns can show up as early as infancy, says Jones. This might look like: Lack of interest in food Forgetting to eat Feeling full quickly Not thinking about food very often These differences can contribute to lack of interest ARFID, the type of ARFID in whichsomeone is not eating enough because the body doesn’t send clear, consistent hunger signals. Gastrointestinal discomfort and physical symptoms Physical discomfort can also play a role. After all, if eating regularly leads to stomach pain, nausea, reflux, or other unpleasant symptoms, it makes sense that food can start to feel stressful or scary. And even if the discomfort isn’t severe, those repeated experiences can add up. Over time, the brain and body start to associate eating with feeling unwell. From there, it’s natural to pull back (whether that means avoiding certain foods or eating less overall). Environmental and experiential contributors to ARFID Another important piece of the puzzle is someone’s experience with food. In some cases, a single distressing event with eating can play a major role in the onset of ARFID. In others, it’s a combination of repetitive experiences and environmental factors. Regardless, these moments tend to interact with patterns that are already there (like a naturally low appetite or eating habits adopted due to underlying gastrointestinal disease), shaping how someone relates to food over time, says Jones. In other words, certain experiences can either reinforce a sense of safety around food, or the opposite. Here are some common examples. Early feeding experiences Early experiences with food can leave a lasting imprint, even if they seem small at the moment. For example, if a child doesn’t have many chances to explore new foods, they may not build the familiarity that helps those foods feel safe. Over time, new foods can start to feel unpredictable or overwhelming. At the same time, pressure to eat can backfire, says Jones. Being pushed or forced to eat foods that feel uncomfortable can turn meals into a stressful experience. Negative food-related events For some people, ARFID begins after a specific experience that made eating feel unsafe, like: Choking Food poisoning Gastrointestinal illness Allergic reaction After something like that, it’s completely understandable for the brain to go into “better-safe-than-sorry” mode. As a result, foods that once felt fine can start to feel risky. And for some people, that sense of caution can stick—and grow—over time, changing how safe or manageable eating feels moving forward. Family and environmental influences The environment around food matters more than people often realize. According to Thrope, everyday moments can shape someone’s experience of eating well into the future, including: How your family or community talks about food Whether meals feel calm or tense The effects of food insecurity, like unpredictable or limited access to food Psychological contributors to ARFID The final piece of the puzzle is how the brain responds to all of these factors. Over time, the brain starts to connect the dots. If eating feels unsafe, it begins to treat food as something to be cautious about (or avoid altogether). And even when the original trigger is gone, that reaction can stick. Here’s how that can play out.  Anxiety Anxiety plays a big role for many people with ARFID—in fact, research has found links between ARFID and anxiety disorders. Here’s why: If eating has felt uncomfortable, unpredictable, or scary, the brain can start to stay on high alert around food. It’s trying to do its job: Keep you safe. But sometimes it gets a little overprotective. That can show up as: Feeling anxious before or during meals Avoiding certain foods or situations where eating feels uncertain Overthinking bad things that could happen Learned fear The brain is really good at learning from experience … especially negative ones. If something distressing happens around food, the brain takes note as a way to protect you from it happening again. Over time, it can start to associate that food with danger. Research also suggests this fear can show up in the brain itself. Studies have found that the brain regions involved in emotion, attention, and sensory processing respond more strongly to food cues in people with ARFID. Put simply, that means food can feel more intense, overwhelming, or even threatening on a neurological level. And for some people, that response is stronger than others. “Individuals predisposed to anxiety may be more likely to experience ARFID symptoms following [negative] events compared to those who are not predisposed to anxiety,” says Jones. Avoidance that reinforces fear Here’s where things can start to snowball. If a food feels scary or uncomfortable, avoiding it brings immediate relief, says Thrope. And that relief sends a clear message to the brain: Good call, let’s keep doing that. In the short term, it helps ease discomfort. In the long term, it can make things harder. The more a food is avoided, the more unfamiliar it becomes—and the more intense the reaction can feel the next time it comes up. This is how the list of “safe” foods can slowly get smaller over time. Neurodivergence How someone’s brain is wired can also shape how all of this plays out. “People with ADHD, autism and other neurodivergence often struggle with sensory sensitivity, which can relate to fear around certain sensory experiences of food,” explains Thrope. “[This] can often look like rigidity or control, but is often related to something deeper like a fear or sensory avoidance.” ARFID and OCD are also linked. Some people develop very strong fears or specific rules around food that feel important to follow. These patterns are the brain’s way of trying to create a sense of safety and control. If this sounds familiar, you’re not broken. These responses are rooted in how the brain processes information and tries to keep things predictable and safe. What ARFID is not caused by When you’re trying to make sense of the symptoms of ARFID, it’s easy to look for something—or someone—to blame. But ARFID isn’t caused by a single mistake or shortcoming. It’s also not driven by many of the things people often assume, like: Bad parenting: While early experiences with food can shape eating patterns, they don’t cause ARFID on their own. Many caregivers are simply responding to a child who is already struggling by doing what feels most helpful in the moment. Picky eating: While it can be hard to distinguish ARFID versus picky eating on the surface, they’re not the same thing, says Thrope. Picky eating is common in childhood and often temporary. ARFID tends to be more severe, longer-lasting, and tied to deeper underlying factors. Body image: Unlike many other eating disorders, ARFID isn’t driven by a desire to lose weight or change appearance, says Jones. Instead, the restriction comes from how eating makes someone feel.  How ARFID develops over time Remember, ARFID typically develops when multiple factors collide. Because of that, ARFID in children builds gradually—sometimes starting as early as infancy or toddlerhood and becoming more noticeable as eating patterns take shape, according to Jones. For example, she says a child might be sensitive to food textures and have strong reactions to certain foods. To keep meals manageable, caregivers may stick to a small set of ARFID “safe” foods. Over time, that can mean fewer chances to try new foods, and unfamiliar foods can start to feel more overwhelming.  In adults, ARFID can look a little different. It may show up after a specific event, like GI surgery or an allergic reaction. After something like that, it’s completely understandable for the brain to shift into protection mode and start linking food with danger. Even then, it’s usually not just the event itself. Underlying factors—like anxiety, sensory sensitivity, or appetite differences—can make that response stronger and more likely to stick. For example, someone might get food poisoning and start to feel anxious about eating. Even after they recover, that association can linger. They may begin avoiding certain foods, then more foods, and eventually rely on a narrow set of options. The bottom line ARFID doesn’t come from a single cause. It develops from a mix of factors, including how someone is wired, what they’ve experienced, and how their brain responds to it all That’s why it can look so different from person to person. It’s also why it’s not something someone can just “push through”—ARFID is rooted in real biological and psychological differences, not a lack of effort or willpower. Put simply, there’s a reason eating feels this way, and you’re not alone in it. These patterns make sense when you understand what’s driving them, and with the right kind of support, recovery is absolutely possible. If you’re wondering whether ARFID might be part of you or your child’s experience, taking a quick screener can be a low-pressure first step toward getting clarity and support. Frequently asked questions (FAQs) Are you born with ARFID or can you develop it? You’re not born with ARFID itself, but you can be born with traits that make it more likely to develop (like sensory sensitivity or low appetite). From there, experiences and learned responses can shape how eating patterns develop over time. How does ARFID develop? There are a number of causes of ARFID. It often develops as the result of a combination of biological traits (like difficulty reading hunger cues), experiences with food (like pressure at meals or a negative event), and how the brain responds over time (like anxiety or avoidance). In children, this tends to build gradually. In adults, it can sometimes start after a specific trigger. What causes ARFID in adults? ARFID in adults often develops after a specific trigger, like choking, food poisoning, or a gastrointestinal illness. But underlying factors—like anxiety, sensory sensitivity, or appetite differences—usually play a role in how those patterns take hold and persist. Deep dive recommendations If you want to learn more or find additional support, these trusted resources can help: Equip: In-depth articles, treatment information, and support options Feeding Matters: Resources on feeding challenges, including ARFID F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders): Guidance and support for families National Eating Disorders Association (NEDA): Education, screening tools, and support resources]]></content:encoded>
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            <title><![CDATA[We Know “Thinspo” Is Bad. Here’s Exactly How It Harms Mental Health]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/thinspo-risks-mental-health</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/thinspo-risks-mental-health</guid>
            <pubDate>Wed, 17 Sep 2025 16:06:00 GMT</pubDate>
            <content:encoded><![CDATA[Almost a decade ago, I was finally fed up with seeing two distinct but related types of disturbing social media content: “thinspo” and “fitspo.” The former is a shortened form of the term “thinspiration,” defined as content that encourages individuals to be thin at any cost. The latter (short for “fitspiration") is, as I wrote in a 2016 article for Seventeen, thinspo’s “not-so-distant cousin,” claiming to encourage a “healthier” lifestyle but actually promoting many of the same disordered habits as thinspo. Both fall under the umbrella of the “pro-anorexia" or "pro-ana" movement, which—unbelievable as it may seem—offers individuals explicit guidance for maintaining eating disorders. Thinspo and the related types of content aren’t just niche problems confined to dark corners of the internet. These harmful images and messaging can trigger or exacerbate disordered eating in those vulnerable to developing eating disorders, and have a negative impact on the physical and mental health of nearly all social media users who encounter them. Read on for more information about thinspo, the real risks associated with it, and how to seek help if you or a loved one is being affected by it. What is “thinspo”? While definitions vary slightly, “thinspiration” or “thinspo” is generally considered to be content that encourages viewers to attain a smaller body through any means necessary. Regardless of how “inspirational” or “helpful” this type of content claims to be, it often promotes disordered eating behaviors and an unrealistic body ideal. “Thinspo is the promotion of thinness via social media and culture—especially the internet,” says Equip therapist Jonathan Levine, LCSW. “Sometimes, this can involve people with active eating disorders or disordered eating promoting harmful behavior that they may not fully even know is harmful.” According to Jamie Drago, a peer mentor at Equip who is in recovery from an eating disorder, the thinspo content she came across generally consisted of photos depicting extremely thin bodies. And even when the content was labeled as “fitspo,” it generally shared the same message of endorsing thinness at any cost. According to Levine, this promotion of one particular body type (often through unhealthy and disordered measures) is due, at least in part, to our society’s tendency to believe that “thin” equals “good.” “Society sells us all the myth that you must be thin to be pretty, rich, successful, etc.,” Levine says “People say ‘I'll be happy when I'm thin, I'll find a relationship, a job, a life, when I'm thin.’ But the truth is, these things are not related, and one can be happy, successful, joyful, and everything else, in a larger body.” It’s also important to consider that for some, eating disorders can create a false sense of control—a reality that, according to Levin, thinspo preys upon. “Thinspo tells us the lie that if we focus, if we try hard, we can be thin—and if we can be thin, we can do anything,” he says. “That's problematic for a plethora of reasons, especially because it leaves out the complexities of genetics, food insecurity, capitalism, and how many parts of our lives impact our bodies and how we store weight.” Tracking the rise of thinspo While diet culture and the idolization of thinness has been around for a long time, thinspo really took off in the late 90s and early 2000s with the rise of the Internet. As photo and content sharing became more accessible, it also became easier to spread harmful rhetoric regarding weight, body image, and eating and exercise behaviors. By the early 2000s, thinspo and pro-ana content was cropping up on social media platforms like Tumblr, Xanga, MySpace, and Facebook. Drago also points out that many forms of non-Internet content throughout the 1990s and 2000s—including magazines and television shows like America’s Next Top Model—showcased images of extremely thin individuals or even explicitly body shamed those who didn’t fit that extreme mold. “As the internet expanded, more intentionally direct thinspo showed up on Myspace, Youtube, and heavily exploded on Tumblr, which was a more anonymous platform with looser safety measures,” Drago says. “Pinterest and Instagram first flourished with ‘aspirational’ or ‘wellness content,’ but later the same hashtags served to find the content that had previously dominated the Tumblr space. Today this content spans every social media app.” Despite several sites attempting to ban thinspo, it’s still rampant. And while the body positive movement pushed a lot of this type of content underground for a while, it never fully went away—and even seems to have made its way to the surface of the culture once in more recent years. “Thinspo continued on but did wane a bit around the 2010s, only to make a massive return in the last two years,” says Levine. “TikTok and other social media sites have again proliferated thinspo, impacting those who do not even go searching for the content due to the insidiousness of algorithmic ingestion.” As for why there is even an audience for thinspo, Drago believes the content appeals to those with and without eating disorders as a form of “inspiration” that is really just a problematic perpetuation of harmful beauty ideals and diet culture. “Oftentimes this content may feel like it’s ‘helpful’ in reinforcing motivation for weight loss,” she says. “Much of this is shame-based, with the idea of ‘tough love’ or that shame is a good motivator for change, which it’s not. For me, this made it very alluring and it almost made me forget that most people in ‘real life’ do not look like that—but because it was all of the content I was consuming, it was easy to think that that appearance is also everywhere.”  The very real risks of thinspo While, on the surface, thinspo may seem like an easy-to-ignore category of online content, its potential harm—and the fact that it’s everywhere—make it legitimately risky and possibly dangerous. According to Levine, the promotion of thinspo content not only normalizes dangerous behaviors that aren't at all healthy or “normal,” but it can also alter a person’s algorithm so that it serves up increasingly dangerous content due to them previously engaging with similar posts. By “liking” (or even just watching) a thinspo post here and there, someone’s feed might gradually become full of accounts promoting disordered exercise, extremely restrictive eating, and more harmful content. “Thinspo can lead to someone trying to lose weight in ways that they believe are healthy but are more aligned with eating disorder behaviors,” Levine says. “We are what we do; so if someone starts engaging in eating disorder behaviors, they will develop an eating disorder whether they knew what they were doing, or not.” Drago agrees, noting that thinspo poses serious risks to both mental and physical health. “As I experienced, it can create a false sense of the reality of what others look like, along with intensifying feelings of self criticism and judgment,” she says. “These online spaces can introduce people to disordered ways of thinking and eating disorder behaviors, as well as being a place to reinforce the thoughts that already exist.”  The relationship between eating disorders and thinspo It’s not hard to see how content that praises thinness at any cost (and often, an extreme and dangerous cost) could potentially contribute to the development of eating disorders. While eating disorders aren’t caused by any one factor, psychosocial factors like the normalization of pro-ana messaging can absolutely trigger disordered behaviors in someone who is genetically predisposed to an eating disorder (or who has been exposed to other known contributing factors). “Ample research shows that the more exposure you have to thinspo content, the more likely you are to feel bad about your body and possibly experience disordered eating habits like restriction of compulsive exercise, which can then lead to a full blown eating disorder,” Levine says. One 2023 study found that social media usage—which may include intentionally seeking out thinspo or pro-ana content—is a plausible risk factor for the development of eating disorders. The study also found that this association is not unique to traditionally Western cultures, given that approximately 60% of the world’s young people engage with social media. Another study from the same year found that social media use—especially via image-based platforms like Snapchat, TikTok, and YouTube—has significantly increased in recent years, and that exposure to weight loss content is associated with poor body image and disordered eating. The more disturbing aspect of this research is that the amount of time someone spends on social media doesn’t necessarily indicate how intense its impact will be—so even a relatively short amount of time viewing thinspo could potentially have the same harmful effect as scrolling for hours. “This study noted that content was more impactful than duration, in that the more severe the content, the higher risk someone would have for developing an eating disorder compared to others who engaged with a larger amount of content that was less severe in thinspo nature,” Levine says. To add to that, curating one’s feed to include “healthy” body image examples doesn’t counter the negative effects of thinspo, as exposure to body positive or body neutral content doesn’t seem to protect against more harmful posts. Drago’s lived experience illustrates how thinspo can feed into the development of an eating disorder, and keep it going: “Thinspo content, ‘pro-ED’ content, and even the very early era of ‘aspirational’ influencers had a massive impact on the escalation of my eating disorder,” she says. “The language used in that community reinforced the thoughts I had in my own head already, and the images I spent hours and hours looking at served a purpose of intentionally triggering my eating disorder—which I think is a behavior that is often not acknowledged or talked about.”  What to do if you’re worried a loved one is seeking out thinspo If you’re concerned about someone who is immersed in the world of thinspo or even just casually perusing thinspo content, it’s important to approach them gently with sincere care and concern. “Be curious,” Levine says. “Ask them about their goals and remind them that their body is not the most interesting thing about them. A full, well-rounded life is more enjoyable than a restricted, rigid one full of calorie counting and compulsive, compensatory exercise, but it's easy to forget that when you're not outside living life and instead are living through someone else's social media content.”  When approaching someone about their interest in thinspo, Drago believes it’s important to attempt to gain an understanding of what they may be getting out of the content—and how you might help them find it in other, healthier places. “It’s possible they are seeking community or a sense of being understood, and there is a chance you could support them in finding a more supportive community and help,” she says. And if you’re being negatively affected by thinspo yourself, Levin encourages you to reach out for support as soon as possible. “Don't be afraid to seek professional help,” he says. “We know early intervention is critical in supporting people's recovery and well-being, so being proactive can go a long way.” ]]></content:encoded>
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            <title><![CDATA[Lanugo and Anorexia: Understanding a Serious Warning Sign]]></title>
            <link>https://equip.health/articles/understanding-eds/lanugo-anorexia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/lanugo-anorexia</guid>
            <pubDate>Tue, 16 Dec 2025 16:47:00 GMT</pubDate>
            <content:encoded><![CDATA[Everyone has some body hair, and it looks different from person to person. Body hair can be light or dark, thick and coarse or fine and soft. This hair plays an important role in keeping your body safe and comfortable. It helps protect your skin from injury such as a scrape, from friction with other body parts (think armpits), and from the sun’s ultraviolet (UV) radiation. Certain types of hair, like eyelashes and nose hairs, also filter out dust, germs, and more. Additionally, body hair helps keep you warm and cool as needed. Hair also plays a role in physical sensations, since follicles are connected to nerves that tell your brain when something is touching your skin. In other words, having body hair in general is completely normal—and, in fact, a good thing! But if you’ve noticed a new growth of fine downy hair on yourself or a loved one, you may be wondering what it is. It could be lanugo. Lanugo hair is a different type of body hair, and its presence is a symptom of malnutrition. Lanugo can show up as a symptom of anorexia nervosa, an eating disorder characterized by severely restricting food intake. Severe nutrition restriction can mean that you or a loved one aren’t getting enough nutrients to meet the body’s needs. When this happens, lanugo develops as a survival mechanism, specifically to keep you warm. If you notice the presence of lanugo, it can be scary or even affect your self-confidence. The good news is that by addressing malnutrition through tailored eating disorder treatment lanugo can go away. In this article, we explore lanugo in anorexia nervosa—including what it is, what causes it, when it goes away, and more. What is lanugo? Not all body hair is the same. So let’s explore the three types to help get at the differences between lanugo and other body hair.  Type of body hair: Vellus: This type of hair is often called “peach fuzz” and appears on most parts of the body. It’s typically short and fine and lightly pigmented. Terminal: This type of hair shows up on the scalp, eyebrows, eyelashes, face, pubic region, and armpits. It is longer, coarser, and more pigmented than vellus hair. Lanugo: This fine, soft hair develops in the womb, usually starting about three months into fetal development. But it can also appear in people during times of severe malnutrition.   Now that we've defined the different types of body hair, let's take a closer look at the characteristics and function of lanugo. Lanugo in the womb: Helps regulate temperature. Holds in place the vernix caseosa, a waxy substance that contributes to innate immunity, the immune system defenses you are born with. Helps protect a developing fetus from damaging substances in amniotic fluid, a surrounding liquid that provides cushioning and more. “Lanugo is typically shed just before birth,” says Barbara Kessel, DO, CEDS, Supervising Child and Adolescent Psychiatrist at Equip. However, sometimes it is present on a newborn before eventually going away. When lanugo shows up in an adult, however, it is usually considered a red flag. “Lanugo can recur in patients with severe anorexia nervosa and is a sign of severe malnutrition,” Dr. Kessel says. “It is differentiated from ‘peach fuzz,’ or vellus hair, because vellus hair is typically more pigmented and shorter than the less-pigmented, fur-like, lanugo,” she adds.  Lanugo vs. "peach fuzz"  Why does anorexia cause lanugo hair to grow? “[Lanugo] occurs because of loss of the body’s insulating layer of fat and is the body’s attempt at helping regulate temperature, similar to how it functions in a fetus,” Dr. Kessel explains. Your body needs fat stores to provide insulation and keep you warm. If you or a loved one has anorexia nervosa, which is characterized by severe food restriction, malnutrition can deplete the body’s fat stores. Food is what powers your body, and you need a certain amount of calories from food just to support everyday bodily functions, like keeping your heart pumping, your lungs breathing, your immune system working, your brain operating, and more. In addition to these baseline needs, you also require calories to support movement and physical effort, whether that’s standing in line at the pharmacy, walking your dog, lifting a package off your front porch, or working out. If you don’t take in enough nutrients from protein, fats, and carbohydrates and get adequate levels of vitamins and nutrients, your body has to start burning the stored energy in your body fat. This can deplete fat storage, including what’s needed for insulation. When your body’s insulation is inadequate, hormones signal to the hypothalamus in your brain that you’re experiencing a bodily threat, like starvation or chronic cold, and it responds with some survival mechanisms. The hypothalamus does the following to try to protect you: Disrupts thyroid-stimulating signals Shuts down reproductive processes increases cortisol (the “stress” hormone) These changes to thyroid, reproductive, and stress hormones then lead to changes in body hair. They promote vellus hair follicles to produce lanugo hair, which is longer and softer.“Lanugo will appear as new hair growth on surfaces of the body such as the face, back, and arms,” Dr. Kessel says. In short, any anorexia hair growth or anorexia body hair is lanugo, which is a survival mechanism your body uses to keep you warm. When does lanugo go away? If you or a loved one is experiencing malnutrition and lanugo, you might understandably be worried. But the good news is that when malnutrition goes away, so does lanugo. Eating disorders are complex and don’t resolve overnight, but recovery is possible with help from knowledgeable providers. “[Lanugo] should shed with weight restoration and replenishing the energy and fat stores in the body,” Dr. Kessel says. How is lanugo addressed during anorexia treatment? The first step of anorexia nervosa treatment generally involves renourishing the patient, normalizing eating habits, and gaining weight if necessary. Lanugo isn’t addressed directly—but through this process, the body realizes it’s no longer in a survival state, and lanugo goes away.  What other hair changes can happen in anorexia? “In addition to lanugo,” Dr. Kessel explains, “individuals with anorexia nervosa or atypical anorexia nervosa might experience other kinds of changes to their hair.” Additional hair changes in anorexia: Receding hairline Thinning scalp hair Brittle hair Hair falling out in clumps Again, addressing malnutrition and food restriction helps resolve these concerns.  The bottom line When lanugo appears on you or a loved one, the fine downy hair can understandably cause worry or impact your self-confidence. But know that this hair is a warning sign from the body, and when you address the underlying problem, it will go away. Lanugo is a soft hair that protects a fetus in the womb. We all have it before we are born. But in adults and adolescents, lanugo can be a sign of the eating disorder anorexia nervosa. Anorexia nervosa is characterized by severe food restriction, which can lead to malnutrition, or not getting enough food to support your body’s functions. Lanugo develops during malnutrition as a form of survival, specifically to keep your body warm. Recovery from anorexia nervosa is possible, and recovery tends to resolve physical symptoms such as lanugo or other body and scalp hair concerns.  FAQ What is lanugo in anorexia nervosa? Lanugo is a fine, downy hair that protects a fetus during development. It usually goes away just before or soon after birth. However, lanugo can return if you develop anorexia nervosa, an eating disorder characterized by severe food restriction. Food restriction can lead to not getting enough nutrients to support everyday functioning, including keeping you warm. Why does malnutrition cause lanugo? Lanugo is a survival mechanism to help regulate body temperature during times of malnutrition. Malnutrition depletes your insulating layer of fat. When you don’t have enough fat storage to keep you warm, the hypothalamus goes into survival mode. Hormonal changes as part of this survival mode encourage lanugo to grow to help keep you warm. Does lanugo go away after anorexia nervosa recovery? Yes, lanugo goes away with anorexia nervosa treatment—typically when weight is restored to a level that supports your bodily needs, including temperature regulation. What does anorexia nervosa do to hair? The eating disorder anorexia nervosa can lead to changes with your body hair. It may cause the growth of lanugo—long, fine hairs that can grow all over the body to keep you warm. Additionally, anorexia nervosa can lead to thinning or receding scalp hair, which may also become brittle from a lack of nutrients. What does lanugo hair look like? Lanugo hair is fine and soft. Some people describe it as “fur-like.” It tends to be lighter than your usual vellus hair, the hair that normally appears all over most of the body and is often called “peach fuzz.” Lanugo is also generally longer than vellus hair.]]></content:encoded>
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            <title><![CDATA[What to Do After Binge Eating: 8 Recovery-Supporting Steps]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/what-to-do-after-binge-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/what-to-do-after-binge-eating</guid>
            <pubDate>Thu, 21 Mar 2024 22:34:00 GMT</pubDate>
            <content:encoded><![CDATA[ When Equip Lead Peer Mentor Makailah (Mak) Dowell was struggling with binge eating, she turned to food for the sense of comfort and safety it provided. But after each binge (which is defined as eating an objectively large amount of food at one time while feeling a lack of control), she felt intense fear and shame. Like many who have experienced binges, Dowell—who was diagnosed with binge eating disorder (BED) and bulimia—was left feeling the need to “compensate” for her behavior or “fix” the damage she had done. “The ‘fixes’ had to be instant,” she says. “I figured I had to show myself that I could never, ever do it again,” she says. “It would be this constant cycle of ‘everything’s fine, binge, response, self-hatred, a lot of time passing, then everything’s fine again.’ Then the cycle repeated itself. It is exhausting, ruthless, and no one comes out unscathed.” As Dowell and eating disorder experts can attest, attempting to “fix” a binge through compensatory behaviors (like purging, overexercise, or restriction, among others) will never actually “fix” the issue at all. In fact, engaging in these behaviors just compounds and perpetuates a harmful cycle. Read on to learn more about binge eating, why it happens, and what to do after binge eating that will actually help you. What exactly is a binge? A binge is defined as an episode in which someone eats a large amount of food in a short amount of time—past fullness and often to the point of physical discomfort—while feeling a lack of control over what or how much they’re eating. Some people experience this as feeling like a “food obsession.” Licensed psychotherapist Tessa Gordon, MA, LMFT says the most important part of this definition is not the amount of food, but the felt experience of losing control. “While diagnostic language often refers to eating more than others might in a similar time frame, I’m very careful with this comparison in eating disorder work,” she says. “Meal plans in recovery can be intentionally larger, and many clients worry they are bingeing simply because they are eating more than parents, peers, or family members who may be influenced by diet culture or have very different eating patterns.” Because of this, Gordon says it’s important to focus on internal experience rather than external comparisons, since ideas of “normal” portion sizes can be shaped by diet culture and other influences. Binges can look different from person to person, but they are commonly followed by intense feelings of guilt, shame, or other distressing emotions. And while binge eating is a common symptom of serious eating disorders like bulimia and BED, it can also occur without being associated with a diagnosable illness. “One common misconception about binge eating is that it only occurs in the context of bulimia or BED,” says Equip Clinical Partnerships Representative and registered dietitian Christina Fattore, MS, RDN. “Anyone who struggles to maintain a healthy relationship with food or deprives their body of necessary nutrients is at risk for engaging in binge behavior.” The reasons why people binge and how they feel after the binge also vary. “We don’t live in a black-and-white world and the same thing applies to the binge-restrict cycle,” Dowell says. “Some binges might ‘feel good’ and fulfill an emotional need, while other binges feel like a complete spiral from the eye of the storm. Binges might de-escalate what is happening within yourself.” Fattore says people often have a difficult time reconciling the shame of a binge with the cultural glorification of restriction (especially since the two are intrinsically linked). “Patients struggling with binge eating are often told to behave in a way that directly exacerbates the behavior—whether that be through dieting, cutting out certain food groups, or engaging in excessive physical activity,” she says. “Unfortunately, I’ve also found that these patients often struggle to seek help. Until we stop pathologizing what can largely be viewed as a normal biological response to restriction, we will continue to see a significant number of people who struggle with binge eating.”  8 things to do after binge eating Thankfully, there are constructive alternatives to the compensatory behaviors that tend to reinforce disordered eating habits. If you struggle with binge eating, try some of these actionable, recovery-supporting steps the next time you’re left wondering what to do after a binge: 1. Reach out for support “Call you friends, your recovery buddies, your aunt; call someone who encourages you and your chosen values,” Dowell says. “Every time I made that phone call, I would be brought back to reality. There is life outside of this binge episode, my people still love me, and I will be okay and I still honor my values.” Gordon adds that there’s no need to feel obligated to over-explain why you’re reaching out. “You don’t have to tell the people you reach out to that you’ve just binged or that you’re struggling (of course, you absolutely can if that feels supportive!). So often, people stay silent because of shame, guilt, or worry about triggering others who are also in recovery,” she says. “If that’s what is keeping you silent, just remember, connection doesn’t have to start with disclosure. You can text a friend about the latest Bridgerton episode, send a meme or Instagram reel, or ask how their day is going. Connection itself is a form of regulation, and it can be a great gateway to reaching out and sharing more openly about what you’re up against when you are ready.” 2. Change your environment “Given binges can happen any time of day, and in any place, I like to make sure recovery-supporting tips are accessible regardless of the context,” Gordon says. “If you are home, can you change rooms? Can you go sit outside? Can you sit on the floor and do gentle stretches instead of sitting or standing in the kitchen? Can you drive somewhere that feels more regulating? If being in the car increases your urge to buy food, set yourself up for success ahead of time: leave the credit cards at home and bring only your phone and driver’s license.” 3. Go for a gentle walk “Engaging in mindful movement after a binge episode can not only help us mentally reset, but also encourages increased gastric emptying and GI motility, both of which can decrease physical discomfort and bloating after a binge,” Fattore says. As the physical discomfort abates, the mental and emotional discomfort also tends to lessen. 4. Do an activity “Get busy in a gentle and non-punitive way,” Gordon says. “Activities that engage your hands and attention can be incredibly regulating after a binge.This might look like knitting, needlepoint, crochet, jigsaw puzzles, Sudoku, crosswords, colouring, journaling, or even using a fidget toy. You don’t need to ‘process’ anything right away. Allow yourself and your body to engage in something grounding and neutral.” 5. Nourish your body, no matter what “Have food after!” Dowell says. “I cannot stress this enough: do not react by not eating. Restricting makes your body and mental health feel much worse after the binge. Continue your day and the next day with the same meals and snacks you would have normally. Remind yourself you are worthy to take space, nourish yourself, and be gentle.” Gordon agrees, saying that while it may seem counterintuitive, meals or snacks should go on as planned after a binge. “As weird as this sounds, if it’s time for a meal or snack, eat it anyway,” she says. “We don’t want to respond to a binge by restricting; continuing to nourish your body at regular, consistent intervals is one of the most powerful ways to interrupt the binge-restrict cycle. Don’t let the binge throw your body off. It will likely feel uncomfortable—and it will still be super supportive.” 6. Give yourself grace Remember that binges are a natural evolutionary reaction to restriction, not a lack of willpower (more on that below). “The binge itself had nothing to do with personal failings and everything to do with biology,” Fattore says. “Your body is doing what it can to keep you safe. Thank it for that.” 7. Get as much rest as you can “I cannot explain how exhausting and emotionally draining a binge can be,” Dowell says. “You may not have even enjoyed the food, you probably worried the whole time beforehand, and afterward is an exhausting experience itself. Curl up with your favorite book or TV show and rest. Let your body heal with sleep. Usually, I would feel so much better even after a few hours of rest.” 8. Seek help If you’re experiencing recurrent episodes of binge eating, you may be struggling with an eating disorder like BED or bulimia. Eating disorders are serious mental illnesses, and not something that you can fix on your own through sheer will or by just deciding to stop. Talk with your doctor or reach out to Equip to get a professional assessment and the support and resources you need to heal. What not to do after binge eating Because of the overwhelming shame many people feel following a binge, it’s understandable why you might be tempted to turn to compensatory behaviors like dieting or overexercising to “counter” the effects of the binge. But tempting as they may seem in the short-term, these methods aren’t helpful: they don’t address the root causes of binge eating, and they usually set you up to binge again. 1. Restrict or purge calories in any way “One of the mistakes I most commonly see is an attempt to compensate for binge behavior via restriction or excessive amounts of physical activity,” Fattore says. “This perpetuates an ongoing cycle of undernourishment and increased hunger cues that sets the stage for another binge episode to occur. By depriving the body of necessary nutrients in the aftermath of a binge, we cause ourselves to experience a desire for food far beyond what can ever be satisfied by ‘normal’ eating.” Gordon agrees, noting that any kind of compensatory behavior will only keep you stuck in the binge cycle. “Restriction and compensation disrupt hunger and fullness cues, teaching your body that nourishment is unreliable,” she says. “When your body can’t trust that food is coming consistently, it becomes more vigilant, more urgent, and more likely to drive future binge behaviour. Over time, this perpetuates the binge–restrict cycle and increases physiological and psychological pressure around food, making binges more likely.” 2. Reprimand yourself “Don’t ‘should’ all over yourself!” Gordon says. “The shame spiral is not helpful. Bingeing often serves a function; it might be meeting an emotional need or acting as a release when feelings like shame, overwhelm, frustration, or exhaustion become too intense. Criticizing and attacking yourself afterwards doesn’t address those needs; it only makes them worse.”  Why binge eating is not an issue of willpower As Fattore points out, and as research shows, most binges are preceded by a period of restriction. “It’s important to recognize that binge behavior often results from a very normal biological response to ongoing restriction rather than a lack of willpower,” Fattore says. “As human beings, our brains have evolved to employ protective mechanisms that ensure our physical safety and physiological stability.” Any time humans restrict their food intake—regardless of whether it’s due to famine, food insecurity, guilt, or a strict diet—the brain’s hypothalamus attempts to remedy the situation by signaling for increased production of ghrelin (the “hunger hormone”), and decreased secretion of insulin and leptin (the hormones that make us feel full). “When this occurs, there’s very little we can do to fight against our own biology,” Fattore says. “In this way, binge eating is our body’s attempt to keep us safe and return to a state of metabolic homeostasis.”  Just as eating disorders are not a choice or an issue of willpower, neither are the behaviors that accompany them, including bingeing. “I’ve never met anyone who enjoys bingeing or wants it to keep happening,” Gordon says. “People don’t binge because they’re lazy, undisciplined, or lacking self-control. They binge because something in their system has been overwhelmed. If binge eating were a willpower issue, then ‘trying harder’ would solve it. It doesn’t.” Fattore points to studies indicating that not only do dieting and restriction increase risk for binge eating (even in people who don’t have a history of disordered eating), but they have also been shown to prolong binge eating episodes, especially in those who may be struggling with bulimia or BED. “We can safely assume, then, that binge eating truly has nothing to do with willpower,” she says. “It’s a learned evolutionary response to a dangerous physiological state: undernourishment.” "Binge eating truly has nothing to do with willpower. It’s a learned evolutionary response to a dangerous physiological state: undernourishment.” As Gordon explains it, most binge eating makes sense in context. “It’s often a response to deprivation, whether that’s physical, emotional, or both,” she says. “Restriction, rigid food rules, chronic dieting, or long gaps between meals put the body on high alert. Add in stress, unprocessed emotions, trauma, exhaustion, or sensory overload, and the nervous system can tip past its capacity.” In those moments, Gordon explains that our bodies reach for whatever brings the quickest relief. “Food becomes a way to regulate, not a moral failure,” she says. “During a binge, the brain isn’t operating from a place of choice or calm decision-making. The stress response is activated, hunger hormones are elevated, and the brain regions responsible for impulse control are less accessible. Expecting willpower here is like asking someone to think clearly while their nervous system is in crisis.”  Having experienced the destructive cycle firsthand, Dowell can attest that attempting to “fix” the problem through “discipline” or self-punishment will only make things worse. “You cannot ‘will’ yourself out of a binge,” she says. “You’re facing a huge problem, and that is your eating disorder. I remember that I used to believe that it was my lack of willpower that was why I would ‘binge’ and be ‘bad.’ I was never bad. My eating disorder was bad and bad to me. And there is no such thing as will with an eating disorder. You need and deserve help to stop.” What you choose to do after a binge can make a big difference in whether you binge again, but often it can feel impossible to make those healthier choices on your own. By reaching out for help, you can get the support you truly need to make changes that stop the binge cycle for good. ]]></content:encoded>
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            <title><![CDATA[Infographic: Understanding the Eating Disorder-Mental Health Connection]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-mental-health-relationship</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-mental-health-relationship</guid>
            <pubDate>Tue, 12 May 2026 02:50:00 GMT</pubDate>
            <content:encoded><![CDATA[When people think of eating disorders, they often think of certain behaviors (like restricting food, binge eating, or purging) or observable symptoms (like weight changes, lanugo, or frequent injuries). But eating disorders go deeper than what you see on the surface. They are, first and foremost, mental health conditions, and can affect every aspect of a person’s mental well-being. Not only are eating disorders mental illnesses themselves, but they also have a complex, bidirectional relationship with other aspects of mental health—meaning they influence and are influenced by various different things going on in your mind and brain. In fact, they can shape mental health on several different levels: Emotional: your feelings and mood Psychological: your thoughts and state of mind Cognitive: your ability to focus, process information, and remember This Mental Health Awareness Month, we’re shining a light on a simple but important truth: eating disorders are mental illnesses—not choices or vanity issues—and need to be part of the mental health conversation. Explore the infographic below to learn about the many ways that eating disorders impact mental health (and vice versa).  Curious to learn more? Here are some more in-depth articles on the topics explored above.  What We Mean By “Eating Disorders Are Brain Disorders” What's the Connection Between OCD and Eating Disorders? Eating Disorders and Anxiety: What’s the Connection? What is the Relationship Between Trauma and Eating Disorders? The Link Between ADHD and Eating Disorders: What We Know What's the Connection Between Body Image and Eating Disorders? Suicide Rates Are Higher in Eating Disorder Populations — Here’s What You Need to Know New Equip Research: The Experience of Caregivers in Eating Disorder Recovery]]></content:encoded>
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            <title><![CDATA[The Problem with Making Weight Loss Your Primary Goal]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/the-problem-with-weight-loss-as-a-goal</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/the-problem-with-weight-loss-as-a-goal</guid>
            <pubDate>Mon, 06 Mar 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[In our society, we’re bombarded by both messages—both explicit and implicit—telling us that losing weight is unequivocally good. Celebrities are praised for slimming down, weight loss tips and ads saturate social media, and many of us automatically assume that losing weight is a step toward health. But in reality, trying to lose weight is usually unhealthy, both physically and mentally. We know, this seems to go against everything the world tells us, but both research and anecdote have shown that not only do most people fail when they try to lose weight, but these attempts also do considerable damage to their mental health. What’s more, dieting and trying to lose weight is a risk factor for developing an eating disorder, with 20-25% of “normal dieters” going on to develop one. Still, 45% of the global population wants to lose weight, and some of them are able to do so in a safe and sustainable way that supports their health, rather than undermining it. So, is it okay to have weight loss as your primary goal? In order to answer that question, we asked eating disorder clinicians and people with lived experience whether weight loss in and of itself is a problematic goal—especially for people vulnerable to eating disorders. The real issues with “weight loss” as as a “health” goal  Equip Dietitian Dani Castellano, RD, succinctly summarizes the issue with single-mindedly pursuing weight loss: “There is no known effective weight loss strategy that ‘works,’ so setting that as a goal is a recipe for failure,” she says. “And because of weight stigma, that ‘failure’ is then blamed on an individual, not the system.” It’s also worth noting that our society’s pervasive weight stigma is upheld by the $72.6 billion weight loss industry. The fact that there is so much money poured into the endless stream of pills, products, supplements promoting weight loss speaks to how elusive that goal is for so many people. If sustained weight loss were easily attainable for all, the booming industry surrounding it would quickly tank. Preying on the perpetual (and futile) search for thinness ensures weight loss companies will always be able to profit off enduring insecurities. But the potential failure rate of diets doesn’t touch the more serious, underlying issue: is weight loss “healthy” for most people? Not really, according to Equip therapist Stacy Rae Godoy. “We have enough evidence to know that weight is not a good indicator of someone's health,” she says. “Also, we know from the data that the majority of weight lost is regained over time, which can leave people feeling even worse about themselves.” Better indicators of health might be things like blood pressure, mobility, and resting heart rate. Is pursuing weight loss ever healthy? If so, when? While those in eating disorder recovery circles may already know the dangers of striving for thinness, the general population has very likely heard the opposite messaging: weight loss is typically considered good. But as we laid out above, striving for weight loss as an end goal often has negative consequences. However, when working toward other health goals, unintended weight loss may occur, and that doesn’t necessarily mean anything positive or negative. For instance, weight loss may come as a result of striving for other health goals, such as: Mobility Cardiac function Increased strength Managing hormonal issues Improved sleep However, making weight loss your primary objective—as opposed to a more concrete health measure, like the ones mentioned above—generally does more harm than good. So if you’re hoping to improve your health by working on nutrition and movement, what is a worthy objective? Many studies have demonstrated the positive impact of approaching weight from a neutral perspective and building healthy habits that are reasonable, realistic, and sustainable. For some, this could mean engaging in a joyful movement practice a few days a week, and for others, it could mean intentionally scheduling rest days or cooking nutritious meals at home. The point is that there is no single, one-size-fits-all solution for each person, and weight loss is not a universal health goal. Castellano also cautions people to keep an eye out for heavily marketed “lifestyle changes” that are a mask for diet culture.  “As a dietitian who used to work in a setting where people came to me for help with weight loss, I realized that ‘lifestyle change’ is often just a synonym for ‘diet,’” she says. “People in larger bodies don’t inherently have ‘poor’ eating and exercise habits. So when you try and make ‘lifestyle changes’ for weight loss, there’s often nothing to change except dropping calories, getting restrictive with ‘clean foods,’ and increasing exercise. This may lead to short-term results until you develop an eating disorder or get a sports injury or some other health consequence. I’ve watched people ‘fail’ at weight loss and become so frustrated with themselves and me.”  By focusing on more constructive measures that actually improve a person’s life, a person sets themself up for success, rather than failure. All that said, when someone does decide they want to lose weight—in particular when it’s a young person—how you respond can help them avoid the physical and psychological pitfalls of pursuing weight loss.  “It’s important not to shame anyone who is striving towards weight loss, especially children,” Godoy says. “You can help your child without demonizing weight loss. You can validate their desire and hold the boundary of protecting their health. We don't want to create more shame, and doing so might only drive them toward or further into an eating disorder. We can only hope to create a supportive environment where we see them, we care for them, and we hold firm compassionate boundaries around managing potential disordered behaviors.” Navigating medical biases around weight Unfortunately, it’s not just society that equates weight loss with health and success; this belief is prevalent within the medical community as well. The vast majority of health providers still subscribe to the body mass index (BMI) scale, a flawed approach to calculating “target” weights and determining health recommendations. It’s understandably a tall order to ask people to stop considering weight loss a health goal when so many physicians are endorsing it as such. Godoy adds that with the new American Academy of Pediatrics guidelines, which recommend weight loss drugs or surgery for children over the age of 12, it’s especially important for parents to make sure they’re aligned with their pediatrician.  “It’s not the parents’ job to teach their pediatrician about the harmful effects of weight bias and fatphobia,” she says, noting that those consequences include disordered eating, eating disorders, shame, guilt, and an overall unhealthy relationship with food and body. Castellano advises people of all ages to work with healthcare providers who understand the Health at Every Size approach. “I have met so many people who have told me that their doctor told them to lose weight for their knee pain and they tried that and the knee pain did not improve,” she says. “But physical therapy exercises could be a more appropriate recommendation than weight loss. It’s unethical to recommend helpful advice to a smaller person with the same ailment as a larger person who is told to lose weight. Let’s focus on changes that need to happen to lifestyle in order to target the concern at hand. Everyone deserves access to healthcare that isn’t ultimately saying ‘your body is bad.’"]]></content:encoded>
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            <title><![CDATA[Will I Lose Weight in Eating Disorder Treatment? ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/lose-weight-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/lose-weight-eating-disorder-treatment</guid>
            <pubDate>Fri, 12 Jan 2024 19:57:24 GMT</pubDate>
            <content:encoded><![CDATA[One of the most common concerns patients have at the start of eating disorder treatment is wanting to lose weight, or often even stronger, the fear of gaining it. Because of the inescapable presence of diet culture, it’s understandable that some patients enter treatment hoping to lose weight. But regardless of a patient’s diagnosis or BMI, intentional weight less will never be part of an eating disorder treatment plan at Equip. This is because research shows that dieting is a trigger for eating disorder onset or relapse, undermining recovery efforts. Some of the core goals in recovery are to normalize eating habits, become more aware of body image issues, build new coping skills, and find community. In this process, many people start to recognize the influence that diet culture has had in their life and to embrace how their body feels when it’s being nourished. As a result, the desire to lose weight often lessens.  Read on to learn more about why experts don’t encourage weight loss in eating disorder treatment, and why it’s so important to seek support anyway. Why weight loss is rarely the goal of treatment For starters, weight loss goals are simply ineffective, even for people who don’t have an eating disorder. As Carise Rotach, MA, LMFT, Equip’s Therapy Manager explains, “when restricting food for weight loss, you may experience temporary results, but you’re statistically more likely to gain the weight back that was lost, or more. This is a completely predictable and normal bodily response to putting the body into a state of starvation.” This cycle is what can cause many eating disorders in the first place. So for people already experiencing one, it can have even more dangerous risks. Here are two reasons why. A weight loss goal can re-trigger disordered habits One reason that weight loss isn’t part of eating disorder treatment is that it can reinforce the very disordered beliefs, thoughts, and behaviors that created the eating disorder in the first place. Food restriction is at the root of most weight loss efforts and most eating disorders. If someone starts restricting in the hopes to lose weight, it can become counterproductive to their healing. This holds true regardless of a patient’s size or weight. It could become a health risk Many people who are beginning eating disorder treatment are in need of weight restoration, a process of reaching a stable, healthy weight. This can include folks who aren’t deemed “underweight” by their BMI, but still require weight restoration in order for their body to function optimally. If someone is in need of weight restoration, losing even more weight could set off a series of health concerns related to malnutrition, like a weakened immune system and organ damage. Health comes in many sizes It’s important to recognize that health can exist in many shapes and sizes. At Equip, we take a Health At Every Size approach, which aims to counteract medical weight bias that assumes illness for fat people and wellness for thin people. Institutions built around weight loss perpetuate the myth that skinnier means healthier—evidence-based eating disorder treatment does the opposite. Our approach aims to help patients achieve a weight that helps them live nourished, fulfilled lives, rather than focusing on being smaller. The importance of weight restoration Weight restoration is often a part of eating disorder treatment (but not always.) According to Rotach, “Weight restoration is the process of stabilizing nutrition and interrupting eating disorder behaviors in order to restore a person's weight to the optimal range for their individual needs.”  While many people assume weight restoration is only for patients who appear ‘underweight,’ that’s not always true. Someone might not be considered ‘underweight’ by the flawed BMI system and still require weight restoration to reach a weight that would be healthiest for them. Rotach points out that each person has a unique target weight range measured by a wide range of factors, including: Historical data (like growth charts and family history) Regular menstruation Stabilized mood Experience of range of emotions Stable vitals Lack of eating disorder intrusive thoughts In short, our bodies and minds function differently when we’re at a stable, healthy weight—and that number is a unique calculation for every individual. Not only is weight restoration crucial to helping patients feel their best and interrupt harmful patterns, but it also helps to mitigate the chance of relapse. According to Rotach, “the number one risk of relapse for eating disorders is weight loss or restriction.”  This is why weight loss goals can be risky for those in recovery, no matter their body size. “These folks are aware that their eating disorder can return swiftly if their body is put in a state of starvation again,” says Rotach. When weight loss might occur in treatment Many patients with eating disorders that involve binge eating wonder if they will lose weight in treatment. The reality is, we cannot predict how a patient's weight will change in recovery: some patients lose weight, some gain weight, and some stay at the same weight. Rotach adds that sometimes weight changes during recovery can be either short or long-term. “Sometimes weight loss is quite temporary as a patient’s metabolism learns how to process nutritional energy again. Other times it’s a fluctuation that meets a patient’s optimal functioning weight range for that season of their life,” she says. That said, weight loss will never be an explicit goal treatment goal at Equip (though it's okay and normal for a patient to start treatment still desiring to lose weight).  What to do if you’re nervous about gaining weight in treatment “It's okay to question what will happen to your body when you are in treatment,” says Rotach. “The problem is that diet culture has taught us to fear weight gain all our lives.” If you’re struggling with the idea of weight gain while healing from an eating disorder, Rotach recommends asking yourself of these open-ended questions: How will my body function differently with adequate and stable nutrition? How will I experience eating, moving, exercising, and existing in a body that is optimally functioning? What will I like most about having energy to get through my day? What will I do with the extra brain space that's currently occupied by obsessive thoughts of food? “Being curious about your own body is okay as long as we stay open to many different outcomes. When we become rigid in how we think our bodies should look, that’s when we become a stones-throw away from engaging in restriction or over-control,” says Rotach. Your mindset may change during treatment A common part of eating disorder treatment is learning new information and unpacking the diet culture messages that may be at the root of disordered behaviors. In the process, your fears might subside.  Jerica Mosello, a Medical Records Specialist at Equip who is in recovery from anorexia binge-purge subtype, says: “Your mindset really changes throughout treatment. You might have gone in for one reason, and changed in a way you didn’t expect. Before treatment, what I wanted was self-love. Of course, I thought I could only have that with weight loss. Through treatment, I learned that losing weight was no longer the catalyst I needed to love myself.” Therapy can play a big role in this process, where you learn to identify and shed harmful mentalities and patterns, according Rotach. Dietitians and medical providers can also help you better understand what nutrition your body needs, and redefine what health looks like for you.  
Equip is a virtual eating disorder program that matches you with a care team including a therapist, dietitian, medical provider, and mentors. This care team is dedicated to helping you break free from your eating disorder, and embrace whatever that looks like for you. ]]></content:encoded>
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            <title><![CDATA[Food Cravings Decoded: What They Mean with (or without) an Eating Disorder]]></title>
            <link>https://equip.health/articles/food-and-fitness/food-cravings-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/food-cravings-eating-disorder-recovery</guid>
            <pubDate>Thu, 07 May 2026 14:00:00 GMT</pubDate>
            <content:encoded><![CDATA[In a society shaped by diet culture, food cravings are typically cast in a negative light. They’re unfortunately seen as something to fear, to be controlled or removed entirely. However, there’s a different and more helpful way of viewing them, whether you have an eating disorder or not: food cravings are part of being human. “Cravings are a normal part of the eating experience and not something that needs to be eliminated,” explains dietitian Amanda Crowe, MS, RD, INHC. Unlike hunger, food cravings are not always related to your body’s biological food needs (but sometimes are, especially if you have an eating disorder) and can sometimes point to issues like unmet emotional needs, hormonal shifts, and medical conditions. Regardless of their source, Crowe says food cravings are important sources of information from your body, not something to fight against. Even if your food cravings are impacting your life negatively—which can be the case, especially if you have an eating disorder—they can still be your body’s way of sending helpful information and ultimately helping you on your path to healing. Today, let’s define food cravings, look at the various types, and see how they show up in active eating disorders and recovery. Plus, we’ll look at when food cravings mean something’s wrong, and explore how to navigate them when recovering from an eating disorder. What are food cravings? Food cravings are defined as intense desires to eat a specific food and are driven by physiological, emotional, cognitive, and behavioral factors, according to a 2024 academic encyclopedia entry. This definition also specifies that people generally and most often crave energy-dense foods (i.e., foods that are high in fat and sugar). “Food cravings are signals that the body or brain wants or sometimes needs a specific type of food,” explains dietitian Hilary Raciti MS, RDN, CDN. "A craving often shows up as a sense of ‘mouth hunger’ or a taste for something specific, but it can also feel more general, like wanting something salty, sweet, crunchy, or comforting [and] thoughts about certain foods may pop up randomly and stick around until the craving is satisfied.” There are several different types of food cravings, each of which has a different cause and may need a different approach to satisfy. “Normal” food cravings If you’ve ever craved something sweet after a meal, psychotherapist Amanda Marks, LPC, RYT says to consider yourself human. “A ‘normal; craving is typically a result of being human and having basic cravings, [like] having dinner and then after dinner you realize you want something sweet, so you eat a cookie and are able to move on from that,” Marks explains. “There’s no sense of urgency related to ‘normal’ cravings.’” Other examples of normal cravings include wanting ice cream on a hot day or wanting a warm, carb-heavy meal after being out in the cold. It’s also important to call out that diet culture sometimes frames emotional food cravings as problematic, when, in fact, craving certain foods in response to emotions is also simply part of being human. Highly palatable foods (those high in fat, salt, and sugar) can activate your brain’s reward system, causing an increase in the neurotransmitter dopamine, and leading your brain to mark certain experiences as worthy of repetition. So, having a slice of cake when you’re feeling sad may temporarily boost your mood, and your brain may later link similar states with that experience, leading to future food cravings in similar scenarios. Emotional food cravings typically only become a problem if they’re your only source of coping. Circumstantial food cravings Many food cravings are products of circumstance. For example, you might notice cravings for specific foods, especially highly palatable foods, when you’re sleep deprived, jetlagged, or (for women) experiencing pre-menstrual syndrome (PMS). This is because in these scenarios, your hunger hormones (called ghrelin and leptin) are thrown off balance. In fact, one 2025 study of female nursing students showed a connection between women with PMS—which most of the women experienced—and increased food cravings and hedonic hunger, or the desire to eat without physical hunger. Cravings driven by restriction When you don’t eat enough food, your body and brain do everything they can to make sure you eat soon so that you can survive. This includes increasing food desire and insistent thoughts of energy-dense foods. Your brain can also kick into this gear when you may be eating enough food, but are restricting certain types of food. “Cravings driven by restriction often occur when foods are labeled as off-limits,’ [because] the more someone tries to avoid a food, the more attention and desire it can create,” Crowe says. “For example, avoiding foods like chips or sweets can lead to stronger cravings and feeling out of control around those foods later.” Cravings that occur during the recovery process Food cravings experienced during eating disorder recovery can have a similar intensity to the cravings caused by restriction. This is because most eating disorders involve restriction, and during recovery, your body and brain are healing and recalibrating. “The body is rebuilding trust that food will be consistently available,” Raciti explains. “When someone begins eating more regularly after a period of restriction, appetite signals and cravings for specific foods, especially those previously restricted, can temporarily feel stronger.” For example, you might have urgent cravings for pizza (a common fear food) after starting to re-incorporate it into your diet, and it may even feel out of control for a while. What’s the relationship between cravings and eating disorders? In a 2026 systematic review of studies about eating disorders and food cravings, authors found that food cravings play a central yet elusive role across eating disorder diagnoses. This is in part because there are major inconsistencies in how food cravings are defined in eating disorder research. What is clear is that food cravings in eating disorders are driven by several factors, and they share similarities and differences across diagnoses. How food cravings show up with an active eating disorder One 2024 study of people with eating disorders and without eating disorders showed that when participants with anorexia have positive emotions, they experience higher food cravings compared to the control group. Interestingly, the same study showed that when participants with binge eating disorder feel positive emotions, they tend to have lower food cravings compared to the control group. However, all eating disorders usually include some kind of food restriction, so you’ll likely notice intense cravings and food preoccupation if you have an active eating disorder, regardless of diagnosis. This is because your body is not receiving regular nourishment, or adequate calories and nutrients, or because certain types of food are restricted. According to Raciti, restrictive behaviors often lead to food cravings, which show up as: Obsessive food thoughts that make it hard to focus on other aspects of life Food fantasies or dreams Feeling out of control around and avoiding certain foods Watching or observing certain foods being prepared or eaten (but not eating) Contrary to popular belief, binge behaviors are often driven (at least partially) by restriction. This then leads to specific food cravings and feeling out of control around those foods. “For example, someone who has decided to go on a diet and not eat any chocolate could likely be able to do that for a period of time, but then the craving for chocolate could get so intense, the person binges on chocolate,” Marks explains. Sometimes, binges are triggered by difficult emotional experiences. Food cravings are a maladaptive coping mechanism, because they can lead to a dopamine boost and temporary relief leading up to or while eating those foods, Raciti explains. “However, when shame or guilt follows, which is often the case,” she adds, “it can reinforce the restrict–binge cycle and perpetuate the pattern.” How food cravings show up in eating disorder recovery Even if you’ve done, or or are doing, the work of recovery, food cravings can still feel abnormal and intense. “This can often be confusing and overwhelming to someone early in recovery,” Marks says, “but it's important to recognize that it's normal and [often] a result of earlier restrictive behaviors.” Food cravings may even become more noticeable at first since you’re learning to loosen food rules, according to Raciti. “People may crave foods they previously avoided or feel unsure how to respond to reappearing hunger cues,” she says. “Over time, as eating becomes more consistent and varied, cravings often feel less intense and less emotionally charged.” Eating disorder recovery doesn’t take food cravings away (remember, they’re part of being human), but it helps dial them down from what feels like a yell to a nudge. When do cravings mean something is wrong? Most of the time, food cravings don’t point to anything being wrong, but there are some scenarios in which they can indicate a problem, like disordered eating, an eating disorder, or a medical condition. Here are some signs that food cravings may be a symptom of an eating disorder: Fulfilling food cravings is your only way to deal with hard emotions Food cravings feel obsessive, intense and all-consuming Cravings occur after long periods of restriction You are physically out of control around foods you crave You feel threatened or scared of your cravings “It may be helpful to look more closely if cravings feel constant, overwhelming, or are paired with restrictive behaviors, guilt, or cycles of overeating,” Crowe says. “These patterns can be a sign that the body is not getting enough nourishment or that there may be a more complex relationship with food that could benefit from additional support.” Additionally, cravings for non-food items (i.e. ice, dirt, chalk, and clay) often point to pica—an eating disorder where someone compulsively eats food without nutritional value or purpose. Pica is often associated with deficiencies of certain nutrients (like iron). Finally, some food cravings point to serious medical issues. For example, strong sugar cravings (along with other symptoms like shakiness) can indicate hypoglycemia (low blood sugar). Regular and strong salt cravings (usually accompanied by other symptoms like exhaustion) can sometimes mean there’s a serious issue, like Addison’s Disease, (a rare disease resulting from hormone insufficiency), hyponatremia (low sodium), or dehydration. Whether they feel physical, mental, or emotional, if you experience food cravings that impact your well-being, it’s best to see both a doctor and registered dietitian, and sometimes a therapist, too. Working with these professionals can ensure your medical stability, help you identify and understand what’s going on, and create a treatment plan to feel better. How to navigate cravings during eating disorder recovery It may feel disheartening if food cravings persist in recovery, especially if they get stronger at first. But remember, these cravings are a part of the healing process. Here are some expert-backed ways to navigate food cravings in eating disorder recovery: Keep yourself fed Although it takes time and patience with yourself, your food cravings will normalize and become more flexible if you’re consistently eating enough food, striking a relative balance across food groups, and giving yourself full permission to eat. “Eating regularly throughout the day, including balanced meals with carbohydrates, protein, and fat, can help reduce the intensity of cravings over time,” Crowe says. “It can also be helpful to include foods you enjoy in a mindful and satisfying way rather than repeatedly saying no, which can increase the likelihood of feeling out of control later.” If you’re not already, it’s important to work with an eating disorder registered dietitian to help you meet your energy and nutrient needs and re-incorporate fear foods. Neutralize cravings and honor them promptly Since food cravings can feel overwhelming in recovery, Raciti suggests neutralization. “For example, if peanut butter is a challenging craving, pair it with a neutral food, like an apple, celery, or cheese,” she says. She also suggests acknowledging and honoring your food craving soon after it starts, so it doesn’t become difficult to navigate. In my eating disorder recovery, after I started allowing myself to eat cookies freely again, I would get uncomfortably strong cravings for them. It was only when I had them around regularly and ate one soon after a craving started that it became more manageable. Take a curious and non-judgmental approach Chances are high your eating disorder brain is quick to judge food cravings as bad or shameful experiences. So when you notice such judgmental thoughts, let them pass as best you can. And then, perhaps with the help of your therapist, let your healthy mind practice curiosity about your cravings. “Cravings can actually be very helpful information during recovery,” Raciti explains. “If we frame cravings as messages from our body, rather than a lack of control or a continued battle with food, it’s amazing how enlightening they can actually be.” When a craving begins, try asking yourself questions like: What might my body be trying to tell me? Where do I feel the craving in my body? Have I eaten within the last few hours? Am I craving something emotionally? Is the craving about a previous (or current) fear food? How does my eating disorder view my food craving, and how do I view it? Consider that your food cravings might be an indicator of something deeper In eating disorder recovery, you’re usually learning how to safely feel and express the full spectrum of human emotions, and food cravings can help the process. Oftentimes, food cravings can symbolize emotional needs, but only if you’re adequately nourished.  “It's important to be able to identify what emotional needs we have and if we are really craving that particular food or what that food may represent,” Marks says. “If someone finds themself often cravings sweet foods, that could be an indication that an emotional need is not being met, such as comfort.” So, if you’ve eaten adequate meals and snacks without rigid rules, you’re not physically hungry, and you have a strong food craving, ask yourself questions like, What might this food represent for me emotionally? How has today or the last 24 hours been? What do I need in this moment? It’s okay to use food as one emotional tool if it’s used alongside other coping skills that help you process your feelings and fulfill the true emotional hunger. Like all parts of eating disorder recovery, navigating food cravings takes time and patience, along with a commitment to full recovery. “If you limit yourself or fall into a pseudo-recovery, these strong, daunting messages may remain because the body feels it needs the alarm system,” Raciti explains. Remember, your food cravings can be a powerful source of emotional healing, and with regular, adequate, balanced, and unrestrictive eating, they will eventually feel more normal and manageable. “Over time, many people find that cravings feel less urgent and more like gentle preferences,” Raciti adds. If you’re feeling overwhelmed and need personalized help navigating your food cravings, work with a registered dietitian and therapist to help you make peace with them.]]></content:encoded>
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            <title><![CDATA[5 Reasons You Deserve to Eat Today (No Matter How Much You Ate Yesterday or Whether You Worked Out)]]></title>
            <link>https://equip.health/articles/food-and-fitness/you-deserve-to-eat</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/you-deserve-to-eat</guid>
            <pubDate>Tue, 05 May 2026 14:08:00 GMT</pubDate>
            <content:encoded><![CDATA[It’s undeniable that our world continues to be dominated by diet culture—and according to this set of beliefs, food is something to be “earned” or “burned.” We’re taught to treat calories like currency, and meals and snacks are the paychecks we get in exchange for hard labor (aka exercise). But this premise isn’t just false; it’s dangerous. Food is a fundamental biological necessity, not a moral reward for good behavior. Treating it as the latter can be a slippery slope to disordered eating, or an eating disorder. Whether you’re struggling with restrictive eating or are working toward a non-diet approach to life, there are plenty of reasons you deserve to eat today. Let’s get into it. The importance of fueling your body If you occasionally (or always) feel guilt or shame around eating, you’re far from alone. Most of us have been exposed to messages promoting “calorie deficits,” meaning we should eat fewer calories than we burn on a daily basis. Otherwise known as a “negative energy balance,” caloric deficits can have serious consequences, especially if they extend over a long period of time. When you don’t eat enough food to support your body and brain’s needs, you can experience a variety of physical, mental, and emotional issues. And in some cases, caloric deficits can lead to eating disorders and even death. While feeling guilt around food isn’t abnormal, moving away from diet culture is an important step in regaining joy, pleasure, and true health. Your body doesn’t require a justification to exist and be nourished. If you need more convincing, here are five reasons your need for daily fuel is non-negotiable. 5 reasons you deserve (and need!) to eat today 1. You’ll think more clearly So often, we hear about calories as components we have to “earn” or “burn off” through exercise. In actuality, calories are essential units of energy that fuel every part of our existence, from the smallest physical movement to processing complex thoughts and ideas. Yes, your brain runs on calories, and without an adequate daily intake, your body prioritizes survival over high-level processing, which can lead to reduced focus, emotional dysregulation, poor memory, food obsession, and even more serious consequences. Even though the brain makes up approximately 2% of your body weight, it consumes roughly 20% of your body's total energy (primarily in the form of glucose), so getting enough food every single day is a must. “Your brain needs and really appreciates being fed on a regular basis throughout the day,” says dietitian nutritionist Alexia Beauregard, MS, RD, LD. “Our modern society constantly bombards the brain with sound, pictures, smells, blue light, and too little rest. Emotional regulation and focus are critical when repairing your relationship with your body, and a hungry brain makes this hard work even harder. The brain’s preferred energy source is glucose so thank yourself next time you put some carbohydrates on your plate. Your brain will thank you with improved focus and the ability to manage any difficult thoughts about eating that might surface. Remember, eating is about partnership with our body.” 2. You’ll be a better friend/partner/parent Not only does eating regularly keep your energy, mood, and focus steadier, but it also helps you show up as a calmer, more present, and more reliable friend or partner. When you eat enough and eat regularly, you’re less prone to irritability and mood swings, and better able to listen and be emotionally available. Consistent fueling also reduces the stress and distraction of hunger, so you can engage in shared activities and support others without being preoccupied by low blood sugar or obsessive thoughts about food. “Making meals a priority at different times during the day is not only about self-care, but also about connecting with others,” Beauregard says. “Meals allow us to connect to ourselves and to others in our shared human experience. In our overly connected lives, we can still feel very isolated from one another. Being part of a community is an essential part of healing, and every meal is an opportunity to nurture that connection—with others, and with yourself. Remember, the table, the picnic blanket, the kitchen island are some of the most powerful places where belonging can be found.” 3. Restriction backfires There’s no denying the fact that strict food restriction often backfires: depriving yourself inevitably increases physiological hunger and preoccupation with food, which increases the chance of eventually bingeing. This binge-restrict cycle isn’t a lack of discipline; it’s a biological survival mechanism. When you don’t eat enough over a period of time, the restriction signals to your brain that food is scarce, which causes it to be on the hunt for large quantities of food when possible. Restriction isn’t just a symptom of an eating disorder like anorexia—it’s at the root of all eating disorders. But you don’t have to have a clinical eating disorder to experience the negative effects of restriction. Any time your body and brain don’t get enough fuel, you’re risking falling into the binge-restrict cycle. 4. You’ll be healthier in every way “Don’t let the word ‘healthy’ turn you away,” Beauregard says. “The term ‘healthy’ has been hijacked and can sound judgey, but let’s take a breath and put this term into the perspective of our body’s health.” In her own work, Beauregard uses the phrase “eating competence,” a research-based model developed by dietitian Ellyn Satter that focuses on how you feel and behave around food. The model is based on the idea that “competent eaters” have: Positive attitudes about eating and about food Food acceptance skills that support eating a variety of foods The ability to intuitively eat enough food to provide energy and stamina and support stable body weight Skills and resources for managing the context around meals While these four points may not all be realistic or attainable for someone in early eating disorder recovery, they’re important goals to strive for and, as research shows, they can improve your overall health. “Studies have shown that eating competence will allow your body to have cholesterol, blood sugar, and blood pressure all within normal ranges,” Beauregard says. “Eating-competent people also tend to sleep better and give themselves permission to eat, which is the foundation of healing. Seeking out food rather than avoiding food is how we find freedom from food rules.” 5. You’re a human Just for the fact that you exist, you unconditionally deserve and require food—period. “As a human walking on this planet, you deserve to nourish your body with food you enjoy—without guilt, without shame, and without having to earn it,” Beauregard says. “Taking pleasure in eating is not an indulgence; it is a biological necessity. Giving yourself permission to sit down, be present, and enjoy a meal is one of the most human things you can do for yourself.” The bottom line is that your body is an incredibly sophisticated system that is trying to keep you safe. While many of us have been taught to fight our biological needs, honoring your hunger will actually help you reclaim the mental space diet culture has stolen. If you’re ready to quiet the noise and build a more peaceful relationship with food, schedule a call with an Equip team member to learn more.]]></content:encoded>
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            <title><![CDATA[Aversive ARFID: When Fear of Choking or Getting Sick Makes Eating Feel Unsafe]]></title>
            <link>https://equip.health/articles/understanding-eds/fear-of-choking-arfid</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/fear-of-choking-arfid</guid>
            <pubDate>Mon, 04 May 2026 14:31:00 GMT</pubDate>
            <content:encoded><![CDATA[Most of us have had a bad experience with food at some point—choking, getting sick, or feeling suddenly nauseous. After something like that, it’s normal to be more cautious around food for a while, especially the specific food that made you feel bad. But for some people, that fear doesn’t fade, and can even develop into an eating disorder called aversive ARFID. When this happens, foods that used to feel fine can start to feel risky. You might find yourself avoiding certain things—or eating less overall—because it just feels safer. Over time, that fear can take up more space and limit what feels possible to eat. This isn't just paranoia or overthinking; it’s a diagnosable condition. Aversive ARFID is a form of avoidant/restrictive food intake disorder. It’s one of three main types of ARFID, alongside sensory sensitivity ARFID and lack of interest ARFID. If you or a loved one feel fearful around food and are wondering whether it’s anxiety, a phobia, or something else entirely, you’re in the right place. Here, you’ll learn what aversive ARFID is, why it happens, and how treatment can help you or your loved one feel safe eating again. What is aversive ARFID (fear of aversive consequences)? Unlike many other eating disorders, ARFID isn’t about weight or body image. Instead, it’s driven by avoidance or restriction of food due to things like fear, sensory sensitivities, or a lack of interest in eating. And it can have a real impact on nutrition and overall health. ARFID can affect people of any age and body size. It’s most commonly diagnosed in children—estimates suggest that anywhere from 0.3% to 15.5% of kids and teens may meet the criteria. It can also continue into adulthood or even start later in life. While there’s less research on adults, current estimates suggest ARFID affects around 0.3% of the general adult population. Within that group, research suggests that aversive ARFID affects about one in three people. Aversive ARFID is a type of ARFID where a person avoids food out of a fear that something bad will happen if they eat, like choking, having an allergic reaction, vomiting, or something else. You might hear this described as a “fear of aversive consequences,” but in plain terms, it just means being afraid of a negative physical reaction to food. “People with fear of aversive consequences in ARFID think if they eat certain foods or a certain amount of food, something bad will happen after they eat,” says Michelle Jones, PhD, a licensed psychologist and clinical instructor at Equip. “They restrict the volume and/or variety of their food intake in an effort to prevent or reduce the perceived chance of a specific negative event occurring." What fears are common in aversive ARFID? At the center of aversive ARFID is fear. But it’s not just general anxiety—these fears tend to be very specific, physical, and tied to what might happen in the body during or after eating. Common fears include: Choking or food getting stuck Vomiting or feeling nauseous Getting sick after eating Having an allergic reaction Stomach pain, gagging, or other uncomfortable sensations In younger children, this can look a little different. Instead of clearly naming fears like choking or vomiting, they might say the food will taste bad, feel “disgusting,” or make them gag, according to Ilana Brodzki Pilato, PhD, a licensed clinical psychologist at Duke Center for Eating Disorders. What are the signs and symptoms of aversive ARFID? Aversive ARFID shows up in more than just food choices. It also shapes how eating feels, both physically and emotionally. The symptoms can look different from person to person, but they often revolve around trying to prevent a feared outcome. Here’s the breakdown.  Behavioral signs According to experts, aversive ARFID can affect how someone approaches food or meals. You might notice behaviors such as: Avoiding specific foods, entire food groups, or all solid foods because they feel unsafe Avoiding where the triggering event occurred Not wanting certain foods in the house Avoiding others eating certain foods Avoiding eating in front of others Obsessive thoughts and worries about food and food preparation Sticking to a very small list of “safe” foods Eating very slowly or taking unusually small bites Cutting food into tiny pieces or over-chewing to feel safer Skipping meals altogether, especially when anxiety is high Relying on liquids, supplements, or a feeding tube Physical signs Over time, eating less or limiting food variety can start to affect the body. According to Christine Ruberti-Bruning, MA, ATR-BC, CEDS, LPC, a certified eating disorder specialist at Ruberti Counseling Services, the restrictive eating associated with aversive ARFID can have a number of physical consequences, including: Unintended weight loss or difficulty maintaining weight For children, falling off their expected growth curve Nutritional deficiencies or malnutrition Electrolyte imbalances Low energy or fatigue Dizziness or feeling faint Gastrointestinal discomfort, especially as eating patterns change Constipation Irregular menstrual cycles Rapid heart rate, heavy breathing, and muscle tension when thinking about food Emotional and cognitive signs Much of the experience of aversive ARFID happens internally. A person struggling with this condition has thoughts and sensations that make eating feel stressful, unpredictable, and even dangerous rather than something routine or enjoyable. Common thoughts and feelings include: Intense fear of choking, vomiting, or getting sick Constant “what if” thoughts before and during meals Feeling hyper-aware of swallowing, throat sensations, or stomach discomfort A sensation or belief that food might get stuck Panic or anxiety that builds around mealtimes Relief after avoiding food How does aversive ARFID develop?  Aversive ARFID often starts with a shift in how your brain and body respond to food. For some people, this shift occurs after a specific experience, like choking, getting sick, or having an allergic reaction to food, says Ruberti-Bruning. The brain flags that moment as unsafe and starts trying to prevent it from happening again. But that’s not always the case. For others, the fear builds more gradually over time. It might start with increased sensitivity to body sensations, ongoing anxiety, or a few uncomfortable experiences that slowly add up. And in some cases, it can seem to come out of nowhere without a clear trigger at all. Because ARFID is a relatively new diagnosis (it was introduced into the DSM in 2013), researchers are still working to fully understand why it develops. What we do know is that, regardless of how it starts, the pattern that follows tends to look very similar. This pattern is often described as a fear-avoidance cycle: Trigger or shift: A distressing experience or gradual increase in fear around eating Fear: “What if something goes wrong?” Avoidance: Cutting out certain foods or eating situations Relief: Anxiety drops when you avoid the feared outcome Reinforcement: Your brain learns that avoidance = safety The challenge is that this loop strengthens the fear of eating over time. “When you're avoiding things, you're limiting your opportunities to challenge any inaccurate or unhelpful beliefs and thoughts around the likelihood of that traumatic event happening again. And you're underestimating your ability to tolerate any distress or discomfort from that,” says Jones. “You get stuck in a cycle of fear and avoidance that can be really difficult to break.” That’s how something that began as a protective response can turn into a pattern that feels hard to break. Are some people more vulnerable to aversive ARFID? Not everyone who has a negative food experience develops ARFID. But some people may be more sensitive to this kind of response. Factors that can increase vulnerability include: Heightened sensitivity to physical sensations (like throat or stomach discomfort) A tendency toward anxiety or strong fear responses Past experiences with choking, vomiting, food poisoning, or allergic reactions Medical conditions that affect swallowing or digestion A history of panic attacks, especially during or after eating For people who have one or more of these risk factors, the body’s alarm system may activate more quickly and stay on high alert for longer, making it harder for the brain to recognize that eating is safe again. Why these fears can feel so real If you’re dealing with aversive ARFID, one of the most confusing parts is how physical it all feels. Before eating, there’s often a sense of dread. While eating, you might notice every swallow, every sensation in your throat or stomach. Afterward, you might find yourself waiting to see if something goes wrong. While this can be distressing, it’s also completely understandable. What’s actually happening is that your brain is trying to protect you—it’s just being a little overactive. Because of a heightened fear response, it starts treating normal sensations, like swallowing or digestion, as signs of danger. Over time, the fear can start to feel less like a possibility and more like a certainty. From the outside, it might look like someone is just avoiding food. But on the inside, it feels like their body is telling them something isn’t safe—and they’re trying to listen. That’s also why simply “pushing through” or forcing yourself (or someone else) to eat often backfires. When the body is in a threat state, pressure can actually increase fear, not reduce it. The good news: This pattern can change. With the right support, your brain can relearn that eating is safe, and those physical and emotional symptoms can start to ease. What are the long-term health risks of aversive ARFID? When fear starts getting in the way of how much you can eat, your body can start to feel it. Even small shifts, over time, can add up. Some of the most common risks include: Nutritional deficiencies: Not getting enough variety can make it harder to meet basic nutrient needs, including vitamins and minerals your body relies on to function well. Low energy and fatigue: When your body isn’t getting enough fuel, it can lead to feeling tired, weak, or mentally foggy. Gastrointestinal issues: Eating less (or eating a very limited range of foods) can affect digestion, sometimes leading to discomfort, bloating, or slowed digestion. Weight loss or difficulty maintaining weight: For some people, intake becomes too limited to support their body’s needs. Delayed growth and development: Restriction during key growth periods can interfere with physical development in children and teens. Cardiovascular effects: In more severe cases, long-term malnutrition can affect heart rate, blood pressure, and overall cardiovascular health. Social and emotional impact: Meals can become stressful or isolating, which can affect relationships, routines, and overall quality of life. Not everyone with aversive ARFID will experience all of these. But these risks highlight why this isn’t something to brush off as “just anxiety” or “just being careful.” The earlier aversive ARFID is recognized, the easier it is to step in and get support before any harmful effects become more serious. If you’re unsure whether what you or a loved one are experiencing could be ARFID, taking a Equip’s clinically validated, ARFID-specific screener can be a helpful first step. What’s the difference between aversive ARFID, anxiety, OCD, and phobias? Aversive ARFID vs anxiety, OCD, and phobias  All of these conditions can involve intense fear and avoidance. But with aversive ARFID, the fear is specifically tied to eating. It starts to affect how much or what someone can eat, to the point that it impacts physical and mental health. With anxiety disorders, the fear is usually broader (like general worry or panic) and not limited to food. With OCD, it’s driven by intrusive thoughts and compulsions. And with specific phobias (like fear of choking or vomiting), the fear is more narrowly focused and doesn’t always lead to ongoing food restriction. That said, they can absolutely overlap—and often do. What matters most is understanding the root cause and getting the right kind of support. How is aversive ARFID treated? Aversive ARFID treatment focuses on helping someone feel safe eating again. “It requires a collaborative approach—a registered dietitian, a therapist, and a doctor or pediatrician are important members of the team,” says Ruberti-Bruning. “The level of care will be based on the medical impacts of ARFID.” Here are common components of treatment. Medical and nutritional support / Weight restoration If someone isn’t getting enough nutrition, the first priority is helping their body get what it needs. According to Pilato, that might mean: Increasing overall intake using “safe” foods Adding nutritional supplements Working toward weight restoration, if needed For kids and teens, it’s usually less about hitting a specific weight and more about getting back on track with growth. And in more severe cases, higher levels of care—like inpatient or residential treatment—may be needed to help stabilize health, says Ruberti-Bruning. Psychoeducation “We pretty much always start off treatment by making sure the patient understands ARFID and how their experience with ARFID plays out,” says Jones. That includes looking at both past and current experiences: what triggered the fear, how it shows up now, and why the pattern sticks. Patients also learn about the nutritional impact of ongoing restriction, which can help make the need for change feel more concrete. In addition, they’re educated about the treatment itself. Patients learn how exposure therapy works and why it’s effective, which helps build trust in the process. “We’re asking them to basically face their worst fears on a regular basis,” Jones explains. “Sometimes, really understanding the rationale can help people shift their perspective.” For younger children, this part of treatment may look different, says Ruberti-Bruning. In family-based treatment (FBT), caregivers take a more active role in helping their child eat, so the focus is less on the child fully understanding the process and more on supporting behavior change at home. Graded exposure therapy  Exposure therapy is the core of treatment for aversive ARFID. Instead of avoiding the fear, the goal is to approach it slowly, safely, and with support. Together with a therapist, patients build a “fear ladder” of foods, starting with what feels most manageable and gradually working up to what feels scariest (for example, going from looking at a feared food to eventually eating it). From there, treatment focuses on working through that ladder step by step. In practice, graded exposure therapy usually involves: Starting with a low-stress food or situation Facing that fear in a small, manageable way (like looking at, touching, or tasting the food) Staying with the experience long enough for anxiety to rise and then come back down Repeating the step until it starts to feel easier Gradually moving up to more challenging foods or situations “This helps the patient prove to themselves that those fears are unlikely to happen, and if they do, they can tolerate them better than they expect they might be able to,” Jones explains. “This supports new learning that counteracts the unhelpful beliefs that are holding them back from engaging in their lives, and it supports a gradual decrease in fear and anxiety over time.” For younger patients, therapists may teach kids about their body sensations in a more playful way rather than using a formal fear hierarchy. They might use fun characters or stories to do this. Pilato says the goal is to help children feel curious about those sensations, rather than afraid. What does recovery look like? For many people, recovery from aversive ARFID starts with small shifts. Eating might feel a little less overwhelming. The “what if” thoughts may still be there, but they feel quieter or easier to move through. Over time, those changes can build. You might notice: More foods start to feel safe Less fear around choking, vomiting, or getting sick Eating becomes more automatic again, instead of something you have to think through Less mental energy spent worrying before, during, or after meals That doesn’t mean the fear disappears completely—there may still be moments where it shows up, and that’s okay. But what’s important is that it feels manageable and doesn’t control food choices or life in the same way. Setbacks can also be part of the process. A difficult experience or stressful period can temporarily bring back the fear. It’s important to remember that this is a normal part of recovery, and doesn’t mean you’re back at square one. With the right support, it’s possible to keep moving forward. When to seek help You don’t have to wait until things feel severe. If eating feels hard or limiting for you or a loved one, that’s reason enough to get support. According to Jones, other signs it may be time to get help include: Avoiding more and more foods or meals Eating feels stressful, scary, or exhausting Weight loss, low energy, or other physical changes Relying on a very small list of “safe” foods Avoiding social situations that involve food Working with a provider who understands ARFID can help you (or your loved one) feel safer around food and start to rebuild flexibility over time. Note that not all providers—even those who specialize in eating disorders—are knowledgeable about ARFID. But true experts are available, and it’s important to seek out an ARFID-informed provider for the best care. The bottom line If eating has started to feel stressful, unpredictable, or even unsafe, you’re not imagining it, and you’re not alone. Aversive ARFID is a real, recognized eating disorder driven by fear, not choice. And while that fear can feel overwhelming (and very physical), it’s also something that can change with the right support. With treatment, it’s possible to rebuild trust with food, expand what feels safe to eat, and spend less time and energy worrying about meals. Frequently asked questions (FAQs) Can fear of choking lead to an eating disorder? Yes, fear of choking can sometimes turn into avoidant/restrictive food intake disorder (ARFID), specifically the fear-based type. If you’ve choked before—or even just feel like you might—it can start to change how you eat. You might avoid certain foods, take smaller bites, or stick to whatever feels safest. And over time, that fear can grow and start to limit what and how much you’re able to eat. What does it mean if someone is afraid to eat? It can mean different things, but in some cases, it’s a sign of ARFID—especially if the fear of food is tied to something bad happening, like choking, vomiting, or getting sick. When that fear starts to affect how much someone eats, what foods feel safe, or their overall health, it’s worth looking into further. Is aversive ARFID the same as anxiety? Not exactly. Aversive ARFID and anxiety can look similar—and often overlap—but ARFID is specifically centered around eating. The fear directly affects food intake and can lead to nutritional or health impacts, which is what makes it an eating disorder.]]></content:encoded>
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            <title><![CDATA[Boys & Men Get Eating Disorders Too: Diagnosing and Treating this Overlooked Population]]></title>
            <link>https://equip.health/articles/understanding-eds/equip-academy-boys-and-men-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/equip-academy-boys-and-men-eating-disorders</guid>
            <pubDate>Mon, 25 Mar 2024 22:27:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. There’s no denying that the United States is in the midst of an eating disorder crisis. Since the start of the pandemic, there’s been a surge in these life-threatening illnesses, not just in the number of people affected but also in their acuity: since Covid-19 first hit, hospitalizations and length of stay have seen a 2x increase, and over half of eating disorder patients experienced worsening symptoms. Perhaps even more alarmingly, nearly 50% of adolescents with an eating disorder have considered suicide. This year alone, 5.5 million Americans will develop an eating disorder, but just 23% will get treatment and an even smaller fraction will get treatment that works. This is particularly difficult to accept, because we know that treatment does, in fact, work. One factor perpetuating this crisis is misconceptions around who gets eating disorders. Despite evidence to the contrary, there’s still a pervasive belief—even among providers—that eating disorders primarily affect thin, white, cisgender women. In reality, this population is just the one most likely to get diagnosed and treated. Eating disorders impact people of all ages, races, body sizes, and genders. Boys and men make up a third of all eating disorder cases, and yet they continue to slip through the cracks. Let’s take a closer look at why that’s the case and what we can do about it.  Eating disorders and cisgender males: an overview While boys and men account for a third of all people with eating disorders, less than 1% of eating disorder research includes males. There’s also significant shame and stigma around eating disorders in males, which interferes with timely diagnosis and treatment. Perhaps predictably, boys and men also report not feeling understood by their providers. Eating disorder symptoms tend to show up differently in males versus females—which perpetuates underdiagnosis—but that doesn’t mean that eating disorders are less serious when they occur in men and boys. In fact, the eating disorder crisis may even be particularly pronounced in males. According to one large study from Canada, hospitalization rates for males with eating disorders increased 416% from 2002 to 2019, and similar trends have been observed in the U.S. Another study found that among patients hospitalized for eating disorders, males tended to be in worse condition. Male patients had longer hospitalizations, lower heart rate, and higher rates of anemia than their female counterparts, likely due to a delay in getting diagnosed and treated as well as their higher macronutrient needs. So how did we get here? Exclusion of male experiences in early diagnostic criteria and research: A domino effect It’s not an accident that boys and men with eating disorders often go undiagnosed and untreated. Rather, there were a series of decisions, events, and tendencies that led us to where we are today. Breaking them down in chronological order, we can clearly see the why behind the current state: Until recently, amenorrhea was listed as essential criteria for an anorexia diagnosis, causing many to go underdiagnosed. An anorexia diagnosis is also predicated on an extreme drive for thinness, fear of weight gain, and emaciation. Males who do get diagnosed with eating disorders are primarily diagnosed “by default” with EDNOS (now known as OSFED). Studies on eating disorders intentionally exclude males, as they were seen as “atypical.” Stigma and challenges with getting a timely and accurate diagnosis further hinder treatment engagement and research efforts around males. Very few residential treatment centers look at treatment outcomes in males. Current screening and assessment tools are not sensitive to the male experience of eating disorders. Symptom expression of eating disorders in males One of the biggest reasons that eating disorders in men and boys get missed is because their symptoms often present differently than they do in females. Providers are used to looking for the more common female symptoms, but many are not familiar with the symptoms that might signal an eating disorder among males. Some of the differences in male presentation of eating disorders as compared to female presentation include: More likely to use anabolic steroids for muscle enhancement More likely to misuse exercise Less likely to misuse laxatives Less likely to use diet pills Eating-related symptoms are muscularity-oriented (i.e. overconsumption of protein-rich foods) vs. thinness-oriented Symptoms are driven simultaneously by acquisition of muscle mass and drive for leanness Greater weight fluctuations Hyperlipidemia common in adolescent males with eating disorders Co-occurring substance abuse more common Equip recently published research on differences in symptom presentation and outcomes across gender. Our study showed that clinical presentation of eating disorders is different in cisgender boys and cisgender girls. Specially, we found that: Cisgender boys are more likely to be diagnosed with ARFID than cisgender girls (41% vs. 11%). Cisgender boys are more likely to have a secondary diagnosis of ADHD than cisgender girls (21% vs. 6%). Cisgender boys are slightly less likely to need weight restoration than cisgender girls (74% vs. 81%). Cisgender boys are less likely to endorse suicidal ideation than cisgender girls (18% vs. 28%). Practice applications for treating eating disorders in males Given all of the above, it’s clear that providers need to adapt their approach in order to better serve male patients who may be struggling with eating disorders. Research has shown that gender-specific adaptations to treatment improve outcomes, and using a gender-specific screening approach will almost certainly ensure that more boys and men get the diagnoses they need. Screening and assessment considerations When screening for eating disorders in boys and men, providers should keep in mind: A male patient’s inability to name or recognize eating disorder symptoms can hinder identification by a provider. The first point of contact for eating disorder treatment in males is usually a PCP (often for gastroparesis, arrhythmias, or low testosterone). It helps if a PCP is attentive, involved, non-judgmental, and avoids use of female-based information and resources. Assess for significant weight fluctuations, and don’t expect low weight or emaciation (though either may be present). There are also some specific assessment tools that can be helpful in screening for eating disorders in men and boys. Specifically: Eating Disorder Assessment for Men (EDAM): This tool incorporates factors that measure symptoms more highly correlated to male behaviors, including depression, body dysmorphia, preoccupation with food, binge eating, and disordered eating. The Drive for Muscularity Scale: A widely used instrument that assesses men’s body image concerns and responses to societal pressure to be lean and highly muscular. Male Body Checking Questionnaire: A questionnaire to measure body checking behaviors in men, such as monitoring changes in muscles and muscle mass. Treatment considerations Treating eating disorders in males requires a different approach than treating eating disorders in females. When you’re considering where to refer a male patient with an eating disorder, it’s important to consider these factors: Male patients often report feeling isolated or unseen in (in-person) higher level of care settings. You can assess the risk of this happening by inquiring about any offerings specific to male patients (like groups, dedicated providers, etc). When available, patient-provider gender concordance (or other shared characteristics) may be helpful in addressing the shame and stigma that many male eating disorder sufferers experience. Providers must often skillfully address issues such as stigma, shame, body dysmorphia, drive for muscularity, maladaptive thoughts, and relationship with exercise. Male patients often warrant more aggressive caloric prescription at baseline, and more frequent escalations in order to achieve medical stability. Eating disorders in males can occur any time from childhood to midlife and later. They are common and serious, but—like all eating disorders—they are fully treatable, as long as providers take the right approach. Schedule a call with our team to refer a patient or learn more about Equip’s evidence-based eating disorder treatment for boys and men.]]></content:encoded>
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            <title><![CDATA[What Do I Need to Know About Eating Disorders in Children?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-in-children-ask-a-provider</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-in-children-ask-a-provider</guid>
            <pubDate>Fri, 10 Feb 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[When you’re seeing a very young patient, eating disorders probably aren’t front of mind. This makes sense, given that eating disorders are often seen as affecting teens and young adults. For the most part, that’s true: the median age of onset for both anorexia and bulimia is 18, while for binge eating disorder, it’s 21. But the truth is that these diseases affect people of all ages, and eating disorders in children are more common than you might think. Very young children—think kindergarten-age—can be diagnosed with anorexia, bulimia, or binge eating disorder, and research shows that eating disorders are skewing younger. This becomes less shocking when you learn that 40-60% of elementary school girls are concerned about their weight or becoming too fat (body image concerns are increasingly common among boys as well). And with Avoidant-Restrictive Food Intake Disorder (ARFID), it’s actually more common than not for the eating disorder to show up in childhood: ARFID generally sets in between age 6 and 13, and accounts for between 14-25% of eating disorders in pediatric treatment settings. Eating disorders are serious and life-threatening, and early intervention is important, especially during the vital developmental years of childhood. As a pediatrician or healthcare provider for kids, it’s important that you have a working knowledge of eating disorders in children. Dr. Amy Rapaport, Medical Director at Equip, answered some of the most common questions on this complex topic. How young can someone be diagnosed with an eating disorder?  A child can be diagnosed with an eating disorder at any age, although the most common time is during adolescence. As early as infancy, a patient can develop food restriction due to an aversion or a traumatic event and be diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID). Binge eating disorder, anorexia, bulimia, and OSFED (Other Specified Feeding or Eating Disorder) can all occur in young children as well. Studies have shown that attitudes around body shape and size may occur as young as the toddler years. Research has shown that attitudes toward body shape and size can begin to develop as early as the toddler years, with children as young as three preferring a thin body shape, and a significant proportion of preschool-age kids expressing anxiety about their weight or body size. These concerns can be particularly pronounced for girls, with 40-60% of elementary school girls saying they are worried about their weight or becoming fat. Which eating disorders are most common in children? All types of eating disorders can occur in children, but the most common eating disorder in young children is ARFID. Unlike patients with anorexia and bulimia, patients with ARFID usually have no body image disturbance. Instead, patients with ARFID have picky eating habits or a general lack of interest in eating. These symptoms may be associated with a child’s aversion to texture, taste, smell, or color of food or it may be associated with a fear of pain, vomiting, or choking. Many young kids with ARFID may have experienced a traumatic triggering event, such as a choking incident, feeding issues as an infant, or an illness like the flu or strep throat. Anorexia and bulimia are more commonly seen after the age of puberty, but disordered eating and body dysmorphia can occur as early as three to four years old. Binge eating disorder, which is defined as recurrent episodes of consuming large amounts of food coupled with a sense of loss of control around eating, can also be diagnosed in childhood. Do eating disorders show up differently in children than they do in teens or young adults? Young children with eating disorders are less likely to have body image disturbances and a fear of being fat than their older counterparts. Children are more likely to present with stomach aches or a lack of interest in eating. Very young children might present with more irritability or tantrums due to inadequate food intake. Instead of rapid weight loss, young children may present with lack of expected height growth and weight gain. One important thing to be aware of is that eating disorders often go undetected if a child is in a larger body. It’s very important to closely monitor a child’s individual growth charts and investigate any change in their height or weight trajectories, rather than just looking at averages. What are some of the specific health risks associated with eating disorders in young children? Given that young children's bodies are growing and developing, when eating disorders occur at this time in their life, nearly every organ system can be impacted. Here are some of the most common health risks specific to young children with eating disorders: Lack of expected growth and delayed puberty Low bone density. Children with eating disorders may not reach their peak bone density, potentially putting them at a higher risk for osteoporosis later in life. Digestive problems. Young children with eating disorders often complain of stomach pains and have constipation and slowed gut motility. Cardiovascular issues. The heart can become smaller and weaker without adequate nutrition, which can make it more difficult to circulate blood at a healthy rate. Children can develop bradycardia (low heart rate), low blood pressure, and abnormal heart rhythms. Malnutrition. In young children, malnutrition can also present with emotional, cognitive, and social symptoms. They can become more irritable and may have increased tantrums, or present with a depressed or anxious mood. Children with eating disorders often have school difficulties, since they’re unable to concentrate and have slowed processing skills due to lack of adequate nutrition. Social interactions with peers can also be affected, as children with eating disorders often become withdrawn. What are the treatment options for young kids with eating disorders?  All treatment options for eating disorders in young children require active involvement of the child’s parents or caregivers. At the outset, it’s important for every caregiver to know that they did not cause their child’s eating disorder, but they are at the center of their child’s recovery. Family-Based Treatment (FBT) is the evidenced-based model that empowers family members to help their loved ones achieve lasting recovery. Initially, family members focus on renourishing their child and helping the child eat throughout the day. They work closely with a treatment team, focusing on nutritional rehabilitation and skill development for the cessation of eating disorder behaviors. Research has shown FBT to be the most successful treatment approach for eating disorders in young people. Unlike older populations, in which patients have more independence and may opt for individual treatment, the young pediatric population requires active family involvement for treatment and recovery. Learn more about FBT and how Equip adapted it to better serve patients virtually.  ]]></content:encoded>
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            <title><![CDATA[Not So “Atypical” Anorexia Nervosa: Clinical History, Diagnostic Considerations, and Treatment Approaches]]></title>
            <link>https://equip.health/articles/news-and-research/equip-academy-atypical-anorexia</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-academy-atypical-anorexia</guid>
            <pubDate>Thu, 25 Apr 2024 16:47:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. When most people think about eating disorders, they think of anorexia, bulimia, or maybe binge eating disorder. But it’s actually a lesser-known eating disorder that has the largest financial impact in the United States. In 2018-2019, other specified feeding and eating disorder (OSFED) cost the country $22.8 billion, or 35% of the $64.7 billion total financial burden of eating disorders. For reference, binge eating disorder cost the country $19.4 billion, while bulimia and anorexia cost $11.4 billion and $11.2 billion, respectively. OSFED is just as serious as other eating disorders, as evidenced by its massive economic toll. So what is OSFED? Put most simply, it’s a catch-all diagnosis used to describe eating disorders that significantly impact a person’s health and life but do not meet diagnostic criteria for another eating disorder. Though it can be used as a general diagnosis, there are several specific diagnosis that fall under the OSFED umbrella, including: Binge eating disorder of low frequency or limited duration Bulimia nervosa of low frequency or limited duration Night eating syndrome Purging disorder Atypical anorexia (AAN) Here, we’ll be looking closely at one of the most misunderstood OSFED diagnoses, atypical anorexia. What is atypical anorexia? Atypical anorexia is a diagnosis that describes someone who meets all of the criteria for anorexia nervosa (AN) except that despite significant weight loss, the individual’s weight is within or above the normal range. Atypical anorexia and anorexia nervosa share many of the same diagnostic criteria, including: Restriction of energy intake relative to requirements Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of illness The primary difference between the two is that in anorexia nervosa, the restricted intake leads to significantly low body weight, whereas in atypical anorexia nervosa, it does not. Additionally, those with anorexia nervosa fail to recognize the seriousness of their illness and low body weight, whereas those with atypical anorexia fail to recognize the seriousness of their illness only (since low body weight isn’t present). Despite the name, atypical anorexia is actually more “typical” than anorexia nervosa: AAN has a lifetime prevalence of 4.9%, as compared to 0.6% for AN. And this number is likely low, given that many people with atypical anorexia are misdiagnosed or undiagnosed due to weight stigma and anti-fat bias in medical spaces. Often, people with atypical anorexia are assumed to have bulimia or binge eating disorder based on their body size alone (if an eating disorder is suspected at all). What’s more, patients with atypical anorexia may even be prescribed restrictive eating behaviors, which can exacerbate symptoms and highlights the confusion that many patients with AAN experience. Because of stigma, misconceptions, and lack of awareness, there’s currently limited research on the effective treatment of atypical anorexia. In fact, atypical anorexia wasn’t even added to the DSM until the publication of the DSM-5 in 2013. Prior to 2013, patients with atypical anorexia presented for treatment, but were often turned away or given a diagnosis of eating disorder not otherwise specified (EDNOS). In an effort to reduce the number of patients diagnosed with EDNOS, atypical anorexia was added to the DSM-5 in 2013 under the new OSFED diagnosis. It’s important to note that patients who met AAN criteria were always there, but were often overlooked by doctors for treatment because there was no established diagnosis that fit their presentation. Is atypical anorexia less serious than anorexia nervosa? The atypical anorexia diagnosis has been referred to as “subthreshold anorexia nervosa” by some researchers, likening it to other OSFED categories of bulimia nervosa of low frequency or duration or BED of low frequency or duration. However, this separation puts patients in danger, because data show clearly that atypical anorexia is just as serious as anorexia nervosa. Patients with atypical anorexia experience: More severe eating disorder symptoms and greater body dissatisfaction Similar rates of suicidality and suicide attempts to those with anorexia nervosa High levels of depression and anxiety, similar to rates among those with anorexia nervosa Atypical anorexia is also more prevalent among cisgender boys/men, BIPOC individuals, and transgender and gender diverse people, all of whom already experience barriers to care. Atypical anorexia comes with many of the same physical health complications as anorexia nervosa, including: Multiple electrolyte imbalances Risk of refeeding syndrome Impaired renal function Bradycardia Hypotension Delayed gastric emptying Impaired liver function Anemia Amenorrhea How do you actually differentiate between AAN and AN? That’s a good question, and we wondered the same thing. To get to the answer, we began by trying to gain clarity about the difference between atypical anorexia and anorexia nervosa. The primary distinction between AN and AAN is that people with AAN are at a weight that is within or above normal range—but there’s no consensus on what this means. In fact, a recent systematic review found that in 75 separate studies of AAN, 29 unique definitions of AAN were used. The four most common definitions for atypical anorexia are: AAN-DSM5: BMI at admission to treatment is greater than or equal to19 kg/m2 for adults aged 18 or older, or above the median BMI for patients under 18. AAN-BMI-18.5: BMI at admission to treatment is greater than 18.5 kg/m2 for adults or over 85% of the median BMI for adolescents and children. AAN-BMI-10th Percentile: BMI at admission to treatment is over the 10th percentile (only relevant for children/adolescents). AAN-DSM5 HLOC: BMI at admission to treatment is greater than or equal to 19 kg/m2 for adults or above the median for adolescents, and they had reported no previous treatment experience beyond outpatient treatment. The BMI thresholds are the same as the DSM-5 definition. However, patients with previous eating disorder treatment at a higher level of care (e.g., treatment at a residential treatment center) were classified as AN even if their BMI was above the threshold, as previous treatment may have resulted in weight gain that would place patient BMI above the threshold.21–23 What does treatment for AAN look like? Little information is available about treatment for atypical anorexia, and few studies have examined effectiveness. Some research supports the preliminary effectiveness of family-based treatment (FBT) and PHP-level care, but this research notes complicating factors related to treatment. A case series examining FBT for AAN described treatment and outcomes for 42 adolescents with atypical anorexia. The research showed symptom improvement and preliminary support for using FBT to treat adolescents with atypical anorexia, but called for more in-depth studies into its effectiveness. Providers who have used FBT to treat atypical anorexia report a few challenges, most notably: Difficulty identifying when an AAN diagnosis is appropriate Pushback in setting target weights for adolescents with AAN Increased need to emphasize seriousness of AAN to families during FBT Equip research on AAN treatment To learn more about what treatment works for AAN—and whether AAN requires a different treatment approach than AN—we conducted a robust study that compared treatment for the two populations. Our aims with this research were to: Compare symptom severity at admission between AN and AAN Evaluate treatment response among AAN patients Compare change over treatment among patients with AN and AAN We used all four of the most common definitions of AAN to ensure that outcomes were not affected by the definition being used. Our patient population included 1,463 patients with AN or OSFED, with a median age of 15.3. Seventy percent were white, and 85.4% were cisgender girls or women. The outcomes we measured were eating disorder symptoms, anxiety, depression, caregiver burden, and weight. The number of patients classified into the AN and AAN analysis groups varied greatly depending on which definition of AAN was used. Some patients were classified as AAN under all four definitions (n = 308), some were classified as AN under all four definitions (n = 299), and a majority were mixed (n = 856). Of the patients classified as AAN, 70.4%-80.7% required weight restoration, compared with 85% to 94% for those with AN, depending on the definition used. Eating disorder symptoms were significantly greater for those with atypical anorexia compared with anorexia for three out of the four AAN definitions. For patients with AAN who required weight restoration, the amount of weight gain required varied depending on the definition used. BMI-10th AAN required the most weight gain to meet target weight (an average of 17.1 lbs). We had three key takeaways from symptoms at admission: Most patients with AAN required weight restoration, regardless of how they were classified Patients with AAN had less weight to gain to meet their target weights, but the average weight to gain was 14+ lbs no matter how we defined AAN Patients with AAN reported more severe eating disorder symptoms than those with AN Upon beginning treatment, there were similarities and differences between patients with AAN and AN. All patients improved with treatment on all measures, and there was no difference in rate of improvement. However, weight gain progressed more slowly for patients with AAN. Since the cut-off threshold between AN and AAN did not have substantial impact on outcomes between definitions, we tested BMI as a continuous variable. If indeed there is a “true” distinction between AN and AAN based on weight status that warrants separate diagnoses, we would expect symptom presentation and outcomes to be associated with BMI. There was no significant association between BMI and symptom presentation or treatment outcomes. Our research showed that there were no differences in treatment response between groups no matter how we defined AAN. FBT created meaningful symptom improvement independent of diagnostic classification or BMI. We suggest that weight status in AN and AAN is, similarly, not a factor requiring diagnostic distinction. Rather, weight status may provide information about the individual’s experience in the world and may be associated with experiences of clinical focus, such as widespread weight stigma, delayed access to care, and praise for weight loss associated with one’s eating disorder.  Implications for practice Although more research is needed to better understand atypical anorexia, how it differs from anorexia nervosa, and how best to treat it, our research does provide some clear implications for treatment of AAN at this point. Considerations for providers treating AAN include: Effectiveness of our treatment wasn’t dependent on classification into AN versus AAN, or BMI There’s growing evidence that AN and AAN may be treated in the same or similar ways Comprehensive Health At Every Size (HAES) training for providers and HAES-informed practice may especially benefit patients with AAN Despite the fact that our study showed no significant differences between treatment effectiveness for patients with AAN vs AN, there are some unique factors that apply to treatment for patients with AAN. Although it’s not diagnostically important, weight may impact patients’ experience with their eating disorder, as patients at higher weights often experience the compounding effects of weight stigma. This can manifest in a number of different ways throughout the trajectory of their illness. During the development of the eating disorder Provider pathologizes body and weight Dual messaging from family and medical community Provider-recommended weight loss Pre-treatment Provider may not notice eating disorder Missed screening opportunities Provider discounts or minimizes eating disorder Provider encourages or congratulations eating disordered behaviors Delayed diagnosis and/or limited access to care During treatment Provider minimizes or denies eating disorder Misdiagnosis and missed symptoms Provider encourages eating disorder Weight stigma in higher levels of eating disorder care Systemic issues of weight bias Reluctance by caregivers or support people to engage with or support treatment Increased fear or grief related to weight gain in recovery Post-treatment Provider now acknowledging eating disorder Weight/weight loss-focused care Aftercare may trigger relapse Overt weight discrimination Systemic issues of weight bias Working with patients with AAN and their families means being aware of these unique experiences and being able to address them. It also means paying attention to other identities that may intersect with body size and impact patients’ experiences, and incorporating these factors into treatment, relapse prevention, and recovery planning. From our research, we make three recommendations: AAN should not be a separate diagnosis from AN. Current diagnostic codes are not clinically useful and perpetuate fatphobia. AN should be an appropriate diagnosis no matter weight, BMI, or body size. Atypical anorexia is a very serious eating disorder, but it is also fully treatable—as long as providers learn how to recognize it and take the above considerations into account during treatment. Schedule a call with our team to refer a patient or learn more about Equip’s evidence-based eating disorder treatment for atypical anorexia.]]></content:encoded>
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            <title><![CDATA[How Do Eating Disorders Affect Physical Health?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-impact-on-physical-health</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-impact-on-physical-health</guid>
            <pubDate>Tue, 18 Oct 2022 14:03:00 GMT</pubDate>
            <content:encoded><![CDATA[While eating disorders are mental illnesses, they’re inextricably linked to the body. They not only shape a person’s thoughts, feelings, and mood, but can also have a significant impact on physical health. Some of these consequences can be obvious, while others may be invisible without a medical evaluation. Eating disorders are the second deadliest mental illness, and because you can’t always tell whether someone is in danger of developing a life-threatening complication, it’s essential to be informed about their health risks. How do eating disorders affect mental health? Because malnutrition affects the brain, eating disorders can lead to or amplify pre-existing mental health challenges like depression, anxiety, and/or obsessive-compulsive disorder. Eating disorders can affect mental health in other ways as well, such as contributing to insomnia, which disrupts emotions and reduces resilience to stressors. Low self-worth, perfectionism, black-and-white thinking, and shame are some common emotional struggles experienced during an eating disorder. Others may experience grandiose thinking and be unable to perceive circumstances accurately or empathize with others.  Because eating disorders thrive in secrecy, they tend to foster a loss of authentic connection with friends and family, while emotional dysregulation interferes with relationships. Online "thinspo" and diet culture content can create an isolating bubble of harmful messages that also take a mental toll.  Having an eating disorder also increases a person’s vulnerability to substance use disorders and raises the risk for suicide. Eating disorders affect the body from head to toe In addition to affecting mental health, eating disorders can take a serious toll on the body. Although this is not an exhaustive list of the physical impacts, some of the more common medical complications seen in patients with eating disorders include: The brain and nervous System Loss of brain matter from malnutrition, which can impair memory and cognition Changes in the brain’s response to external rewards, which can reinforce eating disorder habits The face Damage to the esophagus and teeth from stomach acids found in vomit Puffy cheeks due to swelling of the salivary glands from vomiting Lanugo, a fine downy hair that can grow on the body to compensate for insufficient body fat to regulate temperature The reproductive system Amenorrhea, the loss of a period in someone who should be menstruating Decreased testosterone in males Fertility problems due to lack of menstruation and ovulation The skeletal system Stress fractures from malnutrition and overexercise Osteopenia and osteoporosis (decreased bone mass) Stunted growth that deviates from expected growth chart The digestive system Gastroparesis, the slowing down of the digestive system due to insufficient food intake. This condition can cause nausea, reflux, vomiting, bloating, and early fullness while eating. Constipation Abdominal pain The cardiovascular system Low heart rate (bradycardia) Fainting from low blood pressure upon standing (orthostatic hypotension) Heart rhythm abnormalities Other internal organs Inflammation of the pancreas from malnutrition and purging Liver inflammation from malnutrition Kidney damage from dehydration The skin and hair Dry, brittle hair and hair loss Lanugo Calluses on hands from self-induced vomiting Orange discoloration of the skin from excessive consumption of certain foods (e.g., carrots and sweet potatoes) Can physical effects of eating disorders be reversed? Every body reacts differently to malnutrition and other eating disorder behaviors such as vomiting and overexercise, and undoing the effects will be similarly unique to each person. In a great deal of cases, nutritional rehabilitation can resolve many physical symptoms over time. There are, however, a few possible exceptions. If malnutrition persists for a prolonged period of time, it may not be possible to fully correct bone density loss with nutrition and weight restoration — yet another reason why it’s important to get prompt treatment. Because a lack of menstruation can contribute to bone loss and osteoporosis down the line, it’s very important for period-having people to get to a weight where they menstruate naturally. A common but misguided way to treat amenorrhea is to prescribe hormonal birth control. It’s vital to know that this approach can create what is known as “withdrawal bleeding,” which is not a true menstrual period that would indicate proper reproductive functioning. If malnutrition persists, hormonal medications like birth control do not improve bone density. Nutritional rehabilitation and weight restoration give people of all genders the best chance of restoring their health, including their hormonal and reproductive health. Treatments such as crowns and veneers are available to improve the function and appearance of the teeth, though dental damage may be irreversible. What if my loved one doesn’t believe their health is at risk? It’s worth noting that someone can be very ill with an eating disorder but have no obvious physical symptoms; bloodwork and vital signs may even be in the “normal” range despite severe illness. Many patients feel they aren’t “sick enough” to need treatment if they don’t have certain medical complications. On the other hand, someone with obvious health impacts can still struggle to accept or acknowledge they need help, especially if they are suffering from anosognosia, the inability to recognize their own mental illness. Eating disorders are serious, potentially fatal illnesses that affect the entire person, inside and out. Everyone suffering from an eating disorder deserves treatment to address the physical and psychological effects — and to help them build a strong recovery and a life worth living. That process can take time and almost always takes a village. In addition to a professional treatment team, the support of family and friends can make all the difference in helping someone heal both body and mind.]]></content:encoded>
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            <title><![CDATA[To Disclose or Not to Disclose? Holiday Conversations During Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/holiday-conversations-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/holiday-conversations-eating-disorder-recovery</guid>
            <pubDate>Mon, 14 Nov 2022 23:55:00 GMT</pubDate>
            <content:encoded><![CDATA[For those in the midst of eating disorder recovery, holiday gatherings can be particularly anxiety-provoking. What if an aunt or uncle comments on weight gain or loss? What if a cousin can’t stop talking about their latest crash diet? What if another family member offers up a well-intentioned but triggering remark (“You look so good now!”) or a common but cringe-worthy holiday refrain (“Ugh, I’m so full, I feel sick.”)? If you’re helping someone through recovery or in recovery yourself, these looming social events raise important questions: should you tell your family and friends what’s going on? If so, what should you share? And what can you do in the moment to make the inevitable challenges easier for you or your loved one? We spoke with experts in the field to answer these questions and more. Read on to learn how you can work with your support network to set crucial boundaries, navigate thorny topics with confidence, and actually enjoy the holiday season: 1. Often, the best move is to say something While it can feel daunting at first, speaking up is often an effective way to put you or your loved one's recovery first. You may want to consider reaching out to friends or family members ahead of a get-together to discuss boundaries. “There’s nothing wrong with speaking to family members and loved ones prior to the gathering and asking them to refrain from any triggering topics,” says Equip Family Mentor Laura Cohen. “Make sure to provide examples, because they really may not realize things that could be triggering.” Erin Parks, Ph.D., Equip Co-Founder and Chief Clinical Officer, adds that anticipating and meeting family members’ needs in advance can be critical to a successful gathering. For example, Parks says, imagine that you have an aunt who spends all day cooking and needs to get effusive praise on her food. “So say, ‘Aunt Cathy, Sam is having a really hard time with food right now—your cooking will be amazing as always, but Sam isn’t going to compliment you on it. Please don’t take it personally—food is just a really hard thing for him right now,’” Parks advises. “If your loved one is going to look different—thinner, heavier, etc—say, ‘Hey, so excited to see you. I want to give you a heads-up that Sam looks a little different than the last time we saw you. I really need you to not comment on him physically in a good or bad way."  If you're worried about receiving comments about your own body, you can see if a trusted family member would be willing to ask family members not to make comments, or try changing the subject right away.  Equip Patient Experience Manager Amanda DuPont says she thinks it’s important to discuss expectations ahead of time. “It's not fair to get upset that your partner, parent, or friend didn’t back you up when diet culture talk came up at the dinner table, if you didn't let them know in advance that you needed their support,” she says. By being honest and open about your needs, you give those around you the opportunity to support you through difficult moments. 2. Prepare for push-back… and stay strong When talking with family members ahead of time, you don’t owe them the full diagnostic or treatment status of you or your loved one; you can just tell them about the current challenges and what you need from them. Of course, you can't control their reaction to that. Some family members will respect boundaries around diet and body talk with no questions asked…and some will have a lot of questions or unsolicited commentary. For parents of children with eating disorders, the message can be as simple as ‘My kid is having a hard time right now with food,’" Parks says. If you're struggling yourself, you can explain you've been having issues around eating, and be upfront with your needs. Either way, “Have realistic expectations. Every one of these conversations isn’t going to be great. That’s not the goal. The goal is to get through them.” If a family member interrogates the situation or poses a long list of follow-ups, remain calm but stay firm. “Validate, then reassert the boundary,” Parks says. “Say, ‘This is so confusing, it makes sense that you have a lot of questions. I had a lot of questions when this first started, too. I’ll send you over some articles that kind of helped me understand it. Can we schedule a time to talk after we get through the holidays? Now’s not the right time.’”   3. Prepare anti-diet culture talking points “Even for those who are recovered, it can still be challenging to hear the unsolicited body and food commentary that seems to accompany the holiday season,” Dupont says. Still, regardless of who you choose to tell or not tell about your you or loved one’s eating disorder recovery, people are bound to say problematic things (often unintentionally). From “Diet starts tomorrow!” to “I’m so glad I worked out so I can have dessert,” diet culture is so deeply ingrained in our society that DuPont says it can be super tough to even notice it when it comes up—especially if you’re not sure what to look for. DuPont says that the actual strategies for setting boundaries around diet culture talk will look different depending on one's comfort level with confrontation, the audience, the age of the person in recovery, and whether or not those involved know the person has an eating disorder. “When those topics or phrases arise, it’s completely acceptable to say something like, ‘I’ve been working towards not assigning morality to foods—food is not good or bad, it is just food,’” DuPont says. “Or ‘I prefer to enjoy my food without assigning guilt—it's been a really powerful new approach to food for me.’” Another way to put the kibosh on diet talk is to be as straightforward and blunt as possible. “One could also say, ‘I don't find those types of comments about food to be helpful’” DuPont says. “Or ‘I enjoy focusing on the joy of the holiday and the experience of being together, instead of the calorie count.’” If the person in treatment does not feel comfortable confronting someone when these phrases arise, it can be helpful to have them designate a point person to speak up on their behalf if and when the conversation goes that way. She says it's also reasonable to simply remove yourself from the conversation if the environment is not supportive of your or your loved one's recovery journey: “It's okay to walk away and I think people forget that sometimes, especially when it might encroach on a tradition.” Download a set of coping cards from Equip that you can either print out save to your phone to help encourage you in moments of stress. 4. Control what you can: your own reactions No matter whether you tell everyone in your network or only a few, the reality is that you can’t fully control other people’s words or behaviors—but you can control your reaction to them. That’s where mental and emotional preparation becomes invaluable. One of the best ways to plan appropriate boundary-setting is to anticipate a variety of potential scenarios that may arise at family functions, and practice strategies for handling them. Try to schedule calming, stress-reducing before and after big events so that you or your loved one have some space to process any emotional reactions. You can also decide on a codeword with your loved one that signals a break is needed, or it's time to leave altogether.   Ultimately, who you tell—if you tell anyone at all—will depend on your holiday plans, your family dynamics, and where you or your loved one is in recovery. The main thing to remember is that while confrontation and boundary-setting may be uncomfortable, your priority this holiday season is not other people’s comfort: your priority is helping getting through the challenges ahead while continuing to work toward recovery. By focusing on that this year, you’ll have many more in the future where you can embrace all the trappings and traditions of the season. If you or your loved one are looking for extra support, there's virtual treatment options that can help you get the care you deserve right where you are. Schedule a consultation to learn more. ]]></content:encoded>
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            <title><![CDATA[Eating Disorders and Alcohol Use: The Unexpected Connections]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-and-substance-use</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-and-substance-use</guid>
            <pubDate>Thu, 04 Apr 2024 17:49:39 GMT</pubDate>
            <content:encoded><![CDATA[Alcohol and eating disorders are very connected. Fifty percent of people with eating disorders have also abused alcohol or illicit drugs. Perhaps even more surprising is what that statistic means: the rate of substance use disorders in people with eating disorders is five times higher than in the general population. The numbers go both ways: 35% of individuals with substance use issues have also had an eating disorder (eleven times higher than the general population). Let's look more closely at the relationship between eating disorders and alcohol use. Why do eating disorders and alcohol abuse so frequently go together? "Many people with eating disorders use food restriction and binge eating as a way to regulate emotions, albeit temporarily," says Cara Bohon, PhD and Senior Vice President of Clinical Programs at Equip. "We see the same thing in substance use disorders, where substances are used to self-medicate from particularly strong negative emotions. And these things work in the moment, but often lead to new emotions of guilt or shame or biological responses of hunger, fullness or chemical dependence and withdrawal. The new emotions then lead to more eating disorder behaviors or substance use, causing a cycle that is difficult to stop without a supportive environment." Writer and advocate Lindsey Hall is in recovery from an eating disorder and has publicly spoken about “drunkorexia,” meaning the role alcohol played in her anorexia and bulimia. Hall says that people aren’t often aware of the overlap between eating disorders and substance abuse, but based on her own experience, the conditions can coincide for many reasons. “A lot of people worry about calories in alcohol and there are plenty of people deep in an eating disorder who don’t drink for that reason alone,” she says. “But I think there are a lot of us who struggle with anxiety or impulse control or self-destructive behaviors. So we drink to navigate the eating disorder by trying to silence its raging screams in our head that go on all day every day.” Eating disorder and alcohol use disorder risk factors Hall isn’t alone: research suggests that eating disorders and substance use disorders may frequently co-occur because they share some key risk factors. As one multicenter study found, individuals with eating disorders and alcohol use disorders (AUD) reported, some of the most common risk factors for both eating disorders and alcohol use disorders are: Depressive and anxiety disorders Certain personality disorders Impulsivity Perfectionism traits Family history Low self-esteem Childhood trauma Post traumatic stress disorder (PTSD) The relationship between trauma and these disorders is worth highlighting. In fact, people with both an eating disorder and substance abuse disorder have higher rates of childhood trauma and post traumatic stress disorder (PTSD) than those with either disorder alone. Bulimia and alcohol use disorder Bulimia nervosa is an eating disorder where someone uncontrollably eats a lot of food at once (called bingeing) and then tries to get rid of the food through vomiting, laxative misuse, or excessive exercise (called purging.) It’s also possible to binge drink, which is defined as 4 or 5 drinks within a short period of time for women and men respectively. Bulimia and alcohol use disorder are some of the most common co-occurring conditions. For people who experience both bulimia and AUD, they may binge on both food and alcohol, and then purge both as well. Binge eating disorder and alcohol use disorder Binge eating disorder (BED) is the most common eating disorder in the U.S. It’s defined by persistent “bingeing” behavior, meaning eating a large amount of food with a feeling of being out of control. Unlike bulimia, it doesn’t include purging behaviors. For people with BED and AUD, they may feel like one behavior triggers another. For example, drinking excessively may lead to an intensified craving to binge eat. Alternatively, a binge eating episode often leads to feelings of shame which someone may drink alcohol in an effort to numb those feelings. Anorexia and alcohol use disorder Anorexia nervosa is an eating disorder characterized by extreme food restriction and fear of weight gain. There are two subtypes of anorexia: restricting and binge/purge subtype. Those who fall into the binge/purge category may develop alcohol use disorder due to shared risk factors of impulsivity and binge cycles. For those who fall into the restricting subtype, it can be common for people to use alcohol as a way of suppressing appetite. It’s also worth noting that drinking can change your metabolism, and in extreme cases this can lead to malnutrition which could exacerbate an existing eating disorder. Vise versa, drinking heavily while restricting food intake can cause the effects of alcohol to be accelerated. What is “Drunkorexia?” Drunkorexia is a non-diagnosable slang term that refers to the concept of eating less in order to consume more calories through drinking. This practice is incredibly dangerous and can have long-term side effects, including the development of an eating disorder and/or alcohol use disorder. Diet culture and drinking pressures may contribute to the desire to practice “drunkorexia,” and getting to the root of these factors may help in breaking out of this harmful behavior.  How substance abuse can become intertwined with the eating disorder Substances and eating disorder behaviors serve a similar purpose, and at some point, these behaviors were effective. If you are feeling difficult emotions—guilt, sadness, frustration, worry—drinking, binge eating, vomiting, shoplifting, or having a tantrum will provide some instant relief. These are sometimes called “maladaptive” behaviors because while they work, in the long run, they create more problems than they solve. If someone has found comfort in these maladaptive behaviors and it has worked as a tool to help manage emotions, there eventually comes a time when this “tool” becomes problematic and the person tries to stop. Unfortunately, even if someone stops drinking, they can’t stop hard emotions. And it may become even more difficult to experience hard emotions because of the lack of practice. The easiest thing to do is to choose another maladaptive behavior. This becomes “whack-a-mole” like the old arcade game: when one mole goes down, another pops up. People start using substances when they are trying to stop bingeing and purging, or use eating disorder behaviors when they are trying to become sober. It is the definition of a vicious cycle. How to treat co-occurring eating disorders and alcohol abuse For long-term recovery, eating disorders and substance use disorders (SUDs) need to be treated simultaneously. We know that for many patients, it can be tempting to get treatment for only one—and in certain cases, it may make sense to focus on one condition initially in order to ensure patient safety and the effectiveness of treatment overall (for instance, if someone cannot show up to eating disorder treatment sober, we would need to prioritize substance use disorder treatment). But in most cases, addressing both conditions at once leads to better, more sustainable results—and choosing one over the other can backfire. For instance, someone may decide to get treatment for alcohol use, and then become less willing to part with their eating disorder, which is a more culturally acceptable coping mechanism. Many people go into treatment for one disorder, and when they come out the other disorder becomes more prominent. If you're struggling in these ways, it’s important that you simultaneously get treatment for both your eating disorder and your substance use. And families: help your loved one to find treatment providers that recognize the two are inextricably linked. In treatment, you will learn skills that combat all your urges, so that in recovery you aren’t replacing drinking with eating disorder behaviors, nor replacing eating disorder behaviors with using substances. In recovery, you will be replacing all the behaviors that don’t serve you, with things that bring you closer to joy and the life that you want to live. If someone you love is already struggling with an eating disorder, substance use disorder, or both, comprehensive support and evidence-based treatment is key. ]]></content:encoded>
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            <title><![CDATA[Autism and Eating Disorders: What to Know and How to Provide Support]]></title>
            <link>https://equip.health/articles/understanding-eds/autism-in-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/autism-in-eating-disorder-recovery</guid>
            <pubDate>Fri, 29 Apr 2022 02:13:23 GMT</pubDate>
            <content:encoded><![CDATA[We know that eating disorders often come with co-occurring conditions, like anxiety, depression, ADHD, or OCD. But what's talked about less is the connection between eating disorders and autism—and understanding this connection is essential for getting the right support to every person with autism who struggles with an eating disorder.  Equip Peer Mentor Zaynah Mahon says she spent most of her life not understanding why school, social events, and everyday stimuli were so overwhelming. “I felt incredibly different from everyone else,” she says. It wasn’t until Mahon was diagnosed with autism in her mid-twenties that some of the immense struggles of her younger years began to make sense. “Because of my ability to mask my autistic traits, I looked like every other teenage girl on the outside,” she says. “I was second in my high school class, I had a group of friends, and I always put on a smile, even while overwhelmed.” Before Mahon received an official autism diagnosis, she realized she had another serious challenge to contend with in the form of an eating disorder. “Recovery has been challenging because I am a rule-bound person,” she says. “Once I started letting go of ‘food rules,’ I created my own set of ‘recovery rules.’ Because black-and-white thinking is a huge part of the way my brain works, I started to tell myself things like ‘I'm only in recovery if…’ or ‘recovered people don't ever miss meals or always listen to their bodies.’ This type of thinking was and still is quite frustrating because it puts my recovery in a box, when in reality, my recovery will change as I get older. I often have to ask myself, ‘Is this autism or a past eating disorder thought?’” Mahon has worked hard to honor her autism and eating disorder recovery at the same time, and she has been successful. But her experience speaks to the often overlooked and complex interplay of neurodiversity (i.e. the wide spectrum of ways people think, learn, and act due to different ways that people’s brains work), autism, and eating disorders.  Understanding the link between autism and eating disorders According to the Autistic Self Advocacy Network, a nonprofit organization run by and for autistic people, Autism Spectrum Disorder (ASD), is “a developmental disability that affects how we experience the world around us. Autistic people are an important part of the world. Autism is a normal part of life, and makes us who we are.” ASD can include everything from Asperger's Syndrome and Pervasive Developmental Disorder – Not Otherwise Specified [PDD-NOS]), and the experience of living with autism can be different for each person, which is why it’s considered a spectrum condition. Just like eating disorders, there is no single cause of autism, and receiving the right diagnosis and configuring appropriate, individualized treatment may require a multi-pronged approach. “It's so complicated,” says Equip peer mentor Alexander Thixton. “Being autistic in recovery from anorexia, especially when I spent the majority of that time not knowing I was autistic, I dealt with some unique challenges.” For Thixton, some of those challenges included the stress of routine changes which can lead to “autistic burnout,” i.e. chronic exhaustion, loss of skills, and lowered tolerance for stimuli. But recovery also led to some interesting realizations (“like the fact that diet culture was definitely part of masking for me”) and some unexpected advantages (“like being so drawn to routines and structure that, once I was sold on recovery, I had my own little recovery whiteboard to keep track of progress”). About 1 in 44 children have ASD, and while boys are four times more likely than girls to be diagnosed with autism, people of all racial, ethnic, and socioeconomic groups can be affected. The disparity among boys and girls may even be misleading, according to newer research that indicates classic diagnostic methods may miss the signs of autism in girls, which can be more subtle or less typical than those in boys. Studies have shown that about 70% of young people with ASD present with at least one co-occurring disorder and research indicates there does seem to be an elevated risk of anorexia in autistic women, specifically. Equip therapist Carly Knauf, PsyD, who has worked with ASD individuals for over 14 years in a variety of settings including Ascendigo Autism Services and the nonprofit, REVEL. “Over the years I have worked with amazing individuals on the spectrum who have often been overlooked, misdiagnosed, or misunderstood. Understanding the uniqueness of each person along with their specific concerns, needs, and struggles is vital when supporting them on their journey towards success and recovery. I believe that clients are experts on themselves and therapy is most effective when it’s collaborative and strength-based,” she says. While Equip peer mentor Kelsey Gilchriest has not been diagnosed with ASD, she says being neurodivergent has impacted her eating disorder recovery in specific, nuanced ways. “My nervous system is more sensitive than most; when I become dysregulated, it impacts many areas of my life, including eating and my appetite,” she says. “I have learned that I have to take extra steps to maintain recovery, and that for me, my recovery may look different due to my neurodivergence.” Equip Vice President of Program Development, Jessie Menzel, says she commonly sees ASD and neurodivergence within the context of eating disorders, and has observed many points of overlap in the conditions. “There are many traits that overlap between restrictive eating disorders and autism, like rigid, inflexible thinking, intolerance of uncertainty, sensory sensitivity, social difficulties, and poor interoceptive awareness,” she says. “The increased rigidity and inflexibility of thinking, in particular, can often make changing eating behaviors more difficult.” How autism and neurodivergence can impact eating disorder recovery Gilchriest says that her experience as a neurodivergent person made eating disorder recovery particularly challenging because of the expectations she had for her physical and mental progress. “I remember being so frustrated with my body for not responding ‘normally’ to things others seem to have no trouble with, or having to do things to regulate my body that others didn't have to,” she says. “I had to learn that it's not my body's fault for needing these things; it's just existing in a culture where productivity and pushing through pain and exhaustion are valued over resting and soothing our bodies. “I wish more people knew that neurodivergent folks need to operate in the world differently than others, and that there is nothing wrong with that.” Knauf says that after years of working at the intersection of autism and eating disorder recovery, she has a three-fold wish for the future of treatment: 1) to expand the general population’s knowledge of autism, neurodivergent minds, and eating disorders, 2) to make individual lived experiences more mainstream (like the writing of author Jennifer Cook), and 3) to update public education and research on mental health concerns and eating disorders. “An estimated 46-89% of children with autism have feeding problems, so we know there is a need for more support, services, and understanding,” she says. “Research is lacking in this developing area and clients deserve a better understanding of the intersectionality of ASD and eating disorders so we can continue to establish best practices and provide invaluable resources.” Menzel says it’s essential for autistic patients and their families to know that recovery from an eating disorder is possible. “For parents and patients alike, use your knowledge of autistic traits to guide your approach to recovery,” she says. “Things like a desire for routine or predictability may indicate that structured mealtimes and a pre-planned menu may be helpful. Don't be afraid to advocate for yourself or your child and make sure that your autistic traits are part of your plan for recovery.” As for Mahon, she wishes for individuals with any form of neurodivergence or ASD, as well as their families, to learn to celebrate their uniqueness. “My advice would be to radically accept the cool, quirky, awesome person that you are or your loved one is,” she says. “You are who you are and you don't owe the world ‘normal.’ After I accepted this, I was able to really settle into my recovery. Making a Venn diagram of the traits you have and your eating disorder behaviors might be helpful in figuring out where things overlap. Taking time to use your favorite fidgets, engage in your special interests, or spending time snuggled with a weighted blanket can all be ways to honor your autistic self and use skills against the eating disorder.” *Note: this article uses both identity-first and person-first language when referring to patients part of the autism community at Equip. However, at Equip, when working with patients, we are always proactive to determine what language the patient themselves prefers. If a patient prefers person-first language then Equip providers accommodate that request, and the same in regards to identity-first language.]]></content:encoded>
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            <title><![CDATA[Anorexia vs. Bulimia: Identifying the Differences and Getting Help]]></title>
            <link>https://equip.health/articles/understanding-eds/anorexia-vs-bulimia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/anorexia-vs-bulimia</guid>
            <pubDate>Wed, 15 Oct 2025 23:41:00 GMT</pubDate>
            <content:encoded><![CDATA[Many people mistakenly believe that anorexia and bulimia are essentially the same illness, with a few small differences. And while it’s true that the diagnoses have a fair amount in common, they vary significantly when it comes to symptoms, behaviors, risk factors, health impact, and treatment approaches. Understanding those differences can be essential for getting the right help—and finally recovering from disordered eating. In this article, we’ll cover everything you need to know about both anorexia and bulimia, so you or your loved one can get the right care. What is anorexia? Anorexia nervosa is an eating disorder that causes people to severely limit how much food they eat (skipping meals, fasting, only eating low-calorie foods, etc.), resulting in dangerous weight loss. In some cases, this weight loss can be so severe that it’s life-threatening: anorexia has the highest mortality rate of any psychiatric disorder, with approximately 5% of patients dying within four years of the diagnosis. Unlike ARFID, another eating disorder characterized by food restriction, anorexia isn’t about pickiness or lack of interest in food. According to the DSM-5, people with anorexia limit their food intake due to an intense fear of gaining weight, often accompanied by a distorted self-image (called “body image disturbance”). “Those with anorexia can point out anyone around them who's too thin or who doesn't look healthy, but they really struggle to see their own self in that same light," says Maria La Via, MD, Director of Psychiatry at Equip. "I always tell people that body image disturbance is like looking at yourself in a fun house mirror.” It's important to note that while this eating disorder is most commonly diagnosed in girls and women, men and boys can struggle with anorexia, too. Similarly, it can affect people of any age (including children), race, or body size (you do not need to be underweight to have anorexia—more on that below). The 3 types of anorexia nervosa While many people think of anorexia as a single condition, mental health professionals recognize that it can show up in different ways, and change over a person's life span. In fact, there are three distinct subtypes of anorexia. Anorexia nervosa restricting type (AN-R) Anorexia nervosa restricting type is what most people picture when they think of anorexia. It is characterized primarily by extreme food restriction, sometimes alongside disordered exercise behaviors, both of which are driven by a fear of weight gain and body image distress. “These are people who really minimize what they eat and exercise to decrease weight,” says La Via. This might look like skipping meals, eating only very low-calorie foods, and working out excessively. Like with other eating disorders, those with this type of anorexia will often try to hide their behaviors from others. “They’ll put in an effort in social situations to look like they're eating even when they’re not,” La Via says. “They might push things around on their plate, or claim they're not hungry or have eaten prior.” Anorexia nervosa binge-eating/purging type (AN-BP) People with anorexia binge-purge subtype limit their food intake, like those with anorexia nervosa restricting type. But they also experience episodes of binge eating—or uncontrolled overeating—followed by behaviors that are meant to “undo” the amount of calories they’ve consumed, called “purging.” “Purging could involve throwing up, using laxatives, diuretics or water pills, or excessively exercising. Essentially, it's any compensatory behavior to ‘make up’ for binge eating,” says La Via. Atypical anorexia nervosa (AAN) In the Diagnostic and Statistical Manual of Mental Disorders (DSM), atypical anorexia officially falls under the diagnostic umbrella of OSFED, not anorexia—but it is a form of anorexia. People who struggle with this type of anorexia exhibit all the psychological and behavioral symptoms of anorexia—body image disturbance, food restriction, etc.—but remain within or above a "normal" weight range. The term “atypical anorexia” is actually misleading, as this subtype is actually more common than the other types of anorexia: it affects up to 4.9% of people, while the lifetime prevalence for the other two subtypes is estimated to be 0.6% “A patient of mine who had been over 300 pounds lost half of her body weight, but because 150 pounds for her height was considered normal for her age, sex, and height, she didn't technically meet the criteria for anorexia nervosa. But, in every other way, she behaved like someone with typical anorexia nervosa,” says La Via. It’s important to note that AAN carries almost all of the same mental and physical health risks as AN-BP and AN-R. What is bulimia? While bulimia and anorexia can both involve body image disturbance and restrictive eating, they are different diagnoses. Similar to anorexia, bulimia can involve restricting food, but it is primarily characterized by a repeated cycle of binge eating followed by compensatory behaviors to "undo" what was consumed. These purging behaviors can take a variety of different forms, including self-induced vomiting, misuse of laxatives or diuretics, or excessive exercise, among others. "A lot of my patients have what's called their 'witching hour,' or when they engage in these binge-purge behaviors," says Debra Spector, MS, RDN, CDN. "The most common 'witching hours' I find in my practice are after school or at night after long periods or days of restriction." It's important to understand, Spector explains, that bingeing is distinct from simply overeating: "Bingeing always has an emotional component and intentionality to it that’s not associated with overeating.” According to the DSM-5, a formal diagnosis of bulimia requires at least one binge/purge episode a week for three months. And while this eating disorder can emerge at any point in the lifespan, the median age of onset is around 18 years old. Research also shows that 68% of people with bulimia have at least one anxiety disorder, and about 30% of people have a co-occurring substance use disorder. What's the difference between anorexia binge-purge type and bulimia nervosa? The most important distinction between anorexia and bulimia is weight. “Bulimia nervosa can look like anorexia nervosa binge-purge type, except for the fact that those with anorexia nervosa are significantly low in weight. With bulimia nervosa, people tend to be in a relatively healthy weight range,” says La Via. Health risks of anorexia vs. bulimia Both anorexia and bulimia are serious health issues that can severely impact a person's ability to function and thrive—and they both present specific health risks that are important to understand. Health risks of anorexia: Bone loss and osteoporosis Heart problems (bradycardia, arrhythmias) Hair loss and brittle nails Amenorrhea (loss of menstruation) Muscle wasting Kidney problems Hypothermia and cold intolerance Cognitive impairment Death Delayed puberty Health risks of bulimia: Dental erosion and tooth decay (from vomiting) Electrolyte imbalances (potentially fatal) Dehydration Swollen salivary glands Chronic sore throat Digestive problems and constipation Heart irregularities (from electrolyte disruption) Chronic fatigue Summary of key differences between anorexia vs. bulimia It’s important to understand that eating disorders are complex and nuanced, and can manifest differently from person to person. It’s also common for those struggling to move from one diagnosis to another before they get help. That said, the chart below provides a simplified, at-a-glance overview of the differences between anorexia and bulimia.  Is anorexia treatment different from bulimia treatment? Both anorexia and bulimia require multidisciplinary care, or collaborative support from a team of professionals like medical doctors, therapists, dietitians, and sometimes psychiatrists. Likewise, both require evidence-based treatment modalities and ongoing professional support for full recovery. Below we explore some of the key similarities and differences between treatment for anorexia and bulimia. Primary focus Because people with anorexia are often severely underweight, immediate medical stabilization and weight restoration (or weight gain) are typically the primary focus. After that, people often work with a registered dietitian to develop meal plans and strategies for eating, with the goal being to establish regular eating habits. With bulimia, weight restoration is rarely needed since most people maintain a normal weight. Instead, clinicians will focus on normalizing eating patterns, reducing binge episodes, and stopping purging behaviors like vomiting or laxative use. Therapeutic modalities There are a number of evidence-based treatment modalities for eating disorders, and many can be used for both anorexia and bulimia. Family-based treatment (FBT) is the gold standard modality for treating eating disorders in young people, and this will typically be the first line treatment option for young people with both anorexia and bulimia. For adults with anorexia and bulimia, both enhanced cognitive behavioral therapy (CBT-E) and dialectical behavior therapy (DBT), which helps with emotion regulation, are effective interventions. DBT in particular has been shown to be incredibly successful: a study on women with anorexia found that after an average of 21.7 weeks of DBT, 35% of patients were in full remission, and an additional 55% were in partial remission. The specific modalities used will depend less on the specific diagnosis, and more on a patient’s individual needs and challenges. Timeline and intensity Because people who struggle with anorexia are often severely underweight, they might initially need higher levels of care (inpatient/residential). Those struggling with anorexia also have high rates of relapse, which may mean that they need to remain in treatment for longer to ensure they are set up for sustainable, lasting recovery. Bulimia recovery, however, typically starts in outpatient treatment, focusing on behavioral recovery. Patients only move to inpatient programs if medically necessary, which might be the case if purging behaviors are extreme enough to lead to electrolyte disturbances (which can be fatal). How do I know if I have anorexia vs. bulimia? While people can experience a mix of bulimic and anorexic behaviors or shift between them over time, there are key signs to look for that can indicate which diagnosis you or a loved one are struggling with. Those experiencing anorexia might: Be significantly underweight Eat very little, skip meals, or follow rigid food rules ("safe" vs "unsafe" foods) Feel cold all the time, tired, or dizzy when standing up Exercise excessively to burn off any calories eaten Feel proud or accomplished after restricting food Avoid eating in front of others or make excuses to skip meals Those experiencing bulimia might: Have episodes of eating large amounts quickly while feeling out of control Feel panic/guilt after eating and try to "undo" it through vomiting, laxatives, or intense exercise Plan their day around when binge and purge episodes Withdraw socially or experience mood changes  Anorexia vs. bulimia: Next steps for getting help It’s important to note that you do not need a formal diagnosis to get support. The specific label isn't as important as recognizing that your relationship with food is causing distress and interfering with your life—and knowing that you deserve help. Whether you or a loved one is struggling, it’s normal to feel hesitant to reach out for support. “There can be so much shame and embarrassment around eating disorders that prevent people from getting help sooner,” says Spector. “But early intervention is what really saves lives.” Regardless of whether you or someone you know is struggling with bulimia or anorexia tendencies—or even a mix of both—help is available. With the right multidisciplinary care team and approaches, recovery is possible for everyone. Schedule a free consultation with an Equip team member today to talk through your concerns and discuss treatment options.]]></content:encoded>
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            <title><![CDATA[Home for the Holidays with Eating Disorder Signs: What Now?]]></title>
            <link>https://equip.health/articles/understanding-eds/ed-signs-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/ed-signs-treatment</guid>
            <pubDate>Mon, 11 Dec 2023 18:00:23 GMT</pubDate>
            <content:encoded><![CDATA[Equip Family Mentor Alexia Davis says she knew something was wrong with her daughter, who was in eating disorder recovery, when certain hallmark symptoms reappeared over the holiday season. “Signs that alerted me to my family member relapsing were going back to old coping skills or habits, such as isolating and limiting their food choices,” Davis says. “I wish I had looked out for food restriction and avoidance, and expressions of anger anxiety leading up to the holidays.” Davis isn’t alone — the holiday season is often a challenging time for those affected by an eating disorder. Family dynamics, a heightened focus on food, and financial concerns can trigger an enormous amount of stress and exacerbate eating disorder thoughts and behaviors. For some families, the unusual amount of alone time with loved ones might set off alarm bells that someone could be struggling with a new or developing eating disorder. Maybe a family member has returned from college and something seems off with their behavior. Or perhaps a cousin, uncle, aunt, or friend is expressing or exhibiting food, weight, or exercise concerns that weren’t an issue in the past. So what can caregivers do when eating disorder signs rear their head over the holidays? The signs to look out for Eating disorders show up in a multitude of ways—sometimes the symptoms appear as textbook examples of anorexia, bulimia, or binge eating disorder, and sometimes they’re subtle, nuanced, and easy to miss, especially given that diet culture has seeped into every corner of our society. Some warning signs to potentially look out for include: Expressing fear of gaining weight Uncontrolled episodes of overeating Distress over body image Lack of interest in eating based on how foods taste, look, or smell Compulsive exercise But given the “new year, new me” mentality around New Year’s resolutions, weight loss conversations can be rampant, making it even tougher to distinguish what’s considered “typical” and what’s problematic. “Because we live in a world where disordered eating is normalized, especially during the holidays, sometimes early signs of eating disorders can go unnoticed or even be seen as something to praise,” says Elizabeth Gordon, Psy.D, licensed clinical psychologist at Equip. “Many eating disorders begin as diets, so loved ones should be on the lookout for any talk about wanting to lose weight (even just a few pounds), eat ‘healthier,’ look more ‘fit’ or ‘toned,’ save up calories for holiday meals or desserts, or reduce or eliminate certain food groups.” Davis, whose loved one began falling back into habits of restriction and feelings of anxiety over the holidays, feels it’s critical for caregivers to stay extra vigilant at this time of year. “It can often be easy to overlook these emotions because the holidays — although exciting — can be a busy and stressful time for everyone,” she says. “Noticing if your loved one expresses feeling anxious or upset about eating with or around others is something to look out for.” Why family-based treatment (FBT) may be the right move While spotting the signs of an emerging or recurring eating disorder can be a difficult task itself, addressing the issue with the right support for your loved one may be even tougher. Thankfully, evidence-based methods like family-based treatment (FBT) can help ensure those with eating disorders stand the best possible chance at recovery. FBT, the most effective treatment for children and adolescents, brings the patient’s family directly into the recovery process with a team of experts including a medical doctor, registered dietitian, therapist, family mentor, and peer mentor. “Eating disorders are often considered to be ‘egosyntonic,’ meaning that eating disorder sufferers often feel that restriction and other eating disorder behaviors align with their beliefs and goals,” Gordon explains. “Therefore, it is often very difficult for people with eating disorders to make changes to their eating behaviors on their own. This is where FBT comes in! When caregivers are able to step in and help their loved one get their nutritional needs met, especially during the holiday season, then the recovery process can begin.” Davis says that FBT can also offer support to parents/caregivers who may be struggling by allowing them to recover alongside their loved one while also learning skills for themselves that will continue to be helpful in other situations. “FBT gives all caregivers the opportunity to receive the tools and support they need to help their loved ones fully recover,” she says. Trusting your intuition to help your loved ones Knowing when or how to intervene or raise the subject of disordered eating symptoms can be uncomfortable, awkward, and even painful. Gordon says that while it can be a thorny subject for caregivers to broach, if something seems off with a loved one’s behavior over the holidays, it’s worth investigating. “Trust your gut!” she emphasizes. “A lot of people who struggle with eating disorders believe that they are fine and don't want treatment, but if something seems off to you, don't be afraid to seek help from a professional.” Davis agrees and advises parents and caregivers to be bold and face a loved one’s new or recurring eating disorder symptoms head on. “Don’t be afraid to open a conversation and reach out for help,” she says. “An eating disorder is no one's fault, but it is never too late to help your loved one begin the road to recovery. Opening up this conversation will be difficult and uncomfortable at first and you may even be met with anger and denial. But remind them that your only goal is to help them live a full, happy, and most importantly emotionally and physically healthy life.”]]></content:encoded>
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            <title><![CDATA[6 Ways Employers Can Make the Workplace Safer for People with Eating Disorders]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/eating-disorders-in-the-workplace</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/eating-disorders-in-the-workplace</guid>
            <pubDate>Thu, 02 Mar 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[In a society where both hustle culture and diet culture are normalized, the workplace can be a minefield for those struggling with eating disorders. The good news is that by taking the time to learn and making some small shifts to workplace norms, employers can turn the office into a place that’s safe for everyone, including those in recovery. Equip Registered Dietitian Tanya Hargrave-Klein, knows firsthand what it looks like when a workplace descends into diet culture. Before joining Equip, she spent 15 years as co-owner of a company that ran “health-promoting” initiatives at offices, and in that role, she witnessed everything from employer-endorsed weight loss challenges meant to boost morale to “team-building” group fitness classes marketed as “fat-burning metabolism boosters.” Hargrave-Klein has seen it all, and her conclusion is simple and straightforward: body-based “bonding” activities and weight-focused interventions have no business in the workplace. “There’s much harm that can come out of these well-intentioned worksite wellness challenges,” Hargrave-Klein says. “Crafting a workplace culture that supports diversity and inclusion is an important step so that people feel safe to verbalize their concerns.” The good news is that our society in general is becoming more aware of and sensitive to the overt harm of fatphobia and body shaming. Still, more insidious, everyday triggers persist in the workplace—in fact, everything from lunchtime diet chatter to food-centered meetings can pose real challenges to those struggling with or in recovery from an eating disorder. Given the number of potentially triggering scenarios that occur every day in the workplace, it’s important for employers to do what they can to make the workplace (virtual or otherwise) safe for everyone. Here are six ways to make any workspace more inclusive, weight-neutral, and supportive for people with eating disorders: 1. Immediately cut out any and all weight-based contests, competitions, or incentives Many people, like Equip’s Director of Lived Experience, JD Ouellette, have worked in settings that celebrate or encourage weight loss at any cost. In another article, Ouellette recalled an annual post-holiday tradition at her former job that involved weekly weigh-ins and cash prizes for employees who lost the most weight. “The harms of bringing weight loss-focused events into the workplace are myriad and really result not from malice, but lack of awareness,” Ouellette says. “I don't think most people want their workplace to be full of bullying, and really, sending the message that some bodies are ‘wrong’ and need to be changed—that’s bullying of those in non-small bodies.” “These types of events in the workplace center body size as what determines health and wellbeing and can create a lot of shame,” says Equip Peer Mentor Stacy Jones. “It implies that weight loss is a positive thing no matter the situation or the means to get there and it creates a hyperfocus on size. Plus, we know that weight loss efforts are not sustainable and can lead to dangerous weight cycling as well as increase the risk of someone developing an eating disorder.” It’s important to evaluate any existing programs that incentivize weight loss as a “health-promoting” behavior. “Many employers have incentive-based health promotion programs that offer discounts on health insurance premiums for meeting specific health criteria such as BMI requirements, waist-to-hip ratio guidelines, or offer similar incentives for participation in weight loss programs or exercise programs,” Hargrave-Klein says. If your workplace has implemented any of these kinds of programs, consider immediately shutting them down in favor of programs rooted in the Health At Every Size (HAES) approach, which focuses on promoting self-care, self-esteem building, and body satisfaction. 2. Encourage breaks throughout the day “Hustle culture” can be a real issue in the workplace when employees feel pressured to compete for the title of most productive person in the room (or, in today’s world of remote work, the most productive person on Slack). One strategy for short-circuiting that energy is to encourage breaks throughout the day in addition to reasonable hours and employees setting boundaries to protect their work-life balance. “It's very common in many workplaces to work through breaks and lunches, and have lunchtime meetings, and in fields like medicine, it can be normal to go 12 hours without eating,” Ouellette says. “This isn't good for anyone, and it’s a disaster for folks with eating disorders. We all benefit from regular nutrition throughout the day.” Jones also suggests that employers also give workers adequate notice when food will be involved in workplace events so they can mentally prepare if necessary. So if you’re having an in-person all hands meeting where you will be serving a catered lunch, include that information as soon as you have it.. 3. Pay careful attention to which messages or partnerships you promote In the event that your workplace is holding a special event or distributing information from a third-party healthcare partner, be sure to vet the material for weight-focused messaging or diet talk. “Consider what messaging health benefit vendors are disseminating to employees,” Hargrave-Klein says. “Many health plans partner with Weight Watchers to offer discounted rates or onsite programming. Some offer Lunch and Learns that often feature weight management or ‘healthy eating’ talks that are laden with diet culture messaging.” Audit your existing partners and benefit vendors, and if you find messaging that’s rooted in diet culture or fatphobia, consider replacing them with a more inclusive company. 4. Offer mental health benefits Speaking of benefits from partners, it can also be helpful to provide outside-the-box offerings that show your company’s commitment to employee well-being. That might mean mental health benefits providers like Spring Health, free subscriptions to meditation apps like Calm or Headspace, or a few“mental health days” a year. It might also mean looking into your health insurance offerings and making sure that the plans you offer have robust options for mental health care, including eating disorder coverage such as Equip. 5. Shut down diet discussions whenever possible While it may not be possible or realistic to keep an ear on conversation topics in the office or over virtual chats if diet talk does arise in a meeting or during a team lunch, gently encourage the discussion to go in a different direction. “Food, exercise, and body size discussions as a means of small talk and bonding are—in addition to being boring—alienating to many people and dangerous to others,” Ouellette says. “What would it be like to walk into a conference room with a spread of donuts, bagels, fruit, and coffee and just take what you want without hearing “sure, I’ll be bad!” or ‘no thanks, I’m being good today’ ’? I can tell you what it would be like for many people in the room: a relief and a breath of fresh air.” “Diet culture has been the norm for so long, people often discuss food and their body in harmful ways without realizing they’re doing so,” says Jones, pointing out that it’s often very difficult for those who are struggling to speak up and change the conversation themselves, especially if they’re not sure of their employer’s stance on the issue. This makes it extra important for employers to establish these boundaries whenever possible. 6. Consider all the details you can, and be open to feedback Some of the most seemingly minor details of a workspace can have a major impact on the individuals who spend their days there. In addition to providing office furniture that is comfortable for people in large bodies, Hargrave-Klein also advises against posting any sort of calorie count information in the cafeteria or lunchroom. Of course, it’s near impossible to think of everything at once, so the most important thing is to keep an open mind and create avenues for people to feel safe providing feedback. Eating disorders cost over $48 billion in lost productivity per year. Cultivating a workplace environment that’s safe and supportive for those who are vulnerable to eating disorders is one of the most powerful ways that employers can support business goals while also, most importantly, improving the health and well-being of their employees. Citations: Streatfeild, J, Hickson, J, et al. Social and economic cost of eating disorders in the United States: Evidence to inform policy action. Int J Eat Disord. 2021; 54: 851– 868. https://doi.org/10.1002/eat.23486]]></content:encoded>
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            <title><![CDATA[How Cognitive Dissonance Can Challenge Appearance Ideals in Eating Disorder Patients ]]></title>
            <link>https://equip.health/articles/news-and-research/cognitive-dissonance-and-body-image</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/cognitive-dissonance-and-body-image</guid>
            <pubDate>Thu, 13 Jun 2024 18:02:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation, presented by Cara Bohon and Ally Duvall. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. Eating disorders often involve body image concerns. Addressing these concerns is an important part of treatment, as it helps protect patients against relapse and set them up for lasting recovery. One way to do this may be to challenge harmful appearance ideals, which are often a major contributing factor to body image distress—and research suggests that cognitive dissonance theory may be a particularly effective tool for dismantling deeply ingrained appearance ideals. Here, we’ll evaluate the origins of appearance ideals and body image pressures; examine cognitive dissonance-based body image programs and the theory behind them; and explore how to incorporate specific cognitive dissonance-based approaches to decrease body image concerns. Body image 101 So what exactly is body image? Let’s define the term. Body image is something we all have. In the simplest terms, body image is a person’s experience in their body. This includes their: Perception of their body Thoughts about their body Emotional attitudes toward their body Behaviors toward their body We often talk about “good” or “bad” body image, but it’s more nuanced than that. Body image concepts exist on a spectrum. Negative body image The concepts of “body judgment” and “body dissatisfaction” fall under the umbrella of negative body image. This might show up as body checks, a drive for thinness, a distorted view of one’s self, body comparison, and a strong belief in appearance ideals. Someone with a negative body image may say things like “If I looked like x, my life would be perfect,” or “I wish I was toned like you.”
 Neutral body image The concepts of “body neutrality” and “body trust” fall under the umbrella of neutral body image. This might show up as focusing on body function or qualities versus appearance, neutral statements about one’s body, and self-compassion. Someone with a neutral body image may say things like, “My body is the least interesting thing about me.” Positive body image The concepts of “radical self-love” and “body liberation” fall under the umbrella of positive body image. This might show up as body activism, challenging appearance ideals, loving every single cell, body joy, and body positivity. Someone with a positive body image may believe strongly in these words from author and activist Sonya Renee Taylor: “Making peace with your body is your mighty act of revolution. It is your contribution to a changed planet where we might all live unapologetically in the bodies we have.” What are appearance ideals? There are a number of different appearance ideals that can inform (and often harm) someone’s body image. It’s also important to recognize that not all of us experience the same appearance ideals, as some may be more dominant than others. Race, ethnicity, socioeconomic status, disabilities, and gender identity can all influence what we are told is “ideal”. Feminine ideal When you think of the “perfect” girl or woman, how would you describe her? Though answers may vary, people often respond with words like “slender,” “pretty,” “cute,” or “graceful.” We call this “look” the “feminine ideal.” It’s sometimes called the “thin ideal” because of the emphasis on overall thinness as one of the most important factors that represents femininity. Masculine ideal When you think of the “perfect” boy or man, how would you describe him? Though answers may vary, people often respond with words like “strong,” “toned,” “muscular,” “lean,” or “handsome.” This is sometimes called the “muscular ideal” because of the emphasis on overall muscularity as one of the most important factors that represents masculinity. Non-binary ideal When you think of the “perfect” non-binary person, how would you describe them? Though answers may vary, this is sometimes called the “androgynous ideal” because of the emphasis on overall androgyny as one of the most important factors that represents being non-binary. You might rightly wonder, where do these appearance ideals come from? It’s complex. We have to think about these appearance ideals in the context of various systems of oppression designed to limit who has access in our society. Some of the factors that inform and shape appearance ideals include: Fatphobia and anti-fat bias Racism and anti-blackness Transphobia Sexism Homophobia Ableism Appearance ideals have deep, historical roots. The ideals have changed throughout history based on what will keep institutions, businesses, and privileged individuals profiting and in power. Even as they change, they continue to stay narrow, restrictive, and unobtainable for pretty much everyone. Currently, the appearance ideals are shifting back to the “thin aesthetic” from the early 2000s, with an emphasis on thin and flat stomachs. Appearance ideals show up in our lives in many ways, including: Fashion, clothing, and beauty brands Harmful curriculum and peer interactions Comments from family, friends, colleagues, etc. How we view, talk about, and treat ourselves Media (TV, movies, social media, ads) Ill-informed diagnostic criteria, biased doctors Wellness or “lifestyle change” programs Biased research studies and measures The harmful impact of appearance ideals The pursuit of appearance ideals has a significant negative impact, both on an individual and a societal level. Societally According to Deloitte, appearance-based discrimination (defined as the unjust, prejudicial treatment of somebody purely based on their appearance) has a high cost. Their data shows that in a given year: Appearance-based discrimination (defined as the unjust, prejudicial treatment of somebody purely based on their appearance) leads to $269 billion in financial costs and $233 billion in lost well-being Weight discrimination affected 34 million people and cost $206 billion Skin shade discrimination affected 27 million people in the Black community and cost $63 billion Natural hair discrimination affected 5 million people in the Black community Body dissatisfaction (defined as having a severe and persistent negative attitude toward one’s own physical appearance, which has been caused by harmful beauty ideals) led to $84 billion in financial costs and $221 billion in lost well-being Individually Diet culture thrives on body image concerns, which are fueled by appearance ideals. In our diet culture-informed society, body image distress is extremely common among all populations. 41% of men think they are “too heavy” and are self-conscious about weight 60% of women think they are “too heavy” and are self-conscious about weight 80% of young teenage girls report fears of becoming fat 82% of adults believe weight loss is their responsibility 95% of people who diet regain weight they lost within 5 years $71 billion spent on dieting and weight loss in 2020 Not all people who struggle with body image will develop an eating disorder, but a significant subset will, and body image distress is often a contributing factor to (and symptom of) an eating disorder. In this year alone, 5.5 million people living in the United States will develop an eating disorder, and only 20% of them will receive treatment; an even smaller fraction will get evidence-based care that works. Body image concerns, intense pressure to fit the appearance ideals, and the harsh reality of how many people will experience an eating disorder in their lifetime left researchers wondering: What if we could decrease negative body image concerns and prevent eating disorders from developing in the first place? How appearance ideals can lead to an eating disorder Eating disorders emerge out of a confluence of different genetic, biological, environmental, social, and other factors. Some common traits that predict the onset of an eating disorder are: Fear of weight gain Overvaluation of weight and shape Dieting Distorted self-perception Compensatory behaviors Thin-ideal internalization As researchers explored the emergence of eating disorder traits, a theory developed. Thin-ideal internalization (coupled with sociocultural pressure) starts the cascade effect contributing to body dissatisfaction, then dieting and negative affect, ultimately leading to eating disorder symptoms.  
They wondered: If we could reduce thin-ideal internalization first, would the other risk factors decrease too? Introducing cognitive dissonance theory Research shows that education-based prevention programs are not very effective in creating attitudinal and behavioral change. The theory was put forth that cognitive dissonance could be effective in creating shifts in both beliefs and behaviors. Learning information can feel good and helpful at first, but there is a difference between educating and empowering people to change. Research shows that disclaimers and warnings on photoshopped pictures or ads are unsuccessful at mitigating the body image distress created by unrealistic images in the first place. We often want to wait for our thoughts or emotions to change first before we alter our behaviors, but experiencing dissonance can actually empower us to act now. Cognitive dissonance theory rests on the notion that as humans, we want to maintain consistency between our beliefs, values, and actions. When there’s a conflict between our beliefs and actions, we experience dissonance: mental distress like frustration, guilt, shame, discomfort, anxiety, etc. Dissonance is uncomfortable, so we seek out ways to reduce the conflict and return to a state of consistency. We might do this in one of a few different ways: Reject: add in more affirming beliefs to override the conflicting belief/behavior Rationalize: attempt to decrease the importance of the conflicting belief/behavior Rethink and revise: change and adapt toward the new belief or behaviors Consider this example: Drew, an eco activist, bought their dream car: a Chevy truck with a diesel engine—and their sister just showed them a graph of how high diesel emissions are and says Drew’s car is awful. To reduce cognitive dissonance, Drew could: Reject: by going to chevysRthebest.com and reading how Chevy trucks aren’t bad for the environment because they R the best. Rationalize: by saying their car might not be the best for the environment, but Drew recycles and takes short showers so it all works out fine for their carbon footprint (and their car still totally rocks). Rethink and revise: by turning their car into a dealership and leaving with an eco-friendly truck, realizing their diesel Chevy wasn’t the best car for them because they care about their environmental impact. It’s important to note that the amount of dissonance that you experience can be influenced by how highly you value a belief or the degree to which your beliefs are inconsistent. For instance, Drew might experience decreased dissonance if his best friend Betty, who died last year, also loved driving a diesel Chevy truck and they bonded over that belief, making this a deeply held value for Drew. On the other hand, his dissonance might increase if this was the eighth time Drew heard new information on why diesel Chevys aren’t the best cars, so they had a larger drive to change cars. The Body Project: using cognitive dissonance to challenge appearance ideals Dr. Eric Stice and team developed the dissonance-based eating disorder prevention program The Body Project. The Body Project includes verbal, written, and behavioral exercises designed to position girls to argue against the appearance ideals, as well as discussion-based groups with Socratic questions to highlight costs of pursuing the thin ideal for girls. It was the first prevention program to reduce eating disorder symptoms, and Initial trials showed reduced risk factors and eating disorder symptoms over a short period follow-up. After many years of research and multiple iterations, large efficacy trials revealed The Body Project as the most effective compared to seven other credible interventions in reducing eating disorder symptoms, including thin internalization. Many research teams have replicated these results across languages, countries, and program audience adaptations: The PRIDE Body Project, More Than Muscles, The EVERYbody Project, etc. The “high dissonance” version of the project showed greater reductions in risk factors and eating disorder symptoms, leading to new program updates, like increased voluntariness of participation, public accountability, and difficulty of exercises. The three- to four-hour intervention produced significant reductions in symptoms that remained three and four years after the intervention was completed. Additionally, fMRI imaging revealed The Body Project participants had decreased activation in reward response (Caudate) when shown thin models compared to the control group. Applying cognitive dissonance theory in practice There are a number of different strategies you can employ to apply the learnings of this research with your own patients. Some ways to increase dissonance in sessions include: Have patients volunteer and consent to participate, share their thoughts, and complete activities (increases their agency). Increase the amount of accountability by having patients sign their home activities or encouraging sharing. Introduce roleplay activities designed to put patients in the position of directly challenging their previous beliefs. Resurface the dissonance continually, as appropriate. Repetition will increase the degree to which their beliefs and actions conflict. Utilize activities designed to solidify the new beliefs patients are building from your sessions (letters, lists). Engage in Socratic discussions that challenge or explore the impacts of the ideals—let the patient be the main contributor! Here are some concrete examples of what that might look like. Costs of pursuing the ideals Ask your patient to list out the costs of pursuing the ideals. This can be a collaborative activity where you work together to build a comprehensive list—just ensure the patient is the one leading and contributing. The list might include items like: Loss of self and personality Loss of connections Mental health Physical health Hobbies, passions Time with my dog Memories and pictures SO much time and money Food and body freedom Roleplays This activity is designed to have the participant argue against the ideals by talking you (the provider) out of pursuing them. Choose a character who is struggling to see the impact of pursuing the ideals and ask the patient to tell you why you should stop these behaviors. Go back and forth, making more space for them to share the costs of pursuing these ideals Reflect after: how did it feel to challenge these thoughts? Letter to younger self Ask your patient to think of what advice they would share or things they would say to their younger self about how to build a supportive relationship with their body. You can encourage the patient to think of what they have learned in your sessions or throughout their experiences. Important note: this letter does not need to pretend that everything they have experienced could be avoided if they did x, y, x. The focus is to have them write out ways to challenge the ideals, not to change the past. Negative body talk This activity is designed to have the participant challenge negative body talk statements they encounter in their life. Using a list of negative body talk statements, say the phrase to the patient and have them respond in a quick way that challenges the comment. Practice multiple, and ask the patient if they have any comments they would like to practice challenging. Negative body talk examples might include: Do I look fat in this? What are you, a girl or a boy? You should lose some weight…only for your health! Where are her curves?? I thought she was Mexican. I’m so out of shape. Why do they have a beard? I thought they were non-binary. Reflect after: how did it feel to challenge these thoughts in the moment? How can you use these going forward? Explore opposite action Ask your patient, what would you be doing if you weren’t concerned about your body? What clothes would you wear? What activities would you do? How would you talk to yourself? How would you interact with others? Then help them identify steps they can take to start doing those things right now: Practice wearing the crop top Practice saying kind things to your body out loud Plan time to play your favorite game with friends “Doing the thing” multiple times can help retrain your brain to enjoy the things you are currently avoiding due to body image concerns. For more in-depth information on using cognitive dissonance theory to help your eating disorder patients challenge appearance ideals, watch my recorded Equip Academy presentation on the topic. Our free, self-guided body image program, Explore: Freeform employs cognitive dissonance theory to help participants push back against thin ideals and feel more empowered in their body. Learn more about Explore: Freeform here.]]></content:encoded>
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            <title><![CDATA[Eating Disorder Recovery at School: How to Handle Meals and Snacks]]></title>
            <link>https://equip.health/articles/food-and-fitness/meals-and-snacks-at-school-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/meals-and-snacks-at-school-eating-disorder-recovery</guid>
            <pubDate>Tue, 08 Aug 2023 20:11:00 GMT</pubDate>
            <content:encoded><![CDATA[For a young person in eating disorder recovery, going back to school—whether at the end of summer or after taking time off for treatment—can be a cause for celebration. It’s a milestone of progress, a chance to reconnect with friends and activities, and a return to some semblance of normalcy. But it can also be fraught with challenges, not the least of which center around eating. If you’ve decided that you or your loved one are ready to go back to school or college, you’ve probably already put in ample work to form a healthy foundation and make headway toward stable recovery. Still, it’s important to be aware of the various food-related challenges that may arise and learn tools and skills to ease the transition. The challenges  of the back-to-school transition Whether your loved one is returning to school or to college, and whether it’s after summer break or a break for eating disorder treatment, similar challenges tend to come up. Here are some factors that can make eating at school extra challenging: Chaos at lunchtime Several of my middle and high school-age clients say it can be extremely stressful to complete meals in a noisy, busy cafeteria. It can also be hard for them to find space between or during classes for snacks, whether it’s because of school rules, packed schedules, or other variables. Plus, kids often experience more of a time crunch during their school lunches than they would at home or in treatment, and meals are often at different times than what they’re used to. It’s not uncommon for school lunches to be as early as 10:30 in the morning, and students may only be given 20 or 30 minutes to make it to the cafeteria, potentially buy their lunch, eat their food, and then make it to the next class. The imposition of school meal schedules can also make intuitive eating challenging for those who are at that point in recovery. Reduced support with meals and snacks “We find that clients struggle with lack of oversight from their parents or caregiver, who may have been previously ‘in charge’ of preparing meals and making sure they were eating adequately,” explains dietitian Eva Haldis MS, RD, LDN. Eating disorder behaviors can sneak in when meal- and snack-time support is gone or lessened, especially if it’s someone’s first time eating away from their family or care team. This leaves young people more vulnerable to using behaviors like throwing food away. Food comparisons and diet culture Food and body comparisons are another common challenge young people face at school. Some clients tell me it can feel like their eating disorder is sitting across from them in the cafeteria. “Many of their peers may not be eating the same types or amounts of food,” says dietitian Elyssa Toomey, RDN. “Sadly, disordered eating is common among the school-aged population, and it may be very triggering for a student in recovery to meet their needs when their peers are skipping meals or minimally eating.” Body image distress “Middle and high school years are times of significant growth and development,” Toomey says. So, eating disorder recovery as a preteen or teen has the added layer of puberty, and the natural hormonal and body changes that come along with it, making body image worse —which may make relapse more likely, research shows.” My school-age clients share that going back to school can negatively impact body image because being around new people or people they haven’t seen for a long time can bring up fear of judgment. “The student may have recovered into a larger body,” says Kristin Draayer, RDN. “While this body size is healthy, it could elicit discomfort or, unfortunately, even weight stigma or weight bias in a school environment”.  Tips for handling meals and snacks at school Recovery is a nonlinear experience. It’s full of highs and lows, times of ease and times of challenge—and the return to school is likely to come with plenty of challenges. While you can’t prepare for everything that might come up, you can make a plan to navigate meals and snacks, which can be one of the hardest aspects of going back to school. Here are some expert-endorsed tips to help ease the transition and keep your child on track as school starts: Make a clear plan with your care team. Well before the big first day, make a clear plan with your dietitian and therapist. “It’s helpful to think through all the logistics of meals and snacks when going back to school,” advises Erin Reeves, RD, Director of Nutrition at Equip. “What’s the eating environment like? What time do meals and snacks happen? How long do they have to eat? It’s often that meal and snack times are quite different from what you might do at home, and you might need to make adjustments accordingly.” Be sure to discuss ideas for adequate and balanced meals and snacks, and whether they will be coming from home or the school cafeteria (or a mixture of both); for college students, discuss whether they’ll be eating in a dining hall or getting their meals off campus. For those who are far enough along in their recovery to have moved on to a flexible or intuitive eating-based meal plan, Toomey recommends returning to a more structured approach, at least temporarily. Toomey also suggests identifying yellow and red flags that might indicate your loved one is slipping back into eating disorder behaviors, and being watchful for these. “It’s much easier to course correct from a lapse than a relapse,” she says. Encourage healthy coping skills. Brush up on mealtime skills, like healthy distraction and grounding techniques. Having these skills top-of-mind will make it easier for your loved one to use them in the moment if something distressing comes up at the lunch table. Strategize about what would make the school cafeteria or dining hall feel like a safer place, and come up with a tangible step to foster it. That might mean leaving your child comforting notes in their lunch bag or packing an object that brings a sense of security. Toomey also recommends deep breathing techniques and keeping a list of recovery affirmations easily accessible (on a phone, or a piece of paper taped inside a lunchbox, for instance). “Developing strategies to stay grounded and regulated before and during eating events will help,” she says. Help with food prep. Depending on where someone is in recovery, they may need help with packing lunches and snacks. “I often tell parents, someone with an eating disorder has so many steps to take before they eat, such as thinking about what to eat, how they’re going to prepare it, and then getting themselves to the point they can eat it. This can take so much out of a child and cause a lot of distress,” Haldis says, recommending that parents ease the burden by helping to prepare and pack food. Collaborate with a trusted staff member. It can often be helpful to name a trusted teacher or counselor at school who you or your loved one can rely on for accountability with meals and snacks. “Reach out to the school to see what resources and accommodations they can support,” recommends Reeves. “Many kids struggle to get their needs 100% met at school. They might need to be supervised or have an extra layer of accountability.” Sometimes, eating in a teacher’s classroom or a counselor’s office can feel safer than a cafeteria at first. Alternatively, joining your child for lunch is always an option if necessary. Keep communicating with each other. “Support your child with empathy and compassion,” Draayer says. “Encourage open conversations about their feelings and needs—sometimes, they might just need a listening ear, while at other times, they could be seeking advice.” Open communication can also help you better understand their challenges with eating at school, so you can create helpful strategies together that empower them to nourish themselves. The potential upside of returning to school Keep in mind that returning to school while in eating disorder recovery doesn’t just present challenges. It also has plenty of benefits. “Being in school offers students the opportunity to interact with their peers,” Draayer says. “Social connections can enhance feelings of belonging and help reduce feelings of isolation, which is good for mental health.” School also provides structure and routine, both of which are often helpful in maintaining recovery. “Returning to ‘normal’ can feel settling for the nervous system and help the child remember who they are outside of someone struggling with an eating disorder,” Toomey says. Plus, research shows eating disorders can reduce teens’ independence, and going back to school helps reverse this effect, bolstering autonomy and fostering kids’ confidence in their ability to nourish their bodies and brains so they can experience life outside their eating disorder. “Whether it be academics, athletics, or other school-based extracurricular activities,” Toomey says, “engaging with school, friends, hobbies, and passions builds further motivation for recovery.”]]></content:encoded>
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            <title><![CDATA[Less Common Eating Disorders: The Types of Eating Disorders You May Not Know About]]></title>
            <link>https://equip.health/articles/understanding-eds/less-commonly-known-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/less-commonly-known-eating-disorders</guid>
            <pubDate>Thu, 21 Oct 2021 17:30:00 GMT</pubDate>
            <content:encoded><![CDATA[When it comes to the various types of clinical eating disorders (i.e. the types of disorders that are considered “official” diagnoses per the Diagnostic and Statistical Manual of Mental Disorders), there are just a few — but there is still a great deal most people don’t know about eating disorders. Many have heard of anorexia (characterized by food restriction, malnutrition, and a fear of weight gain) and bulimia (episodes of overeating, otherwise known as bingeing, followed by purging). Even though it’s the most common eating disorder, fewer people are as familiar with the nuances of binge eating disorder (BED), characterized by recurrent binges accompanied by a feeling of a loss of control, as well as shame, distress, or guilt. But there are other diagnosable forms of eating disorders according to the DSM, as well, and even more variations on eating disorders that are poorly understood and rarely discussed. Types of eating disorders you may have heard of The latest edition of the DSM (the DSM-5) has increased the number of eating disorder diagnoses from three to eight. In addition to anorexia, bulimia, and BED, the DSM includes criteria for pica, rumination disorder (RD), and Avoidant/Restrictive Food Intake Disorder (ARFID) . Additionally, there are also two broader “umbrella diagnoses”: Other Specified Feeding or Eating Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED). There are also other variations on other categories of eating disorders, like a binge-eating and purging subtype of anorexia known as AN-BP, which is characterized by restriction, binge eating, and/or purging. All these variations and categorizations are important to recognize as they reflect a variety of experiences. But according to experts like Cara Bohon, VP of Clinical Programs at Equip, it’s also important to acknowledge how labels can sometimes inadvertently silo and separate disorders that exist on a spectrum — a spectrum that can be dangerous or even deadly no matter how a disorder specifically manifests. “Sometimes listing OSFED and UFED separate from the formal diagnoses can minimize the dangers, which is why I like to think about how they actually fit into our existing diagnoses, which most people know we need to take seriously,” Bohon explains. Bellow are the lesser known eating disorder variations many people may be unfamiliar with — and why shedding more light on them is important for legitimating the complexities of eating disorders. Less common eating disorders Avoidant/restrictive food intake disorder (ARFID): Formerly known as “Selective Eating Disorder,” ARFID involves limiting the amounts or types of food one eats. Although it’s similar to anorexia because it involves restriction, it doesn’t typically involve anxiety and distress over body image or fear of fatness, which are characteristic of anorexia. However, the potential long-term complications of ARFID can be just as severe as those of anorexia, including electrolyte imbalances, which can lead to sudden death. Pica: Individuals with pica may eat items that are not typically thought of as food and do not contain significant nutritional value. Some examples of items people with pica might consume include dirt, hair, and paint chips. Diagnosing the disorder involves taking a patient’s clinical history and possibly reviewing lab tests for anemia, potential intestinal blockages, and toxic side effects of substances consumed (like lead in paint or bacteria/parasites from dirt). It’s unclear how many people are affected by pica, but anyone of any age can develop it. The symptoms of pica may include persistent eating (i.e. over a period of at least one month) of substances that aren’t considered food and are not part of a culturally or socially normative practice. Typically, people with pica don’t have an aversion to eating actual food. Rumination disorder: There are various forms of rumination disorder, but in general, the condition involves regularly regurgitating food and then either re-chewing it, re-swallowing it, and/or spitting it out. Most people with this disorder don’t appear to be making an effort to do these actions, nor do they seem upset, stressed, or disgusted by what they’re doing. People with rumination disorder usually aren’t engaging in these behaviors because of any underlying medical condition, and the behaviors themselves aren’t necessarily part of any other eating disorder diagnosis like anorexia, bulimia, or BED (but they can be correlated with anxiety and can accompany another eating disorder). The most common treatment for rumination disorder involves breathing exercises and habit reversal, meaning the person experiencing it learns to recognize the signs and situations that trigger the behavior, and then practices deep breathing techniques in an effort to prevent the regurgitation from happening. Other specified feeding or eating disorder (OSFED): Previously referred to as Eating Disorder Not Otherwise Specified (EDNOS), OSFED is a “catch-all’ classification that was initially developed to include the many individuals who did not necessarily meet the strict diagnostic criteria for anorexia or bulimia, and were still at risk for serious — even life-threatening — consequences. There are myriad examples of OSFED, but a few common ones include: Atypical Anorexia Nervosa, which means a person meets all the criteria for anorexia but their weight remains within or above what is considered “typical” for age and height (it’s important to note “typical” numbers and ranges are often informed by arbitrary and/or outdated criteria). Purging Disorder, which involves recurrent purging (i.e. self-induced vomiting, use of laxatives, exercise, and other methods) that occurs in the absence of binge eating and is intended to influence weight or body shape. Night Eating Syndrome involves recurrent episodes of eating after awakening from sleep, or eating excessively after an evening meal. Unspecified feeding or eating disorder (UFED) — other forms of disordered eating: Otherwise known as UFED, unspecified feeding or eating disorder refers to situations in which symptoms are characteristic of an eating disorder and cause significant distress or impairment, but the symptoms themselves may not meet the full criteria for any one specific disorder. While there are many forms of disordered eating and a spectrum of behaviors and symptoms, some terms that have received recognition in the media over the last few years include orthorexia, diabulimia, and drunkorexia. While none of these are “official” clinical diagnoses, they can and do wreak significant havoc on the lives of those who suffer from them, and can have devastating consequences, just like any other form of disordered eating. Orthorexia involves an obsession with proper or “healthful” eating that can lead to intense fixation and compulsive behaviors.

“Orthorexia is not a formal diagnosis, but can lead to severe impairment or health consequences,” Bohon says. “Indeed, many people may end up with a diagnosis of obsessive-compulsive disorder if the ‘pro-health’ behaviors end up meeting a level of obsessionality or compulsion that warrants the diagnosis. Or alternatively, the behaviors could rise to the level of anorexia nervosa where the ‘healthy eating’ has become severe food restriction of entire nutrients due to fear of fatness, resulting in malnutrition despite the supposed goal of achieving ‘health.’” While there are no clinical treatments developed specifically for orthorexia, the condition is often addressed with the same forms of psychotherapy and exposure therapy experts use to treat anorexia and/or obsessive-compulsive disorder.
 Diabulimia typically occurs in individuals with type-1 diabetes, and involves purposefully restricting insulin in an effort to lose weight. Some medical professionals call this “Eating Disorder-Diabetes Mellitus Type 1” (ED-DMT1), which is used to describe any form of disordered eating that co-occurs with type-1 diabetes.

“Diabulimia is really a form of bulimia nervosa, but rather than the compensatory behavior of vomiting or laxative abuse as many think about in bulimia nervosa, people with diabulimia misuse their insulin to impact their weight and shape,” Bohon explains. “It requires particular close medical monitoring, by skilled physicians given the particular medical dangers involved.”
 Drunkorexia refers to a form of disordered eating in which individuals restrict their caloric intake and/or exercise excessively in an attempt to “mitigate” the calories from alcohol consumption. The affected individual may suffer from an eating disorder, substance use disorder, or both. Reducing food calories in favor of alcohol can have significant risks, including overconsumption of alcohol and a greater degree of intoxication, an increased risk of nutrient deficiencies, and other serious consequences associated with other forms of disordered eating. Regardless of whether an individual is formally diagnosed with an eating disorder defined by the DSM or is suffering from a more nuanced form of disordered thoughts and behaviors, the implications can be serious and even deadly. Reaching out for help, support, and treatment is essential to full recovery, no matter if the issue comes with a recognized label or not. If you're concerned about yourself or a loved one, talk to your doctor or schedule a consultation with our team.]]></content:encoded>
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            <title><![CDATA[How Equip's $58M Series B Will Revolutionize the Eating Disorder Field]]></title>
            <link>https://equip.health/articles/news-and-research/equips-series-b</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equips-series-b</guid>
            <pubDate>Wed, 16 Feb 2022 17:22:00 GMT</pubDate>
            <content:encoded><![CDATA[We founded Equip in 2019, with a dream of making sure that everyone had access to evidence-based treatment for eating disorders. But 2019 was hardly the beginning of our dream. Both of us were diagnosed with eating disorders as children and were fortunate to have parents who brought us to recovery using the techniques of Family Based Treatment (FBT). As the founder of Project HEAL, the largest grassroots eating disorder nonprofit, Kristina was able to help hundreds of patients fund their treatment, but she knew there were millions she couldn’t help. Every day, she had to turn down applications from worthy folks who desperately wanted to get better — who were working multiple jobs and depleting college and retirement funds to afford treatment. As a clinical psychologist in academic medicine, Erin watched people travel from all over the globe to get treatment at the university clinic she helped lead. Every day, she talked to families who couldn’t financially or logistically make the same trip. And throughout this time, we both knew we were barely making a dent in the country’s broken treatment landscape. Every day, we were both meeting families and patients who were desperate for treatment, and who we couldn’t help. It was heartbreaking. Knowing that 80% of the 30 million Americans who struggle with eating disorders weren’t receiving treatment, we decided that we had to move forward in a bold new way to achieve the monumental change needed in the field. So in 2019, we raised venture capital funding and started Equip. Equip’s care model is rooted in Family-Based Treatment — a model built upon the belief that families are best equipped to help a loved one through recovery and recognizes eating disorders are brain disorders — and is built by a powerful combination of clinical and lived experience. We have set out on this bold, imperative mission with a team of people who are called to this work—people who’ve been there. More than 60% of the company has lived experience of recovering from an eating disorder or helping a loved one heal. And our treatment is working. Patients and families are well on their way to healing with Equip. We are incredibly proud that after eight weeks of treatment, 71% of patients report a reduction in eating disorder symptoms and two-thirds report improvements in mood. In that time, 96% of caregivers report feeling more confident in caring for their loved one. Today, we are delighted to announce that we have raised $58m in a Series B in support of our mission to transform eating disorder treatment and the cultural conversation around body image. We carefully chose investment partners who had a connection to our story and their own lived experience. Our investment partners, The Chernin Group (TCG)—an early investor in Headspace—Tiger Global, General Catalyst, as well as existing investors F-Prime Capital, Optum Ventures, and .406 Ventures, made it clear this was more than an investment—it’s a shared mission. We are also so thrilled to share that Katie Couric Media has also invested alongside American soccer champion Alex Morgan—with Couric joining as an advisor—to share their lived experiences and shift the cultural narrative. This Series B funding will set us out to make a reality of our core vision: to get everyone with an eating disorder access to treatment that works. We ended our first year of operations with 10 major commercial payor contracts, our first Medicaid contract with Partnership Health Plan, and with 83% of families utilizing in-network benefits. This funding will allow us to expand to all 50 states, broaden our treatment to adults, partner with all insurance plans, and most importantly, continue to partner with Medicaid and state governments to ensure treatment is no longer cost-prohibitive. We also know that access isn’t meaningful unless treatment is safe and culturally humble. To that end, we’ve built teams that are reflective of the true diversity of eating disorder sufferers. Today, 34% of Equipsters identify as BIPOC, 33% as LGBTQ+, and 7% as transgender or non-binary. And while we started this company to fix this broken system, we are well aware that millions of people still fall through the cracks everyday. That’s why, in our first year of operations, we committed to funding 12 Project HEAL recipients at any given time, and have donated over $100,000 to non-profit partners like The National Alliance for Eating Disorder Awareness, ANAD, FEDUP, and Project HEAL’s BIPOC Treatment Equity Project to ensure that underserved communities have access to care. Our excitement is matched only by our gratitude for our amazing team who have built a culture and a level of recovery for our families that we hadn’t dreamed possible. They’ve pushed us to grow every day, build a team that finally reflects the diversity of those who suffer, and to prioritize the combined power of lived experience and data-driven science to deliver care that works. We are proud to be part of this amazing team, that is committed to building a world free from fat-phobia and diet culture, where every child can grow up safe in their own body, and that believes in their bones that full recovery is not only possible, but inevitable for our families.]]></content:encoded>
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            <title><![CDATA[New Research: FBT Outcomes Across Gender Identity]]></title>
            <link>https://equip.health/articles/news-and-research/fbt-outcomes-gender-identity</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/fbt-outcomes-gender-identity</guid>
            <pubDate>Mon, 05 Feb 2024 18:12:00 GMT</pubDate>
            <content:encoded><![CDATA[People commonly associate eating disorders with thin, white, cisgender girls. While eating disorders affect people across body size, gender, race, and age, this stereotype has persisted for decades, and it’s had an effect on both society and the realm of research. One effect is that most of the current modalities for treating eating disorders in young people focus on cisgender girls, leaving cisgender boys and transgender and gender expansive youth out of the equation. We know that transgender folk are at a heightened risk for developing disordered eating behaviors and eating disorders for a variety of different reasons, and may face barriers to care. We also know that men and boys get eating disorders too, and often go undiagnosed or untreated. Everyone with an eating disorder is equally deserving of effective treatment and lasting recovery, so it’s essential to understand what treatment approaches work for different populations. That was the impetus for our most recent study. In the study, we looked specifically at the effectiveness of family-based treatment (FBT) for cisgender boys and transgender and gender expansive youth. While FBT is the evidence-based gold standard for treating eating disorders in young people, most of the research supporting its effectiveness was based on cisgender girls. This investigation is an important first step toward understanding how best to treat different populations. The fundamental components of the study Our study included 1,235 young people (age 6 to 24) who received FBT-based eating disorder treatment during the time period from September 2020 to November 2022. Of this group, 975 were cisgender girls, 152 were cisgender boys, and 108 were transgender or gender expansive youth. In our research, we looked at various different outcomes, including: Eating disorder symptoms Depression Anxiety Suicidality Caregiver burden Parental confidence in supervising treatment We analyzed outcomes for all patients included in the study, and then compared outcomes for cisgender boys and transgender youth with outcomes for cisgender girls. Our analysis showed that regardless of gender identity, all symptoms and outcomes improved during treatment, and improved at similar rates. Key takeaways for providers The importance of studying treatment approaches for cisgender boys and transgender youth can’t be overstated. Millions of young people with these identities are struggling with debilitating and potentially life-threatening eating disorders right now, and there is an alarming absence of knowledge about how to treat them. There are no universally accepted, empirically supported eating disorder treatment guidelines for cisgender boys and men, or for transgender youth. Because of this, many boys and men and transgender folk report feeling misunderstood by providers, and it’s tragically common for transgender youth specifically to report having negative treatment experiences. We know eating disorder treatment isn’t one-size-fits-all, and so it’s essential to understand what adaptations and modifications must be made to ensure that everyone suffering, regardless of identity, gets effective and supportive care. Because FBT involves family and friends (and, at Equip, peer mentors with similar backgrounds and identities), it allows for treatment to be more tailored to the individual patient, and provides a unique opportunity to address issues like social challenges, stigma, and family support of a child’s intersecting identities. However, up until now, we had no quantitative evidence supporting the use of FBT for populations besides cisgender girls (who make up about 90% of participants in other FBT studies). Our study is the first to demonstrate that FBT leads to meaningful improvements in eating disorder symptoms and other outcomes in young people across the gender identity spectrum. This is promising, especially since FBT is generally the first line of treatment for youth with an eating disorder, and because FBT lends itself well to virtual care, which helps eliminate other barriers to treatment these populations might face. While more research is needed—specifically with larger and more diverse populations—we’re heartened at these initial outcomes. Our research team is looking forward to doing more research into how FBT works for people of all genders and identities, and how we can continue to adjust and personalize treatment to make it the most effective for every patient who seeks help.
 Read the full paper here: https://www.sciencedirect.com/science/article/pii/S1054139X23005967 
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            <title><![CDATA[Eating Disorder Recovery in College: What Parents Should Know About Supporting Their Student]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/eating-disorders-and-college</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/eating-disorders-and-college</guid>
            <pubDate>Wed, 10 Aug 2022 14:58:22 GMT</pubDate>
            <content:encoded><![CDATA[The end of summer is bittersweet for many young adults, but for those recovering from an eating disorder, leaving the security of home for college can make things additionally complex. From anxiety-inducing exams to dining hall food options, college students may face a host of challenges that can complicate their recovery. So how can families prepare for college — including if their loved one should go back to school or if the family should prioritize treatment over academics? “During times of change, it is really common for one’s eating disorders to become louder,” says Equip Peer Mentor Vanessa Do. “Therefore, it’s really important for families to be aware and vigilant regarding potential relapses or increased eating disorder behaviors. The newfound distance or lack of supervision may create potential space for the eating disorder to sneak back in, so it’s important to continue to have check-ins and open communication to keep the individual accountable (and supported) on their journey of recovery.” Fellow Equip Peer Mentor Stacy Jones agrees, noting that students just embarking on their college journeys or starting at a new school may have to be extra vigilant. “Being away at college means being in a new environment,which can be stressful or activating for the person and their eating disorder,” Jones says. “It can require extra protective factors like regular check-ins or local support groups to make sure they are able to stay on the path of recovery.” Establishing and maintaining strong connections with family and care team members can be critical for college students in recovery. But perhaps the most important point to keep in mind is that mental, physical, and emotional well-being should always take precedence over grades, tests, and socializing. It can be tough to keep this hierarchy of needs in mind once the semester starts, but the more family members can help underscore and reinforce these priorities, the better success a student may have in their recovery. “College is harder than many parents remember it — even without an eating disorder,” says Equip Family Mentor Lisa Stein. “Know that some things will go wrong and that your loved one must have the mental and physical strength to deal with these disappointments and distractions without resorting to their eating disorder.” For those unsure of how to help their loved one safely return to school — and for those unsure if a return to college is really the right choice at this point in their recovery process — here are some strategies and suggestions from those who’ve been there. Seriously consider a break from college It can be incredibly difficult to put academics on hold — particularly for those who are high-achieving and ambitious students. But eating disorder recovery isn’t always linear, and sometimes setbacks are part of the process. Before officially starting a new school year, have frank conversations about where a loved one is in their recovery to set the stage for the best possible outcomes in the future. And in some cases, that may mean taking an extended break. “If your child is still saying they can't wait to get to college to get away from you, lose weight, and continue with their eating disorder, they are not ready for college,” Stein says. “This may seem obvious, but sometimes parents miss these warning signs ” Having frank conversations about where a loved one is in their recovery can help set the stage for the best possible outcomes in the future. And in some cases, that may mean taking an extended break. “My biggest suggestion for patients planning to go to school, is to actually consider taking some time off,” says Equip therapist Sara Quint, AMFT. “I was in and out of treatment every other semester, and it was always devastating to have to take more time off. I wish I had prioritized my recovery sooner, and recognized that each and every person is on a different path — school will still be there, and classes are so much more enjoyable without the constant mental fog, distraction, and confusion, trying to ‘just get through the semester,’ all caused by the eating disorder.” Prepare for the logistics of college life A big part of ongoing recovery is having a handle on the practical components of everyday life, including when, where, and what to eat. While staying on track with nutrition can be more manageable at home with a full support network, the independence of college life can set some students up for triggering situations or even relapses. “Your loved one should plan a schedule conducive to allowing for time to eat three meals and snacks,” Stein says. “College dining hall lines are often slow, understaffed and don't have the exact items your loved one may want. My loved one remarked how challenging it is to wait half an hour for a bagel and cream cheese. Your loved one should be able to be flexible and pivot to make sure they get the nutrition they need.” Practice strategies for coping with harmful body talk Harmful commentary on food, exercise, and appearances is everywhere, from social media to magazines and more, but toxic messaging about diets, weight loss, and exercise can be particularly prevalent on college campuses. Families can prepare for these difficult situations ahead of time by: Help your loved one practice recognizing these messages and how they may create challenges during recovery Develop a plan on how to deal with roommates who may be struggling with eating challenges themselves Create a list of strategies and skills to use to in when feeling triggered It’s also worth considering the repercussions of what would happen if a student in recovery were placed in close quarters with a peer who hasn’t dealt with their own eating disorder. Discussing all the possibilities ahead of time and devising action plans and coping strategies may be important tactics to practice before school starts. Familiarizing yourself and sharing some eating disorder recovery affirmations can also help with this.  “College students are inundated with diet culture messages and may be assigned a roommate with eating challenges themselves,” Stein says. “Your child must be well enough to not allow those distractions to trigger them and affect their eating.” Schedule regular check-ins and help put resources in place Some practical ways to ensure your loved one has a good support system while in college are: Videos calls or event visiting them at school to get a better understanding of their physical state and safety Find and set up resources on campus ahead of time Locate local peer support groups, organizations, and treatment centers Examine food options available at the school, and coming up with multiple plans on how to ensure adequate nutrition Jones believes part of the ongoing conversation between family members should involve locating local support for the student. “Asking your loved one what they are needing and having a conversation is a great way to understand how to best support them,” she says. “Find and set up resources — therapist, accommodations, etc. — at the college prior to getting there or a plan for what to do when getting there.” Do adds that local peer support groups and organizations may be critical for ensuring medical and nutritional support as well. “I think continuing therapy is extremely important due to the multitude of changes occurring simultaneously during the college years,” she says. “But it may be helpful to examine the food options available at a school before committing to it, and coming up with multiple plans on how to ensure adequate nutrition.” Is it the right time to return? In the end, the decision to start or return to college is really up to each individual and their support network to decide. There may not be a one-size-fits-all plan for success, but by having open, honest conversations, families can help their loved ones maximize their chances for health, happiness, and success. “Although recovery does vary between individuals, a solid sign that one is ready to go to college is their consistency of being able to have minimal to no eating disorder behaviors,” Do says. “If even with full autonomy and choice of their food, the individual actively chooses to fuel themselves adequately without ‘giving in’ to their eating disorder on a consistent basis for a while, it is a good sign that they may be able to practice this when they are at college. I also think a good sign is when individuals are very open and honest when discussing their eating disorder because it shows that they are motivated for recovery and vigilant about potential relapses.”]]></content:encoded>
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            <title><![CDATA[5 Ways to Push Back Against Summertime “Beach Body” Pressures]]></title>
            <link>https://equip.health/articles/body-image/beach-body-pressure-tips-to-push-back</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/beach-body-pressure-tips-to-push-back</guid>
            <pubDate>Thu, 22 Jun 2023 21:06:00 GMT</pubDate>
            <content:encoded><![CDATA[It happens every year as summer turns to spring, as predictable as seasonal allergies: advertisers, marketers, and influencers will start throwing around the phrases “bikini body” and “beach body.” As soon as June approaches, we're bombarded by social media posts, ads, articles, and more imploring us to get our body “summer-ready.” This tactic isn’t new, and for some of us it might be easy to simply roll our eyes at the tired messaging. But for those who struggle with body image or an eating disorder, it can, at worst, lead to disordered behaviors, and, at best, strip all the fun out of what’s meant to be a joyful and carefree season.
 Let’s unpack where these body image pressures come from, why they’re a problem, and how to shake them off (or helped a loved one do so). The problem with phrases like “bikini body” In many ways, messaging around looking a certain way for the summer is just an intensified version of the societal pressure to be thin that exists year-round—a pressure that many of us absorb without questioning (thanks, diet culture). “Rarely do people talk about the costs that come from pursuing the ‘ideal’ summer body: the time it takes to focus on new diets or exercise routines, the moments you miss out on because you’re focused on how your body should look rather than being in the present, the physical toll of weight cycling and major nutrients not being included in your meals,” says Equip Senior Program Development Lead Ally Duvall. “We’re told that once we achieve the perfect summer body, we will achieve anything. But that assumes we’ll have the brain space and energy to do so, and that the ideal body will stay the same—which it never does.” Equip Peer Mentor Ethan Lopez agrees, noting that descriptors like “summer body” promote the idea that your physical body is what people will be focusing on most (and, thus, what you should focus on most), rather than their own personal enjoyment of the day. Shifting the emphasis to appearance, he says, robs people of an ability to actually enjoy whatever activity they’re engaging in—which is a pretty sad prospect given how precious summertime is to most people. Jessie Menzel, Equip’s VP of Program Development, points out that language emphasizing the idea of a “summer body” compounds the body image pressures that already tend to stack up this time of year. “Summer is a time when bodies are really put on display, with the warm weather and the choice of clothing that comes with it—tank tops, no shirts, shorts, swimsuits,” Menzel says. “For many people, knowing that others are seeing your body increases your own anxiety and awareness of your body and how it looks to others.” Of course, the very notion of a “beach body” or “bikini body” perpetuates the myth that certain body types are better than others, which Equip Peer Mentor Janina Larsen adamantly calls out as a false and damaging premise. “By using these terms, you're reinforcing the idea that people need to look a certain way in order to enjoy spending time at the beach or wearing a bikini. In reality, everyone can enjoy these activities regardless of what they look like,” she says. Lopez agrees, noting that, “when people think of a ‘beach body’ or ‘bikini body,’ the image of a thin white woman or a muscular white man are probably the first images that pop into their mind, because that’s what we see in the media. All bodies exist and should be celebrated as they are, rather than shamed into conforming to a mold that’s usually unattainable for most.” In order for summer to be fun, fulfilling, and truly healthy, it’s important that those struggling with body image or affected by eating disorders are especially mindful about the messages they internalize. The five strategies below can help you or your loved one tune out the noise and focus on the joy of summer, rather than allowing the “beach body” narrative to once again run the show. 5 strategies to bolster body image during beach season 1. Pay close attention to the messages you see online and IRL Experts often recommend taking inventory of the social media accounts you follow (as well as the friends and acquaintances you spend time with) and letting go of any unhelpful, unhealthy, or downright dangerous messages that may be infiltrating your mind. Summer is as good a time as any to hit the “unfollow” button or step away from any toxic relationships that negatively impact your self-esteem and body image. If you're a parent, it can be helpful to look at your child's social media accounts with them and open up a conversation about how certain posts and people make them feel, then block, unfollow, or mute those that make them feel bad. “Anything that focuses on how to achieve a certain body ideal in a short time period screams to me as extremely harmful,” Duvall says. “I see ‘how to get your tummy summer-ready in four weeks’ or ‘beach-ready in one month’ and not only do those messages reinforce that you have to change your body in order to enjoy the summer, but they also heavily encourage eating disorder behaviors as the means to achieve those body changes.” Lopez says that as a trans person, they’ve seen a troubling trend impacting the trans community each summer: the drive to achieve thinness or muscularity in order to fit a stereotypical cisgender standard. “I see an influx of people going to the gym in order to be ‘presentable’ at the beach. I find it troubling that folks are told to change their bodies in order to be in public spaces (but still have underlying fears of microaggressions, safety as a visible trans person, etc.).” Recognizing, interrogating, and ultimately discarding messages that you deem problematic or triggering may help set you up for a healthier, happier summer. “If you use social media, follow hashtags that show a diverse range of bodies to help make your feed more reflective of the ‘real world,’” Lopez says.
 2. Buy (or borrow) clothes that make you feel confident One of the bright spots in the sometimes-bleak landscape of social media is the body diversity that can be found, and the number of influencers and users who offer fashion ideas, styling tips, and shopping recommendations for every shape and size. And while the fashion industry still has a long way to go in terms of size availability, there are more options than ever to create cute, comfy looks that can help you or your loved one feel confident. Rather than buying clothing that’s too snug as “motivation” or because you feel you “should” fit into it, be honest with yourself about what makes your body feel good, and get that instead. “Wear what makes you feel comfortable!” Larsen says. “Clothes are meant to fit you, not the other way around.” If you're supporting a loved one, it might be helpful to hide or cut off the tags of clothing so they can focus on how items feel, rather than what size they are. 3. Tune into the sensory experience of each summer activity Lopez says that being a neurodivergent person has encouraged them to focus on the sensory joys that the season can bring—and that wisdom can help any person become more mindful and connected to their internal experience instead of their external appearance. “For example, feeling the warm sand under my toes and the rays of sunshine on my skin, the smell of the beach mist with a hint of seaweed, and enjoying the taste of a cold soft serve while resting helps keep my mind off of any negative body talk that might come up,” Lopez says.  To help ground a loved one who might be struggling, talk to them about the different sensations you're feeling, and encourage them to share their own experience.
 4. Set healthy boundaries with those around you
 Establishing healthy boundaries with friends, family, and even strangers upfront can spare you from going down a negative thought spiral, or prevent others from saying something triggering in front of a loved one. “Set boundaries with people in your life who make harmful comments about bodies, including their own,” Larsen advises. “It's okay to struggle with body image and it's not acceptable to project your insecurities onto others. Use statements like, ‘I'm not interested in discussing people's bodies’ or ‘please don't comment on my body or anyone else's’ to redirect the conversation and practice body neutrality.” 5. Practice self-compassion every chance you get Perhaps one of the toughest parts of building body image resilience is learning to be kind to yourself, but strengthening this skill can be an invaluable tool in preventing negative body image messages from seeping in.  “We can get caught up in our own thoughts about how our body will look, how we will feel about it, how others will perceive it, making it impossible to enjoy the present moment,” Duvall says. “And understandably so: everywhere you look, there’s a new product to tighten your tummy or new summer diet to try. I always recommend that folks start with self-compassion, because it makes a lot of sense that we feel the way we do about our bodies. Feeling bad about feeling bad only continues a body shame cycle.” There are countless other ways to cultivate a healthier body image, even in the face of “beach body” toxicity. But these five tips are a great place to start laying the foundation for a more embodied, joy-filled summer—and hopefully beyond.]]></content:encoded>
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            <title><![CDATA[From Fitness Tests to PE: What Every Parent, Educator, and Coach Needs to Know About Eating Disorders]]></title>
            <link>https://equip.health/articles/food-and-fitness/PE-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/PE-and-eating-disorders</guid>
            <pubDate>Wed, 07 Sep 2022 14:34:29 GMT</pubDate>
            <content:encoded><![CDATA[Now that a new school year is officially in full swing, parents may have prepared themselves for conversations around food, body image, and weight that could potentially have a negative effect on their child in the classroom or on campus. But one topic that is often overlooked for young students is exercise. While movement and sport can play important roles in a student’s identity and wellbeing, the reality remains that traditional assessments of fitness and wellness can be incredibly outdated and harmful to someone in recovery or at risk for developing an eating disorder. “Moving our bodies is wonderful for a myriad of reasons — however society’s recommendations for exercise are usually based in minutes daily and a fear-based approach that stigmatizes larger body sizes,” says Equip registered dietitian Erin Reeves. “It’s important to focus on helping kids find movement they like — especially through non-traditional sports — to help them find ways they can move that go beyond weight, calorie burn, and ‘health’ as reasons for moving,such as improved mood and better concentration for school work.” The problem is that many academic institutions haven’t caught up to a modern approach to movement and are still measuring physical “success” by outdated, standardized tests, often souring young people’s relationship with exercise. Until 2013, many students had to participate in the "Presidential Fitness Test" which was designed to "capture best performance at core strength, aerobic capacity, upper-body strength, speed and agility, and flexibility." Now, many kids have to take the The FitnessGram PACER Test, "a multistage aerobic capacity test that progressively gets more difficult as it continues.” Additionally, many coaches may not have up-to-date or accurate information on eating disorders and lack the education and training to recognize the signs of problematic behavior. “Physical education in the U.S. has traditionally placed too much emphasis on factors that are largely out of the student’s control, like body mass index (BMI),” says Equip’s VP of Medical Affairs, Katherine Hill, MD. “Many PE teachers and coaches are surprised to learn that BMI doesn’t correlate very well with physical fitness or athletic performance. In addition to being a poor correlate of health and fitness, measuring BMI in a public setting like school can be traumatic and triggering. Some schools publicly weigh children and compute their BMI in front of their classmates. Height and weight measurements should be considered sensitive health information, and should be reserved for private settings like medical visits with a pediatrician.” Whether you’re a parent, coach, or faculty member who wants to know how you can encourage and cultivate a supportive, non-judgmental environment for students in relation to movement, here’s what you need to know. The warning signs of an eating disorder every parent, P.E. teacher, and coach should be aware of While many people are familiar with the common food-based symptoms of eating disorders , few are as well-versed in the signs of a problematic relationship with exercise. Equip therapist Kelsey Hoeper, LPC, NCC, CT, who was an athlete for most of her life, says that while her experience around movement was largely positive, in hindsight, she can see how many of the messages she absorbed may have played a part in the development of disordered eating. “A lot of us are familiar with those go-to motivational statements coaches often preach to their athletes like ‘food is fuel,’” she says. “That mantra, and ones similar to it, can imply that food is only meant to help us achieve those athletic goals, instead of viewing food items as something for the sake of enjoyment and nothing more. When so much emphasis is put on nutrition, macros and micros, athletes may interpret that as them needing to 100 percent control their bodies, and if they can’t, then they can’t trust their bodies.” Given the normalization and prevalence of these messages, the warning signs of problematic or excessive exercise can be tough to spot, because they can resemble the actions of a “dedicated” athlete. But according to Hoeper, there are some telltale signs of a serious issue that parents, teachers, and coaches should know: Body checking (constantly adjusting sports clothing, swimsuits, etc.) Eating only foods they deem “healthy” (e.g. salads, protein bars and shakes) Frequently throwing unfinished food away Not eating with the team during team dinners/trips Skipping social events with team members Excessive exercise (e.g. running an extra mile after practice ends) “Compulsive exercise is a common warning sign of an eating disorder,” Hill says. “If a student is exercising multiple hours a day, never taking a day off even when they’re sick, tired, or injured, or performing ‘extra’ workouts in addition to team workouts, these might be red flags for an eating disorder..” What you need to know about school fitness tests While standardized fitness tests have changed over the years, the notion of “testing” fitness in a one-size-fits-all way doesn’t sit right with many experts and individuals who have lived through the realities of an eating disorder. “Interestingly enough, discussion of the PACER Test recently came up in conversation between my college-age daughter and her best friend,” says Equip family mentor Kristi Humston. “While the intentions of those who developed this test may (or may not) have been well-intended and my daughter and her friend are now able to laugh about their shared experiences of anxiety and ‘cramming’ to do well, the sad reality is that one walked away believing she was an athlete and the other feeling humiliated in front of her peers. Neither was an accurate measure of true fitness nor was it an indication of the incredible young women both continue to become today.” Hill says that overall, standardized testing for physical fitness in schools can be harmful in many ways, from triggering eating disorders to creating a lifelong aversion to exercise. “And often, a student’s grade can be negatively affected if they are not naturally athletic,” she says. “Basing a student’s grade on standardized fitness tests or how fast they can run a mile can be humiliating for some and create fear around exercise. Student’s grades should instead be based upon factors like work ethic, having a great attitude, and being a team player.” Because adolescents with eating disorders can often be very achievement-focused, Reeves agrees that testing can be extremely activating for an eating disorder and should be explored with caution. Luckily, there are ways to opt out of these scenarios. If parents feel that the mandatory tests may be detrimental to their loved one, they have the right to discuss the possibility of having their child excused. “Your health care provider can ensure you have the proper documentation to receive accommodations for your child. Understanding the curriculum and requirements can be extremely helpful in helping your child feel included without being triggered,” Reeve says. Is P.E. class okay for someone with an eating disorder? According to experts, movement and exercise is not always off the table for those in recovery from or at risk for an eating disorder (as long as they are medically stable and approved by their physician to participate). “When done properly, PE can be a therapeutic way to reintroduce activity in a supervised environment,” Hill says. “For some patients with eating disorders, getting back to PE can be motivating and help encourage meal completion. For these students, I recommend a gradual return to full activity.” Hill says the ideal PE course helps students learn that movement — when performed in a sustainable way and for the right reasons — can be immensely beneficial for physical and mental health. “And that there are so many different ways to learn how to move your body — there is truly something for everyone when it comes to physical activity,” she says. “Exercise can and should boost self-esteem, lift mood, improve sleep quality, and relieve stress. But unfortunately, for many, PE does not achieve this mission.” For those with active eating disorder symptoms, participating in PE or other activity-based extracurriculars can potentially do more harm than good. “If the PE course requires weights to be taken or discusses topics like dieting, ob*sity, or weight loss, students or their families should speak to their medical provider to get a medical exemption from the course,” Hill says. Hill also adds that the goal of physical education should not be to shame kids who perform “poorly” on fitness tests or have BMIs in the “red zone” (something largely based on genetics and external factors outside the student’s control anyway). The mission instead should be to instill a lifelong enjoyment of physical activity and movement for all students, not just athletes. What can families do to minimize the potential risks of harmful messages around exercise? Given the prevalence of fitness tests and traditional methods of physical education in schools, what can parents do to ensure their child isn’t exposed to toxic diet culture rhetoric or harmful messages around exercise? Reeves says initiating a conversation with school faculty can be an important starting point for ensuring the academic environment is as safe and supportive for their child as possible when it comes to eating disorder recovery or prevention. “Talk to your school, coaches, and PE teachers,” Reeves says. “Get a feel for their outlook and bias towards movement, weight, and nutrition. Their personal views will largely shape how the programs are run.” Hill also encourages parents of kids with eating disorders to help educate PE teachers and coaches on activities or messages that might be triggering. “Chances are your child is not the first nor last kid with an ED that will be in that class, and chances are also good that your child’s PE teacher has not received a reputable education on eating disorders either,” she says.]]></content:encoded>
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            <title><![CDATA[Grandparents Can Be Key to Eating Disorder Recovery. Here’s How to Involve Them. ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/grandparents-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/grandparents-eating-disorder-recovery</guid>
            <pubDate>Thu, 01 Dec 2022 22:31:00 GMT</pubDate>
            <content:encoded><![CDATA[Anyone familiar with family-based treatment (FBT) knows the invaluable role parents can play in eating disorder recovery. But moms and dads aren’t the only family members who can offer life-changing support to a child or teen struggling with disordered eating. FBT is the evidence-based treatment that’s effective for every young person with an eating disorder, and that means it’s for people from all types of households and family configurations. While anyone’s chosen family can be brought into treatment — siblings, cousins, guardians, etc — for many, including grandparents in the process is a vital step on the road to recovery. Equip peer mentor Makailah Dowell says her grandmother’s involvement was essential not only to her eating disorder recovery, but also her upbringing and development. “For some of us, grandparents have to be more than weekend visits, baking cookies, and spending time on the holidays; they have to be our sole guardians, our back-up parents, our only providers,” she says. “That was the case for me, anyway. My grandmother raised me, as a single parent at the age of 40. My grandmother helped me tie my shoes, graduate 8th grade — and battle an eating disorder. She is there for every moment in my life, big or small..” But even in those cases where the grandparent isn’t a child’s primary caretaker, grandmothers and grandfathers can still play an active — and crucial role — in the family’s collective fight against an eating disorder. Here’s what experts and those with lived experience have to say about the benefits of bringing grandparents into the eating disorder treatment process. The benefits of involving grandparents in eating disorder recovery There are myriad ways to show support in the recovery process, and each friend or family member involved brings something different to the table. Given their life experience, relationship to the patient, and individual personality traits, grandparents may offer specifically unique contributions and insights to the treatment journey. “Grandparents have a very unique perspective,” Dowell says. “They are able to reflect on a life full of memories of raising their children, which provides this understanding and knowledge. They provide a comfortable environment, understanding the culture of meals within the home, and simplicity of knowing you.” Equip Co-Founder, COO, and Chief Clinical Officer, Erin Parks, PhD, says families who bring at least one grandparent into the treatment process often thrive. “If you haven’t invited your parent — the child’s grandparent — to participate, and they’re alive and live near you, think about why you haven’t, and then think about what the benefits could be of bringing them in,” she says. Parks believes there are two specific reasons the support of grandparents may be particularly important in recovery. The first reason is rooted in logistics — simply having another willing and able participant can lighten the load for other caretakers. “It means having another adult that you can help tag in and tag out,” she says. “You don’t have to do every school pickup, you don’t have to be in charge of every dinner. It’s someone else who can learn to help you meal plan, to go grocery shopping, to help make calorically dense food or more frequent food. Having another body to supervise meals or supervise after meals…It can be really nice to have an extra adult to pass the baton to.” (Dowell echoes this sentiment, explaining that because grandparents can help with meals and chores, they “are like backup quarterbacks for the family. My own grandmother would like to consider herself Tom Brady 2.0.”) The second reason Parks recommends including grandparents is to get all family members on the same page so there are no hiccups or miscommunications in the treatment process. “If they live in the vicinity and you see them frequently, it’s easier to bring grandparents into treatment than to police them,” she says. “As parents, you end up in the game of telephone, i.e. ‘the therapist said this, I’m going to tell it to my mom,’ and then ‘why does my mom keep saying the wrong thing at dinner?’ Bring them into treatment. If they’re going to be around anyway, don’t put yourself in the role of playing telephone. It’ll weaken your relationship with your parent.” Equip family mentor Kristi Humston believes the role of grandparents extends beyond practical contributions and into the emotional realm. “It's less about any one thing grandparents may do and more about why grandparents can be so effective,” she says. “Grandparents tend to reflect the purest form of unconditional love. They already know the child well — and the child may trust them even more than their own parents, especially in the thick of an eating disorder! There's a natural bond that isn't easily replicated or broken, and grandparents often have mastered the art of just listening or sitting comfortably in silence.” Not every family includes grandparents who are educated about eating disorders or mental health — that’s understandable. Parks says it can still be hugely beneficial to loop these family members into the recovery process. “I’ve had people say, ‘Oh the grandparents are from a different generation, they’re not gonna be able to learn this stuff and they’re not gonna get into anti-diet culture,’” she says. “I always say, ‘Give them the benefit of the doubt!’ Bring them to treatment even if you think it’ll be a disaster. Worst case scenario, they’ll be exactly where they are now. Best case scenario, you have someone you can tag out to, and you can lean on them instead of being their teacher.” How can families include grandparents in eating disorder treatment? Trying to figure out how to bring grandparents into the treatment process may be tricky for some families — particularly in scenarios where the older adults don’t seem to understand the complexities or seriousness of disordered eating. Dowell says that simply sharing information and initiating a conversation can go a long way. “It can begin with looking through resources like Equip’s blog and FEAST’s user-friendly website, and having conversations as a family about the disorder. The more we communicate about something that seems foreign, the less foreign it will become,” she says. If bringing grandparents into the recovery process still seems difficult or unrealistic, it may be helpful to start with small, actionable tasks that have the potential to lead to greater involvement as time goes on. “They can help to supervise a snack, school lunch or occasional meal so parents may attend to other needs,” Humston says. “They can offer a space for normalcy while playing a game, going fishing, or watching a movie. They can start a welcomed conversation that has nothing to do with food, clothing, appearance, or exercise. And they can send a simple note of encouragement, make a favorite dish of the family — secretly filled with as many calories as they can dream up — and love a little extra on the siblings who are desperately craving some attention.” And if the thought of organizing a formal family meeting to discuss the future sounds overwhelming or exhausting, consider just picking up the phone and seeing where that leads. “Families can start by a simple phone call,” Dowell says. “Reaching out for help is hard, but understanding you need that help is key to making treatment possible. Grandparents can help with preparing meals, supervising on days that you need a break, and also just being an ally during a time of hardship.”]]></content:encoded>
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            <title><![CDATA[Jewish and in Recovery: How to Approach Fasting During the High Holidays]]></title>
            <link>https://equip.health/articles/food-and-fitness/jewish-high-holidays</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/jewish-high-holidays</guid>
            <pubDate>Sun, 05 Sep 2021 14:17:00 GMT</pubDate>
            <content:encoded><![CDATA[As summer winds down and fall approaches, the holiest days of the Jewish calendar are upon us: Rosh Hashanah and Yom Kippur. The former, known as the Jewish New Year, is typically marked by festive customs and symbolic feasts. The latter is the “Day of Atonement”, a somber day of reflection and praying for forgiveness, perhaps best known for the fast that accompanies it. Jewish people who observe Yom Kippur typically eat their last meal with friends and family before sundown on the eve of Yom Kippur, and then abstain from all food and beverages until sunset of the following day. While Yom Kippur is often referred to as the holiest day of the year for Jewish people, it’s a day that can be complex, challenging, and even triggering for those with eating disorders. Equip’s Director of Marketing, Lauren Gerber, knows this first-hand. “While Yom Kippur, the Jewish day of atonement, is intended to be solemn in its focus on personal reflection, it was actually solemn for me because the fasting robbed me, as eating disorders tend to do, of the beauty of a meaningful day,” she says. Eating disorders exist in the Jewish community Gerber certainly isn’t alone. As we know, eating disorders do not discriminate, and they affect individuals of all ages, races, ethnicities, genders, religions, etc. As the National Eating Disorder Association (NEDA) notes, “eating disorders, as with any mental illness, show no boundaries between demographics, with several studies indicating a rise in the problem for Jewish women.” While there’s no single reason for the statistics, a report in the Washington Times suggested that in Orthodox communities in particular, there may be a reluctance to acknowledge eating disorders due to the ongoing stigma of mental illness (a pervasively taboo topic in many cultures). One study found that 25 percent of Jewish girls at a Toronto school suffered from eating disorders that merited treatment, compared with 18 percent of non-Jewish girls. While there is no evidence that fasting during the High Holidays contributes to eating disorders, some individuals have experienced Yom Kippur to be particularly challenging. "Fasting and the High Holidays has absolutely triggered disordered thoughts and behaviors for myself and many close to me,” says Equip peer mentor, Sara Plawker. “As someone who has been working on recovery imperfectly for five years — and struggled with mental health and Jewish identity for the 28 years I’ve been alive — my interpretation of fasting as part of Judaism is ever-evolving.” Where fasting fits into Judaism — and when it is encouraged to skipped As mentioned in a New York Times piece, there can be an unfortunate misinterpretation of Jewish law that may lead some individuals with eating disorders to inappropriately justify their behaviors. While fasting is considered a customary practice on holidays like Yom Kippur, abstaining from food for religious purposes, as Jewish law sees it, never takes priority over one’s health. “Judaism is very clear that literally nothing comes in the way of saving a life — nothing,” explains Rabbi Yakov Saacks, director of the Chai Center in Dix Hills, New York. “Not Kosher, not Yom Kippur, not Shabbat observance. If a baby will be in danger if he gets circumcised — which is a foundational practice in Judaism — then a bris gets pushed off for however long it needs to be. To give a bris to a baby in danger, is considered a terrible sin.” Rabbi Saacks understands the complexities of eating disorders and their intersection with Judaism in a very personal way. As he wrote in an article for the non-profit, F.E.A.S.T., his daughter suffered from an eating disorder. “After my daughter got sick, I had to make some hard decisions,” Rabbi Saacks says. “Once I realized that insisting on the Jewish laws on food and eating was an obstacle to her recovery, I let it go. The philosophy here is that only a living person can observe the commandment to fast on Yom Kippur, and if I encourage her or even allow her to fast, which I will do with my other children, then I am an idiot and not righteous at all. Fasting will serve to exacerbate her eating disorder and make her ability to fight to live another day more difficult.” Gerber also felt that Yom Kippur played a pivotal role in her own eating disorder journey as a Jewish person. “Instead of celebrating—or at least observing—the high holidays, for many years I celebrated—or at least observed—my eating disorder,” she says. “Yom Kippur, and all its praise of food restriction, reinforced the harmful belief that my eating disorder was a badge of honor.” The freedom to interpret and personalize Jewish traditions Plawker says that their current views are largely influenced by the philosophy of intuitive eating and the importance of nutrition. Over the course of their recovery, Plawker has developed a deeper understanding of the ways food can affect focus and mental presence, and uses those concepts as foundational elements in their faith. “One of the reasons we fast on Yom Kippur is because the day is so holy that we need to put aside our physical needs in order to nurture our spiritual selves,” she says. “However, within my eating disorder-filled mind, it felt at the time as though my religion, family, and ethnicity were all validating my eating disorder.” Plawker says that she believes people with eating disorders should avoid fasting. “I believe that it is the Jewish thing to do,” she says. “Yes really! The Talmud [a collection of writing that covers Jewish law and tradition] backs me up. There is a concept in Jewish theology called pikuach nefesh which states that the need to preserve human life overrides every other Jewish commandment. Fasting when you have an eating disorder is not true to our spirit of survival and perseverance that is baked into our bodies through ethnicity and ancestry. Starving ourselves is not Jewish.” Plawker is adamant, however, that their refusal to participate in fasting in no way compromises or diminishes their faith. “The way I personally accomplish healthy recovered observation of the High Holidays is by surrounding myself with trauma educated, ED-informed, body-positive Jews,” she says. “I am blessed to count many friends and family members in that category, Baruch Hashem [thank God].” For anyone still struggling to find a similarly supportive and informed Jewish community, Plawker recommends curating your media consumption to cater to those needs. She recommends following eating disorder therapist and Equip advisor Shira Rose, therapist and writer Rachel Otis, and Laur Plawker "who I am blessed to call my sister,” Plawker says. Plawker plans to commemorate this Yom Kippur in a deeply personal way: out in nature, enjoying homemade Jewish food, nurturing their body while reflecting and repenting on this last year “If you’re a human that struggles with food and diet culture — which virtually everyone is no matter their intersectional identities — you are not alone,” Plawker says. “Now a message specifically for my mishpacha (‘family’ in Hebrew) that struggles with food and body — this is said with love and non-judgment and is my own opinion: our ancestors — my grandmother and yours — did not suffer as they did for you to succumb to diet culture and deadly illnesses like eating disorders. To quote the inimitable Lin Manuel: “the fact that you’re alive is a miracle.” You are enough. To life, to life, l’chaim!”]]></content:encoded>
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            <title><![CDATA[What to Do When “Diet Talk” Arises]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/diet-talk</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/diet-talk</guid>
            <pubDate>Wed, 10 Feb 2021 03:33:13 GMT</pubDate>
            <content:encoded><![CDATA[The weeks leading up to the official start of summer can be tough for anyone with an eating disorder — or, frankly, anyone who's ever had any kind of body image issues. From “beach body workouts” to “detox diets,” our social media feeds are typically flooded with false promises from influencers and companies as swimsuit weather approaches. And while all this "diet talk" is nothing new, it can still be really hard to handle, and have majorly negative consequences. Let's dive deep into the damaging effects of diet talk. What is “diet talk”? Sometimes it can be tough to know what to say to someone in eating disorder recovery. But other times, it can be even tougher to know what not to say when you or someone you love is in the process of healing from an eating disorder. Perhaps unsurprisingly, diet talk is in the latter category. “Diet talk” is exactly what it sounds like: people talking about dieting, whether those conversations include details about restricting calories, specific diets, or musings or plans that are centered around losing weight or changing one’s appearance. Diet talk is usually made up of many diet culture myths, which most often involves conversations about one’s body that encourage negativity about that body. It reinforces the idea that smaller bodies are “better” or represent desirable attributes such as self-discipline. Because of this focus on self-discipline, diet talk often includes comments about wanting to change one’s appearance/eating habits and how to do so. Diet talk can also extend to conversations about other people’s bodies. These comments can sound positive, such as in a statement like “I wish I could eat dessert, but I just don’t have your figure!!” However, below the surface, this is a judgment on the “unacceptability” of both oneself and of specific types of bodies. Why diet talk can be toxic Here’s the thing: diet talk isn’t harmless because diets themselves aren’t harmless. In fact, according to the National Eating Disorder Association (NEDA), dieting can be directly tied to the development of disordered eating, particularly in teens. In a large study of 14 and 15-year-olds, dieting was the number one predictor of developing an eating disorder compared to those who didn’t diet — the teens who dieted “moderately” were five times more likely to develop an ED, and those who severely restricted their eating were eighteen times more likely to develop one. But besides the extreme side of things, the fact that’s almost always brushed under the rug in the $60 billion diet industry is that 95% of diets simply don’t work. So why are we continuing to be targeted by so many people, brands, books, and articles claiming otherwise? Because diet talk is culturally normative and encouraged as a social activity, almost all of us have engaged in this kind of talk. That doesn’t make it okay, however. Diet talk is never a helpful way to bond with others. Here are a few key reasons diet talk is harmful: Diet talk contributes to a culture that shames larger bodies and elevates smaller bodies. Diet talk reinforces the idea that someone’s body is the most important/significant thing about them. Diet talk reinforces the idea that someone’s health can be determined by their appearance alone, and that we have a right to discuss other people’s health/eating habits. Diet talk can be triggering for those trying to recover from an eating disorder. What Can You Do When Diet Talk Arises? If you’re not sure what to do when diet talk comes up in conversation, here are some tips to help you navigate the discussion: 1. Share why diet talk is harmful for you. Example: “I find this kind of talk makes me feel bad about my body.” Example: “Speaking this way about my body makes my eating disorder voice louder.” 2. Excuse yourself if needed. This is not necessarily rude; instead, it is important self-care. Example: “Excuse me, I’m going to get some fresh air.” Example: “I need a break for a moment. I’m going to step outside.” 3. Consider speaking up. Example: “It makes me uncomfortable talking about Jane’s body like this. It’s not appropriate to make judgments about her health.” Example: “I’m trying not to talk about my body negatively. It would be helpful if we could change the subject to support that goal.” 4. Suggest changing the topic. Example: “I’d rather we talk about last night’s baseball game. Did anyone watch it?” Example: “I’d prefer if we talk about Jane’s birthday that’s coming up! How should we celebrate?” Now is the perfect time to examine and question why diet talk is so prevalent in our society. We can start to change the conversation and opt out of diet-focused exchanges if we pay more attention to how we think, feel, and speak about all these topics and how we approach them with our loved ones. Download these coping cards to arm yourself with in-the-moment reminders to ground yourself when diet talk arises.]]></content:encoded>
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            <title><![CDATA[The Importance of Carbs (and Fat): Understanding Your Body’s Needs in the Protein Craze]]></title>
            <link>https://equip.health/articles/food-and-fitness/why-carbs-are-important-balanced-diet</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/why-carbs-are-important-balanced-diet</guid>
            <pubDate>Fri, 07 Nov 2025 18:25:00 GMT</pubDate>
            <content:encoded><![CDATA[When I became a dietitian nearly 10 years ago, protein wore a health halo in the wellness world. It was the macronutrient that was touted as the best or “healthiest” among its counterparts (carbs and fats). Now, protein’s halo seems larger and shinier than ever in our culture—from social media to gyms to ads, the message that we should all be eating more protein is inescapable. In fact, a 2025 food and health survey from the International Food Information Council shows that 71% of Americans are trying to eat more protein and about a third have increased their protein intake over the last year, while a “high protein diet” was reported as the most common eating pattern. In my eating disorder nutrition practice, I’ve also noticed that clients typically have the least amount of fear attached to high-protein foods. While there are likely many reasons why our society is obsessed with protein, there are a few key factors. For one thing, it’s simply never had a negative reputation (like fat in the 90s, and carbs afterward). It’s also the macronutrient most associated with changing body composition (i.e., losing fat and growing muscle), which is a focus for anyone entrenched in diet culture and its harmful beliefs that there is a certain body ideal to chase. Dietitian Ana Pruteanu points out that the protein hype also seemed to increase with the weight loss drug explosion. “Fear of losing muscle mass while losing weight has placed more emphasis on what one could do to limit muscle loss, which often leads to eating more protein,” she explains. “Protein is needed to build and maintain muscle, and our society at this moment is very focused on muscle gain or preventing muscle loss.” While protein is essential to our health and well-being for a myriad of reasons (more on that later), this hyperfocus on one macronutrient at the expense of others is unnecessary and even detrimental in some cases. Today, we’ll explore the importance of carbs and fats, the truth about protein, and how to strike a relative balance between all three macronutrients. Why are carbs important? Carbs get so much hate these days that it’s often (and understandably) hard for many people to believe that they’re the source of energy that our bodies and brains prefer most. “Often, in our society there is a misrepresentation that carbs are empty of nutrition, which couldn’t be further from the truth,” Pruteanu says. “Carbs are an essential macronutrient that our bodies need to function. They are the fuel each cell needs to live and work.” While carbohydrate needs vary from person to person and depend on a variety of factors, like health status and activity level, it’s recommended that most people receive at least half of their calories (and usually more) from carbs on a daily basis. Here are some examples of the critical role of carbohydrates in the body: They allow proper brain function. Research shows the brain uses around 20% of the body’s energy (which is primarily glucose, or sugar, derived from carbs), and eating enough carbs supports important cognitive functions like memory, attention, and decision-making processes. They help preserve muscle. If the body doesn’t receive adequate carbs, it will try to get energy by breaking down muscles into amino acids (protein’s building blocks). As Prutaneau explains, this is “not an efficient pathway and often we can feel the side effects of fatigue, impaired muscle recovery and loss of muscle mass, feeling shaky or nauseous, or having a harder time concentrating.” However, when the body receives the carbs it needs, this process is unnecessary, and muscle is preserved. They support “happy hormone” production. Carbs are required to produce serotonin, a neurotransmitter regulating mood, sleep, and appetite. Serotonin needs a certain amino acid (tryptophan) for synthesis, and eating carbs increases insulin secretion, which helps transport tryptophan into the brain—making serotonin creation possible. They provide vitamins and minerals. Many sources of carbohydrates also provide essential vitamins and minerals, or micronutrients. For example, whole grains (like oats, brown rice, quinoa, or whole wheat bread) provide B vitamins, iron, and zinc, while fruits offer micronutrients like Vitamin C and potassium. Starchy veggies like potatoes and butternut squash provide Vitamins A and C, potassium, and magnesium. Refined carbs (like white breads, pancakes, pasta, rice, and some baked goods) are often fortified with vitamins and minerals, too. They provide fiber. Many carb sources (like whole grains, fruits, and starchy vegetables) include fiber, which helps keep your digestive system healthy. It is also linked to lower risk of diabetes and heart disease because it supports healthy blood sugar and cholesterol levels. In eating disorder recovery, eating enough carbs has even more benefits. “Carbs are also often the easiest nutrient to replenish, which makes them particularly important in eating disorder recovery, where restoring energy balance quickly is key,” explains dietitian Tracy Colin, MS, RDN, LD. Since carbs are currently the most demonized and avoided macronutrient in our culture, and are often fear foods for those with eating disorders, it’s important to eat them regularly—with therapeutic support—during treatment in order to normalize them and create new neuropathways of safety. “Carbs aren’t something to fear,” Colin adds. “They’re a fundamental part of fueling the body and brain, and a cornerstone of rebuilding a healthy relationship with food.” Why you need fats I grew up on non-fat milk as a kid in the 90s. My mother simply thought she was making the healthiest choice for her family, because back then, fats were feared as much as carbs are today. While there isn’t as much societal fearmongering around fats anymore, there seems to be some residual angst about them—even though getting enough is critical for your health and well-being. Like carbs, fat needs vary by person and depend on many factors, but it’s generally recommended that most people receive anywhere between 20% and 35% of their daily energy from fats. It’s also common for those with eating disorders to fear foods high in fat (like oils, cheese, butter, cream cheese, red meat, salad dressing, and ice cream), often because fats provide the most calories of all the macronutrients. “They’re not ‘extra calories’—they’re a nutrient we need for hormone health, brain function, and overall well-being,” Colin emphasizes. Here are some reasons why fat is so essential for your body: They are necessary for vitamin absorption. “Fats are essential because they allow us to absorb fat-soluble vitamins like A, D, E, and K—without them, those nutrients can’t do their jobs,” Colin explains. For example, the fat in salad dressing helps you absorb the Vitamin A and Vitamin K found in your salad greens, and having fat in your milk helps you absorb the Vitamin D within it. You need them to feel satisfied. Chances are high that you’ll leave your meal feeling unsatisfied if you didn’t get enough fat. That’s because fats activate your body’s feeling of satiety—the feeling of being full and satisfied after eating—which signals it’s time to stop eating. Pruteanu adds that fats “flavor our food giving it a delicious taste and texture,” and this make the eating experience more enjoyable, and thus more satisfying. They help create hormones and cell membranes. “Fats break down into fatty acids, triglycerides, phospholipids and cholesterol, and these molecules are used by the body to create cell membranes and make hormones,” Pruteanu explains. “When someone is consuming a diet that is very low in fats, they will often experience impaired hormone production.” Cholesterol, for example, is a type of fat that is the precursor for many important hormones like estrogen and testosterone, and fatty acids are essential for producing eicosanoids, which are hormone-like molecules that regulate essential functions like inflammation and blood clotting. Finally, every brain cell membrane contains fats (usually phospholipids and cholesterol) necessary for forming and maintaining nerve connections, which are vital for healthy brain function. Although they can feel scary, eating fats is a vital part of eating disorder recovery. “Fats provide a concentrated source of energy that can help restore nutritional balance and weight more efficiently,” Colin explains. Regularly eating fats can also help restore the body’s hunger and fullness cues, which are often disrupted by an eating disorder. Additionally, eating fats at all meals and snacks can help to reduce preoccupation with food, since fats contribute to feelings of fullness and satisfaction (and food preoccupation often comes from being undernourished or unsatisfied). Why you really need protein Like carbs and fats, protein is an essential macronutrient that you need on a regular basis for your body to survive and thrive. In fact, protein is needed for nearly every bodily process. However, contrary to popular belief, you don’t need more protein than carbs or fats, and “more protein isn’t always better,” Colin says. “The goal isn’t to overload someone but to make sure they’re consistently meeting their requirements as part of a balanced plan.” Generally, protein recommendations range from 10% to 35% of daily energy needs, but (like the other macronutrients) your individual needs can vary depending on several factors. Like I mentioned, protein is typically the macronutrient group that’s least feared in those with eating disorders, but that’s not always the case. For example, I’ve worked with past clients to address fears surrounding animal proteins (like red meat, poultry, and eggs) because they’d adopted false beliefs from diet culture that such foods are “unhealthy.” Here are some key reasons why your body needs protein: Protein helps build and repair cell tissues all over the body. “Protein breaks down into amino acids, which are the building blocks of any tissue in our body,” Pruteanu explains. This includes everything from hair, skin, and nails to muscles and internal organs. “Protein is necessary to support our muscle mass, for our body to build strong tissues and be able to quickly repair itself,” she adds. It supports immune function. Antibodies, which are protective proteins created by your immune system, are necessary for removing foreign substances, like viruses and toxins, from your body. Without adequate protein, your body can’t produce enough antibodies to effectively respond to infections. Proteins make up vital enzymes and hormones. Proteins are a key component of enzymes, which are necessary for efficiently carrying out chemical reactions all over the body. For example, the enzyme amylase breaks down carbohydrates so they can be absorbed by the body. Some vital hormones consist of proteins, like growth hormone, which helps promote growth in children and maintain healthy body structure and metabolism in adults. It helps maintain stable blood sugar levels. “Since protein digests more slowly than other macronutrients, it can slow down how quickly carbs eaten simultaneously get broken down and absorbed,” Pruteanu explains. “Slower absorption of glucose from carbs leads to fewer blood glucose spikes.” For example, your blood sugar will spike quicker and higher when you eat carbs alone (a handful of crackers) compared to when you eat them with protein (a handful of crackers with peanut butter). Additionally, a 2025 study on anorexia shows that getting enough protein in recovery can help the body maintain lean tissue (which include muscles, bones, organs, connective tissues, and body fluids) and repair cells, and—when combined with enough calories overall—it can support a healthier, balanced recovery. “I always remind my clients that protein isn’t the only star of the show—it’s important, yes, but a balanced diet means also getting enough carbohydrates, fats, fiber, and micronutrients,” Colin adds. “Protein is a piece of the puzzle, not the whole picture.” How to strike a (relative) balance of carbs, fats, and proteins Our bodies and brains need enough of all three macronutrients to be healthy. “When one macronutrient is prioritized while the other ones are ignored, our bodies will show signs of deficiency,” Pruteanu explains. "Even if your goal is to build muscle and you are aiming to eat more protein, your diet should still consist primarily of carbohydrates, followed by proteins and fats.” But it’s also important to take this information as a guide, not strict rules that need to be followed exactly: despite what diet culture says, trying to rigidly balance your macronutrients is not necessary, and can become obsessive and unhealthy. “It’s not about being ‘perfect’ with macros, but about rebuilding trust with food, honoring your body’s needs, and making sure no single nutrient is left out of the picture,” Colin explains. “Having all three macronutrients throughout the day supports metabolism, satiety, and nutrient absorption.” So, shoot to strike a relative balance of carbs, fats, and proteins by including all three at every meal: this means carbs (e.g. bread, pasta, rice, and fruit), fats (e.g. salad dressing, avocado, olive oil, and nuts), and proteins (e.g. chicken, fish, eggs, and legumes). For example, your breakfast might include toast (carb) with butter (fat), eggs (protein) cooked with oil (fat) and cheese (fat), and fruit (carb). “For snacks, pair a carbohydrate with either a fat or protein for the same effect—think fruit with nut butter or crackers with cheese,” Colin suggests. For visual examples of balanced plates, the Plate-by-Plate Approach on Instagram is a good resource. Additionally, try including a variety of macronutrient sources, including simple and complex carbs, unsaturated and saturated fats, and plant and animal proteins, because they offer varying vitamins, minerals, and other nutrients, and support mental and emotional well-being. Here are some examples of each category: Simple carbs: fruit, white bread or rice, white potatoes, cookies or cakes Complex carbs: oats, whole wheat bread or rice, sweet potatoes, quinoa Unsaturated fats: avocados, olive oil, nut butters, nuts Saturated fats: butter, beef, pork, cheese Plant proteins: legumes, nuts, nut butters, tofu Animal proteins: eggs, chicken, fish, beef Wondering about where non-starchy veggies (e.g. spinach, broccoli, lettuce, and bell peppers) fit in? Add them to your plate as you wish—they provide essential vitamins and minerals, and fiber—but keep in mind they aren’t going to provide adequate energy on their own. Since everyone has varying nutrient and energy needs, it’s best to work with a dietitian to help you understand your individual needs and develop a meal structure or eating pattern that supports the healthiest version of you.]]></content:encoded>
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            <title><![CDATA[Who Gets to Be Fat in Hollywood, and to What End?]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/who-gets-to-be-fat-in-hollywood</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/who-gets-to-be-fat-in-hollywood</guid>
            <pubDate>Sun, 22 Jan 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Over the past few months, there’s been a lot of conversation around alleged fatphobia in Darren Aronofsky’s new movie The Whale, in which Brendan Fraser wears a fat suit to portray a 600-pound man. It’s an important discussion, one worth getting into, but also made me think about how Hollywood as a whole tends to depict fatness, and why that depiction matters so much. I started with a movie I think about at least twice per calendar year: a made-for-TV flick called To Be Fat Like Me. Despite Kaley Cuoco’s best efforts, the film is (perhaps unsurprisingly) heavy-handed and patronizing, and includes one of the more infuriating and pervasive tropes in Hollywood: the plight of a fat person…portrayed by a thin person. Cuoco’s popular character, Aly, is a high school softball star with a major chip on her shoulder: a mom who used Aly’s school scholarship money to pay for her own binge eating disorder treatment. Aly is so convinced that her mom and younger brother lean on their weight and food issues as excuses for their hardships that she decides to don a fat suit and document her experience in their shoes. There are…so many things wrong with this movie. Not only is the premise rooted in a binary paradigm that equates thinness with universal beauty and fatness with, well, the opposite, but it’s another Hollywood production that revolves around a thin actor embodying fatness through prosthetics, makeup, and digital enhancement. And because the values and ideals of Hollywood trickle down to society as a whole—especially young, vulnerable people looking to fit in—this persistent fatphobia contributes to the rising rates of poor body image and eating disorders. The problem with the “fat suit” It’s not hard to think of other TV shows and movies that make a mockery of fatness. Friends fans remember “Fat Monica”, Courtney Cox’s character as seen in cringey flashbacks, who is consistently portrayed as “sloppy,” and “socially inept”. We can’t forget about the time the supermodel Tyra Banks decided to wear a fat suit to see how hard larger people have it. And it’s impossible to omit Gwyneth Paltrow’s plus-sized persona in Shallow Hal, in which fatphobia masquerades as a lesson in tolerance. There are so many more examples of fat suits being used for a cheap, cruel laugh or ineffective morality tale, but the latest to make headlines is The Whale. The film drew attention before its official release, thanks to several minutes-long standing ovations for star Brendan Fraser along the festival circuit. But once The Whale officially premiered last month, critics were quick to find fault with it. Fraser plays Charlie, a 600-pound man who struggles to reconnect with his estranged daughter and hides from his online writing students by teaching classes with his camera off. While director Darren Aronofsky has said the goal of the film was to “create a fully worked-out character who has bad parts about him and good parts about him,” writers like Popsugar’s Victoria Edel have questioned why a fat-suited Fraser was chosen to play the part: “If visibility was really one of the filmmakers' goals, wouldn't they have used someone whose weight is closer to Charlie's?” Everyone from iconic writer Roxane Gay to influential podcast host and author Aubrey Gordon have spoken out against the film, calling it “exploitative” and “extraordinarily disheartening,” respectively. When I mentioned the controversial movie to my friend, author and pop culture analyst Erin Carlson, she didn’t sugarcoat her loathing: “The Whale is painfully out of touch, transforming Fraser’s character into a cautionary tale rather than a person worthy of respect, joy, and humanity,” she says. “It follows a terrible Hollywood tradition of hiring actors to wear fat suits in movies, then giving them a pat on the back—maybe even an Oscar nomination—for their ‘daring’ performances.” The consensus seems to be that this should not be considered a progressive attempt at fat representation on screen. An industry built on appearance and steeped in fatphobia I, like most millennials, first saw Elisa Donovan as Amber in the iconic 1995 movie, Clueless, but connected with her much more recently over, among other things, her dedication to promoting eating disorder awareness. When I asked her thoughts on the portrayal of fatness in film and TV, she didn't hold back. “Being on television and in film in the ‘90s was a brutal time to be in front of the camera,” she tells me, referencing the “waif” aesthetic of the time and a culture of pushing eating disorders under the rug. But, she notes, this mentality certainly isn’t confined to the 90s, and the persistence of the fat suit is one sign of that. “Hollywood's historic obsession with putting people in fat suits and then feeling proud of itself for being so inclusive and edgy and human just reiterates the focus on the exterior rather than the interior,” she says.“They’re still presenting bigger body size as a negative—as something to overcome, something the audience is supposed to feel some kind of pity towards. While empathy might be the intention, the result is anything but. It is exploitation and dehumanization of a very human experience.” Despite its popularity in Hollywood, it’s worth noting that the fat suit isn’t always employed on Hollywood sets. But even when actors are encouraged to gain weight for their roles, the result is often offensive. When Renée Zellweger portrayed Bridget Jones, countless moviegoers questioned whether the still-thin actress was meant to normalize body hatred for anyone who lacked supermodel proportions. The revolution will be televised…but we’re not there yet “Entertainment has a big impact on both culture and what we focus on,” Donovan says. “Open up any web browser or go to any supermarket checkout counter and take note of what dominates websites and magazine covers: celebrities and weight loss content. Putting someone of a larger body size on a magazine cover and saying how ‘brave’ and ‘beautiful’ and ‘comfortable’ they are in their own skin is reiterating the narrative that being thin is the norm and what we should all be striving for. The insinuation is still that being skinny is the ideal.” This, she says, speaks to our society’s underlying values—and because of that, we need a major paradigm shift. “Issues of this magnitude have to change on a fundamental level as a culture,” she says. “And to me, we seem very far from that kind of shift.” All of this feeds into a seemingly inescapable diet culture, which, in turn, can contribute to poor body image and disordered eating. It’s true, however, that some progress has been made in authentic, thoughtful fat representation on screen. Fans of This is Us praised the show for casting Chrissy Metz in a leading role. Euphoria’s Kat, played by Barbie Ferreira, took ownership of her body in season one, proclaiming “there is nothing more powerful than a fat girl who doesn’t give a f—” and Ferriera shared that reclaiming the word “fat” made her feel empowered. Aidy Bryant’s Shrill, based on the brilliant book by Lindy West, has also been lauded for its authenticity and depth in portraying the fat experience. These examples are heartening, but the truth is that they remain the exception rather than the rule—and in the meantime, fat representation on-screen may continue to be harmful. For parents wondering how they can protect their kids from the messages about bodies that these movies and TV shows send, Jen Derenne, MD Equip’s VP of Clinical Care Delivery, says it’s best to talk about it directly rather than censoring content. “Engage kids in conversation about what they are watching rather than restrict it outright,” she says. “There are certainly exceptions, but limiting access to content without adequate explanation or discussion tends to limit the development of critical thinking skills and encourages secrecy and hiding.” There may not be an easy solution to this long-standing issue, but given the harm of diet culture and fatphobia, it’s worth addressing. As consumers, we can demand more diverse casting by voting with our dollars and views. As creators, we can let fat people tell their own stories and strive to depict people of all body sizes as being three-dimensional, complex humans. As parents, we can talk with our kids about what they’re seeing. And as viewers, we can look on the screen with a critical lens, using unfair and simplistic depictions to challenge not only Hollywood’s internalized beliefs about bodies and their value, but also our own. A version of this article originally appeared on Katie Couric Media.]]></content:encoded>
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            <title><![CDATA[What Every Parent Should Know About Adolescent Eating Disorders ]]></title>
            <link>https://equip.health/articles/understanding-eds/adolescent-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/adolescent-eating-disorders</guid>
            <pubDate>Thu, 03 Apr 2025 00:01:00 GMT</pubDate>
            <content:encoded><![CDATA[When Equip’s Senior Manager of Content, Kate Willsky, describes the development of her eating disorder and first memories of body image issues, it’s like she’s describing my own millennial upbringing. “My eating disorder began in the summer between 5th and 6th grade, when I was 11,” she says. “I remember in elementary school becoming increasingly aware of my body size, and comparing it to the images I saw on TV or in Seventeen Magazine or the Delia’s catalog.” Willsky began reading nutrition labels and routinely doing abdominal crunches, two habits that I also adopted in middle school. At her annual checkup, Willsky’s doctor noted that she’d grown in height but lost weight. “I mentioned that to a teenage camp counselor that summer, and I remember her saying, ‘oh wow, I wish I could do that,’” she says. “Everyone noticed my weight loss and praised it at first.” From that moment, Willsky says, things quickly accelerated. Her eating habits became more rigid as she carefully monitored fat grams and measured her morning cereal. She began skipping dessert and exercising in secret, eventually setting her alarm so she could wake up in the middle of the night to work out on her bedroom floor. “By the autumn of 6th grade, I'd been diagnosed with anorexia,” she says. “By December of that year, I was admitted to the hospital for inpatient treatment.” While my own eating disorder progressed at a different pace (my anorexia diagnosis came in high school, followed by years in and out of intensive outpatient programs), Willsky and I share one distinct commonality: our illnesses took root during the impressionable years of adolescence. While eating disorders can affect anyone of any gender, sexual orientation, age, race, and socioeconomic status, they’re ranked as the third most common chronic illness in adolescent females specifically, with an incidence of up to five percent. Read on to learn why adolescence is such a vulnerable time for individuals prone to developing eating disorders, how to help prevent these illnesses, and how to get help if you’re concerned about an adolescent in your life. What the research says about eating disorders in adolescence Defined by the World Health Organization (WHO) as the ages from 10 to 19, adolescence is the most common life phase for eating disorder onset, which typically occurs between ages 12 and 25. According to a recent systematic review and metaanalysis, the global overall proportion of children and adolescents with disordered eating from 1999-2022 was 22.36 percent. Disordered eating appears to be more common in girls (30%) than boys (17%), and the numbers are increasing among older adolescents and adolescents with higher BMIs. “The most common eating disorder across all age groups in the United States is binge eating disorder, but adolescents can have other eating disorders including anorexia nervosa, OSFED or atypical anorexia, bulimia nervosa, or avoidant restrictive food intake disorder,” says Equip psychiatrist Dr. Barbara Kessel, DO, CEDS. “Eating disorders can happen to kids of any size and occur in adolescents from all races and ethnicities.” Signs of adolescent eating disorders Eating disorders can show up in a variety of different ways, and many of the hallmark behaviors occur in secret, making them particularly tough to spot. However, if you’re the parent or guardian of an adolescent, you’ll likely be able to notice at least some changes that may indicate there’s a cause for concern. According to Kessel, the most common warning signs of eating disorders in adolescents include: Changes in diet. This could include things like skipping meals, eating alone or avoiding activities involving food, cutting out previously favorite foods or entire food groups, over-focusing on certain macronutrients like protein, or going on diets. Changes in exercise habits. This might look like exercising in addition to designated sports practice times or sacrificing sleep or certain activities to work out. Concerns over body image. This can show up as a preoccupation with appearance, body checking, or wearing baggy/loose fitting clothing to hide their body. Changes in other food- or body-related behavior. This could include hiding or sneaking food, tracking calories, or weighing themselves frequently. Mood changes. While this can often show up as withdrawal, sadness, or having a flat affect, adolescents with eating disorders may also become angrier, more irritable, or more childlike, among other potential mood changes. “Eating disorders can be difficult to spot in the adolescent age group because adolescent bodies are rapidly changing as they undergo pubertal changes,” Kessel says. “Puberty is also commonly associated with changes in mood or irritability from a child’s earlier baseline. This can be confusing for parents and cause them to want to ‘back off’ for fear of rocking the boat or further agitating their adolescent. This is understandable, but it only leads to eating disorders being missed for a longer period of time.”  Why adolescence is a high-risk time for eating disorders “Adolescence is a time that is fraught with changes,” Kessel says. “Pubertal changes can be scary and difficult for some, and this time often comes with changes in peer groups and increased complexity of relationships. Not all kids develop at the same time or same rate, making comparisons to peers a potential challenge.Girls who develop earlier or are on higher percentiles for height and weight are known to be at higher risk for developing an eating disorder.” In addition to the inevitable and often-uncomfortable changes of puberty, Kessel says one of the biggest risk factors for developing an eating disorder at any age is going on a diet. According to one recent study, engaging in any type of dieting in the past 12 months was associated with greater eating disorder psychopathology in most groups. Unfortunately, research shows that many adolescents pursue dieting: according to data from the National Health and Nutrition Examination Survey, 37.6 percent of adolescents aged 16 to 19 tried to lose weight in the past year, with weight loss attempts higher among adolescent girls (45.2%) compared with adolescent boys (30.1%). Some other common eating disorder risk factors for adolescents include: Social media use. One study found that the “misuse of social media platforms” in adolescents is likely a significant contributing factor to the rise of eating disorders. Body-focused sports that encourage weight loss. Studies show that sports and activities that encourage weight loss or emphasize thinness like wrestling or ballet may put adolescents at a higher risk for eating disorders. Family history. Studies have found increased rates of eating disorders in relatives of those with anorexia and bulimia, and a first-degree relative of someone with an eating disorder is up to 12 times more likely to develop one than a person without a relative who has an eating disorder. For Willsky, the social upheaval caused by the transition from elementary school to middle school made her existing problems worse. “I remember being so overwhelmed by the cliques forming and the politics of popularity, and feeling comforted by the simplicity and clarity of my eating disorder's rules,” she says. “There was also the new pressure of dating, crushes, boyfriends, and being attractive to the opposite sex. I wanted to be pretty, to meet the beauty ideals I saw all over movies and TV shows and magazines—and everything I heard and read told me that if I wanted to achieve that, I had to be thin and ‘toned.’” How parents can help prevent eating disorders in adolescents There is no single cause of eating disorders, nor is there one single, guaranteed prevention strategy. However, there are parenting strategies that can help minimize the risk of eating disorders in adolescents, and everyday habits that can foster a healthier mindset around food, exercise, and body image. “Parents certainly can’t control everything in their adolescent’s life,” Kessel says. “In fact, this is really a time in their child’s life that they should be experimenting with increasing independence and autonomy. But, there are some things that are proven to decrease the risk of an adolescent developing an eating disorder.” Here are a few prevention strategies to consider: Demonstrate healthy attitudes. “Watch your own language and audit your own internal beliefs,” Willsky advises. “I still remember things my parents said, with no ill-intent, that lodged themselves in my mind and fueled the eating disorder—for instance, the idea that you ‘earn’ or ‘deserve’ food through physical activity.” Kessel agrees that eating disorder prevention starts in the home by promoting a body-positive environment and modeling an ‘all foods fit’ attitude to nutrition. “This means working on not moralizing foods or bodies as ‘good’ or ‘bad,’ while modeling that varied diets and body types are all part of living life,” she says. “This might mean parents themselves working on their own relationships with food, exercise, and their own bodies. Parents can try to model a positive relationship with their own bodies, exercise, and with food, and if parents are struggling with this, they should consider talking with a professional.” As often as possible, eat together. “Having regular family meals is a great way for parents to keep a pulse on how their kids are relating with food and provides an opportunity to improve connection within the family,” Kessel says. Keep close tabs on social media use. “I would recommend keeping kids off of social media altogether for as long as possible,” Kessel says. “Social media use has been shown to increase risk of eating disorders, disordered eating, depression, and anxiety. If parents allow social media, I recommend that they limit time allowed on the apps and discuss the dangers involved. Teach kids how to spot ads and accounts that might be profiting off of their insecurities and to think about them critically. Parents should require they have access to their adolescent’s accounts and check in on them regularly.” Don’t hesitate to seek support. “If you're concerned, get help immediately,” Willsky advises parents. “The longer these illnesses have to take hold, the more entrenched they become. I know that part of the reason my anorexia as a child accelerated so quickly was because I had time to lose weight, and my malnourished brain fueled the disorder. If you're worried, talk to a professional. Even if your child doesn't have an eating disorder, it's better to be safe than sorry.” Persevere through pushback. “I know that my parents were scared to make me mad—scared that if they pushed too hard I would retreat and close them out,” Willsky says. “But the reality is, if your child has an eating disorder, this is inevitable. The eating disorder will get mad, and get loud, and your kid needs you to fight back, because even though it seems like you're fighting with your child, you're really battling the illness that has them in a chokehold. They will not stop disordered behaviors of their own accord; they need their parents to help them. And though they may kick and scream and say horrible things in the moment, they will be thankful in the end.” Treatment for eating disorders in adolescence While there are a variety of evidence-based treatment options available to those struggling with all forms of disordered eating, only one is considered the gold standard of care for treating eating disorders in young people. “The treatment modality with the most robust evidence in treatment of adolescent eating disorders is family-based treatment, or FBT,” Kessel says. “FBT is a manualized treatment that requires specialty training, and parents should look for providers or programs that offer treatment based on this model. It requires heavy involvement from parents early on in the treatment, with parents gradually guiding their adolescent back to age-appropriate independence over time.” When choosing the type of treatment that will work best for an adolescent, Kessel advises parents to consider the severity of their child’s illness as well as their own ability to supervise the early stages of recovery and participate in treatment. “It is best to keep an adolescent in the least restrictive environment where they will have an opportunity to be successful,” she says. “Thus, allowing them the least interruption to school, activities, and relationships as possible for the shortest amount of time. Options should be discussed with your child’s PCP or mental health providers.” What to do if you’re worried your adolescent might have an eating disorder While it can feel overwhelming or even scary to confront the possibility that your child has an eating disorder, intuition and early action can be life-saving. “If you’re concerned that your child might have an eating disorder, listen to your gut,” Kessel says. “It’s best to bring up your concerns to both your child and their PCP. Don’t wait. The earlier an eating disorder is detected and treated, the higher likelihood that your child will be able to achieve a long and meaningful recovery.” While parents can have a profound impact and influence on their child’s recovery, it’s also critical to understand that parents are not the cause of their child’s eating disorder. “When an adolescent develops an eating disorder, it’s no one’s fault, and they are not a choice,” Kessel says. “Eating disorders have complex causes including genetic risk factors, developmental risk factors, psychological risk factors, and sociocultural risk factors. Once an eating disorder has taken hold, there are biological and psychosocial factors that contribute to maintaining them. Adolescents need consistent and loving support from their parents to make recovery possible.” Willsky agrees, reiterating that eating disorders are not the fault of parents, but parents do play a pivotal role in helping their child recover. “This is something we say a lot at Equip, but it's really, deeply true,” she says. “It won't help anyone to blame yourself or try to trace the ‘trigger,’ but it will help to band together as a family and help your child beat the eating disorder.”  FAQ How common are eating disorders in adolescents? The global overall proportion of children and adolescents with disordered eating from 1999-2022 was 22.36 percent. Eating disorders appear to be more common in girls (30%) than boys (17%), and the numbers are rising in older adolescents and adolescents with higher BMIs. Why is adolescence a high-risk time for eating disorders? The physical and mental changes that accompany puberty can be triggering in and of themselves, but adolescence is also a time of intense social change. Engaging in dieting behavior (which is common during this time), using social media, and participating in body- or weight-focused sports can also increase the risk of developing an eating disorder. How can parents prevent eating disorders in adolescent kids? While there is no single prevention strategy against eating disorders, parents can make a big difference in reducing the risk in their children by modeling healthy behaviors toward food, exercise, and body image. Regularly eating dinner as a family, delaying social media use, and seeking support when necessary can all contribute to a reduced risk in eating disorder development. How are eating disorders treated in adolescents? Family-based treatment (FBT) is considered the gold standard of care for adolescent eating disorders. This manualized treatment requires specialty training and the heavy involvement of parents who can help guide their adolescents back to age-appropriate independence over time.]]></content:encoded>
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            <title><![CDATA[Everything You Know About the “Ob*sity Epidemic” May be Wrong]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/obesity-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/obesity-and-eating-disorders</guid>
            <pubDate>Thu, 29 Sep 2022 18:13:19 GMT</pubDate>
            <content:encoded><![CDATA[Long before Dori Steinberg became Equip’s VP of Research, she was an ob*sity researcher. Of course she didn’t use the censored term at the time, as it was central to her work designing and evaluating weight loss treatments for adults at UNC Chapel Hill and Duke University. But after two decades in the field, Steinberg — who is also a registered dietitian and has a PhD in nutrition and public health — realized that it contained a fatal flaw. The flaw was so glaring that it changed the course of her life and removed the word “ob*se” from her vocabulary (more on that below). “Each study I worked on showed that diets can help people lose weight in the short term, but that weight almost always comes back after the program ends,” she says. “It was through my own eating disorder recovery that I realized the reason people were regaining the weight is that weight loss doesn’t work for the vast majority of people.” Steinberg also came to realize that these programs were not only contributing to weight stigma but actually promoting behaviors often seen in individuals with eating disorders. She notes that while behaviors like calorie restriction, daily weighing, and tracking everything you eat can raise red flags when they’re done by someone in a small body, they’re often applauded and encouraged for people in larger bodies. “I used to think that was okay, but I have now recognized that these behaviors are harmful for everyone,” she says. Once she’d had these revelations, Steinberg couldn’t continue down the career path she’d devoted so many years to — she needed to change course. Today, instead of designing weight loss programs, she’s helping to fill critical research gaps in the eating disorder field, particularly those stemming from the myth of ob*sity. A growing body of evidence is demonstrating the detrimental effects of a flawed paradigm based on weight in relation to height (the ubiquitous “BMI” metric) that classifies people as “healthy” or “ob*se” based on a meager amount of information. This classification system is — at best — doing a disservice to those in large bodies, and — at worst — perpetuating disordered eating, stigma, and shame. Here’s what Steinberg and others in the field wish more people knew about the pervasive misconceptions and flat-out fallacies around ob*sity — particularly as it relates to young people. Why “ob*sity”? First off, you’re probably asking yourself why the term in question has been censored. While different organizations and media outlets have differing perspectives on the word, many people in larger bodies and experts on the topic feel that “ob*sity” is more of a slur than a descriptor or category. Riddled with negative undertones and a problematic history, the word is hardly a neutral or even useful classification. “I have been in the healthcare industry for over 30 years and when I first saw ‘ob*sity’ I didn’t get it — I thought it was odd,” says Equip Family Mentor Laura Cohen. “Now that I’m on the other side of diet culture and understanding weight stigma, I love the change in the way the word is being represented. ‘Ob*sity’ is a word that has been given such negative connotations. It is so triggering to so many people on many levels. If changing the word to ‘ob*sity’ makes it less powerful, sign me up for that!” According to Steinberg, the term has been designated a disease by the American Medical Association for almost a decade and as a result, it’s often used to pathologize larger bodies and to indicate poor health. “That is just not true,” she says. “Weight is not a good marker of health, yet it’s been centered as the key marker of health. We know that there are many factors that impact our health and weight — many of those factors are outside our control, like genetics, food insecurity, or socioeconomic environment.” Just as larger bodies don’t indicate health problems, thin bodies don’t mean that someone is a paragon of wellness. “‘Thinness’ does not equal ‘health’ and there are many examples where diseases happen in people with thin bodies,” Steinberg says. “For example: type 2 diabetes, hypertension, and cancer — all of which have been thought to be associated with obesity. Stigmatizing someone because of their weight has been going on for too long and we need to stop and recognize that people come in all shapes and sizes — just like height and shoe size — and that size is not synonymous with health.” “One of my favorite facts about weight and health outcomes is that most people are able to achieve full remission, or at least significant improvement, in many conditions by normalizing eating behavior and making subtle tweaks to their day-to-day habits independent of weight loss,” says Megan Hellner, PhD, Equip’s Head of Nutrition and Physical Activity Research. In other words, in the majority of cases, people can address medical issues by eating balanced meals and moving regularly — with no need to lose weight. What’s more, the term ob*esity is itself rooted in the unsound premise of body mass index (BMI), which many health experts have come to regard as an inaccurate, misleading measure. “BMI was originally developed to figure out the best way to compare one’s height to one’s weight, and then morphed into being a metric for health,” Steinberg says. “Yet, it doesn’t account for different types of body mass, like muscle, bone, or fat.” Nor does BMI account for different types of people: the 1972 study that made BMI such a prominent and trusted health marker was based entirely on white, European men, and has been shown to be wildly unreliable for those outside that demographic. And those BMI cut-off points that tell you whether you’re “healthy,” “overweight,” or “obese”? They were established by an insurance company to set pricing.” But what about the “ob*sity epidemic”? You’ve almost certainly come across in headlines declaring that the ongoing “ob*sity epidemic” is wreaking havoc on the health of our nation. But experts like Steinberg believe that by labeling the existence of larger bodies an “epidemic” in the first place, we’re actually just contributing to the twin eating disorder and diet culture epidemics that are very much threatening the well-being of millions of individuals. “In my previous life as an ob*sity researcher, it was easy to see it as an epidemic — so many people had it and the prevalence was increasing. We must understand that the data used to determine this epidemic are based on the problematic concept of BMI,” she says. “The truth is that diet culture is what has driven our concept of the ‘ob*sity epidemic’ and we are now starting to see the consequences of that with the surge in weight stigma and our understanding of its negative impacts on health.” Equip Family Mentor Jamila Dawuni echoes Steinberg’s message, pointing out that a diagnosis of “ob*sity” may push individuals to pursue unhealthy behaviors in order to lose weight. “Some people have developed eating disorders after returning from doctors’ visits where they were told that they were ob*se and needed to reduce their weight,” Dawuni says. This diagnosis, she explains, can lead people to cut back on their nutritional intake and become more preoccupied with their bodies, behaviors that can develop into an eating disorder or disordered eating. Research shows that this is certainly true for adolescents and children, who may suffer serious consequences to their mental and physical health after an ob*sity diagnosis. What should parents do if their child is labeled “ob*se”? Steinberg says that even in her years as an ob*sity researcher, she intuitively steered away from working with kids because she worried any kind of diet program could set off a poor relationship with food for life. One major reason interventions for childhood ob*sity are inherently problematic is that many are based on a stoplight approach that categorizes foods as “good” and “bad”: foods in the “green” category are generally low-calorie and are permitted without restriction, foods in the “yellow” category are foods to be eaten on occasion, and foods in the “red” category are higher calorie foods that should be eaten sparingly. “Often ‘junk foods’ are in the red category, but so are nutrient-dense foods like nuts,” Steinberg says. “At Equip and in the research literature, we have seen examples of an eating disorder starting as a result of creating this food hierarchy.” Cohen says the very concept of a weight-loss program aimed at children is incredibly concerning. “When kids are placed on weight loss programs, it’s saying that they are not okay at their weight, and that being ‘fat’ is bad and being ‘thin’ is better. Providers should encourage healthy behaviors, which is different from putting the focus on the number on the scale. It is altogether possible that these kids deemed ‘ob*se’ are perfectly healthy. They may eat a very balanced diet and incorporate joyful movement in their lives. You cannot tell these things from a scale.” So if weight loss programs are decidedly not a good idea for kids, what should caregivers do if their loved one has been diagnosed as ob*se and their medical provider is pushing a particular “treatment” plan? Find the right provider. First and foremost, find a physician who is up-to-speed on the most recent research and adopts a Health at Every Size approach. “For parents of kids in larger bodies, it’s important to establish a relationship with providers who are weight-inclusive in their approach to treating patients,” says Hellner. “We tend to remember early interactions with providers very vividly, especially conversations about weight and shape. While there’s never one cause of a person’s food and body issues, feeling shame around weight and being prescribed weight loss by professionals is certainly a major contributor, and often a precipitating event.” Be your child’s advocate. Remember to speak up for your loved one. It’s okay to ask your pediatrician to never discuss your child’s weight or diet with them present.“ If you don’t have the option to work with a provider who is weight-inclusive in their practice, consider reaching out in advance to set some ground rules,” says Hellner. This could mean asking them to refrain from conversations about weight loss while your child is present, avoid labeling foods as good or bad, and to do “blind” weights, in which your child turns around on the scale and doesn’t see the number. Write down your desires. Consider giving your provider a pre-written letter or card that outlines the detrimental effects of weighing young people. Get help from an expert. In some situations, it might be wise to seek out more specialized support for your child. “If you’re concerned about your child’s eating behavior, consider reaching out to a trusted eating disorder specialist to explore further,” advises Hellner. Steinberg offers an important parting reminder that while weight loss is almost unanimously endorsed as a panacea in our society, it is not always a healthy solution.“We must recognize that prescribing weight loss to ‘solve’ health problems as a result of obesity is ineffective,” she says. “It’s unethical for us to continue to say that weight loss is the answer when it’s not possible for the vast majority of people who attempt it.” Rather than addressing a “problem,” the whole idea of the ob*sity epidemic sets in motion an industry that only does more harm to those caught up in it (which, in our society, is everyone). The answer to the problem is not, and has never been, to change a number on a scale — but rather, to remember that this number rarely tells you anything meaningful at all.]]></content:encoded>
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            <title><![CDATA[What Every Educator Needs to Know For Talking to Students About Weight, Health, and Eating Disorders]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorder-guide-educators</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorder-guide-educators</guid>
            <pubDate>Thu, 11 Aug 2022 15:31:11 GMT</pubDate>
            <content:encoded><![CDATA[Over the past few years, so much has changed about the way elementary, middle, and high school classes operate, and in so many ways, these shifts have allowed for more culturally sensitive and compassionate learning experiences. But there are still a lot of lessons to be learned about the most helpful ways to discuss eating disorders, weight, nutrition, and well-being in a classroom setting. There’s no handbook outlining the appropriate ways to address these issues, and especially given that most people are inundated by diet culture in our society, the risk of disseminating harmful, triggering, or inaccurate information is real. Luckily, understanding some key concepts of eating disorders and body image can help maximize the potential for creating a supportive, empathetic learning environment. “The number one thing educators must do is ensure their classroom and curriculum is weight neutral and not weight stigmatizing,” says Equip Director of Lived Experience and former educators, JD Ouellette. “I encourage health educators to lean into the research about what actually leads to improved lifetime health for their students versus what ‘feels’ like it should work. Educators should not engage in diet talk in front of students — we are powerful role models and we know diets are harmful and set kids up for the triggering of eating disorders and/or weight cycling.” While conversations of weight, food, and exercise can crop up in almost any classroom context, these discussions are often likely to arise in physical education and health classes. Given that many textbooks and class planning information may be outdated, educators may need to find ways to get up to speed on the most helpful educational tactics. “K-12 nutrition curriculum tends to focus on abstract concepts, numbers, and rules or restrictions around food,” says Equip Family Mentor and former educator Oona Hanson. “Health curriculum is also heavily influenced by beliefs and messages around food and thinness can be harmful to students. So what seems like a standard lesson on the risk of having, say, ‘more than X grams of sugar per day’ can end up being harmful to a student's health.” It’s important to know that while educators bear the responsibility of developing accurate and sensitive subject matter, there is a lot of unlearning that our entire society has to do when it comes to eating disorders and health myths. “It's not our fault as teachers that our knowledge about eating disorders is outdated, and there are many ways we can send messages that are damaging, even when our intent is good,” Ouellette says, noting some pervasive myths, like the notion that only thin, affluent white girls get eating disorders. “Be sure you are clear that eating disorders happen in all demographics.” There are plenty of other specific, actionable ways educators can ensure their students feel heard, seen, and understood — and that they’re real, up-to-date information. How to teach constructive, accurate eating disorder and health education According to Equip Peer Mentor Makailah Dowell, one of the most important steps educators can take in spreading accurate, helpful information about eating disorders is to do a deep dive on HAES, the Health at Every Size approach (HAES) framework, and learn the facts about what “health” really means.“HAES has provided many resources and evidence to support constructive dialogue in the classroom,” Dowell says. “It’s not only a facilitator to body positive conversations, but can open up the world of fat activism and communities that children are unaware of. I would also suggest adding in body gratitude segments of the day, as this can create consistency in the classroom and create a positive and open space.” In addition to educators expanding their personal knowledge of HAES, experts have other recommendations for leading constructive conversations in the classroom: Frame exercise as a positive activity for feeling a certain way, not looking a certain way.  “Focus on how joyful it is to move our bodies and encourage kids to find the movement that works for them and do it often because it makes them happy, versus promoting strict exercise routines meant to control body size,” Ouellette says. “Normalize and promote the message that of course they will continue to gain weight into adulthood as their bodies change and grow and prepare them for their adult lives.” Avoid associating foods with morality.  “There has been an elongated discussion about certain foods being ‘bad’ and others being ‘good,’” Dowell says. “There should never be ‘good’ or ‘bad' foods, as food is nutrition and fuel.” Focus on other aspects of “healthy eating” that have nothing to do with calories or fat grams.  “Help them learn skills surrounding food without the focus being on what food they are eating,” says Equip Registered Dietitian Erin Reeves. “These skills will truly help them into adulthood. This could include learning the different foods in different food groups to build more variety, studying foods from different cultures, learning how to prepare basic meals or snacks or how to make a grocery list for a week’s worth of food.” How to handle a scenario in which a student may have an eating disorder Arguably one of the toughest parts of being an educator is knowing when to approach a student about a potentially problematic situation or even escalate the issue. If a teacher suspects a child is exhibiting disordered eating behaviors or developing an obsession with food, exercise, or weight, it can be difficult to know if and when it’s appropriate to reach out to family. The bottom line is that eating disorders are life-threatening, and intervening early could make all the difference. Ouellette offers a few examples of how an educator might initiate the conversation: “I notice you/your child is not their usual sparkly self in class. I am hoping you can share with me what's going on so I can best support you” “I notice you/your child doesn’t seem like themselves lately and I've spoken to their other teachers and we have all noticed you using the bathroom every class period—can you tell me about that?” “I see you/your child struggling with assignments that used to come easily—I know that is something that can happen when bodies and brains don't get enough fuel. Can we talk about this?" “Do remember that just because a student or family denies an issue, doesn't mean it's not there,” Ouellette adds. “Lack of education about eating disorders and a symptom called anosognosia (lack of insight into your own illness) make it common for young people to genuinely not be aware of what is happening. Document your observations and discussions, move forward with your campus protocols for health concerns, and remember that family are almost always the most important people to include and offer resources to.” Familiarizing yourself with information that can be helpful in these scenarios, including Equip’s resources hub, is also important. A few other resources advocates recommend for educators include: National Eating Disorder Association's Toolkit for Educators Anti-Diet Book by Christy Harrison Intuitive Eating by Evelyn Tribole and Elyse Rech Gwen Kostal of Dietitians4Teachers]]></content:encoded>
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            <title><![CDATA[What’s the Relationship Between Intermittent Fasting and Eating Disorders? ]]></title>
            <link>https://equip.health/articles/food-and-fitness/intermittent-fasting-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/intermittent-fasting-and-eating-disorders</guid>
            <pubDate>Thu, 30 Apr 2026 22:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Diet culture is omnipresent in our lives, but it’s always shape-shifting. One of the more recent ways that diet culture has shown up is with the trend of intermittent fasting, or not eating for certain hours of the day. Over the past few years, countless people have jumped on the intermittent fasting bandwagon, usually out of a genuine desire to improve their health. But the reality is that intermittent fasting itself can be a disordered eating behavior, and can lead to other problematic and unhealthy habits. Read on to learn more about the risks and benefits of this practice, the relationship between intermittent fasting and eating disorders, whether it’s safe for those in recovery, and more. What is intermittent fasting? Intermittent fasting is one of the most widespread eating approaches in the United States, surpassing the ketogenic (keto) diet in popularity. Instead of setting rules about what types of foods you can and can’t consume (like limiting carbs with keto), intermittent fasting involves rigid rules about when—rather than what—you eat. “There’s a length of time in the day when a person chooses to eat, and a length of time they choose to fast,” explains dietitian Lauren Chaffin, RD. “There are several methods with varying time ranges,” she says, “such as a 16-hour fast with eight hours of eating, or fasting days, in which a person may cut way back on their caloric intake for five days, and then eat in a surplus for the remaining two days of the week.” According to Equip dietitian Rui Tanimura, RD, other intermittent fasters may have one large meal per day and avoid all meals and snacks otherwise, which is sometimes referred to as OMAD (“one meal a day”) on social media and elsewhere. Exactly how intermittent fasting looks will vary from person to person, but the basic principle is the same: limiting food intake during set periods and allowing unrestricted access to food during other periods. Are there proven benefits of intermittent fasting? Proponents claim that intermittent fasting has several significant health benefits. These include increasing lifespan, improving conditions associated with inflammation (like Alzheimer’s), preventing cancer, and improving heart health. Weight loss is also high on the list of touted benefits. “Supporters claim that it’s an effective approach to control or change weight, improve metabolism, and to prevent overeating,” Tanimura says. Some studies support the benefits of intermittent fasting—but they don’t show direct causation. In other words, the studies might show that intermittent fasting is associated with lower blood pressure, but the research doesn’t indicate whether one causes the other of if there’s a third factor driving the association (for example, maybe people who stick to an IF diet are more likely to take certain blood pressure-supporting supplements). This is an example of how correlation doesn’t equal causation. Another way to think about this concept is through a famous example. Ice cream sales and shark attacks are correlated (associated) with each other. But eating ice cream clearly doesn’t cause shark attacks. Instead, ice cream sales go up in summer because it’s a cooling treat in hot weather. And more people swim in the ocean in summer. Therefore, more shark attacks occur during the season. The existing research on intermittent fasting and eating disorders also lacks data from which we can make any evidence-based recommendations about the trend. “Intermittent fasting, just like any other fad diet, has far-reaching claims attached to it,” Chaffin says. “The problem is, the research on intermittent fasting has been done almost exclusively in a lab on animals.” For example, one study showing a link between intermittent fasting and longevity was conducted with fruit flies, and another was conducted on mice. Research that associated intermittent fasting with Alzheimer’s improvement or cancer prevention also used animals. Chaffin says the reason for the limited number of human trials is because of the restrictive nature of intermittent fasting. “It’s not sustainable,” she explains, “so many people drop out or are unable to complete the trial.” Some human studies show positive associations between intermittent fasting and cardiovascular risk factors like diabetes and hypertension. Yet they are too small and too short in duration to draw conclusive recommendations. “There’s just simply no way to know the benefits versus risk factors without looking at a large population of people over a long period of time,” Chaffin says. “The studies that do show ‘improvements’ only last somewhere between one to 12 weeks total. Compared to a lifetime, it’s a tiny blip of time.” When considering what the research says about weight loss, the story remains much the same. Studies are too small and too short to prove the diet “works” in the long run. “Most intermittent fasting research continues to need more longer-term outcomes,” Tanimura says. A recent randomized clinical trial examined the effects of intermittent fasting on weight loss for 12 weeks. The study showed no differences in weight loss between intermittent fasters and consistent eaters. Like all other restrictive diets, intermittent fasting comes with several potential side effects. These include extreme hunger, fatigue, insomnia, nausea, and headaches. Plus, research shows that dieting can lead to eating disorders. Is fasting bad for you? The potential risks and side effects of intermittent fasting Like all other restrictive diets, intermittent fasting comes with several potential side effects. Physical side effects The potential physical dangers of intermittent fasting include: Dehydration: Fasting windows allow for drinking no-calorie beverages, but research indicates reports of dehydration. Digestive issues: Fasting can cause constipation, gas, and bloating—and prolonged fasting is associated with gallstones and gallbladder attacks. Dizziness: More than half of participants in one study reported this side effect. Extreme hunger: No surprise here, but fasting windows can lead to cravings. Fatigue: Fasting windows can leave you feeling low energy. Headaches: Almost two-thirds of participants in one study reported headaches. Nausea: Feeling queasy during fasting windows is also a reported side effect.  Mental and emotional side effects Additionally, intermittent fasting risks include some potential negative psychological impacts. The main one is mood swings. In one study, more than half of participants reported mood swings with intermittent fasting. This may be because feeling hungry can lead to irritability, or that “hangry” feeling. Eating-disorder-related risks Research also shows that dieting is one of the biggest risk factors for developing an eating disorder. And intermittent fasting specifically can lead to disordered eating behaviors, as well as increased risk for developing a full-blown eating disorder, which we unpack in more detail below. The extreme hunger during fasting windows can lead to uncontrolled or binge eating. Likewise, the feeding window could also drive binge-eating behaviors, worsen restrict-then-binge cycles, or drive restriction in general. Fasting can also lead to a negative energy balance, where you are taking in fewer calories than what you are burning. This can be an eating disorder trigger. Is intermittent fasting an eating disorder? In short, no, intermittent fasting is not an eating disorder. However, all restrictive diets—including intermittent fasting—can be considered a form of disordered eating. This is a term used to describe a vast range of unhealthy eating behaviors that don’t necessarily constitute a full-blown eating disorder. Any sort of rigid food rules, like the ones necessary to maintain intermittent fasting, foster unhealthy behaviors around food and a hyper-fixation on food and body size. Intermittent fasting may also sever the natural connection between our minds and bodies. “When we use external factors, like the time, to tell us when we can and can’t eat,” Chaffin explains, “we’re telling our bodies that they are not to be trusted and that the cues and signals they give us can be ignored.” Intermittent fasting itself is not an eating disorder. But it does encourage several behaviors associated with eating disorders. One year-long study of young adults and teens of all genders showed a significant link between intermittent fasting and eating disorder behaviors like compulsive exercise, vomiting, and severe food restriction. Gretchen Wallace, RD, points out that the very structure of intermittent fasting lends itself to another eating disorder behavior: binge eating. “Intermittent fasting involves restriction for a large part of the day followed by a food free-for-all, which could look or feel like a binge,” she explains. Rigid rules and the behaviors described above are often symptoms of eating disorders. But not all intermittent fasters will experience disordered eating behaviors or thoughts. However, “that can change if the diet is followed for a long period of time,” Wallace says. “You won't find intermittent fasting listed as a diagnostic criteria in the DSM. But it can quickly shift from being an experiment for your health to a disordered relationship with food—or a full-blown eating disorder.” How intermittent fasting can lead to an eating disorder As Wallace explained, intermittent fasting has the potential to lead to an eating disorder over time. What may start out as a genuine attempt to experience health benefits can become a slippery slope that descends into disordered eating patterns. These patterns often build off one another and become more extreme. Remember, any restrictive eating pattern carries psychological and physical health risks. That’s why telling the difference between a diet and an eating disorder can be difficult.  “Your body doesn’t understand that this ‘famine’ is self-inflicted. So it’s going to be on high alert to increase its ability to survive and find food,” explains Equip Nutrition Director Erin Reeves, RD. “You might be thinking about food more or feel more out of control when you do eat,” she adds, “because your body can’t trust there won't be a famine again.” Tanimura tried intermittent fasting herself. She says it was one of the behaviors that ultimately led to her eating disorder diagnosis. “It is an extreme behavior that can likely trigger other eating disorder behaviors or attitudes, such as body dissatisfaction, a desire to adopt severe restriction methods, binge eating, low self-esteem, food rules, and attempting to ignore and suppress hunger cues,” she says. Learning about the Minnesota Starvation Experiment can help illuminate why fasting can have this effect. How can you tell when intermittent fasting is becoming disordered? If you or a loved one has been engaging in intermittent fasting, you might be concerned about disordered eating. If you answer yes to one or more of the following questions, fasting practices could be a concern. You feel guilty, ashamed, or anxious if you eat outside the fasting window. You keep extending your fasting window or adding more rules. You ignore hunger, fatigue, dizziness, or feeling unwell. You use fasting to “make up for” eating. You think about food most of the day. You binge or feel out of control when you finally eat. Your social life, mood, concentration, or all three are suffering. For further insight, you can take the short and clinically validated Equip Health eating disorder screener. Is intermittent fasting safe for people in eating disorder recovery? Experts do not consider intermittent fasting to be a safe practice for those recovering from an eating disorder. This applies whether you’re freshly in recovery or have been recovered for many years. The practice could lead to a relapse. Think of it like this: attempting intermittent fasting while in eating disorder recovery would be like trying to drink one glass of wine a day when you’re in recovery from alcohol use disorder. Plus, the principles of intermittent fasting and eating disorder recovery are in direct conflict with each other. “The components of intermittent fasting do not align with the pillars of eating disorder recovery, such as creating consistent meal and snack times every two to four hours, feeling and honoring our hunger and fullness cues, and removing debilitating food rules,” Tanimura explains. What’s more, intermittent fasting and other diets are externally driven, taking us further away from our bodies, ourselves, and our values—just like eating disorders do. “I would never recommend dieting to a person in recovery. And intermittent fasting is going to be particularly triggering due to its similarity to disorders like anorexia, binge eating disorder, bulimia, and OSFED,” Wallace says. “If you’re in recovery from an eating disorder and are interested in the alleged health benefits of intermittent fasting,” Wallace continues, “I suggest talking to an eating disorder clinician about how to incorporate health-promoting behaviors into your recovery rather than pursuing a diet such as intermittent fasting.” What are the alternatives to intermittent fasting? The healthiest way of eating is one that supports your mental, emotional, and physical well-being, and helps you live in alignment with your core values. One specific eating framework, called intuitive eating, fosters healthy food and body relationships, and includes principles like honoring hunger and fullness cues and making sure you feel satisfied at all meals and snacks.  Intuitive eating encourages internal guidance from your own body and mind (rather than external guidance like the number on the clock) and helps you reconnect to your innate ability to nourish yourself. If you are struggling with an eating disorder, working with a treatment team can help you find the best eating pattern for you right now. That may be using a specific meal plan, the plate-by-plate-approach, or a different structure. Eating intuitively in recovery usually takes time and intentional steps with professional guidance and support, and it usually happens later in recovery. Here are a few general tips for finding balance in eating and building a positive relationship to food, which will support your overall mental and physical well-being: Eat every few hours during the day, by starting with breakfast and continuing with lunch and dinner and snacks in between meals as needed. Ensure you eat a balanced diet on a regular basis by consuming the three macronutrients: carbs, fats, and proteins. Leave room for “fun foods,” or less nutrient-dense foods that you enjoy. (Cake, anyone?). Remember your needs can change from day to day, and that’s okay. Keep in mind that if you’re in early recovery, or have specific nutrition needs or concerns, working with a registered dietitian is helpful. The bottom line Intermittent fasting may be trendy and flashy, but its alleged benefits are not based on solid evidence. And it carries several risks that can seriously harm your physical and mental health. Additionally, intermittent fasting can lead to disordered eating behaviors or even an eating disorder. The healthiest choice is to prioritize your holistic well-being, which can’t be found in any restrictive diet or eating pattern. If you or someone you love is struggling with disordered eating or rigid food rules that are interfering with health and the ability to live a full life, help is available. Speak to your medical provider or schedule a consultation with an Equip team member. FAQ Who should avoid intermittent fasting? Some people should avoid intermittent fasting. These include people with a current or past eating disorder or disordered eating behaviors, children and teens, people who are pregnant or breastfeeding, and people who experience gallbladder attacks. Additionally, people who have diabetes should consult their clinicians to see whether intermittent fasting is safe for them. Is skipping meals the same as intermittent fasting? No, skipping meals and intermittent fasting are not the same thing. Intermittent fasting typically involves a feeding window and a fasting window during a 24-hour period, though other fasting schedules also exist. Many people doing intermittent fasting schedule their fasting window so that the bulk of it is during the night. Because of this, they may skip having a morning meal to extend their overnight fast. Alternatively, some people skip dinner as part of the process. Why is intermittent fasting so popular right now? Intermittent fasting is so popular right now because it has become a dieting trend. You do not need to fast, however, to manage health or weight. Can intermittent fasting delay eating disorder recovery? Yes, intermittent fasting can delay or complicate eating disorder recovery. This is because the dieting method relies on external cues, such as the clock, rather than your body’s hunger and satiety cues, to determine when you should eat or when you’re satisfied. It can exacerbate bingeing and restriction behaviors and worsen an existing eating disorder.]]></content:encoded>
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            <title><![CDATA[Earning free CE credits with Equip Academy just got easier!]]></title>
            <link>https://equip.health/articles/news-and-research/TPN-partnership-Equip-Academy</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/TPN-partnership-Equip-Academy</guid>
            <pubDate>Thu, 30 Apr 2026 20:15:00 GMT</pubDate>
            <content:encoded><![CDATA[Three years ago, Equip Academy was created with one clear mission: to educate the clinical community on eating disorders, for free. By sharing research and insights on a variety of topics—from lesser-known signs and symptoms to treatment recommendations for diverse populations and much more—our goal has always been to provide you and your colleagues with the tools and knowledge to help close the treatment gap for patients struggling with eating disorders. Historically, we’ve offered Equip Academy in a live webinar format for which eligible attendees earn free CE credits.  We’re thrilled to announce that our offering has expanded, making Equip Academy more easily accessible for providers everywhere. We understand your schedules are busy, and attending a webinar live isn’t always possible—and we want you to be able to view these events at your convenience, obtaining CE credit regardless of how and when you do. Going forward:  Equip Academy CE’s can be earned live or on-demand—at your convenience. Playbacks will be posted within 2 weeks of live events. More accreditations will be offered to eligible providers (see full list below). It’s still completely free, at no cost to you.  We’ve partnered with TPN.health to make this all possible. Here’s how it works: On our website, click to register for an Equip Academy event. You’ll be redirected to TPN.health’s site, where you’ll create a free account. Attend a live session by registering with your TPN.health login. Watch past events anytime on our TPN.health profile page. Events are available within two weeks of being streamed live. You can also register in advance to be notified when they’re posted. After you view a live or on-demand event, you’ll receive an email from TPN.health prompting you to complete an evaluation. You’ll then receive your CE credit, which will live in your “CE Wallet” in your TPN.health portal. The following types of providers will be eligible to receive CE or CME credit for attending an Equip Academy event (either live or via playback): Physicians Nurses Dietitians Nutritionists Psychologists Social Workers Marriage and Family Therapists Addiction Counselors Counselors We’re so excited that this partnership with TPN.health will expand our ability to come together as a clinical community and advance care for patients struggling with eating disorders. Browse on-demand events here: https://app.tpn.health/orgs/776/events 
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            <title><![CDATA[New Research: What Social Media Is Actually Doing to How We Think about our Bodies]]></title>
            <link>https://equip.health/articles/news-and-research/equip-research-social-media-body-image</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-research-social-media-body-image</guid>
            <pubDate>Mon, 20 Apr 2026 21:32:00 GMT</pubDate>
            <content:encoded><![CDATA[Social media's impact on how people feel about their bodies has been well documented, but what’s been harder to quantify is its scale. New research from Equip surveyed more than 800 adults to find out exactly what people encounter online, how it affects them, and what happens when they try to push back. Here's what we learned, and what it means for everyone navigating this complex digital environment. The algorithm isn't neutral Nearly 70% of respondents encountered social media content promoting dieting, restriction, body checking, or disordered eating in the past year, without ever looking for it. Only 8% sought it out. When people tried to change what they were seeing, the algorithm often made things worse. Among respondents who actively sought out body-positive or recovery-focused content, 42% were subsequently served more fitness and body transformation content, and 33% received more restriction-focused "what I eat in a day" videos. Trying to opt out of harmful content functioned as a signal to serve more of it. For people in eating disorder recovery, this dynamic can be dangerous. Recovery requires building a healthier relationship with food, movement, and body image—a process that becomes significantly harder when the platform you're on is actively working against you. “It's definitely triggering to see that, it reminds me of my past struggles when I had an eating disorder, and it makes me feel pressured to look a certain way to be accepted or considered attractive. It triggers thoughts that I don't want to think about. It does increase my anxiety and depression around my weight and appearance, and it just makes me feel worse about my body. It reinforces unrealistic societal standards and has the potential to push me towards extreme behaviors.” -39-year-old woman  “These influencers reminded me of my previous eating disorder/disordered eating days when I was younger, like in my teens and 20s. It's taken so much internal work to undo all of the toxicity around women's bodies that I was exposed to when I was growing up, and watching influencer content like that takes me back to those days.” -37-year-old woman Women bear a disproportionate share of the harm The data breaks down sharply by gender. Nearly 75% of women encountered harmful body image content unsolicited, compared to about two-thirds of men. Women were more likely to encounter it frequently, more likely to feel worse about their appearance afterward, and nearly twice as likely as men to report a negative emotional impact. Among women whose behavior was affected, skipping meals was a significantly more common response than among men. Open-ended responses added an important dimension to this picture. Women in their 40s and 50s described expecting body image pressure to ease with age, and finding social media amplified it instead. The moments when they were most vulnerable—including postpartum recovery, perimenopause, and midlife physical transition—were exactly when harmful content hit hardest.  This isn't incidental. Nearly 1 in 3 women develop disordered eating for the first time in midlife, according to Equip's data, and the content environment they're navigating is making that worse. “I was feeling somewhat ok about my body, but the constant focus on appearance makes me more critical of how I look. Every time I'm on any social app, I see tons of Zepbound, Ozempic, & Wegovy ads as well as 'fitness' posts with super fit people in very little clothing. It makes me less confident.” -56-year-old woman  “I work very hard to retain a positive self-image. But when I am bombarded with this sort of stuff every single day, I cannot help a little bit of it seeping into my subconscious. So then I spend days/weeks fighting it back off. The pressure to appear perfect is astounding. And the connotation surrounding having any flaws in appearance at all is absolutely devastating to how I feel about myself.” -56-year-old woman  “As a 52-year-old female who is going through menopause (a HUGE body change!), I am astonished by how many videos are on IG and TikTok showing off women over 50 who have ‘perfect' bodies. They eat 100s of grams of protein per day, work out daily, lift heavy weights, etc. Or they just show off amazing outfits. This is totally unrealistic compared to the bodies of all my 50+ yo friends, and I feel tremendous guilt and shame watching these videos. It often spurs my friends and me to skip meals, overexercise (sometimes to the point of injury), or try silly new apps or wearable devices. It's so depressing and unrealistic. I thought the body image pressure would lessen after we turned 50yo — but I was wrong.” -52-year-old woman Men are affected too—but they may be unaware More than two-thirds of men said they've never felt triggered or distressed by harmful body image content on social media. But the behavioral data tells a different story. Among men who reported that their thoughts or behaviors were actually affected by what they saw, more than half compared their bodies to others online. Men were also significantly more likely than women to increase compensatory exercise after exposure to harmful content. The harm is present. It just doesn't look like what we've been taught to recognize as harm. Men are also encountering a distinct content ecosystem. Where women are more likely to see "thinspo" and weight-loss medication posts, men are more likely to encounter bulking and cutting content, material that frames disordered behavior as discipline, ambition, or self-improvement. This framing makes it far harder for men to identify what's happening to them, and far less likely that they'll seek help. “The fitness and diet advertisements on Instagram made me constantly compare my body to influencers and feel pressured to achieve their physique through strict eating and exercise routines.” -20–year-old man   “Although I don't pay attention to ads and generally take a very dim view of diet culture and weight loss ads, I do find that it's hard sometimes to completely ignore people who present as 'very fit' on social media. I find that it makes me a bit uncomfortable at times, and I have to talk to others or check in with myself to make sure I'm not buying into negative stereotypes.” -40-year-old man  “It constantly shows unrealistically thin or in shape people & makes exaggerated claims about diet & exercise. Even though I know I look okay, constantly being exposed to this gets to me a little, it makes me defensive about my body even though it's realistically fine, and I might exercise a bit more or diet more than I should to compensate.” -55-year-old man Paid content is part of the problem It isn't just organic content driving this harm. Nearly 80% of respondents reported being served paid advertisements or influencer content related to weight loss, dieting, fitness, or body transformation. Of those, 28% said it increased their anxiety about weight or appearance, and 28% felt direct pressure to change their body. Women again reported more negative impacts from paid content than men. But one finding cut across gender lines: GLP-1 and Ozempic ads were named unprompted by dozens of respondents as a distinct source of distress. Several people in eating disorder recovery described the current weight loss drug moment as a regression, a pressure to pursue thinness they thought they had left behind. When advertising for weight loss medications floods social media feeds at scale, the people most vulnerable to that messaging are often the ones with the least protection against it. “I remember seeing an ad for a weight loss injection recently (within the past week or so). It gave me this feeling of "I might need this product if I'm going to have the 'right look' to fit the current social standard for how bodies are 'supposed to' look." I was able to think about it more objectively once that feeling passed, but it was very concerning to me that I had that type of reaction to the ad.” - 34-year-old woman  “I had a really bad eating disorder in my teens, and seeing these grown women looking like they had the body of a 19-year-old triggered thoughts about how I no longer look young in weight.” - 28-year-old woman Looking forward: what our findings mean Social media platforms have the technical capacity to identify and limit harmful content. The fact that recovery-seeking behavior triggers more harmful content reflects how recommendation systems are designed and what they optimize for. Meaningful platform accountability would require platforms to treat body image harm with the same seriousness they apply to other categories of harmful content. For everyone navigating this environment, awareness matters. Recognizing that what appears in your feed is not random and that the discomfort or behavioral change you notice after scrolling may be connected to what you're being served is a first step. If you've noticed that social media is having a negative effect on your body image or overall mental health, it may be time to take a break, or mute or block certain accounts. If you're concerned about how social media might be impacting your child, these expert-endorsed strategies can help.]]></content:encoded>
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            <title><![CDATA[What Are the Different Levels of Care for Eating Disorders?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/eating-disorder-treatment-options</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/eating-disorder-treatment-options</guid>
            <pubDate>Mon, 27 Apr 2026 14:33:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’re wading through eating disorder treatment options for yourself or a loved one and have become overwhelmed with all the different types, you’re not alone. What’s an IOP and what’s a PHP? Where does virtual care fit in and how does it work? These might be some of the questions racing through your mind.  Take a deep breath and exhale. The two key things to know right away is that care is available and that you do have options when considering the type that’s best for you or a family member.  To unpack it all, think of levels of care for eating disorders as a continuum. The spectrum ranges from care on an outpatient basis (once a week or more) to around-the-clock care with inpatient hospitalization (which usually lasts for a few days or weeks).   Ultimately, eating disorder care is not one-size-fits all. What’s right for your circumstances may not be right for someone else. People often progress between levels of care as circumstances or needs change.  In this article, we explore the different levels of care for eating disorders and how they operate. We’ll help you determine what level of care is right for you or your loved one based on individual factors. What are the levels of care for eating disorders? The levels of eating disorder care include outpatient options (virtual and/or in person), an intensive outpatient program (IOP), a partial hospitalization program (PHP), residential treatment, and inpatient hospitalization.  Think of these levels of care as existing on a continuum rather than as strict categories. You might even picture a staircase where you can either “step up” or “step down” in care as needed.  “Eating disorder treatment should be tailored to meet patient and family needs,” says Barbara Kessel, DO, CEDS, the supervising psychiatrist at Equip Health.  “Now, that doesn’t mean just anything will work,” she adds. “It is important that people seek treatment rooted in evidence-based practices. But we also know eating disorder recovery will not work if it does not fit into someone’s life. This means that treatment can vary from person to person.” Outpatient treatment Time commitment Per week: 1 to 2 hours Duration: As long as needed Virtual option: Yes Living situation: At home, attending weekly sessions Level of structure: Minimal and flexible Best for: Patients who are medically stable and need flexibility  Outpatient treatment for eating disorders is best for patients who are medically stable. This means you or your loved one is not currently at risk for malnutrition or serious physical or mental health complications.  Outpatient treatment options typically include one-on-one sessions with a mental health professional. And you or a loved one might have occasional additional sessions with a registered dietitian and a medical provider.  Treatment may occur in person or virtually through video conferencing or other methods. Intensive outpatient program (IOP) Time commitment Per week: 3 to 9 hours Duration: 3 months to 1 year Virtual option: Yes Living situation: At home, attending various sessions throughout the week Level of structure: More structured than regular outpatient treatment but still flexible Best for: Patients who need a higher level of care than can be provided with weekly sessions but who need flexibility  You or your loved one might need a more intensive and structured form of outpatient care. An IOP includes the same elements as a regular outpatient program. But rather than solely meeting with individual providers, you’ll experience more of a coordinated care approach. This type of care integrates other elements such as meals and/or support groups.  IOPs can be built around attending school or going to work. And they can be done virtually or in person. Partial hospitalization program (PHP) Time commitment Per week: 30 to 60 hours Duration: several weeks to several months Virtual option: Yes Living situation: At home, attending sessions on most days Level of structure: Highly structured Best for: Patients who need more extensive care than what can be achieved with regular outpatient or IOP care but who are stabilized enough to live at home  The term “partial hospitalization program” for eating disorders can be a bit misleading because it doesn’t involve overnight stays, and the program typically doesn’t take place in a hospital. Instead, care might be received in another type of in-person setting or even virtually.  PHPs for eating disorders are day programs. You or a loved one will spend about six to 10 hours a day receiving care on five to six days per week. Care typically includes individual and group therapy, meal support, and more.  You can complete a PHP in person or virtually. However, because of the time commitment, you or a loved one won’t be able to attend school or work. Residential treatment Time commitment Per week: 24/7 Duration: a few weeks to a few months Virtual option: No Living situation: On site Level of structure: Fully structured Best for: Patients who need around-the-clock care and monitoring but who are medically stable  Live-in treatment ranges from residential care for eating disorders to inpatient hospitalization. A live-in setting might be right for you or a loved one if an outpatient program or PHP doesn’t provide enough structure. This might be the case if eating disorder behaviors, such as restriction, bingeing, compulsive exercise, etc., are still present and affecting everyday life.  Residential treatment for eating disorders requires ongoing overnight stays in a treatment center or a smaller facility such as a group home. There, you or a loved one will receive ongoing care, including meals, individual and group therapy, and more.  Working during a residential stay isn’t possible. However, some online learning may be feasible. Inpatient hospitalization Time commitment Per week: 24/7 Duration: a few days to weeks or months Virtual option: No Living situation: On site Level of structure: Fully structured Best for: Patients who meet eating disorder hospitalization criteria because of their need for medical stabilization, psychiatric care, or both—around the clock.  Inpatient hospitalization occurs in a hospital setting to offer close care and support for you or a loved one. It may involve:  Medical stabilization: Eating disorders can lead to severe health concerns, such as complications from malnutrition or purging. Medical stabilization, including renourishment, may be necessary as a first course of action in eating disorder recovery. Inpatient psychiatric care: Eating disorders are associated with psychiatric risks, including self-harm. Ongoing psychiatric care and monitoring may be necessary as a safety precaution. Inpatient eating disorder medical-psychiatric hospitalization: Some hospital systems have specialized units where you or a loved one can receive both medical stabilization and psychiatric care. How each level of care compares The following table shows how the levels of care stack up, starting with the least structured and least time-intensive to the most structured.  How do you know what level of care you or your loved one may need? You don’t have to make the decision alone on the type of care needed for you or a loved one. Instead, a medical or mental health clinician can help you decide or guide you in the right direction.  “Recommendations will depend on several factors,” says Dr. Kessel, “such as the severity of your illness; your level of support; your geographic location; your ability to take time away from work, school or family; and what your insurance covers.”  Eating disorder care has also come a long way in the past few decades, offering more flexibility.  “Previously, people seeking comprehensive eating disorder treatment with a unified team had to go to residential facilities or partial hospitalization programs,” Dr. Kessel says. “Now, thanks to innovation and the advent of telehealth services, people can get quality eating disorder treatment wherever they have an internet connection.”  Virtual care will not be right for everyone, depending on factors, such as medical stability, family structure, and co-occurring conditions. But it could be part of a long-term care plan after medical or psychiatric stabilization. What does it mean to “step up” or “step down” in care? You aren’t locked into a specific level of care. You can expect to progress in your level of care as needed while you move toward recovery. Think of outpatient care as the most stepped-down option. Higher levels of care (HLOC treatment), include IOPs, PHPs, residential, and inpatient hospitalization.  “People can move between levels of care depending on their individual needs,” Dr. Kessel adds. “While stepping up to medical stabilization or residential care can help a recovery journey—for the most part, we want people to get better in the least restrictive treatment environment that works for them.” Where does virtual treatment fit into levels of care? Virtual eating disorder treatment is not a level of care. Instead, it is a delivery system. Virtual care offers flexibility and can be beneficial for receiving eating disorder treatment alongside attending school or work. It can be part of a HILOC option or stepped-down care.  Virtual care serves as an option if eating disorder behaviors are present but you or a loved one is medically stable and not experiencing psychiatric concerns that warrant a HILOC.  For example, “Equip allows people to continue working, attending school, and participating in their families and communities alongside comprehensive, evidence-based eating disorder treatment,” Dr. Kessel explains. “This can provide the flexibility people need to get treatment now, rather than waiting until ‘the right time’ or until they have no other choice.”  Equip is an appropriate level of care for all medically stable patients and an appropriate alternative for patients who might otherwise consider residential, PHP, IOP, or outpatient. Not all virtual care is the same. Some virtual care involves individual sessions only. You can also find virtual IOPs and PHPs. Equip is adaptable, and your level of care changes as you move through recovery.  In other cases, virtual options come into play after a step down in care. “Things in the real world are very different than in treatment centers,” she adds. “And most people need ongoing support when leaving a treatment center or hospitalization.”  Virtual care, in these cases, allows you or a loved one to practice necessary everyday skills under the guidance of a treatment team.  “An important step in recovery is building a life worth living outside of the eating disorder,” Dr. Kessel says. “This means building real-life relationships, having passions to follow and giving your life purpose—all things done outside of treatment sessions.” Where do different treatment approaches fit in? You might be wondering how different treatment approaches fit into the different levels of care. Different treatment approaches can generally be used at any level of care. The table below defines some of the most common eating disorder treatment modalities, as well as the settings in which they're commonly used.  What questions should you ask when choosing a treatment program? As you are considering treatment providers or programs, here are some of questions you may want to ask to help guide your decision:  What experience do you have with treating eating disorders? What credentials or special training do you have related to eating disorders? Do you belong to any eating disorder treatment professional organizations, such as the Academy for Eating Disorders (AED) or the International Association of Eating Disorders Professionals (iaedp)? How long will treatment last, and what will it cost? How do you set treatment priorities and goals? How do you measure progress in recovery? What is the role of family or other loved ones in treatment? What is your readmission rate? (for PHP, residential, and inpatient programs) Do you provide the option of virtual sessions? The bottom line Finding the right level of care can take time. And that’s OK. Keep in mind that there isn’t one “right” way to get started with eating disorder treatment.  Even after extensive research, you might still go through some trial and error to find the right fit. The recovery process isn’t usually simple or linear. It’s hard work, but it’s worth it. You can schedule a low-pressure, free consultation here to talk through the available treatment options and see whether Equip might be a good fit for your unique needs.  FAQ What is considered a higher level of care for eating disorders? Higher levels of care (HILOC) for eating disorders include an intensive outpatient program (IOP), a partial hospitalization program (PHP), residential treatment, and inpatient hospitalization. What is the difference between residential treatment and inpatient hospitalization? Residential treatment and inpatient hospitalization sound similar but they are different. Residential treatment involves 24/7 care and monitoring at a residential facility. Residential facilities include large treatment centers or smaller settings, such as group homes. In-patient hospitalization includes 24/7 care and monitoring in a hospital. It is necessary when you or a loved one needs to be medically or psychiatrically stabilized for health and safety reasons. What is the difference between IOP and PHP for eating disorders? Although both options allow you or a loved one to live at home, an intensive outpatient program (IOP) is different from a partial hospitalization program (PHP). An IOP involves three to nine hours of care per week, while a PHP involves 30 to 60 hours. Care can occur in person or virtually, depending on individual needs. Can someone work or go to school while in eating disorder treatment? In some cases, you can work or go to school while in eating disorder treatment. You or a loved one will have this option with outpatient and intensive outpatient (IOP) care. Remember that virtual options are possible and offer the most flexibility.]]></content:encoded>
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            <title><![CDATA[What Is Body Checking? Why It's Harmful and How It Impacts Body Image]]></title>
            <link>https://equip.health/articles/body-image/what-is-body-checking</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/what-is-body-checking</guid>
            <pubDate>Thu, 09 Apr 2026 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[I used to look at my body every which way in the mirror. Then I’d assess what I saw and go back to doing whatever I was doing, like working or reading a book. But then 15 minutes later, I’d be back in the bathroom, in front of the mirror, doing the same thing all over again. Maybe this scenario sounds all-too familiar for you or a loved one. If so, body checking might be going on. Body checking is a behavior that is often associated with eating disorders, though not everyone who body checks has an eating disorder. For me, an eating disorder was the main driver—in my 20s, a therapist diagnosed me with “eating disorder not otherwise specified (EDNOS),” now called otherwise specified feeding or eating disorder (OSFED)—but part of my body checking also had to do with chronic illness. At 21, I was diagnosed with endometriosis, a condition that can feature what’s called “endo belly,” severe and painful swelling and bloating that frequently altered my shape. My body checking was a way for me to try to exert control over my body when I felt I had none. It was a coping mechanism, albeit not a healthy one, as it worsened my eating disorder. In this article, we explore what body checking is, body checking examples, how to stop body checking, and more. What is body checking? Body checking is the compulsive monitoring of body shape, size, weight, and other factors. It shows up in a variety of different ways, such as frequently looking in the mirror, measuring body parts, pinching skin, or trying on clothes (even those already owned) to assess their fit. We all look in the mirror, whether it’s a quick glance or part of getting ready for the day or an event. You might also try on clothes you already own, especially if you haven’t worn something in a while, to see how it fits. Sometimes you might even measure yourself to confirm your size before ordering a new pair of jeans. These general behaviors aren’t body checking. But looking in the mirror, measuring yourself, skin pinching, or stepping on the scale can veer into body-checking territory if the behaviors become compulsive. This means you can’t stop body checking, even when it’s interfering with life and your enjoyment of it. What does body checking look like? Body checking can take many forms, and it might look different for you or a loved one than it does for other people. To help illustrate how it might show up, we’ve divided common body checking behaviors into categories and listed some examples. Common forms of body checking Visual checking Frequent mirror examination of specific body parts Turning sideways or twisting to assess shape Lifting shirt to see abdomen Comparing current shape to older photos Scrutinizing photos or taking repeated progress photos Tactile (touch-based) checking Pinching body fat Measuring a thigh gap Wrapping fingers or hands around wrists, arms, or waist to gauge size Pressing on specific bones to assess their prominence Measuring or weighing Weighing multiple times per day Measuring body parts frequently Checking how clothes fit throughout the day, such as waistband tugging Repeatedly trying on the same outfit to assess fit Comparison checking Comparing body size to others in person Comparing yourself to others featured on social media, film, TV, etc. Mentally ranking your body parts against other people’s Behavioral checking Sitting or bending to see if rolls appear Inspecting shadows or silhouettes Monitoring stomach size after eating Alternating between mirror avoidance and intense checking Body checking isn’t always obvious or clear—sometimes it takes more subtle forms. We’ve included those here with some examples. More subtle forms of body checking Mental checking Mentally scanning specific body parts (without a mirror) Replaying how your body looked during a recent situation Imagining how today’s eating will change body shape later Reassurance-based checking Casually prompting appearance-related comments Interpreting neutral comments as size-related feedback Comparing compliments over time to detect perceived body changes Environmental manipulation Choosing seating, camera angles, or positioning to assess or control how your body appears Using specific lighting to evaluate contours Performance checking Using how clothes stretch, restrict, or shift during movement as feedback about body size Assessing body size based on how much space is taken up, in a chair for example Standing in doorways or against walls to gauge body width Monitoring physical sensations (e.g., skin touching skin) as size indicators Temporal checking Checking at specific times daily (e.g., immediately upon waking or before bed) to compare fluctuations Comparing weekday vs. weekend body perception patterns Social media-driven checking Analyzing tagged photos before they appear in your feed Tracking likes/comments as indirect feedback about appearance Repeatedly reviewing posted images for perceived body flaws Why do people body check? “Body checking is compulsive behavior driven by insecurity or anxiety, where an individual focuses intensely on their body, usually hyper-focusing on specific parts like the legs, stomach, or arms,” says Jonathan Levine, a licensed clinical social worker who specializes in eating disorders at Equip. “Body checking acts as a behavior to minimize that negative feeling by ‘checking’ to see if the perceived flaw is real,” Levine adds. Researchers even refer to this type of behavior as a “safety mechanism.” It may temporarily bring about a sense of immediate relief from the initial anxiety or a sense of having control. But engaging in body checking also perpetuates the behavior, creating a vicious cycle. That sense of relief or of having control leads drives more body checking.  Going back to my personal example, my endometriosis frequently causes endo belly. This is a term to describe uncomfortable bloating. It can make my stomach feel generally normal one day, but then the next, I might feel like I am pregnant. In my body-checking era, I would check my stomach no matter which way I felt. When it was flat, I reassured myself it was flat. When it was distended, I reassured myself that I could still “suck” everything in. Feeling like I had no control over the endometriosis, I turned to body checking to give myself a sense of control. But in doing so, I only reinforced my body-checking behaviors, which also included frequent weighing and trying on clothes to check if they were suddenly “tight.” My example illustrates the cycle of experiencing a trigger, the trigger leading to anxiety, the anxiety prompting body checking, and the checking leading to relief. But then I’d experience doubt soon after a body-checking behavior and repeat the whole cycle. Body checking triggers Many triggers can drive body checking. These range from internal factors, such as how you feel (full for example), to external factors, such as social media. Reels and images often depict influencers and other content makers showcasing their bodies in ways that can trigger (or even be considered) body checking. Sometimes people show before-and-after pictures to illustrate how a specific exercise routine or diet impacted their physical appearance. Other times they are even explicitly depicting body checking, such as measuring a “thigh gap” or showing that they can encircle their waist with their two hands. If you scroll through the comments section, you might see a mix of reactions—some people might point out that the person has gone to extremes, but others may praise the person for their appearance. This can ramp up your own body dissatisfaction or affect self-esteem if you feel you don’t measure up. “Diet culture, or the expectation and belief that thin bodies are better, healthier, and more attractive than all other bodies, or that your body is the most interesting thing about you,” Levine says, are all triggers of body checking. Additionally, internal triggers like a fear of weight gain or hyper-focusing on body image can drive body checking. Mental health also plays a role. Social anxiety and other forms of anxiety can trigger body checking, for example. How is body checking connected to eating disorders? Although eating disorders have many causes, body image distress and fear of weight gain are core symptoms of most, but not all, eating disorders. Body checking tends to become a natural behavior to cope with these feelings of distress and fear. Eating disorders and body checking may even drive each other: one study found that body checking frequency on a given day was associated with restricting food on that same day in females with anorexia nervosa. This was the case for me. If I engaged in body checking, how I felt after often dictated whether I restricted my meals or took exercise to an extreme, even when I was in intense pain. When does body checking become a problem? “Humans are curious creatures,” Levine says. “We all double-check, or even triple-check, many things in our day-to-day lives. Plus, our culture highly values aesthetics and thinness. Consequently, many people without eating disorders or disordered eating frequently check their bodies, how their clothing fits, or how they look in the mirror.” These behaviors are relatively common and play into our body image, which doesn’t always feel positive. “Almost everyone has bad body image days regardless of whether they meet the criteria for an eating disorder,” Levine adds.  Someone might feel constipated or sluggish, or might be in the luteal phase of the menstrual cycle, when premenstrual syndrome (PMS) is common. In these instances, you might look in the mirror a bit more or go through multiple outfits in the morning to see what you feel good in. These typical checking behaviors might veer into body checking if they occur frequently and you (or a loved one) find that you cannot stop doing them. “The shift from normalcy to one of harm resides in the compulsivity,” Levine says, “for example, leaving a social event to go to the bathroom to lift your shirt and check your stomach in the mirror.” As this example illustrates, body checking causes you to become hyper-focused on your body, rather than focusing on the present and enjoying what you’re doing. The constant body-related distraction may leave you with what Levine describes as a “permeating sense of discomfort, unhappiness, or inadequacy.” “If your body image dominates your thoughts, behaviors, and actions, taking away from a holistic quality of life, it's a good sign that it's harmful,” he says. The table below illustrates the difference between the ways we typically check ourselves as part of everyday life and concerning body-checking behaviors.  How to stop the body-checking cycle Body checking involves a cycle, as noted earlier in the article. But the good news is that you can interrupt the cycle. Levine offers a two-part approach that he uses for working with patients. Build awareness: “Many people don't realize they constantly touch their stomach or thighs as a form of body checking,” he says. “Building awareness of the behavior is a critical first step in being able to challenge it.” Decrease the behavior: “Once my patients understand how, why, and when they body check,” he says, “the goal becomes decreasing the behavior and eventually ceasing it entirely.” For building awareness, you can ask yourself a few questions or go through them with a therapist.  Ask yourself: What are my body-checking behaviors? What triggers body checking? What do I hope to achieve with body checking? How do I feel after body checking? Is the behavior offering any benefit? What things truly alleviate my body anxiety? Once you gain awareness from your questions, you can find ways to decrease your body-checking behaviors.. “That can involve taking away access, such as putting blankets or sheets over mirrors in the house so you don’t catch a reflection and feel inclined to engage,” Levine says. This process doesn’t mean you would need to cover all your mirrors forever. It’s just a temporary way to help interrupt the cycle. Another strategy for decreasing body checking might also involve asking for help from people in your support system. “If they notice you pinching your stomach, thighs, or cheek, they can redirect you to break the cycle,” Levine explains. You might also choose to give away certain clothing items that you keep around to gauge specifically how you feel in them. These are just a few examples. Ways to decrease body checking: Cover mirrors in your house (temporarily). Get rid of your bathroom scale or take out the batteries. Eliminate clothing from your closet that you use to “check” size. Give your body-checking tape measure to a trusted friend or family member. Decline to be weighed at doctor’s appointments, or close your eyes or look up when you’re on the scale and ask staff not to share your weight with you. Delete, or hide in a folder, any progress photos or other images you use as part of body checking. Ask friends and family to note if they see you pinching or checking size in some other way. When the body-checking urge occurs, revisit the list of questions above and see if you can arrive at a different coping method for the trigger. Again, these measures are meant to be temporary to help you break the trigger-body-checking cycle. Once you disrupt the cycle, you will likely engage in body checking much less. However, if you find that you are struggling to stop or just want some professional guidance, never hesitate to reach out to a knowledgeable mental health professional. They can tailor strategies that work for you. The bottom line I’m happy to report that I no longer engage in body checking and am recovered from OSFED. I share this to illustrate that recovery is possible, and you can free yourself from the body-checking cycle. Of course, I still look in the mirror. But now it’s usually to make sure I don’t have kale in my teeth or that my bangs aren’t giving too much of a bed-head vibe, rather than to assess my stomach size. This change has been liberating. If you or a loved one is looking for recovery options or help with body checking, know that care is available. Talk with a trusted doctor or schedule a call with Equip to talk through your concerns and explore treatment options. FAQ What does body checking look like? Body checking can take many forms, but commonly it looks like frequent checking in the mirror, compulsively pinching body parts or checking their size in other ways, constantly stepping on the scale, repeatedly trying on the same clothes to see how they fit, taking progress photos and overanalyzing them, and more. How can body checking be stopped? Body checking can be stopped. The process involves interrupting the cycle. The first step is gaining awareness of your specific body checking habits, then you can work to decrease them. Sometimes this involves interrupting triggers. An example might be donating the clothing item you try on frequently to assess fit. Is body checking always a sign of an eating disorder? No, body checking is not always a sign of an eating disorder. It might show up as part of an anxiety disorder for example. However, body checking is a common behavior for certain types of eating disorders, such as anorexia nervosa (though not everyone with an eating disorder body checks). ]]></content:encoded>
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            <title><![CDATA[These Eating Disorder Myths Are Still Keeping People From Getting Help — Here are the Facts You Need to Know]]></title>
            <link>https://equip.health/articles/understanding-eds/what-causes-EDs</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-causes-EDs</guid>
            <pubDate>Wed, 11 May 2022 15:49:23 GMT</pubDate>
            <content:encoded><![CDATA[For all the increased awareness around eating disorders in recent years, myths about who gets them and why still abound. “My hope is that debunking myths about eating disorders will reduce shame and blame, increase the likelihood that people can receive an accurate diagnosis, and increase availability of evidence-based treatments for eating disorders,” says Equip Therapy Director, Tana Luo. Here are some of the major myths that need debunking, stat. Understanding the family connection “The biggest misconception about what causes eating disorders is that families or parents cause them,” says Equip Director of Lived Experience JD Ouellette. “That’s false and incredibly painful and damaging for everyone; it can be — and has been — quite literally, deadly.” Ouellette isn’t being hyperbolic. Eating disorders can be fatal and misattributing their origin can seriously delay or derail effective treatment. “This false belief [that parents cause eating disorders] prevents us from getting both the bodies and brains of those with eating disorders fully back online as a first step in treating their eating disorder to extinction,” explains Ouellette. “It leads to shame, blame, and divorces people with eating disorders from the support of those closest to and most able to help them.” There is a genetic component to eating disorders — in fact, researchers have found that a first-degree relative of someone with a disorder is up to 12 times more likely to develop one than a relative of someone without a disorder. But genetics is only part of the equation; eating disorders are brain disorders rooted in a complex combination of genetic, biological, and environmental risk factors. There is no single “cause” of an eating disorder, and placing the blame on parents or other family members doesn’t help patients get the effective, evidence-based care they need to recover. “We now know that families do not cause eating disorders, and, in fact, families are critical to helping people recover,” Luo says. “This misconception takes families out of their essential role in recovery.” The question of “choice” Another major myth about the cause of eating disorders stems from the outdated notion that eating disorders are somehow born out of choice; as if the people who experience them bring the illnesses on themselves. Just as dangerous as the concept of familial blame, this myth can prevent individuals from receiving the critical help they deserve to get better. “Social stigma surrounding eating disorders takes many forms,” says Jessie Menzel, Equip’s Senior Director of Clinical Training. “From painting these disorders as pursuits of vanity to reframing a complex illness as simply laziness or lack of self-control. This prevents the recognition of eating disorders by medical and mental health professionals, prevents the provision of appropriate treatment recommendations, prevents adequate insurance coverage and reimbursement, and prevents people from seeking help. ” Why myth-busting is critical General awareness and education is critical when it comes to demystifying, destigmatizing, and treating eating disorders — but a major goal of myth busting is to legitimize these illnesses in the first place. “The knowledge that eating disorders are brain disorders can have a tremendous impact on how research into eating disorders is funded,” Menzel explains. “Funding is so crucial to our ability to understand how these illnesses work and thus, to our ability to create effective treatments. Our field is so far behind other fields in psychiatry like schizophrenia and autism when it comes to funding. And that lag shows in the relative lack of progress that has been made in developing innovative treatments and testing of these treatments in large scale studies.” Ouellette adds that language is a critical piece of the puzzle when it comes to validating these illnesses. “We fund research and treatment much better for ‘brain disorders’ versus lifestyle choice,” Ouellette says. “The word ‘choice’ should be nowhere near the term eating disorder, as it reinforces outdated beliefs and disproven tropes about eating disorders and who gets them and perpetuates shame, stigma, and underfunding. Approximately the same number of people will be affected by eating disorders as Alzheimer's, yet funding is about $1 per affected individual for eating disorders and $100 per affected individual for Alzheimer's. ’” Shifting public consciousness and understanding of eating disorders could be the difference between life and death — and those individuals are worthy of the highest quality care and respect possible. “People who are genetically vulnerable to develop eating disorders are some of the most amazing humans there are,” Ouellette says. “They are often brilliant and talented and driven and society reaps the fruits of their intellect and temperament even when we don't recognize it. We know the stories of the ballerinas and ice skaters and runners and Olympians and how their promise was destroyed by an eating disorder, and those stories are the proverbial tip of the iceberg. With early diagnosis and aggressive, evidence-based treatment, we can help these people get well and live fulfilling lives that are both impactful and happy.”]]></content:encoded>
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            <title><![CDATA[The Health Risks of Bulimia: Understanding Its Physical and Mental Effects]]></title>
            <link>https://equip.health/articles/understanding-eds/bulimia-health-risks</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/bulimia-health-risks</guid>
            <pubDate>Tue, 01 Oct 2024 17:58:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders of all kinds can have significant negative effects on both mental and physical health, and have the potential to be fatal. Each different diagnosis, however, poses distinct risks, and understanding the nuances of each one can help illustrate why early intervention and treatment is so necessary. Read on to learn everything you need to know about the physical and mental health risks of bulimia, and how to seek help. What is bulimia? Formally known as bulimia nervosa, bulimia is a particular type of eating disorder characterized by a recurring cycle of bingeing and purging. “Bulimia is marked by episodes of binge eating, which is eating an amount of food in a discrete period of time that is definitely larger than what most people would eat in a similar period of time,” explains Equip family nurse practitioner, Sarah Curran, FNP-C. “These binge episodes are followed by compensatory behaviors to prevent weight gain, including self-induced vomiting; misuse of laxatives, diuretics, or enemas; excessive exercise; fasting; and strict diets.” While binge eating disorder also involves binge eating, registered dietitian Amy Dahl, MS, RD, CEDS explain that bulimia is different in that it involves behaviors to “make up for” the binge. “Binge eating and bulimia share many characteristics, but what sets bulimia apart from binge eating disorder is that there is a compensatory behavior that is associated with the binge,” Dahl says. “This behavior is a result of the intense fear of weight gain associated with bulimia, and there is often a restriction of food intake in between episodes of binge eating.” Studies have indicated that bulimia is a serious issue that affects people of all genders (up to 3% of females and 1% of males, though these numbers are likely low due to all the people who go undiagnosed). The average age of onset for bulimia is 18, but it affects people of all ages. Likewise, people with bulimia are often at or above what’s considered a “normal” weight, but people of all body sizes struggle with bulimia. What are the physical health risks of bulimia? Both the short-term and long-term consequences of bulimia can be devastating. In fact, research suggests that bulimia multiplies a person’s mortality risk by five. From dehydration and dental problems to life-threatening organ damage, the health risks associated with this eating disorder make clear just how vital it is to find evidence-based treatment that addresses this eating disorder. Short-term physical health risks of bulimia While every person is different, it often doesn’t take long for the short-term effects of bulimia to appear. The immediate consequences of bingeing and purging may show up in issues like facial swelling, digestive issues, or fainting, which Curran says can be attributed to the dehydration due to fluid loss from vomiting or using laxatives. Here’s a snapshot of the short-term physical health risks of bulimia: Effects on the cardiovascular system Hypotension (abnormally low blood pressure) Orthostasis (a significant change in blood pressure or heart when going from lying to standing) Electrolyte abnormalities Heart palpitations EKG changes Effects on the musculoskeletal system Stress fractures due to compulsive exercise Muscle weakness Bone density loss Effects on the digestive system Acid reflux or GERD from stomach acid Damage to the esophagus from repeated vomiting. Constipation, diarrhea, gas, bloating or other digestive issues caused by binge eating Effects on dental and oral health Swollen salivary glands Sore throat Worn tooth enamel and cavities due to stomach acid from vomiting Gum disease Effects on the skin and body Edema (fluid retention) Dry skin Thinning hair Brittle nails Long-term physical health risks of bulimia Over time, the symptoms of bulimia can be life-threatening, with bulimia carrying a 3.9% mortality rate. “Cycling episodes of binging and purging through various compensatory behaviors can take a major toll on the body,” Curran says. “Those with bulimia are at risk for long-term complications including cardiovascular disease, diabetes, menstrual irregularities, digestive issues, and low bone density.” Dr. Navya Mysore, MD echoes this, explaining that the long-term effects of bulimia can severely impact the cardiovascular, reproductive, and digestive systems, among other bodily functions. “Long-term problems can include heart rhythm issues, severe constipation, loss of period, osteoporosis, and permanent dental issues,” she says. Dahl adds that over time, a sudden interruption in the behaviors associated with bulimia can also cause severe problems. “If someone is engaging in purging behaviors and these behaviors stop, a condition called pseudo-bartter syndrome may occur,” she says. “With pseudo-bartter syndrome, the body has existed in a dehydrated state for so long that when it starts to be rehydrated, the body will hold onto more water to prevent the body from being dehydrated again, which can cause significant swelling and edema.” It’s important to note that this is not a reason to keep using disordered behaviors: with the risk support, this risk can be mitigated, and pseudo-bartter syndrome is much more manageable and finite than the health risks of continuing to engage in the binge-purge cycle. What are the mental and emotional health risks of bulimia? While bulimia carries significant physical health risks, it is also a mental illness, and has a major impact on a person’s emotional and psychological health. “Bulimia can often lead to self-isolation, fear of eating around others, and chronic low self esteem,” Curran says. “Research shows an increased incidence of suicidal ideation and suicide attempts among those struggling with bulimia and eating disorders in general.” As with other eating disorders, bulimia is associated with a preoccupation with body shape and weight and body image distress, as well as feelings of guilt and shame around disordered behaviors. People struggling with bulimia also tend to withdraw from family and friends, becoming socially isolated; this can be due to feelings of guilt and shame, or a desire to hide their disordered behaviors, or a combination of both. Curran also points out that, as with many other eating disorders, bulimia often co-occurs with other mental health conditions including anxiety and depression. Research indicates that 80.6% of people with bulimia will experience an anxiety disorder at some point during their lives and about 68% of individuals with bulimia have at least one anxiety disorder. Additional research has also shown that while 23-48% of adolescents with eating disorders have comorbid depression, there is a higher prevalence in patients with bulimia (50%) than those with anorexia (11%). Is it possible to reverse the negative physical and mental impacts of bulimia? Because bulimia is a potentially fatal illness, early intervention can mean the difference between life and death. But experts encourage seeking treatment at any stage of the disease, and emphasize that recovery is within reach for all. “The good news is that full recovery from bulimia is absolutely attainable, and it is possible to reverse most, if not all, physical and mental impacts of this illness,” Curran says. “The key is reaching out for support.” Mysore explains that whether or not you can undo the effects of bulimia is impacted by a few factors. “Once treatment has started for bulimia, many of the short-term physical issues improve if the patient is no longer having binge-purge cycles,” she says. “Depending on how long you have been struggling with bulimia and whether or not you’ve been diagnosed with long-term issues secondary to the eating disorder, it can be more challenging to completely reverse the physical and mental impacts.” Dahl agrees, noting that the level of support necessary to address the symptoms and consequences of bulimia may vary widely from person to person, depending on how long they’ve struggled with the illness. “Many of the side effects of bulimia can be reversed by reducing the compensatory behaviors and engaging in nutritional rehabilitation,” Dahl says. “For those at risk for serious complications of nutritional rehabilitation, including Pseudo-Bartter syndrome and cardiac arrhythmias, a higher level care of an eating disorder facility may be needed to safely reintroduce foods. Unfortunately some of the side effects of malnutrition, such as osteoporosis, may be more permanent.” What to do if you or a loved one is struggling with bulimia Becoming aware of bulimia’s short- and long-term risks is an important first step toward recovery, but seeking treatment can be challenging for those who are struggling. “It is important to reiterate how dangerous and life-threatening the behaviors associated with bulimia can be, and how critical prompt intervention is,” Curran says. “With appropriate treatment, it’s possible to address the impacts that bulimia has on your physical and mental health. There are several treatment avenues to pursue, including but not limited to hospitalization, cognitive behavioral therapy, and support groups.” While self-isolation is often a hallmark symptom of bulimia, cultivating a community can also be a critical step in the treatment process. “Building a support network is one of the most essential aspects of lasting recovery,” Curran says. “This can include members of your treatment team, family members, close friends, or anyone you feel comfortable confiding in.” For those struggling with how best to help a loved one experiencing bulimia, Mysore suggests starting with a frank conversation and an offer to show up in person for initial evaluation. “Try to gently bring up the behavior changes you are noticing in them and that you are worried about their health,” she says. “Another option is to accompany them to see their primary care provider to discuss what you’re worried about and come up with a plan to help support them.” Moving forward through recovery, Dahl reiterates the importance of working with a multidisciplinary team of experts. “If you suspect someone you care for has an eating disorder, it is best to speak to an eating disorder professional to assess your loved one,” Dahl says. “A multidisciplinary eating disorder team can include a medical doctor, dietitian, therapist, and psychiatrist, and these individuals can make the best recommendation on the most appropriate level of care to provide as much medical and psychological support as possible.” If you’re struggling with bulimia, or worried a loved one might be, it’s hard to overstate how important it is to seek help as soon as possible. Talk to your doctor or a mental health professional, or schedule a call with our team to talk through your concerns. Frequently asked questions  What are the main physical health risks associated with bulimia? Bulimia negatively impacts physical health in many different ways. The main health risks include: Hypotension (abnormally low blood pressure) Electrolyte abnormalities Heart palpitations Bone density loss Acid reflux or GERD from stomach acid Damage to the esophagus from repeated vomiting Swollen salivary glands Worn tooth enamel and cavities due to stomach acid from vomiting Edema (fluid retention) How does bulimia affect mental and emotional health? Bulimia is a serious mental illness that can have a major impact on a person’s emotional and psychological health. The mental health risks of bulimia include: Body image distress Preoccupation with body shape and weight Feelings of guilt and shame Self-isolation Fear of eating around others Low self-esteem Increased risk of suicidal ideation What are the long-term consequences of untreated bulimia? The long-term consequences of bulimia can be life-threatening: bulimia has a 3.9% mortality rate, and people with bulimia are five times likelier to die than those without the disease. Long-term consequences of bulimia include: Death Cardiovascular disease Osteoporosis Diabetes Permanent dental issues]]></content:encoded>
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            <title><![CDATA[The Complex Ways that Eating Disorders Impact Black Communities]]></title>
            <link>https://equip.health/articles/understanding-eds/black-communities</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/black-communities</guid>
            <pubDate>Thu, 29 Jul 2021 13:58:00 GMT</pubDate>
            <content:encoded><![CDATA[When I first spoke to Stephanie Covington Armstrong almost a decade ago for a story about eating disorders in the BIPOC community, she told me, “I thought I was the only Black person who didn’t know how to eat.” That feeling of isolation inspired Armstrong to write a book, aptly titled, Not All Black Girls Know How to Eat. “When I was in the midst of my eating disorder, it let me hide in plain sight,” she wrote. “...No one would have looked at my brown skin and been like, ‘That poor thing has a problem.’ It protected me in a way.” Non-diet registered dietitian and Equip advisor, Christyna Johnson, MS, RDN, LDN, says that in her experience, Armstrong’s relationship to her race as a protective shield is common. “I have found in practice that this continues to be a theme for clients, and in many cases has been validated by a medical or mental health professional,” she says. “Those with eating disorders already deny the severity of what is happening for them, and having professionals who do not have the tools to provide an accurate diagnosis or intervention is part of the complex problem. For many that I have worked with, they receive praise for their efforts that are disordered in nature.” Armstrong’s book was published in 2009, but according to experts, the problem persists: the vast majority of researchers, clinicians, and even community members still don’t understand how to recognize and treat eating disorders in Black people, and many struggling with EDs fall through the cracks, often never getting treatment at all. Eating disorders in the Black community: what the research says “Researching eating disorders in the Black community has been a journey,” Johnson says. “The research is sorely lacking, and many times is written through a white lens. Most eating disorder research, as we know, is conducted at higher levels of care or in university settings where there is less likely to be ethnic diversity. The research that has been published focuses primarily on the prevalence of binge eating disorder and the consequence of body size or the need to manipulate size/weight/shape after one has recovered to reduce the risk of chronic illness.” To Johnson’s point, perhaps the most well-known research on the topic of eating disorders in the Black community was published over two decades ago. In a 2000 study, researcher Ruth Striegel Weissman found that young black women were just as likely as their white counterparts to report binge eating or vomiting and even more likely to report fasting and laxative and diuretic abuse. One particular piece of research that has stuck with Armstrong is a 2009 study from the University of Southern California that found Black girls were 50 percent more likely than white girls to have bulimia. “This was one of the most important studies in the past twenty years,” she says. According to the researchers, girls from families in the lowest income bracket were also significantly more likely to experience bulimia than their wealthier peers. While these specific areas of research have dominated the limited scientific landscape that exists around eating disorders in the Black community, Johnson points out there . “There is plenty of room for research exploring minority stress and the incidence of eating disorders, minority stress in the context of the treatment environment, the impact of media, and the medical interactions individuals encounter in the process of getting a diagnosis,” she says. Obstacles to care within the Black community While there may be a lack of substantial research on the topic, we know eating disorders can and do impact Black people in significant and uniquely vulnerable ways. . And even if there were a wealth of studies dedicated to exploring the complexities of eating disorders in the Black community, pervasive cultural stigmas around mental health could prevent people from even admitting they or their family members need help. “There are many external factors and inequities in health that present obstacles to proper treatment and care,” says Equip advisor, Benjamin O'Keefe. “But it’s also important to look internally. Black culture has largely stigmatized mental health issues as ‘white people issues.’ They aren’t. We are faced with the same societal pressures to fit in, and in some ways, more pressure as we are forced by society to conform to Eurocentric beauty standards. When Black and POC people do seek care, we are less likely to be listened to and believed, less likely to see providers with cultural knowledge—or folks who look like us—and disproportionately less likely to be of a socio-economic class that can afford the astronomically high costs of care.” Johnson agrees, noting that psychological issues are still considered taboo in the Black community, “especially for masculine folks,” she says. “It's important to eliminate the shame of seeking support in your pursuit of taking care of yourself.” Biases in the medical community impede diagnosis and care too Cultural biases within the Black community are only one piece of the puzzle when it comes to understanding why proper diagnoses and care aren’t being delivered. The research that does exist suggests that medical professionals also have misconceptions around who gets eating disorders. A 2006 study found that clinicians were less likely to assign an eating disorder diagnosis to a fictional character based on their case history if their race was represented as African-American rather than Caucasian or Hispanic. “From a clinical perspective, getting the accurate diagnosis to ensure insurance coverage—which is a privilege in itself—is an important part of the process,” Johnson says. “Getting care for an eating disorder is difficult regardless of ethnic or racial background. This becomes more complex when the treating professionals are unaware of the nuances of existing as a particular ethnicity. It’s not uncommon for the piece of ethnicity and /race to not be talked about as a part of the treatment process, even though it may be a foundational piece of the eating disorder.” Because of the ongoing lack of diversity in the treatment world itself, Johnson says it can be a struggle for Black people to receive proper, comprehensive care. “Seeking support, particularly at higher levels of care (day treatment, residential, inpatient) can be difficult for Black folks when they are the only person of color in their milieu, or when there are no people of color on staff,” she says. “Minority stress is not discussed enough as a contributing factor to developing an eating disorder.” If you haven’t heard the phrase “minority stress,” it’s an important concept to comprehend when learning about eating disorders in BIPOC communities in general. According to the American Psychological Association (APA), minority stress is “the relationship between minority and dominant values and resultant conflict with the social environment experienced by minority group members.” It’s a unique, chronic, and socially based form of stress that “members of marginalized groups experience because of the prejudice and discrimination they face,” according to the Center for Community Practice. hen this experience of minority stress is added to general life stress, it can result in poorer health outcomes compared to individuals who don’t experience it. In addition to overt societal racism, one possible contributing factor to minority stress is the prevalence of microaggressions, i.e. subtle or indirect instances of racism that occur on a daily basis (like, for example, a white person clutching their wallet or purse when a Black person approaches, or a white person telling a Black person “you don’t sound Black,” insinuating that Black people aren’t typically articulate). “Managing microaggressions as they present themselves over the course of life, leads one to try and develop coping skills,” Johnson says. “This can serve as a maladaptive coping skill in an environment where one is required to be, even if they are being mistreated or feel othered.” The expectation that microaggressions will show up in the medical system, which is already marginalizing for many folks, may also be fueling hesitancy to seek help. “There is an inherent lack of trust in the Black community toward the medical community, particularly white professionals,” Armstrong says. “That makes it difficult to overcome the martyr complex handed down through generations where the only option is to suffer in silence. Eating disorders are not uncommon in the Black community but they are often closeted or exchanged for other EDs.” Eating disorders affect everyone—period Eating disorders can and do affect all people from all walks of life, and regardless of the research that does or doesn’t exist to document it, Black people absolutely have suffered and continue to suffer from anorexia, bulimia, binge eating disorder, and the entire spectrum of disorders. “It may be hard to believe in a world as discriminatory as ours, but eating disorders don’t discriminate,” O’Keefe says. “Eating disorders are not racist, but the institutional exclusion and lack of resources around eating disorders in BIPOC people certainly is. It’s only when we broaden our understanding of who is impacted by eating disorders and mental health issues that we can begin to create treatment and advocacy programs that reach everyone who needs them.” Armstrong believes that to truly help Black individuals with eating disorders, the medical community needs to adapt general protocols to the specific nuances of the community. “Treating Black women with ED’s with the same methodology as white women negates their inherent difference and needs,” she says. “EDs are often a trauma response and who has a longer history of trauma in America than Black women? So it should be assumed that we also have a long history of EDs. The ‘strong Black women’ trope that has been normalized by the mental health community is continuing to kill us. It is terrifying to unpack trauma, so without the financial resources and emotional support inherent in rich white communities, our issues will continue to fall under the radar leaving the most vulnerable among us, isolated and alone.”]]></content:encoded>
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            <title><![CDATA[Eating Disorders in Males: Common Co-Occurring Diagnoses]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-males-part-two</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-males-part-two</guid>
            <pubDate>Thu, 28 Jan 2021 18:27:40 GMT</pubDate>
            <content:encoded><![CDATA[Although many perceive eating disorders to overwhelmingly affect women, about one in three people with an eating disorder identify as male. What's more, eating disorders are particularly prevalent in the trans community. In this post I’ll explore frequent co-occurring illnesses that are common in men with eating disorders are more often the rule than the exception. The most common co-occurring mental illnesses are anxiety disorders, mood disorders, and substance use disorders. The presence of these other disorders can make eating disorders more chronic and difficult to treat. Co-occurring disorders In a large population-based study in Sweden of over 7,000 participants in 35 treatment centers throughout the country, co-occurring diagnoses were examined in individuals over the age of 18 with eating disorders. Co-occurring illnesses were identified using semi-structured interviews. Of the men in the study: 71% had at least one co-occurring psychiatric illness. Anxiety disorders were the most common comorbidity, occurring in 53% of the men, with generalized anxiety disorder being the most common anxiety disorder (30.5%). Mood disorders were found in 43.1% of participants, with major depressive disorder (clinical depression) being most common (32.8%). Finally, substance use disorders occurred in 10.1% of participants, and alcohol use disorder was the most common (7.1%). When looking at specific eating disorders in men, bulimia nervosa was most commonly associated with comorbidity (84.5%) and anorexia nervosa-restricting subtype was least commonly associated with comorbidity (56.8%). Although generalized anxiety disorder was the most common comorbidity in men, major depressive disorder was most common in women (3). Overlapping symptoms As the study indicates, comorbid psychiatric diagnoses in men with eating disorders are extremely common. However, eating disorders themselves can often mimic other psychiatric illnesses, particularly in men who are significantly malnourished. There can be unusual behaviors while eating that can mimic OCD, ruminations about food and body image that can appear similarly to generalized anxiety disorder, and isolation and dysphoria that can look similar to major depressive disorder. These overlapping symptoms make diagnosis complicated, to say the least! Presence of these symptoms prior to onset of an eating disorder and persistence of symptoms after weight restoration are helpful clues that suggest the presence of a comorbid psychiatric illness. Measuring eating disorder symptoms An additional complexity is that the standard measurements to assess for eating disorders, particularly the Eating Disorder Examination, were created for predominantly female populations. There is a predominance of questions that assess for symptoms more commonly seen in women than men with eating disorders (see my previous blog post that highlights these gender differences). In fact, Alison Darcy from Stanford University examined EDE scores in both men and women who had a diagnosis of anorexia nervosa. She found that men scored significantly lower than women in overall score and in both the shape concern and weight concern subcategories. To address this problem, specific diagnostic tools such as the Eating Disorder Assessment for Men, a validated measure that includes 50 questions looking at behavioral and cognitive symptoms of eating disorders in men, have been created.  The takeaway on co-occurring diagnoses in males with eating disorders Co-occurring mental illnesses are very common in men with eating disorders, with anxiety disorders being most common. Symptoms of eating disorders overlap with other psychiatric illnesses and presence of symptoms prior to eating disorder onset or after weight restoration, making a true comorbidity more likely. Diagnostic tools commonly used in clinical practice to assess for eating disorders can lead to underdiagnosis in men, and alternative clinical tools have been developed to capture symptoms more commonly seen in men. If you are concerned about someone in your life who you believe may be struggling with an eating disorder there are options! Treatment centers like Equip provide evIdence-based treatments tailored to individuals with eating disorders. If an adult in your life is not yet ready for treatment, continuing to engage the person, expressing your concern, and being supportive and open to listening are very important. This can help someone then seek out treatment when he is ready. I have thus far focused on epidemiology and diagnosis in these blog posts and in future posts will shift gears to treatments!]]></content:encoded>
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            <title><![CDATA[How Your Relationship to Food Impacts Your Child’s Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/parent-food-attitudes-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/parent-food-attitudes-eating-disorder-recovery</guid>
            <pubDate>Sat, 18 Apr 2026 01:03:00 GMT</pubDate>
            <content:encoded><![CDATA[When I worked in a child and adolescent eating disorder hospital, I had the opportunity to be part of many patients’ treatment teams, alongside a doctor, therapist, psychiatrist, and parents. I witnessed parents’ pain, stress, and fear, as well as their unwavering love and hope for their child to be free from the prison that was their eating disorder. After working with countless families, I saw a trend—kids whose parents who had healthy relationships to food, body, and exercise often seemed to have the best chance at recovery. However, kids whose parents held unhealthy food beliefs and behaviors were also able to experience recovery success—if they became aware of and were willing to shift their attitudes. “If you use the experience to ensure the whole family moves forward in a more holistically healthy way when it comes to food and movement, you will have gained something that will improve everyone’s life going forward,” says JD Ouellette, Director of Lived Experience at Equip. Today, let’s look at how parents’ relationship to food impacts their child’s eating, as well as expert-backed ways to best align your food relationship with your child’s long-term recovery. How parents’ eating habits impact their kids Kids often observe their parents and how they interact with other people and the world around them, which includes their relationships to food. According to a 2021 research review of studies about parents and kids ages two to 13, there’s a strong association between parents’ food practices and how their kids eat. “Children internalize not just what parents feed them, but how parents relate to food, bodies, and eating,” says eating disorder therapist Keira Oseroff Lambert, LCSW, CEDS. “Parents and caregivers are the relational anchors within the child’s eating environment.” She says when parents demonstrate healthy food relationships and eating competence (a term and model created by dietitian Ellyn Satter), their kids are more likely to self-regulate and trust themselves and their bodies. Some traits of eating competence and “normal eating” include: Trust in the body and its cues Flexibility and variety with food Eating for fuel and pleasure Relative structure around meals and snacks Food takes up a relatively small amount of brain space “When parents embody these capacities, they offer children a lived experience of eating that is grounded in trust, predictability, and flexibility,” Oseroff explains. However, when parents have disordered relationships to food, children will often internalize their feelings, attitudes, and behaviors. Some signs of unhealthy food relationships include: Restriction, rigidity, or dieting Anxiety or fear around food or bodies Moralizing language (“good” and “bad” foods) Believing you need to earn or burn food Being preoccupied with thoughts of food According to a 2023 study of a diverse group of parents and teenagers, there’s a link between parents’ restrictive feeding practices and lower intuitive eating levels in their teens. “If eating cake is bad when mom or dad does it, and the child enjoys cake, does it make them a bad person? Kids absolutely have these thoughts,” Ouellette says. "And if maintaining a strict diet or specific low weight takes center stage in life for parents, kids notice this as well.” If you’re realizing your relationship with food might be negatively impacting your child, don’t blame yourself. Remember that diet culture infiltrates every area of our lives—it’s in our schools, workplaces, gyms, and healthcare spaces—and its conditioning runs deep. But it’s never too late to start building awareness of your own relationship to food and consider how it might impact your child. Why your relationship with food matters during your child’s eating disorder recovery When a child has an eating disorder, they’re relearning how to eat and how to relate to food and their bodies, so how parents relate to food is more important than ever. “The eating environment either supports restoration of internal regulation or reinforces external control and rigidity,” Oseroff says. In phase one of family-based treatment (FBT), parents’ roles include taking full control of eating—planning, preparing, and supervising. In my practice, we explain to families that when parents or loved ones are modeling healthy food behaviors at the table with the person who has an eating disorder, it’s an external, helpful, and opposing force to their eating disorder brain. “When caregivers have eating attitudes and behaviors that align with treatment goals, like variety, balance, no forbidden foods, and eventually intuitive eating, it positively impacts their child’s recovery,” explains intuitive eating dietitian Meaghan Ormsby, MS, RDN. However, when parents or loved ones are restricting or using other unhealthy food or exercise behaviors, it’s like their eating disorder has an ally at the table. “When they’re eating high-fat and energy-dense foods, on exercise restriction or reduction, and gaining weight, it’s not helpful for them to get verbal or non-verbal messaging that high-calorie foods, taking a break from their fitness routine, or weight gain are too scary for their parents to engage in,” Ouellette explains. According to a 2026 study of mostly female teens and young adults with eating disorders and their parents (mostly mothers), there’s a link between parents with orthorexic tendencies and increased eating disorder severity in the child. Another 2023 study of mostly female and white teens with eating disorders (mostly anorexia) showed that parental dieting behavior may impact teens’ responses to eating disorder treatment. Teens whose parents reported dieting had a slower weight gain and lower BMI at discharge when compared to participants whose parents weren’t dieting. Here are some common, specific aspects of your relationship with food that can have a significant impact on your child’s recovery: Your food language Using language rooted in diet culture, such as terms like “healthy” foods and “junk” foods, and comments related to weight, calories, or compensation (through exercise or restriction at other meals) will be detrimental to your child’s recovery. “Having a neutral, balanced approach to all foods helps children feel safer eating ‘fun foods, while labeling cookies or candy as ‘bad’ reinforces the eating disorder’s black-and-white thinking,” says pediatric dietitian, Emily McNally RD, LD, who encourages parents to focus on how food and eating experiences provide nourishment, energy, and routine. Your emotional tone around food  Even if you’re eating the same foods as your child and not using disordered language or behaviors around them, it’s possible they will pick up on underlying anxiety, tension, or distress about eating, according to McNally. On the other hand, a steady and matter-of-fact approach to meals and snacks is most helpful. Your food variety  “If a parent encourages their child to eat a wide variety of foods but avoids those same foods themselves, the child notices. This can create confusion or mistrust,” McNally explains. Being flexible and including all types of foods without showing signs of guilt is most supportive of your child’s recovery. “Parents can model eating a home-baked cookie the neighbor brought over even though they may not be hungry, missing a run in favor of watching a movie because it’s raining, and accepting gaining a few pounds by simply buying some new clothes,” Ouellette says. “If you don’t walk the walk, it makes it much harder for your child to recover fully from their eating disorder.” How to align your food relationship with your child’s recovery As a parent supporting a child through eating disorder treatment, your food behaviors and beliefs directly impact your child’s relationship to food and their recovery. “When food and weight gain are life-saving measures, it’s vital that parents shift their attitudes and behaviors as well,” Ouellete explains. “Eating disorders have high mortality rates and low recovery rates, so kids need every support and chance to recover.” Now, you might be wondering how to make changes to better align your food relationship with your child’s healing. It can feel overwhelming to address your own issues and blind spots when dealing with their illness, so let’s explore manageable, expert-backed ways to feel more confident in helping your child heal. Take stock of your food beliefs and behaviors Take some time to be curious and compassionate with yourself about your relationship to food, as well as body and exercise. “Parents are often navigating a delicate balance between supporting recovery and managing their own beliefs, histories, and anxieties around food,” Oseroff says. This might include beliefs around thin bodies being “better” than non-thin bodies, certain foods being “bad” or “good,” or needing to “earn” food through exercise, among many others. I recommend getting curious about the origin of such beliefs. You can try asking yourself questions like: When did this belief first take hold? How old was I? Who or what helped instill this belief in me? Does this belief help me align with my core life values? Does this belief help my child’s eating disorder recovery? “If you find you cannot prioritize supporting your child’s recovery over your dieting and exercise, that realization should lead to figuring out why that is,” Ouellette adds. Use neutral language about food and body “Speaking about food, eating, or their (or others’) bodies with a judgmental tone reinforces negative feelings and promotes black-and-white thinking,” says Oseroff. If you notice that the ways you talk about food and body are rooted in diet culture, start shifting towards nonjudgemental language. “Replace ‘That’s unhealthy’ with ‘That’s one of many foods we eat,’ and avoid commentary that implies guilt or virtue tied to eating,” McNally suggests. “Shift the focus away from appearance and toward non-body-related values.” For example, instead of commenting on your friend’s weight loss or gain, describe something funny they said. McNally also recommends focusing on consistency, not perfection, and encourages parents to repair with their child openly when they make a mistake with their language. Normalize all foods Despite what diet culture says, all foods (even desserts and fried foods) are allowed into an adequate and relatively balanced diet and adopting such an attitude will help your child heal. “Remember that all foods fit and have purpose, even if that purpose is pleasure,” Oseroff encourages. “Enjoying food with others is a biopsychosocial drive—since the beginning of time, food has been part of community and celebration.” Eat the same foods as your kid It's not helpful to avoid foods you’re making your child eat, and it helps reduce fear and isolation when everyone at the table is eating the same foods. “This doesn’t mean you have to eat every bite of food they do, though some parents choose to do this,” Ouellete explains. Modeling an all-foods-fit mentality at the table and allowing yourself to enjoy your meal and listen to your body is a powerful way to support your child’s recovery. Be predictable with meals and snacks “Grazing throughout the day and skipping meals is unpredictable and chaotic,” Oseroff cautions. However, providing a solid meal and snack time structure will help nourish your child physically, mentally, and emotionally by decreasing uncertainty and increasing trust within yourself and with your child, according to Oseroff. A common daily food structure is three meals and two to three snacks in between (depending on what your dietitian recommends). “The child is not only learning (or relearning) how to eat, but what it feels like to be fed and provided for,” she says. “Eating disorder recovery is not only about restoring weight or intake, but about rebuilding a relationship with food grounded in trust and safety.” Get help when you need it Whether it’s in a support group or with your child’s treatment team (when your child is not present), take time to unpack your own food, exercise, and body concerns that may be impairing your child’s recovery. “Get some updated information to help you fully understand what’s real and what is frankly diet or wellness-industry propaganda,” Ouellete advises. “For lasting eating disorder recovery, these changes need to be things you believe in, not a temporary measure until you can return to diet culture beliefs and actions.” Ormsby recommends parents learn about intuitive eating (I recommend this workbook), which is usually the end goal in eating disorder recovery. “Parents can be working toward intuitive eating themselves while their child is following a structured plan—and that modeling is incredibly valuable,” she says. Additionally, if you have disordered food behaviors and beliefs that are deeply entrenched and keeping you from supporting your child’s recovery (either disordered eating or an eating disorder), it’s best to work with your own therapist and dietitian to heal. Research shows that parents who go through eating disorder treatment have a positive impact on their kids’ food behaviors. In fact, one 2025 study of mostly white parents with binge eating disorder showed that their positive behavior changes by the end of treatment were associated with fewer disordered eating behaviors in their school-aged children. The bottom line Remember, what your child needs most is a dependable and judgement-free eating environment, not a parent trying to be perfect. “Parents do not need to have a perfect relationship with food to support their child’s recovery. Consistency, neutrality, flexibility, and emotional steadiness matter most,” McNally says. Many parents and families feel freer and happier by the end of treatment, according to Ouellete, because they’re eating foods they enjoy, moving their bodies to feel good, and no longer seeing food, body size, and movement as moral issues. It’s possible to help your child be free from the grips of an eating disorder—I’ve seen countless families reach the other side—and often, everyone ends up in a healthier place than before it all began.]]></content:encoded>
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            <title><![CDATA[How to Help a Child with an Eating Disorder]]></title>
            <link>https://equip.health/articles/understanding-eds/how-to-help-a-child-with-an-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/how-to-help-a-child-with-an-eating-disorder</guid>
            <pubDate>Thu, 12 Mar 2026 21:13:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’re wondering how to help a child with an eating disorder, you’re not alone—and you’re not overreacting. Many parents first notice subtle shifts, like skipped meals, increased anxiety around food, or slowed growth, and aren’t sure what they’re seeing. Because eating disorders in children often don’t look obvious, it’s easy to doubt your concern. Here’s the reality: Noticing patterns and wanting clarity is a strength, not a mistake. Parents are often the first to spot early signs, even before a child can explain what’s going on or medical tests show clear red flags. In fact, these early behavioral shifts are often more important than any single number or lab result, according to Chelyan McComas, MS, LPC, NCC, a licensed therapist and owner of Kind Heart Counseling. This guide is here to help you cut through uncertainty and focus on what actually helps. We’ll explain what eating disorders can look like in children, what steps matter most right now, how to start a supportive conversation, and effective, evidence-based treatments. You don’t need a diagnosis—or perfect words—to take action. And with the right support, recovery is possible. Understanding eating disorders in children Eating disorders are serious mental health conditions that affect how a child eats, thinks about food, and grows. They’re not a choice or a phase. And while they’re more often associated with girls, there are also eating disorders in boys and children of many ages, body sizes, and backgrounds. While they’re often associated with teens, childhood eating disorders can begin much earlier, including in elementary school. In fact, one study found that eating disorder-focused doctor visits more than doubled for children under the age of 17 between 2018 and 2022. And according to another study, as many as one in five children may have disordered eating habits. Children can experience many different types of eating disorders, but two are especially common in younger kids. Avoidant/Restrictive Food Intake Disorder (ARFID): ARFID involves restrictive eating that isn’t driven by weight or shape concerns. A child may avoid foods due to sensory sensitivities, fear of choking or vomiting, or low interest in eating. Over time, this can interfere with growth, nutrition, and daily functioning. Anorexia nervosa: Anorexia in children involves restricting food in ways that impair growth and health. Childhood anorexia often shows up as falling off their expected growth curve rather than dramatic weight loss. Fears around eating or weight may be present, but children don’t always have the words to explain them. Eating disorders often look different in kids than they do in adolescents or adults. According to Lainy Clark, MA, LPC, a therapy lead at Equip, early signs are less about children dieting or losing dramatic amounts of weight. Instead, eating disorders are more likely to initially show up as changes in behavior, mood, or growth, including: Rigidity around food Anxiety at mealtimes Avoiding foods they used to eat without issue Slowed weight gain Stalled height growth Falling off an unexpected growth curve Motivation can also look different in kids. Many children with eating disorders aren’t trying to lose weight or change their bodies. Restriction may be driven by fear (such as fear of choking or vomiting), sensory sensitivities, difficulty recognizing hunger cues, or a need for control during stressful periods. Because these signs are subtle and often mistaken for picky eating, anxiety, or personality traits, eating disorders in children are frequently identified later than they should be. That’s why patterns over time—and parental observation—matter more than any single behavior, says McComas. It’s also important to say this clearly: Eating disorders are not caused by bad parenting. They’re complex conditions shaped by biology, temperament, development, and life stressors. Parents don’t cause eating disorders, but they do play a critical role in recovery. Signs your child may be struggling with an eating disorder Not every change in eating or mood means a child has an eating disorder. Kids go through phases, and appetite can vary with growth, stress, or illness. What’s more concerning is a pattern of changes that persist, intensify, or start to interfere with your child’s health, growth, or daily life. Below are common signs to watch for. Seeing one doesn’t automatically mean an eating disorder. But noticing several, especially over time, is worth taking seriously. Changes in eating behaviors You may notice shifts in how, when, or what your child eats, especially if meals start to feel more stressful or rigid than before. According to McComas, signs include: Skipping meals or eating much less than usual Avoiding certain foods or entire food groups Increased anxiety, distress, or rigidity around meals Asking frequent questions about foods being “good” or “bad” Hiding food, wrappers, or uneaten meals Going to the bathroom immediately after eating A sudden increase in exercise or movement, especially if it feels compulsive Physical changes and growth concerns In children, eating disorders often show up through growth and physical symptoms rather than dramatic weight loss. Here’s what to look out for: Slowed weight gain or stalled height growth Falling off an expected growth curve, even if weight looks “normal” Frequent complaints of stomach pain, nausea, or fullness Fatigue, dizziness, or lightheadedness Feeling cold often or wearing layers to stay warm Emotional and behavioral shifts Changes in mood, behavior, or daily functioning can also be important clues, especially when they coincide with changes in eating. Common shifts include: Increased irritability, anxiety, or emotional shutdown Withdrawal from family meals or social situations involving food Negative comments about their body or eating Heightened perfectionism or need for control Difficulty concentrating or changes in school performance What do to if you’re worried about your child and a potential eating disorder When you’re concerned about your child, it’s easy to feel frozen—it’s hard to know whether to wait, talk to them, or seek professional help.  But you don’t need certainty or a diagnosis to take meaningful action. Here’s a simple roadmap for what to do next: Trust the pattern, not a single moment: Occasional picky eating or appetite changes happen. Ongoing shifts deserve attention. If something doesn’t feel right, it’s worth exploring. Start with a calm, specific conversation: Name what you’ve noticed without accusing or jumping to conclusions. McComas recommends acknowledging observations and inviting your child to share: “I’ve noticed you haven’t been eating breakfast lately. What’s been going on?” Your goal is understanding, not convincing. Prioritize a medical checkup (even if labs look “normal”): Growth patterns and shifts in behavior often signal eating disorder risk before lab results or weight changes do, says McComas. Seek eating-disorder-informed care early: Eating disorders don’t typically resolve on their own and tend to worsen without support. “If you are concerned that your child may have an eating disorder, it is important to have them evaluated as soon as possible,” says Clark. “Early intervention is critical in eating disorder treatment and can significantly improve your loved one’s long-term outcomes.” Reduce opportunities for harmful behaviors at home: Support may include structuring meals, supervising after meals, or pausing exercise, says McComas. She also recommends offering a calm presence and co-regulation when emotions run high. Get support for yourself: Supporting a child with an eating disorder is emotionally demanding. Getting guidance for yourself—through coaching, therapy, and other eating disorder resources for parents—can reduce burnout and help you respond more calmly and effectively. How to talk to a child about eating disorder concerns For many parents, this is the hardest step. It’s normal to worry about saying the wrong thing, triggering defensiveness, or making the problem worse. The good news is that you don’t need perfect words—and you don’t need your child to immediately agree with you—for this conversation to be helpful.  What matters most is how the conversation feels to your child: calm, caring, and grounded in safety. Here’s what to keep in mind. Prepare for the conversation Before you talk with your child, take a moment to check in with yourself. If you’re feeling panicked, angry, or overwhelmed, it can help to pause, breathe, or talk things through with another adult first. Children are very sensitive to emotional tone, and staying regulated yourself makes it easier for them to stay regulated too. A few practical tips: Choose a low-pressure moment (AKA not at the dinner table or during a conflict). Aim for privacy and minimal distractions. Go in with curiosity, not a plan to persuade or correct. What to say (and how to say it) Start with specific observations rather than assumptions or diagnoses. This keeps the focus on what you’ve noticed, not on what you think is “wrong.” For example: “I’ve noticed you’ve been skipping breakfast lately, and meals seem more stressful. Can you help me understand what’s going on?” “I’ve seen you getting really anxious around food, and I want to check in because I care about you.” “I might not have this right, but I’ve noticed some changes and wanted to talk.” “Regardless of their response, I recommend that parents validate and recognize they understand rather than try to convince them of a different behavior,” says McComas. This can sound like: “I’m really glad you told me that.” “That sounds hard. Thank you for explaining.” What to avoid saying (and why) Some well-intended comments can increase shame or shut the conversation down. In general, it helps to avoid: Commenting on weight, appearance, or how your child looks Debating whether the problem is “serious enough” Using fear-based language or threats Framing eating as a choice your child should just make differently These approaches can make a child feel blamed or misunderstood, even when your intention is to help. What if your child denies there’s a problem? “If you choose to talk with your child about their eating habits and they deny having any concerns—or respond with anger or heightened emotional reactions—try not to panic or assume this means there is no problem,” says Clark. “In fact, a strong emotional response can be a common sign of an eating disorder.” So if your child says things like “I’m fine” or “You’re overreacting,” respond with calm consistency: “I hear that you don’t see this the same way. I still want to make sure your body is healthy.” “Even if you don’t feel worried, I am—and part of my job is to keep you safe.” It’s important to know this: You do not need your child’s buy-in to seek help. As a parent or caregiver, getting support is part of protecting their health, even if they don’t want it in the moment. How to find the right treatment for a child with an eating disorder It’s understandable to hope things will improve with time, but eating disorders usually need support to get better. Research shows that early intervention can make recovery more effective for your child and less overwhelming for your family. According to Clark, here are some eating disorder recovery tips: Seek eating-disorder-informed care as soon as possible: Start with a pediatrician or mental health provider who has experience treating eating disorders in children. Medical providers can assess growth patterns and safety, while specialized clinicians can guide next steps. You don’t need a confirmed diagnosis to begin—concern is enough. Look for evidence-based treatment, especially Family-Based Treatment (FBT): For children, FBT is considered the gold standard. It centers parents and caregivers as active participants in treatment, focuses first on restoring nutrition and growth, and gradually returns developmentally appropriate control over eating to the child as recovery progresses. Take a multidisciplinary approach: Effective pediatric eating disorder treatment addresses medical, nutritional, and mental health needs simultaneously. This often includes coordinated care from medical providers, therapists, and dietitians. Consider virtual care: Virtual treatment (like the care available at Equip) allows children to stay connected to school, routines, and family support while accessing specialized care, and it can be appropriate across levels of need. If your child is not engaged in treatment, that’s common—and don’t let it stop you. Many children with eating disorders push back against treatment, especially early on. This resistance is a common part of the illness, not a sign that treatment won’t work, says Clark. How to support a child’s recovery at home What happens at home plays a powerful role in recovery. You don’t need to do this perfectly—steady structure and calm presence matter more than the right words. According to the experts, here’s where to start: Provide consistent structure around meals and snacks: Predictable eating supports nutrition and lowers anxiety. This may include planning meals, plating food, and sitting with your child during meals. Reduce opportunities for eating-disorder behaviors: This can mean supervising after meals, limiting bathroom access right after eating, or pausing exercise. Stay calm during distress: Big emotions are common in recovery. Your steady presence and co-regulation—staying nearby, speaking calmly, and offering reassurance—help your child feel safer. Focus on support, not debate: You don’t need to argue with eating-disorder thoughts or convince your child. Prioritize safety and nourishment. Protect recovery from food and body talk: Avoid comments about weight, appearance, calories, or “good” and “bad” foods. Keep the focus on their health and growth. Maintain connection beyond food: Make time for activities that aren’t about meals or treatment to preserve your relationship. Get support for yourself: Caregiver support reduces burnout and helps you show up more consistently. What to expect during recovery Recovery from a childhood eating disorder is totally possible, but it’s rarely linear. Many parents expect steady improvement and feel alarmed when progress stalls or symptoms resurface. Knowing what’s normal can help you stay grounded and avoid unnecessary self-blame.  Here’s what to expect along the way: Progress often comes in waves: There may be stretches where things feel easier, followed by periods of increased resistance, anxiety, or setbacks. This doesn’t mean treatment isn’t working—it’s just part of how recovery unfolds. Emotional distress can increase before it improves: As nutrition is restored and eating-disorder behaviors are interrupted, children may feel more anxious, irritable, or overwhelmed at first. This can be a sign that the eating disorder is losing control, not gaining it. Behavior change usually comes before insight: Many children don’t feel motivated to recover early on. Improvement often happens because adults provide structure and support, not because a child suddenly understands or agrees with treatment. Your role may shift over time: Early recovery often requires more hands-on involvement from parents. As your child stabilizes and regains capacity, responsibility is gradually returned to them. Setbacks don’t erase progress: A tough week or return of symptoms doesn’t undo the work already done. Recovery is built through consistency over time, not perfection. When to seek urgent help Most eating disorder concerns can be addressed through outpatient care, but there are times when a child needs urgent medical attention. Knowing these signs can help you act quickly and calmly when safety is at risk. Seek immediate medical care if your child experiences: Fainting, passing out, or near-fainting Dizziness or lightheadedness that doesn’t improve Chest pain, trouble breathing, or a very slow or irregular heartbeat Confusion, weakness, or difficulty staying awake Signs of dehydration, such as very little urination or dark urine Sudden or significant changes in weight or intake paired with physical symptoms Self-harm If you’re unsure whether something is urgent, it’s okay to err on the side of caution. “Eating disorders are serious, life-threatening illnesses, and there are times when immediate action is necessary,” says Clark. “If you are concerned about their immediate safety, taking them to the nearest emergency department for urgent evaluation and intervention may be necessary.” The bottom line Helping someone with an eating disorder can feel overwhelming, but you don’t have to do it alone. Eating disorders are serious, treatable illnesses, and early, supportive action makes a real difference. Parents are not to blame, and their involvement is one of the strongest protective factors in recovery. Progress isn’t always linear, but with evidence-based care, a supportive team, and consistent support at home, children can recover and return to growth and connection. If you’re worried, it’s okay to reach out, whether that means learning more, starting a conversation, or scheduling a consultation with Equip. Frequently asked questions (FAQs) What should parents do if a child might have an eating disorder? Start by trusting your concern. Notice patterns over time, have a calm conversation with your child about what you’ve observed, and schedule a medical checkup to assess growth and safety. You don’t need a diagnosis to seek eating-disorder–informed care, and early support leads to better outcomes. It’s also important to seek eating disorder help for parents so you have guidance and support throughout the process. What are the signs of an eating disorder in kids? Signs can include changes in eating habits, increased anxiety around food, rigid food rules, slowed weight or height gain, frequent stomach complaints, dizziness, emotional withdrawal, or negative comments about food or their body. In children, growth patterns and behaviors matter more than appearance. How do I know if my child’s eating is “serious enough” to get help? If eating changes are persistent, affecting growth, health, or daily life, or causing distress for your child or your family, that’s enough to seek help. You don’t need to wait for things to get worse or for your child to ask for support.]]></content:encoded>
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            <title><![CDATA[Who Really Gets Eating Disorders?]]></title>
            <link>https://equip.health/articles/understanding-eds/who-gets-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/who-gets-eating-disorders</guid>
            <pubDate>Fri, 30 Apr 2021 01:06:00 GMT</pubDate>
            <content:encoded><![CDATA[When it comes to the public understanding of eating disorders, the truth is often obscured by assumptions, stereotypes, and flat-out myths. One of the most insidious is that eating disorders only affect thin, young, white women. While that persona may be in line with the media representation we’ve seen—particularly anorexia—over the decades, the truth is that eating disorders affect people from all walks of life. Eating disorders simply don’t discriminate based on age, body type, gender, sexual orientation, race, socioeconomic status, or any other characteristic. Anyone can have an eating disorder: and some experts in the research field have dedicated their careers to uncovering the truth behind the enduring myths. Who do people assume get eating disorders—and are they wrong? “Eating disorders continue to be thought of as problems afflicting only the young, the affluent, and, of course, mostly girls or women,” says Ruth Striegel Weissman, PhD, professor of psychology and Walter A. Crowell University professor of the social sciences, emerita at Wesleyan University. “While it is in fact the case that girls or women make up the majority of eating disorder cases overall, when it comes to socioeconomic status and race/ethnicity, the data suggest a more complicated picture.” In a 2000 study published in the Archives of Family Medicine, Weissman and her colleagues reported that while anorexia and bulimia were more common in white women, young black women were just as likely to report binge eating or vomiting and even more likely to report fasting and laxative and diuretic abuse. “Anorexia is more common in girls or women with higher education or income levels and when asked to choose a racial or ethnic category, they are far more likely to select white, non-Hispanic versus any other racial or ethnic group,” Weissman says. “Eating disorders involving binge eating as a defining feature, such as bulimia nervosa and binge-eating disorder (BED), are more evenly distributed across racial/ethnic groups than anorexia. And, in the case of BED or recurrent binge eating, some studies find that those reporting lower SES or being non-white or Hispanic are more likely to have this type of eating disorder.” The academic and clinical obstacles that perpetuate the stereotype Persistent and pervasive medical bias also likely plays a role in who gets diagnosed with and treated for an eating disorder. According to one 2006 study, clinicians were less likely to assign an eating disorder diagnosis to a fictional character based on their case history if the patient was identified as Black versus white or Hispanic. Even trying to uncover the truth behind who gets eating disorders can be difficult when so much of the research has focused on young, cisgendered, heterosexual females. Men are absolutely vulnerable to anorexia, bulimia and binge eating disorder as well: as many as 10 million males in the United States alone will experience an eating disorder at some point in their lives and 40% of people with BED identify as men. Eating disorders are also an issue for the LGBTQ+ community and the individuals who belong to this community may face unique obstacles and challenges that put them at greater risk of developing an ED. Age also isn’t necessarily a reliable predictor of who gets eating disorders: a groundbreaking 2012 study found that about 13 percent of women over 50 exhibit eating disorder symptoms. Why does the “golden girl” stereotype still exist? “Given all of the above, why is there still the ‘golden girl’ myth of eating disorders?” Weissman asks. “There are several drivers of the image of the privileged, white teenager or young adult woman as the typical person with an eating disorder. One: media images often depict a white young woman when featuring eating disorder stories — the epitome is, of course, the late Princess Diana. And in regards to SES, even when a person of minority background is featured, she’ll likely be a movie star, fashion model, or super athlete.” Another reason the stereotype persists, according to Weissman, is that young, white women simply make up more of the population that’s studied when it comes to eating disorders. “Most studies still are recruiting in places where white young women are overrepresented, such as college campuses or treatment facilities,” she says. “Because of financial barriers and stereotypes about eating disorders, disproportionately fewer people from lower SES or racial/ethnic minority groups go to college/university or seek treatment for an eating disorder, creating a self-fulfilling prophecy that eating disorders only affect who I call the ‘golden girls.’” Weissman says all of this only serves to reinforce preconceived notions of eating disorders within communities and individuals who don’t fit the “golden girl” stereotype. “Individuals I have counseled who do not fit the stereotype sometimes talk about experiencing double shame,” she says. “Having an eating disorder often is experienced as shameful because of another pernicious myth—namely that these disorders are caused by vanity (pursuit of the thin ideal), willfulness ('refusal to eat) or lack of self-control (when binge eating). On top of that, individuals who represent a minority group may feel ashamed for having a problem that suggests disloyalty to their ‘tribe’ — if you have an eating disorder as a Black woman, for example, you may feel that you’ve turned your back on your own culture.” How the stereotype affects those seeking help — and what we can do about that Weismann says the persistent stereotype also limits or restricts individuals who aren’t young, white, or affluent, from entering the treatment field. “Unfortunately, the stereotype also likely reduces interest among minority individuals to want to learn about eating disorders and select a career in research or as a care provider, creating a negative cycle whereby the field is not perceived as welcoming or relevant to anyone who isn’t white,” she says. “The truth is that eating disorders are multifaceted problems that have multi-factorial causal origins; helping reduce the burden of eating disorders requires the contributions of a diverse pool of researchers and clinicians.” As researchers continue to uncover the complicated factors that influence the development of eating disorders, it’s important that we shift the conversation and public perception around who these illnesses affect. Eating disorders have always and continue to afflict individuals from all walks of life, and educating as many communities as possible may go a long way in getting help to those who need it—regardless of what they look like or whether they fit the false narrative of who these diseases impact.]]></content:encoded>
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            <title><![CDATA[What is the Relationship Between Trauma and Eating Disorders?]]></title>
            <link>https://equip.health/articles/understanding-eds/trauma-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/trauma-and-eating-disorders</guid>
            <pubDate>Fri, 10 Oct 2025 18:01:00 GMT</pubDate>
            <content:encoded><![CDATA[The relationship between trauma and eating disorders is complex and varies from person to person and trauma to trauma, but research clearly shows that the two have a strong connection. For many, disordered eating behaviors can develop as a way to cope with the emotions or memories following a traumatic event. And although this link isn't always immediately apparent—to patients, families, or even some healthcare providers—learning to recognize and understand it is crucial for effective treatment and lasting recovery from both. If you or a loved one are struggling with an eating disorder and trauma, read on to get a better grasp on why these two often co-occur, what types of treatment are most effective, and steps to take to get the help and support you deserve. What is trauma? According to the American Psychological Association, trauma is any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning. Trauma can be acute, such as the loss of a loved one or a car accident, or chronic, such as physical abuse or living in a war. Trauma is also very individualized: what is traumatic to one person may not be to another person. What is PTSD? You've likely heard of PTSD, which stands for posttraumatic stress disorder. Trauma is a core component of PTSD, but not everyone who experiences trauma develops PTSD. “Trauma is an event—we can call it a PTE or 'potentially traumatic event,'” says licensed clinical psychologist Zoe Ross-Nash, PsyD. PTSD, on the other hand, is a mental health condition triggered by a PTE. Trauma is discrete and contained, whereas PTSD continues indefinitely, until it is properly treated. PTSD involves: Intrusions: Recurrent, distressing memories, dreams, and flashbacks related to the PTE Avoidance: Trying to avoid any reminders of the PTE or thinking or talking about what happened Negative changes in mood or cognition: Having negative thoughts about oneself or the world, becoming less interested in activities once enjoyed, detaching from others, feeling emotionally numb, or experiencing memory problems related to the PTE Emotional arousal: Irritability, angry outbursts, reckless behaviors, trouble sleeping and concentrating, or being easily startled “What makes someone more predisposed to develop a pathology like PTSD after a PTE depends on risk factors and resiliency factors,” Ross-Nash explains. For example, prior history of a mental health disorder, previously going through stressful events, and neuroticism increase the risk of PTSD. On the other hand, believing that you can cope with what happened and having social support appear to protect against PTSD. Prevalence of co-occurring trauma and eating disorders Many people living with trauma also develop eating disorders, although the exact numbers vary from study to study, and the connection is more common in certain types of eating disorders than others. Overall, it’s estimated that about 25 percent of people diagnosed with an eating disorder also have posttraumatic stress disorder. Drilling down to specific eating disorders diagnoses, according to a review published in the Journal of Eating Disorders in 2022 that included over 200 studies, PTSD affects: 32 to 66 percent of people with bulimia 24 to 32 percent of people with binge eating disorder (BED) 16 to 22 percent of people with anorexia Does trauma increase the risk of developing an eating disorder? In short, yes: trauma can increase the risk of developing an eating disorder. It's estimated that between 18 and 80 percent of patients seeking eating disorder treatment have been exposed to trauma (which is, admittedly, a huge range—but it suggests there is a definite relationship there). Ross-Nash explains that trauma impacts disordered eating behaviors in a lot of different ways, which we unpack below. Why does trauma increase the risk of an eating disorder? There’s not one simple reason that trauma increases the risk of an eating disorder. Rather, several factors appear to connect the two. Note that all of these factors are a two-way street: the eating disorder reinforces avoiding the trauma, and the PTSD reinforces the use of the eating disorder behaviors as coping mechanisms. This self-reinforcing nature makes treatment a challenge, and underscores the need to work with experts who are trained in addressing both conditions. Emotion dysregulation: Disordered eating behaviors may be a way of managing the emotional dysregulation that can occur after a traumatic event. "Neurologically, we see that trauma can impact areas of our brain, particularly the amygdala, which impacts emotion regulation. And then we also see people with eating disorders using food as a way to regulate their emotions,” Ross-Nash explains. Control: From a psychological perspective, eating disorder behaviors may give individuals a greater sense of control, Ross-Nash says. “Their body and what they put into their body offers a lot of agency and autonomy and power. This can feel really good after a traumatic experience, where something happened that's so outside of their control,” she explains. The controlling behaviors related to the eating disorder can feel protective and safe. This may be especially true with sexual or body-based trauma. “A lot of times, there is this belief afterward that, 'If my body was different—if it was smaller, or less feminine or masculine or what have you—then this wouldn't have happened. So let me change my body to make sure I won't be at risk of this happening to me again,'” says Equip Therapist Carol Brown, LCSW. This belief can be even more pronounced if a person was told by their perpetrator that the traumatic event was their fault. Dissociation: People who experience trauma often dissociate to cope, using different strategies to separate from their body, thoughts, or memories. For some, eating disorder behaviors are a way to numb, soothe, or silence difficult emotions. On the other hand, Ross-Nash explains, some people with trauma may use disordered behaviors to achieve the opposite effect: “signs of pain from fullness, hunger, or purging, could act as a way to decrease dissociation—it brings an experience back into the body,” she says. “It's a really complex situation.” Self-punishment: “The eating disorder can echo trauma because there is secrecy and punishment,” Ross-Nash says. “The thinking is, 'I am bad if I eat this cookie, and I deserve to be punished. If I was bad, I deserved the trauma.'” In other cases, the disordered behavior may be someone's way of punishing themselves for the trauma, Brown adds. This may be because someone told them the trauma was their fault, or because that is how their brain pieced together what happened to them and why. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation: The HPA axis regulates the body's response to stress. Trauma and particularly PTSD cause the HPA axis to become overactive, and people with anorexia nervosa also appear to have hyperactive HPA axes. Family dynamics: Any type of child abuse is associated with all types of eating disorders. “People who grew up in a dysfunctional family environment, who were never taught coping skills to manage trauma, are more likely to develop an eating disorder pathology,” Ross-Nash says. These skills were not disseminated from their caregivers.” In the absence of healthier coping strategies, disordered behaviors can seem like the best option for navigating the distress of trauma. Treatment for co-occurring trauma and eating disorders If you or a loved one are dealing with co-occurring trauma and an eating disorder, it’s important to recognize that it’s not your fault—and that while treatment may be more complex, recovery is possible. Working with a provider who offers trauma-informed care and understands eating disorders can make all the difference. “No one chooses this, and it makes sense that you've responded in this way,” says Brown. “There is a path forward for you to recover from your eating disorder and also be able to cope with the trauma so you feel safe.” In an ideal scenario, when a patient has an eating disorder with co-occurring trauma, the therapist is able to treat both conditions at once, Brown says. However, this is a delicate dance. To start, the eating disorder is a coping skill (though a maladaptive one) to help people who have experienced trauma feel safe. “If you take that away, what are they left with?” Brown says. Without alternative coping strategies, individuals may experience a resurgence of trauma symptoms—like flashbacks, nightmares, and intrusive memories—alongside the already challenging aspects of eating disorder recovery, such as the fear of weight gain. At the same time, if you try to process the trauma before treating the eating disorder, you run the risk of a person turning to eating disorder behaviors—such as restricting, bingeing, and purging—to manage the difficult emotions the trauma brings up. For patients who need weight restoration or renourishment, this can be a significant setback. It’s also important to acknowledge the physical impact: when you have an eating disorder, your physical body isn't properly nourished. Among other health impacts, this causes nervous system dysfunction. This can intensify the hyperarousal, anxiety, and dissociation a patient already feels due to their trauma, Brown explains, making trauma processing even more difficult. Because of all of this, trauma treatment often starts with learning coping skills so the patient can manage treatment approaches (like a trauma narrative or exposure therapy) without resorting to eating disorder behaviors or experiencing a trauma response. “We want to create a window of tolerance for them to be able to manage the symptoms,” Brown says. “It's a balancing act to find what works for each person.” Treatment for patients with eating disorders and trauma can take time, and needs to be highly individualized. Be patient with yourself or your loved one, trust the process, and if anything doesn't feel right, talk to your therapist or support team. Types of treatment Research shows that multiple therapeutic approaches can effectively address both eating disorders and trauma. Cognitive behavioral therapy (CBT), psychodynamic therapy, compassion-focused therapy, and integrative treatments have all shown significant improvements in both eating disorder and PTSD symptoms. Importantly, no single approach appears superior to the others. The key, Brown says, is seeking trauma-informed care that is individualized to what a patient is experiencing. Rather than asking, “What's wrong with the patient?”, this treatment approach asks “What happened to them?” This shift recognizes that eating disorder behaviors serve a purpose and makes space to understand that function before working to develop healthier coping strategies. Trauma-informed care is also important because certain aspects of eating disorder treatment could potentially be particularly hard for those with trauma. Consider the challenge of bathroom monitoring for someone whose trauma involved bodily violation, or nighttime room checks for someone with a history of nighttime assault. Trauma-informed providers understand these potential triggers and work with patients to make any difficult elements of treatment more manageable, and process any distressing feelings that arise because of them. Accommodations when treating co-occurring trauma and eating disorders When a patient has both an eating disorder and trauma, providers may need to make some accommodations to standard treatment protocols. “Clear expectations, communication, and consistency can help keep anxiety and unpredictability down,” Brown says. “This is key because that's what can re-traumatize folks.” She recommends these key principles of trauma-informed care: Safety: Ensuring the patient feels physically and emotionally secure during sessions. Clear expectations: The therapist should go over agendas in treatment so the patient has an understanding of what treatment will look like. Regular check-ins to see how the patient is feeling also help. Consistency: Many providers see their patients at the same time on the same day each week. Along with clear expectations, this helps foster trustworthiness in the therapist. Collaboration and choice: When possible, the therapist works together with the patient or lets them make decisions. For example, if they need lab work done, the therapist asks which of two locations the patient prefers. This helps empower the patient. Cultural awareness: If applicable, the therapist acknowledges and helps the patient work through how someone's cultural, historical, and gender contexts shape their experience of the trauma. Lastly, therapy should only proceed if the patient is safe. If they are medically unstable or have suicidal ideation, they need hospitalization. Preventing dropouts and relapse Patients with co-occurring eating disorders and PTSD are more likely to drop out of treatment and relapse after, according to research. This may be due to unresolved trauma symptoms that lead them to turn to eating disorder behaviors to cope. Or it may happen when trauma processing begins too soon, destabilizing the eating disorder recovery. “It's important for therapists to meet the client where they're at,” Ross-Nash says. “This helps decrease the shame and helps with the guilt of the pathology.” As an example, she shares that she worked with one patient who was scared to talk about her trauma, because people didn't believe her in the past. In this instance, Ross-Nash emphasized that sharing was entirely the patient's choice. “That changes the experience,” Ross-Nash explains. “They get to have a choice, they get to decide, and they make the rules.” Over time, the patient was more honest and able to stay in treatment longer. What to do if you or a loved one are struggling with trauma and disordered eating If you believe you or a loved one are battling both trauma and an eating disorder, it's crucial to seek help. In an ideal world, you'd find someone who is both a certified eating disorders specialist (CEDS)—or at least has experience treating patients with eating disorders—and who also is trauma-informed. An expert trained in both areas can provide treatment that feels safe and validates your experiences, while using evidence-based approaches that address how trauma and eating behaviors often reinforce each other. If you cannot find one expert, consider working with two therapists, one who specializes in trauma and one who specializes in eating disorders, and having them coordinate care. It’s also important to work with other specialists, like a registered dietitian and medical provider, who can address the eating disorder from a multidisciplinary perspective. At Equip, each patient works with a dedicated care team of eating disorder experts, including therapists who can provide trauma-informed care that is individualized to each patient’s needs. Also consider building a support team, whether that's family members, friends, or peer support groups. Having other people you can talk to, especially on hard days, helps you feel less alone—and both eating disorders and trauma can be incredibly isolating. Whatever you do, be patient and don't give up. “A lot of individuals who have experienced trauma feel they're not worthy to be taken care of, they're not worthy of support, and they're not worthy of recovery,” Ross-Nash says. “But you are worth it. Freedom is on the other side of recovery. Nobody deserves a life to be shackled by something as debilitating as an eating disorder.”]]></content:encoded>
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            <title><![CDATA[Can Pregnancy Trigger an Eating Disorder?]]></title>
            <link>https://equip.health/articles/understanding-eds/pregnancy-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/pregnancy-and-eating-disorders</guid>
            <pubDate>Wed, 04 Sep 2024 21:42:00 GMT</pubDate>
            <content:encoded><![CDATA[When I became pregnant, I’d been in recovery from anorexia for five years. Upon learning the news, my primary emotions were joy and disbelief. It worked! This is happening! I'm going to have a baby! But in the days after, as the news settled in, I felt a stubborn worry worm its way into my mind: What did this mean for my body? I’d stopped the near-constant body checking that had been a hallmark of my illness, but I still registered how my body looked. I still caught my reflection in windows, still—however unconsciously—assessed my silhouette. What would happen when that silhouette began to do the one thing my now-dormant eating disorder was so terrified of: grow? Pregnancy is almost universally thought of as a precious, special time, one in which a pregnant person watches in awe as their body does miraculous things. New curves form, old ones disappear, foreign movement can be sensed deep inside the body; from nothing, a tiny human grows. But for those affected by an eating disorder, pregnancy can also be fraught. An eating disorder doesn’t simply disappear when a person becomes pregnant, and for those in recovery, pregnancy can cause old thoughts and behaviors to resurface.  Indeed, the relationship between pregnancy and eating disorders is a complex one. The good news is that there's a lot that pregnant people can do to protect themselves and their recovery through these eventful nine months and beyond. How common are eating disorders in pregnancy? A pregnant person has so much going on—ultrasounds and blood tests, growth scans and vital signs, heart rates and genetic screenings, the life-changing experience of preparing for parenthood and a growing family—that it’s understandable for both healthcare providers and society at large to overlook the fact that they may also be dealing with an eating disorder. But according to at least one published paper, “eating disorders are more common than previously thought in pregnancy.” That particular study found that during pregnancy, 7.5% of women met diagnostic criteria for an eating disorder, compared to a pre-pregnancy rate of 9.2%. The most common eating disorder symptom reported was binge eating, with 8.8% of women engaging in binges, and 2.3% engaging in compensatory behaviors, like restricting or overexercising. Another study found that for women who have eating disorders before becoming pregnant, disordered eating often persists into their pregnancy and the postpartum period. Other research paints a different picture, however, showing pregnancy as a time of relief from eating disorder symptoms, which can perhaps explain why the rate of eating disorders among pregnant women is lower than the baseline prevalence. (It's important to note that not all pregnant people are women, but many studies, including the ones cited here, use a female population.) If and how an eating disorder shows up during pregnancy depends on a variety of factors, including the type of eating disorder (pregnancy seems to be a particularly high risk time for binge eating disorder, for instance) and whether a person was in recovery or not when they became pregnant (those in recovery may be vulnerable to a relapse, while those actively engaging with their eating disorder may experience a reprieve). But as with all things related to mental health, how pregnancy affects someone’s eating disorder will be unique to each person. In my case, I was lucky: as my body expanded, my joy and awe did the same alongside it, and there was simply no room for body distress or eating disorder thoughts. Unfortunately, this isn’t the case for everyone. Pregnancy brings specific challenges for those with eating disorders When you’re pregnant, certain parts of your life—and your body—change, and for many people, these changes can be a wake-up call for a latent eating disorder. Some of the most challenging aspects of pregnancy include: Weight monitoring Getting weighed is a standard part of all prenatal appointments. For those in recovery, this can be jarring: many people with a history of an eating disorder have long ago thrown out their scales and make a point of not knowing their weight. With prenatal monitoring, this careful avoidance flies out the window. “Even with my care team knowing my past of an eating disorder, they would still bring up the parameters of how much weight gain was ‘allowed’ to happen during pregnancy,” says Equip dietitian Stephanie Kile, RD. “That worry and focus on weight at each appointment tells a pregnant woman that she needs to fit in this box or something is wrong, and she must do whatever she can to stay in this box. During my first pregnancy, I approached every appointment with a bit of dread that I was going to be told I was gaining too much weight.” Equip therapist Ashley Isenhower, AMFT, points out that this focus on weight has a disproportionate effect on those who begin pregnancy at a higher weight. “Doctors want your weight at every appointment. You’re only supposed to gain a certain amount of weight, and that number is drastically smaller for people in larger bodies,” she says. “If you’re above a certain BMI, like I was, you’re automatically considered a ‘high-risk pregnancy.’” Body changes Equip’s Director of Clinical Training Urmi Patel, PsyD, explains that pregnancy can complicate an eating disorder, as the pregnant person may experience increased anxiety about weight gain due to their changing body. Indeed, eating disorders often go hand-in-hand with body image concerns, and so the rapid bodily changes associated with pregnancy (“Your body changes SO FAST,” emphasizes Isenhower) can be distressing. Research also bears this out, showing that those with a history of an eating disorder may experience increasing anxiety around weight and shape as their body changes throughout pregnancy. As one research paper put it, “being pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching for control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this.” Uneducated providers Unfortunately, many well-intentioned healthcare providers simply aren’t educated about eating disorders. And during pregnancy, when the focus is so squarely on other issues—the baby’s health, the mother’s lab results, monitoring symptoms and vitals—providers may be even less inclined to consider if or how an eating disorder might be at play, and adjust their treatment accordingly. “I'm fresh out of graduate school and I don't remember learning much about pregnancy or postpartum mental health at all, let alone the intersection of pregnancy/postpartum and disordered eating,” says Isenhower. Kile worries that when providers are uneducated about what to say and not say about weight, bodies, and food, it could do lasting damage to vulnerable people. If providers speak about these topics in an uninformed way, she says, “That opens the door wide for an eating disorder to slip right in among all the falsehood of being ‘healthy’ for pregnancy.” Comments from others The unfortunate reality is that most people think it’s fair game to comment on pregnant bodies, even people who would never comment on someone’s body if they weren’t pregnant. Regardless of the content of that commentary (“You look like you’re about to pop!” or “Oh my gosh, you’re so small, I can’t believe you’re six months pregnant!), simply having your body remarked upon can be triggering for someone who has struggled with an eating disorder. “You’re inevitably met with conversations about weight, and comments about your body—how big or small your bump is, or how it compares to someone else’s who is as far along as you,” says Kim Packebush, UX researcher at Equip. A fixation on diet While many people in eating disorder recovery have reached a place where food doesn’t take up too much of their brain space, pregnancy can once again thrust food, nutrition, and dietary concerns into the spotlight. “You’re inundated with information about what foods are best for fertility, what foods are unsafe, what foods provide the best nourishment for your body and baby,” says Packebush. “While this is all well and good, as someone recovering from food rules and restrictions, it felt like a step backward. Those hunger cues I fought so hard to regain were thrown out the window, either because of morning sickness in the first trimester or competing stomach and intestinal space in the third.” This is why it can be especially helpful to explore intuitive eating during pregnancy.  Hormonal shifts Pregnancy also brings hormonal upheaval, which can have a wide range of different effects—both bad and good—when it comes to eating disorder symptoms. Binge eating and body dissatisfaction have a positive association with levels of progesterone, one of the hormones that steadily rises throughout pregnancy, making pregnant people particularly vulnerable to new-onset binge eating disorder or a relapse. In fact, community studies have found that higher progesterone concentrations are associated with binge eating, and that reproductive hormones like progesterone and estrogen account for 24% of the variance in binge eating in women diagnosed with bulimia. For all of the above reasons, pregnancy is considered a high-risk time for relapse in people with a history of an eating disorder. In one study of women in remission from anorexia or bulimia, 67% of participants experienced a relapse during pregnancy, while in another study of people with a previous eating disorder, 23 of 24 participants reported a worsening of their symptoms or full-blown relapse during pregnancy. Both of these studies are quite small, and they don’t mean that relapse is inevitable, but they do highlight the unique risk of this time period. But pregnancy can also provide relief from eating disorder symptoms On the other hand, pregnancy can be a time of eating disorder relief for some people, especially those with active eating disorders or more recent eating disorder history. Research shows that for the majority of women struggling with anorexia or bulimia, pregnancy leads to positive, adaptive changes in their behavior, and while some women may continue to have eating disorder symptoms, those symptoms tend to be less frequent and less acute. Large-scale reports have placed eating disorder remission rates anywhere between 29-78% during pregnancy. There are a few potential reasons for this. Again, hormones may be involved, but this time it’s the power of estradiol, the particular form of estrogen produced during pregnancy. Eating disorder symptoms and estradiol appear to have an inverse relationship, so as estradiol increases, eating disorder symptoms decrease. And since estradiol levels rise throughout pregnancy—with a particularly sharp increase after the first trimester—many people with eating disorders see their symptoms improve. Most of the research into this has been around anorexia and bulimia, with one study finding that symptoms decreased progressively through each trimester, and 75% of women showed no symptoms at all by their third trimester. Patel also points out that for some pregnant people, their eating disorder may improve because of their own concern about the harmful effect it could have on an unborn baby. And for many, simply witnessing what one’s body can do may be transformative for eating disorder recovery. “Being pregnant for the first time allowed my relationship with my body to become the best it has ever been,” Kile says. “There is something about developing life and watching your body house that life that helped me understand the power my body has. With each pregnancy, my body grew and became new each time. I allowed myself to give my body grace, the nourishment it deserves, and the time to heal.” Eating disorders in the postpartum period Unfortunately, the postpartum period can be a particularly hard time for those affected by eating disorders, even people who experienced some relief during their pregnancy. Research shows that while eating disorder symptoms like restriction, purging, and weight concerns all tend to diminish during pregnancy, this effect is short-lived. After giving birth, those symptoms return to baseline levels for most women, with only a small minority experiencing lasting psychological benefit. There are a lot of different factors that can make the postpartum period so tough. For one, there’s the inescapable influence of diet culture: while pregnant women are celebrated as their bodies grow and expand, as soon as the baby is born, they’re once again subject to society’s demand that they be as small as possible. “I will say that the postpartum period has been difficult due to ‘bounce back culture,’” says Isenhower. “I developed preeclampsia and was in the hospital for three weeks before giving birth to my son, then he spent two weeks in the NICU. All that trauma, and some days my biggest concern is, ‘Will I ever fit back into my jeans?’ I loved watching my body grow and expand—but now, there’s a little voice in my head who routinely reminds me that I no longer have ‘an excuse.’” Then there are a panoply of physical, biological, and psychological reasons that the postpartum period is so risky for eating disorders. As one review put it, “the combination of psychological stressors of new motherhood and body image concerns intensified by the residual bodily changes of pregnancy may predispose women to have an exacerbation in eating disorder symptoms.” Studies have also found that women with eating disorder histories tend to both gain more weight during pregnancy and be more concerned about that weight gain while pregnant and postpartum—the combination of which can lead to disordered behaviors. People with eating disorders are also at an increased risk of developing postpartum depression: in one study of women with eating disorders, a third of them experienced postpartum depression, compared to a rate of 3-12% in the general population. Dealing with a serious mood disorder like this adds to the psychological stress of being a new parent, and eating disorder behaviors may arise as a way to cope. And hormones once again rear their head: remember that rise in estradiol we mentioned above, which contributes to a decrease in eating disorder behaviors during pregnancy? Postpartum, those levels plummet, and the opposite effect is felt. While high estradiol decreases eating disorder symptoms, low estradiol increases them—meaning that when a woman’s estrogen levels abruptly fall after she gives birth, she’s vulnerable to her old eating disorder patterns taking hold. But again, these elevated risks are not life sentences, and many people with histories of eating disorders are able to remain in strong recovery through the postpartum period. “My postpartum body was new and scary, just as it had been during recovery, but I was able to look back and see the growth and development and the new life, and that helped me put it all into perspective,” says Kile. How to protect your eating disorder recovery during pregnancy The relationship between pregnancy and eating disorders is complex, multifaceted, and will play out differently for each person. But the reality is that this is a time of elevated risk for those with past or current eating disorders, as well as those who have never experienced an eating disorder but may be vulnerable to one. The good news is there are things you can do to emerge from pregnancy—and the postpartum period—feeling strong in your recovery and empowered to resist any eating disorder thoughts or behaviors that may arise. Find the right provider Both Packebush and Isenhower emphasize the importance of finding an OB who is knowledgeable about the HAES (Health at Every Size) approach and has a fat-positive or weight-neutral philosophy. “While it’s a privilege and dependent on several factors, try to find a doctor who is trauma-informed and weight-inclusive,” Packebush advises. Communicate with your doctor If you have a history of an eating disorder, it’s important to make that clear from the get-go. “At the very least, be upfront with your care team about your history and what are potential triggers for you,” says Packebush. Communication can also help with the dreaded weigh-ins that happen at each prenatal visit. “You can still ask for a blind weight or not to be weighed at all, though some doctors will argue that there is a medical need to check weight—for example, a symptom of preeclampsia is rapid weight gain over a short period,” says Isenhower. Use social media mindfully Patel advises that those who feel vulnerable to eating disorders should limit or reduce their exposure to social media accounts that make them feel bad about their bodies, or that tend to prompt comparisons. It can be helpful to curate your social media and follow fat-positive birthing accounts (Isenhower recommends @theheavyweightmidwife). Seek support Putting in place a robust support system at the beginning of pregnancy can help you stay on track when challenges come up. It’s important to build a support network that includes both loved ones and mental health professionals, a sentiment that Packebush backs up, emphasizing that “this is a really hard thing to tackle alone, and it's important to have someone who can be there and empathize.” “If you’re already seeing a therapist, make sure this is an ongoing conversation so that when and if issues arise, you’ve got someone to hold you accountable. Talk, talk, talk about it,” Isenhower advises. Establish good habits Being intentional about your eating and exercise can go a long way toward keeping you on track throughout pregnancy. Patel says that it’s important to practice regular eating patterns—even during the first trimester, when you might be experiencing aversions or nausea—and incorporate physical activity in a mindful way. “Develop a list of joyful movement and activities to enjoy while pregnant or after birth,” recommends Patel. “This can help reduce the focus on exercising.”  For my part, I found prenatal workouts—which tend to be gentler and focused on how the body feels as it moves versus more external goals, like speed or number of reps—to be truly revelatory for my push-it-to-the-limit attitude around physical activity. Watch your self-talk “Body image concerns are unavoidable—the body is changing so rapidly that once you get used to one change, it changes again,” says Packebush. “It’s important to evaluate and analyze the things you say to yourself about yourself, and challenge if they’re neutral observations or stemming from a place of criticism.” In this area in particular, Kile says, self-compassion goes a long way. “Your pregnancy and postpartum journey is yours alone. Don’t compare yourself to anyone,” she says. “Grace is going to be your best friend in this season of your life.”]]></content:encoded>
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            <title><![CDATA[What's the Link Between PCOS, Eating Disorders, and Disordered Eating? ]]></title>
            <link>https://equip.health/articles/understanding-eds/pcos-eating-disorders-disordered-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/pcos-eating-disorders-disordered-eating</guid>
            <pubDate>Wed, 20 Nov 2024 14:40:24 GMT</pubDate>
            <content:encoded><![CDATA[The hormonal disorder polycystic ovarian syndrome (PCOS) may seem completely unrelated to eating disorders or eating habits in general, but there’s actually a close and complex connection between the two. A growing body of research shows that PCOS increases the risk of developing certain eating disorders, and PCOS can also influence the treatment approach that works best for women affected by both conditions. If you’ve been diagnosed with PCOS, you may feel some relief at having a name for the symptoms you’re dealing with—especially if you struggled to get diagnosed for some time, which is the case for a lot of people. Though this hormonal disorder affects around 10 percent of women of childbearing age, most aren't properly diagnosed until they've spent at least a few frustrating years visiting various healthcare providers. Once diagnosed, however, there are additional challenges that can come up, one of them being issues around eating. Often, the first thing doctors recommend to treat PCOS is lifestyle modifications like changes to diet and exercise, with the goal being weight loss. But this guidance ignores the concerning fact that women with PCOS also have an increased risk of developing bulimia, binge eating disorder (BED), and disordered eating. “If someone has PCOS and an eating disorder—diagnosed or undiagnosed—and you tell them to focus on weight loss and dieting, you could worsen their disordered eating habits,” says Laura Cooney, MD, MSCE, associate professor of reproductive endocrinology and infertility at the University of Wisconsin. “Plus, you aren't treating them as a whole person who has both of these conditions.” The link between PCOS and disordered eating is real and serious, but if you’re navigating both conditions, there are things you can do to manage PCOS while working toward (or protecting) eating disorder recovery. Read on to learn about the link between PCOS and eating disorders, how providers can support patients with both conditions, and how anyone living with PCOS can overcome disordered eating. The impact of PCOS on mental health Articles about PCOS tend to focus on the physical symptoms of the condition, which include acne, irregular menstrual cycles, fertility issues, weight gain, and excessive hair growth. However, PCOS can also affect psychological well-being. If you have PCOS, it might impact your mental health in a number of different ways, including: Reduced self-esteem and poor body image Diet culture continues to hold people to unrealistic expectations when it comes to physical appearance. Our society unfortunately idolizes thin people with flawless skin, forgetting that many of the images we see in the media are often air-brushed, heavy with makeup, or otherwise altered. These standards can cause anyone to struggle with self-esteem and body image, but they can be particularly hard for those affected by PCOS, who may be dealing with symptoms that go against these unattainable standards. Weight stigma According to Jessica Baker, PhD, Senior Researcher at Equip, people who have PCOS often live in larger bodies, and may experience weight stigma, or discrimination and stereotyping based on body size. Baker says that this stigma can come not only from society at large, but also from healthcare providers, which can be particularly harmful. Anxiety and depression An estimated 28 to 39 percent of people with PCOS have anxiety, and between 11 and 25 percent have depression. There may be many reasons for this, including hormonal changes as well as the mental and emotional toll of dealing with PCOS-related weight stigma, infertility issues, and body dissatisfaction—not to mention the stress of trying to get diagnosed in the first place and then manage the condition. Decreased quality of life Combine the above factors with the physical symptoms of PCOS, and it's a lot to handle. Given all that, it’s not terribly surprising that many people with PCOS report a decreased quality of life. They may also withdraw from social activities, intimate relationships, and other opportunities to interact with others, which can heighten all of these psychological symptoms. Understanding disordered eating in the context of PCOS Although we know what PCOS and disordered eating are related, at this time, “we don't have a full understanding of how PCOS can potentially contribute to eating disorders,” Cooney says. “Multiple factors could go into it.” These factors may include hormonal changes, anxiety, depression, and more. Hormonal imbalances Hyperandrogenism (high levels of male hormones, such as testosterone) can increase anxiety and depression. It may also boost appetite while decreasing impulse control, a combination that some research suggests may explain why people with PCOS are at particular risk of developing bulimia compared to other eating disorders. Anxiety and depression As outlined above, many people with PCOS experience anxiety or depression, or both, and this can play into the risk of developing disordered eating habits. As Cooney puts it, anxiety and depression “often go hand-in-hand with eating disorders.” Insulin resistance Our bodies produce the hormone insulin to regulate blood sugar levels. People with PCOS often develop insulin resistance (IR), which is when cells in the body don't respond to insulin. Insulin resistance, in turn, is associated with overeating, which plays a role in eating disorders like bulimia and binge eating disorder. Brain changes The hypothalamus is a part of the brain that regulates appetite, and research shows that it appears to function differently in people living with PCOS. This may contribute to eating beyond fullness. Emotional eating To cope with anxiety, depression, mood swings, and the stress of living with PCOS, people may turn to emotional eating. Emotional eating on occasion isn’t necessarily a bad thing, but when it becomes a pattern, or is a person’s only coping mechanism, it can turn into an eating disorder (in fact, research shows that emotional eating may lead to binge eating disorder). For people with PCOS, Baker says, emotional eating may become a pattern, since the behavior leads to relief from their negative feelings. Unhelpful advice In addition to the pressures from society to be thin, both uneducated healthcare providers and influencers on social media may recommend weight loss or dieting to people with PCOS. But many people with PCOS have already tried dieting without success (not surprising, since diets don’t work), and this advice may further fuel underlying body dissatisfaction and disordered eating. “It could also lead to increased shame or guilt if they're trying to lose weight but are having trouble reaching the goal their healthcare provider set,” Baker adds.  How providers can support patients with PCOS Given the complex relationship between PCOS and eating disorders, healthcare providers play a crucial role in helping patients address both conditions. Treatment should be individualized and holistic, and aim to support both physical and mental health. “Nothing with our bodies occurs in isolation, so just focusing on weight or diet or just giving medication isn't necessarily going to be helpful,” Baker says. “We need to consider the person's whole identity—their mind, body, spirit, and soul—and the whole of their experiences—their environment and stressors. We can't look at just one thing in a vacuum.” Here are some ways that providers can support patients who are managing an eating disorder and PCOS. Screen everyone Given the prevalence of disordered eating in PCOS patients, one of the most important things for healthcare providers who treat patients with PCOS is to screen everyone for eating disorders. “Awareness is so important,” Cooney says. “If you have someone with PCOS and an eating disorder, any treatment needs to focus on the eating disorder first.” Most patients won't come out and say, “I have an eating disorder,” so it's the job of the provider to open the lines of communication and remain nonjudgmental. These guidelines on screening best practices can be helpful. Provide comprehensive care The physical symptoms of PCOS—such as hair growth and weight gain—can feed into the impact PCOS has on mental health—such as anxiety, depression, and eating disorders. In order to properly treat a patient with PCOS, providers must address all of these needs. This is where having a team of experienced therapists, dietitians, and other experts to refer patients to is imperative. “The problem with healthcare is you have short visits, you're trying to fix someone's periods and help them with hair growth and screen them for diabetes, and the mental health and eating disorders piece gets pushed to the back burner,” Cooney says. “Healthcare providers need to have partnerships with outside providers who are able to give patients the time for that piece.” Encourage mindful eating Women with PCOS are already more likely than people without PCOS to distrust medical professionals' opinions. Recommending weight loss may further promote distrust, as well as harm anyone with an eating disorder. Instead, to support a healthy relationship with food, providers should focus on mindful eating, Cooney says. Mindfulness practices have been shown to increase the awareness of hunger, fullness, and cravings, and to decrease psychological distress. These are all things that people with PCOS may struggle with. Additionally, weight-neutral approaches that center around enjoyable physical activity, healthy eating, and other lifestyle behaviors independent of body weight may be helpful. Emphasize well-being over weight “There's no conclusive evidence that someone's weight is causing PCOS and that, if they lose weight, their PCOS symptoms will go away,” Baker says. Additionally, various risks associated with PCOS—such as diabetes, high blood pressure, and high cholesterol—can't be measured by the scale. When providers shift the focus off of weight, they can instead focus on metabolic markers for these conditions, which can be measured via blood tests. “A lot of lifestyle changes don't always come with a change to the number on the scale,” Cooney adds. “It can be really rewarding to show a patient with PCOS that yes, your weight may be the same, but these metabolic numbers are improving or stable—which is good. This is a win.” What to do if you’re struggling with PCOS and disordered eating If you have PCOS and currently have some disordered eating habits or think you may have an eating disorder, you're not alone. The good news is that with the right support, you can both manage your PCOS and overcome any harmful eating behaviors. The sooner you seek treatment for an eating disorder or disordered eating, the higher your chance of achieving full recovery and avoiding serious health consequences, so don't hesitate. Here are some things to keep in mind as you get started with recovery: Find the right therapist for you In an ideal world, you’d find a therapist who has experience treating patients with both PCOS and eating disorders—but the most important thing is to see a therapist that you feel comfortable with and can be honest with. Open communication is key to address all of your emotions and behaviors. Consider a support group Knowing you're not alone can go a long way toward supporting your mental health. Thankfully, there are many support groups for both eating disorders and those navigating PCOS, which can meet either in-person or virtually. Attending these sessions gives you a chance to get things off your chest, relate to others, learn helpful strategies, and get emotional support. Cooney refers her patients to PCOS Challenge, which offers advocacy and support groups, and there are a number of online eating disorder support groups that may be helpful. Seek eating-disorder-informed providers Many providers subconsciously hold weight biases, and some may prescribe weight loss for PCOS, both of which can be especially harmful if you’re dealing with disordered eating. To protect yourself against this, try to find providers who offer a weight-neutral or health at every size (HAES) approach. “HAES says folks can be healthy at any weight or size,” Baker explains. “What needs to be the focus are additional metrics of health, like hormonal levels, metabolic factors, glucose levels, thyroid health, cardiac risk—those sorts of things.” Build a positive relationship with food Mindful eating and intuitive eating are two similar yet different approaches to fostering better body image and a positive relationship with food. With mindful eating, you increase awareness of your hunger cues and respond to them by consciously choosing something to eat and then giving that meal or snack your full attention. On the other hand, intuitive eating is centered around letting go of food “rules,” honoring your hunger and fullness cues, and finding movement you enjoy. Many registered dietitians can help you with either or both of these practices. Get informed “It can be hard to find accurate information about PCOS online,” Cooney says. One vetted resource she suggests is the AskPCOS app. Developed by PCOS experts, it provides information about the condition as well as forums where you can join discussions with other patients. The Equip takeaway: Tackling PCOS and eating disorders together Eating disorders are common in women with PCOS. And since lifestyle modifications are the first-line treatment for the condition, uneducated healthcare providers may recommend weight loss or diet and exercise practices that can worsen disordered eating, negative body image, and mental health. Instead, providers should take a patient-centered approach to care, seeking to develop an individualized plan for each person. The emphasis should be on improving quality of life and health markers, rather than weight. To provide this comprehensive care, doctors need to partner with eating disorder-informed therapists, dietitians, and other experts who can help patients address any underlying eating disorders or disordered eating. At the same time, patients should feel empowered knowing there are weight-neutral and HAES-informed providers who can help them manage their PCOS, let go of their disordered eating habits, and embrace a life free of self-judgment. If you have PCOS and are struggling with disordered eating habits, our team can help. Schedule a call today to talk through your concerns and explore treatment options. FAQ about PCOS and eating disorders What is PCOS and how can it influence eating disorders? PCOS is a hormonal disorder that can lead to physical symptoms—like increased hair growth, weight gain, and acne—that can affect body image and self-esteem. These factors, combined with PCOS-related symptoms like hormonal imbalance, insulin resistance, anxiety, and depression, may lead those struggling with PCOS to develop disordered eating behaviors to cope. How do hormonal imbalances in PCOS affect eating behaviors? Hormonal fluctuations in PCOS can disrupt appetite regulation, potentially contributing to patterns like emotional eating and binge eating. In what ways can healthcare providers support patients with PCOS to prevent disordered eating? Providers can help prevent and treat eating disorders in PCOS patients by promoting a holistic approach that focuses on overall health rather than weight. Providers should screen for signs of eating disorders to provide early intervention and, if an eating disorder is detected, refer patients to eating disorder-informed providers. How can people manage both PCOS and eating disorders effectively? Effectively managing eating disorders and PCOS may involve some combination of medical treatment for PCOS symptoms, therapy to provide psychological support, nutritional counseling, and support groups. Focusing on self-care and seeking professional help from providers who take a holistic approach to care is crucial. At Equip, PCOS patients may work with an Equip medical provider to manage PCOS-related symptoms and concerns while they focus on recovery with the rest of their treatment team.]]></content:encoded>
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            <title><![CDATA[LGBTQIA+ Community Members Face Unique Risks for Eating Disorders. Here’s Why.]]></title>
            <link>https://equip.health/articles/understanding-eds/LGBTQIA-risks</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/LGBTQIA-risks</guid>
            <pubDate>Mon, 14 Jun 2021 19:42:04 GMT</pubDate>
            <content:encoded><![CDATA[Past research has indicated that LGBTQIA+ community members may be more likely to develop eating disorders than their heterosexual counterparts. For example, as the National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports, “gay men are seven times more likely to report binge-eating and twelve times more likely to report purging than heterosexual men, and gay and bisexual boys are significantly more likely to fast, vomit, or take laxatives or diet pills to control their weight.” According to the National Eating Disorders Association (NEDA), those who identify as LGBTQIA+ often face unique challenges that may put them at an increased risk of developing an eating disorder. And according to research, gay, lesbian, and bisexual teens may be at a higher risk of binge-eating and purging than their heterosexual peers starting as young as 12-years-old. What are the unique challenges LGBTQIA+ members face? We know that eating disorders are highly complex and nuanced brain disorders and that there is no single cause of anorexia, bulimia, binge eating disorder, or any other form of ED. But it’s also known that certain factors (like having a close family member with an eating disorder, having perfectionistic tendencies, experiencing weight stigma, etc.) can make it more likely for someone to develop an eating disorder. Certain factors—like discrimination, trauma, and other obstacles that are commonly experienced in LGBTQIA+ populations—can also increase the likelihood of developing an eating disorder. “We know that sex and gender minorities experience disproportionate adverse mental health outcomes – including eating disorders – compared to non-LGBTQ individuals,” says Jonathan Avila, MD, an adolescent medicine physician and clinical assistant professor at Stanford University, where he is an attending physician in both the gender clinic and the eating disorders clinic. “This health disparity is multifactorial, but lack of physician’s knowledge, comfort, or clinical competence plays a major role.” When it comes to the LGBTQIA+ community, there are certain obstacles and challenges that they may be more likely to face than their cisgender and/or heterosexual counterparts, making them more vulnerable to developing an ED. Here are just a few to consider: A fear of or actualization of rejection by family and friends for identifying as an LGBTQIA+ person Past trauma or post-traumatic stress disorder (PTSD), which is known to significantly increase the likelihood of developing an eating disorder Internalized negative beliefs about what it means to identify with a specific sexual orientation, gender, experience, etc. Potential discrimination in social or professional circles Feeling unable to meet certain body image ideals promoted within LGBTQIA+ communities There are many more potential issues to consider that could impact an LGBTQIA+ person’s vulnerability to develop an eating disorder. Maris Degener, Equip’s lead peer mentor, says her experience of growing into her identity was complicated. “As a queer person, I've often struggled to articulate the ways in which this facet of who I am intersects with my experiences with an eating disorder,” she says. “And to be honest, even today, I sometimes struggle to speak about it.” Degener says that for her, feelings of inadequacy spurred some of the struggle and lack of acceptance she felt. “Perhaps in some ways, I see the tape that was playing in my mind of not being enough echoed in these messages I received from the world around me,” she says. “And even as the dust began to settle, and I began to heal from the eating disorder, I did not have tools at my fingertips to better understand this part of my story.” Degener has written about the experience of discovering her sexuality, and the obstacles she faced along the way, and says the opportunity to help others in similar situations inspired her to embrace her own identity as she grew into it. “I was motivated to recover in large part to help others,” she says. “I wasn't sure exactly what that meant or what it would look like, but I knew that as hard as this journey was, I felt that I had an ability to make it the tiniest bit easier for someone else — even if that meant feeling just a little bit less alone. And I wondered, as I began to feel more able to embrace my identity as a queer person, that perhaps part of my story could act in the slightest way against the messages of not enough that echo through many communities.” “I cannot, and would never try to, speak for the entirety of the LGBTQIA+ community,” Degener says. “I can only speak through my own voice and experiences. And I would be remiss if I did not highlight the fact that this community is profoundly affected by eating disorders. As we remember and honor that Pride Month was born from the activism and efforts of queer people of color, we must acknowledge who is still tragically left out of eating disorder healing spaces.” The challenges extend to the treatment arena There’s another major factor at play in the diagnosis and treatment of kids and teens—the overarching lack of proper and specific training in identification and treatment of eating disorders among adolescents. “So many pediatricians graduate their residency without feeling comfortable talking about weight in general with their patients or comfortable identifying people at risk for an eating disorder, or when to be concerned a patient may have an eating disorder,” Avila says. The lack of education about eating disorders and weight bias amongst medical providers creates difficulty for people with eating disorders to be screened and to access appropriate care. Coupled with lack of provider education in gender-affirming care, a lack of understanding about health disparities, and a legal climate that may put stipulations on healthcare utilization, seeking eating disorder care for LGBTQIA+ people is fraught with barriers. This often leads to under-detection of eating disorders and, once an LGBTQIA+ person accesses care, typically more severe symptoms compared to cisgender heterosexual peers. Social stigma, lack of acceptance, and increased rates of trauma may place LGBTQIA+ individuals at higher risk for depression and anxiety. “Emotional dysregulation is not uncommon — especially in adolescents who are still maturing and may not have developed healthy coping mechanisms,” Avila says. There are countless coping mechanisms that people struggling with their mental health may come to rely on, and emotional eating has been identified as one major one. But Avila says it’s important to keep in mind that eating disorders—just like people—are highly variable and diverse, and there’s no way to identify an ED based on a single coping mechanism, an arbitrary weight criteria, or any other standalone behavior or descriptor. “We have to be careful overgeneralizing all sex and gender minorities when talking about eating disorders as all people are affected differently,” Avila says. There may be different motivating factors for using eating disorder behaviors from person to person. Additionally, research shows that gender role is more predictive of eating disorder behaviors than sex assigned at birth, which has unfortunately been erroneously viewed as a deciding factor. Common predictors for eating disorder behavior in LGBTQIA+ people include rigid appearance ideals, minority stress, increased rates of food insecurity, and increased rates of trauma. Similarly, protective factors —or what we refer to as resilience factors—vary greatly and can be heavily influenced by access to resources and social support which may look different for a Black trans person living in a rural area and a white lesbian woman living in an urban area. The nuances of specific communities within the LGBTQIA+ sphere When considering the specific challenges LGBTQIA+ community members face in the landscape of eating disorders, it’s also important to keep in mind that disordered eating behaviors (like binge eating or restriction) are not necessarily the same thing as having an eating disorder, but these behaviors are risk factors for developing an ED. “Among cisgender gay men, several studies have reported a higher rate of body dissatisfaction compared to cisgender heterosexual men,” Avila says. “Body image is so emphasized in the gay community, that gay men are placed into groups depending on their body type or key physical characteristics: bears, cubs, otters, jocks, twinks, etc. Gay dating apps and websites often ask the user to choose their ‘group’ in the user’s characteristics or profile. Obviously this emphasis on body image places gay men at higher risk for body dissatisfaction and engagement in disordered eating behaviors to manipulate their weight and body shape.” Despite those very real, documented challenges and the heightened risk this may pose, gay men are not specifically screened for eating disorders. “It’s only in the past three years, for instance, that we’re starting to see published studies on using and validating eating disorder screening tools in gay men,” Avila says. “Some behaviors have also been normalized for men in general, making it harder for persons or providers to identify disordered behavior. For example, the desire for having a muscular physique among men—whether hetero or gay—has been so normalized if not outright praised, it is often not questioned whether the behaviors that stem from that desire are within healthy parameters, or whether it’s associated with a negative body image, or with an eating disorder.” Avila says that the lack of literacy in the medical field is contributing to the problem and leaving many men without the tools and resources to get proper psychological support when they need it. “Even though we know that muscle dysmorphia (the psychological disorder associated with an obsessive or compulsive desire for a muscular or lean physique) is a major driver for anorexia nervosa in males, many primary care providers are not familiar with muscle dysmorphic disorder or with assessing for this condition.” Key strategies to improve outcomes for LGBTQIA+ community members There are many factors to consider when evaluating the landscape of eating disorders in the LGBTQIA+ community. A focus on continued improvement in the ED treatment field may be one of the biggest keys to better future outcomes: Improve training for ED providers in treating LGBTQIA+ communities Create safer spaces for LGBTQIA+ folks to increase utilization of ED treatment Initiating more expansive, comprehensive, honest dialogues about how EDs show up in the LGBTQIA+ community While there is still so much work to be done to improve access to eating disorder care for the LGBTQIA+ community, Degener is hopeful that with more open and honest communication, more healing can start to happen. “A message that I wish I had heard earlier in my life came from a teacher who once said to me, ‘you are not broken,’” she says. “If there is one message I wish everyone could hear as early in their life as possible, it is this. We can struggle immensely, we can fall ill and need support in healing, we can go through times where we are simply not okay, and through all of it, we are not broken beyond repair. We have inherent worthiness, and embracing ourselves as we are is not the opposite of embracing change. Healing from an eating disorder, or going through any other painfully transformative experience, does not mean we must ‘fix’ ourselves. Because even when we deserve healing, we are already enough.”]]></content:encoded>
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            <title><![CDATA[What We Know (and Have Yet to Learn) about Eating Disorders in Indigenous Communities]]></title>
            <link>https://equip.health/articles/understanding-eds/indigenous-communities</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/indigenous-communities</guid>
            <pubDate>Wed, 21 Jul 2021 18:24:00 GMT</pubDate>
            <content:encoded><![CDATA[We’re still figuring out how and why eating disorders develop and proliferate in particular communities, and the distinct contributing factors that often make diagnoses and treatment so difficult to attain, particularly in BIPOC communities. When it comes to Indigenous people in particular—those who “share collective ancestral ties to the lands and natural resources where they live, occupy, or from which they have been displaced”—we have a particularly long way to go. There are between 370 and 500 million Indigenous peoples in the world, in over 90 countries, and while they make up just 5 percent of the global population, they account for about 15 percent of the extreme poor, Indigenous peoples’ life expectancy is up to 20 years lower than the life expectancy of non-Indigenous people worldwide, according to The World Bank. In the United States, the average income of Native Americans is less than half the average for the U.S. overall. Why does this all matter for eating disorders? Experts say these socioeconomic statistics are critical clues into how and why eating disorders may develop in these populations. “There is very little research on First Peoples in the U.S.,” says Ruth Striegel Weissman, Dipl Psych, PhD, professor of psychology and Walter A. Crowell University professor of the social sciences, emerita at Wesleyan University, referring to individuals who identify as Native Americans and indigineous communities. “Food insecurity, which is a problem among Native American communities, is associated with increased risk for binge eating. Recently, a couple of papers based on Australian samples reported comparable or even higher prevalence of eating disorders in First Australians vs. White Australians.” In 2011, Weissman and her colleagues carried out one of the first psychological studies around eating disorders in Native American (NA) populations. The findings, published in the International Journal of Eating Disorders, found that NA women were more likely than their male counterparts to report behavioral symptoms of eating disorders and that there was a parallel between NA women and ethnically white women when considering the prevalence of binge eating, purging and "ever having been diagnosed with an eating disorder." At the time the study was published, Weissman said, “this commonality between NA and white women refutes the myth that eating disorders are problems that only affect white girls and women.” “BIPOC communities and experiences vary and part of what I have learned through my work at Nalgona Positivity Pride is that the media has done a disservice to us all by only portraying underweight white women with eating disorders,” ​​says social justice eating disorders educator, Gloria Lucas, whose organization promotes eating disorder awareness and body positivity and is dedicated to creating visibility and resources for Black, Indigenous, communities of color (BICC). “The media has limited everyone's view on who gets an eating disorder, making it more difficult for BIPOC to receive the proper care that they need.” Weissman gave a talk last year that was based on the research emerging from Australia on the prevalence of eating disorders amongst Aboriginal and Torres Strait Islander Peoples, also known as First Australians. In her presentation, Wesisman pulled from a 2020 study that found eating disorders were more common in First Australians than in other Australians, ages 15 or older, and that First Australians also reported higher levels of weight and shape concerns. She also referenced the “EveryBODY study” published in 2019, which focused on body image concerns among Australian adolescents. The findings here indicated that night eating syndrome (NES), a condition characterized by eating large quantities of food after dinner, sleep problems, and a belief that eating is necessary to get to sleep, was more common in First Australians. According to Lucas, diet culture may also play a role in indigenous communities and extends beyond the boundaries of mainstream media; it’s another reason disordered eating often goes under the radar in BIPOC populations. “Many times, eating disorders go unidentified in BIPOC families and communities because disordered eating is accepted as a proper form of weight loss,” she says. “The effects of fatphobia and weight-loss culture are alive in BIPOC communities and sometimes they are even more enforced because there is pressure to assimilate to white/thin/cis/hetero standards. Assimilation is perceived to grant a life with less oppression and more opportunities. Many families believe weight-loss is a way to protect their loved ones.” Lucas also adds that the narrow mainstream focus on anorexia and bulimia has made it difficult for many people to receive proper diagnoses and treatment for their eating disorders. “BED [binge eating disorder] is most common in BIPOC communities, yet the stigma and shame does not allow open conversations to take place.” Although more research needs to be done on eating disorders in BIPOC and immigrant communities, Lucas says that food insecurity and food trauma can certainly play a role, as well as a lack of awareness. “Family members might not understand why a loved one struggles to eat,” she says. “Also, generational and cultural differences may play a role in eating disorders going unnamed. Many BIPOC families face so many other obstacles. They have layer upon layer of systemic induced inequity—historical trauma, chronic illness, housing insecurity, domestic violence, mental health, family separation, police brutality and higher rates of imprisonment etc—that eating disorders aren't a priority for many communities because it is not perceived as an immediate threat.” While there is still a long way to go in uncovering the root issues and best courses of action for diagnosis and treatment in BIPOC communities, Lucas has seen education play a huge role in destigmatization and deeper understanding. “When I cover the link between colonialism, historical trauma, and eating disorders, it speaks volumes for people,” she says. “They are able to gain a deeper understanding as to why eating disorders develop and why families and communities are hurting. If eating disorders could be understood as coping mechanisms in response to historical and current political violence, it would remove a lot of the shame and isolation that exists among those that struggle. In general, eating disorder efforts should address food insecurity and center harm reduction methods.”]]></content:encoded>
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            <title><![CDATA[Can Eating Disorders Develop in Midlife?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-in-middle-age</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-in-middle-age</guid>
            <pubDate>Tue, 20 Aug 2024 16:37:00 GMT</pubDate>
            <content:encoded><![CDATA[When it came time to write my master’s thesis on health disparities, I had zero hesitation choosing the topic. I’d recently seen renowned eating disorder researcher Cynthia Bulik, Ph.D. on a morning news show, detailing her latest research on midlife eating disorders. Bulik and her colleagues had surveyed 1,849 participants and found that not only do a significant number of women over 50 express weight and shape concerns, but that about 13 percent of them exhibit eating disorder symptoms. This was a seriously groundbreaking revelation, especially because it debunked the pervasive myth that eating disorders almost exclusively affect teens and adolescents. In my research for the project, which was ultimately published in Oprah Magazine, I spoke with a number of women who had either experienced eating disorders at a young age and relapsed in midlife, or who had developed disorders for the first time in their 40s, 50s, and later. One woman told me that when her husband abruptly left her at 41 years-old, she quickly fell back into a calorie-counting obsession that had given her a sense of control and stability in her teens. “One of my closest friends said, 'Gosh, you'd think at 50 you wouldn't be worried about your weight,'" she told me. "I couldn't stand that feeling of stigma." Another woman told me that her attempts to reclaim her “pre-baby body” as a mother of four in her 40s developed into bulimia, which later morphed into anorexia when her 16-year-old daughter began to grow distant. One day, she was so undernourished that she blacked out while driving her daughter to the mall. "It's ironic because when I was close to my lowest weight, my doctor congratulated me on how wonderful I looked," she said. I heard many stories like these from many women over the course of my reporting, bringing Bulik’s research to life. And while my story and Bulik’s research focused specifically on women, midlife eating disorders can and do affect people of any gender. Yet eating disorders beyond young adulthood are still woefully ignored in larger conversations around disordered eating, and far too many people aren’t getting the care they deserve to fully recover. Understanding the causes, symptoms, and treatment options for midlife eating disorders may help more people recognize that eating disorders don’t discriminate, and anyone of any age deserves the support they need to recover. How common are eating disorders in midlife? According to Bulik’s original research, about 13 percent of women over 50 exhibit eating disorder symptoms. However, this doesn’t account for people of other genders who may struggle with disordered eating, nor does it encompass those who may experience eating disorder symptoms at other points in adulthood (for instance, someone in their mid-forties). “For the first half of my career as an eating disorder specialist, I worked very often with folks who were experiencing midlife eating disorders,” says Equip Lead Therapist and Clinical Supervisor, Brittney Lauro, LCSW. “Some had experienced a relapse after certain life events, others had a multi-decade battle with the eating disorder and never had quite reached full recovery, and some had a new onset of an eating disorder—usually in their 30s and 40s—that persisted.” A 2023 review found that between 2.1 and 7.7% of midlife women are diagnosed with an eating disorder, and less than 1% of midlife men are diagnosed. The review also found that while the prevalence of eating disorders decreases with age in women, it “does not get towards zero even in very high age.” Additionally, women who reported severe menopausal symptoms showed more eating disorder pathology compared with those with less severe menopausal symptoms; hormonal disturbances may also occur in midlife men experiencing eating disorders.  What causes eating disorders in midlife? In many ways, eating disorders that develop in midlife are distinct from eating disorders that develop at younger ages, but one similarity is that—regardless of age of onset—there’s almost never one single cause. Rather, eating disorders emerge out of a variety of biological, genetic, psychological, and environmental factors. Bulik identified three distinct groups of women with midlife eating disorders: Those who had developed disorders in adolescence, recovered, and then relapsed Those who developed eating disorders at a younger age and never fully recovered Those who developed an eating disorder for the first time later in life No matter which of the three buckets a person falls into, there are a number of common factors that can contribute to the development (or worsening) of an eating disorder in midlife. “Like with eating disorders in all ages, major changes in life circumstances—whether social, emotional, or physical—can prompt an eating disorder,” Lauro says. “When thinking about midlife, menopause and perimenopause can absolutely be a prompting event due to the significant hormonal changes. Other prompting events could be children moving out, losing a loved one, being diagnosed with a serious illness, divorce, or retirement.” Lauro has also found that while most people face body image struggles, due in part to media images and social pressures, those in midlife often encounter a distinct challenge related to the aging process: namely, seeing their body shape and size change in ways they may not like. “Another interesting finding that I’ve observed in my career and I believe is currently being published is the fact that folks in midlife are more likely to compare themselves to a younger version of themself, as opposed to media images,” Lauro says. “That doesn’t mean that media images don’t have an impact at all, they certainly do, but in midlife we tend to see a lot of self-comparison.” Are certain types of eating disorders more common in midlife? It’s possible for a person to develop any type of eating disorder later in life, and research is torn about whether or not some diagnoses are more common than others. According to the 2023 review mentioned above, OSFED (other specified feeding or eating disorder) and BED (binge eating disorder) are the most prevalent diagnoses, while other research has indicated that atypical anorexia is the most prevalent diagnosis and binge eating is the most prevalent core eating disorder symptom. “In my experience, there were equal amounts of folks coming in with anorexia, bulimia, OSFED, and BED,” Lauro says. “I was less likely to see ARFID, however that may be due to the fact that ARFID is a relatively newly recognized diagnosis, and so folks may not be aware of it.” (There’s also a common misconception that ARFID only affects kids—that’s not true.) Lauro adds that many people struggling with midlife eating disorders assume their own diagnosis to be BED, when it’s in fact a different type of eating disorder. “I do see a majority of folks self-reporting BED when they first come in,” she says. “However, upon clinical assessment, bulimia, OSFED, or sometimes anorexia is actually a better explanation. I think this is in part because of the fact that we are immersed in diet culture in our society, which puts a big emphasis on demonizing binge eating.” Another diagnosis that Lauro often observes in midlife clients is not yet recognized by the DSM: orthorexia, or an obsession with “clean eating.” “If I were to hypothesize why this diagnosis impacts folks in midlife, I’d say it could be in part due to a hope that eating a certain way will restore health, or restore youth,” she says. “Making adjustments to eating isn’t a problem in and of itself, however when it turns into multiple food groups being eliminated—outside of acute medical necessity—it becomes a problem.” Mental and physical health risks of eating disorders in midlife Eating disorders at any age can contribute to a long list of physical and psychological consequences, ranging from thinning bones and slow pulse to brain damage, organ failure, and even death. These illnesses are damaging and potentially fatal at any age, but some of the resulting issues—including heart and lung problems, bone loss, gastrointestinal symptoms, diabetes, and skin breakdown—can be particularly dangerous for those in midlife. “In addition to typical eating disorder risks like worsening anxiety or depression, brittle bone disease, cardiovascular implications, and issues related to gastric motility and gut health, eating disorders in midlife can further exacerbate other medical and mental health conditions,” Lauro says. “Perimenopause can also interact with eating disorders due to the substantial shift in hormones. Both perimenopause and eating disorders can have a profound impact on mood and level of functioning.”  How are midlife eating disorders treated? While there are several different types of evidence-based treatment for eating disorders, Lauro says enhanced cognitive behavioral therapy (CBT-E) can be a particularly effective approach for older adults. “When thinking about eating disorders in midlife, I’ve found the most success in working with individuals using CBT-E,” she says. “I cannot emphasize enough that when implemented correctly, CBT-E is vastly different from regular CBT or even prior adaptations of CBT for eating disorders.” Specifically designed to treat eating disorders, CBT-E is unique in its modular integration of strategies and procedures that allow it to be both flexible and individualized. “CBT-E differs from some of the front-line treatments for adolescents in that the adult has more autonomy and is essentially in the driver’s seat in their own recovery and what they want recovery to look like for them,” Lauro says. The treatment is typically divided into four stages that revolve around personalized education, progress monitoring, patient-specific sessions, and planning ahead for the future. “What I find most effective when implementing CBT-E is the motivational interviewing component,” Lauro says. “One strength in midlife is that your brain is fully developed—with the exception of atrophy that comes with severe malnutrition—and this allows folks to be more engaged in the process. We essentially draw a ‘road map’ of how the eating disorder works for the individual specifically, and then use that as our guide throughout treatment.” While CBT-E may be the most appropriate treatment option for most people in midlife, Lauro says that for some with a long history of an eating disorder—particularly severe and enduring anorexia— an FBT (family-based treatment) approach may be best. “I’ve worked with a number of adults in midlife who have had substantial histories of eating disorders, and I’ve seen them make amazing strides when they are able to access an FBT-style approach and are surrounded by supports who hold loving but firm boundaries,” Lauro says. “In these situations, it truly takes a village. It can feel unconventional at times due to the person being an adult, but I’ve seen this approach be a game changer for folks. Hope is not lost based on age.” What are some of the barriers to treating eating disorders in midlife? Unfortunately, people of all ages face barriers to effective eating disorder treatment, be they financial, logistical, geographical, cultural, or otherwise. However, those in midlife might come up against specific roadblocks. “There are a variety of barriers when it comes to those in midlife accessing eating disorder treatment,” Lauro says. “Most often, I see it being related to financial challenges and responsibilities. Many folks struggle with finding treatment covered by insurance. And often, if intensive treatment is needed, people have more limited ability to take family and medical leave. Even with family and medical leave, this can lead to major financial burdens that aren’t sustainable for some families and individuals.” Societal pressures, expectations, and stereotypes around what it means to be in midlife and what it “looks like” to have an eating disorder can also keep people from getting the care they need. In other words, someone in midlife may hesitate to seek help because they don’t fit the mold of the “typical” eating disorder patient (spoiler alert: that patient doesn’t exist), feel shameful about struggling with something that they don’t think they should be, or believe they’re “not sick enough” to need help. “Second to financial and responsibility burdens, I often see stigma and beliefs like, ‘I’ve been this way most of my life, I must not have a problem,’” Lauro says. “Even in 2024, there is still such little information and education available on eating disorders. When I think of folks currently in the midlife range, I think about how in years past, there was even less information available. So many disordered eating habits are praised as healthy and idealistic in our society.” While eating disorder education and awareness has become more widespread over recent years, it’s also important to understand that even medical professionals are still learning to adequately and sensitively receive patients who present with eating disorder concerns or symptoms, and this can be particularly true for older patients. “The lack of knowledge and education historically also impacts providers in the field, many of whom don’t receive training on eating disorders,” Lauro says. “There’s a saying: ‘we don’t know what we don’t know’ and unfortunately, this lack of education results in mounting barriers and missed opportunities for treatment.” Despite the roadblocks and challenges that may prevent those in midlifes from receiving proper care, there are many reasons to believe people of all ages can achieve full, lasting eating disorder recovery. “There is so much hope for people seeking eating disorder treatment in midlife,” Lauro says. “I have seen firsthand folks making tremendous strides. I’ve seen folks with 30, 40+ year histories of eating disorders reach a point of stability. I’ve seen folks with a new onset of eating disorder in midlife reach recovery. It is never too late to get treatment. Aside from the improvements in health status and longevity, folks who receive treatment for eating disorders in midlife often tell me what a positive impact it has had on their relationship with their family, friends, and loved ones.”  If you’re struggling with a midlife eating disorder, or are concerned about a loved one, don’t wait any longer to get help. Schedule a free, no-obligation consultation with our team.]]></content:encoded>
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            <title><![CDATA[What Do Eating Disorders Look Like in Adults?]]></title>
            <link>https://equip.health/articles/understanding-eds/do-I-have-an-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/do-I-have-an-eating-disorder</guid>
            <pubDate>Mon, 18 Sep 2023 21:01:21 GMT</pubDate>
            <content:encoded><![CDATA[  While eating disorders often affect adolescents, teens, and young adults, the reality is, eating disorders don’t disappear after a certain age. If you’re an adult wondering, “do I have an eating disorder?” you aren’t alone. And the truth is: adults get eating disorders, too. An adult with an eating disorder typically falls into one of three categories: those who are still suffering from an eating disorder that began in adolescence, those who previously had an eating disorder and experienced a relapse in adulthood, and those who developed an eating disorder for the first time as an adult. Below we’ll provide a fundamental guide to everything you need to know about what eating disorders in adults look like, how they develop, and what to do if you’re concerned. Types of eating disorders While bulimia and anorexia are perhaps the most well-known eating disorders, they actually aren’t the most common. Let’s briefly review the different types of eating disorders: Bulimia: is an eating disorder where someone eats a large amount of food uncontrollably and then engages in “purging” behaviors in an attempt to get rid of it. These behaviors include vomiting, misuse of laxatives, and compulsive exercise. Studies show around 5 million women and 1.6 million men will develop bulimia in their lifetime. Binge eating disorder (BED): is an eating disorder where people eat a large amount of food in a short period of time accompanied by a feeling of being out of control, a behavior known as “bingeing.” Unlike bulimia, bingeing is not followed by “purging” behaviors. Binge eating disorder is the most common eating disorder in the U.S, with approximately 11.7 million women and 6.6 million men experiencing BED during their lifetime. Anorexia: is an eating disorder characterized by severe food restriction and an intense fear of weight gain. It affects an estimated 3 million women and 1 million men. Someone with anorexia doesn’t necessarily appear visibly underweight. When someone meets all diagnostic criteria for anorexia except for being underweight, it’s referred to as atypical anorexia. Avoidant restrictive food intake disorder (ARFID): is an eating disorder in which a person struggles to eat certain foods, enough foods, or both, due to sensory sensitivities, lack of interest, or various fears around eating. Unlike many other eating disorders, someone with ARFID is not motivated by body image distress or a desire to lose weight. While the prevalence of ARFID isn’t widely-agreed upon, population surveys estimate as much as 6.6 million adults develop ARFID. Learn more about what causes ARFID in adults.  Other specified feeding and eating disorder (OSFED): is a more general diagnosis used to describe other eating disorders that don’t meet the criteria of those described above. That said, it can be just as serious. One study found that about 12 million females and 5.3 million males experience OSFED. Common eating disorders and co-occurring conditions in adults Binge eating disorder is the most common eating disorder among those 18+, bulimia is the second most common for adults, and anorexia is the third. There’s also some evidence that anorexia is particularly life-threatening for older adults. Many adults develop eating disorders alongside other co-occurring diagnoses, including anxiety, mood disorders, impulse control, and substance use disorders. How to know if you have an eating disorder Many adults struggle to recognize that they’re dealing with an eating disorder, especially in a society where diet culture reigns supreme and weight loss pressures are rampant. Stacy Jones, a peer mentor at Equip, encountered this in her own journey of experiencing an eating disorder as an adult. “I didn't know it was an eating disorder and didn’t have the language to identify it,” she says. “I just thought something was wrong with me and I needed to have more willpower around food.” It was a psych 101 class that helped Jones recognize how her eating disorder was hiding behind certain behaviors. She says, “I started to reflect on how I was engaging with food and exercise and realized that the restriction, ‘clean’ eating, and obsessive exercise wasn't actually a positive,” she says. “It was reinforcing a toxic belief system and contributing to my binges.” Eating disorder symptoms in adults “When it comes to eating disorders in adulthood, they can take a big toll on your social life, romantic life, work life, physical health, and more,” says Amaya Evans, a peer mentor at Equip. So how do you know if you have an eating disorder? According to Director of Adult Programs at Equip Lara Effland, LICSW, there are some common characteristics that clinicians look for when diagnosing eating disorders in adults: Behavioral signs Extreme concern with body size and shape Strong discomfort eating around others Behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns Frequent body checking Skipping meals or taking smaller portions of food at regular meals Newfound interest in food-related activities (watching Food Network, cooking/baking), but not in eating Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism or veganism) or trying restrictive eating approaches like intermittent fasting Physical signs Noticeable fluctuations in weight, both up and down Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) Menstrual irregularities (missing periods or only having a period while on hormonal contraceptives) Feeling cold all the time Difficulty sleeping Dental problems, such as enamel erosion, cavities, and tooth sensitivity Dry skin and hair, and brittle nails Questions to ask yourself if you’re worried Jones emphasizes that some signs of an eating disorder can seem ordinary at first, especially in our society. “Symptoms are often masked by ‘healthy behaviors,'” she says. “It’s normalized to eat less than we actually need and to have a tense relationship to food. But just because it’s normalized, doesn't mean it's normal or healthy.” Jones recommends asking yourself these questions to help you identify harmful patterns: Do you have rules for what foods you can and can’t have, or when you can have it? Do you have constant food-related thoughts or stress each time you have to eat? Do you have no interest in food, and because of that you don't eat often? Do you exercise as a way to make up for eating food or to make sure you can have a planned meal? Do you feel out of control around food and the more you try to "get back on track" the harder it feels? Do you often turn to food habits (restriction or eating uncomfortable amounts) to cope with tough emotions? Often the answers to these questions will lead to even more questions, and that’s okay. If you’re wondering how to know if you have an eating disorder, answering that question isn’t always a straightforward journey. Understanding the biopsychosocial factors at play can help reduce confusion or shame. What causes eating disorders in adults Effland stresses that there’s typically more than one reason someone develops an eating disorder. “While specific risk factors can vary, it’s often the interaction of biological vulnerabilities, psychological traits, and social or environmental influences,” she says. Biologically, there’s strong evidence to suggest eating disorders are partially hereditary, and that brain chemistry may play a role. Effland points to various psychological vulnerabilities, including low self-esteem, perfectionism, and body dissatisfaction. She says that environmental factors like cultural pressure for thinness, a history of trauma or bullying, or social isolation can also play a big role. Unique challenges in middle to late adulthood can add additional stress and trigger an eating disorder, especially if someone is predisposed. This can explain why some adults relapse or develop an eating disorder for the first time later in their life. Some of these adult-specific challenges  include divorce, loss, parenting stress, health issues, anti-aging advertising, and retirement. Hormonal changes, especially during pregnancy and menopause, are also risk factors for adults. Understanding the causes of an eating disorder can be empowering for some, but if there’s not a clear root, that’s okay too. You don’t need to know what caused an eating disorder in order to recover. How to get help for an eating disorder Unfortunately, eating disorders often go under- or misdiagnosed: only 23% of Americans with an eating disorder get treatment. As Effland puts it: “Due to diet culture, thin-obsessed societal expectations, and a lack of education, even trained professionals can miss the warning signs of an eating disorder.” This can be particularly true for adults, since so many people wrongly associate eating disorders with only younger populations. When looking for support, seek out solutions that are validating and trust your gut. If you’re worried that you might be struggling with an eating disorder, here are some helpful steps: Do some research You're here reading this article, and that’s already something to be proud of. Doing more reading on the Equip blog, Project HEAL, or other reputable sources can help you better understand how to know if you have an eating disorder. This will arm you with more accurate information and also help you push back against the pervasive myths about eating disorders. Reach out to a loved one Sharing your concerns with someone you trust, or in a support group, can help this experience feel less isolating. As Evans so beautifully puts it, “asking for support has no age limit. If you think you might be struggling with an eating disorder, open up to a friend or a loved one. Even though they might not understand exactly what you are going through, they can still be supportive.” Seek treatment that works for you Experts agree on this truth: eating disorders are treatable with evidence-based treatment. Finding treatment that works for your needs is key. “Do your research. It’s not always a viable option to take off work or leave family behind to go away to treatment, so finding outpatient providers or seeking virtual care could be a great option,” Evans advises. At Equip, treatment is fully virtual but as intensive as you need it to be: each patient is matched with a dedicated, multidisciplinary care team who tailor treatment to your specific needs and empower you to recover at home, without uprooting your life. Trust your instincts “That part of you that feels like you might have an eating disorder, follow that part,” says Jones. “Give yourself the chance to shift your relationship to food and your body. Even if it’s not an eating disorder, the part of you that’s questioning is telling you that something isn’t okay.”  It’s never too early (or late) to seek support. Eating disorders affect people across race, gender, and age—and that includes people in their 40s, 50s, 60s, 70s, and beyond. It’s not always clear how to know if you have an eating disorder, but understanding what an eating disorder looks like is a vital first step. Reaching out for help is a worthy next one. In Jones’ words, “It can feel uncomfortable, but when you get support, you are giving yourself the chance at a life that is more full and nourishing.” If you’re an adult concerned you may be struggling with an eating disorder, it’s important to get help promptly. Talk with a trusted medical provider or schedule a free consultation to learn more about eating disorder treatment at Equip.]]></content:encoded>
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            <title><![CDATA[The Biggest Misconceptions About Binge Eating]]></title>
            <link>https://equip.health/articles/understanding-eds/binge-eating-disorder-misconceptions</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/binge-eating-disorder-misconceptions</guid>
            <pubDate>Fri, 20 Mar 2026 14:13:00 GMT</pubDate>
            <content:encoded><![CDATA[When I tell people that I’m an eating disorder dietitian, they often ask questions about each eating disorder and how it manifests in people. When it comes to binge eating disorder (BED), they might ask, “So, they’re addicted to food?” or “Why can’t they just stop eating?” Questions like these remind me of how little most people understand eating disorders. While all diagnoses carry stereotypes and myths, BED—which is the most common eating disorder in the U.S.—seems to be especially misunderstood. For example, it’s often assumed that people with BED must be lazy, lack willpower, and live in a larger body, and that they should follow a strict meal plan to get better. Such misconceptions are rooted in diet culture and can do real damage, increasing the shame and stigma surrounding BED and making it harder for those struggling to get the care they need to recover. Today, let’s dive more deeply into the biggest misconceptions about binge eating and explore the truth behind them. The biggest misconceptions about binge eating I talked to three other eating disorder dietitians to identify some of the most pervasive myths about binge eating disorder. Here are the six biggest misconceptions, along with the truth. Misconception: BED only affects people in larger bodies This is perhaps one of the most common misconceptions about BED. It’s also one of the most harmful, as it’s based on the fat-phobic stereotype that people in larger bodies must be eating large quantities of food (and that eating large quantities of food always equates to a larger body). “It assumes that a person with an eating disorder who lives in a larger body has BED, when many may meet criteria for other eating disorders,” explains non-diet dietitian Kelly Abramson, MS, RD, MSCP. For example, you may be living in a larger body and be suffering from atypical anorexia. “Atypical Anorexia and BED are distinct diagnoses that meet different criteria, but gaps in screening exist because of weight stigma,” Abramsam explains. Also, the belief that only larger-bodied folks have BED can prevent people of “normal” or lower weights from being screened for BED, even if they’re exhibiting other symptoms. "It’s underdiagnosed and undertreated, and we know that many individuals are slipping under the radar,” Abramsam adds. Truth: BED can exist in people of all body sizes Research from 2025 shows that BED symptoms can manifest in people (specifically preteens and teens in this study) across the weight spectrum, including those in a “normal” weight range. In fact, research shows that about 30% of people with binge eating disorder have a normal BMI. Plus, the unscientific assumption that body size is directly related to food consumption is rooted in weight bias, or internalized negative attitudes and beliefs towards others because of their weight. “Your gravitational pull to the Earth (i.e. your weight) or the way your muscle and fat are distributed in your body doesn’t tell us anything about your eating behaviors or health status,” explains weight-neutral dietitian Jessica Villalvir, MS, RDN. In fact, your weight, shape, energy needs, and metabolism are determined by many factors, including “genetics, health conditions, medications, access to care, and resources, to name a few,” explains eating disorder dietitian Ana Pruteanu, Misconception: People with BED lack willpower Diet culture incorrectly leads us to believe that people who eat large amounts of food (which is a key behavior in BED) must be lazy, lack discipline, and simply need to develop more willpower. This is based on the assumption that BED is a matter of choice. “This harmful belief assumes that the person binge eating can easily choose to stop, and it implies that if they don’t stop, they are to blame for any health or emotional consequences,” Pruteanu explains. The guilt and shame resulting from such a belief can prevent people suffering from BED from getting the support they need to recover. Truth: Like all eating disorder behaviors, binge eating is driven by many factors In general, eating disorders are multi-faceted mental illnesses, usually driven by genetic, environmental, and physiological factors. No one ever consciously chooses to have an eating disorder, including BED. In my practice, when my clients with BED get curious about their binge behaviors, they usually realize that they’re often driven by food deprivation (since the body is starved after being in a prolonged calorie deficit), emotional discomfort, and a dysregulated nervous system. “Binge eating is a form of coping, not a moral failing,” Pruteanu says. “Folks need more support, not judgment about how they are coping.” There are many other factors that contribute to and perpetuate binge eating, including: Emotional regulation: Disordered behaviors often develop as a way to seek emotional safety when life feels too difficult, and then snowball into a full-blown disorder. Differences in brain function: Research from 2023 shows that binge episodes in women may be linked to altered habit learning neural circuits, which might cause binging to become automatic and hard to control. Other research from 2023 shows that BED in adults is associated with neurocognitive dysfunctions in many stages of decision-making, which may contribute to the development and persistence of BED, and help explain the loss of control experienced during binge episodes. Weight stigma: Research from 2025 also found that weight stigma—or discrimination against people based on their weight or body shape— from healthcare providers, which is unfortunately common, can lead to intensified binge eating behaviors. Food insecurity: Finally, 2024 research of preteens shows that food insecurity is associated with binge eating, revealing that food insecure preteens are at risk of having binge eating disorder later in life. Misconception: Following a strict diet plan will cure BED Again, diet culture leads us to believe that if you stick to a rigid food plan, you’ll be in control and “back on track” after experiencing binges. However, research from 2025 of mostly white college-age women shows that following restrictive diets can in fact worsen binge eating over time (the study specifically followed people on a low-carbohydrate diet). Like other eating disorder behaviors, binges are often caused by some sort of restriction. That means that following rigid rules and a diet plan that leaves you in a calorie or nutrient deficit (or mentally and emotionally unsatisfied) is not the answer, and is likely exacerbating things. Truth: Developing a balanced and enjoyable eating pattern can help with BED recovery While rigidity isn’t the answer, a flexible and predictable eating pattern can help your body feel safe and break the binge-restrict-cycle. “You might find yourself binge eating at night, then waking up feeling sick or guilty, and trying to ‘reset’ by not eating or eating too little the next day, only to find yourself starving at night and repeating the cycle,” Pruteanu explains. “In this case, undereating earlier in the day sets off the binge eating at night. Having more predictable, structured eating avoids this pattern.” Developing a meal structure with a non-diet eating disorder dietitian can help you find a way of eating that supports your physical, mental, and emotional well-being. Your dietitian can also help you brainstorm meal and snack ideas if that feels helpful. “Some may find initially that choosing what to eat on the fly is too stressful or leaves them vulnerable to binge eating, in which case pre-planning their meals and snacks can be beneficial,” Pruteanu says. “As binge eating urges decrease, you can introduce more flexibility and spontaneity into your food choices.” Misconception: Overeating is the same as a binge episode Over the years, some of my clients have come to nutrition counseling sessions saying they binged last night or over the weekend—but when we look at the eating experience, it’s clear that it wasn’t a binge at all. “A common misconception is that undereating during the day and then eating more at night is always a binge episode,” Villalvir explains. “Frequently, that nighttime snacking consists of a relatively small amount of food, like a handful of pretzels, some cheese and a few cookies,” she says. This is a hearty snack, not a binge. Truth: Binge eating is a disordered behavior, and overeating can be a part of normal eating A binge is defined as eating an objectively large quantity of food in a discrete period of time (e.g., within a two-hour window) while feeling a lack of control. For someone to meet the diagnostic criteria for BED, they need to engage in binge eating at least once per week for a minimum of three months. “Feelings of blacking out and being physically ill are often described after a binge,” Villalvir adds. However, overeating, or as I call it, “eating past fullness,” is not an eating disorder or the same as binging. In fact, it’s a part of eating normally and intuitively—sometimes you get overly hungry or enjoy a meal so much that you choose to eat more than usual or what’s comfortable, and that’s okay. Misconception: When you stop binge eating, you’ll lose weight It’s a common belief that if binging stops, caloric intake will decrease and weight loss follows. The belief is based on the oversimplified (although still widely believed) energy balance theory, which says that body weight is determined by the relationship between calories in and calories out, so if calories drop, weight will too. “We know from those in larger bodies with a diagnosis of atypical anorexia that reduced caloric intake does not necessarily correlate with weight loss,” Abramsam explains. Truth: Weight may or may not change when you stop binging As mentioned earlier, body weight is determined by a myriad of factors, like genetics and health conditions, and eating less food doesn’t necessarily lead to weight loss. Again, the energy balance is theory is a simplistic way of viewing body weight regulation, because it ignores all the biological, environmental, and genetic factors (that are largely unchangeable) that influence weight. Moreover, it’s not automatically true that overall caloric intake will drop if binge eating ceases, since many people experience binging at night after long periods of restriction during the day. Ideally, their recovery includes eating adequate meals and snacks throughout the day instead, which could mean their caloric intake doesn’t change much. “While binge episodes often result in significant caloric intake, we can’t assume that will mean a significant calorie difference over several days or a week,” Abramsam adds. Misconception: People who binge eat are addicted to food It’s often assumed that if someone is craving foods, feeling a lack of control around those foods, and binging on them, they must be addicted to food. However, such a belief can be dangerous, because it places all the power on the food itself and distracts from the fact that disordered behaviors like restriction and binging are usually a result of maladaptive coping mechanisms, which need to be healed for recovery to happen. Truth: Binge episodes are often not about the food itself There’s a saying in the eating disorder recovery world, “It’s never really about the food,” although it certainly looks like it is. As I mentioned, binge episodes are often driven by a combination of factors, like restriction earlier in the day, difficult emotions and thoughts, and other genetic and physiological factors. If you believe that your binging is a result of food addiction, you run the risk of being afraid of certain foods forever and avoiding them at all costs. However, full recovery requires being at peace with all foods, especially your fear or trigger foods. Plus, research behind the theory of food addiction lacks strong scientific support. In fact, a 2022 systematic review of studies (including people of all ages with and without eating disorders) found that food addiction is not currently recognized as a valid diagnosis and that there is insufficient clinical evidence to draw firm conclusions about its existence. Conclusion: BED recovery requires compassionate, knowledgeable care “These common misconceptions about BED continue to perpetrate the same harmful cycle, and delay people from seeking help, if it all,” Villalvir says, “and there’s a level of loneliness to not being understood and accepted by the masses.” Like all eating disorders, BED is a mental illness caused by multiple factors that can occur in any body size. It is best treated with a flexible and personalized eating plan (not a restrictive diet) developed by a weight-inclusive dietitian, and under the guidance of a multidisciplinary treatment team, including a weight-inclusive doctor, therapist, and (sometimes) a psychiatrist. If you’re struggling with BED, know that you deserve compassionate care, deep healing, and long-term recovery.]]></content:encoded>
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            <title><![CDATA[Life-Saving Eating Disorder Care: Addressing Suicidality Throughout Treatment & Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/suicidality-nssi-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/suicidality-nssi-eating-disorders</guid>
            <pubDate>Sat, 23 Nov 2024 18:00:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. The unfortunate reality is that people affected by eating disorders are at an elevated risk for experiencing suicidality and engaging in nonsuicidal self-injury (NSSI). Knowing how to identify and address both issues effectively can be a challenge for healthcare providers, but it is crucial to saving lives. Today, I’ll provide an overview of the connection between eating disorders and suicidality, how to identify suicidality or NSSI in eating disorder patients, and what providers can do to reduce risk of suicidal and self-harming behaviors. I’m going to be talking about scientific theory and clinical applications, but I want to ground what we’re talking about in the individuals we work with. Why is this topic important? It matters because of people like my former patient "Mary” (not her real name). She was 16 years old, struggling with bulimia, and wanted to recover but felt unheard and unsure how to express herself. In desperation, she began cutting herself to try to cope with the pain she experienced. Through therapy, she was able to find new ways to cope and a path forward—and it’s for patients like “Mary” that this work is so important. Overlap of suicidality, NSSI, and eating disorders First, let’s define the terms we’re using: Suicidality: self-harming behaviors meant to end one’s life. Suicidality is often indicated by signs like suicidal ideation, having a suicide plan, or past suicide attempts. Nonsuicidal self-injury (NSSI): deliberate self-harm without any intention of death as a result. NSSI doesn’t include culturally sanctioned self-harm, such as piercings or tattoos. Though NSSI involves no intent to die, it is associated with elevated risk of suicide. Eating disorders: mental health conditions characterized by persistent disturbed eating behaviors that negatively impact physical and psychological health Current research suggests that self-injury most commonly begins between ages 12 and 15, with a second onset peak in early adulthood, around age 20. Typically, rates of self-injury increase through early- to mid-adolescence, and decline in later adolescence. Note that these are just tendencies, and suicidality or NSSI can occur at all stages of life: some people first start to self-injure before the age of 12 (in which case it is is associated with more severe self-injury over a longer period of time), and some first self-injure much later in life. A 2015 meta-analysis of 116 studies showed that girls and women are slightly more likely to self-injure than boys and men, with this gender difference particularly evident in clinical samples. Self-injury is also more common among individuals identifying within the LGBTQIA+ community, with rates two to three times that of heterosexual/cisgender individuals. There is significant overlap between eating disorders, suicidality, and NSSI. The estimated lifetime prevalence of NSSI in the general population is 4.86%, compared to significantly higher rates among those with eating disorders. According to a 2020 review: 33% of people with bulimia nervosa report NSSI 22% of people with anorexia nervosa report NSSI 20% of people with binge eating disorder report NSSI NSSI must be understood as an individual experience that occurs in an interpersonal, community, and societal context. Different factors can contribute to NSSI in different populations and demographics, as illustrated by the graphic below.  
In terms of suicidality, rates are also higher among those with eating disorders. While about 4% of the general population have had suicidal thoughts, up to a third of people with eating disorders have thought about suicide, and one quarter to one third of people with eating disorders have made a suicide attempt. Among people with anorexia nervosa, suicide is the second leading cause of death. Why do NSSI, suicidality, and eating disorders overlap? There are several different ways to understand the overlap between NSSI and eating disorders. One way to think about it is through the four-function model of NSSI, a framework which hypothesizes that NSSI is maintained by four different reinforcing processes: interpersonal negative reinforcement, interpersonal positive reinforcement, intrapersonal negative reinforcement, and intrapersonal positive reinforcement.  According to a 2023 study, NSSI in eating disorder patients is reinforced by the negative functions: interpersonal negative reinforcement, and intrapersonal negative reinforcement. In both cases, the NSSI is a means of escaping, either from distressing feelings or a particular situation. You can think about the relationship between suicidality and eating disorders by looking at the three-step theory of suicide, which theorizes that suicide results from a combination of pain and hopelessness. The theory assesses the risk of suicide or suicidal ideation by asking a series of three questions: 1. Are you in pain or hopeless? An answer of “No” indicates no suicidal ideation, while an answer of “Yes” indicates suicidal ideation. If the answer to question 1 is yes, move to question 2. 2. Is your pain greater than your connections to life? An answer of “No” indicates modest suicidal ideation, while an answer of “Yes” indicates strong suicidal ideation. If the answer to question 2 is yes, move to question 3. 3. Are you capable of attempting suicide? An answer of “No” indicates ideation only, while an answer of “Yes” indicates the risk of a suicide attempt. While not everyone with an eating disorder will have suicidal ideation or suicidality, when you consider these questions in the context of the experience of having an eating disorder, it’s apparent why those with eating disorders are at heightened risk. People with eating disorders often feel emotional and psychological pain, which their disordered behaviors (paradoxically) both perpetuate and help them cope with. It’s also common for those with eating disorders to feel hopeless that things can get better, a problem exacerbated by barriers to diagnosis and treatment. These factors together contribute to an increased risk of suicidal ideation and suicide. Assessment of NSSI and suicidality The first step toward helping people struggling with both an eating disorder and suicidality or NSSI is knowing what to look for. In addition to knowing how to screen for eating disorders, healthcare providers should be knowledgeable about the signs and symptoms of NSSI and suicidality in patients. Signs of NSSI Common forms of nonsuicidal self-injury include cutting, burning, scratching, biting, and headbanging. Physical signs Scarring, fresh cuts, burns or scratches Wearing long sleeves and pants even in hot temperatures; several bracelets on arms Having or collecting sharp objects Behavioral signs No longer engaging in things they once enjoyed; isolating themselves Reporting feelings of hopelessness and worthlessness Secretive behavior Signs of suicidality Suicidality can show up in many different ways, including mood changes (like becoming increasingly agitated), or sleep disturbances like insomnia or nightmares. Another way to assess the risk of suicidality is through the acronym “IS PATH WARM?” I: Ideation Talking of wanting to die, looking for ways to die, talking about death S: Substance abuse Increased or excessive substance use (alcohol or drugs) P: Purposelessness No reason for living; no sense of purpose in life A: Anxiety Anxiety, agitation; inability to sleep T: Trapped Feeling trapped, like there's no way out; resistance to help H: Hopelessness Hopelessness about the future W: Withdrawal Withdrawing from friends, family and society; sleeping all the time A: Anger Rage, uncontrolled anger; seeking revenge R: Recklessness Acting recklessly or engaging in risky activities, seemingly without thinking M: Mood changes Dramatic mood changes Assessment tools for clinicians In addition to keeping the signs and symptoms above in mind, healthcare providers can also use a variety of different clinically validated screening tools to assess the risk of NSSI or suicidality. NSSI assessment tools The Brief NSSI Assessment Tool: This 12-item assessment focuses on forms, functions, recency, frequency, habituation, and perceived life interference. It is freely available on the Cornell website. NSSI Decisional Balance, Processes of Change, & Self-Efficacy Scales: More focused on change, including motivation, confidence, and tools. Suicidality assessment tools Columbia-Suicide Severity Rating Scale: Individuals engaging in even one item from this scale are eight to 10 times more likely to die from suicide. Available at the Columbia Lighthouse Project. Ask Suicide-Screening Questions: There are different versions of this assessment, and it is available for free at Zero Suicide. When assessing for the risk of NSSI or suicide, it’s important to create a safe environment for the patient that encourages them to open up about what they are struggling with. Providers should aim to be: Direct and transparent Collaborative Nonjudgmental Compassionate Authentic Open-ended It is also important to involve supports as appropriate and be flexible in communication. Risk reduction for NSSI and suicidality Providers can save lives by taking steps to reduce the risk of NSSI and suicidality among patients. There are three primary means of risk reduction: developing a safety plan, lethal means counseling, and evidence-based treatment. Safety plan A safety plan gives patients something to turn to if and when they feel the urge to hurt themselves. It’s important that the safety plan is made collaboratively with the patient, and that they have easy access to it at all times. There are several different versions of safety plans, but the Stanley-Brown version (below) is a good example. Safety plans can also include reasons for living and steps the patient can take to make themselves safe.  Lethal means counseling Lethal means counseling refers to assessing whether a person at risk for suicide has access to guns or other lethal means, and then working with them and their loved ones to limit their access to these items. Lethal means counseling may include: Restricting access to lethal means (e.g., firearms, sharps, medications) Firearm safety (VA resource) Counseling on Access to Lethal Means course (Zero Suicide) Evidence-based treatments Patients struggling with eating disorders and NSSI or suicidality need access to evidence-based treatments that can address both conditions. Evidence-based approaches to address NSSI and suicidality include: Brief cognitive behavioral therapy for suicide prevention (BCBT-SP) Dialectical behavior therapy (DBT) Collaborative assessment and management of suicidality Evidence-based approaches to address eating disorders include: Family-based treatment (FBT) Enhanced cognitive behavioral therapy (CBT-E) Dialectical behavior therapy (DBT) Additional considerations When treating patients dealing with NSSI or suicidality, you can help support their recovery by working on the following focus areas: Increasing emotional safety Building emotional and communication skills Developing strategies to soothe pain Working on problem solving skills Fostering hope Strengthening connections with others Making meaning As a provider, it’s important to use the patient’s chosen pronouns and validate their feelings and experiences. It can also be helpful to keep the three-step theory of suicide and four function model of NSSI in mind as you work with patients, to help you better understand what may be driving their feelings and how you can redirect them. When dealing with such urgent and life-threatening issues, it’s vital to keep hope alive. A quote that resonates with me, and may with you, is this one from Albert Schweizer: “Always hold firmly to the thought that each of us can do something to bring some portion of misery to an end.” For more information on addressing suicidality in eating disorder treatment, watch my recorded Equip Academy presentation on the topic. You can also explore past Equip Academy presentations and register for upcoming events here.]]></content:encoded>
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            <title><![CDATA[Understanding the Three Phases of Family-Based Treatment (FBT)]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/FBT-phases</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/FBT-phases</guid>
            <pubDate>Wed, 01 Oct 2025 22:16:00 GMT</pubDate>
            <content:encoded><![CDATA[Maris Degener is clear that her eating disorder recovery was in no way easy. That said, Equip’s Director of Peer Mentorship is also clear that the type of treatment she received—known as family-based treatment or FBT—was life-changing. “Treatment was still challenging, and at the time, I really didn’t want my family to intervene, or to recover at all,” she says. “But them stepping in, and stepping between myself and the eating disorder, made all the difference in my healing.” FBT is widely considered the best approach for treating eating disorders in young people, thanks to a large body of research supporting its effectiveness. According to Equip Therapist Lead Ana Luz Gardner, MSW, the clear-cut structure of FBT makes it an empowering and effective protocol. “FBT has a clear three-phase system where the individual gradually gains independence over eating and plating their meals in an age appropriate manner,” Gardner says. “FBT allows and empowers carers to take charge of meals until the patient is ready and able to work towards more independence.” For families choosing to pursue FBT, the path ahead can feel overwhelming, even if you know it’s the right choice and the straightest route to recovery. But often, knowing what to expect makes the journey feel more manageable, and can reduce uncertainty and anxiety for caregivers. Read on to learn more about FBT, its structure, and what happens during each of the three phases. What is FBT? Originally known as the Maudsley Method (because it was developed at London’s Maudsley Hospital), FBT is a treatment approach that empowers a patient’s family to take a central role in all aspects of their eating disorder recovery. Considered the gold standard for eating disorder treatment in children, adolescents, and young adults, FBT can be used to treat anorexia, bulimia, binge eating disorder (BED), and other specified feeding or eating disorder (OSFED). FBT can also be used to treat avoidant/restrictive food intake disorder (ARFID) in young people, although it is commonly paired with another form of treatment called cognitive behavioral therapy for ARFID (CBT-AR). “FBT is a form of therapy for eating disorders focused on empowering the family to renourish their loved one and interrupt disordered eating behaviors,” Gardner says. She explains that this specific type of treatment differs from others in a few distinct ways: The family leads. “In FBT, the therapist takes a ‘consultative stance,’ highlighting that the carers are the experts on their child while the therapist is the expert on eating disorders,” Gardner says. It separates the patient from their eating disorder through externalization. “Externalization involves understanding that the eating disorder is a biologically-influenced external force that has taken control of the adolescent—not a reflection of the patient's character or a result of faulty parenting,” Gardner says. “Externalization reduces blame and allows the family and patient to focus on pushing the eating disorder out and eventually creating an identity without the eating disorder in their life.” It prioritizes addressing the present symptoms. “FBT takes a pragmatic approach, empowering carers to focus on the here and now, not on the cause of the eating disorder,” Gardner says. In fact, FBT is generally agnostic when it comes to the “reason” for the illness, believing that you don’t need to know what caused an eating disorder in order to treat it effectively. “In its simplest form, FBT is based on the concept that support from others helps us stay on the path to recovery,” Degener says. “We task supports—often parents—with helping their loved one begin pursuing recovery. This usually means providing meals and ensuring they get eaten to help them physically renourish and heal. Over time, the supports begin to step back and provide more autonomy to their loved one as they make progress and begin to manage their recovery independently.” Degener acknowledges that the unique structure of FBT can initially be disorienting. “It can feel really topsy-turvy to many,” Degener says. “Shouldn’t my loved one be self-motivated to get better? If they’re sick enough, won’t they see they need help and choose it for themselves? But FBT takes into account the unique nature of an eating disorder: often, folks struggling may not want to get better, or not recognize that they are ill. At the time my parents stepped in to support me, my eating disorder was making it impossible for me to recognize just how sick I was, or take the steps I needed to get better. Without their intervention and consistent support, it would have been immensely more difficult for me to make the decision that I needed help, and I needed to take swift action to protect my health and well-being.” What to expect from FBT Degener says her mom routinely tells a story of talking to a doctor about starting FBT. At the time, Degener was hospitalized. “The doctor asked her what she thought things would be like,” she says. “And my mom said, ‘It’s going to be hard.’ The doctor replied, ‘It’s going to be harder than you think.’” Degener adds that many families are surprised by the level of involvement asked of them in FBT. “And in truth, it’s no small task to be responsible for meal planning, grocery shopping, preparing meals, and making sure your loved one eats all those meals until they achieve weight restoration,” she says. “Plus, families are often doing this while their child or loved one is feeling ambivalent about recovery—or, in my case, actively not wanting it. It’s worth saying: FBT is not easy, and recovery is not easy.” At the same time, however, Degener emphasizes that recovery is worth it. “I look back now with immense gratitude for the effort, time, and energy my parents put into helping me fight back against the eating disorder before I felt ready to do so myself,” she says. “It wasn’t the health effects, or the huge impact on my life and relationships that pushed me to begin recovery. It was my parents stepping in and saying, ‘let us help you until you are ready and able to help yourself.’” Here are a few key things caregivers can expect from FBT: An immense amount of caregiver participation. “FBT requires significant caregiver involvement,” Gardner says.. “Sometimes, caregivers need to take time off from work and other responsibilities to devote themselves to plating meals, monitoring their loved one, and providing full support.” An adjustment period. While FBT allows the patient to continue living at home and attending school, some families may find it helpful to take a brief break from everyday routines in order to get familiar with the protocol. “Taking your child out of school or taking a break from school may be necessary in the beginning of recovery,” Gardner says. An initial intense focus on interrupting disordered behaviors. “FBT seeks to stop eating disorder behaviors and keep those behaviors from being further entrenched into your loved ones life,” Gardner says. “It will take work, time, and stamina to outlast the eating disorder.” Forward movement in treatment, even if the patient is reluctant. “FBT also does not need buy-in from the patient,” Gardner says. “To the surprise of many carers, FBT treatment does not need the patient to agree or even want to do treatment. In fact, most patients can be resistant and not want to participate in treatment. Since carers are driving the change in the home, it is up to the carers to instill boundaries and determine meal times.” The three phases of FBT: an overview FBT not only differs from other forms of treatment in its inclusion of caregivers and family members, but in its structure. Instead of seeking out and discussing the root causes of the eating disorder, FBT is mainly focused on changing the behaviors, regardless of what initially triggered them. This approach is based, in part, on the understanding that a malnourished brain will not be able to effectively participate in therapy, and that it’s essential to loosen the grip of the eating disorder mind—by disrupting behaviors and normalizing eating habits—before any psychological or relational work can begin. In practice, this means FBT progresses through three distinct phases: Full caregiver control: The focus is on reduction of symptoms and weight restoration (when needed). Gradual return of control to the child: The focus is on development of skills and independence. Establishing autonomy: The focus is on identity formation and relapse prevention. “I find the structure of FBT to be motivating, as you can clearly define progress, and gaining independence can be a motivating and important factor throughout treatment,” Gardner says. “I love FBT because it pushes the eating disorder out and allows patients to relearn what their life could look like without an eating disorder.” Phase one: full caregiver control Phase one of FBT primarily focuses on restoring a young person’s physical health through the guidance and participation of their caregivers. Because those with eating disorders typically struggle with decisions around food, eating, and sometimes exercise, FBT temporarily puts the caregivers in charge of these choices. And because malnutrition can severely impact a patient’s ability to think clearly, phase one removes the decision-making burden and allows patients to simply follow predetermined steps toward physical recovery. This means that caregivers take on the responsibility of deciding what, when, and how much their child eats, as well as monitoring food intake and helping the patient reduce physical activity as needed. This phase continues until there is steady weight gain and regular eating habits, and eating disorder symptoms begin to slightly improve. “When I was hospitalized and first diagnosed with anorexia, my parents were given the lowdown on phase one,” Degener says. “My mom always described it as having a newborn again: you are now in charge of making sure your child eats enough, and regularly, and providing constant supervision throughout. But she also always says that the difference between caring for me and caring for a newborn was that this time, I—or, more accurately, the eating disorder—was fighting back. This was the most explosive period for us. Every meal came with tears, angry words, and sometimes even violence. This was the stage where we came face to face with the reality that eating disorders can truly cause us to act in ways we never would otherwise—even far outside of our true values.” According to Gardner, phase one can be especially intimidating to families beginning their FBT journeys. “Phase one can feel daunting, intense and stressful,” Gardner says. “I often remind caregivers that this is a time that won’t last forever. But it’s a crucial time of breaking life-threatening cycles. It's okay to feel stressed during this phase. Find micro breaks and remember you are in the thick of the eating disorder. Expect pushback and difficulties—this is normal. When you hold boundaries compassionately and firmly, it can reroute the trajectory of your loved one’s health and life.” Phase two: gradual return of control to the child Throughout phase two, caregivers gradually give their loved one more responsibility over their eating. This phase typically moves steadily and slowly to avoid losing any progress. “Phase two is when the patient gradually receives some autonomy over their food,” Gardner says. “This is a time where caregivers and the FBT team are vigilant towards any eating disorder behaviors. This is also a special time where trust and ownership are built.” As Degener can attest, the slow pace of phase two is critical to continued success. “I’ll be totally honest, we rushed this stage,” she says. “Simply put, I think we were all exhausted. The constant meal preparations, fights, long stand-offs at the dinner table, were all draining. And my parents struggled at times to see me appear so unhappy.” Degener points out that this reaction from caregivers is typical and to be expected. “I remember talking to a parent who did FBT with their child who said this treatment can make you second guess yourself constantly, wondering, ‘are we doing the right thing here?’” she says. “So when the time came to practice more independence, I think we all leapt at the chance. But doing too much too quickly definitely resulted in my eating disorder calling the shots wherever it could—some meals definitely ended up in the trash at school.” If she could redo any part of her FBT journey, Degener says phase two is where she and her parents would slow down the pace and move more intentionally. “If we could do it all over again, I’d take this process much more gradually, with more scaffolding in place to help me stand up to the eating disorder, when doing so alone was still remarkably challenging,” she says. Phase three: establishing autonomy The final phase of FBT typically focuses on reviewing progress and assessing where the patient is, developmentally. Throughout phase three, the patient and their family collaborate with the treatment team to develop long-term relapse prevention strategies and future goals. This is also the time when the patient is encouraged to explore their identity beyond the eating disorder and redevelop their sense of identity. “Phase three is when age-appropriate autonomy over food is given back to the adolescent—what a wonderful time!” Gardner says. “Resilience and building a life without the eating disorder occurs here. Often this allows the individual to explore who they are without their eating disorder. Their identity can truly come alive. This gives the patient the opportunity to reconnect with a life that feels fuller and more aligned with their values.” For Degener, phase three included establishing certain systems that now, in full recovery, don’t require much effort. “But they have made all the difference in creating a life that helps me resist the always-present influences of diet culture in our society,” she says. “Sometimes these are simple non-negotiables—I never skip breakfast, for example—and sometimes they’re practical habits, like always having snacks in my purse. And other times, this looks like doing things that support my all-around well-being, whether that's spending time with friends or on hobbies that bring me joy, or going to therapy to find support when I need it, even for non-eating-disorder specific topics.” Because phase three is the time to focus on relapse prevention strategies, Gardner advises patients and caregivers to seek out simple tools and systems that can support continued recovery. “Using the green/yellow/red light metaphor has been helpful to many patients to identify which behaviors are positive (green), warning signs (yellow), or signs to seek immediate help and support (red),” she says. How to get started with FBT Because FBT hinges on caregiver involvement, many families may find it intimidating, but know that you don’t have to go it alone. In fact, it’s important to do it with the support of FBT-informed eating disorder specialists, and there is plenty of expert guidance available. At Equip, patients are matched with a dedicated team of eating disorder specialists who are deeply knowledgeable about FBT, and help families navigate all three phases with the resources, support, and information they need. “It's completely normal to feel nervous—FBT can seem overwhelming at first,” Gardner says. “But for so many families, it's made a life-changing difference. Starting something new often brings uncertainty and questions, but this could be the step that helps save your loved one's life and support them in building a future free from an eating disorder.”  Degener says that a common fear many families have is that FBT will irreparably damage the parent-child relationship—but she found the experience actually solidified her family’s bond. “At the time, I couldn’t have hated it more—and yet today, I have nothing but gratitude for their willingness to step in and put action to the words many parents say: ‘I would do anything for my kid.’ Today, I feel that my relationship with my parents has strengthened throughout this process. Now, more than a decade later, we’re able to look back and even laugh about some moments of the experience—something we never would have thought would be possible at the time.” “I’ve had families come back to me after going through FBT, and even though it was hard, they’ve said it was absolutely worth it,” Gardner says. “It helped their child recover and gave them hope again. Recovery is possible. You don’t have to feel ready or confident to start—just willing to try.” If you are worried about a loved one with an eating disorder, schedule a call with an Equip team member to learn more about our FBT-informed approach.]]></content:encoded>
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            <title><![CDATA[4 Approaches Proven to Treat Eating Disorders in Adults]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/adult-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/adult-eating-disorder-treatment</guid>
            <pubDate>Fri, 03 Nov 2023 19:40:00 GMT</pubDate>
            <content:encoded><![CDATA[There’s a significant treatment gap when it comes to adults with eating disorders: Nearly 30 million Americans will develop an eating disorder in their lifetime, but only about 20% will get treatment. It’s possible that many aren’t familiar with the treatment options. While Family-Based Treatment is the gold standard treatment for children and adolescents this method isn’t feasible or appealing for many adults. So what are the treatments that we know can successfully help adult patients? Here are four evidence-based modalities that are proven to work (with varying levels of success depending on the individual) that we frequently use here at Equip. Enhanced cognitive behavioral treatment (CBT-E)  Enhanced cognitive behavioral treatment, otherwise known as CBT-E, is one of the most effective eating disorder treatments for adults. It was developed for outpatient eating disorder patients, but can also be used in other settings. According to Shannon Patterson, M.Ed., Ph.D., and clinical instructor at Equip, “CBT-E encourages patients to become curious about their eating habits. Through the use of strategic behavior changes, such as regular eating routines and new coping skills, patients are able to see changes in their thought patterns and symptoms.” CBT-E is a highly collaborative 1:1 individual psychotherapy that encourages patients to become curious about their eating problems and the expert on their lived experience. Through the use of strategic behavior changes between sessions, such as regular eating and use of new coping strategies, patients are often able to see changes in their thought patterns and symptoms. CBT-E treatment typically lasts 20-40 weeks and is broken up into four stages: changing patterns, evaluating next steps, challenging the root of the disorder, and preparing for life after treatment. The goal of CBT-E is to “reduce disordered eating by changing behavior patterns and challenging less helpful beliefs that affect the patient’s self-worth,” says Patterson. CBT-E also explores the influence that personal relationships, cultural environment, societal stigma, and discrimination or trauma may have on the eating disorder. What CBT-E looks like in action CBT-E has the greatest breadth of research proving its effectiveness in treating adults. One 2020 study found that patients in CBT-E treatment were more likely to recover from an eating disorder within 20 weeks and also showed significant improvements with self-esteem. CBT-E has various rates of remission depending on diagnosis, with a recent meta-analysis finding that it is most effective in treating bulimia and binge eating disorder in adults. Cognitive Behavior Therapy for Avoidant Restrictive Food Intake Disorder (CBT-AR) CBT-AR is an offshoot of CBT that is specifically designed to treat Avoidant Restrictive Food Intake Disorder (ARFID). “During CBT-AR, the patient and their therapist work together to reestablish nourishment. Then, the heart of the treatment helps them gain experience with new or feared foods, and with facing situations that make it hard to eat,” says Director of Adult Programs at Equip Lara Effland, LICSW. Effland explains, “CBT-AR can help a patient obtain weight restoration, correct nutritional deficiencies, eat foods from all five basic food groups, and feel more comfortable in social situations.” This is a gradual process over an average of 20-30 weekly sessions. CBT-AR effectiveness There’s still research needed when it comes to quantifying CBT-AR effectiveness for treating ARFID, however there’s been an increase in evidence to suggest that it can be helpful. One study found that nearly 50% of CBT-AR patients no longer met criteria for ARFID by the end of their treatment. An even greater number, 80% were rated as “much improved” by their therapists. CBT-AR patients were also able to incorporate an average of 18 new foods, and those in need of weight restoration gained an average of over 11 pounds. “We suspect that CBT-AR is effective because it helps people face and overcome their eating-related fears. Patients gradually discover that it is possible for them to get through difficult situations and start feeling more comfortable around fear foods,” says Patterson. Family-Based Treatment for Transition Aged Youth (FBT-TAY) FBT-TAY is a form of family-based treatment for young adults aged 18-26 who may be living at home. Having family play a more hands-on role can be particularly beneficial for patients while in this transitory phase of life, whether they’re balancing treatment with college or building independence in their early professional life. They can help provide the meal prep, supportive environment, and accountability that the patient might not have on their own. “In FBT-TAY, therapy is similar to traditional FBT in that it’s based on the idea that family members or positive supporters are the ones best suited to help their loved ones recover. It empowers patients’ families to be active participants in their recovery,” says Patterson. How FBT-TAY compares to FBT One of the main differences between FBT-TAY and FBT is that there’s a greater amount of independence for a FBT-TAY patient. “In Equip treatment, we encourage young adults to be an active collaborator in their treatment” says Patterson. She adds that the type of supporters may also be different: “Many young adults may have valuable supporters who aren’t family members, like friends or romantic partners, who we welcome into their treatment.” The three stages of FBT-TAY are similar to FBT: in the initial period the family prepares meals, the patient gradually returns to managing their own meals, and then ultimately establishes full autonomy. However, there’s a greater level of independence established for FBT-TAY patients throughout all three stages. One study of anorexia patients found that FBT-TAY led to significant improvement in symptoms and weight restoration both by the end of treatment and three months after. Dialectical Behavior Therapy (DBT) The basic philosophy of DBT is to “provide tools that help people accept hard realities in their life and change unhelpful thoughts and behaviors,” says Patterson. DBT focuses on four key skills: mindfulness, distress tolerance, emotion regulation, and relationship strengthening.  How DBT is applied in eating disorder treatment DBT can help eating disorder patients cope with distress around meal times, regulate emotions that may trigger disordered behaviors, and specifically interrupt the binge-restrict cycle. DBT may also improve a patient’s communication skills with their support system, treatment team, and other people in their life. Some examples of DBT skills used in eating disorder treatment are: DEAR MAN Technique: Which stands for “Describe, express, assert, reinforce, mindfulness, appear confident, and negotiate” and is a skill for asking for what you need. Opposite Action: Which is a technique that encourages individuals to act in a way that is opposite to their emotional instinct. Observing and Describing: This DBT skill asks individuals to observe and put into words their thoughts, emotions, and physical sensations without judgment. Initial studies show that DBT appears effective in addressing both eating disorder behaviors and co-occurring diagnoses. Another study of women with binge eating disorder found that patients who received DBT had greater reductions in symptoms such as bingeing, eating issues, body image, and anger. Additional treatment modalities for treating eating disorder in adults There are several other therapy techniques that are used with adult patients and combined with other modalities. Some additional treatments include: Exposure-Based Therapy (EBT) In this therapy the patient is gradually exposed or reintroduced to the things they’ve developed chronic fear or anxiety around. In eating disorder treatment, this means facing the fears and triggers that contribute to disordered eating behaviors. This could include fear of certain foods, eating in public, or exercise. Motivational Interviewing (MI) MI is a collaborative form of therapy in which the therapist guides a patient to explore their feelings of ambivalence or insecurity that might be blocking their motivation to change. One study found that patients who took part in MI were 38% more likely to complete eating disorder treatment. Adult eating disorder treatment at Equip Equip provides virtual, evidence-based eating disorder treatment, so patients can recover at home. Our clinicians are highly trained in each treatment listed above, and utilize therapy modalities depending on the individual. For example, an older adult with ARFID may be treated with CBT-AR, whereas a younger adult with the same diagnosis may respond best to FBT-TAY. If communication and relationship difficulties are main triggers for an adult with bulimia, they may respond well to CBT-E and involvement in a DBT skills group. These treatments are delivered by a multidisciplinary care team of a therapist, medical provider, dietician, and peer mentor who has experience recovering from an eating disorder. Equip also invites the patient to be an active collaborator in their treatment. Together, the team and patient partner to ensure the best method is being used, and make changes when necessary. Lasting recovery is possible and there are many science-backed treatments to help you get there. Schedule a free consultation to learn more about treatment at Equip. 
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            <title><![CDATA[Equip Case Report: FBT+ Is Effective For Children with Binge Eating Disorder]]></title>
            <link>https://equip.health/articles/news-and-research/fbt-for-binge-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/fbt-for-binge-eating-disorder</guid>
            <pubDate>Tue, 14 Feb 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Evidence has shown Family-Based Treatment (FBT) to be the most effective treatment approach for anorexia and bulimia in children and adolescents, but research on FBT for binge eating disorder (BED) is lacking. This may be, in part, because binge eating disorder tends to develop in adulthood, and so the research has focused on adult treatment. The reality, however, is that binge eating disorder affects children and adolescents as well, with prevalence estimates ranging between 1% and 5%. FBT has positive outcomes with adolescent bulimia, which is characterized by recurrent binge eating, suggesting that it may also be a promising treatment for adolescent binge eating disorder. In Equip’s new case study, we found that to be true. The case study, which was published in the journal Cognitive and Behavioral Practice in February 2023, follows an adolescent female with BED, Julia (names have been changed to protect privacy), who came to Equip after gaining weight over the course of a year due to what her parents described as “emotional eating.” When Julia began treatment, her eating was cloaked in shame and secrecy, and she at first struggled to admit there was a problem at all. Her parents, meanwhile, expressed substantial weight bias, stating that they thought Julia would be happier if she lost weight, and sharing concerns over her BMI. They expressed these sentiments both to their providers and to Julia directly. In individual treatment, providers would have been able to work with Julia to normalize eating habits and stop eating disorder behaviors, but they would not have been able to target the weight stigma and harmful assumptions that existed within the family. By using Equip’s FBT+ approach, they were able to do both. “FBT gives us the opportunity to work with both patients and families where they are at,” says Jessica Baker PhD, Equip Senior Researcher and an author of the report. “As is emphasized by this case, targeting certain aspects of the family unit are essential for recovery.” Using a Health at Every Size (HAES) framework, providers were able to validate Julia’s parents’ concerns while also helping them acknowledge the pervasive weight stigma within our society. The family's assumptions were gently challenged during sessions, and they were able to effectively refocus their attention on helping Julia develop a healthy relationship with food. “It’s incredibly meaningful to see eating disorder behaviors change and overall wellness improve as parents challenge deeply ingrained beliefs about weight and shape,” says Jennifer Derenne MD, Equip’s VP of Medical Care and an author of the report. After 21 weeks of treatment, Julia had achieved full remission of her eating disorder symptoms. What’s more, there was a significant reduction in weight- and food-based shame within the family. This is important, because these types of family-level factors can contribute to and reinforce eating disorder behaviors, and addressing them head-on reduces the chance of relapse and paves the way for lasting recovery. “The first question that often comes to mind when people think of BED is how to control or restrict the amount of food someone is consuming. This case highlights the ways restriction and food rigidity can perpetuate binge eating, and how vital weight neutrality is in eating disorder treatment approaches,” says Ally Duvall, Equip’s Body Image Program Manager and an author on the report. “As providers, we can shift the cultural narrative that encourages food rigidity and morality by supporting our patients from a HAES+ lens.” While more research is needed to understand the effectiveness of FBT for binge eating disorder in adolescents, this case study shows that it may be effective, making it an evidence-based approach for adolescents across the eating disorder spectrum. “Our preliminary findings suggest that FBT is an effective treatment approach for all eating disorders,” says Baker. Read the full case report here: Enhanced Family Based Treatment for An Adolescent with Binge Eating Disorder: A Case Report]]></content:encoded>
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            <title><![CDATA[New Equip Research: Eating Disorders in the Black Community]]></title>
            <link>https://equip.health/articles/news-and-research/equip-research-black-experience</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-research-black-experience</guid>
            <pubDate>Fri, 06 Feb 2026 21:39:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders are often framed as a problem that primarily affects white, affluent women. But research—and lived experience—tell a very different story. Black individuals experience eating disorders and disordered eating at significant rates, yet are far less likely to be diagnosed or receive treatment. At Equip, our mission is to make effective eating disorder treatment accessible to everyone who needs it. That starts with recognizing how culture, identity, and lived experience shape both risk and access to care. To help close long-standing gaps in research, we conducted a nationwide survey of 858 Black-identifying individuals to better understand eating disorder prevalence, body image, cultural influences, and barriers to treatment within the Black community. Our findings point to a clear truth: when clinical models fail to reflect cultural realities, people fall through the cracks. Why we conducted this research Existing research already shows troubling disparities. Black teenagers are 50% more likely than white teenagers to engage in bulimic behaviors like binge eating and purging, yet Black, Indigenous, and People of Color (BIPOC) are half as likely to be diagnosed or receive treatment. Binge eating disorder is the most prevalent eating disorder among Black adolescents, followed by bulimia nervosa and anorexia nervosa. Implicit bias plays a major role. In one study, clinicians reviewing identical case studies identified eating problems as concerning in 44% of white women and 41% of Hispanic women—but only 17% of Black women. This means Black patients are less likely to be asked about symptoms, referred for treatment, or diagnosed early. What’s often missing from the data, however, is how cultural norms around food, family, and body shape create unique pathways to disordered eating that don’t always fit white-centric diagnostic frameworks. Our goal was to document those experiences directly and use them to inform more equitable, culturally responsive care. Who we surveyed (and what we asked) We gathered responses from 858 Black-identifying individuals across the United States. Here’s a snapshot of key demographic details: Age: Millennials (41%) and Gen Z (39%) made up the majority of respondents Gender: 62% identified as female and 35% as male Sexual orientation: 26% identified as LGBTQIA+ Cultural identity: 76% said celebrating their Black heritage is very important to them Seventeen percent reported having been diagnosed with an eating disorder. Another 26% suspected they had an eating disorder but had never been formally diagnosed—highlighting a significant gap between lived experience and clinical recognition. To better understand what contributes to that gap, we asked questions about provider representation, cultural identity, body image, and the role food played in respondents’ families and communities. Key findings The survey results revealed a lot of eye-opening truths, but three central themes emerged. Caught between “clean your plate” and disordered eating Food often holds deep cultural meaning in Black communities: 76% of respondents said food brings people together, 66% connect it to tradition or celebration, and 64% associate it with love and care. At the same time, many described how these cultural norms can collide with disordered eating patterns. Despite 65% never being diagnosed with an eating disorder, 41% reported restricting or skipping meals and 35% reported binge eating. “Cooking is and always has been a huge part of my family's cultural identity. And not eating a cooked meal is seen as a sign of disrespect… I have always been expected to finish my whole meal.” — survey respondent “Growing up, food in my family and culture was tied to love, celebration, and comfort, but it was usually really rich, heavy stuff like fried foods, mac and cheese, and desserts, and I felt pressured to eat it even when it wasn't good for me. Over time that turned into a real compulsion and messed with my mental health and relationship with food.” - survey respondent Younger generations appear especially affected. Among Gen Z respondents, one in two reported skipping meals, and one in three said adults commented on their weight growing up—often delivering conflicting messages about food and body size. “My mother constantly commented on my weight if I gained even five pounds. She would also then say that I shouldn't worry because I would lose it eventually. My cousins constantly commented on how small I was.” - survey respondent Navigating impossible beauty standards Black women, in particular, face an increasingly narrow and contradictory body ideal: a tiny waist paired with exaggerated curves. Social media trends, including the normalization of cosmetic procedures like Brazilian Butt Lifts, have intensified pressure to conform, sometimes at the expense of health. Seventy-seven percent of respondents said mainstream beauty ideals negatively influenced their body image, and 53% reported being dissatisfied with their bodies. More than half (56%) said dieting was driven by dissatisfaction with their body shape or weight. “This idea that the ideal image for black women is the hourglass figure has led people to turn to plastic surgery or extreme dieting to get a tiny waist and thick thighs.” — survey respondent Others described how these pressures were reinforced at home from an early age. “My dad would always instill how small a woman should be… ‘Nobody wants a fat girl,’ he says. Some of the things I've heard growing up.” — survey respondent Gen Z women reported the worst mental health outcomes overall, suggesting that rapidly shifting and hyper-visible body standards may be compounding risk. The treatment gap remains wide While 21% of respondents rated their mental health negatively and 17% had eating disorder diagnoses, 39% had never seen a therapist. The most commonly cited barriers to care were cost (47%) and limited provider access (23%). Representation also matters. One in three respondents said they want a Black provider, yet many reported that difficulty finding culturally competent care discouraged them from seeking treatment at all. Gen Z respondents reported the greatest need for mental health support, along with the greatest structural barriers—pointing to a system that is struggling to meet rising demand. How these findings can shape care going forward This research reinforces what many in the Black community already know: eating disorders don’t look the same across cultures, and neither should treatment. To create more equitable, effective care, we must: Improve cultural competence and representation among providers Rethink screening and diagnostic criteria to capture culturally specific experiences Address structural barriers like cost, access, and provider shortages Cultural differences are often framed as obstacles to care. Our findings suggest something more hopeful: when understood and respected, culture can become a pathway to more responsive, effective treatment. At Equip, we’re committed to continuing this work—and using these insights to help ensure that everyone with an eating disorder can access care that truly meets them where they are. Explore more of Equip’s research advancing equity and access in eating disorder care.]]></content:encoded>
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            <title><![CDATA[Understanding the Link Between Food Insecurity and Eating Disorders]]></title>
            <link>https://equip.health/articles/food-and-fitness/food-insecurity-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/food-insecurity-eating-disorders</guid>
            <pubDate>Mon, 17 Mar 2025 22:07:23 GMT</pubDate>
            <content:encoded><![CDATA[When it comes to the causes of eating disorders, we often point to the more straightforward ones: body image concerns, a history of dieting, a genetic predisposition, perfectionism. But the reality is, a huge range of diverse factors can contribute to a problematic relationship with food, many of which we never think of. One of those factors? The availability of food itself. For Equip Lead Peer Mentor Makailah (Mak) Dowell, uncertainty around what and when she would be able to eat directly impacted the development of her eating disorder. “I was homeless and food insecure for six years of my life,” Dowell says. “And even when we made it out of this spot, my grandmother and I were limited to what food stamps could provide.” Once she did gain more reliable access to food, Dowell says she began to binge eat. “That led me into the binge-purge cycle, and I developed bulimia nervosa,” she remembers. Looking back now, she sees clearly that her food insecurity led to these harmful behaviors, but at the time she could neither identify nor stop them. Read on to learn the nuances of food insecurity, how it can directly impact eating disorders, and how to get support. What is food insecurity? The United States Department of Agriculture defines food insecurity as “the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” According to Feeding America, a nationwide network of food banks, food pantries, and local meal programs, 47 million people (including 14 million children) experience food insecurity annually in the United States. “Food insecurity is a state where individuals and communities have a lack of consistent access to adequate amounts of safe, nutritious foods to support growth and development,” says Equip Therapist Lead Ana Gardner, LCSW. She explains that food insecurity can be broken down into four pillars: Availability: how much food is being procured Accessibility: how easily the food is accessed Utilization: how people use food Stability: how stable the food system is over time Gardner also notes that food insecurity can be experienced at different levels of severity. According to the Food and Agriculture organization of the United Nations (FAO) there are three levels of food insecurity:  Food security/mild food insecurity: People who are food secure have reliable access to enough food, both in terms of amount and nutritional value. Mild insecurity includes facing uncertainty about continued ability to obtain adequate food. Moderate food insecurity: People experiencing moderate food insecurity are forced to limit the quality, quantity, or both of the food they eat. Severe food insecurity: People experiencing severe food insecurity have typically run out of food and, at worst, gone a day (or days) without eating. While millions of people struggle with food insecurity, the issue affects some groups more than others. “Food insecurity has a higher prevalence in low income households, and with racial and ethnic minorities,” Gardner says. “It’s linked to a decreased variety of food and a lower consumption of micronutrients. Food insecurity additionally affects pregnant women negatively and is associated with pregnancy complications.” The COVID-19 pandemic also negatively impacted the overall health (which includes mental health) of many, specifically those who are low income and/or experience food insecurity. “The pandemic increased food insecurity globally, and correspondingly eating disorders have also increased,” Gardner says.  Food insecurity and eating disorders The link between eating disorders and food insecurity is well-documented. Research shows that food insecurity is associated with higher rates of binge eating disorder, bulimia nervosa, and overall eating disorder pathology. Food insecurity during adolescence has been shown to be a risk factor for developing disordered eating in adulthood. “Food insecurity directly affects eating habits,” Gardner says. “Those experiencing food insecurity may stretch their food supplies to make them last longer, skip meals to prioritize feeding other family members, or prioritize other expenses, like medical bills, over meals. Food insecurity is also a psychological stressor that can lead to increases in stress, depression, and anxiety.” People experiencing food insecurity are more likely to live in areas that are low income and have limited access to affordable and nutritious food, also known as food deserts. “The combination of food insecurity, financial barriers, and food deserts leave many undernourished and with disordered eating practices,” Gardner says. As Dowell sees it, eating disorders and food insecurity can, in some cases, go hand in hand. “Eating disorders can be heavily influenced by the lack of food options, which can create both higher urges to binge, but also an ability to skip meals while having a valid excuse for why you’re skipping it.” Dowell says that her own eating disorder enabled her to justify skipped meals and the restriction cycle. “I felt guilty asking my grandmother to buy more food that we couldn't afford," she says. “I would lean into isolation, guilt, and invalidation, which my eating disorder thrived on. Food insecurity started my eating disorder by driving high hunger cues and kicking off a binge cycle when access to food was provided.” Dowell is far from alone in this scenario, as food restriction has been linked to a heightened preoccupation with food and binge eating (in fact, restriction is often at the root of any eating disorder). “The binge-restrict cycle is a well documented pattern of restricting food intake, followed by a craving to eat, and an eventual binge,” Gardner says. “In food-insecure environments, restricting food intake can be a survival mechanism that may lead to a binge when food becomes available, and over time this can engrain disordered eating practices.”  Barriers to treatment for food-insecure folk While there are effective treatment strategies for eating disorders, those experiencing food insecurity may have a particularly challenging time accessing care. “People struggling with food insecurity face various barriers to eating disorder treatment, and general medical and mental health care,” Gardner says. “Some barriers include stigma and financial issues. Specifically, ethnic minorities face higher stigma surrounding mental health issues. Financial barriers can also be one of the biggest impediments for people in seeking eating disorder treatment.” Dowell agrees that the financial aspect of seeking help for food insecurity and eating disorders can pose a major obstacle. “If people are leveraging public assistance for food and healthcare, they have limited options and education on what they can do for their eating disorder,” she says. “Not to mention the shame of not knowing if you can get support, which can drive many folks away from recovery.” What to do if you’re affected by food insecurity and an eating disorder While both eating disorders and food insecurity can cause feelings of shame and isolation, it’s important to know that these issues are far more common than they may seem—and that everyone is deserving of help. “If someone is struggling with food insecurity and an eating disorder, it can feel overwhelming and destabilizing,” Gardner says. “Please know you are not alone and there are resources available.” Gardner says that seeking out mental health resources, professional support, and a support system can all have lasting benefits for those experiencing food insecurity and an eating disorder. “Working towards meeting basic needs lays the foundation for eating disorder recovery,” she says. “Focus on the progress or the ‘wins’ you have each day, do not focus on being perfect.” In addition to reaching out to local food banks, food pantries, and resources like Feeding America, Gardner recommends that anyone experiencing food insecurity research assistance programs and nonprofit organizations. “Some people may qualify for government assistance like the Supplemental Nutrition Assistance Program (SNAP) or Women, Infants, and Children (WIC) to receive financial support for purchasing food,” she says. “Eating disorder support resources include Project Heal, National Eating Disorders Association (NEDA), and the Alliance for Eating Disorders. These resources can be a lifeline.” Dowell advises those facing food insecurity to visit their local state office for public resource assistance. “This can be a great spot to connect with a case manager on what your options are and what is most accessible,” she says. “I would also look to the free resources available, like virtual support groups, meal support groups, educational blogs, and so much more. Resource and information gathering will empower you to take the steps you deserve to heal.” Gardner hopes more people become aware of the fact that neither food insecurity nor eating are always “visible,” and they don’t discriminate. “Both eating disorders and food insecurity can deeply impact people of all backgrounds, cultures, body sizes, etc., and also deeply affects mental health,” she says. “If you’re struggling with either of these, or both, please know that there is hope. Healing is a process, and it happens one step at a time. Recovery is never linear, and asking for help can be the bravest thing someone can do. No matter how difficult things may seem, there is a path forward, one step at a time.” Based on her own experience, Dowell agrees. “Do not give up,” she says. “The road can be long, but it’s worth it.” FAQs What is food insecurity? Food insecurity refers to people not having enough to eat and possibly not knowing where their next meals are coming from. About 47 million people, including 14 million children, experience food insecurity annually in the United States. How does food insecurity lead to eating disorders? Food insecurity directly affects eating habits because the uncertainty of when and where a meal will come from can cause people to restrict, skip meals, prioritize the feeding of their family members over themselves, and/or prioritize medical expenses over food expenses. Food insecurity is also a psychological stressor that can lead to stress, depression, and anxiety, which are all common among individuals with eating disorders. Additionally, food insecurity can contribute to the binge-restrict cycle, a pattern of restricting food intake, followed by a craving to eat, and an eventual binge. For those in food-insecure environments, food restriction may start as a survival tactic that may lead to a binge when food becomes available. What eating disorders are most associated with food insecurity? Food insecurity has been associated with higher rates of binge eating disorder (BED), bulimia nervosa, and overall eating disorder pathology, but anyone can experience any type of eating disorder whether or not they are struggling with food insecurity. How can you address both food insecurity and an eating disorder? Seeking out mental health resources, professional support, and a support system can all be beneficial in addressing food insecurity, eating disorders, or both. For those struggling with financial barriers, there are government assistance programs and nonprofits dedicated to helping those in need.]]></content:encoded>
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            <title><![CDATA[The Relationship Between Exercise and Eating Disorders: When Fitness Goes too Far]]></title>
            <link>https://equip.health/articles/food-and-fitness/exercise-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/exercise-and-eating-disorders</guid>
            <pubDate>Fri, 11 Feb 2022 14:29:00 GMT</pubDate>
            <content:encoded><![CDATA[Growing up, exercise was what Equip Peer Mentor Jillian Yatso-Bukoski called “the centerpiece” of her life. She pursued competitive dance as a child, and ventured into competitive rock climbing as a young adult. “Both of these sports were my identity—the reason I got out of bed in the morning, my source of perceived worth,” she says. “But they were also my fuel for restrictive eating.” Exercise, of course, can be perfectly healthy for many (or even most) people, but as Yatsko-Bukoski's story illustrates, compulsive exercise and eating disorders often go hand-in-hand. Leading up to her first international climbing competition, Yatso-Bukoski says she severely restricted her food intake while “training my body into the ground.” This culminated in a sobbing breakdown after her qualifying round in France, which left her “hungry, exhausted, and emotionally at one of my lowest points.” On the other side of the world, friends, family members, and sponsors woke up to the news of her making the finals and messages of praise began to roll in. “My suffering for this sport felt invisible,” she says. “Starving and torturing yourself for ‘excellence’ looks an awful lot like dedication to those around us. You begin to veil your self-destruction as inspiring motivation.” What the research says about eating disorders and exercise Yatso-Bukoski’s experience is quite common, and not exclusive to athletes. While it’s tough to nail down an exact definition or even a single name for the phenomenon—over-exercise, compulsive exercise, overtraining, exercise addiction—this type of disordered relationship with movement often exists alongside disordered eating. Some experts use the term “addiction” to describe “excessive and obsessive” patterns of exercise, and estimate that anywhere from 3 to 9% of people are affected worldwide. Others take issue with the term “addiction,” and say characterizing the issue as “problematic” is perhaps more precise and less stigmatizing. Regardless of how it’s described or categorized, research has consistently shown a strong relationship between excessive or compulsive exercise and eating disorders, and it’s often a major factor in maintaining the illness and predicting poor treatment outcomes. A recent study found that nearly half of those with eating disorders engage in excessive exercise, and the current prevalence is highest in people with anorexia (48%), followed by those with bulimia (45%), OSFED (38%), and binge eating disorder (BED) (11%). The lifetime prevalence of excessive exercise in all eating disorders is 63%. How exercise shows up in eating disorders According to Equip Lead Therapist and Clinical Supervisor Brittney Lauro, LCSW, exercise often shows up in the context of eating disorders as a rigid relationship with both routine and a “no days off” mindset. “People will often feel guilt or sadness for taking time off,” she says. “They may feel compelled to stay on exercise machines for a specific amount of time or complete a rigid requirement for an amount of reps with no flexibility to reduce.” This can mean that those who are struggling exercise when sick or injured, or in poor weather. Lauro also notes that people with eating disorders may use exercise as a compensatory behavior—meaning they “have” to work out if they allow themselves to eat certain types or amounts of food. This mindset is unfortunately common in our society (which is heavily informed by diet culture), so it's an important reminder that food is a fundamental human need, not something that needs to be earned. Underfueling for exercise is also a major issue among those with eating disorders. “People are often praised for spending early morning hours in the gym instead of sleeping adequately or eating breakfast with their children,” Yatso-Bukoski says. “Not only do we hide eating disorders under banners of health, but we’ve gone further to create a fitness niche called ‘fasted fitness’ where people are encouraged to exercise in a malnourished state because the shape of our bodies are more important than the wellness of our spirits. The most insidious part of this is that those who have gone the longest without eating prior to their exercise are praised as being the most committed to their ‘health and fitness.’” How extreme exercise can lead to an eating disorder Board-certified pediatrician, Katherine Hill, MD, says that compulsive exercise is something she’s become familiar with in her profession, but is also an issue she witnessed firsthand during her days as an NCAA Division I swimmer. “Problematic exercise is extremely common in people with eating disorders, and is often the primary behavior that sets off the eating disorder in the first place, almost always with great intentions,” she says. Hill says the external validation so many individuals get when they apply a “more must be better” mentality to exercise only serves to reinforce problematic behavior—even for those in the throes of a life-threatening eating disorder. “The trickiest part about exercise is that it is not only socially acceptable to exercise, but also socially acceptable to exercise to the extreme,” she says. “Training for a marathon or ultramarathon, for instance, is often seen as more impressive and more ‘healthy’ than training for a 5K. Too often, exercise behaviors that started in moderation to improve health become compulsive, to the point where people are exercising when sick, injured, or fatigued without taking a day off.” Former college football player and current mental health advocate Patrick Devenny, who once struggled with bulimia, says excessive exercise is the number one thing he emphasizes when speaking about eating disorders. “The reality is that ‘bro science’ and gym life affirm and glorify overexercise, and people have begun to associate overexercise and pushing yourself to burn calories as a badge of honor,” he says. “There is so much harm being done to the mind and body when this kind of gym culture exists.” Compulsive exercise symptoms: how to know when it’s gone too far Considering how celebrated exercise is in our society, it can be difficult, if not impossible to know how much is “too much.” According to Lauro, assessing whether exercise has become compulsive can be likened to assessing whether substance use has gone too far: “I think of this the same way I think of conversations surrounding substance use like alcohol or marijuana,” she says. “If someone can stop their exercise or skip days without feelings of guilt, anxiety, shame, or sadness, it is likely not a problem. If someone does experience these feelings, exercise is no longer serving a healthy purpose and has instead turned into a ‘maintaining mechanism’ or ‘compensatory behavior’ that contributes to an eating disorder.” Of course, all of this can be complicated in the context of a society that considers thin bodies to be more desirable than other body types and praises hours-long, punishing workouts. With that in mind, here are a few telltale signs that someone’s relationship with exercise has gone too: Chronic fatigue Frequent or recurring injuries Frequent illness, or taking a long time to recover from illness Mood changes including increased irritability, agitation, anger, or confusion Symptoms of depression or anxiety Trouble concentrating Feeling guilty or anxious about missing a workout, or continuing to exercise despite injury or severe fatigue Changes in menstrual cycle, such as irregular periods or amenorrhea (loss of periods) Compulsive exercise treatment options Compulsive exercise is a disordered behavior with serious consequences that often co-occurs with eating disorders, and treatment typically involves a multidisciplinary approach that tackles both the physical and psychological aspects. The same evidence-based modalities we use at Equip to address eating-related behaviors can be effective for managing exercise-related symptoms and concerns. In addition to family-based treatment (FBT), cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and other forms of therapy, treatment for compulsive exercise may also include structured exercise and safe, supported re-exposure to movement. This generally involves a gradual and planned reintroduction to moderate movement to help reduce rigidity, process urges, and build a non-compulsive relationship with physical activity. Sometimes, it’s important to take a complete break from exercise initially, especially if there are injuries or severe medical complications. The role of exercise in eating disorder treatment Understandably, there are a lot of varying opinions about the role movement should (or shouldn’t) have in eating disorder recovery. Some experts advocate for total abstinence from exercise, while others believe some form of physical movement is necessary for long-term healing. Hill says that she’s a big believer in moderate exercise done “for the right reasons,” and that learning to integrate movement into a healthy lifestyle can improve both physical and mental well-being. However, given the societal pressures around the “more is better” mentality, it can be challenging for those in recovery to strike a balanced relationship with movement. “I tell patients that they need to be both medically and behaviorally cleared for exercise,” Hill says. “What this means is that they need to have stable vital signs and labs, but they also need to be completing meals and snacks and not engaging in compulsive exercise behaviors for the purposes of weight loss or modifying their body.” Equip’s approach to exercise during recovery Equip’s Staged Approach for Exercise Reintroduction (SAFER) Protocol is based on the Safe Exercise at Every Stage (SEES) guidelines, which were created by leading experts in eating disorders, sports nutrition, and psychology. These guidelines are intended to assist clinicians through the process of reintroducing activity across all stages of eating disorder treatment. Because of the growing body of evidence suggesting that closely monitored, nutritionally supported physical activity may improve eating disorder symptoms, treatment response, and long-term prognosis, Equip works with each patient and their support system to help them safely navigate recovery and their return to movement. Hill adds that at Equip, the decision to allow exercise in recovery is made with input from the entire care team, including the patient and families. “I tell families that we all want the same thing: for the patient to be doing all the activity they want to do, but for it to be done in a safe way that supports recovery,” she says. “I’ve seen the addition of activity go both ways in recovery, and it can be very discouraging if we advance too quickly. Because of this, we typically start slow with lower intensity activities like yoga or walks before increasing in volume and intensity to set our patients up for success.” Lauro agrees, noting that Equip takes a personalized approach that meets each patient where they are. “Our team can guide folks on which activities are safe at which time, and help patients work towards their exercise goals while removing the eating disorder from their relationship with exercise,” she says. “In some cases, we may take a harm reduction approach of gradually reducing exercise, and in other cases it might make sense to go ‘cold turkey’ for a period of time. In either of these situations, we can absolutely work with patients to return to a healthy exercise routine.” For Yatso-Bukoski, repairing her relationship with exercise was one of the toughest parts of her recovery journey, but one she’s so grateful she had the opportunity to take on. “I have always been extremely competitive, and for so long I was told that I had to stifle that part of myself in order to enjoy athletics again. It was impossible with the constant triggers of diet culture always challenging us to be more driven, more dedicated, more disciplined. The light came on when I chose to lean into my competitiveness rather than try to stifle it. I challenged myself to find mindfulness during cycling instead of burning more calories than my last ride, to complete proper breathing cycles in yoga to calm my mind instead of holding my plank longer than the person next to me, and to challenge myself to get a good night’s sleep instead of attending a 5 a.m. workout class.” Fostering a balanced relationship with exercise can be challenging in a culture that rewards compulsive attitudes toward fitness. But the pressure to push to the limit can lead to serious mental and physical consequences, regardless of whether others may mistake the effort for pure “healthy” dedication. If you find yourself experiencing guilt, anxiety, or distress when you miss a workout, or if you continue to exercise despite injury or fatigue, your relationship with movement may be problematic. If you or a loved one is struggling, schedule a call with an Equip team member to talk through your concerns. FAQ What is the relationship between eating disorders and exercise? Compulsive or excessive exercise is a common and serious symptom across many eating disorders and may be driven by an unhealthy preoccupation with body weight or shape. For those with eating disorders, exercise is often used as a rigid or compensatory behavior (e.g., to 'burn off' calories or alleviate anxiety), rather than for health or enjoyment. Is compulsive exercise an eating disorder? Although compulsive exercise is not a formal standalone eating disorder diagnosis in the DSM-5, it is considered a serious and common symptom or feature of established eating disorders, including anorexia and bulimia, where it is used to control weight and body shape. What is the treatment for compulsive exercise? Treatment for compulsive exercise is typically integrated into the overall treatment plan for the underlying eating disorder and involves a multidisciplinary team. Key components of treatment usually include psychotherapy, education, and, if medically appropriate, a gradual, supervised re-introduction of movement.]]></content:encoded>
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            <title><![CDATA[Emotional Eating: Why It Happens, When It’s a Problem, and How to Get Help]]></title>
            <link>https://equip.health/articles/food-and-fitness/emotional-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/emotional-eating</guid>
            <pubDate>Mon, 26 Aug 2024 21:11:00 GMT</pubDate>
            <content:encoded><![CDATA[Equip Lead Peer Mentor Makailah (Mak) Dowell says that emotional eating ruled her life for over a decade. “Emotional eating is when you eat to fulfill an emotional need, and these emotional needs are usually very big,” she says. “For me, it was an answer to the bullying I faced and to inconsistency in my life.” Eating as a response to strong emotions isn’t a problem in and of itself (in fact, emotional eating is considered a normal coping mechanism for intense feelings) but in some cases, it may indicate a deeper issue. Read on to learn more about the relationship between eating and emotions, when emotional eating might be considered a problem, alternative coping strategies, and when to seek help. What is emotional eating? Almost all of us have eaten emotionally at one time or another. Maybe you’ve tried to remedy the boredom of an all-night study session with a big bag of chips, or found yourself hitting the bottom of a box of cookies after a particularly sad day, or had so much fun with friends that your full stomach didn’t stop you from consuming the better part of a pizza. In all these cases and more, your emotions, rather than your hunger cues, may have driven you to consume food. It can even feel like a "food obsession." “Emotional eating occurs when we eat in response to emotions or unmet needs rather than biological hunger,” says registered dietitian nutritionist Briana Mancha of As You Are Nutrition. “It's easy to confuse emotional hunger with biological hunger. One of the differences is in the underlying intention for eating.” Equip Therapist Lead Jonathan Levine, LCSW, points out that emotional hunger is just as “normal” as its biological counterpart. “I think of emotional eating as eating for any reason other than hunger or nutritional need,” he says. “Food plays so much of a role in our lives and only one of those roles is nutrition or energy—we all emotionally eat all of the time and it's often fantastic!” While emotional eating is often associated with binge eating, the two aren’t necessarily connected. For some people, consuming food in response to positive or negative emotions is just a way to manage intense feelings, and doesn’t lead to a binge or binge-like behavior. In many cases, emotional eating is nothing more than its textbook definition: “the propensity to eat in response to positive and negative emotions.” While this may lead to increased food intake or eating past fullness, is emotional eating really a problem? The potential risks of emotional eating While emotional eating can sometimes lead to binge eating (more on that below) and distressing feelings like guilt or remorse, many eating disorder experts say that, in the absence of other symptoms, emotional eating itself isn’t risky or disordered. “There aren't any real mental or physical risks to emotional eating,” Levine says. “Sure, you may get a little extra bloated or gassy from eating past fullness, but that will pass in time. Mentally, maybe you get some brain fog from the added digestion but realistically that's going to pass barring any extreme circumstances.” Levine believes that any perceived “risks” of emotional eating are rooted in our society’s inherent anti-fat bias and idealization of thinness. “The ‘risks’ of emotional eating are primarily tied to diet culture, or the overvaluation of thinness coupled with the belief that fat is bad,” he says. “This vilification of emotional eating is really connected to the belief that weight gain is innately dangerous (it's not).” As Dowell sees it, emotional eating is neither good nor bad—it’s simply a behavior. “As a society, we love to think in black and white about topics that are more nuanced than that,” she says. “Emotional eating can be an answer, a resource, a pain point, a response, a support, or an enemy. Emotional eating does come with side effects, such as the risk of developing disordered eating behaviors, gastric pain, and comorbid mental health diagnoses. That being said, it can also come with positive side effects, like relief, nourishment, and self-compassion. Again, it is not as black and white as you might think.” Mancha also views emotional eating as a normal and valid way to cope with emotions, but believes it’s important to remain aware and curious about what’s driving the desire to eat. “While emotional eating isn’t inherently harmful, relying on it as your sole coping mechanism can lead to a cycle of guilt, shame, and an unhealthy relationship with food,” she says. Because emotional eating can serve so many different needs and present in so many different ways, Dowell says it’s critical to view it as a neutral behavior worthy of inquiry. “That is why we don’t shame ourselves when we eat emotionally—we reflect,” she says. “We try to gain an understanding of a behavior that we are engaging in. This allows us space to stop, have autonomy, and be kind to ourselves.” Are there any benefits of emotional eating? If you do a Google search for “emotional eating,” it almost exclusively turn up articles on the supposed dangers associated with the behavior and strategies to stop it. But in reality, emotional eating isn’t something that needs to be universally avoided; under certain circumstances, it can actually serve an important purpose, and condemning it entirely isn’t helpful or productive. “Absolutely there are benefits to emotional eating!” Levine says. “Eating can be an act of pleasure, of connection and community building, of nostalgia for past times in our lives. It can be one of the main ways we cultivate joy. There is so much more to eating than meeting nutritional needs, and while we as a society know that, we often like to pretend it's not true. Normalize eating for pleasure!” While many of us think of emotional eating as a reactionary answer to stress or bad news, it can also provide joy and hope. In Dowell’s case, food served as a source of security and community, which had both been missing at times in her life. As someone who comes from a background of food insecurity and being houseless, food was a sort of sanctuary: “For me, emotional eating allowed for safety, comfort, and connection in response to accessible food,” she says. Mancha also points out that food can be nostalgic, letting people reconnect with happy moments from the past. “For instance, familiar flavors or meals from childhood can allow pleasant memories,” she says. “Eating itself can offer temporary relief, grounding, and distraction during stressful times, which is not always a bad thing. It's important to acknowledge and honor emotional eating, while also building awareness of emotions and developing additional coping skills.” Is emotional eating an eating disorder? Given the flood of messages we receive via diet culture that “food is fuel” and should only be consumed as a source of energy, it’s understandable that many people view emotional eating as wrong or even disordered. So is emotional eating an eating disorder? “No—hard no,” Levine says. “Eating is human. Seeking joy, respite, connection, community, and even sometimes numbing with food, are all parts of the human experience and have been for a long time.” Dowell agrees, and believes labeling emotional eating as “disordered” can do more harm than good. “If emotional eating is a moment and not a disordered pattern of behavior, then we should not label the moment,” she says. “We should not shame it or doubt it, or discredit the fact that for someone, it may be a form of healing.” If emotional eating does become a consistent pattern of behavior, however, it may be time to reach out for help or guidance. “Emotional eating on its own shouldn't be classified as an eating disorder, as it's a common behavior many people experience,” Mancha says. “However, if it begins to interfere with daily life or contributes to disordered eating patterns, that may require support.” Emotional eating vs. binge eating While some people equate emotional eating with binge eating, Levine says they are distinct from one another; people with binge eating disorder may eat emotionally, but emotional eating itself doesn’t indicate BED. Levine recommends that people only seek help for emotional eating if the behavior is causing them distress or if their eating habits are beginning to mirror the symptoms of binge eating. Because both emotional eating and binge eating may originate from the drive to fill an unmet emotional need, it can sometimes be difficult to differentiate between the two. But generally speaking, binge eating disorder is also accompanied by other signs and symptoms, like: Stealing or hoarding food Eating in secret/avoiding eating with others Periods of intense food restriction (before and/or after binges) Social withdrawal Feeling a loss of control while eating (i.e., feeling unable to stop eating when no longer hungry or wanting to eat) Excessive feelings of guilt, shame, or other distressing emotions during and/or after eating Feeling physical discomfort and pushing through that discomfort to continue eating Taking actions to "counter" the binge episodes, like restricting your intake, excessively exercising, or using medicine or other tools to go a long time without eating While emotional eating is not the same as binge eating disorder, in some cases, the former can contribute to the latter. “Some people do develop a coping skill of eating to numb their feelings, and if that persists frequently, it's possible that it could lead to the development of a diagnosis like binge eating disorder (BED),” Levine says. When is emotional eating a cause for concern? For the most part, occasional emotional eating is considered a perfectly normal and common behavior. “Many people experience emotional eating at times in their life,” Levine says. “Sometimes that's for celebration, like at a wedding Thanksgiving. Sometimes that's for when things feel hard, like the quintessential pint of ice cream in bed after a breakup. These eating experiences all exist on a continuum, and what may feel totally normal for one person may look like an emotional or even binge experience to another. It's important that we acknowledge these differences and view eating patterns in grayscale, not black and white.” That being said, there are instances in which emotional eating can veer into potentially harmful territory. To assess whether emotional eating has become a problematic behavior, Levine says to look out for the signs and symptoms of binge eating disorder, outlined above. Mancha also advises paying attention to the frequency and intensity of the behavior. Emotional eating typically happens only periodically, and while someone may eat past fullness, it’s usually not very extreme; someone with binge eating disorder experiences consistent and recurrent binges, which involve eating an objectively large amount of food in a short amount of time, past fullness and sometimes to the point of physical pain. “If emotional eating happens in a pattern of behavior, please get help,” Dowell agrees. “This puts you at high risk of having BED and eating disorders in general.” It’s also important to assess whether or not emotional eating is the only tool in your emotional toolbelt. “Emotional eating can become harmful when it is the primary or only way to cope with emotions,” Mancha says. “This reliance can hinder the development of other coping strategies, leading to temporary relief without addressing the underlying issues.” Finally, Levine advises listening to your gut instinct and using common sense: “Emotional eating becomes harmful when it feels harmful. If you ate a big dinner yesterday and maybe it was more than usual but you keep going about your life, that's just living. But if you start hyperfocusing on your meals, what to eat, what not to eat, when to eat; if the eating patterns become the primary focus of your life instead of a part of your life, you may be experiencing something harmful.” Treatment options for emotional eating First, remember that emotional eating is not inherently bad, and does not need to be “treated.” However, if it becomes a pattern of behavior and is contributing to disordered eating habits or psychological distress, it’s important to get some support. “Treatment isn't necessary for emotional eating,” Levine says. “But if you feel like emotional eating may be shifting into something else or has become a problem for you, an eating disorder-informed therapist and dietician are always a good place to start.” Mancha agrees that emotional eating is a common experience that doesn’t always require intervention, but encourages anyone who feels that their eating is problematic to work with a specialist. Regardless of whether you’re dealing with a diagnosable eating disorder, forging a therapeutic relationship with an expert can help you build a deeper understanding of your emotional needs and reduce feelings of shame or guilt. “This support can help normalize emotional eating and introduce other long-term coping mechanisms,” Mancha says. “What’s important is developing a compassionate understanding of when it becomes challenging and exploring other coping strategies as needed. Instead of demonizing emotional eating, we should view it as one of many tools for managing emotions.” From Dowell’s perspective, treatment is a worthy pursuit for anyone who feels their thoughts or behaviors around food are impeding their happiness or progress in other areas. “Treatment is necessary if emotional eating is getting in the way of your life worth living,” Dowell says. “You can gain support from a therapist or support groups, and if treatment is on the table and accessible to you, pursue it. Do not let anything get in the way of living a full life, versus just having a full life.” If you’re struggling with emotional eating and feel like you need support, schedule a call with someone on our team. The calls are no obligation, and we can talk through your concerns and guide you to helpful resources whether or not you want to pursue treatment at Equip. 
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            <title><![CDATA[Understanding Eating Disorders in Athletes: The Hidden Toll of Performance Pressure]]></title>
            <link>https://equip.health/articles/food-and-fitness/eating-disorders-in-athletes</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/eating-disorders-in-athletes</guid>
            <pubDate>Mon, 24 Nov 2025 18:52:00 GMT</pubDate>
            <content:encoded><![CDATA[Olympic figure skater Gabrielle Daleman is all too familiar with eating disorders in athletes. The two-time Olympic competitor won gold with team Canada during a team figure skating event at the 2018 Olympics. But in 2019 she took a step back from her career to address her mental health and eating disorder.  Daleman said her eating disorder started when she was in 6th grade, and that figure skating’s expectations contributed to her symptoms.  “I just grew up in a very strict sport,” Daleman said. “It's not only strict with what we physically have to do, but it's a judged sport, and we're also judged on our appearance.”  Daleman, who is also a 2017 world bronze medal winner, is currently in eating disorder recovery. And she shared that it’s possible for other athletes to get to recovery too, even though the journey can be hard.  “A lot of times when you go through this, you feel very alone, very isolated, and like you're never going to be able to get out of the rabbit hole. You are,” Daleman said. “It gets better.”  Daleman’s experience with an eating disorder is common among athletes. In this article, we’ll explore why athletes are at increased risk for eating disorders, how to recognize the signs of eating disorders in sports, and what recovery looks like. How common are eating disorders among athletes? Sports and eating disorders often go hand in hand. Eating disorders in female athletes are more commonly diagnosed than eating disorders in male athletes. But athletes of all genders can develop an eating disorder. Up to 45% of female athletes and 19% of male athletes develop eating disorders. Young athletes are up to three times more likely to have an eating disorder compared to their nonathletic peers. Nearly 46% of athletes in weight-sensitive sports like gymnastics, wrestling, and swimming have an eating disorder, compared to about 20% in non-weight sensitive sports (which is still higher than the risk for non-athletes). An estimated 12% of female athletes and 6% of male athletes have disordered eating patterns.  Athletes may develop any type of eating disorder, including anorexia, bulimia, or binge eating disorder. But the two most common EDs among athletes that Amy Goldsmith RDN, LDN, owner of Kindred Nutrition & Kinetics, sees in her practice are anorexia and bulimia.  Those with anorexia severely restrict their food and have an intense fear of gaining weight. Athletes may eat far fewer calories than their body needs while also having a distorted view of their body size or shape. Athletes may also develop anorexia athletica. Although not an official eating disorder diagnosis, anorexia athletica includes severe calorie restriction along with compulsive exercise.  Bulimia is an eating disorder where someone consumes a lot of food and then try to “get rid of” or “make up for” it by purging. Purging can take many different forms, but common purging behaviors are self-induced vomiting and laxative misuse. In athletes, Goldsmith says, purging may look like excessive exercise to compensate for calories eaten. Why are athletes at higher risk for eating disorders? Athletes are at higher risk for an eating disorder due to a number of factors. These range from sport-specific influences to things that can happen in someone’s personal life. Sport-related factors Gym culture: Toxic gym culture is very rigid, which can contribute to eating disorder behaviors. It encourages restrictive eating habits, excessive exercise, perfectionism, and comparisons. Seeing disordered patterns in teammates: Noticing disordered eating or compulsive exercise in other teammates can also trigger an eating disorder. Plus, disordered patterns like excessive exercise or being overly rigid about food can often be normalized/praised in athletic contexts as "discipline" or "dedication." Injuries: “When my athletes have an injury, there is a feeling of a loss of control,” Goldsmith said. As a result, an athlete may instead turn to what they can control, which is the way they look and what they do with their body. Pressure to maintain a certain body shape or weight: Depending on the sport, someone may be pressured to look a certain way or weigh a certain amount, which encourages disordered eating. Body comparison: Body comparisons can lead to food restriction or compulsive exercise to try and “measure up” to other athletes. Starting a sport early: Specializing in a single sport early in life increases someone’s risk for developing an eating disorder. This may be due to the pressure to maintain a specific look or weight for your sport early on. Playing an individual vs. team sport: Athletes who participate in individual sports are more likely to develop an eating disorder compared to those who play a team sport. Those who play an individual sport may be more likely to work extra hard to be thin and be more dissatisfied with their body. Personal factors Perfectionism: Athletes are high performers, but perfectionism can sometimes push someone into eating disorder behaviors. “[Perfectionism] can lead to counting your calories or your macros or looking at your weight every day, which can perpetuate rumination and create that eating disorder,” Goldsmith said. In addition, athletes often receive praise and validation for their hard work, which plays into perfectionism and further encourages disordered eating and exercise patterns. Negative energy balance: Sometimes, an athlete may unintentionally be under-eating and have a negative energy balance, where they burn more calories than they need to consume. Being in a negative energy balance is often the triggering even that “turns on” an eating disorder in someone who is vulnerable to developing one.  Societal factors Comments about someone’s body: It’s not uncommon for athletes to hear comments about their body size, shape, or weight. These comments may encourage an athlete to try and change the shape of their body through disordered eating or excessive exercise. Diet culture: Athletes aren’t immune from the wider diet culture in our society. Diet culture places higher value on thin bodies and restrictive diets to try and achieve those body sizes. Misinformation about foods: Athletes may get misinformation about what they need to eat. “The sports and fitness industry teaches improper nutritional behaviors to athletes,” said Stephanie Kile MS, RDN, lead registered dietitian nutritionist at Equip. As a result, athletes may not be fueling their bodies correctly, which can lead to disordered eating. Other factors Like anyone else, athletes may be at risk for an eating disorder due to things that happen outside their sport. This includes stressors like low self-esteem, family problems, a family history of eating disorders, physical or sexual abuse, depression, or internalizing distress. The role of sports culture and performance pressure “Athletes are often praised for being ‘driven’ with long workout hours or pushing themselves or for being disciplined with their nutrition,” Goldsmith said. This performance pressure is especially felt in weight-sensitive sports.  Weight-sensitive sports (also known as “lean” sports) place value on aesthetics (how an athlete looks), weight, or endurance. Examples of weight-sensitive sports include:  Wrestling Cycling Gymnastics Diving Swimming Body building Running Figure skating Dance Rowing  Although athletes who play these types of sports are more likely to develop an eating disorder, likely in part because of the extra pressure they experience, all athletes are at increased risk. The connection between fueling, energy, and RED-S Not all undereating in athletes starts as intentional—in some cases, they might be underfueling after workouts without knowing it. But even when it’s unintentional, this can lead to a serious health condition called relative energy deficiency in sport (RED-S). RED-S is when someone’s body regularly does not have enough calories to fuel all of its daily functions. An estimated 63% of athletes are at risk for RED-S.  Common RED-S symptoms include:  Fatigue Loss of endurance Decreased muscle strength Increased injuries Impaired judgement Lack of coordination Difficulty concentrating Lower agility Missing training due to sickness Depression Hormone disruptions Slow heart rate Low sex drive Menstruation irregularities  RED-S used to be called the female athlete triad, which included only three symptoms: irregular menstruation, loss of bone density, and low energy availability. However, the International Olympic Committee changed the term to RED-S in 2014 to be more inclusive. Now RED-S covers all genders as well as a wider range of the health consequences that come along with it.  Not all people with RED-S have an eating disorder, and vice versa. But there’s a strong overlap in the symptoms, and RED-S “can trigger a full eating disorder,” Goldsmith says, as being in a negative energy balance plays a role in eating disorder development. What are signs of eating disorders in athletes? Signs of an eating disorder among athletes include physical, behavioral, and emotional symptoms. Physical signs Common physical signs of an eating disorder in athletes include:  Fatigue Inability to recover quickly Increased injuries, including stress fractures Loss of periods (amenorrhea) Changes in weight Dizziness Weakness Fainting Getting cold easily Sweating or hot flashes Chest pain Slow heart rate Swelling Shortness of breath Digestive issues like nausea and vomiting Low sex drive Low blood sugar (hypoglycemia) Disrupted sleep cycles Lanugo hair (fine hair that grows on the face and body) Dry hair Brittle nails  It’s important to note that some of these symptoms, like loss of a period or a slow heart rate, are sometimes considered “normal” for high-performing athletes. But experts caution against completely dismissing these potential red flags, as they could point to an eating disorder or RED-S. “You're definitely not eating enough if you have a low heart rate,” Goldsmith said. Behavioral signs Behavioral signs that could mean an athlete has an eating disorder include:  Isolating more than usual Delayed reaction time Slower decision making Making more errors in their sport Skipping meals Rigid diet rules Not eating with teammates Difficulty concentrating Compulsive exercise Trouble taking days off Preoccupation with what other people are eating Removing food groups from their diet Emotional signs Eating disorders can also affect an athlete’s mental health and lead to symptoms such as:  Mood changes Irritability Depression Anxiety Impatience Getting easily frustrated after practice or a competition Perfectionism Rigid thoughts around food intake and training  If you’re concerned for yourself, someone on your team, or a loved one, take Equip’s eating disorder screening quiz to better assess eating disorder risk. How do eating disorders affect athletic performance? Eating disorders in sports can have a major impact on an athlete’s short- and long-term performance. Here are some of the most common effects. Fatigue Athletes with low energy availability due to under-fueling are 2.5 times more likely to experience fatigue or decreased performance. Slower recovery Eating disorders among athletes lead to a slower recovery. Someone won’t “bounce back” quite as quickly after an intense workout or performance because their body doesn’t have the nutrition it needs. Lack of concentration Research suggests that when someone has an eating disorder, their cognitive ability—the ability to think clearly—can be reduced by as much as 40% during intense exercise. Not being able to concentrate can negatively impact performance in a number of ways, like slowing reaction time and impairing coordination, both of, which can lead to more errors,. Higher injury risk Athletes with eating disorders are 4.5 times more likely to experience an injury—and take longer to recover. This includes fractures and overuse injuries. Compulsive exercise can also lead to muscle damage. Getting sick more often An athlete may end up missing out on practice more often, because eating disorders affect their immune system’s ability to fight off illness. As a result, they may be prone to getting colds or other infections. Loss of bone density Disordered eating can reduce bone density, which may cause stress fractures as well as osteoporosis. Osteoporosis causes bones to get thinner and weaker, also increasing someone’s risk of fractures. Heart issues Eating disorders can lead to a number of heart issues. If someone’s heart rate gets too low, they may experience fatigue, dizziness, and fainting. In severe cases, eating disorders can lead to heart attacks or heart failure. Hormone changes “If you're not eating enough or fueling enough, it will negatively affect hormones,” Goldsmith said. Disordered eating can disrupt an athlete’s levels of estrogen or testosterone. These hormones help build muscle, reduce risk of injury, and help with endurance.  Ghrelin, a hormone that helps us recognize hunger cues, can also be disrupted if someone has an eating disorder. This makes it difficult for that person to know when they’re hungry or when they feel full, Kile said. Mental burnout An eating disorder isn’t just a physical health problem. It also takes a toll on mental health and can lead to mental burnout. Mental burnout can cause a lack of focus or motivation and it can lead to exhaustion as well as dropping out of their sport entirely. How to support an athlete who may be struggling If you think an athlete may be struggling with an eating disorder, speak up right away. As hard as it may feel, “as soon as you notice something, you have to have that conversation,” Goldsmith said. “The longer that you walk on eggshells and you don't say anything, that strengthens the eating disorder.”  To approach the conversation, Goldsmith suggests leading with love and support, but “start with the facts” and “keep it unemotional.” Here’s some examples of how you can start the conversation:  “I've noticed that you aren't recovering like you used to…” “It seems like you're more fatigued at practice. I'm wondering if it has anything to do with your nutrition…” “Do you feel like you fuel enough? Are you struggling with eating?” “How are you feeling from a body image standpoint?”  Once you’ve talked with your athlete, encourage them to seek professional help, especially if you’ve noticed: Weight loss or gain Decreased fluid intake Decreased food intake Fatigue Delay in decision making  “Symptoms that make someone suspicious of an eating disorder are just as concerning as someone limping from ankle pain, which would get checked out quickly,” said Goldsmith. The sooner an athlete gets into eating disorder treatment, the better.  “Early intervention is going to be able to prevent the bone issues, the injury, the fatigue, the nutritional deficiencies,” Goldsmith said. “You still have a decent amount of cognition where you're able to really receive the information and the education and move from there.” But regardless of how long it’s been going on, it’s still crucial to get help.  Keep in mind someone may need to pause participating in a sport for a time when they start recovery. While this may be hard, remember that eating disorder recovery will help athletic performance in the long run. An athlete in recovery will be more likely to avoid injuries and their body will be properly fueled for optimal performance when they return. How Equip treats athletes Equip offers comprehensive, personalized care for athletes with eating disorders. Equip’s approach takes into account the specific sport while also helping develop healthy fueling and exercise patterns. All of it can be done through virtual treatment in the convenience of an athlete’s home.  Equip’s treatment team includes sports experts who understand the unique pressures and consequences athletes with eating disorders face. “There are support groups, trained dietitians, and therapists to help navigate these complex situations,” said Kile.  Using the Staged Approach for Exercise Reintroduction (SAFER) protocol, Equip also helps athletes safely return to exercise and their sport when they’re ready. This is based on the Safe Exercise at Every Stage (SEES) guidelines, which were developed by experts in eating disorders, psychology, and sports nutrition. If an athlete is not able to leave their sport during treatment, Equip also has specialists who understand how to handle that situation too, added Kile. The bottom line Athletes are more likely than nonathletes to develop an eating disorder. This is due to the performance pressures athletes face, such as perfectionism, body comparisons, the need to maintain a certain look or weight, and gym culture. Eating disorders can cause a range of physical, behavioral, and emotional symptoms that include fatigue, low heart rate, loss of periods, avoiding certain foods, and depression. From slower recovery times to an increased risk of injury, eating disorders can have a major impact on an athlete’s performance.  So if you notice signs of an eating disorder in an athlete you care about, it’s important to have an open conversation. Start by stating the facts about what you’ve noticed and gently ask how they’re feeling about their fuel and body. Remember that eating disorder recovery is possible, especially with the help of specialized sports treatment teams like those at Equip. FAQs What are the three disorders of the female athlete triad? The three disorders of the female athlete triad include irregular periods or loss of menstruation, bone density loss, and low energy availability. Does wrestling cause eating disorders? Wrestling doesn’t cause eating disorders, but wrestlers are at higher risk for developing one. Research suggests that wrestling has higher rates of eating disorders compared to other sports. This may be due to the fact wrestlers need to maintain a specific body weight to stay in their weight class. They also deal with body image pressures to look muscular. Can athletes develop eating disorders even if they’re not trying to lose weight? Yes, athletes can develop eating disorders, even if they’re not trying to lose weight. “Under-fueling a body can cause a cascade effect to kick in and can end up leading to an eating disorder due to imbalanced intakes, unintentional weight loss, and increasing risks for eating disorder thoughts,” said Kile.]]></content:encoded>
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            <title><![CDATA[How Eating Disorders Affect the Digestive System (and Vice Versa)]]></title>
            <link>https://equip.health/articles/food-and-fitness/eating-disorders-digestive-system-gastrointestinal-issues</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/eating-disorders-digestive-system-gastrointestinal-issues</guid>
            <pubDate>Mon, 02 Mar 2026 15:23:00 GMT</pubDate>
            <content:encoded><![CDATA[One of the hardest parts of recovering from an eating disorder is enduring mental, emotional, and physical discomfort—and while it’s not often talked about, a big source of discomfort is digestive distress. The relationship between eating disorders and gastrointestinal (GI) problems is complex, because one can trigger the other and they can have a reinforcing dynamic. In fact, one 2023 research review of studies showed that digestive issues and eating disorders have a bidirectional relationship: sometimes symptoms show up before the eating disorder starts, and other times, they appear afterward, making the eating disorder worse or helping to sustain it. Today, let’s look at how digestive problems can lead to disordered eating or eating disorders, how eating disorders impact the GI system, and how such concerns are addressed during eating disorder treatment. Why GI issues can contribute to disordered eating Of course, GI issues don’t automatically cause disordered eating or eating disorders, but they can be a significant contributing factor. According to lifestyle medicine physician Nneoma Oparaji, MD, 2025 research shows that irritable bowel syndrome (a common GI condition that can include chronic abdominal pain, bloating, diarrhea, and constipation, and is often referred to as IBS) is associated with a higher risk of developing disordered eating and full-blown eating disorders in young people compared to young people without IBS. This correlation can be attributed to a number of different factors. Here are a few reasons why digestive and GI issues can lead to disordered eating, and sometimes even eating disorders: GI symptoms can cause you to avoid food. The same IBS study showed that participants with IBS were at higher risk of dietary restraint and increased concerns about eating. “Chronic GI issues can turn our everyday meals into food avoidance, which over time can cause distress, anxiety, and restrictive food habits,” Oparaji explains. “This can happen because GI symptoms such as nausea, bloating, and pain can lead people to avoid and restrict the foods that trigger these symptoms.” It’s an understandable tendency: when you’re dealing with ongoing GI distress, it can feel tempting to try and avoid certain foods or food groups, eat smaller portions, delay eating, or even skip meals altogether to try and feel better. “At first, those changes feel practical, but over time, they can become rigid,” says dietitian Kristine Berube, RD, LDN. “When nourishment becomes inconsistent, digestion often slows further, which can actually worsen symptoms and reinforce fear around food.” Your body might feel like it needs to be controlled. When your body feels like it requires close management, disordered eating or an eating disorder can take hold more easily than if it feels trustworthy and reliable. That’s because your digestive system and brain are interconnected through what’s known as the gut–brain axis, a bidirectional pathway between the GI tract and the central nervous system (which includes the brain and spinal cord). Research from 2022 showed that disordered eating was particularly prevalent among adults with digestive issues caused by disorders of gut-brain interaction. Oparaji points out that such disruptions can impact hormones that throw off hunger and fullness perception, which can then increase anxiety around eating. Berubes adds that “the gut and brain are deeply connected. When digestion feels unpredictable, the nervous system often tightens, and that tightening can show up as hypervigilance, food rules, or restriction.” In short, digestive issues can increase your desire to control your body, especially if you already have predisposing traits associated with disordered eating, such as perfectionism or anxiety. While GI issues can contribute to any eating disorder, there’s increasing evidence showing a connection between ARFID and gut-brain disruption, with GI issues causing ARFID-like restriction (meaning the restriction is based on fear of negative outcomes or sensory sensitivities, rather than body image issues). This restriction, in turn, makes GI symptoms worse. You may be guided towards restriction by a healthcare provider. Unfortunately, people with GI issues seeking help may be misguided to cut out food unnecessarily—often based on what’s called an IgG test, which is not recommended for diagnosing food allergies, sensitivities, or intolerances. This can be a slippery slope into disordered eating or an eating disorder. “This recommendation could lead the patient to start restricting certain foods that they may not have to be restricting, which can then lead them down a rabbit hole of food being labeled as the issue,” explains Equip dietitian Slava Kharitonenkov, MS, RDN, CEDS. “With my cases, I have seen what can happen when patients begin to cut out the foods, and aren't working with a trained professional with eating disorder knowledge to reincorporate foods back into their diet—adding any new food could feel like fighting through a tsunami of overwhelm.” How eating disorders affect the digestive system Although digestive problems and eating disorders have a bidirectional relationship, the most recent research, including a study from 2024, suggest that eating disorders usually come first. This makes sense, given that eating disorder behaviors directly impact the digestive system, as do frequently co-occurring issues like anxiety, depression, and stress. Below, we’ll go through how certain specific disordered behaviors impact the digestive system. How purging impacts the digestive system Purging—compensatory behaviors used to “get rid of” or “make up for”—food eaten is a dangerous behavior associated with several eating disorders, including bulimia and anorexia binge-purge type. It impacts the digestive system in several different ways, including: Digestive tissue damage, heartburn, and disrupted colon. Purging in the form of vomiting or using laxatives or diuretics disrupts the digestive system’s normal process and damages tissues, according to Oparaji. “Acid from frequent vomiting can lead to heartburn, and chronic laxative use damages the nerves and muscles of your large intestine, which can make the colon incapable of moving stool on its own,” she explains. This often leads to symptoms like constipation, discomfort, and pain. Esophageal issues and oral damage. Regular self-induced vomiting impacts esophageal functioning, which can lead to GI issues like gastroparesis (delayed stomach emptying) and early fullness. It can also damage your throat and esophagus, which can cause serious, long-term health issues, such as Barrett’s esophagus, a condition where the lining of your esophagus is damaged by acid reflux. “It can lead to blood in vomit caused by mucosal tears,” Kharitonenkov says, “and the weakening of the muscle will also lead to the body developing a sensitive gag reflex, which can cause spontaneous vomiting or regurgitation to occur when someone isn't planning to.” Repeated exposure to stomach acid can also lead to oral infections, because the acid erodes tooth enamel and irritates soft tissues, creating an environment vulnerable to bacterial growth. Nutrient loss, electrolyte changes, and exercise-related pain. “Purging will cause some of the nutrients consumed to not be processed, while also expelling many key vitamins and minerals,” Kharitonenkov says. Plus, purging can cause abrupt and sometimes deadly electrolyte shifts, which can worsen GI issues like constipation, slowed gut motility, and abdominal cramping. Excessive exercise (another form of purging) may be linked to GI issues like abdominal pain, nausea, and diarrhea, according to a 2025 study. How restriction impacts the digestive system Food restriction is a key part of most eating disorders, and also a somewhat normalized behavior in the context of diet culture. While it might seem relatively harmless on the surface, it can lead to a cascade of physical and mental health issues, including gastrointestinal problems. Here are some ways restriction affects your digestive system: Slowed digestion and energy conservation. Food restriction slows your body’s processes, including your digestive system and your stomach’s motility (the automatic, coordinated movements of the muscles in your digestive tract). “Digestion takes energy,” Berube explains. “When the body isn’t getting enough fuel, it conserves energy and digestion downshifts.” A 2020 review showed that malnutrition and weight loss from undereating can indeed slow the GI tract, leading to overall digestive dysfunction, which can cause conditions like gastroparesis, constipation, reflux, heartburn, bloating, and diarrhea. Berube adds that restriction can cause feelings of early fullness and nausea, too. Thankfully, such symptoms are often temporary effects of gastroparesis, and go away once your body gets used to adequate nourishment. Reduced enzyme production and swallowing difficulties. Since the body doesn’t have enough energy to perform its regular processes during periods of starvation, restriction may also reduce the production of digestive enzymes needed to properly break down food. This further worsens GI symptoms, and can even lead to muscle loss and weakness in the throat, which can cause dysphagia, or difficulty swallowing. Impaired nutrient absorption and difficulties eating enough. Restriction can compromise nutrient absorption thanks to side effects like digestive hormone disruption and reduced food and nutrient transport throughout your GI system. In fact, one 2022 review showed a connection between severe food restriction in anorexia and carbohydrate malabsorption specifically. This is compounded by the fact that restriction makes it more difficult to eat enough food in the long-term. As Kharitonenkov explains, “the more that restriction occurs, the body adapts to a starvation state, and it will become harder to eat an adequate amount of food.” That’s because the body goes into conservation mode, which usually means a combination of side effects like slower digestion and disrupted hunger and fullness hormones—making it especially challenging to eat enough food, even aside from the eating disorder thoughts. How binge eating impacts the digestive system Binge eating is defined as eating an objectively large amount of food in a short period of time, while feeling a lack of control. It’s a behavior associated with several different eating disorders, including binge eating disorder, bulimia, and anorexia binge-purge type. Here are a few of the many ways bingeing can disrupt your digestive system: Reflux, distension, and indigestion. Bingeing can cause GI issues typical across eating disorder diagnoses, like reflux, abdominal pain, and abdominal distension. One 2023 research review showed that stomach emptying and accommodation may be affected by eating large volumes of food in short periods of time, which may explain why people with binge eating disorder often have functional dyspepsia, or chronic indigestion that causes frequent stomach aches and bloating after eating. Heartburn, regurgitation, and altered fullness. “Bingeing will lead to the body having an influx of nutrients in a short period of time,” Kharitonenkov explains. “This will lead to unintentional heartburn and regurgitation due to the stomach being full past capacity.” He adds that bingeing can alter fullness perception, since your body might adapt to larger quantities of food over time. Lower GI issues, stomach ruptures, and gut microbiota changes. After food passes through the stomach, there can be more digestive issues, Kharitonenkov explains. “The load will be difficult to manage or regulate, which can lead to diarrhea, incontinence, and fecal urgency,” he says. Bingeing can also lead to potentially life-threatening stomach ruptures caused by reduced blood flow after a binge episode (although it’s rare). Lastly, recent research from 2025 suggests that binge eating disorder (along with bulimia) are linked to disruptions in gut microbiota, or bacteria living in your digestive system that help with digestion, immunity, and generally keeping your gut healthy. These disruptions can compound any existing digestive problems, as well as other health issues. How GI issues are addressed during eating disorder treatment Although digestive distress is often a difficult part of eating disorder recovery, there are several ways a treatment team can support healing in your GI system. “In eating disorder treatment, we absolutely take digestive symptoms seriously,” Berube says. “And that’s not just because they’re uncomfortable, but because they can become a very real barrier to eating.” Here are some ways GI issues are addressed during eating disorder treatment: Managing symptoms When you’re feeling nauseous, your stomach hurts, or you’re experiencing another digestive issue, eating can feel impossible, so focusing on symptom relief and management is usually top of mind for healthcare providers. “That might include gradual fiber adjustments, hydration support, adequate dietary fat, gentle movement, warm beverages, or short-term medication use in collaboration with a physician,” Berube says. According to Oparaji, examples of medications that can be used (temporarily) under close medical supervision are stool softeners and laxatives to relieve constipation without causing dependency, and antacids to help with reflux. Kharitonenkov adds that sometimes medications to inhibit nausea or stimulate appetite become part of GI symptom management. Your medical provider can also review your medications to make sure there’s nothing contributing to GI distress and adjust them if that’s the case. “The goal isn’t to push someone to ‘just eat through it,’” Berube explains “It’s to reduce discomfort enough that eating feels possible and sustainable.” Additionally, research from 2023 suggests that having a trusted healthcare provider with whom you can discuss GI issues—receiving reassurance, empathetic validation, and clear explanations—is central to the effective management of such symptoms. Kharitonenkov recommends seeing a dietitian often when struggling with digestive issues. “It can be helpful to meet with this provider in a more frequent manner, as doctor follow-ups are generally spread out,” he adds. Your dietitian can also eventually help you re-integrate any foods you struggle to eat because of digestive problems, at a pace that feels manageable for you. Focusing on nutritional rehabilitation and weight restoration Since malnutrition and weight loss can cause GI problems, addressing these issues can bring harmony back to your digestive system. A 2021 review of individuals with anorexia suggests that nutritional rehabilitation (alongside other treatment interventions) may help improve GI symptoms by the end of treatment. “In many cases, symptoms improve significantly with consistent, adequate nourishment,” Berube says. “Regular meals, enough overall intake, and weight restoration when needed are often some of the most effective ‘GI interventions,’ even though that can feel counterintuitive at first.” During eating disorder treatment, you’ll generally work with a dietitian who will develop an individualized meal plan or eating pattern to help you meet your energy and nutrient needs, and work with you to remove any barriers (including GI issues) that prevent you from doing so. Oparaji adds that restoring weight when necessary, eating enough food, and normalizing eating habits can “reset the digestive system,” she says. “This is important because refeeding gradually increases gut motility, which then resolves GI symptoms, such as bloating and constipation.” Ruling out medical conditions while avoiding further restriction Sometimes, it may be necessary for healthcare providers to test for other medical conditions that may be causing GI distress during eating disorder recovery, such as a true food allergy or intolerance. As I mentioned, it’s crucial for providers to be highly cautious when exploring such potential issues, to avoid unnecessary food restriction. “Even well-intended GI protocols can unintentionally increase rigidity or avoidance,” Berube explains. “The goal is symptom relief without sacrificing psychological safety—supporting both digestive function and a more flexible, trusting relationship with food.” Healing the nervous system One less obvious way to help heal GI issues is to work on nervous system regulation, or helping the body move out of a stressed state. Research from 2021 found that nervous system dysregulation is common in people with eating disorders. “The gut is highly responsive to stress, and when someone is anxious, bracing, or hyper focused on their body, digestion tightens,” Berube says. “When the body shifts out of fight-or-flight and into a more regulated state, digestion often improves.” In her practice, Berube integrates diaphragmatic breathing, grounding techniques, and gentle yoga to help her clients regulate. Other ways to help heal your nervous system include increasing external safety (e.g. listening to calming music or wearing soft and comfortable clothing), using cold water, incorporating mindful movement, and checking in with yourself often. “Supporting eating disorder recovery means supporting nourishment, yes,” Berube says, “but it also means supporting regulation, rhythm, and self-trust.” It can be extremely difficult to navigate GI issues in eating disorder recovery, whether they appeared before or after your eating disorder started. Know that you’re not alone in your digestive struggles, you’re not doing anything wrong, and—with patience, time, and the support and reassurance of an eating disorder specialized treatment team—your brain and body can find harmony. “The body is adaptive, and if it has been undernourished or stressed, it takes time for digestion to normalize,” Berube encourages. “When regular meals return, when your breath slows, and when the nervous system feels safer, digestion often follows.”]]></content:encoded>
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            <title><![CDATA[Transgender People May Be Significantly More Likely to Have Eating Disorders. Here's Why.]]></title>
            <link>https://equip.health/articles/understanding-eds/trans-folks-EDs</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/trans-folks-EDs</guid>
            <pubDate>Tue, 22 Jun 2021 19:51:00 GMT</pubDate>
            <content:encoded><![CDATA[As a society, we’re slowly waking up to the fact that eating disorders don’t discriminate—and that certain populations may be particularly prone to developing them. We know that members of the LGBTQIA+ community are more likely to develop eating disorders than their cisgender heterosexual counterparts and face a slew of unique challenges in diagnosis and treatment. But even as we begin to recognize the reality of who gets eating disorders and why, myths still abound, and many of them stem from stereotypes about gender. Eating disorders don’t just affect cisgender women and girls While there are inconsistencies in the literature and a need for a larger body of research, transgender individuals are very much at risk for diseases like anorexia nervosa, bulimia nervosa, binge eating disorder, and more — and they may be much more at risk than most people realize, with one commonly cited paper reporting that trans people are four times more likely to experience these illnesses than their cisgender counterparts. “There is a wide variation in the medical literature concerning the actual prevalence of eating disorders among transgender youth, so we don’t quite know the actual statistics,” says Jonathan Avila, MD, an adolescent medicine physician and clinical assistant professor at Stanford University, where he is an attending physician in both the gender clinic and the eating disorders clinic. “But we do know – both from clinical experience and several studies – that it is definitely much higher. Depending on the study you use, the range goes from twice as high to up to 18 times higher. So the true number is probably somewhere in that range.” One statistic that’s often cited: transgender students are over four times more likely than their cisgender female counterparts to report an eating disorder diagnosis like anorexia or bulimia, and two times more likely to report eating disorder symptoms like purging. A 2013 survey of high schoolers found similar results, indicating that transgender students were “nearly three times as likely than their cisgender peers to restrict eating, almost nine times as likely to use diet pills, and seven times as likely to use laxatives to control their weight.” Regardless of the precise stats, the fact is clear that transgender individuals face distinct challenges that may increase their risk for developing eating disorders. “One important thing to keep in mind – and another challenge to the study of eating disorders in trans folks – is that we’re overgeneralizing a whole diverse group of trans experiences,” Avila says. There are a myriad of transgender identities and much of the existing eating disorder research focuses solely on trans-binary experiences - that is, experiences of transgender women and transgender men. More research looking at the experiences of non-binary, genderqueer, intersex, agender, and other gender identities is needed. Gender dysphoria—which is described as significant distress, discomfort, or misalignment with one's gendered body experience—can cause increased risk for the development of an eating disorder. This underscores the importance of screening for eating disorders when assessing for gender dysphoria, and vice versa. This screening can help identify opportunities for early intervention by utilizing therapeutic modalities and/or medical transition, when desired. Common predictors for eating disorder behavior in transgender people include rigid appearance ideals, minority stress, discrimination, increased rates of food insecurity, and increased rates of trauma. Similarly, protective factors—or what we refer to as resilience factors—vary greatly and can be heavily influenced by access to resources and social support which may look different for a Black transgender woman living in a rural area and a white non-binary person living in an urban area. Why it’s essential to understand gender dysphoria Especially in adolescent populations, gender dysphoria often goes untreated because teens are dependent on their caregivers for treatment. This paradigm can create complexities if a child or teen is afraid to disclose their gender identity to their parents or family, or if their caregivers simply don’t have access to pediatric gender centers. “When you don’t have someone to advocate for you, or you don’t feel comfortable talking to someone who can advocate for you, and you have raging gender dysphoria, you’ll try to treat your suffering through whatever means you can,” Avila says. By Avila’s reasoning, eating disorder behaviors—when present out of a desire to align someone’s body to their gender identity or to prevent the development of secondary sexual characteristics not aligned with their gender identity—can put people with gender dysphoria at a significantly increased risk of developing anorexia nervosa or bulimia nervosa. “But there are other reasons trans youth may engage in disordered eating, such as controlling their weight as a means of asserting control when their lives feel out of control,” Avila says. “Or using increased food intake or food restriction as a means to cope with negative feelings, which are more common in persons suffering from untreated dysphoria.” For Equip senior peer mentor, Hayden Kapalka, self-acceptance was a difficult but essential component in both eating disorder recovery and personal growth. “A critical part of healing from my eating disorder was accepting and embracing that I am trans,” Kapalka says. “I never realized that a major piece of my body image distress was actually gender dysphoria and that I was using behaviors, not just as a coping skill, but as a way to change the shape of my body to feel more affirmed in my gender identity.” According to Kapalka, limited knowledge in the medical community about how to navigate trans and gender dysphoria issues can be a big impediment in someone’s ability to get the help they need. “Sadly, a challenge that I have heard many TGNCI [transgender, gender nonconforming, and intersex] folks face is a lack of education from providers about the intersections of gender-affirming care and eating disorder recovery,” Kapalka says. “An example of this is cisgender providers gatekeeping gender-affirming medical letters for clients because the provider believes that the desire to have a gender-affirming surgery is perpetuated by the eating disorder.” Gender-affirming care is something many cisgender individuals may not know about: it’s a type of health care that holistically attends to the needs and physical, mental, and social well-being of trans individuals while “respectfully affirming their gender identity,” according to experts. This kind of specific, comprehensive care is critical, because trans and gender diverse (TGD) people have been shown to experience significant health disparities rooted in discrimination, lack of access to care, and existing biases in the medical community. As Kapalka points out, health care providers who aren’t specifically trained in TGD issues may make life-altering decisions for patients that aren’t informed or sensitive. What are the most dangerous myths around EDs in the trans community? “Minority groups experience more adversities,” Avila says. “A common (although often not the most effective) coping mechanism for someone suffering from daily or almost daily microaggressions and microtrauma—as is the case for many of our transgender youth—is food.” It is important to understand that witnessing a loved one eating does not negate the possibility that they may be restricting their food when alone. Additionally, while increasing food intake may be a coping mechanism to deal with constant stress, restriction of food may also be a coping mechanism. Hormone regimens may cause increased appetite for some, and many people may restrict in an effort to feel control during this first or second puberty, and to attempt to modify their body size or shape in a way they feel is congruent with gendered appearance ideals. There’s a more dangerous myth about eating disorders in the trans community as well: the false belief that treating a person’s eating disorder will eliminate gender dysphoria. “It’s a terrible myth because it invalidates a whole other condition someone is suffering from which can potentially worsen as it remains untreated!” Avila says. “It is true that some disordered eating behaviors may be minimized or cease once the proper treatment is given. For example, someone who is losing weight intentionally to stop menstrual periods because their periods cause significant psychological distress may stop engaging in their disordered eating behavior because their end goal of menstrual suppression is now being addressed through medical intervention. However, if their disordered eating behavior is part of psychopathology, stopping their periods will not treat their psychopathology, and they’ll continue to engage in the disordered eating behaviors even though their menstrual dysphoria is now appropriately treated.” What can be done to help trans people cope with eating disorder risks? Research has shown that support from family, friends, peers, and more can play a major role in significantly reducing the odds of developing disordered eating, and Avila says finding that support is crucial. “Treatment of gender dysphoria with hormonal interventions also decreases those risks,” he adds. “Those findings suggest that untreated gender dysphoria—the lack of social interventions such as acceptance of your identity by family/friends and your social circles in general and/or the lack of medical interventions (when needed)—is a major risk factor for the development of disordered eating, which can then develop into an eating disorder.” Another essential step in improving the landscape of diagnosis and care in the trans community is to educate medical providers and increase awareness of trans-specific issues. “Because early recognition of any condition is very important and because there is a high degree of intersection between body dysmorphia and gender dysphoria, our healthcare provider community should be particularly sensitive to screen for gender dysphoria in individuals with an eating disorder, and to screen for eating disorders in individuals with gender dysphoria,” Avila says. Recommended screening measures include the Gender Identity Reflection & Rumination Scale (GRRS) for gender dysphoria and the Eating Disorder Examination Questionnaire Short Form (EDE-QS) for eating disorders. As experts and advocates continue to pave the way for more comprehensive, informed, compassionate care for the trans community, it’s critical for our society to start recognizing and respecting the spectrum of issues all individuals face in the fight against eating disorders. Keeping the dialogue open and honest is a goal we should strive for not just during Pride Month, but all year round.]]></content:encoded>
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            <title><![CDATA[What's the Connection Between Body Image and Eating Disorders?]]></title>
            <link>https://equip.health/articles/body-image/body-image-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/body-image-and-eating-disorders</guid>
            <pubDate>Wed, 07 Dec 2022 00:22:00 GMT</pubDate>
            <content:encoded><![CDATA[ The phrase “body image” has become part of the fabric of daily language — you see it in magazines and newspapers, hear it on TV, use it in everyday conversation. But what’s less well understood is the intersection of body image and eating disorders. They’re related, certainly, but how? Does negative body image cause eating disorders? Do all eating disorders involve body image issues? The answer, as with most things related to eating disorders, is complex. What exactly is body image? Body image, at the highest level, is the subjective picture you have of your body, regardless of what it actually looks like. Breaking it down a bit, body image reveals itself as a multidimensional concept, comprised of cognitive, perceptual, behavioral, and emotional components that all come together to shape your relationship to the body you live in. It encompasses your thoughts, feelings, attitudes, and behaviors toward your body, impacting how you react when you see yourself in the mirror, put on clothes in the morning, or get your picture taken. Everyone’s relationship to their body is complex and ever-changing; however, when thinking about how body image can impact someone’s life, it can be helpful to apply some broad definitions. For people with healthy body image, their body doesn’t take up too much space in their mind. They see their physical form fairly objectively, and can separate their value as a person from the way they look. Those with negative body image (which is also referred to as distorted body image or body dissatisfaction) have a less straightforward relationship with their bodies. When they look in the mirror, they don’t see the physical reality — a yellow shirt, a ponytail, the curves and lines and objective shape of their body — but rather a distorted perception that may evoke shame, anxiety, and self-consciousness. But negative body image doesn’t disappear when they look away from the mirror. It’s an abiding state of mind that follows them when they step away from their reflection and go about their life. It can have a negative impact on self-esteem, mood, social and occupational functioning, and health. “Many people think of body image as a vanity issue, although we know that it’s much more than that,” says Equip Senior Program Development Lead Ally Duvall. “It’s a mental health issue that leads to higher risks of eating disorders, anxiety disorders, low self-esteem, depression, suicidal ideation, and impaired functioning.” How common is negative body image? Given how much negative body image can impair a person’s life, it’s disheartening to learn of how pervasive it is, especially among young people. While body image dissatisfaction can occur at any age (depending on the source, researchers put the global rate between 30-75% of people), studies observe the highest levels in adolescence and early adulthood, and especially among women. You see this play out in some truly heartbreaking research of school-age kids: one study found that 77% of adolescent girls reported body image dissatisfaction, while another found that around 60% of girls expressed a desire to lose weight. Still more research showed that girls start to express concerns about their weight or shape by just six years old, and 40-60% of elementary school girls are concerned about their weight or becoming “too fat.” While much of the research on negative body image has focused on girls, boys aren’t exempt. Nearly one third of teenage boys use unhealthy weight control behaviors like skipping meals, vomiting, or taking laxatives, and one study found that 69% of teen boys were self-conscious about their bodies. Indeed, research shows that while many boys and young men are feeling increased pressure to be muscular and lean, they don’t admit to these feelings because of a perception that body image is a “girl’s issue.” To understand why negative body image has become the rule rather than the exception, you don’t need to look too hard. “We’re constantly inundated with reasons we should change our bodies and appearance: TV shows, movies, our friends and family, various products, and social media all tell us that we’ll be more lovable, respected, worthy of a life worth living if our body looks smaller and thinner,” says Duvall. “We’re not born hating our thighs or wishing our stomachs were smaller. These are beliefs we develop through social and interpersonal conditioning. If all you hear is how you should change your body and all the reasons your current self is not enough, it would be extremely difficult to find value and love for yourself, as you are right now.” What’s the relationship between negative body image and eating disorders? While the numbers above show that a huge proportion of people have negative body image, just 9% of the U.S. population will be affected by an eating disorder in their lifetime. This, of course, drives home the point that not everyone who is dissatisfied with their body will develop an eating disorder — but the former can definitely play a role in the latter. It’s important first to understand that there’s never any one cause of an eating disorder; in the absence of other factors, negative body image alone isn’t going to lead someone down the path to anorexia, for instance. “There’s no singular cause of an eating disorder, and yet we know that there are various factors that can increase someone’s risk of developing one,” says Cara Bohon, Equip’s VP of Clinical Programs. She explains that body dissatisfaction has been shown to predict the development of eating disorders, meaning that people who report body dissatisfaction have a greater risk of developing an eating disorder later in life. Indeed, research indicates that body dissatisfaction is a core element of many eating disorders, and it’s the best-known contributor to the development of anorexia and bulimia. But, as the numbers show, the relationship between negative body image and eating disorders isn’t one-to-one: many people without eating disorders struggle with body dissatisfaction. Although it was formerly assumed that people without eating disorders had a positive perception of their own bodies, more recent research has shown that body image distortions commonly occur in people without a diagnosis. “Poor body image experienced by someone without an eating disorder may be very similar to that experienced by someone with an eating disorder, although the feeling is likely more intense in those with eating disorders,” Bohon explains. “The core root of the body image distress, however, is likely the same: society’s appearance ideals and the internalized pressures we feel to meet those ideals.” And here’s one more nuance to the relationship between body image and eating disorders: just as not everyone with poor body image has an eating disorder, not everyone with an eating disorder has poor body image. Whether or not someone with an eating disorder experiences body dissatisfaction depends largely on the type of eating disorder they have. In the case of anorexia and bulimia, negative body image is part and parcel of the diagnosis. Both diseases are characterized by a fixation on shape and weight, as well as a distorted view of one’s own body (for example, one study showed that people with anorexia tend to overestimate their body size). With other eating disorder diagnoses, negative body image isn’t a given. The relationship between binge eating disorder (BED) and negative body image hasn’t been very thoroughly examined, but initial studies show that people with BED are more concerned with weight and shape than those without BED. With avoidant-restrictive food intake disorder (ARFID), the diagnostic criteria actually specifies that there be no distorted body image, however people with ARFID may still have internalized society’s thin ideals and aspire to look a certain way. Do you need to address negative body image to recover from an eating disorder? With eating disorders like anorexia and bulimia, where negative body image is a core component of the illness, it might seem logical that improving body image should be a first priority in recovery — but research doesn’t support this idea. “Because physical nourishment is disrupted by eating disorders, most treatment starts with a focus on normalizing eating patterns,” explains Bohon. “For some people, the process of improving nutrition leads to a shift in how they experience their body. For example, some people gain weight with treatment, and the improved quality of life coupled with a growing body can have a strong, positive influence on their body image.” For others, though, it’s necessary to address body image concerns directly. In fact, this step can be a vital part of treatment, as research has shown that lingering concerns about body size and shape is linked to a higher risk of relapse. Even in these cases, however, it’s important to remember that this will come later in treatment. “Body image is generally one of the last symptoms of an eating disorder to recover,” Bohon says. Duvall says improving body image can be “a vital puzzle piece of recovery,” for some, pointing to her own journey as an example. “I could have put in all the work to learn new skills and not engage in harmful behaviors, but the world would still treat me horribly because of my fat body. If I didn’t have the opportunity to focus on my body image concerns and start challenging societal fatphobia while in treatment, I don’t believe my recovery would be as strong as it is.” But eating disorder or not, healthy body image is a journey, not a destination. There will be ups and downs, and negative body thoughts will almost inevitably arise even after putting in the work. “Because body image dissatisfaction is so pervasive in our society, it’s unrealistic for many people to recover from their eating disorder without any body dissatisfaction — it’s become part of the human experience in our culture,” says Bohon. The goal of recovery, she explains, is for body dissatisfaction to not impact a person’s eating, exercise, work, relationships, or other aspects of their life. It’s important to keep this last piece in mind, to remember that body image isn’t static, but rather ever-evolving; because of the very nature of our world, we need to work to protect it from society’s onslaughts, but we also need to recognize that we haven’t failed when there’s a chink in the armor. As Duvall puts it, “having tough body image days or a conflicted relationship with your body doesn’t dictate if you’re recovered or not.”]]></content:encoded>
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            <title><![CDATA[Anorexia Causes: How Biology, Environment, and Psychology Intersect]]></title>
            <link>https://equip.health/articles/understanding-eds/causes-of-anorexia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/causes-of-anorexia</guid>
            <pubDate>Mon, 23 Feb 2026 22:38:00 GMT</pubDate>
            <content:encoded><![CDATA[When people ask what caused my anorexia, I still hesitate—not because I don’t have ideas, but because the question assumes there’s a single, clear answer. There wasn’t. It developed gradually, shaped by a mix of biology, personality, and circumstances that I didn’t understand were causes of anorexia at the time. That uncertainty is familiar to many parents and caregivers. A diagnosis of anorexia often comes with shock, fear, and guilt, along with questions like: Did I cause this? How did this happen? People experiencing anorexia may ask the same thing in a different way: Why me? Here’s the most important thing to know upfront: anorexia does not have a single cause. It isn’t caused by bad parenting, vanity, or a lack of willpower. “Anorexia is a genetically loaded gun,” explains Michael Wetter, PsyD, ABPP, FAACO, a psychologist at UCLA Health and owner of Wetter Psychological Services. “Any number of environmental or societal factors can pull the trigger.” That said, you don’t need to identify a specific cause to deserve help or begin recovery. Here, learn how anorexia can develop, what contributes to it, and what doesn’t, so you can move forward with clarity rather than blame. The basics to know about anorexia Anorexia nervosa is widely known, but it’s actually less common than many other eating disorder diagnoses. Estimates suggest it affects up to about 4% of women and 0.3% of men. It typically develops in kids and teens aged 11 to 19 years old, but can affect people at any stage of life, including young children and older adults. At its core, anorexia involves ongoing food restriction and intense fear of weight gain or body changes. Because restriction can lead to malnutrition, anorexia is the most life-threatening eating disorder. It has one of the highest mortality rates of any psychiatric illness, with more than 5% of people dying within four years of diagnosis. Rates of anorexia have increased in recent years, especially among adolescent girls and young adult women.  But anorexia doesn’t look the same for everyone—symptoms can vary widely, and so can the factors that contribute to how the illness develops. Common signs of anorexia can include: Eating much less than the body needs or tightly restricting certain foods Feeling uncomfortable or avoiding eating in front of others Ritualized or obsessive eating behaviors Being highly focused on weight, shape, or body size Noticeable or ongoing weight loss It’s also important to know that anorexia isn’t defined by your appearance. You don’t need to look underweight to be at risk or need help. People of any body size can experience anorexia and its physical and mental effects. In fact, there’s a specific diagnosis for people who meet all the criteria for anorexia except for low body weight, known as atypical anorexia. What causes anorexia? “Anorexia is a complex mental health condition,” says Sonya Elefante, LCSW, LCADC, a therapist at Equip. “There are several factors that increase the likelihood of developing AN, though none are predictive on their own. These risk factors span biological, psychological, social, and cultural domains.” It’s helpful to think of anorexia as a process rather than a formula. There isn’t a set equation where certain traits or experiences automatically lead to the disorder. Some people have underlying vulnerabilities and need only a small trigger for symptoms to emerge. Others may have fewer risk factors but experience a cluster of stressors that shifts their relationship with food and their body, explains Wetter.  Clinicians often group these influences into three categories. These categories overlap and interact, and their balance looks different for every person: Risk factors that increase vulnerability Triggers that mark the start of restrictive behaviors Reinforcing factors that keep anorexia going once it begins Risk Factors vs. Triggers vs. Reinforcing Factors Risk factors increase vulnerability over time Genetics Brain chemistry Perfectionism Anxiety or OCD traits Neurodivergence Gender-related stress Triggers activate existing vulnerability Dieting or restriction Illness or weight loss Stress or life changes Puberty Trauma Weight-focused sports Cultural body pressure Reinforcing factors keep the cycle going Restriction provides relief from hard emotions Brain changes from underfueling Praise for weight loss Weight stigma Fewer coping skills What are the risk factors for anorexia? Risk factors are not causes of eating disorders. Having one—or even several—doesn’t mean someone will develop anorexia. They simply increase a person’s vulnerability, especially when multiple factors overlap. Often, these vulnerabilities have been there for a long time, even before anyone notices changes in eating, which can make anorexia feel like it came out of nowhere. Genetics Research consistently shows that your genetics are part of the story. If you have a close family member with anorexia or another eating disorder, your own risk is higher, says Elefante. “This increased risk likely reflects a combination of genetic influences and environmental factors such as learned behaviors,” she explains. This vulnerability often overlaps with family histories of anxiety, depression, or obsessive-compulsive traits, which commonly show up alongside anorexia, adds Wetter. Neurobiology For some people, the way their brain is wired can make them more vulnerable to anorexia, says Wetter. In fact, research has found differences in brain chemistry and in the systems that handle reward, fear, and impulse control among people who develop the illness. What this can mean in real life is that food restriction may feel unusually calming or relieving, especially during times of stress. Signals like hunger, fullness, or fatigue may also feel muted or confusing, making it easier for restriction to continue without setting off internal alarms. These are brain-based differences, not choices or personal failures. Psychological traits According to Wetter, certain personality traits and thinking patterns also show up frequently before anorexia develops, such as: Perfectionism Rigid thinking Feeling uncomfortable with uncertainty and change Wetter adds that difficulty tolerating distress and managing strong emotions, particularly during stressful or overwhelming periods, often overlaps with anorexia, too. For some, restriction can start to feel like a way to cope—even though it ultimately makes things harder. Neurodivergence Neurodivergent people, including those with autism or ADHD, may face additional challenges that increase vulnerability. Sensory sensitivities, strong preferences for routine, or intense focus on rules can make eating more complicated, even before any disordered behaviors appear. For example, certain food textures, unpredictability around meals, or changes in routine can be genuinely distressing. These traits don’t cause anorexia—but in the right (or wrong) circumstances, they can make someone more vulnerable. Sex and gender identity Anorexia affects people of all genders. While it’s more commonly diagnosed in women and girls, boys, men, and transgender and nonbinary individuals are likely underdiagnosed and may face more barriers to care, says Elefante. Transgender and gender-diverse youth, in particular, may experience added vulnerability related to body distress, gender dysphoria, minority stress, or lack of affirming support. Taken together, these risk factors help explain why anorexia can develop in people who seem outwardly “fine,” and why there’s never a single, simple explanation. Most importantly, they reinforce a truth many families and individuals need to hear: Vulnerability is not a failure, and it’s not something anyone chooses. What are common triggers that can lead to anorexia? Triggers don’t cause anorexia on their own. Instead, they can be what “turns on” an eating disorder when biological and psychological risk factors are already present, explains Wetter. Often, triggers are ordinary life experiences—things that wouldn’t cause an eating disorder in most people, but can tip the balance for someone who’s already vulnerable. “It is important to note that while these circumstances may act as a catalyst or accelerate progression, they do not cause the eating disorder,” adds Elefante. Dieting, restriction, and negative energy balance Dieting and intentional restriction are among the most common triggers for anorexia, says Wetter. Most people aren’t trying to develop an eating disorder—they’re trying to be “healthier,” or under-eating due to a busy schedule, or responding to subtle pressure around weight or food. That’s how it started for me.  Here’s how this happens: restriction can lead to negative energy balance (also known as a calories deficit), meaning the body is burning more fuel than it’s getting. If you’re vulnerable to anorexia, this state can change how the brain functions, increasing anxiety around food while also making restriction feel relieving or calming. Over time, that relief can reinforce the behavior and make it harder to stop. Negative Energy Balance, Explained What it is: The body isn’t getting enough fuel to meet its needs. What happens: Hunger signals get quieter Anxiety around food increases Restriction can feel calming or relieving Why it matters: In vulnerable brains, underfueling can “flip a switch,” reinforcing restrictive behaviors even when no harm is intended. Key takeaway: This is a biological response, not a choice. Puberty Puberty is a period of intense physical, emotional, and neurological change. Hormonal shifts, rapid growth, and body changes can increase vulnerability, especially for kids and teens who are sensitive to control, perfectionism, or body discomfort. During this stage, even small changes in eating or activity can have outsized effects on the brain and body. Trauma, stress, and life transitions According to Elefante, restriction can become a coping mechanism when life feels unpredictable or emotionally overwhelming. Traumatic or stressful events that can contribute to this include: Bullying Grief Abuse Illness Family conflict Divorce Moving Starting a new school or job Media and cultural messages Cultural pressure around body size, health, and appearance can also act as a trigger, especially if you’re already vulnerable to the condition, says Wetter. This can look like: Exposure to unrealistic body “ideals” or diet culture “Clean eating” messages Constant comparison on social media Altogether, these factors can quietly shape beliefs about worth, control, and success. While these messages don’t cause anorexia by themselves, they can normalize restriction and make early symptoms harder to recognize. Athletic and professional pressures Certain sports and performance-driven environments place extra emphasis on body size, weight, or appearance. In these settings, early restriction may be praised or encouraged, which can delay concern and reinforce eating disorders in athletes. While eating disorders can affect athletes in any sport, the activities most commonly associated with anorexia include:: Gymnastics Ballet Figure skating Cheerleading Wrestling Distance running Bodybuilding Weight-class sports What factors reinforce anorexia? “The same factors that increase the risk of developing AN can also reinforce symptoms,” says Elefante. Changes in the brain, body, and environment can also quickly turn early symptoms into a self-perpetuating cycle. Restriction as a coping mechanism In the short term, restriction can feel like it helps, according to Wetter. For some people, eating less brings a sense of control during chaotic or stressful periods. For others, it numbs difficult emotions or quiets anxiety. That relief is temporary, but it’s powerful. Over time, as restriction becomes a go-to coping strategy, healthier ways of managing stress or emotions get crowded out. The brain learns, incorrectly, that not eating is what keeps things manageable. Malnutrition affects the brain Malnutrition doesn’t just affect the body—it significantly affects the brain. One of the clearest examples of this is the Minnesota Starvation Study, which found that prolonged energy restriction leads to increased anxiety, obsessive and rigid thinking, and preoccupation with food. Put simply, starvation alters brain chemistry in ways that can reinforce anorexia, says Wetter. Prolonged restriction can heighten fear around eating, contribute to rigid thinking, and make it harder to think clearly or change course. In this state, continuing to restrict can actually feel psychologically rewarding, even as physical health deteriorates. It’s important to remember this isn’t a character flaw—it’s a predictable biological response to underfueling. Social reinforcement and weight stigma External feedback can also reinforce anorexia, often unintentionally. In a culture that praises weight loss, early changes in eating or body size may be met with compliments or encouragement, says Wetter. I experienced this firsthand—at first, the attention felt positive, even affirming. Those responses can quietly reinforce restriction and make it harder for anyone to recognize what’s really happening. When weight loss is automatically treated as a good thing, early signs of distress or malnutrition are easier to miss (or are brushed off altogether). This is especially true for people in large bodies, who are more likely to have their symptoms dismissed or praised, allowing anorexia to progress further before it’s named or treated. What doesn’t cause anorexia? When anorexia shows up, it’s common for people—especially parents and caregivers—to blame themselves or others for things that do not actually cause anorexia, including: Bad parenting: Anorexia isn’t the result of being too strict, too permissive, too focused on food, or not focused enough. Parents do not cause anorexia, even when symptoms first appear at home. Vanity: Anorexia isn’t caused by a desire to be thin, a phase, or a bid for control or approval, says Wetter. People don’t choose anorexia, and they don’t stay in it because they enjoy it. Lack of willpower or motivation: Anorexia is a serious mental illness that changes how the brain and body function. Once restriction takes hold, willpower alone isn’t enough to undo it, he says. A single comment, meal, or mistake: Even well-intended remarks about food, bodies, or health do not cause anorexia on their own. The illness develops through a much broader and more complex process. “Anorexia is not a lifestyle choice [or] moral failing,” says Wetter. “People do not choose to develop anorexia, nor can they 'snap out of it' through willpower alone.” These misconceptions can carry a real emotional cost. Blame and guilt often slow down help-seeking and add unnecessary distress. Understanding what doesn’t cause anorexia helps shift the focus back to support, care, and healing. What Doesn’t Cause Anorexia Bad parenting Vanity Desire to be thin Lack of willpower A phase A single comment or meal Anorexia is a serious illness, not a personal failure or parenting mistake. The bottom line There’s never one cause of anorexia, and it doesn’t follow a single path. Instead, it develops through a mix of biological vulnerability, psychological traits, and life experiences that interact over time. For many families and individuals, that complexity is exactly what makes the illness so confusing. What matters most is this: No one causes anorexia, and you don’t need to understand why it started in order to deserve help. You don’t have to wait until things get worse. You don’t have to be certain. And you don’t have to carry guilt as proof that you care. Anorexia is serious, but it is also treatable. With the right support, nourishment, and evidence-based care, recovery is possible. Reaching out sooner rather than later can make a meaningful difference, for both the person experiencing anorexia and the people who love them. If you’re here wondering whether it’s time to ask for help, that question alone is often reason enough to start the conversation. FAQ How does anorexia develop? Anorexia usually develops over time. It often begins when underlying vulnerabilities—like genetics, anxiety, perfectionism, or how the brain responds to stress—intersect with something that changes eating, such as dieting, illness, stress, or a major life shift. Once restriction begins, underfueling can change how the brain works, making the behaviors feel harder to stop. That’s why anorexia can feel like it took over, even if it didn’t begin that way. Can anorexia develop without dieting or trying to lose weight? Yes. Dieting is common, but it’s not the only path. Anorexia can also begin after unintentional weight loss from illness, increased activity, chronic stress, or skipped meals during busy or overwhelming periods. In some cases, restriction starts as a way to cope or feel in control, not to lose weight. What matters isn’t the original intention, but what happens when the body isn’t getting enough fuel. Do you need to know what caused anorexia to treat it? No. You don’t need a clear explanation or a single “cause” to start treatment or recover. Many people never land on a neat answer, and that’s completely okay. Treatment focuses on nourishment, support, and breaking the patterns that keep anorexia going, not on figuring out exactly how it started. 
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            <title><![CDATA[Autism and Eating Disorders: Exploring the Complex Relationship Between These Conditions]]></title>
            <link>https://equip.health/articles/understanding-eds/equip-academy-autism-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/equip-academy-autism-and-eating-disorders</guid>
            <pubDate>Tue, 14 Jan 2025 19:14:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. There is significant overlap between autism and eating disorders. In this article, I’ll describe the common presentations of co-occurring eating disorders and autism, explore treatment outcomes for patients with autism and eating disorders, and discuss ways in which evidence-based interventions can be adapted for the treatment of these two conditions. What is autism? Defining the terms First, let’s define some of the terms we’ll be using here and what we mean by them. When we speak of autism, we’re referring to a specific expression of neurodivergence, while acknowledging that many other neurodivergences exist and may be impactful to eating disorder treatment. The neurodivergent umbrella also encompasses: Attention deficit hyperactivity disorder (ADHD) Obsessive-compulsive disorder (OCD) Dyslexia Epilepsy Misophonia Tic disorders Post-traumatic stress disorder (PTSD) Bipolar disorder …and many others Like other aspects of neurodivergence, autism is defined by differences in the way in which people learn, communicate, interact, and behave. Autism presents in many different ways, and is generally characterized by: Challenges communicating with others or understanding how others feel Specific or narrow areas of interest Engaging in repetitive movements or behaviors However, it’s important to keep in mind the principle that if you know one person with autism, you know one person with autism. The spectrum is vast and diverse, and while we will discuss specific concerns and strategies today, we want to remind everyone that it will be critical to adapt these strategies to fit the unique and specific needs of each individual. We will also be aiming to use identify-first language (i.e., “autistic person” rather than “a person with autism”), as that is the preference for most people in the autism community. However, this preference is not universal and we may, at times, slip into person-first language. It is always important to ask someone what their language preferences are with respect to autism and to not make assumptions. The perspective reflected here is informed by research, clinical training, and from our colleagues and clients with lived experience of autism. The overlap between autism and eating disorders The overlap of autism and eating disorders is much higher than previously thought. Research shows that 37% of people with anorexia nervosa have autism, and that 55% of people with ARFID have autism and other developmental conditions. While there are fewer studies, an overlap exists between autism and bulimia nervosa and binge eating disorder, too. Case examples Consider these two case examples to understand some of the different ways that co-occurring autism and eating disorders might present: Grace: autism and anorexia Grace was a young teenage girl diagnosed with autism. She had an intense interest in and passion for animals. A video at school on the meat industry led her to become a vegetarian. This focus then turned to “healthy eating.” Grace later said that the desire to eat healthy became one of the extreme areas of focus for her autism. She controlled all of her meals at home, sometimes having intense outbursts if her mother stepped in to get her to eat more. She struggled to eat with others, particularly her brother who she said was “gross” at mealtimes. Andrew: autism and ARFID Andrew was an elementary school-aged boy who had always preferred a small number of foods. He lived in a large city and had specific street vendors or small shops that served the foods he preferred most. Each day, his mother would go out and purchase all the foods he needed for each meal. Attempts to swap frozen or homemade versions resulted in tears and refusal to eat. His growth was poor and the family felt very stuck and isolated. Andrew’s clinicians wondered if Andrew might have autism. Similarities between autism and eating disorders The overlap between autism and eating disorders can be better understood by looking at some of the similarities between the two conditions. Cognitive processing styles Both people with autism and people with eating disorders, particularly anorexia and ARFID, may struggle with areas of executive functioning, such as difficulty set shifting and more rigid thinking styles. Black-and-white thinking and preference for routine are also common. Differences in social and emotional communication Difficulty identifying and understanding other people’s emotions, trouble interpreting facial expressions, and a lower tendency to study facial features are all traits that appear to link autism and anorexia. Sensory sensitivities Differences in sensory processing are common among people with autism, and also drive one of the three main presentations of ARFID: food avoidance due to sensory sensitivity. Hypo- and hyper-sensitivity can apply to food, noise, light, clothing, and more. Challenges to treatment for co-occurring autism and eating disorders Research shows that patients with co-occurring autism and eating disorders face a number of barriers to treatment, and may have a more difficult time achieving recovery. Late diagnosis Many women diagnosed with autism and eating disorders received their eating disorder diagnosis first. Autism often goes undiagnosed in women because they learn to mask (suppress autistic behaviors in an attempt to “fit in”). Lack of training Many eating disorder clinicians report a lack of training or familiarity with autism. Therefore, clinicians have also expressed a lack of confidence in working with autistic patients. Greater treatment utilization In general, research is mixed regarding the impact of autistic traits on eating disorder treatment outcomes. However, autistic patients do have longer hospital stays and spend more days in PHP/IOP treatment settings. Adapting treatment for autistic patients There have been a number of studies and research initiatives that provide guidance on treating autistic patients with eating disorders. The accommodations we’ll review in this article have been drawn from our own clinical experiences as well as the following studies and resources: The PEACE Pathway This resource includes recommendations for specialist inpatient and day programs that involve staff training, changes to the clinic environment, and use of special menus. Loomes and Bryant-Waugh These researchers have provided detailed descriptions of how family-based treatment (FBT) could be adapted to meet the needs of autistic patients with anorexia. Field, Fox, Jones & Williams These researchers conducted a Delphi study that brought together expertise from clinicians, researchers, and lived experience to generate consensus statements on the needs and service recommendations for autism and anorexia. There are distinct aspects of autism that can impact eating behaviors and should be considered in treatment. The five that we’ll focus on here are: Sensory processing Executive functioning Communication Behaviors Demand avoidance Sensory processing Many people with autism experience an increased or decreased reactivity to sensory input. Sensory processing may influence eating and feeding from a biopsychosocial perspective, and can have a wide impact on eating, including food aversions, insistence on sameness, social eating, hunger and satiety cues, body image, and intuitive eating. Given all this, it may be necessary to adapt environment and meal plans to accommodate the sensory needs of autistic patients. Eating and feeding behaviors impacted by sensory processing issues for autistic individuals can be categorized into three main areas: exteroception, interoception, and proprioception. Exteroception Exteroception is the process of perceiving the external environment through the senses (vision, hearing, touch, smell, and taste). When possible, providers can accommodate exteroceptive preferences related to both the environment and food in order to help reduce overall anxiety. Environmental accommodations: Minimizing sensory triggers or distractions by dimming bright lights, creating a quiet environment, or allowing for noise-cancelling headphones, for example. Food-related accommodations: Adjusting the temperature and texture of foods, and incorporating the use of appropriate distractions during mealtimes, like music, fidgets, etc. Interoception Interoception is the ability to sense and be aware of internal bodily sensations, such as heart rate, hunger, fullness, thirst, temperature, pain, etc. When possible, providers should work with individuals to identify how their interoceptive awareness interacts with their feeding and adapt treatment goals and strategies based on individual needs. Is the individual you’re working with able to feel the sensation of hunger, fullness, and thirst? How do they experience and communicate temperature, pain, etc.? Proprioception Proprioception is the perception or awareness of the position and movement of the body. People with autism may experience atypical proprioception, and they may prefer to move or position their bodies differently when eating (for example, eating while standing or walking, eating while lying down, etc.). When possible and appropriate, providers should allow individuals to eat in positions that fit their needs and are comfortable for them to facilitate a positive eating experience. Executive functioning People with autism may have difficulty with executive functioning. This can create challenges with working memory, cognitive flexibility, and inhibition control (self-regulation), which could result in issues around managing everyday tasks like planning, problem-solving, and adjusting to new situations. Adding tools, such as visual cues and communication systems, can help support executive functioning needs during treatment. Some strategies and examples to consider: Create predictable routines and meal plans. This can help people on the autism spectrum prepare for and manage stress and anxiety while they adapt to changes, expectations, and switching tasks at mealtimes. Use visual systems. For many people with autism, visualizing their way through a specific task or process can be incredibly helpful. For instance, visualizing the steps involved in making a meal (gathering all of your ingredients and utensils, breaking down each step of the instructions, etc.). Adapt systems and tools based on each individual’s preferences and needs (visual versus verbal, specific challenges, etc). Communication Many people on the autism spectrum experience difficulties with communication, including auditory processing speed differences. Communication is a key aspect of interpersonal relationships, connection, and self-advocacy, so it is essential to support and accommodate this need when working with individuals on the spectrum. Providers should take care to use alternative language tools and options to support communication with patients who have co-occurring autism and eating disorders. Some strategies and considerations to keep in mind: Be patient and allow extra time for responses. Avoid rushing or adding pressure to communicate, especially at meal times. Bolster the ease of communication by stating clear and reasonable plans, goals, and expectations ahead of time Add visual communication aids, such as visual schedules, timers, etc. Use different communication tools and options such as AACs (Augmentative and Alternative Communication systems) and/or sign language to support communication. Literal thinking can influence eating-related behaviors for individuals on the spectrum. Diet culture and health messaging may be interpreted as rules that must be followed, and it can be difficult for them to separate from them (e.g., food morality: “good” versus “bad” foods). Behaviors In treating patients who have co-occurring autism and eating disorders, it can be helpful to understand how different behaviors may be used as coping mechanisms. The strategies below can help you address unwanted behaviors appropriately in autistic patients: When addressing behaviors, concentrate on the eating behavior goal, not the individual’s disruptive or distracting behaviors. Establish a routine and make meals predictable, which will help increase feelings of control and decrease feelings of uncertainty and disruption. Model appropriate behavior during food exposure. Use yourself as a model to demonstrate eating new foods, trying something different, using coping skills at mealtime, etc. Non-injurious stimming (self-stimulatory) behaviors—like hand flapping, fidgeting, rocking, clapping, and repeating words or sounds (echolalia or palilalia)—can be very important communicative, self-regulating, and self-soothing mechanisms for neurodivergent people. Don’t judge or stop these behaviors, as they may be a way for the individual to cope and work through a difficult meal exposure. Be mindful of social factors. People on the spectrum may prefer to eat alone, as social interactions and settings can contribute to sensory triggers and interrupt the focus and coping skills that are necessary for meal completion. Continue to build coping skills that can help with regulation. If a behavior is concerning and dangerous, consult with an autism professional to make a plan that supports the individual’s needs and health. Demand avoidance Individuals with demand avoidance may avoid or refuse certain tasks or activities that create discomfort or dysregulation with sensory overwhelm. Mealtimes often involve many demands—explicit and implicit—that set expectations, and this can become overwhelming and unbearable for some people on the spectrum. To avoid struggles around demands, you can employ a few strategies: Offer choices Use indirect phrasing instead of direct demands Encourage autonomy Working together with patients When treating patients who have co-occurring autism and eating disorders, it’s essential to work collaboratively together. Be creative, flexible, and focused. Work with the co-occurring diagnosis: invite autism into the room! Talk about their diagnosis from the beginning. This will create an environment where you can work together to identify accommodations. If you suspect a patient has autism but they haven’t yet been diagnosed, refer them out for an evaluation. You’ll both gain valuable information. Some strategies to create a collaborative, effective relationship with your autistic patients: Create a plan together by listening to the individual’s needs. As you listen to the individual’s needs, respect autonomy, promote self-efficacy, and encourage flexibility. Provide education, options, and rationale for accommodations and adaptations to help validate the individuals’ experience and create an environment of collaboration, trust, and autonomy. Ask the individual what their specific sensory triggers are (smells, sounds, colors, lights, textures, etc.). Work with the individual to make a list of accommodations that can help (eating alone vs. group, dimmed lights, quiet environment with access to headphones, etc.). Create a clear Cope Ahead plan that establishes what warning signs they show/feel/experience when feeling overwhelmed and/or overstimulated, and what coping skills they can use in that moment to help. Make sure this plan is visible at mealtimes as a reminder. Collaborate with other professionals, family members, and support systems to ensure all their needs are taken into consideration, and that follow-through and meal plans can be supported by all. This might include a registered dietitian for nutritional needs/deficiencies; speech pathologist for oral-motor difficulties, etc; occupational therapist for daily living skills; clinical neuropsychologist for diagnosing and treatment planning recommendations; psychiatrist for medications; RN/medical provider for medical support; therapist for mental health and eating disorder support. For more information on the intersection between autism and eating disorders and how to treat both, watch my recorded Equip Academy presentation on the topic. You can also explore past Equip Academy presentations and register for upcoming events here.]]></content:encoded>
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            <title><![CDATA[Can an Eating Disorder Test Tell You If You Should Be Worried?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorder-test</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorder-test</guid>
            <pubDate>Fri, 01 Sep 2023 21:24:00 GMT</pubDate>
            <content:encoded><![CDATA[Recognizing harmful habits—especially in yourself or a loved one—isn’t always easy, but it can go a long way in helping you identify an eating disorder and getting the necessary treatment. If you’ve recognized potential signs of disordered eating in yourself or someone close to you, it may be beneficial to take a comprehensive eating disorder test to determine if it’s time to get help. Below we’ll go over what a comprehensive eating disorder test does, signs that you should take one, and some initial self-assessment questions. The purpose of a comprehensive eating disorder test A comprehensive eating disorder test is essentially a screening tool to help you get a better idea of how your nutritional, emotional, cognitive, and behavioral patterns match with those of a diagnosable eating disorder. Regardless of the results, it can be helpful to complete an eating disorder test. The potential benefits include: Increasing your self-awareness about your mental, emotional, and behavioral health Helping you examine your relationship with food Offering a different perspective on your thoughts, emotions, and behaviors Identifying symptoms of other mental health disorders Helping you determine if you need to seek treatment The main goal of an eating disorder assessment is to help you see if you align with the symptoms of common eating disorders. The different types of eating disorder diagnoses (as outlined in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders) include: Anorexia nervosa: You have an extremely restricted diet and fear of gaining weight, as well as a disturbance in the way you view your body weight or shape. Avoidant restrictive food intake disorder (ARFID): You don’t eat enough food, enough food variety, or both, due to sensory sensitivities, disinterest, or fear of a bad outcome. Other specified feeding & eating disorder (OSFED): You have eating disorder symptoms that cause significant distress but do not meet criteria for a specific diagnosis. Bulimia nervosa: You experience recurrent episodes of binge eating, followed by compensatory behaviors (purging) like vomiting, laxative abuse, or exercise in an effort to control weight and shape. Binge eating disorder (BED): You experience recurrent episodes of binge eating in a short amount of time, causing intense distress. You experience a lack of control when eating, eat until uncomfortably full, and experience feelings of guilt and shame after the binge. Signs it’s time to take a comprehensive eating disorder test The symptoms of eating disorders can sometimes be hard to identify. For example, a loss of appetite or a habit of picky eating can appear normal, but if these behaviors are persistent and becoming more intense, they may be a sign of something serious. It’s never too early (or too late) to start reflecting on your eating habits and make a change, and one of the simplest first steps toward doing that is to take an eating disorder assessment. If you do meet the criteria for an eating disorder, you’ll be able to get connected with the proper resources, support, and treatment. Even though every eating disorder has different symptoms, there are some general warning signs that indicate you may be struggling with an eating disorder. Here are some signs that you should take an eating disorder assessment: High concern about weight loss Frequent dieting Refusal to eat particular foods or entire food groups Skipping meals or eating extremely small portions Notable weight fluctuations Severe mood swings Gastrointestinal issues Menstrual irregularities Self-assessment questions from a comprehensive eating disorder test A comprehensive eating disorder test gives you the opportunity to reflect on your own behaviors and compare them to common eating disorder symptoms. By contemplating these questions, you’ll be able to assess your mental, emotional, and physical health, as well as determine whether you may be struggling with an eating disorder. Here are a few self-assessment questions based on Equip’s eating disorder screening. Food-related signs: Do you avoid eating dinner with your family or in group settings? Are you fixated on the calorie count of every food or drink you consume? Do you rely on nutritional supplements to grow or treat deficiencies? Do you eat excessive amounts of food in a short period of time? Do you continue eating after you feel full? Are you worried about getting sick or choking if you eat certain foods? Do you avoid certain foods due to their texture or color? Are you constantly trying a new diet? Exercise-related signs: Do you feel required to exercise as a way to compensate for or “earn” eating? Have you experienced injuries from overexercise? Do you exercise even when you feel sick or there’s bad weather? Are you rigid about your workouts, scheduling your life around them? Emotional signs: Do you feel withdrawn from your social relationships? Have you been feeling weak or dehydrated? Do you experience hyperactivity? Do you struggle with mood swings? Navigating the results of an eating disorder test If your screening shows that you align with the symptoms of an eating disorder, it’s important not to take the results as a formal diagnosis. Similarly, if your results indicate that you don’t have an eating disorder but you’re still worried, you shouldn’t brush off your concerns. These tests aren’t foolproof and they’re not meant to be used for making diagnoses; they’re simply tools that can be helpful for some people in determining whether or not to seek an expert assessment. You can also schedule a free consultation with the Equip team to help you take the next step toward addressing your concerns. If you are diagnosed with an eating disorder, Equip can match you with a multidisciplinary care team to normalize your eating habits, manage triggers, and improve your overall quality of life—entirely from home.]]></content:encoded>
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            <title><![CDATA[Unpacking the Relationship Between ARFID and OCD ]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-and-ocd</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-and-ocd</guid>
            <pubDate>Thu, 23 Oct 2025 16:30:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’ve ever experienced an eating disorder or know someone who has, you’re likely familiar with the array of obsessive thoughts and compulsive behaviors that often accompany these illnesses. For some, obsessing over food, weight, or body size can lead to high anxiety and compulsions like restricting, purging, or over-exercising to cope with those anxious feelings. That uncontrollable combination of obsessions and compulsions is an inherent part of obsessive-compulsive disorder (OCD), a mental illness that up to 60% of people with eating disorders experience. While it may be easy to see how the symptoms of OCD can sometimes overlap with those of diagnoses like anorexia (which involves food restriction) and bulimia (which includes purging) it may not be as clear in the cases of other eating disorders. Avoidant/restrictive food intake disorder (ARFID), for example, is an eating disorder characterized by a disturbance in eating or feeding that’s not driven by fear of weight gain, distorted body image, or a desire to change body shape or size. But ARFID and OCD do intersect—just in a different way. “ARFID involves restriction of food variety, volume, or both, due to a variety of possible factors, including sensitivity to sensory aspects of food, lack of interest in food, or concern about perceived negative outcomes of eating,” says Equip Clinical Instructor, Michelle Jones, PhD. “For people with ARFID, this restrictive eating results in low weight or failure to grow as expected in children, nutritional deficiencies, heavy reliance on nutritional supplements, and problems with psychosocial functioning.” Read on to better understand how ARFID and OCD might intersect, the differences and similarities between the diagnoses, and how to seek effective treatment for both. How often do ARFID and OCD co-occur? While experts are well aware of the potential overlap between ARFID and OCD, more research is needed to investigate how often they co-occur. “There’s limited research on the comorbidity rates of ARFID and OCD,” Jones says. “However, the rates of diagnosed anxiety disorders, including OCD, within individuals diagnosed with ARFID are high, with studies estimating 40-70% of patients diagnosed with ARFID also meet criteria for an anxiety disorder.” One study on adolescents with ARFID found a significant presence of OCD symptoms, with 67% of participants experiencing mild-to-severe OCD symptoms. Another study involving adults with ARFID found that 6.1% of those with ARFID also had a formal OCD diagnosis. In her clinical experience and current work supervising therapists at Equip, Jones says she has anecdotally seen OCD frequently co-occur with ARFID. “Particularly with patients who experience intense fears of negative outcomes occurring during or after eating, like vomiting, choking, pain, and allergic reaction,” she says. Differentiating between ARFID and OCD: similarities and differences ARFID and OCD share more similarities than many people might realize. Both diagnoses typically involve high anxiety and the overestimation of negative outcomes. Additionally, both people with ARFID and those with OCD typically believe that by performing certain behaviors, they can control whether or not their expected negative outcomes occur. While both ARFID and OCD can vary significantly in how they present, Jones explains that it’s common for those diagnosed with both conditions to have intrusive thoughts about the potential for something bad to happen from eating. It’s also common to “engage in repetitive or ritualistic behaviors as a way to reduce the perceived likelihood of those outcomes from occurring,” Jones says. “For example, someone who is fearful of vomiting after eating may limit the overall amount of food they eat, but they may also chew each bite of food they do eat a specific number of times as a method of reducing their chances of vomiting.” While the diagnoses do share commonalities, there are also some important distinctions that make each one unique. “ARFID does not always involve repetitive or compulsive behaviors and thoughts related to negative outcomes,” Jones says. “Or negative experiences with foods may not always be experienced as intrusive or unwanted the way they would be in OCD. Additionally, OCD symptoms often don’t involve eating or food.” Treating ARFID and OCD together While exposure and response prevention (ERP) is widely considered to be the gold standard for OCD treatment, Jones explains that cognitive behavioral therapy for ARFID (CBT-AR) has the most substantial evidence to support its efficacy in treating ARFID. Because CBT-AR incorporates many elements of ERP, experts consider it the ideal option for treating ARFID and OCD simultaneously. In ERP, patients are purposefully exposed to the thoughts, images, objects, and situations that raise anxiety or provoke obsessions alongside a trained therapist. This allows them to encounter these triggers in a safe environment while learning to avoid their compulsive behaviors. ERP is typically the go-to treatment strategy for OCD, but it’s also been shown to be highly effective in treating ARFID. CBT-AR, on the other hand, is a specialized type of CBT that involves several phases: first, teaching patients about ARFID and how it manifests, and then prescribing interventions to help them notice and challenge ARFID-related thoughts and behaviors. These interventions often involved exposures in some capacity. “Depending on the extent of OCD symptoms, some patients who are being treated with CBT-AR may also need ERP or other OCD-specific interventions during or after their ARFID-specific treatment to more adequately address OCD symptomatology,” Jones adds. Considering treatment for any kind of psychological disorder can be scary and overwhelming—whether you’re experiencing symptoms yourself, or worried about a loved one.But seeking out experts who specialize in both ARFID and OCD is the key to receiving research-backed care that can lead to long-lasting success and permanent recovery. “My advice to parents whose child is experiencing both ARFID and OCD would be to find providers who specialize in these disorders and have training in evidence-based treatment options,” Jones says. “I would also reassure them that while these disorders are challenging and distress before and during treatment can be high, both ARFID and OCD are treatable and many individuals who experience these conditions can go on to live symptom-free.” At Equip, patients get individualized treatment plans, and our providers are trained in treating co-occurring conditions like OCD alongside eating disorders. Schedule a call with an Equip team member to talk through your concerns and learn if our virtual, evidence-based care is right for you or your loved one.]]></content:encoded>
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            <title><![CDATA[The Link Between ADHD and Eating Disorders: What We Know]]></title>
            <link>https://equip.health/articles/understanding-eds/adhd-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/adhd-and-eating-disorders</guid>
            <pubDate>Wed, 04 Mar 2026 21:25:00 GMT</pubDate>
            <content:encoded><![CDATA[Attention deficit hyperactivity disorder (ADHD) shows up differently from person to person. But a few common characteristics include difficulty with planning, organizing, focusing, managing time, adjusting to changes or new routines, and more. ADHD is not a character flaw; it’s a neurodevelopmental disorder that presents challenges with executive function, or the way your brain tackles tasks and regulates behaviors. The condition can affect your quality of life or that of a loved one. In comparison to ADHD, eating disorders are mental health conditions rather than developmental disorders. However, ADHD and eating disorders can significantly overlap. This doesn’t mean that one causes the other, just that they share some characteristics and can occur together. “ADHD and eating disorders can be intertwined in so many different ways,” says Brittany Lauro, a lead therapist at Equip who also has lived experience with ADHD, “from eating as a way to self-regulate, to forgetting to eat for long periods of time, to feelings of shame or guilt, perfectionism, and body image concerns. ADHD and all different forms of eating disorders can often pair together.” In this article, we explore ADHD and eating disorders, ADHD eating habits, ADHD and hunger cues, ADHD and appetite, ADHD and overeating, ADHD and impulsive eating, ADHD and food aversion, food noise and ADHD, food hyper-fixation, and more. Understanding the connection between ADHD and eating disorders The Venn diagram below shows, in a nutshell, how ADHD and eating disorders overlap through dopamine dysregulation, impulsivity, emotional dysregulation, and more. For those with ADHD, food can be both a stimulant and a tool for coping.  First, let’s unpack what ADHD and eating disorders are, and then we can explore more in depth how their characteristics overlap. What is ADHD? ADHD is a neurodevelopmental condition rooted in executive dysfunction. Executive functions are cognitive abilities that help you achieve goals, manage everyday life tasks, adapt to situations, and manage social interactions. Think of executive functioning as a project manager or coach in your brain. Having executive dysfunction means that your brain’s project manager just operates a little differently than that of the general population’s. Why? The exact cause is uncertain, but it’s potentially due to some structural or functional differences. Regardless of why it happens, executive dysfunction doesn’t mean a person is flawed. ADHD can affect quality of life, because of having to adjust to a world that often demands high executive functioning. (“In my opinion, the hardest part is living in a society that is designed around a completely different brain type and having to try to get by,” says Lauro). However, the condition is also linked to enhanced creativity, curiosity, adventurousness, determination, resilience, and even energy. The condition is common. More than 11% of children in the United States have an ADHD diagnosis, while about 6% of adults do. More males tend to get diagnosed than females, especially in childhood or adolescence, but ADHD is underdiagnosed in females because the condition can look a bit different based on sex assigned at birth. What are eating disorders? Eating disorders are a group of mental health conditions characterized by disturbances in eating behaviors and, often, a preoccupation with body size or weight. These disturbances can dramatically impact physical, psychological, and social health and overall functioning. Prevalence varies based on the specific eating disorder. Otherwise specified feeding and eating disorder (OSFED) the most common for females, while pica and rumination disorder are the least common. Binge eating disorder (BED) is the most common for males, while anorexia nervosa (AN) is the least common. About 14% of males and 20% of females in the United States will experience an eating disorder in their lifetime. However, eating disorders tend to be underdiagnosed in males. This likely stems from the way society tends to assume that eating disorders are largely a female issue, which is a myth. Additionally, stigma plays a role. How ADHD traits can affect eating patterns Having ADHD does not cause an eating disorder, and vice versa. But research has long found associations between ADHD and eating disorders. For example, some studies show that 20% of children with ADHD also develop eating disorders. This means that if you (or a loved one) has ADHD, then you may be more vulnerable to an eating disorder. Likewise, if you have an eating disorder, you might have undiagnosed ADHD. Some of the commonalities between ADHD and eating disorders can be found in the factors that contribute to both conditions. A common misconception about eating disorders is that they are caused by a desire to be thin or that they’re rooted in vanity. In reality, eating disorders are complex mental health conditions driven by a variety of factors, including: Brain chemistry (including levels of chemical messengers, such as dopamine or serotonin) Brain functionality (differences in brain networks and how they work together) Childhood trauma or trauma in general Cultural norms surrounding body size Genetics Personality traits such as perfectionism, obsessive-compulsive tendencies, and others Some of these issues—like genetic and environmental factors and differences in brain chemistry and functionality—can also contribute to ADHD. Additionally, ADHD traits can affect eating patterns, causing an additional level of vulnerability to developing an eating disorder. ADHD traits and how they may impact eating behavior  Lauro weighs in on some of the ways ADHD traits and eating disorder traits overlap. “ADHDers may lack internal sensing abilities that neurotypical people have, and thus it may not be realistic for us to rely on our hunger and fullness cues alone,” she says. Additionally, hunger cues may be absent to a certain extent, since some ADHD medications can suppress appetite while also revving metabolism, leading to weight loss. “ADHDers are also often sensory seekers,” she says. “Movement helps me focus and regulate. I can think and perform so much better with movement, including ‘sedentary movement.’ Oftentimes, that looks like a lot of snacking on crunchy food items.” She explains that since society somewhat stigmatizes snacking, this can foster feelings of shame or guilt, which may trigger binge eating. Lauro adds that in order to function, ADHD brains crave dopamine, a neurotransmitter linked to reward, motivation, and pleasure. “There might be a very real and helpful purpose for your desire for highly palatable foods like desserts, chips, etc.,” she explains. All-or-nothing thinking is also common with ADHD, and this mindset can foster perfectionism. “The thought ‘I will only do this thing if I can perfect it’ or ‘I can only start this task under the right circumstances’ lends itself to perfectionism. There’s a loss of the middle ‘gray’ area,” Lauro says.  “On the one hand,” she adds, “this style of thinking can be great for making decisions in crisis situations. When an eating disorder is in the picture, it can co-opt ADHD and take advantage of the thinking style to use for self-deprivation.”  For example, if you’ve eaten something that you’ve deemed “off-limits,” a donut for example, then you might decide you cannot eat anything for the rest of the day because of having consumed this “bad” food.  She also notes that ADHD can lead to feeling as if you need to hide or mask parts of yourself. “This can play into perfectionism and fuel the belief that one must look, dress, or act a certain way in order to fit in and be accepted,” she explains. Again, society tends to expect everyone to have the same types of executive function. But with ADHD, your executive function simply looks different. This may drive you to hide your ADHD or to “fit in” in other ways you might perceive as a societal expectation, such as by being as thin as possible.  “Time blindness” is another common ADHD trait. This can refer to a few things, like getting overly focused on something and not realizing that time has gone by, or having difficulty estimating how long a task will take.  “Hyper-focus is a tricky situation,” Lauro says. “Most commonly we see this dance with eating disorders as a means of restriction. ADHD can make it hard to remember to eat, especially when you’re ‘locked in’ on a task in front of you.” She adds that an “eating disorder loves to take advantage of this to support the restriction part of the eating disorder cycle.”  Lauro is quick to point out that traits related to ADHD that can make someone more vulnerable to an eating disorder can also be beneficial for eating disorder recovery. These traits can include perfectionism or hyper-focus, both of which have benefits as well as drawbacks. “It’s really easy to have these conversations from a neurotypical lens,” she says, “but that often positions neurotypical brains as superior, and I respectfully disagree with that notion. I’ve seen so many instances where those traits are the exact features that let someone with ADHD ‘lock in’ to applying all of the evidence-based interventions and achieving recovery.” ADHD and specific eating disorders The connections between ADHD and eating disorders differ depending on the specific eating disorder. So let’s take a brief look at how certain traits might match up to different eating disorder diagnoses.  Why ADHD and eating disorders are often missed or misunderstood Both ADHD and eating disorders often go undiagnosed, and Lauro says this is because they are misunderstood disorders. “It’s true that not many providers, across various fields, receive training on ADHD or eating disorders,” she says. “ADHD and eating disorders often get overlooked, being chalked up to a person ‘just being lazy’ or unmotivated.” And weight loss can get lauded as a good “lifestyle change” when it may be the manifestation of an eating disorder.  She recommends seeking help if you (or a loved one): Think about food for the majority of your day, sometimes referred to as “food noise” Go for long periods without eating, whether intentionally or accidentally forgetting to eat Experience distress when not working out or when you can’t fit exercise in Skip other plans or rest days to work out Feel out of control with food Have only a few specific foods that you eat, whether from aversion or food restriction Link eating to shame, guilt, or body image distress Face difficulty eating in social situations What treatment looks like when someone has ADHD and an eating disorder If you or a loved one has ADHD and an eating disorder or a suspected one, treatment is within reach. A common perception is that people with ADHD will have difficulty with treatment, but that’s false. “Oftentimes ADHDers are the ones who excel in evidence-based care,” Lauro says, “particularly the structured evidence-based care models.” Treatment requires looking at the process through an ADHD lens, however. Lauro shares a few examples. “This could look like flexibility or digital accommodations for completion of tasks like self-monitoring tools and monitoring records,” she says. “It could also include discussions of how to plan-in certain meals or snacks to help with regulation and focus.” She adds, “We also often talk about establishing a regular pattern of eating—and maintaining this goal over relying only on intuitive eating.” Sometimes treatment requires modifications based on sensory needs. “Many ADHDers might be ‘super sensors,’” Lauro explains, “and one way we can improve eating is by addressing areas of overstimulation, like sound, by incorporating ear plugs.” That’s just one example, however. At Equip, eating disorder recovery occurs through a team-based approach that’s individualized to you (or your loved one). This means that if ADHD is a factor, clinicians and other providers will work to understand the specific ADHD traits that are present and how they may be affecting eating, exercise, or purging patterns. The team will also tailor treatment to your unique needs, or those of a loved one. The bottom line ADHD and eating disorders share some strong connections, including what drives them, behaviors and traits associated with them, and more. If you have ADHD, you might be more vulnerable to developing an eating disorder. And if you have an eating disorder, you might also have ADHD. But they don’t always occur together. The associations are just something to be aware of. The good news is that ADHD traits can also be an asset for eating disorder recovery. The bottom line is that help is available, and knowledgeable clinicians can tailor eating disorder recovery to you and your unique needs. FAQ Does ADHD affect eating habits? Yes, ADHD can affect eating habits in multiple ways, including leading to forgetting to eat because of missed hunger cues, binge eating for dopamine release or emotional regulation, and more. Having ADHD can make you more vulnerable to developing an eating disorder because of these issues. Can ADHD cause food aversion? Yes, if you have ADHD, you might have sensory concerns regarding certain food textures, smells, appearances, tastes, or even how foods sound when you eat them. You might also have reduced appetite from ADHD medications or reduced hunger cues in general. How do you treat ADHD and an eating disorder together? Treating an eating disorder when ADHD is present requires considering the specific traits unique to your experience with ADHD and how those traits might contribute to the eating disorder you have. Additionally, eating disorder treatment should be tailored to the ways in which you best learn or adapt to situations.]]></content:encoded>
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            <title><![CDATA[My ARFID Recovery Story: I Felt Alone—Until I Found Mentorship]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/ARFID-recoveryjourney</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/ARFID-recoveryjourney</guid>
            <pubDate>Mon, 01 Mar 2021 21:31:00 GMT</pubDate>
            <content:encoded><![CDATA[I once met with a registered dietitian who was new to my treatment team, and when I mentioned my eating disorder, she immediately assumed it was anorexia nervosa. When I began explaining that no, it wasn’t anorexia, she cut me off and asked, “bulimia?” Trying to contain my exasperation, I said, “no, I have ARFID.” Her response was, “what’s ARFID?” This isn’t the first time I’ve been asked this by a medical professional, or even a mental health professional. My eating disorder is far less common than the ones most of us grow up hearing about, and rarer still because I am an adult. ARFID stands for Avoidant/Restrictive Food Intake Disorder and is associated with a lack of interest in food or a low appetite, avoidance based on sensory sensitivity to certain foods, and/or a fear of food/eating due to a traumatic experience (like choking or vomiting). ARFID is most common in children and adolescents — in fact, the average age ARFID patients seek treatment is 12-years-old. People with ARFID constitute about 14% of those seeking eating disorder treatment (Fisher, 2014). The notable factor that separates ARFID from more common eating disorders, like anorexia or bulimia, is that body image issues are not a core aspect of the eating disorder — however, some folks struggling with ARFID do have those issues and a fear of fatness. Like many children who develop ARFID symptoms, I grew up a picky eater. In addition to the picky eating, I also began having nightly spells of nausea at an early age, the exact cause of which is still unknown. I would fall asleep night after night on the bathroom floor, overwhelming anxiety convincing me that I was going to be sick. I never was. But my brain convinced me that nausea was something to fear. For a brief period, I adopted compulsive behaviors in an attempt to fall asleep in my bed rather than on the bathroom floor. Soon I got anxious about certain foods, sure that they would cause me to vomit, so I avoided them altogether. This childhood avoidance of certain fear foods started small—I was still receiving appropriate nutrition. Later though, adulthood became a breeding ground for uncertainty and anxiety. Far from the meals I trusted—the meals my mother made—I grew more and more fearful of food. Though I had not experienced food poisoning since well before the chronic nausea set in, my anxiety was certain that if I wasn’t careful enough, I would wind up sick. Then a couple years after college, a close coworker got food poisoning in the middle of our shift. As a result, I was required to step in to help with their work, and heard excruciating details of my coworker’s sickness from my peers. That night, I had my very first panic attack. It was also the night that I decided to stop eating entirely. Because of my emetophobia (aka, a fear of vomiting), I fall under the “aversion to eating due to a traumatic experience” category of ARFID. Trauma is defined as any experience that overwhelms your ability to cope. Years of chronic nausea had left me unable to cope, and the experience with my coworker only traumatized me further. A few months later, malnourished and underweight, I was strongly encouraged to seek treatment by my therapist and was admitted to the University of California San Diego’s Eating Disorder Center for Treatment and Research (UCSD). My outpatient therapist recommended UCSD because of its intensive and rigorous program and top of the line ARFID treatment. However, during my first week, my eating disorder fought hard, and begged my parents to let me switch to a less intense treatment program. I was required to eat all meals and snacks in treatment, and refeeding/nutritional rehabilitation after many months of restriction was incredibly tough. Not to mention, in group therapy (a daily occurrence) I spouted on and on about how I didn’t belong there and how no one understood me. ARFID can be an isolating diagnosis when it seems like no one understands your specific experiences, and eating disorders have a way of speaking through you, pushing you to live outside of your values, to isolate you even further. Using the skills I was offered, I ultimately chose to remain at UCSD, and I’m so glad I did. I soon found that the more I ate, the more I wanted to eat. I also quickly realized I had much more in common with my fellow patients than I first thought. I made lifelong friends, and even though most of them could never fully understand my specific disorder, they knew what it was like to be consumed by the darkness of an eating disorder. I wouldn’t have made it through treatment without them. It is because of these experiences that I became a Peer Mentor with Equip. As soon as I read about Equip’s revolutionary treatment approach, with each patient being surrounded by a five-person provider team which includes mentors with lived experience, I applied. Equip provides each family with a family and peer mentor in addition to a therapist, dietitian, and medical provider and I felt called to offer the mentorship that I never had. Struggling with ARFID can be an isolating and confusing experience, even within the eating disorder treatment community. I hope to help others feel less alone and more optimistic about their potential for full recovery by working as a mentor and telling my story. ARFID is less common, yes, and I hope there continues to be education about this disorder. It can feel even lonelier and more disorienting for someone struggling with ARFID when their own doctor or outpatient therapist isn’t familiar with the disorder. Equip recognizes these experiences, and provides patients with a provider team familiar with ARFID, which includes both a peer mentor and family mentor with lived experience with this eating disorder. We are excited and dedicated to offering mentorship to those who may also feel isolated within an ARFID diagnosis. Over the years, once I nourished my brain and body back to health, I honed and curated a toolbox of skills that work best for me, to be able to live a life worth living, free of the distress and dysregulation of my eating disorder. My anxiety is significantly reduced and manageable, and I am able to approach food with joy, spontaneity, and flexibility; something I never would have thought possible in the throes of my eating disorder. It wasn’t until a few years after I left treatment that I began processing the initial trauma that led me to ARFID, and now that I default to healthy coping skills rather than maladaptive ones, I am able to do this work. I am proud of the work I have done in recovery to be able to be in the position to help others on their recovery journeys. I am living proof that recovery from ARFID is possible. If you're concerned that you or a loved one are struggling with ARFID, reach out to your doctor or schedule a consultation with our team.   ]]></content:encoded>
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            <title><![CDATA[Never Miss a Diagnosis: Screening for Eating Disorders]]></title>
            <link>https://equip.health/articles/news-and-research/screening-for-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/screening-for-eating-disorders</guid>
            <pubDate>Mon, 23 Sep 2024 19:11:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. Screening for eating disorders is essential to ensuring that patients don’t slip through the cracks and that everyone who is struggling gets the support they need. However, many providers aren’t equipped with the knowledge and tools required to properly screen for these illnesses. Today, I’ll explain everything providers should know about screening for eating disorders. What is screening? First, let’s define what screening is and why it’s important. At their broadest definition, screenings are medical tests used to check for diseases and health conditions before there are any signs or symptoms. According to the World Health Organization, “the purpose of screening is to identify people in an apparently healthy population who are at higher risk of a health problem or a condition, so that an early treatment or intervention can be offered and thereby reduce the hospitalization, incidence, and/or mortality of the health problem or condition within the population.” Some examples of screening options include: A routine survey at each checkup Questions from a clinician during exams Routine testing of blood, vitals, imaging, etc. Screening is essential for eating disorders for a few reasons. First, the lag between the onset of eating disorder symptoms and treatment is on average five to seven years. We know that early detection and swift entry into treatment can improve outcomes, and so this lag is significant. And secondly, misconceptions and stereotypes about eating disorders mean that many people with these illnesses go undiagnosed—just 20 to 25% of patients with an eating disorder actually get treatment, and this number is even smaller for marginalized groups. Eating disorders are still thought of as a niche issue, despite prevalence similar to other mental health disorders, and newer diagnoses like ARFID and OSFED are identified less often. More screening would shed light on the millions of people with eating disorders and make clear that more accessible treatment is needed. Screening options There are a number of different options for screening for eating disorders in patients. Below, we’ll go through some of the screening tools used for different patient populations. Screeners for adults SCOFF The SCOFF questionnaire is a series of five questions. An answer of “yes” to two or more questions indicates the need for a more comprehensive assessment. Questions: S: Do you make yourself Sick because you feel uncomfortably full? C: Do you worry you have lost Control over how much you eat? O: Have you recently lost more than One stone (6.35 kg) in a three-month period? F: Do you believe yourself to be Fat when others say you are too thin? F: Would you say Food dominates your life? The SCOFF’s strengths are that there is lots of research on it; it is accurate at distinguishing those with an eating disorder from those without an eating disorder; it’s brief and easy to score; and there’s a low likelihood of false alarms. Its limitations are that it is primarily focused on anorexia and bulimia, so is less accurate for diagnosing binge eating disorder (BED), other specified feeding or eating disorder (OSFED), or avoidant/restrictive food intake disorder (ARFID); it only raises a red flag after symptoms have started; it is only validated in adults; it is less accurate in studies that include men; and it does not pick up on disordered exercise behaviors. Eating Disorder Screen for Primary Care (ESP) In this screener, responses are classified as normal or abnormal. A “no” to question one is classified as an abnormal response, and a “yes” to questions two through five is classified as an abnormal response. Any abnormal response indicates that the patient needs further assessment. Research shows that the best individual questions for ruling out an eating disorder are questions one and three. Questions: 1. Are you satisfied with your eating patterns? 2. Do you ever eat in secret? 3. Does your weight affect the way you feel about yourself? 4. Have any members of your family suffered with an eating disorder? 5. Do you currently suffer with, or have you ever suffered in the past, with an eating disorder? The strengths of the ESP are that it is conversational, short, has simple scoring, and there is a high likelihood of not missing any cases. Its limitations include the fact that it is only used in one study and a few case studies, so there is less validation, and it is prone to more false positives. Screener for Disordered Eating (SDE) In this screener, each item is scored one if present, and a score of two or more is predictive of the presence of an eating disorder. Questions: 1. Do you often feel the desire to eat when you are emotionally upset or distressed? 2. Do you often feel you cannot control what or how much you eat? 3. Do you sometimes make yourself throw up (vomit) to control your weight? 4. Are you often preoccupied with the desire to be thinner? 5. Do you believe yourself to be fat when others say you are thin? The strengths of the SDE screener are that it is brief, and similar to SCOFF but with questions that improve accuracy for BED. Its limitations include the fact that there are still no questions that would catch ARFID; it is only used in adults; and it only picks up after more severe symptoms have started. Eating Disorder Examination Questionnaire-7 (EDEQ-7) This screener is based on the full EDEQ, but pared down to focus on dietary restraint, shape and weight valuation, and body satisfaction. Questions: 1. Have you been consciously trying to limit the amount of food you eat to influence your shape or weight? 2. Have you attempted to avoid eating any foods which you like in order to influence your shape or weight? 3. Have you attempted to follow definite rules regarding your eating in order to influence your shape or weight; for example, a calorie limit, a set amount of food, or rules about what or when you should eat? 4. Has your weight influenced how you think about (judge) yourself as a person? 5. Has your shape influenced how you think about (judge) yourself as a person? 6. How dissatisfied have you felt about your weight? 7. How dissatisfied have you felt about your shape? The strengths of the EDEQ-7 are that it is briefer than the full EDE-Q, but still maintains the quality and validation of the full questionnaire. Its limitations are that it is lower in accuracy than the full EDE-Q, so may miss some cases; it also does not include questions about ARFID. Screeners for college-age youth Stanford-Washington University Eating Disorder Screen (SWED) The SWED is primarily for college-age women. It is embedded into the screener on NEDA’s website. Its strengths are that it is comprehensive; has lots of good validation; and is tested most widely across diagnoses. Its limitations are that it is only applicable to a subset of those with eating disorders; accuracy is lower for OSFED; has very little data in men and racial or ethnic minority groups; and is lengthy and somewhat complex to score. The NEDA screener has a wide reach, with 71,362 people taking the screener. Of that group, 86.3% screened positive for a possible clinical or subclinical eating disorder—but only 14% report receiving treatment. Brief Assessment of Stress and Eating (BASE) The BASE screener is based on the full Eating Pathology Symptoms Inventory (EPSI), but is pared down to focus on specific behaviors and cognitions. It is for student healthcare and college research settings.  Its strengths are that it is brief, captures a more diverse range of behaviors, and has strong outcomes in men and gender diverse populations. Its main limitation is that it only applies to a select population of young adults. ARFID screeners Nine Item ARFID Screen (NIAS) This screener distinguishes between ARFID subtypes: selective eating, lack of interest/low appetite, and fear of aversive consequences. Scores of >9 or 10 indicate a potential diagnosis. Its strengths are that it is brief, provides clarity on presentation types, is validated in youth and gender diverse groups, and is translated into multiple languages. Its main limitation is that it doesn’t rule out other eating disorders.  Pica, ARFID, Rumination Disorder Interview - ARFID - Questionnaire (PARDI-AR-Q) The PARDI-AR-Q is a 32-item questionnaire based on the diagnostic interview. Its strengths are that it can provide information on ARFID subtypes, has a screening algorithm, is comprehensive, and there’s a patient version as well as a parent version for kids as young as age four. Its limitations are that it’s a longer survey, has complicated scoring, and there are no validation studies yet for screening. Below is a sampling of the questionnaire.  Use of screeners in clinical practice So how can providers incorporate these screeners into clinical practice? There are few important things to keep in mind when it comes to using the screeners outlined above. Some tips and tools to remember: Incorporate screening tools early Integrate behavioral health screeners into existing medical screeners, like growth charts Recognize that screening doesn’t mean diagnosis, and further assessment is always needed Have referral sources handy The SBIRT model is also an important concept to understand. SBIRT stands for Screen, Brief Intervention, and Referral to Treatment. If the screening is positive, the healthcare professional asks further questions to assess level of use. For high-risk use, a brief intervention is recommended; for severe use, a referral to treatment is recommended. The SBIRT approach has been shown to be valid for identifying and improving outcomes for people who have high risk use of alcohol and drugs. The SBIRT-ED is a novel screening tool for adults in primary care. After screening, the tool walks you through a brief intervention and resources for referral. Gaps, limitations, and what’s next We need more research on eating disorder screening. There are currently no validated screeners for youth, and evidence for adult and adolescent screening (among asymptomatic patients) has been deemed insufficient, despite the many screeners that are available. The current state of eating disorder screening is considered insufficient for a few reasons: There are no studies directly assessing the benefits and harms of screening, which is needed They are mostly assessed in adult women, and available data lack information about underrepresented groups Treatment trials did not recruit screen-detected participants from primary care settings Limited generalizability to populations who would be detected by routine screening In addition to refining and further researching screening tools, it’s also important that screening begin earlier. Eating disorders often peak in childhood or adolescence, making youth a high-risk time for onset—yet there are no screeners developed for kids 12 and under. There are limited validated screening tools for adolescents, but many of the adult ones are used with teens. A tool for youth needs to focus on catching early symptoms of an eating disorder, and be relevant to the symptoms we expect to show up in this age group (e.g., ARFID). It’s likely that parents or other caregivers may be the best source for administering these screeners. There are currently a number of in-progress studies looking to create clinically-validated screeners for youth. These include studies from Equip, AED/AAP Workgroup, and The CARE Lab at the University of Kansas. For more information on screening for eating disorders, as well as in-depth information about the Equip research team’s pediatric ED screener, watch my recorded Equip Academy presentation on the topic. You can also explore past Equip Academy presentations and register for upcoming events here.]]></content:encoded>
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            <title><![CDATA[Is It Okay to Eat Vegan or Vegetarian in Eating Disorder Recovery? ]]></title>
            <link>https://equip.health/articles/food-and-fitness/vegetarian-vegan</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/vegetarian-vegan</guid>
            <pubDate>Wed, 10 Feb 2021 01:44:13 GMT</pubDate>
            <content:encoded><![CDATA[It’s safe to say that going on a diet can be a slippery slope into an eating disorder or relapse—but does the same go for veganism and vegetarianism? Eating a vegan or vegetarian diet is often a valid and important choice rooted deeply in someone's values and identity. However, vegetarianism and veganism can sometimes complicate eating disorder recovery, because it can be difficult to know who’s truly calling the shots: the person and their authentic values or the eating disorder. In my practice as an eating disorder dietitian, I’ve seen both scenarios. I’ve seen people who start their recovery as vegans or vegetarians, and eventually realize that this choice was driven by their illness and that they’ll only be able to reach full recovery if they return to eating meat. On the other hand, I’ve also witnessed people stay vegans and vegetarians throughout the course of their treatment and for whom the choice comes from their true values. So, what can you do if you or your loved one is beginning the path toward eating disorder recovery while also practicing a vegan or vegetarian diet? Read on to learn more and navigate the complexities of veganism and vegetarianism in eating disorder recovery. What’s the relationship between veganism and eating disorders? First, let’s define the two eating styles: vegetarians avoid meat, poultry, and fish, but may eat dairy and eggs, while vegans avoid all animal products, including meat, dairy, eggs, and honey. While research shows that being a vegetarian or a vegan is not inherently a risk factor for eating disorders, their relationship is complex and depends largely on the “why” behind the way of eating. A 2024 study of healthcare providers treating vegetarians with eating disorders shows that in recent years, vegetarianism has increased among people with eating disorders, particularly young women and teens. The study shows that two key factors can help determine whether vegetarianism is driven by the eating disorder or not: timing and motivation. They shared that it’s more likely an eating disorder-based decision when vegetarianism is adopted around the time of eating disorder development or during treatment, versus if it started well before the eating disorder began. Deciphering the motivation behind adopting a plant-based diet can be trickier, but it’s just as important. Was the diet adopted out of a desire to lose weight, or due to genuine values and preferences? “People may choose to be vegan or vegetarian for reasons like concern for animal welfare or environment, cultural or religious preferences, or health concerns,” says weight-inclusive eating disorder dietitian Ana Pruteanu. One 2023 study of people following vegan diets for at least six months echoed the same notion: what matters the most is figuring out the “why” behind the veganism. In fact, this study showed a significantly low number of disordered eaters, likely because most participants cited ethics and animal rights as reasons for being vegan. Another 2020 study of college students showed motivation as a dominant factor again, as vegetarians driven by weight concerns showed higher eating disorder symptoms than non-vegetarians and vegetarians motivated by other factors. “Someone struggling with an eating disorder or disordered eating may choose to limit their diet by following a vegan or vegetarian diet in part motivated by fear of eating certain foods or by a desire to avoid certain foods,” Pruteanu explains. “It’s important to understand someone’s reason for this choice and how they are choosing to follow a vegan or vegetarian diet.” Finally, a 2022 research review revealed that avoiding meat is not a clear risk factor for eating disorders like anorexia or bulimia, however it showed an association between “healthy eating obsession” or orthorexia-type behaviors and vegetarianism and veganism. Given this finding, the study concluded that flexibility is another factor to consider when trying to determine if a vegan or vegetarian is at risk of an eating disorder. “If you are vegan or vegetarian and notice that over time you become fearful of more foods, your diet becomes more limited, and your list of ‘safe foods’ is shrinking, think of that as a red flag that may be pointing towards disordered eating or an eating disorder,” Pruteanu says. “If someone is vegan or vegetarian but only eats fruits and vegetables, I would argue that is an extreme way of applying this lifestyle and can lead to nutrient deficiencies and potentially mask disordered eating or an eating disorder.” When being vegan or vegetarian masks eating disorder behaviors In some cases, a person’s eating disorder will use veganism or vegetarianism as a front or a justification for certain disordered eating rules and behaviors. “Sometimes being vegan or vegetarian is used to avoid going out to eat or eating sweets or other foods,” Pruteanu explains, “but with the abundance of options we now have at hand, there’s no reason to feel like you can’t enjoy desserts or go out to eat if you’re vegan or vegetarian.” For those with an eating disorder, however, their reasons for restricting certain foods extend far beyond wanting to avoid meat and other animal products. Underneath the surface, vegetarianism and veganism can be about: Being smaller (in multiple ways): In the context of an eating disorder, vegetarianism or veganism may be about both physical smallness and striving to have as little impact on the earth as possible, a feeling that can come from low self-worth.. Reinforcing moral worth: Identifying as a vegan or vegetarian can create a false sense of moral superiority or righteousness. High standards of purity/perfectionism: Identifying as a vegan/vegetarian can be a way to chase after a narrow definition of “purity,” which can also placate the eating disorder’s desire for perfectionism. Black and white thinking: The eating disorder can hijack real moral beliefs (compassion for animals, environmentalism, etc.) and turn them into a rigid, all-or-nothing mindset. Realistically, small steps can make a difference in the health of our planet, but black and white thinking shows how the eating disorder can be stronger than one’s personal desire to make an impact in a practical, sustainable way. Normalizing restriction and food avoidance: Adhering to a vegan or vegetarian diet can be one way to easily say no to challenging foods or “junk” foods, as well as restrict food in contexts where there’s not much (or any) plant-based food available.. The safety blanket: Having a label to describe one’s diet can make eating feel safer and more controlled. For example, eating dairy-based ice cream could be viewed as scary, but vegan ice cream may be doable. While this could seem harmless on the surface, it can mask situations where restriction is still happening and create an illusion of safety and control. “I know many people that have sought treatment for an eating disorder who were vegan or vegetarian, and after spending time with them and exploring their eating disorder, it’s determined that their veganism or vegetarianism are a part of their eating disorder,” says therapist Amanda Marks, LPC, RYT. “It takes a lot of exploration in therapy and working with the individual's dietitian to determine what is actually an eating disorder behavior and what is something that is aligned with their own true values.” The differences between disordered eating and healthy veganism or vegetarianism If you’re a truly healthy vegan or vegetarian, there will be stark differences in the way you eat and live, compared to someone whose eating disorder is running the show. “Eating vegan or vegetarian without restriction looks like having the freedom to go out with friends to restaurants that offer vegan or vegetarian options and being able to enjoy vegan baked goods without guilt,” Pruteanu explains. “And most importantly, it looks like eating a diet that fully nourishes the body, providing the nutrients your body needs to function well without deprivation.” Here are some other signs of healthy veganism or vegetarianism: Your food choices are connected to your values, and your veganism or vegetarianism is driven by factors like animal welfare or the environment. You can be flexible and are okay if you need to bend your “rules” sometimes. Your veganism or vegetarianism supports your mental health and well-being and is just one part of your identity. You’re able to meet your energy and nutrient needs daily. “If someone is vegan or vegetarian but feels a lot of fear about eating foods prepared by others, eating foods that are still vegan but are outside of their safe foods list, is afraid of certain nutrients like sugar, carbs, sodium, or fats, these are red flags for disordered eating,” Pruteanu adds. Here are some other red flags of unhealthy vegetarianism or veganism: Your reasons for being vegan or vegetarian are wrapped up in diet culture (e.g. weight or shape control, moral superiority, or food avoidance). You have rigid, black-and-white rules and are anxious if they’re broken. You spend much of your day thinking about food, and experience food-related fear and guilt. You find yourself avoiding social outings or gatherings because of food. You’re unable to meet your body’s energy and nutrient needs and are medically unstable. Can you stick to a vegan or vegetarian diet while recovering from an eating disorder? Whether or not you can stick to a vegan or vegetarian diet in recovery depends on your situation and some key factors, like your motivation for being vegan or vegetarianism and whether or not you’re able to meet your energy and nutrient needs and be medically stable. “I do think that recovery from an eating disorder while being a vegan or vegetarian can be possible,” Marks says, “however, it would take a solid treatment team and a lot of discussion around the reasons for restricting food, as well as having ongoing, transparent discussions around food and values.” If you’re unable to eat adequately while following your vegan or vegetarian diet, it may be necessary to take a break to achieve medical stability and increase mental flexibility. Once you’ve accomplished these goals, it will be easier to clarify who’s calling the shots: you or your eating disorder. Here are a few other considerations to keep in mind: One way you can support your own recovery or the recovery of a loved one is by honoring the idea of activism while simultaneously trying to remove the focus on “food as activism.” Activism doesn’t just happen on a plate, after all. You can engage in animal welfare or environmental activism that is unrelated to food, like volunteering at an animal shelter or picking up litter in a park. Remind yourself or your loved one that to be kind and compassionate to animals and the earth, we first must practice those qualities with ourselves. Sometimes, especially in recovery, that may mean choosing to eat meat or meat products. Ultimately, an eating disorder can hijack a person’s kindness and compassion and transform it into fear, which is not the spirit of veganism or vegetarianism. Being vegan or vegetarian in recovery is possible, but sticking to a strict vegan or vegetarian diet may also mask eating disorder beliefs and behaviors, making both progress and engagement with loved ones and the planet impossible. How to ensure a plant-based diet doesn’t become disordered Finally, here are some tips for following a vegan or vegetarian diet without falling into disordered behaviors: Connect with your core vegan or vegetarian values. Identify why you’re choosing a vegan or vegetarian diet, write it down, and make sure it’s in alignment with core values and that it’s a genuine decision. Then, let it be a guiding and flexible principle rooted in health and authenticity, not a rigid tool for self-deprivation or control. Eat fun foods and remember pleasure. If you’re a vegan or vegetarian for ethical reasons, it doesn’t mean you have to eat the “cleanest” foods—but that’s how the eating disorder operates. Allow yourself the vegan or vegetarian cakes, cookies, chips, and any other foods you enjoy. If you restrict these foods, it’s easier for an eating disorder to re-emerge or develop. Remember, eating is meant to be a nourishing and pleasurable part of life. Be flexible. One of the hallmark symptoms of an eating disorder is rigidity around food, so check in about your flexibility, and loosen up if you notice obsessive and strict tendencies. “Stay flexible, enjoy foods, and be okay eating a variety of foods in different settings,” Pruteanu says. Notice how much mental space it’s taking up. It’s possible to be a vegan or vegetarian without being preoccupied with thoughts of food all day every day. However, if you notice a large amount of your mental space is taken up by food and crowding out the rest of life (like relationships, work, and hobbies), it’s time to re-evaluate. Make sure you’re eating enough food and meeting your nutrient needs. It can be challenging to get enough calories, and meet your macronutrient needs (carbs, fats, and proteins) and your micronutrient needs (vitamins and minerals) being a vegetarian or vegan. “If you are new to a vegan or vegetarian diet, or not sure if you’re getting all the nutrients you need, consider working with a registered dietitian who specializes in plant-based eating and who is at least eating disorder-informed,” Pruteanu says. “You may need to supplement certain micronutrients that aren’t easy to access through a vegan diet.” For example, you may need to add B12 and iron supplements into your routine. Keep moral superiority out of it. Being a vegan or vegetarian doesn’t make you a better person than someone who eats meat or animal products. Remember, it’s a part of who you are and one value in your life—not your entire life. Ultimately, it’s your decision whether you will remain vegan or vegetarian long-term. “If you’re not sure whether the eating disorder was part of the choice in becoming vegan or vegetarian, find a supportive dietitian who is willing to explore this with you and approach this process without coercion or an expectation that you will or won’t change your mind,” Pruteanu encourages. “You can work towards learning how to fuel your body fully, giving it enough nourishment to thrive, regaining freedom and flexibility and joy with eating—whether you are following a vegan or vegetarian diet or not.” If you are concerned that your or your loved one’s vegan or vegetarian diet may be driven by an eating disorder, schedule a call with an Equip team member to talk through your concerns and explore treatment options.]]></content:encoded>
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            <title><![CDATA[When the Lights Come Back On: What Real Eating Disorder Recovery Looks Like]]></title>
            <link>https://equip.health/articles/news-and-research/equip-survey-lights-coming-back-on</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-survey-lights-coming-back-on</guid>
            <pubDate>Fri, 21 Feb 2025 14:34:00 GMT</pubDate>
            <content:encoded><![CDATA[When a person gets treatment for an eating disorder, it’s with the goal of achieving recovery. But what does “recovery” really mean? There’s not one definition that eating disorder professionals agree on, despite the fact that experts have been trying to come up with one for years. And this might be inevitable, because recovery looks different from person to person depending on their personality, their life circumstances, their goals, and the specifics of their eating disorder, among many other factors. But even if there’s never one set definition for recovery, the more we understand about what recovery entails, the better we can support people who are navigating the process. A recent study from Equip took a deep, close look at the meaning of recovery for those who went through it themselves. In the study, researchers conducted structured interviews with 27 people who had firsthand experience of eating disorder recovery, either recovering from an eating disorder themselves or supporting a loved one through recovery. They wanted to understand what recovery means to the people living it. The findings revealed, among other things, that recovering from an eating disorder is about so much more than just restoring weight or stopping disordered behaviors: it’s about identity, connection, and what’s possible in a person’s life. This deeper understanding of recovery can help eating disorder treatment professionals provide better support to their patients. But perhaps even more importantly, the findings illustrate that no matter how you define recovery, it is possible—and worth it. Recovery turns the light back on… One thing that this study and others highlight is the fact that eating disorder recovery is an ongoing process, rather than a singular task that can be achieved. For those going through it, it can often feel like two steps forward and one step back—a nonlinear journey with ups and downs in which the eating disorder slowly but surely fades away. But that said, people supporting those through the recovery process often remark on a particular moment when they noticed their loved one emerging from behind the eating disorder. Participants in the study often described these moments as seeing the “spark” return to their loved one, or as the lights coming back on. Here’s how one person put it: “Laughter, sense of humor coming back. She’s a very funny person, and with a really witty sense of humor, and that was completely gone when she wasn’t eating enough. So when she was able to respond to humor or make humor, that was really the beginning of her coming back.” The lights coming back on can mean so many different things. It might mean that someone starts singing in the shower again, or reconnecting with hobbies they loved before; it might mean giving a spontaneous hug, or spending time with friends again, or enjoying a book or movie. Whatever the specifics, the theme was the same: as a person moved closer toward recovery, they began to return to their old self. They lit back up, they came back to life. …but the light reveals a new person What’s really interesting is that for those who recovered from an eating disorder firsthand, it was less about turning the lights back on, and more about who emerged into that light. For them, the study found, they didn’t feel like they were returning to their old self, but rather becoming a new version of themselves. Throughout the recovery journey, they said, they expanded into a different person. While eating disorder treatment focuses on behaviors around food and exercise (for good reason), people navigating the process often see changes in completely unrelated parts of their lives. In the study, participants talked about exploring new interests, connecting more deeply to their values, reframing their relationships, and shifting their identity. Recovery, to them, allowed the world to get bigger and the possibilities more vibrant. Here are some quotes from study participants that illustrate what that looked like: “A lot of recovery for me was identity, exploration, and finding out who I am without the eating disorder. So finding out just simple things about myself, like what’s my favorite color, and like what makes me happy? What are some things I’m interested in? What are my favorite scents? Finding those things out about me just made me feel whole again.” “I didn’t necessarily feel like an old me, because that wasn’t even what I was. That wasn’t what my goal was. I remember my mindset going into treatment was like, if there’s a better version of my life, I need to try to experience that or see if that’s possible. Once I left treatment, I felt completely different. There were some interests that were still there, but I felt a new sense of confidence, a big motivation to actually pursue things that I wanted to do. I had the room to actually think about it since I wasn’t thinking about food all the time.” “It’s not really getting back to a person, it’s like building a new person and figuring out who you are. I never felt like I was going back to my old self again. I just kind of realized, oh I’m a person. Now I have a personality and I have interests and friends.” Eating disorder recovery is possible One big takeaway from the study is that even though recovery looks different depending on who you ask, it’s a transformative and life-affirming experience for everyone who goes through it. As the eating disorder fades, the real person steps into the light — and if that means a return to their old self or stepping into a new version of themselves, it always means a brighter future. Eating disorder recovery isn’t one achievement or a finished process; it’s a nonlinear journey that looks completely different from person to person. But what’s clear is that during this journey, the eating disorder loses control, and the person within emerges. Whether they return to their old self or expand into a new version of themselves — wiser, happier, more connected to their values — depends on who you ask. But that’s not what matters. What matters is that the eating disorder is no longer in control of their life and the possibilities ahead of them. What matters is that with the right support and evidence-based treatment, everyone with an eating disorder can reclaim the narrative of who they are and what they can become. If you or a loved one are struggling with an eating disorder, know that recovery is possible. You can schedule a call with an Equip eating disorder expert to talk through your concerns and explore treatment options.]]></content:encoded>
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            <title><![CDATA[Finding Festivity with Difficult Family Dynamics While in Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/family-and-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/family-and-recovery</guid>
            <pubDate>Mon, 11 Dec 2023 18:17:13 GMT</pubDate>
            <content:encoded><![CDATA[It’s no secret that the holidays can be an emotionally challenging time for anyone, and are often especially tough for families navigating eating disorder recovery. “The holidays are like a marathon of dealing with these culturally loaded interactions with food and bodies,” says licensed psychologist and gender therapist Sand Chang, PhD. “And they are also a time where a lot of people are having big feelings about their families, like estrangement or grief for whoever is no longer around. So it's a time when a lot of people can feel like there's increased conflict or isolation and this can exacerbate eating disorder symptoms.” One common obstacle that family members may want to be prepared for is unsolicited body commentary. While this can of course be challenging for anyone to navigate, those with eating disorders may need significantly more support in dealing with comments around weight, eating behaviors, exercise habits, and more. “This is the first holiday season where people have been feeling more safe to gather because more people are vaccinated and that's wonderful — but that also means people are seeing each other for the first time in a long time and that body appraisal and surveillance is going to be more intense,” Chang says. “So they might say, ‘I haven't seen you for two years — you look so good, what are you doing?’ or ‘you gained weight.’ This can exacerbate an eating disorder, so this holiday will be bringing up more of those difficult feelings for people.” If you’re unsure of how best to support your loved one through recovery this holiday season (while maintaining your own mental well-being), read on for tips from experts and those who have navigated challenging family dynamics themselves: Set realistic expectations for yourself and for your loved one When Equip family mentor Lisa Stein first began dating her boyfriend, celebrating the holidays with his boisterous family was initially a challenge for her daughter who is in recovery from anorexia. “It was hard for my daughter to eat food that was prepared very differently than I make it,” Stein says. “I had to explain to his family members that my daughter had an eating disorder and that eating food prepared by others in a big group was challenging to her. His family was compassionate but had little understanding of eating disorders. They also have a background of food insecurity, so the concept of restricting food was hard to comprehend. I now realize that I so badly wanted my daughter to enjoy the holiday trips, but that was probably not realistic.” Stein says that although her daughter was eating on a meal plan at that point, she was not fully recovered and eating freely. She advises other caretakers to set realistic expectations and to meet their loved ones where they are in the recovery journey. “Honestly evaluate where your child is in the recovery process and be realistic about their ability to participate in the event,” Stein says. “If possible, put their mental health needs before your own need to participate and to not disappoint other family members this year." Make a plan with extended family ahead of time "Many parents are hesitant to gather with extended family when their child is in eating disorder recovery because they are terrified of the seemingly inevitable diet or weight comments that other adults may make,” says Equip Family Mentor Oona Hanson. “One option is to talk to those folks ahead of time and explain that you really could use their help in supporting recovery. Even when you make a clear request, however, it's likely someone will forget or not realize their food or body comment could be harmful. So parents also need to be ready to gently interrupt those comments and redirect the conversation." Help your loved one identify their needs and set boundaries “What I try to do in my work with people who are struggling with eating disorders or with family members commenting on their bodies is help them recognize what choices they have,” Chang says. “A lot of times people feel like they're trapped in conversations or they have to have them because they can't get out. It's about recognizing the options that you might have in a conversation with someone else. It might be about healthy distraction or changing the subject. It’s about creating emotional boundaries for ourselves.” Allow space for loved ones to ask questions and show concern Eating disorder recovery can be an intensely private journey for many families. But in some cases—if all members of the family are comfortable and consent to sharing—discussing the situation with others outside the immediate circle of loved ones may be helpful. “I wish people knew it's okay to break the silence to not let it be the elephant in the room,” says Sue Bowles, a Life Coach who is in recovery from an eating disorder and describes growing up in “a dysfunctional family where emotions weren't discussed.” Bowles says that after her parents divorced, she felt torn between her mom and dad and reluctant to share her own struggles. “Sometimes, time with friends or being invited over to someone's house may be the one 'escape' afforded during the holidays which helps decompress from the other stress. Never assume someone isn't available or not interested.” If you’re concerned, lead with consent “A lot of people who are going to be struggling with an eating disorder might not be aware of it or they might feel pretty defensive when other people bring it up, so consent is really key,” Chang says. “So being able to pull someone aside, and say, ‘hey, I am feeling concerned about you and I'm wondering if you would be open to talking about it or hearing about that?’ It can feel like for the person on the other side that they're being criticized or in trouble, so with care and connection and concern and consent is important.” Know that it’s okay to stray from the “traditional” plan Stein says that at times, it was difficult to balance the needs of her other children throughout her daughter’s recovery journey. “My older daughter is very family-oriented and it is disappointing for her to not attend events because of her sister's eating disorder,” she explains. “Consider dividing and conquering with your family this holiday season. It's okay to send other siblings with dad to a family event. It's okay to drop off other siblings if you are in a single parent household. It's okay to feed your child at home and bring them to the non-food portion of the event." Show support to your fellow caretakers too Caring for a loved one with an eating disorder is difficult work, and in many cases, parents and other caregivers share the responsibility. Remember to show support to one another while you show support for your loved one in crisis or recovery. “Give extra grace to each other,” Bowles suggests. “Not every family is the 'perfect' family, no matter the image they try to portray. Your sibling or spouse may have to play the 'dutiful person' role and may need some decompression time afterwards. Be supportive, understanding, and have a code word to 'rescue' them when it's time for them to go — [choose] a word they can say to you which indicates, ‘I've got to go. I've given all I can.”]]></content:encoded>
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            <title><![CDATA[Life After ARFID Treatment: How to Continue Food Exposures at Home]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/arfid-food-exposures-at-home</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/arfid-food-exposures-at-home</guid>
            <pubDate>Fri, 20 Jun 2025 16:59:10 GMT</pubDate>
            <content:encoded><![CDATA[I’ve always considered ARFID to be an eating disorder outlier—the one that doesn’t have much in common with the others. But once I got to interviewing experts and diving into the research, I realized that ARFID has more similarities to other diagnoses than I thought. And there’s one similarity that’s perhaps the most critical, which is that lasting recovery requires ongoing attention and conscious participation, especially in those first weeks and months following treatment. “ARFID recovery isn’t a one-and-done thing. It’s like tending a garden: you can’t just stop watering once things start growing,” explains Tracy Colin, MS, RD, LDN. Much of ARFID treatment is food exposure work, where patients and loved ones develop skills to try and include new foods, increase flexibility, and confront food fears. “Keeping up with variety and exposure is what helps those wins stick and keeps progress blooming for the long haul,” Colin adds. Read on to explore why it’s so important to continue food exposures at home, and expert-backed ways to do so. Why you need to continue food exposure work after ARFID treatment While you can make significant progress toward increasing food variety during treatment, it can happen at a slow pace, meaning there’s often more work to be done after discharge. In fact, Michelle Jones, PhD, licensed psychologist and clinical instructor at Equip, says it can take ten or more tries of a new food to become comfortable with it. “Patients can successfully end treatment without having tried every food they are willing to explore or challenging every difficult eating-related situation in session, which means there may be continued exploration of novel foods and anxiety-provoking situations after formal treatment ends,” she explains. “There may still be benefits to adding new foods to improve nutritional intake, reduce anxiety, or improve psychological or social functioning even after the primary goals of treatment have been achieved, but the patient and family may not need professional support to accomplish these tasks.” Jones says the ideal scenario is one in which patients and their families have the tools to continue working on food variety on their own, which helps keep the momentum from treatment going. Sometimes, patients and families can (understandably) feel burnt out by the end of treatment and want to take a break—but this can lead to setbacks. “Without realizing it, you might find yourself falling back into familiar patterns, letting the new foods you tried during treatment slip away,” says ARFID registered dietitian Ana Pruteanu, MS RDN LDN CEDS-C. “When we stop eating a food, it can start to feel unfamiliar again, which makes it harder to eat later on, and that’s why it’s so important to keep practicing after treatment.” Like other eating disorders, ARFID’s potential consequences include serious issues like malnutrition, nutrient deficiencies, stunted growth, anxiety, and depression, so it’s critical to continue the recovery process after discharge to continue healing. Plus, research shows that ARFID can lead to feeling a loss of freedom and inability to participate in social activities, and continued food exposure work can bring greater comfort and ease in social settings and more flexibility while out in the world. “Intense treatment doesn’t cover all real-world scenarios,” Colin says, “so as you continue to expand on food varieties, you’re also reducing anxiety in unpredictable food environments.” How to continue food exposures at home, according to experts Now that you know why it’s so important to keep increasing food variety post-discharge in ARFID recovery, let’s explore some of the most helpful ways to do so. Start by keeping foods from treatment regular. The first step is less about increasing exposures and more about maintaining the progress you’ve made from previous exposures. To do this, it’s important to keep all the foods you introduced during treatment in regular rotation. Pruteanu recommends incorporating such foods at least every week, “as ongoing practice to keep these foods familiar and comfortable.” The reason for this is that if too much time passes without eating a previous fear food, it could become hard to eat again. Take small steps. Keep in mind that food exposure doesn’t necessarily mean eating a new food right out of the gate. In fact, Pruteanu suggests interacting with new foods in non-eating ways at first, taking the pressure off of eating them, and going at your own pace. “You might start by preparing or cooking a new food for a friend or family member,” she says. “Even just touching the food, smelling it, or noticing how it changes when it’s cooked can help make it feel more familiar.” Additionally, Jones suggests working on increasing flexibility with foods you or your loved one are already eating, trying new preparations or combining it with new foods. Take breaks when you need. Sometimes, expanding food variety can feel like way too much, which may be a sign to take a break from expansion for a bit. Instead, focus on the foods you or your loved one can eat with relative ease consistently and adequately, giving yourself space until stress levels are lower and it feels manageable to begin progressing again. “There will be times when it just feels too overwhelming, or when you might experience sensory overload,” Pruteanu says. “Give yourself permission to pause and take care of yourself.” Connect with your personal “why.” Take some time to quiet the expectations of your treatment team or loved ones and connect with your own desires and reasons for increasing food variety. “Maybe it’s to feel more confident at social meals, to have more energy, or to make eating feel less stressful,” Pruteanu says. “Focusing on your own motivations can make the process feel more empowering and less pressured, and finding your ‘why’ is key to sticking with it after treatment, especially when it gets tough.” Create a relapse prevention plan. Relapse can be a normal part of recovery, so it’s important and helpful to have a concrete resource to turn to when the going gets tough. “Creating a relapse prevention plan is what helps to ensure long-term success for my patients by helping them think about any potential obstacles that may impact their ongoing relationship with food,” Colin shares. A prevention plan can include anything you feel may be helpful to you or your loved one during hard times, including a meal plan or structure, grocery lists, back-up meal and snack ideas, a safe foods list (and perhaps a list of successfully added foods), potential triggers and warning signs with coping tools to navigate them, recovery motivators, and a list of people to reach out to if for more support. Consider working with an outpatient team. Working with outpatient providers, including a therapist and dietitian, can help make your or your loved one’s transition out of treatment easier. They can guide you as you continue to explore new foods and navigate any challenges that arise. “Having a team in your corner can make the journey feel less overwhelming and more supported,” Prutaneau explains. It’s typical to meet with outpatient providers weekly after treatment and then slowly taper appointments as you’re ready, but how often you see them will depend on your or your loved one’s specific recovery needs and desires. Be sure to choose providers who are experienced in ARFID. Keep some sort of journal to track progress. In treatment, you or your loved one may have created a food hierarchy list with your dietitian to help sort foods from safest to scariest, and it can be helpful to continue working through this list post-discharge. It may also help to create lists of foods that you or your loved one have tried before but no longer eat, so you can circle back to them. As you find foods that you or your loved one are willing to eat, note sensory factors like taste, texture, and smell, which can help guide you to your next new food. Finally, consider making a food group chart, where you name foods within each food group (such as carbs, fats, proteins, fruits and veggies) that you or your loved one eat or are considering eating, to help you work towards a well-rounded diet. Use strategies from treatment. There are several evidence-based therapeutic approaches for ARFID, including cognitive behavioral therapy, family-based treatment, and exposure and response prevention—all of which come with specific strategies for new food exposures that you’re likely familiar with at this point. Even though treatment is over, you can continue using in-session and at-home practice strategies, says Jones, who recommends applying them to real-life situations to try new foods. Use mealtime tools to reduce anxiety. Since trying new foods can feel scary and cause significant anxiety, focus on creating as much safety as possible, before, during, and after food exposures. While what helps evoke emotional safety is highly personal, some common tools include breathing practices (like deep diaphragmatic breathing or extended exhale breathing), having safe objects (like a comforting photo or blanket), having a beloved pet nearby, having healthy distractions like conversations with a friend, or listening to relaxing music (in fact, research shows music therapy may help with pre-meal anxiety in recovery). Use food chaining. You may already be familiar with a tool called food chaining, which Colin describes as a “gentle approach to introducing more foods without the overwhelm,” and which you can continue at home. It’s a process of gradually adding variety to foods that already feel safe (e.g. having if you like french fries, trying waffles fries, or if you like white rice, trying brown rice). “It helps build a bridge from the foods that are successfully incorporated in your diet to new foods by providing exposure to similar foods with some variation,” Tracy explains. Focus on fostering positive eating experiences. Research shows that parents’ efforts to create low-pressure and pleasurable eating experiences is helpful in expanding food variety, improving attitudes towards food, and minimizing social discomfort around eating. On the other hand, parents exerting forcefulness and food demands around the table is generally unhelpful and unproductive. Some ways to create a more positive experience include practicing gentleness and compassion, talking about lighthearted topics (not food), and playing music that everyone at the table enjoys. Have reasonable expectations. Keeping expectations in check is helpful for both the person with ARFID and their loved ones. “It’s important to continue to focus on objective experiences of tasting and incorporating new foods, and be careful to avoid placing expectations on the patient to like new foods,” Jones advises. “Many patients may continue to expand variety slowly and may continue to have a more limited variety than their peers and other family members.” ARFID resources If you or your loved one need extra support in recovery post-discharge, the experts featured in this article recommend several valuable resources to explore: List of ARFID providers (dietitians, therapists, doctors, feeding specialists, and recovery coaches) from ARFID Collaborative ARFID support groups for patients and families from ARFID Collaborative Bridge the Food Gap: An ARFID Recovery Workbook by Amanda Garant, RD and Valerie Weesner, PhD ARFID: Avoidant/Restrictive Food Intake Disorder: A Guide for Parents and Carers by Rachel Bryant-Waugh The Picky Eater’s Recovery Book: Overcoming Avoidant/Restrictive Food Intake Disorder by Jennifer J. Thomas Wherever you are on your food exposure journey, remember to acknowledge all the progress you or your loved one have made so far, be compassionate with yourself, and lean on support when you need it. ARFID recovery is a journey, but with the skills and knowledge you gained in treatment, you have what it takes to continue down the right path.]]></content:encoded>
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            <title><![CDATA[What Are Fear Foods? (And Why It's Important to Face them In Recovery)]]></title>
            <link>https://equip.health/articles/food-and-fitness/fear-foods-in-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/fear-foods-in-eating-disorder-treatment</guid>
            <pubDate>Thu, 08 Feb 2024 19:15:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’ve been through eating disorder treatment or know someone who has, chances are high that you’ve encountered the term “fear food.” But now—due in large part to social media—the phrase has begun to enter the mainstream, and with that shift, the definition of fear foods has become a bit hazy. Read on to learn what exactly fear foods are, who is affected by them, what the most current research says about them, and how fear foods fit into eating disorder treatment. What are fear foods? “Fear food” is an age-old term used by us eating disorder dietitians to help clients progress in recovery and find lasting food freedom. But what does it mean?
According to Equip Nutrition Director and dietitian Erin Reeves, RD, fear foods are foods that feel unsafe, triggering, and emotionally charged. She explains that for people with fear foods, consuming those foods—or even thinking about them—can increase negative thoughts or feelings. “This might feel like ‘fear’ or being ‘afraid’ to eat the food, but people could experience a variety of negative emotions or thoughts associated with it,”she says. Any food could theoretically be a fear food, but certain specific items or types of food are more likely than others to fall under this designation. In my practice, my patients’ and clients’ most common fear foods are carbohydrate-based foods (like bagels, pizza, pasta, and bread), desserts (like ice cream, cookies, brownies, and cakes), and fried foods (like potato chips, French fries, chicken nuggets, or other fast food). Typically, fear foods tend to be those that diet culture deems “unhealthy” (and that I call “fun foods”). However, some clients may struggle with other, less expected foods, even those that diet culture praises. This could be for a variety of reasons, including past trauma (like choking on a certain food or getting ill after eating it), emotional associations, childhood conditioning, or arbitrary eating disorder rules. Others may not be afraid of certain foods, per se, but instead have conditions and rules they need to follow to make it “okay” to eat them. “There might be foods that people feel they have to do some sort of compensatory behavior after eating in order to ‘feel better.’ That could be increased exercise, restriction, or vomiting,” Reeves explains. “They’re afraid of eating the food and not doing the compensatory behavior.” Such conditional fear foods are typically higher in fat, carbohydrates, and sugar. Who has fear foods? In general, the term “fear food” is associated with eating disorders, and fear foods tend to show up more frequently in people with eating disorders than in people without eating disorders. To take one data point: a study of women with bulimia and women without eating disorders showed that for those with an eating disorder, exposure to “highly palatable” foods (aka delicious foods that diet culture tends to demonize, like cookies and candy), elicited more negative responses, including fear, than they did for those without eating disorders. But while it’s true that people without eating disorders feel generally safer around food, it’s possible for them to have fear foods for multiple reasons, too. “Our society has an irrational relationship with disordered thoughts and ideas about food, and people who repeatedly hear negative messages develop a cognitive response, which makes them fearful of the food,” explains dietitian Amy Goldsmith, RD.  Among people who do have eating disorders, fear foods are common, but they’re not always present, or may only show up in certain contexts, like when there’s “too much” of a specific food. For example, someone may be afraid of ordering a serving of French fries to themselves at a restaurant, but be okay with having a few fries from a shared plate. Or, someone may fear having a sandwich with two pieces of bread, but can have a piece of toast with little struggle. How fear foods present can also vary across different eating disorder diagnoses. With avoidant restrictive intake disorder (ARFID), for instance, fear foods typically have different roots than fear foods in bulimia or anorexia. “People with ARFID might not identify with being ‘fearful’ of a food, but perhaps find that certain textures, smells, or flavors create anxiety or feel overwhelming. Other people with ARFID have diagnosable phobias related to certain foods, if perhaps there's a fear of choking or a food making them sick,” Reeves says. “Two people might have a fear of pizza, but one has ARFID and doesn't like the melted cheese texture and mixing with tomato sauce and another person with bulimia is fearful of the fat content.” Research also shows those with binge eating disorder are more fearful around foods than those without an eating disorder, but they may have less fear around foods than people with other diagnoses like anorexia or bulimia.  Do you have to face fear foods in eating disorder recovery? As both a dietitian and a person living in recovery, I believe that facing fear foods is an imperative part of reaching full recovery. That’s because without complete food freedom, the eating disorder still has power over your life and room to live, and can potentially take control again. In fact, one study of people recently discharged from inpatient treatment showed that lingering food fears predicted increased eating disorder symptoms, like drive for thinness, just a month after discharge. “Sometimes the eating disorder likes to create logic around why someone would exclude a food, such as ‘I just don't like it’ or ‘I never ate that food growing up,’ when it's perhaps the eating disorder’s judgments preventing them from experiencing the food,” Reeves explains. “The eating disorder loves to hide in rules that haven’t yet been addressed. And the best way to address fear foods is through exposure, or incorporating the food at regular intervals to allow fears and anxiety to decrease over time.” Research shows a connection between fear food exposure work and recovery progress. One small study of patients with anorexia found that anxiety, restriction, and eating concerns reduced after eight 60-minute sessions of fear food exposure work. In another study, inpatients with eating disorders of various types were guided through challenging and eating fear foods, and prevented from engaging in compensatory behaviors like purging. After completing this exposure process, the patients experienced significant reductions in “eating-related fears and avoidant behaviors.” With each of my clients, I typically start by creating a fear food pyramid together, with three sections: the lowest part of the pyramid is for the least challenging foods, the middle is for moderately challenging foods, and the top is for the hardest ones. We explore beliefs, thoughts, and feelings around each food, and work on incorporating it into their intake on a regular basis. Their fears associated with each food typically decrease a little bit every time they eat it, and it gets a little easier and feels a little safer each time. Eventually, fear foods become neutral and even enjoyable. As Reeves explains, this continued exposure is essential, as simply eating a fear food once or twice isn’t sufficient to help someone feel comfortable or make peace with that food.“It often takes 15 or more times to really allow for reincorporation and decreased negative feelings,” she says.  There’s no doubt that facing fear foods in eating disorder treatment is mentally and emotionally difficult—“It's hard to continue to do something that doesn't feel great over and over,” Reeves says—however, with the support and guidance of a treatment team you trust, it’s completely possible. I overcame a laundry list of fear foods in my own recovery, and have watched countless patients and clients do the same. Plus, the payoff is massive: by facing fear foods, you earn a life of feeling empowered and at peace around all foods, and greater resilience to other life fears. “It does get better,” Reeves says, “and you get better in how you react to something hard, priming you to tackle other hard things.” ]]></content:encoded>
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            <title><![CDATA[Male Anorexia: What It Looks Like and Why It’s Often Missed]]></title>
            <link>https://equip.health/articles/understanding-eds/male-anorexia-what-to-know</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/male-anorexia-what-to-know</guid>
            <pubDate>Wed, 18 Mar 2026 19:33:00 GMT</pubDate>
            <content:encoded><![CDATA[For decades, eating disorders have been framed as something that mainly affects girls and women. That belief shows up everywhere: in media, healthcare, and everyday conversations. It’s also wrong. Years ago, a friend of mine was known for being “gym-obsessed.” He tracked everything he ate, never missed a workout, and talked about getting leaner often. Most people saw discipline. Some even admired it. What they didn’t see—and what none of us had language for at the time—was that he was quietly struggling with anorexia. Though we often associate the illness with girls and women, boys and men develop anorexia, too. They struggle with food, body image, and control. They face the same medical risks. Yet many go years without being recognized or diagnosed because what they’re experiencing doesn’t match the narrow stereotype of what anorexia is “supposed” to look like. Let’s be clear upfront: Anorexia doesn’t have a gender. Here, we’ll dive into how it can show up in boys and men, why it’s often missed, and what treatment and recovery can look like. If you’re worried about yourself or someone you love, you’re not alone, and help is available. What is male anorexia? Anorexia nervosa is a serious eating disorder that involves ongoing restriction of food, intense fear of weight gain or body changes, and behaviors that interfere with getting enough nutrition. It also involves rigid rules around eating, a strong need for control, and distress when those rules are disrupted. “Male anorexia” isn’t a separate diagnosis. It’s a descriptive term sometimes used to describe anorexia nervosa in boys and men—and the fact that it’s even used draws attention to how often anorexia nervosa in men is overlooked. “Eating disorders are still often assumed to be a ‘female issue,’ which contributes to under recognition in boys and men,” explains Rachel Levine, LMFT, LSWA, CEAP, a therapist at Equip. In fact, as many as 30% of people with eating disorders are male, yet many boys and men are never diagnosed or treated. In reality, anorexia can affect people of all genders, body sizes, ages, and backgrounds. You don’t have to look emaciated or fall below a specific weight to have anorexia. Many people with anorexia live in bodies that appear average or larger, (a condition called atypical anorexia), and it carries many of the same medical risks. Regardless of how anorexia shows up, it’s still a treatable mental health condition—and boys and men deserve recognition, care, and support. How anorexia can show up differently in boys and men  Eating disorders in men don’t always look like a drive for thinness. “In boys and men, concerns often center on lean muscularity or low body fat rather than weight loss,” says Levine. According to Levine, these patterns can resemble dedication to fitness or performance, including: Strict food rules Cutting out entire food groups Focusing on protein, supplements, or macros Compulsive exercise Distress about missing workouts Training despite injury or exhaustion And because these behaviors align with cultural ideas about discipline and masculinity, they’re often reinforced rather than questioned, she adds. Many boys and men grow up absorbing the message that they’re supposed to be lean and muscular. In fact, research suggests that up to 30% of men feel unhappy with their bodies, particularly when it comes to muscularity. That’s why, for some, anorexia can overlap with muscle dysmorphia (sometimes called bigorexia). This is a pattern where someone feels “not muscular enough” or “not lean enough” and uses extreme eating or exercise behaviors to try to change their body. But just because male anorexia can look different on the outside doesn’t mean it’s any less serious. Whether someone is chasing thinness, leanness, or muscularity, anorexia carries the same underlying risks. Signs of anorexia in boys and men “Male anorexia is often concealed behind a 2-hour-a-day gym routine or a rigid 3,000-calorie-a-day meal plan.” – Kaila Hattis, MA, LMFT Anorexia doesn’t look the same in everyone. Some boys and men may appear visibly underweight, while others may not. Some may talk openly about food or body concerns, while others keep their struggles private. What matters most is patterns—especially when thoughts, behaviors, or physical changes start to revolve around food, body shape, or control. If you’re noticing several of the signs below in yourself or someone else, it may be a signal that it’s time to reach out for help. Behavioral signs These are changes in eating, exercise, or daily routines that may signal a problem. In practice, this can look like: Skipping meals, eating very small portions, or following increasingly rigid food rules Cutting out food groups (like carbs or fats) without a medical reason Obsessively counting calories, macros, or tracking food Compulsive or rigid exercise, distress when unable to work out, or exercising despite injury or illness Using exercise as a way to “make up for” eating Avoiding eating in front of others or frequently making excuses to skip meals Spending excessive time planning, preparing, or thinking about food Using supplements, laxatives, diet pills, or steroids to try to control weight, shape, or muscle mass Withdrawing from social situations that involve food Psychological signs Not all signs are visible. Some signs of anorexia in males show up in thoughts and feelings, like: Intense fear of gaining weight or changing body shape Preoccupation with leanness, muscularity, or body fat Feeling “never good enough” physically, even with significant weight loss or muscle gain Irritability, anxiety, or distress around food or meals Perfectionism, rigid thinking, or a strong need for control Shame or secrecy about eating habits or exercise Difficulty recognizing the seriousness of symptoms or believing help is deserved  Physical signs Physical changes can also develop as the body becomes undernourished or overworked, such as: Noticeable weight loss or failure to gain expected weight during growth Fatigue, dizziness, or feeling cold often Slowed heart rate or low blood pressure Gastrointestinal issues Hair thinning or hair loss Hormonal changes Frequent injuries, stress fractures, or slow healing Health risks of anorexia in boys and men Anorexia is a serious medical condition for anyone, regardless of gender. When the body isn’t getting enough fuel—or is being pushed through excessive exercise—multiple systems are affected. This can happen even when someone doesn’t look “extremely thin” or when weight loss seems subtle, says Levine. In other words, someone can be in real medical danger even if it isn’t obvious. Health effects of anorexia in boys and men may include: Slowed heart rate, low blood pressure, or irregular heart rhythms Hormonal changes, such as low testosterone or reduced sex drive Bone loss and a higher risk of stress fractures Electrolyte imbalances that affect the heart and muscles (can be dangerous and there is a risk of refeeding syndrome, so must be managed under clinical supervision) Fatigue, weakness, and brain fog Digestive issues like constipation or bloating Higher risk of anxiety, depression, substance use, and suicidal thoughts Some warning signs are easy to misread. A very low resting heart rate, for example, may be chalked up to being “in great shape,” even when it reflects a medical issue, according to Kaila Hattis, MA, LMFT, a therapist and owner of Pacific Coast Therapy. And because boys and men are often diagnosed later, their bodies may endure these stresses for longer, which further increases risk. Why anorexia in boys and men is often missed  Cultural stereotypes: Eating disorders are still seen as a “female issue.” Praise for extreme behaviors: Weight loss, rigid eating, and intense exercise are often celebrated in fitness culture. Different symptom patterns: Focus on leanness, muscle, or performance instead of thinness. Screening gaps: Many assessments are built around thinness-focused concerns. Stigma and shame: Boys and men may feel embarrassed or weak asking for help. Provider blind spots: Clinicians may not recognize male-specific presentations.  Many boys and men with anorexia go unnoticed because our culture, our healthcare systems, and even our diagnostic tools weren’t built with male experiences in mind. Instead, eating disorders are still widely seen as a “female issue,” says Levine. That belief shapes who gets screened, who feels comfortable speaking up, and, ultimately, who gets diagnosed. According to Levine and Hattis, several overlapping factors contribute to this: Cultural stereotypes: The idea that eating disorders mainly affect girls and women makes it harder for boys and men to recognize their own symptoms (and harder for others to see them, too). Stigma and shame: Many boys and men grow up with messages that they should be tough, self-reliant, and unemotional. Struggling with food or body image can feel embarrassing or “unmanly,” which keeps people silent. Praise for extreme behaviors: Weight loss, rigid eating, and intense exercise are often framed as signs of discipline or dedication, especially for males. This praise can hide serious risk. Gaps in screening and assessment: Traditional screening questions tend to focus on fear of weight gain or desire for thinness, which may miss muscularity- or performance-focused concerns. Amenorrhea (lack of menstruation) also used to be—and sometimes still is—used as criteria for an anorexia nervosa diagnosis. Provider dismissal or lack of awareness: Some clinicians simply don’t know what anorexia can look like in boys and men, leading to missed or delayed diagnoses. What contributes to anorexia in boys and men There isn’t one single cause of anorexia. Like all eating disorders, it develops from a mix of biological, psychological, and sociocultural factors that interact over time.  According to Hattis and Levine, some common contributing factors for boys and men include: Genetics: Having a family history of eating disorders, anxiety, depression, or other mental health conditions can increase risk. Cultural pressure around masculinity and bodies: Many boys and men absorb messages that they should be lean, muscular, disciplined, and in control. These ideals are reinforced by media, fitness culture, and social norms. Dieting or sport-related restriction: Weight-cutting sports, bodybuilding, or performance-focused training environments can normalize extreme eating and exercise behaviors that can slide into eating disorders in athletes. Stressful transitions or major life changes: Puberty, injuries, relationship changes, academic pressure, career stress, or other big shifts can increase vulnerability. Using control as a coping strategy: Restricting food or overexercising can become a way to manage anxiety, numb difficult emotions, or feel a sense of control. How anorexia is diagnosed and treated Anorexia is diagnosed based on patterns in eating, exercise, and thoughts (a good place to start is this quick screener). Clinicians also take into account the impact those patterns have on someone’s physical and emotional health—including their bloodwork results, any weight loss, and other physical symptoms. It’s important to note that while weight loss can be a factor, anorexia affects people of all body sizes. Clinicians look at things like: Changes in eating habits Rigid food rules Compulsive exercise Fear of body changes Mood shifts Medical markers such as heart rate, blood pressure, labs, and growth or weight history For boys and men, it’s especially important that providers ask about muscularity goals, supplement use, and exercise patterns, not just fear of gaining weight. When those questions aren’t asked, many people are left wondering whether what they’re experiencing “counts.” That uncertainty often turns into the belief that they don’t look “sick enough” to deserve help. This belief is incredibly common, and it’s one of the biggest barriers to care. But you don’t have to meet a stereotype to deserve support. Once you have a diagnosis, treatment focuses on two things at the same time: restoring physical health and addressing the thoughts and coping patterns that keep the disorder going. That usually includes: Medical monitoring to make sure the body is safe Nutrition support to help the body get the fuel it needs Therapy to build healthier coping skills and address anxiety, perfectionism, or control Family or caregiver involvement when helpful Ongoing support to strengthen recovery and prevent relapse Research shows that when boys and men receive evidence-based treatment, they respond just as well as females. The takeaway: Anorexia in any gender is treatable, and recovery is possible. Barriers boys and men often face when seeking help “Emotional socialization teaches many boys and men to minimize vulnerability and suppress distress, which may delay recognition of internal struggles and promote disordered behaviors.” — Rachel Levine, LMFT, LSWA, CEAP Even when something feels off, reaching out can be hard. According to Levine, many boys and men run into obstacles such as: Feeling like they won’t belong in treatment spaces Telling themselves it’s “not that bad” Struggling to put emotions into words Lack of provider expertise regarding male anorexia Being dismissed in the past These barriers are real. But they don’t mean help isn’t available. Inclusive, knowledgeable care exists, and asking for support is not a sign of weakness. “Genuine strength is displayed through vulnerability,” says Hattis. Anorexia in LGBTQIA+ boys and men LGBTQIA+ boys and men experience higher rates of eating disorders, including anorexia. This isn’t because of their sexual or gender identity—it’s because many face higher levels of stigma, discrimination, and pressure about their bodies. In some LGBTQIA+ spaces, there can be strong and sometimes conflicting ideals about appearance, such as pressure to be lean, muscular, toned, or a specific “look” tied to belonging or desirability. For someone who already feels vulnerable, controlling food or exercise can start to feel like a way to cope, gain a sense of control, or try to feel safer in their body. For transgender and nonbinary people, eating disorder symptoms can also intersect with gender dysphoria: For example, using restriction or weight manipulation in an attempt to change how the body looks or is perceived. These experiences are real and deserve the same level of care as any other presentation of anorexia. Because of these added stressors, affirming and inclusive care matters. Everyone deserves eating disorder treatment that honors who they are—feeling respected, understood, and safe in treatment can make a meaningful difference. Supporting a boy or man with anorexia Watching someone you care about struggle with anorexia can feel frightening, confusing, and exhausting. You may not know what to say, when to step in, or how to help without making things worse. But you don’t have to have the perfect words to make a meaningful difference. Here are some ways to support a loved one who may be struggling: Trust your gut: If something feels off, it’s worth paying attention. You don’t need proof or a diagnosis to express concern. Look beyond weight or appearance: Changes in eating, exercise, mood, or isolation can matter more than how someone looks. Lead with care, not confrontation: Use “I” statements (for example, “I’ve noticed you seem really stressed around food, and I’m worried about you.”) rather than accusations. Encourage professional help: Offer to help find a provider, schedule an appointment, or attend a consultation together. Reduce isolation: Many boys and men feel alone or like they don’t belong in eating disorder spaces. Connecting them with others who have lived experience—such as Equip’s male-specific support groups or peer mentors—can be powerful. Advocate when concerns are dismissed: It’s okay to speak up, ask more questions, or look for another provider if you don’t feel your loved one is being taken seriously. Take care of yourself: Consider talking with a therapist, joining a caregiver support group, or leaning on trusted people in your life so you’re not carrying this alone. Recovery is possible for boys and men “Despite the barriers, when boys and men do receive evidence-based care, treatment response is similar to females, underscoring the importance of early recognition and inclusive practice.” — Rachel Levine, LMFT, LSWA, CEAP Recovery from anorexia is real, and it happens for boys and men. With evidence-based treatment, people can stabilize medically, restore regular eating, reduce compulsive exercise, and loosen the rigid thoughts that keep the disorder in place, according to Levine. Getting support earlier can improve outcomes, but it’s never too late to start. Many people seek help after months or years of struggling and still see meaningful improvements in their health, relationships, and quality of life. Recovery doesn’t mean losing your identity, strength, or goals. It means having enough energy to think clearly, train or move in healthier ways (if and when appropriate), show up for school, work, and relationships, and handle stress without relying on food or exercise as the only coping tools. The bottom line Even though eating disorders are still seen as a “female problem,” anorexia doesn’t have a gender. Boys and men can and do develop this illness, even when it doesn’t look the way most people expect. Anorexia in boys and men is often missed because symptoms may center on leanness, muscularity, performance, or compulsive exercise. Different presentation doesn’t mean different severity. The risks are real, regardless of body size or appearance. Boys and men deserve to be taken seriously. They deserve access to informed, inclusive care. And they deserve to know that recovery is possible. So if you’re worried about yourself or someone you love, you don’t have to wait for things to get worse. Help is available, and recovery is within reach. Frequently asked questions (FAQs) Can you have anorexia without wanting to be thin? Yes. Many boys and men with eating disorders are not trying to be thin. Instead, their concerns may focus on being lean, having very low body fat, looking more muscular, or improving performance. The underlying pattern—restriction, rigid control, and fear of body changes—is what defines anorexia, not a desire for thinness. Is excessive exercise a sign of anorexia in men? It can be. Many men with anorexia feel driven to exercise in a rigid or compulsive way, become anxious if they miss workouts, or use exercise to compensate for eating. When exercise starts to feel out of control or interferes with health, relationships, or daily life, it may be part of an eating disorder. What should I do if I’m worried about someone’s eating or exercise? Start by sharing your concern in a calm, supportive way. Focus on specific behaviors you’ve noticed rather than appearance. Encourage a medical and mental health evaluation, and offer to help find providers or attend an appointment. Advocate for your loved one if they feel dismissed: It’s okay to ask questions, try a new doctor, and request an eating disorder screening or referral to a specialist.]]></content:encoded>
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            <title><![CDATA[5 Early Signs of an Eating Disorder]]></title>
            <link>https://equip.health/articles/understanding-eds/early-signs-of-an-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/early-signs-of-an-eating-disorder</guid>
            <pubDate>Mon, 12 Feb 2024 18:01:00 GMT</pubDate>
            <content:encoded><![CDATA[While eating disorders can manifest in a variety of ways, there are a number of common and widely recognized red flags: fixating on nutrition labels and calorie counts, severely restricting food intake, or visiting the bathroom immediately after meals, for example. But often, by the time these signs become obvious and impossible to ignore, the eating disorder has already taken root. Considering how complex these illnesses can be and how ingrained disordered habits can become over time, there really is no better tool to combat eating disorders than prevention. And one of the best preventative tools is knowing the early signs of an eating disorder. “Eating disorders are notoriously tough to treat once they become entrenched,” says Equip’s Director of Lived Experience, JD Ouellette. “While anyone can recover at any age or length of illness, the earlier you act, the easier it is. Early action also lowers the risk of lifetime physical complications.” She drives this point home by noting that these are serious—and sometimes deadly—mental illnesses, with one American dying from an eating disorder every 52 minutes. To put it bluntly, early intervention saves lives—however, those first signs of trouble can be tough to spot. This is true for a variety of reasons, including the fact that people struggling often hide their disordered behaviors, and that our diet culture-informed society tends to praise and normalize a number of different eating disorder symptoms. “Early signs can be obvious or they can be subtle,” Ouellette says. “Because the initial phases of a restrictive eating disorder are in line with what society values—’discipline,’ weight loss attempts— it’s common for these signs to be ignored, or even celebrated, particularly if someone has a body size that medicine and society deem too large.” This is particularly notable given that all eating disorders, in fact, contain an element of restriction. Still, with a bit of education, it is possible to identify an eating disorder in its earliest stages. Here are five early signs of an eating disorder. Early signs of an eating disorder to know about  1. A history of an eating disorder or disordered eating in the family While this isn’t necessarily a visible sign, knowing someone’s family history can provide helpful context about their eating disorder risk. Eating disorders aren’t inheritable, but there is a genetic component to them. So if someone’s parent has an eating disorder, it doesn’t mean they will too, but it can make them more predisposed to developing one. Female relatives of people with anorexia have been shown to be 11 times more likely to develop the disease than relatives of people without anorexia. Rates of other specified feeding or eating disorder (OSFED) are elevated in first-degree relatives of people with anorexia and bulimia, and there’s research suggesting a genetic element in the development of binge eating disorder (BED) and bulimia as well. 2. Starting a diet or yo-yo dieting In today’s society, it can be hard to tell the difference between the early stages of an eating disorder and diet culture habits that, while disordered, don’t signify an underlying issue (think: intermittent fasting, extreme exercise regimens, cutting out entire food groups, etc.). But showing interest in any kind of dieting behavior—no matter how “normal” or common—can be a red flag. It can also be the first step on a slippery slope toward an eating disorder. “Disordered eating is more common than not in 2024,” Oullette says. “We've been told for a long time now that our eating should be rules-based rather than listening-to-our-bodies based, and our movement should be compensatory, paying for the food we've eaten.” While dieting is sadly normal, she notes that it might be tipping into dangerous territory if a person becomes distressed when they can’t follow their eating or exercise regimen, they become defensive when their diet is questioned or loved ones bring up concerns, or their diet negatively affects their mood and ability to engage in normal life. 3. Fear of social situations that involve food One early sign of an eating disorder is a fear of eating around others. This anxiety over social situations involving food can result from a number of things, including a desire to isolate, a fear of “losing control” around “unsafe” or unfamiliar foods, distress over straying from a rigid routine, or worry over being “caught” restricting or bingeing. Many people with eating disorders also feel shame about eating, and simply don’t want others to see them eat. “Do they skip meals, rarely eat in public, or only pick at food when eating with others?” asks Lara Effland, LICSW, Equip’s Director of Adult Programs. “If yes, it’s a sign that they’re struggling with eating.” Effland adds that progressively worsening pickiness around foods and an insistence on eating the same thing every day—both of which can make it difficult or anxiety-producing to eat with others—can be signs of trouble as well. 4. New and uncommon eating or exercise behaviors Rigidity and rituals are both common among people on the brink of an eating disorder, and this can rear its head in a variety of ways. Ouellette points out that inflexibility around exercise is a telltale sign: for instance, if someone adopts a new or increased exercise routine that they’re unwilling to take a break from for any reason, even injury or illness. Unusual food behaviors can also pop up. Some examples Ouellette cites are drinking an excessive amount of noncaloric beverages (sugar-free energy drinks, coffee, tea, diet sodas), cutting food into tiny pieces or taking very small bites, or only eating using very small utensils. But any uncommon and rigidly enforced habits around food or exercise are potential cause for concern. 5. A strong urge to keep moving (and checking) the body Body checking, defined as any behavior that involves the use of external markers to get information about the size and shape of one’s body, is common among those who are starting to develop an eating disorder. “This can include pinching, measuring, or spending a lot of time in mirrors evaluating your body,” Oullette says. Chronic use of a scale can also be considered a form of body checking, as can feeling one’s body for protruding bones or muscles. Feeling bad about your body can often be attached to this body checking.  In addition to compulsive body monitoring, people slipping into a troubled relationship with food and their bodies might also feel compelled to keep moving in an effort to burn calories or release anxiety. “Standing, jiggling legs, or being unable to be still are signs,” Oullette says.  Why it's essential to get help, even without a clinical diagnosis Eating disorders are treatable and with the right support, full recovery is possible for everyone struggling, regardless of how long they’ve been living with their illness. But once an eating disorder has fully taken hold, it can take a lot of time, heartbreak, and sacrifice to heal; halting the disorder in its tracks by staying vigilant and looking out for early warning signs is the key to successful prevention and easier recovery. “If there’s one thing I could change about our healthcare system, it would be for us to focus more on prevention than intervention,” Effland says. “I’ve had patients who were turned away from treatment because they were ‘not sick enough.’ This is the wrong message to send to people who are brave enough to ask for help.” Effland and other professionals who diagnose and treat eating disorders every day believe prevention is the key to reducing the number of people affected by eating disorders. “If you’re experiencing any level of suffering related to food, shape, or weight, it’s worth seeking support from someone who is educated in eating disorders,” she says. “Even if you’re uncertain about what level of care you or your loved one need, starting a conversation with a trained professional is a wonderful place to explore your options. Without support, disordered habits can quickly progress, and they only get more complex. They won’t go away on their own, and it’s tough to recover without help.” If you’ve noticed any early signs of an eating disorder in yourself or a loved one, it’s important to get help promptly. Talk to your medical provider or schedule a consultation with someone on our team to get a professional assessment.  ]]></content:encoded>
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            <title><![CDATA[Eating Disorders Cost the U.S. $65 Billion a Year. Here’s How You Can Help Change That]]></title>
            <link>https://equip.health/articles/news-and-research/cost</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/cost</guid>
            <pubDate>Fri, 02 Jul 2021 21:32:00 GMT</pubDate>
            <content:encoded><![CDATA[There are a myriad eating disorder facts that are slowly—thankfully—starting to enter the public consciousness. We know that eating disorders affect people of all ages, genders, races, sexual orientations and what eating disorders actually are (brain disorders—not vanity issues, choices, or personality traits). But one eating disorder fact that’s still very much under the radar is the financial impact eating disorders have on our society—and the truth may surprise you. According to a recent report for the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPE) and the Academy for Eating Disorders (AED) conducted by Deloitte Access Economics, eating disorders cost the United States a staggering $65 billion a year. If that number surprises you, consider where that money is going: three-quarters of that cost (almost $50 billion), is attributed to productivity losses (think: absenteeism or impaired work performance because people are suffering from their illness or caring for ill family members). But the price tag is even higher when experts add in the annual “additional loss of wellbeing” due to eating disorders — these costs aren’t financial, per se, but account for the reduced quality of life and even premature deaths that can result from eating disorders. “Our report is the first of its kind for the United States, but not for the world,” says S. Bryn Austin, ScD Professor at the Harvard T.H. Chan School of Public Health and Director of STRIPED, who served on the report’s expert advisory panel. “We followed in the steps of pioneers from Australia’s Butterfly Foundation and from the UK’s Beat Charity, who each commissioned comprehensive national economic reports for their own nations years ago.” The goal for the STRIPED-AED-Deloitte collaboration was to follow in the footsteps of those other organizations and conduct a rigorous and comprehensive study estimating the economic and social costs of eating disorders in the U.S. One priority for Austin and her collaborators in crafting the report was to engage policymakers in government and healthcare to take action in reducing barriers to care and accessibility. “Our study represents a critical step toward more fully understanding the social and economic burden of eating disorders in the United States, as well as making it possible to estimate the cost-effectiveness, improved quality of life, and, most importantly, lives to be saved by scaling up effective prevention, early detection, and treatment interventions,” Austin says. The 92-page report is indeed comprehensive, taking into account data from a combination of nationally representative surveys and modelling studies in the U.S. between October 1, 2018 and September 30, 2019. Among some of the other major findings: Eating disorders resulted in 53,918 emergency room visits, costing $29.3 million Eating disorders resulted in 23,560 inpatient hospitalizations costing $209.7 million Individual and family caregivers providing 6 weeks of informal, unpaid care per year lost a total of $23.5 billion The cost of eating disorders to employers was $16.3 billion The cost of eating disorders to the government was $17.7 billion Society as a whole lost $7.1 billion due to the impact of eating disorders “Eating disorders are expensive, costing the U.S. economy almost $65 billion each year,” Austin says. “Employers and policymakers should take note: Three-quarters of that cost – or almost $50 billion – is productivity losses. The majority of people affected by eating disorders are in the prime of their working years, which intensifies the impact on the economy. Each year, caregivers provide nearly six weeks of informal, unpaid care for loved ones with an eating disorder.” These diseases aren’t inevitable, and as Austin and colleague Cynthia Bulik, PhD, FAED, penned in an op-ed for The Hill last year, “eating disorders are treatable and their costs to society and burden on our medical system can be prevented.” Despite that fact, the CDC currently leads no national, ongoing data collection to monitor eating disorder symptoms or cases despite repeated urging from Congress. Austin and Bulik point out that the CDC’s only meaningful, ongoing, national monitoring of ED symptoms (via the Youth Risk Behavioral Surveillance System) was eliminated in 2015 and in 2017, and the NIH only provided $1 of funded eating disorder research per affected person (compared to approximately $239 per person for Alzheimer’s disease, $109 for autism, and $69 for schizophrenia). “Eating disorders are much more common than most people realize, and affect people of all genders, race/ethnicities, sexual orientations, body sizes, and ages,” Austin says. “Nearly 30 million Americans or almost 9% of the population will have an eating disorder at some point in their lifetime. Eating disorders are among the most deadly mental health conditions, killing over 10,000 Americans every year or one person every 52 minutes. Think about that — every 52 minutes, someone’s sister or brother, child or parent needlessly dies from this preventable and treatable condition.” While there are no simple solutions to this complex, multilayered, societal issue, Austin and her colleagues implore the CDC to launch systematic, longitudinal, national monitoring of eating disorders to allow for more data that can help eliminate barriers to care. They also believe an NIH plan needs to be implemented to allow for more support and funding for eating disorder researchers. And finally, existing insurance coverage gaps within Medicaid, Medicare, TRICARE, and the Indian Health Service need to be corrected to ensure comprehensive eating disorders treatment coverage. If you’re interested in learning more about how you can advocate for change, visit this page and click on your state to pull up a few key facts about eating disorders and costs in your area. Here, you’ll also find information that you can download and use with lawmakers or decision makers in your state in meetings about eating disorders treatment access and more.]]></content:encoded>
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            <title><![CDATA[New Equip Research Publication: Standards of Care for Treating Eating Disorders in Young People]]></title>
            <link>https://equip.health/articles/news-and-research/standards-of-care-summit-paper</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/standards-of-care-summit-paper</guid>
            <pubDate>Thu, 01 May 2025 16:30:00 GMT</pubDate>
            <content:encoded><![CDATA[The United States is in an eating disorder crisis, making it more important than ever for healthcare providers to understand how to diagnose and treat these potentially deadly illnesses. To achieve this, it’s important that there be clear and agreed-upon standards of care—which is why we’re pleased to share our latest published research. The paper, titled “United States-based practice guidelines for children and adolescents with eating disorders,” was published in the Journal of Eating Disorders on April 11, 2025, and was co-authored by Equip researchers alongside other leading experts in the field. It outlines the current state of guidelines for treating eating disorders in young people, recommends best practices for diagnosis and treatment, and identifies important areas for research and improvement going forward. We’ve highlighted key takeaways below, and you can also read the published paper for a more in-depth discussion. How we developed our guidelines Several professional organizations in the U.S. provide their own guidelines for assessing and treating eating disorders in children and adolescents. These organizations include: the American Psychiatric Association (APA) the Society for Adolescent Health and Medicine (SAHM) the American Academy of Pediatrics (AAP) the American Academy for Child and Adolescent Psychiatry (AACAP) In June of 2023, The Kennedy Forum and Equip brought together leaders from all of these organizations as well as other stakeholders—such as health systems, payors, policy advocates, and people with lived experience recovering from an eating disorder—for a summit to review current eating disorder treatment guidelines. The published paper highlights key areas of alignment across these different guidelines, identifies recommended standards of care, and points out future opportunities for research. Key takeaways Out of the summit discussion, several clear recommendations emerged. When it comes to effectively diagnosing and treating eating disorders in adolescents and children, these four tenets are both agreed upon and extremely important: Primary care providers should routinely screen for eating disorders to enable early detection and treatment referrals. The initial and preferred treatment for eating disorders in young people is outpatient treatment, with family involvement, including family-based treatment (FBT). The diverse health impacts of eating disorders can be effectively addressed by multidisciplinary treatment teams, encompassing mental, nutritional, and physical health. Hospitalization may be necessary for patients who meet certain medical criteria, such as bradycardia or specific lab abnormalities. These takeaways are validating rather than surprising—evidence has long shown that early intervention is crucial, that multidisciplinary treatment is key, and that outpatient care should be a first-line treatment as long as a patient is medically stable. But identifying this alignment is important, because it allows there to be a universal standard of care that can be used to educate and empower providers across the country. At Equip, multidisciplinary care is a core component of our treatment, with each patient and family getting access to a dedicated care team that includes a therapist, dietitian, medical provider, and mentors. We also emphasize the importance of family involvement, and generally use FBT (which is the gold standard for eating disorder treatment in young people) with pediatric patients. We’re also committed to educating healthcare providers of all types on how to screen for eating disorders, so that fewer people slip through the cracks. To learn more about screening for eating disorders, you can watch our recorded Equip Academy presentation on eating disorder screening, or read the written summary of the event. It’s also important to highlight the gaps and opportunities identified during the summit. Specifically, we recommend future research focus on: Treatment for avoidant/restrictive food intake disorder (ARFID) Weight-inclusive care Validated screening tools for children and adolescents Our research team will prioritize these focus areas going forward, as part of our ongoing mission to make sure everyone affected by an eating disorder gets access to effective, evidence-based treatment. Read the full paper.]]></content:encoded>
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            <title><![CDATA[The Important Role of Fathers in Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/dads-ED-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/dads-ED-recovery</guid>
            <pubDate>Fri, 17 Jun 2022 14:28:08 GMT</pubDate>
            <content:encoded><![CDATA[As his child’s primary caretaker, former Equip family mentor Simon Gowen understood his profound role in their eating disorder treatment—but not all fathers grasp the significance of their involvement in recovery. “Generally speaking, husbands and fathers are often excluded or self excluded through attitudes, social bias, or circumstances. Our importance isn't recognized enough,” he says. Gowen is right: for a variety of reasons related to stereotypes around parenthood, masculinity, and more, men are often left out of the picture when it comes to eating disorder recovery. While research has demonstrated the indispensable role family can play in the treatment process, studies have shown that fathers’ engagement is comparatively low, despite the fact that it can be have a profound impact on recovery . According to a 2018 study published in the Journal of Clinical Adolescent Psychology, over the course of six months of family-based treatment (FBT), fathers' attendance at treatment sessions declined slowly. However, the researchers found that when fathers did show up for more sessions, it predicted better outcomes for their kids “Dads being involved in treatment is helpful in so many ways!”, explains Equip therapist Brittany Ashmore. “ It communicates to their loved ones that they are here to do what it takes to get them well, it communicates to the eating disorder that the family is working together to defeat it, and to their spouse that they are not in this alone and have a partner in navigating this stressful and scary situation.” Hearing about the impact fathers can have from those who’ve been there Nothing can truly illustrate the critical role fathers play quite like the words of parents and patients who’ve been through the treatment process themselves. “Reflecting back, I appreciate the little signs of affection, worry, and support from my dad,” says L., who is in recovery from an eating disorder. “My dad showed up in subtle but firm ways. He was the one that handled all the research and logistics for treatment — from finding a doctor who comes from the same culture as my family to filling out insurance paperwork to often driving me to another city for appointments. He was also the one who often shielded me from difficult conversations with people who commented on my eating habits by gently redirecting conversations.” J., mom to a child in recovery, says that the participation of her husband was crucial. “My child’s ‘dad’ is her step father,” she says. “He was often extra cautious in the beginning to not ‘overstep’ and within a few months, he and I had begun to understand how to tag-team what needed to be done. He was and is my soft place to land..” While Gowen served as his child’s primary caregiver, he believes partnership can be a powerful tool in families that include more than one parental figure. “It is helpful to have someone else there to give emotional support for the child to lean on and share emotions with. If that is the dad coming home and offering hugs and listening, that's powerful. FBT is hard and families supporting each other is also valuable.” Dads are important — but all father figures can fill vital recovery needs When dads are part of their childrens’ lives, they can play indispensable roles in ED recovery — but father figures don’t necessarily have to be blood relatives to affect major progress. “The support of any male figure (grandfather, uncle, godfather, etc.) in someone's life can be so powerful in the recovery journey — not just that of dads or husbands!” L. says. “For me, it was my male friends who first noticed that something was off and took the initiative to push me to talk about it and seek help. While they did not always understand what I was going through, their determination to have me stay accountable and work towards healing often felt like a rock of support — I always felt that I had someone to turn to outside my family.” Based on her experience, J. can also speak to the support of a father figure who is willing to educate themselves on the most effective treatment strategies. “Our daughter was on the phone with her bio dad, who was counseling her to ‘just eat right and exercise and you will be fine,’ even though we had spent the previous 48 hours in hospital for medical stabilization. After the call ended, she asked if dad had gone to bed. She went into our room and said, ‘I just want to thank you for being my dad.’ She was thanking him for putting her well-being ahead of anything else, for supporting me to know I could do really hard things, for not allowing her illness to run unchecked, even when it raged, he didn’t budge from being the one we knew had our backs.” Celebrating fathers who support recovery, all year round While it may be hard to know what to say or do at various points of the journey, it’s important to recognize and celebrate all father figures who are willing to show up and learn along the way. “From my observations, sometimes dads might struggle with feeling that they don't know how to support their child,” Ashmore says. “Some dads feel like they want to fix the problem and don't know how, some feel targeted by the eating disorder and pushed away when their child is sick, and some feel ready and able to navigate the work. No matter where a dad is when they come into this process, there's no wrong way to show up for treatment. I applaud the dads who I work with and the courage it takes to be involved in a treatment like FBT.”]]></content:encoded>
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            <title><![CDATA[Reclaiming New Year's Resolutions from Diet Culture]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/resolutions-in-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/resolutions-in-eating-disorder-recovery</guid>
            <pubDate>Thu, 04 Jan 2024 23:36:54 GMT</pubDate>
            <content:encoded><![CDATA[Throughout my years of eating disorder recovery, the holiday season always proved to be a particularly tough time, but the start of a new year was arguably the most anxiety-provoking element. The pressure to set and commit to one or more resolutions always created an internal sense of distress as I felt stuck between hard-wired disordered tendencies and the desire for a healthier future. When you’ve grown up with a steady stream of magazine subscriptions encouraging detox diets on their January covers, it can be difficult to disentangle the “new year, new me!” mentality from restriction and self-punishment. It took a lot of time, effort, and nonlinear progress to arrive at a place in my life where the impending new year and thought of making resolutions doesn’t actively trigger my eating disorder or tempt me toward a relapse. The truth is, resolutions aren’t for everyone, and in fact, buying into the annual tradition of total transformation can set the stage for unhealthy, image-based objectives that ultimately fail and reinforce negative self-image. But, there is nothing inherently body-based about resolutions; the reason so many of us conflate the idea of resolutions with weight loss and body image is because diet culture has co-opted the tradition through an endless supply of weight loss programs, supplements, and other products. If you choose to make a New Year’s resolution, you can absolutely opt for one that rejects diet culture, supports your recovery, and helps encourage your growth as a happier, healthier person—here are some ideas for reframing the New Year’s narrative.  1. Be specific while giving yourself grace Research has shown that SMART goals (i.e. objectives that are specific, measurable, achievable, relevant, and time-bound) are a good way to stay on track when it comes to long-term success. That means that rather than settling on a vague resolution, such as, “I will commit to recovery,” it may be more helpful to define what “recovery” ideally looks like for you. Some people find it helpful to work with loved ones or support members to jot down actionable items, like meal plans and/or exercise guidelines so there’s no second-guessing whether food or exercise-related goals will help or hurt recovery. But while specificity can be helpful, attainability is another important part of the SMART goal-setting system. That means it’s essential to set goals that are realistic and achievable, given your time, resources, and more. Setting strict rules for yourself likely won’t make recovery easier or more comfortable and may contribute to feelings of disappointment or failure when you can’t be “perfect.” Consider working with your recovery team and/or friends and family to create a few clear, action-oriented resolutions that will help you stay committed without adding stress to your life. 2. Re-think about your relationship with social media There are a lot of potential positives when it comes to social media and recovery, including support groups, online forums, and body positivity accounts. But there are plenty of undeniably toxic and triggering aspects of social media as well, as evidenced by the documented correlation between social media usage and symptoms of depression and/or low-self-esteem. Research has shown that young women who engaged with an attractive peer on social media experienced increased negative body image while another study indicated that individuals who limited their social media use to 30 minutes per day reported significantly reduced depression and loneliness over a three-week period. It’s difficult for anyone to engage with social media without falling into “compare and despair” territory, but those in recovery should be especially mindful of how certain posts, groups, and creators can affect their well-being. For some people, unfollowing certain accounts and/or setting a timer for scrolling can help curtail unhelpful comparison that may jeopardize recovery. 3. Focus on resolutions rooted in feelings Because so many of us are taught to base New Year’s goals on appearance-related metrics (like the number on the scale or a clothing size), it may be difficult to reconnect with how we feel rather than how we think we look or are perceived by others. When you consciously move away from physical or weight-related resolutions, you have the opportunity to think of goals that will enhance your life and have nothing to do with food or exercise. This can be a great time to get curious about your passions or to re-discover the emotionally fulfilling activities, hobbies, and experiences you loved before your eating disorder. For some people, setting resolutions around reading, mindfulness, starting an affirmation practice, or spending more time with friends can help pull the attention away from the ingrained thoughts and behaviors of an eating disorder and refocus their energy on positive, enriching habits. While the start of a new year can be an intimidating time, there are strategies and tactics to take the pressure off setting resolutions and to actually find ways to strengthen your recovery. The most important thing is to connect with goals that speak to you and align with your values and hopes for the future. Remember how far you’ve already come and how bright your future can possibly be.]]></content:encoded>
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            <title><![CDATA[Equip's New Branding: Exploring the Meaning Behind Our New Look]]></title>
            <link>https://equip.health/articles/news-and-research/equip-new-brand-announcement</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-new-brand-announcement</guid>
            <pubDate>Tue, 20 Jun 2023 15:33:00 GMT</pubDate>
            <content:encoded><![CDATA[Equip has a new look! And we wanted to give you a peek at the “why” behind our new brand. Whether you’re a designer or brand aficionado—or not, hopefully this will feel a bit meaningful to you. <3 When we set out to transform the eating disorder treatment landscape in 2020, we didn’t dare to dream how many lives we’d touch in just three years. Our original brand was built to get us off the launchpad. This new brand is built to reach every single person with an eating disorder. This means we’ll be showing up with more humanity, more vibrance, more depth, and more personal stories.  You might notice a curving line in our new brand—and it’s at the heart of Equip and the world of eating disorder recovery. This line symbolizes the nonlinear path to recovery experienced by nearly everyone affected by an eating disorder.  For those of us who’ve been through it, we know that the recovery journey spans across a vast range of human emotions; travels along peaks and valleys big and small; can feel expansive and constricting even in the same moment; can fill us with fear and hope; and ultimately, moves with us through it all. This line also symbolizes Equip’s support and presence in our patients’ lives as they move through recovery—wherever they are.  You’ll also notice our brand has a brighter, more dynamic feel. We’re showcasing more diverse faces and bodies to represent the far-reaching stories of eating disorders. The new, modernized Equip look matches the innovation of our treatment model, and brings a sense of vibrancy and color to an issue that can feel heavy at times—but one we face with infinite hope, optimism, and motivation. We are also rolling out a brand new website, which has been fully reimagined to provide a more content-rich, interactive, intuitive user experience that ensures every single person has easy access to the information they need in that moment—whether it’s a provider looking to learn about screening for eating disorders, an athlete wondering if they may have a problem, or a parent trying to understand the treatment options for their child. We know that eating disorders affect people in countless different ways, and built our new site to speak to all the questions and concerns that arise on the road to recovery. As we continue forward in our mission to make eating disorder treatment that works accessible to everyone who needs it, we hope our new branding and website serve as powerful platforms from which to make strides toward this ambitious goal.    ]]></content:encoded>
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            <title><![CDATA[The Role of OB/GYNs in Identifying Eating Disorders: Key Red Flags to Watch For]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/obgyn-eating-disorder-red-flags</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/obgyn-eating-disorder-red-flags</guid>
            <pubDate>Thu, 24 Oct 2024 17:57:42 GMT</pubDate>
            <content:encoded><![CDATA[Obstetrician-gynecologists (OB/GYNs) specialize in women’s health—not eating disorders. Yet, because of when and how eating disorders tend to present, and how frequently they go undiagnosed, it’s vital that OB/GYNs become well-versed in spotting and screening for these illnesses among their patients. Eating disorders are good at hiding, often in plain sight. Some people go to great lengths to keep their behaviors and symptoms a secret, while other behaviors and symptoms (like restrictive eating and compulsive exercise) have become so normalized by diet culture that some people don’t realize they’re a problem. Coupled with the pervasive stereotypes and misinformation about who gets eating disorders, this means that far too many people go undiagnosed. Healthcare providers play a key role in solving this problem and helping detect eating disorders early. Primary care providers are often on the front lines, but they aren’t the only ones who can help. OB/GYNs also can also be pivotal in helping people get diagnosed and access eating disorder treatment. One reason for this is that it’s common for adolescent and adult females who have eating disorders to experience irregular or absent periods. Another is that many women see these providers every year at their annual women’s wellness checkup (or more often), and this recurrent interaction gives OB/GYNs an opportunity to notice something is wrong and intervene. “OB/YGNs are seeing patients during pregnancy, postpartum, and menopause,” says Barbara Kessel, DO, CEDS, supervising psychiatrist at Equip. “These are periods when women’s bodies undergo massive changes and could be high-risk times to develop disordered eating.” Read on to learn eating disorder warning signs OB/GYNs should be on the lookout for, as well as how OB/GYNs can screen and support patients. The impact of eating disorders on reproductive health Why is identifying eating disorders in gynecology important? In short, the earlier an eating disorder is detected the better, and eating disorders can often show up in gynecological symptoms before loved ones or other providers notice something is wrong. What’s more, eating disorders can have negative consequences for reproductive health. Let’s look at some of the reproductive health risks associated with eating disorders. Fertility challenges and pregnancy risks Malnourishment caused by an eating disorder can affect the hypothalamic-pituitary-ovarian (HPO) axis. When this happens, the brain produces less gonadotropin-releasing hormone (GnRH). This leads to a decrease in the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Without enough LH and FSH, follicles won’t develop, and a woman won’t ovulate or have a period. In turn, this can lead to infertility. Additionally, women with bulimia nervosa and binge eating disorder are at higher risk of miscarriage, though it’s unclear why. However, despite common misconceptions, women with eating disorders can and do conceive. So those who don’t wish to become pregnant need education on all contraception options as part of a shared decision-making process. Decreased bone health and menstrual irregularities Disruption of the HPO axis often leads to menstrual irregularities, and can play a role in bone health. LH and FSH prompt the ovaries to produce estrogen, which isn’t only a reproductive hormone: estrogen is also necessary for bone growth, maturation, and turnover, or the process where bone tissue is broken down and rebuilt with new tissue. This is why prolonged amenorrhea is linked with low bone mineral density and could eventually lead to osteoporosis. Although for some time it was believed that hormonal contraceptives, such as birth control pills, help with bone health, scientific evidence shows these medications don’t help and may actually lead to decreased bone density. Instead, weight restoration is recommended. Using birth control to “treat” amenorrhea is like covering up acne with concealer, Kessel says. “Amenorrhea is a symptom of a problem. The problem is malnourishment,” she explains. “Taking a birth control pill covers up the symptoms of the problem, but it doesn’t treat the problem.”  What are the key red flags of eating disorders in OB/GYN practice? The different eating disorder diagnoses can present in many different ways, and, on its own, any one sign isn’t a definitive indication of a problem. Still, OB/GYNs should be aware of the following symptoms and ask questions to determine if an eating disorder may be the underlying cause. Menstrual irregularities Menstrual disturbances, such as irregular periods and amenorrhea (when periods stop altogether for at least three months), are common in women with eating disorders. “People who are malnourished may not be able to menstruate,” Kessel says. Disordered eating, excessive exercise, and stress can cause changes in hormonal levels that disrupt regular menstruation. Physical and gynecological symptoms associated with eating disorders Muscles found throughout the body have estrogen receptors. So if estrogen levels drop due to an eating disorder, it can have wide-ranging effects. It may lead to smaller breasts, atrophic vaginitis (when thinning tissues lead to inflammation of the vagina), and pelvic pain (possibly because decreased estrogen appears to lead to muscle atrophy in the pelvic floor). Behavioral and psychological indicators By asking questions, OB/GYNs may pick up on behavioral and psychological symptoms of eating disorders, such as: Obsession with food or weight Weighing oneself frequently or compulsively Concerns about body weight and shape that affect how they feel about themself Perfectionism and being self-critical Fear or weight gain Social withdrawal/preferring to eat alone Depression or anxiety “Malnutrition can cause obsessions, anxiety, and depression,” Kessel explains. “Eating disorders are the second most deadly psychiatric illness, behind opioid abuse, and there’s a high risk of suicide.” So if you think a patient may have an eating disorder, take action to help them. Our free eating disorder screener can also help you determine if a patient may have an eating disorder. How OB/GYNs can screen for eating disorders in their practice The red flags above are an indication to investigate further whether a patient may have an eating disorder. To work to identify potential eating disorders in gynecology patients, it helps to use screening tools, physical exams, and sometimes lab work. Practical screening questions and tools Basic, open-ended questions such as “How do you feel about your weight?” or “What does a typical day of eating look like for you?” may lead to a deeper conversation that sheds light on disordered eating patterns. Additionally, there are a number of clinically validated tools that can help providers screen for eating disorders. Two of the most widely used are the SCOFF questionnaire and the Eating disorder Screen for Primary care (ESP). The SCOFF questionnaire consists of five questions. If a patient answers “yes” to two or more questions, it indicates the likely presence of anorexia or bulimia. The questions are: Do you make yourself Sick because you feel uncomfortably full? Do you worry that you have lost Control over how much you eat? Have you recently lost more than One stone (14 pounds) in a three-month period? Do you believe yourself to be Fat when others say you are too thin? Would you say that Food dominates your life? The ESP questionnaire also consists of five questions. A “no” to the first question and “yes” to the other questions are considered abnormal responses, and any abnormal response indicates a need for further assessment. The questions are: Are you satisfied with your eating patterns? Do you ever eat in secret? Does your weight affect the way you feel about yourself? Have any members of your family suffered with an eating disorder? Do you currently suffer with or have you ever suffered in the past with an eating disorder? Physical examination and laboratory tests Questions can help OB/GYNs get at the psychological aspect of eating disorders, but a complete evaluation also involves looking for physical signs. In addition to asking about menstrual history, OB/GYNs should conduct a complete physical exam, and potentially order lab work. When conducting a physical exam, some signs to look out for include:: Swollen salivary glands Calluses on the knuckles Dental decay Languo, or soft, downy hair all over the body Bradycardia, or a slow heart rate Weight loss or falling off the growth curve Although lab work isn’t always part of an OB/GYN exam, if you suspect that a patient might have an eating disorder, it can be helpful to order some tests. Common indicators of eating disorders that might show up in lab work include electrolyte imbalances, anemia, low potassium levels, and thyroid dysfunction. These results can also help rule out other possible diagnoses. In addition, OB/GYNs may consider ordering tests to check bone density. Kessel says that if somebody has lost their period for at least six months, it’s fairly common to order a DXA scan, an x-ray test that measures bone mineral density. Low bone density, which can be a result of malnutrition, puts people at risk of developing osteopenia or even osteoporosis.  Best practices for OB/GYNs: supporting patients with eating disorders If you think you spot eating disorder symptoms in your OB/GYN practice, the best thing to do is open the door to a conversation, Kessel advises. “If you don’t ask the screening questions, people aren’t going to tell you,” she says. Before you begin talking, keep the following in mind. Create a supportive and non-judgmental environment It’s essential to be non-judgmental about any disordered behaviors or thoughts someone mentions. This helps create a safe space and makes patients more inclined to continue the discussion. “Talk about how eating disorders are pretty common, educate them about the risks, and normalize getting help,” Kessel says. Being empathetic and validating their experience can go a long way toward helping them open up. At the same time, Kessel recommends avoiding any focus on a patient’s weight, body size, or dieting. It’s also best to avoid weighing patients unless absolutely necessary, since doing so may be triggering. If you must weigh patients for any reason, offer a blind weight (when a patient turns so they don’t see the number). Providers should also be careful not to inadvertently reinforce or celebrate disordered behaviors (like restrictive eating or compulsive exercise) or weight loss. Collaborate with multidisciplinary teams While OB/GYNs play a key role in identifying eating disorders in patients, they can’t be expected to provide treatment. In order to best support patients, OB/GYNs should develop relationships with therapists, dietitians, and other medical providers who specialize in eating disorders. This kind of collaborative, multidisciplinary approach has been shown to lead to the best treatment outcomes for patients with eating disorders. “Know what resources are available in your community, and create a referral list of experts,” Kessel suggests. There is also virtual treatment (like Equip), which research shows is as effective as in-person eating disorder treatment. Equip offers evidence-based eating disorder treatment for patients of all ages and all diagnoses in all 50 states.  Lastly, if someone shows any of the following signs, they should be hospitalized for medical stabilization: Very low weight (<75% of the 50th percentile BMI for age and sex) Dehydration Electrolyte disturbance (low potassium, sodium, phosphorus) Severely low heart rate (<50 beats/minute daytime; <45 beats/minute sleeping) Abnormally low blood pressure Low body temperature (<95 degrees F, <35.6 degrees C) Orthostatic changes in pulse or heart rate Dehydration Arrested growth and development Uncontrollable binging and purging Medical complications of malnutrition Concurrent medical or psychiatric conditions that limit appropriate outpatient treatment Learn more about when to refer a patient to eating disorder treatment and how to know if a patient needs inpatient hospitalization. The Equip takeaway: OBGYNs can help women get the care they need OB/GYNs are in a unique position to help recognize signs of eating disorders in their patients and support them in getting proper treatment. Many, though not all, women with eating disorders experience gynecological symptoms, and it’s common for this population to get an annual women’s wellness exam, putting OB/GYNs in a position to notice concerning signs of trends over time. By asking nonjudgmental questions, knowing eating disorder screening tools, and performing a complete physical examination, OBGYNs can help identify potential eating disorders in their patients that might go unnoticed otherwise. At the same time, OBYGNs are not experts in eating disorders. They need to have a working knowledge of these conditions so they can identify red flags, and they should also develop relationships with eating disorder professionals to whom they can refer patients. With a deeper understanding of eating disorders and how they might show up in a gynecological setting, OB/GYNs can play a vital role in early eating disorder intervention and be part of a multidisciplinary team that supports recovery. If you’re concerned that a patient of yours has an eating disorder, it’s important to connect them to eating disorder professionals who can help. Schedule a call with our team to talk through your concerns or begin a referral.  FAQs What are the early signs of eating disorders that OB/GYNs should look for? The early signs of eating disorders are often subtle. Still, OB/GYNs may be able to detect warning signs by asking open-ended questions about the person’s eating behaviors, physical activity, and self-esteem. If a person mentions frequently checking their weight or thinking about what they’re eating, new or uncommon eating or exercise behaviors, or avoiding social situations that involve food, these may be warning signs. How do eating disorders affect menstrual cycles and reproductive health? Eating disorders can lead to irregular periods, amenorrhea (no periods for three months or longer), infertility, miscarriage, and pregnancy complications. What should an OB/GYN do if they suspect a patient has an eating disorder? If an OB/GYN suspects a patient has an eating disorder, they should ask questions and perform a physical examination that can help determine whether an eating disorder is present. They should be empathetic and nonjudgmental, and normalize seeking treatment. It’s also essential to refer patients to virtual or in-person eating disorder specialists who can help them get the support they need to recover. When is hospitalization necessary for patients with eating disorders? According to the Society for Adolescent Health and Medicine, hospitalization may be needed if a person presents with one or more of the following: Electrolyte disturbance (low potassium, sodium, phosphorus) Very low weight (<75% of the 50th percentile BMI for age and sex) Severely low heart rate (<50 beats/minute daytime; <45 beats/minute sleeping) Abnormally low blood pressure Low body temperature (<95 degrees F, <35.6 degrees C) Orthostatic changes in pulse or heart rate Dehydration Arrested growth and development Uncontrollable binging and purging Medical complications of malnutrition Concurrent medical or psychiatric conditions that limit appropriate outpatient treatment Why is a multidisciplinary approach important for treating eating disorders? A multidisciplinary approach is important for treating eating disorders because eating disorders affect a person’s mind, body, and life. A team of experts, such as medical providers, therapists, dietitians, and more, can address all aspects of the eating disorder and work together to provide the support a person needs to recover. This is also the most effective approach for weight restoration, according to research.]]></content:encoded>
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            <title><![CDATA[Think You Might Have an Eating Disorder? Here's How to Talk to Your Doctor About It]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/talk-to-doctor-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/talk-to-doctor-eating-disorder</guid>
            <pubDate>Fri, 15 Dec 2023 16:59:41 GMT</pubDate>
            <content:encoded><![CDATA[Equip Peer Mentor Stacy Jones knew she had a problem, but she didn’t think anyone could help. After spending years blaming herself for binge eating disorder (BED), Jones was ready to ask for help—but she wasn’t sure how to do it. “I felt so many things leading up to telling my provider,” Jones says. “I was anxious, I doubted if it was worth bringing it up, and I felt confused on what all of it could mean. But I realized that if I didn't say anything, nothing would change—I would continue to feel anxious around food, be critical of myself, and hate looking in the mirror.” Rather than continue to ignore the issue, Jones decided to address it head-on. “I made a list of what was concerning me and what questions I needed answered,” she says. “When I met with my healthcare provider, I just started with being as open as I could about what was going on and letting them know I needed support with it.” Many people with eating disorders continue to get overlooked in the healthcare system and go undiagnosed. Every single person deserves effective, evidence-based treatment. Why so many people with eating disorders don’t get the support they deserve There are myriad reasons why so many people—particularly those in marginalized groups—don’t receive proper diagnoses and treatments. “Stigma, biases, and misconceptions heavily influence who gets a diagnosis and care,” Jones says. “There has been a long-standing stereotype for who people believe develop and can have an eating disorder.” Research has shown that eating disorder rates are higher among transgender, gender non-conforming, and queer individuals, but pervasive stereotypes about who gets eating disorders (often depicted as affluent, cisgender, white, heterosexual girls) continue to leave members of the LGBTQIA+ community without proper attention and care. For similar reasons, BIPOC individuals often slip through the cracks of the healthcare system, despite the fact that 20-26% of those affected by eating disorders identify as BIPOC. BIPOC individuals with eating disorders are also half as likely to be diagnosed or to receive treatment and are significantly less likely than white individuals to be asked about symptoms by a doctor. “My body never fit into the box of someone who has an eating disorder,” Jones says. "The behaviors I engaged with were sometimes even encouraged. It wasn't until I found the language of having an eating disorder and decided to advocate for myself that I began to find the needed support.” Equip Director of Psychiatry, Maria C. La Via, MD, says that there’s also a common misunderstanding of what “qualifies” as disordered, which can lead many individuals to avoid reaching out for support. “When an individual doesn't think their eating disorder symptoms are ‘bad enough,’ it’s important to educate them on both the medical and psychological impact and the co-occurring medical and psychological symptoms,” La Via says. While it may be extra challenging for some to broach the topic with their healthcare providers, there are strategies that can help ease the tension and ensure adequate support is offered. How to talk to your provider about your eating disorder symptoms While it can be challenging to raise the topic of a suspected eating disorder, it’s important to inform a medical provider about symptoms as early as possible so you can get quick, effective treatment. Here are a few tips for how to discuss an eating disorder with a doctor: 1. Organize your thoughts before your appointment A lot can happen in the course of a doctor’s appointment; putting your thoughts on paper (or in your phone) can help ensure all your questions are addressed. “Get clear beforehand what you want to communicate and what you are hoping will come from it,” Jones says. “It can be helpful to write this out and bring it with you.” If you’re having trouble phrasing your thoughts, try being direct, detailed, and to-the-point. “Be as open and honest as you can be about your concerns,” La Via says. “Start by saying, ‘I'm worried I may have an eating disorder.’ Be specific about symptoms, even if they may seem embarrassing.” Eating disorders are complex brain illnesses, and not a reflection of your own willpower or personal choices. 2. Prepare for it to be hard to talk about at first Allowing yourself to be honest and vulnerable can be incredibly challenging. Make sure you practice self-care before and after your appointment, either by making plans with trusted friends or scheduling comforting activities that can help you de-stress. “Create a plan for how to care for yourself leading up to and after talking to your provider,” Jones says. 3. Understand that you may need to talk to more than one doctor Unfortunately, not every healthcare provider is well versed in eating disorders. Know ahead of time that your doctor may not fully understand your symptoms or how disordered eating is affecting your quality of life. “Your doctor may not be familiar with eating disorders and how to diagnose them,” La Via says. “Ask for help in finding someone who has more knowledge if they feel underprepared,” La Via says. One resource La Via recommends patients share with their providers is the Academy for Eating Disorders (AED) website. 4. Do your own research on eating disorder treatment programs If you leave the appointment not feeling heard or taken seriously, pursue an appointment with a doctor or program who specializes in treating eating disorders. There are many treatment options out there, including virtual care, and these programs will be happy to walk you through how to get a proper diagnosis and care. “Remember that no matter how your doctor responds, you deserve care,” Jones says. “There are no conditions for deserving proper care.” 
If you’re worried you might have an eating disorder, you can talk to the Equip team today to ask questions and learn more about Equip’s unique virtual treatment model that offers evidence-based care from home.]]></content:encoded>
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            <title><![CDATA[The Real Problem with Workplace Wellness Programs]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/workplace-wellness-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/workplace-wellness-eating-disorders</guid>
            <pubDate>Tue, 27 Jun 2023 14:37:00 GMT</pubDate>
            <content:encoded><![CDATA[Over the past decade or so, there’s been a major boom in “workplace wellness programs” —they’re now implemented in about half of American workplaces. On the face of it, that’s a great thing. But the problem is, these programs aren’t always rooted in true health-promoting behaviors, with most of them based on the assumption that losing weight and moving more are healthy goals for everyone (spoiler: they’re not). It’s worth understanding how problematic these programs can be for employees—especially those vulnerable to eating disorders—and the types of health-positive initiatives that can actually help promote wellness for everyone. The (many) problems with workplace wellness programs Some workplace wellness programs may include incentives for behaviors that are universally considered healthy, like quitting smoking, stress reduction, or sleep hygiene guidance. But many, if not most, focus primarily on outdated, inaccurate, and reductive measures of health—most commonly, weight. In fact, about 17 percent of workplace wellness programs are based solely on weight management, and almost 30 percent are designed to “address physical activity, fitness, or sedentary behavior.” In many instances, businesses big and small have taken it upon themselves to encourage “healthier” habits with explicitly harmful tactics like weight loss competitions, which reward employees who shed the most pounds by whatever means necessary in the shortest length of time. These types of programs can be seriously triggering for people vulnerable to eating disorders, but they can also be detrimental to anyone. Let’s break down some of the major problems with workplace wellness initiatives promoting weight loss and exercise: They can encourage disordered behaviors “I’ve heard of some workplace wellness programs offering money prizes or bonuses for losing X amount of pounds or walking 10,000 steps for X days,” says Equip Registered Dietitian Gabriela Cohen. “I can see many harms to this type of program. Most of the time, intentional weight loss requires restriction which we know increases the risk of disordered eating patterns and eating disorders.” Cohen explains that these programs risk reinforcing many of the disordered thoughts and beliefs rooted in diet culture that can trigger or exacerbate eating disorders. “It can create the belief that someone needs to change their way of taking care of their body or the way they look,” she says. “This belief in itself can be very triggering to eating disorder behaviors, starting with restriction—and we know that restriction can lead to other behaviors such as binging. Pressure to participate in a certain physical activity or to hit certain numbers can also create a compulsive relationship with exercise. Programs that moralize certain foods or food groups can create orthorexia tendencies, which can evolve into another eating disorder.” They’re one-size-fits-all While encouraging employees to eat healthier or be more active may seem innocuous—even admirable—the truth is that fitness, nutrition, and weight are all highly subjective and personal. To truly incentivize employees to make wellness-oriented choices, companies would need to individualize and diversify their health offerings rather than push all employees toward the same arbitrary goal. “How do we know that weight loss is going to produce wellness in every individual employee who is going to participate?” Cohen asks. They uphold weight bias Equip Senior Program Development Lead Ally Duvall points out that these types of programs also exacerbate weight discrimination in the workplace, which (with the exception of a few cities) is shockingly legal in 49 states. “Wellness programming in workplaces often positions disordered behaviors as healthy, while normalizing weight bias,” Duvall says. “The programming focuses on how you can change your body and shift the life you currently have, solidifying the societal messages that thinner is better and more desirable.” They’re not really about health, after all First off, most of these programs aren’t designed by doctors or dietitians or anyone else with expertise about health, and there are no rules or standards governing how nutrition or exercise advice is doled out. Duvall remembers when, growing up, her parents’ company had a wellness program that gave insurance discounts to employees and their family members who participated in a weight loss program. This dynamic perpetuated Duvall’s undiagnosed eating disorder at the time, but in retrospect, she sees the damage it was doing to everyone involved. “Even for someone not struggling with an eating disorder, these programs create financial incentives for folks to move closer toward disordered behaviors and further away from a version of health that’s actually supportive and individualized.” What companies can do to actually promote health While there’s no single solution for all workplaces, there are plenty of practical, tangible ways to promote employee well-being without resorting to tired, potentially harmful weight-focused challenges. “First and foremost, don’t focus on numbers—they create rigidity, and rigidity can become very limiting and anxiety-producing for a lot of individuals,” Cohen says. “I would also stay away from body changes, because we should not be encouraging anyone to change their bodies.” In terms of what can be helpful to focus on, Duvall suggests a slew of stress-reducing social activities that may actually make a positive impact—a worthy area of attention given that 83% of American workers suffer from work-related stress and 77% have experienced employee burnout “A majority of the wellness programs out there center on weight control or weight loss; we need to fully move away from this arena and focus more on all the other ways folks can best support their brains and bodies, like workshops on burnout,” she says. She also suggests more constructive, morale-building activities, such as social hour, craft hour, and open discussions on important topics (like how to challenge harmful body image ideals!). Cohen says that in order for corporate settings to foster authentic wellness for every worker, we need a paradigm shift. “Employers need to help redefine what the true definition of wellness is: mental health, social connection, spiritual connection, self care, time off, mindful and joyful movement, seeing food as a source of joy and connection rather than something we must control or restrict,” she says. “For example, a cultural cooking class for team bonding, regular meditations for team members, ‘Bring Your Pet to Work’ day—all of these can increase how well employees feel in their workplace and increase their job satisfaction.” Ultimately, numbers and metrics are an important part of any successful workplace. But they should be mostly directed toward measuring business KPIs or revenue growth charts. When it comes to the health of employees and cultivating a supportive work environment, focusing on pounds lost or steps taken undermines the goal at hand. By avoiding the weight loss trap and thinking about what true, sustainable health looks like, employers can build workplace wellness programs that actually move the needle toward wellness.]]></content:encoded>
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            <title><![CDATA[What We Mean By “Eating Disorders Are Brain Disorders”]]></title>
            <link>https://equip.health/articles/understanding-eds/braindisorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/braindisorders</guid>
            <pubDate>Tue, 06 Oct 2020 16:47:00 GMT</pubDate>
            <content:encoded><![CDATA[Anyone who’s ever had an eating disorder or supported a loved one knows one thing for certain: there is no shortage of misinformation out there. Some people still believe that eating disorders are rooted in vanity or that these illnesses are a choice—but neither of these beliefs could be further from the truth. Myths like these are pervasive, and continue to distract from the truth about eating disorders like anorexia, ARFID, bulimia, and binge eating disorder: eating disorders are brain disorders. But what, exactly, does that mean? When someone is in the throes of an eating disorder, their brain is undergoing various chemical and physiological imbalances that drive them to act, think, and behave outside of their norm. This is especially true if they’re also malnourished, as malnutrition can significantly affect normal brain functioning. Here are four ways in which eating disorders affect the brain, all of which make it incredibly difficult for someone to stop eating disorder behaviors without outside help: Eating disorders can often cause malnourishment Eating disorders can alter the reward system in the brain Eating disorders can cause dysregulation of serotonin levels Eating disorders can make it difficult for the brain to read hunger cues The good news is that the brain is incredibly resilient and capable of change, a phenomenon known as neuroplasticity. Just because someone’s brain is altered by an active eating disorder, it doesn’t mean those changes are permanent. In eating disorder recovery, both the brain and body get the opportunity to heal. Let’s dive a bit deeper into why eating disorders are brain disorders, and why evidence-based treatment is so important. Eating disorders aren't a choice Research has shown time and time again that eating disorders are not one-dimensional; they're rooted in biological, psychological, and social risk factors and triggers. Above all, eating disorders are not a choice. Here are four ways that eating disorder behaviors stem from changes happening in the brain, not from personal choices or a desire to look a certain way: Eating disorders often cause malnourishment Many eating disorder patients are below their optimal weight when they begin treatment (even if they don’t “look” underweight). When a person is below their optimal weight, their brain is likely malnourished, and if the brain is malnourished, it’s not receiving the fuel it needs to carry out its many functions correctly. A malnourished brain is also more susceptible to feelings of fear, anxiety, and depression. Often in the case of eating disorders, these feelings become closely associated with worries about body image, weight, and food habits. During malnourishment, the brain has a hard time making rational decisions, thinking clearly, and regulating emotions. For these reasons and for the general well-being of the patient, weight restoration is always the first goal of eating disorder treatment (when it’s needed). Only once their brain regains nourishment can the patient take on the psychological and emotional elements of recovery. Eating disorders can alter the reward system in the brain The reward system, also known as the mesolimbic system, is an incredibly powerful driver of our behaviors. In this system, the hypothalamus and amygdala receive a stimulus, and send signals to release dopamine. This dopamine, in turn, binds to neurons and creates a sense of pleasure. The prefrontal cortex remembers the good feelings that came from that stimulus, and then reinforces the brain to repeat it. When functioning correctly, this reward system is especially important in reminding us to eat. Research has shown that this system is altered in patients with eating disorders. While most people naturally avoid the unpleasant feelings that can arise from eating too little or expending too many calories, people with certain eating disorders may actually find these feelings calming. In the case of anorexia, hunger and overexercise can trigger feelings of pleasure. Alternatively, in the case of binge eating disorder, eating may feel overly rewarding, causing people to engage in binges where they eat a large amount with a feeling of being out of control. How eating disorders impact the reward system is also important to keep in mind during treatment. For example, mounting research has shown that people with anorexia specifically have a tough time learning from reward but too easy of a time learning punishment. Understanding this and working with it (such as emphasizing a negative consequence of disordered behavior) can lead to lasting, positive change. Eating disorders can cause dysregulation of serotonin levels People with eating disorders tend to have dysregulated levels of serotonin, which is the neurotransmitter associated with feelings of happiness and calm. Serotonin is released in our gut, which means our eating habits can have a strong effect on serotonin levels. Many people are also naturally born with high or low levels of serotonin, which can affect how susceptible they might be to an eating disorder. People with eating disorders like anorexia and bulimia tend to have higher than normal serotonin levels, while those with binge eating disorder tend to have lower than normal serotonin levels. In either case, dysregulated serotonin can cause anxiety, depression, mood swings, and hyperactivity. These effects can all be underlying factors driving eating disorder behaviors, which makes them essential to address during treatment. Eating disorders can make it difficult for the brain to read hunger cues Eating disorders can impair the functioning of the hypothalamus and prefrontal cortex, which regulate hunger signals and impulse control. When these brain areas are affected, it’s especially difficult to maintain regular appetite and eating patterns. Someone with an eating disorder may feel physically less hungry, even if it’s time for their body to eat. They may also feel more impulsive around food, without knowing why. As a result of their unique neurobiology, people affected by eating disorders can also experience something known as impaired interoceptive awareness. This means their subjective perception of internal body sensations is altered, making it difficult for them to connect to their physical bodies. This can also impair their ability to read hunger cues. People can be born with these neurological differences, or develop some of them as a consequence of the eating disorder. Either way, full recovery—and a return to normal, healthy brain function—is entirely possible for everyone. How to treat eating disorders like brain disorders Eating disorders are complex and varied, and require personalized, targeted treatment strategies that are backed by solid science. That’s why Equip believes in and practices evidence-based modalities tailored to each patient’s unique needs. For young people, this usually means using family-based treatment (FBT). FBT is considered the gold-standard treatment for eating disorders and makes family members active participants in their loved one’s recovery. FBT allows families to lean into the unique variability of their loved one’s neurobiology and truly customize treatment so that it works. For adult patients, enhanced cognitive behavioral therapy (CBT-E) and dialectical behavioral therapy (DBT) are some of the leading evidence-based treatment approaches. These modalities help the patient establish regular eating patterns and address underlying issues such as co-occurring anxiety or depression. No matter what treatment modality is used, weight restoration is always the first priority in eating disorder treatment. This allows the brain to recover from the effects of malnourishment before attempting deeper therapeutic interventions. At Equip, we empower patients and their loved ones to do the hard work necessary to achieve real results in recovery. We’re particularly sensitive to the ways a patient’s brain chemistry can and does affect their ability to heal, and we use their unique neurobiology to our advantage. ]]></content:encoded>
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            <title><![CDATA[When to See an Eating Disorder Specialist]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/Eating-disorder-specialist</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/Eating-disorder-specialist</guid>
            <pubDate>Thu, 26 Oct 2023 00:02:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders are complex brain disorders. Unfortunately, because of how normalized disordered eating patterns can be in our society (thanks, diet culture), it’s easy to minimize or ignore the signs that you need help. You may think you’re “not sick enough” for treatment, or that you can just push through and recover on your own. But the truth is, eating disorders of any severity need specialized eating disorder treatment. In order to achieve lasting recovery, it’s important to work with an eating disorder specialist or specialists who understand your specific diagnosis and unique needs. Signs that you should see an eating disorder specialist Changes in eating habits. Any major shift in what or how you eat can be seen as a warning sign of an eating disorder. This could include cutting out entire food groups, counting calories, binge eating, or “purging” food through excessive workouts, vomiting, or misuse of laxatives and diuretics. Major weight fluctuations. Major weight changes, either up or down, are another common sign of an eating disorder. These changes could result from sudden changes in your eating habits, newly adopted purging behaviors, excessive exercise, or other disordered eating patterns. If there’s no other medical explanation for your weight changes, an eating disorder could be the cause. An eating disorder specialist can help you evaluate and address the factors contributing to these fluctuations. Preoccupation with food or body image. Do you spend a lot of time thinking about food? If thoughts of food or your body are taking up most of your mental real estate—taking priority over work, family, or other important parts of your life—it’s a bright red flag. Constant thoughts of food, exercise, or your body signal that something bigger is going on. If you feel bombarded by constant thoughts related to food or your body image, an eating disorder specialist can help. Social withdrawal. Withdrawing from your normal social life is another sign that you may need help. If you’re struggling with an eating disorder, you may want to avoid situations that involve food or eating around other people. You might find yourself declining invitations to parties, avoiding restaurants, and even skipping family meals. An eating disorder specialist can help you understand the emotional and physiological roots of this behavior, and develop healthy coping strategies to reconnect with the people you love in your life as you move toward recovery. Emotional distress. Difficult emotions often go hand-in-hand with eating disorders. This can be because of the stress and anxiety that eating disorders cause, as well as the fact that nutrient imbalances can have a major impact on the way your brain functions. A specialized eating disorder dietitian can help you regain nutritional balance, and an eating disorder therapist can help you reach a place of emotional stability and resilience. Persistent stomach pain. Do you experience recurrent stomach pain without another clear cause? Your pain might be connected to an eating disorder. Digestive issues are a common sign of eating disorders, often resulting from irregular eating patterns. Bingeing, purging, and restriction—three of the most common disordered eating behaviors—can all lead to gastrointestinal distress. What do eating disorder specialists do? Eating disorder specialists are clinicians who are specifically trained in treating eating disorders. The term “eating disorder specialist” can refer to a variety of different types of providers, including dietitians, therapists, physicians, psychiatrists, and nurses. Eating disorder specialists have all received training and licensing for their particular role, as well as additional training in and hands-on experience treating patients with eating disorders. Eating disorder specialists may be specialized in a variety of different evidence-based approaches to treating eating disorders, such as FBT, CBT-E, and DBT. This means that eating disorder specialists will take a targeted, recovery-focused approach to treating an eating disorder. For example, a therapist who specializes in eating disorders will conduct sessions in a different way than a general therapist. They’ll focus sessions specifically on developing coping skills specific to eating disorder challenges, identifying root causes of disordered behaviors, and developing strategies to handle triggers. An eating disorder dietitian, in turn, will take an eating disorder-informed approach that avoids diet culture messaging and helps you build food freedom. There are many different types of eating disorder specialists who can help you tackle different aspects of the eating disorder. At Equip, each patient is matched with a dedicated 5-person care team that consists of a medical provider, therapist, dietitian, peer mentor (someone who has recovered from an eating disorder themselves), and family mentor (someone who has helped a loved one through recovery, who can support your friends and family). The entire care team specializes in helping patients with eating disorders achieve lasting recovery. Get in touch with our team today for more information or to schedule a consultation.
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            <title><![CDATA[What Is an Eating Disorder Dietitian, and Why Are They so Essential to Recovery?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/eating-disorder-dietitian</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/eating-disorder-dietitian</guid>
            <pubDate>Fri, 08 Mar 2024 19:32:00 GMT</pubDate>
            <content:encoded><![CDATA[  Like the medical world, the field of nutrition and dietetics encompasses a vast variety of niches and specialties. I have dietitian colleagues who are experts in almost every area of nutrition you could imagine, including diabetes, kidney health, food allergies, cancer treatment, gut health, and (like me) eating disorders. Just like your gynecologist isn’t also going to be your cardiologist, a dietitian who specializes in food allergies isn’t going to be the best choice to treat an eating disorder. In that case, you need to see an eating disorder dietitian. Specialties and training aside, dietitians can also have varying philosophies on nutrition, weight, and health, and this perspective has an impact on their work with clients. When seeking treatment for an eating disorder, you’ll want to work with someone whose philosophy is aligned with recovery, which is another reason why it’s essential to seek out an eating disorder dietitian. Read on to learn more about the role of an eating disorder dietitian, why it’s key to include one in your care, what makes a dietitian equipped to work with you, and some tips to consider in your search. What we mean when we say “eating disorder dietitian” “An eating disorder dietitian is someone who has the skill set, training and philosophical alignment to work with someone through their eating disorder recovery,” explains Equip Director of Nutrition Erin Reeves, RD. “They’re familiar with all eating disorders and have robust knowledge in how to work through nutritional and therapeutic challenges associated with recovery work.” Regardless of the level of care you choose (residential, inpatient, partial hospitalization, intensive outpatient, or outpatient), eating disorder dietitians are a necessary part of a multidisciplinary team. This team may also include a doctor, therapist, psychiatrist, support people (like parents or spouses), and sometimes a recovery coach (learn more about multidisciplinary care teams at Equip).“Eating disorder dietitians work in tandem with doctors to ensure medical safety and with therapists to help patients cope by using new tools that are not their eating disorder,” explains Taylor Aasand, MPH, RDN, of Taylor Aasand Nutrition. A 2021 systematic review of a dietitian’s role in eating disorder care showed they can wear several hats. During eating disorder treatment, an eating disorder dietitian may help clients: Reach energy (calorie) balance Restore weight and correct nutrient deficiencies if necessary Meal plan, grocery shop, and prepare and cook food Understand eating behaviors Face and incorporate fear foods Find peace at mealtimes Heal relationships to exercise and body Let go of destructive thoughts, beliefs, and behaviors In my work as an eating disorder dietitian, I view my sessions with clients as opportunities to help them understand the emotional purpose of their disordered behaviors and to create more safety within their bodies and around food so they can live authentic and values-aligned lives. Eating disorder dietitians also help clients leverage the skills they learn in therapy. For instance, a dietitian might help you employ the DBT skill of opposite action, where you work to choose and eat foods that your eating disorder mind declares off-limits, or to use the concept of wise mind, where you focus on making food choices from a place of alignment with your values. An eating disorder dietitian may also work with parents, spouses, or others to help them understand how to help their loved one normalize their eating habits and stop disordered behaviors. If a child or adolescent client is using family-based treatment (FBT), the dietitian typically supports parents in the nutrition rehabilitation process by providing education and tips for nutrient-dense meals and snacks, and offering insight on energy and nutrient needs. An eating disorder dietitian’s role in a person’s eating disorder recovery is typically dynamic and always essential. In fact, a 2023 review of patients’ lived experience perspectives on the role and value of an eating disorder dietitian in treatment revealed a common theme: patients felt like they shared their recovery journey with their dietitians because they compassionately held space for their emotional struggles and listened to and honored their needs. Why it's crucial to work with an eating disorder dietitian in recovery Working with an eating disorder dietitian is critical in recovery because eating disorder dietitians undergo extensive training beyond the baseline education and experience required to become a dietitian. Given that eating disorders are serious and sometimes deadly diseases, this additional training is a non-negotiable. “Eating disorders are the second deadliest psychological illness, and it’s vital to work with a dietitian who understands that,” Aasand says. “Eating disorder dietitians are often the ones sending patients to their doctor for vital checks, lab work, electrocardiograms, and whatever else may be clinically warranted.” Patients with lived experience of eating disorder treatment report that working with dietitians who specialize in eating disorders enhanced their treatment engagement, helped them learn to honor their bodies, and provided personalized and collaborative care. They also reported that dietitians who were thoroughly trained and “upskilled” in eating disorder therapeutic modalities were able to help them beyond food and nutrition intake, and in fact facilitated a larger understanding of their experiences. Beyond the benefits of working with an eating disorder dietitian, there are also risks to not working with one. “Untrained dietitians in the field of eating disorders may recommend interventions that actually fuel the eating disorder,” Aasand says. Dietitians are not immune to diet culture: many of them promote disordered practices like intentional weight loss through fad diets, eating ‘clean,’ and counting calories. Unfortunately, there are also dietitians who have their own active eating disorders with little insight into how their personal food and weight fears may seep into their work. What qualifies someone to be an eating disorder dietitian? All dietitians-to-be are required to complete specific coursework, earn advanced degrees in nutrition science, participate in over 1,000 hours of supervised practice, pass an exam and become licensed, and maintain licensure through regular continued education. For dietitians to further specialize in a specific area of nutrition, like eating disorders, additional training and experience is necessary so that they can safely and ethically treat patients. At the most basic level, eating disorder dietitians need to be trained in how to identify and assess eating disorders and their various manifestations, understand medical and mental complications of eating disorders, guide nutrition rehabilitation, develop meal plans, assess general mental health state and suicide risk, and collaborate with a multidisciplinary team. Ideally, eating disorder dietitians are also trained in more nuanced areas of recovery, like: Challenging fear foods Reframing limiting thoughts and beliefs Eating intuitively Navigating hard emotions that surface during meals and snacks Eating with clients Implementing mindfulness techniques at meals Healing body image and relationships to exercise Forming co-regulatory relationships built on trust Providing compassionate and non-judgmental spaces for clients to heal One 2022 study of caregivers and patients receiving care from eating disorder dietitians found that the most valued aspects of working with them are their person-centered approaches to nutrition care, therapeutic alliances between dietitians and patients or caregivers, and sharing the recovery journey together. “I am the expert eating disorder dietitian, however, my client is the expert in their own lives,” says eating disorder dietitian Lauren Dorman, RD. “We help determine nutrition needs for recovery based on your preferences, and we look at you as a whole person. We listen to your lived experience, holding space where you are not judged, you are seen, heard, validated, and understood. We honor your natural body size and how your body exists in the world.” While it’s necessary for dietitians to get extensive training atop the foundation they built while earning their license in order to become an eating disorder dietitian, there’s not one right path to getting there. Personally, I chose to participate in a counseling training on the non-diet, weight-inclusive approach to treating eating disorders, and studied the medical complications of eating disorders. From there, I continued to build on my knowledge base with additional trainings as I started to work with clients and patients with eating disorders. Some eating disorder dietitians may have a Certified Eating Disorder Specialist (CEDS) certification, which Reeves says “ensures a solid baseline training.” However, she goes on, “there are many fully trained and qualified providers that don't have their CEDS, as this is a complex and expensive certification, so asking follow-up questions related to their eating disorder training is very helpful.” On that note, I’ll leave you with some actionable tips for your eating disorder dietitian search: Look for eating disorder-specific training, education, and experience, beyond base coursework and dietetic internship. “Some clinicians may post their training and any certificates on their website,” Aasand says. “If not, it’s important to ask dietitians upfront about their training and skills either during your discovery call or your first appointment.” Pick a dietitian who is rooted in weight-inclusivity and a non-diet approach to nutrition. Reeves suggests steering clear of anyone who promotes restricting food or intentional weight loss. “Unfortunately, diet culture is everywhere, which includes healthcare. It's possible a dietitian without specific training might not be Health at Every Size-aligned or be more supportive of diet culture or eating ‘healthy,’ instead of looking at all the aspects that contribute to health and how to truly support recovery,” she warns. Find someone who is always learning. Ensure they are committed to keeping abreast of nutrition science and eating disorder research (both of which are always evolving), continuing to expand their skill sets and knowledge, and participating in clinical supervision (where they meet with a mentor and sometimes peers for support). Continued education, training, and support is a career-long endeavor for many eating disorder dietitians. Don’t hesitate to ask as many questions as necessary. “I would ask them what experience they have with eating disorders specific to your diagnosis,” Reeves advises. “Ask questions to ensure they are a good fit—it’s important. The right person will not make you feel bad for doing so.” Trust that you deserve care, regardless of diagnosis. “You do not need a diagnosis of an eating disorder to receive support and guidance,” Dorman says. “If food and body chaos take up a lot of space in your mind, you can work with an eating disorder dietitian.”]]></content:encoded>
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            <title><![CDATA[What if There's Not a Dietitian Near Me? The Power of Virtual Treatment with an RD]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/dietitian-near-me-virtual-RD-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/dietitian-near-me-virtual-RD-treatment</guid>
            <pubDate>Wed, 19 Apr 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Three years ago, if someone struggling with an eating disorder had asked, “How can I find an eating disorder dietitian near me?” I would have sat down with them and helped them find all their local options, considering things like commute time and appointment availability and even parking. Today, if asked the same question, I would respond much differently. I would tell them that location shouldn’t even be a consideration, that we should find the right dietitian for their unique needs, rather than thinking about how near or far they may be. Indeed, virtual treatment has changed everything—and I’m as surprised as anyone. As an eating disorder registered dietitian (RD), I was conditioned to work in treatment centers, clinics, and counseling offices—so that’s what I did, without a second thought. Then, COVID-19 turned the world upside down. For my work with clients, that meant going online abruptly as we waded through an uncertain and traumatic global crisis. At the time, I was simply doing what most other eating disorder providers were doing: learning how to take care of clients and support their recovery in a virtual space. However, as I became accustomed to this new normal, I came to realize that virtual RD treatment could not only take the place of in-person sessions, but also expand access to those who may not have eating disorder dietitians near them. The role of the RD in eating disorder treatment As a critical part of an eating disorder treatment team, RDs work with clients and patients on several aspects of their recovery, including meal planning and support, weight restoration and/or stability, reviewing lab work, and healing patients’ relationships to food, body, and movement. “The RD educates the patient and helps them understand normal food intake patterns and meals, metabolic rate, and how to identify the feelings of hunger and fullness,” says Rebecca Jaspan, registered dietitian specializing in eating disorders. “They also help the client become aware of the body's physiological, biological, and emotional responses to food and exercise.” Beyond these physical components, dietitians also guide patients to let go of destructive beliefs, thoughts, and behaviors, and help them to develop a sense of safety in their bodies so they can live nourished, rich, and authentic lives aligned with their values. Jaspan describes the dietitian as a “partner in guiding the client” towards truly healthy relationships to food and body. “You can expect to address all aspects of body and mind in visits with a dietitian,” she says. “During sessions, the client and dietitian may review their food intake, go over different aspects of nutrition education, create meal structures, and help the client formulate more neutral, fact-based, and helpful thoughts and feelings toward their food and body.” Dietitians also regularly communicate with the rest of the team, including doctors, psychiatrists, therapists, and family members, to best support clients and patients in their recovery. At Equip, the dietitian is part of each patient’s 5-person treatment team, which also includes a medical provider, therapist, peer mentor, and family mentor. Wouldn’t it still be better to find a dietitian near me over a virtual RD? In this new, stabilizing post-pandemic world we live in, it’s fair to wonder if receiving online eating disorder care is effective. After all, eating disorder recovery is extremely challenging and personal, and the stakes are high. “I have seen incredible success with virtual treatment,” says Lauren Chaffin, a registered dietitian specializing in weight-inclusive treatment and eating disorders. “The clients receive all of the same education and guidance that they would in-person, but both client and clinician get to do this in the most comfortable and convenient location for them.” In fact, emerging research is showing that virtual treatment works. One 2021 study in the International Journal of Eating Disorders compared outcomes of in-person and virtual outpatient eating disorder treatment and found similar improvements, such as weight gain, decreased symptoms, and patient satisfaction in both groups. Another 2021 pilot study in the same journal showed no differences in outcomes, including weight, eating disorder symptoms, perfectionism, and depression, when comparing a virtual, multidisciplinary intensive outpatient (IOP) program and an in-person one. Additionally, Equip’s research shows virtual Family Based Treatment (FBT) with a multidisciplinary team, including an RD, is effective. Their 2022 study in Eating Disorders showed improvements of Equip patients and their families who received virtual FBT for up to one year, including weight restoration and increased caregiver self-efficacy, as well as decreased eating disorder symptoms, depression, anxiety, and caregiver burden. In my own practice, I observe similar progress in my clients as I did when practicing in-person. In fact, we are often able to have more complete sessions virtually, because there’s not the added layer of traffic and commuting.   What are the benefits of working with a dietitian virtually? One of the biggest benefits of virtual treatment is that patients can meet their dietitian from a space that feels safe to them. “[Virtual treatment] allows the client to see their care team in the comfort of their own home, allowing them to be more vulnerable and more willing to share in their sessions,” Chaffin says. Dietitians can guide clients through mindfulness practices in their own safe spaces, which supports clients’ connections to their bodies and selves but can feel quite vulnerable, especially when done in an unfamiliar office. “In virtual sessions, I may walk my clients through breathing exercises or a body scan that they can do from their own personal yoga mat or even their bed,” says Jaspan. Virtual treatment also gives patients more options when it comes to choosing a dietitian. “Distance is not a factor,” says Chaffin. “This allows patients to choose a great fit for them and their recovery journey.” In other words, instead of asking “Who’s a good dietitian near me?” those seeking care can ask, “Who is the best dietitian for me?” Virtual nutrition sessions can also be highly interactive. “Dietitians can be invited right into a client’s kitchen and pantry to review what they’re eating, answer their questions, and make individual recommendations,” Jaspan adds. “I have had a number of sessions with clients where we cook together, eat a challenging meal, or do an exposure to a fear food all from home.” I find it impactful to use a patient’s personal surroundings to enhance our work together. For example, I’lll invite clients to find items in their home that create a sense of safety, such as seashells from a recent beach trip, framed photos of loved ones, paintings of nature, comforting blankets, or a trusted furry friend. Fostering a sense of safety promotes nervous system regulation, helping clients feel more at ease and connected to the present moment, and better able to communicate in session and get their nutrition needs met. There are logistical benefits, too. According to a 2021 scientific review article in International Journal of Environmental Research and Public Health, research shows that for teens, virtual eating disorder treatment makes it easier to include other family members in treatment. The same review found links between virtual care and significant financial savings for families from avoiding costs of travel and the time burden necessary for in-person visits. “Clients can schedule sessions during their day without the added stress of commuting to and from a provider’s office,” Jaspan says. There’s no worse way for a client to start a session than fresh out of rush-hour traffic, running late.” Personally, my clients like to meet on their lunch breaks or in the early morning before they’re off to work, which would be impossible without virtual care. Virtual treatment also allows for continuity of care—I love that I can continue working with my teen clients who go off to college and need continued nutrition and body image support in their recovery. The unfortunate reality is that there are far too many barriers to effective eating disorder treatment. The good news is that, through the power of online care, physical location is no longer one of those barriers. In today’s virtual treatment landscape, the answer to the question “Is there an eating disorder dietitian near me?” can now always be this: it doesn’t matter. Effective RD care is at your fingertips, no matter where you are. Citations: Steiger, H., et al. (2022). In-person versus virtual therapy in outpatient eating-disorder treatment: A COVID-19 inspired study. International Journal of Eating Disorders, 55( 1), 145– 150. https://doi.org/10.1002/eat.23655 Levinson, Cheri A et al. “Pilot outcomes from a multidisciplinary telehealth versus in-person intensive outpatient program for eating disorders during versus before the Covid-19 pandemic.” The International journal of eating disorders vol. 54,9 (2021): 1672-1679. doi:10.1002/eat.23579 Dori Steinberg, et al (2022): Effectiveness of delivering evidence-based eating disorder treatment via telemedicine for children, adolescents, and youth, Eating Disorders, DOI: 10.1080/10640266.2022.2076334 Maglia, Marilena et al. “Evaluation of the Effects of Telepsychotherapy in the Treatment and Prevention of Eating Disorders in Adolescents.” International journal of environmental research and public health vol. 18,23 12573. 29 Nov. 2021, doi:10.3390/ijerph182312573]]></content:encoded>
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            <title><![CDATA[Bulimia Treatment: What to Expect, Why It’s Important, and How to Get Help]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/bulimia-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/bulimia-treatment</guid>
            <pubDate>Tue, 29 Oct 2024 23:38:00 GMT</pubDate>
            <content:encoded><![CDATA[When I reached out to Equip Lead Peer Mentor Makailah Dowell to learn about her experience with bulimia treatment and recovery, she was preparing to have her annual upper endoscopy, a procedure to examine the upper portion of the GI tract. For patients with a history of bingeing and purging, this procedure is a necessity to help detect throat cancer—a disease that those with a history of bulimia are at high risk of developing. “I wish someone had had this conversation with me,” Dowell says. “This procedure is for someone like myself who had bulimia and, most importantly, had purging symptoms for a very, very long time—undiagnosed and untreated. Untreated bulimia creates a life full of barriers, regret, and health risks.” Thankfully, Dowell was able to eventually receive a diagnosis and get effective bulimia treatment, but it was a journey. Now on the other side of recovery, Dowell looks back on her days of struggling with undiagnosed bulimia and wishes she’d known more about the disease, how it could affect her life, and how to get help. Here’s what everyone should know about bulimia treatment: what to expect, how it works, and why it’s critical. What are the risks of untreated bulimia? The complications associated with bulimia can be devastating, ranging from stomach rupture, heart problems, and dental erosion to depression, anxiety, suicidal behavior, and death. “Untreated bulimia can result in some very serious consequences, both physically and mentally,” says Angela Celio Doyle, PhD, VP of Behavioral Health Care at Equip. According to Doyle, some of the biggest physical risks of untreated bulimia include: Electrolyte imbalances, which disrupt your heart rhythm and, in severe cases, could lead to heart failure Strain on the digestive system due to purging. Frequent vomiting can damage the esophagus, lead to severe acid reflux, and even cause the esophagus to rupture. Significant dental problems due to stomach acid eroding tooth enamel In Dowell’s case, it was actually her dental problems that led her to get an official diagnosis. “It took a long time but finally, it was my dentist who saw the damage to my oral health and called out my eating disorder in the dental office,” she says. “They said, ‘this is a problem—what’s going on?’ I could feel the tears in my eyes form as I processed the reality in front of me. My eating disorder was harming me in ways I did not understand.” In addition to these physical repercussions, bulimia also has consequences for psychological health. “Bulimia is often linked with anxiety and depression, and if left untreated, these issues can spiral,” she says. “There’s also the constant preoccupation with food and body image, which can lead to isolation from friends and family. And in some cases, the psychological stress can even lead to self-harm or thoughts of suicide.” Untreated bulimia can also cause significant harm in areas of life beyond just mental and physical health. “Socially, bulimia can create a lot of strain in relationships,” Doyle says. “The secrecy, guilt, and shame often associated with the disorder can make it hard to connect with others, and this isolation can make everything feel even more overwhelming. It can also impact your work or school life, as the physical and mental exhaustion takes its toll.” The long-term health consequences of bulimia The long-term health consequences of bulimia can be severe and irreversible, which is why early intervention and evidence-based treatment are so crucial. “In the long run, untreated bulimia can lead to chronic health issues, like heart disease and digestive problems, and can even increase the risk of early death,” Doyle says. “And for people thinking about starting a family someday, bulimia can affect fertility and lead to complications during pregnancy.” The good news is, evidence-based treatment vastly increases the odds of permanent recovery. One study found that after receiving treatment for bulimia, the majority of study participants remained in recovery at a 22-year follow-up. Additional research has shown that in adolescents, family-based therapy (FBT) doubled the success rates for bulimia treatment compared to other forms of treatment. “This is why treatment is so essential,” Doyle says. “With the right support, including therapy, medical care, and nutritional counseling, it’s possible to break free from the cycle of bulimia and start the journey towards recovery. Early intervention can prevent many of these risks and help you regain control of your health and well-being.” The main treatment options for bulimia Like other eating disorders, effective bulimia treatment involves working with a multidisciplinary team of experts, but the specific types of treatment used varies depending on the individual patient. “When it comes to treating bulimia, there are several effective options that can really make a difference,” Doyle says, offering a quick rundown of the main treatment approaches: Cognitive behavioral therapy (CBT): “CBT is often the go-to treatment for bulimia,” Doyle says. “It focuses on changing the negative thought patterns and behaviors that drive the disorder. With CBT, you’ll work on identifying and challenging distorted beliefs about food, body image, and self-worth. It also helps you develop healthier coping mechanisms and gradually reduces the urge to binge and purge.” Family-based treatment (FBT): “FBT, also known as the Maudsley approach, is particularly effective for younger individuals and young adults,” Doyle says. “It involves the family in the recovery process, empowering parents to take an active role in supporting their child’s return to healthy eating behaviors. FBT helps the whole family understand the disorder and work together to create a supportive environment for recovery.” Dialectical behavior therapy (DBT): “DBT is great for people who struggle with intense emotions and impulsivity, which are often linked to bulimia,” Doyle says. “This therapy teaches skills like mindfulness, emotional regulation, and distress tolerance. The goal is to help you manage your emotions in a healthier way, reducing the need to turn to harmful behaviors like bingeing or purging.” Nutritional counseling: “Working with a dietitian who specializes in eating disorders can be incredibly helpful,” Doyle says. “They can guide you toward a balanced diet and help you understand how to nourish your body properly. Nutritional counseling often goes hand-in-hand with therapy, helping you rebuild a healthy relationship with food.” Medication: “In some cases, medication can be part of the treatment plan,” Doyle says. “Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are sometimes prescribed to help manage the underlying depression or anxiety that often accompanies bulimia. While medication alone isn’t a cure, it can be a useful tool alongside therapy.” Support groups: “Connecting with others who are going through similar experiences can be really empowering,” Doyle says. “Support groups offer a sense of community and provide a space to share challenges and successes. They can be a great complement to individual therapy.” “Each of these approaches offers something unique, and often, a combination of approaches is used to create a comprehensive treatment plan,” Doyle says. “The key is finding the right mix that works for you, with the support of a skilled treatment team.”  What role can medication play in bulimia treatment? As Doyle mentions, medication may be an appropriate part of bulimia treatment in some cases. “Medication can play a supportive role in treating bulimia, especially when it comes to managing some of the underlying issues like depression or anxiety that often go hand-in-hand with the disorder,” she says. “While medication isn’t usually the primary treatment for bulimia, it can be a helpful addition to therapy.” A few of the most common medications used in bulimia treatment include: SSRIs: “The most commonly prescribed type of medication for bulimia is SSRIs, with fluoxetine (Prozac) being the most well-known,” Doyle says. “SSRIs help to increase serotonin levels in the brain, which can improve mood and reduce the frequency of binge-eating and purging episodes. They’re particularly useful if you’re dealing with co-occurring depression or anxiety, which can make bulimia even harder to manage.” Other antidepressants: “Sometimes, other types of antidepressants might be prescribed if SSRIs aren’t effective or if there are other factors to consider,” Doyle says. “For example, tricyclic antidepressants or MAO inhibitors are sometimes used, but these come with more potential side effects, so they’re less common.” Mood stabilizers and antipsychotics: “In some cases, if bulimia is accompanied by severe mood swings or other mental health conditions, mood stabilizers or atypical antipsychotics might be considered,” Doyle says. “These medications can help regulate emotions and reduce impulsivity, which can be beneficial in managing bulimia.” While medication can make a huge difference for some patients, it isn’t a one-size-fits-all solution and typically is just one piece in the larger recovery puzzle. “Overall, medication can help take the edge off the emotional and psychological symptoms that fuel bulimia, making it easier for you to engage in therapy and focus on recovery,” Doyle says. “It’s important to remember that medication is usually just one part of a comprehensive treatment plan that includes therapy, nutritional counseling, and support from healthcare providers.” The role of nutritional support in bulimia treatment Nutritional counseling is an essential component of bulimia treatment. “Nutritional health restoration is a really key part of bulimia treatment,” Doyle says. “Since bulimia often involves unhealthy eating patterns like bingeing and purging, your body can end up missing out on essential nutrients, which can lead to a whole host of physical issues. Working on restoring your nutritional health is about getting your body back to a healthy, balanced state so you can start feeling better physically, which also supports your mental recovery.” While dietitians may specialize in a variety of specific areas, those specializing in eating disorders are familiar with the nuances of these illnesses and have robust knowledge and experience in working through nutritional and therapeutic challenges. “A registered dietitian who specializes in eating disorders is a vital part of the treatment team,” Doyle says. “They can help you develop a realistic and sustainable eating plan that meets your body’s needs. The goal is not for them to tell you what to eat—a dietitian will help you rebuild a positive relationship with food.” As Doyle points out, there are a variety of services a dietitian can provide in the recovery process, including education and emotional support. “They guide you through normalizing eating patterns, addressing nutrient deficiencies, relearning hunger and fullness cues, and overcoming fear foods,” she says. “Ultimately, restoring your nutritional health is about giving your body the fuel it needs to heal and thrive.” The role of support groups in bulimia treatment While bulimia treatment will look different for everyone, support groups are often hugely beneficial. “Support groups can be a really valuable part of recovery from bulimia,” Doyle says. “They offer a sense of community and understanding that can be hard to find elsewhere, especially when you’re dealing with something as challenging as an eating disorder.” Support groups may look different and offer different benefits depending on where they take place and how they are led, but in general, they exist to provide space for patients (and sometimes loved ones) to share their experiences, hear from others on similar journeys, and gain new perspectives. “Just knowing that you’re not alone—that other people truly get what you’re going through—can be incredibly comforting and empowering,” Doyle says. “There are support groups led by peers who have recovered or are in recovery themselves and the focus is on mutual support and shared experiences. There are also support groups facilitated by a mental health professional and might include more structured activities or topics. They can be a great option if you’re looking for something that combines peer support with expert guidance.” Dowell says that in her case, support groups were life-changing. “To hear of others partaking in the same behaviors as me and having the same strong urges made me realize that: A) I wasn’t alone, and B) There was a possibility of recovery,” she says. “For the longest time, I thought I would live a life full of loss of control, bad behaviors, and even worse health outcomes. When I realized others were getting diagnosed and helped, I knew I needed the same thing. I deserved it.” Long-term strategies for maintaining bulimia recovery and preventing relapse “Maintaining recovery from bulimia and preventing relapse is an ongoing process, but with the right strategies in place, it’s definitely achievable,” Doyle says. “Seeking help for bulimia can feel really tough, especially when there’s so much shame tied to it. It’s important for people to know that there is nothing to be ashamed of.” Although bulimia has been shown to affect more women than men (3% versus 1%), anyone of any gender can develop the illness, and those identifying as male may have a particularly difficult time seeking help. “For men, it can be especially hard to talk about, because there’s often this idea that eating disorders are a ‘women’s issue,’ but that’s just not true,” Doyle says. “Men’s struggles are just as valid. By taking that step to seek help, they’re not only taking control of their life, but they are also breaking down those barriers and showing others that it’s okay to ask for support. It's important to remember that bulimia doesn’t discriminate—it can affect anyone, regardless of gender, age, or race—and reaching out for help is a sign of strength, not weakness.” Here are some long-term strategies that can help support recovery: Build a support system. “Having a solid support network is crucial,” Doyle says. “This might include staying connected with your therapist, attending support groups, and leaning on family or friends who understand your journey. These people can offer encouragement, accountability, and a listening ear when things get tough.” Practice regular self-care: “Prioritizing self-care is key to maintaining recovery,” Doyle says. “This means making time for activities that help you relax and recharge, whether that’s healthy movement, hobbies, or simply taking a moment to breathe. Self-care helps reduce stress and keeps you grounded, which can prevent triggers from taking over.” Implement regular, healthy eating patterns. “Continuing to follow a balanced eating plan is important,” Doyle says. “Working with a dietitian can help you keep your eating habits on track and ensure you’re nourishing your body properly.” Proactively address triggers. “Through therapy and increasingly over time, people get better at recognizing what triggers the urge to binge or purge,” Doyle says. “Whether it’s stress, certain situations, or emotional challenges, being aware of these triggers allows people to manage them before they lead to a setback. Having a plan in place for how to cope with triggers can make a big difference.” Be willing to return to therapy. “Even after making significant progress and ‘finishing’ therapy at one time in your life, sometimes returning to therapy can be really beneficial,” Doyle says. “It gives you a space to explore any new challenges that come up and keeps you focused on maintaining your recovery. Some people find that periodic check-ins with their therapist help them stay on track.” Set realistic goals. “It’s important to set realistic, achievable goals,” Doyle says. “Recovery isn’t about being perfect; it’s about progress. Celebrating small victories and being kind to yourself if you stumble along the way can help you stay motivated and keep moving forward.” For those who may fear judgment or stigma because of their illness, Doyle reiterates the strength it takes to ask for support. “There’s nothing to be ashamed of in seeking help,” she says. “It’s one of the bravest things people can do, and it opens the door to a healthier, happier future.” Dowell says that learning to ask for support has enabled her to remain steadfast in her recovery, and she advises those struggling to do the same. “Be open to asking for help, again and again,” Dowell says. “One thing that makes my recovery extremely strong is the fact that I’ve put my ego to the side. If I am not doing well, I will call my therapist, family, friends, everyone. I will get the help I need before jumping full-blown into a relapse. By becoming self-actualized, I had to realize that I may not handle life perfectly and need to be open to the reality of asking for help, rather than pretending recovery was ironclad.” If you or a loved one are struggling with bulimia, know that lasting recovery is possible. Don’t wait to reach out for help—schedule a call with our team today to talk through your concerns and treatment options.]]></content:encoded>
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            <title><![CDATA[What Do Eating Disorder Meal Plans Look Like?]]></title>
            <link>https://equip.health/articles/food-and-fitness/eating-disorder-meal-plans</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/eating-disorder-meal-plans</guid>
            <pubDate>Wed, 03 Jul 2024 14:24:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorder meal plans are kind of like casts when you break a bone: they’re necessary for healing, and are eventually and carefully discarded when it’s time. As an eating disorder dietitian, I view meal plans as temporary tools to help patients build healthy habits in place of disordered ones and stay regularly nourished. However, the same tool doesn’t work for every person, so eating disorder meal plans need to be created on an individual basis to best support a patient’s unique physical and mental needs. Read on to learn why meal plans are important in recovery, different types of meal plans, and how we create them, as well as how to follow one and when it’s time to let go of your meal plan. The purpose of eating disorder meal plans When you’re consumed by an eating disorder, it’s nearly impossible to properly judge the energy (calorie) and nutrient requirements for you to be physically, mentally, and emotionally healthy. A meal plan takes that responsibility away from the eating disorder brain, providing a meal-and-snack template designed to help bring your mind and body back into balance. “Meal plans provide the structure of what to eat, how much to eat, and when to eat that people need in order to fuel adequately despite the eating disorder voice telling them they’re full, not hungry, or don’t need to eat,” says Equip lead dietitian Tanya Hargrave-Klein MS, RDN. Since eating disorders sever the connection between the brain and body, meal plans provide an external guide while that connection is being restored. “Meal plans are important early in eating disorder recovery when individuals can’t rely on hunger and fullness cues because these cues have been blunted or muted by the eating disorder,” Hargrave-Klein explains. “People often need to rely on mechanical eating—or eating by the clock—to ensure they’re meeting their nutritional restoration needs, because they can’t rely on their body to prompt them to eat.” Aside from aiming to restore energy balance, meal plans are also meant to help you find relative balance by incorporating all food groups (grains, proteins, fats, fruits and veggies, and dairy) and a mix of nutritious and “fun” foods, along with fluids. “Meal plans ensure the body is refueled with enough food, replenish any nutrient deficiencies, and address any nutrition-related conditions such as Celiac disease,” says dietitian Kristin Draayer, MS, RDN. “Meal plans help people relearn skills for creating adequate, balanced meals for long-term recovery and gain independence in making food choices.” According to Hargrave-Klein, meal plans can also be helpful for challenging the harmful messages society sends us about food and eating. “Between the eating disorder voice and the diet culture we all try to exist in, many people have been fed big lies about what their bodies need to survive and thrive,” she says. “A meal plan can aid them in learning or re-learning how to nourish their body in a way that promotes physical and psychological health.” Different types of eating disorder meal plans Eating disorder meal plans are never one-size-fits-all, and there are various styles for different circumstances, preferences, and personalities. “There’s no right or wrong meal plan, as it’s dependent on the individual and a variety of factors including co-occurring conditions like OCD or ADHD, prior experiences using meal plans, diagnosis, treatment approach, and many other nuanced variables,” Hargrave-Klein says. Here are some of the most common eating disorder meal plan styles: Calorie-based meal plans According to Equip’s 2023 study on digitally delivered dietary interventions, calorie-based meal plans typically include a daily calorie target goal, which is provided to parents or caregivers of the eating disorder patient by their dietitian. They’re also given the number of meals and snacks the patient should have, with individual calorie targets for each. Calorie-based meal plans are often used in Family-Based Treatment (FBT), since someone other than the person with the eating disorder is typically in charge of the food and menu in FBT. “Caregivers may find calorie-based plans helpful, as they provide measurable reassurance,” Draayer explains. Since discussing calories can be triggering for the person with the eating disorder, it’s not recommended that they are involved in the calorie goal conversations. Outside of FBT, there are only a few instances when calorie-based meal plans could make sense, according to Dylan Murphy, RD, LDN. “There are some scenarios where a client has a neutral relationship with calories and seeing those numbers,” she says, “and in those cases, using calorie-based meal plans may be beneficial.” Plate-by-Plate The plate-by-plate approach is a numberless, flexible meal structure that emphasizes including all food groups at meals and snacks. It’s visually based, using a plate to help patients and caregivers create adequate and balanced meals. It was originally created for FBT, but is now used widely in all types of eating disorder treatment. The approach includes different guidelines for building meals and snacks, depending on treatment goals. For weight restoration, for example, it’s recommended for starches to take up half the plate, protein to take a fourth, and fruits and veggies to take the remaining fourth; dairy and fat sources are included on the side or within the meal, as determined by the dietitian. The plate-by-plate approach also includes similar guidelines for snacks. “Plate-by-plate is the meal plan we use most often because it takes numbers and counting out of the picture and focuses more on how the food items should look on the plate,” Murphy says. “This approach is especially beneficial in outpatient settings when we’re working on increasing flexibility with food, like eating out and traveling.” Exchange system The exchange system is what’s often used in higher levels of care at eating disorder treatment centers. It was developed by the American Diabetes Association and groups foods into six categories, with each exchange indicating a specific amount of food (for example, an 8-ounce glass of milk counts as one dairy exchange). The exchange system encourages balance and adequacy while including numbers other than calories (i.e., the number of exchanges needed), and typically requires some measuring of foods. “These meal plans offer precision in terms of serving size and number of servings, so there’s little room for the eating disorder to negotiate,” Hargrave-Klein says. “And the meal plan feels very black-and-white, which can be comforting for those experiencing an eating disorder.” Rule of Threes Another more fluid meal structure, the Rule of Threes includes a simple rule of thumb to follow daily: include three meals and up to three snacks, each containing all three macronutrients (carbs, fats, and proteins), and eat about every three hours. “This less structured approach is ideal for clients who need some guidance with flexibility,” Draayer says. Like the Real Food Guide, a flexible yet comprehensive eating disorder meal planning tool studied in 2018 in Australia and New Zealand, the Rule of Threes provides you with a template to develop a menu with your dietitian that fits your energy and nutrient needs. Eventually, it can be used to guide you in making present-moment food decisions. “The suitability of meal plans varies, because everyone is different, and so is every eating disorder,” Draayer explains. “Sometimes a more structured meal plan is preferable, such as when a person is earlier in recovery or for children and teens, while more flexible plans might be appropriate as recovery progresses or for someone with heightened anxiety around rigidity.” In my practice, I’ve discovered that merging two meal plan approaches can be supportive sometimes, such as an exchange-based plan fused with the plate-by-plate approach, so the client thoroughly understands how much food they need from each food group and how it translates to a plate. Adopting a "mechanical eating" approach can be helpful at first, especially if natural hunger cues are difficult to read. When clients need to understand what a serving of a food looks like, I also find it most helpful to use objects instead of measuring cups or utensils. For instance, one cup of rice is about the size of a baseball, three ounces of meat is like a deck of cards, and two tablespoons of peanut butter is about the size of a Ping-Pong ball. How RDs create eating disorder meal plans When creating an eating disorder meal plan, dietitians consider several factors. According to Hargrave-Klein, some factors that need to be taken into account include: Whether or not a patient needs to weight restore Cultural and religious-related food preferences Access to food and food preparation facilities Whether the patient or their supports will be in charge of food preparation The starting point for the meal plan is determining the amount of energy (calories) a patient needs to support physical and psychological health, and from there, dietitians create a structure, usually using one of the meal plan styles explained above. “The dietitian supports the individual or caregiver in determining how best to divide up their food intake between meals and snacks,” Hargrave-Klein explains. Throughout treatment, meal plans are usually adjusted depending on how a patient’s body responds and your needs change. One 2023 study concluded that extra care needs to be taken when preparing meal plans for eating disorder patients, because even small changes can cause significant issues for patients mentally and emotionally—it’s one of the reasons why collaboration and ongoing communication are key. “We want to make sure creating a meal plan is a team effort, so we have several sessions where we go over what the meal plan looks like and then work with the client to come up with meal and snack ideas that fit the parameters of the meal plan,” Murphy says. “We want to ensure the meals and snacks are ones the client would enjoy or typically consume.” Dietitians also assess factors like your cooking skills, access to food, and budget, all of which can be accommodated. “A dietitian can collaborate with patients and families to craft an individualized meal plan,” Hargrave-Klein says. “The plan can include the foods that a person has access to through a food pantry or that can be purchased using SNAP benefits.” Specific dietary needs are also considered, such as dairy or egg allergies. “Meal plans also should be flexible to accommodate traveling, eating out, and special celebrations,” Hargrave-Klein adds. Often, meal plans are necessarily more structured and fixed in earlier and more acute stages of recovery (when the eating disorder brain is its loudest) and can become more flexible once a patient has gained adequate weight (if necessary) and addressed any nutrient deficiencies. In my outpatient practice, meal plans are the backbone of my eating disorder patients’ energy and nutrient needs at first. Once they’ve progressed and are eating regularly, we can explore increased flexibility, variety, and autonomy in eating, and start to dabble in intuitive eating practices, like acknowledging hunger and fullness cues—all within the structure of a meal plan. Research shows it’s possible for eating disorder patients to eat intuitively eventually, however it’s important to approach it with awareness and intention, and not to rush it. How do you stick to a meal plan?  When it comes to eating disorder meal plans, creating the plan is just the dietitian’s first step—we’re also equipped to help you develop strategies to follow your meal plan consistently. “Having a meal plan and actually consuming the meal plan are definitely two different things when it comes to eating disorder treatment,” Hargrave-Klein says. “The dietitian collaborates with the patient, client, or support person to identify foods that the patient or client might be willing to eat in order to meet the meal plan. They also provide psychoeducation about the value of consistent and adequate nutrition on physical and psychological health, offer simple tips and tricks to increase the density of meals and snacks when weight restoration is a goal, and troubleshoot perceived barriers to meeting the meal plan.” In my practice, I work with clients to develop mealtime tools to overcome such barriers, which can be integrated into the meal plan itself. Common effective strategies include using nervous system regulation tools (i.e. breathing practices or music); increasing external safety cues with support people, comforting objects, or pets; and incorporating distress tolerance skills developed in therapy. Murphy says she starts with small goals to make meeting the meal plan achievable for her clients. “Depending on where the client is when we begin working together, we know 100% completion may not happen at first,” she says, “So we work to meet the client where they are and find ways to gently challenge them towards their goals.” Sometimes, it’s helpful to log feelings and thoughts at meals and snacks to identify patterns that may be making it hard to meet parts of the meal plan. From there, together with your dietitian and therapist, you can start to understand how your eating disorder is functioning emotionally at specific points in your day and address hard emotions and disordered thought patterns to make it more realistic for you to get nourished. Do you have to follow an eating disorder meal plan forever? At this point, you may be wondering, “How long do I have to stay on my eating disorder meal plan?” The answer isn’t black-and-white, because everyone’s recovery moves at a different pace; however, they aren’t meant to be used forever. “Readiness to transition from a meal plan to a more intuitive eating style typically takes place later in treatment and recovery,” explains Hargrave-Klein. “The individual needs to be in a place of good psychological and physical health and demonstrate consistent flexibility around food and eating. Hunger and fullness cues should be reconnected and fairly reliable before someone is ready for intuitive eating.” Transitioning off of a meal plan needs to be done with awareness and care (and often in stages) together with your dietitian, and at a pace that feels safe to you and supportive of your recovery. In the future, it may be helpful to return to your meal plan when you’re needing more structure and a tangible reminder of your nourishment needs. That might mean temporarily following your meal plan during big life transitions (like starting college), grieving periods after losing a loved one or an ending to a relationship, and an eating disorder relapse. So, when you and your team decide it’s time to let go of your meal plan, it’s wise to keep it tucked away somewhere you’ll easily be able to remember.]]></content:encoded>
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            <title><![CDATA[Not Sure How to Talk To a Loved One About Eating Disorders? Read This. ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/how-to-talk-about-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/how-to-talk-about-eating-disorders</guid>
            <pubDate>Mon, 07 Mar 2022 19:28:19 GMT</pubDate>
            <content:encoded><![CDATA[Perhaps one of the most challenging aspects of supporting someone with an eating disorder is knowing how to broach the topic in the first place. There’s no manual on the dos and don'ts of sharing your concerns with someone you suspect may be struggling, and it can be uncomfortable to discuss sensitive topics, like food, weight, and body image. All of this could, understandably, make you consider staying quiet. But if you’re worried about someone you love, it’s important that you find the courage to speak up—because many times, that's what gets someone on the path to recovery. To help you out, we asked eating disorder experts how to talk to someone with an eating disorder. Whether you're concerned about your loved one's behavior or you want to support them as they work through treatment, this advice will help you be the changemaker your loved one needs to start healing. Why it’s so hard to talk to someone with an eating disorder Talking to someone with an eating disorder isn’t easy. For one thing, eating disorders often thrive in secrecy: people who are struggling may lie about what they’ve eaten, or engage in bingeing, purging, compulsive exercise, and other disordered behaviors in private. This can make it challenging to spot warning signs and gauge if someone's behaviors are worrisome or not. It can also make it difficult to point to specific examples of why you’re concerned. Second, eating disorders (particularly anorexia nervosa) can be egosyntonic, meaning the person believes the disorder aligns with their goals and values, and because of this, they don't want to change their behaviors. Additionally, many people with eating disorders have anosognosia, meaning they don't believe they’re ill and therefore don't believe they need help. In turn, they might react defensively or shut down the topic if you try to talk to them, says Equip peer mentor Elizabeth Moscoso. And lastly, many of us are just scared to say the wrong thing. “There seems to be this genuine, empathetic concern that you might trigger your loved one and make their behaviors or disorder worse,” says Laura Sproch, PhD, CEDS-C, psychologist and owner of Vibrant Psychology. Despite all of these real challenges, it's essential to talk to someone with an eating disorder. In many cases, the intervention of loved ones is what leads a person to get the care they need. “I've heard from many patients through the years that sometimes they’re waiting for someone to offer support,” Sproch says. “Some people need someone else to help along the way, to offer care, and to identify what they're concerned about.” The sooner this can happen, the better. Patients who start treatment earlier have better outcomes: they show greater reductions in eating disorder behaviors and psychological distress and greater improvements in overall functioning. “Approaching someone you are concerned about nonjudgmentally—with objective things you’re noticing and appropriate resources—can help get folks evaluated and, if need be, treated,” says Sam Kolander, MD, a psychiatrist specializing in eating disorders and former medical director at Equip. How to talk to someone you’re worried might have an eating disorder So you know you need to bring up your concerns and are ready to do it—but exactly how do you talk to someone with an eating disorder? “Having these conversations can be intimidating. Maybe you've never had to talk about this before, or it makes you really uncomfortable. That's totally valid,” Moscoso says. “Know that it can be powerful to ask meaningful and respectful questions and show the other person that they matter.” The tips below can help you prepare, so you feel confident approaching your loved one. 1. Learn about eating disorders You don't need to be an expert; however, you may feel more prepared and less worried about saying the “wrong” thing if you educate yourself about eating disorders. “When you don't know the facts, your mind can create scary scenarios,” says Equip Community Advisor Kym Piekunka. “Learning about the illness will help you better understand some of your loved one's experience and their behaviors. It will remove the terrifying thought that you are somehow to blame, and you will have a better idea of what to expect.” 2. Find the right time and place “Don't bring it up at meal time or when lots of people are around. Instead, choose a place that's quiet and comfortable for both of you,” Moscoso advises. This allows both you and your loved one to be calm and untriggered, so you can focus on the conversation. It’s also helpful to give them a heads up so they don’t feel ambushed, which can put them on the defensive from the get-go. Try something like, “I'm hoping we can have a conversation about some things I've been worried about. I care about you and want to give you the space to talk. When’s a good time later today?” 3. Share specific observations Rather than zeroing in on their body or other potentially triggering topics, focus on their behaviors and how this impacts them and your relationship. This could include: I've noticed you haven't come out to Trivia Night in a while. I miss laughing so hard with you that we both cry. We haven't baked together in weeks. I look forward to that every week. Is this just a really busy time for you right now, or is something else going on? You seem to be exercising a lot recently, and I’ve noticed that you’ve been tired and getting sick more frequently. I wonder if those two things could be connected? You haven’t been wanting a snack when you get home from school anymore. Do you know why that changed for you? 4. Be curious and listen Your loved one may not talk much during the conversation. If that's the case, let them be. “You probably planted some seed and, later on, they might process this conversation in a different way and want to proceed with seeking treatment,” Sproch says. If they do talk, truly listen. Don't interrupt, knowing that it's likely hard for them to talk about this, and their words may come slowly. Letting them steer the conversation (without letting them get too off topic) can give them a sense of control during a time that feels out of control, and helps them feel heard. Consider using reflective listening skills, which basically means paraphrasing what they said: “I hear you say that you're feeling anxious about starting a new school. Is that accurate?” 5. Stay positive Don't forget that your loved one has wonderful gifts and strengths. If you can, incorporate those into the conversation. “You've been through so much in your life, and you are so resilient—you have done X, Y, and Z already. I want to support you in living the best life you possibly can in the way you want to see it,” Sproch suggests. 6. Offer to help If your loved one is open to seeking treatment, offer to look at resources together or ask if it would be okay if you looked into some eating disorder specialists in your area and emailed a list to your loved one. Doing these kinds of tasks can feel extremely overwhelming to someone affected by an eating disorder, and your help can be a game changer. While they may not act immediately, having this information handy could help them make that phone call when they do feel ready. 7. Expect pushback “A whole host of emotions might happen. Someone might feel angry, someone might be relieved, someone might be sad, someone might be worried, someone might have a whole mixture of emotions. All of that is okay, and it doesn't mean you triggered them. It's likely the eating disorder reacting,” Sproch says. Even if your loved one walks away, remain available to them. This type of reaction isn’t unusual, and you’ll likely need to have multiple conversations. 8. Plan a follow-up At the end of the conversation, Sproch suggests planning a way to check back in, even if they feel frustrated or defensive. Ask them, “What would feel supportive to you? When can we do that? What will that look like?” For some people, that may mean talking face-to-face in five days; for others, that may look like texting once a week to check in on them and reassessing from there. How to talk to someone in eating disorder treatment If your loved one has started eating disorder treatment, it's common to still worry about potentially saying the “wrong” thing. It can be helpful to flip the script, and instead consider how talking can help them in their recovery journey. “Eating disorders are really severe illnesses that can affect all aspects of life—psychological, social, financial, academic, occupational, emotional, physical—and so oftentimes, people need support to help them navigate their recovery journey,” Sproch says. “We know support people can make quite a difference. When we're doing really hard things, having other people alongside us can be very useful.” Here are some tips to keep in mind when talking to someone in eating disorder treatment. 1. Ask what they need If they’re uncertain about what would help, offer some ideas: maybe you can help them set up a comfortable space in their home to join virtual sessions, have dinner together twice a week, or redo their social media accounts to block unhelpful content and follow supportive accounts. Whatever it is, let them guide you, and ask again down the road. “What someone needs to begin with may be very different five or 10 weeks into treatment. Just be there for the type of support they need,” Sproch says. 2. Be their accountability person Accountability is crucial during the eating disorder treatment process. Some patients choose a support person and text them at the end of every therapy session to share what they’ll be working on that week and make a plan for checking in on progress: “Here are two things I'm working on this week. I'll text you at 8 p.m. every night to let you know how this goal is going.” If you don't hear from them by that time, you reach out, leading with curiosity. “You've been doing so well with X goal. How'd it go today?” Accountability could also look like sending pictures of meals and snacks, providing daily updates about exercise behaviors, or anything else they need help sticking with. 3. Join a session Research shows that having loved ones involved in treatment can support recovery. This is often family, but can also include partners, friends, or other support people. If their treatment program includes loved ones, offer to be a part of the journey, whether that means ongoing involvement or joining a session or two. “This can be exactly the time to talk about what is going on and any concerns you're having,” Sproch says. “It's a safe place because you have a professional there.” At Equip, support people are integrated into the recovery process at whatever level feels most supportive to patients and their loved ones. For young patients doing family-based treatment (FBT), supports play a key role in the process. 4. Seek your own support Supporting someone through eating disorder recovery is hard, and it’s important to take care of yourself. “I've worked with support people—sometimes they need their own support,” Sproch says. This could be an eating disorders specialist who can educate you about these diseases and treatments, a therapist who focuses on self-care, or a trusted friend. At Equip, loved ones have a dedicated Family Mentor with lived experience helping someone recover from an eating disorder who can provide empathy, compassion, and real-life advice. How to talk to different types of people with eating disorders There are no rules around who can be affected by eating disorders—or on how to “best” talk to any one person. Still, if your loved one fits any of the categories below, these tips may help. Males: Ask what their goals are for working out more, adjusting their diet, or whatever their behavior is. If the person is your son, “Openly ask if they are reducing calories, restricting food, or more concerned about their bodies than they previously were,” says Equip Family Mentor Linsey Henry. “If any answers hit an alarm button in your gut, reach out to your local doctor.” Students: Teachers may be among the first to notice shifts that could indicate an issue with food, exercise, or weight. Start the conversation with your observation. For example, isolating from peers is a common early symptom of an eating disorder. If that's the case, you might say something like, “I notice you aren't hanging out with X, Y, and Z like you used to. Is there something going on you can share with me?” “A student's reaction to caring questions can be informative,” says Equip's Director of Lived Experience, JD Ouellette. It’s also important to share any concerns with the student’s parents. Student athletes: Athletes are at an increased risk of developing an eating disorder. If you’re a coach or trainer, it’s important to know the red flags and speak up if you see any. “Ask simple questions with an observation, such as, 'I've noticed that the past week you've been skipping the pre- and post- practice snack, how's your energy feeling?’” Moscoso suggests. “This gives the student the opportunity to open up.” Again, if there is a concern, talk to the parent. Coworkers: “This is tricky territory and will depend on your closeness to this co-worker and their level of visible impairment,” Ouellette says. “If you feel you can or must say something, be mindful of timing, the setting, and your demeanor. It might also be important to involve human resources if you have a strong safety concern for them.” If you're concerned a loved one has an eating disorder, speak up Initiating a conversation about eating disorders with someone you care about may be challenging, but it may also be life-saving. Here are some important tips to remember that can make the discussion more productive: Choose a quiet time and place Share your observations without judgment Avoid any talk about appearance or weight Ask questions, and truly listen to the answers Expect pushback, and know you may need to have multiple conversations Above all, don't be discouraged. Eating disorders don't go away on their own, and early intervention saves lives. Your actions may be just the thing your loved one needs to seek help—even if that's not right this instant. “You are planting seeds. They might not grow immediately,” Sproch says. But over time, with more conversations, texts, and other types of support, your loved one will likely choose recovery. If you’re concerned about a loved one, schedule a call with an Equip team member to learn more about our evidence-based, at-home treatment.]]></content:encoded>
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            <title><![CDATA[How Long Is Eating Disorder Treatment?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/how-long-is-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/how-long-is-eating-disorder-treatment</guid>
            <pubDate>Mon, 13 May 2024 17:12:00 GMT</pubDate>
            <content:encoded><![CDATA[Beginning eating disorder treatment can feel overwhelming. Your mind is likely swirling with questions: Will this work? What will life in recovery look like? Can I do this? And one question that tends to come up frequently is, how long will this take? It’s natural to wonder about this. When you’re embarking on something as big and unknown as eating disorder recovery, it can be a comfort to know how long it will last, to have an endpoint that you can look toward. So let’s get into it: how long is eating disorder treatment, really? How long is eating disorder treatment? It depends. As much as we might wish there were one, clear-cut answer, the reality is that the length of eating disorder treatment is highly variable and depends on a number of different factors. “Eating disorder treatment length can vary widely,” says Kathryn Coniglio, PhD, Program Development Lead at Equip. For higher levels of care—like inpatient, residential, or partial hospitalization programs—she explains that an individual stay can vary from a few weeks to a year or more, citing a recent review paper that found that the average length of stay in residential treatment centers ranged from 17 days to 377 days. Often, but not always, the more intense a program is, the shorter it is: for instance, someone may be in a partial hospitalization program (that might meet five days a week, eight hours a day, for example) for four weeks, and then step down to an intensive outpatient program (that might meet four days a week for three hours) for eight weeks. “It’s also important to remember that a patient’s entire recovery journey may involve receiving treatment in several of these settings,” says Coniglio. “In many cases, these people have been living with their eating disorder for a long time before they were connected to care.“ Indeed, research has shown that recovery is nonlinear and can occur over the course of years. (In my own treatment journey, I had many different lengths of stay at many different treatment facilities—inpatient for three weeks, IOP for the duration of one summer, PHP for a semester’s length of care, residential for several months, outpatient for years—before finally achieving recovery.) One of the reasons that recovery can take such a long time is because relapse is unfortunately common for eating disorders, and so treatment needs to account for that. One study referred to relapse prevention as “a matter of essence” for recovery from anorexia nervosa, and recommended that all patients with anorexia develop a personalized relapse prevention plan at the end of their treatment and be monitored for at least 18 months after discharge. Read more about what relapse prevention looks like at Equip. However, this doesn’t mean that eating disorder treatment is always a matter of years. “There are several approaches that are delivered in an outpatient setting that can successfully treat eating disorders in a much shorter time frame,” says Coniglio. Two of those approaches, she says, are family-based treatment (FBT) and cognitive behavioral therapy (CBT), both of which have evidence supporting their effectiveness over relatively short time periods. “These treatment modalities can be used with a variety of eating disorder diagnoses and have been shown in clinical research trials to lead to symptom remission in just a few months,” she explains. Factors that influence the length of treatment Eating disorders look different from person to person, and so does eating disorder recovery. Two people who seem exactly the same on paper—same age, same diagnosis, same demographic details—might have very different needs when it comes to length of treatment. However, there are a few factors that tend to influence how long treatment takes: Age: Some research has shown that patients who begin treatment at a younger age need treatment for a shorter amount of time than older patients. Weight: One meta-analysis found that a lower weight at admission was associated with longer length of treatment, while another study found that for patients with anorexia, admission weight was associated with a longer length of stay. Co-occurring conditions: Treatment modalities like FBT and CBT are flexible enough to address co-occurring conditions like depression, anxiety, or OCD in the context of eating disorder treatment, Coniglio explains. Some providers may opt to treat each condition sequentially, which may prolong overall length of treatment, but, she says, “the addition is a few weeks or months, not years!” Both options are supported by data. Duration of illness: Some research shows that the longer someone has struggled with an eating disorder, the longer they’ll need to remain in treatment (which is part of the reason that we always advocate for early intervention). However, Coniglio points out, “a delay in a patient’s ability to access high-quality care affects illness duration. There are so many barriers that contribute to this delay, including the cost and accessibility of treatment. So it’s difficult to tease apart whether illness duration itself affects treatment length, or whether the gap between eating disorder diagnosis and access to treatment is to blame.” But regardless of any of these factors, it’s important to remember that lasting recovery is possible for everyone affected by an eating disorder. “No matter how long it may take, there’s strong evidence that recovery is within reach for folks no matter their age or diagnosis at the start of their treatment journey,” says Coniglio. How long is Equip treatment? “Treatment length is different for everyone at Equip. Recovery is highly personal and there is no one-size-fits-all approach,” explains Coniglio. However, she says, our data shows that patients generally see results quickly. “After just two months at Equip, 80% of patients show a decrease in eating disorder symptoms and nearly 40% of patients report no eating disorder symptoms at all,” she says. “This is especially exciting to consider in light of the fact that 59% of our patients come to Equip after having had at least one prior treatment. In other words, many of our patients who experience this rapid symptom reduction have been struggling with their eating disorder for a long time.” We also take an integrated approach to treatment—meaning we offer a range of resources for treating co-occurring conditions while patients are at Equip—which, as Coniglio mentioned, can shorten the duration of treatment. “Equip has many treatment offerings for treating conditions that frequently co-occur with eating disorders, like anxiety, perfectionism, obsessive-compulsive disorder, and emotion regulation,” she says. “We believe treating the whole person helps set our patients up for sustained recovery.” Equip treatment works—and it starts working quickly—but that doesn’t mean that patients are in and out of treatment in a matter of weeks or a couple months. While recovery looks different for everyone, we generally seek insurance authorization for up to a year of treatment for all patients at Equip. A year might seem like a lot of time, but the intensity of treatment doesn’t remain the same for the whole duration. You’ll start off with frequent weekly appointments, but they become less frequent as you make progress and move toward recovery. Most patients achieve remission (meaning their eating disorder symptoms are gone, they’ve reached their target weight, and they’re eating normally) before the year is over, and then have the support of their provider team as they navigate those vulnerable first few months in recovery. This provides a safety net, allowing them to taper down support in a gradual and thoughtful way that protects against relapse. Ultimately, the length of eating disorder treatment is less important than ensuring that treatment thoroughly and effectively addresses the eating disorder. How long this takes will vary from person to person, but by using an evidence-informed and individualized approach, providers can help patients reach recovery more quickly than they might otherwise. “Because eating disorders are life-threatening illnesses, it’s so important for providers to use treatment approaches that prioritize making behavior changes as early as possible in treatment,” says Coniglio. “But the optimal length of treatment is the length it takes for eating disorder symptoms to resolve.” Lasting recovery is possible for everyone struggling with an eating disorder—and with the right support, it can happen sooner, rather than later. ]]></content:encoded>
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            <title><![CDATA[What Is Anorexia Athletica?]]></title>
            <link>https://equip.health/articles/understanding-eds/anorexia-athletica-symptoms-causes-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/anorexia-athletica-symptoms-causes-treatment</guid>
            <pubDate>Tue, 23 Jul 2024 02:34:00 GMT</pubDate>
            <content:encoded><![CDATA[Most people have heard of anorexia nervosa, one of the most widely known eating disorders, but fewer people are aware that anorexia can come in a number of different forms. There’s atypical anorexia, which is when someone meets all the criteria for anorexia except for low body weight, and anorexia binge-purge subtype, which includes episodes of binge eating and purging alongside restriction. Then there’s anorexia athletica, a condition that’s lesser known and less firmly defined, but still serious. Read on to learn more about anorexia athletica, who it affects, its health risks, and how to get help. What is anorexia athletica? According to Megan Hellner, MPH, Director of Nutrition and Physical Activity Research at Equip, anorexia athletica describes “the obsessive pursuit of thinness or leanness in athletes, accompanied by severe calorie restriction.” A person with anorexia athletica will exercise compulsively—often with a focus on performance as well as body weight or size—while also dieting or failing to properly refuel their body. Hellner explains that, as it’s currently defined in the literature, the term anorexia athletica only applies to athletes, but similar drives for thinness accompanied by restriction and problematic exercise is also common outside of sports circles. How does anorexia athletica differ from other eating disorders? One of the main differences between anorexia athletica and other eating disorders is that anorexia athletica isn’t recognized as a distinct mental disorder in the DSM-5, and, Hellner says, the term is rarely used in practice or research. “The syndrome was coined by the American College of Sports Medicine. The resistance to using the term in practice is due to the idea that anorexia athletica isn’t different enough from other restrictive eating disorders to warrant a separate diagnosis,” she explains. “When it comes to treating athletes with eating disorders, we think of them as ‘unique not special,’” Hellner goes on. “What we mean by that is that athletes are subject to all the same consequences of undernourishment as their non-athlete counterparts.” In other words, anorexia athletica isn’t distinct enough to need its own diagnostic label or a specific treatment approach, but that doesn’t make it any less serious or concerning. There are, however, some differences between anorexia athletica and similar conditions, like anorexia. For one, a person with anorexia may eat a very small amount of food, and while people with anorexia athletica may do the same, the latter often involves eating less food than your body needs to sustain its level of physical activity. In other words, someone with anorexia athletica might eat what looks to be a normal amount, but it’s still far from adequate to meet their energy needs given how intensely they’re training or working out. Another key difference between anorexia nervosa and anorexia athletica is that anorexia athletica exclusively appears in the context of sports, and disordered behaviors are often driven by a desire to improve performance or stay in peak physical condition, as opposed to a fear of weight gain or body image distress. How common is anorexia athletica? Because anorexia athletica isn’t considered a distinct mental health diagnosis, there’s not a lot of research on its exact prevalence. However, given the fact that athletes are at a higher risk for developing eating disorders in general, we can assume that a sizable proportion of them are struggling with anorexia athletica. According to research, athletes have two to three times the risk of developing an eating disorder as compared to their non-athlete peers. In one study of elite and pre-elite female athletes, researchers found that 80% had symptoms of relative energy deficiency in sport (RED-S), a group of symptoms that occur when calorie intake is too low to meet the demands of training (which is also a defining characteristic of anorexia athletica). Studies also show that about half of adolescent athletes across genders and sports don’t eat enough food for the amount of physical activity they’re doing. What are the health risks of anorexia athletica? As Hellner explained, many of the health risks of anorexia athletica are similar to those of other restrictive eating disorders. Because a person with anorexia athletica isn’t eating enough to properly refuel, their body is deprived of the nutrients it needs to thrive or even function. This can lead to a whole host of serious health complications, including: Stunted growth Heart problems, like slowed heart rate, low blood pressure, or heart attack Gastrointestinal issues, like constipation or gastroparesis Poor bone health, osteoporosis Weakened immune system Arthritis Amenorrhea or irregular periods Infertility Pregnancy complications The bottom line is this: despite not having its own entry in the DSM, anorexia athletica is a serious condition that can lead to lasting health consequences if left untreated. What are the symptoms of anorexia athletica? Because there’s no formal criteria for anorexia athletica, there isn’t one definitive set of symptoms. However, Hellner says, “based on how most of the people with symptoms of anorexia athletica tend to present, they would likely meet criteria for anorexia nervosa or atypical anorexia.” It’s also important to recognize that even the same eating disorder diagnosis can show up differently from person to person, and that many eating disorders share some symptoms. That said, there are a number of distinct signs to look out for that might indicate anorexia athletica. Behavioral symptoms of anorexia athletica Exercising more than is necessary or healthy (exercising more than peers in their sport, using their sport as an excuse to exercise excessively) Consistently training beyond what is prescribed by a coach or trainer Exercising despite injury, illness, or bad weather Prioritizing exercise over other aspects of life, including work, school, relationships, and daily responsibilities Hiding exercise Restricting food intake Using exercise to compensate for eating Anorexia athletica shares many behavioral symptoms with exercise addiction, which is another unofficial condition. Both involve excessive exercise, but anorexia athletica differs in that the excessive exercise occurs alongside calorie restriction, which isn’t always the case with exercise addiction. Physical symptoms of anorexia athletica Weight loss Plateau or decline in athletic performance Fatigue or low energy Frequent injury or re-injury Injuries that are slow to heal Growth of excess hair on the body Irregular, missed, or absent periods Lightheadedness or dizziness Needing a longer recovery time between workouts, practices, or competitions Psychological symptoms of anorexia athletica Anxiety, guilt, or distress when unable to exercise Mood changes A perfectionist attitude in maintaining what’s perceived as peak physical condition Irritability Problems with concentration or focus Low self-esteem. Feeling that their training or exertion level is “never enough” Social withdrawal  What causes anorexia athletica? As with all eating disorders, there isn’t one single cause of anorexia athletica. Rather, it emerges out of a combination of different factors, which can be genetic, biological, social, psychological, or environmental. However, there are a few things that can increase a person’s risk of developing anorexia athletica, both on a societal level and on an individual level Societal and cultural factors One of the biggest risk factors for anorexia athletica is, unfortunately, the culture we live in. Because of our society’s obsession with thinness and weight loss, behaviors that are actually disordered and harmful are often treated as normal or even praiseworthy—and this can be especially pronounced among athletes. Some of the specific cultural factors that might contribute to anorexia athletica include: Fitness and gym culture promoting an unhealthy relationship with exercise (think phrases like “no days off,” “never skip a workout,” or “no pain no gain”) Diet culture normalizing restrictive eating behaviors Social media influencers promoting extreme exercise habits and body comparison The pressure to maintain a specific physical condition for peak athletic performance Pressure from coaches, trainers, or teammates to perform at a certain level Sports-related body assessments, like weigh-ins, judging criteria, or tight-fitting uniforms Participating in weight-sensitive sports like wrestling, ballet, gymnastics, distance running, or figure skating Individual factors Certain people can also be more vulnerable than others to developing an eating disorder. Some things that might increase a person’s risk of anorexia athletica include: Perfectionism, including a desire for peak athletic performance Doubts related to personal abilities Social uncertainty Body image concerns and a strongly idealized image of a “good” body Impulsivity or lack of self-control A history of depression or other mood disorders Childhood obesity How is anorexia athletica treated? Despite the fact that anorexia athletica isn’t a distinct eating disorder diagnosis, it is a serious and harmful condition that often occurs in the context of another eating disorder, like anorexia nervosa or atypical anorexia. Conditions like this don’t go away on their own, and almost always require professional support to overcome. The good news is that if you’re worried that you or a loved one might be struggling with anorexia athletica or a similar eating disorder, there are a number of different evidence-based options for recovery. What treatment looks like Because anorexia athletica isn’t in the DSM, there’s not much research on the best evidence-based treatment strategy, but it’s likely that approaches that work for other eating disorders will be successful. “Anorexia athletica is treated in the same manner as other restrictive eating disorders, with the caveat that it’s important to be sensitive to the unique needs of athletes, including sport culture and team dynamics,” says Hellner. As with treatment for all eating disorders, the first step is to normalize eating habits and address any nutritional deficiencies or physical issues related to undernourishment. This usually involves working with a registered dietitian to create and stick to a meal plan, and sometimes a medical provider who can monitor any health complications. Treatment also involves working with a licensed therapist, who might use modalities like cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT) to help patients challenge problematic thought patterns and behaviors as well as address any underlying causes of the eating disorder. It can be extremely powerful to involve family, friends, and other loved ones into eating disorder treatment, and for those with anorexia athletica, it might be particularly helpful to include coaches, trainers, or teammates. One unique consideration for treating anorexia athletica is the role of the athlete’s sport in recovery. “We often need to pause on training for a period of weeks to months so that we can make sure the individual is safe to engage in any exercise,” says Hellner. “The return to sport is generally gradual, and guided by the athlete's support system. We want to see hormone function normalize, weight and body fat restore, and injuries heal before we place any additional demands on a body that is already compromised from malnutrition. The team will work together to help the athlete address their food and body issues in a way that enables them to enjoy longevity in their sport.” How to get started with treatment If you’re worried that you or a loved one might be dealing with anorexia athletica, it’s important to get a professional assessment. While anorexia athletica isn’t an official diagnosis, it often occurs in the context of another eating disorder and its symptoms can be extremely harmful on their own. You can take our eating disorder screener to better understand how concerned you should be, but if something seems off, we highly recommend you talk to a doctor, mental health provider, or eating disorder specialist. You can also schedule a call with our team to talk through your concerns and get an expert opinion.  Preventing anorexia athletica in athletes While anorexia athletica can commonly occur in athletes, it's important to understand that you can be a successful athlete without developing anorexia athletica or an unhealthy relationship with exercise. “All athletes—across sport and gender—are more vulnerable to eating disorders than their non-athlete counterparts,” Hellner explains, but says there are steps they can take to mitigate this risk. To protect against anorexia athletica or another eating disorders, athletes can: Work with an experienced, weight-inclusive sport dietitian, who is also eating disorder savvy. Resist the urge to conform to a particular “athletic aesthetic,” and remember that you can be (and have been) successful in your sport with the body you have. Reach out to a trusted support person for help if you are struggling (emotionally or physically) to fuel properly for training. Familiarize yourself with RED-S signs and symptoms. Hellner recommends Project RED-S as a great resource for athletes and sport professionals. Remember that prioritizing your health and well-being is important for many reasons, and is essential if you want to continue in your sport (or any sport) throughout your lifespan. Tips for coaches and trainers It’s also important to recognize the role that coaches and trainers can play in protecting athletes from disordered thoughts and behaviors around eating and exercise. Below are some tips for creating a safe environment for all athletes, which you can consider sharing with coaches or trainers: Learn to recognize the signs and symptoms of eating disorders so you can help catch them early. Remember that eating disorders affect people of all body sizes. You can learn more about how eating disorders show up in athletes to better spot red flags. Be aware of providers who specialize in disordered eating in athletes so you can easily refer athletes to a specialist if needed. Avoid minimizing eating disorder symptoms as “normal” for athletes (for instance, low heart rate, loss of period, overuse injuries). Limit use of “diet” foods, diet talk, or supplement recommendations, and avoid demonizing food groups. If you feel inclined to make nutrition recommendations, focus on what athletes can add, not what they can remove. Emphasize the health risks of low weight and underfueling, both for overall health and for performance. Organize training and feedback around the body athletes have, not the body you want them to have. Avoid comments on weight or shape, including compliments. De-emphasize weight by evaluating current weight monitoring procedures, and reconsidering the need to check weight at all. If it is necessary, consider weighing athletes at a lower frequency and in a private setting, and be mindful of how you deliver feedback. Don’t automatically stop an athlete from participating in their sport if you find out they have eating problems, unless it’s warranted by a medical condition. Consider their mental and physical health when making decisions about their degree of participation. Explore your own values and attitudes regarding weight, dieting, and body image, and how these values and attitudes may inadvertently affect your athletes. And most importantly, Hellner says, don’t underestimate the power you have as a coach: “Know that your leverage is a superpower for helping athletes get into treatment and recover!” The Equip takeaway: what to remember about anorexia athletica Anorexia athletica isn’t an official eating disorder diagnosis, but it is a cluster of concerning symptoms that often occurs alongside an eating disorder like anorexia nervosa or atypical anorexia. It’s important that athletes, their loved ones, coaches, and trainers are aware of anorexia athletic and its risks, and take steps to prevent and address disordered behaviors like excessive exercise and restrictive eating. If you or a loved one are struggling with symptoms of anorexia athletica, it’s important to get help. A team of professionals can help promote a healthy relationship with exercise, eating, and body size that not only protects against harmful habits but also promotes longevity and performance in athletics. FAQ  What is anorexia athletica? Anorexia athletica is a condition that affects athletes and is defined by excessive and compulsive exercise alongside dieting or food restriction. Anorexia athletica isn’t an official eating disorder diagnosis in the DSM-5, but people who present with anorexia athletica symptoms often have another eating disorder, like atypical anorexia or anorexia nervosa. What are the mental and physical health risks of excessive exercise? Contrary to the messaging of the fitness industry, there is such a thing as too much exercise; overtraining or working out too much carries a number of different risks for both mental and physical health. Physical health risks include stunted growth, heart problems, poor bone health, arthritis, weakened immune system, gastrointestinal problems, and infertility or pregnancy complications. Mental health risks include depression, anxiety, mood changes, irritability, social withdrawal, problems with concentration or focus, and low self-esteem. What are the warning signs of anorexia athletica? The primary sign of anorexia athletica is excessive exercise alongside food restriction. This might show up in different ways, such as: Exercising more than is necessary or healthy Consistently working out more than peers or more than what’s prescribed by a coach or trainer Exercising while injured or sick, or in bad weather Prioritizing exercise over work, school, relationships, and daily responsibilities Hiding exercise Restricting food intake Using exercise to compensate for eating Frequent injuries How can coaches help prevent anorexia athletica in athletes? Coaches and trainers have a lot of power when it comes to helping prevent disordered behaviors around eating and exercise in the athletes they work with. They can protect their athletes against anorexia athletica and similar conditions by learning the early warning signs of eating disorders; de-emphasizing the importance of weight for performance; educating athletes about proper sports nutrition and why adequately fueling your body is vital for performance; and avoiding comments on weight and body size or shape, even if they’re complimentary. What are the treatment options for anorexia athletica? Because anorexia athletica isn’t an official diagnosis, there isn’t much research on specific treatment strategies. However, the approaches used for other restrictive eating disorders are likely to be effective. A comprehensive treatment plan for anorexia athletica should include: A multidisciplinary care team, including a registered dietitian, licensed therapist, and medical provider. Involving a sports psychiatrist or someone who specializes in sports nutrition can also be helpful, as can mentors who have a similar background. Evidence-based treatment modalities, like cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), or family-based treatment (FBT) The involvement of loved ones to help with accountability and protect against relapse A plan for taking a break from and returning to sport]]></content:encoded>
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            <title><![CDATA[What Is Purging Disorder? Exploring Symptoms, Causes, and Treatment]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-purging-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-purging-disorder</guid>
            <pubDate>Fri, 21 Jun 2024 17:33:00 GMT</pubDate>
            <content:encoded><![CDATA[In the context of eating disorders, the word purging is most often associated with bulimia, where it makes up one half of the binge-purge cycle. But purging behaviors can also exist on their own, and when this happens, it’s known as purging disorder. Read on to learn more about purging disorder, its health risks, what treatment looks like, and more. What is purging disorder? Purging disorder is characterized by recurrent episodes of purging behavior in the absence of binge eating. This pattern of behavior was first identified and described as an eating disorder in the early 2000s, but it didn’t become an official diagnosis until the publication of the DSM-5 in 2013. The decision to add purging disorder to the DSM was based on “considerable evidence to support the clinical significance of this disorder.” In the DSM, purging disorder is described as “recurrent purging behaviors to influence weight or shape, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, in the absence of binge eating,” and it falls under the category of OSFED (Other Specified Feeding or Eating Disorder). Not having its own distinct category in the DSM doesn’t make purging disorder any less serious or common. Symptoms and signs of purging disorder Purging disorder involves recurrent episodes of purging in the absence of binge eating. Purging can take many different forms, including: Self-induced vomiting Misuse of laxatives, diuretics, or other medications Excessive exercise Fasting It’s important to note that purging is almost always done in secret, so if you’re concerned a loved one may be purging, you’ll need to watch for other signs. Here are some red flags to look out for that might indicate purging behaviors: Disappearing or going to the bathroom after meals Frequent use of mints, gum, or other breath-freshening products Damage to teeth Constipation or other digestive problems Fatigue or weakness Fear of gaining weight or a preoccupation with losing weight Placing a lot of value on weight, body size and shape, and appearance Body checking behaviors Purging disorder also shares many of the signs and symptoms of other eating disorders. Our eating disorder screener can help you identify if you or a loved one might be dealing with purging disorder or a different diagnosis. How common is purging disorder? Because purging disorder is such a new diagnosis, there’s not a lot of research about how common it is and who it tends to affect. What’s more, many people with purging disorder may have been incorrectly diagnosed with bulimia or left undiagnosed completely, skewing the numbers in the research that does exist. However, we do have some data that gives a sense of just how prevalent purging disorder is. Estimates of lifetime prevalence for purging disorder (meaning the percent of people who will experience the disorder at some point in their life) range from 1.1% to 5.3%. Among populations of people in eating disorder treatment, up to 7% have purging disorder, according to Tana Luo, PhD, Director of Program Development at Equip. Though purging disorder can occur at any age, it most commonly emerges in late adolescence and early adulthood (it affects about 2.5% of adolescents each year). The disorder occurs more commonly in girls and women than in boys and men, though 5-10% of those affected by purging disorder are men. Purging disorder typically affects people who are classified as normal weight or larger. What causes purging disorder? Frustrating as it might feel, eating disorders almost never have one clear cause. Instead, they emerge out of a confluence of different factors: genetic, physiological, environmental, social, psychological. However, there are some things that can increase a person’s chance of developing purging disorder. “In terms of risk factors, people who struggle with body dissatisfaction and with dieting behaviors are at increased risk for developing purging disorder later in life,” explains Luo. “There’s also some evidence that those with purging disorder may experience excessive fullness and GI distress after mealtimes, compared to both people with bulimia and people without an eating disorder, which may increase risk of purging.” Here’s a snapshot of the risk factors for purging disorder: A history of dieting Body dissatisfaction Nausea, stomachache, or other GI distress after eating Hormonal response (some research suggests that people with purging disorder might overproduce hormones that cause the feeling of fullness after eating) Family history of an eating disorder Trauma Co-occurring conditions like depression or anxiety Bulimia vs. purging disorder: understanding the difference Bulimia is defined by recurrent episodes of binge eating followed by purging behaviors, while purging disorder is defined by recurrent episodes of purging without binge eating beforehand. “The lack of objective binge eating is the main difference between purging disorder and bulimia,” says Luo. “There’s some evidence that purging disorder may be characterized by a loss of control while eating normal or small amounts of food.” In other words, since loss of control is one of the defining characteristics of a binge, someone with purging disorder might eat a totally normal amount of food (objectively not a binge), but because of the loss of control and excessive feelings of fullness they felt while eating, feel the need to purge afterward. Here are some of the key differences between purging disorder and bulimia: Bulimia includes episodes of binge eating, while purging disorder does not. In bulimia, purging occurs after eating an objectively large amount of food. In purging disorder, purging occurs after eating a normal or small amount of food, though it may be subjectively perceived as a binge. Some evidence suggests that purging behaviors in purging disorder may be due to gastrointestinal distress or excessive fullness after eating, rather than a desire to change body weight or size. Bulimia is a distinct diagnosis in the DSM, while purging disorder falls under the OSFED category (this doesn’t make purging disorder less serious). Purging disorder and bulimia also share a number of characteristics. Some of the similarities between the disorders include: “Getting rid” of food that’s been eaten through purging behaviors like self-induced vomiting, misuse of medication, or excessive exercise Weight fluctuations Physical symptoms like sore throat, tooth decay, and gastrointestinal issues Other serious health risks (outlined below) The health risks of purging disorder Purging disorder may be less well-known than other eating disorders, but that doesn’t make it less serious. Left untreated, purging disorder can cause a long list of physical and mental health problems, just like other eating disorders. Because purging is extremely harmful to a person’s body, purging disorder poses serious risks to physical health, many of which overlap with the physical consequences of bulimia. Some of the physical health issues associated with purging disorder include: Electrolyte imbalances (which can be very serious and even cause death) Dehydration Kidney failure Dental erosion and tooth decay Gastrointestinal issues Heart problems Impaired bone health Tears in the esophagus And while purging takes a significant toll on the body, purging disorder is ultimately a mental health issue, and can cause a variety of different psychological and emotional problems. Purging disorder carries many of the mental health risks of other eating disorders, including: Mood swings Depression Anxiety Suicidal ideation What does purging disorder treatment look like? “There’s currently a lack of research on the treatment of purging disorder specifically,” says Luo. However, she says, CBT-E is an evidence-based treatment approach that has been shown to be effective across eating disorder diagnoses, so it’s likely to be effective for purging disorder. Luo also points out that the purging behaviors associated with purging disorder might serve a different purpose than the purging in bulimia, and so this needs to be taken into account. “Treatment should take into consideration the specific triggers and functions of purging episodes in people with purging disorder,” she advises. “Given some of the research on satiety and GI distress following meals, people with purging disorder may also specifically benefit from tools to help them tolerate feelings of fullness and other GI symptoms after eating.” As with treatment for any eating disorder, there are a lot of different options and decisions to make. There’s in-person treatment, virtual treatment, inpatient programs, outpatient programs, and seeing individual providers without a program, not to mention all the different potential treatment modalities (like CBT-E, FBT, DBT, and others). Eating disorder treatment isn’t one-size-fits all, so there’s not one “correct” way to reach recovery. However, here’s what to keep in mind when seeking treatment for purging disorder: It’s important to have a multidisciplinary care team. This is because eating disorders affect a whole person—their mind, their body, their social life, their family, their daily functioning—and so one provider can’t treat every aspect of it. A multidisciplinary care team should include, at the minimum, a medical provider, a registered dietitian, and a licensed therapist. Look for evidence-based practices. Not all eating disorder specialists and eating disorder programs use approaches that are backed up by evidence, so it’s important to ask about evidence-based modalities. Some of the evidence-based modalities for eating disorders include CBT, CBT-E, FBT, ERP, and TBTS. Loved ones should probably be involved. Eating disorders don’t only affect the person with the diagnosis—they also affect friends, family, and other loved ones. Involving these people in treatment helps them feel supported and engaged throughout the tough journey of recovery, and also helps educate them about eating disorders so that they can create a recovery-supportive environment outside of treatment. Involving loved ones can be a powerful step toward preventing relapse. Virtual treatment can be a smart choice for many. Research shows that virtual eating disorder treatment is just as effective as in-person care. Given that the average American lives over two hours from the closest eating disorder treatment center, and that in-person care tends to be financially inaccessible and often not covered by insurance, virtual treatment offers a more accessible alternative. Being able to recover at home is also an advantage, as it means patients don’t have to uproot their lives to get better, and allows them to tackle real-world triggers and challenges with the support of their treatment team. The Equip takeaway: What to remember about purging disorder Purging disorder is a lesser-known eating disorder that’s characterized by recurrent episodes of purging (i.e., engaging in behaviors to “get rid” of food that’s been consumed) without binge eating beforehand. Purging disorder was introduced into the DSM in 2013 under the category of OSFED, but not having its own category doesn’t make it any less serious than other eating disorders. Because it’s a relatively new diagnosis, we don’t know all that much about how common it is or which treatment approaches work best, but as awareness increases, we’re hopeful this will change. Recognizing purging disorder as its own distinct and harmful diagnosis is an important first step toward getting everyone struggling the care they need and deserve. If you’re worried that you or a loved one might be struggling with purging disorder, know that lasting recovery is possible. Don’t wait to seek help—eating disorders don’t go away on their own, and early intervention is associated with better outcomes. Talk with your doctor, mental health provider, or an eating disorder specialist, or reach out to our team for a no-obligation consultation. FAQ  1. What is purging disorder and how is it different from bulimia? Purging disorder is an eating disorder characterized by recurrent episodes of purging behavior (like self-induced vomiting, laxative misuse, or excessive exercise) without binge eating beforehand. Bulimia is an eating disorder characterized by recurrent episodes of binge eating followed by purging. The primary difference between the two is the absence of binge eating in purging disorder. Purging disorder falls under the OSFED (other specified feeding or eating disorder) category in the DSM, while bulimia has its own entry. This doesn’t make purging disorder any less serious or harmful. 2. What are the common symptoms of purging disorder? The primary symptom of purging disorder is recurrent episodes of purging behaviors to “get rid of” food that’s been eaten. These behaviors might include self-induced vomiting, laxative or diuretic misuse, or excessive exercise, among others. Purging is usually done in secret, so loved ones should look for other signs of purging disorder, like disappearing after meals, frequent use of breath-freshening products, damage to teeth, digestive problems, and body image distress. 3. How can purging disorder affect physical and mental health? Like all eating disorders, purging disorder carries significant risks to mental and physical health. Physical health risks include electrolyte imbalance, kidney failure, heart issues, digestive problems, tooth decay, dehydration, and impaired bone health. Mental health risks include mood swings and increased risk of depression, anxiety, and suicidal ideation. 4. What are the causes and risk factors for developing purging disorder? Like all eating disorders, purging disorder emerges out of a combination of different factors, which can be genetic, psychological, social, or environmental. Some things that might increase a person’s risk of developing purging disorder include a history of dieting, body dissatisfaction, gastrointestinal distress after eating, family history of an eating disorder, trauma, and co-occurring conditions like depression or anxiety. 5. What treatment options are available for purging disorder? There’s not much research on treatment for purging disorder specifically (yet), but it’s likely that other evidence-based eating disorder treatment approaches can be effective options. Enhanced cognitive behavioral therapy (CBT-E) may be a good option for adults with purging disorder, and family-based treatment (FBT) may be a good option for young people with eating disorders. As with all eating disorders, purging disorder can be treated via in-person or virtual treatment, as well as with inpatient or outpatient care. When considering treatment options for purging disorder, it’s important to look for a multidisciplinary care team, evidence-based treatment approaches, and the involvement of loved ones. For many people struggling, virtual treatment may be a more accessible (and equally effective) treatment choice than in-person care.]]></content:encoded>
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            <title><![CDATA["I Don't Like My Body." Expert Advice on What to Do If You Feel This Way]]></title>
            <link>https://equip.health/articles/body-image/how-to-combat-bad-body-image</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/how-to-combat-bad-body-image</guid>
            <pubDate>Tue, 10 Mar 2026 16:49:00 GMT</pubDate>
            <content:encoded><![CDATA[Despite all the wonderful things the body positivity movement has brought to the world, it’s understandable why so many people struggle with the concept. How can we be “positive” about our bodies when it seems like everything—from movies and magazines to social media posts and even IRL friends and family—have conditioned us to feel the opposite? While my own negative ideas about my body were shaped decades ago, I see how hard it might be for young people today to build their own body confidence in a world that continues to celebrate extreme thinness while disparaging just about everything outside of that. With the continued proliferation of AI filters, cosmetic procedures, and weight loss drugs, it seems like it’s become increasingly harder to opt out of comparison and truly like our unique bodies for what they are. If you feel like you don’t like your body, you’re anything but alone. Research has shown that body image, weight, and shape concerns can start as young as five years old (with body size stereotypes being internalized as young as three). The issue is highly prevalent among young people, with 24-46% of adolescent girls and 12-26% of adolescent boys reporting dissatisfaction with their bodies. Early adolescence is thought to be a particularly vulnerable time for unhealthy behaviors to be normalized, setting the stage for long-term negative body image and insecurities. Occasionally feeling less than positive about your body isn’t necessarily a sign of trouble. But chronically being down on yourself because of your weight, shape, or other physical characteristics can be risky, and lead to a cascade of negative health consequences. The good news is that despite the abundance of triggers in our current cultural moment, there are expert strategies for combatting negative body thoughts—both in the moment and over time. Read on for tips and tricks to overcome not liking your body. Why you may dislike your body First thing’s first: feeling bad about your body isn’t your fault. Most of us are bombarded by messages from every direction that tell us our bodies aren’t “good enough” for any number of reasons. And in this climate, it can unfortunately feel rare or unusual to actually like your body. Below are a few of the many contributors to body dissatisfaction: Diet culture When we talk about the inescapable societal agreement that thin bodies are more desirable than other body types, we’re talking about diet culture. This set of beliefs not only deems thinner bodies to be more attractive, but also morally “better.” “Diet culture plays such a pivotal role in how we view ourselves and those around us,” says Equip Therapy Lead Jonathan Levine, LCSW. “So many of us are taught—both explicitly and implicitly—that most of our value comes from our bodies, and that that value is really tied to being thin and being muscular.” In other words, when we believe our worth is tied to our bodies, and that our bodies must look a certain way in order to have value, it’s inevitable that many people will feel inadequate. Social commentary  While diet culture is widespread and shows up on a societal level, it trickles down to individual people and relationships, shaping dynamics and conversations in a way that can negatively impact body image. “It starts on a larger level, but it hits us individually,” Levine says. “So we hear these comments from our friends, our family—sometimes we even hear them from ourselves—and we tell ourselves that we need to look a certain way to really reach our goals or feel valued.” Diet culture messages can affect not only your own body image, but also your attitude toward other people’s bodies, which can then create a self-perpetuating cycle of body dissatisfaction among groups of people. “The larger cultural experience becomes the individual experience, which can make us feel bad about our bodies,” Levine says. “And often, when we feel bad about our bodies, we scrutinize other people in the same way we scrutinize ourselves, so it’s this kind of cyclone of judgment and criticism, because how we talk to ourselves is often how we talk to others.” Personal history and/or trauma Having negative personal experiences or any type of trauma can also play a large role in how we perceive our bodies. “So often, when someone experiences trauma, that can come with a sensation like a loss of control, as well as an unjust world,” Levine says. “And sometimes when we feel like we're totally out of control of our lives, we try to regain control where we can; and what many people do is try to change their bodies by changing what they eat or engaging in really intense exercise, trying to regain that control. Initially, it may make them feel more in control, but sadly, in time, it creates less stability, because it becomes so compulsive that the control controls them.” The negative effects of disliking your body It probably comes as no surprise that disliking your body can result in a number of negative consequences, ranging from insecurity to strained relationships, and even an increased risk for eating disorders. According to Levine, the following are common effects of body dissatisfaction: Reduced self-esteem Lower self-worth Isolation and avoiding friends Negative self-talk (which can lead to less kindness toward others) Low mood And while not everyone who dislikes their body will necessarily contend with a clinical mental health condition, it’s important to know that body dissatisfaction is a major predictor of eating disorders. “It can spiral, creating more issues like depression, anxiety, substance use, or being impulsive in behaviors with other people, whether it's socially, sexually, or otherwise,” Levine says. “And those things can compound and lead you to developing a full-on eating disorder. The good news is, if you catch it early on in one capacity, you can really stop it from spiraling.” What to do in the moment when negative body thoughts arise Realistically, just about everyone will experience negative body thoughts from time to time. While they can lead to uncomfortable feelings, these thoughts are understandable, given the many ways our society reinforces body dissatisfaction. Here are some expert strategies to cope with these thoughts in the moment: Notice and name the thoughts “I'm a big fan of just noticing them,” Levine says. “So often, we'll be scrutinizing ourselves repeatedly, being quite cruel and not even aware of it. You may have a running dialogue in your brain all day and you don’t even notice it. Just cultivating awareness to better understand how you're talking to yourself is really a big piece. Once you're able to notice that, then you can try to reframe the thoughts.” Shut down body or diet talk Sometimes our negative body thoughts are a direct reaction to hearing others talk about their bodies or their diets, weight loss plans, etc. Rather than allowing these conversations to continue around you or participating in the “normalized” rhetoric, consider changing the subject or excusing yourself from the dialogue. Or, if you feel up for it, think about speaking up and expressing why this kind of talk is harmful to everyone involved. Make subtle shifts in your self-talk “Instead of saying, ‘I love my body,’ try ‘I see my body supporting me today,’ or ‘I appreciate my body keeping me warm in this really cold weather,’ or ‘I can see that my body is strong because I was able to go for a long walk today,’” Levine says. “There are more neutral things we can look at that have less to do with thinness and our perception of our weight and image and more to do with our body’s function. Then maybe from that neutrality, we can move towards positivity in time.” Focus on the good thoughts “We all have bad body image days, but sometimes you have good body image days too,” Levine says. “I would urge you to try to focus on the good as much as the negative or the neutral. Try to create a holistic perspective.” How to improve your long-term relationship with your body Cultivating and maintaining a healthy, positive relationship with your body long-term takes time and effort. But consistency is key, and with practice, you can develop a kind, compassionate connection that will positively affect other parts of your life, as well as your relationships to those around you. As Levine mentioned, working toward body neutrality is a helpful first step. While body positivity is an important concept and can be a good goal to strive for, many people find body neutrality to be a more realistic midpoint between negativity and self-love. It involves appreciating and respecting your body without needing to unconditionally love everything about yourself. Rather than rooting your self-worth in your physical appearance, body neutrality can help shift the focus and reframe your identity, with your body playing just one small part of who you are overall. “It's pretty impossible to go from feeling negative about your body to feeling positive,” Levine says. “But we can try to shift to a more neutral place and then go into positivity at a later point.” One of the most impactful ways to combat body dissatisfaction is education and professional guidance. “I would really recommend doing some therapy to talk through body image stuff and to talk about society,” Levine says. “I highly recommend looking through an intersectional feminist lens, because it can really show all the layers of how our culture impacts us—a lot of which is really subtle and hard to catch.” If you’re unsure where to start, consider Freeform, Equip’s free, self-paced, virtual module designed to help people 13 years old and up build awareness of harmful appearance ideals and practice new ways to push back against them. Overall, body dissatisfaction is a normal—albeit unfortunate—consequence of living in our modern society: we’re taught from a very young age to pick our bodies apart and compare ourselves to specific, unrealistic, and even digitally or surgically altered ideals. While we can all experience feelings of disliking our bodies from time to time, feeling chronically negative about your weight, shape, or physical appearance can take a serious toll, impacting your mood, relationships, and health. It’s important to remember that your body is not the problem or the obstacle standing between you and happiness—happiness is something you deserve right now, in the body you’re in. “The main thing is to give yourself grace,” Levine says. “Undoing a lifetime of messaging is really hard and it doesn't happen quickly. If you have good days, that's great; just acknowledge you're probably gonna have bad days too. And a bad day doesn't mean you're not making progress. The world wants us to be thinking in black and white because we're easier to manipulate that way. Trying to cultivate a sense of living in the gray is really critical for body image, for well-being, and for cultivating a better life.” ]]></content:encoded>
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            <title><![CDATA[New Year’s Resolutions Around Diet Can Be Harmful — Here’s What to Do Instead]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/healthy-new-years-resolutions</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/healthy-new-years-resolutions</guid>
            <pubDate>Thu, 19 Dec 2024 16:14:00 GMT</pubDate>
            <content:encoded><![CDATA[If you've made it this far through the holidays, take a moment to celebrate. This time of year can be hard for anyone, and especially so for people navigating eating disorder treatment. But just as the major December festivities pass, it’s time to get ready for the bombardment of “new year, new you” messaging on TV, social media, subway ads, and more. Although setting goals to improve yourself isn't a bad thing, per se, New Year's resolutions often have two problems: First, people don't tend to follow through on them. According to one recent study, about 64 percent of people abandon their commitments within a month—and failure to reach your resolution may make you feel worse about yourself. Second, the vast majority of year-end goals are centered around diets, weight loss, and fitness, which makes the whole resolution business particularly problematic for those in eating disorder recovery. If you or a loved one are working toward recovery (or in recovery), this might be triggering, or even cause a slide back into disordered eating and exercise habits If you feel tempted to “improve” yourself this January with diet or fitness-related resolutions, we encourage you to keep reading. Learning why so many resolutions are rooted in physical appearance—and how to successfully strive for something more meaningful—can help you create resolutions that are aligned with your values and put you on track to follow through with those goals. Why diet-focused New Year’s resolutions are harmful “It’s totally understandable in our current culture why, when we think about a time of change and transformation, we think about changing our bodies to be more ‘acceptable’ and ‘healthy,’” says Equip therapist Kirstin Quinn Siegel, LMFT. “We have so many messages—constantly, every day—bombarding us with false ideas about health, body size, and what will make us happy.” The desire to be accepted is completely natural. The problem, Siegel says, is that diet culture has co-opted and capitalized upon these very fundamental and basic human needs. “Diet culture tells us that thinner bodies are better in every way and larger bodies are potential projects to be changed and ‘transformed’ by any means necessary,” she says. This mindset is damaging for anyone with a body, and particularly for people living with an eating disorder or disordered eating.See, whether a resolution is about a particular weight, a fitness goal, or simply being “healthier”, many of these ambitions are associated with achieving a specific number, following certain “rules” about eating or exercise, and other rigid practices. These things are common signs of disordered eating and, in turn, may fuel unhealthy habits that people in recovery are working so hard to let go of. On top of all that, body-centric resolutions are often unsustainable. As many of us have experienced, restrictive eating can often lead to bingeing and an unhealthy relationship with food; and your body can handle only so much exercise before it starts causing injury, messing with your sleep, or leaving you tired all the time, among other negative effects. Adding insult to injury, failing to reach a goal can trigger or increase anxiety and depression. How diet culture shapes our resolutions If “new year, new you” messaging is so harmful...why is it everywhere? Because it sells, and the timing couldn’t be more perfect for those looking to profit. At the end of the year, we celebrate Thanksgiving, Hanukkah, Kwanzaa, Christmas, New Years, and often more. For most people, these holidays are not only a time to gather with loved ones, they're also a time to connect over food. And the message we tend to hear about this eating centers around guilt and “overindulging.” No matter how little or much we actually eat, companies know we may think we “overdid it”—so they take advantage of that opportunity to sell us their weight-loss program, cleanse, workout plan, detoxification, or other “quick fix.” And since January 1 is approaching, they promote their product as a way to kick off the new year with a bang and “improve” yourself. The fact is, focusing on external changes like weight loss detracts from holistic health goals. When you fixate on a number, it not only casts a lot of gray area into black and white, it’s also arbitrary and fleeting: no specific weight or size makes you “healthy” or “unhealthy,” and all too often, the target for these goals keeps moving (you continue to want to lose more and more). On the other hand, resolutions that promote positive body image, a healthy relationship with food, and simply feeling good support both your physical and your mental health, and help you listen to and trust your inner voice. These are the types of changes that ultimately lead to confidence, fulfillment, and real well-being. How can you make an actually healthy resolution? In a world where “clean” eating (whatever that means) and a “more-is-more” attitude about exercise are so widely considered to be good things—despite evidence otherwise—it can be tough to know what a “healthy” resolution actually entails. For starters, it helps to remember that “health” is not about a number on the scale or arbitrary body-based goals. It’s about doing things that positively impact your mental, physical, and emotional well-being. With that in mind, here are some tips to help guide you toward resolutions that promote real health. Set intrinsic resolutions “A key aspect of a supportive resolution is that it comes from an intrinsic desire and is aligned with your values,” says Equip Peer Mentor Stacy Jones. “Having resolutions that are intrinsically driven means they aren't about others seeing you a certain way, or about what you ‘should’ do. It is something truly for you that will support your most expansive and aligned life.” Seek joy, not guilt As Equip co-founder and Chief Clinical Officer Dr. Erin Parks, PhD puts it, no one should be “should”-ing themselves when setting their resolutions: “A healthy resolution is one that makes you happy when you think about doing it—and doesn't make you feel guilty when you think about not doing it.” To her point, Parks picks a resolution each year that's based around learning a new skill or engaging in an activity she’s always wanted to try. One year it was knitting, another year it was surfing. “It’s not about changing myself—I certainly am not becoming a knitter or a surfer. Instead, I wanted to have the experience of learning how to do something,” she says. “And if I hadn't followed through and didn’t actually learn to surf, I wouldn't have felt guilty about it.” Determine your “why” To prevent slipping into the “should” mentality (even when setting non-body-based goals) Siegel suggests finding the reason behind the resolution and asking yourself what purpose it serves. Park agrees, adding that you may have to ask yourself several times to help you set the right intention. “When making a resolution, ask yourself why you're resolving to do it, and when you think you've answered it, ask ‘why’ again,” she says. “So if your answer is ‘to be healthy’, what does healthy mean to you? Why do you want to be healthy? Maybe it’s, ‘I want to be healthy so that I can have the energy to play with my grandkids.’ If it’s, ‘I want to drink more water,’ and you say it’s because you want to ‘be healthy’, maybe what you really want is to feel in control of your health. So maybe that means trying to have a regular sleep schedule, and it's not actually about drinking more water. Figure out what you're really saying and be honest with yourself.” Take your mental health into account Resolutions don’t have to be about physical health; your mental health matters just as much. “Characteristics of a ‘healthy’ resolution might include practicing daily acceptance of where you are, just as you are, and turning focus inward to the state of your nervous system and mental well-being first,” says Equip Family Mentor Inga Yanoski. “‘Healthy’ goals might include gratitude, intentional rest, and achievable resolutions that don’t have anything to do with physical transformation or diets. Like focusing on joyful movement rather than movement that is coming from a place of ‘I should,’or a resolution of giving oneself permission to say ‘no’ instead of always saying ‘yes.’” Be honest If you currently struggle with disordered eating or an eating disorder or have in the past, be honest with yourself about whether it’s you or the eating disorder setting goals. Take the time to have a heart-to-heart with yourself (and any professionals or loved ones who are part of your support team). You'll know in your gut who's controlling the steering wheel. Work with your team If you're in treatment for an eating disorder, loop your therapist and other healthcare providers in on your resolution-making process. They can work with you to help you determine whether setting resolutions could be helpful or harmful in supporting recovery. And if it could help, together you can brainstorm ideas of resolutions that promote your physical and mental health. Alternatives to diet-focused resolutions If we can agree that weight loss- and appearance-focused resolutions are more likely than not to result in disappointment at best—and trigger or exacerbate disordered behaviors at worst—how can people (both in recovery and otherwise) go about setting end-of-year goals that will help them feel happier and healthier? Jones believes it may help to initially switch up the language that describes New Year ambitions. “What I really like to do is set ‘intentions’ for the New Year instead of ‘resolutions,’” she says. “This allows me to view my life in a holistic way and consider how I want to feel in it.” Yanoski agrees that the semantics can make a big psychological impact: “Setting an intention takes the pressure off of ‘resolving’ to do something. It softens the rigidity and the rules that come along with a resolution,” she says. (This is particularly important for those in recovery, as rigidity is often characteristic of an eating disorder mentality.) Non-weight goals Only you know which intentions are best for you. To help you, here are some goals to inspire your brainstorming: Engage in joyful movement Prioritize sleep hygiene Develop hobbies, like gardening or learning a new skill Volunteer in the community Practice deep compassion for myself Heal my relationship to food and my body Take a cooking class with a friend or partner Travel more Read or write daily How to stick to your goals Setting resolutions is one thing. Sticking to them so you reach your goals is another. While you should allow yourself grace to not “achieve” everything on your list, these tips can help you continue moving toward your intentions for the year: Journal your progress: Sometimes, an end goal can seem far away. But if you record your progress daily or weekly, you'll see the small improvements that you're making, and that will eventually lead you to achieving your big goal. As a bonus, this process helps you stay motivated, because success inspires success. Find accountability: It's easy to ditch a resolution when nobody else knows about it. But when you tell one person (or more), suddenly you're accountable for your goal. You could schedule regular check-ins with your accountability buddy or reach out when you need support. Either way, just by them being aware of your intention, they’ll help keep you on track. Stay flexible: If you find yourself struggling to stick with a resolution, pause for a moment and have another honest conversation with yourself. Do you truly want this intention, or have your desires shifted? It's perfectly acceptable to change your mind and drop or adjust a resolution at any time of the year, especially if doing so aligns with your inner values. Tips for dismantling diet culture in January and beyond Let's face it: Although the new year is one time when diet culture is particularly rampant, it can make an appearance in our lives any day of the year. The tips below can help you stay strong and avoid its influence. Curate your social media Instagram, TikTok, and other platforms can be sources of knowledge and connection, but there's also a lot of misinformation and deception. Unfollow any accounts that make you feel worse about yourself, promote unhealthy behaviors, or produce weight-centric content. Adopt body neutrality Body neutrality is a mindset where you appreciate and respect your body for what it can do, rather than focusing on how it looks. This can help you better value yourself based on your internal worth, not your external appearance. Consider intuitive eating This practice helps many people develop a more positive relationship with food. With intuitive eating, you give up any “food rules” and instead listen and respond to your body's cues about what and when to eat. This practice embraces all the reasons we eat: for nourishment, pleasure, socialization, and more. If you’re in eating disorder treatment or recovery, talk with your care team or a dietitian about whether intuitive eating is a good choice for you. It can be a very supportive and empowering practice, but it’s not for everyone at every stage of recovery. Set boundaries If friends or family engage in diet or weight talk, you can let them know you don't want to be part of that discussion. Simply say, “I'd rather not talk about food. Let's talk about [other topic].” Or you could try something like, “I'm trying to keep a positive outlook about my body. Can we change the topic?” If they ask questions, you can explain your feelings—but you don't have to. How to support loved ones in avoiding diet-centered resolutions If New Year's resolutions are triggering for a loved one (and especially if they struggle with body image or eating) you can be a source of solace this time of year. By being more mindful of resolution-related triggers, you can help them set intentions that align with their true selves. Foster positive conversations about goals Making resolutions can cause us to focus on what's “wrong” with us and what “needs” to change. This doesn't make anyone feel good. Instead, center these discussions around how your loved one can feel even better than they do today. It may help to begin their resolution brainstorm by having them think of all the awesome things about them, then considering how they might build upon those things. Use neutral language Remember, we want to avoid diet or weight talk. If your loved one brings up a resolution that's even somewhat related to these things, help them off the slippery slope. You can ask them why they want to set their suggested resolution. Once you get at the real underlying intention, you can suggest a body-neutral goal. Such resolutions may be about starting a new hobby, practicing self-compassion, or doing something each day that makes them happy. The Equip takeaway: Embrace intentions over resolutions While experts advise avoiding any “shoulds” in resolution-setting, there’s one exception: at the end of the day (or year!), your resolution “should” be rooted in your true values and inspire feelings of joy, excitement, and inspiration. Body-focused goals don’t take these feelings into consideration, stemming instead from a diet culture mentality that often evokes feelings of shame and unworthiness—feelings that are awful for everyone, and possibly dangerous to those affected by eating disorders. Instead, lean into activities, hobbies, and behaviors that enrich your life, your relationships, and your sense of self, goals that are much more likely to stick and that help you evolve into the person you’re striving to be. “Clean slates can be really exciting,” Parks says. “I think the new year is an opportunity for us to be introspective, to be reflective, and to look back on the previous year. And it's an opportunity to celebrate, give ourselves grace, and then think about what we want to do next.” ]]></content:encoded>
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            <title><![CDATA[What Eating Disorder Experts Say About Fasting During Ramadan for those in Recovery]]></title>
            <link>https://equip.health/articles/food-and-fitness/eating-disorders-ramadan</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/eating-disorders-ramadan</guid>
            <pubDate>Tue, 18 Mar 2025 18:18:53 GMT</pubDate>
            <content:encoded><![CDATA[It’s no secret that navigating the ins and outs of eating disorder recovery can be rife with challenges and setbacks. But traversing that road while also honoring your culture’s religious or spiritual practices that include food restriction can be particularly tough. Just as those who observe the Jewish high holidays may experience, those who participate in Ramadan, the Muslim period of spiritual reflection, worship, and self-improvement, may have to make some difficult decisions about how they or their families choose to worship — specifically because the holy month involves abstaining from food and beverages for most of each day. “Fasting Ramadan is one of the essential worships,” says Hala Abu Taha, senior dietitian and volunteer at the Middle East Eating Disorder Association (MEEDA). “Muslims stop having any food or drinks or smoking from sunrise until sunset. As a Muslim who fasts for Ramadan, I can say fasting is challenging and has many spiritual benefits if individuals have no medical conditions. However, fasting during the journey of eating disorder recovery or treatment can be harmful.” The intention behind fasting, and meaningful alternatives According to experts like psychologist Omara Naseem who penned a guide for patients and loved ones about the intersection of Ramadan and eating disorders, the purpose of the fast is to “allow the individual to understand the pain and suffering of those less fortunate in the world who live their lives in poverty and famine, leaving the participant feeling more grounded and grateful for all that they have.” Naseem makes it clear that intention matters and that “an eating disorder may skew your mindset away from faith and more towards fasting for the eating disorder (e.g. to lose weight)” instead of focusing on purposeful mindfulness. While fasting may be a central part of Ramadan, Taha says it is not the only way to express or explore one’s faith during the holy month. “The bigger picture isn't only about restricting food and drinks,” she says. “Patients in recovery can engage themselves in other spiritual worships like donating money and food or reciting Quran, forgiving others, and praying more.” Taha explains that while she has observed prejudice in the Muslim community toward individuals who are unable to fast, Islam itself doesn't endorse or condone stigmatizing those who don't traditionally observe the holy month. “In Islam, Allah [God] has given permission to people who can't fast not to — all they have to do is ask imam [a person that is well knowledgeable and trustworthy] to confirm they do not need to fast.” Taha says this principle is often applied in the case of pregnant women and those living with a chronic disease that would be negatively impacted by the fast. “As a Muslim member of MEEDA, it was crucial for me to ask and investigate thoroughly if people with active eating disorders can fast,” Taha says. “The answers I got from high-ranked individuals in Islam were that each patient should be evaluated by their medical doctor and if their doctor confirms that fasting will be harmful, they shouldn't. If fasting will affect a patient's physical or mental health, there is no ‘best way’ to fast.” The dangers of fasting while in recovery If you or your loved one are considering fasting during Ramadan, consulting a medical professional may serve as an important first step in making the decision. In a 2014 clinical case report in the International Journal of Eating Disorders, researchers found that the “drastic change in one's diet such as that which occurs during Ramadan” may play a role in triggering or exacerbating eating pathology in teens predisposed to eating disorders. They concluded that it is crucial to have a physician evaluate the situation when warning signs are present. In her own practice, Taha has seen how fasting can be a slippery slope for disordered behavior and the importance of considering potential triggers. “Many of my patients with anorexia recall preoccupation with food which can cause high anxiety and lead to more fatigue,” she explains. “One of my patients recently stated that fasting Ramadan triggered her to restrict more. Another patient who suffers from binge eating disorder recalled how fasting triggered more binge episodes.” Tips for people who can safely fast For those who do decide to fast, reflecting on where you are in your recovery journey can help with coping ahead of these potential pitfalls. By anticipating the mental and emotional toll of abstaining from food, your family can determine what additional resources and support you may need. Taha suggests starting with making a meal plan and scheduling ahead of time. “Break [your] fast as soon as [the sunset prayer] to nourish the body with all the food groups needed and not eliminate any group or reduce portions. After iftar [the meal eaten after sunset], frequent meals should be followed by a maximum three-hour gap. Delaying the suhur [the meal consumed early in the morning before fasting] is essential for people to have stable blood sugar and energy levels throughout long fasting hours.” While there are many factors to consider when deciding how to safely and appropriately observe Ramadan, Taha emphasizes that the support of family members can be critical for those who are not able to fast and that shifting traditional attitudes and beliefs can go a long way in helping individuals in recovery. “It's very important for family members to understand that an eating disorder is not a choice and patients can be triggered by any behavior,” she says. “Family members can show support by making sure that food is always available in fasting hours for the patient to have. They can also encourage and join the patient in other spiritual worships and try to avoid talking about ‘healthy food’, dieting or even weight changes during Ramadan.”]]></content:encoded>
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            <title><![CDATA[Should You Be Worried? Signs and Symptoms of Eating Disorders in Children]]></title>
            <link>https://equip.health/articles/understanding-eds/is-it-an-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/is-it-an-eating-disorder</guid>
            <pubDate>Mon, 16 May 2022 17:23:00 GMT</pubDate>
            <content:encoded><![CDATA[As a parent, it can be very scary to notice signs of an eating disorder in your child. It can also be scary to realize that many signs are easy to miss. But learning about the signs and symptoms of eating disorders in children will help you better understand whether or not you should be worried, and what you can do to help. Eating disorders are the second deadliest mental illness; they have far-ranging consequences for mental and physical health; and early intervention makes a big difference in how long it takes a person to recover. Because of all this, it's important for parents and caregivers to recognize potential signs of an eating disorder in a child, adolescent, or teen—even if their loved one doesn't fit the stereotypical mold of someone who gets an eating disorder. You can't tell if someone has an eating disorder by looking at them, and they affect people across gender, race, ethnicity, and body size. Knowing what to look out for can at the very least help educate you about this important issue (which undoubtedly affects someone you know), and at best save the life of your loved one. Signs and symptoms of eating disorders in children  There are several different eating disorder diagnoses, and the same type of eating disorder will look different in different people. Given that, there's no exact symptom profile you can use to determine if your loved one is struggling. Still, there are a number of common behavioral, physical, and emotional signs and symptoms of eating disorders in children that tend to show up. Here are some potential signs your child has an eating disorder: Placing a high value on weight, weight loss, and body size or shape Preoccupation with food and its nutritional content (calories, carbs, fat, etc) Avoidance of meals or snacks with other people New eating behaviors, such as a new diet, significantly different portion sizes, eating much more slowly, or cutting food up into small pieces Mood changes, including but not limited to anxiety, depression, or euphoria Weight fluctuations, or failure to meet expected height or weight gains in growing children Digestive issues Feeling cold all the time Poor immune function (getting colds frequently) Social withdrawal Exercising obsessively If you’re concerned about your child, it's important to look at the big picture—not just their eating—to be able to accurately identify potential signs of an eating disorder. You can use this screener to help you consider various areas of your child’s life that may be affected by disordered eating or an eating disorder and determine whether to see a health professional. Why signs of eating disorders are so tricky to spot Despite the fact that eating disorders are on the rise, many of them continue to go undetected. This is in part due to the self-obscuring nature of these diseases themselves, and partly due to a larger societal misunderstanding about what eating disorders are and what they look like. First, let's talk about the self-obscuring part. This basically means that someone with an eating disorder will try to hide it, making the typical signs of an eating disorder tough to spot. Here's how that might show up: Eating disorders thrive in secrecy and many of the concerning symptoms—restricting, bingeing, vomiting, and overexercising—may happen privately without anyone noticing at first. Parents who pick up on troubling cues may not get an honest answer if they ask their child a direct question about food. This has nothing to do with how trustworthy a child is, but is a result of their eating disorder compelling them to deceive. A teen or tween who might normally share worries with their parents is unlikely to ask for help for an eating disorder. This could happen for a number of reasons, including shame, denial about the problem, or a belief that their eating disorder is a good thing. This last part—the idea that an eating disorder could be a good thing—emerges out of the confusing fact that our culture praises many of the behaviors common to eating disorders. All around us, society encourages people to limit portion sizes, choose lower-calorie options, avoid caloric drinks, cut out certain food groups, and exercise as much as possible. Because of this, the early signs of an eating disorder could at first seem like a “healthy” behavior. Now, let's talk about the ways in which unconscious misconceptions about eating disorders can make people blind to the signs of an eating disorder even if it's right in front of them. Some common myths around eating disorders include: Myth 1: Only thin people can have eating disorders. Despite what the media tends to portray, eating disorders don’t have a “look.” Anyone can develop an eating disorder, regardless of gender, race, body size, age, or socioeconomic status. Myth 2: Everyone with an eating disorder wants to be smaller. While many people with eating disorders are concerned about their weight or body size, not everyone with an eating disorder has body image concerns (for instance, those with ARFID rarely have any body image distress). Myth 3: Eating disorders are a choice. Eating disorders are not phases, choices, or lifestyles. They are complex illnesses rooted in biological, psychological, and social risk factors. As we believe strongly at Equip, eating disorders are not vanity issues, they are brain disorders. Myth 4: Eating disorders are always tied to other mental health struggles. People can develop eating disorders without any history of mental illness, abuse, or other trauma. If you think you're noticing signs your child has an eating disorder, it can be a frightening thing to acknowledge. Parents are often wary of making things worse by drawing attention to their child’s eating, changes in their body, or other warning signs. It makes sense to feel anxious about these topics, but the truth is that you can’t make an eating disorder worse by talking about it. In fact, ignoring it just gives the eating disorder time to strengthen its grip. If you've noticed any of these signs and symptoms of eating disorders in children, it's important to get a professional evaluation. Doing so will either ease your mind that everything is okay, or get your family the support you need to move toward recovery. If your child does have an eating disorder, accessing treatment as soon as possible will help give them the best chance of a swift and robust recovery—and being aware of warning signs is the first step on the path toward healing.]]></content:encoded>
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            <title><![CDATA[How to Create an Eating Disorder Relapse Prevention Plan—and Why You Need One]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/relapse-prevention-plan</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/relapse-prevention-plan</guid>
            <pubDate>Tue, 29 Aug 2023 19:56:00 GMT</pubDate>
            <content:encoded><![CDATA[Somewhere along her eating disorder recovery journey, Equip Peer Mentor Gabrielle Terzano hit a crossroads: she was out of treatment, but could feel her eating disorder starting to creep back in. “I thought I had recovered, but just because you reach weight restoration doesn’t mean your thoughts are gone,” she says. “I had to continue to challenge myself and my thoughts. I leaned on friends who had similar experiences, and my family knew which eating disorder red flags to look out for and how to  support me in the moment.” The ability of Terzano and her support network to spot those red flags and jump into action was thanks to what’s known as a relapse prevention plan. Experts characterize a relapse prevention plan as a method for identifying thought patterns that have the potential to lead to eating disorder behaviors after treatment ends. It’s often one of the last steps of treatment—but definitely not one to skip. What is a relapse prevention plan—and why are they important? While lasting recovery is possible for everyone, eating disorder relapse is discouragingly common. While there's various data around just how common it is, research puts the overall relapse rate somewhere between 22% and 51%, and the risk is highest during the first months after treatment ends (though it can happen anytime). This high relapse rate is in part due to shortcomings on the treatment side—not using evidence-based treatment, not setting high enough weight goals, not involving a patient’s support network—but regardless the reason, a relapse prevention plan can help bolster someone’s chance of maintaining their recovery long-term. “A relapse prevention plan, sometimes called a maintenance plan, is essentially a go-to roadmap for lasting recovery,” says Therapist Lead and Clinical Supervisor at Equip, Brittney Lauro, LCSW. “We know that recovery is not linear. A relapse prevention plan helps folks think ahead and plan for challenges that can arise, while reflecting on what has worked well in treatment. It can also guide folks in knowing when and who to reach out to when the going gets rough.” Equip Family Mentor Lisa Stein says that by the time her daughter moved away for college, she had stopped active treatment for her eating disorder. “When this happened, I didn't have a specific written relapse prevention plan in place,” Stein says. “Since joining Equip, I’ve created  a written agreement with my daughter to protect her continuing recovery. She has now lived successfully for over three years in dorms, with roommates, and now in her own apartment. Each time we had to adjust the relapse prevention plan to accommodate her living situation and set her up for success and support.” Equip therapist Sasha Solov, LSW adds that a relapse prevention is important because it allows patients and families to recognize that even when someone is discharged from formal treatment, ongoing success requires active engagement. “A relapse prevention plan allows us to be proactive and cope ahead for the inevitable ups and downs of recovery,” they say. “Rather than feeling like a slip-up is a full-blown catastrophe, it allows you to have a clear plan in place for how to respond and get back up when you stumble or fall.” Lauro emphasizes this point, explaining that “a written document makes coping skills easily accessible and helps ensure a ‘lapse’ doesn’t turn into a full relapse. The act of creating a plan helps folks reflect on their progress in treatment and consolidate the information they’ve learned; not having a plan can make the road ahead tricky. It’s far more challenging to navigate surprises if you have to ‘think on-the-fly’ as opposed to having a ‘go-to’ that can lead you in the right direction.” A relapse prevention plan is particularly important when patients go to treatment outside of their daily life—residential care or an in-person IOP or PHP, for instance—because the transition from these highly contained settings to the “real world” can be quite jarring. “Going out into a world that’s going to challenge you with diet culture every day will be tricky,” Terzano says. “I like to call it the ‘treatment bubble,’ where you may be protected from external triggers. In treatment, you may have all the support you need to resist urges, but when stepping out into the real world, it’ll be more challenging.” With fully virtual treatment like Equip, which fits into patients’ lives and incorporates their support network, there’s not as big of a treatment bubble to pop: patients have been living their real life and encountering real-world challenges throughout their treatment. But even so, a relapse prevention plan is still important to help strengthen patients’ recovery when they’re no longer surrounded by their treatment team. What’s included in a relapse prevention plan? Creating a relapse prevention plan generally takes a collaborative approach that involves many players, including the person in recovery, any caregivers or supports they may have, and their clinical team. Solov says that when various members of a person’s care team are involved in the creation of the plan, each person can contribute something unique. “Your medical provider can let you know about the best ways to monitor physical health and signs that health may be declining,” they explain. “Your dietitian can support you in figuring out how to continue with your meal plan or move on to a more intuitive approach to eating. Mentors can give sage advice on their own lived experiences with relapse prevention and ways to set yourself up for success. Your therapist can help you identify the ways you have already successfully engaged in recovery, distress tolerance, emotion regulation, and more.” Solov considers relapse prevention plans as actionable blueprints patients and their families can use to recognize and address eating disorder relapses if and when they happen. “Such a plan will often include potential signs of a relapse— like starting to only eat safe foods, isolating, etc—and ways to intervene if those signs begin to crop up—like requesting more mealtime support, reaching out to a friend, etc,” they say. “It can also provide specific guidelines for when an increased level of care may be indicated.” According to Lauro, there are five essential components to a relapse prevention plan: Ongoing skills used to maintain recovery. This might be something straightforward, like sticking to a regular eating pattern, or it might involve specific skills from DBT, CBT, or other modalities, such as “urge surfing” (waiting for an urge to pass without doing anything about it), or distraction/delaying techniques (mindfully using distraction to make it through a triggering situation or ride out an eating disorder impulse). Tools to navigate particularly challenging moments. Whether it’s a short-term challenge—like stress at work or school—or a more long-term upheaval—like divorce or the birth of a child—it’s important to identify specific tools to use during tough moments. At Equip, patients and their loved ones learn a panoply of coping skills and strategies from different modalities, and can work with their treatment team to identify which ones would be most helpful in distressing moments. Awareness of relapse warning signs. In order to prevent a relapse, it’s important to know what to look out for. Create a list, which should include specific behaviors as well as weight targets set forth by the treatment team (if applicable). A plan of action. You need to know what to do when those warning signs crop up. This part of the relapse prevention plan should lay out specific actions to take depending on what signs you’re noticing, including when to use coping skills, when to reach out to providers, and when to go to a high level of care or hospital. Motivation for recovery and things to look forward to. When someone starts to slip back into old behaviors, it can be helpful for them to remember the “why” behind treatment. Writing out a list of goals, affirmations, and reasons to recover makes it simple to tap back into a sense of motivation when it seems to disappear. In addition to the above, Stein calls out  some particularly important aspects of recovery to consider. “Whether your loved one lives with you or independently, it's important that the relapse prevention plan makes clear how a healthy day looks including sleep, meals, activity if appropriate, and supportive relationships,” she says. “A relapse prevention plan should spell out what continuing treatment, if any, should take place. It should have a plan for mental health care including seeing a psychiatrist for medication management or a therapist if deemed necessary. Be clear how often these appointments will take places and who will make them” Stein also advises mapping out any necessary medical monitoring, including weight checks, but offers the reminder that weight fluctuations are not necessarily indicative of a relapse. “Real life happens and sometimes people get distracted by the business of their lives,” she says. “This is the perfect opportunity to remind yourself or your loved one about the relapse prevention plan and work to get back on track. For friends and family, it’s important to continue talking to your loved one about their recovery and validating the hard work they’re doing. Always keep your eyes and ears open and be a safe place for your loved one to talk about thoughts or behaviors that might be creeping back in.” Solov recommends viewing the plan as a living, breathing document that can always be updated and adjusted as needed. “The actual logistics of making a relapse prevention plan entail finding a template that works well for you—there are many out there,” they recommend. “You can tweak it to be most relevant to your own life, either on your own or with your treatment team.” When to start creating a relapse prevention plan A relapse prevention plan is simply a written document intended to help prevent an eating disorder relapse after treatment, so anyone can create one at any time, but it’s generally recommended to do so with the support of experts. “Some folks may take the initiative to create one on their own, others may have it integrated into their formal treatment process, depending on the treatment modality being used,” Lauro says. “You can absolutely create a relapse prevention plan after you’ve finished treatment, however it’s recommended to create it while you’re still linked to additional support.” In terms of when that plan gets made during treatment, it can vary. “Often we begin formulating a relapse prevention plan in the later stages of treatment to prepare for discharge, but they can also be relevant when someone is about to go through a transition, particularly one that may come with increased independence,” Solov says. “For example, I’ve worked on relapse prevention plans with families when their child is about to go to or return to college. We might use a green/yellow/red light system to identify when the person with the eating disorder is doing well with recovery (green), when they may be slipping back into eating disorder thoughts and urges and require added support (yellow), and when they’re actively engaging in eating disorder behaviors and require a higher level of care.” Lauro can think of many scenarios in which a relapse prevention plan has been crucial in her patients’ success. “This comes up frequently for the college-age folks I’ve worked with over the years,” she says. “I’ve had other folks revisit their old relapse prevention plan before their wedding to assist with dress shopping. The same has been true for folks who have chosen to become parents and are dealing with pregnancy and postpartum body changes. Revisiting skills and stepping away from unhelpful conversations prove to be effective no matter how much time passes.” Terzano says that in her case, creating and implementing a relapse prevention plan with the support of her family and therapist was crucial to her ongoing recovery. “Over time, I adopted an anti-diet mentality and realized that body image concerns may always be around, even if I was recovered,” she says. “The only difference is, now I’m not using my eating disorder behaviors to cope with negative body image. I use my coping skills toolbox from my relapse prevention plan that gives me healthier ways to cope with negative feelings that have nothing to do with changing my body.”]]></content:encoded>
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            <title><![CDATA[What Is Exercise Addiction? (And What to Do If You’re Dealing with It)]]></title>
            <link>https://equip.health/articles/food-and-fitness/exercise-addiction-how-to-treat</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/exercise-addiction-how-to-treat</guid>
            <pubDate>Wed, 15 May 2024 20:34:00 GMT</pubDate>
            <content:encoded><![CDATA[A few years ago, I wrote a story for Vanity Fair about my journey with exercise addiction, and it may have been one of the scariest things I’ve ever done. This is saying a lot, considering I’ve been an open book about my own eating disorder, documenting years of anorexia in dozens of outlets. But something felt particularly vulnerable about publicly discussing my problems with exercise. I knew there was something relatable in my journey, but I was grappling with some doubts about its validity. I’d heard from countless people—including medical professionals—that there was “no such thing” as too much exercise and that I should be so lucky to have an “addiction” to such a “healthy” habit. But my own experience said otherwise: I knew something was off with my relationship to exercise. So is exercise addiction real? Read on to learn more about exercise addiction, how it relates to eating disorders, and how to seek help for a very real problem. Is exercise addiction a real diagnosis? The phrase “exercise addiction” is currently a bit contentious, but diagnostic criteria for “exercise dependence” was developed in 1987, based on the symptoms of alcohol addiction. The original definition of “exercise dependence” was a “multidimensional, maladaptive pattern of exercise, leading to clinically significant impairment, or distress.” And while this concept was often interchangeably referred to as an “addiction,” many experts today agree that there are potentially more accurate descriptors for the thoughts and behaviors associated with exercise dependence. “While the term exercise addiction is sometimes used in clinical settings—and even in some validated clinical assessment tools—more often, ‘unhealthy’ exercise thoughts and behaviors are captured by other terms, like ‘maladaptive,’ ‘problematic,’ ‘compulsive,’ ‘compensatory’ and ‘excessive,’ says Equip’s Head of Nutrition and Physical Activity Research, Megan Hellner. “I find myself leaning away from using the term ‘addiction’ with patients, mostly because it feels so final and heavy, and may not resonate with someone who is just beginning to re-examine that relationship.” With that said, Hellner does acknowledge that a problematic relationship with exercise can certainly include some characteristic features of addiction, including dependence and withdrawal symptoms. “In a nutshell, exercise can become something that we misuse to manage or avoid experiencing negative emotions,” she says. “There’s often intense rigidity in terms of exercise mode and duration, and a strong sense of obligation to follow through with exercise plans despite negative consequences. So yes, it is a real phenomenon, and something we observe often as a core symptom in folks with eating disorders.” Equip’s Product Operations Manager, Kimmy Packebush, experienced precisely what Hellner describes. “When I think about my relationship with exercise, I know it reached toxicity when I joined a second gym,” she says. “At the time, I could have defended and justified this until I was blue in the face. My CrossFit workouts didn't push me enough and therefore required me to spend extra time in the gym to work towards my goals. Now, looking back, I can clearly see the serotonin and dopamine bursts I used to get from working out weren't doing it for me anymore, so I had to go multiple times a day.” Some researchers do still use the term “exercise addiction” when discussing these problematic patterns. A 2023 paper, for example, examined over 1,000 articles over a 12-year period on the topic of exercise addiction, acknowledging that there’s still a lot to learn about the issue. As the authors note, “despite its known dysfunctional characteristics,” exercise addiction is still not recognized as a diagnosis in the clinical reference manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). So while exercise addiction—and all other names that may be used for this phenomenon—is, in fact, a real thing, it’s not yet recognized as its own distinct form of mental illness. How can you tell if you’re “addicted” to exercise? The challenging part of recognizing exercise addiction is that physical activity is generally celebrated and encouraged in our society. So much so, that many people (and, as mentioned above, many medical professionals) are unaware of the real repercussions of excessive workouts, including fatigue, depression, injuries, anxiety, and more. “Problematic exercise behaviors often hide in plain sight, as exercise is thought of as a virtuous health-promoting behavior, worthy of praise,” Hellner says. “Because of that, it can be confusing to try to separate the healthy from the unhealthy. When I think of exercise addiction, I think of a person who feels an intense pull to engage in exercise at the expense of other activities, opportunities, and relationships. And they aren’t able to give the risks of doing so appropriate or full consideration.” Because there is no single diagnostic definition for exercise addiction, there’s also no exhaustive list of signs and symptoms. In general, the concept of exercise addiction/dependence is defined by a person’s insistence on exercising “excessively and obsessively to a point of dependence and, often injury or illness.” According to Hellner, some red flags that might indicate exercise addiction include: Recurrent or slow-to–heal overuse injuries, like stress fractures Fatigue Plateau or decline in performance Hair loss Menstrual cycle disruptions (absent, or short, irregular periods) Depressed mood Altered bone density “The tricky thing about identifying exercise addiction is that people with it are really, really good at justifying it,” Packebush says. “Like with an eating disorder, it becomes normal and like something you're ‘supposed’ to do. ‘I feel better when I move’ or ‘it makes me feel less anxious’ are things that can be true and are often sold as benefits of exercise. And, like an eating disorder, exercise addiction can do a really good job of convincing you that it's necessary and totally normal.” If you’re concerned that you or a loved one might be struggling with exercise addiction, it can be helpful to ask the following questions: Are you/they able to find joy and connection through other activities that aren’t centered around movement? Are you/they able to honor rest days, and to rest when sick or injured? Are you/they exercising outside of planned training hours/schedules, or at inappropriate times? Are you/they consistently training beyond what’s been prescribed by a coach? Are you/they finding it hard to disentangle food intake from urges to exercise? That is, does what/how much you/they eat often drive exercise behavior? Are you/they struggling to regulate emotions when unable to exercise as planned? While these questions can’t definitively tell you whether you or a loved one are dealing with exercise addiction, their answers tell you valuable information. If there were a lot of “yeses,” it’s probably worth taking a close look at the role exercise is serving in your or your loved one’s life. What does the research say about exercise addiction? As Hellner reiterates, the term “exercise addiction” has become a bit of a controversial label in the research world, and is used somewhat infrequently in clinical settings since there is an absence of clinical criteria for diagnosing the issue. “The lack of consensus hinders advancement in research,” Hellner says. “The underlying mechanisms of exercise addiction are not well understood, but we do know that this usually occurs in the setting of other psychiatric comorbidities, such as disordered eating, body dysmorphia, anxiety, or obsessive-compulsive disorder (OCD). So understanding how to effectively treat problematic exercise behaviors requires also understanding how to concurrently treat the underlying issues. We also know that endurance athletes are at higher risk.” To Hellner’s point, research has shown that not only is exercise addiction more common among elite athletes, but the prevalence among that population also increases with the level of competition. Surveying 417 participants from 15 different sports disciplines, researchers found that 7.6% of respondents were at risk of exercise addiction, and the group was “younger, exhibited tendency to exercise despite pain and injury, felt guilty if not exercising enough, and reported substantial eating disorder symptoms.” Research on ultra-endurance athletes (those participating in sporting events that last at least six hours) has also shown that certain personality traits, including neuroticism, may be associated with exercise addiction. Defined by the authors as “a persistent tendency to experience negative emotions while being aware of psychological suffering and exhibiting recurrent nervousness,” neuroticism is a trait that has also been associated with people struggling with alcohol, tobacco, and marijuana use disorders, as well as social media and gambling dependence. Researchers found that neuroticism is commonly related to the symptom of exercise withdrawal (i.e. negative effects in the absence of exercise) and that because neuroticism is related to negative emotions, people may use excessive exercise as a maladaptive coping strategy to try and alleviate unpleasant feelings. How does exercise addiction relate to eating disorders? While the phrase “exercise addiction” is used relatively infrequently in the eating disorder field, Hellner says the symptoms associated with it are extremely common. “Compulsive exercise is a core feature of eating disorder symptoms in the large majority of people with eating disorders,” she says. “When we think of those with bulimia, it’s common to think of self-induced vomiting as the form of purging, but compensatory exercise (i.e. exercising to ‘make up’ for calories consumed) is also a form of purging. It’s also common for folks with eating disorders. especially "anorexia athletica," to misuse exercise for purposes of changing weight or achieving a certain ‘athletic aesthetic.’” Packebush also notes the potential psychological similarities between those with disordered eating and those struggling with exercise compulsions. “I think people addicted to exercise likely share temperament traits of those with eating disorders: perfectionism, attention to detail, perseverance,” she says. “Also, there is a certain level of anosognosia—not realizing there's something wrong or a sickness—that goes with exercise addiction..” What should you do if you’re worried that you’re addicted to exercise? While exercise addiction can be difficult to spot, it is a problem that merits support and there are effective treatments to address it. “Treatment for problematic exercise depends on the underlying issues, and is more complex than simply interrupting the behavior,” Hellner says. “Effective treatment generally requires specialized multidisciplinary support. A medical provider can offer information about physiological consequences and guardrails around future exercise. A registered dietitian can assess whether or not you’re eating appropriately to meet the demands of training, and can make any necessary adjustments as time goes on (sports nutrition basics). A licensed therapist can bring in cognitive behavioral therapy-based or mindfulness-based approaches to address underlying thoughts and emotions that may be driving the problematic behaviors.” While treatment may look different for everyone, Hellner says that in general, treatment teams will strongly encourage the person struggling to refrain from exercise as they begin treatment. Then, as treatment progresses, they can work toward a gradual reintroduction of exercise over time for those wishing to return to their sport. Hellner also underscores the importance of working with specialized providers who will take concerns about exercise addiction seriously, and who may be well-versed in the principles of relative energy deficiency in sport (RED-S), a condition characterized by “insufficient energy intake to meet the body's demands during exercise and essential daily functions like growth, respiration, and digestion.” For me, working with a specialized team of clinicians, including therapists, dietitians, and medical doctors, helped me slowly rebuild my relationship to exercise. For others, reevaluating social networks and priorities can also make a big difference. “What helped me was to start hanging out with people who don’t exercise, or at least don’t view it as a must,” Packebush says. “This made me realize that maybe my behaviors weren’t as normal as I thought they were. I also had to remove myself from exercise for a while. When I did feel ready to return to exercise, it wasn’t back to a CrossFit gym. I had to completely redefine what movement meant to me.” Slower, joyful movement options like dance or yoga in recovery can be great ways to ease back into exercise in a new way.  Regardless of how concerning your or your loved one’s relationship to exercise might seem, if you’re worried it’s always a good idea to reach out for information, guidance, and expert insight. “It’s never too early to ask questions and seek support!” Hellner says. “Initially, this may look like talking to a trusted professional like a registered dietitian, licensed therapist, or medical provider with relevant expertise to better understand the issue—and associated risks—and plan for next steps.”  ]]></content:encoded>
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            <title><![CDATA[Suicide Rates Are Higher in Eating Disorder Populations — Here’s What You Need to Know ]]></title>
            <link>https://equip.health/articles/understanding-eds/suicide-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/suicide-and-eating-disorders</guid>
            <pubDate>Thu, 15 Sep 2022 14:27:05 GMT</pubDate>
            <content:encoded><![CDATA[Content warning: This article contains information and discussion around the topic of suicide. We know that eating disorders have the second highest mortality rate of all mental illnesses after opioid use disorder. One of the most serious and potentially fatal effects of eating disorders is suicide. Research shows that eating disorders carry a significant increased risk for suicide. In fact, suicide is the leading cause of death among individuals with anorexia. Although suicide risk appears to be elevated for individual with anorexia nervosa wtih binge/purge behaviors, all people with eating disorders are a increased risk of suicide, with about 26% of people attempting suicide. Given the incredibly delicate and difficult nature of discussing suicide—particularly with a child or teen—it may seem like an impossible topic to broach. But knowing how to initiate the conversation and recognize the warning signs can literally be life-saving. Here is what the experts have to say about getting started. Recognizing the warning signs of suicide According to Menzel, most people who are contemplating suicide display or give warning signs of their distress. Here are a few common indications she says to be aware of: Talk of suicide or suicidal ideation (e.g., “I'm going to kill myself” or “I wish I could go to sleep and never wake up”) Mentioning strong feelings of guilt and shame Suicide notes or plans (e.g., posted on social media), making preparations for death (e.g., donating or giving away prized possessions, making arrangements for someone to take care of a pet) Previous suicide attempts or related behaviors (e.g., self harm) A preoccupation with death Significant changes in appearance, feelings, or behavior (e.g., no longer showering, being suddenly withdrawn) Sleeping more or less than usual Sudden calm or improved mood following a period of time marked by a depressed mood Risk-taking or impulsive behaviors (e.g. driving at dangerous speeds) Equip Provider Relations Specialist Jillian Carter says that while many warning signs may be somewhat easier to spot because they include changes in outward behavior, others may not be obvious at all. “I've learned that sometimes an outwardly shift towards an extremely ‘positive’ mood may also be a risk factor,” she says. “In these instances, a person may be attempting to cope with their mental health by insisting they are ‘fine’ and no intervention is necessary, trying to convince others as much as they are themselves.” Equip Family Mentor Mary Martinez-Schmidt agrees that in some cases, warning signs can be subtle. “Some of these signs include displaying extreme mood swings, withdrawing from loved ones, displaying an abnormally elevated mood, and even sudden, drastic changes in eating habits,” she says. “In some instances, individuals suffering from restrictive eating disorders might suddenly be more open to eating foods that were once ‘off limits,’ as they might feel that ‘it won’t matter how their body looks or feels anymore.’ The key is to be wary of thoughts or actions that deviate drastically or suddenly from the patient’s norm.” The most impactful ways to show support to someone with an eating disorder who may be contemplating suicide While becoming aware of the warning signs is crucial, Carter says it’s critical to remember that suicide can affect anyone. “Remember to check in on your people whenever you have a chance,” she says. “I had a peer commit suicide a few years back, and they were the most outwardly joyful person you would have ever met. It was incredibly difficult to come to terms with not understanding their pain before they passed because they had never shown us signs of isolation, withdrawing, or depressed mood. Being intentional about asking those you care about how they are really doing, regardless of how they seem like they are doing, is something I value more than ever.” Menzel agrees that regular, honest check-ins can make all the difference to someone who is struggling. “Family members and friends should not be afraid to ask directly about suicide or thoughts of self-harm if their loved one is struggling,” she says. “It's important for your loved one to know that they can talk to you about these thoughts. But if you ask, it's incredibly important to control your reaction to their response. Do your best to listen — and not shame or judge your loved one negatively for their thoughts. People who are considering suicide are in incredible pain, don't want to die, and are often trying to communicate a need for help. Do your best to instill hope, let them know that you care about them, and connect them to resources that can help them” (note: for those seeking such crisis resources, please refer to this list).” When it comes to supporting those with eating disorders, Martinez-Schmidt points out a common obstacle that can impede open conversation. “Oftentimes, caregivers have a strong impulse to try to ‘fix’ what’s wrong by trying to come up with solutions to the individual’s concerns or even by trying to ‘reason’ with the eating disorder voice,” she says. “However, the number one most helpful thing a caregiver can do is hold space for their loved one to express their feelings without fear of judgment by simply listening with empathy. It can be especially difficult to accept that they cannot change their loved ones’ feelings or attitudes toward food or their own body, but they can provide comfort and even aid recovery by listening to their loved ones’ fears and concerns without necessarily intervening to change these thoughts.” While it may be difficult to get a loved one to open up about suicidal thoughts if they feel their honesty may garner intervention, Menzel says it’s important to be transparent and seek help when you feel it’s necessary. “Never promise to keep suicidal thoughts secret,” she says. “And if you are particularly concerned about your loved one, don't leave them alone and take steps to remove any means for self-harm from your home.” How healthcare providers can help  Those in the healthcare field can have an enormous impact, helping to identify warning signs and intervene in situations where a patient may be suicidal. Whether you’re a medical provider or want to work with your child’s physician or team to become aligned on a plan, experts have some ideas for improving communication and care. Menzel says that while many healthcare providers can be uncomfortable talking to their patients about suicide, frank, compassionate conversations are necessary to reduce the stigma around suicidal ideation. “Especially in talking with parents of children and teens, it can help to normalize that suicidal thoughts are not uncommon and are treatable,” she says. “We also need to direclty confront myths that someone expressing suicidal thoughts is only trying to get attention. All suicidal thoughts need to be taken seriously..” While all this information may be overwhelming and even a bit scary, education can be empowering and help direct the course of a child’s recovery and survival. “Suicide is preventable,” Menzel says. “And anyone can put themselves in a position to help at any time, simply by asking someone how they are doing and letting them know that you care. That expression of love and caring alone can be a powerful way of preventing suicide.” If your loved one (or yourself) is struggling with an eating disorder and suicidal thoughts, it's important to get help immediately. Contact your primary care physician or schedule a consultation with our team.]]></content:encoded>
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            <title><![CDATA[Eating Disorders & Pregnancy: How to Support Patients Navigating Both]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/pregnant-patients-eating-disorders-obgyn</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/pregnant-patients-eating-disorders-obgyn</guid>
            <pubDate>Mon, 16 Sep 2024 18:20:00 GMT</pubDate>
            <content:encoded><![CDATA[I read the books, I listened to the podcasts, I even attended a series of classes specifically designed for first-time parents. While all of that helped me wrap my head around first trimester nausea, nursery must-haves, and what to expect as someone who is expecting, none of it prepared me for the challenges of navigating pregnancy with an eating disorder history. I’ve written extensively about my fertility and eating disorder journeys, but one thing I haven’t explored in writing is the absolute make-or-break impact a healthcare provider can have in supporting eating disorder patients through pregnancy. While I was lucky to have a firm grip on recovery prior to becoming pregnant, I was highly aware of the potential eating disorder triggers that come with pregnancy—and the words and actions of every provider I saw left a meaningful mark on my experience. From discussions of “normal” weight gain to recommendations around food and exercise, healthcare providers have innumerable opportunities to impact how pregnant people feel about their growing bodies. And for those in recovery (or actively dealing with an eating disorder), they play a pivotal role in helping protect both mother and baby from disordered habits. Here’s what every healthcare provider should know about supporting their pregnant patients with an eating disorder history. Why all providers should have an education in eating disorders While it may seem like all medical professionals would be well-versed in illnesses that are as common as eating disorders—which affect about 9% of the U.S. population, or 28.8 million Americans in their lifetime—that’s not actually the case. “Eating disorders are often not covered in-depth during medical school or OB/GYN training,” says reproductive endocrinologist Dr. Aimee Eyvazzadeh, MD, MPH. “Most medical curricula focus on the physiological aspects of pregnancy, often neglecting the psychological and behavioral components, including eating disorders.” According to Equip family nurse practitioner Sarah Curran, FNP-C, many patients with eating disorders report feeling dismissed or invalidated by medical providers, including OB/GYNs, and that may be due to a lack of education and training. “While they are experts in their field, they simply do not hold the knowledge or have the bandwidth to adequately and holistically support pregnant patients with an eating disorder history through pregnancy and beyond,” Curran says. “Many OBs have received minimal training on conditions such as hypothalamic amenorrhea or RED-S, which can be consequences of underfueling and over-exercising, and will jump to quick fixes like hormonal birth control rather than addressing the root cause.” While eating disorders are unequivocally defined as brain disorders, they have serious physical implications and consequences that can affect, among other things, pregnancy. “Given that eating disorders can significantly impact both maternal and fetal health, it's crucial for providers to have a comprehensive understanding of how to identify, manage, and support pregnant patients with an eating disorder,” Eyvazzadeh says. “Providing eating disorder-specific education helps healthcare providers recognize the unique challenges these patients face, tailor their care plans accordingly, and improve outcomes for both the mother and the baby.” Why pregnancy can be challenging for patients with an eating disorder history There’s no doubt that pregnancy can be challenging for any birthing person, but for those who have dealt with an eating disorder, the experience can be particularly difficult and even triggering. “It’s easy to assume that weight gain is the only major trigger for those with an eating disorder history during pregnancy, but there is so much more at play, creating the perfect storm for relapse of behaviors,” Curran says. “Pregnancy is a time of rapid change, lack of predictability, as well as lack of control. It is well known that those struggling with eating disorders often carry personality traits in line with ‘type A,’ meaning they may hold perfectionistic tendencies, and struggle with change or lack of control.” Of course, weight gain is one of the major triggers that patients with an eating disorder history have to contend with during pregnancy. Weight changes in general can be difficult for those who have dealt with an eating disorder, but to make matters worse, many of the country’s leading organizations on pregnancy wellness continue to rely on outdated measures of how much weight pregnant people “should” gain. “The American College of Obstetricians and Gynecologists (ACOG) and the American Pregnancy Association recommend strict weight gain guidelines based on BMI, which is a deeply flawed measurement of health, and fails to consider individual nutrition history or health status,” Curran says. This is all exacerbated by the inescapable force of diet culture, which places unattainable expectations and pressures on pregnant people. “Diet culture is incredibly pervasive in the pregnancy world,” Curran says. “From pregnancy apps with daily messages, community forums online, or even resources provided by well-meaning medical providers, the overarching message unfortunately remains ‘gain weight, but not too much’ and ‘be sure to stay active.’” While those messages are fueled by good intentions, they can push those prone to eating disorders onto a slippery slope of harmful behaviors. Aside from the rapid and often unpredictable changes in body shape and size, Eyvazzadeh says pregnancy can also be triggering for patients with an eating disorder for several other reasons: Loss of control: “Patients with eating disorders may struggle with the lack of control over their bodies and eating habits, as pregnancy requires a different approach to nutrition and self-care,” Eyvazzadeh says. Hormonal fluctuations: “Hormonal changes during pregnancy can exacerbate mood disorders, anxiety, and depression, which are often comorbid with eating disorders,” Eyvazzadeh says. Focus on food and nutrition: “The increased emphasis on dietary intake and nutritional monitoring during pregnancy can trigger obsessive behaviors or lead to relapse in those recovering from restrictive or binge-purge eating patterns,” Eyvazzadeh says. This can also lead to what's often referred to as "pregorexia"  Another often overlooked obstacle for many birthing people is “morning sickness;” a common symptom I personally found can occur at any time of day. “Eighty percent of women will deal with some form of nausea during pregnancy, which can make eating enough a challenge,” Curran says. She goes on to explain that even if you’re eating less for non-disordered reasons—i.e., out of a desire to avoid nausea rather than any eating disorder impulses—undereating can trigger pathways in the brain that lead to further restriction and other disordered behaviors. How to support pregnant patients with an eating disorder history “When caring for pregnant patients with a history of an eating disorder, it’s crucial for providers to adopt a holistic approach that integrates both medical and psychological support,” says Eyvazzadeh. “Pregnancy can be a transformative but challenging time, especially for those who have dealt with eating disorders. While every patient and pregnancy is unique, there are some helpful, expert-approved guidelines for supporting pregnant patients with an eating disorder history: 1. Avoid unnecessary weight monitoring or offer “blind weighing.”  “Honor a patient's right to refuse weights, or offer blind weights periodically if absolutely necessary,” Curran advises. Eyvazzadeh agrees that providers may not need to closely monitor every pregnant patient’s weight, but in cases where a scale measurement is deemed necessary, the patient can simply turn around or avoid looking at the number if they prefer. “This can reduce anxiety associated with weight gain and prevent triggering obsessive behaviors around weight,” she says. “Providers should focus on overall health and well-being rather than weight.” 2. Get to know the patient’s past and stay vigilant.  “Understand the patient's full medical and psychiatric history, including eating disorder behaviors,” Curran says. “And screen frequently throughout pregnancy for relapse of symptoms or behaviors.” Eyvazzadeh says that signs of relapse may include frequent discussions about weight and body image, or food avoidance. She also advises that providers check in regularly on patients’ mental health.“Early intervention is key to preventing a full relapse,” she says. 3. Prepare patients for what’s to come.  “It’s critical to educate patients early on in the pregnancy journey about what to expect with regards to body changes—physically, hormonally, mentally and emotionally,” Curran says. “It can also be beneficial to normalize the fact that pregnancy can be an equally beautiful, exciting, and challenging experience. All feelings that arise during pregnancy are valid." 4. Be mindful of diet culture messaging.  “Avoid language that reinforces diet culture or stigmatizes certain foods,” Eyvazzadeh says. “Instead, encourage a balanced, inclusive approach to nutrition that focuses on nourishing the body for both the mother and baby. Remind patients that all foods can have a place in a healthy diet.” 5. Monitor mental health symptoms.  ”Due to increased risk for depression and anxiety during pregnancy, it’s important to assess mental health frequently,” Curran says. “Educate patients on safe options for treatment including CBT, SSRIs, and alternative medicine options.” 6. Recommend an eating disorder-trained dietitian.  “Refer patients to a dietician who specializes in eating disorders—and ideally prenatal nutrition—to ensure the patient is equipped with ongoing, compassionate support,” Curran says. Eyvazzadeh agrees, noting that a registered dietitian who is well-versed and experienced in the realm of eating disorders can help provide tailored nutritional guidance. “This collaboration ensures that the patient receives specialized support to meet the nutritional needs of pregnancy without triggering disordered eating patterns,” she says. 7. Create a safe, non-judgmental space. “Encourage open communication by creating a safe and supportive environment,” Eyvazzadeh says. “Let patients know that they can talk about their struggles with eating or body image without fear of judgment. This can help build trust and encourage honesty about any behaviors or feelings they may be experiencing.” 8. Acknowledge your gaps in knowledge or experience.  “Own your limitations as a medical provider who may or may not have received adequate training in eating disorders, and refer out when applicable,” Curran says. When to make a referral to an eating disorder specialist Even the most well-intentioned and educated medical professionals need support in providing their patients with the most appropriate care. Here are some signs that a patient may be relapsing or require more support: Down-trending weight or failure to gain adequate weight during pregnancy. Report of increase in disordered behaviors such as purging, compulsive exercise, calorie counting, or body checking. Changes in mood or behavior. “Increased irritability, depression, or anxiety may be signs of relapse or heightened distress related to the eating disorder,” Eyvazzadeh says. Pregnancy complications that indicate potential inadequate nutrition, including intrauterine growth restriction (IUGR), often seen later in pregnancy. Significant anxiety around weight gain or body changes. “This could manifest as excessive worry, avoidance of appointments where weight is measured, or repeated requests to discuss weight management,” Eyvazzadeh says. Frequent conversations about caloric intake or “safe” foods. “This may indicate restrictive eating or obsession with dieting during pregnancy,” Eyvazzadeh says. Physical signs of nutritional deficiency. “These may include hair loss, dental issues, or dizziness, which may indicate purging behaviors or inadequate nutritional intake,” Eyvazzadeh says. It’s also crucial for providers to be on the lookout for these and other red flags after pregnancy. “As challenging as pregnancy can potentially be for those affected by eating disorders, it is imperative for providers to also be aware of the challenges that arise during the postpartum period,” Curran says. “New mothers are going through a major life transition and identity shift, and can often be blindsided by the ‘fourth trimester.’” According to Curran, some potentially triggering factors during the postpartum period include: Sleep deprivation (which can exacerbate mood dysregulation) Increased risk for postpartum depression and anxiety Less time to prepare and eat adequate meals Breastfeeding struggles Body changes Diet culture messaging around “losing the baby weight” General lack of support from providers outside of the six-week postpartum check-up “Providers should be proactive in their care, provide a supportive environment, and utilize a multidisciplinary approach to address the complex needs of these patients,” adds Eyvazzadeh. “Encouraging a focus on the health and well-being of both the mother and the developing baby, rather than solely on weight or appearance, can foster a more positive pregnancy experience.” If you’re concerned that a patient of yours might be struggling with an eating disorder, we can partner with you to support them. Start a referral or reach out to learn more.]]></content:encoded>
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            <title><![CDATA[Are Eating Disorders Really About Control?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-and-control</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-and-control</guid>
            <pubDate>Wed, 16 Jul 2025 19:40:00 GMT</pubDate>
            <content:encoded><![CDATA[So many stereotypes exist about eating disorders, it can be hard to know which are actually rooted in truth. Many stereotypes are patently false: for instance, contrary to popular belief, eating disorders do not only affect young, white women, and they are absolutely not a vanity issue or a choice. But when people say eating disorders are really all about control…are they right? Equip Peer Mentor Jamie Drago says that while a combination of factors influenced her eating disorder, control certainly played a role. “I felt like there were a lot of decisions in my life that were being made for me that I didn’t get a say in, or identities placed onto me by others that I wanted to be different,” she says. “I felt like I couldn’t get a grasp on not only the emotions related to that lack of autonomy and control, but also what felt like character flaws related to a lack of control or even ‘self discipline.’” To cope with those feelings, Drago leaned into her illness. “Eating disorder behaviors felt like something that could be mine, and no one could make those decisions for me,” she says. While no two eating disorders are the same, many people do describe a similar relationship to control, and how the eating disorder gave them some semblance of autonomy or independence that they weren’t able to find in other areas of life. Read on to find out more about the role of control in eating disorders, how to find control outside of the illness, and strategies for making peace with the uncontrollable aspects of life. What the research says about eating disorders and control In a 2023 paper published in the Journal of Eating Disorders, researchers argued that while control can play a role in some eating disorder experiences, it’s not beneficial to overemphasize this factor to the exclusion of others. According to Equip psychotherapist Hannah Bishop, LPC, this study illustrates how exclusively focusing on the concept of control can actually further stigmatize and pathologize patients with eating disorders. “It’s my understanding from the research that personality style subtypes may be a more useful way to think about eating disorders, in comparison to believing that, for example, anorexia is an overcontrolled eating disorder and bulimia or binge eating disorder is an undercontrolled eating disorder,” Bishop says. “In my own experience, I believe both ideas to be true: eating disorders can be a maladaptive way of developing a false sense of control and there is much more to the predisposition and ongoing cycle of an eating disorder than control.” Rather than associating “control” with specific eating disorder diagnoses (and disassociating it from others), Bishop says it’s important to view personality traits as important factors that influence a person’s desire for control. “Personality factors such as perfectionism and harm avoidance can contribute to a person’s search for control. Perfectionism can include a hyper-focus on achievements—school, work, sports—and there can be a level of control and discipline necessary to achieve at a higher rate. Additionally, when an individual experiences harm avoidance they are more likely to want to control their environment so they won’t experience negative emotions or discomfort in new situations.” Drago believes that in a sense, any eating disorder can include some desire for control. “Whether that be control of how others in society perceive or treat the person, control over ‘health’ or illness, emotions, or circumstances,” she says. “That desire for control just might show up through different presentations. Eating disorder behaviors are always serving some sort of function to meet a need, or the person likely wouldn’t be doing it..” Why eating disorders can create a false sense of control According to Bishop, eating disorders can provide a false sense of control by allowing people to focus on various behaviors like weighing or measuring food, following rigid schedules, calorie counting, monitoring the number on the scale, and more. “Those with eating disorders may use these controlling types of behavior to avoid the fluidity of emotions, the influence of trauma symptoms, or any other sort of triggers that may bring about some sort of emotional dysregulation,” she says. Those with an eating disorder often have a distorted sense of hope, explains Bishop. That hope is rooted in the notion that by utilizing their disordered behaviors, they will find a sense of relief from uncomfortable feelings without actually having to face the sources of that discomfort. In this way, disordered behaviors create a false sense of control in order to feed this false sense of hope. “The reason why it is labeled a ‘false’ sense of control is because it is not the individual who is in control at this point—it’s the eating disorder,” Bishop says. “This idea can be really tough to navigate, especially when malnourished, because the eating disorder is such an all-encompassing illness that touches every part of someone's life and so it can be difficult to separate the individual from their eating disorder mindset.” Drago agrees, noting that the illusion of control that eating disorders provide can often be very convincing. “For example, in my experience, I felt that my eating disorder would be a productive way to improve my situation or control my emotions and circumstances, when in reality, it actually ended up getting in the way of me being able to have the brain space to focus on actually addressing the difficulties I was experiencing,” she says. “When using eating disorder behaviors, it sometimes can feel like that is an active choice the person is making in the moment, but really, it eventually becomes an automatic unhelpful behavior that feels extremely difficult to resist or change—which is evidence that it actually is not that person's authentic self that is in full control over their actions anymore.” The risks of using an eating disorder to feel in control While the behaviors associated with eating disorders may temporarily offer someone a sense of control, that false feeling can lead to significant physical, psychological, and emotional consequences. And in the most severe cases, the drive for control can be fatal. “An eating disorder can hijack the brain into thinking that the individual is in control and as a result, the individual could lose their health and life if they continue the behaviors,” Bishop says. “The behaviors that often perpetuate the eating disorder and feelings of ‘control’ are used to feel short-term relief or as a maladaptive coping tool.” The varied risks of using an eating disorder to feel in control can lead to a long list of negative consequences, according to Drago “From damage to physical health, to increased isolation and strained social relationships, impacts on overall mental health, as well as the fact that the person just is not addressing the root of what is making them feel the need to search for control,” she says. “When we don’t address the root causes, they will always remain underneath the behaviors on the surface.” Without proper evidence-based treatment, Bishop says the eating disorder behaviors may continue to shield a person from feeling the discomfort of emotional ups and downs—but this shield doesn’t offer long-term protection against uncomfortable or negative feelings; instead, it impedes the ability to move past them (while also doing deep damage to a person’s mental and physical health and quality of life). “The emotions do not go away unless appropriately coped with and processed,” Bishop says. “While disordered behaviors may provide a short-term relief, the emotions that need to be coped with do not go away and can eventually become even more severe, leading to an even more intense spiral of behaviors and avoidance.” How to find control outside of the eating disorder As a clinician and someone with lived experience recovering from an eating disorder, Bishop says that any feeling of protection the eating disorder provides is inherently deceptive. “I can first handedly tell someone that life does not stop, even if the eating disorder tricks us into thinking we have some sort of safe bubble with its companionship,” she says. “The path of life with its ups and downs is a gift, and although parts of it can feel overwhelming and difficult, we are resilient individuals and can handle so much more than we believe we can.” To begin reclaiming life outside of the eating disorder, Drago says it’s important to identify what may be provoking the sense of being out of control in the first place and finding healthy activities that offer reprieve from that feeling. This can be a complex and difficult process, which is why support from a multidisciplinary team is so critical to recovery. “For me, doing things like cleaning and organizing my room or house can help me feel like I have taken action to decrease what feels like chaos,” she says. “Writing things down can sometimes help get all of those ‘out of control’ things onto paper to then try to see what action steps need to be taken that might help.” Additionally, Drago says a longer-term practice may involve distinguishing the things in life that are actually controllable and those that aren’t, and learning to make peace with the parts of life beyond our jurisdiction. In the mental health field, this process is often referred to as “radical acceptance,” or accepting what is beyond our control and embracing the reality of our current circumstances. “We can understand and recognize that not being able to control outside factors can be very frustrating, anxiety provoking, etc.,” she says. “But anchor back into the control we have over how we react to these feelings.” With all this in mind, Bishop feels it’s important for people to know that while control may play a significant role in the evolution of eating disorders, there are often many other factors at play as well. “By focusing solely on control when treating patients, we could be ignoring other areas of their life that may be responsible for the illness,” she says. “Eating disorders are stigmatized, and the notion that someone may choose to utilize the eating disorder as a sense of control should continue to be dismantled. We know eating disorders are complex illnesses and there are various factors leading someone to be more susceptible to having one, including genetics, societal norms, life events, and other environmental factors.” Bishop encourages anyone struggling with an eating disorder to reach out for help and allow a professional or team of experts to provide the necessary support and guidance. “I would remind anyone struggling that nobody is perfect and we all have the ability to learn new skills to engage in life in a healthier way,” she says. “Recovery is messy and life can be as well. The sooner we can practice radical acceptance of the things we cannot control, the sooner we can move through the peaks and valleys of healing.”]]></content:encoded>
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            <title><![CDATA[Eating Disorder Treatment Didn't Work for You? Here's Why to Try Again]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/try-eating-disorder-treatment-again</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/try-eating-disorder-treatment-again</guid>
            <pubDate>Tue, 31 Oct 2023 16:40:00 GMT</pubDate>
            <content:encoded><![CDATA[As someone who’s been through many forms of eating disorder treatment, I understand the immense frustration and disillusionment that can result. The first intensive outpatient program (IOP) I attended wasn’t particularly successful. The hospital setting was cold and sterile, the facility’s dietitian was on leave, and there was little guidance on transitioning back to the real world post-treatment. When I started struggling again a few years later, I wasn’t surprised—but was frustrated. Unfortunately my experience wasn’t all that uncommon: many people also encounter these issues with traditional eating disorder treatment like residential treatment centers (RTC), partial hospitalization programs (PHP), and intensive outpatient programs (IOPS.) “When previous treatment hasn’t worked for a patient, I often hear them express feelings of failure, as well as frustration, exhaustion, despair, grief, isolation…” says Equip Program Development Lead Carly Knauf, Psy.D. Equip’s VP Behavioral Health Care, Angela Celio Doyle, PhD adds, “Thinking you have failed at treatment feels incredibly bad, especially when you have gathered up the courage to dive into the really hard work of recovery from an eating disorder.” For me, it took a long time and a lot of convincing before I was willing to give treatment another shot, but it became clear that a second attempt was truly the right decision. Here’s why treatment is worth trying again, some of the most common reasons it might not have worked the first time, and what to look for in a new treatment approach. Why it’s worth trying treatment more than once Put simply, just because one form of treatment didn’t work, doesn’t mean another will fail a patient as well. “It’s absolutely true that not all treatments work for all people,” Doyle says. “Treating eating disorders is complex—it takes a lot of grit and strategizing with a professional to know what is working, what isn't, and what next steps should be.” Understanding the variety of treatment options available and knowing the most common obstacles to recovery can help individuals with eating disorders and their loved ones better prepare for the road ahead. “I can say with 100% confidence that it’s worth giving treatment a second, third, or even tenth try,” Doyle says. “I sometimes see the most lasting recovery in people who have learned different things from different providers over time. Ideally, people have relief after their first experience of treatment and I do believe that ‘first try’ recovery can happen. But I would always recommend trying again, and advise people to possibly change up their treatment team if they feel like they’re not being understood or making progress at all.” Sometimes it's hard to try again purely out of affordability. If that's the case, check out this guide to insurance for eating disorder treatment for tips.  Why treatment might not have worked the first time Regardless of someone’s treatment history there’s hope for every person to reach full, lasting recovery. Here are the most common reasons why treatment may not have worked in the past—and why it’s still worth trying again. Reason #1: The eating disorder treatment program wasn’t evidence-based Not only can eating disorder treatment be difficult to access in the first place, but when options are available, they aren’t always backed by science. Research has indicated a lack of available treatments that adequately address the neurobiological complexities of various eating disorders like anorexia. In the wake of academic medical center closures, an array of private treatment programs have appeared to fill the gap, but many unfortunately only offer untested, non-evidence-based interventions. Eating disorder recovery responds best to evidence-based treatments that work, such as family-based treatment (FBT) and cognitive behavioral therapy for eating disorders (CBT-E). “People don’t fail treatment, treatment fails people. Treatment may fail people for multiple reasons, and that often includes lack of evidence-based programs,” Knauf says. To truly maximize the odds of reaching lasting recovery, treatment programs must be vetted, evidence-based, and patient-centered. “The best treatment for an eating disorder is based on best practices and involves a synchronized team,” Doyle says. “The care team should meet an individual where they are in their recovery journey and should be willing to adjust if treatment isn't working.” Reason #2: You didn’t receive enough preparation for adjusting back to real-world triggers When I completed my first IOP program, I didn’t feel ready to jump back into the “real” world after dedicating three days a week to all-day therapy sessions. Unfortunately, my program didn’t offer much post-treatment resources or support, and I struggled to adjust back to “regular” life. Research has shown that FBT and virtual treatment can help buffer against this susceptibility to relapses once treatment is complete. When patients are able to maintain many of their “normal” activities while getting comprehensive care and support, they’re more likely to thrive on the other side of treatment. At Equip, treatment is entirely virtual, so you don’t have to uproot your life and can practice implementing new skills into your real life. Equip also invites friends and family into treatment, so you get support in real life too. Reason #3: Your treatment team wasn’t as resourceful when navigating setbacks Doyle believes that it’s also important to appreciate and anticipate the gray areas of recovery and understand that recovery can involve setbacks, missteps, and plateaus and still be considered “successful” with time. “I think it's important to not see recovery as black or white,” she says. “People can make significant, life-changing progress and still not feel quite like they’re at the place they want to be with their recovery. An unsuccessful try at treatment could be the result of a number of things— everyone on the team and the person in treatment should work together to critically think about what barriers to recovery might be.” Doyle adds that sometimes a care team isn’t properly aligned or doesn’t take into account the other disorders or issues that may be affecting treatment. “There may also be other highly serious problems that treatment needs to pause, like active suicidality,” she says. “I believe that all people can recover from an eating disorder and sometimes it takes creativity and can include one step forward and one step back in the process. Recovery is not linear.” Reason #4: Treatment didn’t include your support network There’s no denying the profound impact social support can have on the success of eating disorder treatment. According to research, support groups have been found to help reduce stigma and isolation while improving engagement, and be helpful for those supporting a loved one through recovery. And while most of the current research revolves around the importance of family support, emerging studies indicate that social support that includes friends, colleagues, neighbors, and significant others, could be hugely impactful as well. “We know that a strong support system can make a huge difference in recovery,” Knauf says. “At Equip, we offer a five-person care team for each individual to not only help the patient through recovery, but to also provide support to their loved ones as well.” Reason #5: Weight gain wasn’t prioritized or sufficient While weight restoration is rarely easy or pleasant for someone with an eating disorder, it’s a critical part of achieving full recovery for most diagnoses. Weight restoration supports healing and is considered one of the best predictors of psychological improvement and reduced eating disorder symptoms. Without restoring weight to a healthy and sustainable number, full eating disorder recovery just isn’t possible. “Be careful of treatment that only ‘feels good’ but does not show any changes in health,” Doyle says. “Recovery can be really hard but with a trustworthy, focused, and research-informed team, recovery can be achieved.” Understanding why treatment may not have worked in the past can help prepare you for a fresh start and a new chance at lasting recovery. “For those who have been failed by previous treatment, I am sorry,” Knauf says. “You deserve better and you deserve recovery. My advice for anyone discouraged about past treatment programs is that there are treatments that work! I would encourage patients and their support systems to look for care that is comprehensive, evidence-based, and tailored to the individual. You are not alone. There are professionals waiting and eager to help. Full recovery is possible and there is so much life to be lived—I hope and know you can build a life worth living with the right support and treatment.” It’s never too late to give treatment another try. You deserve the relief that comes with full recovery. Equip was built to solve these common pitfalls, and be the last eating disorder treatment someone will need. Schedule a free consultation to learn more.]]></content:encoded>
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            <title><![CDATA[Hunger and Fullness Cues During Eating Disorder Recovery: How to Listen to Your Body]]></title>
            <link>https://equip.health/articles/food-and-fitness/hunger-fullness</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/hunger-fullness</guid>
            <pubDate>Sat, 06 Feb 2021 01:38:35 GMT</pubDate>
            <content:encoded><![CDATA[While you may be having trouble understanding your natural signals now, your body has been sending you all kinds of different cues to help you identify specific needs since the time you were born. Think about babies: when they’re hungry or tired, they cry. Since these tiny humans aren’t able to figure out what they want, crying is their only way of communicating distress. It makes sense, right? But as we move through life, certain obstacles can interfere with this simple system. Eating disorders or other traumas can complicate our ability to figure out what our bodies are telling us. However, with time and proper attention to your body, you’ll eventually be able to decipher its messages about hunger and fullness (seriously!). Not only will you be able to tell when you have an appetite, but you’ll be able to discern how hungry you are and if/when that hunger has been satisfied. Different people have different cues for hunger and fullness. While some may experience hunger as a stomach rumble, others may get a headache or feel weak. Some may feel full sooner than they anticipate and others, depending on the stage of their recovery, may feel uncomfortable with even a slight feeling of hunger or fullness. Identifying these body cues and figuring out when your body is telling you to either eat or stop eating is a process that may involve a lot of trial and error. But as you learn how your body communicates with you, you’ll learn more about yourself and strengthen your connection with your body. Questions to help you tap into your hunger and fullness cues As you work with your team, you can think about the following questions: How do you know when you are hungry? Where do you feel these sensations in your body? Is it a physical feeling? A mental hunger? Do you feel sensations in the same place every time you are full? Do you always experience hunger in the same way or does it vary depending on the day or the time of day? Does your hunger feel extreme? Does your hunger come on gradually or does it arise suddenly? How do you know when you feel full? Does fullness happen at the same time you feel satisfied or are these two different feelings? What makes you decide whether to start eating or stop eating? What happens in your body if you do not listen to your hunger? What happens if you do not listen to your appetite? Do you eat what you truly want? How does your body feel if you don’t eat what you desire? Does your desire for food change based on how hungry or full you may feel? Does the taste of these foods change because of these factors? Can you remember the last time you ate and felt satisfied after? Can you remember the last time you were hungry and listened to those feelings of hunger? Do your feelings about yourself or your body change depending on whether you feel hungry, full, or satisfied?]]></content:encoded>
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            <title><![CDATA[So Your Child Wants to Lose Weight? Here’s How to Handle It. ]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/children-weight-loss-dieting</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/children-weight-loss-dieting</guid>
            <pubDate>Mon, 03 Feb 2025 18:17:00 GMT</pubDate>
            <content:encoded><![CDATA[Long before JD Ouellette became well-versed in eating disorders, she encountered a seemingly harmless parenting issue: her high schooler started a diet. “When my 17-year-old daughter and her friends went on a ’healthy eating makeover,’ it never occurred to me this would be anything other than a rite of passage in womanhood,” says Ouellette, now Equip’s Director of Lived Experience. “What I learned the hard way—and it's a devastating way to learn—is that in a genetically vulnerable person, anorexia is triggered by burning more calories than you eat, and my daughter was one such person.” Like many parents, Ouellette didn’t initially suspect any risk for disordered behavior when her daughter expressed interest in dieting. After all, our society associates many forms of food restriction with “healthy” discipline (a false notion continuously reinforced by diet culture). “A common trap I see parents get caught in is thinking that a focus on being ‘healthy’ or wellness is a good thing—or at least not harmful,” says Equip Vice President of Program Development, Jessie Menzel, PhD. “Often, health and wellness is just a cover up for your child or teen's weight loss and extreme dietary changes. Don’t make the mistake of letting a new interest in ‘healthy eating’ go undiscussed.” While her daughter has recovered in the decade-plus since her anorexia diagnosis, Ouellette can’t help but reflect on their family’s good fortune. “She is very well today, and not every story turns out this way,” she says. Indeed, research has shown that dieting is associated with greater eating disorder risk and psychopathology, and so there’s reason to be concerned if your child has started changing their eating habits in order to lose weight. Luckily, there are ways to navigate the dieting conversation and protect your child from walking a dangerous path that could lead to a disorder. Here’s what every parent should know when it comes to dealing with kids and diets. Kids, body image, and dieting Although it’s a common belief that eating disorders and body image concerns only affect teenage girls and young adult women, anyone of any age can struggle with food, weight, or exercise issues—including young kids. “Unfortunately, I don’t think young children being concerned about their bodies is anything new,” Menzel says. “There has been research for decades that body image concerns can begin to develop as young as four or five years old, and that body dissatisfaction can be well established by eight years old. Messages about thinness, weight loss, and dieting have been pervasive in our culture for a long time.”  Ouellette believes that much of this messaging is rooted in the moralization and worship of certain body types. “Children have long known that ‘thin is good’ and ‘fat is bad,’” she says. “It's very telling to look at a selection of toddler/preschool/elementary school books on diversity and see the unwritten message: you can be any skin color, but your body must never be anything but thin.” Eating and body concerns affect people of all genders as well. “Remember that body image and diet culture are not just concerns for young girls—they also impact boys,” Menzel says. “There has been a trend over the past few decades for boys and men to feel more pressure to conform to societal appearance ideals and to use extreme dieting behaviors to manage their appearance.” Complicating matters is the fact that social media has completely transformed the cultural landscape in the past few decades, leaving many parents bewildered about the messages their kids are absorbing. “Today it’s not just books or TV—it is everything, everywhere sending the message that being thin and ‘fit’ is the only option for being a ‘good’ human being,” Ouellette says. “This message comes from the media, from doctors, from schools, from diet culture, and from wellness culture. It's inescapable; body size has become intertwined with morality.” Menzel agrees, and notes that while body image concerns have long been prevalent in young children, online culture has certainly intensified the pressure to conform to a particular body type and weight loss-driven behavior. “I do think that the relatively recent increase of social media use among children and teens poses an insidious and unique new risk for the development of body image problems,” she says. “Social media gives kids unprecedented access to information on dieting, fuels social comparison—which is a major risk factor for body image dissatisfaction—and allows for the very public criticism of people’s appearances.” What to do if your child wants to lose weight Navigating conversations about dieting and weight loss as a parent can be incredibly tricky and even intimidating, given the possible slippery slope that could end in an eating disorder. But with the right strategies, you can encourage constructive conversation, model healthy behavior, and help guide your child toward a positive relationship with food and their body. 1. Stay firm in your stance but discuss the why “Explain that growing up means your body is in a constant state of growth and change, which requires a lot of food, and be clear that bodies come in all shapes and sizes,” Ouellette says. “Explore the why of wanting to lose weight; validate that it can be hard to not fit an unrealistic ideal and you will support them to process and deal with that—and you have a responsibility to their physical and mental health to not let them do something damaging.” 2. Get curious and ask questions “By asking questions first, you can get to the root of your child’s worries, connect with them, and then start to help shift their way of thinking,” Menzel says. “This can offer an important opportunity to correct misinformation from peers or social media and foster more helpful beliefs about weight and eating.” Ouellette also recommends looking into messages they may be getting from their school that could promote harmful thinking about food and bodies (for instance, that certain foods are “good” and others “bad”). 3. Demonstrate healthy body image “Never forget to model comfort with your own body, even if you have to fake it until you make it. There's a powerful short video called ‘Poodle Science’ that can help with getting your message across,” Ouellette advises. The Health at Every Size-themed video explains the lack of diversity in current weight and health research and the importance of taking individuality into account when considering these issues. “Check your own thoughts and actions,” Menzel adds. “Parents are not immune to diet culture and we reinforce it at home in subtle and sometimes not-so-subtle ways. Try to catch yourself before you comment on your own weight or eating habits, take note of how often you compliment others on their appearance. Are you, yourself on a diet and how do you talk about or show that at home? Changing your own self-talk is important role modeling for your child.” 4. Call out diet culture at home “Educate your children about the harmful messages and images that they see and hear,” Menzel says. “Make sure that children and teens know about how easy it is to manipulate images and that what they see often isn’t real. Call out misinformation about food, weight, and wellness. Talk about how all food is good food and can nourish our bodies—not to mention that food also makes us feel good and fuels connection. Discuss how weight gain is normal and healthy for a developing child.” 5. Help them feel prepared to confront diet culture in their social world “Research has shown that of all the sources of pressure to diet and lose weight, peers are often the most influential,” Menzel says. “Introduce them to body positive or anti-diet social media accounts. Help them figure how they will respond when their friends bring up dieting, disparage their own appearance, or comment on someone else’s. It can be hard to challenge this kind of conversation in the moment, and talking about it ahead of time can help your child feel confident navigating these conversations without sacrificing their friendships.” When (and how) to seek help Having frank and honest conversations with your child about the potential dangers of dieting is an important part of fending off disordered eating behaviors, but in some cases, professional guidance and support is crucial. “If you are validating your child and helping them to understand bodies come in all shapes and sizes and they’re still struggling with body image or trying to lose weight, seek professional support,” Ouellette says. “Interview prospective therapists about their views on bodies and weight and the treatment model they use. Ask them for literature that informs their treatment approach and what materials they’ll share with your child. If available, a therapist aligned with Health at Every Size is a good place to start.” Ouellette also adds that it can be helpful to get an eating disorder screening for your child if you observe eating disorder signs, like: Dramatic weight loss or gain in a short period of time Restriction of food Restrict/binge cycles Exercise they cannot take days off from Worsening body image issues Other mental health concerns, like anxiety, depression and self-harm According to Menzel, parents also should be aware of the following signs that their child’s body image issues might be cause for more concern: Their body image worries take up an increasing amount of time and resources (i.e. they’re spending more time in their room getting ready, consuming more content on social media, or spending more money on products—especially at the expense of other activities or interests). Their body starts to become a reason for them not to do certain things (i.e. they give up a sport they love or they avoid pool parties with their friends or they no longer wear clothes they used to love). They have significant mental health shifts like increasing anxiety, depression, or loneliness. “All of these changes are signs that your child’s body image concerns might be a symptom of a bigger problem,” Menzel says. If you’ve noticed these red flags or other troubling symptoms, it’s important to seek help for your child right away. “I usually recommend that parents start by talking to their pediatrician—however, be mindful that the pediatrician’s office can often be a source of weight loss and diet messages,” Menzel says. “An evaluation with a mental health professional who specializes in eating disorders is the best way to go.” Reflecting on her own experience, Ouellette now sees the immense influence parents can have on their children’s relationships to their bodies. “Diet and wellness culture are everywhere and it can be very hard to know what is true and what is designed to make you feel bad about your body and sell you things,” she says. “We are never going to be able to avoid diet culture completely, but we can work on our relationship with our own bodies in order to model the self-acceptance and self-care we want to impart to our children. We can ‘just say no’ to our own and our children's participation in a toxic system that deprives people of true mental and physical well-being.” If you’re concerned about your child’s eating habits, don’t ignore it. Some good first steps are to take our free eating disorder assessment, talk with your doctor or a trusted mental health professional, or schedule a consultation with Equip.]]></content:encoded>
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            <title><![CDATA[Eating Disorders in Primary Care: Why Early Intervention Is Key]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-in-primary-care-early-intervention</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-in-primary-care-early-intervention</guid>
            <pubDate>Tue, 15 Oct 2024 23:17:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders often hide in plain sight, going unnoticed and undiagnosed for weeks, months, or even indefinitely. This is concerning, given the fact that eating disorders have the second highest mortality rate of all mental illnesses, and that the longer someone has an eating disorder, the tougher it is to recover. One important way to address this problem is by educating primary care providers on how to identify eating disorders, and what to do if they’re concerned about a patient. Read on to learn more about the important role primary care providers play in spotting eating disorders and helping patients find support. Why primary care providers need to look out for eating disorders Eating disorders are common and deadly. According to a meta analysis of 94 studies, the lifetime prevalence of eating disorders were 8.4% for women and 2.2% for men, and these rates have been rapidly increasing over the past few decades, especially among young people and marginalized groups. What’s more, the actual numbers are likely even higher than those reported, since many eating disorders go undiagnosed. Experts estimate that due to lack of awareness and insufficient methods for diagnosing eating disorders, anywhere from 50% to 80% of these illnesses go undetected or are misdiagnosed as something else. And even if someone is diagnosed, there are still significant barriers to treatment that keep people from getting better: according to research, only one in four people with eating disorders seek help. Primary care providers play a critical role in helping to close this gap and get more people the care they need. Not only are PCPs in a position to spot concerning signs and symptoms before others might, medical management by an informed provider is also an essential part of eating disorder treatment. Eating disorder experts have recommended that primary health care settings put in place an early intervention model to address eating disorders, and the United States Preventive Services Task Force published a recommendation on screening for eating disorders among adolescents and adults in primary care. Adam Arsenault, RN, MSN a psychiatric nurse practitioner at Equip, agrees with these recommendations, elaborating on the important role of PCPs in recognizing eating disorders. “Often with adolescents, the primary care setting is the first instance that families are made aware that something is ‘not right’ with their child, such a drastic weight change or abnormal vitals signs and labs,” he says. “Adults with eating disorders may have been struggling with their disorder for prolonged periods of time, and the PCP may be the first provider to meet with the patient and recognize symptoms. Early recognition of eating disorders is critical, because these conditions are associated with significant morbidity and mortality. Primary care providers play a key role in early identification, which can lead to timely interventions.” Why eating disorders often go undetected at the doctor’s office Eating disorders are self-protective illnesses that tend to be hidden by nature. Symptoms and behaviors that might be obvious red flags—like binge eating, purging, compulsive exercise, or restricting food—usually occur in private, and those who are struggling often go to great lengths to hide their disorder. This is partly due to the shame and stigma that often comes with these illnesses, and partly due to the fact that many people with eating disorders don’t actually want to get better (which is what we mean when we describe eating disorders as being egosyntonic). The secretive nature of these illnesses can make it difficult for PCPs or other providers to detect them. There are also societal and systemic factors that prevent PCPs from identifying eating disorders in their patients. For one thing, due to lack of awareness on the many ways that eating disorders show up, providers may associate eating disorders with a specific type of person (usually white, thin, young, and female) or a specific set of symptoms, like binging and purging or extremely restrictive eating. In reality, eating disorders affect people of all ages, genders, races, and body types, and they show up in a wide range of different psychological, physical, and behavioral symptoms. “Various barriers impede PCPs from identifying eating disorders, including stigma associated with mental health, weight biases, lack of specific training in recognizing these disorders, and misconceptions about the patient population affected,” says Arsenault. “Someone in a larger body may not be screened and identified with an eating disorder due to the provider’s belief that only those who are underweight have eating disorders. Why is early intervention critical in eating disorder management? A large body of research suggests that the earlier someone gets help for an eating disorder, the better their outcomes. The opposite is also true: the longer somebody struggles with an eating disorder, the more difficult it is for them to recover and the likelier it is that they’ll experience long-term consequences for their mental or physical health. “Studies have shown that patients who receive prompt treatment have better outcomes, demonstrate higher rates of remission and a decreased likelihood of developing chronic eating disorders,” says Arsenault. “Furthermore, early intervention can mitigate the impact of eating disorders on overall quality of life and functioning. Evidence suggests that addressing eating disorders at an early stage can facilitate healthier coping mechanisms and resilience in patients, ultimately leading to improved self-esteem and social functioning.” Indeed, research shows that intervening and improving symptoms early decreases a person’s risk of struggling with an eating disorder long-term, and there’s reliable evidence that early intervention improves a person’s chance of achieving full, lasting recovery. One large meta analysis also found that early intervention programs have been shown to significantly reduce risk factors and encourage help-seeking behaviors. Besides improving the odds of recovering from the eating disorder, early intervention also helps prevent long-term physical or psychological consequences of the illness, as well as recovery from any co-occurring conditions. “Early intervention helps prevent the progression of the disorder, which can lead to severe physical and psychological complications, including cardiovascular issues, metabolic imbalances, and increased risk of comorbid mental health conditions such as anxiety and depression,” says Arsenault. Research shows that identifying any co-occurring conditions and addressing them early, alongside the eating disorder, can be another key to effective and lasting recovery.  What are the early signs of eating disorders in primary care? Eating disorders show up in many different ways, and the same diagnosis can look different from person to person. However, there are a number of signs that PCPs should be on the lookout for that are cause for alarm. Common physical signs of an eating disorder Some physical signs that PCPs might notice in patients are: Weight loss or fluctuations In growing children, falling off the growth curve or gaining weight at a slower rate Orthostatic vital signs Abnormal electrolytes Abnormal cardiac rhythms Dental enamel erosion Russell’s sign (calluses on the knuckle from repeated purging) Lanugo (fine, soft hair on the body) Dizziness/episodes of syncope Gastrointestinal complaints Menstrual irregularities Common behavioral signs of an eating disorder While PCPs likely won’t directly observe any disordered behaviors, they can ask questions—both in conversation and in questionnaires—to try to identify troublesome habits. Some behaviors that might indicate an eating disorder include: Hiding food Avoidance of family meals/social eating situations Social withdrawal Excessive exercise Exercising secretly Common psychological signs of an eating disorder PCPs may be able to directly observe some of psychological symptoms that might indicate an eating disorder, as well as ask questions that might bring them to light. These symptoms include: Preoccupation with food or body image Anxiety Depression Obsessive thoughts about food Body image distress How can primary care providers screen for eating disorders? It’s essential that PCPs know how to screen for eating disorders in their patients. Screening helps prevent these life-threatening illnesses from going undetected, and improves treatment outcomes by catching eating disorders early. Thankfully, there are a number of evidence-based screening tools that providers can use to identify potential eating disorders in their patients. Screening tools and practical questions During well visits and check-ups, it’s important for PCPs to ask patients practical, non-invasive questions about their relationship to food, exercise, and their body. This is important for all patients, but is especially critical in high-risk populations, like teens and adolescents. Some potential questions might include: Have you made any changes in your eating habits? Do you feel in control of your eating? What’s your relationship with exercise like? How do you feel about your weight? What do you like about the way that you eat? What do you dislike? Would it be okay if we discussed your eating habits? PCPs should also consider using an evidence-based eating disorder screener. One of the best options is the SCOFF questionnaire, which is a simple five-question assessment. If a patient answers “yes” to two or more questions, it may indicate the presence of an eating disorder. SCOFF questions: S: Do you make yourself Sick because you feel uncomfortably full? C: Do you worry you have lost Control over how much you eat? O: Have you recently lost more than One stone (6.35 kg) in a three-month period? F: Do you believe yourself to be Fat when others say you are too thin? F: Would you say Food dominates your life? There are a number of other eating disorder screening options, which are outlined thoroughly in this article on screening for eating disorders. Some of the most commonly used screeners include: Eating Disorder Screen for Primary Care (ESP) Eating Disorder Examination Questionnaire-7 (EDEQ-7) Nine Item ARFID Screen (NIAS) Providers should incorporate screening tools early, and integrate behavioral health screeners into existing medical screeners, like growth charts. It’s important to recognize that screening doesn’t mean a diagnosis, but indicates the need for further assessment. Diagnostic approaches: physical examination and lab work Besides screeners and practical questions, PCPs should also look for physical indicators that a patient is dealing with an eating disorder. This can include things to look out for during a physical exam—such as dental erosion, calluses on the knuckles, and unstable vitals, among the other physical signs of an eating disorder outlined above—as well as specific labs to order. “PCPs should consider lab tests to check electrolyte imbalances. In addition to baseline complete blood count and comprehensive metabolic panel, testing for magnesium and phosphorus can assist in eating disorder detection and prevention of refeeding syndrome,” advises Arsenault. Other tests experts recommend include testing FSH, LH, and TSH levels (in the case of amenorrhea); running an EKG (especially important in patients who are bingeing and purging); and performing a bone density scan. Best practices for PCPs: supporting patients with eating disorders No matter what population PCPs work with, it’s important that they are knowledgeable about eating disorders and how to support patients who might be struggling. Besides learning about warning signs and screening practices, this also involves creating a safe space for patients with eating disorders and having resources ready when somebody needs support. Creating a supportive and non-judgmental practice environment Eating disorders tend to be shrouded in shame and guilt, making it difficult for patients to voice their concerns or ask for help. This is often exacerbated by diet culture and weight stigma, which can cause those who are struggling to fear judgment about their behaviors—especially if they’re in larger bodies or engage in binge eating behaviors, which diet culture paints as a moral failing. PCPs can help counter this by creating a supportive environment that encourages patients to discuss their eating behaviors without fear of judgment or being reprimanded. Here are some strategies for creating an environment that feels safe for eating disorder patients: Educate those in your office about eating disorders Learn about the Health at Every Size (HAES) approach Remember that eating disorders affect people of all body sizes Watch how you speak about bodies, food, and exercise Become aware of the different ways that weight stigma shows up in healthcare settings Ask questions from a place of curiosity, rather than judgment Knowing when—and how—to refer patients While it’s essential that PCPs become educated about eating disorders, it’s important that those struggling with these illnesses work with eating disorder specialists. Primary care providers are often involved in treatment in some capacity, but effective eating disorder care involves working with a multidisciplinary team of specialists who are specifically trained in eating disorders. For this reason, it’s important that PCPs develop relationships with eating disorder-trained dietitians and therapists, as well as eating disorder treatment programs they can refer patients to. “If a PCP suspects an eating disorder, they should approach the patient with empathy, provide psychoeducation, and refer them to specialists such as dietitians, therapists, and eating disorder clinics for comprehensive treatment,” says Arsenault. “There are multiple levels of eating disorder treatment including residential treatment centers, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and virtual outpatient treatment such as Equip.” While every patient has their own unique needs, Equip is an appropriate treatment option for patients of all acuity levels, as long as they’re medically stable. In addition to having referral options readily available, PCPs should also feel confident in determining when to refer patients to specialized care. Some signs that a patient needs to be referred to eating disorder treatment include rapid weight loss, significant mood changes, or when the patient’s disordered behaviors or thoughts are interfering significantly with their life. Learn more about how to know when it’s time to refer a patient. In cases where the eating disorder has significantly impacted a patient’s physical health, they may need to be referred for inpatient hospitalization before they’re ready for treatment. “If the patient is medically at at risk—bradycardia less than 45 BPM, an ideal body weight under 75%, electrolyte imbalance, acute food refusal for 48 hours, or orthostatic vitals—the PCP may want to recommend going to the emergency room for evaluation for an inpatient hospitalization,” advises Arsenault. Learn more about how to tell if a patient needs inpatient hospitalization. The Equip takeaway: PCPs are key to early eating disorder intervention Primary care providers play a central role in detecting eating disorders and helping patients get the care they need to achieve lasting recovery. Here are the key things all PCPs should remember about eating disorders: PCPs are often in a position to spot signs of eating disorders before other people in a patient’s life. Because early intervention leads to better outcomes, it’s essential that PCPs become educated on the early signs of eating disorders and how to refer patients to treatment. Many barriers prevent PCPs from identifying eating disorders in their patients. Some of those barriers include lack of education and awareness about eating disorders, weight stigma and diet culture, and the self-protective nature of eating disorders. PCPs should become educated about some of the early signs of eating disorders that might show up during well checks and exams, such as weight loss, unstable vitals, abnormal electrolyte levels, shifts in mood, irregular cardiac rhythms, enamel erosion, and gastrointestinal complaints, among others. Experts recommend that PCPs regularly screen for eating disorders in their patients. They can do so by asking practical, nonjudgmental questions about their patients’ eating and exercise habits, as well as their attitude toward their body and weight. They can also integrate evidence-based eating disorder screening tools, such as the SCOFF questionnaire. It’s important for PCPs to create a supportive and nonjudgmental environment in which patients feel comfortable voicing concerns they may have about disordered eating habits. This can include learning about the HAES approach and addressing any weight bias or diet culture-informed beliefs they may hold. In order to best support patients, PCPs should develop relationships with eating disorder-informed dietitians, therapists, and other providers, as well as evidence-based eating disorder treatment programs. Effective eating disorder treatment involves working with a multidisciplinary team specifically trained in eating disorders. Get in touch to learn more about Equip’s evidence-based, fully virtual eating disorder treatment and how we work with referring PCPs. FAQ What are the early signs of eating disorders that PCPs should look for? Primary care providers are often in a position to spot symptoms of eating disorders that others might miss, making it essential that they know the early signs to look out for. PCPs should look out for physical signs like weight loss, unstable vitals, abnormal electrolyte levels, irregular cardiac rhythms, enamel erosion, and gastrointestinal complaints, among others. They should also look out for and ask questions about psychological and behavioral symptoms, such as preoccupation with body and weight, social withdrawal, excessive exercise, feeling out of control around food, restrictive eating, and body image distress. How can PCPs effectively screen for eating disorders in their practice? Experts recommend that PCPs regularly screen for eating disorders in their patients. They can do so by asking practical questions, using evidence-based screeners, and/or ordering lab tests. Practical questions may include nonjudgmental questions about a patient’s eating and exercise habits and their attitude toward their body and weight. Screening options include the SCOFF questionnaire, the NIAS, and the EDEQ-7. Lab tests to order include a CBC, electrolyte levels, EKG, and hormone tests. Why is early intervention so important in the treatment of eating disorders? A large body of research shows that early intervention in eating disorders leads to better outcomes. Those who get treatment early have a higher likelihood of achieving recovery and remaining in remission, as well as a lower risk of experiencing negative physical or psychological consequences from the eating disorder. What are the best practices for referring patients with eating disorders to specialized care? Effective eating disorder treatment requires working with a multidisciplinary care team of eating disorder specialists. PCPs should develop relationships with eating disorder-informed dietitians, therapists, and other providers, as well as evidence-based eating disorder treatment programs. They should also become educated about how to determine when to refer a patient to treatment and when a patient needs inpatient hospitalization.]]></content:encoded>
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            <title><![CDATA[What Is RED-S and How Does It Relate to Eating Disorders?]]></title>
            <link>https://equip.health/articles/food-and-fitness/red-s-syndrome-relative-energy-deficiency-in-sport</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/red-s-syndrome-relative-energy-deficiency-in-sport</guid>
            <pubDate>Mon, 03 Jul 2023 18:28:00 GMT</pubDate>
            <content:encoded><![CDATA[The term RED-S might seem pretty obscure and jargon-y, but in reality, it’s a simple—but very serious—condition, and it’s important for all athletes or people who work out regularly to be aware of it. RED-S, sometimes referred to as RED-S syndrome, stands for relative energy deficiency in sport, but it can affect people who don’t play any sports at all, and the consequences can be quite concerning. Read on to learn what exactly RED-S is, who’s at risk, how it relates to eating disorders, and more. What is relative energy deficiency in sport (RED-S)? First, let’s unpack what we mean when we talk about RED-S. The term “relative energy deficiency in sport,” better known as RED-S, was coined by the International Olympic Committee in 2014 to reflect the numerous consequences of low energy availability (LEA), a state when the body doesn’t have enough calories to support all of its functions. More simply put, it describes what happens to a person’s body when their food intake is too low to meet the demands of living and physical activity. The RED-S framework replaced and retired the less inclusive phrase “female athlete triad,” which had been in use since 1992. The female athlete triad described a cluster of three symptoms frequently experienced by female athletes who weren’t properly fueling their bodies: menstrual dysfunction, decreased bone density, and low energy availability. This descriptor was incomplete for a few reasons. First, it failed to acknowledge that the consequences of low intake impact people across the gender spectrum; and second, it missed the many other symptoms that can come when an athlete or someone who works out regularly isn’t properly renourishing. The diagram below shows the physiological outcomes associated with RED-S. As you can see, under this new framework, the female athlete triad is a subset of RED-S.    RED-S also leads to declining athletic performance. The diagram below shows the different ways performance can be impaired by low intake, which are related to the physiological symptoms above (for instance, mood instability will often impact training response and performance, poor bone health will increase injury risk, etc.):   The physiological health risks associated with RED-S are: Reproductive/sexual health: irregular or absent periods (in menstruating females), low libido Poor bone health: low bone density, increased risk of stress fractures, early onset osteoporosis Reduced immune function: frequent colds, increased risk of infection Metabolic issues: slowed metabolism, as the body holds onto food for longer and processes it more slowly Gastrointestinal distress: slowed digestion can lead to gas, constipation, and bloating, among other GI issues Cardiovascular issues: low heart rate, which can cause dizziness and the potential for long-term heart damage Psychological repercussions: anxiety, depression, impaired concentration and focus Vitamin and mineral deficiencies: such as iron, B12, and zinc Delayed growth/development: falling off the growth curve, failing to gain expected weight and/or height Hormonal disruption: imbalance levels of important hormones, like testosterone and estrogen  What’s the connection between RED-S and eating disorders? If you’re familiar with the physical consequences of eating disorders, you might notice that there’s a lot of overlap with the symptoms of RED-S. This isn’t a coincidence, given that low energy intake (not eating enough food) is a driving force for both. What’s more, many people with eating disorders engage in compulsive exercise, making them more vulnerable to the performance-based symptoms of RED-S as well as the physiological ones. As RED-S is a relatively new framework, research on RED-S and eating disorders is still in its infancy. But we do know that both are underrecognized in athletes, and both RED-S and most eating disorders share low energy intake as a core feature. There’s also the fact that disordered and restrictive eating is strikingly common among athletes. According to the recently published Female Athlete Report: A staggering 91% of the female athletes surveyed admitted to worrying about their calorie intake Half reported restricting calories in hopes of improving performance or changing their weight or shape Half reported having at least two symptoms of RED-S, while roughly one-third reported having five or more symptoms. We’re still learning about the connection between RED-S and eating disorders, but there are a few key takeaways here. First, it’s important to remember that not everyone with an eating disorder has RED-S, and not everyone with RED-S has an eating disorder. That said, both are associated with undernutrition, which has significant health consequences regardless of the root cause. Additionally, dieting and restrictive eating for any reason raises a person’s risk of developing an eating disorder. Often RED-S is associated with a disorder known as anorexia athletica.  Dispelling common myths about RED-S Despite the fact that RED-S is common among athletes, and that many people with eating disorders also have RED-S, most people haven’t heard of RED-S. And among those who do know about it, there are many misconceptions around what it is and who it affects. Those misconceptions can make identifying RED-S and getting appropriate help a challenge. Let’s talk about a few of the most common myths around RED-S:  1. Myth: RED-S is only a concern for competitive athletes. Despite “sport” being part of the name, any person engaging in regular exercise (i.e. “recreational” athletes, or people who don’t identify as an athlete but work out frequently) and not eating enough to meet the demands of life and activity can suffer from RED-S. 2. Myth: Low body weight is part of the criteria for RED-S. Athletes who are not “low weight” are actually at higher risk for developing symptoms of RED-S, as they’re often dismissed or overlooked precisely because they’re at a “normal” weight.  Additionally, athletes who don’t fit that “athletic aesthetic” (a certain ideal of a “fit” body that’s often upheld in athletic circles) may feel pressured to go to extreme lengths to change their bodies, making them even more susceptible. 3. Myth: RED-S only occurs in cisgender females In part because of the older “female athlete triad” framework, many people still assume that only cisgender females are at risk for RED-S. But we know now that the harms of low energy availability don’t discriminate: they affect people across the gender spectrum. 4. Myth: RED-S only affects those who are intentionally trying to lose weight or eat less. This is a huge misconception. The body doesn’t care if the restriction or underfueling is willful or purely accidental. Let’s add to that the fact that adequate calorie intake is only half the battle — timing of meals and snacks are of crucial importance as well for decreasing risk of injury and enabling peak performance. Sometimes, even well intended efforts to meet the energy demands of training may not be enough to avoid RED-S if an athlete isn’t eating at the right times. 5. Myth: The consequences of RED-S can be avoided by taking hormonal contraception (i.e. birth control pills). When a person is taking hormonal contraceptives, what they experience is withdrawal bleeding, not an actual period. Getting what appears to be a period gets rid of one concrete marker of low energy availability, but pill users with RED-S actually have a hormonal profile that is identical to that of an amenorrheic athlete (aka an athlete who doesn’t get a period at all). These hormonal disruptions have a number of negative health implications, including increased injury risk and decreased bone density, for example. If you’re concerned that you or someone you love might be dealing with RED-S, it’s important to get informed and seek help if you need it. Here are a few great resources: The Consensus Statement by the International Olympic Committee from 2014 that made RED-S a thing The Project RED-S website, dedicated to awareness and prevention efforts, is a wonderful resource for both athletes and their supporters. ]]></content:encoded>
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            <title><![CDATA[Restaurants and Recovery: How to Handle Going Out to Eat]]></title>
            <link>https://equip.health/articles/food-and-fitness/restaurants-eating-disorder-recov</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/restaurants-eating-disorder-recov</guid>
            <pubDate>Fri, 30 May 2025 16:33:00 GMT</pubDate>
            <content:encoded><![CDATA[Going out to eat can feel fun, relaxing, and luxurious—a welcome break from the ordinary cooking and cleaning routine at home and a chance to connect with people you love. However, if you’re living with an eating disorder, going to a restaurant can feel like you’re being tortured—in many ways, restaurants are the ultimate threat to the eating disorder brain, since there’s much less ability to control food and its details (e.g. ingredients, preparation, and serving sizes). On top of that, there are the added pressures of having to choose from several options on a menu, eating with other people, and potentially dealing with hard emotions in public. The good news is, with the right tools and support, it’s possible to reclaim eating out as a joyful part of your life, or your loved one’s life. Today, we’ll explore why eating out can be tough, why it’s necessary to do it, and how to take steps in getting there. Why eating out can be so hard in recovery Since the stress of eating out in recovery is multi-faceted, let’s look at some of the most common reasons it can be difficult: Loss of control Eating at restaurants means letting go of control of how meals are prepared, as well as their ingredients, calories, and serving sizes, which feels scary when you’re struggling with an eating disorder. “Eating out in eating disorder recovery can be very difficult due to the unknown. A lot of eating disorders thrive on control and eating out takes away that control,” explains dietitian Brianna De la Cruz, MS, RDN. “There are also more 'temptations' and fear foods, which can create an inner battle between what the person wants and what their eating disorder wants.” Menu overwhelm For many people, getting to choose exactly what you want to eat is part of the pleasure of going out to a restaurant, but this can be extremely daunting to someone in recovery. Equip Lead Dietitian Shira Feldman, MPH, RD, LD says going out to eat with an eating disorder can cause “feelings of overwhelm with the menu, deciding what to eat, trying to order what you actually want versus what the eating disorder wants you to order, and worrying about what others will think of what you do or don’t eat.” Plus, she adds that this “all might be swirling in your head while those around you seem to easily choose the foods and drinks that sound best to them.” Then, there’s the major issue of calorie counts on some menus, typically at larger restaurant franchises. As a registered dietitian, I believe calories on menus are unnecessary and unhelpful for everyone—for one thing, it sends the misleading message that calories are the most important nutritional aspect of food—but especially so those in recovery. Research supports this belief, showing that the addition of calories on menus can negatively impact people with eating disorders. One 2025 review of research found that for many people with eating disorders, calories on menus exacerbated behaviors like restriction, and in a study from 2017, participants with anorexia and bulimia consumed a lower number of calories when they were listed while those with binge eating disorder consumed a higher number of calories. Another 2024 study of people with eating disorders also showed mostly negative results from menu labeling, including strained relationships, exclusion of certain restaurants, social isolation, restricted freedom and inner conflict, disembodiment, and anger at diet culture. A small group of participants said they found calories on menus provided safety, comfort, and reassurance. Eating with others Going out to a restaurant usually involves eating with other people, and a hallmark symptom of an eating disorder is the fear of eating in front of others. In fact, one 2020 study of central eating disorder fears showed that eating in social situations is one of the participants’ five central fears. Another 2022 study on eating disorder fears showed fear of judgement to be another core concern, particularly in those diagnosed with other specified feeding or eating disorder (OSFED). In my practice, I’ve witnessed several clients being afraid to eat a meal or snack with others because they’re worried what other people will say or think about their food choices, amounts of food, or simply the fact that they’re eating at all. Dealing with difficult feelings in public Eating experiences in recovery often come with intense and difficult emotions, which can be hard enough to manage when you’re at home or in a familiar and safe space. Facing such big feelings in public at a restaurant can feel daunting and unsafe, especially if you’re early in the process and haven’t had much practice yet. “While eating out for someone without an eating disorder brings up emotions, they are typically ones of excitement for eating a favorite food, trying a new place, or even because they don’t have to cook or do the dishes that night,” Feldman comments. “For someone working through eating disorder recovery, there are a lot of emotions as well, but usually ones of stress and anxiety.” Why it’s important to practice going to restaurants during treatment Eating disorder treatment can seem hard enough without adding the extra challenge of going out to eat. But the truth is that on the path to full recovery, it’s important to leave no stone unturned so you can enjoy the freedom of life without an eating disorder—and this includes going out to eat (and enjoying it). If the eating disorder prevents you from engaging in normal life experiences like going to restaurants sometimes, that means you’re still in its grips, even if you’re eating enough food at home. “The more one listens to their eating disorder, the more power it is being given. It’s important to challenge fear foods and challenge the unknown, because the more we hide from the fears, the more they control us.” De la Cruz says. “It can be helpful to have a food and not know all the ingredients, calories, or macros in that food, and then see later that everything is okay.” In treatment, exposure therapy is an important part of the process towards freedom, so you can look at eating in restaurants as just that: exposure to something that feels scary so that you’re one day able to participate in eating experiences in restaurants with full freedom. With the guidance and support of your dietitian and therapist, you can take steps towards eating out at a pace that feels relatively manageable to you. Going out to eat can also eventually be a way of reconnecting with yourself outside of your eating disorder, especially if it used to be something you enjoyed. “For many people, eating out was a regular part of their lives before the eating disorder, and something that many people want to feel comfortable with again,” says Feldman. She adds that it can also be a helpful way of connecting with other people, which is important because eating disorders thrive in isolation. “Having a level of comfort with eating out at restaurants or in social situations can provide opportunities for social connection, and a way to see food in a more enjoyable light,” she says. As someone who lives in full recovery and used to dread going out to eat with my eating disorder, it’s now one of my favorite activities—few things bring me more joy than sharing a delicious meal out at a favorite restaurant with my husband, mom, or friend. Plus, exploring new cuisines while traveling in eating disorder recovery or even locally helps me learn about different cultures and places on a global level. Tips to manage going out to eat If you are on the road to recovery and want to begin incorporating restaurant meals, it’s important to do so with the support of a team. Ideally, you’ll work with a registered dietitian and therapist to formulate a plan tailored to your specific needs, but here are some general tips to support your process: Break it into steps (maybe baby steps) If going out to eat feels unrealistic and too overwhelming right now, know that there are several steps you can take in that direction, without even setting foot in a restaurant. For example, you might practice exploring and choosing meals from menus online to help you become more comfortable with reading menus and making food decisions aligned with recovery. Other steps can include formulating a cope-ahead plan with your team or a loved one, naming a few restaurants you’d like to try in the future (it could be one you liked before the eating disorder or something brand-new), practicing ordering, and visualizing yourself eating a meal out. If you’re ready to go to a restaurant, perhaps you start by ordering a meal that feels relatively safe, with the intention of eventually ordering the meal you truly want, even if it feels like the scariest option. Join a restaurant meal group or simply eat with others Eating out with others in recovery can create a feeling of common humanity and community, so check to see if any eating disorder dietitians or therapists offer restaurant group trips in your area. If you’re not quite ready for an outing and feel uncomfortable eating in front of others, start with gathering a small group of loved ones to share a meal. This can help you get used to eating in front of more people, which can make restaurants feel more approachable. Practice letting your healthy brain make decisions When you look at a restaurant menu during the recovery process, it’s common to experience a mental battle between your eating disorder brain and your healthy brain. To prepare for this, work on learning the difference between your eating disorder brain’s preferences and your authentic preferences. Then, practice choosing food options at home that you want to eat (not your eating disorder), to get your brain more used to it. This might take some work and be difficult at first, but by paying attention and being mindful of the “why” behind your food choices, you’ll eventually tease out what you truly want to eat. Learning more about digestion in eating disorder recovery can be helpful too.  Use the mealtime strategies you usually find helpful Keep in mind your typical mealtime strategies can be used in restaurant settings, too. Some of my favorite ones include breathing exercises (at the table or in the bathroom), sense-engagement practices (like focusing on smells), and keeping conversations lighthearted (and off food). Feldman also recommends dressing comfortably and bringing objects that evoke a sense of grounding or distraction, like a fidget toy, affirmation card, or a seashell from a beach trip. Learn to deal with calories on menus If you’re (understandably) not ready to face calories on menus, Feldman suggests eating somewhere at local restaurants rather than chain restaurants, as you’re less likely to encounter unwanted nutritional information this way. When you know calorie counts will be present, try looking at the menu beforehand with your dietitian and picking an option or two that feels doable, then have a loved one hold you accountable to choosing it when you’re out. Alternatively, De la Cruz recommends a family member read aloud menu options once you’re seated at the table. Eventually, you can work towards ordering what you truly want from menus with calories listed, but give yourself time and patience to arrive there. Go with safe, supportive people and communicate Eating at restaurants can feel scary, but doing so with safe people can make a huge difference and help create a feeling of safety that’ll support you through the meal. Feldman recommends “talking ahead of time with your support people about what you might need from them, and letting them know if you want them to pick something you used to eat or if you need to talk through your menu choices ahead of time to help determine if your eating disorder voice is playing a part in the order.” You can also choose a “safe word” together to use if you need help in the moment or for them to join you in a short break from the table. “For some, it’s even helpful to talk about what they might need to look for in your behavior if you’re having a hard time,” Feldman adds. How loved ones can support someone in recovery at restaurants Exactly how loved ones can help someone with an eating disorder handle restaurant meals depends on where you are in the recovery process. Feldman suggests loved ones ask the person in recovery what they need and let them know they’re available for support and preparation beforehand, too. “Don’t assume what might be stressful or overwhelming and don’t assume that something will be easy,” she encourages. “Sometimes your loved one might need a pep talk and for you to be the biggest cheerleader possible, and other times they might just need some space to work through emotions and would love a welcoming space to cry.” Supporting someone in recovery at restaurants can often look somewhat like supporting them during meals at home, which includes: Avoiding commenting on anyone’s food or how much anyone ate. Focusing on lighthearted table topics to provide healthy distraction. Be sure not to talk about diets, weight, or bodies to avoid triggering the eating disorder. Offering to take breaks from the meal for a five-minute breather if necessary. Holding non-judgmental space before and after meals for feelings to be shared, and co-regulation and emotional safety to occur. Learning which tools and skills your loved one may want to use at the table (like mindfulness practices) so that you can remind them what they are, if forgotten in the heat of the moment. In terms of restaurant-specific meal support, things like reading menu options aloud, talking through food choices before going to the restaurant, or making sure you’re seated at a table that doesn’t feel too stressful (i.e., not in a very busy or noisy part of the restaurant) can be helpful. However, there’s not necessarily always something for support people to do when it comes to restaurant meals—but simply showing up can make all the difference. As Feldman says, “Oftentimes, just letting your loved one know they aren’t alone in this step can be incredibly supportive and give the boost of confidence they need.”]]></content:encoded>
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            <title><![CDATA[Back-to-School Shopping Can Be a Minefield for Those in Eating Disorder Recovery. Here’s How to Make It Easier.]]></title>
            <link>https://equip.health/articles/body-image/back-to-school-shopping-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/back-to-school-shopping-eating-disorder-recovery</guid>
            <pubDate>Mon, 21 Aug 2023 15:44:00 GMT</pubDate>
            <content:encoded><![CDATA[If Equip’s Director of Lived Experience, JD Ouellette, were to describe back-to-school shopping for her four kids in two words, she would choose “tactical mission.” A self-professed loather of all things shopping-related, Ouellette always did her best to knock out the stressful annual experience in a single day. But when her youngest daughter developed anorexia, Ouellette’s strategic shopping plans had to shift. “That is not an approach that’s likely to work with a loved one in eating disorder recovery,” she says. “I needed to adjust my expectations.” Having experienced her own eating disorder, Equip Peer Mentor Amaya Evans knows firsthand the kind of anxiety and distress a yearly clothing restock can evoke. “My back-to-school shopping experiences were always tough,” Evans says. “Struggling with an eating disorder for a good portion of my school years meant my body was often changing in size. After shopping, I often felt really bad about myself and my body.” There’s no denying that back-to-school shopping can prompt all kinds of feelings for those in recovery, but the experience doesn’t have to be excruciating. By implementing a few simple strategies, families can help avoid intense distress and even find some joy in the process. Why is back-to-school shopping so challenging for those in recovery? As Evans articulates, recovering from an eating disorder often involves a fair amount of weight fluctuation. “Someone who has experienced body changes over the summer break may have fears of others noticing or pointing out those changes upon their return to school,” she says. “When you’re struggling with an eating disorder, shopping in general can be a challenge because you’re coming face-to-face with dressing room mirrors, repeatedly trying on pieces of clothing, and struggling to find sizes that fit comfortably. Adding these fears can make clothing shopping even more intense than it already may be for someone struggling with an eating disorder.” The process can also provoke emotional uneasiness rooted in comparison. “Back-to-school shopping always felt really anxiety-inducing for me,” says Equip Admissions Operations Coordinator Jerica Mosello. “I had one particular peer I always did back-to-school shopping with that was much leaner and slightly taller than me. It felt like we were pitted against each other and I would dread the experience every summer.” Mosello says that by the time the first day of school rolled around each year, the chronic comparison had drained any sense of excitement. “There is so much pressure to come back better and better each new school year,” she says. “When you already struggle with body image and then have this negative pressure, it’s hard to get off on the right foot.” Diet culture can also play a role. Ouellette says the societal pressures most kids and adolescents face to look a certain way can exacerbate anxiety for those in recovery. “The pressure to have the smallest body and thus the smallest clothes is intense in our culture,” she says. “You have stores that advertise ‘one size fits all,’ and what that really means is ‘our clothes are for tweens and teens, but we size them for 8-year olds.’ An eating disorder magnifies the insecurity and distress, and then when you add in moving up sizes as a treatment goal—it's a lot.” How to navigate back-to-school shopping during recovery While every person and family will have to find their own strategy for successfully navigating back-to-school shopping, there are some tried and true tips that Ouellette, Evans, and Mosello have to offer from their own lived experience: Make a tentative plan ahead of time that includes breaks, meals, and snacks. “Plan ahead. Determine what your goal for that trip is and how many stores and how much time you think you can spend before it becomes too much,” Ouellette says. “Make sure everyone is nourished, hydrated, and rested.” Contrary to the one-day shopping marathon she used to undertake before her daughter’s eating disorder, Ouellette found that what worked better in recovery were “brief forays over a period of weeks, with clear forethought about what we were shopping for.” Infuse the process with some fun by shopping for non-clothing items: supplies, accessories, and more. “Besides just buying clothes, I think the biggest strategy would be to buy some non-wearable back-to-school items that really help your loved one express themselves and really give them a boost of self-confidence,” Mosello says. Have a frank conversation about the wide variability and inconsistencies of sizes between brands. “Dressing rooms are often a place where we pick ourselves and our bodies apart,” Evans says. “Something I still tell myself to this day before I shop for new clothes is that it is completely normal and okay if my clothing size differs across different stores or different brands,” Evans says. Discuss whether it might be helpful to conceal sizes before hitting the dressing room. “Consider bringing painter's tape to cover up sizes so your loved one can judge what feels comfortable versus being in their head about a specific size,” Ouellette says. Plan a fun post-shopping activity you can all look forward to. “Not only can shopping take time out of your day, it can also take a lot of energy out of you,” Evans says. “Having a distraction or something relaxing planned to do after shopping can be a good place to end.” Pack helpful reminders to keep recovery thoughts top-of-mind. “Coming prepared with affirmations written down on Post-it notes or index cards can help challenge negative self talk,” Evans says.” Consider skipping the mall altogether to sidestep discomfort. “Some kids feel guilty that their families are having to spend money to cycle through several sizes as they recover,” Ouellette says. “I also think it can be an overwhelming experience to go shopping at a busy store or mall, especially if you have been on hiatus from this kind of environment as recovery work was prioritized. Uniform swaps, Buy Nothing community pages, and resale stores are places to look to ease the financial burden. Consider clothes that expand as you need them to (basketball shorts, leggings, dresses) so you don't need to size up so frequently.” In addition to the strategies above, Ouellette emphasizes that it’s important to validate all emotions and challenges that might arise during back-to-school shopping season. “This is not all in their heads: society, including school, does judge people on body size or appearance all the time,” she says. “What can we do to build up our loved one’s sense of self in other areas so that this one is not outsized in impact? Give permission to be upset and grieving—and also lean into developing resilience and evolving views on body image.”]]></content:encoded>
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            <title><![CDATA[Understanding OSFED Symptoms: How to Spot this Little-Known Eating Disorder]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-osfed-symptoms-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-osfed-symptoms-treatment</guid>
            <pubDate>Thu, 13 Oct 2022 12:06:00 GMT</pubDate>
            <content:encoded><![CDATA[ OSFED is an acronym that stands for Other Specified Feeding or Eating Disorders, an eating disorder diagnosis that includes a wide range of eating challenges that do not fit neatly into other clinical diagnoses. Because of the wide range, identifying OSFED symptoms isn't as straightforward as identifying the symptoms of other eating disorders—but there are red flags you can look out for. First, what is OSFED? A lot of people aren't even aware of the term OSFED, let alone its symptoms. Once reason that the diagnosis may be less familiar to both medical professionals and the general public is that it's relatively new. In 2013, OSFED officially replaced the term EDNOS (Eating Disorder Not Otherwise Specified) in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Despite the formal change in the name, some people continue to use the name EDNOS. Because OSFED can be viewed as a “catch-all” term, many people falsely assume this diagnosis isn’t as severe as more commonly known eating disorders, such as anorexia nervosa, bulimia nervosa, or binge eating disorder. It’s important to know that OSFED is just as serious as other eating disorder diagnoses. There are several specific diagnoses that fall under the OSFED umbrella: “Atypical anorexia nervosa” (AAN): This term, which is believed by many to be outdated and stigmatizing, describes an eating disorder in which all anorexia nervosa criteria are met except that the patient isn't considered medically “underweight.” It’s important to know that anorexia in any body size is dangerous. Although it was once thought that anorexia in “normal” or higher weight bodies was less serious, we now know that patients with AAN often have more severe symptoms and may have often lost an even larger percentage of body weight. Subthreshold binge eating disorder: Meets all the criteria for binge eating disorder, except that the binge episodes occur at a lower frequency and/or for less than three months. Subthreshold bulimia nervosa: Meets all of the criteria for bulimia nervosa, except that the binge eating and purging behavior occur at a lower frequency and/or for less than three months. Purging disorder: Recurrent purging behavior (e.g., vomiting, abusing laxatives, excessive exercise) in an attempt to change weight or shape but without binge eating. Night eating syndrome (NES): Recurring episodes of night eating that may include eating after awakening from sleep or binge eating after the evening meal. The night eating causes significant distress/impairment and is not better explained by environmental influences or social norms. NES is diagnosed when the behavior is not better explained by another mental health disorder (e.g., binge eating disorder). There are some other lesser-known eating disorders that are sometimes characterized as OSFED, such as pica, pediatric feeding disorder, and chew and spit disorder.  OSFED symptoms Because OSFED is an umbrella term encompassing several different diagnosis, the symptoms of OSFED can vary widely. Depending on which sub-diagnosis a person has, their symptoms may be similar to those of anorexia, bulimia, or binge eating disorder. Given that, some OSFED symptoms to look out for include: A preoccupation with body weight or shape Negative body image Rigid rules around food Frequent dieting Avoiding meals with others Excessive exercise Feeling cold, even in a warm environment (associated with atypical anorexia) Using the bathroom after meals (associated with subthreshold bulimia) Abusing laxatives (associated with subthreshold bulimia) Depression and/or anxiety Mood changes Lack of expected growth in children and adolescents Digestive issues Frequent illness or injury Loss of regular periods in someone who should be menstruating What are the health effects of OSFED? As with other eating disorder diagnoses, OSFED can cause serious harm to both physical and mental health. The entire body can be affected by OSFED, with particular risk to the brain, the heart, and the digestive system. Having OSFED can also trigger depression, anxiety, and obsessive-compulsive disorder, or worsen those conditions if they existed before the eating disorder. Eating disorders, including OSFED, also increase the vulnerability to substance use disorder and heighten suicide risk. OSFED interferes with the ability to connect fully with family and friends. This social-emotional toll can intensify mental health struggles and drive further eating disorder behaviors. How is OSFED treated? As with all eating disorders, treatment for OSFED focuses on helping patients eat regular meals and snacks throughout the day and eliminating purging or other eating disorder behaviors. For night eating syndrome, treatment also seeks to address any disruption in the wake-sleep cycle. For other OSFED types, treatment would resemble approaches for similar diagnoses; for instance, the treatment for subthreshold bulimia nervosa would be the same as for bulimia nervosa. For all types of OSFED, having the support of family and friends–in addition to a clinical treatment team–offers the best chance for a robust recovery. Restricting, bingeing, and purging are harmful in any amount — even when they don’t meet official clinical thresholds for the more commonly known eating disorders. The good news is that eating disorders are treatable, and anyone suffering in their relationship with food should seek out effective treatment options, such as Equip. No matter how someone’s eating disorder manifests, they deserve the support they need to experience life in recovery.]]></content:encoded>
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            <title><![CDATA[13 Eating Disorder Recovery Affirmations to Help You When the Journey Gets Hard ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/eating-disorder-recovery-affirmations</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/eating-disorder-recovery-affirmations</guid>
            <pubDate>Tue, 08 Oct 2024 18:28:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorder recovery affirmations can be a powerful tool in treatment, but not all affirmations work for everybody. Read on for 13 affirmations that you can use on your own recovery journey, share with a loved one who is struggling with recovery ambivalence, or use as inspiration to create your own personalized recovery affirmations. Licensed psychotherapist Tessa Gordon, LMFT, remembers the first time she was ever taught a recovery affirmation. “I was 13 and a woman who came to my church group ran a course called IALAC: I Am Loveable And Capable. We even got buttons at the end,” she says. At the time, Gordon was being bullied and on the brink of a long battle with an eating disorder. “I left with that button and the instructions to stand in front of the mirror and tell myself repeatedly, ‘I am loveable and capable,’” she says. “I remember thinking, ‘so what?’ That isn't going to stop others from bullying me at school and it isn't going to stop the way I feel about my body or food. It wasn't going to give me a place to eat during lunch time, or have people look at me differently or give me friends to hang out with.” Gordon’s struggles with affirmations—which can be defined as short statements meant to emphasize your strengths and improve your sense of well-being—continued years later, when she entered eating disorder treatment. The traditional affirmations just didn’t seem to move the needle in her eating disorder recovery. While it was comforting to tell herself “I love my body,” that statement didn’t always ring true, and it didn’t offer any help during her most challenging moments, like mealtimes or when she felt the urge to exercise excessively. Gordon believes that many people have a similar experience when they’re presented with traditional, generic recovery affirmations, statements like “I am loved,” “I am enough,” or “I am allowed to take up space.” But, as she realized, that doesn’t mean that affirmations don’t work. For many people, finding the right affirmations can make a world of difference. “My struggles in recovery are not going to be the same as everyone else’s,” she says. “But what did help me was making things that I wanted—and things that I didn't want—very concrete, and finding ways to hold onto that in my recovery. The affirmations I created became incredibly important to me, so much so that I continued to use and repeat them throughout my recovery, and now my life.” Below are the 13 recovery affirmations that helped Gordon the most as she overcame her eating disorder. If you’re struggling with an eating disorder or know someone who is, consider incorporating some of these affirmations into your recovery process, or using them as a jumping off point to inspire your own words of wisdom. Once you find an affirmation (or affirmations) that resonate with you, try repeating them aloud to yourself several times a day. You might want to write them down and put them in prominent places, or even create visual representations of them through Instagram or another photo editing tool, as Gordon did, and set them as screensavers on your phone. “Just for now.” For Gordon, this phrase alluded to staying in the moment and remembering that the way things currently are is not necessarily the way they will stay. “When, where, and what that may look like is unknown, which can add to the fear this will last forever,” she says. “Remember that is just the fear talking. Whatever you’re feeling or experiencing is just for now. I came up with this during my recovery and to this day, I continue to use it for both myself and my clients.” “Feelings and emotions can be felt without responding." As Gordon learned in her own recovery, life can—and often is—unpredictable. “I used to think the goal was to get stable in life, and then everything in recovery would be easier,” she says. “Boy, was I wrong.” After completing her last treatment program, she faced a series of unexpected challenges, including an apartment break-in, joblessness, multiple car accidents, and serious health problems. Gordon made it through all of those devastating obstacles by allowing herself to feel sadness and fear, but to continue moving forward anyway. “Allow yourself to feel it, experience it, and don't judge it,” she says. “ I not only share this with my clients now, but I continue to use it in my own life, beyond the eating disorder, because life continues to throw curveballs, and this is a great reminder of how to keep moving forward.” “Connecting to what you love and care about makes all the difference.” Because eating disorders typically thrive in isolation, Gordon believes recovery requires connection and community. “When people discover their passions, values, and what they hold dear, the eating disorder begins to lose its grip,” she says. “It's crucial to create space and time during recovery to support the nurturing of existing connections or the discovery of new values. This process involves finding ways to remain engaged with what you care about.” “It’s a hard thing you are doing, but you can do the hard thing when you have to.” Gordon believes it’s best not to sugarcoat the truth: eating disorder recovery can be brutally hard. But those who have been living with an eating disorder have also been coping with intense difficulties. “So whether or not you are able to do ‘hard’ things isn't actually a question,” she says. “But sometimes, it's hard for those who are in the fight and working to remember how much strength and power they actually have. This is a great reminder while still acknowledging how difficult it currently is.” "Allow yourself to be scared and overwhelmed, just don't change your food because of it." There’s no doubt that recovery comes with a wide range of different emotions—many of which are unpleasant. Gordon says that it’s important to allow space for those feelings rather than repressing them with old habits. “Feelings can be felt; it's the response to them that matters,” she says. “Eating disorders are excellent for helping people deal with emotions, especially big, overwhelming, or uncomfortable ones. When navigating recovery, you figure out how to experience these different types of emotions without returning to the eating disorder behaviors.” "Give yourself an evening off from overthinking.” For those prone to anxious thoughts, the goal of intentionally taking a break from the non-stop inner monologue may seem lofty. But Gordon says scheduling regular overthinking breaks can really help. “When worry is near, it can feel all-consuming,” she says. “Sometimes, the nicest thing to do for yourself is to take the night off and take a break from overthinking.” Knowing that you’re “allowed” to overthink again later can help even the busiest minds calm down for a period of time. “Deal with what is, not the worries of the future.” Gordon is drawn to this particular affirmation because it’s action-oriented, providing a sense of direction and purpose. “There are times that the eating disorder can get so caught up in all the ‘what ifs,’ worries, and future tripping, that it can paralyze you from taking any action or dealing with what is right in front of you,” she says. “It’s super important to remind yourself that all your worries are about things that aren't actually here yet, and that you are capable of stopping the worry and dealing with what is here now.” "Feelings are just visitors, let them come and go." Remembering that feelings are fleeting can be a comforting reminder to those in the throes of a particularly tough time. “It can be so hard in the moment to remember that what you’re feeling won't last forever: anxiety, sadness, loneliness, fear, happiness, sorrow, even the feeling of fullness,” Gordon says. Whatever the feeling is, it will pass in time. "Stop should-ing all over yourself." One of Gordon’s favorite recovery affirmations, this one not only brings some much-needed levity to difficult moments, but also empowers you to recognize how the eating disorder is projecting its judgmental and perfectionistic tendencies. “Eating disorder recovery is about more than bringing to light the various ‘shoulds’ you’re living with in regards to food and body,” she says. “It's about exploring the ways these ‘shoulds’ show up in all areas of your life and how these rules, which the eating disorder took up and used to its advantage, are woven into the fabric of your life and how you move through the world.” "You can't know what you know until you know it." When life takes unexpected turns, Gordon says it’s common to look back and notice all the things that could have gone differently. “However, that is the benefit of hindsight,” she says. “You now have the knowledge and information that you didn't have previously. Eating disorders love opportunities to find flaws, areas of perceived imperfections, ‘mistakes,’ and fester on them.” But by using this recovery affirmation, Gordon says you can effectively remind yourself that knowledge comes from experience. “While the eating disorder would love to tell you you should have known, the fact is, you can't know something until you actually know it,” she says. “So give yourself a break. Your job is just to remember this for the future, not blame yourself for not knowing it in the past.” “With one meal, the stakes are not so high.” Preparing, ordering, and eating meals can be overwhelmingly stressful for anyone in eating disorder recovery. While each meal may feel loaded with meaning, Gordon recommends using this affirmation as a reminder that our bodies are resilient and adaptive, and one meal will never cause any drastic changes. “When you stretch yourself to eat that pizza with your new college roommates, or go to ice cream after the movie and get two scoops, or spring for the burger and fries and not the salad because you agreed to try that with your dietitian this week, the eating disorder can come in and start to criticize and tell you all the ways you really messed up,” Gordon says. “This is a great comeback to that voice, as it reminds the eating disorder that one meal won’t make or break anything. The body won't notice the difference.” “Appetite comes with eating." One of the many consequences of an eating disorder is the inability to recognize hunger and fullness cues. Using this affirmation can help encourage consistent nutrition even when your appetite is lacking. “Often people will say they don’t want to eat or can't eat because they either ‘aren't hungry’ or ‘don't have an appetite,’ Gordon says. “However, what they may not realize is that this is usually a symptom of the eating disorder. It is through eating consistently that appetite returns.” "Everything is okay, it's just a transition." Periods of transition can be incredibly disorienting and difficult, particularly for those navigating recovery. “Sometimes people forget they are in a transition and don't know why things are more challenging or why they are suddenly struggling more,” Gordon says. “Having this as a reminder that things are okay—nothing is broken or ruined; just in transition—can be incredibly helpful.” Recovery affirmations can be powerful tools during eating disorder recovery, as well as throughout life in general. If one (or a few) of the affirmations above resonate with you, try saying it aloud to yourself a few times a day. You might also want to write it down or type it out and put it in places where you’ll see it regularly (like making it your phone background or taping it to your mirror). Affirmations aren’t magic bullets, but if you find the right ones, they can help you get through tough moments and shift to a mindset that supports lasting recovery.]]></content:encoded>
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            <title><![CDATA[A Disease of Privilege or Poverty? The Research on Socioeconomic Status and Eating Disorders]]></title>
            <link>https://equip.health/articles/understanding-eds/socioeconomicstatus-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/socioeconomicstatus-and-eating-disorders</guid>
            <pubDate>Fri, 01 Oct 2021 16:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Equip Family Mentor Christine Harris* says she doesn’t just think poverty had a direct impact on her son’s eating disorder—she knows it did. “Both my children were sent to the emergency room with mental illness—one with an actively at-risk heart due to anorexia,” she says. “The compounded trauma of homelessness harmed their minds—I could see it happening in real time and it was horrifying.” Harris, who had split from her children’s father and is estranged from her own family, experienced a job loss in May 2018 and by December, she and her children were homeless. A friend from high school let them stay at her home, and over the course of a few months, the family was able to couch surf for survival. But shelter, safety, and food were not always reliably available. Harris says that their saving grace was that her son had the “right” kind of insurance that afforded him the opportunity to enroll in a residential treatment facility to address his eating disorder. “We had been food-unstable, and in the program, they weren’t just feeding my kid but they provided food for me as well,” Harris says. Others also helped to stabilize her household during the hospitalization. “In some ways, being poor—so long as our needs were met and we had stable food and housing—made me more flexible to meet the needs of eating disorder recovery. I had already lost my social standing so I didn’t keep this a secret. We were sick and out and proud about it.” Harris has remained a loud and proud advocate through her child’s recovery and her experience speaks to a major misconception that is still rampant in society—one that she herself believed until her child experienced it: that eating disorders only affect affluent individuals. “My friend had a niece who struggled with anorexia for years,” she says. “The year before my child developed an eating disorder, I said to her, ‘I just think it’s a disease of privilege.’ I said those words. Assuming this is a disease of privilege meant I was linking it to willpower and making it an issue of choice—as if only those with the choice would be likely to choose it. It’s not. People think it’s a privilege to not eat or to never go hungry. I believe food instability absolutely contributed to the triggering of my child’s eating disorder—one hundred percent. His fear foods were the foods we ate while poor, and that he’d been okay with eating while poor.” Harris's experience isn’t unique, but it’s a perspective that’s still poorly represented and understood socially, clinically, and even academically. That’s why researchers at the University of California, San Francisco (UCSF) took it upon themselves to investigate the topic of socioeconomic status (SES) and eating disorders in a paper titled, Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders, recently published in the journal Eating Behaviors. “I have too often heard healthcare professionals and trainees dismiss eating disorders as niche issues that weren't of interest to them, because they believed that these illnesses only affected certain types of privileged people,” says the study’s lead author, Kathryn Huryk, Ph.D, assistant clinical professor in the eating disorders program at UCSF. “This simply didn't match my clinical experience, so I felt compelled to dig into this literature and see what the data showed.” Huryk and her colleagues reviewed the existing literature investigating socioeconomic diversity in distinct eating disorder diagnoses and uncovered some important findings: There is no pattern of evidence that links higher SES with eating disorders, meaning it doesn’t matter how “rich” or “poor” a person is — anyone can develop an ED. There is a major lack of accessible eating disorder treatment available to people of all socioeconomic statuses, with people with lower SES facing additional barriers. “Our results demonstrate that there really is no pattern of evidence to support the affluence stereotype,” Huryk says. “I hope that this review compels stakeholders to recognize that eating disorders do not discriminate, so that we can build more equitable systems of healthcare.” Cara Bohon, Ph.D, Equip’s VP of Clinical Programs, says that the study confirms what she’s observed to be true in her own practice over the years. “This study is a review of other studies, so it is less susceptible to bias from a single sample, which shows that time and again the data show that eating disorders affect people from all socioeconomic groups,” she says. “There is emerging research that shows that food insecurity, the lack of availability or ability to obtain food, is related to a higher incidence of eating disorders. Future research should further investigate how systemic changes to food access may reduce eating disorder prevalence or increase the likelihood of recovery.” Bohon also notes that many providers with expertise to treat eating disorders are inaccessible to people with limited financial means. “The fact that eating disorders are just as prevalent in low-income people means that there is an urgent need to make treatment financially accessible,” she adds. “We need insurance and Medicaid contracts with specially trained treatment providers, as well as providers who know how to support families in securing food to meet the needs of recovery.” Harris says she hopes studies like these open peoples’ eyes to the reality that eating disorders don’t discriminate, and restricted access means those with limited financial resources may face even tougher obstacles to care and recovery. “It’s frustrating because so much of the problem of poverty is that the decision makers are not poor people or people who have been through poverty. The perspective has to be expanded to look at how primary care approaches eating disorder treatment and how we should be going into impoverished communities to talk about eating disorders. My concern is not, ‘is there an affluence bias?’ My concern is how [unaware] we are to what’s happening amongst poor people with eating disorders.” *Name has been changed to protect the family's privacy.]]></content:encoded>
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            <title><![CDATA[The Link Between Bullying and Eating Disorders, and What to Do About It]]></title>
            <link>https://equip.health/articles/understanding-eds/bullying-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/bullying-and-eating-disorders</guid>
            <pubDate>Fri, 21 Oct 2022 13:35:00 GMT</pubDate>
            <content:encoded><![CDATA[There’s no doubt that bullying is an issue that affects just about all young people — whether they’re on the receiving end of it, witnessing the trauma of others, or actually perpetrating the act themselves. According to the U.S. Department of Health and Human Services, about 20% of students between the ages of 12-18 have experienced bullying firsthand.  It makes intuitive sense that persistent bullying can have serious mental health consequences, including raising the risk of depression and anxiety. What might be less obvious is that bullying can also directly contribute to the development of an eating disorder. In fact, according to the National Eating Disorder Association (NEDA), about 65% of those with eating disorders say bullying contributed to their condition. There’s never any singular cause of an eating disorder, and bullying is no exception. “We know so many things go into the perfect storm that can bring about an eating disorder,” says Equip Clinical Instructor Natalia Orloff, PhD. “Bullying happens more than we would ever want it to, and not every child or adolescent who gets bullied develops an eating disorder.” Still, she says, it can have a profound impact on not only how a young person feels about their body but also their overall mental health. Here’s what every parent and caregiver should know about how bullying can contribute to the development of an eating disorder — and how to help prevent it. The connection between bullying and eating disorders According to NEDA, children in higher weight bodies are 63% more likely to be teased than their thinner peers and about 40% of higher weight kids are teased about their weight. Experts believe anti-bullying guidance must help young people and their mentors unlearn weight shame to reduce this core component of bullying. “Bullying and other external factors like school BMI [Body Mass Index] testing, nutrition that equates food choice with morality, social media that equates thinness with worthiness, and a host of other common messages about bodies are common triggers for eating disorders,” says Equip Director of Lived Experience JD Ouellette. “What bullying and many other environmental triggers have in common is they encourage behaviors — like restricting or purging to lose weight — that interact with a person's genetic and biological vulnerabilities and can lead to an eating disorder. When that happens, societal and individual bullying turns into a bully that now lives 24/7 in the person's brain.” Equip Family Experience Navigator Pallavi Kumar points out that bullying erodes a young person’s self-esteem — and we know that low self-esteem is a risk factor for developing an eating disorder. This risk can be particularly pronounced for young people struggling to find validation and acceptance, Kumar explains. “Commenting on someone's appearance, race, language, or gender identification can lead to self-image distortions and a person trying to ‘fit in’ or look a certain way,” she says. “Any comment about their appearance or a rejection can lead to a downward spiral that kicks off an eating disorder.” Ouellette says that physical or verbal abuse from one young person to another isn’t the only form of bullying that exists — and it’s important for adults to recognize that so they can be aware of their own potential contribution to the issue. How to prevent bullying — and stop it in its tracks There’s no single, surefire method to prevent bullying, but there are plenty of tactics parents, teachers, and other caregivers can implement to interrupt or stop abusive behavior altogether. “Children and adolescents are exposed to so many things that can increase their vulnerability for developing an eating disorder, so fixing one thing won’t make eating disorders disappear,” Orloff says. “However, the more we can do to decrease all things that have a negative impact on the mental health of young people, the better.” Here are some tips for preventing bullying and helping a child or adolescent understand when and how to take action: 1. Talk about bullying before it’s an issue. Initiate conversations around the topic, and allow the child to ask questions and express feelings. Make sure to educate kids about the many forms bullying can take and make it clear that any form of bullying is unacceptable. We most frequently think of physical bullying (pushing, hitting, or otherwise harming someone’s body) and verbal bullying (name-calling, saying hurtful things), but there’s also social bullying (excluding someone, spreading rumors), cyberbullying (using social media or other technology to bully someone), sexual bullying (unwanted physical contact or sexual comments about someone’s body), and prejudicial or racial bullying (saying hurtful things related to a person’s race, ethnicity, sexual orientation, or religion). 2. Strategize how to stay safe. Make a plan with kids about what to do if they feel they are being bullied. Practice having conversations with bullies and think of straightforward, confident responses or behaviors that make a child feel empowered. 3. Initiate frequent conversations. Taking a few minutes each day to check in with a child and asking how they’re feeling about school, friends, peers, and more can help them feel safe to open up and know they are not alone. 4. Work together with other adults in the child’s life. If you’re a parent, try to attend “Back to School” nights to get to know your child’s teacher, or introduce yourself via email early in the school year. If you’re a teacher, communicate with your students’ guardians often, and if you suspect a child is experiencing bullying, intervene immediately and involve other faculty if necessary. Parents may also want to consider exchanging phone numbers with other guardians to form a network and share information, tips, and support. Sticks and stones may break kids’ bones, but words can deeply hurt them, too. And while this hurt alone cannot cause an eating disorder, it can certainly be a catalyst in young people who are predisposed to develop one. The good news is that there are steps you can take to educate yourself and empower your child to be resilient in the face of bullies. In our society, bullying is almost inevitable — but its potential negative consequences, including eating disorders, don’t need to be.]]></content:encoded>
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            <title><![CDATA[I’m Worried My Loved One Might Be Having an Eating Disorder Relapse]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/eating-disorder-relapse</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/eating-disorder-relapse</guid>
            <pubDate>Fri, 14 Oct 2022 13:58:00 GMT</pubDate>
            <content:encoded><![CDATA[There's a common misconception that people can never truly recover from an eating disorder, or that they are destined to relapse. It’s true, the risk of eating disorder relapse can be significant: the numbers vary depending on which study you look at, but research suggests that up to 50% of people in eating disorder recovery relapse within the first few years of treatment. While the statistics can be disheartening, it’s important to know that true healing is possible. To help your loved one get there, it’s essential to understanding the risks and warning signs associated with eating disorder relapse—and be prepared to intervene. What is an eating disorder relapse? The words “recovery” and “relapse” might seem straightforward, and yet the eating disorder field doesn’t have exact definitions of these terms. However, there is a consensus that a relapse is characterized by a return of symptoms after a period of recovery. When do eating disorder relapses occur? Eating disorder relapse can happen any time, but we know from research that the first year after completing treatment is the most vulnerable period for patients, with the relapse risk generally decreasing over time. In addition, certain stressors, including work or school stress, big life events, and special events like holidays, can be common triggers for relapse. Some of the most vulnerable times for relapse include: Starting or returning to college Beginning a new job or graduate program Getting married Pregnancy Surgery, particularly oral surgery, such as wisdom teeth removal Weight loss for reasons not related to an eating disorder (illness, grief, medication, increased activity, etc.) Death of a loved one Loss of a friendship or romantic relationship Traumatic events What are the warning signs of an eating disorder relapse? If you’re concerned a loved one may be experiencing a relapse, that worry can sometimes be a sign in itself—even if you can’t put your finger on a specific behavior or red flag. Family and friends who’ve supported someone through eating disorder recovery talk about developing a “spidey sense” that the eating disorder may be active again.

The same warning signs for the onset of an eating disorder can re-emerge during a relapse, as well as relapse-specific warning signs. These may include: Deviating from the post-treatment plan (specific to relapse) Looking back at the eating disorder with fondness (specific to relapse) Secrecy around food or exercise (While secrecy is also a sign of the onset of an eating disorder, the secrecy that develops with a relapse may be more pronounced, as the person struggling knows that most of the people around them are aware of their eating disorder history and treatment plan.) Weight loss Lack of expected growth in children and adolescents Skipping meals Avoiding eating with family or friends Following new “rules” about eating Wearing baggy or oversized clothing Evidence of purging behaviors (e.g., using the bathroom after meals, excessive exercise) Changes in mood, such as symptoms of depression or anxiety, or signs of euphoria What can you do if you think your loved one is relapsing? If you notice warning signs of an eating disorder relapse, it can be difficult to know what to say and how to say it. It’s important to share your concerns with compassion and a nonjudgmental tone. Your loved one may not even realize they are struggling again, despite the evidence of relapse being clear to you. Their eating disorder may lead them to vehemently deny there is a problem, or they may realize what’s happening but refuse treatment and not want to acknowledge it due to a sense of shame. Expressing your unconditional love and willingness to support them can go a long way toward encouraging a continued recovery journey. Practical steps, like offering meal support and scheduling appointments with medical and/or mental health care providers, will help you both feel steadier as your loved one resumes focus on healing. Some patients and families prefer, when possible, to continue care with members of their prior treatment team; others find it necessary or helpful to start working with someone new. No matter what the next stage of treatment looks like, having your loving support can make all the difference. Do you have to start over after a relapse? It can feel overwhelming to consider starting treatment again. It makes sense to feel grief and fear at the thought of returning to the hard work of recovery. The good news is you aren’t usually starting over at square one: this time, you have a lot more skills, knowledge, and resources than you did before. So while it may feel like “starting over,” both patients and their families are often more equipped to handle the challenge of eating disorder recovery. And for those who didn’t have sufficient support during prior treatment, a relapse can be a time to gather additional professional and social support for recovery. What's the difference between a lapse and a relapse? Sometimes it’s difficult to tell if someone is experiencing a temporary struggle or is on the path to an eating disorder relapse. A lapse, a brief or isolated return of eating disorder behaviors, does not always signal the beginning of a relapse but could indicate the need for more skill-building and support. It can be helpful to remember that recovery in real life isn't linear; it's common throughout the weeks, months, or even years of recovery to occasionally have periodic returns of eating disorder thoughts or behaviors. It’s unrealistic to expect that recovery means always feeling happy or never having an eating disorder thought. We should expect that these challenging moments will happen, and understand that experiencing these emotions, thoughts, and urges is normal. What matters most is how someone responds to these challenges when they come up. Do they respond by acting on their thoughts or feelings? Or do they use skills they learned in treatment or reach out for more support? The former signals an inability to bounce back from these moments, and could turn a lapse into a relapse. Encourage your loved one to be kind to themselves. Remind them that no one is perfect, and recovery certainly isn't perfect—nor does it need to be. Even those without eating disorders have bad days. A lapse doesn't have to lead to a full-blown relapse. Instead, a lapse can be an opportunity for your loved one to use skills, reach out for support, and learn what they need to be more resilient going forward. How do you lower the risk for relapse? The first step in lowering the risk for relapse is reaching a solid recovery rather than what many call “partial recovery.” Partial recovery often means the patient has a significant reduction in symptoms or an improvement in nutrition that resolves medical complications (such as orthostatic vitals, bradycardia, or amenorrhea) but they still feel burdened with eating disorder thoughts and behaviors that interfere with their life. Some families describe partial recovery as “surviving,” while full recovery is “thriving.” Patients in partial recovery may have a lot of rules around eating, anxiety around certain foods, fear of weight gain, and/or body image concerns. Often these patients have restored some weight but may not be at a recovery-supporting weight that is right for their body; research indicates that a higher weight at discharge may predict a lower risk of relapse. Other patients may have reached a recovery weight range but still feel beholden to the eating disorder’s rules around food, exercise, or body size; having these lingering psychological symptoms also increases the risk of relapse. Recovery is hard work that takes time and a lot of patience; it’s tempting for patients and their families to want to pause or be done once the worst is behind them. Without sufficient support to continue challenging the eating disorder, however, patients in partial or “half-way recovery” are at increased risk for a full relapse. What is an eating disorder relapse prevention plan? Even patients in a state of robust recovery still benefit from having a relapse prevention plan, or a written document co-created by a patient, their treatment team, and any family or friends supporting recovery. This plan is developed in preparation for discharge from treatment and addresses the following key areas: Anticipating potential triggers Having coping skills and strategies in place to manage stressors Knowing where to go for support Identifying signs of relapse Defining when a return to treatment would be necessary Is there such a thing as relapse-proof recovery? In a world that is strongly influenced by diet culture and constantly sends messages that sound like eating disorder thoughts (“eat less, move more” is just one of the more normalized examples), it can be challenging to stay in recovery. With the support of a treatment team and loved ones, however, patients can develop a relapse prevention plan that sets them up for a strong and resilient recovery. If you're worried that a loved one is experiencing an eating disorder relapse, it's important to get them prompt support. Early intervention can prevent a lapse from turning into a relapse, or help them get back on track quickly if a full relapse occurs. Talk with your medical provider or schedule a consultation with our team. ]]></content:encoded>
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            <title><![CDATA[Eating Disorders in Midlife and Beyond: Insights from Equip's Survey]]></title>
            <link>https://equip.health/articles/news-and-research/aging-eating-disorders-survey</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/aging-eating-disorders-survey</guid>
            <pubDate>Thu, 02 Jan 2025 17:04:00 GMT</pubDate>
            <content:encoded><![CDATA[When we think about eating disorders, we often picture young people: adolescents, teens, and young adults struggling with body image and disordered eating behaviors. But, as Equip’s recent survey makes clear, eating disorders and body image issues don’t disappear as we age: they affect people at every stage of life, including older adults. In fact, hormonal shifts during menopause and andropause—key life transitions that typically occur after age 40—can play a significant role in triggering or intensifying eating disorders later in life. For women, menopause typically begins around age 40, when estrogen levels drop by about 60%, and progesterone production ceases almost entirely. The rapid decrease in these hormones can trigger a variety of symptoms, including mood swings, weight gain, and hot flashes, all of which can have an effect on eating behaviors and body image. Men also experience their own version of hormonal changes, known as andropause. Starting around age 25, testosterone levels decrease by about 1% annually, and then begin to decrease more rapidly in middle age. Symptoms of andropause include lower energy, depression, increased belly fat, muscle loss, a decrease in libido, and more emotional reactivity, which can have their own impact on body image and eating habits. These hormonal shifts, along with other life challenges that show up in older adulthood, can contribute to disordered eating, body image struggles, and diagnosable eating disorders. Our recent survey of over 1,000 people aged 40+ highlights this reality, showing that eating disorders are not just a youth issue—they are a lifelong struggle that needs greater attention, especially as we age. Key findings: eating disorders and body image struggles in midlife Equip’s survey reveals that eating disorders and concerns over body image are not confined to younger individuals. The survey shows that hormonal changes, particularly those experienced during menopause and andropause, contribute to eating behaviors and body dissatisfaction in midlife and beyond. Here’s what we learned: Body dissatisfaction is widespread Our survey found that 75% of respondents aged 40+ are dissatisfied with their bodies. Among them, 64% reported that they often judge their worth based on their weight, indicating how body image struggles persist throughout life. Eating and appearance concerns take an emotional toll More than half of respondents admitted feeling guilty after eating because of its effect on their weight or appearance. This widespread guilt suggests a deeper psychological burden, often intensified by the hormonal changes that occur during midlife. Midlife brings increased pressure 38% of respondents stated they think about body image more frequently in midlife compared to their younger years, feeling even greater pressure to control their weight. Disordered eating behaviors can begin in midlife The survey highlighted that 35% of women reported picking up disordered eating behaviors—such as meal skipping, excessive exercise, or restrictive dieting—for the first time in midlife (ages 36-65). Many attributed these behaviors to feelings of loss of control over their bodies, particularly during hormonal shifts like menopause. The role of hormonal shifts: menopause and andropause Hormonal changes during menopause and andropause often have a profound impact on eating behaviors and body image. These shifts can cause weight gain, emotional instability, and body dissatisfaction, all of which can trigger or exacerbate disordered eating behaviors. Hormones impact women’s body image The survey found that 42% of women in menopause reported negative changes in how they felt about their bodies. Many women noted that weight gain, mood swings, and feelings of losing control over their appearance led them to engage in disordered eating behaviors, such as restrictive dieting and over-exercising. Andropause: men are affected too While much of the conversation around body image focuses on women, our survey also found that 39% of men felt worse about their bodies as they aged. Symptoms of andropause—such as increased belly fat, muscle loss, and decreased energy—can exacerbate body dissatisfaction. Among our respondents, 62% of men met the clinical threshold for andropause, but only 15% self-identified with the condition, indicating a significant gap in awareness and treatment. Diet culture can make it hard to seek support Our findings made it clear that the effects of diet culture don’t go away once people age out of teenage or young adulthood: societal pressures continue to shape eating habits, particularly for women in menopause. Among our sample, 82% of women in menopause reported that they were actively managing their weight, often engaging in disordered behaviors such as dieting or meal skipping to meet unrealistic beauty standards. The good news is that most survey respondents believe that people of any age can seek mental health support: 63% agreed that it’s never too late to seek treatment for disordered eating behaviors. This statistic highlights an opportunity to address this issue with more targeted care and support. Real voices: respondent quotes The survey results are powerful, but the real-life experiences shared by respondents add a personal dimension to the data. These voices illustrate the emotional and psychological toll that eating disorders and body image issues can take in midlife and beyond: “I absolutely feel more constrained by societal expectations to control both my weight and the overall look of my body than when I was younger. It’s harder to reach that ideal as I get older. It’s harder for me to get the exercise and well-balanced diet that society expects me to have now than it was just a few years ago.” - 40-45-year old male “The same disgust about my body has returned, but now I have a reason to be. When I had anorexia as a teen and young adult, I was actually very thin/underweight. My current mental health issues have affected my body image. I’ve started restricting my food intake.” - 57-61-year-old female “Perimenopause caused an ovarian cyst which brought on the worst episodes of binge eating disorder that I’ve had in my adult life.” -40-45-year-old female “I am constantly aware when I am eating, how much I am eating and why, and keeping mental notes of how many calories I’m consuming.” - 51-56-year-old female: “I was diagnosed with anorexia at age 53 when I was hospitalized for lumbar compression fractures due to osteoporosis, which the anorexia caused. What brought on the anorexic episode in my early 50s was a traumatic experience that I wasn’t coping with properly, and so I returned to anorexic behaviors. I would say that even to this day, at age 65, I still have anorexic-type behaviors.” - 65-year-old female Moving forward: the need for more awareness and better support The findings from our survey highlight the urgent need for greater awareness of and support for older adults dealing with eating disorders and body image issues. Hormonal shifts during menopause and andropause significantly contribute to these struggles, but stigma and misconceptions about eating disorders remain barriers to treatment. Thankfully, many adults dealing with eating disorders are open to getting help. This presents an opportunity for healthcare providers, support networks, and society at large to focus on adults in midlife and beyond, offering them the resources they need to address eating disorders and improve body image. If you or someone you know is struggling with disordered eating or body image concerns, remember that help is available. It’s never too late to seek support. Together, we can create a more supportive and compassionate environment for older adults facing these challenges.]]></content:encoded>
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            <title><![CDATA[Navigating Eating Disorder Treatment Is Hard. Doing So With a Disability Is So Much Harder]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/disability-awareness</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/disability-awareness</guid>
            <pubDate>Wed, 30 Mar 2022 03:54:29 GMT</pubDate>
            <content:encoded><![CDATA[When Equip lead peer mentor Jillian Yatsko was diagnosed with multiple sclerosis at 20-years-old, her doctor told her the chronic condition would need to be the most important part of her life from that point forward — bigger than other aspects of her wellbeing, her social life, and even bigger than her eating disorder recovery. “People with disabilities are often cast into a role where they are already seen as broken,” Yatsko says. “So adding an eating disorder on top of that doesn’t come across as extraordinary to medical professionals and often gets left out of the treatment conversation.” Yatsko’s experience exemplifies an issue that many individuals with a variety of physical and mental disabilities* have to face when seeking out and receiving eating disorder treatment: the feeling that they must choose which health issue to prioritize, which inevitably means one part of their wellness must take a backseat. While there is a lack of research examining the links between disability and disordered eating, eating disorders do seem to disproportionately affect certain groups within the disability community, and the individuals in these communities may face unique stressors that contribute to the development and maintenance of their EDs. Facing ableism in eating disorder treatment The obstacles disabled people face on a daily basis are the consequence of living in an ableist culture. “Ableism” can be defined as social prejudice and discrimination against those who are disabled in any way due to a underlying belief that they are inferior to non-disabled folks. Just like sexism and racism are rooted in erroneous beliefs and harmful stereotypes, ableism is often perpetuated by generalizations and assumptions that disabled people need to be ‘fixed.’ “Ableism—discrimination in favor of able-bodied people—is more widespread and found in more places than we’d like to think,” explains DT Bruno, MSW, a clinician at Greater Nashua Mental Health. “Disabled patients regularly face accessibility barriers and unfortunately, that goes for mental health care as well. The barriers include but are not limited to: language barriers, navigating the complex health care system, and focusing on their families/caregivers’ needs instead of providing client-focused care. [And] some disabled people living with mental health symptoms may have invisible disabilities so they often have to defend their disability and that can be exhausting.” Obstacles that prevent disabled folks from seeking care Based on her own experience, Yatsko has observed first-hand some of the ways eating disorder treatment specifically is rife with barriers to entry, even for those without disabilities. “Add in something like requiring a wheelchair to move around or having pre-existing financial burdens from your disability and you are looking at a treatment that can be impossible,” she says. “Many residential treatment centers provide care in non-clinical environments like standard homes — this means that your wheelchair might not fit through a doorway or your shower might require you to have to climb in a tub. These types of centers do not always have trained staff to help you move safely around if you have a disability that requires assistance.​​” But even in the context of outpatient care, Yatsko says eating disorder treatment has been developed, refined, and targeted for neurotypical, able-bodied individuals, which consequently leaves disabled people out of the picture. “If you have a developmental disability that perhaps affects your ability to speak or process information in the same way as your peers, you may find that there are few, if any, groups that provide services to meet your unique needs,” she says. “Traditional treatment can be very cookie-cutter, and folks with disabilities often struggle to find another cookie like them.” There are, of course, other practical hoops to jump through when it comes to receiving adequate and effective treatment, including financial obstacles. While costs vary depending on the level of care, geographic location, and insurance coverage, it’s not uncommon for residential treatment centers to charge upwards of $30,000 a month. “A good number of disabled people rely on subsidized health care such as Medicare and Medicaid to cover critical treatments, so if more robust coverage could be provided, that would be a great starting point,” Bruno says. What needs to change to make treatment more accessible While there’s no simple solution to accessibility for disabled people, it might start with treatment centers hiring a more diverse array of competent, skilled professionals adept at offering a variety of services. “For deaf** people in this country using American Sign Language (ASL), there are virtually none-to-minimal treatment options available directly in sign language in some settings such as within EDs and for those with substance use disorders,” Bruno points out. “We need to have disabled people in both client-facing and leadership positions making decisions in order to make a significant impact on the mental health recovery landscape; too often we are an afterthought.” Yatsko agrees, adding that she believes many professionals in the eating disorder treatment industry are invested in providing quality care for all people, including those with disabilities, but face their own obstacles in the pursuit. “A big challenge lies in care providers not being trained, educated, or personally experienced in the day-to-day challenges of what it’s like to live with a disability,” she says. “If we look beyond the initial barriers (moving around a space, financial challenges) you are also faced with the harsh reality that this person may have significant distress and/or trauma around medical care providers. They may have been brushed off, pushed aside, and invalidated by medical professions for years. The disability is an essential part of a person and the ramifications of which need to be addressed and provided for during treatment.” * At Equip, we know that some folks use identity-first language to self-describe, while others prefer person-first language. Throughout this piece we use both to reflect the complexity of this conversation and honor the preferences of the people who are quoted in the piece. ** The word “deaf” is used to encompass all types of the deafness spectrum regardless of cultural identity, including but not limited to Deaf, Hard of Hearing, DeafBlind, DeafPlus, Late-Deafened, and more.]]></content:encoded>
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            <title><![CDATA[First Steps: How and When to Seek Eating Disorder Treatment]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/first-steps-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/first-steps-eating-disorder-treatment</guid>
            <pubDate>Fri, 25 Mar 2022 21:31:00 GMT</pubDate>
            <content:encoded><![CDATA[Knowing when and how to seek help for an eating disorder is one of the most challenging pieces of the recovery puzzle. Because eating disorders can present in such a wide variety of ways, it can be particularly tough to know when someone's symptoms merit professional attention. The bottom line, however, is that eating disorders are deadly diseases: in fact, eating disorders have the second highest mortality rate of all mental illness. Taking decisive, targeted action early can literally save your or your loved one’s life—even if the symptoms you've noticed don’t seem severe or don’t appear to fit the full criteria for a diagnosable disorder. Anyone struggling on any level with food, weight, exercise, or body image deserves—and often needs—support, but knowing how to get started can be tricky. Here are the main points to consider when deciding whether you or your loved one need eating disorder treatment. When to seek help for an eating disorder Identifying the early warning signs of an eating disorder can be challenging, but the odds of recovery increase when the disease is caught early, so knowing some of the signature signs can be life-saving. Here are some of the hallmark symptoms to be aware of: Behaviors and attitudes that suggest extreme concern, preoccupation, and/or obsessive/compulsive thoughts and actions about weight loss, dieting, controlling food, exercise, etc. Skipping meals, only eating small portions, or refusing to eat certain foods Noticeable weight fluctuations, including weight loss or gain Difficulty concentrating, menstrual irregularities, sleep problems, feeling cold all the time, and/or having signs of impaired immune functioning Hiding binges or hoarding food (for loved ones, you might notice signs of this, like food wrappers hidden in strange places or food going missing) Engaging in dieting behaviors (i.e. reducing the amount or types of food eaten) Purging food (i.e. vomiting or misusing laxatives or diuretics. For loved ones, this might mean signs of potential purging, like frequent trips to the bathroom after meals, or laxatives suddenly appearing in the medicine cabinet) There are many other possible signs and manifestations of disordered eating to be aware of, and these are just the tip of the iceberg. Know that warning signs can vary dramatically from person to person and the absence or presence of one or more symptoms doesn’t guarantee a diagnosis.  If you notice any concerning patterns or behaviors in yourself or a loved one, seek a professional opinion immediately and don’t discount your intuition. How to seek treatment for an eating disorder One of the most helpful starting points for putting together an eating disorder treatment plan may be your or your loved one's primary care physician. A primary care provider can make critical referrals so you can piece together the most comprehensive treatment team for your specific needs.  Traditionally, the crucial members of a multidisciplinary eating disorder treatment team include: A mental health professional, including a therapist for psychological services and/or a psychiatrist for medication prescription and management Medical and/or dental specialists to treat any physical issues that may have resulted from the eating disorder A registered dietitian to create a therapeutic meal plan and/or provide nutrition education Peer or family mentors to offer advice based on their own lived experience Assembling a team may take work, but the process often starts with a primary care provider. If you feel you or your loved one merit a higher level of care than the services available in low-touch outpatient settings, you may want to consider an evidence-based, comprehensive recovery program like Equip. Questions to ask during your search for eating disorder treatment There is no perfect template for eating disorder recovery; every person's treatment plan depends on a multitude of factors. Knowing which questions to ask as you start your search for support may help you identify the approach that works best for you or your loved one: What kind of experience does a healthcare provider have with treating eating disorders? How long have they specialized in eating disorders? What kind of credentials does the healthcare provider have? Do they belong to a reputable organization like the Academy for Eating Disorders (AED)? What are the financial implications of treatment? Are the services you’re considering covered by insurance? If not, how much will they cost out-of-pocket? What kinds of measurable criteria does the provider use to assess how well treatment is working? What role will family and loved ones play in the treatment process? Are there physical and mental health implications of the eating disorder that need to be addressed immediately? What’s the best strategy for addressing them? Again, these are just a handful of the myriad considerations you may need to make as you start the process of seeking treatment. But having these questions in mind can help you start to make sense of the overwhelming amount of information out there and help you hone in on what truly matters most: finding treatment that will help you or your loved one achieve lasting recovery.  ]]></content:encoded>
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            <title><![CDATA[College Can Be a High-Risk Transition for People with Eating Disorders. Here’s How to Prepare.]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/transition-to-college-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/transition-to-college-eating-disorder-recovery</guid>
            <pubDate>Wed, 22 Mar 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[When it was time for Equip Family Mentor Laura Cohen to help her daughter navigate college applications, she had one rule: recovery would always take priority. “My daughter started college two years into her recovery,” Cohen says. “Even during the application process, her recovery was in the front seat. We and her team were very clear that just because she got into a college didn’t mean she could go that fall. Recovery was first and foremost and if that meant a gap year was needed, we wouldn't have hesitated.” Transitions are a tricky time for those with eating disorders, and starting college is one of the biggest transitions there is. For many students, the sudden shift in environment, expectations, and schedule can be jarring, and is compounded by anxieties around academics and social status. Even for those who aren’t moving away from home, the change in structure and responsibility can be a lot to handle. And for anyone prone to or in recovery from an eating disorder, all of these changes—combined with the endless food choices and diet talk that are both hallmarks to college culture—can cause considerable stress and potentially trigger a problem or relapse. Given all this, it's no coincidence that the median age of eating disorder onset tends to coincide with the typical age of college enrollment, according to research. “This is a time of great developmental change. Young adults are focusing on individuation from their family of origin, deciding who they are, and developing intimacy in significant relationships,” says Equip VP of Medical Care, Jennifer Derenne, who has edited two books on transitioning from adolescent to adult mental health care. “All of this change can be exciting and exhilarating while also overwhelming and destabilizing. They may change their eating or activity behaviors to manage their stress and anxiety, or out of a fear that they’ll gain the ‘Freshman 15.’” But while all these risk factors can make this time particularly precarious, eating disorders in college are not inevitable. With the right information, resources, and support, families can help their child prioritize recovery and make this time of transition exciting rather than overwhelming. Why the college transition can be so tough for those in recovery While any type of transition can be triggering for people prone to eating disorders, starting college can be particularly tough for a number of reasons. In addition to the universal stressors of school life and potentially leaving home for the first time, students also run up against challenges around food, exercise, and eating socially. “College is a time of increased independence, and if someone can’t adequately eat on their own, it can be very easy to relapse,” Cohen says. “With more independence comes increased responsibility. Being comfortable eating with others and making sure you’re comfortable choosing food in a big and loud dining hall is essential.” Ah, the dining hall. It’s a place defined by seemingly endless food choices, big crowds, and social dynamics on full display; and while this environment is fun for many college students, eating in a dining hall can be incredibly challenging for someone vulnerable to or in recovery from an eating disorder. For some, the pressure of eating in front of a large group can be overwhelming, and for others, the unfamiliar foods themselves can prove problematic. At home, the pantry and fridge were full of your go-to brands and family staples, and now you’re surrounded by a self-serve frozen yogurt machine, an omelet station, five kinds of pizza and a salad bar the length of your whole house; the overwhelming amount of choices and presence of potential “fear foods” can be paralyzing for many struggling with eating disorders. What’s more, a number of college dining halls now display nutrition information (or the arguably more problematic “traffic light” labeling, in which “healthy” foods are marked with green and “unhealthy” foods with red) for the food they provide. This type of nutritional labeling can be potentially triggering for those in recovery who are working not to judge food as “good” or “bad. “You need to be comfortable choosing adequate meals even while the calorie contents are often listed all over the dining hall,” Cohen says. “And if you’re eating with others, you need to be comfortable doing so and choosing meals that are recovery-minded, which may differ from some of your friends who may be entrenched in diet culture,” Cohen adds. “College is an easy place to hide an eating disorder and it’s very easy to relapse.” Equip Registered Dietitian Stephanie Kile adds that one of the biggest potential triggers for college students is peer pressure. “College life has so much diet culture and it is easy to slip into these behaviors that will then derail progress and increase risk of relapse,” Kile says. “Being able to have a plan and steps to prevent this from happening is key.” How to prepare for the college transition while prioritizing recovery While it’s impossible to anticipate all the potential obstacles or challenges college can bring, experts strongly recommend building a strong recovery foundation as early as possible. “The key is to be very prepared heading into the process,” Derenne says. “I advise families to think about the transition much sooner than they might think is necessary, and even consider these things as they are going on college visits and filling out applications.” Here are some helpful ways to prepare and make the transition to college one that supports recovery: Do a trial run Derenne, Kile, and Cohen all advocate for “practice runs” prior to the start of the semester, or allowing the person in recovery to slowly take on more responsibility while still having the structure and safety net of home. This may mean allowing them more freedom around meal planning, giving them the opportunity to make their own doctor’s appointments, or having meals in unfamiliar and public settings, like a mall food court. “A good idea is to test ‘food independence’ the summer before college,” Cohen says. “This could look like having your loved one plan and prepare their meals so if they have a wobble, they can navigate getting back on track.” Create a contract Cohen is a big advocate of the summer behavior contract, in which families write out what is expected of their loved one before they leave to show that they are ready. She also recommends extending that contract into the start of college to help those in recovery stay accountable. While every family may choose to use the contract differently, Cohen believes having a target recovery weight range is important, as it helps loved ones keep close tabs on potential backtracks. “A contract should also include what is expected in terms of appointments with providers—virtually or in-person—and if weights and vitals will be needed,” she says. “The campus health center can do this and may need your outpatient team to request what is needed. You can also add limitations around exercise, and I strongly suggest adding something about what to do if a scale is accessible to prevent obsessive weighing.” Having a contract also ensures that there will be swift, serious consequences if recovery starts to fall by the wayside. “Families and treatment teams need to consistently enforce and follow through on contingencies,” Derenne says. “If someone isn't attending their treatment sessions or appears to be deteriorating, sound the alarm sooner rather than later to get things back on track and prevent a full-blown relapse. Support the student getting connected to appropriate (re)evaluation or treatment as soon as possible. If it isn't possible to arrange that on campus, consider bringing the student home or having a family member travel to them to help navigate the system and provide support around improving nutrition and stopping behaviors.” Put a team in place Establishing a solid care team on or off campus is critical, and this will require some advanced research. “All schools are different in terms of the mental health and medical services offered,” Derenne says. “Families also need to think about logistics such as the availability of medical or psychiatric hospitals in the event of an emergency, transportation and ease of getting to appointments, and distance from home. How long would it take a family member to get there if there is a problem? Will they live alone or with roommates who can reach out if there is a concern?” Set up check-ins Experts also recommend setting a schedule for regular check-ins with family to keep everyone on the same page of recovery. “Having regular calls and texts can help everyone stay accountable,” Kile says. “Set up a time so everyone knows it’s coming and can be prepared. Also make sure that your loved one has a trusted family member they can reach out to when highly triggered and in need of immediate support. Having someone on campus that they can turn to when they need someone quickly is also a great thing to set up: a counselor, the health center, or a family member nearby who can be there quickly to help in those heightened moments would be beneficial.” Be honest with yourself Finally, it’s important to recognize the reality of a young person’s current recovery. If they aren’t ready for a major life change, it may be best to press pause on college and focus on rebuilding health. “I see loved ones send their kids to college because they are too scared to hold them back and that can be a recipe for disaster,” Cohen says. “Many parents can’t imagine pulling their loved ones out of school, but it’s often the thing that is more important than any grade. College is not going anywhere!” If you’re struggling to decide whether your loved one can go to college without compromising their recovery, here are 12 questions to help you make your decision.]]></content:encoded>
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            <title><![CDATA[It’s Common to Feel Ambivalent About Recovery. Here’s How to Handle It.]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/ambivalence-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/ambivalence-eating-disorder-recovery</guid>
            <pubDate>Mon, 16 Dec 2024 18:50:57 GMT</pubDate>
            <content:encoded><![CDATA[When Equip Peer Mentor Jamie Drago began treatment for her eating disorder, she Googled the phrase, “how to want to recover.” At the time, Drago couldn’t find a way to make herself feel enthusiastic about the changes she was making and the goals she was setting in treatment. “‘Ambivalent’ was how I felt about recovery for probably the majority of my journey,” Drago says. “I would feel motivated and ready to dedicate myself to moving forward, and then end the night telling myself, ‘I am going to walk in there tomorrow and tell them I quit! And slam the door on my way out!’ Instead, I would show up the next day and do it all over again. And I think that’s okay.” Drago is describing an experience that Equip Therapist Lead Jonathan Levine, LCSW, says is not only common but somewhat expected. “There are so many reasons why someone might feel ambivalent about recovery,” he says. “Change—any change—is hard, even if we know it's something ‘good’ for us or something we actively want, so I see ambivalence as just a key part of the human condition.” Read on to learn more about why ambivalence is so common in eating disorder recovery, and how to overcome it. Why you might feel ambivalent about recovery As Levine points out, it’s natural for humans to have mixed feelings about transitions and changes of any kind—and this becomes even more intense when a complex mental health issue is involved. “When you add an eating disorder to the mix, that ambivalence is amplified because, for many diagnoses, the behaviors that keep the eating disorder active are serving a purpose,” Levine says. “If you take away these behaviors, you lose access to a safety net of sorts, and that is a scary thing to undertake because it's new, it's uncertain.” Indeed, eating disorders can also be egosyntonic—meaning that they feel aligned with a person’s self-image and values—and so those affected by one might not want to recover at all. Of course, this sense of alignment is a symptom of the eating disorder itself, but to the person struggling, it feels very real. As Levine explains, some people with eating disorders might want to get better in theory, but feel compelled to retain at least some aspect of their eating disorder (for example, a low weight) while letting go of others (for example, obsessive thoughts). “Realistically, those two things are intertwined and you can’t really change one without changing both,” he says. There’s another major reason people might feel ambivalent about recovery, and it’s pretty straightforward: “Plain and simple: recovery is hard,” Drago says. “Challenging long-held beliefs or fears is scary and uncertain. For a lot of people, eating disorders are serving a very real function, whatever that may be, and it would be hard to feel 100% sure about giving it up if you don’t know what the outcome will be.” There are also environmental factors that can contribute to ambivalence. Trying to contend with a society immersed in diet culture can be incredibly confusing and disorienting for anyone considering recovery. Unfortunately, we exist in a world that conflates thinness with health and deems certain foods “good” and others “bad”—and since so many of the principles of recovery directly oppose these diet culture beliefs, it can make it hard to choose that path, even if you know it’s the right one. Surrounded by all these contradictory messages, even someone who truly wants to recover may experience a fair amount of internal conflict and ambivalence. This can be particularly true for people whose bodies don’t match society’s (harmful and unrealistic) ideals. “Something I have also heard from a lot of people in large bodies is that living in our society constantly being faced with weight stigma, it is really hard to challenge an eating disorder when people—even healthcare professionals—are actually encouraging things that reinforce eating disorder thoughts and behaviors,” says Drago. How ambivalence can undermine recovery “Ambivalence is that sticky middle ground where you think about changing and get stuck in inaction,” Levine says. “But if you don't take action, nothing will change; if you don't try to reach towards a place of recovery, then you will not be able to get there. It's a feedback loop, a nonstarter. You can't keep on doing the same thing and expect a different outcome, and that fear of change will keep the eating disorder active and in control, which will make recovery out of reach.” Drago says that in her case, ambivalence kept her stuck for a long time because she felt she needed to be completely “ready” or “sure” before embarking on a healing journey. “Ambivalence can be really tricky,” she says. “Ambivalence can sound a lot like, ‘well, I don’t even want to recover anyway,’ ‘I can’t recover if I don’t agree with XYZ parts of it,’ or ‘I will recover but only under these specific conditions.’” No matter how ambivalence shows up, it can be a hurdle on the path to recovery. In many cases, recovery from an eating disorder is a self-driven exercise: the person with the eating disorder is the one who needs to actually stick to the meal plan, stop compensatory behaviors, and turn to healthy coping skills when urges come up. When the person in the driver’s seat isn’t sure of where they want to go, it makes it much less certain that they’ll reach the right destination. How to overcome ambivalence and commit to recovery Ambivalence can be difficult to navigate in any context, but it’s particularly tough to handle on your own—that’s why it’s so essential to seek out expert guidance if you or a loved one is struggling with any form of disordered eating. “Ask for help!” Levine says. “Find a therapist, a dietitian, a team, someone who can support you so that you have people in your corner on the days you feel motivated, and especially the days you do not.” It’s also important to acknowledge that in many ways, some level of ambivalence is to be expected—but it doesn’t have to be a dealbreaker in the recovery process. “Ambivalence is a part of life, of eating disorders, of change; expect to not want to do the hard work of recovery some days, and don't let that dictate your actions,” Levine says. “Discipline and follow-through beats motivation every day, so having people that can help you on the darker days is critical.” Levine also advises anyone struggling with ambivalence to make a list of pros and cons of recovery, which may help clarify the real motivation driving the desire for change. “And give yourself grace to be imperfect and don't let one bad meal, day, or week lead to a decision to drop recovery actions entirely,” he says. “It's not all or nothing, even when your brain tells you it is. Keep showing up to the work.” For Drago, a pivotal moment came when her dietitian asked her to identify one thing about recovery that sounded appealing or that might improve her quality of life. “I might not have wanted the things that scared me about recovery, but I knew I wanted to have more energy,” Drago says. “I might not have wanted to challenge my anxieties, but I knew I wanted to be able to go out with my friends. Sometimes the entire mountain of recovery just looks way too big to climb, so maybe you don’t agree to the whole mountain at first. Maybe you make it up the most climbable hill and then go from there.” While ambivalence may be uncomfortable to navigate, it doesn’t have to stall or stop progress. The path to recovery can start at any time—even when the conditions don’t feel quite right or the journey seems messy and uncertain. “I waited for so long to feel ‘ready’ to recover, and I tried for so long to find a way to keep the parts of my eating disorder that I ‘wanted’ at the time but not have the parts I didn’t want,” Drago says. “If I had kept waiting to feel ready or to feel fully on board, I would still be waiting.” If you or a loved one is dealing with an eating disorder, don’t wait to feel fully “ready” to get help. You can get started on the road to recovery even if just one little voice inside you knows it’s the right choice. Talk with your doctor or a trusted mental health professional, or schedule a call with an Equip team member to talk through your concerns.]]></content:encoded>
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            <title><![CDATA[Why I Co-founded Equip]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/erin</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/erin</guid>
            <pubDate>Tue, 22 Sep 2020 21:38:31 GMT</pubDate>
            <content:encoded><![CDATA[Dr. Erin Parks is a clinical psychologist, researcher, and co-founder of Equip. Erin serves as Chief Clinical Officer (CCO) of Equip, leading a team of clinicians and researchers that are passionate about increasing access to treatment that works. A forever optimist, and often prone to black/white thinking, I left college and dove into a career in research. I was confident, if not overly optimistic, that everything would have a logical answer. Things would be researched, answers would be found, and everyone would embrace the newfound knowledge and facts. After a decade in neuroimaging research, I ended up in the eating disorder field almost by accident. I had just given birth to my first child, and was off-cycle for fellowships (the step after receiving your doctorate). I asked a few friends from graduate school to meet me for lunch, brought my baby to meet them—and I asked the question, “Do you know anyone hiring off-cycle for postdocs?” My friend, June suggested that I look at the UC San Diego Eating Disorders Center. The bias of my training showed when I asked, “Why would I want to work in eating disorders; that sounds awful?!” That is what I had been taught, and what most are taught (either directly or by omission) as they go through graduate school or medical school—the stereotypes that are rampant in our culture about eating disorders (e.g., difficult families, white-girl vanity issue) are just as prominent in our medical training. But June assured me—the UC San Diego program is special. What came next was the most incredible decade of my career. I had the immense privilege of training, working, and eventually co-leading the most incredible eating disorders program in the world. That is not hyperbole. What is happening at UC San Diego is so unique and special that people travel from all over the world to get treatment at their amazing program. UC San Diego conducts research, delivers cutting-edge treatment, employs the best clinicians, includes family and lived-experience in a meaningful way, tracks outcomes and demands success, and they care about patients and families passionately. If I were to briefly disclose their secret sauce, it would be that they have a truly collaborative multi-disciplinary team, focus on the present (not the past) by teaching skills to patients AND carers, and finally, they value treatment that works more than treatment that feels good. I know they won’t be mad that I’m sharing their “secret formula”—UC San Diego goes out of their way to host free workshops/CE training (online and in person), publish articles, chapters, videos, blogs and podcasts to share with others. They sincerely want every center to provide excellent treatment. It is likely confusing that my “Why I founded Equip” is reading like a marketing piece for UC San Diego. The thesis is, UC San Diego is incredible, and leaving was a devastatingly hard decision… and it all goes back to my optimism and black/white thinking. While I was working at UC San Diego I met hundreds of families, too many families, that (prior to arriving at UC San Diego) had been to numerous eating disorder treatment centers (without success) and were experiencing deep financial hardship. During their first weeks of treatment, I’d watch many experience hope and relief (This place is so different—now my child will get better!) followed by anger—why didn’t I know about evidence-based treatment earlier, before we’d spent years and our family’s savings on treatment that didn’t work? Lisa Sabey captures this frustration well in her documentary, Anorexia. Initially, my optimism held. If UC San Diego just did more free trainings, more publishing, more outreach—we could help educate consumers on how to choose treatment that works, over treatment that feels good. We could also help to disseminate evidence-based treatment and more providers would offer treatment that works. I keep saying that, “treatment that works, not treatment that feels good”—what does that mean? Lots of things feel great: massages, outdoor walks, talking to someone who is a great listener—and while all of these things can give us pleasure, they do not cure someone of an eating disorder. The treatments that do result in recovery in real life--those treatments are very difficult on the provider, on the family, and certainly on the patient. It is a parent telling their child that they cannot leave for college until they are engaging in pro-health behaviors. It is a provider challenging the parents on their decision to eat salads while their child eats pasta. It’s a patient, eating six times per day, every day, and resisting urges to engage in eating disorder behaviors. It is all hard work--and it often doesn’t feel good. During my 10 years at the university, two things were happening in parallel. Every year, researchers and clinicians offered exponentially more free resources to educate consumers and train providers about evidence-based treatment. Every year, private equity built and purchased exponentially more treatment centers, employing more marketers than therapists to tell the public about the feel-good treatments that would cure their eating disorders. Despite all of the hard work of many advocates, clinicians, and researchers--bad treatment was proliferating faster than evidence-based treatment was being adopted. With the exponential increase in privately-owned treatment centers, patients and their parents were conned into spending their money on treatment that felt good--but that ultimately didn’t work. And worse, when their child didn’t get better, the treatment centers blamed the patient--saying that they weren’t ‘ready enough’ or ‘motivated’ for recovery. Many families have been duped into returning to the same center, over-and-over, thinking they were the reason the treatment failed, instead of recognizing that the treatment center was insufficient. UC San Diego is not the only center that uses evidence-based treatment, the problem is that it is one of the few. While advocates, clinicians and researchers must continue the effort to train more people in evidence-based practices, those efforts aren’t sufficient for families who need help today but don’t live in a community with access to trained specialists. And that is why we created Equip. We created Equip for the families that don’t live near a good treatment center. For families that can’t travel hundreds or thousands of miles to see an evidence-based provider. For parents that want their child to heal at home instead of being sent away. For patients that want to fit treatment into their life, instead of stopping their life to go to treatment. In 2019, before COVID was on our radar, we built the first collaborative-care, 100% telehealth, eating disorder treatment. We built Equip. We built Equip for your family.]]></content:encoded>
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            <title><![CDATA[What We Mean By "Building a Life Worth Living" in Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/building-a-life-worth-living-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/building-a-life-worth-living-eating-disorder-recovery</guid>
            <pubDate>Fri, 03 Feb 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[  I saw an Instagram Reel the other day that stopped me in my tracks. The video showed a pair of hands making a beautiful coffee drink, complete with cream, sugar, and chocolate, as text across the clip declared: “You cannot be the baddest b*tch if you are f*cking hungry. Eat something.” This statement, so bold and so simple, struck me to the core. As someone in recovery from anorexia, I’ve spent years—maybe decades—of my life being hungry. I floated through adolescence, college, and parts of my twenties as a ghost of myself, living a hazy half-life simply because I wasn’t eating enough. Of course, I had moments of joy and laughter, I accomplished things, I formed lifelong relationships; but, if I’m being completely honest, I was often only partly there. The rest of me was thinking about my body, or exercise, or, most often, food. I was hungry. I remember vividly one night in my senior year of college, when my boyfriend’s older brother came to visit. I loved his brother—he was a writer, I was a writer, we got along swimmingly—and my boyfriend had planned a fun evening for us to chat about post-college plans over nice beer. It would be fun, maybe even fruitful for my career. But, of course, my eating disorder thought differently: not only did this plan include beer with an unknown amount of calories and perhaps snacks I’d need to dodge, but it would also disrupt the ritualistic exercise and eating routines I had planned for the evening. When my boyfriend came to my dorm room, I lay still on my bed, letting him knock and knock at the locked door. When he eventually gave up, I peeked my head out and watched his crestfallen silhouette retreating down the hallway. Later, I texted to say I was sick, that I’d slept through his knocking. Maris Degener, Equip’s Director of Peer Mentorship, recounts an anecdote with echoes of my own from when she was struggling with an eating disorder. She’d just been asked to prom by a boy she liked, but her initial excitement was almost immediately replaced by dread. “There was a gathering for pictures and pizza before heading to the dance—I couldn’t even fathom how my peers would be able to eat pizza and not think about it all night long,” she recalls. “There was more food at the dance itself—food my eating disorder, again, couldn’t imagine eating without guilt or shame. And staying out late was of course a problem, since it would interrupt the rituals I had around exercise.” She spent the night hungry and irritable and had her mom pick her up early, just two hours into the night. “The eating disorder took what could have been a fun and exciting memory of teenagehood and made it one that I now look back on with a lot of sadness,” she says. “I wish I could have danced without caring about what time it was, and I wish I could have eaten the pizza and the cookies, and I wish I could have been kinder to someone who had invited me to share a memory with them.” Anyone who has struggled with an eating disorder has memories like this, examples of opportunities missed, of occasions both special and mundane ruined by their disease. For me, at least, I didn’t even realize how small my life was until I began to recover, to reclaim the space in my mind where the anorexia had been squatting for so long. This hijacking of one’s brain is characteristic of eating disorders. While many people associate eating disorders with certain observable behaviors, the cognitive and mental component can be even more oppressive. Indeed, people with eating disorders are almost universally preoccupied with thoughts about food, eating, body, and weight, and these thoughts limit their ability to truly think about anything else—their friends, a book, their life goals—let alone be present and participate fully in life. “Building a life worth living is what ultimately freed me from my eating disorder,” says Kristina Saffran, Equip’s co-founder and CEO. “Participating in treatment from home enabled me to make new friends in high school and act in the school play. When my family slowly started to hand back control of food, it was tempting to relapse, but I’d already built up enough good things in my life that I knew there were real consequences to relapsing. Recovery gave me back significant brain space to invest in people, ideas, hopes, and dreams far beyond the narrow confines of food and body.” That’s why, at Equip, we talk about “building a life worth living” through recovery. When the eating disorder goes away, the whole world opens, and you can reconnect with the things you love, the things that are meaningful to you, rather than scrambling every day to keep the eating disorder happy. You tear down the protective, confining walls of the eating disorder and allow in the full range of emotions—from exuberant joy to despair—that make us human and give life meaning. I look at my life today and see countless experiences that bring me great joy that simply wouldn’t be possible if the anorexia were still in control: cuddling in bed with my family on the weekends (the eating disorder would yell at me to get up and exercise); actually eating one of the cookies I bake with my daughter (the eating disorder would tell me to make hair-brained excuses and promise I’d eat one later); scouring my beloved collection of cookbooks to plan out a week’s worth of meals (the eating disorder would lead me to a sad online search for the lowest-calorie recipes I could pass off as normal meals). Today, that’s what a life worth living looks like for me. Here’s what it looks like for some other people on the Equip team: “Being able to enjoy food and eat what sounds good for you in the moment without having to think about it all the time. This in itself will allow you to be more present in the moment and in your life.” - Gaby Cohen, Registered Dietitian “A life that allows for a range of experiences; happy, sad, anxious, elated, unsure. My eating disorder forced me into a life of tight controls because I was so afraid of experiencing the range. Now my life is filled with so much variation and the freedom to be uncomfortable without collapsing into an anxiety spiral.” - Equip employee “Having food freedom so that you don't pass any of the ED food traits you used to partake in down to the children that you never thought were possible. Being able to focus more in the moment of life rather than thinking about how your body looks or what foods are going to be offered.” -Stephanie Kile, Registered Dietitian “When I was in treatment, I had a goal to be able to take care of a dog even though I couldn’t take care of myself. Now I have a dog, I am able to take care of her, and she has helped me access my values during times when it was difficult. She constantly reminds me why life is worth living, and has even been able to teach me about trusting my body. For me, she is ‘a life worth living’ personified.” -Kelsey Gilchriest, Peer Mentor “Being able to fully participate in all that life can offer you without holding back or having regret over missed opportunities. Feeling fully alive and filled with hope, purpose, and promise. Believing that you are worth it, and dearly loved.” - Equip employee “My life worth living allows me to live alongside all of my emotions and thoughts without being consumed by them.” -Equip employee “Building a life worth living means building a life where I don't need to use harmful coping mechanisms to make me feel okay. It means finding confidence and security in myself, and building my coping tools so that I can handle whatever my life throws at me. Recovery is so much more than stopping a behavior, it's also about fully connecting to the world, and turning my isolation into connection with others.” -Olly Millar, Clinical Operations Associate “Building a life worth living for me means doing all of the things I was scared of doing while living with my eating disorder. It means spending time with family members, signing up for art classes, traveling, dating, cooking, trying new foods, exploring new clothing styles, making new friends, and moving on with my life. During my last treatment stay I really focused on ‘enjoying the little things in life’—that was my mantra. I started to enjoy and take notice of all of the small things in life that my eating disorder made me numb to or kept me from.” -Equip employee “Building a life worth living means putting into action the things that will bring you closer to your goals, your dreams and your authentic self. Whether it's facing a fear food, finding new hobbies, taking time to rest, or taking a big leap like moving abroad, building a life worth living is reclaiming your life as your own, free from an eating disorder.” -Equip employee “To me, building a life worth living really describes the pillars I have put in place to help hold up my recovery. When I was in my eating disorder, it felt like that was the one life raft keeping me afloat. Recovery for me was setting up pillars that kept me anchored into recovery rather than floating away. Pillars like pursuing schooling I feel passionate about, friends, family and chosen family, meaningful work, and leaning into all the hobbies and passions that I authentically and shamelessly love.” - Jamie Drago, Peer Mentor “A life where I can invest in relationships, show up for myself, and show up for others. A life where I have a sense of purpose and am able to make meaning. A life where I'm able to be present with myself and others.” -Scout Silverstein, Senior Programming Lead For patients who go through treatment at Equip, we see them start to build a life worth living in different ways. Often, it begins as a look of happiness on their face—families often say that “the lights went back on” when describing their loved one’s recovery in real life—a revival of their sense of humor, an ability to participate in and enjoy the activities they used to love. It shows up in the joy of eating, of trying new and adventurous foods; it shows up as socializing with friends again, getting a part-time job, applying to college, becoming excited about the future. These stories of recovery are so important to tell.  A life worth living is different for everyone, but what matters is that it’s a life chosen by you and not by the eating disorder. For me, today, that meant happily accepting the syrupy bite of waffle my little girl forked toward my mouth while she ate her breakfast. Tomorrow, I’m not sure what it will mean—because, when an eating disorder stops ruling your life, the possibilities become infinite. Citations: Lydecker, Janet A et al. “Preoccupation in bulimia nervosa, binge-eating disorder, anorexia nervosa, and higher weight.” The International journal of eating disorders vol. 55,1 (2022): 76-84. doi:10.1002/eat.23630]]></content:encoded>
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            <title><![CDATA[If You Know Someone in the 2SLGBTQIA+ Community Who has an Eating Disorder, You’ll Want to Read This]]></title>
            <link>https://equip.health/articles/understanding-eds/lgbtqia-support</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/lgbtqia-support</guid>
            <pubDate>Thu, 23 Jun 2022 19:05:38 GMT</pubDate>
            <content:encoded><![CDATA[One thing we know about eating disorders is that members of the 2SLGBTQIA+ community face unique and significant social, cultural, and psychological challenges and may be more likely to develop eating disorders. “Queer folks receive messages on a daily basis that their bodies and core identities are unacceptable, unimportant, or at worst, repulsive,” says Equip therapist Carise Rotach. “Layer these messages with eating disorder thoughts — both internal and externally confirmed by society — and it can often feel like they are swimming upstream.” According to Rotach, while all members of the 2SLGBTQIA+ community are subject to some level of discrimination, BIPOC individuals have even more systemic odds stacked against them. “For BIPOC queer folks, eating disorders can go unnoticed, undiagnosed, or unacknowledged, but other triage safety issues take precedence,” she says. “Friends and family of queer-identified folks — particularly BIPOC queer folks — can do best by their loved ones by truly seeing all facets of the individual and encouraging full spectrum treatment.” “Some of the unique challenges that the BIPOC 2SLGBTQIA+ community face is having to go the journey of recovery alone,” adds Pita Meanata, Equip Peer Mentor. “Many people in the BIPOC queer folks have had to remove or distance themselves from their family units in order to protect themselves and in doing so miss out on some of the financial and emotional safety nets. So support from friends and family is incredibly crucial.” Equip therapist Lainy Clark says another unique challenge the 2SLGBTQIA+ community faces is the lack of research on prevalence rates, treatment strategies, and more. “Most data on eating disorders does not directly look at the experiences of 2SLGBTQIA+ identifying folks,” she says. “In light of this, friends and family can be so crucial to care and recovery simply because they know their loved one best. Their support sends the message that their loved one is worth fighting for and their life is worth living. With suicide rates highest in the 2SLGBTQIA+ community, knowing loved ones that affirm their identity and value of life is vital.” If you know a loved one is struggling with an eating disorder—or you suspect they may be suffering in silence—you may be at a loss for how to show support. While there are many factors that contribute to effective treatment and lasting recovery (including gender-affirming, queer-affirming, anti-racist care, according to Rotach), acting as an advocate for your loved one can have a tremendous impact. If you’re not sure where to start, here are what experts with professional and/or lived experience have to say about showing support for 2SLGBTQIA+ people when it comes to eating disorder treatment: Listen and ask questions before you act.  “The best way to show support is to listen and affirm,” Rotach says. “Use their identified pronouns. Use their name. Listen to their experiences and believe them when they indicate how the world views them. Don’t assume that everything is related to their queer identity but also don’t assume that what they are experiencing is outside of their queer identity. Let them tell their story and ask them how you can remove barriers to care for them.” Meanata agrees that it’s important to ask questions first. “I find it uncomfortable when people are trying so hard to connect with me by projecting what they think I might be into based on my identity, but are worried about saying the wrong thing. The energy is very palpable.” says Meanta. “You don't have to make assumptions, you can just ask. If you come in with the energy of wanting to connect, you are probably more likely to connect.” Be aware of the healthcare obstacles 2SLGBTQIA+ members often experience.  One essential component of successful treatment is gender-affirming care, which treats individuals holistically, supporting and affirming their gender identity when it conflicts with the gender they were assigned at birth. Unfortunately, this isn’t always available, affordable or accessible to those who need it. “Gender affirming care starts with a conversation with each person about what their pronouns are, what their identity is and what it means to them,” Clark says. “It involves being unassuming, curious, and open-minded. This is so important in the context of eating disorder recovery because we have to understand people as a whole person. Affirming care in general should include the journey each person experiences, the adversities they have faced, and the beliefs they have about themselves. When those in the healthcare world lack this piece, they lack a critical part of a person’s life and story that could contribute to their problem and their solution.” Equip peer mentor Alexander Thixton says that gender affirming care ideally does not involve automatic attribution or assumption of gender. “Patients are given space to freely question their gender without judgment and providers do not expect their patients to educate them on trans issues, and either come with an understanding of trans issues or are willing to learn on their own time,” Thixton explains. Know that trans people face distinct challenges in getting care.  Thixton says one particular issue to be aware of if you are supporting a trans person through their recovery journey is a phenomenon known as “trans broken arm syndrome,” which describes a scenario in which a trans person seeks medical care for something wholly unrelated to being trans yet the issue ends up being linked back to their gender journey. “This is a really common phenomenon, and sometimes ends up happening even to the most well-intentioned providers,” Thixton says. “I wish more providers knew how serious this can be because a lot of trans people do not want to go back to providers who are insensitive with regards to their trans status; this can lead to people being underdiagnosed and untreated, which is very dangerous, especially considering the prevalence of eating disorders in the trans community.” Equip peer mentor Ethan Lopez says finding competent medical professionals educated in 2SLGBTQIA+ issues can be a critical piece of the recovery process. “I wish more healthcare providers knew that being trans affects everyone’s recovery differently,” Lopez says. “For some it may be a key component in their relationship with their ED through gender dysphoria, but for others it may not even play a role.” Thixton adds that for trans people who do experience body image issues connected to gender dysphoria (which can be defined as distress or discomfort due to the misalignment between a person’s sex assigned at birth and gender identity), additional, intensive body image work may be necessary. “Support from friends and family can help the person in recovery feel affirmed in their gender, which can help greatly ease dysphoria,” Thixton says. “Support from friends and family also can help the person in recovery feel accepted as they are, and give them somewhere to go if they need someone who just ‘gets it’ to talk to.” Know that small actions can mean a lot.  “You can show your queer/2SLGBTQIA+ loved ones that you care by showing them that you are there for them throughout their recovery process,” Lopez says. “I loved receiving snail mail or handwritten letters that reminded me I was not alone in my struggle and I do have a support system of chosen family. I’ve kept every letter that my friends have written to me throughout the years and I like to read them when I’m feeling low.” Advocate for BIPOC individuals in the 2SLGBTQIA+ community and openly honor the origins of Pride.  Whether you are trying to support a specific person in your life or not, Rotach says it's imperative that we all do a better job of acknowledging BIPOC individuals within the 2SLGBTQIA+ community and making their experience visible. “Pride that is not centered on queer folks of color is ignoring the history of Pride in our communities,” Rotach says. “Pride started as a riot. A Black trans woman against systemic violence and oppression threw the first brick which lead to widespread visibility and acknowledgment of queerness in our communities. Queer folks of color continue to be the targets of anti-2SLGBTQIA+ legislation, violence, and erasure. We all do better when we all do better.” Whether you show your support with one of the tips listed here or you find your own way to demonstrate your advocacy and care, know that your presence can make all the difference in a loved one’s recovery. “A person with an eating disorder is consumed by an illness that likely steals their soul, their being, their joy, and potentially, their life,” Clark says. “They need a community that knows their loved one is still there, who remembers when their faces lit up with joy, and who won’t let go of the hand that is cuffed to an unforgiving ED.”]]></content:encoded>
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            <title><![CDATA[Can My Child Go to College During Eating Disorder Treatment? 12 Questions to Ask]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/deciding-on-college-during-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/deciding-on-college-during-eating-disorder-treatment</guid>
            <pubDate>Wed, 08 Mar 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[When J.D. Ouellette’s daughter was diagnosed with anorexia, she was a senior in high school. She and her husband pulled her out of school to complete a partial hospitalization program, but when the program was complete, they faced a choice: should she go to college as planned? Given how early they’d caught the eating disorder and how much hard work everyone had put in, they landed on a “yes” with the full support of their treatment team. “Her first semester she really did try so hard to do what she needed to do, and she was able to hang onto recovery by her fingernails,” recalls Ouellette, Equip’s Director of Lived Experience. “She relapsed at the beginning of second semester, and thankfully her roommates were immediately all about tough love: you call your parents or we will.” She left school for several months to resume treatment and solidify her recovery, and when she eventually returned to campus, things were different. “We were much wiser and used an accountability contract with frequent weight checks to keep things on track,” says Ouellette. “This was integral to her full healing.” Indeed, Ouellette’s daughter isn’t alone in her experience. A NEDA survey estimated that between 10-20% of young women and 4-10% of young men in college suffer from an eating disorder, and there’s been a significant increase in eating disorders among college students since the pandemic hit. When you look at the characteristics of the college experience, you can see why it might be challenging for those vulnerable to eating disorders: there’s sudden, newfound independence; an unfamiliar environment; an abundance of food choices and food-centered activities without parental guidance; social and academic stress; and the ubiquitous fear of the “Freshman 15,” among other harmful examples of diet culture. However, college can also be an enriching, positive experience, helping young people gain a greater sense of self, build lifelong relationships, and explore the possibilities for their future. Which direction it goes depends largely on where someone is in their recovery, making it essential that families are honest and intentional when they decide whether or not their loved one is ready. So how can you make that choice? Let’s get into it. Why is it so important that my child be well on the way to recovery before going to college? If someone has started their recovery journey and seems to be doing well, it might be tempting to go ahead with big life changes, like heading to college. They’re doing a great job, so shouldn’t they be rewarded with this opportunity? Couldn’t the challenge even help recovery? Unfortunately, both research and anecdote show that’s not the case. If a person isn’t stable in their recovery when they leave or step down from treatment, they’re much more vulnerable to relapse, especially when thrown into a high-risk setting like a college campus. For patients whose recovery involves weight gain, numerous studies show that leaving treatment before becoming fully weight restored increases risk of relapse. “What I didn’t really know in my bones until after her relapse is that sending your child to college when not in full, robust, long-term recovery is actually depriving them of the experience both you and they are envisioning,” Ouellette says. “It requires some recovery time under one’s belt to live a bit more effortlessly. To be able to say yes to midnight pizza in the dorm and road trips that require stocking on gas station snacks and sitting in a car without obsessing over whether you can get out and go on a run. To have a brain that’s free to learn and grow and build connections without valuable cognitive real estate being taken up by trying every day to do a very hard thing, on your own, in a very triggering environment where diet culture reigns, structure is largely absent, and food options may be challenging.” How to know if college is the right choice for recovery this year To decide whether or not your loved one is ready to go to college, Ouellette recommends thinking of their whole life, not just this chapter in it. While it may feel like college is the thing to do at this moment—because their peers are going, because it was the plan—opting out of that thinking frees you to truly prioritize recovery, which will enable your child to build a life worth living in the many years ahead. But even once you’re thinking of their life as a whole, you’re still left with making the ultimate decision: are they ready or not? Will college jeopardize their recovery, or enhance it? Ouellette, along with Jennifer Derenne, MD, Equip’s VP of Medical Care, and Gabriela Cohen, RD, Equip registered dietitian, shared 12 questions parents and family members should ask themselves when making this choice: Is your loved one medically stable? If there are any indicators of medical instability, like hydration concerns or an inability to maintain a stable weight range while at home, college is a risky choice. How long have they been medically and psychologically stable? While there’s no set amount of time in recovery for a young person to be ready to go to college, Ouellette encourages families to wait until their loved one has six full months of independence and weight maintenance. Says Derenne, “the longer the stability, the higher the level of success.” Do they have a relapse prevention plan? And if so, are they aligned with what it says and on board with a plan to track their recovery with objective measures? An accountability plan with frequent weight checks, like Ouellette put in place with her daughter, might be a smart choice. Are they aware of what triggers their eating disorders? When those triggers arise, are they comfortable reaching out for support and using coping skills? Are you suspecting any sneaky behaviors, like lying about food intake, hiding food, or engaging in compensatory behaviors? “Think about how they act after eating their fear foods,” advises Cohen. Are they able to plate meals and snacks for themselves using appropriate portions and without restricting any food groups? “I would highly recommend plating practice before transitioning to being on their own at college,” says Cohen. Can they eat freely and flexibly? Cohen emphasizes that it’s important for a young person going to college to be able to try new foods and eat in potentially challenging environments, like in restaurants, on the go, while traveling, and around other people. How is their time management and ability to prioritize recovery when life gets stressful? College comes with many academic and social demands, and it’s important for a young person to be able to put recovery first when things become hectic. “Think about current situations at home,” advises Cohen. “Are they able to still make time for meals and snacks while having to study for school or preparing for a special event?” Do they have a healthy relationship with exercise? This means being able to practice flexibility around their exercise routine, refueling properly after a workout, resting when necessary, and, as Ouellette puts it, pursuing “movement based on joy versus compensation for eating or compulsion to move.” Will they live alone or with a roommate? If it’s the former, who can you reach out to if you’re concerned? If it’s the latter, do you have their contact information and does your loved one agree to inform them about the situation? Will there be adequate medical and mental health services in place at college? Derenne points out that all schools are different in terms of medical and mental health services offered, making it important to suss out what support and resources your loved one will have while away at school, if any. What would be the logistics in the case of a medical or psychiatric emergency? Parents and families should think about how close the school is to a hospital, what the options are for transportation, and how long it would take a family member to get there if there were a problem. Being honest with yourself, answer the questions above and think about what your answers mean for the likelihood of your child maintaining their recover\y while at college. If their recovery is far enough along and the right support system is in place, college can be an exciting opportunity for them to gain independence and begin to build a life beyond their eating disorder. But if recovery is too fresh or the environment too challenging, college could be a major setback. “I caution against ‘magical thinking,’ or believing that things will improve away from home,” says Ouellette. “For most people, most of the time, the opposite is true.” Should my child be included in this decision? In an ideal world, the choice about whether or not to go to college would be made collaboratively as a family. Cohen points out that having the patient’s insight can be especially helpful when it comes to determining the type of support and check-ins they might need while away at school, and identifying red flags that might signal a need to come home. But in cases where the eating disorder brain still maintains control, parents need to take the reins. “At the end of the day, it really is a family decision, and we empower parents to lead that decision-making process with the support and consultation of their treatment team,” says Derenne. “With an adult patient, it’s always preferable to work collaboratively if possible. But if a young adult isn’t at a point where they’re able to make decisions to prioritize health and well-being, we encourage parents to step in and make that decision.” If you’ve decided that your loved one isn’t ready for college, it’s understandable for them to have big, negative feelings about that choice: anger, resentment, sadness, frustration. If this comes to pass, here are some strategies to hold strong in your decision while preserving your relationship and helping your loved one cope: Be firm and loving. “I’d encourage families to be firm and consistent while also being warm, hopeful, and understanding,” says Derenne. “It helps a lot for parents to validate the disappointment and frustration their child is likely to be experiencing.” Set clear expectations. Cohen advises making it clear what your loved one needs to achieve to show that they’re ready for college. “When those expectations are set, they can be motivating for the child to work toward and fight past recovery ambivalence,” she says. You can use the questions above to begin to draft a list of what needs to happen before college is an option.  Try to find a middle ground. While going away to college might not be possible at the moment, that doesn’t mean your loved one can’t participate at all. Can they take courses online? If the school is close, can they go part-time? Fill life with other things. Not going to college along with their peers can feel tremendously disappointing for young people, so it’s important to help them find other things to engage in and look forward to. Derenne advises that families work together to actively map out how to achieve their child’s goals, which could include things like volunteer efforts or taking an interesting class they might not otherwise consider. Making a decision like this is never easy—and it can be particularly hard when the choice you land on isn’t the one that your loved one wants. But in the end, prioritizing recovery will be well worth whatever disappointment and emotional challenges this season presents. “Your recovered child will understand and embrace this choice at some point, just not likely the day they learn they’re not going to go to school,” says Ouellette. “And that’s okay. We can do and survive hard things.”]]></content:encoded>
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            <title><![CDATA[How Can I Best Support Transgender Eating Disorder Patients? ]]></title>
            <link>https://equip.health/articles/understanding-eds/transgender-eating-disorder-patients-advice-for-providers</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/transgender-eating-disorder-patients-advice-for-providers</guid>
            <pubDate>Fri, 23 Jun 2023 17:04:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders don’t discriminate. They affect people across race, socioeconomic status, body size, sexual orientation, and gender identity—but the reality is that certain of these groups are more likely than others to develop an eating disorder. In particular, transgender and nonbinary folks face a mountain of risk factors, and eating disorder rates are significantly higher among these populations. Consider just some of these stats: Transgender college students report experiencing disordered eating at about four times the rate of their cisgender counterparts; transgender high school students are nearly three times as likely to restrict eating, nine times as likely to use diet pills, and seven times as likely to use laxatives to control their weight as their cisgender peers. And 32% of transgender people report using their eating disorder to modify their body without hormone replacement therapy. Given all this, it’s important for healthcare providers to be informed about eating disorders in transgender patients: how they might show up, the unique challenges trans patients face, their specific treatment needs, and more. Jessie Menzel (she/her), PhD, Equip’s VP of Program Development, answered some of the common questions providers have about eating disorders in transgender patients. Do eating disorders look different in transgender patients than they do in cisgender patients? If so, how? Are there particular signs to look out for? Eating disorder signs and symptoms are generally the same regardless of a person’s gender identity. However, eating disorders occur more frequently in transgender people. What’s different about eating disorders in trans folx is that often the eating disorder serves a very specific purpose for them: many trans folx use extreme weight- and shape-control behaviors out of a desire to achieve a physical state that’s more in line with their gender identity. For example, by losing weight to maintain a more boyish frame or to suppress puberty and the development of secondary sex characteristics. What are the risk factors that put transgender folks at increased risk of developing an eating disorder? 
Trans people are at increased risk for developing an eating disorder for many reasons. The first is because these individuals are the subject of a considerable amount of stigma and discrimination in our society. The increased stress that trans folx experience from living in communities that are non-accepting, non-affirming, and—at times—outright hostile or violent towards them places them at increased risk for developing mental health issues in general. Eating disorders, though, are a unique risk in this community because of the gender dysphoria that trans folx may experience. Gender dysphoria is the term used to describe the very significant stress that results from a discrepancy between a person’s gender identity and their assigned sex at birth. It should be noted, though, that not all transgender individuals experience gender dysphoria. Often, a patient may not be out yet or may not be open about struggling with their gender identity. Figuring out that piece—that the eating disorder may be a person's way of responding to their extreme discomfort with their body because of their gender identity—can be crucial for successful treatment. Are there certain questions I should ask if I’m concerned a transgender patient might be struggling with an eating disorder? All transgender patients should be screened for eating disorders. While not perfect, we can still use our current screening tools—like the SCOFF or the NIAS—to quickly assess for the presence of an eating disorder. In particular, if your patient experiences gender dysphoria, be curious and inquire about any attempts the patient has made to alter their body or resolve their gender dysphoria. Note that body image is an extremely complex issue in this community because of the double stress of living in a body that may not match one’s gender identity and the added stress of then having to live up to or match societal appearance standards for one’s gender identity. What barriers and challenges do transgender patients face when it comes to getting eating disorder diagnoses and treatment? Like many other marginalized communities, transgender individuals have faced significant hurdles and barriers to accessing care. Many of these people may be wary of seeking out help due to prior traumatic or stigmatizing encounters in healthcare and other settings. And more recently, legislative bans aimed at gender-affirming medical care may make it more difficult for trans folx to trust in healthcare establishments and seek out care. While not outwardly related to eating disorder care, research has shown that inability to access gender-affirming medical care—either as the result of legislative bans or lack of parental consent—is a major risk factor for development of an eating disorder in transgender individuals. Lack of access to this care may then significantly hinder successful treatment. Access to gender-affirming care is so important for trans folx because it provides an affirming and safe way for them to address their gender dysphoria (if present), embrace their identity, and live authentically. What kind of unique treatment needs do transgender patients have? What should I look out for when referring them to an eating disorder provider or program? It is incredibly important that both potential providers and treatment centers be inclusive of transgender individuals with respect to representation, training, and programming. If you’re seeking in-person treatment, look out for clinics and treatment settings that are gender-inclusive in terms of their restrooms, rooming policies, and program offerings. Some questions to ask: Does the provider or program have specific treatment approaches or programs for the trans community? Do they have providers or staff that have received specialized training in working with transgender patients or do they consult with outside specialists in gender affirming care? Significant experience with, knowledge of, or access to specialized supervision or training from folx who work with or are a part of this community will go a long way toward ensuring safe and effective treatment.]]></content:encoded>
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            <title><![CDATA[Understanding Insurance Coverage for Eating Disorder Treatment]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/insurance-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/insurance-eating-disorder-treatment</guid>
            <pubDate>Fri, 09 May 2025 18:44:12 GMT</pubDate>
            <content:encoded><![CDATA[When you or a loved one are struggling with an eating disorder, the last thing you want to do is navigate the convoluted world of health insurance. Unfortunately, confirming coverage is often necessary to get the care you need. The good news is that the landscape of insurance for eating disorder treatment is complex, but manageable—and by understanding it, you can make the process a lot less overwhelming. Let’s break down the main things to know, piece by piece. Understanding insurance coverage Eating disorders like anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED), and avoidant/restrictive food intake disorder (ARFID) require comprehensive, multidisciplinary treatment. This often includes medical care, therapy, nutritional support, and potentially work with other specialists. Whether this type of care is covered for you or your loved one can vary widely depending on factors such as: The type of plan: Commercial insurance, employer-sponsored plans, Medicaid, and Medicare each have different coverage options. The insurance product: Many companies offer different insurance products, such as HMO, PPO, EPO, and POS, and even within the same insurance company, coverage typically varies between these products. There may also be several levels of coverage—such as bronze, silver, gold, and platinum tiers—that generally determine how much you’ll be expected to pay out of pocket. State and federal laws: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires many insurers to provide mental health coverage—including eating disorder treatment—at the same level as medical coverage. Some states may also have their own laws mandating certain types of coverage. Medical necessity: Insurance companies often require a provider to demonstrate that treatment is “medically necessary” for a patient, based on specific criteria. The level of care: Coverage and cost of treatment can vary depending on whether treatment is inpatient, residential, partial hospitalization (PHP), intensive outpatient (IOP), or outpatient therapy. Why it's important to understand your specific insurance plan Since health insurance plans have different network coverage for eating disorder treatment, it's crucial to review and understand the details of your specific benefits. This can help you avoid headaches down the road, because you can: Find in-network providers. Knowing your specific plan and utilizing a provider directory on your insurance company's website will help you identify in-network providers who offer care with a lower out-of-pocket cost. You can also call the number on the back of your insurance card to get direct support from Member services in finding in-network providers. Avoid unexpected costs. By understanding your copays, deductibles, co-insurance, and out-of-pocket maximum, you can avoid surprise bills. Know your coverage limits. If you know your coverage limits—like the maximum number of visits you can have with a type of provider or if certain types of treatment aren't covered at all—you’ll be able to make informed choices about your care. Navigate complex processes. In some cases, you may need to go through an insurance company’s pre-authorization or appeals process. Understanding how that process works and what to expect can help you navigate these steps with confidence.  Does Medicaid cover eating disorder treatment? The answer (unfortunately) is, it depends. Because Medicaid is both a state and federally funded program, Medicaid eating disorder treatment coverage varies based on where you live. That means each state has its own standards as far as eligibility requirements for care, what services are covered, the duration of those services, and rates for services. Additionally, each state designates managed care organizations (MCOs) to deliver covered services to enrollees. You may be required to enroll in an MCO, or this may be voluntary. Either way, if you enroll, you work with the MCO to manage your care, so they can answer all of your questions about eating disorder treatment coverage, including which providers are in network and whether you need prior authorization. How to check Medicaid benefits If you have Medicaid, you’re probably familiar with the fact that it has many intricacies. The best way to gain clarity is by contacting your state’s Medicaid agency to understand your specific benefits for eating disorder treatment. Your state government will have a website that provides information specific to your area (select your state here). You can also call the member services number on the back of your Medicaid card to confirm your covered treatment options. For those who have MediCal (Medicaid in California), the California Healthcare Foundation offers helpful information on understanding that state’s unique programs. Navigating insurance for eating disorder treatment Health insurance companies typically provide several resources you can use to determine your coverage for eating disorder treatment and then find a provider or program that is in network. Contacting your insurance company The best way to understand what eating disorder treatment coverage you have is to contact your insurance company directly. You can call the member services number on the back of your insurance card, or search for services on your insurance’s online portal. Depending on your insurer, your mental health benefits may be managed by another company entirely (called a managed behavioral healthcare organization, or MBHO). When you contact your insurance about eating disorder treatment, they’ll be able to tell you if your mental health benefits are managed by an MBHO, and how to get in touch with them if so. To help you gain clarity on your eating disorder treatment benefits, we recommend asking the following questions: Do I have behavioral health benefits? If so, are those managed by my plan or by an MBHO? (This helps make sure you’re talking to the right person.) Are there any restrictions on covered diagnoses? Do I need a referral from my provider or from the health plan to pursue treatment? How much can I expect to pay for treatment? (Or ask how much of your deductible you have left to hit this year. This is how much you must pay out of pocket before your insurance will start paying.) Do you cover any virtual treatment options? Can you help me identify a high-quality, evidence-based eating disorder treatment provider? Also, if you have a specific type of provider in mind (such as a registered dietitian) or a specific provider or program you'd like to work with, you can ask if that type of service, provider, or program is covered. Finding in-network providers Generally, it’s easiest to work with in-network providers because this means lower out-of-pocket costs and less paperwork. There are two ways to find in-network providers: Call your member services number and speak to a representative. Before you make the call, know what type of provider you're looking for or, if you have it, the name(s) of any clinics, programs, or providers you're interested in using. Use the provider search tool on your insurance's website. You typically can search by things such as provider name or speciality, as well as the distance you're willing to travel to see them. The results should clearly identify if a provider is in network or out of network. Finding out if a specific provider is covered You may have heard wonderful things about a treatment center or therapist in your area and wonder if they're in network. Most of the time, you need to use your insurance company's provider search tool or call the member services number to figure this out. Contacting member services has the added bonus of potentially helping you get a rough estimate of your out-of-pocket costs. They can tell you how much deductible you still owe for the year, as well as your coinsurance, which is the percentage of the costs of covered services you'll pay once you hit your deductible (so if you have 30% coinsurance, and a covered service costs $100, you’ll pay $30). Once you know that information, member services can explain your copay for outpatient office visits, inpatient treatment, virtual care, or any other form of eating disorder treatment. However, you should always check these with the provider or clinic. If you're interested in Equip treatment, you can use our insurance screener to see if we're in-network with your plan. Prior authorization and coverage limitations As if deductibles, coinsurance, and finding a quality provider who's in network aren't enough things to think about, sometimes insurance companies require prior authorization or set coverage limitations. But don’t worry, we can break down these elements into understandable pieces, too. Understanding prior authorization Prior authorization (sometimes called preauthorization) is when an insurance company requires your medical provider to submit a formal request and receive permission from your insurance company before it will cover the service. Most of the time, this means your chosen healthcare provider (or you) need to submit specific clinical information showing that the care you seek is medically necessary. Even after your healthcare provider submits their paperwork, your insurance company may deny the request. In some instances, they may explain what additional information is needed to approve the request. All of this takes time, which can further delay treatment. Your best bet for navigating prior authorization is to contact the healthcare provider you wish to see as soon as possible and ask what their prior authorization requirements are. They can tell you what, if any, documents they need from you and also how involved you need to be. You can always contact them as well as your insurance company for updates during this process. Equip also does our best to make prior authorization easy. Our dedicated utilization management team requests prior authorization directly from insurance companies when required.  Dealing with coverage denials If your insurance provider denies coverage for eating disorder treatment, they'll send a letter explaining why your prior authorization request was denied. Read this carefully, because it should detail the appeals process. Many times, your insurance will ask for additional documentation to support your request. You may also be able to have your healthcare provider write a letter or call your insurance company directly to advocate for your care. Extending insurance coverage In some cases, coverage for treatment ends before a patient has achieved full recovery. This can happen for a variety of different reasons. Sometimes insurers may completely end coverage, while others may require that a patient steps down to a lower level of care. Unfortunately, research shows stepping down before a patient is ready (particularly if they haven’t reached their target BMI) can increase relapse rates—which is why it’s important to try to stay in the appropriate treatment for as long as you or your loved one needs it. The good news is that payors are often open to extending coverage if they see that it will benefit their members. If you find yourself in this situation, know that you have options. You can ask your medical provider to explain the need for continued care, or appeal directly to the insurance company, providing clinical justification for extended coverage. Financial assistance and additional resources Even if you have insurance benefits, eating disorder treatment can often be expensive—this is for a few reasons, including the fact that it requires a team of specialists and is generally a matter of months (or even years) rather than days or weeks. But this shouldn't keep anyone from seeking and accessing care. Eating disorders are serious illnesses, and they do not go away on their own. The sooner you or your loved one receive treatment and the more comprehensive that treatment is, the better your outcomes. And if it turns out that your out-of-pocket costs will be more than you can manage, know that there is help available to pay for care. First, some healthcare providers offer payment plans. For example, Equip offers no-interest payment plans and has financial counselors available to help you navigate those options. Others offer scholarships, often based on the individual's need. Ask your chosen provider if they have similar types of assistance. Second, some organizations offer financial assistance for eating disorder treatment. These include: Project HEAL. Project HEAL provides a one-time grant to individuals who demonstrate that they need financial assistance to access the care they need. Moonshadow's Spirit. This organization offers need-based financial aid to those seeking treatment at residential facilities or partial hospitalization programs. When applying for any type of financial aid, be sure to follow the organization's directions, which typically ask for proof of your financial resources as well as for information about your diagnosis and recommended treatment. If you have any questions while filling out an application, contact the organization directly. Equip is committed to making treatment accessible Battling an eating disorder takes a lot of patience and grit—and you may find yourself needing that same resolve while navigating your health insurance plan. Through it all, remember that recovery is possible, and it’s worth fighting for. At Equip, we firmly believe that everyone struggling with an eating disorder should have access to evidence-based care that works, and that finances shouldn’t be a barrier to treatment. Our goal is to be in-network with as many health plans as possible, and we are focused on making this a reality. Equip is currently in-network with most private insurance plans and a growing number of Medicaid plans. Equip's overall mission is to provide access to quality eating disorder treatment for as many Americans as possible, so that anyone living with an eating disorder has access to cost-effective treatment that works. Navigating insurance with confidence Insurance can be incredibly confusing, but don't be scared away if you have questions or don't understand something. Whether you have private insurance, an employer-sponsored plan, Medicaid, or Medicare, calling the member services number on the back of your card can be a huge help in learning what eating disorder treatment benefits you have. Additionally, many healthcare providers, such as Equip, offer financial assistance and have dedicated team members to answer your questions about the cost of care or if your insurance denies a claim. Lean on this support and don't hesitate to advocate for your or your loved one's needs. The sooner they get care, and the more comprehensive that care, the better. If you want to understand your insurance coverage at Equip, you can use our insurance screener or schedule a call with a team member, who will confirm your benefits. FAQs Does Medicaid cover eating disorder treatment? Generally speaking, yes. Medicaid is required to provide mental health coverage that's comparable to the coverage they offer for other medical conditions. Since eating disorders are mental health illnesses, treatment must be covered by Medicaid. However, the exact coverage options vary from state to state. How can I find out if my insurance covers eating disorder treatment? The best way to find out if you have eating disorder treatment insurance coverage is to call the member services number on the back of your insurance card and ask about your behavioral health benefits. If you’re interested in Equip treatment, you can use our insurance screener to confirm your coverage. What is prior authorization, and how does it affect my treatment? Prior authorization is when an insurance company requires a patient to get approval for care before they can access that service. Most of the time, this means your chosen healthcare provider (or you) need to submit specific clinical information showing that the care you seek is medically necessary. Getting prior authorization takes time, which can delay treatment. And if your insurance provider denies coverage, you need to decide whether to appeal or pay out of pocket. What can I do if my insurance denies coverage for eating disorder treatment? If your insurance denies coverage for eating disorder treatment, you can appeal. Check the denial letter, which should explain what additional documentation you need to submit. You may also want to ask your healthcare provider to write a letter to your insurance company explaining why the treatment is medically necessary, or see if they'll talk to the medical director at your insurance company (this is called a peer-to-peer review). Are there financial assistance programs for eating disorder treatment? Yes. Two organizations that offer financial assistance for accessing eating disorder treatment are Project HEAL and Moonshadow's Spirit. Additionally, several healthcare providers offer payment plans or scholarships. Equip offers no-interest payment plans. How can I find in-network providers for eating disorder treatment? You can find in-network providers for eating disorder treatment by visiting your insurance provider's website. Most have a provider search tool, where you can search by things such as provider name or speciality, as well as distance from where you live. You can also call the member services number on your insurance card to find in-network providers.
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            <title><![CDATA[Can Exercise Be a Healthy Part of Eating Disorder Recovery? ]]></title>
            <link>https://equip.health/articles/food-and-fitness/exercise-during-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/exercise-during-eating-disorder-treatment</guid>
            <pubDate>Wed, 03 Dec 2025 18:33:00 GMT</pubDate>
            <content:encoded><![CDATA[Exercise was a massive part of my eating disorder. It shifted quickly from something that was a leisurely and fun part of my life to an extremely compulsive and dangerous numbing mechanism. My relationship to exercise got hijacked by my eating disorder, and I used it as a way to survive difficult experiences and emotions—a pattern that I commonly see among my patients as an eating disorder dietitian. In fact, a 2025 study of over 21,000 participants with eating disorders showed that about half of them were participating in excessive exercise. So, is it possible to incorporate exercise into eating disorder recovery, even when it’s so closely intertwined with the eating disorder’s rules and values? The answer isn’t black-and-white and carries a significant amount of nuance (like most matters in the eating disorder world). Today, we’ll look at the benefits and risks of incorporating exercise into recovery, some ways to know whether you or your loved one is ready for movement, and how to reintroduce exercise in a safe way. What are the benefits of incorporating exercise into eating disorder recovery? Traditionally, exercise has been something that’s left out of the treatment conversation, something that’s meant for later, when full recovery is reached. However, recent research shows that—when implemented carefully and appropriately—exercise can be a useful tool that enhances recovery and offers mental and physical benefits throughout the course of their recovery processes. Some of those benefits include: Improved physical strength, better mental health, and decreased eating disorder behaviors One 2023 review of studies showed that thoughtfully supervised and adapted physical activity during eating disorder treatment can benefit those in recovery, especially when the focus shifts from compensatory and weight-control motives to functional and health motives—in other words, exercising to improve strength or balance, for example, rather than to lose weight or change how your body looks. The review showed that for people in treatment for anorexia or bulimia, carefully integrating movement into treatment had neutral or positive effects, like increased physical fitness and decreased compulsive exercise. Another 2022 review showed that including closely monitored and individualized exercise therapy can be safe in treatment, and could have benefits for muscular strength, mental health, and reducing disordered exercise symptoms in those with anorexia. “Exercise can have positive effects on mental health, like stress relief and mood regulation,” explains Equip therapist Jalia Henry, MA, LMFT. Both reviews found no evidence that integrating exercise into treatment is harmful to eating disorder patients. More research from 2025 found that incorporating exercise (particularly resistance training) into eating disorder recovery while under the supervision of a multidisciplinary team is linked to improved muscular strength and body composition (muscle and bone mass). It also led to better relationships with exercise, helping patients shift their focus toward healthy goals like building strength, and away from the eating disorder’s focus on weight loss or control. According to the Safe Exercise Guideline at Every Stage (SEES) guidelines, which were created by leading eating disorder experts, appropriately and intentionally implemented exercise can help achieve positive outcomes, like improved eating-disorder symptomatology, general psychological well-being, cardiac functioning and musculoskeletal health, and increased adherence to meal-plans and treatment. Embodiment, body appreciation, and joy Movement can also help people connect with and appreciate their body, a huge shift after living with the disconnection and judgment that comes with an eating disorder. “Movement or exercise allows us to connect to our bodies and relearn how to be present in them without self-criticism,” says dietitian Ana Pruteanu. Additionally, it can help improve body image. Research suggests that mindfulness-based activities such as yoga can support healthier body relationships. For example, a 2019 study of college students reported that practicing yoga was associated with better body image, greater appreciation for their bodies, increased self-compassion, and reduced preoccupation with physical appearance. “To move from a negative body image space to a more neutral space, we need to be able to tolerate being in our bodies and movement can help with this,” Pruteanu explains. Finally, movement can be a source of joy when it’s approached from a healthy place. Joyful movement, which is one of the ten intuitive eating principles, is about focusing on how your body feels instead of how it looks, how many calories you’re burning, or how it will affect your body shape or size. It’s about moving in ways you enjoy and that enhance your well-being, and for reasons outside of appearance or emotional numbing—like feeling empowered, connecting with nature, or other goals that have nothing to do with changing the body. “Movement can also help athletes rediscover joy in their sport apart from appearance or performance outcomes,” says dietitian Korrinna Kelly, RDN. “The key is ensuring it’s done for self-care, not self-control.” What are the risks of incorporating exercise into eating disorder recovery? While it’s often helpful to integrate exercise into the recovery process, there are risks to consider. First, it can exacerbate malnutrition. If you or your loved one aren’t consuming enough food to support the body’s energy needs, engaging in exercise can severely compromise medical status. “There’s an increased risk of stress fractures and bone loss, loss of regular menstrual cycles and potential fertility impairment, and deterioration of organ function, including potential heart, kidney, and liver damage,” Henry explains. According to the SEES guidelines, exercise may not be healthful or safe for all people with eating disorders, especially those who are medically compromised (e.g. experiencing cardiovascular issues or electrolyte abnormalities). “Exercising during this time puts additional strain on the body and can cause further harm,” Pruteanu cautions. The other major risk is making the eating disorder worse, especially if it’s not approached intentionally, at a pace that matches recovery progress, and with professional guidance. If exercise is introduced too quickly or intensely, or without parameters or supervision, it can make the eating disorder even stronger than before. For example, one of my clients noticed urges to restrict food got stronger when she started exercising without guidance after being in recovery for a short time. In my recovery efforts, I noticed that if I exercised in the same ways and amounts that I did when my eating disorder was at its worst, it was a slippery slope back into its grips. “Exercise can easily become a disguised form of the eating disorder if it’s reintroduced too soon or without the right support,” Kelly says. "Psychologically, it can reinforce compulsive behaviors, guilt, or ‘earning food’ mentalities if those thought patterns haven’t yet been addressed.” Even mindfulness-based exercise like yoga can cause issues if it’s approached inappropriately or prematurely: in a 2021 study that examined eating disorder providers’ thoughts on yoga, they agreed that higher intensity practices (like power and hot yoga) can be especially detrimental and sometimes dangerous to people with eating disorders who are early in recovery or medically unstable (or both). How can I know if it’s okay to resume exercise? Now that you know the benefits and risks of exercise in recovery, take some time to consider your or your loved one’s unique circumstances to determine whether or not it’s safe to start exercise. “Readiness to resume movement depends on nutritional stability, medical stability and behavioral readiness,” Henry emphasizes. Start by answering these questions: Are you/your loved one medically stable (e.g. vital signs and labs are within healthy ranges)? Are you/your loved one consuming enough additional calories to support the increased demand from exercise (on top of your baseline and recovery energy needs)? Do your healthcare providers agree that you/your loved one are well enough to exercise? If you answered “yes” to the above questions, it’s a good sign you may be ready to return to exercise. But if you answered “no” to any of them, it’s likely you still need more time before resuming movement beyond activities like stretching or restorative yoga (more on that later). All three questions are important—if you don’t feel confident about any of them, it’s probably best to hold off for now. “Being medically cleared to resume exercise is one of the first steps,” Pruteanu says. “In addition to that, the person needs to be willing to fuel their body for whatever exercise they want to incorporate, meaning they need to be willing to eat more than their baseline eating.” If all of those fundamental questions are a yes, it’s helpful to ask a few additional questions that probe more deeply at the mental and physical impact movement might have. Ask yourself (or your loved one): Does movement cause physical pain? Is your/your loved one’s desire for movement driven primarily by a desire to change body size/shape? Does exercise feel compulsive and rigid? Does exercise increase mental distress or preoccupation with body size or weight? If you answered “no” to the above questions, you might be ready for exercise, but if you answered “yes” to any, it’s likely you’re not there yet. Henry says it’s time to pause exercise if you’re doing any of the following: working out in secret; lying about the frequency, duration, or intensity of workouts; using external metrics like calories burned or time spent to dictate food intake, mood, or self worth; experiencing intense anxiety, guilt, or distress if you miss a workout. “Additionally, if you’re prioritizing exercise over essential recovery activities, such as eating breakfast, therapy appointments, or social commitments, it’s time to take a step back from exercise,” she says. Best practices for incorporating exercise into recovery Since everyone’s eating disorder recovery process is unique, whether exercise needs to be a part of yours (or your loved one’s) is up to you and your treatment team. If you’re interested in incorporating exercise into your recovery, here are some rules of thumb to consider: Go at a slow pace It’s best to start with gentle movement like walking, stretching, or restorative yoga. The SEES framework and guidelines is a helpful, evidence-based tool that lays out exercise readiness in recovery, based on physical and mental health symptoms and recovery status. While it was created for clinicians to guide exercise recommendations, it can be a helpful tool to understand how and when to increase exercise intensity and duration, and reference alongside your treatment team. Equip developed the Staged Approach for Exercise Reintroduction (SAFER) protocol, which is based on the SEES framework and helps patients safely and gradually return to exercise in a way that supports long-term recovery. Work closely with a healthcare team As the research suggests, having the guidance and support (and sometimes supervision, depending on your medical status) of a multidisciplinary team will help protect recovery and transform your or your loved one’s relationship to movement. This team should generally include an eating disorder dietitian, a therapist, and a medical provider. An eating disorder-informed dietitian is particularly important, as they will help ensure that you’re adequately fueling your workout. “Talk to your dietitian about what fueling can look like based on your personal needs,” Pruteanu encourages. Choose something different “Start with forms of exercise that in the past have not been tied with the eating disorder,” Pruteanu says. “For example, if running was at one point part of the eating disorder, try rollerblading or swimming instead.” You may be able to go back to running in a healthy way later. Focus on how movement feels Before, during, and after exercise, take note (mentally or in a journal) of how you feel physically, emotionally, and mentally. Taking inventory regularly will help keep you accountable and your relationship to exercise genuine and healthy, and you can notice any harmful patterns, like exercising when you feel sick or tired. Keep connecting with your “why” Regularly check in with yourself and make sure your reasons for exercising are in alignment with your authentic core values. “Be mindful of your reasons for wanting to exercise and how your approach may be changing,” Pruteanu suggests. Take a break when necessary  If you notice the eating disorder taking over before, during, or after movement, pump the brakes and reassess with yourself and your team. “It is ok to pause and restart if it doesn’t feel good,” Pruteanu adds. Find what brings you joy To reclaim exercise from my eating disorder and develop a healthy relationship to it, I had to get honest with myself about which forms of movement brought me joy, and make a commitment to leave any disordered exercise behaviors behind. Now, my movement practice helps me celebrate my body and connect with nature and loved ones, rather than adhering to an illness’s rigid rules. Take some time to consider which types of movements and ways of doing them you truly enjoy, and if you’re not sure, consider how you loved moving as a kid—that’s always a genuine place to start. As an eating disorder dietitian living in full recovery, I believe that anyone with an eating disorder that has hijacked their relationship to exercise can reclaim it, and—with the right support, guidance, and intentions—experience a vibrant and joyful movement practice.]]></content:encoded>
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            <title><![CDATA[Why Breakfast Is So Important During Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/food-and-fitness/importance-of-breakfast-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/importance-of-breakfast-eating-disorder-recovery</guid>
            <pubDate>Wed, 18 Feb 2026 01:01:00 GMT</pubDate>
            <content:encoded><![CDATA[The phrase “Breakfast is the most important meal of the day” has been spoken in the U.S. for more than 100 years, since Kellogg’s first used it as a marketing slogan to get people to eat more cereal. As a dietitian, I’m often skeptical of food marketing ploys, but this time, I agree. Breakfast is important—eating breakfast leads to better focus, mood, and energy throughout the day, and it’s also linked to decreased risk of diseases like diabetes and hypertension, according to research from 2021. That’s not to say that the rest of your meals and snacks aren’t also important (they absolutely are), but breakfast plays a unique role, helping you break the fast from your night’s sleep and laying the foundation for your day ahead. In eating disorder recovery, the importance of breakfast is even greater, as it can help you reconnect with your body and meet recovery goals. However, breakfast is often one of the most difficult mealtimes for those with eating disorders. So, today we’ll look at why that is, delve deeper into why it’s critical to eat breakfast during recovery, and explore strategies from dietitians to help make it easier. Why breakfast is so hard for those with eating disorders All mealtimes can feel like a battleground in eating disorder recovery, but breakfast can sometimes feel especially challenging. “Not having strong hunger cues combined with a fear or trouble with eating in general makes breakfast more of a chore than an act of self-care,” says dietitian Jessica Villalvir, MS, RDN. “Mental and physical effort is necessary for a breakfast meal to happen, and often, it can feel easier to skip breakfast entirely.” We’ll take a closer look at the different reasons why breakfast can feel tough in recovery: Hunger and fullness cues might be suppressed Eating disorders often cause hunger and fullness hormones (called ghrelin and leptin) to go haywire, which makes it difficult to feel your body’s cues. When you’re affected by an eating disorder, it’s often especially hard to eat a meal when you’re not feeling hunger, especially in the morning. “Breakfast can be a particularly difficult time to recognize hunger, because the body is already in a fasting state from sleeping,” Villalvir explains. Then, the eating disorder brain will often try to use lack of hunger as a reason to skip or restrict breakfast.  There might be negative associations Research from 2023 shows that mealtime obstacles in eating disorder recovery include disordered ideas about “healthy” or “unhealthy” foods. Many classic breakfast foods, like bagels with cream cheese, pancakes and waffles with syrup, bread with butter, and bacon and sausage are typically (yet wrongfully) vilified by diet culture and are placed off limits by the eating disorder brain. In recovery, it can feel extremely difficult to start incorporating such fear foods, because the eating disorder makes them feel dangerous and threatening.  Additionally, dietitian Elizabeth Harris, MS, RDN says people struggling with eating disorders might associate eating breakfast with other factors that threaten the eating disorder, like increasing food intake, weight gain, or eating certain demonized food groups (like carbs). The eating disorder voice could be louder at first Mornings can be a vulnerable time. In my own recovery, I remember feeling like eating breakfast was “failing” at the beginning of the day, according to my eating disorder. If I listened to that eating disorder voice and skipped breakfast, it was then much harder to honor my recovery throughout the rest of the day. Many of my clients have also said they’re more likely to restrict meals and snacks later in the day if they started out skipping breakfast—like the eating disorder gets the power first thing in the morning, and then gets to keep it. The eating disorder brain might also tell you that you haven’t had time to “earn” breakfast yet, either through exercise, restriction, or some other accomplishment that makes you “worthy” of eating. It’s also common for the eating disorder to convince you that you’re too busy to eat in the morning, and getting to school or work becomes an excuse not to eat breakfast. Although such thoughts and explanations are wrong and unscientific, the eating disorder brain can be very loud and convincing. It’s like having a bully sitting with you at the table, trying to convince you of all the reasons why you’re a loser if you eat your pancakes. Emotions might be more difficult in the morning In my practice, many of my clients have found mornings to feel overwhelming and daunting with their entire days ahead of them. Plus, research from 2024 shows that some people may experience higher depressive and anxious moods in the mornings than other parts of the day. Such hard emotions can make restricting breakfast feel tempting, since restriction can temporarily bring numbing and distraction. There may be a lack of safety or time Some people in recovery may feel a lack of safety in the environment where they’re trying to eat their breakfasts. For example, one of my clients needed to eat breakfast at school alone, which felt unsafe for her nervous system. It wasn’t until she asked a friend to join her in a trusted teacher’s classroom that she was able to eat breakfast on a regular basis, because she felt comforted, connected, and supported by her friend and teacher. Additionally, it can feel too stressful and hurried to eat breakfast if there’s not enough time built into the morning. The importance of breakfast—especially in recovery Eating breakfast regularly is essential to feel your best, whether you’re in eating disorder recovery or not. “When your alarm goes off, your blood sugar—which powers your muscles and brain—is often at its lowest, and breakfast swoops in to replenish it and kick your energy level into high gear,” explains Equip lead dietitian Tanya Hargrave-Klein, MS, RDN. “Think of breakfast as your first shot at hitting all those essential vitamin, mineral, and nutrient goals for the day. Skip it, and you're fighting an uphill battle to get what your body needs before bedtime.” Villalvir adds that without breakfast, “you might feel extra exhausted and sleepy, and have brain fog and difficulty concentrating.” These are compelling reasons for anyone to eat breakfast. However, breakfast becomes even more vital when you’re healing from an eating disorder. Here’s why: Regular eating schedules help restore hunger cues and nutrient status Although eating disorders can disrupt hunger and fullness hormones, eating meals regularly (including breakfast) can fortunately help regulate hormones and reconnect you to your body’s signals. This can sometimes feel scary at first, but ultimately helps make eating in general much easier. Additionally, eating breakfast daily will help you meet your energy and nutrient needs and protect your recovery. “Skipping breakfast can easily lower your total daily food intake, creating an energy deficit,” says Hargrave-Klein. “That alone can be enough to reactivate the eating disorder.” Having breakfast can also support weight restoration, which is often necessary to reach full recovery. Eating breakfast makes it easier to choose recovery later It can sometimes feel difficult to choose recovery later in the day if you restricted or skipped breakfast earlier. “In recovery, breakfast is even more important because you are learning to build trust and safety with food and yourself,” Villalvir explains. “If you miss breakfast, it makes it harder to apply the skills and tools you’re learning in recovery and easier to fall back on old coping strategies.” Once you’ve nourished yourself at the start of your day, you’ve already weakened the eating disorder’s control over timing and permission to eat and increased your chances of making recovery-aligned decisions (like using a healthy coping tool instead of restricting) later. Having breakfast can support your mental and emotional well-being One 2024 research analysis suggests that people who routinely miss breakfast may have a heightened risk of depression and poorer concentration, and people who regularly eat it might have better mood and cognitive skills. Another study from 2025 shows skipping breakfast may be linked to lower mood and difficulties in young people, and lack of focus could be part of the reason. Since eating breakfast can contribute to a more stable mental and emotional state, it can also make eating disorder recovery feel a bit more attainable—it’s easier to journal, breathe, call a friend, or use another coping skill when you’re feeling more stable. It promotes stability and structure for the day ahead Starting your day with an adequate and balanced meal (including carbs, fats, and proteins) supports blood sugar regulation (which contributes to more sustained energy throughout the day) and increased physical, mental, and emotional stability. One 2025 study of teen girls showed that eating breakfast improves blood sugar stability later in the day, when compared to skipping it. “In recovery, it’s important to establish a regular eating schedule, usually with three meals and two or three snacks per day, to provide a routine and structure around meals. This helps let your body know that food is available,” Harris says. She explains that integrating breakfast into your routine makes it less likely you’ll feel out of control around food at future meals, since your body won’t be in a deprivation state. “For those recovering from binge eating disorder in particular, eating consistent, well-balanced meals throughout the day, including breakfast, can help minimize binges later,” Harris adds. Expert-backed tips to start eating breakfast in recovery Now that we’ve covered the importance of breakfast in eating disorder recovery, here are some dietitian-backed strategies to help get you started: Lean on mechanical eating if you don’t feel morning hunger Mechanical eating, or eating by the clock, can be a helpful tool when you’re in the process of reconnecting to your body’s hunger cues. Hargrave-Klein recommends establishing a schedule: “Maintain a regular sleep and wake time so that breakfast occurs at the same time daily, making it a predictable part of your routine,” she says. Harris suggests setting an alarm to eat breakfast, just in case you need the external reminder. Plan and prep ahead of time If it feels hard to put meals together in the morning when you’re not feeling hungry, make it easier on yourself by taking a little time to meal prep ahead of time. “Prepare a larger batch of safe meals that can be grab-and-go,” Villalvir says. “This eliminates the need to think first thing in the morning before your brain is nourished.” However, if planning also feels like too much, Hargrave-Klein recommends leaning on convenient options like breakfast bars, smoothies, and last night’s dinner leftovers. Work with a non-diet eating disorder dietitian “It can be really helpful to meet with a dietitian who can help you identify and plan well-balanced meals that meet your energy and nutrient needs,” Harris says. One 2025 review shows that purposefully including meals and foods that people with eating disorders often avoid (like breakfast and breakfast foods) and working through them with support can be helpful. Your dietitian can help you come up with breakfast ideas that feel realistic for you to eat on a regular basis, and address any obstacles or self-destructive patterns that get in the way at breakfast time. Your dietitian may also eat breakfast with you (either in-person or virtually), and help you identify and challenge disordered beliefs from your eating disorder brain that get in the way of breakfast. Have your coping tools ready to go first thing Since the eating disorder brain can be quite the breakfast bully, it’s a good idea to have your go-to coping skills top of mind. Sometimes, journaling before or during breakfast can help, especially if you’re noticing loud eating disorder thoughts and difficult emotions. You can use a food journaling app like Recovery Record or a physical journal to write down what’s happening inside. Or, if distraction feels more supportive, try listening to a favorite song, reading a book, or watching your favorite morning show. Simple mindfulness techniques can also help make eating breakfast feel a bit easier, especially if you’re feeling anxious and overwhelmed. For example, you can try a few rounds of an extended exhale breath, by breathing in to the count of four and out to the count of six. Perhaps you find it helpful to develop a self-compassionate statement about breakfast, like, “This is really difficult and I am capable of eating my breakfast today.” If you’re not sure which coping tools will help the most, come up with a breakfast coping toolkit with your therapist. Start with easier foods Because eating disorders can turn many breakfast foods into fear foods, Hargrave-Klein recommends starting with the foods that feel safest to you, and avoiding foods that currently feel more challenging. Harris adds that a nutrient-dense shake or smoothie can also be incorporated temporarily if eating breakfast feels impossible. Once you’re in a regular breakfast groove, you can start to incorporate foods that feel more difficult (which is best done with the support and guidance of a dietitian).  Help yourself feel safe enough to eat Take inventory of your internal and external environments at breakfast time. Ask yourself questions like: “Do I have enough support?” “Do I need more time?” “Do I have a peaceful atmosphere to eat in?” If you need more support, ask for help, whether it’s helping with preparing breakfast, eating together, or both. “Asking for help can be scary because you have to be vulnerable and rely on others, but taking the mental and physical load off breakfast will improve the chances of you eating,” Villalvir says. And Hargrave-Klein encourages eating the meal with a trusted support person, because it “can provide a helpful distraction, allowing you to focus on conversation rather than the act of eating.” Plus, a 2024 review shows that meal support may help improve eating disorder recovery outcomes. If you need more time built into your morning for breakfast, work with your dietitian or therapist to help you make those adjustments. Maybe you need to get up slightly earlier, or make a plan to eat breakfast at work or school. If your environment is chaotic in the mornings and it makes it harder to eat, make adjustments, like playing relaxing music, eating in a different location, having a pet nearby, or bringing a calming object to the table (like a cozy blanket, a photo of your best friend, an affirmation written out, or a soothing essential oil). Eating breakfast regularly is a necessary part of recovery, however several factors can make it difficult. “Remind yourself that what you’re doing is hard, and you are allowed to have feelings about stepping away from your eating disorder,” Villalvir encourages. By starting to eat breakfast daily, you’re providing your body and brain with the nutrients and energy they need to overcome your eating disorder and thrive. “You are doing what’s best for your body and mind in the moment,” Villalvir says. Keep in mind that each breakfast you eat, you’re feeding new neural pathways to show your body and brain that having breakfast is safe, and it might even feel enjoyable in the future. So, take it one day and one breakfast at a time, and trust that someday you’ll be eating your pancakes without a second thought.]]></content:encoded>
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            <title><![CDATA[Weight Loss Drugs Are Suddenly Everywhere. Here’s How Parents Can Handle It.]]></title>
            <link>https://equip.health/articles/news-and-research/weight-loss-drugs-ozempic-what-parents-can-do</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/weight-loss-drugs-ozempic-what-parents-can-do</guid>
            <pubDate>Tue, 04 Apr 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Let’s be real: our society has always valued thin bodies more than larger ones. But in recent years, with the rise of body positivity and other movements that challenged the thin ideal, it seemed like we were taking collective steps in the right direction. Over the past few months, however, there have been some huge strides backward. In January, the American Academy of Pediatrics issued new and controversial guidelines recommending weight loss drugs to kids as young as 12 and weight loss surgery for those just one year older. At the same time, headlines started being dominated by Ozempic, a diabetes medication that’s surged in popularity as a weight loss drug. The backdrop of it all is the return of the thin worship and heroin-chic aesthetic that characterized the 90s. It’s overwhelming for anyone with a body, but all of these cultural shifts can be particularly worrisome for parents and their young children. How can you protect your kids from the bombardment of messages telling them their bodies aren’t good enough? Several Equip experts weighed in on what to say and do to push back and help kids and teens build the resilience that will ward off struggles with self-esteem, body image, or even a full-blown eating disorder. How did we get here in the first place? First up, Ozempic. Ozempic is a brand name for semaglutide—which is also sold under the names Wegovy and Rybelsus—a drug developed in 2012 to treat type 2 diabetes. Semaglutide increases the secretion of insulin, which lowers blood sugar levels. This is crucial for people with diabetes, but for those who don’t have diabetes, it has the effect of reducing appetite by slowing down digestion in the stomach. It also causes gastrointestinal side effects like nausea, vomiting, diarrhea, and constipation. All of this makes food less appealing, driving people to eat less. In 2021, the FDA approved a high-dose version of semaglutide for weight loss under the brand name Wegovy (Ozempic hasn’t yet been approved for weight loss and is currently being used by many off-label). It was approved for adults with ob*sity or excess weight and at least one “weight-related condition,” such as high blood pressure, type 2 diabetes, or high cholesterol. In the past year or so, semaglutide-based drugs like Ozempic and Wegovy surged in popularity as celebrities and influencers have started taking them to lose significant amounts of weight in short amounts of time. At the time I’m writing this, the #ozempic hashtag has been viewed over 700 million times on TikTok. Then, in 2022, the FDA approved Wegovy for weight loss in kids as young as 12. The press release from Novo Nordisk, the maker of Wegovy, notes that it is approved for use in adolescents with a BMI at or above the 95th percentile. Just weeks after this approval, the AAP came out with new guidelines for treating obesity for the first time in 15 years. In the guidelines, the AAP—the largest professional association of pediatricians in the U.S.—recommended weight loss medication (like Wegovy) for children as young as 12 and bariatric surgery for children 13 and older. For some children with a certain genetic condition, weight loss drugs were recommended as young as six. (Read our statement on the AAP guidelines.) Shannon Walding, a therapist at Equip, likens today’s current obsession with weight loss drugs to the popularity of Fen-Phen (fenflurmine-phentermine, a weight loss drug in the 80s and 90s eventually taken off the market because it caused cardiovascular issues). “But this time, the stakes are much higher, with the AAP recommending weight loss drugs to children as young as six and weight loss surgery to those as young as 13,” Walding says. “Eating disorder treatment professionals have been loudly ringing alarm bells about the damage these AAP recommendations will cause, knowing that up to 25% of diets will turn into an eating disorder. And when we know that someone dies every 52 minutes from an eating disorder, the message is loud and clear: we’re willing to risk the actual health and safety of children for the sake of a manufactured aesthetic of ‘health.’” What parents can say and do about it all Given all of the above, it’s understandable that parents might be concerned about the effect on their children. After all, while kids may not be reading the abundance of think pieces about Ozempic, the current societal obsession with thinness at all costs almost inevitably trickles down in other ways. “I don’t know if you need to bring up Ozempic directly, and I don’t know if kids are really hearing about Ozempic,” says Dr. Erin Parks, Equip co-founder and Chief Clinical Officer, but she notes that young people are likely observing a shift in the types of bodies that are valued (i.e., very thin). Here are some actionable things that you can say and do (or not say and not do) to keep your kids safe from the harmful fatphobia currently swirling in the air. Watch how you talk about bodies “More important than what you say to your children about their bodies is what you say to yourself or in front of your kids about your body and other people’s bodies,” says Parks. “Do they hear you say to your friend, ‘Did you see that Katie lost weight? I wonder what she’s been up to?’ Do they see you greet your brother and say, ‘Oh my goodness you look like you lost weight, you look amazing!’ Those are the things that are communicating the loudest to your children.” Parks explains that when we compliment people on weight loss or trying to lose weight, we send two harmful messages to our kids: first, that being small is better; and second, that people have direct control over the size of their body, which isn’t true. When possible, don’t comment on people’s bodies at all, and if you do, try to comment on things besides body shape or size, like a bright smile or a new hairstyle. The same goes for your own body: don’t make disparaging remarks about your weight or shape, and try to shift the focus to how you feel rather than how you look (“I want to do this workout so I can feel stronger!”). Emphasize that bodies change—and that’s normal For adolescents and teens whose bodies are rapidly changing, all of the societal focus on being rail-thin is especially trying. “I think one thing in particular to emphasize to your kids about both your body and their body is that bodies change and that’s normal,” says Parks. “Bodies change as they go through puberty, bodies change as you age. It’s normal for bodies to change over time.” Do some social media curation While each family has their own boundaries and rules around independence, it can be helpful for parents to take the reins when it comes to their child’s social media use. “Consider muting certain words and phrases—like Ozempic or weight loss, for instance—on your children’s social media feeds, or blocking weight loss content completely,” recommends Walding. “Don’t be afraid to make social media work in your favor: help your kids find creators and influencers in all different kinds of bodies. We’re constantly fed the narrative, explicitly and implicitly, that being thin is associated with health and good social status, while being fat is unhealthy and undesirable. Calling b.s. on these tropes and making sure that your kid’s social media feeds are curated to show people in diverse bodies enjoying life is a great way to start reversing the harm done by the cultural thin ideal.” Set boundaries at the doctor’s office Given the new AAP guidelines, parents may need to take proactive steps to keep their kid’s doctor from making harmful statements or recommendations. “Our bodies are our most constant companions, and we owe it to our children to protect their relationship with their bodies as fiercely as possible,” says Walding. “One way we can advocate for them is by setting clear boundaries in the doctor’s office about how weight will be discussed.” If setting these boundaries feels intimidating to you, Walding recommends using resources like these “Don’t Talk About My Child’s Weight” cards. Model critical thinking To help your kids push back against harmful messages from society, show them how to think critically about these messages. “Parents should always be initiating conversations around their observations about society,” says Parks. “We want to raise our kids to be critical thinkers. Our culture has such an inherent, structural, systemic, and implicit bias toward fatness. We idolize thinness, we allow jokes about fat people, we discriminate against fat people, and it’s such an ongoing part of our culture that you don’t even notice it until you stop and try to observe it. We want kids to be able to step back and observe the culture they’re a part of.” Parks says this should be an ongoing dialogue, rather than a one-time conversation. She recommends calling out fatphobia or ads for weight loss whenever you see them, but also calling out misleading messages in general so that your kids learn not to blindly trust the messages they’re being peddled. “Who profits when we believe our bodies are problems to be fixed? This is a question parents can start exploring with their children,” Walding adds. Thin worship never went anywhere, but it feels particularly inescapable right now. But society’s skewed values don’t need to make their way into your family or into your child’s mind. With some proactive conversations and critical thinking, you can help your child build resilience against whatever “health” guidance comes down the pipeline next. Citations: Hampl, Sarah E. et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics (2023) 151 (2): e2022060640. https://doi.org/10.1542/peds.2022-060640 Abstracts of the 48th EASD Annual Meeting of the European Association for the Study of Diabetes. Diabetologia 55 (Suppl 1), 1–538 (2012). https://doi.org/10.1007/s00125-012-2688-9 Social and economic cost of eating disorders in the United States of America. Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020.]]></content:encoded>
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            <title><![CDATA[Unpacking Equip’s Media Guidelines: What to Say (and Not Say) About Food & Bodies]]></title>
            <link>https://equip.health/articles/news-and-research/how-to-talk-about-food-and-bodies</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/how-to-talk-about-food-and-bodies</guid>
            <pubDate>Wed, 22 Feb 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Words matter. Research shows that the language we use to describe the world shapes the way we think about that world, and from there the consequences continue, dominos toppling one after the other: our thoughts affect our actions, our actions affect our lives and the lives of others. When we’re talking about bodies and food, the language we choose can have a lasting and even life-changing impact. It can mean the difference between enjoying a meal and suffering through it; between self-confidence and self-doubt; between a feeling of acceptance and one of alienation. Because words are so powerful, Equip recently released its Media Guidelines, which outlines how journalists, members of the media, and content creators can talk about bodies, food, eating, and eating disorders without reinforcing stereotypes or elevating harmful beliefs (read more here). Though media and content professionals have a larger audience than most of us, the words we all use in our daily conversations—and our own internal monologues—matter, too. This is always true, but even more so when speaking to somebody who is struggling with or in recovery from an eating disorder. Even if you enter a conversation with the best of intentions, wanting nothing but to support your loved one, you might use language that is unintentionally harmful. That’s because potentially harmful phrases aren’t always obvious, and most of us have spent our lives steeped in a society that normalizes unhealthy and damaging beliefs. For that reason, we’re sharing the same guidelines we provided to the media on what words and phrases to avoid, and what you might consider saying instead: Avoid: “They lost x amount of pounds,” “They ate x amount of calories,” etc. Using specific numbers about weight, calories, nutrition, and body measurements can be triggering to those vulnerable to eating disorders. Try not to talk about other people’s bodies or diet altogether if you can (there’s so much more to say about a person!), and if you must refer to a body change or something a person ate, avoid specific numbers whenever possible. She made a lot of new friends during her first semester at college. I ate too many cookies and now my stomach hurts. Aunt Debbie lost some weight because she had a parasite. 
 Avoid: “Earn your calories,” “reward yourself,” “I deserve this dessert,” etc. Exercise should not be viewed as a compensatory behavior for eating, and food should not be considered a prize for physical exertion. Humans need to eat in order to stay alive, and also eat for a variety of other perfectly valid reasons: comfort, culture, taste, socializing, etc. Food never needs to be earned, and verbalizing this belief encourages unhealthy eating behaviors. Focus instead on the joy of eating, or how eating something will make you feel afterward. There’s something about eating corn off the cob that makes it taste even better. I make this amazing protein oatmeal that gives me so much energy for my morning jog. It’s so fun to eat fried chicken out of a bucket—shouldn’t everything be served like this? 
 Avoid: “Guilty pleasure,” “cheat day,” “junk food,” etc. Food has no morality. There are no “good” foods or “bad” foods, and categorizing them that way can encourage an unhealthy, rigid relationship with eating. There’s so much else to say about a food beyond applying judgment to it; you can focus on flavor, emotional connection, meaning, how it’s prepared—the list goes on. What did you do to make these brownies so fudgy? Eating a ripe nectarine always takes me back to summertime as a kid. Wow, the basil on this pasta is so fresh! 
 Avoid: “The obesity epidemic,” “obese,” “obesity,” etc. We believe the word “obesity” to be harmful, as it’s tied to the flawed measurement of BMI and loaded with negative connotations. In fact, a growing number of experts in the field (including Equip) are choosing to censor the term as “ob*sity,” which you might consider as well. Instead of using this word, choose factual language to describe people’s bodies, or use a person’s preferred terminology (for instance, some people self-identify as “fat,” seeing it as a body neutral descriptor like “short” or “brown-eyed”). Or better yet, just don’t describe people’s bodies at all! It would be nice if more people in larger bodies were represented on TV and in movies. They are a fat activist. The idea of the ob*sity epidemic is increasingly being called into question. 
 Avoid: “Bikini body,” “best body,” “beach body,” etc. These phrases reinforce the untrue idea that only those who look a certain way (aka thin) can wear or do certain things—including putting on a bikini on warm days. If you have a body at the beach, you have a beach body; if you choose to wear a bikini, you have a bikini body. Instead of using phrases that implicitly encourage weight loss, emphasize how someone might want to feel in these circumstances instead. Examples include: Does going bathing suit shopping make you feel excited for the season? The bright colors in this bikini make me feel so energized. I feel strong and energized after jumping in the water. 
 Avoid: “Thunder thighs,” “muffin top,” “cankles,” “problem areas,” etc. Outdated phrases from the tabloid era continue to appear in the media and our daily conversations. These mean-spirited phrases reduce individuals to their body parts and can make people hearing them feel self-conscious about their own bodies. Instead, refer to body parts by their proper names and avoid any and all pejorative labels. I need to remember to put sunscreen on the back of my thighs. I like the way this dress looks with a belt around my hips. My shirt shrunk in the dryer so now it shows my stomach—new crop top! 
 We hope that by sharing these guidelines with everyone, not just journalists, we’ll provide people with the knowledge they need to have inclusive, supportive, and productive conversations. If you’re used to saying some of these phrases or words, it might take a bit of an adjustment to remove them from your vocabulary—but it will be worth it, not only for those in your life who are vulnerable to eating disorders, but also for you. 
 Citations: Lodge, J et al. “Children's self-talk under conditions of mild anxiety.” Journal of anxiety disorders vol. 12,2 (1998): 153-76. doi:10.1016/s0887-6185(98)00006-1 Maria Richter, Judith Eck, et al. Do words hurt? Brain activation during the processing of pain-related words, PAIN, Volume 148, Issue 2, 2010, Pages 198-205, ISSN 0304-3959, https://doi.org/10.1016/j.pain.2009.08.009. Tabibnia, Golnaz et al. “The lasting effect of words on feelings: words may facilitate exposure effects to threatening images.” Emotion (Washington, D.C.) vol. 8,3 (2008): 307-17. doi:10.1037/1528-3542.8.3.307]]></content:encoded>
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            <title><![CDATA[New Equip Research: Does Early Weight Gain Predict Treatment Success for Anorexia?]]></title>
            <link>https://equip.health/articles/news-and-research/new-research-early-weight-gain-anorexia-treatment-success</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/new-research-early-weight-gain-anorexia-treatment-success</guid>
            <pubDate>Mon, 14 Jul 2025 17:45:00 GMT</pubDate>
            <content:encoded><![CDATA[In eating disorders like anorexia, where weight restoration is often an initial goal, it makes sense to consider whether the rate of weight gain can predict long-term treatment success. This seems intuitive: if someone makes early, consistent progress toward this important benchmark, aren’t they more likely to achieve lasting recovery than someone who struggles to gain weight? As our latest research reveals, the answer isn’t so black and white. Our research team recently examined the link between early weight gain and anorexia treatment success using real-world data from over 200 patients with anorexia who received virtual family-based treatment (FBT). We wanted to test whether early weight gain alone can serve as a reliable benchmark for remission—and what actually works better for guiding treatment decisions. What the study looked like This study, which was published in Eating Disorders: The Journal of Treatment and Prevention, analyzed 233 patients with anorexia nervosa (AN) who received virtual outpatient FBT through Equip. We examined whether early weight gain—specifically, weight change by week eight—could accurately predict remission by week 20. Remission was defined using several clinical markers, such as normalized weight and symptom reduction. To assess this, we used several different methods: ROC (receiver operating characteristic) analysis, a common statistical method for classifying outcomes based on thresholds. Logistic regression models, which allowed us to consider more variables (like each patient’s starting weight as a percent of their individualized target). This side-by-side comparison helped us assess not just whether early weight gain works as a predictor—but how accurately and fairly it does so for diverse patients. What we learned At Equip, we recognize that recovery is rarely linear and never one-size-fits-all, and our findings further strengthened this belief, driving home just how individual the treatment and recovery journey can be. Below are some of our key takeaways. 1. Early weight gain alone doesn’t tell the full story ROC analysis using early weight gain was only moderately accurate when it came to prediction. Even at the best-performing threshold—gaining 8.9 pounds by week 8—it still misclassified 36% of patients. That means more than a third of patients were incorrectly labeled as likely to succeed or fail based solely on this benchmark. 2. Including individualized context improves accuracy When we added another variable—percent target weight at admission—to a logistic regression model, accuracy improved significantly. This model didn’t just offer a binary outcome (i.e., a “yes” or “no” on whether someone would recover)—it returned the probability of remission, which is far more useful for informing personalized care. 3. Rigid benchmarks don’t work for everyone The core takeaway? Applying blanket benchmarks to determine who’s “on track” can be misleading and even harmful. Patients with different body types, growth patterns, or illness histories may gain weight at different rates, and that variability is normal. 4. Early progress matters—but not in isolation While early weight gain does matter (it is associated with better outcomes), it’s only meaningful when viewed in context. Two patients may gain the same amount of weight in the first two months, but their clinical profiles and risk factors may suggest very different prognoses. Context is key. How our findings will inform Equip treatment going forward This study reinforces several core principles that guide Equip’s approach: 1. Individualized, data-informed care works best Instead of relying on rigid milestones or numbers, we use individualized metrics—like target weights based on personal growth histories, not static BMI charts. Our goal is to tailor care to each patient’s unique journey, not force every person into the same mold. Our providers also look at early progress within the full picture. They consider where a patient started, how they’re trending, and what other clinical signs suggest about engagement and medical stability. 2. Evidence-based care must be flexible and inclusive This study is part of our broader mission to make sure that our research doesn’t just live in journals—it also shapes the care we provide. That means continuously evaluating what’s working, questioning outdated models, and creating pathways that serve all patients, not just those who fit neatly into a dataset. 3. We’re committed to expanding representation in research While our sample was larger and more naturalistic than many clinical trials, we recognize that it wasn’t as diverse as it should be. Going forward, we’re working to increase representation across race, ethnicity, gender identity, and geography to ensure our care—and our data—truly reflects the communities we serve. Recovery from anorexia isn’t a race to a number on a scale—and this study makes that clearer than ever. While early weight gain can be a helpful signal, it’s not a definitive answer. By using individualized, data-informed models that incorporate each patient’s unique context, we can better predict who will benefit from which type of care—and when they might need extra support. At Equip, we’re committed to turning research into real-world impact. That means moving beyond one-size-fits-all benchmarks toward a more compassionate, nuanced understanding of progress, one that adapts to the patient, not the other way around. Read the full paper here.]]></content:encoded>
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            <title><![CDATA[Ask an Equip Provider: What Do I Do if My Patient Says They Want to Lose Weight?]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/patient-weight-loss</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/patient-weight-loss</guid>
            <pubDate>Tue, 17 Jan 2023 20:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Nearly half of all New Year’s resolutions involve weight loss. This isn’t terribly surprising given the inundation of diet and fitness-related messaging at the beginning of January, but it can still be a challenging subject for healthcare professionals to navigate. As the new year marches on, providers may be hearing from patients who want to meet certain weight loss goals in the coming months, goals that—at least on the surface—are grounded in a desire for better health. But, unfortunately, it’s not as simple as that. Not only do most diets fail, setting people up to feel a sense of shame and failure, but dieting is also a risk factor for the development of an eating disorder, and can be particularly dangerous for young people. What’s more, many people’s weight loss goals emerge from internalized weight bias, which has been linked to a range of psychological and physical issues.  That said, weight loss isn’t inherently bad in all circumstances. So as a practitioner, how can you best support patients who express a desire to lose weight? Dr. Lauren Hartman, Medical Director at Equip, answered some of the most common questions providers have on this complex topic. If a patient tells me they want to lose weight, how can I know whether or not to advise them against it? I usually don’t think it is beneficial to recommend weight loss, due to all of the potential negative outcomes that can result. However, weight loss is not always harmful—if it’s a means to another end, like cardiovascular or mobility goals. In these cases, it’s best to work toward the actual health goal rather than weight loss, though weight loss might be a “side effect” of these efforts. As practitioners, what we can do is aim to partner with our patients to better understand their concerns and goals. You may screen if this desire is occurring alongside other symptoms of an eating disorder, in which case early intervention is key.  If a patient says they want to lose weight without it being tied to another specific health goal, or to "bounce back" after pregnancy, use it as an opportunity to dispel long-standing myths that equate “health” and “weight,” and share the harm being done by diet culture. It is also an opportunity to discuss behaviors and goals that are healthy but not weight-related, like joyful movement, eating regular and balanced meals, or sitting at a table for meals. If I think it would be harmful for a patient to lose weight, how can I effectively change their intentions? Should I try? Yes, it is important to try. I’d suggest starting from a place of curiosity and hearing from the patient about why they are interested in weight loss. Here, it can be helpful to acknowledge the years of mixed messages that someone may have received about weight loss, whether from social media, family members, friends, or the medical community. It is also important to make the person feel that we are not judging or shaming their intention, but rather helping them to understand the medical and psychological harms of “weight loss” as a goal. Some of the medical harms of weight loss as a goal are lowering your heart rate, developing a heart arrhythmia, vomiting (which can lead to electrolyte imbalance and internal bleeding), lightheadedness and fainting, and osteopenia or osteoporosis, among others. Some of the psychological harms are stress, anxiety, depression, mood instability, lack of concentration, self-harm, and suicide. In the case of children and adolescents, is it ever okay for weight loss to be a goal? No. Childhood and adolescence is a critical time of growth and development. This is the time that a person’s brain, heart, bones, and all the organs in the body are developing. In order for this to happen in a safe way, they need to be adequately nourished. Losing weight at a time when the body has high metabolic needs and is requiring a lot of nutrition can result in significant medical consequences. What can I do if a parent is insistent that their child lose weight? If a patient insists that their child lose weight, I would use it as an educational opportunity. I would talk with parents and families about how research shows that adolescents whose parents talked with them about weight loss are more likely to engage in dieting, unhealthy weight-control behaviors, and binge eating. I would try to shift the focus with the parent from their child losing weight to them developing a long-term healthy relationship with food and their body. I would encourage the things that we know help achieve that, such as having frequent family meals, avoiding diets, and doing joyful movement. If a patient is going to go ahead with their weight loss goal, what guidelines or resources can I share with them to help them do so in a healthy way? This is a tough question, since I wouldn’t recommend guidelines or resources for weight loss. Given that someone can quickly move from weight loss to a place of medical instability, I would recommend that they check in regularly with their doctor for medical monitoring. I would discuss with them warning signs of medical compromise such as lightheadedness or fainting, fatigue, cold intolerance, abdominal bloating, and lack of a period in those with ovaries. Citations: Daee, Allison, et al. "Psychologic and physiologic effects of dieting in adolescents. (Review Article)." Southern Medical Journal, vol. 95, no. 9, Sept. 2002, pp. 1032+. Gale Academic OneFile. Eric Stice, C. et al. Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study, Behaviour Research and Therapy, Volume 49, Issue 10, 2011, Pages 622-627, ISSN 0005-7967. Dianne Neumark-Sztainer, et al, Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later? Journal of the American Dietetic Association, Volume 106, Issue 4, 2006, Pages 559-568, ISSN 0002-8223. Marshall Rachel D., et al. Internalized Weight Bias and Disordered Eating: The Mediating Role of Body Image Avoidance and Drive for Thinness. Frontiers in Psychology, Volume 10, 2020. Berge JM, Maclehose R, et al. Parent conversations about healthful eating and weight: associations with adolescent disordered eating behaviors. JAMA Pediatr. 2013 Aug 1;167(8):746-53.]]></content:encoded>
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            <title><![CDATA[Equip Survey Shows How Eating Disorders Affect Fertility, Pregnancy, and Beyond]]></title>
            <link>https://equip.health/articles/news-and-research/fertility-survey</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/fertility-survey</guid>
            <pubDate>Thu, 05 Sep 2024 20:15:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders affect people of all ages, but there are certain stages of life that are higher risk than others. Because of hormonal fluctuations, body changes, societal pressure, and many other factors, pregnancy can be one of those high-risk times. In order to better understand how this plays out, we conducted a comprehensive survey looking at the relationship between disordered eating and the entire reproductive journey, including fertility, pregnancy, and the postpartum period. Our survey We surveyed 645 American women over the age of 18 who self-reported a history of an eating disorder or disordered eating habits. The survey itself included a thorough set of questions that explored fertility, pregnancy, and the postpartum period. We looked into how respondents’ eating disorders or disordered eating habits impacted their efforts to conceive, their pregnancy experience, their body image after pregnancy, and more. Here’s the breakdown of our survey respondents: 610 respondents with a history of disordered eating, 553 of whom had tried to conceive within the past 10 years 35 respondents with a history of a diagnosed eating disorder, 30 of whom had tried to conceive within the past 10 years The majority of respondents were 30-39 year-old cisgender women What we learned When we set out to conduct the survey, we assumed that both diet culture messaging and past or current disordered eating habits would have some impact on women’s fertility and pregnancy experience, but we didn’t know what that would look like. Below are some of our most important findings, several of them quite eye-opening. The fertility and conception journey Here are some of the most notable things we learned about how eating disorders and disordered eating impact the fertility and conception experience of women: 45% of women with a history of an eating disorder or disordered eating experience infertility, compared with the national average of 11% More than 1 in 10 women (13%) delayed trying to conceive because of an eating disorder or disordered eating habits 25% of respondents felt that their eating disorder, disordered eating habits, or dieting played at least somewhat of a role in their fertility challenges 23% of women would not have sought help for their eating disorder or disordered eating habits if they weren’t trying to conceive, emphasizing how sticky and self-protective eating disorders can be (as well as how much diet culture normalizes and minimizes disordered eating behaviors) Working with doctors Unfortunately, most doctors receive very little education on eating disorders, and this can come through in the experience many women have working with their reproductive health care provider. Only 18% of providers discussed potential links between respondents’ conception journeys and a history of dieting or disordered eating 34% of women felt at least somewhat scared to tell their reproductive health care provider about their eating disorder, disordered eating, or dieting 35% of respondents were advised to lose weight while trying to conceive; of this group, 83% found the advice difficult to follow or triggering 13% of respondents were advised to gain weight while trying to conceive; of this group, 72% found the advice difficult to follow or triggering Eating disorders and pregnancy Here’s what we learned about how eating disorders, disordered eating, and body image concerns impact the pregnancy experience for women: 32% of respondents were concerned about how pregnancy might impact their eating disorder or disordered eating behaviors 64% of respondents were concerned about how weight changes during pregnancy would impact their body image More than half of respondents (53%) were concerned that unwanted body comments and people touching their bodies during pregnancy would negatively impact their mental health Eating disorders and postpartum body image Our findings showed that diet culture can be heard loud and clear during the postpartum phase for many women: 88% of women felt pressure to “bounce back” and return to their pre-pregnancy body after giving birth Two in three women felt less confident in their bodies post-pregnancy Our takeaway Before conducting this survey, we knew there was a complicated relationship between eating disorders and pregnancy, but our findings made apparent just how big of an impact disordered eating can have on this journey. It’s clear not only that diet culture has a negative effect on women’s pregnancy experience and outcomes, but also that there’s a great need for eating disorder education among providers who work with women who are pregnant or trying to become pregnant (like reproductive endocrinologists and ob-gyns). We hope to see more research into this topic, and to have it become part of the greater cultural conversation around childbirth. In the meantime, if you want to learn more eating disorders and pregnancy, the articles below are a good place to start. Navigating Pregnancy Weight Gain in Recovery Can Pregnancy Trigger an Eating Disorder? Eating Disorders Increase In the Postpartum Period. Here’s Why (and What to Do)]]></content:encoded>
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            <title><![CDATA[What to Say (and Not Say) When it Comes to Food, Fitness, and Body Image]]></title>
            <link>https://equip.health/articles/food-and-fitness/how-to-talk-about-EDs</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/how-to-talk-about-EDs</guid>
            <pubDate>Mon, 12 Sep 2022 14:58:32 GMT</pubDate>
            <content:encoded><![CDATA[In a perfect world, we’d all be armed with the most helpful, supportive words and actions when trying to support our loved ones. We would instinctively know exactly what to say and do. Unfortunately, there’s no handbook and conversations about eating disorders and body image are specifically tricky because certain phrases can be triggering to those who are suffering. A well-meaning word of encouragement could be perceived as a veiled insult, and even something as seemingly innocuous as telling someone they “look healthy” could induce anxiety and panic. “The language we use when discussing health, food, and appearance is so important both in the context of eating disorders and everyday life because it becomes our internalized self-talk,” says Equip Therapist Emily Boyle, MA, LAC, NCC. “The words used by loved ones, teachers, and the media form the foundation of beliefs and internal dialogue of young people, so we need to be extremely mindful of how we speak about these topics.” Knowing how to talk to someone who is struggling or in recovery from an eating disorder (or even someone who is just existing in a body!) can be tough. Here are some tips for navigating conversations around health, food, and appearance. First, avoid talking negatively about your own appearance or the appearance of others. It’s become so normalized in our society to say things like “I feel fat in these clothes” or “I’m so bad — I shouldn’t have eaten that,” but that kind of dialogue only reinforces the damaging effects of diet culture myths. Instead, try a body neutral approach. “Regardless of who we are talking to, language that focuses on outward appearance, specifically weight, can be harmful,” says Equip Family Mentor Inga Yanoski. “Comparing or picking apart bodies, equating weight gain with moral failure or bad health and lack of discipline promotes fatphobia and reinforces the insidious diet culture. ‘I am getting so fat, this makes me feel fat, I need to lose weight, I ate way too much, I am stuffed, you look great, have you lost weight’, etc. The same goes with nutrition. It’s not so black and white.” Equip Providers Partnerships Manager Melanie D'Andrea says she makes a conscious effort to not to talk about her appearance or size around her children or around peers. “I never realized how often people talk down on themselves (including me) until I really stepped into my own recovery,” she says. “These are things I do for my children, but really they are for my own recovery as well. By sharing my experience with my husband, and connecting it to his relationship with food as well, we are unlearning decades of food and body biases. It is not always easy, but remember this kind of outward and inward talk takes practice and time.” Avoid talking about anyone’s body when you can — whether you mean it as a compliment or not. “If you want to compliment someone, tell them they look happy, you love their new haircut, or you think that t-shirt color really makes them glow. We've been trained to compliment bodies, particularly women's, and we need to make an effort to stop doing that, as a collective,” D’Andrea says. Boyle says that even when intentions are pure, telling someone in recovery that they look “much healthier” can trigger the eating disorder and cause distress. “It is far more beneficial to give your child compliments based on non-physical attributes as they make progress in recovery, such as, ‘It’s so good to see you having more energy to engage in the activities that you love,’ or, ‘I love to see your funny sense of humor coming back,’” she says. Avoid inadvertently reinforcing or celebrating disordered behaviors. Equip Peer Mentor Elizabeth Moscoso says the most unhelpful thing she encountered in her recovery was the sentiment that someone “wished” they had her problem. “My ‘problem’ being a life-threatening eating disorder,” she says. “That comment not only was confusing as someone actively fighting so hard to overcome my eating disorder, but implies that people with eating disorders somehow choose to have one,” she says.This could not be further from the truth.” As Moscoso makes clear, eating disorders can ruin relationships, negatively affect physical and mental health, and can rob sufferers and their loved ones of joy. “I wish most people knew what actually happens to the body and mind when in the throes of an eating disorder,” she adds. “It's not glamorous. It's painful, isolating, and debilitating at times. The culture we live in places so much value on an ideal body, and the cost of trying to achieve that body can be relationships, jobs, and even life. It's simply not worth the price tag.” Avoid language that moralizes, labels, or demonizes food. “My own experience was so much calorie counting, "bad" vs. "good" foods, and being "healthy." I vividly remember growing up in the early '90s and eliminating fat was all we heard with marketing. My household was full of "fat-free" products and I was raised thinking butter was "bad" for you. I do not want my children to be preoccupied with any of those thoughts,” D'Andrea says. “Instead, I teach them to focus on listening to our bodies and how we feel as/after we are eating.” D'Andrea offers some examples of how she talks about food with her kids: "How did that Mac and Cheese make your belly feel?" "It is good for our bodies to eat a variety of foods - gummy bears are really yummy and so are strawberries and blueberries." "We should listen to our bodies when they tell us to eat more or stop eating - you do not have to finish your dinner and there is plenty more if you would like more." "We had ice cream at lunch today, but we can have more some other time - would you like apple slices or blackberries with your dinner?" Avoid prescribing something that makes you feel good to someone else. Regardless of who you are talking to, discussion of diets and weight loss are seldom helpful to anyone involved. “Diet, health, and weight are nuanced, individual issues that are best discussed with health professionals,” Boyle says. “Talk of weight, diets, and food with friends can all too easily turn into comparison traps and negative talk, so it is best to be avoided.” Try re-thinking how you use certain words. “There are so many things that would be so wonderful if we collectively stopped saying to make the world a more inclusive and safe space,” Moscoso says. “One of the biggest ones would be to stop using ‘fat’ as an insult or as a negative description, or as a code word for the true emotion that is coming up for us. Fat is a neutral term, it's not good and it's not bad. It's a descriptive word. It does not have an emotion tied to it.” Try separating the person from their thoughts about their body. “The most supportive and helpful things to say to someone who has struggled with food/weight/body image are, ‘your worth is not defined by a number on a scale’, or the foods that you have eaten, or the size or shape of your body,” Yanoski says. Some reminders you may want to share with your loved ones (or yourself!) are: All bodies are good bodies. You are worthy of respect and love. Your body is doing amazing things for you all day long. All food is good food. The culture is the problem, not you. ” Try just listening. Moscoso believes one of the most supportive things someone can say to someone struggling with weight, body image or food is "I'm here for you," and validating any emotions that arise. “Recovery is one of the hardest things a person can do and lots of fear can come up around friends or peers no longer liking the recovered person,” Moscoso says. “We can understand that and show up for someone in recovery. You don't have to say much, sometimes your supportive presence is more than enough.” Try telling them the non-physical ways recovery is bringing them to life. “Encourage children’s progress by reminding them of ways recovery is restoring them and helping them be themselves without the confines of the eating disorder,” Boyle says. “Is your child experiencing more energy to play with friends? Smiling more with family? Making non-disordered decisions regarding food? Validate and verbally encourage your child when you see these positive changes!” Boyle says that having a child who is in eating disorder recovery is a learning experience for the entire family — and everyone can become more wise, thoughtful, and conscious of their words and actions along the way. “As your child battles his or her eating disorder, the whole family begins to learn and challenge the ways they have discussed and internalized beliefs about health, food, weight, and body image,” she says.]]></content:encoded>
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            <title><![CDATA[One Size Doesn’t Fit All: Growth Patterns Matter More Than Your BMI]]></title>
            <link>https://equip.health/articles/news-and-research/research-using-bmi-to-set-target-weights</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/research-using-bmi-to-set-target-weights</guid>
            <pubDate>Sat, 17 Dec 2022 00:43:00 GMT</pubDate>
            <content:encoded><![CDATA[In eating disorder treatment, there’s one number that carries a lot of significance: the patient’s “target weight”. While not all patients in eating disorder recovery need to gain weight, many do, and in those cases, the care team establishes a target weight. This number matters, not only because it becomes a point of focus along the treatment journey towards renourishment, but also because it has implications for the patient’s prognosis and their chance of relapse. So how does the care team arrive at the optimal target weight for renourishment? Well, there are a few different approaches — and, as a new research paper by Equip clinical researchers makes clear, using a one-size-fits-all BMI approach to calculate a target weight has significant drawbacks. The paper, titled “Evaluating differences in setting expected body weight for children and adolescents in eating disorder treatment,” was published in the December 2022 issue of the International Journal of Eating Disorders, and was led by Dori Steinberg, PhD, RD, Equip’s VP of Research, alongside a team of other researchers that included Cara Bohon, PhD, Equip’s VP of Clinical Programs; David Freestone, PhD, Equip’s Lead Data Scientist; Megan Hellner, DrPH, MPH, RD, CED-S, Equip’s Head of Nutrition & Physical Activity Research; Jessica Baker, PhD, Equip’s Senior Research Manager; and Taylor Perry, Equip Research Intern and PhD candidate. In the study, the researchers collected weight and other clinical data from over 600 patients ages six to 20 who were enrolled in Equip’s virtual eating disorder treatment, all of whom had a goal of weight restoration, and compared two different approaches to setting target weights using CDC growth charts. Target weight — referred to in the study as “expected body weight” — could be established by using median BMI, or it could be established through a more individualized approach. The individualized approach also used BMI to help determine target weight, but took into account the patients' growth chart trajectories to come up with a weight target that more accurately reflected their unique body needs. They found that when providers used an individualized approach, the target weight they arrived at was significantly higher than it would have been if they’d relied on BMI. In fact, 70% of patients had a higher expected body weight when using the individualized approach vs. the BMI approach. The reason this matters is simple: if a patient doesn’t become fully weight restored, their risk of relapse is higher. In other words, if a patient’s target weight is too low—which, the research suggests, might be the case when using BMI to calculate it—they will leave treatment without actually reaching the right weight for their body. Steinberg sums it up like this: "Target weights are always a moving target. We know that an individualized approach — where dietitians set personalized target weight goals for all patients, monitoring and adjusting along the way — is the best approach. If the patient needs more nourishment, the dietitian should modify the target weight so that the patient can achieve their renourishment goals and head towards solid recovery. This helps patients stay in treatment longer, and it may set them up for long term success with recovery!"]]></content:encoded>
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            <title><![CDATA[Eating Disorders on Campus: Recognizing Signs & Best Practices for Treatment in College Populations]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/equip-academy-eating-disorders-on-campus</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/equip-academy-eating-disorders-on-campus</guid>
            <pubDate>Wed, 21 Aug 2024 17:44:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. College can be a particularly high-risk time for the development of eating disorders. Today, we’ll look at unique risk factors and common clinical presentations of eating disorders in college populations in order to arm you with the knowledge you need to identify eating disorders and help college students who may be struggling. Eating disorders among college students The median age of onset for eating disorders is between age 18 and 21, which overlaps almost exactly with the age range of college students. College is also a particularly vulnerable period due to several different factors, including: Separation from family/disruption of support system Being out of one’s normal routine and habits Normalization of diet culture and disordered eating habits Lack of awareness about the warning signs of disordered eating All of these factors have the potential to trigger an eating disorder in those who are genetically or biologically predisposed to developing one. Among college students, research has shown a high prevalence of eating disorder symptoms, such as: Binge eating Restriction of food intake Purging behaviors Weight concerns From 2013 to 2021, the prevalence of eating disorder risk increased significantly, rising from 15% to 28%. Young, female, and Hispanic students experienced the largest increases. Given all the above, it’s very important that college students have access to eating disorder support, education, and interventions. Identifying eating disorders in college populations Because of the heightened risk of eating disorders among college students, it’s crucial for those who work with this population to know how to detect these illnesses. In many cases, it can be helpful to progress through several different stages when determining whether an individual has an eating disorder: screening, assessment, and identification. Screening To screen for an eating disorder, the SCOFF questionnaire is often helpful. This is a commonly used screener for primary care physicians and health clinics. It’s useful in that it is simple to remember and captures a full spectrum of behaviors. The screener consists of five questions, below. Every “yes” response earns one point, and a score of two or more indicates that an eating disorder is likely and further evaluation is recommended. SCOFF questions: Do you make yourself sick because you feel uncomfortably full? Do you worry that you have lost control over how much you eat? Have you recently lost more than one stone (14 pounds) in a three-month period? Do you believe yourself to be fat when others say that you are too thin? Would you say that food dominates your life? Assessment Whether or not a patient presents with concerns about an eating disorder, it can be helpful to ask a few questions that can help you assess whether they may be engaging in disordered eating behaviors. These assessing questions generally center around their current behaviors and personal and family history. Questions to ask include: Have you made any lifestyle changes recently? What do you tend to eat throughout the day? How often during the day do you think about your weight, body shape, or food? Have you ever been diagnosed with an eating disorder? Has anybody in your family? Identification There are several valid and evidence-based measures used to identify the severity of an eating disorder. These include: Eating Disorder Examination Questionnaire Short (EDE-QS): Assesses key attitudes and behavioral features of an eating disorder along with a severity rating. Nine Item ARFID Survey (NIAS): Helps identify ARFID and its subscales: fear, picky eating, and appetite. Along with EDE-QS, this can be an excellent tool to determine the mechanisms that have caused and maintain the eating disorder. Compulsive Exercise Test (CET): Helps to identify the individual’s relationship to exercise, and the frequency and severity of exercise-related behavior.  Strategies for providing support to students experiencing eating disorders As healthcare providers, there are a number of steps we can take to support students who are struggling with eating disorders, disordered eating, or body image issues during college. Knowing and implementing the screening and diagnostic tools outlined above is one important way to help, but there are other approaches that can provide support on both an individual and campus-wide level. Three areas that healthcare professionals can focus on are reducing stigma, increasing access, and raising awareness. Reducing stigma Stigma can be a major barrier to seeking treatment for mental health concerns like eating disorders. We can all work toward reducing stigma through initiatives like: Education Guest speakers Fundraising Specialty classes Book clubs Increasing access Many students don’t seek help because they don’t have access to—or aren’t aware they have access to—the support they need. We can help increase access by: Providing on-campus support when possible, including online options Having a ready referral list if there isn’t extended counseling offered on campus (there are a lot of telehealth options for treatment available now that would be less disruptive to a student) Referring out to eating disorder-informed registered dietitians Offering groups and/or peer support Utilizing campus-wide events to plug mental health resources on campus and in the community Raising awareness Many eating disorders go undiagnosed through a lack of awareness about what these illnesses look like and who they affect. We can spread education and raise awareness by: Partnering with nonprofits like NEDA or Project Heal to offer resources Developing eating disorder-related programming and education during Eating Disorder Awareness Week Creating and publicizing resources on the common signs and symptoms of eating disorders and where to get help Debunking the “Freshman 15” myth, emphasizing that it’s appropriate and fine to grow into a different body than the one students had when they were teens Social media campaigns Fliers across campus When to refer to an eating disorder specialist If you’re concerned that a college student might be dealing with an eating disorder, it’s a good idea to connect them to a trained eating disorder professional. Eating disorders don’t go away on their own, and early intervention is associated with better outcomes. If and when it comes time to determine the best intervention for someone with an eating disorder, it’s important to consider the many different options that are available. The option you recommend will depend on the severity of the student’s symptoms and whether or not they have any co-occurring conditions, as well as their preferences, lifestyle, and insurance coverage. The three primary options to consider are: 1. Outpatient treatment: Outpatient programs can be low-touch with infrequent appointments, or be quite structured and include a high frequency of appointments. Equip, for instance, offers comprehensive, multidisciplinary support that is appropriate for eating disorders of all acuity levels, as long as patients are medically stable (learn more about Equip’s level of care here). Outpatient treatment generally lasts for several months to a year depending on the individual’s symptoms and specific challenges. When referring to outpatient treatment, make sure that you choose a multidisciplinary program with multiple sessions per week. 2. Higher level of care (HLOC): This includes partial hospitalization programs (PHP) and residential treatment. You may opt for a HLOC if an individual requires daily observation because of high-risk issues like suicidal ideation, self-harm, or other complications. With residential treatment, patients receive care 24 hours a day, whereas PHP programs are usually five to 10 hours a day, five to seven days a week. Length of stay tends to be about 30 to 90 days, depending on the severity of the eating disorder. 3. Inpatient care: Inpatient care is generally only required or recommended in the case of dire medical complications and very high-risk behaviors. There is a conservative patient to provider ratio in order to ensure that providers can intervene during medical or psychiatric crises. Inpatient care is the most intense treatment option and is only meant to be used for short periods of time. For more in-depth information on recognizing eating disorders among college students, watch my recorded Equip Academy presentation on the topic.  You can also explore past Equip Academy presentations and register for upcoming events here, and start a referral here.]]></content:encoded>
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            <title><![CDATA[Untangling OCD and Eating Disorders: Differentiating and Addressing These Closely Related Conditions]]></title>
            <link>https://equip.health/articles/understanding-eds/equip-academy-ocd-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/equip-academy-ocd-eating-disorders</guid>
            <pubDate>Mon, 30 Dec 2024 16:57:00 GMT</pubDate>
            <content:encoded><![CDATA[The information in this article originally appeared in an Equip Academy presentation. Watch the presentation here, and register for future Equip Academy events to learn about other eating disorder-related topics and earn free CE credits. Often, people with eating disorders have another co-occurring mental health condition. One common co-occurring diagnosis is obsessive-compulsive disorder (OCD). In this article, we’ll explore what providers should know about identifying, differentiating, and addressing these two conditions in patients. Read on to learn the shared risk factors for both OCD and eating disorders, how to tell the two apart, and considerations for sequencing treatment for a patient with both diagnoses. Prevalence of OCD and eating disorders Why do we so often link these two disorders? Well, one reason is because eating disorders and anxiety disorders, like OCD, commonly co-occur. The overall prevalence of OCD in the United States for both children and adults is 0.5%-1%, with an average age of onset around 10 to 12 years old, or in late teens/early adulthood (which mirrors the average age of onset for eating disorders). Among eating disorder patients, between 16-69% have a co-occurring anxiety disorder, and for 41% of this group, it’s OCD. One recent review found that lifetime prevalence of OCD for eating disorder patients is 38%; on the other side, an estimated 11% of OCD patients also report having clinically significant eating disorder symptoms. It’s also worth noting that anxiety disorders precede eating disorders in 50-60% of cases. While disordered eating symptoms may not be more elevated generally in OCD patients, there is a higher risk for having clinically significant eating disorder symptoms in female OCD patients: 9% among female OCD patients vs 1% among the control group. According to a meta analysis, there are no differences in the prevalence of OCD among the different eating disorder diagnoses; there is some evidence that symptoms of OCD may be higher among those with anorexia than those with bulimia, but that could be due to the fact that low weight can exacerbate obsessive-compulsive symptoms. Similarities between OCD and eating disorders In many ways, it makes sense that OCD and eating disorders have significant overlap, because the two disorders have many similarities: Both OCD and eating disorders involve distressing, intrusive thoughts. Both OCD and eating disorders involve behaviors that function to alleviate distress associated with intrusive thoughts. Both OCD and eating disorders can involve thought-action-fusion (TAF), or the idea that obsessional thoughts can influence the actual outcome of events. People with eating disorders and OCD share similar personality traits. There is a high genetic correlation between anorexia and OCD (though genes linked to metabolism and weight loss are distinct to eating disorders) So are they the same disorder? Different? Are eating disorders a type of OCD? One way to answer these questions is through network analysis. Network analysis is a way of studying the causal role of symptoms in activating and maintaining psychological disorders. Symptoms that are more central—or more strongly connected—play a larger role in activating a disorder. When comparing the networks between two disorders, it’s important to look for symptoms that are strongly connected and that co-occur between both diagnoses. The most common shared symptoms between the two disorders are symmetry, checking, and ordering, and the most common shared personality traits are perfectionism, neuroticism, conscientiousness, and impulsivity. Both disorders also involve concern over mistakes and difficulty controlling thoughts. While one network analysis found no connection between the two disorders, another found that perfectionism and difficulty controlling thoughts both bridge the two disorders. There appears to be a synergistic relationship between OCD and eating disorders. Research supports that the presence of OCD in a person with an eating disorder increases the severity of the eating disorder and leads to a worse prognosis—which is all the more reason to detect and adequately treat OCD in someone with an eating disorder. Differentiating between OCD and eating disorders So, how do you know if your eating disorder patient has OCD? And how can you differentiate between OCD and an eating disorder, and vice versa? To effectively make this distinction, it’s important to understand how OCD is diagnosed. For someone to be diagnosed with OCD, they must meet the following criteria: Presence of obsessions, compulsions, or both The obsessions and compulsions are time-consuming, or cause clinically significant distress or impairment in social, occupational, or other areas of functioning The obsessions and compulsions aren’t related to substance use or another medical condition The obsessions and compulsions aren’t better explained by the symptoms of another disorder (like an eating disorder) There are several screening tools that providers can use to assess for OCD. Two options are: Obsessive Compulsive Inventory Revised (OCI-R) Widely available, brief screening instrument to assess for OCD Adult and child versions Available in multiple languages, including Spanish Clinical cutoffs available for adults and children Yale-Brown Obsessive Compulsive Scale (Y-BOCS and CY-BOCS) Semi-structured diagnostic interview, freely available Can be administered to ages 6+; children may be interviewed with parent or separately Provides a full symptom checklist and severity ratings for determining impairment Remember that it’s always a good idea to ask patients about OCD symptoms, rather than waiting for them to bring them up. Often people are too embarrassed or ashamed by their obsessions to admit them freely. There are a few questions to ask when considering whether a patient has OCD or if the obsessive-compulsive symptoms stem from the eating disorder. Providers should think about: 1. Timing: Are obsessive-compulsive symptoms exclusive to a period of extreme weight loss? Do they abate with weight gain? 2. Beyond food and weight: Are there obsessions or compulsions outside of the realm of food or weight? To what extent will treatment focus on eating? 3. Egosyntonic or dystonic: The body image disturbance seen in anorexia is egosyntonic (meaning it aligns with a person’s values or self-image). It is a perceptual disturbance, not just body dissatisfaction. Case examples To better understand how co-occurring OCD and eating disorders might present, it can be helpful to look at some case examples. Case example 1: a Black, teenage girl obsessively cleans every part of her body to the point of causing her skin to bleed and crack to prevent catching Covid while hospitalized for acute weight loss and anorexia. Case example 2: a White man in his early 20’s fears that his food has expired and will make him sick. He obsessively checks expiration dates and inspects food for signs of spoilage before eating it and avoids eating out at restaurants. Case example 3: An adult woman with body image concerns meticulously cleans all surfaces, including wiping down her food before eating it because she fears absorbing fats. She wears gloves when out in public to avoid touching things. Integrated care for OCD and eating disorders When treating co-occurring OCD and eating disorders in patients, integrated care is essential. Using an integrated care approach reduces the burden on patients and removes barriers to accessing treatment. Being able to treat multiple disorders at the same location or with a single provider/team of providers is not only an efficient use of resources, it’s also best for patients. There are a number of different evidence-based treatment approaches for OCD. These include: Cognitive-behavioral therapy with exposure and response prevention (ERP): First-line treatment that involves facing fears imaginally or in real life while preventing compulsions. Pharmacotherapy (serotonergic agents): First-line treatment using SSRIs including fluoxetine, sertraline, fluvoxamine, paroxetine, and escitalopram. Research has linked genes involved in coding serotonin to OCD. Combination therapy: Psychiatric medication in combination with exposure and response prevention therapy can also offer a good option. Treating OCD and eating disorders together There are a few different potential options for treatment of OCD and an eating disorder. The conditions can be treated in sequence, simultaneously, or you can just treat one. Option 1: Sequence the treatments. Treat the most impairing or “primary” diagnosis first. Option 2: Treat the conditions simultaneously. Alternate sessions, integrate treatment together, or split sessions. Exposure is a common thread woven through both eating disorder and OCD treatment. The particular exposures will be different for each condition and vary from person to person. For those with OCD, they may be exposed to fears and prevented from engaging in compulsions. Common exposures in eating disorder treatment involve exposure to fear foods, to challenging eating environments (like restaurants), or to challenging behaviors (for instance, not exercising). In one naturalistic study of 56 patients with both OCD and eating disorders in a residential facility, researchers found that treating both issues concurrently resulted in improvements in both OCD and eating disorder symptoms, and weight restoration. Some important tenets of treating both OCD and eating disorders include: Weight gain: Standard meal plans and supervised eating. Low body weight or weight suppression exacerbates obsession and compulsion symptoms, and may interfere with learning. Exposure and response prevention (ERP): ERP for OCD symptoms delivered in three-hour blocks daily. Consider the patient’s ability to tolerate distress during exposure so that eating disorder behaviors are not used to cope with increased anxiety. Eating fears: Eating fears are addressed in a manner consistent with ERP. Key takeaways about OCD and eating disorders Here are the important things providers should remember about OCD and eating disorders: OCD and eating disorders commonly co-occur. People with all eating disorders are at particularly heightened risk of developing OCD. While OCD and eating disorders are distinct and separate conditions, they share many features, including personality traits and cognitive styles/features. When both disorders are present, an activation of symptoms in one disorder can worsen or activate symptoms of the other disorder. Cognitive behavioral therapy with exposure and response prevention and SSRIs are the first-line treatments for OCD. There is a small amount of evidence that simultaneous treatment of eating disorders and OCD can be effective; exposure is a common element of treatments for both disorders. The amount of body weight lost, the need to restore weight, and the patient’s ability to tolerate distress are all important considerations in the decision to start ERP during eating disorder treatment. For more information on the intersection between OCD and eating disorders and how to treat both, watch my recorded Equip Academy presentation on the topic. You can also explore past Equip Academy presentations and register for upcoming events here.]]></content:encoded>
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            <title><![CDATA[As a Clinical Psychologist, I’m Terrified About Anti-Trans Legislation.]]></title>
            <link>https://equip.health/articles/news-and-research/anti-trans-legislation-equip-statement</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/anti-trans-legislation-equip-statement</guid>
            <pubDate>Mon, 27 Mar 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[In the first 3 months of the 2023 legislative session, 430 anti-LGBTQ bills have been proposed in the United States. The majority of these bills are anti-transgender and specifically target free speech, education, civil rights and especially health care. In just the past 7 weeks, 19 of these bills have been signed into law in 10 states, stripping away the rights of parents, children, and their medical providers. Hundreds of additional laws, in nearly all 50 states, are under consideration. These laws (both proposed and passed) outlaw gender-affirming care, ignoring the clinical recommendations of every major medical organization, including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the Endocrine Society, the American Medical Association, the American Psychological Association and the American Psychiatric Association. I am a midwesterner, where we are supposed to politely avoid talking about politics, religion or money. I am a startup co-founder, where we are supposed to avoid alienating customers that may have different political beliefs. But at my core, I am a parent and a clinical psychologist who is saddened, angered, and deeply worried about how these new laws, driven by misinformation, fear-mongering, and transphobia, will hurt my patients, my colleagues, and my loved ones. At Equip, we are honored to have already served over 150 children and adolescents that are transgender or non-binary. Transgender individuals experience eating disorders at rates significantly higher than cisgender individuals. (For those of you new to learning about gender identity, cisgender describes people whose gender corresponds to their sex designation at birth.) Recent studies have shown that 10-30% of transgender individuals will develop an eating disorder, compared to 2-5% of their cisgender peers. Additionally, over 40% of transgender people report having attempted suicide at some point in their lives, a rate exponentially greater than the rest of the population. As a clinical psychologist, it is easy to see how thoughts of suicide, common in over 80% of transgender people, have been tied to the rampant discrimination and mistreatment they experience in education, housing, and employment; the rejection many experience from families and communities; the elevated levels of violence perpetuated against them; and the lack of access they have to healthcare. These new laws codify the same discrimination and mistreatment of transgender people that make their lives feel unlivable. These laws tell them that they can’t wear what they want to wear. These laws tell them they can’t receive the evidence-based medical and behavioral health care that they seek, their parents desire, and their doctors advise. These laws tell them that they can’t learn about other people like them in school. And many of these laws permit and encourage housing, employment, and commercial discrimination against them. As a clinical psychologist and a human being, it is terrifying to watch our state governments make laws that we know will harm people's physical and psychological well being, while having absolutely no benefit for our society. As both a clinician and a parent, I’m terrified by politicians' intrusion in our personal healthcare decisions and their blatant disregard of experts and clinicians. For weeks, I have not been able to stop thinking about Pastor Martin Niemoller’s poem, First They Came. First they came for the Communists And I did not speak out Because I was not a Communist Then they came for the Socialists And I did not speak out Because I was not a Socialist Then they came for the trade unionists And I did not speak out Because I was not a trade unionist Then they came for the Jews And I did not speak out Because I was not a Jew Then they came for me And there was no one left To speak out for me These laws take away the rights of parents. These laws say that politicians know more than physicians, researchers, and medical experts. Do you see the slippery slope? It takes only a one-minute Google search to find misinformation about ADHD medication. There are already politicians that think stimulants, like Ritalin and Adderall, are “harmful to children”, “equivalent to meth”, and “a gateway to drug abuse and addiction.” Thankfully, there is not (yet?) a politician sitting with me, my husband, and our child in our doctor’s office discussing the medication that we all agree has drastically improved his social and educational experience. The same negative rhetoric and debate exists around prescribing children antidepressants and antianxiety medications. There are current lawmakers who have been vocal about their opposition of these medications for minors-and I’m glad that they too weren’t in the room with our medical team when we all decided that our other son needed Zoloft in 2nd grade when his anxiety was robbing him of enjoying life. But for both of our sons, while there are currently politicians that would object to their doctor’s evidence-based recommendations, they would not reject my children as humans. These laws targeting the human rights of transgender people not only rob them of evidence-based healthcare and the autonomy to make medical decisions for their family, but they also rob transgender people of their humanity. And so while I am sad as a clinician and worried as a parent, I am mostly outraged–as a friend, a colleague, and a loved one to the many transgender and nonbinary people in my life. They are kind and brilliant and funny and deserving and HUMAN. I hope that we can all unite in our shared humanity to stop the dehumanization of our peers, and replace the fear mongering with our shared belief that we all deserve the same human rights. To combat this legislation, there are a few actionable steps you can take in your communities and beyond: 1. For my peers in healthcare: hire transgender people, train providers in gender-affirming care, support your transgender patients, and create explicit gender affirming care protocols to enable providers to put their training into practice. Over the past three years, Equip has learned from, consulted with, and hired people from some of the organizations below. Please reach out if we can be helpful and/or if you have suggestions on other organizations. 2. To support transgender people in accessing healthcare during these unprecedented times or simply to learn more, here are a few resources: FEDUP Collective, a transgender and intersex run group providing direct support, case management, and advocacy to impacted communities. Trans Health Legal Fund, a legal defense fund for those criminalized for accessing gender-affirming healthcare. Trans Week of Visibility and Action (TWVA), a website with specific action for Mar 25-31, the third annual TWVA Project HEAL, an eating disorder non-profit providing earmarked funds specifically for transgender and intersex people to access care. American Civil Liberties Union, a nonprofit organization founded in 1920 to defend and preserve civil rights and liberties. Erin in the Morning’s substack, a great resource for accurate up-to-date information. Queer Legislation Alerts, real-time updates as bills either move or are defeated. 
 3. You can reach out to your state representatives to make your voice heard. You can look up your state legislators here. Click on their name to get their contact information and call or email your representatives. We have drafted emails here. 4. Importantly, check on your friends and colleagues who are transgender, or who have transgender kids and loved ones, to see how they would best feel supported during these times. They may need you to listen and process fears, and they may need you to participate with them in joyful resistance.]]></content:encoded>
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            <title><![CDATA[Helping Your Child Build their Identity Outside of the Eating Disorder]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/building-identity-in-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/building-identity-in-eating-disorder-recovery</guid>
            <pubDate>Mon, 26 Jan 2026 15:05:00 GMT</pubDate>
            <content:encoded><![CDATA[As a parent and an eating disorder survivor, I feel both well-informed and overwhelmed by what it takes to support a child through mental health challenges. When I was in treatment, therapy and nutrition appointments were the main priorities, but there were many other facets to lasting recovery, including rediscovering—and reclaiming—my identity. “One of the most important, and often overlooked, components of lasting eating disorder recovery is helping a child build an identity outside of the illness,” says Equip Therapy Lead Jennifer Simmons. “Eating disorders tend to hijack a child's thoughts, behaviors, relationships, and sense of self. Over time, a child may begin to feel that they actually are the eating disorder, rather than someone experiencing one.” Simmons is spot on—there were many times in my recovery when I questioned who I was without my disorder. Now that I’m a parent, I want to better understand how to help my child retain their identity in case something as overpowering as an eating disorder takes hold. Here are the steps Simmons suggests taking: 1. Externalize the eating disorder One core element of family-based treatment (FBT) is externalizing the eating disorder, or separating it from the child. Asking your child, “what do you—not your eating disorder—have to say?” can help reduce their shame and help them see themselves as separate from, but being controlled by, their illness. It can also be helpful to refer to the eating disorder as a “mask.” “You can kind of see out of it, but it's difficult,” Simmons says. “We are working to remove that mask so that they can see more clearly and truly be themselves.” 2. Focus on strengths “Call out their bravery, kindness, effort, humor, and resilience!” Simmons says. “Let your child know that you see them, not just the disorder.” Resist any urge to only praise improvements in their eating, weight, or body image; doing so can unintentionally reinforce the eating disorder mindset, according to Simmons. 3. Encourage meaningful activities and connections Eating disorders thrive in isolation, so encouraging a child to reconnect with hobbies and friends can go a long way in fostering their identity. “Help your child re-engage with activities like art, music, volunteering, clubs, or sports—spaces where they experience joy, purpose, and belonging,” Simmons says. 4. Adapt therapeutic techniques FBT is the gold standard approach to treating eating disorders in young people. The third phase of FBT focuses on establishing a healthy identity by strengthening coping skills, addressing social challenges, and more. “This identity-focused work isn’t limited to FBT,” Simmons says. “Across all treatment models, recovery is strongest when children are supported in rediscovering who they are beyond the illness and parents are able to transition back into their primary role: being parents, not eating disorder managers.” While eating disorders can be incredibly destabilizing for patients and families, helping a child rebuild their identity can improve the odds of full, lasting recovery. If you have concerns about disordered eating, consider scheduling a free consultation with Equip. “We value education, collaboration, and making sure families find the care that best fits their needs,” Simmons says. “Your family does not have to navigate recovery alone.”]]></content:encoded>
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            <title><![CDATA[Prom & Eating Disorders: What to Do When Appearances Become the Spotlight]]></title>
            <link>https://equip.health/articles/body-image/prom-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/prom-and-eating-disorders</guid>
            <pubDate>Thu, 19 May 2022 15:50:00 GMT</pubDate>
            <content:encoded><![CDATA[When JD Ouellette was helping her daughter prep for prom season, she was also supporting her through the very early stages of her eating disorder recovery. While the prospect of dressing up and dancing the night away with friends sounded like a positive step toward reclaiming fun and freedom, it also raised some major concerns. “Prom was one of our very first hopeful experiences, and also an experience that came with many triggers,” says Ouellette, Equip’s Director of Lived Experience. “Prom is full of all manner of body image and social anxiety concerns for even the most mentally healthy of teens—add an eating disorder and all of these things become magnified.” Between the anxiety of choosing an outfit, inviting a date or being invited, participating in elaborate, pressure-filled pre-event rituals, special events like prom, graduations, weddings, Bar Mitzvahs and quinceaneras can conjure up a lot of intense feelings. Factor in potential group dinners, endless photo ops, and the unfortunate prevalence of diet talk that may lead up to the event, and these celebratory events can quickly become something young people in recovery dread. We spoke with several clinical experts, parents, and teens to understand how they got through special events like prom while navigating an eating disorder: Make a game plan Discuss all of this as early as possible as a family, and also have your child talk to their therapist and/or peer mentor if they have one. Ouellette suggests that families cope ahead versus simply hoping it will all be okay by: Starting clothing shopping early and sticking to a plan Following good practices like being rested, hydrated, and nourished Shooting for relaxed versus rushed Going for a couple of hours maximum Having a comforting, distracting activities planned for afterwards Cultivate a support circle Equip peer mentor Isabella Dean reflects that “so many of the ‘fun’ things that events like prom and weddings brings, like shopping with friends, dressing room fashion shows, and getting ready for the event, are often the things that can become a source of extra distress while working on eating disorder recovery,” says Equip peer mentor Isabella Dean. She suggests that young people make sure to lean on friends and surround themselves with “people that make you remember why going to prom is important to you: to spend time making memories with the people you care about. As cliche as it sounds, prom is a once (or twice) in a lifetime experience, and that time spent singing and dancing the night away are what you will remember, not the size of the attire or what you looked like in the mirror." Be prepared for the dressing room Dressing rooms are notoriously triggering for just about everyone — eating disorder or not. Between the inconsistent sizes, bad lighting, and tricky mirrors, the dressing room can become a prime location for triggers and subsequent arguments. Here are a few ways to minimize stressors when shopping for that special outfit: Decide if the teen will pick clothes off the rack, or point to things they like for the parent to estimate appropriate size Take painter's tape and temporarily cover tags so the focus in the dressing room is not on the size of the garments You may find it helpful to start with a size that is likely a bit too large and go from there “Be mindful of the way you evaluate clothing and stay away from the f-word (that’s ‘flattering’ as a euphemism for slimming). Ask about comfort and confidence instead. Be prepared to run interference and cut off sales staff that may make unhelpful comments,” says Ouellette. Anticipate the challenges of online shopping too If you are ordering online, read reviews about sizing and be sure you are ordering more than one size, including one that is absolutely sure to not be too small. Your teen may well want to wear something that's not your first choice and it's a good opportunity to remember you raised them to be themselves. If an outfit arrives in the mail and requires some tailoring, take precautions to offset potentially triggering language at that step as well. If you need to have your dress or tux altered, let the tailor/seamstress know ahead of time to not make any body comments. They may need some coaching as to what they should not say and what is a better way to say it. Keep it all in perspective “Remember, this is just one day,” says Equip family mentor Laura Cohen. “Events like prom get a lot of hype and it is just another night. Set low expectations. Try to stay in the moment and enjoy yourself. You will not be the first or last person to not feel that prom was the best night ever. GIve yourself some grace.” Events like prom are stressful under the best of circumstances and with the added stress of eating disorder recovery can be challenging. Do not be hard on yourself, be realistic. And if you feel that the event is going to be too hard—skip it. Maybe make another plan that night that you would enjoy more. Equip’s VP of clinical care delivery, Jennifer Derenne MD, adds that the lingering traditional expectations around events like weddings and prom may add an additional layer of complexity. But it is the ritual of outfit selection in particular that may open up a Pandora’s Box of problematic comments and pressure from peers, salespeople, and even other parents. “It's similar to a celebrity preparing for an awards show or the Met Gala,” Derenne says. Painstakingly curated ‘highlight reels’ on social media present additional potential pitfalls or challenges to someone vulnerable to unhelpful comparisons and self criticism.” For Ouellette, the prom journey from beginning to end required vigilance — and a sense of humor. “We now laugh about the shopping experience, which started with my daughter and I driving down the freeway when ‘she’ said, ‘I want to find a long black dress, with long black sleeves, and a high neck.’” Ouellette says. “By this point I could tell exactly who I was talking to and that was pure anorexia; I (safely) pulled to the shoulder and turned to her and said : ‘I am so excited Kinsey is going to prom and I am also absolutely not going to take anorexia shopping for a funeral dress my grandma would wear. Can you get on board with that or should we turn around now?’ Kinsey got on board, anorexia stayed in the trunk of the car while we shopped, and she ended up with a beautiful, spaghetti strap, high/low floral chiffon dress]]></content:encoded>
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            <title><![CDATA[5 Ways to Shut Down Diet Culture Commentary During Thanksgiving]]></title>
            <link>https://equip.health/articles/food-and-fitness/diet-culture-thanksgiving</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/diet-culture-thanksgiving</guid>
            <pubDate>Mon, 18 Nov 2024 14:59:16 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorder recovery can be difficult any time of year, but navigating the holiday season—a time filled with food-centered celebrations—can be especially thorny. Thanksgiving in particular tends to be a challenging day for those struggling to improve their relationship to food or their bodies. In addition to the big meal and any distress that might cause, those working toward recovery might also have to interact with family members or friends who don’t fully understand or know about their recovery journey. Bracing for unsolicited and potentially hurtful comments on top of an atypical meal can be tough—but there are things you can do to make the day more manageable and continue thriving in recovery. “Thanksgiving is one of those holidays where disordered eating and thoughts are both prevalent and popular,” says Ally Duvall, Senior Program Development Lead at Equip. “When comments around dieting, eating behaviors, or bodies come up, it can be hard to know what to say in the moment, especially when it comes from family members or friends.” Here are some of the tried-and-true tips that Equip team members have for addressing diet culture messaging and triggering comments during Thanksgiving: Set boundaries ahead of time “One thing you can do is practice making some boundary statements ahead of time, so that if those topics come up, you're prepared,” Duvall says. “Some of my favorites are: ‘I'm not comfortable talking about my body like this, please change the topic’; ‘I don't have to earn or compensate for the food I am eating’; ‘I'm trying to not talk about diets or bodies this year. Would you like to try that with me?’” Equip’s Director of Program Development, Tana Luo, PhD, says boundaries are an integral part of preparing for the holiday. “It can be helpful to cope ahead and role play with a trusted loved one about how you might respond if someone brings up weight or dieting at Thanksgiving,” she says. “Assert and honor your boundaries. Come up with a list of safe topics ahead of time that you can fall back on if the conversation turns to weight or dieting.” Megan Hellner, DrPH, MPH, RD, CEDRD-S agrees that an important part of planning for the holidays includes setting boundaries with family members around appropriate and preferred discussion topics. “Engaging in talk about weight or body shape may be part of the family culture, but that doesn't mean we need to participate. If it's difficult to have those conversations directly, or you're afraid you may not be heard, ask a safe person to help you reach the family member in question,” she says. “Acknowledge that loved ones may be in a very different place as far as their relationship with food goes. This is not an excuse for engaging in diet talk, but it may be an explanation.” Practice expressing your feelings in a positive way One strategy Hellner recommends is implementing “I statements,” a style of communication that involves using the first person pronoun to convey emotions or address relationship issues. One example Duvall suggests is: "I have a hard time staying present and enjoying the meal when the conversation goes toward weight loss. If it's important to talk about weight loss, can we agree to have those conversations when I'm not around? I would really appreciate the support with my recovery." Additionally, if there are concerns about family members inquiring about your struggles with food or weight, Hellner says it’s perfectly fine to specifically ask that those topics also be avoided on the holiday or in the company of others. “Family can help with this as well,” she says. “Think of a respectful and direct one-liner you can use during dinner to move the conversation away from food and weight. For example, ‘Talking about food and weight is a pain point for me. Is it alright if I change the subject?’” For those who feel comfortable being a little more straightforward, Hellner recommends this: "It really is concerning that we're spending this special time we have together talking about weight and calories, and it's harmful for my recovery. Let's focus on something more energizing or fun." If you're looking for extra encouragement, download coping cards from Equip for some friendly reminders you can print or keep on your phone.  Make an effort to be your own best advocate Holiday challenges offer a great opportunity to really practice our skills in an environment that would otherwise be overwhelming for pro-recovery behaviors. “Expect to have to advocate for your recovery, and think about what this may look like for you in practical terms,” suggests Hellner. “Does this mean creating a new holiday tradition that's less food-centric? Or finding a new group to enjoy the meal with? Or a smaller-than-usual family gathering? Ask for help from your treatment team on how to make the holidays feel a bit more safe.” Prioritize proper nutrition before, during, and after the holiday While it might feel tempting to stray from your meal plan in an effort to “make room” for an impending Thanksgiving dinner, Hellner emphasizes that restriction of any kind almost always backfires in a big way. “As far as the meal itself, let's reject this idea of 'saving your appetite' for Thanksgiving dinner,” Hellner says. “It's neither helpful nor necessary. Try maintaining normalcy around meals and snacks leading up to the holiday meal. This helps us by allowing us to approach the meal with a subtle—vs urgent—feeling of hunger, which in turn makes the meal feel more manageable and less 'scary.’” Eating adequate portions in the days leading up to the event can also help prevent some of the more challenging emotions that often arise after larger-than-average meals. “It can help with post-meal fatigue and feelings of distress and fear that some folks experience in the days after the holiday,” Hellner explains. “Give yourself grace. This meal is different—more dense, and perhaps scarier than meals you'll encounter throughout the year.” Self-compassion is key To Hellner’s point about grace, a tip all experts endorse is to practice continued patience, self-compassion, and gentleness toward yourself. Holidays can be a challenge for anyone, and they can be particularly tough to navigate during recovery. Approaching potential obstacles with an attitude of unconditional acceptance can go a long way toward helping you manage difficult situations. “Be kind to yourself!” Luo says. “This holiday can be a difficult day for many people recovering from eating disorders. Do your best, and be gentle with yourself. You can always reset and get back on track with the next meal or snack.”]]></content:encoded>
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            <title><![CDATA[How Yoga Can Support Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/food-and-fitness/yoga-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/yoga-and-eating-disorders</guid>
            <pubDate>Tue, 06 May 2025 17:06:00 GMT</pubDate>
            <content:encoded><![CDATA[When I was 18 and a freshman in college, I was living in quasi eating disorder recovery and consumed by crippling anxiety and regular panic attacks that made it hard to function. My mother suggested I sign up for a yoga class offered at my school and, out of desperation, I went. I was skeptical that it would help. Little did I know, showing up to that class was a huge step toward full freedom from my eating disorder. Originating from ancient India thousands of years ago, yoga’s name comes from the Sanskrit word “yuj,” which means “to yoke” or “to unite,” and its ultimate purpose is to unite and harmonize a person’s body, mind, and spirit, and their connection to their world around them. Beyond helping people achieve this sense of harmony, yoga also has a number of proven health benefits, including reduced stress, anxiety, back pain, and depression, and improved sleep, blood pressure, concentration, and coordination. When you think of yoga, your mind probably goes to a physical posture, like downward dog—and while the physical practice is a key aspect of yoga, it’s one of many others. Outside of the poses, yoga includes elements like meditation and breathing techniques, several guiding ethical principles, self-study, and service. “Yoga is a practice that captures many experiences that can take place off of the yoga mat,” says Equip Director of Peer Mentorship, Maris Degener, who also found yoga helpful in her eating disorder recovery. “For me, yoga has been a supportive framework for connecting to myself, finding harmony between things that feel like opposites, and becoming closer to those around me.” Eventually, my yoga mat became a safe space to slow my mind without judgement, listen to and move my body with compassion, connect to my breath and a higher power, surrender what no longer serves me, and let myself feel big emotions. Read on to learn more about the relationship between yoga and eating disorders, including its benefits in recovery, different types, potential risks, and when and how to incorporate it into your recovery. Benefits of yoga in eating disorder recovery As a yoga student and teacher and eating disorder survivor and dietitian, I believe the holistic practice of yoga can have a significant, positive impact in recovery when it’s practiced safely, for the right reasons, and alongside medical and therapeutic interventions. Importantly, research shows yoga can benefit eating disorder recovery: in one 2018 study of females with eating disorders who started practicing yoga, participants showed reduced eating disorder psychopathology after the yoga intervention and at the six-month follow-up. Here are some of the research-backed ways that yoga can support eating disorder recovery: Embodiment Eating disorders sever the connection between mind and body, and yoga can help reconnect the two and foster positive embodiment (or the ability to feel a mind-body connection). Embodiment is powerful in recovery, since eating disorder thoughts typically consist of rigid rules around food and movement choices—choices that have nothing to do with how our bodies feel or what they might be communicating to us about their unique needs. “Yoga postures, especially when done with a therapeutic intention and pranayama breathing practice, are pathways to embodiment, which is an essential part of recovery, because living with an eating disorder is a disembodying experience,” says yoga therapist and founder of Yoga for Eating Disorders Jennifer Kreatsoulas, PhD, C-IAYT. “These practices guide us toward our body rather than away from it. This is a huge paradigm shift, because living with an eating disorder is a state of turning away from one's body.” Interoception One side effect of disembodiment is a difficulty feeling our internal sensations, an ability known as interoception. “We know eating disorders can interrupt our interoceptive awareness, or ability to connect with and understand internal cues like hunger and fullness. Yoga helped me rebuild those connections over time,” Degener shares. I have also found my yoga practice (and many of my clients’ yoga practices) helps foster connections to authentic preferences and desires, with both food and other areas of their life. Emotional processing and coping Although I’ve been living in full recovery for years, my yoga mat continues to be a place where I can help myself feel, express, and process the full spectrum of emotions—which live not only in the mind, but also in the body. It’s a place where I can come back to my authentic self and quiet down enough to hear what I need, physically, mentally, and emotionally. Kreatsoulas says yoga helps us “cultivate our inner resources to cope with challenging moments and be more present in our life.” One 2022 review showed yoga’s impacts on participants include increased self-compassion, feelings of centeredness, and improved coping skills. Plus, many yoga practices (like breathing techniques) can be used off the mat, like at mealtimes and during other potentially difficult moments that arise on a person’s path to recovery. “These practices help regulate the nervous system, which is key because healing happens when we’re in a rest-and-digest state, not fight-or-flight,” Kreatsoulas says. Body image Often, body image distress is a significant piece of the eating disorder puzzle, and research shows yoga can help heal people’s relationships to their bodies. One 2024 study of females with eating disorders showed that yoga helped some of them to focus on what their bodies feel like from within (rather than what they look like on the outside) and connect with their bodies’ strength and power. Another 2019 study of college students showed a link between practicing yoga and improved body image, body appreciation, and self-compassion, as well as decreased concern with physical appearance. Kreatsoulas describes yoga as a path to softening and even transforming harsh body beliefs: “Through the path of yoga, we practice harmony within and strengthen our relationship with our body,” she says. Community and spirituality Since yoga is often practiced in group settings, it can be a helpful way to cultivate a sense of belonging and connection with others. “I found community through this practice, where my eating disorder often led to isolation and loneliness,” Degener shares.” Additionally, yoga can serve as a source of spiritual connection, and foster feelings of gratitude and connection to a higher power. This connection can help some people better align with their values, rather than the values of the eating disorder, as well as regain a sense of perspective and calm during challenging moments. Non-violence While there are several yogic principles and ethical guidelines that support recovery, I find the principle of non-violence (“ahimsa”) to be the most helpful in recovery. Degener said she found studying non-violence in her practice helped her reflect on the ways in which her eating disorder caused harm to both herself and those around her. The principle of ahimsa reminds us that practicing yoga (both on and off the mat) is about treating ourselves (including our bodies) and each other with care and compassion. What is yoga therapy vs “regular” yoga? You may have heard of the term “yoga therapy,” which is different from typical group classes you can take in studios, gyms, or online. So what exactly is yoga therapy? As Kreatsoulas explains, “yoga therapy is a private session that focuses on the practices, tools, and philosophies of yoga to support clients.” While yoga teachers typically focus on certain yoga methods for their groups of students, yoga therapists generally start with each individual client’s needs—which usually include symptom reduction and relief from a health condition—and utilize yoga principles and practices to address them. For people in eating disorder recovery, Kreatsoulas says yoga therapy can effectively complement traditional therapeutic techniques by involving the body while healing the mind. “Whereas a client may work with their therapist on the specific nuances and symptoms of their eating disorder experience, yoga therapy is the space to explore where certain feelings like fear live in the body and create practices of self-compassion to integrate into daily life,” she says. “We can process in real time what comes up for clients when they engage in these practices, and include other care providers for deeper processing if necessary.” In her sessions, Kreatsoulas helps clients develop coping tools, practice centering and breathing exercises, gently move their bodies, explore yoga philosophy, and set goals to promote healing. Plus, some therapists and dietitians who are also yoga teachers offer yoga-infused therapy or nutrition sessions, combining traditional therapy and nutrition counseling with yoga practices on an individualized basis. “This means focusing on the other aspects of yoga, such as meditation and breathwork, in addition to the ethical principles of yoga,” explains psychotherapist Amanda Marks, LPC, CPCS. In my practice, I offer clients the option to practice yoga in various forms within sessions, with the intention to help them nonjudgmentally observe thoughts and reconnect to the present moment, their bodies, and their emotions. Regular yoga classes, on the other hand, are typically focused on the physical practice of yoga, and tend to follow specific styles. The different styles of yoga you might see include: Yin yoga: emphasizes long-held floor postures and deep stretching Restorative yoga: includes long-held floor postures for relaxation, typically with props like blankets, bolsters or pillows, and blocks Hatha yoga: emphasizes floor and standing postures at a slow pace with focus on the breath Vinyasa yoga: includes continuous movement and flowing through poses, matching breath to movement at a swift pace Power yoga: includes strength-based poses and fiery sequences Gentle yoga: emphasizes mindful, slow, and soft movement Potential risks of practicing yoga in recovery While yoga can be a powerful tool in recovery, it can also do harm if not practiced mindfully. There are a few particular areas of caution to keep in mind, outlined below. Much of the yoga industry is steeped in diet culture. I’ll never forget being in the middle of a yoga practice when the teacher started talking about how “bad” she had eaten over the weekend, naming specific foods and expressing her guilt about it. While I was firmly rooted in my recovery at that point and so was more annoyed than triggered, such comments can be significantly harmful to recovery. They also take us away from yoga’s roots—as mentioned above, yoga is so much more than a physical practice, and the physical practice is not about burning calories, earning food, or chasing a certain body aesthetic. “Unfortunately, in our appearance-obsessed world, yoga studios are not exempt from being influenced by diet culture,” Degener says. “There have been times where I've been in classes and heard remarks about certain poses changing our appearance or needing to push through pain to ‘feel the burn.’” Other red flags include studios that promote restriction of any kind, like detoxes or juice cleanses, or that don’t celebrate body diversity among teachers and idolize thinness within marketing photography. “Like many aspects of wellness today, yoga has been swept along with social media, promoting the stereotype of a particular body type,” Kreatsoulas adds. “The yoga selfie craze can breed body comparison, and the hyper-focus on yoga as fitness can inadvertently prompt competition, overexertion, and perfectionism.” Yoga can become part of the eating disorder. Exercising obsessively or punitively is common in eating disorders, and yoga can easily become wrapped up in such behaviors, especially since what Kreatsoulas calls “workout yoga” is idealized in our culture. “High-intensity, fitness-focused classes, and workshops often reinforce unhealthy drives, such as over-exercising and focusing on weight loss to change one’s body to fit an ideal,” she says. “These messages can be counterproductive to the values of acceptance, self-care, and self-love inherent to both the true heart of yoga and the recovery process.” Being a “yogi” or devoted yoga student can sometimes become a facade behind which eating disorders hide. In fact, even the non-physical aspects of yoga, like the suggested tools for cultivating happiness and confidence, can be misused by the eating disorder brain. For example, one yoga-based suggestion is practicing purity or cleanliness on and off the yoga mat—and while this is meant to encourage healthy practices like keeping clean living spaces, the eating disorder can warp it to be about only eating certain foods, or fasting. When I work with clients to develop a yoga practice in their recovery, we always discuss the “why” behind the types of practices they choose and how they integrate yoga into their lives (on and off the mat) to ensure they’re using yoga to help them live in recovery—not stay imprisoned in their eating disorders. The physical practice requires medical stability. Like with any other physical activity, it’s critical to ensure you’re healthy enough to exercise before you start a physical yoga practice, since exerting yourself while medically compromised is dangerous. In a 2021 study that explored eating disorder clinicians’ perspectives on yoga, they agreed that higher intensity practices (like power yoga and yoga done in hot studios) can be especially detrimental and even dangerous to people with eating disorders who are early on in recovery or medically unstable (or both), and that more research should be done on the risks of practicing physical yoga in recovery. Despite all of yoga’s potential benefits, it’s not always going to be healthy or helpful for every person in eating disorder recovery, and those who aren’t yet medically stable fall into that category. When to incorporate yoga in eating disorder recovery Depending on which aspects of yoga are used, it can often be incorporated at any point in recovery, even early on. For example, while you may not be ready for physical poses, you can start to integrate non-physical yogic practices into your life, like self-study, breathing techniques, and meditation. Or perhaps you start a physical practice with one restorative posture, like legs up the wall—all of it “counts” as yoga. “What is most important is that you're staying connected to your unique needs,” Deneger says. “I always come back to what my teachers taught me: if you’re breathing, and if you’re practicing being in the moment, it doesn't matter whether you're in child's pose the entire class—you're practicing yoga.” Supporting this approach is one 2024 study of women with eating disorders, which showed that practicing gentle yoga can be a safe way to incorporate healthy movement and experience the body compassionately at all stages of recovery—even at the inpatient level of care. However, physical practices of any level should be guided by your healthcare provider or treatment team to create a medically and mentally safe plan that hopefully supports and ideally enhances your recovery. “There are many different styles of classes that have varying levels of physical intensity,” Degener adds, “and a provider who knows your physical needs can help you determine what would be a good fit for you, and when.” How those in recovery can start yoga safely Clearly, there’s a lot to consider when starting a yoga practice in recovery. While the most important thing is to collaborate with your treatment team, here are some other factors to consider when you’re getting started: Look for trauma-informed teachers. Being trauma-informed generally means that teachers are aware of students with trauma (which is common among those with eating disorders) and trained to safely help them become more connected to what’s happening in their bodies. It also means they give their students choice and avoid potentially triggering positions and language. Look for studios and teachers who focus on yoga holistically. Some facilities or online teachers or schools offer meditation, breathing, and yogic philosophy classes. More commonly, some teachers will infuse such elements into physical practices. “It’s okay to take your time finding a space that you feel comfortable in and that respects the entirety of the practice rather than only focusing on the physical elements,” Degener adds. Stay aware of diet culture. While it can take time to find authentic yoga sources that are free of diet culture and in alignment with eating disorder recovery, it’s possible to find safe spaces and teachers. Marks suggests looking for yoga therapists and teachers who have “a non-diet mentality and are weight- and body-neutral and accepting and encouraging of all body sizes.” Marks also recommends asking your therapist or dietitian for referrals, as well as“searching social media for fat or plus size yoga teachers, because they will focus on making yoga accessible and safe for almost everybody.” Do your research. Whether you’re looking to practice yoga online or in person, it may take some trial and error to find the right fit for you. “I would strongly encourage folks to research studios in their area and consider reaching out to ask them about their philosophy as a studio and how they approach their teaching,” Degener encourages. “Personally, I feel most at home in studios that don't prominently feature mirrors, have teachers that discuss yogic philosophy in addition to the physical practice, and offer many variations or options for modification throughout the class.” Start gentle. If you’re physically and mentally ready to start a physical yoga practice in eating disorder recovery, Kreatsoulas recommends “choosing classes that are gentle, for beginners, or restorative in nature.” This recommendation remains true whether or not you’re actually a beginner in yoga. Over time, if it’s supportive of your recovery, you may explore other, more physically demanding, types of yoga, with the support and guidance of your healthcare team.. Finally, here are some communities and books that can support your yoga journey: Yoga for Eating Disorders Eat Breathe Thrive The Courageous Path to Healing Body Mindful Yoga Overcoming Trauma through Yoga]]></content:encoded>
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            <title><![CDATA[Eating Disorder Relapse Is Common. Here's Why and How to Handle It]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/eating-disorder-relapse-causes-prevention-advice</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/eating-disorder-relapse-causes-prevention-advice</guid>
            <pubDate>Mon, 12 May 2025 16:52:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorder recovery was a long roller coaster for Equip Peer Mentor Jamie Drago. “I would go a few steps forward, then a few steps back, maybe a mile forward, maybe three miles back, and so on. I had multiple setbacks before I got to a sustainable, long-term recovery,” she says. Looking back, she believes the reason for this pattern was that she never fully recovered during those earlier attempts of life after eating disorder treatment. “A lot of things were better, but I was also cutting a lot of corners. So it was sort of a natural progression back to more disordered thoughts and behaviors,” she says. Many people in eating disorder treatment experience a similar cycle of progress and setbacks, and this can lead to harsh, negative self-talk. “People talk about recovery as a singular thing: you cross a finish line, and you've done it. And if you relapse, it can feel like you failed. Or if you go in circles a few times, it can feel like that will be your life forever,” Drago says. But she stresses that this isn’t true: you haven't failed, and you don't have to live in this cycle forever. Adriana Lindenfeld, LMHC, a primary therapist for Equip, agrees with this perspective. “A relapse is not failure. It's feedback and it’s an inevitable part of the recovery journey,” she says. “Think of it as data, not defeat: It can provide valuable insights into what triggers you, where your weaknesses are, and what strategies need reinforcement. It can be an opportunity to deepen your recovery, refine your skills, and come back stronger than before.” Read on to learn what an eating disorder relapse (and a lapse) is, why it's so common, how to try to prevent them, and advice on what to do if you or a loved one relapse. What is an eating disorder relapse? Although there's no standard definition of a relapse during eating disorder treatment, Lindenfeld describes relapse as a significant return to old eating disorder behaviors and thought patterns. “It's more than just one instance,” she explains. “It signifies a substantial deviation from established recovery and a resurgence of the core symptoms of the eating disorder.” A relapse differs from what some people call a lapse or slip. “A slip is like a stumble. It’s a momentary lapse in judgment or a one-time occurrence of an old behavior,” Lindenfeld says. For example, maybe you restrict at dinner after a super stressful day, but you have your nighttime snack and return to your usual eating in the morning. “A relapse, on the other hand, is more like falling down the stairs—it's a series of missteps leading back into the depths of the disorder,” Lindenfeld says. This might be several days of restrictive eating, along with intensifying thoughts about weight and increasing isolation from your support systems. Or think about it this way: If a single slip happens, you can quickly get back on track to recovery. But a sustained relapse requires more intensive attention.  Many, many people in eating disorder treatment experience slips and relapses, though the exact number differs from study to study. Some estimate that 25 percent of young adults go through at least one relapse, while one study found that 52 percent of patients with anorexia nervosa relapse. Research shows that the risk appears to be highest in the first year following treatment. Why is eating disorder relapse so common? “The complexity of eating disorders—which involve psychological, biological, and sociocultural factors—contributes to the frequency of relapses,” Lindenfeld says. Psychologically, eating disorders often serve as coping mechanisms, and these patterns can be deeply ingrained and resurface during stressful times. Biologically, imbalances in neurotransmitters that affect mood and appetite may make it harder to resist urges to engage in disordered eating behaviors. And societal pressures related to body image, thinness, and diet culture can significantly impact a person’s vulnerability to relapse. There are also a number of specific factors that research has shown can increase the risk of relapse, including: Not achieving weight restoration (if appropriate) Maintaining food rules, exercise rules, and other psychological symptoms of the eating disorder Persistent feelings of body dissatisfaction Longer duration of the eating disorder Having more severe eating disorder symptoms Having a co-occurring condition Going through a life transition High stress Unresolved trauma Lack of social support Ending treatment early But although relapse is common, it’s also common to go on to achieve full recovery after that. To ensure that relapse is just a small detour on the road to recovery—and not a final destination—it’s important to view it as an opportunity to learn, adjust your treatment if appropriate, and grow. “Relapse helped me understand my patterns better. I could look back and see from a distance the patterns of disordered thoughts that would come up and then lead to another disordered thought. Or I would realize certain triggers, like that if I traveled and came back home, that was hard for me,” Drago says. “I learned what my risks were for relapse, and I figured out what to do when those things came up.”  How to prevent an eating disorder relapse First, it’s important to understand that you can do everything in your power to prevent a relapse, and it may still happen. Eating disorders are that powerful and sneaky. “It was really easy to convince myself of all the reasons that it 'wasn't that bad' or 'things have been worse' or 'things could be worse,'” Drago says. “Eating disorders can be very creative with justifications, explaining things away and finding evidence for why it's 'fine.'” Still, you can take action to make a relapse less likely to disrupt your or your loved one’s recovery—and less harmful if one does occur. Here are some tips. Make a relapse prevention plan Since relapse is so common, many patients collaborate with their care team to create a relapse prevention plan toward the end of their treatment. This written document often includes several lists for easy reference. That may include: Skills used to maintain recovery Tools to employ when challenging moments pop up Relapse warning signs to watch for Specific actions to take if you notice signs of a relapse Motivation for recovery Maintain a strong support system “Regularly connect with trusted friends, family members, support groups, or mentors who understand your struggles. Talking about your challenges and feelings with supportive individuals provides emotional grounding and reduces isolation, which can be a major relapse trigger,” Lindenfeld says. Continue therapy even if you're doing well “Ongoing therapy provides a safe space to process emotions, address underlying issues, and improve coping skills,” Lindenfeld says. It’s also a proactive step to prevent possible slips from escalating into a relapse. This is one of the reasons that we recommend patients continue treatment with Equip during the first few months of recovery. Practice stress-reduction techniques Managing stress reduces the risk of turning to disordered eating behaviors as a way to cope with overwhelming feelings, Lindenfeld says. Do whatever works for you, which could be spending time in nature, mindful movement, deep breathing, meditation, journaling, or something else. Be mindful of your thoughts and triggers “Identifying the situations, thoughts, or emotions that trigger the urge to engage in eating disorder behaviors allows you to develop strategies to navigate them, such as having a plan for challenging social events or practicing cognitive restructuring to challenge negative thoughts,” Lindenfeld explains. Set realistic goals With the help of your support team, break down large recovery goals into smaller, manageable steps. “Celebrating small victories and recognizing progress, however small, helps maintain motivation and prevent discouragement, which can contribute to relapse,” Lindenfeld says. Be kind to yourself Practice self-compassion and avoid self-criticism, Lindenfeld says. “Treating yourself with kindness and understanding helps build resilience and reduces the shame that can fuel further relapses.” Follow your meal plan Sticking to a meal plan created by your dietitian can provide the structure that helps prevent the eating disorder from sneaking back in. Eating disorder meal plans are specifically designed to help patients consume a well-rounded diet, eat at regular intervals, and stop engaging in food rituals and other disordered behaviors. Doing all of these things helps improve physical and mental healing, Lindenfeld says. Don't ignore the red flags If you notice yourself or your loved one slipping, try not to blow it off. “When you slip, it’s a sign to turn around—and the earlier you turn around, the less distance you have to walk back.” Drago says. Seek help and make a change before your slip becomes a full-blown relapse. What to do if you relapse If you find yourself sliding from a lapse into a relapse, be kind to yourself. Remember: Up to half of all people in recovery face this exact challenge, and acknowledging the situation is your first step back to health. “Shame only fuels the disorder,” Lindenfeld says. “Instead, understand this is part of the journey—it's a detour, not the end of the road.” After you’ve made that recognition, it’s time to take action to keep moving toward recovery. The advice below can help. Get support Contact your therapist, support team, or treatment program ASAP. As Drago noted, the sooner you reach out for help, the less work you’ll have to do to get back to a healthy place. Working with trusted eating disorder specialists helps you address the underlying factors contributing to relapse so that you can back on track, Lindenfeld says. Remember that small steps count No matter the size, every step forward is a step closer to recovery. “When it felt like there was no imaginable chance of full recovery for me, and I felt so hopeless, my dietitian asked, 'What if we focus on your quality of life? What small steps might improve your quality of life by even one percent?' No step was too small, and thinking about it that way made it seem possible,” Drago says. “I couldn't imagine a full picture of recovery, but I could imagine making small changes. We worked our way up from there, until now—now I’m at a place where, back then, I could not even imagine what it could look like.” Build a recovery-focused lifestyle Rather than simply “trying to recover,” Lindenfeld recommends thinking about how to integrate recovery principles into your daily life in a sustainable way. “It’s more than just managing what you eat; it's about cultivating a peaceful relationship with food, accepting and respecting your body, and nurturing your overall well-being,” she adds. This could mean things like only surrounding yourself with supportive people and finding fulfilling activities that aren’t related to food or body image, like volunteering or hobbies. Be honest with yourself “Call an eating disorder thought out for what it is, and fight the urge to explain it away,” Drago recommends. “I had to come to terms with what I was losing by staying in my eating disorder—I'd say 'I have a job, it's fine. I have friends, it's fine.' But did I want ‘fine’ for myself, or did I want more?” Don't let fear of another relapse hold you back “When I was stuck in the cycle of recovery and relapse, I felt like my two options were either being fully recovered for the rest of life or being doomed to a miserable life with an eating disorder. But it doesn't have to be that black and white,” Drago says. “Even if you reach recovery now and then, years later, you experience setbacks or another relapse, there is value in however long you spend in recovery. There is so much joy to be had in a life with more freedom of any amount and improved quality of life overall. And that is worth it.” What to do if a loved one relapses If someone you care about relapses during eating disorder recovery, you may feel a storm of emotions: worry, frustration, helplessness. These reactions are natural when watching someone you love struggle. You might also feel conflicted about what to do: scared that you’re overreacting, but also afraid of doing nothing. Know that if your loved one is starting to slip, they need you perhaps more than ever. Here’s how you can provide meaningful support while respecting their autonomy. Speak with acceptance One of the most important things is to avoid judgment or disappointment—these types of reactions often amplify the harsh inner critic berating your loved one. Instead, approach them from a place of unwavering compassion that acknowledges their struggle without defining them by it. During every conversation, “listen actively, validate their feelings, and avoid any blame or shame,” Lindenfeld says. “Their vulnerability requires sensitivity from you.” Help them help themselves Encourage them to reconnect with their support team and offer practical help like driving them to appointments or preparing a meal, Lindenfeld says. Or simply ask them what would feel helpful. If your loved one is a minor, you may choose to reach out to their treatment team yourself. Find support Eating disorder treatment and relapses are difficult for both patients and their parents, caretakers, and other loved ones. So consider seeking therapy for yourself or finding a support group for parents of children with eating disorders. Equip offers support groups and mentors, and FEAST (Families Empowered and Supporting Treatment of Eating Disorders) is another resource that many families find helpful. Knowing you're not alone often goes a long way toward shifting your outlook about relapse. Be patient Eating disorder recovery can be a difficult and long journey—for you and your loved one. Whether you’re facing a first relapse or managing the fifth, it's valid to feel defeated. However, research shows that persistent support significantly improves recovery outcomes. So don't give up. Be patient, keeping in mind that each relapse is a chance for your loved one to strengthen the skills required for lasting change. With your support and love, they can do this. The Equip takeaway on eating disorder relapse Eating disorder recovery isn't easy, and it isn't a linear race with a finish line. Many people experience one or more relapses along the way. Though you may feel like you failed if you relapse, you haven't. Have hope, because a relapse—or a series of them—is an opportunity for growth, and can make your recovery even stronger in the end. “Recovery is a roller coaster. It won’t be easy, yet it will be the most gratifying journey to embark on. Remember that healing is possible and seeking help is a sign of strength, not weakness,” Lindenfeld says]]></content:encoded>
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            <title><![CDATA[Navigating Pregnancy Weight Gain in Recovery]]></title>
            <link>https://equip.health/articles/body-image/pregnancy-weight-gain-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/pregnancy-weight-gain-eating-disorder-recovery</guid>
            <pubDate>Tue, 03 Sep 2024 18:48:00 GMT</pubDate>
            <content:encoded><![CDATA[When you’re consumed by an eating disorder, gaining weight can feel extremely scary and like the worst possible outcome. However, it’s often a non-negotiable aspect of healing your body and mind and is a necessary step on the way to living in full recovery. Pregnancy is another scenario in which weight gain is essential, and this can be challenging for anyone living in a world where weight gain is considered inherently negative. For those in eating disorder recovery, however, this weight gain can be especially fraught. As an expecting mother living in recovery and an eating disorder dietitian, today I’ll share some truths about pregnancy weight gain in recovery, how weight stigma can impact your experience, and ways to deal with gaining weight during such a pivotal time in your life. Pregnancy weight gain in eating disorder recovery First, it’s important to note that having an active eating disorder has adverse consequences on pregnancy. A review of research from 2020 shows that having an active eating disorder while pregnant is related to anxiety and depression, as well as negative outcomes for mom and baby, including miscarriages and premature births. Another review from 2021 shows eating disorder symptoms during pregnancy can make both pregnancy and delivery more complicated. Eating disorders in pregnancy can also lead to breastfeeding issues, dehydration, and cardiac abnormalities. Additionally, a 2023 study showed that pregnant mothers who were underweight before conception were at higher risk of delivering low-weight babies compared to those who were not underweight. “If a patient needs weight restoration prior to pregnancy, it’s recommended that they gain weight before getting pregnant,” says registered dietitian Melissa Bloom. But regardless of whether weight gain is needed before pregnancy, it’s almost always essential during pregnancy, and this can be very difficult for people affected by eating disorders—even those in recovery. According to Equip lead dietitian Dani Castellano, RD, CEDS, there are several reasons why this can be so tough, including: body image distress that may come from weight gain increased energy needs nausea or vomiting that could be triggering for someone who has struggled with purging behaviors societal pressure to “bounce back” to a pre-pregnancy body after giving birth or to lose the weight via breastfeeding the way pregnant bodies are represented in media as thin bodies with perfectly round bumps the extra focus and commentary made about pregnant bodies However, adequate weight gain is critical for the health of you and your baby. In a 2023 study, mothers who didn’t gain enough weight were more likely to birth low-weight babies compared to those who gained adequate weight. “Women who receive inadequate nutrition and gain inadequate weight give birth to low-weight infants, which is a risk factor for morbidity and mortality,” explains dietitian Amy Goldsmith RDN, LDN, who adds that pregnancy weight gain is essential for proper physical and emotional growth. “Infants of low birth weight have a hard time fighting infection, regulating body temperature, and have difficulty eating and potential damage to organs.” Despite our diet culture’s toxic messaging that pregnant women shouldn’t gain “too much weight,” research indeed shows that not gaining enough is in fact the riskier outcome. In author Emily Oster’s science-based book Expecting Better, she cites four different studies highlighting the adverse side-effects of low-birth-weight babies, which include higher mortality rates, serious lung complications, higher diabetes risk, and lower cognitive skills. Weight stigma and pregnancy weight gain Weight stigma—or the bias against people because of body size—unfortunately infiltrates every corner of healthcare, including (and perhaps especially) prenatal care. Castellano says two clear ways it shows up are: 1) Being asked to gain less weight if you’re in a larger body 2) Waiting room chairs, medical equipment, and maternity and nursing products that aren’t size-inclusive People in larger bodies are undoubtedly impacted the most by weight stigma, especially because standard pregnancy weight gain guidelines are unfortunately based on BMI. This is problematic because BMI is an unreliable measurement of health that was developed 200 years ago by a Belgian mathematician to quickly measure “obesity” (not overall health) in a mostly white and male population. If you live in a larger body and aren’t working with weight-inclusive providers, you’ll likely need to take extra steps to create healthy and safe boundaries that ensure you get the care you need and deserve throughout your pregnancy, and to protect your recovery. Though weight stigma can be most damaging to pregnant women in larger bodies, those of all body sizes can be negatively impacted by fear-mongering messages about weight in pregnancy. In my experience, nearly every prenatal resource I read encourages gaining enough weight, but often comes with a caveat, like, “but don’t gain too much weight.” In fact, a 2020 study of pregnant and postpartum women showed nearly one in five felt judged, shamed, or guilty because of their weight in healthcare settings. Regardless of your body size, know that your body will gain adequate weight for your pregnancy when you regularly engage in health-promoting practices that feel realistic for you (many of which are likely a part of your recovery), like eating regular meals and snacks, eating a relative balance of nutrients, doing your best with sleep, and going to your prenatal visits. How to cope with pregnancy weight gain while in recovery Many people with eating disorder history can find pregancy weight gain challenging, and fall into old habits in order to counteract the weight (sometimes referred to as "pregorexia"). Here are several strategies to help you navigate gaining weight in your pregnancy while keeping your recovery intact: Set boundaries with your providers.  At my first prenatal visit with my midwife, I told her about my eating disorder history and explained that I would prefer blind weights (i.e., not seeing my weight on the scale) throughout my pregnancy, and only discussing my weight if I’m not gaining enough to support a healthy pregnancy. Now, toward the end of my pregnancy, I’ve obviously and thankfully gained weight, and we haven’t talked about it since our initial discussion. Personally, not concerning myself with a number that once controlled my life and that I feel is unimportant for me to know—even during pregnancy—feels mentally and emotionally supportive. Although I’m not entirely sure how I would respond to regular open weights for nine months, I’d prefer to protect myself from the potential of feeling more anxiety than I already do growing a human. Of course, my approach is only one route you can take in your pregnancy. Consider what approach to weighing (blind, open, or less often) feels safest and most supportive of your recovery and go from there. “Have an upfront conversation with your provider about how weight gain will be monitored so you know what to expect and can advocate for your needs at whatever level feels comfortable for you,” Castellano advises. Stay connected to (or reconnect with) your team.  If you’re still working with an eating disorder treatment team, continue accepting their support and leaning on them when body changes feel difficult. If it’s been a while since you were in treatment, now is a good time to check back in with your therapist or dietitian (or both) for extra support during a vulnerable time. Your therapist can help you navigate hard emotions around weight gain, and your dietitian can help you stay on track nutritionally and eat to support adequate weight gain and optimal health for you and baby. If you’re years into recovery and feeling confident in your ability to handle weight gain, it’s a good idea to at least have an eating disorder provider in your back pocket in case the road gets rocky. “Accept that weight gain may trigger past thoughts and feelings that could affect nutrition intake, and be open to start working with a provider who understands both pregnancy needs and eating disorders,” Goldsmith suggests. “This provider can help with education as well as set challenges and hold you accountable as you move through the pregnancy.” Decode negative body thoughts.  Sometimes, negative body thoughts aren’t about your body at all. In my practice, my clients often have worsening body image when they’re feeling harder emotions or going through significant life changes. When they realize their bodies have become the scapegoat for all their difficult emotions, they’re able to be kinder towards their bodies and deal directly with how they’re feeling. Pregnancy can feel overwhelming and bring a myriad of emotions—both pleasant and unpleasant. So, check in with yourself when negative body thoughts increase and see if there’s a deeper layer of emotion that needs to be addressed. From there, identify what you need emotionally and circle back to coping skills that have helped you endure hard feelings and transitions in your past. One of my go-to coping skills is self-compassion, which includes mindfulness, common humanity, and self-kindness. Use body image tools.  To help befriend or at least be neutral towards your body during pregnancy, try reframing negative thoughts about weight gain. “When you have a negative thought about your body, practice shifting the focus to the positives of your body being able to carry a baby and how weight gain supports this process,” Castellano suggests. If positivity feels hard to access, work towards viewing your body and your growing belly as neutrally as possible, starting by writing down each body part and how it functions daily. Revisit your list whenever you start to notice thoughts going south. If it feels right, you may eventually start to extend gratitude (mentally or in writing) towards your body and all that it’s doing to support you and your baby. Additionally, consider unfollowing any social media accounts that worsen your body image and following ones that foster a healthy one during pregnancy, including @plussizebirth, @jessiemundell, and @fertility.prenatal.dietitian. You might also want to consider taking Equip’s free, self-paced body image program, Explore: Freeform. Define and get rooted in your values.  Crystalize your core values for this pregnancy and think about how gaining weight helps you align with them. For example, one of my values is safety for me and my baby, and adequate weight gain is a key factor in cultivating such safety. Another one is holistic health, which includes staying the course of my eating disorder recovery—which, in turn, involves eating intuitively during and after pregnancy and trusting that my body knows what to do, especially with my weight. So, try writing out your highest values for this time in your life and be sure to include how weight gain will help support them. When the going gets tough, validate your feelings first and apply self-compassion (it’s okay to feel uncomfortable with a drastically changing body, and many women do). Then, revisit your values and remember: growing and birthing a healthy human always requires sufficient weight gain.]]></content:encoded>
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            <title><![CDATA[What Is Purging? Understanding the Many Forms of Bulimia]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-purging</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-purging</guid>
            <pubDate>Thu, 07 Dec 2023 18:37:00 GMT</pubDate>
            <content:encoded><![CDATA[ Melanie D'Andrea, Manager of Clinical Partnerships at Equip, experienced an eating disorder for the first time after going through a breakup at 18. D’Andrea began purging, a hallmark symptom of bulimia that involves “getting rid” of food after consuming a large quantity of it (a behavior known as binge eating). But while bulimia is often stereotyped as an illness that involves one very specific type of purging—vomiting—D’Andrea’s symptoms included a different, but equally dangerous behavior. “My purging came in the form of compulsive exercise,” she says. What began as an interest in yoga and treadmill running eventually spiraled into an obsession that consumed D’Andrea day and night. “I started tracking calories in and calories out, using exercise as a form of punishment for eating ‘poorly,’ and making sure to ‘burn off’ every cookie or Frappuccino I consumed.” Over time, D’Andrea discovered another way to achieve the “empty” feeling she craved: laxatives. “It began in small doses but quickly escalated to taking large volumes daily,” she says. “Laxatives, along with compulsive exercise, became my daily habits. Eventually, the laxative abuse meant I could no longer exercise due to lack of energy, inability to run without needing to use the restroom, and increasing depression.” D’Andrea’s experience illustrates an important, but widely unknown fact about bulimia: it doesn’t always involve vomiting. So what exactly is the definition of purging? While it can commonly take the form of vomiting after meals, it can also appear as laxative or diuretic abuse, excessive exercise, restricting food to compensate for a binge, and more—and all these forms of purging can be just as serious and dangerous. Here’s what everyone should know about the realities of bulimia, the different types of purging, and why anyone struggling with any of these behaviors deserves care. Purging definition: What “counts” as a purge? Bulimia is characterized by uncontrollably eating large amounts of food (bingeing), followed by attempts to “get rid of” or “make up for” the food eaten, a behavior known as purging. Purging can manifest in a variety of different ways. “Purging is the intentional act of compensating for calories,” says Equip Psychotherapist Hannah Bishop, LPC. “The stereotype for what is purging is recognized as vomiting, but that doesn’t mean other behaviors can’t fall into this definition." According to Registered Dietitian, Nutrition Consultant, and Certified Personal Trainer Alix Turoff, purging refers to any intentional behavior used to try to “undo” or compensate for eating. While vomiting is the most commonly recognized form of purging, other versions she often sees in her clinical practice include: Compulsive or excessive exercise Laxative or diuretic misuse Insulin manipulation (a behavior known as diabulimia) Fasting or severe calorie restriction after eating Sauna abuse Using food rules and behaviors to “cancel out” intake “These behaviors are often socially praised or normalized, which makes them harder to recognize and easier to dismiss,” Turoff says. “But if the behavior is being used to compensate for food or relieve distress or guilt about eating, it falls under purging.” What are the different types of purging? Oftentimes, people struggling with bulimia engage in a combination of multiple purging behaviors. Here’s what you should know about the types of purging and their dangers. Self-induced vomiting Vomiting in an effort to expel “excess” food is a very common behavior in people with bulimia. One study found that 56% of bulimia patients experienced self-induced vomiting at least once per day. Common signs of this behavior are frequent trips to the bathroom or disappearing after meals, and using gum or mouthwash frequently to mask the smell of vomit. Self-induced vomiting can also lead to a variety of medical complications including: Stomach rupture Heart and kidney problem Dental problems including stained teeth, tooth erosion, and cavities Irregular menstrual periods Inflamed esophagus Electrolyte imbalances, which can be fatal Self-induced vomiting is a very serious purging behavior in itself, and can become even more serious when combined with other forms of purging. Excessive exercise As D’Andrea experienced, purging can often appear in the form of compulsive exercise (some people refer to this as “exercise bulimia” or “exercise addiction”). According to research, “problematic exercise”—which can be characterized by intense preoccupation and compulsivity around exercise and using exercise for weight regulation—occurs in about 55% of bulimia patients. “The easiest form of purging to dismiss as ‘healthy’ is probably excessive exercise,” Turoff says. “Because exercise is so normalized and generally praised as a healthy behavior, it’s easy for compulsive or compensatory movement to fly under the radar. People are frequently praised for these behaviors for being disciplined, motivated, or ‘taking care of themselves,’ even when the exercise is being used to punish eating, relieve guilt, or earn food.” But even though compulsive exercise is often viewed as a positive achievement, it can be extremely unsafe. “I struggled with compulsive exercise and would often receive many compliments on my ‘determination,’ which would fuel the eating disorder,” says Bishop, who is also in recovery from bulimia. Overexercising can result in everything from fatigue and depression to overuse injuries and the loss of menstrual periods. Turoff adds that it also “reinforces the belief that food needs to be earned or erased, which keeps the eating disorder cycle going.” Compulsive exercise can also lead to a variety of medical complications, including: Hormone disruption Irregular or absent menstrual cycles Impaired bone health Strain on the cardiovascular system Fatigue Worsened mood and anxiety “Exercising seems so normalized in today’s society, but the ‘why’ behind it is what matters,” Equip Peer Mentor Gabrielle Terzano says. “If you’re using exercise to compensate for what you ate, then it may be a sign that you’re using exercise to purge.” Misuse of laxatives, diuretics, or diet pills Many people with bulimia misuse various medications and pills in an effort to purge. Not only is this practice ineffective for weight loss, it’s also highly dangerous. Laxatives artificially stimulate the large intestine to empty—but most calories are actually absorbed before food reaches this part of the digestive system. The "weight" that's lost from laxatives, diuretics (water pills), or diet pills is most often a combination of water, electrolytes, minerals, indigestible fiber, and colon waste. Studies suggest that anywhere from 10-60% of people in the U.S. with eating disorders have misused laxatives at some point in their life. The list of medical problems associated with laxative abuse is long, and it includes electrolyte imbalances and changes to the body’s pH levels, which can result in potentially lethal kidney and cardiovascular complications. Fasting or compensatory restriction While food restriction is often exclusively associated with anorexia, it’s a symptom that’s common to all eating disorders—including bulimia. And eating very little (or not at all) is a somewhat common form of purging. Here’s why: In most cases, the binges that are characteristic of bulimia are preceded by periods of restriction. The resulting biological hunger from that restriction can trigger a binge, and make the person feel they’ve lost control. This combination often leads people to restrict after binges in an attempt to “make up” for the episode, but the restriction only perpetuates the harmful cycle. You can learn more about the differences between anorexia vs bulimia here. Insulin misuse/mismanagement Insulin misuse or mismanagement, sometimes called “diabulimia,” is a form of purging specific to people with diabetes. “Diabulimia is probably the least well known because it impacts a smaller subset of individuals with eating disorders,” Turoff says. Research on diabulimia has indicated: People with type 1 diabetes (T1D1) may restrict or use extra insulin as a form of purging. Insulin by itself doesn’t affect weight: when someone with T1D1 correctly manages their condition with insulin, their weight isn't affected. But according to the Cleveland Clinic, up to 40% of young people assigned female at birth and 10% of young people assigned male at birth with T1D take less insulin than they need in an effort to lose weight. The negative effects of insulin mismanagement include (among many others): Severe dehydration Serious infections Eye damage Cardiovascular, kidney, and liver disease How to help yourself or someone you know who struggles with purging Everyone who struggles with any type of purging deserves immediate, effective support—period. It’s important that you or your loved one seek out specialized treatment from providers who are educated on the complexities of bulimia and the variety of ways it can show up in patients. “The most important step in treating purging is early, specialized intervention with professionals who specialize in eating disorders,” Turoff says. “If purging isn't addressed, it can escalate quickly. Getting help as early as possible is critical, because purging behaviors can become more ingrained and medically risky the longer they continue.” Because many of the physical consequences of purging—particularly electrolyte imbalances, cardiovascular strain, and hormonal disruption–can develop quickly and may not be obvious at first, Turoff says immediate care is critical. “Early treatment improves outcomes, reduces medical complications, and makes recovery more achievable,” she says. However, no matter how long you or a loved one have been struggling, recovery is possible. It’s also important to note that if someone is exhibiting purging behaviors but not episodes of bingeing, they may fit the criteria for purging disorder, a sub-type of other specified feeding and eating disorder (OSFED.) It’s important to seek out a provider who will listen carefully to your symptoms and give you a proper diagnosis. Talk to your medical provider, or schedule a free, no-commitment consultation with an Equip team member. Treatment for purging No matter where you seek care for yourself or your loved one, it’s important to work with a multidisciplinary team of specialists who can address the different aspects of the eating disorder. This will usually include a therapist, dietitian, and medical provider, at a minimum. At Equip, patients work with a 5-person care team specialized in using evidence-based treatment modalities to treat bulimia. These providers work together to help the patient understand and combat their unique purging behaviors. Care is 100% virtual and built to fit into patients’ lives. Effective treatment should be personalized to each patient’s unique needs, but care for purging behaviors often involves some similar, evidence-based approaches. These include: Urge surfing: In bulimia treatment, patients learn various coping skills that can help replace or resist the urge to engage in purging behaviors. One example Terzano encourages patients to explore is called “urge surfing,” and describes a technique used to avoid acting on harmful behaviors. “If you feel the urge to purge, set a timer for 10 minutes before you act on it,” she says. “Even if you do end up going through with the behavior, it’s still progress if you’re able to delay it! And then do this over and over again because repetition is key.” Therapy: Therapy can also be a key to recovering from purging behaviors. Using modalities like CBT-E and DBT, a therapist can help a patient unpack the underlying issues that may have caused them to begin the binge and purge cycle in the first place, and create a plan on how to break it. In fact, CBT-E is proven to be most effective when treating bulimia. Relapse prevention: Like other eating disorders, relapse can be a common part of the recovery journey. Terzano wants all patients and their loved ones to know that relapse isn't equivalent to failure. “It can take time to completely stop the behavior and even more time for the urges to stop completely,” she says. “Oftentimes when we feel stressed, we want to turn to a behavior that will make us feel better in the moment. Purging may give you instant satisfaction and gratification, but it won’t help in the long-term.” At Equip, patients work with their team to develop a relapse-prevention plan that provides concrete, actionable guidance to address slip-ups and protect recovery. No matter what type of purging behaviors you or your loved one are struggling with, know that recovery is possible with the right support. Talk to a trusted medical provider, or schedule a call with Equip today.]]></content:encoded>
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            <title><![CDATA[Halloween Costumes Can Be Tricky for Those in Eating Disorder Recovery. Here’s How to Help. ]]></title>
            <link>https://equip.health/articles/body-image/halloween-costumes-body-image</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/halloween-costumes-body-image</guid>
            <pubDate>Mon, 17 Oct 2022 13:47:00 GMT</pubDate>
            <content:encoded><![CDATA[There’s a scene in the movie Mean Girls where Lindsey Lohan’s character Cady (who has never celebrated Halloween in America) shows up to a party dressed in an old-fashioned wedding dress and false teeth, with fake blood dripping from her mouth. “Why are you dressed so scary?!” asks Amanda Seyfried’s Karen. “It’s Halloween!” Cady answers, confused. The other female-presenting party attendees are mostly decked out in lingerie and animal ears.  The scene is a parody, of course, but it plays upon an underlying truth: Halloween costumes put pressure on young people — particularly those who identify as girls and women — to look a certain way. This can take the form of sexualization, as in the movie, or simply an increased emphasis on appearance that can exacerbate existing body anxieties. While it’s perfectly fine for young people to express themselves creatively, get silly, or even rock revealing costumes during Halloween, the whole act can pose a stressful challenge to those struggling with body image or recovering from an eating disorder. Most holidays present challenges for those in recovery, but Halloween can be particularly tricky. Besides the pressure to participate in big social events and the abundance of candy, which is a common “fear food,” there’s the focus on physical appearances vis a vis costumes. Here’s how to set the stage for a more fun, festive Halloween in recovery: Halloween costumes have become all about the body First of all, no: it’s not your imagination. Halloween costumes have become less about creativity and dressing up as something fun, and more about showcasing one’s body and meeting society’s beauty ideals. While some people may feel comfortable in revealing clothing, others — particularly those grappling with body image issues or navigating recovery — may have a lot of negative feelings about the costume options. And that’s okay. But acknowledging the reality of the situation may help initiate a productive conversation. “There definitely seems to be an increased focus on form-fitting costumes,” says Jennifer Derenne MD, VP of Clinical Care Delivery and Head Psychiatrist at Equip. “In my clinical work, I see a lot of young people focused on changing their body shape or size in order to wear a specific costume.” She explains that this can be particularly problematic when planning “theme” costumes with friends or romantic partners. Doing so often causes young people to compare their bodies to those of others in their social group, leading to dissatisfaction with their own appearance and the urge to engage in eating disorder behaviors. “Depending on age and your social support system, the traditional constraints of looking ‘sexy’ can be very harmful to anyone dressing up for Halloween, and certainly to those who have struggled with disordered eating in the past or present.” says Equip Practice Coordinator ​​Jerica Mosello. “No matter how you identify your gender, we all feel those constraints to be thin, buff, or just ultra-fit in general. Most commercial costumes are not designed or constructed for a realistic body-type. If you want a fright this Halloween just head to a costume shop: shopping can truly be the stuff of nightmares!” Mosello says she’s observed an undeniable surge in the number of sexualized costumes over the last decade or so. “Last week, I saw examples of this that include Sexy Corn On the Cob, Sexy Minion, Sexy Fortune Cookie, Sexy Wednesday Adams, and Sexy Baby Food,” she says, noting that children’s cartoons and even characters that are traditionally children are part of the trend “Children's cartoons and even characters that are traditionally children — how cringy is Wednesday!?” Costumes aren’t always made with all bodies in mind In addition to the obvious sexualization issues, Halloween costumes — and all costumes for that matter — have historically been manufactured for a very specific (read: thin) body type, creating a lot of unnecessary suffering for those who can’t find options that work for their bodies. “Anytime we dress up as someone else or try to match a character, comparison is bound to come up and negative body thoughts are quick to follow,” says Equip Body Image Program Manager Ally Duvall. Duvall believes that because costume trends — much like fashion fads — tend to change over time but still reference prior eras, we may have to brace ourselves for an onslaught of potentially triggering options that could further alienate many shoppers. “As our society is shifting back into the ‘Y2K’ aesthetic, we’re seeing very low rise jeans, short spaghetti strap tops, and a re-glorification of thinness,” Duvall says. “I foresee this trend continuing over to Halloween costumes, with the outfits aiming to showcase thinness and smaller bodies.” How to prepare for Halloween and find a costume that’s just right There’s no one-size-fits all strategy for managing costume anxieties. But if a loved one is struggling with Halloween stressors, approaching the topic with openness and compassion may help them alleviate their anxieties and figure out what makes them feel most comfortable. Here are some suggestions: Listen to your loved one and allow them to take the lead. “Suggest your loved one trust their instincts about what they’re ready to do this year,” Derenne says. That might mean that they skip out on dressing up altogether — and that’s okay. “If they do decide to wear a costume, encourage them to focus on wearing something that is comfortable and feels good to them. It will be challenging for them to be present in the moment and able to enjoy themselves if their clothing is constricting or makes them feel self conscious.” Connect with trusted allies in advance and make a plan for costumes, activities, and events. Mosello encourages you to help your loved one avoid triggers by reaching out to your support system in advance and making safe plans. By getting ahead of things, you can help ensure they avoid risky exposures and negative influences. Overprepare and stock up on options. “Instead of picking one costume, it can be helpful to pick out a couple different options in order to meet your loved one where they’re at body image-wise,” says Duvall. “You can also support them by coming up with ways to challenge any negative body thoughts that might pop up, whether that's through distraction, using positive self-talk, or otherwise.” Think outside the box. “A great principle for costumes is one I myself now apply every year: I try to find body-neutral or body-embracing costumes that I can usually make from clothing I already feel great in at home,” Mosello says. “Find funny costumes using what you already love and that make you love yourself so your Halloween season can be a little less scary!” Know that costumes aren’t even necessary for a good time. “Sometimes making Halloween about costumes and how they look might be too much to cope with at one time,” Duvall says. “In that case, you can maybe host a game or scary movie night with comfy pajamas to both take the pressure off and have a good time.” In the end, how you or your loved one choose to spend October 31 (remember, it’s just a day!) is a totally personal decision. Initiating conversations with others in your community and creating a dialogue around potentially problematic costumes, comments, and expectations may help more people understand how to be sensitive and caring. “It's always so eye-opening for me when people are surprised about the challenges inherent to navigating holidays during ED recovery,” Derenne says. “I wish more people realized that any occasion focused on food or wearing certain clothes can be triggering. Increased awareness helps us be more thoughtful and able to support loved ones during difficult times.”]]></content:encoded>
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            <title><![CDATA[Helping Your Child When Halloween Candy Is Stressful, Not Sweet ]]></title>
            <link>https://equip.health/articles/food-and-fitness/halloween-candy-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/halloween-candy-eating-disorder-recovery</guid>
            <pubDate>Fri, 28 Oct 2022 15:40:00 GMT</pubDate>
            <content:encoded><![CDATA[In 6th grade, I dressed up as a fortune teller for Halloween. I spent the weeks leading up to October 31th focused on various details of the night: my costume (where could I find a crystal ball?), who to trick-or-treat with (did I need to invite my neighbor?), whether or not my mom would allow a sleepover afterward (it was a school night!). But when my friends and I stepped out into the cool autumn air, plastic pumpkin buckets in hand, I remembered the other not-so-subtle detail about Halloween: candy. I was 11 years old and newly in the throes of undiagnosed anorexia. I panicked. Throughout that evening, as my pumpkin filled up with Snickers and Skittles, my body filled with anxiety and my mind with thoughts about how I could avoid eating the candy, and what would happen if I couldn’t— and this coming Halloween, the same will be true for thousands of other young people in the grips of an eating disorder. The good news is that candy doesn't need to hold as much power as it did over 11-year-old me. By understanding the complexity of the moment, planning ahead, and offering support, family members of someone struggling with an eating disorder (or body image!) can help diffuse the tension of the candy-crazed holiday. Why candy is so challenging… To people without eating disorders, a fun-sized pack of Twizzlers might not seem like a big deal. But for someone living with an eating disorder, it can mean everything. To understand why, it’s important to first understand the concept of fear foods. Fear foods are foods or food groups that trigger anxiety and discomfort in those with eating disorders, and tend to cause shame and guilt if consumed. While each person has their own unique fear foods, there are some that are particularly common: fats, fried foods, caloric drinks, and — you guessed it — candy. “Candy is a common fear food, whether people think they’ll lose control around it, or worry about weight gain,” explains Erin Reeves, RD, Director of Nutrition at Equip. There’s also the fact that candy is increasingly demonized by our society, which spreads the word that eating candy is akin to smoking cigarettes, that a love for some processed sugar will spiral into a “sugar addiction”. Reeves concurs, explaining that society’s negative messaging around sugar can make the sheer volume of candy on Halloween feel overwhelming. For those in recovery or struggling with body image, the sweets associated with the holiday may also carry an emotional resonance. Says Reeves, “Halloween candy can have a lot of memories attached to it, both positive and negative. It’s easy for the candy to trigger some of those memories – especially for someone in recovery, even if they feel like they’ve made a lot of progress.” …And how to make it easier Halloween doesn’t need to bring stressors just because candy has turned not-so-sweet. Here is what family members can do to help their loved ones navigate the challenge of Halloween candy: Talk about it. It’s always easier said than done, but simply opening up a dialogue about Halloween candy can help your child feel supported — and seen. “It’s helpful to know rather than guess or assume,” says Reeves. Watch your words. Reeves advises that families pay attention to their own language and avoid phrases that imply candy is bad, such as I’ll just have one or I definitely need to go for a run after this. “The worst thing to do is fear and demonize the food,” says Reeves. “This creates a space of fear and anxiety.” Set boundaries. Trick-or-treating is not mandatory, nor is filling your home with candy for trick-or-treaters. You might choose to skip out on the event altogether — including turning your outside lights off — and plan another festive activity not centered around sweets: go on a haunted hayride, carve a pumpkin, watch a movie. If your loved one does want to go trick-or-treating or to a Halloween party, work with them to create boundaries that make them feel safer, like setting a time limit. Normalize candy throughout the year. “Candy is okay year-round,” says Reeves. “Enjoying candy is something that should be incorporated all the time. It’s important to help kids have a healthy relationship with all foods. This helps decrease behaviors like compensating for intake, secretive or shameful eating, and bingeing.” In practical terms this means not restricting or hiding candy or other sweets throughout the year. Ensure adequate nutrition throughout the day. If your loved one plans on going trick-or-treating or out to a Halloween party, it’s essential to help them eat regular meals and snacks in the hours beforehand, says Reeves. People with eating disorders may be tempted to “save up” for sweets later in the day rather than eating normally, which almost inevitably leads to more disordered behavior and psychological distress down the line . Use it as an opportunity. As Halloween approaches, family members might be wondering whether it’s better for their loved one to skip the candy altogether, or use the holiday as an opportunity to face a challenge by incorporating candy into their meal plan. “Avoiding vs facing the fear food depends completely on where someone is at in their relationship with that food and what support they have,” says Reeves. “It’s always great to lean into a challenge, and the best way to do that is to cope ahead, which starts with making sure that nutrition intake has been solid all day.” Halloween is meant to be fun, even silly. But if your family is dealing with an eating disorder, it might have a different tone this year — and that’s okay. Remember, the holiday is happening around you, not to you; if and how you and your family chooses to participate is completely up to you. In the end, prioritizing recovery will not only mean an easier Halloween for your loved one this year, but also the opportunity to have less complicated (and more fun!) Halloweens in the future.]]></content:encoded>
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            <title><![CDATA[Understanding Atypical Anorexia: When Restriction Doesn’t Fit the Stereotype]]></title>
            <link>https://equip.health/articles/understanding-eds/atypical-anorexia-nervosa</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/atypical-anorexia-nervosa</guid>
            <pubDate>Mon, 12 Jan 2026 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[After being diagnosed with atypical anorexia, Nicky England, a peer mentor at Equip, struggled at first to get proper care for her eating disorder—because she didn’t fit the anorexia stereotype “I was warned by providers that it would be challenging to get insurance coverage for atypical anorexia,” she says. “I experienced providers treating me differently from other patients because I was in a larger body. Many of them reassured me that they weren’t going to let me gain weight, even though gaining weight ended up being a crucial aspect of my recovery.” Anorexia nervosa (AN) is one of the most commonly known and most well-researched eating disorders. But most people only associate it with food restriction and low body weight, not realizing that AN can present in ways people might not expect. There are actually anorexia subtypes—including atypical anorexia, which doesn't look like the stereotype of anorexia nervosa from the outside. “Atypical anorexia entails the same symptoms as anorexia, except someone who struggles with atypical anorexia is not classified as underweight,” says Hannah Bishop, LPC, an Equip Health eating disorder clinician with lived experience. “The term/diagnosis is problematic because it is using weight as an indicator of health and the seriousness of the illness. The term is suggesting that due to the size of someone’s body, the impact is less severe, and we know that isn’t true.”  Although the term includes the word “atypical,” the disorder may actually be even more prevalent than anorexia nervosa. And in reality, atypical anorexia nervosa presents the same or similar health risks as anorexia nervosa and impacts quality of life and overall health just as negatively. Unfortunately, a lack of awareness about atypical anorexia combined with diet culture and weight stigma can lead to people going undiagnosed or facing delays in care and treatment. In this article, we explore types of anorexia, atypical anorexia nervosa, atypical anorexia diagnostic criteria, atypical anorexia symptoms, atypical anorexia recovery, and more.  What is atypical anorexia? Let’s start out with understanding what anorexia nervosa is to help us better explain the specifics of atypical anorexia nervosa. Eating disorders are known mental health conditions as outlined in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5-TR), the guide that clinicians use to help diagnose eating disorders based on specific criteria. The following criteria must be met for a diagnosis of anorexia nervosa: Restriction of food and drink: If someone doesn’t eat or drink enough, they’re going to have lower energy than what they need to support health, leading to substantially low body weight in the context of age, sex assigned at birth, and other factors. Intense fear of gaining weight: Even though people with anorexia can be underweight, diagnostic criteria for anorexia nervosa includes a fear of gaining weight or becoming fat—and/or the person engages in persistent behavior that interferes with weight gain. Disturbance in body image: People with anorexia nervosa may equate weight with self-worth, have a distorted sense of what their body looks like, and deny the seriousness of their low body weight. Atypical anorexia nervosa is a separate eating disorder, but it shares most of the same criteria as anorexia nervosa. In the DSM-5, the disorder is listed under the category of “other specified feeding or eating disorder”(OSFED), formerly called “eating disorder not otherwise specified” (EDNOS). “The symptoms of atypical anorexia are the same as anorexia nervosa,” Bishop explains. Those can include intense fear of weight gain, severe restriction of food intake, rapid weight loss, distorted body image, and can include compensatory behaviors. “The only difference is that the DSM-5 states that the individual is not underweight—in reference to using the BMI scale, which we know is also problematic.” But when it comes to atypical anorexia nervosa, the DSM-5 doesn’t look at BMI or weight as a tool to diagnose. It does, however, explain that someone has atypical anorexia nervosa when all the diagnostic criteria for anorexia nervosa are met but their weight is still within the “normal”—or even higher than normal—range. A bit more about BMI BMI stands for body mass index, which is a calculation of weight relative to height. As Bishop notes, BMI can be a problematic assessment. The DSM-5 doesn’t use a strict BMI cut-off, nor does it use BMI as diagnostic criteria for anorexia nervosa. However, it does use BMI to indicate severity after a diagnosis for adults. So, even if you or a loved one is of “normal” or “above normal” weight, you or they could have atypical anorexia nervosa. What are the signs and symptoms of atypical anorexia? Now let’s get into the symptoms of atypical anorexia nervosa and compare them to anorexia nervosa. The tables below illustrate how similar the two eating disorders are. The main difference is that people with atypical anorexia don’t have a significantly low body weight. Psychological and behavioral symptoms By and large, the psychological impact of these two eating disorders are the same. Below is a list of symptoms that can be (but aren’t always) seen in both disorders.  Physical symptoms Since some physical symptoms will only present when body weight is significantly low, a few of the physical symptoms of anorexia nervosa are less common in atypical anorexia nervosa. The appearance of lanugo, fine long body hair, is an example. Below is a list of symptoms that can appear (but don’t always) in those with each disorder.  Medical red flags requiring immediate attention For both eating disorders, sometimes immediate medical attention is required to protect your safety or the safety of a loved one. As you can see, the red flags are the same for both eating conditions.  Why is the term “atypical anorexia” misleading (and potentially harmful)? Again, the major difference between atypical anorexia nervosa and anorexia nervosa has to do with weight status, but this can be a problematic distinction. For example, with atypical anorexia nervosa, you or a loved one may be of a relatively “normal” or even a higher weight based on age, sex assigned at birth, and height. But you or a loved one may still meet much of the criteria for having anorexia nervosa and face the same serious health risks. At the same time, you, a caregiver, or even a healthcare provider may deem you “not sick enough” to warrant treatment. “Atypical anorexia can be missed due to the stereotype of eating disorders,” Bishop says. “When society and even medical providers hear about eating disorders, they often think of a severely underweight Caucasian female. However, we know that eating disorders impact various genders, races, and people of all body sizes. In addition, a person who does not ‘appear’ underweight may be praised for losing weight or restricting their diet due to the societal belief that ‘thinner is better’ or restriction equals strength.”  What causes atypical anorexia? “Eating disorders, including atypical anorexia, are not caused by one underlying issue,” Bishop says. “We know that eating disorders occur as a result of a combination of psychological, biological, and environmental factors.”  There are many factors that contribute to someone developing atypical anorexia. These factors can include: Psychological: Psychological factors might include traits such as perfectionism and underlying mental health conditions, including anxiety, depression, or obsessive-compulsive disorder (OCD). Biological: Biological factors might include a genetic risk or predisposition, brain changes, differences in neurotransmitters and hormones that impact reward centers in the brain, and more. Environmental: Environmental factors might include a history of trauma, complex family dynamics, and even cultural influences, such as from social media or film and television. These factors tend to be somewhat unique, meaning that the specific factors affecting you or a loved one may be different from those of someone else with the diagnosis. How is atypical anorexia diagnosed? Atypical anorexia nervosa is diagnosed much in the same way as anorexia nervosa. A clinician will evaluate physical and behavioral symptoms, weight status, nutritional status, and whether you’ve lost a significant amount of weight. They will work with you to rule out other possible mental or physical health conditions that could be the cause of symptoms. Along with their assessment, they will investigate whether symptoms align with the criteria outlined in the DSM-5. It’s important to work with an eating disorder-informed and Health at Every Size (HAES)-aligned clinician to ensure you won’t be dismissed or given harmful advice. Atypical anorexia treatment If a clinician determines you or your loved one do show symptoms of anorexia nervosa or atypical anorexia nervosa, they’ll formulate a treatment plan. “Treatment at Equip includes a five-person treatment team: a therapist, dietician, medical team member, peer mentor and family mentor,” Bishop says. “We utilize different modalities dependent upon the age of the patient. Treatment at Equip lasts for one year, and time can be extended, if necessary, or a referral can be placed for an outside provider at that time.” The bottom line Atypical anorexia nervosa is currently considered a separate eating disorder from anorexia nervosa, but the criteria and symptoms are largely the same between the two, with the exception of weight. While people with anorexia nervosa have a substantially low weight, those with atypical anorexia nervosa tend to be of “normal weight” or even above that. But the “atypical” label can often be more harmful than helpful. At Equip, clinicians and other staff consider it all "anorexia" and treat both diagnoses with the same evidence-based, personalized approach. Atypical anorexia nervosa is as common as, if not more common, than anorexia nervosa. Yet, it often goes undiagnosed. Because of the weight distinction, it can fly under the radar, despite it being just as serious to health. If you’re experiencing symptoms consistent with atypical anorexia, know that you need and deserve help. Schedule a call with Equip to talk through your concerns and whether our virtual treatment is right for you. FAQ What qualifies as atypical anorexia? Atypical anorexia nervosa is currently considered a separate eating disorder from anorexia nervosa. However, the symptoms are largely the same, with the exception of weight status. While people with anorexia nervosa have a substantially low weight, people with atypical anorexia nervosa are of “normal” or “above normal” weight. What is the controversy with atypical anorexia? The controversy surrounding atypical anorexia nervosa has to do with the diagnostic criteria regarding weight. People with anorexia nervosa have a substantially low weight for their age, sex assigned at birth, height, and other factors. People who meet all other criteria for anorexia nervosa but are of “normal” or “above normal” weight have atypical anorexia. With weight factoring into the picture, and with less awareness surrounding atypical anorexia, the condition often goes undiagnosed, putting people at risk for serious health issues. Are there different types of anorexia? The two types of anorexia are anorexia nervosa and atypical anorexia nervosa. These are two separate but related eating disorders. They share the same basic criteria for diagnosis. However, People who meet all other criteria for anorexia nervosa but are of “normal” or “above normal” weight have atypical anorexia. Additionally, anorexia nervosa has two subtypes: the restricting type and the binge eating/purging type. Can you have anorexia without being underweight? Yes, you can have what’s called atypical anorexia nervosa. This is a separate eating disorder that shares most of the criteria for diagnosis as anorexia nervosa. However, people with atypical anorexia are not underweight.]]></content:encoded>
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            <title><![CDATA[Eating Disorder Recovery Isn't Linear. Here’s Why—and Why It’s Okay.]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/nonlinear-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/nonlinear-eating-disorder-recovery</guid>
            <pubDate>Thu, 24 Apr 2025 15:39:42 GMT</pubDate>
            <content:encoded><![CDATA[When Equip Peer Mentor Elizabeth Moscoso was first diagnosed with an eating disorder, she felt immense relief. Finally, Moscoso says she had the language to describe what she had been experiencing for so long. “As I began treatment and started to understand the magnitude of work that lay ahead of me, I realized that I wanted to fast forward to the part of my life when I had already recovered,” she says. “I didn't want to go through the nitty gritty of it all.” Looking back now, Moscoso says she continued to cling to parts of her eating disorder, even as she committed to treatment. “I would make progress one week, and then the next week, the fear of my body rapidly changing and the uncertainty of what recovery would look like for me would send me right back into eating disorder behavior,” she says. “I was caught in this loop of motivation to finally give recovery an earnest go in one moment, and the comfort of the familiar yet harmful eating disorder the next.” Equip Peer Mentor Kelsey Gilchriest had a similar experience after she completed a treatment program for avoidant/restrictive food intake disorder (ARFID), struggling to find adequate post-treatment support and remain committed to recovery. “I had a tough time with the definition of recovery that I had learned in treatment, and felt intense shame when I struggled with eating disorder urges or behaviors,” Gilchriest says. “My expectation was that once I was discharged from treatment, I would leave the eating disorder in the past. My shame really kept me stuck at times, and with it came fears that I would never reach ‘true recovery.’ What I've learned is that recovery is not the absence of struggle, but how we handle that struggle.” The reality is that this type of experience—two steps forward, one step back (or sometimes two steps back)—is more the rule than the exception when it comes to eating disorder recovery. While many might assume that once someone has been diagnosed and begins treatment, it kicks off a clear, one-way path to lifelong recovery, the journey is rarely that straightforward. Read on to learn why eating disorder recovery is often non-linear, what that really means, and why it’s totally okay. The myth of linear recovery People often picture the road to recovery as a straight line—and that misunderstanding is rooted in how we’ve been taught to think about forward progress. When you think back to middle school math, a linear line on a graph cuts clean across the grid: straight, consistent, unwavering. In the context of recovery, linear implies consistent movement towards behaviors in line with recovery and away from behaviors in line with an eating disorder. In other words, once you start working on recovery, you should have decreased symptoms and behaviors, and get closer to your goals every day. "’Linear’ refers to something that moves in a straight line—up, or forward—with no breaks,” says Equip Therapy Lead Jonathan Levine, LCSW. “If recovery were linear, there would be no moments of feeling stagnant or feeling like you're going backwards.” However, Levine is clear that eating disorder recovery is not linear for the vast majority of people for two main reasons: Human nature The fact that eating disorders are good at protecting themselves, and recovery is challenging “Any change in behavior, like trying to go to sleep earlier, spending less money at restaurants, or implementing a meditation routine, are difficult because they require an ongoing shift in our day-to-day routines,” he says “And we are, if nothing else, creatures of habit—the more we do something, the harder it is to stop doing that thing, even if we want to. So when you factor in human nature with how powerful eating disorders are, how they subtly dominate so many pieces of our daily routines—especially those outside of meal times—it makes sense that recovery would be difficult, would take time, and that someone wouldn’t see immediate and ongoing improvement every day from the moment they decide they want to recover. That's an unrealistic expectation.” For Moscoso, the challenges of diet culture contributed to and amplified the ups and downs of her treatment journey. “It's extremely hard work to change neural pathways so that you can build new ones that aren't eating disorder-driven,” she says. “My recovery wasn't linear due to not only the eating disorder thoughts and behaviors, but also the fears of recovering in a society that praises thinness and restriction. It was hard to imagine ever feeling happy in recovery when, culturally, we’re given subtle and not so subtle messages that in order to find joy, success, love, acceptance, and ‘health,’ I would have to do the very things that were keeping my eating disorder in place.” Sometimes, unrealistic expectations of what recovery might look like—consistent, solid, forward-moving—can lead to a sense of failure, making any setbacks harder to accept, and harder to bounce back from. “When my recovery ended up looking like a bit of a squiggly mess rather than a straight line, I blamed myself,” Gilchriest says. “I thought it was my fault that I couldn't maintain perfection. I think we, as a society, often expect perfection. And when going through something difficult, like eating disorder recovery, we tend to expect or hope that it will be like climbing up a mountain; difficult, but slow and steady. So when we feel like we've been stuck on a steep cliffside or blown off the mountain entirely, we think it's our fault. Eating disorders often thrive in shame, so when we struggle our eating disorder says, ‘See? I knew you couldn't do it,’ when in reality, those struggles are to be expected. Plot twist: perfection is unattainable!” What recovery really looks like While linear progress may seem ideal, the reality is far more complicated. Research has shown that eating disorders are highly recurrent in nature, with high rates of relapse. On average, relapse rates over a 10-year-period were shown to be approximately 40–50% for anorexia, 40% for other specified feeding and eating disorder (OSFED), and 30% for bulimia and binge eating disorder (BED). Despite these numbers, it’s important to remember that with the right support and treatment approach, lasting recovery is possible for everyone affected by an eating disorder—but the journey there may not be direct. Gilchriest says she wishes someone had sat her down at the start of her treatment journey to explain what recovery might realistically resemble. “I don't think that I would've been quite so hard on myself for struggling had I known what the true expectation of recovery is,” she says. Moscoso understands why those who haven’t experienced an eating disorder might not fully understand the overwhelming power these illnesses can have over a person’s life, or why recovery can’t be faster and more straightforward. “It's hard to see loved ones being challenged multiple times a day for weeks, months, or years on end, and it's completely understandable to wish for recovery to be a straight line, with no periods of stagnation or lapses,” she says. “In reality, it takes a lot of learning, through both the ups and downs of recovery, to build up coping skills and resilience against the eating disorder.” To her point, Moscoso says that if recovery were easy, there wouldn’t be a need for all the specialists, treatment programs, and levels of care devoted to helping people recover. “I think about it like learning to rollerblade,” she says. “In treatment, we are asking you to let go of the safety of holding on to the rails of the eating disorder and learn to move freely without going back to the rails. Your providers are the safety pads there meant to keep you safe as you move towards that freedom, but it would be unrealistic for you not to fall as you're learning new skills, right?” How—and why—to keep going in recovery No two recovery journeys are identical—and that’s not only okay, but expected. “Recovery looks different for everyone, so it's important to be curious, vigilant, and honest with yourself—and your support system—to best understand if you're moving in the direction you want to be,” Levine advises. “I recommend paying close attention to your behaviors, because those will show you how you're literally acting versus what you are saying or thinking.” Levine also underscores the point that taking two steps forward and one step back is the expectation, so a bad day or a bad week doesn't necessarily indicate a lack of improvement. “What's most important is how you respond to a bad moment/day/week/month: do you give yourself grace to be imperfect and continue trying?” he says. “Or do you fall into an all-or-nothing thinking pattern, and say, ‘screw recovery, there's no point now that I've had a low spell?’ Consistency is key, because motivation and discipline will wax and wane. Finding a way to not give up during the hardest moments is critical.” Moscoso says she would invite those who feel they aren't progressing in eating disorder treatment to find the subtle ways in which they actually have made progress, and to remember that each tiny step is meaningful. “Maybe they are more open to joining a group after weeks of strongly opposing it—that's progress,” she says. “Maybe they are eating a snack that they wouldn't even imagine being able to eat a month ago—that's a win! Maybe they are attending provider sessions when they really don't feel like it. Those are things not to be discounted.” “For folks who fear they are taking steps backward, I understand how stressful and confusing that can be, and even if those fears aren't based in reality, I would strongly recommend letting someone know, whether that's a trusted loved one, a provider, or even a journal,” Levine says. “Lapses are a normal part of the journey, and it's in the shame and secrecy that the eating disorder can continue to thrive. It's an act of bravery to say, ‘hey, I need some additional support right now,’ and it can really make all the difference.” It’s also important to know that recovery doesn’t always feel good—in fact, Levine says it’s common to feel worse before things start to improve. “Here's an example that I like to think of,” he says. “If you've been walking around with a broken ankle for years and you decided to start healing intentionally, it would make a lot of sense that the initial steps of recovery would feel really, really hard. You wouldn't expect to get out of surgery or start physical therapy and be fully healed immediately. No, you need to relearn some skills, build up strength, and that takes time and effort. Mental health and eating disorders are no different. You need to show up, do the work, and be consistent for a long time. If it was easy, you would have already done it, right? There's no shame in it being hard, it just is. You can do hard things.” Gilchriest reminds those struggling that even if you’ve experienced a major setback, or a full relapse, you’re not back where you started. Everything you experienced, learned, or absorbed throughout treatment is still within you, even if you haven’t yet been able to put it into practice. “When someone tells me they feel like they are moving backwards, I say that there is no backwards, because the version of you that was on square one has learned so much since square one. It's impossible to undo the experiences you've had between day one of recovery and now,” she says. Gilchriest urges anyone who feels as though they're moving backwards in recovery or feeling stuck to be extra gentle with themselves. “You are doing such a hard thing rewriting your body's narrative, and that takes hard work, time, and compassion for yourself along the way,” she says. “You will never hate yourself into healing. Celebrate how far you've already come! Even when it doesn't feel like it, there are always wins to celebrate.” The take-home message from all three experts is to take recovery one day at a time, and for anyone struggling to give themselves grace. “Be kind and speak to yourself like you speak to a loved one,” Levine says. “Remember that it is normal to take a few steps forward and a few steps back. In fact, if you just immediately got better in a linear fashion, I would be more concerned as your therapist because you wouldn't be working through the hard points! The hardship, the struggle—that's what will lead you to recovery. You just have to keep going. If it feels easy, you're probably not feeling as challenged as you need to be to make real steps towards recovery, especially early on. Lean on your people, be kind to yourself, and expect imperfection—the beauty is in the struggle. You can do it.” Sharing your story of recovery, including the ups and downs, can be a beautiful way to honor it as well. ]]></content:encoded>
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            <title><![CDATA[What Happens After Eating Disorder Treatment Ends?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/what-happens-after-eating-disorder-treatment-ends</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/what-happens-after-eating-disorder-treatment-ends</guid>
            <pubDate>Wed, 11 Jun 2025 02:48:04 GMT</pubDate>
            <content:encoded><![CDATA[Completing eating disorder treatment can be a joyful experience filled with pride, gratitude, and even relief. But finishing a formal treatment program doesn’t mean all the challenges are behind you, and for many, this monumental accomplishment comes with a range of complicated feelings. “Transitioning out of treatment brought up a whirlwind of emotions for me,” says Equip Peer Mentor Amaya Evans. “Excitement, doubt, hopefulness, fear. I was excited to live my life in recovery, and at the same time, I was fearful of leaving behind my treatment team and stepping into recovery on my own. Experiencing a lapse in my recovery was something I was very nervous about. But I had to remember that I had many skills and tools to get me back on track.” Effective, evidence-based treatment is an essential step for those with eating disorders, laying the groundwork for lasting recovery. But treatment programs and protocols are designed to be finite, and recovery can be a longer journey—so what happens after eating disorder treatment ends? Read on for everything you need to know to stay consistent in recovery—or support the recovery of a loved one—on the other side of treatment. How to know you’re ready for discharge The prospect of leaving treatment can provoke a complex mix of emotions—making it hard to know whether you or your loved one are actually ready to leave the structured and safe environment that’s become familiar. “While preparing for discharge can be exciting, it can also be a time of fear and apprehension,” says Equip Therapist Lead Jennifer Simmons. This is understandable and common, but it can also cloud decision-making about when to cease treatment, making it important to know the signs of readiness. While every patient is unique, Simmons says there are some commonalities that may indicate a patient is ready for program discharge, including: Having fewer eating disorder thoughts or behaviors to discuss during sessions Having fewer food issues (like restriction or bingeing) arise, and/or quickly being able to acknowledge and correct them without much difficulty when they do Having more room for other activities and focusing less on food, as eating has become a regular and habitual part of every day “If you are noticing you have less challenges to discuss in sessions with providers, you’re experiencing an overall decrease in eating disorder thoughts, and successfully using skills to cope outside of treatment sessions, these could be great indicators that you’re getting the hang of recovery,” Evans says. “When recovery starts to feel less like something you have to choose at every single meal and more like your default, you might be ready for a lower level of care.” Transitioning back to “normal” life Simmons says she frequently observes patients or their loved ones feeling nervous to leave the watchful eyes of their treatment teams, even after making significant recovery progress. “Sometimes transitioning back to normal life after treatment can feel challenging for both the patient and the family,” she says. “The family might struggle with not having as many treatment sessions where the providers are checking on progress, they might feel that they are unsure how to keep up the patient's success, or the parents might feel scared about a relapse and what to do,” she says. Finding outpatient providers One thing that can ease these anxieties—and an integral part of transition from formal treatment back to “normal” life—is finding an outpatient support team. According to Simmons, this may involve having your program treatment team find appropriate outpatient providers and help patients get set up with initial appointments. “What I tell most patients and parents is that support continues!” she says. “While it might not be the same treatment team or the same amount of sessions, the patient can expect eating disorder-informed outpatient providers happy to continue to support them. This might include an eating disorder therapist, dietician, and medical providers. The hope would be that the patient is seeing the outpatient provider regularly for a week or two before discharge.” Creating a relapse prevention plan While lasting recovery is entirely possible, eating disorders have a relatively high relapse rate, with research showing that between 35% and 41% of people experience a relapse within 18 months of completing treatment. For this reason, another important component of the discharge process is working with your treatment team to create a solid relapse prevention plan that can be shared with your outpatient team. “If the patient has had family and friends involved in treatment, I usually recommend a joint session before the end of treatment to talk about the relapse plan together, and so the patient can ask for the support that they might need now as the support needed at the end of treatment is usually different than when patient is in treatment,” Simmons says. Evans says that something she found particularly helpful in her transition out of treatment was having open, honest conversations with her team, and identifying potential relapse triggers. “In my experience, I needed to shape my environment to support my recovery,” she says. “This looked like getting rid of clothes that no longer fit my body, clearing out diet culture from my social media feed, and informing my support system on what I needed from them.” Evans’ experience aligns with Equip’s independent research, which showed that an essential part of post-treatment life is building a recovery-supporting environment that enlists the help of loved ones and helps you push back against external forces that might trigger disordered behaviors. Reconnecting with others Transitioning back to non-treatment life may also be challenging for those who feel they’ve grown distant or separate from friends and peers during their recovery journey, but there are strategies to handle this challenge. “Sometimes patients have friends that are aware of treatment, but sometimes they do not and this can create feelings of isolation or loneliness due to being separated from their normal life,” Simmons says. “Usually this is a temporary state, but this is why a great support network is essential in recovery. I would tell patients to lean on their team, their friends, and their family who are aware of what they went through.”  Tips for transitioning out of treatment While transitioning out of treatment can have its challenges, there are plenty of expert-approved strategies for navigating the path. The tips below can help give you the structure and strategy to make this big transition with confidence. Maintain a routine. “Structure is essential in keeping to regular eating schedules and meal plans,” Simmons says. “If the structure falls away, the eating disorder is more likely to come back. That doesn't mean unintentionally skipping a snack will cause a relapse, but if meals or snacks are regularly skipped, this is one of the most common ways the eating disorder might show back up.” Keep coming back to treatment fundamentals. “Practicing and continuing to practice the skills that worked for the patient is incredibly important,” Simmons says. Research has shown that DBT skills (which are a core component of Equip treatment) can be a powerful tool for helping people overcome eating disorder urges. Set new life goals. “Something that helped me ease back into ‘normal’ life was becoming excited for the experiences I was going to continue having in recovery,” Evans says. “I remember making a recovery bucket list which included everything from trying new cuisines and cooking new recipes to traveling to new places and making memories.” Communicate clearly with trusted providers. “I tell parents and patients to lean on their support team and ask as many questions as they need to,” Simmons says. “Clear, kind, and open communication is very important!” Continue cultivating a support network. “Eating disorders thrive in chaos, loneliness, and feeling misunderstood or not understood at all,” Simmons says. “I always tell my parents and patients to talk to each other. Support each other! If it is a difficult meal for the patient, maybe the parent can start to play a game with them at the table to help distract but also show support in continuing to eat. If an adult is struggling, maybe they can call a friend or share a meal with a support person to ensure success.” See tips for sharing your recovery story.  While eating disorder treatment is difficult, Simmons reminds patients and parents that dealing with an eating disorder alone is much harder. “It is okay if you need more support after you leave Equip,” she says. “Eating disorders can be pervasive, and might continue to try to cause chaos for the person dealing with it. If you are worried about yourself or your loved one after treatment, I would suggest an open, honest conversation. Sometimes the best support someone can provide is showing concern. Remember that asking for additional help at any stage is okay.”]]></content:encoded>
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            <title><![CDATA[What Is FBT? The Power of a Loving Family]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/what-is-fbt</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/what-is-fbt</guid>
            <pubDate>Mon, 18 Jul 2022 16:54:00 GMT</pubDate>
            <content:encoded><![CDATA[  With so many different eating disorder treatment options, finding the right fit for your loved one can be an overwhelming process. One of the many challenges is the alphabet soup of treatment acronyms—PHP, IOP, RTC, CBT, DBT, FBT—you can encounter when trying to navigate the various approaches. To help clarify things, we'll break down one of the most important acronyms when it comes to eating disorder treatment for young people: FBT. So, what is FBT? Let's get into it.  What is family-based treatment (FBT)? Family-based treatment, or FBT, is based on the Maudsley Method, developed at the Maudsley Hospital in London. Many people use the terms “FBT” and “Maudsley” interchangeably because their core approach is the same: young patients with eating disorders (who are medically stable) can recover at home with the support of their family.  FBT is considered the gold standard for eating disorder treatment in children, adolescents, and young adults, as a large body of research shows it to be the most effective approach for achieving lasting recovery. For young people with an eating disorder, Equip almost always uses FBT, and it almost always works. In cases where FBT isn't the right approach, we'll switch to a different treatment approach. What eating disorders can be treated with FBT? Although initially developed to treat anorexia, FBT has shown promise as an effective treatment approach for many other eating disorders, including bulimia, binge eating disorder (BED), Avoidant/Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding and Eating Disorder (OSFED). Why is it called family-based treatment? Family-based treatment can sometimes be confused with “family therapy,” and although there may be elements of family therapy incorporated into treatment, FBT is a separate model. It's a targeted, structured treatment for eating disorders that doesn’t presume any underlying problems within the family and is so named because families take on a central role in recovery.  With the ongoing support of trained healthcare professionals, family members are empowered to renourish their loved one. Families gain the knowledge, skills, and strategies they need to fight the eating disorder at home, one meal at a time. Despite what conceptions are out there about FBT, this type of treatment is for all types of patients and families (learn more about FBT myths here.) What’s different about FBT? Unlike many traditional talk therapy approaches, FBT targets eating disorder symptoms first. While it’s natural to wonder about possible causes of someone’s eating disorder, FBT is “agnostic,” which means that providers do not focus on searching for a cause. The good news is that we don't need to know the exact cause of someone’s eating disorder to treat it effectively. Many traditional treatment approaches remove a patient from their home environment or tend to exclude parents from the recovery process. In FBT, however, patients get the support of their family—including chosen family—at every step of the way. What does FBT look like? In FBT, the initial focus is on renourishing the patient. This period of nutritional rehabilitation is so crucial because an undernourished brain is an anxious brain. Being weight-suppressed (under the weight the body prefers to be) further fuels obsessive and fearful thoughts about food and can make any body image concerns even worse. For patients who have lost weight or fallen off their growth curve, weight restoration to the right weight range for their body is a goal at the start of FBT. Even for patients who are not underweight, nutritional rehabilitation is essential: disordered eating habits like binge eating, purging, and restriction can lead to malnourishment, regardless of a patient's weight.  Nutritional rehabilitation involves supporting the patient to eat regularly, to eat enough, and to eat a variety of foods. This initial phase of treatment is sometimes referred to as “re-feeding.” In addition to addressing dietary restriction, families also support their loved one to cease any other eating disorder behaviors, such as vomiting, overexercising, or hiding food. Once fully nourished and free from most, if not all, eating disorder behaviors, many people experience a significant reduction in their psychological symptoms, such as rigid or obsessive thoughts about food, severe body image distress, depression, and/or anxiety. At this phase of treatment, patients gradually relearn how to eat independently—without being controlled by their eating disorder or needing constant support from a loved one. Navigating this transition can be tricky for both patients and their families, so sessions focus on addressing any stumbling blocks along the way. Later on in treatment, FBT sessions can shift focus to support a patient’s overall social-emotional development, such as navigating friendship challenges, improving communication skills, and learning additional healthy coping strategies for stressful times. Therapy sessions also address any remaining eating disorder symptoms or co-occurring mental health conditions. Patients and families explore factors that could contribute to re-activating eating disorder thoughts and behaviors; these triggers might include social media, peer pressure, and body image concerns. Building awareness of and resilience to these potential triggers is a key component of relapse prevention. Why is FBT the gold standard of eating disorder care in young people? FBT is so effective at treating eating disorders because it combines the most recent evidence-based clinical research with the power of family. Eating disorders are biological, brain-based illnesses, and FBT’s focus on nutritional rehabilitation and symptom reduction acknowledges that fact first and foremost. Armed with the knowledge that food is medicine, families can start to renourish their loved one even when the eating disorder is causing resistance and lack of motivation. FBT helps patients stay in recovery because treatment is happening in the midst of the stressors and challenges of everyday life. Recovering at home means that patients are building the tools and coping skills they need all along the way, reducing the risk of relapse that can occur during a transition from a separate treatment setting back into real life. No matter where it happens, eating disorder recovery is hard work, but undergoing treatment can be that much easier when surrounded by family members, friends, and the comfort of home. Check out these FBT tips and strategies for parents. How has Equip built upon FBT? Helping a loved one recover from an eating disorder is no small feat. Many families find they need more support than weekly sessions with an FBT therapist in order to achieve full recovery. Equip builds on the foundation of FBT by making treatment fully virtual and adding the wraparound support of a dedicated 5-person care team, which includes a mentorship component. In addition, because body image can be such a challenge for someone recovering from an eating disorder, Equip enhances traditional FBT by offering an evidence-based body image program for patients. Building body image resilience and body empowerment strengthens recovery and reduces the risk of relapse. With virtual treatment, patients and families have more time to focus on life outside of the eating disorder, because we know that lasting recovery comes from building a life worth living. If you'd like to learn more about how FBT could work for your family, schedule a consultation.]]></content:encoded>
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            <title><![CDATA[Tips for Traveling During Eating Disorder Treatment]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/traveling-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/traveling-eating-disorder-treatment</guid>
            <pubDate>Thu, 26 Jun 2025 17:22:00 GMT</pubDate>
            <content:encoded><![CDATA[For a lot of people and families, travel is a special treat. Whether it’s a summer beach trip, a winter getaway, or a quick adventure over a long weekend, exploring new places and spending time away from home is often a highlight of the year. But if you or a loved one are in treatment for an eating disorder, travel can feel much more complicated. How can you continue to support recovery and keep up your momentum when you’re in vacation mode? And is it even okay to prioritize travel in the midst of eating disorder treatment? Because effective eating disorder care requires structure, sessions with providers, and sometimes physical limitations, travel may seem off the table until after discharge—but it doesn’t necessarily have to be. “Traveling with an eating disorder requires careful navigation, as recovery does not take a holiday,” says Equip Lead Dietitian Tanya Hargrave-Klein MS, RDN. “Engaging in treatment in a familiar setting presents its own challenges, and travel can amplify these difficulties.” But these difficulties are not insurmountable. While travel may not be the best option for some individuals and families navigating treatment, others may be able to fit a trip into their lives without losing momentum or backsliding. Read on for expert-approved strategies for navigating travel while in eating disorder treatment, and guidance on how to determine if travel is a good choice for you right now. Why travel can be challenging during eating disorder treatment According to a 2024 study, traveling while recovering from an eating disorder can present a number of different challenges: disruptions to daily routines, adjustments to medication schedules, and the need to spend a fair amount of time being sedentary in an airplane seat (or car or train for that matter). And considering how important routine and structure can be in helping to reduce anxiety, travel can certainly complicate treatment. Another big factor are the almost inevitable changes to sleeping and eating schedules, which can make it harder to stick to a meal plan and have the potential to trigger, enable, or conceal disordered behaviors like restriction. “This disruption can make it easier to rationalize skipping or not fully completing meals and snacks, which is essential to protecting treatment progress,” Hargrave-Klein says. Then there’s the mental load of eating under unfamiliar conditions, which is a common difficulty that those in eating disorder treatment face when traveling. “Eating in public or with people who may or may not know about the eating disorder often leads to anxiety about what and how much is consumed. Eating out and ordering from unfamiliar menus can overwhelm individuals, especially those in early recovery,” Hargrave-Klein says. Finally, a potentially overlooked consequence of travel is the significant uptick in physical activity, which may be an issue for those who have specific caloric requirements. According to one 2023 study, participants engaged in more activity while on vacation, which could be a risk for those in eating disorder treatment. “Trips often involve increased physical activity, such as extensive walking, hiking, or swimming, making it easy to neglect the extra nutrition needed,” Hargrave-Klein says.  How to decide if it’s okay to travel Hargrave-Klein says that in her experience as a registered dietitian, it can be helpful to explore a series of questions to assess whether someone in eating disorder treatment is truly ready to travel. Important questions to consider are: Is the patient medically safe to travel and participate in planned activities? How might the patient’s psychological health impact their travel experience and the experience of others on the trip? How likely is it that the patient can maintain their same meal and snack schedule consistently on the trip? Is the patient able to effectively and regularly use coping skills to avoid outbursts when experiencing distress around food, eating, and exercise? How active will the patient likely be on the trip, and how does that compare to their typical activity level? Is the patient willing to add extra nutrition to account for increased activity level? Are compulsive exercise or over-exercise behaviors minimal or resolved? Has the patient had practice eating in restaurants, eating in public, and/or eating with others who do not reside in their home? Is it possible to pack, ship ahead, or have delivered supplement drinks (Ensure, Boost), bars, and other dense food items to have on hand at your destination? How flexible is the patient about eating in unfamiliar restaurants? Eating food prepared by others? Eating fried foods? Non-organic foods? Go through these questions thoughtfully, and note how many of your answers support the idea that you or your loved one are ready for travel, and how many indicate that it might be best to stay home. If you have more than a few answers that suggest travel could be a risky choice, it’s probably best to hold off a bit longer. (And remember—this doesn’t mean you’ll never travel again. It just means it’s not the safest option right now.) Tips for navigating travel during treatment If you’ve determined that you or your loved one are ready to tackle the challenge of a trip during eating disorder treatment, it’s important to take some precautions to ensure that you continue to make progress toward recovery during your travels. And in cases where you don’t feel ready, but travel is non-negotiable for whatever reason, it’s even more essential to put the proper guardrails in place. Whatever the reason may be for taking a trip during treatment, iIf you do decide to travel, the strategies below can help you or your loved one stay on track. Let the treatment team know about your trip as soon as you can An important part of effective treatment is clear communication with your treatment team, so alerting your providers to an upcoming trip as soon as it’s booked (or even sooner) is essential for advanced planning and preparation. “Work with your treatment team ahead of time and establish cope-ahead plans to minimize and prepare for anticipated challenges” Hargrave-Klein advises. Plan meals and snacks in advance when possible While it may not be possible to plan every meal or snack before hitting the road, a bit of research and strategic packing can go a long way in staying committed to a nutrition plan. “Bring along snacks, supplements, and bars in the event meals are unexpectedly delayed,” Hargrave-Klein says. “Check out restaurant menus in advance; plan your order before arriving. Order groceries to be delivered at the time of arrival.” Maintain a regular eating schedule Even if planning the contents of every meal and snack isn’t feasible, adhering to a regular eating schedule that closely mirrors the one at home can help re-establish a familiar structure. “Stick to the meal and snack schedule as closely as possible,” Hargrave-Klein says. “It’s easy to skip eating episodes when the schedule is lax.” Take heightened physical activity levels into account More movement requires more fuel, and traveling often keeps us in motion, even when the activities are low-key or laid-back. “Even a relaxing beach vacation typically involves more activity than usual,” Hargrave-Klein says. “Add an extra snack on days when you are moving around more.” Apply therapy skills to real-life scenarios One potential advantage of taking a trip during treatment is the opportunity to put learned strategies and skills to practical use. “Lean into skills to cope with distress when it arises during the trip,” Hargrave-Klein says. “Practice mindfulness and grounding techniques, cue up dialectical behavior therapy (DBT) skills, or seek out support from others close to you.” Stay in touch with your team One of the great aspects of virtual eating disorder treatment is that it can happen from anywhere. While you may not be able to maintain your regular schedule of provider sessions during your travels, you can continue to check in with your providers and reach out for support as needed. If you’re in treatment at Equip, you can message your providers at any time that you feel you need extra support, and get a response back within 24 hours. If you or a loved one are currently in eating disorder treatment and wondering whether travel is an appropriate and safe option, it’s best to check in with your treatment team. If, after a frank and honest conversation, the team gives a green light for travel, following the tips above and staying in communication with providers and your support network can ensure a vacation that not only promotes health and relaxation but doesn’t derail recovery.]]></content:encoded>
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            <title><![CDATA[ Can Going on a Diet Cause an Eating Disorder?]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/do-diets-cause-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/do-diets-cause-eating-disorders</guid>
            <pubDate>Wed, 29 Oct 2025 16:38:00 GMT</pubDate>
            <content:encoded><![CDATA[While I can’t speak for everyone who has or has had an eating disorder, I can say with certainty that my own years-long issues with food restriction started with a diet. It makes perfect sense, of course: the foundation of a diet designed for weight loss is food restriction. While it’s always important to keep in mind that eating disorders are not a matter of choice or vanity, but are complex, multi-faceted brain diseases, most eating disorders are inherently rooted in restriction. So while there are biological, psychological, and social risk factors that can contribute to the development of an eating disorder, there is often an environmental or behavioral trigger—like being in a negative energy balance due to a restrictive diet—that “turns on” the eating disorder. Read on to better understand how diets and eating disorders intersect, and how to get help if a diet goes too far. What the research says about dieting and eating disorders “Dieting is one of the strongest predictors for the development of an eating disorder,” says Equip Dietitian Lead Tanya Hargrave-Klein MS, RDN. “Research reveals a stark connection between dieting and eating disorders in adolescents.” Hargrave-Klein cites one three-year study, which found that teenage girls who dieted severely were 18 times more likely to develop an eating disorder than their non-dieting peers. “Even moderate dieting significantly increased risk, making girls five times more likely to develop a disorder,” she explains. “A more recent study found that female and male adolescents who dieted were more likely to exhibit eating disorder psychopathology and behaviors, including laxative use, compulsive exercise, and dietary restraint.” Even when a diet is not framed as a strict or punishing route to weight loss, Hargrave-Klein says the underlying restriction inherent in almost all diets can still set in motion a cycle of disordered eating. “From my perspective as a registered dietitian specializing in eating disorders, I've observed that dieting, even when presented as ‘healthy’ eating, commonly precedes the onset of an eating disorder,” she says. Why dieting is a risk factor for eating disorders Research has consistently identified dieting as one of the strongest predictors and a significant risk factor for the development of an eating disorder. In some cases, this may be due to what experts refer to as the “diet cycle,” which begins with a restrictive diet (i.e. limiting the amount or type of food eaten), and inevitably leads to physical and psychological deprivation. This then leads to breaking the diet rules through overeating or a binge, resulting in guilt and dissatisfaction with weight or shape, which leads back to another diet. In other words, diets generally lead to the binge-restrict cycle, a pattern of behavior that plays a key role in many eating disorders. As mentioned above, diets can also be the external factor that flips “on” an eating disorder in someone who is vulnerable to developing one. “Some people have a heightened susceptibility to eating disorders, though the precise reasons remain a mystery,” Hargrave-Klein says. “The critical trigger for these disorders often appears to be an energy deficit, which isn't always a deliberate choice. In some cases, individuals may inadvertently reduce their caloric intake while attempting to eat ‘healthy.’ For athletes, intense training can lead to an unintentional underfueling that doesn't meet their energy expenditure. Alternatively, the deficit may stem from an intentional effort to lose weight through dieting.” But the important takeaway is that being in a calorie deficit can contribute to the development of an eating disorder, no matter the reason. Is it possible to diet in a healthy way? Many people are initially drawn to diets because they can effectively cause short-term weight loss, and in our society, weight loss tends to be universally praised as a good thing. But putting aside the fact that weighing less doesn’t make a person more valuable or worthy or healthier—studies have also consistently shown that most dieters regain the weight they lose, and that diets themselves often promote the adoption of disordered eating behaviors. So in most cases, dieting for weight loss doesn’t promote true health. That said, Hargrave-Klein is clear that in some particular instances, specific dietary modifications are medically necessary and may be considered healthy. “Individuals with conditions like celiac disease or dairy allergies must adhere to specific diets that restrict certain foods,” Hargrave-Klein says. “These diets, while limiting, are distinct because they provide sufficient energy and do not promote weight loss or an energy deficit. In these cases, following such a diet is essential for managing the health condition and, therefore, can be considered healthy.” However, these diets are specific to those with particular medical needs or conditions; weight loss diets and their relation to “health” are a different story. “For years, the diet and wellness industry has peddled the promise of health through weight loss,” Hargrave-Klein says. “But behind the glossy advertisements and celebrity endorsements lies a darker truth: the pursuit of a smaller size can significantly increase the risk of developing a dangerous eating disorder. This focus on weight loss often leads to an energy deficit, a precarious state that can trigger the onset of an eating disorder. It's a risk frequently omitted from weight-loss diet marketing, leaving consumers vulnerable to a devastating spiral.” The important takeaway here is that weight loss is not synonymous with health. In fact, there are a variety of health-promoting behaviors that anyone can adopt that have nothing to do with weight. “As an anti-diet dietitian, I propose to clients a different path to well-being, one that prioritizes genuine health over the scale,” Hargrave-Klein says. “Instead of fixating on weight, individuals can cultivate health through adequate sleep, stress management, joyful movement, and strong social connections. These lifestyle choices offer profound benefits without the perilous gamble of dieting, providing a safer, more sustainable route to a healthier life.” Diet vs. eating disorder: how to tell the difference First, let’s define the two terms. Diet: While the word “diet” can refer to what a person eats in general, it’s more often used to describe weight loss eating plans. In that context, a diet is typically considered an eating plan that requires a person to eat smaller quantities of food or only specific types of food in order to lose weight. Eating disorders: Eating disorders are mental illnesses characterized by severe and continuous disturbances in behaviors when it comes to food. Eating disorders also include distressing thoughts and emotions and have serious—even potentially deadly—consequences. “Diets and eating disorders, while sharing common traits such as calorie restriction, weight monitoring, excessive exercise, and food logging, diverge significantly in their nature and impact,” Hargrave-Klein says. “A key distinction lies in their controllability: dieting is a voluntary practice a person can choose to halt or stop at will, whereas it requires professional treatment to address an eating disorder.” Diets and eating disorders also differ in how significantly they impact a person’s daily life. “Dieting typically has a minimal effect on one's daily routine and overall quality of life,” Hargrave-Klein says. “In contrast, an eating disorder exerts pervasive control over daily life, severely diminishing quality of life.” And while the “rules” of a diet typically remain consistent throughout its duration, Hargrave-Klein points out just how volatile and extreme eating disorder rules can be over time. “With an eating disorder, food rules tend to morph and multiply, becoming increasingly rigid and complex,” she says. “While a diet solely involves food, an eating disorder may also encompass the misuse of laxatives or diuretics, or other purging behaviors.” Some of the main differences between a diet and an eating disorder include: The duration. Diets usually last for a finite amount of time while eating disorders have no natural end. The significance of its impact. Unlike diets, eating disorders significantly impair the physical, emotional, professional, and/or social areas of a person’s life. How much psychological space it occupies. Eating disorders often involve obsessive and compulsive thoughts and behaviors associated with food, exercise, or body size and shape, whereas someone on a diet won’t think about it excessively. The importance. While diets are usually solely rooted in a desire to achieve a certain weight, eating disorders are typically attached to much higher stakes, rules, and emotions. The ability to choose. Going on a diet is usually a choice someone makes; an eating disorder is not. While a person can decide whether they want to remain on a diet or not, a person cannot simply decide to stop having an eating disorder. What to do if you’re worried your diet is becoming disordered If you're worried your diet (or the diet of a loved one) is veering into eating disorder territory, the most important first step is to seek professional support from an eating disorder specialist. Know that there’s no such thing as “not sick enough” to get help, and that earlier intervention is associated with better outcomes. Reach out to an eating disorder-informed therapist or dietitian, or schedule a call with an Equip team member. You can also take our free, 5-minute screener to help you assess if you or your loved one might have an eating disorder. “Don't delay,” Hargrave-Klein says. “Schedule a consultation with a therapist or medical provider specializing in eating disorders to request an assessment.” FAQ Do diets cause eating disorders? While not all diets will lead to an eating disorder, research consistently identifies dieting as the single most significant behavioral risk factor for developing an eating disorder. Because eating disorders are complex mental illnesses with underlying biological, psychological, and sociocultural roots, dieting may act as a trigger and activate these underlying vulnerabilities in a susceptible individual. Can I go on a diet if I’m in recovery from an eating disorder? Experts generally agree that engaging in a diet is not only incompatible with eating disorder recovery, but can be highly detrimental. Because dieting involves external rules around food restriction, judging foods as “good” or “bad,” calorie counting, meal timing, and more, those in recovery from eating disorders may experience a relapse when engaging with rules that so closely mimic the core behaviors of a disorder. How can I tell if a loved one’s diet is actually an eating disorder? While a diet is typically considered an eating plan that includes smaller quantities of food or only specific types of food in order to achieve a goal of becoming thinner, eating disorders are mental illnesses characterized by severe and continuous disturbances in thoughts and behaviors related to food. While a diet is a lifestyle choice, an eating disorder is not. If you’re concerned about a loved one, our free eating disorder screener can help you determine next steps.]]></content:encoded>
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            <title><![CDATA[How to Help Someone With an Eating Disorder: Guidance for Family and Friends]]></title>
            <link>https://equip.health/articles/understanding-eds/how-to-help-someone-with-an-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/how-to-help-someone-with-an-eating-disorder</guid>
            <pubDate>Mon, 27 Oct 2025 17:23:00 GMT</pubDate>
            <content:encoded><![CDATA[When someone you care about is struggling with an eating disorder, you may notice a change in their eating habits, body, or behavior and want to help them. But helping someone with an eating disorder can be easier said than done—you may not know what to say or do, or even if you should intervene at all. The truth is, there’s not one specific way to help someone who is dealing with an eating disorder, and determining your next steps is rarely straightforward. Despite this, your support is essential and may even be lifesaving. Research shows that doctors may not recognize what is going on, which can lead to delayed treatment, and eating disorders are the deadliest psychiatric illness outside of opioid abuse. To make things more difficult, eating disorders are self-protective: they often convince the person struggling that nothing is wrong, they don't need treatment, and that the eating disorder is part of their identity. This makes them unable to recognize or acknowledge their own illness. Because of these factors, the intervention of family and friends is often the turning point to get someone into treatment and onto the path toward recovery. If you don't feel equipped for this role, read on. There are concrete, meaningful ways you can support someone with an eating disorder beyond just talking to them about it. From validating their feelings to continuing to invite them out to setting your own boundaries, the actions you take can make a real difference in their journey toward healing. How can I tell if someone I care about has an eating disorder? It can be difficult to know whether what you've noticed in your loved one is cause for concern or not. Eating disorders show up in different ways for each person and thrive in secrecy, plus many disordered behaviors are considered “healthy” in today's diet culture. Still, some common red flags, including early signs and subtle signs of eating disorders are: Weight changes, either up or down Starting a new diet or other consistent change in their typical eating behavior (such as cutting food into tiny pieces or eating large amounts of food in a short period of time) Anxiety over social events that involve food No longer eating around others Inflexibility around exercise, like working out when sick or turning down plans to exercise Rigid rules about eating, which cause distress when broken (for example, if a parent buys the “wrong” brand of snack bar or a restaurant forgets to hold the cheese on their sandwich) A preoccupation with body shape and size Body checking, or compulsively checking their weight or other external markers of their size and shape Cooking or baking for others but not eating the food Personality changes Social withdrawal You can also use Equip's free, five-minute screener to help determine if your loved one is struggling. Above all, trust your gut. If something seems off in someone you know and love, it probably is. How to help someone with an eating disorder: 11 tips Helping someone with an eating disorder can feel overwhelming and scary, but it’s an important and compassionate act—and your loved one may be more receptive than you assume they’ll be. “Sometimes we worry about overstepping, or saying something we're not supposed to say,” says Jen Simmons, PhD, LPC, Equip Lead Therapist. “But if someone is struggling with anything, sometimes they're afraid to ask for help. Support makes a world of difference.” So go ahead and take the initiative. Whether your loved one is not yet in treatment or has already started seeing a team, these expert-endorsed tips can help you help them along every step of their journey to recovery. 1. Educate yourself Using a reputable source, such as FEAST (Families Empowered and Supporting Treatment for Eating Disorders), Equip, or the Academy for Eating Disorders, learn about eating disorders so you can better understand what’s going on with your loved one. Then, if you have the time and space, connect with other families who have loved ones with eating disorders. Since they’ve been through this or are going through it, “they can provide a lot of good information,” says J.D. Ouellette, Equip’s director of Lived Experience. Having a better understanding of eating disorders and what’s happening in your loved one’s brain and body will set you up to provide thoughtful, sensitive support. 2. Explore your own thoughts and feelings about food and body size “This is critical. We all live in diet culture. It's the sea we swim in,” Ouellette says. “And once you do this, it provides another source for connections and conversations.” You can tell your loved one, “These are things I've thought as well.” To help you explore your internalized beliefs about food and bodies, consider taking Equip's free Freeform body image program. You can also turn to books, podcasts, or social media; searching for terms like “weight neutral,” “healthy at every size”, and “body image” should guide you to resources that don't reinforce diet culture tropes, Ouellette says. Also pay attention to when you get the “ick” feeling, Simmons suggests. Maybe you feel uncomfortable when someone else has two servings of dessert or tells you they had to go up two pants sizes. “If anything food-related is causing distress, get curious. What is it about this that's making you uncomfortable? If you went up two sizes, what would come up for you?” Simmons says. “It's going to take time to challenge these thoughts,” she adds. “You're going to need to do a lot of work, and you might fail at first because this is new. It may also bring up other things. Compassion is super important.” 3. Validate their feelings You can let your loved one know their feelings are reasonable and, at the same time, encourage treatment. It's all about the power of “and,” Ouellette says. You can validate, “I see this is a really hard conversation for you. It's stressing you out. It's a really tough thing,” and then add something like, “and I really feel the need to call out what I'm seeing, and I'm doing it out of love.” As long as you connect your validation—”I know it's probably really upsetting to have me comment on these things”—with the next step you'd like them to take—”and I love you and I want to support you,” then you're balancing making your loved one feel heard with making your wishes known, Ouellette says. 4. Ask what they need You can't guess what your loved one needs, and their needs will likely shift from day to day. So ask them what would be supportive or helpful. This could be a wide variety of things, like having a weekly meal with them (either in person or via FaceTime), helping them with grocery shopping, doing gentle exercise together, or simply checking in with them regularly. And if you notice they're struggling in the moment or something feels off, get curious. If you're out to dinner and they ordered but aren't eating, you could say, “What's going on today? Are you having a hard moment?” Then, gently questioning their assumptions—“Why can't you have pizza?”—may help them see that this is challenging for them. “They might not have put it together that it is an eating disorder,” Simmons says. 5. Suggest small ways you can help Some people with eating disorders may not know what they need. In these cases, it may be helpful to offer some suggestions. This could include: Inviting them out to an ice cream date, just the two of you, and they can bring their own food Inviting them to dinner and, if they're scared to order, have them pick out their option ahead of time and you order for them Offering to attend a therapy session with them Researching possible providers Booking their consultation call with Equip 6. Accept that you cannot "fix" the eating disorder “You're not a trained therapist, so you probably don't know what to do. And that's okay,” Simmons says. “You're not here to fix it, you're here to support your loved one.” Let their treatment team help them take steps toward recovery, and you focus on how you can be there in ways that professionals may not be able to, since you know your loved one on a different level. 7. Invite them Eating disorders tend to be very isolating, often due to low self-esteem and the secretive nature of these illnesses, as well as fears of eating in front of others. Still, invite your loved one to all of the things you normally would ask them to attend, even if they keep declining. “Let them know they are welcomed, valued, and loved,” Ouellette says. “Inviting them lets them know that you're there for them, even if the eating disorder may make them say no to you.” Continuing to show them that you care about them by extending invitations means that when they are ready for help, they’ll be more likely to reach out to you. 8. Let them know they're worthy If someone has low self-esteem, the eating disorder can collude with that and tell them that they're only cared about because, for example, they're a good runner—and if they're no longer a good runner, people won't love them anymore. Of course this isn't true, but they need to be reminded about their inherent worth. So rather than talking to your loved one about their potential or what they can do, talk to them about being worthy because of who they are, Ouellette recommends. This may sound something like, “I've always loved spending time with you,” “You are so kind,” or “Your warmth has always helped me.” 9. Manage your expectations Helping a loved one seek treatment often takes multiple conversations and, in the case of adults, you need to respect their autonomy. Once a person does enter treatment, eating disorder recovery is a long-term process that takes months (or sometimes years) and involves both progress and setbacks. This is why it's important to educate yourself so you know what you're getting into and can manage your expectations. Know that your help and support is extremely important, even if it doesn’t lead to immediate changes. 10. Know that it's okay to save yourself If your loved one is an adult, there's only so much you can do to try to motivate them to seek treatment. “If you can help your loved one, they're willing to accept help, and it's working out logistically, put everything into it,” Ouellette says. On the other hand, if you've put every effort into helping them and they haven't changed, as difficult as it may be, recognize when you've done enough.. Part of this involves establishing and respecting your boundaries. If you can figure out how you want to live and have a conversation with your adult loved one about that—expressing, “This is happening in our home and our life. I want to help you, and these are the ways your behaviors are impacting me, and I have to consider that as well”—that often is the thing that pushes someone to seek help, Ouellette says. To be clear, this isn't an ultimatum: you are conveying how you wish to live and that you want them to be part of that. Talking to a therapist who understands eating disorders and others who have dealt with this can help you set healthy boundaries while still being there for your loved one when they’re ready to make a change. 11. Realize that setbacks and relapses are likely to happen Once your loved one enters treatment, no matter their age, they may make great progress...and then take some steps, or even some leaps, backward. Eating disorder relapse is a common part of the journey to recovery. “It's not that your loved one 'didn't want it enough' or that they like living like this,” Ouellette says. “It's just the nature of the illness. It's very hard to treat.” If you spot any warning signs of relapse, don't panic. Instead, speak up immediately, before the eating disorder takes back too much power. “The earlier you say something, the more likely their brain is going to be in a place to receive it,” Ouellette says. You can say something as simple as, “It seems like you're struggling with dinner a lot more than you used to. When things were going better, we would play a game at the table. Do you want to do that again?” Remember: You know more than you used to know. Use that insight to help your loved one get back on track. What to do if your loved one needs immediate help If your loved one is medically or psychologically unstable, seek immediate medical attention at your local hospital. Determining if someone requires hospitalization often calls for checking their vitals or lab work. Signs to watch for include: Severely low heart rate Abnormally low blood pressure Dehydration Electrolyte disturbance Uncontrollable bingeing and purging Fainting Seizures Very low weight Suicidal ideation Self-harm behaviors “If you suspect someone might have an emergency, do your homework in advance,” Ouellette recommends. “Our system comes with many limitations and a lot of lack of understanding.” Look online or join local support groups to find which hospitals near you are educated about eating disorders and will perform the right tests to determine if your loved one should be admitted. Otherwise, you risk being turned away, and that may reinforce your loved one's belief that they don't have a problem. On the other hand, if your loved one is medically stable and not in imminent risk but their eating disorder symptoms are severe, contact an eating disorders professional as soon as possible. You can always schedule a call with Equip to determine if your loved one has an eating disorder and if our program is right for them. The Equip takeaway: Key points about helping someone with an eating disorder Helping someone with an eating disorder isn't easy, but it's worth it. Many people are scared to ask for help, and your support may be just the thing they need to seek treatment. “There is a path forward. It won't be easy, and a lot of things in life aren't easy. We can do hard things,” Ouellette says. If you notice any warning signs of an eating disorder, speak up and encourage professional care. Whether or not they take your advice, be there for them. This can mean educating yourself about eating disorders, validating your loved one's feelings, suggesting ways you could help them, letting them know how much they mean to you, and being prepared for relapses. However, if your loved one is in danger medically or psychologically, get them to an emergency room for immediate care. FAQ What should I do if I’m worried someone I love has an eating disorder? If you're worried a loved one may have an eating disorder, first educate yourself about eating disorders by checking out authoritative sites like FEAST (Families Empowered and Supporting Treatment for Eating Disorders), Equip, and the Academy for Eating Disorders. When you decide to talk to them, follow these tips, which can help you find the words to express your feelings during a challenging conversation. Lastly, encourage them to seek professional care, perhaps offering to help them find a provider or go to an appointment with them. Do eating disorders ever go away on their own? No, eating disorders do not go away on their own. They are serious, brain-based mental illnesses that require professional support and intervention. At a minimum, this includes a therapist, who can help the patient work through the mental aspect of their disorder and learn skills to better cope with challenges; a dietitian, who can help with meal planning and making sure the patient is giving their body everything it needs; and a medical professional, who can monitor any physical health complications. How can I help get an adult into eating disorder treatment? You cannot force an adult into eating disorder treatment (unless they pose harm to themselves or others). You can, however, talk to them, focusing on your objective observations related to their disordered behaviors. Listen without judgment and express empathy for their feelings so they feel understood. If possible, find some common ground you can agree on, and then work with them to find a treatment plan they are open to trying. What can I do if my loved one denies they have an eating disorder? It's common for people who are struggling to deny they have an eating disorder. One reason is that the illness often involves anosognosia, a condition where a person doesn’t realize they’re ill. “For many people, it's not denial. It's that their brain doesn't recognize it,” Ouellette says. In other instances, a person may simply not want to get better (this is because eating disorders are self-protective, and when they are in control, they can convince the person affected that the illness is a good thing). Whatever the case, when you talk to your loved one, be open and honest, pointing out the specific behaviors you observe and expressing your concerns. “It's harder to say objective things aren't happening,” Ouellette explains.]]></content:encoded>
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            <title><![CDATA[Exploring Eating Disorders in the Latinx Community: What Equip's New Survey Reveals]]></title>
            <link>https://equip.health/articles/news-and-research/eating-disorders-latinx-research</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/eating-disorders-latinx-research</guid>
            <pubDate>Mon, 15 Sep 2025 18:55:00 GMT</pubDate>
            <content:encoded><![CDATA[Despite the fact that Latinx folks experience eating disorders and disordered eating at rates equal to (or higher than) their White peers, they remain significantly underdiagnosed and undertreated. Our core mission at Equip is to make effective eating disorder treatment accessible to everyone struggling—and that often begins with understanding the unique ways that culture, identity, and lived experience influence a person’s ability to be diagnosed and get care. That’s why we recently launched a nationwide survey of nearly 1,000 Latinx individuals to better understand their experience when it comes to body image, disordered eating behaviors, mental health, and eating disorder treatment. Our findings underscore the fact that culture isn’t just context for a problem—it’s often the key to the solution as well. Why we conducted this research We already knew that Latinx youth experience comparable or higher rates of disordered eating than their White peers, yet are less likely to be diagnosed or treated. Research has also found that body image dissatisfaction and acculturative stress (the psychological stress a person experiences when adapting to a new society or culture), rather than media ideals, were key predictors of disordered behaviors in Latinx youth, pointing to the role of family dynamics and cultural conflict. In adult populations, Latinx individuals have been found to experience higher levels of body dissatisfaction. Previous studies have also found that culture shapes the recovery process: in interviews with Latina women, mental health stigma emerged as a major barrier to care, while family support—once engaged—played a critical protective role. But existing research had gaps. How do intersecting identities—gender, sexual orientation, language, and region—shape access to care? How do cultural norms influence body image, eating behaviors, and the likelihood a person reaches out for help? And how does representation impact treatment-seeking? Our goal was to fill in these gaps, and use our findings to inform eating disorder treatment that truly reflects the needs and realities of Latinx individuals. Who we surveyed (and what we asked) We gathered insights from 980 Latinx-identifying respondents across the United States. Here are some key demographic details about our survey respondents: Age: Most (74%) were between 18–39 years old Gender: Almost even split between those who identify as men/boys (51%) and those who identify as women/girls (47%) Sexual Orientation: 75% identified as heterosexual/straight, with bisexual (13%) being the most common minority orientation Language: 98% spoke English, and 42% also spoke Spanish Key questions To capture the full picture of eating disorders among Latinx populations, we asked questions that explored both individual experiences and cultural context. Some notable questions included: How important is it that your mental health provider be part of the Latinx community? How would you describe your current relationship with your body? How often did adults comment on weight or eating when you were growing up? In your experience, what role does food play in your cultural or family life? How do you perceive body image standards within the Latinx community compared with mainstream ideals? Have you ever been teased, treated unfairly, or discriminated against because of your weight? Asking questions that touched on wide-ranging topics—like family background, body image, disordered behaviors, and attitudes toward mental health care—helped us connect the dots between personal behaviors, cultural expectations, and systemic gaps in care. Key findings Though the responses we received were varied and multifaceted, our survey brought to light several key themes. Eating disorders in Latinx populations are more common than diagnosed More than 70% of respondents reported experiencing at least one disordered eating behavior in the past year. The most common behaviors were restriction (52%), binge eating (37%), and water loading (27%) Yet, only 12% reported having been formally diagnosed with an eating disorder 16% weren’t sure if they currently or previously had an eating disorder—pointing to stigma, lack of education, and inadequate culturally informed screening. “I received an appropriate explanation on the triggers of my anorexia and the treatment. Although, due to Latinx beliefs on mental health and illness, I was unable to receive the treatment.” — 18–29 y/o woman with anorexia People want care—but it’s often inaccessible 1 in 5 rated their mental health as negative—but 63% weren’t seeing a mental health provider. Among those seeking care, 47% said it was important their provider be part of the Latinx community, and 25% had been discouraged from seeking care when they couldn’t find a culturally aligned provider. Culture is both support and strain In Latinx communities, food is overwhelmingly seen as both positive and central to life: 85% said it brings people together, 78% tie it to tradition, and 68% associate it with love. However, family and cultural expectations also create pressure, with 55% reporting that they had experienced teasing or discrimination related to weight. Family was named the #1 influence on body image—more so than peers or social media. “In Hispanic/Latinx communities, being slim is beautiful—but food is how we connect. It’s a contradiction.” — 30–39 y/o male “When I'm thin, it’s too thin. When I'm fat, it’s too fat... The ideal body is always just out of reach.” — 30–39 y/o bisexual woman How our findings can shape care going forward This research confirms what many in the Latinx community already know: eating disorders do not look the same across cultures, and neither should treatment. To create more equitable, effective care, we must: Improve cultural competence in providers. This doesn’t just mean language access, but a deep understanding of Latinx values, family dynamics, and body image norms. Redesign screening tools to capture the diverse expressions of disordered eating and body image distress in Latinx populations. Expand community representation in both clinical teams and recovery narratives, so Latinx individuals can see themselves represented in treatment and know that recovery is possible for them. We often speak about cultural differences as being barriers to care, but our findings show that while this may be true, there’s a deeper, more hopeful truth underlying it: cultural differences also offer a pathway to more effective, individualized, and responsive treatment. At Equip, we’re committed to continuing to explore the unique ways that different identities experience eating disorders, and using our findings to inform our future work—all in the mission of helping everyone with an eating disorder find a path to lasting recovery.]]></content:encoded>
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            <title><![CDATA[Eating Disorders in the AAPI Community: How They Show Up (and Why They're Often Missed)]]></title>
            <link>https://equip.health/articles/understanding-eds/asian-american-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/asian-american-eating-disorders</guid>
            <pubDate>Fri, 06 Aug 2021 15:30:00 GMT</pubDate>
            <content:encoded><![CDATA[Growing up, Equip Peer Mentor, Grace Sung Un Kim, saw her family face an abundance of obstacles. One point of attempted comfort, however, came in the form of food. “As the daughter of non-English speaking, Korean immigrants who physiologically experienced famine post-Korean War and then poverty immigrating to the United States, food has always been a love language that eclipsed cultural and linguistic barriers,” she says. “The plates full of triangular cubes of chamoe 참외 (Korean melon) are tantamount to a million ‘I love yous’ never verbally expressed.” Grace’s experience of food as a cultural love language isn’t uncommon, but her eventual diagnoses with binge/purge subtype of anorexia (which involves restriction and purging) and other specified feeding and eating disorder (OSFED), may come as a surprise to those unfamiliar with the existence of eating disorders in the Asian American and Pacific Islander (AAPI) community. According to the National Alliance on Mental Health (NAMI), the AAPI community encompasses about 50 ethnic groups speaking over 100 languages, with connections to Chinese, Indian, Japanese, Filipino, Vietnamese, Korean, Hawaiian, and other Asian and Pacific Islander ancestries. And while it’s impossible (and harmful) to generalize about such a diverse group, it’s important to recognize the shared challenges and barriers to eating disorder care that members of the AAPI community face. For Grace, complex ideals within her community and a lack of awareness of those ideals outside of it made acknowledging and treating her eating disorders difficult, at best. She says that during the course of her illness, she received problematic messages from friends and family that inadvertently reinforced her behaviors. “Bingeing in public was praised as an act of reverence toward my parents,” she says. “I responded accordingly to their urgency to feed me every morsel, and from the outside, I was the model daughter obediently consuming every bit of my parents’ lovingly cooked meals. Yet, unbeknownst to my community, that obedience cost me an eating disorder.” There are many reasons people like Grace from AAPI communities may be uniquely predisposed to eating disorders (and we’ll explore the possible factors below). But according to Norman H. Kim, Ph.D., co-founder and principal, at the Institute for Antiracism and Equity and the deputy director of Ayana Therapy, widespread perception of AAPIs as “foreign” and pervasive forms of micro and macro aggressions
may one major contributor to the “ubiquitous experiences of chronic race/ethnicity-based traumas focused on ‘othering.’ He says these are “powerful and underrecognized risk factors for the development of eating and body issues for people from AAPI communities.” What is the data around eating disorders in the AAPI community? As is the case with eating disorders in other non-white populations, the research is sorely lacking when it comes to the AAPI community. The studies that do exist, however, demonstrate that eating disorders very much do exist in the AAPI community; we just may not have the answers as to why they develop and why they’re not adequately diagnosed and treated. According to one study, Hispanic and Asian girls reported significantly greater body dissatisfaction than white girls and may be at greater risk for adopting eating disorder behaviors than previously recognized. Another study found that Asian American women specifically demonstrate higher rates of disordered eating than other women of color and comparable rates to European American women. Furthermore, a recent study found that Asian American college students reported higher rates of food restriction compared with their white peers and higher rates of “purging, muscle building, and cognitive restraint” (i.e. ‘the control over food intake in order to influence body weight and body shape’) than their white or non-Asian, BIPOC peers. The study also found that Asian American college students report higher levels of body dissatisfaction than their non-Asian, BIPOC peers. But if that’s the case, why aren’t more AAPI individuals seeking treatment — and what are the reasons for these observed higher rates? The distinct risk factors driving eating disorders in the AAPI community There is no single genetic or environmental factor that guarantees a person will develop an eating disorder, but it’s known that a heightened perceived pressure to be thin and the idealization of thinness can be risk factors for disordered eating for any group. According to the aforementioned 2019 study, “Asian and Asian American cultures endorse a similar heightened value for the thin ideal as mainstream Western culture” and “women experience pressures to maintain or achieve thinness through multiple sources, such as the media (e.g., magazine advertisements), family members (e.g., parents encouraging weight loss), and peers (e.g., weight-related teasing).” As far as Grace is concerned, the pressures around thinness in the Korean community are potentially even more intense due to internalized cultural beliefs. “Weight stigma and anti-fatness is pervasive in the Korean community so much so that Korean society has carefully calculated and capitalized modern cosmetic technology to market ideal bodily proportions and complexions into attainable cosmetic procedures,” she says. “The narrative around attaining beauty is not pathologized in Korea; rather it is valorized as a status symbol for the wealthy and shared strife for the middle class as a common, welcomed coffee-time conversation.” Grace says that in her experience, her physical appearance was always considered an appropriate topic of conversation among her community. “The collectivist, interdependent Korean culture where filial piety and saving face is paramount, my body is my family’s business,” she says. “Body commentary—often expressed as a greeting—is not considered unwarranted or rude, it’s conveyed as an extension of deep affection and concern. This often disrupted my ability to eat intuitively, affected my ambivalent self-worth, and challenged my sense of developing individuality living in the American culture as an Asian American.” Grace says that the size of her face—too big or too small—was often considered a relevant matter of discussion and the scrutiny was considered an extension of her family’s care and affection for her. “A completely different form of communication,” she says. While there may be increasing awareness and critical examination of eating disorders in Western culture, Grace feels mental illness is still significantly misunderstood—and even praised—in AAPI culture at large. “While in the white community, an eating disorder warrants medical attention and a DSM diagnosis, in the Asian community an eating disorder is a cosmetic achievement,” she says. Why aren’t AAPIs receiving adequate treatment for eating disorders? According to a survey from the Substance Abuse and Mental Health Services Administration (SAMSHA), AAPIs are the most likely to say they avoid seeking mental health treatment because of confidentiality concerns and fear of neighbors’ negative opinions and are ​​three times less likely to seek mental health treatment than their white counterparts. NAMI’s take is that denial or neglect of mental health problems—especially among first-generation AAPI immigrants—may be the result of a lack of understanding about mental illness and a cultural stigma associated with mental health issues. The organization also points out that “shame” and “loss of face” are important factors to consider when understanding why so few AAPI people seek out mental health care. “The ability to receive treatment and diagnosis comes at the cost of physiological and academic consequences,” Grace says. “My parents were able to accept and conceptualize the imminent threat an eating disorder had on my life after they witnessed me on a 5150 hold
[a section of the Welfare and Institutions Code that allows a person with a mental illness to be involuntarily detained for a 72-hour psychiatric hospitalization], failed out of university, and went to residential treatment — all things I myself sought out with the help of providers, not my parents – another barrier made impossible when my family has Medi-Cal/Medicaid.” Kim says that to simply provide a proper diagnosis and deliver adequate treatment, the medical community needs to be attuned to the diverse AAPI communities they’re serving. “Recognizing and providing appropriate and adapted care to people in the AAPI communities who are struggling with eating disorders necessitates that clinicians and other carers understand the unique confluence of factors which can impact the presentation of eating and body issues,” he says. The “model minority myth”, which is rooted in the stereotype that Asian Americans are universally “studious, successful, smart”
and pits people of color against one another is an important concept to grasp in the systemic racism and internalized pressures Kim references. The As Sarah-Soonling Blackburn wrote in a Learning for Justice article, “the model minority myth erases the differences among individuals,” “ignores the diversity of Asian American cultures,” and “operates alongside the myth of Asian Americans as perpetual foreigners.” It also delegitimizes the racism AAPIs face. “As Asians have historically been largely absent from conversations about the myriad consequences of systemic racism and its impact on health care and peoples’ well being, in part due to fallacious ideas like the model minority myth, it is imperative that we not lose our momentum in attempting to improve our systems for more culturally relevant and intelligent care,” Kim says. Looking toward the future of better eating disorder awareness and treatment in the AAPI community While there is still so much that is unknown and unstudied about the prevalence of eating disorders in the AAPI community including the distinct sociocultural and psychological forces driving them, Grace believes increased awareness may help AAPI folks struggling with eating disorders understand they are inherently worthy of support and help, even if their direct community is unable to show up that way. “For those in the AAPI community, or who are children of immigrants who watched their parents struggle and often assumed the role of parenting themselves, who felt shame for asking for help and shaped themselves to be fiercely independent: you are allowed to have others help and love you in your eating disorder,” she says.]]></content:encoded>
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            <title><![CDATA[Common Signs of an Eating Disorder Relapse: Here’s What You Need to Know ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/signs-of-eating-disorder-relapse</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/signs-of-eating-disorder-relapse</guid>
            <pubDate>Tue, 09 Jan 2024 20:44:02 GMT</pubDate>
            <content:encoded><![CDATA[As anyone who has ever navigated an eating disorder knows, recovery can be messy, uncomfortable, and far from direct. Relapses—typically defined as a return of symptoms after a period of relief—are common among eating disorder patients, with an estimated 31-41% of patients relapsing within two years of receiving treatment.  “Relapses can and often do occur—in fact, almost half of all people with an eating disorder will experience a relapse,” says Equip’s VP of Program Development, Jessie Menzel, PhD. There are several factors related to eating disorders and their treatment that might lead to a relapse, including the severity of the illness, the presence of co-occurring conditions, and the need for higher levels of care. “Essentially, the more severe your eating disorder, the more likely you are to experience a relapse.”  But just because relapses are a reality for many, they aren’t a reason to avoid recovery altogether or to give up hope. By learning the common telltale signs and symptoms of a relapse, you can help minimize the impact it has on your long-term health and happiness and get back on track as soon as possible. Here’s how. What causes eating disorder relapses? While there are many aspects that may contribute to the ultimate success of eating disorder treatment, two important considerations, according to research, are adequate weight restoration when necessary, and the cessation of disordered behaviors. “Several studies have found that not gaining enough weight during treatment or continuing to experience regular eating disorder symptoms—e.g., compulsive exercise, or food avoidance—can lead to a higher likelihood of relapse,” Menzel says. “Eating disorder relapses can also be triggered by the same things that brought them on in the first place, like major life stressors including a traumatic event, a loss, or an acute illness.”  Menzel believes that by understanding your own triggers (or those of a loved one in recovery), you can help prevent a relapse or at least reduce its detrimental effects. Creating a “relapse prevention plan” is an important strategy to identify risk factors for a relapse. Part of your relapse prevention place could mean: Knowing the initial signs or symptoms to watch out for Connecting with support systems Calling on coping skills Understanding when a return to treatment is necessary Menzel also advises patients and their families to be mindful of the non-linear nature of recovery—and to learn to accept apparent slip-ups. “It’s important to differentiate between what I call a ‘blip’ and a full blown ‘relapse.’” Menzel categorizes a ‘blip’ as a temporary period during which eating disorder thoughts, urges, or negative emotions may become stronger or more frequent, and some behaviors may even return, for a short time. “During blips, you’re able to use skills and lean on your support system to ride them out and get yourself back on track with recovery.” During a relapse, on the other hand, “Those thoughts, urges, emotions, and behaviors have intensified and gone on long enough that they are starting to significantly impact your physical and emotional well-being again,” says Menzel. The most common telltale signs of an eating disorder relapse While every person and situation is unique and the presentation of relapses can vary as much as the eating disorders themselves, Menzel says these are some common warning signs to be aware of: Weight loss: “For many people recovered from an eating disorder, weight loss is a common sign of relapse. Even a little bit of weight loss can quickly cause eating disorder thoughts and urges to intensify, causing a snowball effect that leads to further weight loss.” Not finishing meals: “While it's perfectly normal not to finish a meal from time to time, this could be a slippery slope for someone with an eating disorder. It’s easy to rationalize that it ‘doesn’t matter,’ but an eating disorder relapse often starts with these kinds of small acts of restriction that can quickly become more common and lead to further restriction.” Weighing: “Weighing can be a sign of increased concern or investment in your weight or body image—things that increase the importance of your appearance and lessen the importance of other valued areas in life.” Worsening mood or anxiety: “For many patients that I’ve worked with, the first sign of a possible relapse were changes in their mood or anxiety. They were more irritable, more inflexible, or down—and it was almost always accompanied by weight loss, a sure sign that they had started to restrict again.” Eating alone or in secret: “Finding reasons not to eat with others or preferring to eat certain foods or meals alone may be another sign of relapse. Feeling shame around eating or what you eat is most certainly caused by the eating disorder.” A growing list of restricted foods: “Finding reasons to avoid eating specific foods that you used to eat could also lead to a relapse. Maybe you’re sticking to safe foods or avoiding a type of food for health or body image reasons. Starting to exclude foods from your diet, though, could definitely become cause for concern.”  What to do if you or someone you love might be experiencing a relapse If a relapse does appear to be on the horizon or is already occurring, returning to the early steps of recovery and reaching out for support can make a significant impact on recovery. “Go back to basics and lean on your support system,” Menzel says. “Eating disorders thrive in isolation. Letting in someone from your trusted support network can give you the strength you need to start making changes.” Many people find it helpful to return to the basics they learned in treatment, like: Regular eating Increased accountability or supervision Self-monitoring Using coping skills Meeting regularly with your treatment team Oftentimes a return to formal treatment is necessary, at least for a period of time. Having a dedicated care team providing guidance can help you through a relapse and help you start to reduce disordered behaviors again. Virtual eating disorder platforms like Equip make it possible to get support for a relapse without uprooting your life. Reaching out for consultations can also help you determine if it’s time to return to a form of treatment. The most important thing to keep in mind is that relapses are not a sign of weakness or an inability to fully recover—they are a normal, common part of the recovery process (learn more about why they are so common here.) Accepting the possibility of relapses and maintaining a set of coping strategies will go a long way in mitigating their impact. “Sometimes we have this expectation that being ‘recovered’ means that you’ll never have another eating disorder urge, or you’ll never have intense, negative emotions,” Menzel says. “And that’s just not realistic—we all have times in life where we have thoughts, urges, and emotions that are unpleasant, unhelpful, or uncomfortable. We all have times where we struggle and are not at our best. Recovery is not perfection. What matters most is not whether you have these thoughts and urges, but rather how you respond to them.”]]></content:encoded>
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            <title><![CDATA[Are Perfectionists More Likely to Get Eating Disorders?]]></title>
            <link>https://equip.health/articles/understanding-eds/perfectionism-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/perfectionism-and-eating-disorders</guid>
            <pubDate>Tue, 27 Feb 2024 21:22:00 GMT</pubDate>
            <content:encoded><![CDATA[Looking back, Equip Peer Mentor Jamie Drago says her perfectionistic tendencies far predated her eating disorder. But growing up, she would have never described herself as someone striving for perfection. “I actually would have described myself more as ‘wishing I could be a perfectionist,’” she says. “I felt ‘lazy,’ ‘average,’ and ‘not very good at things,’ and I have always really struggled with procrastination.” It wasn’t until Drago’s first therapist informed her that procrastination can be a symptom of perfectionism that she started to realize how her self-imposed, impossibly high standards were affecting her mental health. “I always felt like I needed to be on a quest of self-improvement, and that if I wasn’t excelling at everything under the sun it was because I wasn’t trying hard enough or I didn’t ‘want it badly enough,’” she says. Reflecting now from a place of recovery, Drago sees that this kind of negative self-talk fueled her shame, and her eating disorder by extension. While no one specific personality type is most prone to developing an eating disorder, experts have long known that perfectionism is associated with them. Perfectionism, which is often defined as the tendency to hold oneself or others to extremely high or flawless levels of performance, is considered a common trait among those struggling with anorexia, bulimia, and binge eating disorder (BED). Understanding the connection between perfectionist qualities and disordered eating behaviors can help you identify early warning signs in yourself or a loved one and get the support you need. Here’s why perfectionists are more likely to get eating disorders—and what to do about it. How personality traits play into eating disorders Eating disorders are complex illnesses rooted in biological, psychological, and social risk factors and triggers. They never have one single cause. That said, there are certain contributing factors that can elevate a person’s risk of developing an eating disorder including genetics, family history—and personality. Defined as “the relatively enduring patterns of thoughts, feelings, and behaviors that reflect the tendency to respond in certain ways,” personality traits aren’t inherently positive or negative. Rather, they have the potential to shape a person in different ways, contributing to their interests, values, strengths, emotional patterns, and more. When it comes to eating disorders, researchers have identified certain personality traits that may play into the development and maintenance of anorexia, bulimia, BED, and other diagnoses. One 2016 systematic review and meta-analysis asserted that neuroticism, avoidance motivation (a desire to avoid stressful or unpleasant things), and perfectionism often show up in those diagnosed with eating disorders. While having these personality traits doesn’t guarantee someone will develop an eating disorder, they can make people more vulnerable to them. “Temperament traits are present from birth, and they stick with a person throughout their life. When someone experiences internal or external stressors, those temperament traits may then get expressed in the form of eating disorder behaviors,” says Equip Director of Program Development, Tana Luo. These innate tendencies can be harmful when channeled toward disordered behaviors, but they often serve a protective purpose. “Eating disorder behaviors may reduce someone’s experience of distress, which then makes it more likely that they will continue to engage in those behaviors,” Luo says. “So, those harmful expressions of their temperament get strengthened over time.” The link between perfectionism and eating disorders While perfectionism can manifest in many different ways, the core characteristics (extreme ambition, fear of failure, extremely high standards) do tend to overlap with many of the traits observed in those with eating disorders. “Perfectionism can be closely tied to shame, which, at least for me, was a core feature of my eating disorder and mental health struggles as a whole,” Drago says. “Some people may constantly feel the need to be ‘doing more,’ ‘doing better,’ ‘pushing harder.’ This can show up in a number of eating disorder behaviors, with never feeling like we’ve done enough.” Luo says that people who are perfectionistic may be highly self-critical and may overemphasize what they perceive to be mistakes, which can ultimately result in disordered behaviors. “These tendencies, coupled with external stressors—like societally imposed appearance standards—may contribute to the development and maintenance of eating disorders,” she says. Drago experienced this firsthand, with her self-doubt and self-criticism contributing to the symptoms she eventually developed. “If a person feels like they aren’t ‘good at anything,’ it can be common for restrictive eating disorder behaviors to become a thing they might feel ‘good at,’ which can be a tricky cycle to get out of,” she says. “On the other side of the coin, I also experienced instances of binging behaviors, where it felt like I was rebelling against my own perfectionism, only to feel the shame afterwards that reinforced restrictive eating disorder thoughts, and the cycle continued.” Which eating disorder diagnoses are most associated with perfectionism? Perfectionism isn’t exclusive to any one eating disorder, but research shows the strongest link with two in particular: anorexia and bulimia. “Both are characterized by an overvaluation of weight and shape, so people who have a natural tendency to strive for high standards and be fearful of ‘failing’ to meet those standards may be at increased risk for both,” Luo says. However, research has also found perfectionism to be closely associated with binge eating itself, meaning it could also be linked to binge eating disorder, anorexia binge-purge subtype, and other disorders that involve bingeing. Drago also points out that those struggling with orthorexia—which isn’t technically considered a diagnosis but includes disordered behaviors—may exhibit more overt perfectionistic qualities. “Almost across the board, perfectionism will show up in some amount in orthorexia, because the thoughts about food are really based around ‘perfect’ eating and ‘perfect’ choices,” she says. “While many people may assume that a restrictive eating disorder like anorexia may be most associated with perfectionism, I think it’s important to recognize that perfectionism can actually be a factor in any eating disorder,” Drago says. How eating disorder treatment can help you use perfectionist qualities for good Despite its ability to contribute to eating disorder behaviors, perfectionism isn’t inherently negative. In fact, perfectionists have been found to have higher levels of conscientiousness and motivation, and are often high achievers. It’s only when these perfectionistic tendencies are channeled into maladaptive behaviors, that they can contribute to mental health challenges. So is there a way to harness perfectionism for good, rather than allowing it to contribute to unhealthy thoughts and behaviors? According to Luo, cutting-edge eating disorder treatments are doing just that. “A new treatment, Temperament-Based Therapy with Support (TBT-S), is based on the notion that individuals can harness their natural temperament traits to help them recover,” she says. “The idea is that temperament traits in themselves aren’t good or bad, but they can show up in helpful or harmful ways.” In Drago’s case, treatment empowered her to channel her perfectionistic traits into more effective modes of expression. She says this was among the greatest skills she learned in her recovery process. “With a trusted provider, I went through a list of all of the traits I felt like I had—the ones I thought were strengths and the ones I maybe wished I didn’t have,” she says. “Then, we went through the list together and brainstormed what word I would use if that trait were being expressed in a more helpful way.” When the time came to evaluate the word “perfectionism,” Drago was able to see how that trait could be channeled in a more productive way by expressing it as “high attention to detail,” “thoroughness,” or “dedication” when it came to things that brought her joy and enhanced her life. “When my perfectionist trait is being expressed in a less productive way, that’s actually when it fueled my eating disorder rigidity, or when it comes out as ‘laziness’ because it drives my procrastination or task paralysis,” she says. Luo says this ability to harness personality traits for good is the purpose of TBT-S and other forms of comprehensive eating disorder care—and the results can be life-changing. “Treatment can help people figure out how their traits can be used to stop meeting their eating disorder's goal and instead meet their own goals, like building a life worth living outside of an eating disorder,” she says.  ]]></content:encoded>
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            <title><![CDATA[Dietitian vs Nutritionist: What’s the Difference, and Which Provider is Right For You?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/dietitian-vs-nutritionist</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/dietitian-vs-nutritionist</guid>
            <pubDate>Wed, 29 Nov 2023 17:18:00 GMT</pubDate>
            <content:encoded><![CDATA[I’m a registered dietitian (RD), yet I’m called a “nutritionist” at least once a week. Although there are stark differences between dietitians and nutritionists, I get it—it’s confusing. There are seemingly endless titles for nutrition professionals, ranging from dietitians, nutrition specialists, nutritionists, health coaches, holistic nutritionists, and more. With so many titles, figuring out the most skilled provider to help you heal from an eating disorder or disordered eating can be difficult. I’m hoping to help you clearly understand the differences in training, education, roles and qualifications so you can make an informed decision about who is the right fit for you. What’s the difference between a dietitians and nutritionists’ training? Education and schooling are two of the largest differences between dietitians and nutritionists. The two licenses to be aware of for dietitians and nutritionists, respectively, are registered dietitian (RD) and Certified Nutrition Specialist (CNS). In fact, RD and CNS credentials are the only titles for dietitians or nutritionists that require years of higher education, supervised practice, licensure exams, and continuing education. Here's what it takes to become a RD: Earn a bachelor’s or master’s degree from an accredited nutrition program, which includes wide-ranging coursework, including biochemistry, food science, and medical nutrition therapy. Starting in 2024, there will be a requirement for a master’s degree. Complete 1,000 hours of supervised training in multiple settings, including hospitals, clinics, community centers, schools, and private practices. Pass an exam and become licensed. Continue to learn through additional training to maintain credentials. Here’s what it takes to become a CNS: Earn a master’s degree or doctoral degree in nutrition or a related healthcare field. Complete coursework from an accredited program with topics like biochemistry, anatomy and physiology, and life sciences. Finish 1,000 hours of supervised training from a qualified supervisor in a choice of settings, like private practices, institutions, and clinics. Pass the Certification Examination for Nutrition Specialists On the other hand, uncredentialed nutritionists, which may have titles like “health coach” or “nutrition consultant,” are not subject to the same intensive training or education for the RD or CNS certifications. “There are other nutrition certification programs that aren’t regulated by any organizations in the United States,” registered dietitian Courtney Darsa explains. “If there’s someone who goes by one of these titles, it’s best to look into their education and credentialing with their state and if their title is regulated. This is because their advice may be harmful if it’s not evidence and research-based.” What’s the difference between a dietitians’ and nutritionists’ qualifications? Because the main difference in training for a RD vs a CNS is medical nutrition therapy, the same goes for what they’re qualified to do. “While both RDs and CNS can offer counseling and education, RDs hold a unique distinction,” explains Ana Pruteanu, MS, RD, LDN, CEDS-C. “They are qualified to provide medical nutrition therapy and a range of clinical interventions. The scope of practice for RDs is extensive, encompassing a wide array of nutritional interventions.” Specifically, RDs can help diagnose and treat illnesses, like eating disorders, using individualized nutrition treatment, including specific intravenous feedings, tube feedings, and meal plans. CNS are qualified to provide services like nutrition education and programming and to work in nutrition research and health promotion campaigns. They’re also equipped to create educational materials about nutrition and healthy lifestyles. Uncredentialed nutrition professionals (anyone other than a RD or CNS) likely don’t have adequate education, training, and qualifications to provide custom nutrition advice and guidance. Depending on the state they live in, it may even be illegal to do so without becoming a licensed RD or CNS. Why is it important to see a dietitian in eating disorder recovery?   Fully understanding medical nutrition therapy is essential when treating eating disorders, which is why it’s important to specifically seek out a registered dietitian. Eating disorders have many medical complications, and so it’s important that nutrition professionals have a deep clinical understanding of treatment goals and how nutritional changes interact with other medical conditions.  Dietitians working with eating disorder patients often work with a team of other providers, including a doctor, therapist, and psychiatrist, which requires regular communication and collaboration. “This is something that registered dietitians get schooling on and often have experience with in the clinical and hospital setting where medical nutrition therapy is being practiced,” says Darsa. Research shows dietitians’ skills and knowledge are necessary complements to psychological treatment of eating disorder clients. This is because without proper nutrition rehabilitation and care, psychological progress may not be sustained because of the effects of starvation on the brain. Plus, findings from a 2021 review of research suggest that not only can RDs aid with refeeding, weight restoration, meal planning, and nutrition education in treatment, but that they can also help patients work on their relationships to food, body, and exercise, and to develop a sense of safety within their bodies. “In my personal situation in my daughter's recovery, her RD was pivotal to her recovery,” shares Equip family mentor Laura Cohen. “She was extremely helpful to stand alongside my daughter during her recovery and was a pillar of her treatment team.” What should you look for when choosing a dietitian? When you’re looking for a RD to help you heal from an eating disorder or disordered eating, here are two key factors to keep in mind: Not all RDs have eating disorder experience or specialization. “When seeking an RD for eating disorder treatment, it's essential to inquire about their specific experience in eating disorders,” Pruteanu suggests. “This includes their educational background, years of practical experience, and the variety of settings they've worked in.” If they don’t have a ton of experience, make sure they’re under the supervision of someone who does. Some RDs are steeped in diet culture and fatphobia. Unfortunately, there are RDs (and other eating disorder providers, research shows), who carry weight bias about people in larger bodies. Some RDs will say they treat eating disorders while also providing “weight management” or even weight loss services—consider that a red flag. “If an RD ever says to a client ‘do not worry, I will not let you gain too much weight,’ I would run fast away from that provider,” says Cohen. Instead, look for a RD who describes their approach as “weight-inclusive,” “weight-neutral,” or one that is rooted in Health at Every Size (HAES). Pruteanu suggests asking four questions in your RD vetting process: How long have you been working with clients with eating disorders? What additional training have you received in eating disorders? What eating disorders diagnoses have you worked with? What is your approach to treating eating disorders? “By working with RDs specializing in eating disorders,” Pruteanu adds, “individuals in recovery can benefit from the nuanced expertise and compassionate guidance necessary for a successful journey towards healing and well-being.” At Equip, patients work with registered dietitians who have specialized training in treating eating disorders and using a HAES-informed approach. Dietitians play a key role in treatment. Some of their responsibilities include: Safely increasing calories through a nutrition prescription Helping patients and their families with recipes and meal planning Providing nutrition education and debunking diet culture myths Facilitating exposures to incorporate fear foods Managing physiological symptoms like stomach pain and acid reflux These dietitians collaborate with the other members of a patient’s care team to craft a treatment plan with the highest chances of success. If you or a loved one are looking to connect with an eating disorder care team, you can schedule a free consultation to learn more about our virtual, evidence-based program.]]></content:encoded>
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            <title><![CDATA[What Is Body Dysmorphia, and How Does It Relate to Eating Disorders?]]></title>
            <link>https://equip.health/articles/body-image/body-dysmorphia-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/body-dysmorphia-and-eating-disorders</guid>
            <pubDate>Tue, 25 Jul 2023 23:54:00 GMT</pubDate>
            <content:encoded><![CDATA[Before Equip Peer Mentor Stacy Jones was diagnosed with an eating disorder, she struggled with a related but separate issue: body dysmorphia. Body dysmorphia, also known as body dysmorphic disorder (BDD), is a mental health condition in which a person can’t see themselves objectively, and instead fixates on certain body parts or “flaws” in their appearance. “I had no idea what my body actually looked like and I felt so much anxiety from that,” Jones says. “If I didn't know how I looked, how would I know whether or not I looked acceptable to others?” Jones says that she felt so much societal pressure to fit a specific standard that it was disorienting not to have an accurate reflection of her appearance. “This fueled my eating disorder, because I thought if I could change my body enough, I would eventually be happy with it and able to see it clearly, but this of course never happened,” she says. Just as other psychological conditions like obsessive compulsive disorder (OCD) have been co-opted and incorrectly incorporated into mainstream language (“I like to be tidy, I’m so OCD!”), “body dysmorphia” has been misused as a synonym for body dissatisfaction. But while body image struggles can be serious and are worth addressing, body dysmorphia is different. It’s a diagnosable mental health condition, and it can be all-consuming. Those who struggle with body dysmorphia aren’t just annoyed or upset about a perceived defect in their appearance: they can’t stop thinking about physical characteristics they deem to be imperfect, and may experience intense distress, anxiety, or shame about things that appear minor or nonexistent to others. “I think of body dysmorphia as a distorted perception of one's body shape and size that impacts their overall self-perception,” says Equip therapist Maddie Friedman, LCWS. “It’s a brain-based issue that often results in people seeing themselves in a starkly different way than they’re seen by others.” What causes body dysmorphia or BDD? Experts believe that about 2.4% of the general population across all identities has body dysmorphia, and much like eating disorders, there’s no single cause; body dysmorphia results from a complex combination of environmental, psychological, and biological factors. However, there are certain risk factors that can increase the likelihood of a person developing body dysmorphia. These include: Negative social experiences like bullying or teasing that can heighten feelings of shame, fear, and anxiety A family history of the condition (or other similar mental disorders) Abnormal brain chemistry Certain personality traits, such as perfectionism Certain adverse life experiences Comparison with others Friedman calls out this last factor as a biggie, especially in today’s media-saturated landscape. Because of how our brains work, we tend to take a more generous view of others than we do of ourselves; this is particularly true of those with body dysmorphia, and this tendency can lead to comparisons that feed into a distorted and negative self-image. “When we see others, we see them as a whole, which is vastly different from how someone with body dysmorphia sees themselves,” she says. “Something that helps with body dysmorphia is working on viewing oneself as a whole person, rather than fixating on specific body parts or physical traits.” What are the symptoms of body dysmorphia or BDD? Body dysmorphia can manifest in many ways, but the symptoms typically involve obsessive thoughts and body checking behaviors, often focused on the face, skin, hair, chest, and/or stomach. Some of the common symptoms of body dysmorphia include: Constant body checking in mirrors and/or other reflective surfaces Avoiding mirrors altogether Always comparing yourself to those around you Frequently asking other people for reassurance about your appearance Using accessories like scarves, hats, or makeup to hide parts of your body Grooming and/or exercising obsessively Seeking out unnecessary plastic surgeries to change your appearance Picking at your face or skin Refusing to leave the house and/or participate in social activities In extreme cases, body dysmorphia can lead to severe feelings of anxiety and depression, and can even prompt thoughts of suicide.  How is body dysmorphia distinct from body dissatisfaction? One common misconception Jones is eager to clear up is the idea that body dysmorphia is just perceiving your body as bigger than it really is. “It’s actually an inability to recognize yourself in the mirror or not being able to figure out what you look like, along with a strong fixation on certain body parts,” she says. “This happens because you only focus on one feature at a time, rather than viewing yourself as a whole. And because you’re seeing parts of your body without any context, it’s easier for the brain—which is influenced by society’s beauty standards—to warp them from what they actually look like.” According to Equip Registered Dietitian Stephanie Kile, body dysmorphia is a brain disorder that requires effort and support to treat. “For someone with body dysmorphia, the preoccupation with and obsessive way of thinking about their body starts to impact other aspects of their lives,” she says. “This can lead to disordered eating behaviors to help ‘fix’ the areas they’re dissatisfied with.” Friedman adds that body dysmorphia is distinct from general body dissatisfaction because it tends not to be a wholly emotional and cognitive experience, but more of a perception issue. “It absolutely can impact one's feelings and yield harsh self-critique, but I think it usually has a broader impact,” she says. What's the relationship between body dysmorphia and eating disorders? While not every person with body dysmorphia has an eating disorder (and vice versa), the two illnesses are, unsurprisingly, closely tied. “Body dysmorphia is often a symptom of an eating disorder,” Friedman says. “While eating disorders are genetically predisposed, they're often activated by environmental triggers. Body dysmorphia may precede the activation of an eating disorder, and may worsen as other symptoms and behaviors escalate.” According to a recently updated paper on body image distortion, misperceptions in body image (i.e. the discrepancy between the picture you have of your body and how it actually looks) are common in eating disorders like anorexia and bulimia. One study found that out of 200 people diagnosed with body dysmorphia, 32.5% had an eating disorder. On the other side, The Body Dysmorphic Disorder Foundation, a nonprofit dedicated to raising awareness of the condition, states clearly that BDD and eating disorders are distinct. Unlike most eating disorders, body dysmorphia usually isn’t centered on weight concerns, but an obsession with a particular body area. However, food restriction is a common tactic individuals with body dysmorphia employ in an attempt to alter their bodies. “For some people, body dysmorphia offers an opportunity for eating disorder behaviors to creep in as a way to help the person ‘fix’ themselves,” Kile says. “It’s like the fitness industry's idea of ‘spot reducing,’ meaning if you dislike a particular part of your body you can ‘fix’ it through exercise or by removing food. In actuality, this isn’t possible, yet body dysmorphia takes hold of a particular body part and keeps saying, ‘you can change it by doing X, Y, or Z.’” How to treat body dysmorphia If you suspect you or a loved one are dealing with body dysmorphia, there are evidence-based treatments that can help. Experts often recommend a combination of cognitive behavioral therapy (CBT) and certain medications to help control body dysmorphia. While CBT can help you learn how to control negative thoughts and behaviors, medications can help with related mental health conditions like depression and OCD. For those who are struggling with disordered eating as a result of their body dysmorphia, normalizing eating habits can also help. “Body dysmorphia can be healed by adequate nutrition, weight restoration, and medication when appropriate,” Friedman says. One of the most important things to understand about body dysmorphia or any mental illness is that you don’t need to have a clinical diagnosis to seek help or support. Equip’s body image program, Freeform, is a four-week virtual course in challenging societal ideals and can help participants feel more empowered in their bodies. This kind of work is crucial, considering up to 75% of people worldwide are unhappy with their bodies. “Talking about body dysmorphia is critical, because it is so misunderstood and can have a deep impact on one's mental health,” Jones says. “Body neutrality can be very supportive through this, as well as releasing the need to meet body and beauty standards. We don't always have to know how our body looks or is perceived by others, and when we are in a more neutral place, there is space for that to be okay.”]]></content:encoded>
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            <title><![CDATA[What Is Intuitive Eating? (And Can It Fit into Eating Disorder Recovery?)]]></title>
            <link>https://equip.health/articles/food-and-fitness/intuitive-eating-benefits-risks-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/intuitive-eating-benefits-risks-eating-disorders</guid>
            <pubDate>Mon, 06 Jan 2025 16:55:00 GMT</pubDate>
            <content:encoded><![CDATA[The term “intuitive eating” has entered the mainstream, and it’s easy to find influencers and self-proclaimed experts on social media touting its benefits. As explained on, say, TikTok, the idea is pretty straightforward: you eat exactly what and how much you feel like eating, listening to your body’s hunger and fullness cues as well as its cravings. But in reality, intuitive eating is much more complex—especially for those who have struggled with an eating disorder. Read on to learn the definition of intuitive eating, its risks and benefits, how it relates to eating disorder recovery, and more. So, what is intuitive eating exactly? Often when people learn about intuitive eating for the first time, their response is something like this: “But if I allow myself to eat whatever I want, I’ll just eat donuts and French fries all day.” Indeed, there’s a common fear that without the structure of a diet plan or food rules, eating will start to feel out of control, and you’ll only choose “junk foods.” But while intuitive eating does emphasize giving yourself permission to eat a wide variety of foods, including the fun foods you love, this doesn’t mean saying “screw it” and never eating a fruit or veggie again. “Intuitive eating is a framework that helps people improve their relationship with food,” says registered dietitian and certified intuitive eating counselor Jen Baswick. “Intuitive eating is all about unlearning and letting go of the external ‘rules’ taught to us by diet culture and re-learning your natural internal cues to let them guide your eating habits.” Listening to and honoring your body’s cues instead of a diet (or eating disorder voice) is a foundational aspect of intuitive eating, but it’s not simply about eating when you’re hungry and stopping when you’re full—it’s a lot more nuanced than that. “Intuitive eating includes how and why we eat what we eat—preferences, nutrition, access, nervous system and health function—as well as our emotional relationship to food and even how we view physical activity,” shares eating disorder dietitian Tracy Brown, RD. Developed in the 1990s by dietitians Elyse Resch and Evelyn Tribole, intuitive eating includes ten principles. These ten principles are: Honoring hunger and fullness cues Breaking up with diet culture Challenging the inner “food police” Giving yourself unconditional permission to eat Finding satisfaction at meals Learning to feel your fullness Developing healthy coping strategies for emotions Body acceptance Joyful movement Balancing eating for health and pleasure (AKA “gentle nutrition”) The risks and benefits of intuitive eating Intuitive eating is a practice that can have a powerful and positive domino effect in your relationships with food as well as life beyond the plate. In my own practice as a dietitian, I observe clients of all genders, ages, body sizes and diagnoses reaping numerous benefits of intuitive eating, and my colleagues in the space report seeing similar changes. “Some of the benefits of intuitive eating include fostering more self-compassion, higher self-esteem, and more optimism,” Baswick says. “It’s also associated with a decrease in disordered eating, preoccupation with food, food-related anxiety, and binge eating.” Research shows associations between intuitive eating and better body image and self-esteem, increased metabolic health, weight stability, and higher fruit and vegetable intake. However, intuitive eating can be a risk for people who struggle with eating disorders and try to go all in before they’re ready, or for those who don’t have the right support (like a dietitian and therapist) in place. “Sometimes, people can jump right into intuitive eating without understanding that as soon as the container of their ‘diet’ is lifted, often big emotions can arise that they aren't prepared for, and a ‘whack-o-mole’ situation can happen,” explains Brown. “Like ‘if I’m not restricting, then I over-exercise.’” There are a number of different ways this might show up, but people should be on alert for compensatory behaviors—like compulsively working out—that arise once the restriction is gone. For this reason and others, it’s critical that those in eating disorder recovery take baby steps toward intuitive eating. Doing this allows time for organ systems to heal, for the eating disorder voice to quiet, and for a person to become reconnected with their body. There’s one more risk that merits a mention: the risk of intuitive eating getting warped by the forces of diet culture. I often catch this in my own practice, when intuitive eating starts to morph into a perfectionistic hunger-fullness diet. “The wellness and diet industry has now co-opted the term intuitive eating and uses it in a restrictive way surrounding weight loss, which it is not meant for,” Baswick says. Who is intuitive eating for (and not for)? Generally, intuitive eating is meant for every human, since we come out of the womb connected to our hunger and fullness cues. However, diet culture, disordered eating, or eating disorders can often sever our connections to our bodies and require us to re-learn how to get in touch with them through professional support. “Some people will need guidance as anyone who has struggled with emotional under- or overeating has been disembodied for months or years,” Brown says, “and they’ll likely progress more efficiently and with less guessing and stress with someone offering feedback and a safe relationship.” Mechanical eating might be a more helpful alternative at first.  According to Baswick, there are a few populations that may have a harder time practicing intuitive eating, such as those who are food insecure or have food allergies. “Using intuitive eating with populations who may have a more complicated relationship with food is not impossible, but should always be approached on a case-by-case individualized basis.” Intuitive eating could also be a risk for someone with a metabolic condition, like diabetes or hypertension. “If someone who has diabetes wants to practice intuitive eating, they should get the support of a dietitian to help them understand how to use the principles of intuitive eating while also understanding how to keep their blood sugar managed well,” says Baswick. Can intuitive eating fit into eating disorder recovery? Research says yes. One study shows a link between using intuitive eating principles on college campuses and improved eating disorder symptoms among students, versus using self-weighing and calorie counting. Another study evaluated an intuitive eating program in an eating disorder treatment center, finding an association with intuitive eating abilities and positive treatment outcomes. In my clinical opinion, intuitive eating can be successfully and effectively used at any part of the eating disorder recovery process, as long as it's done so consciously and carefully. For example, I’ve had clients who are still weight-restoring, disconnected from internal cues, and still need to mechanically eat and follow meal plans closely; however, they can start to learn to practice permission with food (a foundational part of intuitive eating), within the structure of their plans. I’ve also had clients simply start to notice hunger and fullness cues (another critical step in intuitive eating) before and after meals without necessarily letting these cues guide eating habits yet. For clients further along in recovery, we work to move them away from meal plans and into alignment with their bodies. “I believe that aspects of intuitive eating can be very complementary to eating disorder recovery, especially rejecting the diet mentality, making peace with food, and body respect, to name a few,” adds Baswick. However, Brown, Baswick and I all agree that honoring hunger and fullness are two of the trickier intuitive treatment principles to follow early on in recovery. “It takes time to develop accurate interoception, or feeling hunger and fullness separated from emotions or trauma body memories,” Brown says. “People can and do get signals back, but accuracy builds as physical, emotional, and mental healing occurs.” Baswick adds that gastroparesis (slowed stomach motility) and feelings of early fullness despite needing more food (which is common in anorexia) can complicate things. She also points out that the rigid thinking common in eating disorders can make the looser framework of intuitive eating tricky. “One danger is if a patient turns following their hunger and fullness cues into another restrictive pattern to follow,” she says. “This is why it's so important to work with a dietitian that specializes in eating disorder recovery and knows intuitive eating well to support people along their recovery journey.” Whether you are in eating disorder recovery or are simply working on your relationship to food and body, intuitive eating offers a liberating alternative to the rigid, black-and-white thinking of diet culture and eating disorders. A departure from eating and living with self-control, judgment, and punishment, intuitive eating provides a nuanced, compassionate way of nourishing yourself from an embodied place of self-care, self-trust, and self-respect.]]></content:encoded>
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            <title><![CDATA[Why Weight Restoration Is So Important in Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/weight-restoration-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/weight-restoration-eating-disorder-recovery</guid>
            <pubDate>Wed, 10 May 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[  One of the toughest parts of eating disorder treatment may be weight restoration, or helping a person reach a healthy weight. But as an eating disorder registered dietitian in recovery, I know firsthand that the discomfort of weight restoration—the physical, the emotional, the psychological—is well worth it. What is weight restoration? In eating disorder recovery, weight restoration is the process of gaining enough weight to reach a healthy, stable, and sustainable weight for a person's body. Weight restoration can be a challenge for the person in treatment as well as for their loved ones and providers, but it’s an essential part of treatment. Without full weight restoration, full recovery isn’t possible. When is weight restoration necessary? Weight restoration isn’t just for people who are underweight. It’s necessary in multiple instances regardless of a person’s body size. These include: When a person loses weight through disordered behaviors When a persons is chronically below their body’s healthy weight (which may be different than what the BMI chart says they “should” be) In the instance of a child or teen, when they experience a drop on their growth chart or fail to gain appropriate weight to support their physical and cognitive growth The bottom line is this: in order to achieve lasting recovery, full weight restoration is crucial for most eating disorder patients. Otherwise, it can pose the risks of quasi recovery. Read on to learn why this is the case, as well as common questions that both patients and their loved ones have about weight restoration. Why is weight restoration so important? In short, weight restoration is essential so that the patient can reach a stable weight that allows them to function optimally. Contrary to what I was taught in my (traditional) dietetics training and have now unlearned, Body Mass Index (BMI) is not a reliable predictor of a person’s health nor weight, and it’s often a faulty tool for setting an eating disorder patient’s target weight. This means that even if a person’s weight falls into the “healthy BMI range,” they can still be weight-suppressed, meaning they are below their body’s healthy weight. Weight suppression comes with many significant psychological and physical health risks. Weight suppression symptoms Brandy Minks, an RD specializing in eating disorders, says that not gaining adequate weight can cause a poor quality of life due to “debilitating physical or mental symptoms.” Those symptoms can include: Cold intolerance Heart conditions Dizziness Low blood sugar GI issues Fatigue Headaches Anxiety Death Caroline Thomason, an eating disorder registered dietitian, adds, “Further, if weight suppression reaches the point of malnutrition, it can have even more serious consequences like decreased immune function and risk for osteoporosis.” Another significant physical risk of weight suppression is functional hypothalamic amenorrhea (FHA), or the absence of regular periods in those who should be menstruating. FHA can cause infertility, poor bone health, declining heart health, and unstable hormones. This happens because when someone is below their body’s healthy weight, their body will distribute its minimal energy to critical organs (like the heart) to ensure they stay alive; meanwhile, the reproductive system basically shuts down until it has enough energy and fat to work again.  The mental effect of weight restoration Weight restoration can also provide a pivotal mental shift for eating disorder patients. Weight suppression can help keep an eating disorder alive by allowing the disease to maintain its grip on a person’s mind. Despite food intake being largely improved, every single one of my clients who was still weight-suppressed reported being consumed with eating disorder thoughts and thoughts of food until they had achieved full weight restoration. This was true even if they “looked healthy” and were eating what seemed to be a “normal” amount. Weight suppression can also prevent progress in other areas of treatment, like individual therapy. Without a clear connection to their body and a relatively clear mind, it can be futile for patients to attempt to do the deeper work. What are the benefits of weight restoration? Although it can be a hard process for both patients and their loved ones, reaching full weight restoration is well worth the struggle. In addition to avoiding all of the mental and physical risks outlined above, weight restoration also comes with many benefits for those struggling with an eating disorder. Physical health Physically, weight restoration supports healing across several body systems, including the cardiovascular, skeletomuscular, immune and reproductive systems. For example, anemia is a typical condition I see in my clients who are malnourished and weight-suppressed. Anemia directly affects immune health—making it harder to fight off illness and infections—and heart health—putting clients at risk for developing serious cardiac complications. Thankfully, with an adequate and relatively balanced intake along with weight restoration, anemia can be reversed. “Weight restoration allows the body to heal from macro- and micronutrient deficiencies, resulting in significant quality of life improvements,” Minks says. Mental health Research shows adequate weight gain is one of the best predictors of psychological improvement and reduced eating disorder symptoms. Another study showed an association between weight restoration and improved mental processing speed in kids and teens with anorexia nervosa. In my practice, one of the most common symptoms I observe in clients who are restricting (even slightly) and weight suppressed is the mind being nearly or completely consumed with thoughts of food. Weight restoration allows a patient to get rid of their scarcity mindset and eliminate this preoccupation. Social life Early on in our work together, I ask my clients to draw a pie chart showing the percentages of brain space that thoughts of food takes up. Their charts always show food taking up at least 75 percent, with only 25 percent left (at most) for the entire rest of their life. Once they’ve become weight-restored, their new pie chart will typically show food taking up around 10 percent of brain space, leaving most of it free for a whole life, full of family, friends, passions, education, and work. Common questions about weight restoration Weight restoration can feel daunting or confusing at first for patients and their families at first, especially if their patient doesn’t seem ‘underweight.’ Here are some of the most common questions about weight restoration, and their answers.  Why is my or my loved one’s target weight so high? In the weight restoration process, a person’s target weight (typically set by their RD and doctor) is typically at least their weight prior to eating disorder onset and sometimes higher. In the case of children, teens, and younger adults, it’s almost always higher in order to support healthy development. Sometimes, a person’s target weight is higher than what may seem to be a “healthy” or acceptable weight, according to society’s narrow standards. “Weight stigma [or bias against larger-bodied people] is the main reason for resistance to target weights that seem too high,” says Minks. “I’ve had families and providers voice that if the patient gains ‘too much weight’ they will no longer be healthy, or will develop diseases like diabetes or heart disease, or will not be attractive or find a partner.” Not only are these beliefs untrue, but they also ignore the fact that if a patient fails to reach their true target weight, they cannot be fully rid of their eating disorder. Like Minks, I often help clients and their loved ones gently pull back the veil on diet culture and see that recovering into a larger body is okay and often necessary. In fact, weight and health are not synonyms: it is entirely possible to live in a larger body and be a healthy, happy human, and body diversity is part of human biology.  Can you lower your target weight? Patients and their families might feel overwhelmed at the idea of reaching a higher-than-expected target weight, so it may feel more attainable or realistic to lower it. However, lowering the target weight (if it was set appropriately) will often make reaching full recovery harder, because this is exactly what the eating disorder desires. As writer and eating disorder recovery activist Emily Boring put it in a 2021 podcast interview, “When in doubt, aim higher.” Why is weight restoration necessary if someone looks healthy? One of the most dangerous misconceptions about eating disorders is the belief that we can tell how sick a person is based on their weight and appearance. “While a patient may be doing ‘better than before,’ there are often still signs that more weight restoration is needed,” says Minks. She says some of those signs include: Binge eating Abnormal hunger Fullness cues Preoccupation with food Ongoing physical symptoms that can’t be tied to another medical issue (like frequent colds or digestive issues). What are common weight restoration challenges? Some of the most common obstacles that patients face while working towards weight restoration include: Resistance: One of the most significant challenges to weight restoration is fighting the mental resistance that can occur. The eating disorder voice can be so loud that it’s incredibly difficult for eating disorder patients to see the motivation for gaining weight at first. This is why the support of friends and family can be so helpful at this stage. Co-occuring conditions: Most eating disorder patients have some kind of co-occurring condition, like depression or OCD. During the weight restoration process, the way these other conditions present can shift in unpredictable ways. That’s why it’s key to treat all conditions simultaneously. Needing to set a higher target weight: Sometimes a patient’s care team can assess over time that someone’s target weight needs to be higher. This can be especially true for patients that are still growing. Relapse: it’s very common to go through periods of ‘relapse,’ where someone starts restricting again. Leaning into your treatment team can help you get back on track. How long does weight restoration take? The timeline of achieving weight restoration is different depending on many factors including initial weight, target weight, and severity of eating disorder symptoms. For most people who need weight restoration, they can expect to start gaining weight in the first few months of treatment. At Equip, for example, 86% of patients are gaining weight by week 8, and 70% have achieved full weight restoration after one year. What does weight restoration feel like? Like all aspects of eating disorder recovery, this can vary greatly from person to person. In general, the weight restoration process can often be an emotional one. At first, it may be scary, frustrating or upsetting to gain weight. This is because the eating disorder brain can be very powerful in creating a fear of weight gain. Over time, however, patients report feeling physically and mentally better. They have greater energy levels, their mood is more stabilized, and their mindset about their body image can start to shift. Recovery is all about re-establishing a life worth living, one that is aligned with a person’s needs and desires, and being weight suppressed makes it significantly more difficult to do so. It may be challenging, but weight restoration gives people the mental and emotional energy they need to live in connection with their core values and pour themselves into the parts of life that mean the most to them—like family, travel, and joy—instead of pouring everything they have into their eating disorder. ]]></content:encoded>
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            <title><![CDATA[5 Common Obstacles to Receiving Eating Disorder Treatment (And How to Overcome Them)]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/5-obstacles-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/5-obstacles-eating-disorder-treatment</guid>
            <pubDate>Thu, 24 Mar 2022 22:23:00 GMT</pubDate>
            <content:encoded><![CDATA[Growing up, Ally Duvall was often told she “took up too much space” but says she simultaneously felt invisible. “I went undiagnosed for about 10 years because of pervasive and deeply-rooted weight bias, both in society and the medical field specifically,” Duvall says about her eating disorder. “I had doctors, dietitians, and an elementary school counselor encouraging weight loss and intense dieting, only strengthening the grasp my eating disorder had on my self esteem, my body, and my relationship with food.” Today, as the manager of Equip's body image program, Duvall helps support families on the road to recovery, but she knows from her own experience that effective treatments aren’t universally within reach for a number of reasons. “A majority of treatment options are not affordable or accessible and leave 80% of folks with an eating disorder undiagnosed and untreated—eighty percent,” she emphasizes. Reflecting on some of these common obstacles to treatment—and the strategies to overcome them—can help shed light on why so many people are unable to access the treatment that they need, and the need for more information, access, and evidence-based care. The 5 biggest obstacles to overcoming an eating disorder 1. Finances and insurance Anyone who’s had to deal with a chronic condition likely knows the nightmare that can ensue when medical bills roll in and insurance doesn’t cover the exorbitant costs of care. Eating disorder treatment can be notoriously expensive and in some cases, may not be covered or even available. “I live in a county where access to eating disorder treatment is practically nonexistent, which makes finding quality eating disorder treatment very challenging for families,” says Equip therapist Brittany Ashmore. “Unfortunately for low income families that I've worked with in the past on MediCal insurance plans, their plan limits them to only being able to utilize providers within the county, leaving them to find care at local county or county contract clinics with no specialized eating disorder providers.” Ashmore says the real danger in this scenario is that families receive care that is not specifically designed for eating disorders, meaning the treatments could be ineffective. “As the families wait for their child to improve, precious time for early intervention slips away and the eating disorder becomes more and more ingrained in the child's life,” she says. “For families who have commercial insurance, they may be able to find a provider if they are willing to commute for two hours or if they are able to find a provider who offers telehealth. But unfortunately, most families don't even know what they should be looking for when seeking a provider.” For low-income families, Ashmore recommends trying all possible avenues to find and advocate for specialized care. “When it comes to your child's life, don't take no for an answer. Start by identifying what resources are available to help you. Most counties have a patient and family advocate who may be familiar with the system of care and the people who run it,” she says. “Additionally, spend time researching your rights as a patient and don't be afraid to be the squeaky wheel. Utilize the process of filing a grievance, read the patient's rights materials, and continue to work their way up the chain of command, advocating for appropriate and specialized care, even if it requires a single case agreement for a more appropriate care provider” 2. Access to evidence-based care Equip’s care model builds upon Family-Based Treatment (FBT) for one simple reason: this type of treatment works. In fact, it’s the only evidence-based treatment for adolescent eating disorders that exists. While methods like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) can play important roles in the recovery journey, FBT is the gold-standard of eating disorder care for children, teens, and young adults. But even for families who know all the information, finding a practitioner or team experienced in the model isn’t always easy. “Families who are seeking eating disorder care for their child often have to try their best to navigate a system that is not prepared to help them, and are often left working with providers who are trying their best but lack the knowledge and resources to even know where to start,” explains Ashmore. “I encourage them to think outside of the box; consider telehealth or commuting to an area with appropriate care. However, I know first hand that this is not always possible, and in cases where families are not able to find creative ways to access care, I am a strong believer that advocating for your child is the only way that you have a chance at getting what you need.” Equip Patient Experience Manager Amanda DuPont recommends families investigate a variety of avenues to care. “There are a lot of online resources for families to help provide additional caretaker support (online eating disorder support groups), books that break down how to do FBT at home, national directories that allow you to search for eating disorder treatment, and non-profits such as Project Heal that offer scholarship opportunities for financial assistance for treatment,” she says. Ashmore adds that when she applied to work for Equip, she was excited to become a part of an organization set on changing the treatment landscape. “It is infuriating that effective and evidence-based treatment exists for this illness, yet so few are able to access it,” she says. “It is unacceptable that people are dying or suffering health complications from an eating disorder because the system of care is failing them. Everybody deserves to recover from an eating disorder, no matter their social or economic status.” 3. The perceived stigma of having a mental health condition Despite the massive strides our society has made in talking openly and honestly about mental health, many people still feel uncomfortable admitting they need psychological support. The particular stigma around eating disorders and the misinformation that abounds about these diseases can keep people sick — particularly those who identify as men, LGBTQIA+, and low-income individuals. “The feelings of guilt and shame that may come up around seeking support can be intense, hard to navigate, and maybe even persuade you from taking that step,” Duvall says. “We need to break down the stigma around who can get an eating disorder, spread awareness of what symptoms look like in a diverse range of experiences, and continue to create more treatment options that are Health At Every Size (HAES)-aligned, gender-affirming, culturally inclusive, and physically (or virtually) accessible.” Ashmore adds seeking treatment can be especially tough for those with eating disorders because the diseases themselves are so ridden with those feelings of shame and guilt, which can be compounded by societal misconceptions and stereotypes. “I hope that people experiencing these feelings will have some understanding and grace for themselves, and know that it is very common to feel guilt or shame when seeking treatment,” she says. “Sometimes giving yourself permission to acknowledge those feelings can take a bit of the power away from them. I also suggest seeking out articles, influencers, podcasts, and other materials that can help to debunk the stigma of eating disorders and treatment.” According to DuPont, the support of a community or others traversing the same recovery path can also go a long way in alleviating these feelings of shame and guilt. “Once a family is ready to seek treatment, it can really be an eye opening experience as they begin to surround themselves with a supportive community that is also going through the same journey,” she says. “When you're in the depths of dealing with an eating disorder, it can often feel like you're the only family who is having to battle through meal times or the only family who feels hopeless in their recovery journey – you are not alone. Many people are going through this journey as well and the more you speak up about your experience, the more you will find the support and empathy you need on this journey to full recovery.” 4. Assembling the right team Given the lack of qualified, healthcare practitioners who offer evidence-based care for eating disorders, putting together a comprehensive team of specialists can be tough — especially because effective treatment often requires a multi-prong approach including psychotherapy, nutrition, medical exams, and more. “In general, having a coordinated care team is definitely an obstacle for families,” DuPont says. “There are a lot of ways to approach eating disorder treatment. When families have to piece together a care team on their own, using multiple outpatient providers, each of those providers might approach treatment differently. This leads to mixed communications, an unclear treatment approach and delayed progress in recovery.” The most streamlined solution for this issue is to find a single source of care that provides all the necessary elements for effective treatment. “Having all the providers using the same approach, working for the same company greatly impacts a patient's ability to gain traction in treatment, as well as reduces the stress and overwhelm of caretakers having to coordinate multiple outside providers,” explains DuPont. 5. Feeling like you’re “not sick enough” “Eating disorders impact people of all ages, all genders and all ethnicities—eating disorders do not discriminate,” Dupont says. “They also do not appear the same way in all bodies. For example, some people can have anorexia without having a low weight. If you feel you or your loved one has an eating disorder, please seek treatment. If your medical provider does not listen, keep speaking up. If they still don't take your concerns seriously, please seek a second opinion. Your family deserves full recovery.” Duvall says that when she was struggling with her eating disorder, she often felt discounted by healthcare professionals because of societal and medical weight bias. Now, she’s on a mission to help dispel these types of myths that prevents people from being properly diagnosed and treated. “I used to believe that I didn’t deserve what recovery would bring me. But I did, you do, and everyone else around battling an eating disorder does too. Your life worth living is ready for you.”]]></content:encoded>
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            <title><![CDATA[Dating While in Recovery Can Be Hard. Here’s How to Navigate It.]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/dating-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/dating-eating-disorder-recovery</guid>
            <pubDate>Thu, 13 Feb 2025 19:06:00 GMT</pubDate>
            <content:encoded><![CDATA[I’ll never forget when a guy I was newly dating invited me over for dinner, saying, “I’m making steak and salad—no carbs tonight.” Then, there was the guy who, over a delicious Italian dinner, confided in me that his biggest fear in life was “getting fat.” At the time, I was several years into my eating disorder recovery, so wasn’t triggered by their disordered actions and words, but had I been earlier in recovery, they certainly could’ve had a negative impact on my healing process. Regardless, I still found such situations and conversations tricky to navigate and they became barriers to developing deep connections necessary for lasting relationships. Unsurprisingly, neither person turned out to be my life partner. By itself, “Dating can be really hard and it’s so vulnerable,” says Equip dietitian Dani Castellano, RD, CEDS. While people of all ages date, eating disorder onset often coincides with a period of life when dating is especially common—in young adulthood—and dating in recovery can be especially challenging to navigate. Today, we’ll explore how diet culture and other common factors can make dating tough on the road to eating disorder recovery, and strategies to help you feel as prepared as possible before heading out on your next (or maybe first) date. Why dating can be tough when in eating disorder recovery Dating in recovery can be difficult for a myriad of reasons—here are some of the most common obstacles: Navigating diet culture comments Unfortunately, most of society is steeped in diet culture, so chances of going on a date with someone who has weight bias (negative attitudes and beliefs about others because of their weight) or uses disordered food behaviors (e.g. restricting carbohydrates), are relatively high. “When meeting someone new you may also be exposed to diet culture language such as ‘good’ vs ‘bad’ foods, calories, mention of diets or dietary restrictions, or self-deprecating talk that can feel triggering,” says dietitian Sydney Engberg, MS, RDN, LD, CPT. “Seemingly innocent commentary such as checking in regarding what someone had for a meal, commenting on how much one eats, talking about one’s own nutrition, fitness, and weight goals are some things patients have shared that are triggering,” Castellano adds. Getting your needs met One of my clients new to recovery had a hard time getting her nutrition needs met when eating around the person she was dating, because he regularly made diet-based comments about his own food and negative comments about other people’s bodies. Yet, even if your date seems to have a healthy relationship to food, it can still be tough sticking to your meal plan or making sure you’re staying true to your recovery while dating. “Because dating and relationship building often occurs over food or drink, it can increase food-related anxiety about what to order, how much to eat, or just feeling self-conscious eating in front of someone new,” Engberg explains. Additionally, diet culture has sexist roots, which is exemplified in research showing college-aged people may consider there to be acceptable “dating foods” and off-limits “non-dating” foods, including more “feminine” foods (e.g. salad) and acceptable for those identifying as females, and foods (e.g. steak) that are more “masculine” and acceptable for those identifying as males—making it all the more difficult to feel rooted in recovery when first impressions feel particularly important. Dealing with body image The current dating world is largely found online, which can further complicate eating disorder recovery. In fact, research links dating apps to poorer body image and disordered eating. One study of young adults and another study of adults between ages 18 and 65 found that dating app users may be more likely to engage in disordered behaviors than non-users. Another study of sexual minority men (those who differ from the cis-heterosexual society) linked dating app usage and poor body image, and eating disorder behaviors, like diet pill and laxative use and self-induced vomiting. Psychotherapist Amanda Marks, LPC, CPCS, says poor body image is an issue several of her clients face while dating, on and off the apps. “Most of my clients are concerned that they will be judged for their appearance, regardless of their actual body size,” she says. “Those in larger bodies are fearful about being someone's fetish.” Additionally, poor body image can extend into sexual intimacy while dating. In fact, research shows that women with eating disorders have higher levels of self-consciousness about their bodies during sexual activity which is associated with sexual dissatisfaction. Being embarrassed about recovery In my practice, I’ve worked with several clients who (understandably) need support in sharing about their eating disorder and recovery with people they’re dating, because they feel especially vulnerable to judgement. Since eating disorders are often (wrongly) stigmatized and largely misunderstood, it can feel scary to explain to a new person about your journey and needs. Personally, I went through a time in my recovery when I was too ashamed of my eating disorder history to share my past struggles with anyone new, because I was afraid they would see me in a negative light or even outright reject me. Strategies for navigating dating while in eating disorder recovery Despite all these challenges, dating in recovery is not only possible, it can also be fulfilling, exciting, and even fun! The strategies below can help you get there. Make sure you’re ready First and foremost, take a moment to be honest with yourself, so you can gauge whether it’s time to date or not. “I always encourage my clients to have their own identity firmly rooted in recovery before beginning to date,” Engberg says. “The saying, ‘You can’t pour from an empty cup,’ really applies here.” She suggests asking yourself questions like, “Can you show up authentically on a date right now, without feeling like you have to change or hide parts of yourself?” and “Do you feel comfortable being honest about your needs, preferences, and boundaries in a dating situation?” If your answer is no and you think you need more time in recovery before dating, consider using your desire to date to fuel your recovery. “If you value connection and want to be able to go on a date and eat the ice cream cone,” Castellano says, “that’s a great reason to keep working on your recovery goals,” like conquering your fear foods. Full recovery enables you to be the most genuine version of yourself and thus to form genuine connections with others. Set boundaries If you’re on a date with someone who makes diet culture comments, boundaries are key to making your experience (and potential future dates) enjoyable and aligned with your recovery. However, boundaries can feel tricky, especially in the moment with someone new. Depending on your comfort level, there are a few ways to set them. Castellano suggests gently redirecting the conversation to a different topic or saying something like, “’I’m not really into diet culture and would love to talk about x instead’ or ‘I’m actually going through some things that make these topics pretty difficult for me to discuss and for right now it’d be helpful if we didn’t talk about food or bodies.’” Engberg encourages clients to rehearse what you would say in an uncomfortable scenario to take care of yourself. “Remember, you get to decide how much you share,” she adds. “Boundaries are about protecting your peace, not convincing others to change their mindset.” Prioritize your needs One of the best ways to make sure your food and nutrition needs are met on dates is to gently plan and prepare beforehand. For example, I ended up bringing a carbohydrate source (potatoes) as a side to the steak and salad dinner mentioned earlier. It’s completely acceptable to bring food along to round out a meal when you know a whole food group will be missing. Honestly, I can’t recall if my date ate the potatoes or not—what was important was that I got a balanced and satisfying dinner. “Try your best not to compare what’s on your plate to what the other person is eating because it is unlikely you have the exact same nutrition needs day in and day out,” Castellano explains. She also encourages her patients to speak up about their needs. “Normalize that it’s okay to advocate for getting your needs met,” she says. For instance, “[you might] need to take a break from what you’re doing to eat a snack.” Check out these tips for navigating restaurants in recovery. Plus, Engberg suggests working to stay connected to hunger and fullness cues as much as possible. “From butterflies and nerves to different schedules, it’s easy to get distracted while dating but skipping meals or ignoring your body’s needs can be a slippery slope.” She recalls her first date with her current partner where she ordered food when he wasn’t eating. “That moment was a reminder that I don’t have to shrink myself (literally or figuratively) to be worthy of connection,” she says. “By allowing myself to eat in front of him, I was able to remain present, enjoy the conversation, and communicate (without even realizing it at the time) that my needs and wants are important.” But what if you do lose connection to your body amid dating? Lean on your meal plan or practice what I call “self-care eating,” or eating when hunger is absent because it’s been over three or four hours since your last meal or snack. “I always recommend keeping a snack in your bag or car and planning dates that allow for eating opportunities,” Engberg adds. She encourages clients to have a game plan if eating at a restaurant feels hard. “This might mean reviewing the menu ahead of time or selecting a setting where you feel more comfortable,” she says. “Also remember that meeting your needs doesn’t just start when you arrive on your date—make sure that you are nourishing adequately throughout the day so you can show up energized and present.” Tend to your body image Working on your relationship to your body is necessary to date healthfully in recovery. Marks recommends her clients work on body image before and during dating, since “it's often based on the perception of appearance and to make sure they’re not projecting any of their own issues or insecurities on someone else.” She recommends a few techniques, including “reminding yourself that you are much more than your appearance—that you are more than a body, focusing on body acceptance and neutrality, wearing clothes you feel comfortable in, and accepting compliments [instead of] deflecting or minimizing them.” While dating, clarifying your values and evaluating your date’s values can help you decide whether you want to continue spending time with them. Marks suggests asking yourself some questions: “If someone highly values a particular physical appearance, or physical appearance in general, is that someone that you want to be with? How will their values and behaviors impact you? Have you worked through your own body images to be true to yourself and confident?” Improving body image takes time and practice, and working with a therapist can make a significant impact. “It can be exhausting but it's something that we have to keep doing as insecurities and issues will come up,” Marks adds, “and we have to be prepared to address those issues.” For supplemental support, some of my favorite body image books are “More Than a Body,” “The Embodied Healing Workbook,” and “Reclaiming Body Trust.” You can also explore Equip’s free body image course, Freeform. Practice authenticity Forming meaningful relationships takes emotional risk and requires authenticity. So, being up front about your eating disorder recovery and needs is important in dating. However, how, when, and with whom you share is at your discretion. There’s no need to share your eating disorder history on a first (or second or third) date, unless you feel compelled to do so, until there’s trust and safety established between you two. When you’re ready to share, the right person for you will respond with compassion and respect. Personally, one of the most rewarding parts of my eating disorder recovery has been—after years of dating—finding my way to my husband, who has always seen and accepted me for who I truly am (and who loves his carbs). It’s entirely possible to date and find love while in eating disorder recovery. However, it’s imperative that you’re far enough along in your healing process to be ready for a genuine and healthy relationship. If you need help getting there, reach out for professional help from a therapist and dietitian to support your process.]]></content:encoded>
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            <title><![CDATA[Understanding Pica: Symptoms, Causes, and Treatment for this Lesser-Known Eating Disorder]]></title>
            <link>https://equip.health/articles/understanding-eds/what-is-pica-treatment-therapy</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/what-is-pica-treatment-therapy</guid>
            <pubDate>Tue, 12 Mar 2024 20:23:00 GMT</pubDate>
            <content:encoded><![CDATA[While many people are at least somewhat familiar with the signs and symptoms of well-known eating disorders like bulimia and anorexia, lesser-known eating disorders continue to fly under the radar. One of those eating disorders is pica, a diagnosis that’s significantly different from other eating disorders in many ways, but still just as serious. Read on to learn more about pica, its different symptoms and causes, what pica eating disorder treatment looks like, and more. What is pica? Pica disorder is primarily characterized by the consumption of things that aren’t food and don’t contain any nutritional value. Those with pica might eat a large variety of things that aren’t meant to be eaten, such as dirt, paper, charcoal, cloth, and more. The medical term for the illness originates from the Latin word for magpie (Pica pica) which is a bird known for eating unusual objects. “Pica is an eating disorder where a person habitually eats non-food items,” says Jessie Menzel, PhD, Clinical Psychologist and VP of Clinical Programs at Equip. “The Diagnostic and Statistical Manual of Mental Disorders classifies something as an eating disorder if the main target of treatment is going to be eating, which is certainly true for pica.” Menzel goes on to explain that pica can affect anyone, but it occurs more frequently among children and those with cognitive or intellectual disabilities. While up to one third of children ages one to six exhibit eating behaviors like those observed in pica, experts aren’t entirely sure just how many intentionally consume non-food materials, like dirt (in other words, they’re not sure which of these children have pica and which are just putting non-food items in their mouths because they’re little kids). Registered dietitian Katy Zanville, MS, RDN, adds on to Menzel’s definition, explaining that “pica is a condition in which a child or adult eats non-food substances such as ice, raw starch, dirt, baby powder, chalk, coffee grounds, charcoal, and egg shells for a period of at least one month. It’s often seen in children, intellectually impaired adults, and pregnant women.” While, as Zanville points out, pica can occur in adults, experts aren’t sure how common adult pica is and the diagnosis initially appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a “disorder usually first diagnosed in infancy, childhood, or adolescence.” Pica only appeared in its current form—as a disorder affecting people of all ages—with the 2013 publication of the DSM-5. Given this, research on pica in adults is fairly limited. Here’s what we know based on the current research on the prevalence of pica: Approximately 1.1% of adults experience recurrent pica behaviors, according to one study. About 5% of kids ages 7 to 14 experience pica symptoms according to another study. Between 27.8–34% of pregnant and postpartum women experience pica symptoms, according to a global meta-analysis of pica during pregnancy and the postpartum period. Prevalence was higher in Africa compared with other locations, increasing as the prevalence of anemia increased, and decreasing as education on the deficiency spread, suggesting that pica in these instances may be driven by nutritional deficiencies. About 1 in 5 adults with intellectual disabilities may experience pica symptoms, according to research. What are the symptoms of pica? While pica can take many forms, the defining symptom is the regular consumption of non-food items. “The hallmark symptom of pica is eating something that isn’t food,” Menzel says. “Some examples of items that someone might ingest include hair, paper, clay, chalk, small rocks, erasers—anything! The eating can often be compulsive in nature, meaning that a person will have a strong, almost irresistible urge to eat.” The DSM defines pica as “eating non-nutritive, non-food substances over a period of at least one month.” The specific symptoms of pica include: Eating non-food, non-nutritive substances over a prolonged period of one month or more Ingesting non-food items for reasons other than a medical condition or gastrointestinal problem Eating these items in a way that is considered developmentally inappropriate. For example, it’s common for children under two years old to put small, non-food objects in their mouths in order to explore their senses. Even when this accidentally results in consuming the object, children under two are not diagnosed with pica. Consuming non-food substances that are not part of cultural or social norms or practices (for example, in some cultures it may be considered appropriate or customary to consume non-food materials for medicinal or spiritual practices). Menzel emphasizes this last point, noting that “eating non-food items is common practice in some cultural groups and it’s important to be aware of this potential.” Zanville adds that pica does not involve the body image concerns or mental health implications of other eating disorders. “Pica differs from other eating disorders because it doesn’t include a desire for weight loss and can be treated with nutrient supplementation,” she says. “Other eating disorders, such as anorexia or bulimia, are treated with mental health, medical, and nutrition interventions.”  What causes pica? As with all eating disorders, there is no single, definitive cause responsible for the development of pica. Eating disorders develop due to various biological, environmental, and social factors, and there are myriad explanations for why someone might experience pica symptoms. “There are several different reasons why a person might develop pica,” Menzel says. “Sometimes pica is linked to a nutritional deficiency, like anemia. In this case, a person might be driven to eat non-food items due to a vitamin or mineral deficiency.” She explains that any condition that profoundly changes someone’s nutritional needs—like pregnancy or weight loss surgery—could also trigger pica. According to Zanville, a few of the most common causes of pica are: Anemia or iron deficiency Zinc deficiency Low hemoglobin concentration in the blood Low hematocrit concentration in the blood “Other times, pica is a compulsive behavior that can be triggered by stress or anxiety,” Menzel says. “Other people with pica eat because they find the sensations associated with the non-food object to be enjoyable or stimulating.” Experts also theorize that pica may sometimes be related to autism spectrum disorder and intellectual disability, but anyone can develop the disorder, regardless of whether they have an additional diagnosis. What pica eating disorder treatment looks like Though pica is less well-known than other eating disorders and doesn’t share the same body image struggles or fears around weight gain, it’s no less serious. There are real, potentially life-threatening consequences to pica, and it requires professional treatment from specialized providers. Among the biggest risks associated with pica are poisoning (the most common type being lead poisoning), which can result in coma or death. Infections, parasitic infestations, gastrointestinal complications, and dental problems are also possible consequences of the disorder. “Pica can be an incredibly dangerous condition if left untreated,” Menzel says. “Depending on what a person ingests, it can result in emergent, life-threatening medical complications.” The good news is that there are effective, evidence-based treatment options for pica. These include: Medical interventions Pica eating disorder treatment typically starts with specific tests to identify and address any nutritional issues. “There isn’t a ‘medical’ cure for pica, with the exception of addressing vitamin or mineral deficiencies if they’re present,” Menzel says. “Psychiatric medications may also be helpful when used to treat co-occurring conditions that impact pica behavior.” Zanville adds that nutritional therapy often distinguishes pica treatment from other types of eating disorder treatment. “Pica treatment often involves iron or zinc supplementation if a deficiency is discovered,” she says. “If the behaviors are not caused by malnutrition or nutrient deficiency, then working with a collaborative team to redirect consumption of non-food items is encouraged.” Pica therapy Once physical symptoms are addressed, the next step is pica therapy. Psychotherapy is a cornerstone of all eating disorder treatment, and pica is no different. “Overall, treatment for pica usually involves some form of psychotherapy,” says Menzel. “Therapy may involve treating the underlying cause of pica, such as trauma or stress or anxiety.” Behavioral changes While a patient is undergoing pica therapy, they’ll also work to stop disordered behaviors. Menzel notes that in younger children, using a reward system may be an effective way to address pica symptoms (i.e. praising and honoring when a child discards a non-food item instead of consuming it). For people of all ages with pica, treatment will generally include becoming conscious of disordered habits and creating a plan for avoiding them. “Pica treatment may also involve learning awareness of urges and developing new coping strategies to deal with the urge or learning substitute behaviors that a person can engage in instead,” Menzel says. If you’re worried that you or a loved one may be struggling with pica, it’s important to get help. Pica is a serious eating disorder that carries significant health risks, but with the right treatment, lasting recovery is possible for everyone. ]]></content:encoded>
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            <title><![CDATA[Healthy Movement vs. Toxic Fitness: How to Tell the Difference]]></title>
            <link>https://equip.health/articles/food-and-fitness/healthy-movement-toxic-fitness</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/healthy-movement-toxic-fitness</guid>
            <pubDate>Tue, 04 Jun 2024 21:58:00 GMT</pubDate>
            <content:encoded><![CDATA[If you spend any time in the fitness space—whether that’s following fitness influencers on social media, going to exercise classes, hitting the gym, or doing at-home workouts—you’ve probably heard phrases like these:
 “No pain, no gain.” “Sweat is just fat crying.” “Pain is weakness leaving the body.” “The only bad workout is the one that didn’t happen.” Phrases like these are unfortunately pretty normal in our society, where diet culture tends to inform most people’s attitude toward exercise. But they’re also examples of toxic fitness. Though it can be framed as “motivating,” the reality is that relating to fitness in such an aggressive and unyielding way can take a toll on your body and mind—I know from experience. For a long time, my fraught relationship with exercise led me to have poor physical health, including reproductive issues and amenorrhea (or loss of period), as well as mental and emotional issues, like panic attacks, crippling anxiety, and a disconnection to my true self. Thankfully, there’s a much different, truly healthy way to relate to exercise. While there’s no official name for this life-supportive relationship to exercise, it’s commonly referred to as healthy movement or joyful movement (as a dietitian who works with clients on such relationships, I like to use the word “movement” as opposed to “exercise” to help differentiate it from more toxic forms of fitness). Today, we’ll explore toxic fitness and its consequences, and joyful movement and its benefits. You’ll also learn how to spot the differences between the two within both your internal and external worlds, and what to do if you’re struggling. Defining healthy movement and toxic fitness Healthy or joyful movement is about focusing on how your body feels as you move it, instead of how it looks, how many calories you’re burning, or how it will affect your body shape or size. It’s about moving in ways you enjoy and that enhance your well-being, and for reasons outside of appearance. When you engage in healthy movement, you might move to improve focus, feel empowered, connect with community, or other goals that have nothing to do with changing your body. In my experience personally and professionally, one of the game-changers of healthy movement is flexibility instead of rigidity. “When you have a healthy relationship with movement, skipping a workout feels easy and uncomplicated when life happens or an unplanned rest day is the better choice,” explains sports dietitian Lexi Moriarty, MS, RDN, CSSD. Another important aspect of healthy movement is its respectful and intuitive approach to the body. “Healthy movement is something that can be adjusted and adapted for our needs,” says Maria Sylvester Terry, MS, RDN, LDN. “It's full of gray area and less about exercising ‘right’ or ‘wrong.’” In other words, it’s about being with and doing something for your body, instead of battling and disconnecting from it. Toxic fitness is the exact opposite of healthy movement. In fact, the only commonality between the two is that they both involve moving your body. Terry describes toxic fitness as transactional, meaning that you must complete certain movement-related goals in order to deserve or “earn” something else in your life. “With a toxic fitness mindset, you might say, ‘I can't eat X until I walk Y number of steps,’ ‘I have to run X miles per week to eat Y number of calories per day,’ or ‘I can't go out to dinner tonight because I haven't exercised,’” she says. “It negates the benefits of movement and rest in general to fulfill an arbitrary expectation of what ‘counts’ as exercise.” Toxic fitness also includes black-and-white thinking and an all-or-nothing mentality. According to Terry, someone trapped in these unhealthy thought patterns might set rigid standards for themselves, like, “burn X calories in a fitness class or it doesn't count, run all miles under a certain pace or else you didn't really try, and no days off.” She describes it as a “you-versus-you” mentality, which “may appear ‘committed’ on the outside but can erode your relationship with movement, food, and your body.” Moriarty adds that if you’re an athlete or are training for an event, being intentional and consistent with training is typically necessary and normal. “However, ignoring an injury, training through significant illness, overtraining, going above and beyond your coaches’ recommendations, and underfueling your training should never be the case,” she explains. “Doing things like this often indicates a more unhelpful mindset around training or exercise.” Benefits of healthy movement Healthy movement can improve your holistic health and well-being in significant ways. A growing body of research shows that healthy movement—usually defined as two to three hours of moderate physical activity per week—has a host of different benefits. Specifically, studies show that this level of exercise can improve mental health conditions like anxiety and depression. Research also shows that healthy movement can help improve physical well-being, including balance and coordination, and help prevent or manage some diseases, like diabetes and heart disease. Another scientific review shows an association between healthy movement and improved cognitive functioning. “It’s important to note only a small amount of movement is required to experience these benefits,” says Equip lead dietitian Camilla Blanton, RD, CEDS. “This means that exercise does not have to be strenuous, structured, or take a long time to have benefits.” And it’s not just the actual exercise that has benefits, it’s also the relationship to exercise that healthy movement fosters: one study found a link between women who relate healthfully to physical activity and better body image and self-esteem, when compared to those who have a more difficult relationship with exercise. Personally, I feel way more empowered and have a much better relationship to my body after replacing toxic fitness with healthy movement. Instead of being the only way I deal with hard emotions, movement is one of several emotional outlets. My flexible, functional, and joyful movement is one of many self-care practices that support my core life values, so I can be more fully myself. By trading toxic fitness for healthy movement, I freed myself from defining my identity through exercise and my body’s performance. Consequences of toxic fitness Just as healthy movement can positively impact your body and mind, research shows that an unhealthy relationship with exercise can come with harmful—and sometimes life-threatening—side effects. “The main consequences of excessive exercise include cardiovascular risk like arrhythmias and cardiac arrest, and musculoskeletal consequences like injury to the muscles or nearby tendons, joints, and ligaments,” Blanton explains. “The hormonal risks include loss of period, which can occur if you’re not eating enough to support your workouts, and prolonged unhealthy exercise in the absence of adequate nutrition can cause loss of bone mineral density over time, which may lead to osteoporosis.” Having an unhealthy relationship to exercise can also cause sleep issues, decreased immunity, and mood swings. Social isolation is another major side effect. This may show up as choosing exercise instead of important events, classes, work, and major life opportunities, according to Blanton. “Exercise takes precedence over everything else, moving someone further away from what is truly valued or meaningful in life.” In my practice, several of my clients begin our work feeling like slaves to their exercise routines, and distressed about how much of their lives, energy, and brain space are taken up by a toxic fitness mindset. “When exercise feels like a ‘have to’ instead of a ‘want to’ or ‘get to,’ it can make us feel powerless in our own routines. Instead of us controlling the movement schedule, the movement schedule controls us,” Terry says. How to spot the differences, inside and out If you’re worried that your relationship to exercise has tipped into the harmful territory, it’s important to take action to course correct. An unhealthy relationship with exercise does damage to your mental and physical health, but you can reset that relationship and find a way to bring joyful physical activity into your life in a way that actually promotes health. To discern whether you’ve become trapped in a toxic fitness mindset, ask yourself these questions: Does exercise feel wrapped up in your food choices? The toxic fitness mindset subscribes to the belief that you have to “earn” your food, while healthy movement has nothing to do with your food intake. Does it feel like exercise defines you? Take stock of how much time and energy exercise takes up in your mind and life in general. If it feels like it’s only one part of your life and self-care routine, that’s a sign that you’re engaging in healthy movement. If it dominates your days, that’s a red flag. What’s your motivation for movement? If you exercise to change or control your body, you’re slipping toward toxic fitness. Healthy reasons to move include empowerment, fun, function, strength, focus, energy, improved mood, and community. Do you only choose workouts for their calorie-burning effects? How would you move your body if it wasn’t about trying to change it? These two questions are helpful in further determining whether body control is at the heart of your exercise choices. Try to imagine what kind of movement you would want to do if they would all burn the same amount of calories or have the same “results.” Healthy movement is all about finding the joy in moving your body and figuring out what feels the best for you. Toxic movement is punitive and prescriptive. Do you let yourself have rest days with ease? “If you aren't comfortable taking adequate rest days, this could be a major red flag for your relationship with movement,” Moriarty says. “Whether they're built into your training or when your body unexpectedly needs it, rest days can make your workouts more effective.” Does your movement routine feel flexible or rigid? If it feels like the world is ending when you miss a day of exercise or you walk instead of run as planned, for example, it’s a sign of toxic fitness. “If going on a long walk sounds like a ‘cheat’ day, we need to reassess how we perceive and participate in movement,” Terry says. Is your movement routine helping you connect more with your body or push past your body’s cues? Remember, healthy movement includes respecting the body and its boundaries, and toxic movement often means overriding its signals to complete workouts. If you’re following a certain plan—whether created by yourself, the internet, or a trainer—make sure it’s adjustable and allows for an intuitive approach to movement, versus a prescriptive one. How's your stress? “Exercise is great for stress management but only to a point,” Moriarty says. “If your workout routine is regularly making your days more chaotic and stressful than they need to be, your routine may need a shift.” What messages are surrounding your movement spaces? Unfortunately, diet culture messaging is typically loud in many fitness spaces, which includes the language used by trainers and instructors. “Out in the ‘fitness world,’ there’s a lot of messaging around ‘earning food’ or ‘burning calories,” Blanton cautions. In fact, research shows fitness instructors are more likely to have unhealthy relationships to exercise than the general population. Given that, it's important to set boundaries and find safe spaces and people that support healthy movement. If you’re realizing that your relationship to movement may be more harmful than helpful to your well-being, consider working with a dietitian and therapist to start your healing process. Please know, a freer and more harmonious way of moving is possible for your future. And if you’re worried that your exercise is a symptom of a deeper underlying issue, like an eating disorder, don’t wait to reach out for help. Disordered exercise habits often go hand-in-hand with eating disorders. Our free eating disorder screener is a good first step toward determining if you need help.]]></content:encoded>
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            <title><![CDATA[Food Restriction Is at the Root of Most Eating Disorders—Not Just Anorexia ]]></title>
            <link>https://equip.health/articles/food-and-fitness/the-role-of-restriction-in-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/the-role-of-restriction-in-eating-disorders</guid>
            <pubDate>Thu, 01 Jun 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[ When author Glennon Doyle revealed her struggle with anorexia last year, she said that she was shocked by her new diagnosis, having spent years of her life believing she had bulimia. While it’s easy to wonder how on earth this misdiagnosis could have happened—anorexia and bulimia are quite different, aren’t they?—when you look at the driving behaviors of the two eating disorders, it starts to make sense. As we shared at the time, Doyle’s diagnosis highlights the fact that most, if not all, eating disorders have one shared root cause: food restriction. While there’s a general understanding that food restriction is part of anorexia, many people—including eating disorder professionals and those suffering themselves—fail to recognize that it’s a core component of other eating disorders, like bulimia, binge eating disorder (BED), and avoidant restrictive food intake disorder (ARFID). Here’s what everyone should know about how deprivation and hyper-vigilance often fuels the fire of illnesses across the eating disorder spectrum. How food restriction fuels eating disorders besides anorexia  Eating disorders are never the result of a single cause, but rather the manifestation of complex biological, psychological, and social factors. That said, we do know that food restriction is frequently a driving factor in most eating disorders—not just anorexia. “It’s true that restriction is a significant component of anorexia, however, I can confidently say that it’s present in all eating disorders, either in the form of actual behavior or mentality,” Equip Dietitian Gabriela Cohen says. “Let's think about binge eating disorder. Why do we think that people feel the need to binge on food? Because they’re not allowing themselves to have it on a consistent basis, or to have the amounts or types of food they desire, which is the definition of restriction.” Equip Dietitian Caitlyn Neuendorf agrees, explaining that all types of eating disorders can be rooted in restriction, and that “restriction” doesn’t necessarily have to mean limiting food in order to avoid weight gain; it can also be physiological or psychological. “In patients with ARFID, many are restricting food variety, volume, or both,” she explains. “In patients with BED, there is often both a physiological and psychological restriction going on concurrently.” She says that even if a person is eating throughout the day, if they’re mentally restricting—meaning they only focus on nutrients, avoid foods they think they “shouldn’t” eat, or make food rules for themselves (like just one French fry or just one bite of cake)—their brain still registers that as restriction. “This can lead to binging behaviors and an unhealthy relationship with food,” she says. Here’s a brief look at how food restriction might show up in different eating disorder diagnoses: Anorexia: This is the eating disorder most of us associate with restriction, and for good reason, as restricting food is a defining characteristic of the disease. Those with anorexia severely restrict their food intake, often eliminating entire food groups and adhering to strict food rules. There are two types of anorexia: restricting subtype and binge-purge subtype. The former is defined purely by food restriction, while the latter is defined by restriction/a desire to lose weight followed by episodes of binge eating and purging. Bulimia: Bulimia is defined by repeated episodes of binge eating and purging. Someone with bulimia feels a loss of control during binges, and shame after them. In most cases, binges are preceded by periods of restriction, and the biological hunger that results from that restriction can both trigger a binge and contribute to the out-of-control feeling. Often, people with bulimia also restrict after a binge in an effort to “make up” for it. BED: Just like with bulimia, those with BED engage in repeated episodes of binge eating accompanied by a loss of control, followed by feelings of shame. And again, in most cases, the binges come after a person has been restricting, for the same reasons outlined above (more on this cycle below). ARFID: In all the diagnoses above, restriction is related to thoughts and fears around weight gain and body size. With ARFID, this is almost never the case, but the restricting behavior is still there. People with ARFID restrict both the type and amount of food they eat, usually due to anxieties about negative consequences of eating, extreme issues with food texture/taste/smell/etc, or a lack of interest in food. The underlying reasons differ, but the restriction remains the same. You can learn more about the science behind restriction by reading about the Minnesota Starvation Experiment.  Understanding the binge-restrict cycle It’s widely understood that both bulimia and BED are characterized by episodes of binge eating. But what’s not often talked about is that most binges are preceded by a period of restriction. Most people with eating disorders not only assign morality to foods—labeling foods like salad as “good” and burgers as “bad,” for instance—but also tie their own self-worth to what they eat and don’t eat. This means that their days are governed by strict food rules, leading to mental exhaustion, physical hunger, and almost inevitable “slip-ups.” And when a slip-up happens, “since we know we ‘shouldn’t’ be eating that food, the now-or-never mentality kicks in, which leads to a binge, followed by the same-restriction cycle,” says Cohen. This explanation clearly shows the way in which restriction contributes to binge eating disorder. With bulimia, the cycle is nearly the same—restriction, binge, shame, restriction—except that there are usually purging behaviors after the binge. This cycle doesn’t have anything to do with self-control or willpower; it’s a biological inevitability. After a period of food restriction, the biological drive for food is a survival tool. When you don’t eat enough, that sends signals to the brain that food is scarce, causing it to seek out large quantities of food when possible. In other words, for people with BED and bulimia, the binge eating and purging behaviors wouldn’t occur were it not for the restriction that came before them. Food restriction is often praised—and that can be a slippery slope into an eating disorder When Equip Email Marketing Lead Morgan Cornacchini was initially diagnosed with anorexia, she says she was met with more admiration than worry. “Society praises restriction,” Cornacchini says. “When my eating disorder started, I got more compliments than notes of concern. People applauded my ‘healthy willpower’ and my weight changes. This praise fueled my eating disorder and distracted me from the fact that I was sick.” Cornaccini’s experience is unfortunately relatable to many who have been diagnosed with anorexia. After all, we live in a world that’s dominated by diet culture, a system of social beliefs and expectations that values thinness over everything else. While this insidious messaging affects us all, it can be particularly dangerous to those who are predisposed to develop eating disorders. Dieting—otherwise known as “inhibition of eating behavior” or restriction—also almost invariably leads to an obsession with food, and dieting is a known risk factor for developing an eating disorder. Cornacchini adds that all people—whether they’re struggling with a diagnosed eating disorder, supporting a loved one who is struggling with one, or have simply been exposed to toxic societal messaging around food—can work to challenge their thoughts on restriction. “We can start by noticing and changing how we talk to others and ourselves about what we’re eating and our bodies,” she says. “Are you praising others’ weight changes or even your own? Are you commenting about what others are eating? What is your internal dialogue surrounding your own food choices or body? What we say to ourselves and others can have a bigger impact than we think.” Why people restrict—and how we address it head-on in treatment While many people may understand how extreme restriction can manifest in one very specific eating disorder, the vast majority still aren’t aware that any form of physical or psychological food restriction can contribute to a variety of eating disorders, disordered eating, or general harm to your mental or physical health. But despite all those negative consequences, restricting does serve a purpose for people with eating disorders—as with all disordered behaviors, as destructive as restricting may be, people turn to it for a reason. For many, restriction is a coping mechanism gone awry. Restricting might begin as a way to cope with tough emotions, helping people distract themselves from or numb out challenging feelings. Restricting can also make people feel good, not only because the act itself is praised by society, but also because it spares those with eating disorders the guilt and shame they often feel for honoring their own hunger. Regardless of the purpose it’s serving, restriction is always one of the first things we tackle in Equip treatment. We know that a malnourished brain doesn’t think clearly or take in new information well, and so our very first priority is renourishment and normalizing eating habits (which entails stopping any restriction behaviors). At Equip, patients and their loved ones work closely with a registered dietitian to address restriction head-on. Though our specific treatment approach is tailored to each patient’s unique needs, in practice this might look like: Recognizing the gap between daily nutritional requirements and current intake, and how that gap might be perpetuating disordered behaviors Prioritizing regular meals and snacks throughout the day (eating every three to four hours, always eating within one hour of waking up) Learning to advocate for oneself in settings that might lead to skipping a meal or snack (like social events or obligations at school or work) Diversifying the types of food a patient will eat, expanding beyond “safe” foods. This is important both for helping patients shed the rigid constraints of their eating disorder and for meeting macro- and micronutrient needs Identifying food rules and developing a plan to challenge or break them Providing the nutrition education patients need to become a savvy consumer of food- and body related media Restriction may look simple and harmless on its surface—who would bat an eye if someone declared they were cutting out sugar for a month?—but in reality, it can become a disordered compulsion that fuels an eating disorder (and not just anorexia). The good news is that, with the right support and tools, everyone struggling can break free of the restriction cycle. And once restriction is gone, there’s room for its opposite: freedom.]]></content:encoded>
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            <title><![CDATA[What Are the Risks of a Calorie Deficit? How a Negative Energy Balance Affects Your Body]]></title>
            <link>https://equip.health/articles/food-and-fitness/negative-energy-balance-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/negative-energy-balance-eating-disorders</guid>
            <pubDate>Fri, 19 Sep 2025 17:32:00 GMT</pubDate>
            <content:encoded><![CDATA[So often, in both my personal and professional life,I hear folks say how fearful they are of calories, whether it’s about generally consuming “too many” or eating calorically dense foods deemed by diet culture to be “unhealthy.” As a dietitian, one of my missions is to help people understand how necessary and helpful calories are. After all, calories are energy, and we need a substantial amount of them (the exact amount varies from person to person) to stay alive and even more to thrive. But our society has mostly lost sight of this reality, and tends to praise the idea of being in a calorie deficit as a good thing—when in fact, living in a negative energy balance is a serious problem. Today, we’ll delve into what it means to be in a negative energy balance, why it happens, the health risks of being in a calorie deficit, its role in eating disorders, and what to do instead when it comes to nutrition.  What is a negative energy balance? A negative energy balance, also known as a calorie deficit, is when you consume fewer calories than you burn. This can occur for several different reasons, which we’ll go into below, but regardless of the reasons, it usually comes with a number of serious consequences for both mental and physical health, especially if it lasts for a significant period of time. This might seem confusing, because in our society (especially on social media and in the diet and fitness industry) calorie deficits are generally viewed as a universally good thing, and something all of us should strive to achieve. So why is there this disconnect between how most people view calorie deficits, and how they actually impact you? The answer lies in our societal obsession with the pursuit of smallness. “Being in a negative energy balance is touted as a good thing in our society because we are taught from a young age that in order for someone to be ‘healthy,’ they have to be in a small body, even though research shows us that’s not the case,” explains dietitian Katie Schwartz, MS, RD, LD. “Since a negative energy balance may lead to initial weight loss, our society sees it as a sign of success, willpower and health,” adds dietitian Hilary Raciti, MS, RDN, CDN. Why does a negative energy balance happen? A negative energy balance happens anytime you don’t eat enough food to match your body’s energy needs. There are many reasons you might find yourself in this situation, so let’s explore some of the most common ways it happens: Dieting for weight loss Most restrictive diets aiming for weight loss cause an energy imbalance. In the U.S., around half of the population goes on a restrictive diet every year (thanks largely to diet culture). “The dieting industry is a multibillion-dollar industry that is constantly marketing towards people about how eating less calories is the answer to all of their problems,” Schwartz says. Keep in mind that diets typically don’t “work” in the long run, and they carry many negative consequences. Unintentionally underfueling for sports or activity Recent research highlights a high prevalence of undereating and energy deficits in certain groups, such as athletes experiencing low energy availability (a state where inadequate food intake combined with high energy expenditure leads to an imbalance). Such an imbalance can also happen when energy expended on physical labor or even the activities of daily living (also known as non-activity exercise thermogenesis) is higher than energy consumed. Food scarcity Living with food scarcity or food insecurity could cause someone to be in an energy deficit. In fact, data from the USDA shows that food insecure households in the U.S. typically consume fewer calories than food secure homes. Eating disorders Most of the time, eating disorders involve getting into a negative energy balance through disordered eating and exercise behaviors. “Though not always the case, many people with eating disorders find themselves in a chronic or temporary negative energy balance due to behaviors such as dietary restriction, self-induced vomiting, laxative use, or overexercise,” Raciti explains. Digestive disorders Research shows that people with inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, often experience energy deficits and malnutrition due to factors like low energy and nutrient intake, malabsorption, and increased energy expenditure. Neurodivergence There are several factors that put neurodivergent folks, such as those with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD), at risk for living in energy deficits. They may unintentionally skip meals due to factors such as medication side effects, hyperfocus (becoming completely absorbed in tasks), or reduced interoception (difficulty sensing hunger and fullness cues). Plus, they may experience decision fatigue—where mental overload makes food choices more difficult—and challenges with executive functioning skills, like planning meals. Certain states requiring higher energy intake There are several conditions that increase energy needs, like pregnancy and lactation, infections, or recovering from illnesses or injuries. If these increased energy needs aren’t met by eating more food, it will lead to a negative energy balance. Some medical conditions and illnesses Some medical issues, like hyperthyroidism, impact the metabolism, raising resting energy needs and making it more likely for a deficit to occur. Diseases impacting metabolism and appetite, like cancer, can also create a negative energy balance. Some mental health issues Anxiety can create a negative energy balance because of the increased energy expenditure caused by being in a fight-of-flight state. Other mental illnesses, like depression, can cause appetite loss or lack of motivation to eat or prepare food. The relationship between eating disorders and negative energy balance Most eating disorder diagnoses involve being in a negative energy balance at some point for some period of time. In fact, falling into a calorie deficit can sometimes be what triggers an eating disorder in the first place. “Dropping into a negative energy balance can ignite eating disorders by causing a person's focus to shift to food and body image, and losing insight into other areas that are important to them,” says Equip lead dietitian Stephanie Kile, MS, RDN. In a 2023 study of patients with eating disorders found that calorie deficits were significantly associated with eating symptoms, anxiety, and body image concerns. Another 2024 study of teens and young adults found that engaging in any dieting in the last year was linked to greater eating disorder psychopathology—suggesting that the calorie deficits caused by dieting may contribute to the development or exacerbation of eating disorder symptoms. Raciti adds that there are some physical and mental reasons why negative energy balance can ignite eating disorders. “[It] signals to the body that it’s unsafe. Remember, as humans we are designed for survival, not to become the smallest version of ourselves,” she explains. Her insight highlights one of the key takeaways of the landmark Minnesota Starvation Experiment: not eating enough food causes physical and psychological changes to a person, including becoming preoccupied with food (which is the body’s way of trying to survive). Raciti also says that the “body may drive strong urges to eat large amounts of food or even binge, often setting off a difficult cycle of restriction, bingeing, and compensatory behaviors.” Additionally, being in a negative energy balance (whether unintentionally or intentionally) can put those in recovery from an eating disorder at risk for relapse. “For example, this could be due to the temptation of weight loss for an upcoming event, and they think they have control over it now—but losing weight and recovery are slippery slopes,” Kile explains. Raciti cautions that “even a few skipped meals or a seemingly small deficit can act as a spark that reignites disordered thoughts and behaviors in someone who is vulnerable or has a history of an eating disorder.” How living in a negative energy balance impacts your health Even if it doesn’t lead to an eating disorder, living in a calorie deficit can negatively impact your physical, emotional and mental health, both immediately and in the long-term. “Even a moderate deficit over time can impact nearly every system of the body, and if you don’t give your body what it needs, it will still find a way to survive — but in the least efficient, least supportive way possible,” Raciti explains. “It’s like running a factory without enough power: the machines keep going, but more slowly, less effectively, and at higher cost to the system.” Here are a few of the many ways that living in a negative energy balance can impact you: Mental and emotional issues As mentioned above, the famous Minnesota Starvation Experiment found that negative energy balances can cause food preoccupation, increased anxiety, emotional dysregulation, feeling out of control around food, and even social isolation. “Your body’s only job is to keep you alive, and it does not know the difference between a diet and a famine,” Schwartz says. “Regardless of your weight or body size, when a basic biological need like food is not met, the autonomic nervous system shifts into a state of stress and threat, which only intensifies the cycle of preoccupation and dysregulation.” Additionally, a negative energy balance can cause nutrient deficiencies over time, and being deficient in nutrients like vitaminB12, folate, and zinc is linked to depression, irritability, and cognitive issues. In fact, a 2021 meta-analysis shows that anorexia (which is characterized, in part, by being in a calorie deficit) is associated with cognitive decline, including memory impairment. Given the toll it takes on your mental and emotional well-being, it’s difficult to live a full, authentic life that’s in alignment with your values if you’re living in a negative energy balance. Physical side effects In the long run, living in a negative energy balance can cause serious health conditions like anemia and osteoporosis. The immune system can also weaken, since calorie deficits can lead to nutrient deficiencies in key immune-regulating nutrients, such as protein, fat, vitamins A, C, and D, and minerals like zinc and selenium. “Reproductive health is affected too, with loss of menstrual cycles, infertility, and poor libido being common,” Schwartz says. In fact, living in a negative energy balance is one factor that can contribute to hypothalamic amenorrhea, or the loss of a period for more than three months, according to The Journal of Clinical Endocrinology & Metabolism. Being in a negative energy balance can eventually lead to a suppressed metabolism, which can cause many issues, including fatigue and cold intolerance. Plus, research shows that malnutrition and weight loss from being in a calorie deficit can slow the gastrointestinal (GI) tract, leading to conditions like gastroparesis (slowed movement of stomach muscles), reflux, bloating, constipation, and diarrhea—all which can impact quality of life significantly. Living in a calorie deficit can also have life-threatening impacts on vital organs. “Prolonged deficits also place strain on the kidneys due to dehydration, electrolyte imbalances, and muscle catabolism, or breaking down muscle mass for energy,” Schwartz explains. “Over time, electrolyte imbalances can develop and, in severe cases, lead to sudden death.” Increased eating disorder risk As mentioned above, one major risk of calorie deficits is that they can contribute to eating disorder development or relapse. In those who are predisposed to eating disorders, being in a negative energy balance can be the triggering event that sets disordered thoughts and behaviors in motion. For those in recovery, eating under your body’s energy needs can shift the brain into a state where old thought and behavior patterns reemerge, and the eating disorder begins to regain control. Healthy alternatives to a negative energy balance Despite what diet culture says, there are ways to set nutrition goals and intentions that have nothing to do with living in a calorie deficit. “Your body doesn’t need to fall into a negative energy balance to see positive shifts in it, and fueling yourself properly will have more positive outcomes,” Kile says. Here are some ways to foster sustainable, life-supporting, and truly healthy food habits: Focus on variety and balance “Some great ways to pursue ‘healthy eating’ or more balanced eating is by making sure you consume a variety of foods, striving to have foods from all food groups within your day, eating from the rainbow of nutrients, and properly hydrating with water,” Kile encourages. A good rule of thumb to use at meals is to include carbs like rice and bread, fats like butter and avocado, and proteins like beef and beans, plus fruits and veggies. I always recommend shooting for a relative balance, instead of a perfect one—for instance, if you don’t have veggies at lunch, don’t sweat it and see if you can have some late. And remember that eating fun foods —or as diet culture calls them, “junk food”—is part of having a balanced intake. A balanced diet can certainly include French fries and cake. Shoot for consistency Eating at regular intervals throughout the day will keep you feeling energized, focused, and more emotionally regulated (along with many other benefits). “Aim to have three meals a day and snacks as needed,” Kile suggests. While everyone has different needs, it’s best not to go longer than four or five hours without food during the day. “Our bodies thrive on consistent and frequent nutrient intake to support blood sugar levels, digestion, and overall regulation, and prevent intense hunger and cravings,” Schwartz adds. Remember, not every day will be the exact same: some days you’ll be hungrier or simply require more fuel for your day’s activities than others. However, if you’re recovering from an eating disorder, following the same meal plan or eating pattern (ideally guided by a dietitian) for a significant period is often necessary. Think about adding, not subtracting Diet culture conditions us to focus on what we should take away from our plates, but what if you thought more about what you could add? “Instead, the question becomes, ‘What can I add to support my body?’” Schwartz says. “For example, if you feel like you’re not eating enough vegetables, you don’t need to stop eating burgers—you can simply add a side salad to your burger meal.” If you feel like you're lacking other nutritious foods (e.g. fruits or whole grains) on a regular basis, try adding at least one to each meal, instead of taking other foods away. Instead of cutting carbs, Raciti suggests assessing whether any meals are lacking any of the macronutrients (carbs, fats, and proteins) that your body and brain need to function optimally instead. “If so, work on filling in that gap,” she recommends. Perhaps you’re missing carbs at breakfast, so you add toast or oats, or protein is lacking at lunch, so you add beans or turkey. If you think you generally may not be eating enough food and need to add to your overall intake, check out our article on how to fuel your body adequately. Tune into your body “Most of us are born with the ability to self-regulate energy intake,” Schwartz explains. However, both eating disorders and diet culture create a disconnection between the mind and the body, which makes it difficult or impossible to listen to and honor our body’s cues when it comes to food, movement, rest, and other needs. Fortunately, there’s a way to eat and care for your body that fosters healing and reconnection, called intuitive eating. Intuitive eating is a framework designed to support a healthier relationship with food that focuses on letting go of external rules and reconnecting with internal cues to guide eating and self-care habits. Good places to start include taking stock of any food rules dictating your decisions, using a hunger fullness chart to notice what different levels of hunger and fullness feel like in your body, and noting how different food combinations and meals make you feel. For example, you might feel more energized when you have two carb sources at lunch instead of one, or perhaps you realize you’re more satisfied when you add avocado to your turkey sandwich. Work with a dietitian Dietitians are trained to help you reconnect with your body’s cues and find the best eating pattern to support your mental and physical well-being. Whether you want to learn to eat intuitively, understand your body’s nutrition and energy needs, or heal your relationship with food (or all of the above), having the support and guidance of a dietitian can be invaluable. When looking for a dietitian, make sure they take a non-diet approach to nutrition and that they’re experienced and trained in eating disorders if you’re struggling with one. The truth is, living in a negative energy balance will keep you from living a healthy, full life and can bring serious and sometimes even life-threatening consequences. By focusing on other, life-supportive ways of eating and caring for your body while living in energy equilibrium, your body and brain will have what they need to support an authentic, dynamic, and healthy existence.]]></content:encoded>
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            <title><![CDATA[How Body Neutrality Can Help in Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/body-image/body-neutrality-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/body-neutrality-eating-disorder-recovery</guid>
            <pubDate>Tue, 30 Jul 2024 16:51:00 GMT</pubDate>
            <content:encoded><![CDATA[Given the amount of appearance-focused messages that bombard us daily from every direction, you’d be hard pressed to find someone who feels completely neutral about their body. Advertisers and influencers force us to focus on our “problem areas,” heavily filtered social media photos lead us to compare our bodies to ones that don’t even really exist, and tired diet culture myths trick us into viewing our bodies as objects that require constant monitoring and modification. With that amount of noise constantly ringing in our ears, the phrase “body neutrality” can feel like an oxymoron. And yet, body neutrality is actually an achievable approach that not only helps cancel out the constant deluge of appearance-focused messaging, but can also power eating disorder recovery. Equip Senior Program Development Lead Ally Duvall says body neutrality was instrumental in helping her heal from her eating disorder. “I spent so many years wanting to distance myself from my body—begging for change, thinness, and confidence,” she says. “Body neutrality gave me the permission to lay down my judgments and hatred, without the pressure to pick up positivity in its place.” So what is body neutrality, how does it differ from body positivity and other anti-diet culture movements, and can it really help those in eating disorder treatment move toward full recovery? Here’s everything you need to know about body neutrality and its potential role in recovery and beyond. Defining body neutrality When you hear the phrase “body neutrality,” you might assume that it means cultivating complete indifference to how your body looks. That’s decidedly not the definition of body neutrality, which has more to do with appreciating what our bodies do versus how they look. “I view body neutrality as the midpoint between self-defamation and radical self-love,” says Equip Clinical Partnerships Representative and registered dietitian Christina Fattore, MS, RDN. “It’s the idea that we can appreciate and respect our bodies without needing to unequivocally love everything about ourselves, especially on days when that may seem close to impossible. Body neutrality shifts the focus away from our bodies as our defining feature, and instead frames our bodies as a small part of who we are as a whole.” While the phrase itself seems to have originated around 2015, it picked up popularity when eating disorder specialists online started using “body neutrality” as a paradigm for building a healthier relationship to food, exercise, and body image. Anne Poirier, a certified intuitive eating counselor and eating disorder specialist, is credited with defining body neutrality as “prioritizing the body’s function and what it can do rather than its appearance.” In her book, The Body Joyful, Poirier underscored the notion that we don’t have to unconditionally love our bodies or hate them; we can simply choose to feel neutral about them. Licensed psychotherapist Tessa Gordon, LMFT, who has recovered from an eating disorder herself, says she sees body neutrality as a way to let go of any attachment to what our bodies are or aren’t and actively tune out body-focused noise. “It can be a step towards greater body acceptance, but it doesn't have to be,” she says. “Some may be able to love their body; my hope was that I would be able to live in mine. To me, that is body neutrality: when your body is no longer center stage requiring so much focus and attention, and steps into the background or becomes a supporting character, so your life can take center stage.” Duvall believes that body neutrality lets us meet ourselves on neutral ground, rather than on the roller coaster of diet culture and appearance-obsessed chatter. “When we can see our bodies as the way we exist in this world, we remove the pressures to love, hate, or pick ourselves apart,” she says. “My body is the way I give my husband a hug and feel the cool pool water on my skin. It’s my way of traveling and how I experience cotton-candy sunsets.” This shift allows us to view our bodies as a means for experiencing life, rather than an object that’s meant to look a certain way.  How does body neutrality relate to body positivity, body liberation, and body acceptance? Today, there are (thankfully!) so many approaches to navigating how we feel about our bodies that the terminology can get a bit confusing. Between body positivity, body liberation, and body acceptance, it can be difficult to discern the differences between each concept and decide which approach will be most helpful for you. Because all of these approaches come from a place of rejecting diet culture and redefining your relationship with your body, they all share some qualities, Duvall explains. “Body image theories like body neutrality, body positivity and body liberation exist on a spectrum. There are no clear boundaries on where one begins or ends, however each theory has unique components,” she says. Body positivity Body positivity is perhaps the most well known of these approaches, and also the one that’s been around longest: it dates back to the 1960s Fat Acceptance Movement. “Body positivity was built on the work of black, fat body liberationists, who not only focused on loving your body as it is but finding freedom from the oppressive systems we live in,” Duvall explains. As it exists today (largely in the form of social media hashtags), many people believe body positivity has been adopted and co-opted in ways that diminish its original intent. Body liberation In contrast to body positivity, body liberation continues to be considered a form of “freedom from social and political systems of oppression that designate certain bodies as more worthy, healthy, and desirable than others,” and is closely tied to social justice issues. “Body liberation is a thread that can flow in any of these theories as it exists to create a world of body freedom—both collectively and individually,” Duvall says. Author Chrissy King dives deeper into this concept and understanding the impacts of racism and diet culture in her book, The Body Liberation Project. Body acceptance Body acceptance and body neutrality are similar in that both are centered on simply accepting and remaining objective about the fact that your body is yours, regardless of its weight, shape, size, or state. However, while body acceptance has a slightly positive spin and is more closely tied to the original Fat Acceptance movement, body neutrality is truly that: achieving complete neutrality about your body, not viewing it as good or bad, and learning to focus on its functions rather than its form. While different theories and approaches may work for different people, Fattore believes body neutrality may feel like the most realistic or achievable goal for some. “Even as an eating disorder dietitian, I would be lying if I said that I am always able to practice body positivity!” she says. “Body neutrality allows us to move away from persistent negative self talk, while still accepting that we may not feel great about ourselves every minute of every day.” What are the benefits of body neutrality? According to Fattore, body neutrality empowers people to value themselves on the basis of their internal worth, rather than how they feel about their external appearance at any given time. “It allows us to appreciate the ways our body can act as a vehicle for our successes, rather than as a defining characteristic of them,” she says. “Body neutrality challenges us to permanently shift the conversation away from our appearance, and in doing so helps us reclaim the nuances of our identity.” In her experience, Gordon has seen many different benefits of body neutrality, including: Providing space for you to be where you are in your relationship with your body, no matter what that look like Decreasing attachment to how your body looks Encouraging gratitude toward your body for existing and being your vessel to carry you through life Providing space to acknowledge the ways your body does and doesn't work; holding onto both Exposing and encouraging the exploration of social messages, beliefs, systemic oppression, and more Offering a more realistic and attainable goal than body positivity “Body neutrality can be an incredibly powerful stepping stone away from the harmful ways we are taught to engage with our bodies,” Duvall says. Are there drawbacks to body neutrality? The biggest potential drawback of body neutrality is its emphasis on the body’s function, which can be problematic for some. “Body neutrality can sometimes be focused on gratitude for abilities—for instance, ‘I’m grateful that my legs get me down the stairs or that my arms can lift my favorite surfboard,’” Duvall says. “While this can be incredibly helpful compared to the previous negative statements you might have said to yourself, relying on ability-based gratitudes still encourages a body relationship with conditions.” In other words, this approach values the body based on its ability to do things; if those abilities changed or went away, so would the body’s value. For some, this not only detracts from the body’s inherent value, but can also be considered ableist. “Body neutrality can be ableist as it focuses on the body’s functionality and appreciation of what the body can do, and emphasizes ‘not noticing’ your body,” Gordon says. “For those living with chronic pain or disabilities, or those whose bodies may not function in the same way they once did, the privilege to ‘not be aware’ of their body, may not be something they are afforded.” However, even though some may find this to be a limitation or drawback to body neutrality, there are still ways to expand and apply body neutrality in less function-focused ways. “What if your legs can no longer support you down the stairs or your shoulder injury impacts your ability to carry your surfboard?” Duvall says. “Body neutrality rooted in conditional acceptance can be a sneaky, slippery slope into a harmful relationship with your body. One way to challenge this is to incorporate other types of gratitude alongside the ones based on physical ability. For example, ‘I’m grateful that my presence encourages other people to feel comfortable being themselves’ or ‘I’m grateful that my sense of humor brings myself and others joy.’” Who is body neutrality good for? Though everyone’s relationship to their body is unique, many experts consider body neutrality to be a widely applicable and adaptable strategy. “Everyone can benefit from body neutrality!” Fattore says. “I think the concept itself makes self-acceptance seem a lot more attainable, regardless of where someone is at in their self-love journey.” Gordon emphasizes the fact that a huge benefit of body neutrality is its attainability. “We live in a society that is constantly telling us that our bodies, what we look like, our gender, our size, our shape, our age, our appearance, how we dress—all of this is a measurement of our value and worth,” she says. “The messages that certain bodies hold more value and worth than others are bombarding us 24/7. Asking someone swimming in that to take up body positivity is beyond a Herculean task. Body neutrality offers a life raft to help us begin to get out.” Duvall agrees with the idea that anyone can adopt and apply the principles of body neutrality—especially for those who have particularly fraught relationships with their body. “Body neutrality may be even more supportive for those who have felt distanced from their body or judgment towards their body, or have identities that are outside of what society considers ‘ideal,’” she says. “Body neutrality can be a way to access a body peace they may have yet to experience.” How can body neutrality fit into eating disorder recovery? “The pursuit of body neutrality is so important in the context of eating disorder recovery,” Fattore says. “It is much easier to prioritize healing when we learn to value all the ways our bodies serve us, rather than how they look. Body neutrality allows us to say ‘I may not love what I see in the mirror today, but I am still worthy of nourishment and self-care.’” Because body positivity may feel unattainable—particularly to those in early recovery—Gordon believes body neutrality could be a more practical approach. “For so many, body positivity can feel akin to toxic positivity,” she says. “Encouraging people struggling with an eating disorder to ‘love their body’ can feel inauthentic, and, as I like to say, ‘floofy.’ Body neutrality can feel like a more realistic first step when coming from a place of such body hatred.” Duvall adds that while actively working toward body neutrality can take time, the results make it worthwhile—particularly for those who have long struggled with body image issues. “Many people in eating disorder recovery find body neutrality to be the ‘aha’ moment after years of body distress,” she says. “People often expect body image to magically heal itself as someone goes through eating disorder treatment. While body image distress may decrease through treatment, taking active steps to incorporate body neutrality in your recovery can help you build a more neutral foundation to exist on.” (Read more: Do You Address Body Image Issues in Eating Disorder Treatment?) How to start practicing body neutrality While the concept of body neutrality may seem like a nice idea on paper, you need to put it into practice to feel its positive effects. “This isn’t something you read about, believe, and immediately feel transformed,” Duvall says. “It requires active reflection, reshaping your automatic thoughts, and finding the places you can begin shifting towards neutrality.” If you’re not sure where to start, here are some practical tips from Fattore, Gordon, and Duvall to start incorporating body neutrality into your everyday reality: 1. Notice what your body does for you. Start taking stock of how your body enables you to show up in the world (not only physically, but in every other non-aesthetic way). “Focus on all the ways your body allows you to do the things you love,” Fattore says. “Identify the various ways your body serves you each day.” That might mean allowing you to feel the sunshine on your shoulder, to experience a hug from someone you love, to taste your favorite drink, to sit in a comfortable chair and read a book. Mindful movement, like yoga in recovery, can also help with this.  2. Become more mindful of your automatic thoughts. “I always recommend beginning with mindfulness practices—pausing to notice your thoughts and bringing awareness to how your thoughts show up physically and emotionally,” Duvall says. “Then you can explore what it’s like to shift those thoughts into more neutral, acceptance-based messages to your body.” 3. Once you’re more aware of your thoughts, start responding to them. “Maybe you notice your mind veering into judgments on how your legs look in shorts,” Duvall says. “Once you notice that judgment, take a breath and respond with, ‘my body is my way of existing with the world’ or ‘my body’s value is not based on jean shorts.’ This may feel out of place or silly, but saying these responses out loud or writing them down can be helpful in making them stick for future moments.” 4. Wear comfortable clothing and avoid clothes that keep you hyper-focused on your body all day. “It should be a balance between what is physically comfortable, emotionally comfortable, and what keeps you present, even if it doesn’t align with mainstream fashion,” Gordon says. “It’s up to you to find your edge of tolerance—and it may change every day.” 5. Slow down and be present during meals and activities. “Engage with food and exercise mindfully, focusing on what makes you feel good, both physically and mentally,” Fattore advises. “This might look like honoring hunger and fullness cues, incorporating rest days, or basing food choices on what sounds most satisfying in the moment.” 6. Use the mirror as a skill-building tool. “If you’ve been avoiding mirrors and reflective surfaces, the next time you see yourself in a glass door when walking into a building, decide to look at yourself and say, ‘that's me,’ and then look away,” Gordon says. “It's okay if you find yourself caught by judgment or comparison or negative thoughts afterwards. You have to start somewhere. If you find yourself looking and forgetting what to say, you can always try again. That’s why we call this a practice.” 8. Opt out of toxic dialogue. “Make a conscious effort to exclude ‘body talk’ from your conversations—both with yourself and others,” Fattore says. 9. Assess who you follow. “Curate your social media feed!” Gordon says. “Go through and do a cleanse of the profiles you are following that may not be helpful. Then add and follow new accounts that promote body acceptance and body liberation.” 10. Practice self-compassion. “Be patient with yourself,” Fattore says. “It can be difficult to shift the way you think about self-talk and body image—give yourself some grace.” Duvall also reminds those getting acquainted with body neutrality that we can’t always control what we are thinking or what comes up in tough moments. “Our first thought may be a body judgment or critique, no matter how long we’ve been working on challenging them,” she says. But what matters most is what you want that next thought to be.” If you’re struggling with body image issues and want to take the first step toward a better relationship with your body, you might benefit from Equip’s free body image program, Explore: Freeform. Learn more and register for the program here.]]></content:encoded>
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            <title><![CDATA[6 Effective Eating Disorder Support Groups You Can Join Today]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/eating-disorder-support-groups</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/eating-disorder-support-groups</guid>
            <pubDate>Tue, 23 May 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders thrive in secrecy and hijack a person’s ability to make healthy and safe choices for themselves. That means that overcoming one of these illnesses requires the support of other people whose minds are free from eating disorder thoughts. That support often comes in the form of expert clinicians, family, friends, and mentors—but another crucial component are eating disorder support groups. Why support groups matter As the name suggests, an eating disorder support group is a group of people who meet to support one another through eating disorder recovery, and they’re generally a supplement to—not a substitute for—eating disorder treatment. While there are many different types and formats of eating disorder support groups, the goal of each is the same: to provide community and peer support to people doing the hard work of beating an eating disorder. Support groups can make a huge difference on a person’s recovery journey. Connecting with others who are navigating similar experiences often has a palpable and invaluable impact on people struggling, helping them to recognize that they’re not alone, and that healing is possible. What are the benefits of eating disorder support groups? The benefits of support groups in eating disorder recovery have long been discussed and shared with patients in all forms of eating disorder programs. More recently, studies have backed up these benefits through research. Let’s take a look at some of the core advantages of incorporating groups into the recovery process. Reducing isolation and stigma Support groups allow people to feel less alone by connecting with others who truly get it. And because eating disorders are often so rooted in shame, hearing people share stories that mirror your own can be truly revelatory. A 2020 study affirmed this power, showing that support groups significantly helped to reduce stigma and isolation among adults in eating disorder treatment. Enhancing motivation and engagement Support groups provide camaraderie and connection, show patients and families real-life proof that recovery is possible, and provide a safe space to talk through struggles. These benefits help motivate patients to commit to the recovery process and engage in their treatment program: that same 2020 study also found that support groups measurably boosted motivation and engagement. Equip’s Director of Lived Experience, JD Ouellette, adds another often overlooked way that support groups can boost engagement: “There’s almost always laughter, and laughter is so healing,” Ouellette says. “Painful situations are also often absurd, and being able to have some levity around them can be vital.” Providing practical skills and strategies Eating disorder recovery often requires learning skills to cope with tough emotions, triggering situations, or difficult relationships. Support groups offer an opportunity to learn skills and hear about how they worked for real people in real life, which can be more impactful than learning skills and strategies in an abstract way in a therapy session. Implementing these skills into recovery can have a direct impact on how a patient manages and reduces their eating disorder symptoms. One study found that support groups helped reduce post-meal distress in young people with anorexia, and another showed that support groups can reduce and prevent disordered eating in middle school students. Supporting families and loved ones Research shows that support groups can be hugely helpful for those supporting a loved one through recovery, with groups improving parents’ relationship with their child and providing an opportunity to connect with others who understand their experience. Ouellette experienced this benefit firsthand when she was helping her daughter recover from anorexia. “For both me and my daughter, groups helped normalize the experiences we were having,” she says. “It matters to hear that others are sharing your experience. And because most groups contain folks in different places, those further along the road to recovery provide hope, showing that recovery is possible.” How to choose the right eating disorder support group While all eating disorder support groups share certain qualities and provide certain benefits, there are vast differences from group to group, and choosing the right one is important. Here are some important factors to consider when deciding among different eating disorder support groups: Moderation and facilitation We highly recommend attending a group that is moderated by a trained facilitator who can ensure that the group remains a constructive, supportive space. “The number one factor is having facilitators who are up-to-date in their eating disorder knowledge and aware of evidence-based practices,” says Ouellette. “This is particularly important with patient groups, to ensure that the group doesn’t devolve into a space that encourages disorder habits.” Scheduling and frequency We believe that support should fit into people’s lives, not the other way around—this allows you to remain connected to the things that matter most, building up a full life outside the eating disorder. For this reason, it’s important to find groups offered at times that don’t disrupt the important commitments in your life. You’ll also want to consider how frequently a group meets: if you want a lot of extra support, you might choose a group that meets twice a week rather than one that meets twice a month. Specificity and population fit General eating disorder support groups can be tremendously helpful, but sometimes it can be more beneficial to connect with people whose situation is even closer to yours. That might mean joining a group for a specific diagnosis (like an ARFID-specific group, for instance), a certain population (BIPOC, LGBTQIA+, etc.), or a certain age range. There are also specialized groups for loved ones supporting someone through an eating disorder, like support groups for single parents. Participation and comfort level Some support groups require that members participate, while others let you speak or not speak depending on how you feel. Consider what format you’d be most comfortable with and what would be most helpful for you. Alignment with your needs Each eating disorder support group has its own goals and structure: some might be around building skills, others might be around sharing stories, others might be an open check-in discussion. “You want to see if the group’s purpose aligns with what you’re looking for. Is it just support? Do you want skills-building? For adults, it might be a harm-reduction focus,” says Ouellette. “I would recommend visiting a few groups to get an idea of what’s going to suit you best, vibe-wise.” A good indicator is noticing how you feel after attending a group: if you feel better than you did before the group, there’s a good chance that group will be a helpful resource on the road to recovery.  6 eating disorder support groups you can join today There are a lot of eating disorder support groups to choose among. To help you make your choice, we’ve pulled together a list of seven places where you can find high-quality support groups that are open to the public (many support groups are only offered to patients in a specific treatment program): 1. National Alliance for Eating Disorders The Alliance offers various free, weekly disorder support groups, both online and in-person, which are led by licensed clinicians (psychologists, therapists, dietitians, etc.) All facilitators are experienced in the field of eating disorders and attend robust training and monthly supervision with The Alliance’s clinical director. They offer groups for those in recovery, groups for those supporting people in recovery, and LGBTQIA+ groups. 2. National Association of Anorexia Nervosa and Associated Disorders (ANAD) As the largest peer support resource for eating disorders in the country, ANAD offers free, virtual support groups for both people in recovery and those supporting someone in recovery. Each group is facilitated by a licensed clinician—such as a psychologist, therapist, or dietitian—and are 75 minutes long. 3. The Eating Disorder Foundation (EDF) EDF offers a variety of highly specialized support groups every day of the week, allowing you to find a group of people in situations very similar to your own (for example, groups for those over 30, groups for men, art journaling groups, adolescent groups, etc.). Each group is facilitated by a licensed professional on the EDF team and is typically an hour long. 4. F.E.A.S.T. While F.E.A.S.T. doesn’t offer a live support group, they do have an online support forum for parents and family members supporting a loved one through eating disorder recovery. Each forum is moderated by experienced parent-caregivers who are trained to guide you on how to best use the forum and find resources to support your loved one. F.E.A.S.T. also offers webinars regularly that teach important skills and education, especially for caregivers. 5. Multi-service Eating Disorders Association (MEDA) MEDA offers a variety of online eating disorder support groups for patients and their loved ones. Groups cover a wide range off different topics, from trauma to body image to more general groups on eating disorder recovery. MEDA’s support groups are led by licensed therapists and are structured as 8-12 week cycles. Because they’re entirely virtual, these groups are a great way to get the benefits of group therapy from wherever you are. 6. Equip We offer a variety of different, population-specific support groups for our patients and their families, including groups for athletes, boys and men, BIPOC, LGBTQIA+ folk, Spanish-speaking patients, and more, as well as groups on specific topics, like body image or DBT skills. For those not enrolled in Equip treatment, we recommend you sign up for our newsletter to learn more about free support group opportunities. You can also join our free pre-admissions support group, open to the public, to learn more about Equip treatment and ask questions. The importance of finding community Eating disorder support groups can be a crucial part of treatment—just one session might give you the glimmer of hope you need to push through a tough day, or a new skill that helps you finally overcome a persistent problem, or a kind word that lets you feel seen. Whether you have an eating disorder yourself or are helping someone who does, you’re not alone, and having people who remind you of that can be key to the recovery journey. Here’s a summary of the groups we highlighted in this article so you can take the next step towards finding your community: National Alliance for Eating Disorders National Association of Anorexia Nervosa and Associated Disorders (ANAD) The Eating Disorder Foundation (EDF) F.E.A.S.T. Multi-service Eating Disorders Association (MEDA) Equip  FAQs What are eating disorder support groups? An eating disorder support group is a group of people who meet regularly to support one another through eating disorder recovery. They’re generally a supplement to—and not a substitute for—eating disorder treatment. Support groups help combat the isolation patients and loved ones frequently feel during the often difficult process of eating disorder recovery. How do support groups help with eating disorder recovery? Support groups have several potential benefits: they help reduce stigma and isolation among patients, teach new skills and encourage resource-sharing, increase a patient’s motivation, and provide a dedicated space for family and friends to get support. What should I look for in a good support group? Some key factors to keep in mind when looking for a support group are the credentials of the moderator/facilitator; how the group fits into your schedule; if you want a group for a specific diagnosis, age group, or other identity; and how it fits with your needs and goals. All support groups are slightly different, so it’s important to find one that resonates with you and keeps you coming back! Can family members join support groups? Yes, there are many support groups out there for family members of eating disorder patients. Typically these are separate groups dedicated exclusively to the experience of a loved one, and family members don’t accompany their loved ones to support groups that are intended for patients. Some organizations that offer support groups for family members include National Alliance for Eating Disorders, National Association of Anorexia Nervosa and Associated Disorders (ANAD), and The Eating Disorder Foundation (EDF). How can I find a support group that fits my schedule? Luckily there are a plethora of virtual support groups, which makes it easy to fit sessions into your schedule from wherever you are. The best way to find a support group that fits your calendar is to consider the various different options and pick out a couple that might work. Give each a trial run to see which one is the most convenient and best meets your needs.]]></content:encoded>
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            <title><![CDATA[Heroin Chic Is Back — But That's Not the Real Problem]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/heroin-chic-body-image</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/heroin-chic-body-image</guid>
            <pubDate>Thu, 29 Dec 2022 19:22:00 GMT</pubDate>
            <content:encoded><![CDATA[In 1996, the arrival of a new Delia’s catalog—the trendy clothing source for girls in the 90s—was a major event in my home. After my older sister had her turn, I would pore over the images, scrutinizing each page, pencil in hand to mark the items I wanted—but, in reality, I was far less interested in the clothing than in the bodies wearing them. We were in the thick of the “heroin chic” era, and though the catalog was aimed at tween girls, the young models within reflected the decidedly adult aesthetic of the time. I took in the flat-as-a-board bellies, the attenuated arms; I memorized how they looked and then compared those vivid images to my 10-year-old body in the mirror. The discrepancies were vast. I was failing. The “heroin chic” look dominated the fashion scene throughout the 90s, when I and many millions of other young girls were passing through those formative years of adolescence and early teenagehood. Characterized by pale, strikingly slim, curve-free models who tended to be described in terms like “waifish,” the aesthetic came to the fore as opioid use was rising in the United States, and is said to have been originated by model Gia Carangi, who was addicted to heroin herself and died of AIDS in 1986. After some other high-profile heroin-related deaths—including a prominent fashion designer at the time—as well as a full-throated condemnation of the trend from then-President Bill Clinton (“Glorifying death is not good for any society,” he said in a national address), the trend faded, as all trends eventually do. But for many, the damage had been done. “Heroin chic was in full swing during my puberty years, so going from rail thin to curvy was especially hard,” my friend Christina, a brand strategist based in Abu Dhabi, told me. “It amplified the already difficult pubescent years, and I’d say is still pretty hardwired in my brain for what’s idealistic.” My friend Kat, an LA-based director of audience development, who also entered teenagehood during the ‘90s, remembers thinking that Kate Moss and the heroin chic campaigns she led for Calvin Klein at the time were “the pinnacle of cool.” Katie Baxter wrote in Cosmopolitan that she remembers “returning home from a grueling and lonely day at school to compare myself to the emaciated frames on the internet.” For my part, I descended into full-blown anorexia, which was by no means caused by the fashion of the time, but certainly fueled by it. For all these reasons, many like me who went through round one of heroin chic reacted with outrage when, in November, the New York Post ran a cover story with photos of Kate Moss and the newly slimmed-down Kardashians, a headline blaring across them: Bye-bye booty: Heroin chic is back. Jameela Jamil, one of the most outspoken voices on eating disorders and body image, wrote, “I am mortified to announce that the recent revival of ’90s fashion trends has brought back with it ’90s eating disorder culture. ‘Heroin Chic’ had my generation in a chokehold. Most of us still haven’t fully recovered.” In the aftermath, influencers and regular social media users alike voiced their anger at the heralded return of the trend, and a cascade of thought pieces questioned its meaning. While heroin itself is no longer a core component of the look, women are once again being pressured to attain dangerously thin bodies in order to be “fashionable.”  This swing in fashion ideals is natural. Just as the first run of “heroin chic” was a reaction to the busty, pageant-esque models who dominated the scene beforehand—think Cindy Crawford on Sports Illustrated—this go-round appears to be a reaction to the notoriously curvy bodies of the Kardashians (and, it must be noted, it was when the Kardashians started to slim down that this “trend” really began to gain steam). “With fashion, things are constantly changing,” said my friend and former boss Elizabeth, who was a style editor to my style intern at a glossy magazine and has spent decades working in fashion. “It will go from realistic to some extreme look. If heroin chic is indeed coming back, we’re going to move away from it eventually. We’ve moved on from it before and we’ll move on again.” That’s true. The pendulum of fashion will swing in the other direction. But in the meantime, here we are: Another generation of young people is absorbing unattainable, even sickly images and fashion ideals—through fashion models and magazines, as with heroin chic’s first appearance, but now also through social media platforms like Instagram and TikTok, and the filters that come along with them—and these images may forever shape how they feel about their bodies. It’s not enough to wait for heroin chic to be replaced by the next trend: Much has been written on the ways in which the heroin chic trend affected a generation’s sense of body image, and experts agree that its return could do significant harm, especially since poor body image is the best-known contributor to the development of anorexia and bulimia. In order to protect this generation and those that come after them, we need to fundamentally change how we think about fashion and bodies. Because here’s the thing: The rise of heroin chic is getting a lot of attention because for many people — indeed, the majority of people — attaining that waifish physique is downright dangerous and almost impossible without engaging in disordered eating or even developing an eating disorder. But the truth is, female-presenting bodies are always subject to changing ideals; for women, keeping up with fashion trends doesn’t simply mean trying out a new cut of pants or a particular color or hairstyle, it means changing the shape of one’s body, again and again and again. This, of course, is impossible, and attempting it is tremendously unhealthy. Yet we can’t expect (or even want) to stop the cyclical nature of fashion—fashion is exciting, fun, and beautiful, and it would not be so were it static—but we can reject the idea that bodies need to look a certain way to wear those fashions. “Talking about body types as fashionable or not is so reductive and useless,” Elizabeth said to me. “It’s a joke. Your body type is your body type.” Ally Duvall, Equip’s Body Image Program Manager, points out that treating thinness as an accessory not only causes harm, but also misses the point of fashion: "How boring would it be if we all had the same body, wearing the same fashion trends? To me, body diversity is the foundation to our endless range of styling opportunities." Vogue’s culture writer Emma Specter put this idea into plain language when she tweeted, “Do [the] people who insist the return of crop tops and low-rise jeans means we all have to adhere to early-aughts levels of compulsory thinness realize i will just………wear those things w my large and beautiful stomach hanging out?” That's the message we must embrace if we are going to ride the inevitable waves of fashion with our body image and self-worth intact. We’re not oppressed by changing fashion trends—we’re oppressed by the idea that our bodies must look a certain way in order to wear those trends, an idea that gains strength from the fact that many brands and designers don’t have size-inclusive lines. Thankfully, this idea is baseless, and easily invalidated if we simply choose the fashion trends we like, and wear them regardless of our body size. “I spent my whole life waiting to wear overalls because I believed I didn’t have the body that would vibe with overalls,” Duvall says. “But turns out, my body and overalls were meant to be. Everyone deserves the denim overall hug and endless pockets.” I never needed to change my body to buy that clothing from Delia’s, just as I don’t need to change it today if I’m interested in jumping on the trends of the moment. Fashion is displayed on bodies; bodies are not fashion. If, as a society, we can learn to separate the two, we can weather whatever comes down the runway at us next.  A version of this article originally appeared on Katie Couric Media. ]]></content:encoded>
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            <title><![CDATA[From Fertility Struggles to Food Freedom: Emily’s Equip Story]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/patient-recovery-story-emily-pierce</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/patient-recovery-story-emily-pierce</guid>
            <pubDate>Sat, 03 Jan 2026 14:28:00 GMT</pubDate>
            <content:encoded><![CDATA[This post was written by an Equip patient who wanted to share her eating disorder recovery story. Personal accounts are extremely powerful, and show that lasting recovery is always possible. If you'd like to share your recovery story, email recoverystories@equip.health. I struggled with a vicious cycle of binging and obsessive exercise/restrictive eating for years. I didn’t recognize things were out of control until I was no longer able to hide these behaviors (as well) from loved ones and was having visible changes to my body (sadly my primary concern at the time). At the same time, I was going through a brutal fertility struggle, suffering 5 miscarriages in 4 years. This put my mental health in a dark place and made me incredibly angry with my body. I learned about Equip through my insurance and figured it wouldn’t hurt to reach out. Little did I know how much my year of treatment would impact my life in such an incredible way. I had struggled with bulimia in high school to the point of hospitalization, and knew signs that I needed help. However, I still questioned it at first—do I really have an eating disorder? I could be so much worse. I have been so much worse. My thoughts about my body and myself in general were so unhealthy and routinely obsessive that I took it as normal to hate myself and beat myself up over every minute decision that didn’t align with my idea of “perfection.” It was my way of distracting myself from my emotional pain, and while it was temporarily effective, it ultimately became the source of even more pain and hardship in my life. It was negatively affecting my relationships with others and, of course, with myself. At first when I enrolled with Equip I went through the motions. I went to every session but wasn’t convinced it was necessary. At first, my husband didn’t completely understand why I couldn’t just change my behavior and, to be honest, neither did I. Everyone used to tell me how “healthy” and “strong” I was and looked, so in my mind if I could only stop binge eating things would be ok again. Unraveling my beliefs about bodies in general, as well as the judgment surrounding them and eating and lifestyle choices was extremely eye-opening to me. I never imagined that I would get to a place where I would not only be able to use hunger cues to intuitively eat (mine had been absent for quite a while) and no longer feel the impulse to binge or restrict, but also be able to accept my body for the gift that it is in spite of its appearance. Equip not only helped me to be kinder and more accepting of myself, but of others as well. It helped me focus on my core values, which certainly do not include vanity and judgement in the way I had been incorporating them into my existence. It also helped me recognize triggers and argue with the thoughts or outside messages that told me my life would be better if I were thinner. I know firsthand how untrue that is. My primary goal at this stage of life has been to sustain a healthy pregnancy—my husband and I have both deeply desired the opportunity to have children. When I graduated from Equip in February of 2025, little did I know that I had just become pregnant after being unable to conceive for two years. Beyond that, I certainly did not know that I would be carrying that pregnancy to term. I am currently typing this while bouncing on my birth ball waiting for my son’s arrival at 37 weeks pregnant (due 10/27/25!), and am filled with gratitude as to how much Equip set me up for success over the past nine months. I have watched my body grow (not just in my belly) and the scale rise each week, and while there have been some negative thoughts and feelings that have come up at times, I have been able to navigate them with general ease. I have nourished my body and never skipped a meal or used unhealthy coping mechanisms—not only out of protection for my baby, but also in order to honor my very clear hunger cues. My husband has on more than one occasion commented on how proud he is of my ability to take care of my body in a way I was not before. I wholeheartedly know Equip changed my life and helped me bring life into this world.]]></content:encoded>
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            <title><![CDATA[How to Set New Year’s Resolutions that Support Recovery (+ 5 Ideas)]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/new-years-resolutions-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/new-years-resolutions-eating-disorder-recovery</guid>
            <pubDate>Mon, 29 Dec 2025 14:30:00 GMT</pubDate>
            <content:encoded><![CDATA[Another year, another holiday season capped by some not-so-subtle pressure to set a New Year’s resolution. While goal-setting can be a great thing, New Year’s resolutions specifically can be not only tough to stick to, but actually harmful to eating disorder recovery. In fact, about 64% of people give up on their resolutions within the first month (often leading to feelings of discouragement or disappointment), and most resolutions tend to focus on dieting, weight loss, or fitness—all of which can be incredibly triggering and even dangerous to those recovering from eating disorders. The good news for resolution-motivated people is that purposeful, intentional language and mindful goal-setting can actually support eating disorder recovery, according to experts. If you or a loved one are committed to setting a New Year’s resolution but concerned about how it might impact recovery, read on for insights and tips for creating helpful, healing resolutions this year. Why most New Year’s resolutions are harmful According to licensed marriage and family therapist Tessa Gordon, LMFT, the majority of typical New Year’s resolutions can be harmful and anti-recovery for a few reasons. “Mainly, they come from the idea of wiping the slate clean and starting over, starting fresh,” she says. “They’re often rigid and goal-oriented, encouraging black-and-white thinking. Typical resolutions center around the ideas of self-improvement, wellness, weight loss, and transformation. They thrive on shame and guilt as motivators.” Another reason resolutions can be problematic is the fact that so many of them focus on what a person is going to get rid of, cut out, restrict, or abstain from, rather than what they are going to add to their lives. “At the heart, typical resolutions are about exerting control and absolutes,” Gordon says. “Recovery is the opposite of this. In recovery, we are looking for ways to live in the rainbow, not the black or white. We are looking for ways to encourage flexibility over rigidity, foster self compassion, and reduce shame and guilt.” A third red flag is the pressure to adhere to specific “rules” of transformation (which, unfortunately, are often rooted in diet culture). “Resolutions tend to be arbitrary and one-size-fits-all, whereas recovery really should be about where you are at,” says licensed marriage and family therapist Alyssa Mass, LMFT. “We want a New Year's resolution to meet you where you are now. Resolutions tend to follow a societal list of rules. And I think a lot of recovery involves breaking down perceived rules in society, understanding how those might apply to us in our own personal lives.” And finally, another harmful aspect of typical resolutions is the concept that a person can (or should) change their whole life, their values, or ideas in a single day. “New Year’s resolutions perpetuate the idea that change needs to happen on a specific day, when the reality is, there is nothing magical about January first,” Gordon says. “Every moment of every day is an opportunity to create change, do something different, shift a habit, take up a new behavior.” How to approach New Year’s resolutions in a recovery-supporting way While the majority of messaging around New Year’s resolutions always seems to focus on diet, weight loss, and exercise, that doesn’t mean you have to fall into the trap of diet culture. In addition, you don’t even have to think of a New Year’s resolution as a “fix” for something “wrong.” “Instead of thinking about resolutions as a response to something that is wrong or problematic, it can be helpful to think about what you want instead,” Gordon says. “I prefer thinking about New Year's intentions instead of resolutions. Less rule-focused, and less rigid. Intentions are flexible, and values-based. They encourage the person to think about how you want to be, feel, and manifest in their life, and explore why that is important to them and be curious about possible actions to support those intentions.” Rather than following the traditional resolution-setting route, consider applying this goal-driven practice to your own healing journey. “If you're really set on a New Year's resolution, think about how that resolution connects to your recovery,” Mass says. “They should be linked, so one should influence the other. The recovery process should be taken into account when coming up with any sort of New Year's resolution. It’s important to think, ‘where am I at in my recovery?’ and ‘how do I want to support that?’” 5 recovery-supporting resolutions With your own health and happiness in mind (or the health and happiness of your loved one), here are five recovery-supporting resolutions to consider making this year: Keep going. While this one may seem simple, staying committed to recovery can be incredibly challenging, especially in the face of so many contradicting messages from the outside world. It can take a lot of strength and resilience to persevere amidst all the constant noise, so resolving to move forward can be a big motivator. “Keep building on whatever it is that you're doing,” Mass advises. “And whatever is working, keep doing it.” Nourish yourself physically and emotionally. So much of early eating disorder recovery focuses (purposefully and necessarily) on physical re-nourishment and prioritizing proper meals and snacks. While this portion of treatment is absolutely essential, it can be challenging, which is why it’s also important to nourish your emotional side as well. Build your resolution around finding ways to feel fulfilled, whether that’s through rewarding hobbies, regular chats with friends, good books, or quality time with pets. Make sure your emotional needs are being met, right alongside your physical needs. Intend to cultivate meaningful relationships. While a strong support system can be a game-changer when it comes to eating disorder recovery, not every person is lucky enough to have a close circle of friends. It’s not necessary to be part of a big social group, but cultivating deep, trusting connections with a few family members or friends can make a significant impact on the recovery process. If possible, resolve to strengthen your connections with those closest to you by making time for regular meet-ups, FaceTimes, phone calls, or even text exchanges. Be patient with yourself, wherever you are. “Recovery is not a straight line, so be patient with whatever the New Year brings and stay grounded in recovery,” Mass says. “This means you're going to stay grounded in the goal and progress is going to look different for everybody—we can only measure against ourselves.” Prioritize rest when your body needs it. The vast majority of typical New Year’s resolutions focus on hustling, grinding, and essentially working yourself to exhaustion—none of this behavior supports recovery. Rather than further exacerbating the disconnection between your brain and body, focus on finding ways to listen and respond to your physical needs. While it may be challenging to hone in on your hunger and fullness cues in early recovery, you can start to foster a stronger connection with your body by noticing when you need sleep, a nap, or just a quiet moment of reflection. By allowing yourself to rest when your body calls for it, you’ll continue building a strong foundation for lasting recovery. As another new year begins, remember that recovery doesn’t require a specific deadline or a perfectly worded resolution. Just by showing up for yourself consistently, you’re doing more than enough to move toward lasting healing. But if you’re the type of person who finds goal-setting to feel supportive, there are ways you can gently approach New Year’s resolutions with flexibility and self-compassion. Above all, continue to be kind to yourself and keep in mind that even when progress feels slow or stalled, you’re still moving forward. January 1st can feel like a nice restart, but there’s nothing magical about that date—every day offers the chance to start fresh, adjust your approach, or simply meet yourself where you are.]]></content:encoded>
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            <title><![CDATA[Equip’s New Research Shows Virtual Treatment Works for Eating Disorders – Here’s What We Now Know]]></title>
            <link>https://equip.health/articles/news-and-research/research-virtual-fbt</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/research-virtual-fbt</guid>
            <pubDate>Thu, 16 Jun 2022 18:40:45 GMT</pubDate>
            <content:encoded><![CDATA[Prior to the pandemic, less than 1% of all mental health care was virtual. For eating disorder treatment, most families traditionally turned to residential centers or upending routines for in-person appointments. With only 20% of people getting treatment for eating disorders (and a fraction reaching recovery), there’s no longer a question of access, but rather a question of closing the massive access gap. This week, we’ve made a huge stride in answering that question with our newly published research article, “Effectiveness of delivering evidence-based ED treatment via telemedicine for children, adolescents, and youth”. The headline: not only does virtual eating disorder treatment work, it works just as effectively than traditional treatment. Equip’s clinicians and researchers Dori Steinberg ( VP of Research), Taylor Perry (Research Intern), David Freestone (Data Scientist), Cara Bohon (VP of Clinical Programs), Jessica Baker (Senior Research Manager), and Erin Parks (Co-Founder & CCO) found our virtual Family-Based Treatment model clearly delivers positive patient outcomes to help bring children & teenagers to recovery alongside their (chosen) family at home: Average weight gain per week (for those who needed it) was 1 lb* Patients’ eating disorder symptoms were reduced by half* Symptoms of depression and anxiety lessened by ⅓* Family members felt more confident and a reduced burden in taking care of their loved one *after 16 weeks of treatment For those who might be interested in the clinical fine print, we’ve broken down each section of the research paper below. What it means Family-based treatment (FBT), the leading evidence-based treatment for young people, empowers families to help their loved ones through recovery at home – traditionally with a therapist. Equip’s treatment model builds upon FBT to include a dedicated five-person care team including a therapist, physician, dietitian, family mentor, and peer mentor. All study participants were Equip patients who were in treatment between September 2020 and August 2021 Individuals 6-24 years old with an eating disorder diagnosis who lived with a family member in CA, NY, TX, or NJ More than half (63%) had a diagnosis of anorexia nervosa (restricting type), 14% had ARFID, and the rest spanned various diagnoses 83% identified as cis-gender female and 29% as BIPOC (13% Asian, 10% Latinx, 2% Black, and 1% Native American) Most patients (83%) were also being treated for depression or anxiety While this group of patients represents Equip’s patients in our first year of treatment, we have since grown significantly to treat more diverse populations: 50% of Equip patients currently identify as white and 19% as cis-male, trans, or non-binary. The research team track the following measurements of patients’ and their family’s physical, mental, and emotional health to evaluate the efficacy of our virtual FBT: Weight restoration: Weekly weigh-ins for patients who had gain weight goals Eating disorder symptoms: Eating disorder behaviors (e.g. restricting, purging, etc.) and thoughts (e.g. fear of gaining weight) as measured by the clinically validated Eating Disorder Examination Questionnaire Short (EDE-QS) Mood: Symptoms of depression and anxiety tracked by the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) tools Caregiver burden: Family members’ perception of their loved one’s eating disorder having a negative impact on their emotional state or their daily lives measured through the Burden Assessment Scale (BAS). Caregiver self-efficacy: Sense of confidence family members reported in taking care of their loved one via the Parent Versus Eating Disorder Questionnaire. While there is still so much work to be done in ensuring that all families have access to treatment that works, Dr. Steinberg believes that this study was a significant step towards transforming the eating disorder treatment landscape. “Many people think that when you deliver something virtually that there is a ‘dilution effect’—meaning that it's not going to be as effective as in-person. And for some people that is true,” explains Dr. Steinberg. “But the 200+ patients that we looked at in this study all saw clinically meaningful outcomes that are comparable to what they’d get in person.” As the largest study to date assessing the effectiveness of virtual FBT treatment, our study confirms that families can successfully recover from an eating disorder at home. This is groundbreaking for the millions of people facing significant geographic and financial barriers in accessing eating disorder care. And yet, there is still much we do not know and are committed to discovering: how geography, ethnicity, race, and body size may impact families’ experience with FBT, its impact on quality of life, and how we can best empower patients to build a life worth living beyond their eating disorder recovery. As Equip continues to grow, our research team plans to dig even deeper into important questions like these, as well as looking at how virtual treatment works for our adult patients who don't use FBT—so that treatment can be safe and effective for all. “It just gives me a lot of hope that there are new, innovative ways we can be providing treatment, and they are truly effective,” says Steinberg.]]></content:encoded>
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            <title><![CDATA[DBT for Eating Disorders: What Is Dialectical Behavioral Therapy and How Does It Work?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/dbt-for-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/dbt-for-eating-disorders</guid>
            <pubDate>Tue, 09 Apr 2024 19:02:00 GMT</pubDate>
            <content:encoded><![CDATA[  When I entered outpatient treatment for my eating disorder, I was surprised to learn just how many forms of therapy my program included. There were, of course, solo sessions with my assigned therapist, where we mostly used cognitive behavioral therapy (CBT), as well as group therapy with other program participants and facilitators. But my particular program also mandated regular meetings with a dietitian, weekly art projects, thrice-weekly group meals, and a form of therapy I’d never heard of before: DBT. As I’d later learn, DBT for eating disorders is a widely used and well-studied approach, but at the time, it was completely new to me. DBT, which stands for dialectical behavior therapy, is a therapeutic modality that helps people shift harmful behaviors and build a skill set that enables them to thrive in recovery. It was first developed in the 1970s to treat personality disorders and address interpersonal conflict, but a growing body of research shows that it’s also an effective approach to treating eating disorders. Read on to learn more about DBT for eating disorders, how it works, its benefits and drawbacks, and more. What is DBT? At its core, DBT is a form of talk therapy designed for people coping with very intense emotions. While the approach is based on the structured, goal-oriented form of talk therapy known as CBT, DBT is distinct in that it focuses not only on helping people accept the reality of their specific situations and behaviors, but also on learning strategies to change unhelpful patterns. “DBT is a specific therapeutic approach aimed at helping people find balance with managing their emotions and relationships,” explains Jessie Menzel, PhD, clinical psychologist and VP of Program Development at Equip. DBT was developed by Marsha Linehan, a psychologist and researcher who has lived experience with borderline personality disorder (BPD). Due to Linehan’s own experience and research, DBT is often referenced as a treatment for BPD, a mental disorder characterized by patterns of impulsiveness and unstable, intense relationships, among other things. “While DBT is considered the gold-standard treatment for BPD, it has been used in applications far beyond it,” Menzel says. “DBT is now used in the treatment of substance use, major depression, bipolar disorder, suicidal ideation and self-harm, PTSD, and eating disorders.” The word “dialectical” refers to the integration of opposing ideas. By helping people both accept and change their unhelpful behaviors, DBT offers space for two opposite truths to exist simultaneously—and introduces the possibility that there is more than one way to perceive a specific situation. Why is DBT used in eating disorder treatment? The goal of all DBT practices is to help people learn to regulate their responses to challenging emotions in an adaptive way. Because problems with emotion regulation and awareness can be common in eating disorders, using DBT for eating disorders was a natural expansion of its original purpose. “DBT has been used in eating disorder treatment largely because of the prominent role that emotions play in maintaining eating disorder behaviors,” Menzel explains. “Many eating disorder behaviors are triggered by difficult emotions and may even be used as a way to help people cope with difficult emotions.” Indeed, people struggling with eating disorders often use disordered behaviors to regulate emotions in the short-term—for instance, restricting to numb difficult feelings, or bingeing to quiet distressing thoughts—but doing so actually increases emotional dysregulation in the long-term. Because of this, the emotion-regulation skills of DBT not only serve as healthy replacements for disordered coping strategies, but also help people better navigate the ups and downs of life and connect with those around them. “By teaching patients how to manage their emotions effectively and in a way that isn’t harmful, we can help them reduce their vulnerability to difficult emotions and their need to rely on eating disorder behaviors as a way to cope,” Menzel says. What does the research say about DBT for eating disorder treatment? There are several studies examining the effectiveness of DBT for eating disorder treatment, and the results indicate largely positive effects. One early study looking at the effect of DBT on binge eating disorder (BED) found that 89% of participants who were taught DBT skills didn’t binge eat as compared with only 12.5% in the waitlist control condition. A subsequent study on BED found that 40% of DBT participants abstained from binge eating as compared to 3.3% in the waitlist control condition. “DBT can be very effective as a treatment for eating disorders,” Menzel says. “There have been studies that support the success of DBT particularly in the treatment of BED. Clinically, DBT is also a great treatment choice for individuals with more complex eating disorders or eating disorders with multiple co-occurring problems, such as self-harm or suicidal ideation and substance use.” But research on DBT and eating disorders isn’t limited to BED. There is also data indicating that people diagnosed with binge/purge behaviors (like people with bulimia or anorexia binge-purge subtype) who were assigned to once-weekly individual DBT treatment had higher rates of abstinence from binge/purge behaviors as compared to a waitlist control group after 20 weeks (28.6% versus 0%). And a study on women with anorexia found that after an average of 21.7 weeks of DBT, 35% of patients were in full remission, an additional 55% were in partial remission, and there was also a significant increase in post-treatment BMI. Potential drawbacks to using DBT in eating disorder treatment While research suggests that DBT can have a significant impact on treatment success, Menzel does caution that the protocol requires serious commitment. “Traditional DBT is a very time-intensive treatment,” she says. “It requires weekly individual therapy and weekly skills groups. Patients are also asked to commit to treatment for a minimum of 6 months or up to a year. While these aspects of DBT may seem overwhelming, they’re part of what makes DBT so effective.” Another potential obstacle to be aware of when considering DBT for eating disorder treatment is accessibility. Firstly, there’s a limited number of trained and experienced clinicians who specialize in using DBT to treat eating disorders. And secondly, DBT treatment isn’t always covered by insurance. “Treatment that is truly adherent to DBT may be very difficult to find and harder to access if a provider or clinic doesn’t accept insurance,” Menzel says. “Because DBT is so intensive and a big commitment, it isn’t typically recommended as a frontline treatment for most eating disorders.” At Equip, DBT is incorporated into our treatment approach (more on that below), and Equip is in-network with most insurance plans. What does DBT look like and what can you expect? While the specifics of DBT will vary depending on the provider, the program, and the patient, there are some elements that remain consistent. Menzel explains that DBT treatment has four components: Weekly individual therapy Weekly skills group therapy Out-of-session phone coaching A consultation team for DBT therapists Weekly individual therapy sessions typically last about 40-60 minutes. During these sessions, patients and their therapist will work toward creating goals around: Minimizing self-harm behaviors (if applicable) Limiting unhelpful behaviors Addressing specific blocks to progress Learning skills to replace maladaptive behaviors “For patients, treatment also relies heavily on doing work out of sessions,” Menzel explains. “Patients are expected to complete a daily log of their emotions, behaviors, urges, and skills use, as well as completing weekly practice of skills learned during group therapy.” What does DBT look like at Equip? Equip treatment incorporates DBT in a specific and thoughtful way. “At Equip, we focus on one component of DBT: skills group therapy,” Menzel says. “While skills are just one component of DBT, we believe that they are a very important component.” Research has shown that just the skills group therapy piece of DBT alone—especially when combined with other types of care—can be an effective way of supporting those struggling with eating disorders. In general, DBT skills training covers four main topics: Mindfulness Interpersonal effectiveness Emotion regulation Distress tolerance skills Each of these four skills categories includes a number of different specific skills, all of which can be employed in different moments to help people manage distressing emotions or situations without turning to disordered behaviors. According to Menzel, learning skills seems to be essential for getting the most out of treatment. “We’ve woven skills into our treatment in a few ways,” Menzel says. “First, we offer weekly skills group sessions for our teens and adults. We also provide weekly skills videos to our patients and their supports because we believe that our patients have the best chance for recovery if their loved ones are learning skills, too. Finally, all of our mentors are trained in how to teach DBT skills so that they can support our patients in using these skills in their everyday lives as they recover.” You can find all of our weekly DBT skills videos on our YouTube page. If you’re struggling with an eating disorder or supporting someone who is, try watching a few different videos until you find a skill that resonates. DBT skills can be truly game-changing for stopping disordered eating as well as other patterns and behaviors that aren’t serving you. Below is an example of one of our videos that talks about distress tolerance skills for eating disorder recovery. And if you want to learn more about DBT for eating disorders at Equip, reach out to our team. We’re here to answer any questions you have and to talk through next steps. ]]></content:encoded>
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            <title><![CDATA[Depression and Anorexia: What Happens When You Experience Them Both?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/depression-anorexia-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/depression-anorexia-treatment</guid>
            <pubDate>Fri, 01 Sep 2023 21:18:00 GMT</pubDate>
            <content:encoded><![CDATA[Some people turn to food for comfort when they’re feeling sad, a behavior sometimes called "emotional eating." Others may struggle to eat when they’re experiencing distressing emotions. These behaviors can be normal and harmless if they happen from time to time, but if you find that your emotions are regularly contributing to disordered eating habits, you may be experiencing a mood disorder and an eating disorder at the same time. Depression and anorexia are both common mental health disorders. They can often co-occur, meaning someone experiences symptoms of both disorders, and oftentimes the symptoms of one can exacerbate symptoms of the other. Read on to learn how these two disorders are connected, how they affect each other, and how they can be treated simultaneously. How are depression and anorexia connected? Depression, or major depressive disorder, is a mood disorder that causes overwhelming distressing emotions and thoughts. Anorexia, or anorexia nervosa, is an eating disorder that’s characterized by restricting the quantity or types of food a person eats due to an intense fear of gaining weight and a disturbance in the way one experiences their body weight or shape. Because both of these mental health disorders affect millions of people every year, it’s not surprising that there’s often overlap between the two diagnoses. While there has been limited research, the percent of people struggling with both depression and anorexia can range between 36% and 80%. Depression and anorexia can be connected to one another for a number of reasons, including the fact that your nutrition and emotional regulation are deeply intertwined. The undernourishment that comes from anorexia can alter the parts of the brain that affect your mood, causing distressing emotions that lead to depression. Conversely, emotional dysregulation and distressing feelings associated with depression can often affect someone’s appetite, body image, and feelings toward food. Depression and anorexia also share some symptoms, including: Changes in appetite Weight loss Fatigue Social withdrawal Flat affect How do depression and anorexia affect each other? The symptoms of depression and anorexia can feed off of each other, causing behavioral, psychological, and emotional patterns that interfere with your quality of life. Here are a few ways that depression and anorexia affect one another: Lack of appetite: When you’re experiencing pervasive feelings of sadness from depression, it can lead to a consistent loss of appetite and lack of energy for eating. This undereating can both trigger and fuel the symptoms of anorexia. Low self-esteem: Anorexia can cause you to obsess over your shape and weight, which can lead to a decrease in confidence and low self-esteem. Low self-esteem, in turn, can lead to depression symptoms, such as pervasive feelings of worthlessness and shame. Loss of interest in food: One of the most common symptoms of depression is feeling a lack of interest in things that used to bring you pleasure, including food. When someone is also struggling with anorexia, this loss of interest makes restriction not only easier but more desirable. How therapy can treat symptoms of both depression and anorexia Living with any disorder that impacts your mental, emotional, and physical health can be a struggle. Having two mental health disorders that continuously affect one another can cause you to feel overwhelmed, but lasting recovery is possible—and worth it. When you’re dealing with a co-occurring condition alongside an eating disorder, it’s essential to address both during treatment. Treating one issue might naturally have a positive domino effect on the other, but both deserve dedicated attention. One of the key aspects of almost any mental health journey is therapy, which is why every patient at Equip works with a therapist specialized in eating disorders. Our therapists use a variety of different evidence-based therapy modalities, such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). Through therapy, patients learn to identify how emotions and eating patterns are intertwined, and work to learn skills for addressing triggers in daily life. At Equip, patients are matched with a multidisciplinary, dedicated care team that includes a therapist, dietitian, medical provider, peer mentor, and family mentor to help address the effects of depression and anorexia simultaneously. If you’re struggling with depression and anorexia—or are concerned about a loved one who is—get in touch with our team today for more information or to schedule a free consultation. About Pepper Snider, LMHC Pepper Snider is a Licensed Mental Health Counselor Associate with over 15 years of eating disorder experience in advocacy, patient care and research. Pepper started in the field as an advocate sharing her story of eating disorder recovery. Over the years her story has been showcased in interviews, articles and broadcasts on a local and national level. Pepper has worked in eating disorder treatment centers at all levels of care as a therapist, patient care assistant and diet technician. In addition, Pepper has given back to the eating disorder field as a research participant at Columbia University, University of North Carolina at Chapel Hill and Seattle Children’s Hospital. Pepper has a unique perspective and insight into eating disorders given her multifaceted roles and experiences in the field.
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            <title><![CDATA[Intuitive Eating During Pregnancy: Honoring Your New Hunger in Recovery ]]></title>
            <link>https://equip.health/articles/food-and-fitness/intuitive-eating-pregnancy</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/intuitive-eating-pregnancy</guid>
            <pubDate>Thu, 12 Sep 2024 02:28:00 GMT</pubDate>
            <content:encoded><![CDATA[Once a woman gets that positive pregnancy test, she’s almost immediately inundated with information, including the shoulds and shouldn'ts of everything she consumes. It can feel incredibly overwhelming during a time that’s already full of intense emotion. For people with a history of an eating disorder, this can be even more pronounced. That’s why, when I became pregnant, I was relieved to know that I could lean on my intuitive eating practice and keep trusting my body, even during those special nine months. The thing is, though eating intuitively when you’re pregnant can look and feel different than eating intuitively when you’re not pregnant, you can still apply all its principles—they just need to be adjusted to help you healthfully grow a human. Read on to learn everything you need to know about intuitive eating in pregnancy, including all its benefits, challenges, and strategies to help you confidently adapt to a new season. Benefits of intuitive eating in pregnancy Honestly, I would’ve been lost in my pregnancy without my intuitive eating practice. It benefited me in more ways than I can properly capture in this article, but I’ll highlight some of its most significant benefits: It fosters body trust. I can’t think of a more important time to trust and honor your body’s communication—the essence of intuitive eating—than when you’re pregnant. Instead of constantly looking outside of yourself for the rules and lists of what to eat or not eat, eating intuitively encourages you to rely on interoception, or your body’s internal cues. It helps you to feel empowered instead of helpless during a pivotal time in your life. According to Equip lead dietitian Dani Castellano, RD, CEDS, it also gives you “self-permission to honor your cravings without judgment.” It helps you maintain recovery. If you’re like me and developed an intuitive eating practice in recovery, you know it takes conscious effort to protect yourself from harmful food and weight messaging in the media, which is unfortunately loud in the prenatal world. Pregnancy also brings some food and drink limitations (more on that later), which can feel triggering for those in recovery. Staying rooted in your intuitive eating practice is one of your best tools to avoid any slippery slopes brought on by diet culture and help keep your recovery going strong. Castellano also points out that intuitive eating in pregnancy helps lessen the pressure of doing things perfectly, another recovery-supporting benefit. It may help with adequate weight gain, and your outlook on it. Part of intuitive eating is about releasing the desire to control your body and instead letting your body do its thing—which can come in particularly handy when your body is rapidly and drastically changing. In fact, research from 2019 shows an association between intuitive eating in pregnancy and healthy weight gain, while other research from 2020 shows a link between intuitive eating in pregnancy and a more positive attitude about gestational weight gain. It could help manage gestational diabetes. While gestational diabetes is largely unpreventable, a 2019 study of women with the condition found that intuitive eating could help them manage their blood sugars successfully throughout their pregnancies. The same study also showed that intuitive eating could help prevent the same group from developing postpartum diabetes. And it makes sense, because applying intuitive eating concepts—like eating and drinking regularly, striking a relative balance with all food groups, moving your body joyfully, managing stress and difficult emotions healthfully, and eating to honor your health—all support stable blood sugar levels. It may help your mental health. Many aspects of pregnancy can make you more vulnerable to anxiety or depression: drastically shifting hormones, preparing for a new baby, managing various physiological symptoms (like insomnia), and dealing with pregnancy after loss, to name a few. According to Melissa Bloom, MS, RD, LD, CEDS-C, lowered anxiety is one benefit of intuitive eating in pregnancy, and a 2024 review links the practice to helping pregnant women with depressive tendencies to better manage their symptoms. Challenges of intuitive eating in pregnancy While I can’t imagine approaching food and eating in pregnancy any other way (and would never recommend anything else, as a registered dietitian), intuitive eating while expecting can feel tricky for many people. Here are some of the challenges you might come up against: There are some “rules” to follow. Intuitive eating is all about releasing food rules and letting your body lead, which is mostly still possible in pregnancy, but there are some necessary limitations (like excluding raw fish and unpasteurized cheeses). It can feel difficult and hypocritical to follow food rules within an intuitive eating practice, especially when you’ve spent ample time setting yourself free from them. However, through an intuitive eating lens, avoiding sashimi, for example, is in fact a form of gentle nutrition (one of the principles of intuitive eating that encourages eating to honor your health, and, in this case, your baby’s health). Your body needs more food. Another foundational part of intuitive eating is honoring your hunger, which will likely increase as your pregnancy progresses. While the notion of eating for two is kind of an overused exaggeration, your energy (calorie) needs increase significantly throughout pregnancy, especially in the second and third trimesters, to support your baby’s growth and health. Especially in eating disorder recovery, honoring heightened hunger can feel scary, and if your body isn’t clearly communicating its increased need for food through bodily cues, you’ll need to mechanically eat (or as I like to call it, “eat out of self-care”) more than before pregnancy. Eating this way may feel confusing, but your body still needs adequate fuel regardless of its signals. Pregnancy symptoms can throw a wrench in your eating. Every woman has different experiences with pregnancy symptoms, but some of the most common ones, like nausea, can make your typical intuitive eating practice more challenging. “In the first trimester, many women are nauseous and extremely tired, and this makes it very difficult to be mindful and check in on cues,” explains dietitian Amy Goldsmith RDN, LDN. She says you need to push harder to support your body with adequate nourishment, regardless of how you physically feel. While it may be difficult to eat when you’re not feeling it, you can make it more intuitive by checking in with what your body can tolerate. In my first trimester, I could only tolerate a relatively small variety of foods from each food group, and I let that be enough (along with my prenatal vitamins) until I felt like I could expand my palate again. Diet culture makes it harder. Unfortunately, we live in a world largely dominated by the dieting mentality, and so intuitive eating can feel hard to follow with all of diet culture’s noise in such a vulnerable time. Bloom says societal expectations about what you should eat and how much you should move your body during pregnancy can make being intuitive more difficult. Plus, harmful messaging about pregnancy weight gain (mostly saying, “don’t gain too much”) can make trusting your body even more difficult. Strategies for intuitive eating during pregnancy While you can practice intuitive eating throughout pregnancy, there are some differences between doing so while pregnant versus not pregnant. For one thing, pregnancy cravings or aversions may change your typical eating habits or preferences, while your hunger cues can also change drastically from trimester to trimester—and not necessarily reflect your intake needs, requiring you to eat mechanically. Plus, you may be applying the gentle nutrition principle more than typical, depending on your symptoms and metabolic health during pregnancy. Since prenatal constipation is common, “you may need to incorporate foods and hydration differently to support bowel movements,” Castellano adds. During my pregnancy, my iron levels were slightly low (a common occurrence in pregnancy), so I applied gentle nutrition by increasing heme iron sources, like red meat, and adding a daily iron supplement. Here are some strategies to help you practice intuitive eating during pregnancy: Review the 10 principles. “I'd suggest looking back on the 10 principles of intuitive eating and developing a plan of how to integrate this throughout the pregnancy,” Goldsmith says. Remember, they won’t be the exact same as when you’re not pregnant, so consider how each principle may support you during this finite period and write it down to revisit when necessary. Feel free to tweak your intuitive eating plan throughout pregnancy, since symptoms typically shift from stage to stage. Work with a dietitian. If you’re in eating disorder recovery and unsure or struggling to find your footing with intuitive eating in pregnancy, working with an eating disorder dietitian who teaches intuitive eating and has prenatal experience will go a long way. They will help you learn or relearn how to use intuitive eating practices to help keep you and your baby healthy, as well as help to manage symptoms like nausea and heartburn or conditions like anemia or gestational diabetes. If you don’t have any eating disorder history but are new to intuitive eating or uncertain in how to apply it to your pregnancy, working with an intuitive eating and prenatal dietitian is a great idea. Combine brain and body wisdom. “Remember that part of eating intuitively is using your ‘brain knowledge’ and not just hunger and fullness cues,” Castellano says. As mentioned earlier, some pregnancy symptoms can throw off hunger cues, making it critical to feed yourself often—even if your body isn’t directly asking for it. “Lean into regular eating and focus on consuming meals and snacks every two to four hours throughout the day,” Castellano suggests. Additionally, if you have any nutrient deficiencies, be sure to inform yourself (perhaps with the help of a dietitian) on how to properly supplement and use gentle nutrition to adjust your food intake. Find resources that resonate. From social media accounts to books and podcasts, there are many resources that can help support a prenatal intuitive eating practice. My favorite workbook and book are The Intuitive Eating Workbook, to learn the ins and outs of intuitive eating and Expecting Better, to understand the scientific truth behind food and drink consumption in pregnancy. Fellow dietitian Christy Harrison has a helpful podcast episode on intuitive eating in pregnancy, and another intuitive eating dietitian McKenzie Caldwell (@fertility.prenatal.dietitian) has an informative Instagram account for expecting mothers and those trying to conceive. Practice body and self-trust. “Continue to trust yourself and the process,” Bloom encourages, which could look like honoring your cravings and aversions throughout pregnancy even if they feel foreign (I couldn’t look at sweet potatoes but loved white potatoes during the first trimester, and craved breakfast sausages throughout the second and orange juice throughout the third, which were all out of the ordinary for me). If you’re medically cleared to exercise, it could also look like approaching joyful movement (another intuitive eating principle) on a day-to-day basis and letting your body tell you how much and what type of movement feels right. Consider how an adapted intuitive eating practice will help support your pregnancy values, you and your baby’s health, and eating disorder recovery (if applicable) for the nine months ahead. Perhaps it’s greater flexibility and enjoyment, or maybe it’s overall health and well-being—whatever your “why” is, name it (and perhaps jot it down), in case self-doubt or diet culture trickles in. Remember, your job is to show up and offer your body stability through intuitive eating and other forms of self-care—like adequate rest and hydration, and prenatal medical visits—and it will take care of the rest.]]></content:encoded>
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            <title><![CDATA[Debunking 5 Diet Culture Myths that Continue to Haunt Us]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/diet-culture-myths</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/diet-culture-myths</guid>
            <pubDate>Thu, 04 Jul 2024 15:35:00 GMT</pubDate>
            <content:encoded><![CDATA[Growing up in the golden age of teen magazines (aka the late ‘90s and early 2000s), I absorbed countless messages about what bodies “should” look like and how I could make mine look that way. Looking back at that time with modern-day vision, I can now clearly see that the majority of those messages were cringeworthy at best, and downright dangerous at worst. And while I like to think our society has come a long way in terms of how we think about and talk about bodies, I only have to go as far as Instagram or TikTok to see that we still have a lot of unlearning to do when it comes to diet culture. Though it may not be as blatant today as it was in the ‘90s, diet culture—which is a set of beliefs that values thinness and weight loss above all, and often masquerades under the guise of “health” or “wellness”— has a significant impact on how we view and treat our bodies. To better understand the pervasive diet culture myths that continue to haunt us, I spoke with Equip Lead Dietitian Kristin Quill, RD and licensed psychotherapist Tessa Gordon, LMFT. Here’s what they had to say about some of the most common myths they routinely debunk, where these ideas originated, and how to tune out diet culture noise, no matter where it’s coming from. Myth #1: Carbohydrates are bad for you and you should avoid them Why it's wrong: From Atkins to Keto to Paleo and many others, fad diets have long villainized carbohydrates as the ultimate health underminers. In actuality, media figures have mostly had it out for this macronutrient because of its supposed hindrance on weight loss, not any real health effects. But not only are carbs not the enemy when it comes to nutrition, they are absolutely essential to overall well-being. “Despite all the fear mongering done by diet culture, carbohydrates are actually very important to include in your intake throughout the day,” Quill says. “Glucose, the breakdown product of carbohydrates, is the most efficient source of energy for your body. Your brain depends on glucose as its main energy source!” Quill also points out that labeling certain foods as “bad” tends to increase fixation on that food and increases the likelihood of experiencing guilt or feeling “out of control” when eating it. “When you move away from rigidly labeling foods as ‘good’ or ‘bad,’ you create space to listen to your body and eat in a way that feels good for you, both mentally and physically,” she says. Myth #2: You can never drink too much water Why it’s wrong: It seems every magazine article I’ve ever read and every TikTok I’ve ever consumed has professed the benefits of ingesting water all day, every day, with no limit in sight. Those “benefits,” of course, typically revolve around weight loss. The truth, however, is that while water is vital, you can have too much of a good thing. “You can absolutely drink too much water!” Gordon says. “And it’s surprisingly easier than you may think.” Gordon isn’t just relaying this info as a professional: she’s actually lived the experience of chugging down too much H2O. “Take it from someone who learned this the hard way many years ago and found herself in the ER for simply drinking too much water,” she says. “While not my finest hour, I will say, I never ended up back there for that again.” Influencers may claim that the more water you drink, the more aesthetic benefits you’ll see, but overhydration can lead to a severe electrolyte imbalance known as water toxicity. “When you consume too much water in a certain amount of time, it dilutes the levels of electrolytes the body needs to function,” Gordon says. “The kidneys, which regulate the body’s balance of water and electrolytes, can’t get rid of the excess fluid fast enough. So the electrolyte level becomes diluted.” One of the biggest risks of drinking too much water is hyponatremia, a condition that occurs when the blood concentration of sodium is abnormally low. “When sodium levels become low—hyponatremia—the extra water enters the cells and they start to swell, which leads to even more severe symptoms,” Gordon says. A particularly confusing aspect of this myth is that the symptoms of water toxicity—lightheadedness, dizziness, nausea, confusion, headache, muscle cramps, disorientation, etc.—are extremely similar to the symptoms of dehydration. So because of the overabundance of advice around excessive hydration, some people might drink more water to address certain symptoms, when they actually need to be drinking less. And unfortunately, it doesn’t take all that much overhydration to experience water intoxication. “It’s generally recommended not to drink more than 48 ounces in an hour, although many water bottles now hold that much or more,” Gordon says. “Water toxicity most commonly occurs in situations where someone has experienced excessive sweating and then over-replenishes, such as a hot yoga, intense workouts, spin class, or workout out in the sun.” Myth #3: Your body is healthier when you weigh less  Why it's wrong: Consider this the reigning ruler of all diet culture myths. But no matter how many times this lie is repackaged and repeated in various forms, there is no truth to the idea that a lower weight equals a healthier body. “Weighing less does not automatically translate to being healthier,” Quill says. “In fact, being underweight can lead to a host of consequences for mental and physical health, including worsened anxiety and depression, compromised bone health, weakened immunity, impaired digestion, and increased risk for developing an eating disorder.” Not convinced? Consider a one-year study that found that a non-diet approach to wellness can produce similar improvements in metabolic fitness, psychology and eating behavior as a diet-centered approach—without all the harmful rhetoric and restriction. Or take a look at this six-month study that found the Health At Every Size (HAES) approach to wellness, rooted in intuitive eating and size acceptance, led to lasting, sustainable health improvements while a diet approach did not. “For people who are looking to improve their health, research shows that we can see sustained improvements in a variety of health parameters without a focus on weight loss,” Quill says. “Despite our society's obsession with thinness, we know that healthy bodies come in a variety of shapes and sizes.” Myth #4: If you work hard enough, you can get the body you want (aka the body diet culture has told you you want) Why it’s wrong: Repeatedly attempting the same impossible task over and over again inevitably has a negative impact on your mental health. And that’s just what I (and countless others) have done over the years, poring over celebrity diet and exercise plans, replicating their supposed methods, and ultimately being disappointed by the results. It turns out, even if the tabloids had correctly printed every detail of Paris Hilton’s early aughts food and fitness regimen (which I am certain they did not), and I followed it to a tee, I could have never been her doppelganger. “If this was actually possible and attainable, wouldn’t everyone who worked hard enough and followed the ‘right’ plan have the body of their dreams by now?” Gordon says. “This myth exists to support diet culture. The lie is that your body weight and size is completely under your control, and if you do all the ‘right things’ then you can change your body to look how you want it to look. It oversimplifies weight to calories in, calories out, when it is far more nuanced. Body shape, size, weight, fat distribution, presence of cellulite, bones, ligaments, muscle mass, etc. are not determined solely by exercise and diet.” No matter what the internet or any outdated article claims, weight and shape are not exclusively determined by diet and exercise. Everything from genetics to race, ethnicity, age, gender, hormone levels, stress, health conditions, medications, sleep, mood, and trauma can contribute to why our bodies look and perform the way they do. Not to mention access to food, healthcare, and other services, which is hugely impactful as well, and largely out of our control. “Suggesting that anyone can set a body goal based on weight and body size is unrealistic because it implies that the ability to change your weight and body composition is fully within your control. It sets people up for frustration and disappointment, and for an internalized sense of failure and shame when it doesn't work,” Gordon says. “And if any changes do occur, they are rarely sustainable.” Myth #5: You only deserve to eat when you’re hungry Why it’s wrong: While “honor your hunger” can often be good advice, and is one of the core tenets of intuitive eating, it has its limitations. There are plenty of times when it’s totally fine—and, in fact, wise—to eat when you don’t feel physically hungry: you might need to eat before you’re hungry because of logistical concerns (you’re about to be in the car for a few hours and need to fuel up beforehand, for instance); or you might eat without hunger because you want to share a joyful experience with others (you just ate a satisfying meal but now your family is going out for ice cream). “While honoring your hunger and fullness cues is an important part of having a healthy relationship with food, this is a nuanced topic,” Quill says. “Let's say it's 12 p.m. and you're not particularly hungry for lunch, but you’re heading into hours of back-to-back meetings all afternoon; it's important to eat something so you don't get ravenous later on. Even if you're not hungry for dessert at a family wedding, eating a slice of wedding cake can help you connect with the joy of the event. Food is more than just fuel—it can be a powerful way to connect to celebration, love and cultural traditions.” Diet culture myths continue to permeate our society, and it can feel difficult to differentiate myths from reality. In general, Gordon recommends avoiding rules or beliefs that use all-or-nothing thinking, and looking out for language like “always/never,” “good/bad,” “should/shouldn’t.” When you notice yourself following one of those rules, take a step back and consider why you’re doing so, and whether or not it serves you. “This can be a great place to start in getting curious about where the beliefs you have come from,” she says. It can be difficult to rebel against diet culture, but it’s worth it. Doing so not only reduces your risk of developing an eating disorder and helps you support those in your life who might be struggling with one, but also frees up your mind from the guilt and judgment that accompanies so many of these beliefs. Ultimately, you are the number one expert on your body, and tuning out myths like these will help you tune into what your body truly needs.]]></content:encoded>
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            <title><![CDATA[Body Image During the Holidays: Expert Guidance on Navigating this Challenging Season]]></title>
            <link>https://equip.health/articles/body-image/body-image-holiday-challenges</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/body-image-holiday-challenges</guid>
            <pubDate>Mon, 08 Dec 2025 19:49:00 GMT</pubDate>
            <content:encoded><![CDATA[The holidays can feel intense. There’s so much to manage, from balancing work or school with travel and celebrations, to navigating complex family dynamics, to attending social obligations, sending cards, buying gifts, and more—all while trying to take care of yourself and others. Amidst all this, you might start to notice more negative thoughts about your body, especially if you’ve struggled with body image or an eating disorder (or both). If that’s the case for you, know that you’re not alone. In fact, a 2025 study of people with body image concerns showed a link between the holiday season and increased body dissatisfaction, which may be related to heightened expectations surrounding social gatherings, associated pressure to pose for photos, and expectations to set diet culture-based New Year’s resolutions. The good news is that, whatever the reason for this increased distress, there are ways to find relief. According to the National Eating Disorders Association, body image is defined as “the thoughts, perceptions, attitudes, feelings, and behaviors around one’s physical appearance, [and includes] how one senses and controls their body as they move and how one physically experiences one’s body.” In other words, body image isn’t about what your body looks like, or its shape or weight; it’s about how you see and feel it, what you think and believe about it, and how you treat it. This means that in order to improve your body image, your body doesn’t need to change —but your mindset does. Read on to better understand why the holidays can cause body image distress, and learn expert-backed ways to help you avoid spending the season preoccupied by how you look Why this season can be so tough for body image So, why do body image struggles often crop up or intensify during the holidays? Typically, it’s not one driving factor, but at least a couple that, together, create the perfect storm for body distress. Here are some common reasons why your relationship to your body can be difficult this time of year: Diet culture Unfortunately, you’d be hard-pressed to find a holiday table free of diet culture. It infiltrates many conversations any time of year, but seems to get louder between Thanksgiving and New Year’s. “The holidays often include a lot of food, and people talking about that food, and that commonly leads to conversation around bodies,” says dietitian Paige Aberasturi, RDN, CPT. Unfortunately, most of our society is still steeped in diet culture, so these conversations tend to be about what’s “good” and what’s “bad,” while body talk typically includes unnecessary shame, judgement, and guilt. Then, there’s the media frenzy surrounding “New Year, new me” messaging, which inevitably leads to people everywhere discussing diet- and fitness-focused resolutions. “It's not surprising that all of this may result in personal feelings about your own body,” Aberasturi adds. Being perceived by others If you’re in eating disorder recovery and healing your relationship to your body, you might be worried that people you haven’t seen in a while will judge how you look, especially if you’ve recovered into a larger body and were praised for your smaller body. “This leads to worries of how our bodies will be perceived, if anyone notes any changes and if they might comment or ask us about it,” explains dietitian Ana Pruteanu, MS, RDN, CEDS-C, LDN. And even if you’re not in recovery from an eating disorder, you may feel anxious about reuniting with family and friends if your body has changed. Comments about other people’s bodies are unfortunately common in our society, so it’s understandable to feel this concern. Then, there’s the pressure of taking more photos than usual. “For some, including folks in recovery, this can lead to an increase in negative body image thoughts and pressure to change their bodies leading up to the holidays and seeing others,” Pruteanu explains. Stress, overwhelm, and other hard feelings If you notice that negative body thoughts tend to increase after difficult emotions, it’s possible that your body has become a funnel for your feelings. “When stress and overwhelm start to happen, it's easy to project those feelings onto how you feel about your body. They become an object in your mind when you’re stressed and it’s the ‘easy’ thing to do—blame your body for something,” explains therapist Amanda Marks, LPC, LMHC, CPCS. While the holidays can be a time of joy and happiness for many, they can be equally troubling for others, whether they’re grieving or struggling with feelings of depression or anxiety, or something else. This difficulty, in turn, can exacerbate negative body image. For example, one of my past clients always noticed an intense heaviness in her body when she was around a certain family member at the holidays, and she would shame her body and herself for feeling this way. Over time, however, she realized that her body’s heaviness was in fact an intense sadness that was waiting to be felt and processed. Oftentimes, it can seem easier to try and bypass hard feelings and blame your body, instead of feeling and safely expressing them. Festive food and family In my practice, I notice an uptick in negative body image among clients this time of year, especially the ones who struggle being around certain family members. The abundance of festive foods combined with complicated or chaotic family dynamics can contribute to distress and negative body image for those with an eating disorder or in recovery, or anyone who struggles with body image. Plus, returning home for the holidays can cause old patterns around food, body image, and approval to resurface, even if you’ve been committed to healing. “When you’re under stress, it is easier to fall back on old coping mechanisms because they’re comfortable, even though they no longer serve you,” explains dietitian Jessica Villalvir MS, RDN. Villalvir adds that since food is often the main event during the holidays—and the food served is often challenging itself—there’s an extra layer of emotional complexity. The eating disorder brain can get louder when there are more fun foods around, since the food scene feels more threatening than usual. “For some going through the recovery process, holidays may be a time when they are faced with fear foods—foods which cause stress or anxiety. And being faced with having to eat foods prepared by others or foods outside of one’s safe range may also cause additional body image distress,” Pruteanu adds. Check out these dietitian tips for navigating holiday meals. Strategies for fostering better body image this holiday season It’s common to experience heightened negative body image this time of year. But fortunately, there are ways to navigate this holiday season more peacefully and avoid spending it consumed by body hatred or distress. Here are some expert-backed ways to help soften your relationship to your body as you move through the holidays: Designate a safe person Whether it’s someone you’re around often throughout the holidays or someone you can text or call easily, clarify who your safe person or people will be this season. “Identify your support system—people you can reach out to for support if you’re struggling with body image, who would listen or encourage you,” Pruteanu advises. “Let them know ahead of time how you’d like to be supported in those moments and what you find most helpful.” If your safe person is at the table or event with you, try creating a safe word together for you to say when you need a break and their support. Set boundaries This one’s hard, because it can feel scary to speak up to friends or family members about what’s okay and not okay for you. However, setting boundaries about conversation topics at holiday gatherings can be empowering and help to mitigate triggering scenarios. For example, a relative may always comment on your body size or other people’s body size when you reunite, and you can set a boundary by asking them to leave body size comments off the table this year. You can have this conversation either beforehand or in the moment, depending on what makes sense and feels safest for you. If it feels overwhelming, role play what you’ll say with your therapist or dietitian before setting the boundary. Remember, many people are likely to respect your boundaries, but not everyone will. What’s important is that you’re voicing them. Marks also encourages “stepping away from the table or conversation and taking some grounding breaths or reaching out to your support person” as another way to create a boundary. Changing the topic can be another way to make it clear that you don’t want to engage in diet culture talk this year. Pamper your body Maybe it’s putting on a soothing lotion after a shower, or wearing a piece of jewelry that brings you comfort—whatever helps you and your body feel most at ease before a gathering or event, do that. Then, go for the clothes and accessories that fit well (not ones that are too tight or feel uncomfortable sitting or eating in) and feel authentic. “Choose an outfit that makes you feel comfortable and confident,” Villalvir says. “Add a little spice that gives you an extra pep in your step—wear your hair in your favorite way, do your nails, or put on those special earrings. I love putting on a nice lipstick.” Decode your negative body thoughts Negative body thoughts are often an indication that something deeper is happening. First, take some time to make sure your nervous system is regulated. Then, with curiosity and non-judgement, ask, “What am I feeling?” and “Is this actually about my body?” Based on what you find, follow up with, “What do I need?” If your distress is about something else, you can address the true stressor instead of blaming your body and try to get your honest needs met the best you can. Express your feelings Since feelings are felt in the body and it’s common to take hard feelings out on the body, it helps to have go-to, safe ways to express your emotions. It could be journaling, mindful movement, crying, some form of art, or venting to a safe person. If you’re unsure of how you can safely express feelings, especially hard ones, it can be helpful to work with a therapist to help cultivate a healthy coping toolkit. Shift your perspective If you struggle with taking photos, try seeing the process of being in or looking at photos as opportunities to create treasured mementos from special moments in your life. Marks encourages her clients to focus on what’s happening in the picture instead of what people look like. Try zooming out over the whole image and experience instead of fixating on how your body looks, which will help soften judgment. Pruteanu also suggests not reviewing photos for flaws, and instead, “letting them be on your phone as a memory of the 2025 holiday season,” she says. “Future you may want to have this recording.” Another way to change perspective is to focus on what your body can do for you instead of what it looks like, or viewing your body as an instrument in your life—not as an ornament to be judged. So, consider what you’re glad your body allows you to do this time of year, and keep it simple (e.g. hugging loved ones, smelling cinnamon, singing your favorite songs, or feeling warmth from a fire). Embrace your inner child–literally My clients can often pinpoint when their negative body image started, and it’s usually in childhood. Consider envisioning your younger self (alone or with the support of a therapist, depending on what feels safest), and be specific: what were you wearing, where were you, and who was there? Then picture you now walking toward your younger self, holding them close, and offering the words they longed to hear. Maybe it’s something like, “I am more than a body,” “I deserve to take up space,” and “My body isn’t the problem.” Stick with the same one throughout the holiday season, write it down, and say it out loud on a regular basis, especially when you’re struggling. Reconsider social media use Social media can affect how you relate to yourself and your body, especially this time of year. If you follow social media that disturbs your relationship to your body or heightens your body anxiety, eliminate those accounts and sources as soon as possible. You might even consider taking a break from social media entirely: a 2024 study of young women showed that even a one-week break can help improve body image. Reconnect with your holiday values Ask yourself what you want this holiday season to be about. Perhaps it’s calm, peace, joy, fun, connection, or self-care. “Think of what you enjoy or value about the holiday season,” Pruteanu suggests. “Maybe it’s spending quality time with a specific person or people, or a specific tradition you enjoy. Try to add one value-centric activity to each day during the holidays if you can.” You can also set the daily intention to seek out glimmers (micro-moments of joy that signal safety to the nervous system) that connect you to your values for little pockets of time. This could be admiring a crackling fire or a beautifully decorated tree, smelling hot chocolate or coffee, or listening to the sound of birdsong on a walk or your favorite holiday tune. Practice self-compassion To use self-compassion during a tough body image moment, identify your negative body thoughts and find some space between you and the thought by placing the statement, “I am having the thought that” in front of it. Then, observe the thought and call it what it is: a negative thought about your body. Instead of continuing to be fused with the thought and berating your body, speak to yourself and your body with kindness. This could be something as simple as, “I am struggling right now, but my body is working for me.” You’re not alone in your struggle and other people are struggling with negative body image at this moment, too. If self-compassion feels difficult, that’s understandable—all that matters is that you give it a shot. “Remember, this is your eating disorder’s favorite time of year, and you’re fully capable of surviving,” Villalvir encourages. “Don’t put pressure on yourself to be perfect.”]]></content:encoded>
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            <title><![CDATA[Dietitian-Backed Ways to Navigate Holiday Meals During Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/food-and-fitness/holiday-meals-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/holiday-meals-eating-disorder-recovery</guid>
            <pubDate>Mon, 22 Dec 2025 15:59:00 GMT</pubDate>
            <content:encoded><![CDATA[The holiday season can be a time of joy and celebration, but it can also bring with it a significant amount of stress—and that stress seems to be at an all-time high. According to a poll of more than 2,000 people from the American Psychiatric Association, folks are experiencing more anxiety than last year this holiday season. The poll also reveals that a quarter of Americans say the holidays have a negative impact on their mental health, with grief, financial stress, loneliness, and hard family dynamics being the top contributing factors. Yet holiday feasts can be something that people look forward to all year—in fact, the same poll shows that more than half of the participants are looking forward to holiday eating. However, if you’re in eating disorder recovery or supporting a loved one who is, holiday meals can feel like giant undertakings, adding an additional layer of stress to your plate. Today, let’s see why holiday meals can be difficult in eating disorder recovery, and discover dietitian-endorsed ways to navigate big holiday meals (for both those in recovery and those with loved ones who are). Why holiday meals are so hard Holiday meals can feel emotionally unsafe, overwhelming, and disorienting for those recovering from eating disorders. It can also be hard for their loved ones to understand why what might’ve once felt like a joyous occasion is now a complicated experience—and it’s often not about the food, which can make things even more confusing. Here are several reasons why big holiday meals can be so tough in recovery: Emotions are often running high. For someone in eating disorder recovery, distress at holiday meals often isn’t about the food, although it may seem like it. According to the Alliance for Eating Disorders, it can instead be about food getting coupled with deeper issues and difficult emotions, like stressful family dynamics, unresolved conflicts, or traumatic memories. Eating disorders function as (maladapative) coping mechanisms, so when someone is in distress or feeling emotionally unsafe, it can be much harder to choose recovery instead of using eating disorders behavior to numb feelings like shame, guilt, sadness, anger. Diet culture talk and eating disorder thoughts get louder. Eating disorder thoughts tend to get louder around holiday mealtimes because the eating disorder is threatened the most when there’s an abundance of tasty food and lack of structure. Then, there’s the amplified holiday diet culture talk. From your old high school friend to your great aunt, it seems like everyone has something to say about food and body this time of year, whether it’s about their own or someone else’s. Especially at the dinner table, people tend to comment on things like how much food there is or how much weight they want to lose, which can be extremely triggering for someone in eating disorder recovery. One of my past clients described her holiday meals with family like she was sitting at the table with her eating disorder outside of her, because her family members were speaking her eating disorder’s language. This, of course, made it much harder for her to nourish herself, let alone enjoy her time. Routines are usually disrupted. Routines can be supportive in recovery, because they provide predictable times and structure to rest, eat, and work or go to school. However, the holidays are usually a time when routines are temporarily forgotten, which is natural and normal, but can feel disruptive for someone in eating disorder recovery. “Holiday meals are often at unconventional times—like 3 PM—which can lead to confusion as to what meal this will be ‘counted’ as for some folks in recovery,” says dietitian Ana Pruteanu, MS, RDN, CEDS-C, LDN. “Eating at times we’re not accustomed to can throw off someone’s day of eating and create more anxiety.” Other routine disrupters like early or late travel times and altered sleep can also destabilize eating patterns. You may feel added pressure. Having friends and family know about your eating disorder is important and can be supportive, but it can also feel high-pressure, especially at big holiday meals. “For someone in eating disorder recovery, holiday meals are tough because there is an added spotlight on them,” explains dietitian Jessica Villalvir, MS, RDN. “They feel under a microscope with every food and movement decision they make. They know they still have to take care of themselves, but the feeling of being in the spotlight makes it way more difficult.” Per the Alliance for Eating Disorders, the holidays can also cause pressure to perform joy, making it harder to have authentic conversations about your struggles. There may be more time at the table. “Holiday meals usually involve prolonged time we spend at the table with loved ones, eating and hanging out over the course of often several hours,” Pruteanu says. “Spending this much time at the table can be stressful for some.” Catching up over a glass of cider or punch and several leisurely courses may sound relaxing to many people, but that’s often not the case for those in eating disorder recovery. Fear foods are abundant. While distress at holiday meals is often not about the food itself, sometimes it is. “You may be eating foods that you’re not eating on a daily basis or foods, and which may be ‘fear foods.’ For those struggling with an eating disorder, there’s a tendency to feel like these foods should ‘count’ for more than regular foods,” Pruteanu explains. “Foods served at holiday meals might be some of your favorite foods and also foods that really scare you or foods you haven’t let yourself eat in a very long time. This can make it feel overwhelming to choose whether and how much to eat.” Dietitian-endorsed strategies for navigating big holiday meals Although holiday meals can be significant sources of stress if you’re in eating disorder recovery or supporting someone who is, there are steps you can take to make them more manageable, and maybe even enjoyable. Below are dietitian-endorsed tips for before, during, and after holiday meals that can make these events easier for yourself or a loved one. For those in recovery Before the meal: Regulate your nervous system. Since a big holiday meal will feel threatening for your eating disorder, your anxiety might be higher, and your sympathetic (fight-or-flight) nervous system may be activated. Take some time to let your body and brain know that you’re safe by picking a regulating activity, like spending time with a person who feels safe and calming, listening to soothing music, or petting a beloved pet. If you’re unsure of what feels regulating, work with your therapist or dietitian to come up with a few ideas of regulating practices to try this season. Ask for what you need. Establish who your top support person will be (whether it’s someone at the meal or someone you can call) and communicate your needs. “Let them know ahead of time what they can do to support you,” Pruteanu says. “Maybe that’s listening to you vent, sharing a specific reminder about recovery with you, making you laugh by sending you memes, or something totally different.” Consider creating a safe word to say if you need help in the moment and make sure your support person knows what it means and how they can support you when you say it. Stay nourished. “On the day of the holiday meal, maintain a regular eating schedule leading up to it, and resist the urge to not eat because of the unknown of the holiday meal,” Pruteanu recommends. She also suggests trying to incorporate some of the foods you expect to eat at holiday meals in the weeks beforehand, so you feel more comfortable eating them. This is best done with the support of an eating disorder dietitian. Make a plan for reaching your goals. Alone or with your therapist, clarify your recovery-aligned goals and intentions specifically for this holiday season, and how you plan to meet them the best you can. Perhaps there’s an affirmation you can write down and repeat to yourself as often as you need (e.g. “My body can handle holiday eating”). It may help to role-play responses or even develop a holiday script for comments that may feel triggering at meals so you feel prepared if they happen. Picking a post-meal coping tool ahead of time can also help later on. During the meal: Try mindfulness. If your eating disorder brain starts to send your body into (or back into) a threat response at the table, take a few mindful moments to ground yourself. This may look like taking a few deep breaths and engaging your senses by naming to yourself five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. Take breaks if you need them. “Remove yourself from the table to ground and take a break from the food or conversation when you need it,” Pruteanu suggests. Decide if you want to take a solo break or if you want someone to join you (by phone or in person), and take a few minutes or so to breathe, pause, share, or reconnect with your recovery intentions. Leave diet culture conversations. You can't control what others do, but you can control what you do,” dietitian Paige Aberasturi, RDN, CPT says. “I encourage considering what you can do at these meals.” If a friend or family member starts making food or body comments, you can (depending on your comfort level) change the topic entirely, let them know you want to talk about something else, or enter another conversation that may be happening at another part of the table. Know that you’re worthy of talking about things that ignite your interest and joy at the table this year. After the meal: Regulate your nervous system, again. Your eating disorder is likely to feel threatened after a big holiday meal, too, so pick another regulating activity to do alone or with your support person. This often makes it easier to resist urges to use compensatory behaviors, like future restriction or overexercising. Additional ways to regulate when in a state of fight-or-flight include taking extended exhale breaths (which research suggests activate the rest-and-digest response, which promotes relaxation), spending some time outside or in nature, or using cold water or an ice pack on your face or hands. Reflect on your holiday meal experience with compassion. Take some time to debrief with yourself or your support person. Consider what helped, what was especially hard, and what you can adjust for your next potentially challenging event or meal. Give yourself space to identify and express any residual feelings and try not to judge your experience. Instead, extend words of kindness to yourself (like you would to a close friend), regardless of how the meal went. This might be something like: “That was very difficult and I did the best I could to nourish my body and protect my recovery.” Remember, you are not your feelings, and they will pass once they’re processed. Keep eating regularly. Just like it’s important to stay nourished leading up to big holiday meals, it’s equally as important to do so afterwards. Do your best to stay on track with your recovery meal plan or eating pattern (which always means eating regular meals and snacks). If it’s possible and you need the support, consider scheduling a session with your therapist or dietitian afterwards to help you stay on track. For those supporting a loved one Before the meal: Brainstorm table topics or activities. You can help take the heat off the person in eating disorder recovery by thinking about conversation topics and activities they’d likely enjoy. “Come up with some ideas ahead of time for things you can talk about or games to play that don't have to do with food or people's food choices,” Aberasturi recommends. Additionally, let others who will be joining the meal know that diet culture talk is respectfully off limits. Check in with your loved one beforehand. “Ask if there are specific ways in which they would like you to support them,” Pruteanu suggests. Try not to assume what they need and try your best to honor what they say they need from you during the meal. Also, give them room to share any thoughts and feelings they need help processing, if any. Make gentle reminders. Offer gentle reminders to your loved one to nourish themselves with regular meals and snacks leading up to the holiday meal and make it as easy as possible for them to do so. “Offer to prepare food for them and eat together,” Pruteanu encourages. Additionally, ask them if they’d like to review and remember their recovery goals for the holiday season. If they agree, hold space for them to reconnect with their intentions and values before sitting down to the table. During the meal: Be intentional with your words. “Being a ‘safe’ person who isn't going to comment on food choices, or say anything about the size of anyone's body, would be an amazing gift for your loved one,” Aberasturi says. Even if you’re concerned about your loved one’s food intake, it’s best not to comment on their meal (or anyone else’s). “Engage them in conversation that is not related to food or bodies,” Pruteanu suggests, since talking can be a welcome distraction from eating disorder thoughts or uncomfortable feelings. “Redirect any weight- or body-related conversations others may be engaging in,” Pruteanu adds. While you can’t control what others are talking about at the table, you can help change the topic to something lighthearted (like movies or travel plans) if it veers into potentially triggering territory. Practice patience and provide reassurance. Remember that your loved one’s eating disorder thoughts are likely at their loudest around holiday mealtimes. Even if they’re having a hard time following through with their recovery goals, show them compassion by being patient and supportive in the moment. “They are doing their best and they might feel overwhelmed and forget or struggle with changing plans,” Villalvir explains. “Be open to mistakes—everyone is human and no one is perfect.” Some examples of patient and compassionate phrases to support your loved one during mealtimes are “I’m here to keep you safe” and “Let’s take a bite together.” You can also give them silent reassurance by gently smiling or nodding your head. Take a break with them or let them take one. If they used their safe word, leave the table with them for a few minutes to talk, take a few mindful breaths together, or make any possible changes to make them feel more supported throughout the rest of the meal. However, if they need a solo break, let them have it.  After the meal: Provide a safe place for them to regroup. Villalvir also recommends a post-meal check-in with your loved one. “After the meal, touch base with your loved one to see how they think it went,” she says. Gently help them reflect on their experience by asking them how they’re feeling or simply giving them space to share if necessary, letting them guide the pace of the post-meal check-in. Share your perspective. Ask them if they’re open to compassionate feedback, and if so, reinforce what went well at the meal and refrain from analyzing their food choices or intake. For example, you can simply acknowledge their resilience after a relative made a body-focused comment or the fact that they were at the table despite their loud eating disorder thoughts. Offer a peaceful post-meal activity. Chances are good that your loved one’s nervous system may be dysregulated after a big holiday meal, especially if it caused significant distress. Plus, research shows that having support and staying engaged after meals can help lessen difficult thoughts and feelings and discourage compensatory behaviors. Try offering to do some sort of downregulating activity together, like taking a short walk or getting some fresh air, watching a lighthearted movie, listening to music, or playing with kids or pets. You can also explore our article on tips to navigate post-meal distress. Holiday meals can feel intimidating in eating disorder recovery, but they’re not impossible. Whether you’re navigating them yourself or supporting someone you love, try looking at every meal as a chance to practice mindfulness, compassion, patience, and resilience—even when the going gets tough—and that will have a meaningful impact. Recovery during the holidays (or any time) is not about “doing it perfectly,” but instead about meeting yourself (or your loved one) where you (or they) are, and doing the best you can.]]></content:encoded>
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            <title><![CDATA[Virtual Binge Eating Disorder Treatment: What It Looks Like and How to Get Care]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/virtual-binge-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/virtual-binge-eating-disorder-treatment</guid>
            <pubDate>Wed, 25 Oct 2023 00:08:00 GMT</pubDate>
            <content:encoded><![CDATA[In the world of mental health care, virtual treatment options have emerged as a game-changing approach, especially for eating disorders like binge eating disorder (BED). Binge eating disorder is the most common eating disorder in the United States, affecting 3% of people across all age groups, genders, and backgrounds. Binge eating disorder is not a matter of willpower: it’s a serious mental illness that requires professional treatment. Traditionally, there have been many barriers—logistical, geographical, financial, and otherwise—to receiving BED treatment, but with the advent of telehealth, many of those barriers are coming down. Read on to learn more about virtual binge eating disorder treatment, what it looks like, and how to access it.  What to expect from virtual treatment for binge eating disorder Binge eating disorder is an eating disorder characterized by recurrent episodes of binge eating, or consuming large amounts of food rapidly with a feeling of being out of control. Unlike bulimia, which also involves binge eating, BED typically doesn’t involve compensatory “purging” behaviors, like vomiting or laxative abuse. Whether you seek in-person or virtual treatment, BED treatment will have the same goals: to stop disordered behaviors, establish regular eating patterns, and address any of the underlying emotional or psychological issues that are contributing to the eating disorder. If your disordered eating habits have led to nutritional deficiencies or other medical issues, those will also be addressed in treatment, whether it’s virtual or in-person. During virtual treatment for binge eating disorder, you’ll get all your treatment through a computer, tablet, or phone, and can access treatment wherever you are. This allows you to fit treatment into your life, not the other way around, and means you don’t have to press pause on work, school, or other important parts of your life. The specifics of treatment will look different depending on the program you choose, but a virtual treatment program will often include virtual therapy sessions, support groups, and nutritional guidance. It brings your provider team of specialists into your home, letting you get compassionate and tailored care in an accessible and convenient way. Some components of virtual treatment for binge eating disorder include: Therapy sessions: You’ll meet virtually with a licensed therapist who specializes in treating eating disorders and has experience working with patients with BED. Your therapist will help you identify triggers for your disordered behaviors and develop healthier coping skills, as well as address underlying emotional and psychological factors contributing to your eating disorder. They can also help you improve complex relationships in your life, work toward improving body image, and address any feelings of shame or guilt caused by your eating disorder. Support groups. Eating disorders can feel very isolating, so connecting with others who know what you’re going through often makes a world of difference. Virtual support groups allow you to share your feelings and challenges with other people on the road to recovery, who can offer a listening ear, empathy, and understanding. This connection can ease any loneliness you feel on the road to recovery, as well as provide motivation and inspiration to keep going. The beauty of virtual treatment is that it can erase geographic boundaries and help to create a wider community. Nutritional guidance. One of the biggest parts of binge eating disorder treatment is normalizing eating habits. It’s essential to do this with the help of a registered dietitian who is experienced in treating eating disorders. Your dietitian will help you build a reliable approach to eating that works with your lifestyle, needs, and preferences, and provide accountability and support to stick to that plan. You may even eat meals “together” over the screen, or they can virtually coach you through preparing food in your own kitchen. Dietitians can also help you better understand your body’s nutritional needs and tune into hunger and fullness cues. Getting started with virtual binge eating disorder treatment If you’re struggling with binge eating disorder, don’t try to white knuckle it through recovery on your own, and don’t wait until you feel “sick enough” to deserve treatment. Every eating disorder requires treatment, and the sooner you get help, the sooner you can begin living a full, free life in recovery. And the best part about virtual binge eating disorder treatment is that you can usually get started right away (at Equip, there is never a waitlist). Here’s how to get started with virtual binge eating disorder treatment: Find a provider. You can start by searching for a mental health provider or treatment program that offers virtual binge eating disorder treatment. Many individual providers offer virtual sessions these days, but we always recommend going with a treatment program that offers a multidisciplinary approach where team members collaborate. At Equip, you’ll be matched with a five-person team who all have experience treating binge eating disorder. Check insurance coverage. It’s important to check with your insurance provider to see if virtual binge eating disorder treatment is covered under your plan. Many insurance plans now include telehealth services in their coverage; however, it’s always smart to double-check. Equip is in-network with most major insurance providers in the U.S. Schedule a consultation. Once you’ve found a potential provider or program, you should schedule a consultation. A consultation will give you the chance to ask questions, get familiar with their online platform, and see if the program is right for you. Prepare for your sessions. After you have your consultation and select a program, you’ll want to get ready for your virtual treatment sessions. You’ll want to find a quiet, comfortable place where you won’t be disturbed. Make sure you confirm that your device’s camera and microphone are working properly and that your WiFi is fast enough to handle a video call. Enlist friends and family. While it’s not essential to bring loved ones into treatment, it can make the process easier and make recovery more sustainable. Integrating loved ones into treatment allows them to become educated about binge eating disorder so that they can better support you outside of treatment, and also helps combat any of the isolation or disconnectedness caused by and contributing to your eating disorder. Benefits of virtual binge eating disorder treatment Research has shown virtual treatment to be just as effective as in-person treatment for patients with eating disorders. Virtual treatment also offers some unique benefits over traditional models, including: Convenience: Virtual treatment spares you the headache of battling traffic, finding parking, and spending time commuting to and from appointments. It brings care to your doorstep, saving you time and energy. It allows you to schedule sessions around your life, not vice versa. Comfort: Feeling comfortable is essential to have productive sessions with providers. Virtual treatment allows you to feel safe and at ease in your home, which can make it easier for you to open up. Privacy: Privacy is important to a lot of people seeking eating disorder treatment. Virtual care allows you to do all of your treatment in the private and secure setting of your own home. While there’s no shame in seeking care—it’s a sign of strength, not weakness—virtual treatment can be very discreet for people who want their recovery journey to go unnoticed. Access to specialists: Many people struggling with eating disorders live hundreds of miles from the closest eating disorder specialist. But with virtual treatment, geographic barriers like this no longer have to prevent someone from getting help. Virtual binge eating disorder treatment means you’re not limited to who is nearby, and can work with highly qualified specialists across the country. Personalization. Eating disorders treatment isn’t one-size-fits-all, and when you meet individually with providers in a virtual setting, it allows treatment to be truly tailored to you. At Equip, we provide an individualized approach to all patients, tailoring your treatment plan to meet your exact needs and your support system. We treat you as a whole person, not as a diagnosis or particular symptoms. Virtual binge eating disorder treatment brings care right into your living room, allowing you to recover at home alongside a supportive team of eating disorder experts. If you seek virtual binge eating disorder at Equip, you’ll be matched with a dedicated team that includes a medical provider, dietitian, therapist, peer mentor (someone who has recovered from an eating disorder themselves), and family mentor (someone who has helped a loved one through recovery, who can support your friends and family). Our treatment is evidence-based and proven to work. Get in touch with our team today for more information about virtual binge eating disorder at Equip, or to schedule a consultation. 
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            <title><![CDATA[How Do Eating Disorders Affect Breastfeeding (and Vice Versa)?]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-breastfeeding</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-breastfeeding</guid>
            <pubDate>Thu, 19 Sep 2024 18:46:00 GMT</pubDate>
            <content:encoded><![CDATA[Breastfeeding is challenging for many women: there’s the stress of needing to feed a tiny new human with your own body, concerns about baby’s weight gain, latching issues, complicated breast pumps, not to mention the pressure to breastfeed in the first place. But for those with a history of an eating disorder, breastfeeding can be even more fraught. As someone with a history of anorexia, I was surprised to find that I had no trouble with the weight gain and body changes associated with pregnancy. My motivations and goals were clear (nourish my body well so that I can grow and birth a healthy baby!), and those around me praised and marveled at my expanding bump. But breastfeeding was much more complicated. My objectives were suddenly murkier, society’s expectations different, and there were a whole host of new stressors brought about by life with a newborn. In the weeks and months after my daughter’s birth, disordered thoughts and habits that had long ago disappeared began to resurface, shaping my breastfeeding experience in ways I hadn’t anticipated. My experience isn’t unique: many women who have been affected by an eating disorder or disordered eating have struggled with the particular set of challenges that breastfeeding can present. Read on to learn more about the link between breastfeeding and eating disorders, risks and benefits to be aware of, and expert insights on how to navigate breastfeeding while in recovery. Do eating disorders affect breastfeeding? Because eating disorders have such a profound impact on the physical body, including hormone levels, it’s natural to wonder whether breastfeeding is even possible for those dealing with or in recovery from an eating disorder. According to the research, the answer is overwhelmingly yes. In fact, studies have shown that when it comes to whether or not a mother initially breastfeeds her infant, there’s no statistically significant difference between those with eating disorders and those without. However, some research does suggest that eating disorders can impact both how long breastfeeding lasts and how it goes. Several studies have found that those with eating disorders are more likely to stop breastfeeding “early” (which is defined differently from study to study, but can range from two to six months postpartum). This seems to be particularly true for women with a history of anorexia or purging disorder, and for those considered to be underweight. Research has also found that those with eating disorders may have a harder time with the experience of breastfeeding itself. One meta-analysis showed that women with an eating disorder history had more negative experiences and emotional problems during breastfeeding, while another study found that those with clinically significant eating disorder symptoms felt less confident in their ability to breastfeed. It’s important to note that there’s relatively little research into this topic, and these findings don’t mean that if you’ve dealt with an eating disorder you are destined to struggle with breastfeeding or stop breastfeeding earlier than you want to. Rather, they simply highlight the fact that those who have been affected by eating disorders may face unique challenges along their breastfeeding journey—and with the right support, these challenges are surmountable. Why breastfeeding can be challenging for those affected by eating disorders Regardless of whether or not you’ve dealt with an eating disorder, there are a multitude of potential food- and body-related triggers that can come up after giving birth, and breastfeeding can be one of the biggest. “The postpartum period presents a number of potential challenges for women regardless of their lived experience with eating disorders, disordered eating, or body image concerns,” says Maddie Friedman, LCSW, therapist lead at Equip. “Breastfeeding is one of many options people may or may not choose to pursue that can pose additional physical and nutritional needs during the postpartum period.” If you decide to breastfeed your baby, the journey can be complicated by a number of different challenges, including: Difficulty eating enough When my baby was inside my body, I had no trouble eating the amount of food recommended to me. It made intuitive sense: there’s another human inside me, so I need to eat more. Once the baby was outside, however, things changed. I logically understood that my body still needed a significant amount of calories to produce breast milk, but this reasoning wasn’t strong enough to override the eating disorder logic telling me, “The baby isn’t in your body anymore, so you don’t need to eat as much.” This line of thinking is all too common among women who have struggled with eating issues: in an Equip survey of women with a history of an eating disorder or disordered eating, 56% of respondents reported finding it at least somewhat challenging to give their bodies adequate nourishment to support lactation. With the support of a dietitian, I was able to fight back against the eating disorder voice and provide my body with enough energy to feed myself and my daughter. However, Friedman points out, it’s important not to adopt a line of thinking that views eating as conditional on breastfeeding: “We want to be careful to balance an understanding of increased nutritional need without a strict justification that this is ‘only’ because of breastfeeding, and try to maintain psychological flexibility around food intake fluctuating during different days and life moments to promote recovery,” she says. “Bounce back” culture Because of the seemingly inescapable reach of diet culture, many women experience extreme pressures to “lose the baby weight” as soon as they’ve given birth. I felt this pressure acutely, and was paralyzed by the mixed messages I was receiving: on the one hand, I was supposed to eat enough to support lactation, but on the other, I was supposed to return to my pre-pregnancy body as quickly as possible. It doesn’t help that a lot of the research and educational materials on breastfeeding amplify diet culture messages by pointing out that breastfeeding may help with weight loss. Numerous studies have been conducted to evaluate the effectiveness of breastfeeding for weight loss, with one study even concluding that mothers should be encouraged to breastfeed exclusively “as a means of overweight and obesity prevention.” This mindset is concerning. So concerning, in fact, that several eating disorder experts published a letter in the International Journal of Eating Disorders raising an alarm about the potential for breastfeeding and pumping to be used as maladaptive weight control behaviors. In the letter, they note that in their clinical practice, they’ve observed a number of postpartum women with a history of or current eating disorders using breastfeeding, pumping, or both to influence body shape and weight. Pressure from healthcare providers Regardless of eating disorder history, many women experience pressure to breastfeed from all sides: from doctors, social media, well-meaning friends and family. There’s endless discourse online about whether or not and how long new mothers “should” breastfeed, and many women feel intense pressure to meet these expectations. For those with a history of an eating disorder, this pressure can be a risk factor for slipping back into disordered habits. According to one study, pressure to breastfeed was linked to increased eating disorder symptoms in postpartum women. This effect was particularly pronounced when the pressure came from women’s healthcare providers. Other postpartum stressors The challenges of breastfeeding can be compounded by other challenges of the postpartum period: body image concerns, grappling with a new identity, postpartum depression or anxiety, stress about baby’s growth chart, and more, all compounded by an extreme lack of sleep. “Even at its most successful, breastfeeding requires folx who are often already scattered and sleep deprived to consume more food more often to make up for nutritional deficits caused by feeding,” says Friedman. “Rapid hormonal and body changes may also cause discomfort with body image as well as a sense of loss of control.” Indeed, according to research, the psychological stressors of new motherhood and postpartum body image concerns have been shown to exacerbate eating disorder symptoms and postpartum mood disorders, which can, in turn, affect mother-baby attachment, including breastfeeding. Benefits of breastfeeding for those in recovery While the choice to breastfeed can present difficulties for many women with an eating disorder history, it can also have the opposite effect, strengthening recovery. Which direction it goes may depend on how long you’ve been recovered, what kind of support you have, your baby’s nursing style, and an infinite number of other factors—it can also change from day to day. Breastfeeding has the potential to help those in eating disorder recovery in a number of different ways, including: Appreciation for your body “For many people with lived experience of eating disorders, being able to carry a pregnancy to term and use their body to feed their baby can be incredibly healing and empowering,” says Friedman. “Where their body once felt like a battleground, this experience of giving and sustaining life can alter one’s perspective of what their body is capable of and generate a sense of gratitude for its ability to heal past previous challenges.” In the moments when breastfeeding was going well for me, I experienced this deeply. Seeing my daughter’s weight move up the growth charts and knowing that it was my body helping her do that filled me with a gratitude for my body that I’d never felt before. Helpful hormones The hormone oxytocin plays an important role in breastfeeding, stimulating milk letdown. This is notable because oxytocin has also been linked to a sense of calm that can be helpful in mitigating eating disorder-related stress. In fact, some research has called for more studies into the potential role of oxytocin in eating disorder treatment. Connection Eating disorders thrive in secrecy and can be extremely isolating. Many people who struggle with eating disorders feel disconnected from others in their life, both physically and emotionally. Breastfeeding is one of the most intimate forms of connection a human can have with another human, and this sense of connection can be deeply healing for those who have struggled with eating disorders. For me—someone who had been in recovery for years but still felt some of the lingering isolation of my eating disorder—the unbridled physical and emotional connection I experienced when nursing my daughter was nothing short of revelatory. A new perspective on eating An infant nursing is one of the most primal acts we witness as human beings: the babies are driven by pure intuition and instinct for survival, they know exactly what to do and they do it without any other concerns or clutter in their mind. Newborns know they need to eat to survive, and so they eat, and they enjoy it, and that’s the end of the story. Watching this happen can be eye-opening for those affected by eating disorders. “I’ve heard folx with active eating disorders reflect on observing babies eating with reckless abandon and without any self-perception or body image worries,” says Friedman. “Breastfeeding and taking a more agnostic approach to feeding can feel very contrary to one’s past experiences with eating and can promote a more objective approach.” How to navigate breastfeeding while in recovery If you’ve dealt with or are dealing with an eating disorder, it’s first important to be thoughtful about whether or not to breastfeed. Breastfeeding has benefits, but—despite messaging to the contrary—you can still be a good parent and give your baby all the nutrients and love it needs without breastfeeding at all. It’s a personal decision and one that should be made thoughtfully and without being swayed by external pressures. “I would always defer to someone’s preferences, goals, and concerns when it comes to whether or not to breastfeed,” says Friedman. However, if you do choose to breastfeed, there are some strategies you can use to help keep your recovery strong and support your breastfeeding journey. Stay in the present moment During the postpartum period, it can be easy to spiral into worries, fears, or your never-ending to-do list, and this stress can increase risk of turning to disordered behaviors. To combat this, do your best to stay present—and try using your baby as a tool for achieving that. “Babies are so helpful for increasing present moment awareness, so I would recommend tapping into that whenever possible,” says Friedman. “Feet on the ground, deep breaths, and connecting with loved ones for support.” Be mindful of your thoughts If you’ve struggled with an eating disorder, you’re likely familiar with how good eating disorder thoughts are at taking over your whole mind—it’s for this reason that we often say that eating disorders hijack a person’s brain. One way to combat this is by taking time to notice and observe your thoughts objectively, rather than identifying with them. “I think it’s important to remember that thoughts are stories and not facts. They come and they go if we let them pass,” Friedman says. Get support As you navigate all the ups and downs of taking care of and nourishing a new baby, remember that you don’t need to go it alone. Lean on loved ones to give you help and let you take breaks, and don’t be afraid to turn to professionals for extra support. As Friedman says, “the postpartum period can be so challenging and transformative, and I think carving out space for regular therapy and self-care is critical.” When I found myself struggling to eat the amount of food I knew my body needed, I called up the eating disorder dietitian I’d worked with many years earlier. She was able to coach me over the phone and provide a loose meal plan that I could use to get back on track with my eating. Put your mental health first If, along the way, breastfeeding begins to take a toll on your well-being, remember that you can stop at any time, and it isn’t a sign of failure. What’s most important for a baby is that it has a parent who is mentally and physically healthy. “Birthing parents’ mental health is of utmost importance, and if breastfeeding is not feeling like a good choice for them, I would support them through alternative considerations,” says Friedman. Eating disorders can present breastfeeding challenges, and breastfeeding has the potential to trigger eating disorder behaviors—but neither of these outcomes are inevitable. If you’ve dealt with an eating disorder in the past, or are currently struggling with disordered behaviors, you can still breastfeed successfully while protecting (or working toward) recovery. What’s important is that you embark on your breastfeeding journey thoughtfully, and enlist support when you need it. Reach out to our team to talk through your concerns and get the resources you need to support you and your baby.]]></content:encoded>
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            <title><![CDATA[What Does Gender-Affirming Care Look Like for Eating Disorder Patients? | Ask an Equip Provider]]></title>
            <link>https://equip.health/articles/understanding-eds/gender-affirming-care-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/gender-affirming-care-eating-disorders</guid>
            <pubDate>Thu, 28 Sep 2023 00:17:20 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders disproportionately affect transgender folks. According to one oft-cited statistic, transgender college students are 4x more likely to have an eating disorder diagnosis. When you start to dig into the why behind these numbers, it’s easy to identify various risk factors that transgender populations face: rigid appearance ideals, minority stress, discrimination, higher rates of food insecurity and trauma, and gender dysphoria, just to name a few. Gender dysphoria—significant distress, discomfort, or misalignment with one’s gendered body experience—can play a particularly big role in the development of an eating disorder, feeding into both psychological distress and body image issues. In fact, 32% of transgender people report using their eating disorder to modify their body without hormone replacement therapy. For all of these reasons, it’s essential for providers to take a specialized and nuanced approach when working with transgender eating disorder patients—and one of the core tenets is incorporating a gender-affirming care protocol. We’ve already explored the best ways providers can support transgender eating disorder patients, but gender-affirming care is such an important topic that we wanted to focus on it specifically. To shed more light on this important topic, Jessie Menzel, PhD, Equip’s VP of Program Development, answered some of the most common questions providers have about gender-affirming care for eating disorder patients. What is gender-affirming care? And what is a gender-affirming care protocol? When a person’s gender identity conflicts with the sex they were assigned at birth, gender-affirming care is care that helps them bring all aspects of their life into alignment with their gender identity so that they can live as their authentic self. It is an approach to working with patients that respectfully affirms their gender identity, considering all the physical, mental, and social aspects of their well-being. This could encompass anything from medical interventions to social services to counseling or therapy. How does gender-affirming care show up in eating disorder treatment? Why is it so important? Transgender and gender expansive (TGE) people are at increased risk for developing eating disorders in large part because the considerable amount of stigma and discrimination they experience in our society. And trans and non-binary people are not immune from the harms of cultural appearance ideals, either—and the ideals for people in these communities can often be more extreme or even necessary for safety reasons. However, individuals who also experience gender dysphoria (the distress that results from a discrepancy between one’s gender identity and their physical characteristics) are at unique risk for developing eating disorders. Someone who is TGE may engage in extreme attempts to alter their body by preventing weight gain, losing weight, or striving for a certain physique in order to align their body more closely with their gender identity. In these cases, it’s impossible to separate out someone’s gender identity from their eating disorder, and it will be necessary to address gender dysphoria in order to successfully treat the eating disorder. Therefore, gender-affirming eating disorder care is care that addresses a person’s identity and eating disorder concurrently. What should I look for in treatment providers to ensure they incorporate gender-affirming care? If you want to refer a TGE patient to an eating disorder specialist or program, it’s essential to find one that takes a gender-affirming approach. The first indicator that a provider is gender-affirming in their approach is if they ask! Do they ask you about your patient’s gender identity and pronouns? Do they ask about their trans experience and whether or how gender identity has impacted the development of an eating disorder? Beyond asking, you’ll also want to make sure that the provider has received training in gender-affirming care or if they work with or can refer to gender specialists. Most importantly, your patient should feel safe to be open about their identity and have that identity be affirmed in every aspect of the treatment experience.]]></content:encoded>
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            <title><![CDATA[Ask an Equip Provider: How Can I Support my Patient in Recovery During the Holidays? ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/how-providers-can-help-patients-during-holiday-season</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/how-providers-can-help-patients-during-holiday-season</guid>
            <pubDate>Thu, 23 Oct 2025 23:08:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders affect people year-round — in the U.S. alone, about 5.5 million people will develop an eating disorder and over 10,000 will die from one in one year’s time — but the holiday season can be particularly hard for many. With the stress of family gatherings, food-centric events, travel, social pressures, and more, the winter holidays offer up challenge after challenge to people who may be struggling, and the families supporting them. As a healthcare professional, your guidance can make a huge difference for these families in making it through the holiday season. Contrary to pervasive myths, lasting recovery is possible for all people with eating disorders. By providing support during this fraught season, you can help guide your patients and their families toward the treatment they may need or help them protect the recovery they worked so hard to achieve. So how can you best support patients with eating disorders during the holiday season? Tanna Vayon, MPAS, PA-C, a Physician Assistant at Equip, answered some of the most common questions providers have on this important topic. Why is it so important to look out for signs of eating disorders during the holidays? It’s vital to increase awareness around screening for eating disorders during the holiday season, as the level of eating disorder behaviors are often heightened. The holidays involve stressful circumstances for many people, regardless of whether they have an underlying eating disorder — and for those who are living with one, these stressors can cause an uptick in behaviors. Family members can come with unwanted anxieties, disagreements, and triggers of past trauma, and a lack of control around foods and the timing of family meals can be detrimental to a patient with an eating disorder. Patients might attempt to “numb out” the anxieties that come with family and counteract their perceived lack of control around food with compensatory mechanisms. These include, but are not limited to food restriction, purge behaviors (vomiting, laxatives, diuretics), overexercising, and more. The medical complications are vast when it comes to these behaviors. They can lead to dangerous electrolyte imbalances (hypokalemia, hypophosphatemia, hypoglycemia, metabolic alkalosis), cardiovascular compromise (bradycardia, arrhythmias), vital sign abnormalities (hypotension, orthostatic tachycardia, hypothermia), and acute, rapid weight loss. Often, medical providers are the first to bring eating disorders to the attention of family members. The holidays are a time where pediatric patients are out of school, and have time to follow up with their primary care providers. It's the job of the PCP to screen for eating disorders and their related medical complications. It’s also their job to empower families to address the underlying disorder and seek treatment for their loved one. If my patients are in the midst of eating disorder treatment, should I advise that they sit out their holiday plans this year?  Each patient in eating disorder treatment is unique, and the recommendation you make on this decision will need to be individualized. Some questions to think about when discussing restrictions on holiday plans may include: Will the family be traveling? If the patient is struggling to complete meals at home, it may be best to avoid an increased risk of food restriction in an unfamiliar environment. Will there be increased physical activity in their holiday plans? Some patients who need weight restoration are placed on complete activity restrictions, and shouldn’t be engaging in added physical activity (for now). Is the patient on a meal plan consisting of scheduled meals and snacks? Most patients in eating disorder recovery are on a scheduled 3 meals and 2-3 snack plan to provide adequate nutritional rehabilitation. Large holiday gatherings where one meal is planned the entire day is typically not ideal for a recovering patient. If the patient will be participating in holiday plans as usual, it might be beneficial to recommend adding some precautions. This might include having family members plate and supervise meals and snacks, monitoring the patient before and after meals to guarantee the patient isn’t engaging in eating disorder behaviors like purging or compulsive exercise, and checking in on the patient's emotional status to ask if they need additional support during or after family gatherings. Should I talk to my patient about holiday weight gain or New Year’s resolutions around weight?  This is an excellent question and a valid concern for many medical providers. Before you answer, I would suggest you assess your own internal biases and stigma around weight. Although many medical providers are educated on the “dangers” of weight gain and the “health risks” associated with fat, the medical details of these claims are rarely discussed or proven. In fact, research shows that weight stigma and shame around weight gain worsens an individual’s health through increased cortisol production, elevated blood pressures, weight cycling, and fears of seeking medical attention at the risk of weight shame. In my experience, it is not beneficial to address holiday weight gain or encourage New Year’s resolutions around diet or weight loss. When I discuss New Year’s with patients, I tend to ask questions like: What are your joy goals for this coming year? What core value do you have that you want to live out more this coming year? What was one positive experience you had this previous year that you want to bring into the next year? Goals that are directly related to an individual’s positive attributes will help them establish higher self-esteem and encourage a more positive trajectory for the new year. How do I know when to refer a patient to treatment for an eating disorder?  The first step to establishing the urgent vs emergent need for eating disorder treatment depends on the medical status of a patient. We use the following criteria to determine if a patient is in need of emergent hospitalization for medical stabilization: Vital sign instability   Heart rate < 50 while awake, <45 while asleep (bradycardia) Blood pressure < 90/45 (hypotension) Temperature < 35.6 degrees Celsius or 96 degrees Fahrenheit (hypothermia) An increase of > 20 beats per minute in heart rate upon standing, or a decrease of 20 mmHg (systolic) or 10 mmHg (diastolic) blood pressure upon standing Body weight less than 75% of median BMI for age and sex Electrolyte abnormalities  Potassium <3.5 (hypokalemia) Phosphorus < 3.0 (hypophosphatemia) Magnesium < 1.8 (hypomagnesemia) Sodium < ~135 (hyponatremia), which may be sign of water loading EKG abnormalities Sinus bradycardia (HR < 50 while awake) Prolonged QTc interval (> 450 ms) Other acute complication of malnutrition Examples: pancreatitis, heart failure, kidney failure, syncope, severe dehydration, GI bleed Acute food refusal (<500 kcal consumed per day for over 3 days) If your patient meets any of this criteria, I would recommend you send them to the nearest emergency room (preferably one with eating disorder specialists) for further evaluation. For your patients who do not meet any of these criteria, the decision about whether to refer them for treatment is ultimately up to you as their provider. However, I would recommend starting treatment as soon as possible and not waiting until the end of the holidays. The physical state of an individual facing malnutrition can deteriorate rapidly. A patient can have stable vital signs one day and a heart rate under 40 beats the next. I’ve seen it happen. I sometimes use the analogy of a patient who has an acute infection: If you had a patient with bacterial pneumonia present at your clinic, would you send them home without treatment and expect their infection to resolve by the end of the holidays? I would hope not! Rather, you would probably think about the most common bacterial etiologies, consider the antimicrobial resistances in their area, and ultimately start your patient on an immediate course of antibiotics with ER instructions at the ready. A patient with an underlying eating disorder and malnutrition is no different. Any delay in treatment can be detrimental. I would advise you to sit the patient and family members down to express your concerns, and reach out to local treatment centers for support. Eating disorders never take a holiday, so treatment shouldn’t either. Equip's expert care teams are ready to support your patients, no waitlist necessary. Learn more about Equip treatment and how to make a referral. ]]></content:encoded>
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            <title><![CDATA[“White Knuckling” Your Way Through an Eating Disorder Doesn’t Work — Here’s What Does ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/white-knuckling-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/white-knuckling-eating-disorder</guid>
            <pubDate>Thu, 30 Nov 2023 00:35:00 GMT</pubDate>
            <content:encoded><![CDATA[When Equip therapist Hannah Bishop, LPC, hears people say they don’t feel they need treatment for their eating disorders, she understands their hesitation. Before Bishop embarked on a career in therapy, she was also struggling with her own eating disorder—and she wasn’t sure she wanted or needed support. “As someone who is very independent and struggles with asking for help, I thought that I could figure things out on my own and be okay.” Bishop says. Now on the other side of recovery, Bishop not only sees the immense value in receiving comprehensive treatment for an eating disorder, but also in the willingness to fully commit to the process. “I am a firm believer that having grit and determination, in addition to support, is what creates a lasting recovery,” she says. “I wouldn't have been able to be in recovery without my support system, and this looks different for everybody.” Struggling with an eating disorder is often an isolating experience, and many people are tempted to just “power through” their illness with enough self-discipline. Often referred to as “white knuckling,” this process of fighting through a challenging situation or illness isn’t just ineffective; it can be anxiety-provoking, debilitating, and even life-threatening if it prevents a person from receiving treatment for their eating disorder. We know that eating disorders aren’t vanity issues or lifestyle choices; they’re serious brain diseases that are considered to be among the deadliest of all psychiatric disorders. Everyone deserves access to the evidence-based treatment, trained providers, and peer support that can be so critical in overcoming an eating disorder. Here’s why no one should try to “white knuckle” their way through recovery—and why asking for help is so crucial. The potential obstacles preventing people from getting proper care Given the myriad of treatment barriers many people face, it’s understandable why they may feel too scared, intimidated, or financially unable to commit to a structured treatment plan with trained providers at the helm. “The hurdles to recovery look different for everyone,” Bishop says. “But often finances can play a large role in whether someone has the opportunity to enter treatment and it often comes down to the unfortunately broken, underfunded mental health system." Most eating disorder care is rarely covered by insurance, and the average eating disorder treatment is estimated to cost $80,000. Plus, many eating disorder treatment centers are geographically far away and require relocation or travel. These factors are part of why Equip was built as a fully virtual program that accepts most insurance plans. Finances aren’t the only roadblock preventing individuals from seeking treatment. There are other potential obstacles related to familial support (or lack thereof), social stigma, logistical complications, or stereotypes about who gets eating disorders. “Recovery thrives on resources, support, and the ability to put our needs first—and sometimes that isn't readily available for patients,” Bishop says. Bridging this gap is the motivation behind her work as an Equip therapist, “I want to be a provider who is a part of decreasing the hurdles that patients have to jump through in order to receive care and thrive.” Why you can’t just “white knuckle” eating disorder recovery The truth is, no amount of willpower alone can heal an eating disorder. Eating disorders are complex mental health conditions that can hijack a person’s thinking and decision-making. With an illness that asks a person to fight their own brain every time they eat, it’s incredibly difficult to facilitate recovery alone. Here are some key reasons why. Eating disorders are egosyntonic Egosyntonic is a term that describes when actions or behaviors align with a person’s ideal self-image. Eating disorders are often egosyntonic, meaning someone might feel like their food restriction or excessive exercise habits are helping them become the person they want to be, when in reality these behaviors are perpetuating an eating disorder. The eating disorder brain creates this egosyntonic mindset, which can make people initially not want to get better. Even if someone knows they need help, they might have a difficult time detaching from these ideas without structured treatment. Malnutrition can affect the brain When a brain is malnourished, it impairs cognitive function, making it very difficult to make decisions and changes on your own. Many treatment programs begin with a period of renourishment to restore brain functioning and more reasonable thoughts patterns in a patient. Dietitians can create tailored, evidence-based plans for how to execute this process safely. This combination of a professional care team and the support of loved ones is invaluable during the critical renourishing phase of recovery. Many believe they’re “not sick enough” Stereotypes about who gets eating disorders can make many people feel isolated or undeserving of treatment. Many people think you have to be underweight in order to seek professional treatment, and attempt to “white knuckle” their own recovery since they are not “sick enough.” These stereotypes aren’t just harmful, they’re also untrue. Fewer than 6% of people with an eating disorder are ever medically diagnosed as underweight. There’s no such thing as not being “sick enough” to get help, and early intervention is actually one of the most effective strategies for overcoming an eating disorder. Why evidence-based treatment is so critical to lasting recovery Research has repeatedly shown that​ the most effective ways to recover from an eating disorder is to seek out evidence-based treatment, like family-based treatment (FBT) and cognitive behavioral therapy for eating disorders (CBT-E). Finding affordable, accessible care from a team of competent, experienced, and compassionate providers can be challenging, but it’s not impossible, and Equip believes treatment is for everyone. “The eating disorder can trick us into thinking that we are not ‘good’ or ‘worthy’ unless we are demonstrating high restraint and willpower when it comes to behaviors,” Bishop says. “It’s important to do the opposite of what the eating disorder is telling us to do, and instead rely on trained professionals and comprehensive treatment in order to facilitate lasting recovery, rather than a false sense of grit or willpower.” Equip was built on the idea that it takes a village to overcome an eating disorder. That’s why each patient receives comprehensive care from a 5-person care team, and is encouraged to invite their friends and family to be a part of the recovery process too. If you or a loved one are struggling and ready to get professional care, schedule a free consultation to learn more.]]></content:encoded>
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            <title><![CDATA[Equip Update: Kerry Washington Invests in Equip to Expand Access to Eating Disorder Care]]></title>
            <link>https://equip.health/articles/news-and-research/kerry-washington-investment-equip</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/kerry-washington-investment-equip</guid>
            <pubDate>Thu, 20 Feb 2025 15:15:00 GMT</pubDate>
            <content:encoded><![CDATA[Equip was started Equip with a simple but bold vision: to transform the broken system that leaves too many people without the care they deserve, and ensure that everyone struggling with an eating disorder has access to evidence-based treatment. Today, we are thrilled to announce that Kerry Washington has joined our journey as an advisor and investor in Equip. There isn’t a better time to announce her investment than during this year’s Eating Disorder Awareness Week, which is dedicated to shedding light on the realities of eating disorders, challenging misconceptions, and advocating for more access to treatment. Kerry is more than an award-winning actress, producer, and director. She is a fierce advocate for social justice and mental health who has used her voice and platform for years to elevate underrepresented communities and push for meaningful change. When we first met with Kerry, we immediately saw how deeply aligned her values are with Equip’s mission. Like us, Kerry believes that eating disorders don’t discriminate—but, unfortunately, access to treatment often does. With Kerry’s partnership, we are doubling down on our commitment to reaching those needing virtual, evidence-based care. What this means for Equip Kerry’s involvement is more than just an investment; it’s a partnership built on shared values and a bias toward action. We will continue to work tirelessly to: Expand our reach so that more people can access life-saving treatment, no matter where they live. Destigmatize eating disorders and change the conversation about who they affect and who needs treatment. At Equip, we believe full recovery is possible and that everyone deserves the chance to heal. With Kerry on our team, we are even more confident in our ability to make that vision a reality. This is just the beginning, and we couldn’t be more excited about what’s to come.]]></content:encoded>
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            <title><![CDATA[Are Food Rules Always Bad? How Rigid Eating Patterns Fuel Disordered Behaviors]]></title>
            <link>https://equip.health/articles/undefined/food-rules-disordered-eating</link>
            <guid isPermaLink="false">https://equip.health/articles/undefined/food-rules-disordered-eating</guid>
            <pubDate>Fri, 05 Dec 2025 19:01:00 GMT</pubDate>
            <content:encoded><![CDATA[Given the number of “healthy” diet plans circulating online and the sheer volume of “What I Eat in a Day” videos flooding social media sites, it may seem like everyone follows some sort of food rules. Whether they’re avoiding gluten, cutting dairy, or sidestepping seed oils, both influencers and everyday people seem excited to share the eating rules that have supposedly transformed their lives for the better. Thanks (but no thanks) to diet culture, food restriction has, in many ways, become normalized. And while restricting or eliminating certain foods may be important in some specific scenarios, the truth is that externally imposed rules and restrictions on eating generally tend to do more harm than good. Not only that, but food restriction can be a slippery slope to an eating disorder. So are food rules inherently bad? Read on to hear what the experts say. What are food rules? Food rules are just what they sound like: rules and boundaries about what and how you eat. These rules are typically influenced by external sources, usually have a sense of obligation at their core, and you likely feel compelled to follow them—and guilty or ashamed when you don’t. “​​Food rules are self-imposed guidelines for eating that can lead to high levels of distress if broken, or restriction to avoid breaking them,” says Equip Lead Registered Dietitian Dani Castellano, RD, CEDS. While it may be medically necessary for some people to avoid certain foods or have rules around these foods in order to protect their health, food rules are most commonly associated with the fear of weight gain or pursuit of weight loss. These types of food rules may involve avoiding a food or food group entirely because of a belief that that food will cause weight gain or have a negative impact on your health. Unfortunately, diet culture and the countless non-experts sharing info online has normalized following food rules that may actually be problematic or dangerous. “Because of diet culture and anti-fat bias, foods are consistently being considered “good” or “bad,” and our body sizes and health are considered things we have the ability to control entirely,” Castellano says. “It’s associated with superiority if you have the self-restraint to be eating ‘healthy’ foods and are as thin as possible.” Understanding the risks and benefits of food rules When food rules are driven by external factors like a strict diet, social media, or wanting to look a certain way—rather than by true health reasons—they tend to have several harmful characteristics and consequences. These rules are generally rigid, not allowing for any flexibility when it comes to what, when, and how much you eat, and encouraging you to ignore your own hunger and fullness cues. According to Castellano, the risks of these types of food rules include: Inadequate energy intake. “Because overall calories are restricted due to avoiding certain foods, this makes it difficult to meet the body’s energy needs,” Castellano says. This can put you into a negative energy balance, which carries consequences for both physical and mental health and can lead to an eating disorder. Isolation. “It’s difficult to engage in normal social activities, which often revolve around food given that we need to eat every few hours to meet our energy needs,” Castellano says. Development of an eating disorder. “There is never one cause of an eating disorder, but food rules leading to inadequate intake can cause weight loss, which can lead to the development of an eating disorder due to the impact of weight suppression for individuals with genetic predisposition for eating disorders,” Castellano says. Initiating a binge-restrict cycle. “I see this happen frequently when people avoid eating energy-dense foods and then experience loss-of-control eating or binge eating, which becomes cyclical,” Castellano says. “People often think that because they inevitably eat these foods, they aren’t restricting. But because of the ‘mental restriction’ of feeling like they’ve done something wrong, it often has the same effect.” Can food rules ever be okay? But are all food rules inherently bad, or can they be beneficial? It’s clear that rigid, externally-driven food rules are linked to disordered eating and mental distress, but in very specific scenarios (allergies, celiac disease, etc.), an individual may need to adhere to certain food rules for their own health and overall well-being. But generally speaking, in the absence of an allergy or medical condition, experts typically advise against implementing hard and fast food rules. “I think the term ‘rule’ is so tricky here, because rules imply they can’t be broken which leads to rigidity,” Castellano says. “Unless someone is allergic to a food, I wouldn’t advise implementing food rules. Several of the 10 principles of Intuitive Eating by Elyse Resch and Evelyn Tribole focuses on how to challenge food rules and the importance of doing so. This can be a really great starting point for people to dig in and learn more.” (You can also learn more about intuitive eating on the Equip blog.) For those with specific health conditions that require adherence to certain food rules, Castellano says eating disorder dietitians often speak to food choices that impact health conditions as “nutrition by addition,” as opposed to nutrition by subtraction or restriction. For example, someone with diabetes who intentionally balances their plate with proteins, carbohydrates, fats, and fiber-rich foods to support blood sugar stabilization may need specific, gentle rules in place to manage their health condition through the addition of certain foods. The connection between food rules and eating disorders Research has shown that following food rules can be the link between perfectionism and various signs of disordered eating—meaning those with perfectionistic traits are more likely to develop eating disorder symptoms because they use rigid food rules. One 10-year longitudinal study found that dieting (aka restricted food intake or rigid food rules) and disordered eating behaviors predicted an increased risk for problematic outcomes, like eating disorders, in adolescents and young adults. “Many people in our society engage in dieting and have some kind of rules regarding what they do or do not eat,” Castellano says. “And even though this often leads to a level of restriction or disordered eating, the reality is not everyone is going to end up with a diagnosable eating disorder. However, most people struggling with an eating disorder have food rules as a symptom of their eating disorder.” The psychological aspect of food rules plays a large part in the connection to disordered eating. One study found that the cognitive effort involved in following food rules is a key pathological factor that predicts problematic eating. Another study which used daily diary data from college students, found that rigid food rules can make people more vulnerable to disordered eating when their ability to self-regulate was affected by issues like feeling mentally drained or experiencing intense cravings. How to break free from food rules Breaking free from rigid food rules is a process of unlearning diet culture, rebuilding trust with your body’s internal cues, and moving forward with compassion, patience, and in some cases, professional support, especially if you think the rules are part of an eating disorder Here are a few ways to start separating from food rules: Challenge each of them, one by one. Castellano recommends ranking your food rules from those that would be the least distressing to break to those that would be the most distressing to break. Start by breaking the least distressing ones first, then gradually work your way up the list. “Continue to incorporate these challenges to reduce the anxiety over time,” she says. “It can be helpful to do these challenges with a trusted support person and to have some coping skills in mind to deal with anxiety that may arise.” Practice positive self-talk and mantras. “Write out messages or affirmations that you want to be true and review them regularly, such as, ‘all food is good food,’” Castellano says. “Because our brains have neuroplasticity, we can form new pathways through exposure and doing things differently.” Go fact-finding and get support. “Seek information from eating disorder or HAES-informed professionals and activists via social media, books, and podcasts that debunk some of the myths that led to these rules in the first place,” Castellano advises. “If necessary, seek treatment with a therapist and dietitian specializing in eating disorders to support you in the process, where they can tailor treatment methods based on your diagnosis and severity of symptoms.” When to seek help for rigid eating patterns If rigid food rules are affecting your everyday life or the life of a loved one, it’s important to get support from a professional as soon as possible. According to Castellano, it’s essential to seek help for rigid patterns if the food rules: Lead to undereating and/or result in weight loss Cause nutritional deficiencies Result in a binge-restrict cycles Lead to isolation from friends and family Cause high levels of distress or inability to tolerate if they’re broken “Talk to a trusted support in your life and ask for help in finding treatment,” Castellano says. “Eating disorders thrive in secrecy and you do not have to do this alone. Equip’s website has a lot of information for starting points, and reaching out to your PCP or insurance company for options can be other helpful routes to get started.” You can also schedule a call with an Equip team member to talk through your concerns and discuss potential treatment options.]]></content:encoded>
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            <title><![CDATA[Equip Partners with theSkimm to Share Guidance on Supporting Someone with an Eating Disorder]]></title>
            <link>https://equip.health/articles/news-and-research/the-skimm-erin-parks-partnership</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/the-skimm-erin-parks-partnership</guid>
            <pubDate>Thu, 13 Nov 2025 22:35:00 GMT</pubDate>
            <content:encoded><![CDATA[If someone you love is dealing with an eating disorder, it can be hard to know how to help. What can you do? What should you say? How do you even know for sure that there’s a problem? It’s a nuanced and difficult situation, so it’s understandable why loved ones are sometimes hesitant to get involved. But research shows that friends and family are often key to helping someone get the care they need—and early intervention leads to better outcomes. That’s why we’re so thrilled that Equip recently partnered with theSkimm to shed light on this complex topic. As part of this partnership, Dr. Erin Parks answered common questions about how to tell if someone you love is struggling with an eating disorder, and what you can do to help. Check out the video for compassionate, realistic guidance that will arm you with the knowledge you need to support your loved one with confidence.  Be sure to follow Equip on Instagram to see more clips from her interview in the weeks and months ahead.
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            <title><![CDATA[What Is Refeeding Syndrome? Everything You Need to Know]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/what-is-refeeding-syndrome</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/what-is-refeeding-syndrome</guid>
            <pubDate>Mon, 28 Aug 2023 18:04:00 GMT</pubDate>
            <content:encoded><![CDATA[Malnutrition can occur for many reasons — like food insecurity, for instance, or your body being unable to properly absorb food. Another common cause is an eating disorder that involves the restriction of calories or lack of nutritional balance. In eating disorder treatment, addressing malnutrition is the first priority. But that doesn’t mean just jumping right into three square meals a day. Reintroducing food into your system after you’ve gone an extensive amount of time eating very little isn’t always easy, and going about it in the wrong way can result in various issues. One of the most common issues that can stem from this process is refeeding syndrome. Read on to learn what refeeding syndrome is, what it does to your body, and how to avoid it. The basics of refeeding syndrome Nutritional rehabilitation is a key part of treatment for eating disorders like anorexia nervosa and bulimia nervosa, helping patients to achieve weight restoration and address nutritional deficiencies. It involves introducing calories to the body, either by eating and drinking or through a feeding tube. Refeeding syndrome refers to a dangerous complication that can occur during nutritional rehabilitation if it’s not done correctly. When the body starts to ingest calories after a long period of restriction, it can cause a metabolic disturbance that could lead to potentially life-threatening shifts in the body’s fluid and electrolytes, most commonly potassium, phosphorus and magnesium, levels. The severity of refeeding syndrome can vary from person to person; one recent study showed that approximately 22% of adolescents with anorexia experienced mild symptoms during the refeeding process, while 6% experienced severe symptoms. There are many medical issues that can be symptoms of refeeding syndrome, including: Muscle weakness		 Increased heart rate Heart weakness (cardiomyopathy)	 Low blood pressure Difficulty breathing		 Nausea, vomiting, loss of appetite Double vision		 Fatigue Trouble swallowing		 Fluid retention/fluid in your lungs Seizures		 Low blood pressure Coma			 Muscle spasms and tremors	 Nausea and vomiting		 Heart arrhythmia Loss of appetite		 Coma Patients may have a higher risk of experiencing refeeding syndrome if their body mass index is lower than 16 or if they’ve lost 10% or more of their body weight in the last three to six months or have had severe restriction for the past 7 days. What happens to the body during refeeding syndrome? Refeeding syndrome is caused by a shift in fluid and electrolytes that can have a domino effect throughout your body and cause severe symptoms, including death. These fluid and electrolyte shifts are related to low stores of electrolytes, most often, potassium, phosphorus and magnesium. Electrolytes are minerals that play a vital role in many of your body’s functions. When someone is undergoing the refeeding process — which we also refer to as nutritional rehabilitation — their body needs these electrolytes to metabolize the food they are eating. This causes a depletion of electrolytes, which, in turn, causes the fluid shifts that often accompany these electrolyte deficiencies. All of this then causes the multiple symptoms that you often see in refeeding syndrome. The most common example of a dangerous imbalance that can occur in refeeding syndrome is decreased phosphorus levels. Phosphorus is important for many things in the body, including energy storage and regulating how hemoglobin carries oxygen throughout the body. Even small decreases in phosphorus can affect our organs, leading to potentially serious health risks such as muscle weakness, heart weakness, difficulty breathing, and coma. Another potential effect of refeeding syndrome is a deficiency of vitamin B1, or thiamine. This results from carbohydrates being quickly used up in glycolysis, or the process of breaking down sugars in the body. This deficiency can lead to severe neurologic symptoms like amnesia, unsteady gait (ataxia), and delirium. Prevention and treatment of refeeding syndrome While there is no way to 100% guarantee that a person won’t experience refeeding syndrome, it’s possible to significantly minimize risk. The key to doing so is adapting the refeeding process to a person’s particular physical condition, BMI, and vitamin deficiencies. Monitoring the process and making electrolyte adjustments when necessary can also go a long way in reducing the risk of any severe complications. Refeeding syndrome can sometimes mean that calories are being introduced to the body too quickly. In these cases, patients need to work closely with a physician and dietitian trained in treating eating disorders to come up with a game plan for gradually ramping up calories. This may mean that weight restoration goes a little more slowly at first, but it’s an important precaution to take if someone is experiencing severe symptoms. If you or your loved one do start to experience symptoms of refeeding syndrome, alert your medical team immediately. They’ll determine the best way to proceed, which may include slowing down the refeeding process as well as electrolyte replacement and closely monitoring fluids and electrolyte levels. Weight restoration is one of the first steps for most people working to recover from severe malnutrition, and an essential component of lasting recovery. At Equip, you have a dedicated team of professionals to help you throughout your recovery journey, including a medical provider and dietitian, both of whom are well trained in working with people who have eating disorders. Together, they’ll assess any risk of refeeding syndrome and come up with a plan that minimizes risk and closely monitors progress and any complications.. With the correct treatment, you can safely reintroduce your body to the nutrients it needs to properly function and reach a weight that allows you to live a full, eating disorder-free life. Get in touch with our team today for more information or to schedule a free consultation.]]></content:encoded>
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            <title><![CDATA[What Causes ARFID in Adults?]]></title>
            <link>https://equip.health/articles/understanding-eds/arfid-in-adults-causes-risk-factors</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/arfid-in-adults-causes-risk-factors</guid>
            <pubDate>Thu, 06 Mar 2025 18:44:00 GMT</pubDate>
            <content:encoded><![CDATA[While there’s still a common misconception that avoidant/restrictive food intake disorder (ARFID) solely affects young people, there’s growing awareness about the fact that it can also impact adults. Research shows that ARFID—which is characterized by extremely limited or picky eating that’s not related to body image concerns or a desire to lose weight—affects anywhere from 0.3% to 4.8% of general adult populations across different countries. But even as more people come to understand that ARFID can exist beyond childhood, there are still questions about what causes ARFID in adults. While every case of ARFID is different and each person experiencing an eating disorder has a unique history and recovery journey, understanding the common causes of ARFID in adults may help shed light on the realities of the illness. Read on to learn about the potential causes of adult ARFID, the signs and symptoms to be aware of, and how to seek help. How common is ARFID in adults? “Generally, we have less data on ARFID in adults than in children, but recognition of the disorder in adults is growing quickly,” says Equip’s VP of Clinical Programs, Jessie Menzel, PhD. “It used to be that we thought ARFID was just as common as anorexia nervosa in adults, but more recent studies suggest that it could be much more common.” While the lifetime prevalence of anorexia in adults is estimated to be 0.6%, prevalence rates of ARFID range from 4.51% to 11.14%. According to a 2023 cross-sectional study of 50,082 adults, 2,378 (4.7%) screened positive for ARFID. What causes ARFID in adults? Like all eating disorders, ARFID isn’t the result of one specific cause, but rather a complex mix of different factors including genetics, environmental influences, brain biology, and experiences. While some adults with ARFID may have actually had the illness as children and never received treatment or even a diagnosis, others may have developed the condition later in life due to traumatizing events, health issues, or other factors. Before diving into the potential causes of adult ARFID, it’s first helpful to understand the three different presentations of ARFID. People with ARFID eat a very small variety or very small amount of food (or both), due to one of three different causes, known as "presentations." These are: Sensory sensitivities, like being unwilling to eat things with certain textures or smells Fear of something bad happening from eating, like choking, vomiting, or an allergic reaction Lack of appetite or interest in food Many adults with ARFID may have unresolved or untreated food issues from childhood. “Sensory sensitivity to food or lack of interest in eating, in particular, tend to appear in early childhood and can persist into adulthood,” Menzel says. She explains that for some, symptoms that are mild and manageable in childhood later have a significant impact on adult life: “For example, as they grew, their tolerance of different foods narrowed and became more inflexible, or years of mild nutrient deficiencies began to take their toll, or their eating began to have a greater impact on their social lives.” Others, however, may develop ARFID for the first time in adulthood. “While there are certainly adults who developed ARFID as a child and go undiagnosed until they’re adults, ARFID can also develop in adulthood,” says Equip Peer Mentor Kelsey Gilchriest, who was diagnosed with ARFID as a young adult. “My ARFID got worse during and after college, when I was exposed to many new foods, as well as more independence and responsibility around food.” Menzel also says that adults can develop ARFID as the result of making dietary changes in an attempt to manage other health conditions, like gastrointestinal symptoms. “Research in adults shows that elimination diets, a common recommendation in the treatment of many gastrointestinal disorders, significantly increases someone’s risk of developing ARFID,” she says. People can also have traumatizing events or experiences that trigger or worsen ARFID symptoms. That might mean choking, having an allergic reaction, getting food poisoning, or even observing any of these experiences in someone else. While Gilchrest learned as an adult that she had unknowingly been exhibiting signs and symptoms of ARFID since an early age, one particular incident intensified her illness in a major way: “The most severe restriction that led to malnourishment came when I witnessed a coworker get food poisoning as an adult,” she says. “This experience really cemented my anxiety and avoidance around food, and led me to finally receive a diagnosis of ARFID and a referral to treatment.”  What ARFID looks like in adults vs. children While the causes of ARFID may vary between children and adults, the illness tends to present similarly across age groups. “The core symptoms of ARFID are the same in adults as they are in children,” Menzel says. “In other words, ARFID in adults is also associated with one or more of the following presentations: extreme sensitivity to the sensory properties of food, a fear of something bad happening after eating, or a lack of interest in food or eating.” Although ARFID symptoms do not seem to differ significantly between children and adults, Menzel says there are some notable exceptions. “For example, some data show that children with ARFID are much more likely to be underweight and need to weight restore as part of treatment, whereas adults with ARFID are less likely to need weight restoration as part of treatment,” she says. A new study also found that adults with ARFID tend to report more symptoms regarding lack of interest in food, including a small appetite and struggling to eat enough food. Adults and children with ARFID may also differ in how they present to treatment, according to Menzel. “As with other eating disorders, families typically seek treatment on behalf of their child, and a common motivator may be the significant challenges or limitations posed on the family by the child’s ARFID,” she says. “Parents are also more likely to be concerned by a child’s pickiness than the child themselves. However, that perspective may shift with time. Adults are more likely to be self-motivated in seeking treatment, and they’re often concerned about how their eating impacts their relationships, socializing, and ability to navigate public spaces.” Menzel also notes that ARFID can have profound mental health impacts on adults, and is associated with depression, loneliness, anxiety, and even suicidal thoughts. According to Menzel, common symptoms of ARFID in adults include: Sensitivity to the smell, taste, or texture of food Eating few total foods or a very narrow range of foods Inflexibility with respect to the brand or preparation of food Not eating enough food Needing to push oneself to eat throughout the day Getting full easily Fears of choking, vomiting, allergic reactions, illness, or pain after eating General anxiety around food or eating Weight loss Nutritional deficiency Reliance on nutritional supplements or feeding tube for nutrition Struggling to function socially or occupationally (e.g., avoiding restaurants, not eating with others, feeling ashamed or embarrassed about eating habits) Treatment for adults with ARFID Unlike most other eating disorders, ARFID is not driven by body image and weight concerns, making treatment a bit unique. The core of ARFID treatment is often exposure, which helps patients cope with anxiety-provoking or challenging foods and experiences. While this is true for ARFID treatment at any age, there are some differences between how the illness is treated in children versus adults, and specific challenges adults with ARFID may face when seeking treatment. “Because ARFID and its symptoms have historically been associated with children, there are often many systems in place to support children who struggle with ARFID,” Menzel says. “Adults, however, are much more limited in their options.” While children can receive support from mental health providers as well as feeding disorder specialists, Menzel notes that feeding specialists rarely provide treatment for adults. Children may also receive occupational therapy, oral-motor skills therapy, nutritional counseling, or behavioral therapy, along with adapted versions of family-based treatment (FBT) and cognitive behavioral therapy (CBT). “For adults, treatment is largely limited to the support of mental health providers and dietitians,” she says. “Thankfully, CBT for ARFID (CBT-AR) was developed to meet the needs of adults with ARFID. It’s the only treatment for ARFID in adults that has been systematically studied, and it shows very promising results.” Because misunderstandings about ARFID (and particularly the way it affects adults) continue to abound, some patients find it challenging to access adequate care. In Gilchriest’s case, presenting as an adult with ARFID symptoms complicated her ability to receive effective treatment. “When I found the ARFID diagnosis on a Google search and brought it to my therapist at the time, she assured me I did not have an eating disorder, despite the fact that I was only eating a handful of foods at that time,” she says. Once Gilchriest did manage to get help, she was the only adult with ARFID at her treatment center. “This was incredibly isolating, and many resources I looked for were geared more towards children rather than adults,” she says. “I had a hard time seeing my experience reflected anywhere, which made me feel like a black sheep and, at times, even misunderstood.” Based on her experience, Gilchriest says the major difference in treatment options for adults versus children with ARFID is around external support. “I work with many children with ARFID who are doing an FBT approach,” she says. “This is where the caregivers of the child have much more of an active role, whereas when I went to treatment I was largely supporting myself. The treatment modality I find my teams using the most with adults with ARFID is CBT-AR. This modality specifically addresses the particular presentations of ARFID, and can be very personalized to the patient depending on what it is they struggle with.” While finding treatment for ARFID as an adult can be challenging, it’s important to understand that treatment options do exist, and that it’s essential to seek help from an ARFID-informed provider. “If you’re concerned about any aspect of your relationship with food, it's worth talking to someone about it,” Menzel says. “However, be aware that many health providers are still unaware that ARFID is an eating disorder that impacts adults. I recommend doing your own research and talking to an eating disorder professional who is more likely to be trained to recognize ARFID in adults.” If you’re an adult struggling with symptoms of ARFID, know that full recovery is possible, but that it requires specialized, evidence-based support. Our free, 5-minute ARFID screener can help you determine potential next steps, or you can schedule a call with our team to talk through your concerns and see if Equip can help.]]></content:encoded>
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            <title><![CDATA[5 Sneaky Ways Negative Body Image May Be Impacting Your Life]]></title>
            <link>https://equip.health/articles/body-image/negative-impact-of-body-image-issues</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/negative-impact-of-body-image-issues</guid>
            <pubDate>Mon, 10 Jul 2023 19:25:00 GMT</pubDate>
            <content:encoded><![CDATA[ It’s no secret that harboring negative thoughts and attitudes about your physical appearance can contribute to the development of an eating disorder, but the reality is that negative body image affects most of us at some point,  Research has shown that anywhere from 40% to 90% of women are dissatisfied with their bodies, and men are far from immune — up to 30% of men  and 69% of male adolescents  report body dissatisfaction. And none of this research even touches on the innumerable unique body image challenges facing trans and non-binary individuals. These numbers aren’t a sign of individual failing, but rather an inevitable result of the culture we live in, which is steeped in diet culture and singularly focused on a thin, largely unattainable body ideal. Equip Senior Program Development Lead Ally Duvall says that negative body image can have serious consequences that extend far beyond a glimpse in the mirror or an “unflattering” photo.  “Having a negative body image goes deeper than not liking how you look,” she says. “If we believe that we aren’t good enough, we don’t pursue our dreams the way we once wanted to. We don’t feel comfortable in relationships or have the brain space to communicate with loved ones. It affects nearly all of us, as we live and breathe in a society designed to control our bodies” The good news is that while body image issues may be common, they’re not inevitable and don’t have to be permanent. “None of us were born hating our stomachs, hoping for a thigh gap, or wishing we had clearer skin,” Duvall says. “These are learned thoughts that have been hammered into our minds, much like other deeply rooted systems of oppression.” Understanding all of this may help debunk the myth that negative body image is an unavoidable or unimportant concern; in fact, feeling bad about your physical appearance can contribute to serious health issues (including eating disorders) and significantly hinder your quality of life. Here are some less obvious ways body dissatisfaction may be holding you back—and how to start building body confidence to reclaim the life you deserve. 5 Ways Negative Body Can Affect Your Life 1. It may hold you back in your career While we’d like to think our society has made major strides in accepting humans for the quality of their character over their physical appearance, there is still work to be done. Many people are still being made to feel bad about their bodies, even in the workplace—and that kind of discrimination can have serious consequences. “The diet industry is a multi billion dollar business. People with eating disorders aren’t the only people falling victim to it,” says Equip Therapist Ashley Isenhower. “Negative body image might impact someone’s effort to apply for a promotion or ask for a raise. In several states, it is legal to fire someone for being ‘overweight.’” For those who are “straight-sized” or at lower weights, negative body image can impair their career goals in other ways, like a lack of self-confidence or a preoccupation with how their body looks that makes it difficult to fully engage in work. 2. It may keep you from feeling safe or free in your clothing choices Clothing isn’t frivolous. Feeling seen and represented by the fashion industry can go a long way toward helping you feel comfortable and liberated rather than constrained and repressed. Expressing your identity through your clothing can make you feel more confident in who you are, and holding yourself back in order to wear what you’ve been told is “flattering” or “appropriate” for your body can mute your ability or desire to shine. “People wear clothes that they believe they should wear rather than clothes that make them feel comfortable and bring them joy,” Equip Peer Mentor Nicky England says. 3. It may make you feel like you’ll never measure up It’s no secret that social media can be a major source of harmful body image messaging, and content rooted in comparison can perpetuate feelings of unworthiness beyond the physical. “I find ‘What I Eat in a Day’ or ‘My 9-5’ videos sneakily harmful,” Duvall says, explaining that when we see someone that fits society’s thin ideal, we may feel subconsciously compelled to adopt their behaviors. “Although they might not be directly telling you to do a workout or eat a specific food, we see a romanticized version of their supposed daily life. This can make us feel even more inclined to adapt to what they do, the products they use, or the way their body looks often without even knowing we are being marketed to.” And, of course, because your body will never look like someone else’s, striving to match someone else’s appearance or physique will always leave you feeling worse about your own body. 4. It may prevent you from feeling present For many, feeling grounded and present in the current moment can help prevent or decrease the intensity of anxious thoughts and cultivate more feelings of gratitude, happiness, and connectedness with others. When negative body image thoughts are front and center, it can be difficult to experience the present moment and avoid getting swept up in worries and fears. “Because of the value society places on outward appearance, negative body image tells us we’re not enough: not good enough for the promotion; not pretty/smart/funny enough for the relationship; not a good enough friend, parent, sibling,” Isenhower says. “This can cause us to pull away from others and isolate, whether we mean to or not.” England agrees, adding that the time and energy investment required to entertain thoughts of body dissatisfaction inevitably take away from more joyful experiences. “People spend so much time worrying about how their bodies look that they miss out on enjoying some beautiful moments in life, like meals with loved ones,” England says. 5. It may hurt your romantic life Romantic love certainly isn’t a necessity or desire for every person, but for those who do want to pursue a relationship, negative body image can create a barrier to vulnerability and connection. “We often hear the phrase, ‘we accept the love we think we deserve,’ and in a similar vein, I find that having a negative body image can prevent us from connecting with our partners in ways we might not even be aware of,” Duvall says. “Feeling like we are not enough and unworthy of care unless our bodies look a certain way can seep into the way we relate to our significant others. It often shows up as questioning and fear: ‘What if they don’t truly love me? What if they’re just saying it but don’t mean it? Who would want to be with someone like me?’ All of these what-ifs can keep us from the love we’re surrounded with and the care we inherently deserve.”  How to start building a more positive body image While negative body image can feel inescapable, there are tactics and strategies to help decrease its power. Here are some tips for quieting body dissatisfaction thoughts and working toward feeling happier and healthier in your skin: 1. Be curious. “Once we can pause and ask ourselves about our relationship with our body, we can identify what we may be avoiding—your body, reflection, certain events, clothing—and instead, try to incorporate body-approaching behaviors, like compassion towards your body, trying different types of clothes you’ve wanted to wear, and engaging in activities you love,” Duvall says. 2. Curate your social media. “Unfollow accounts that make you feel bad about yourself,” Isenhower says. “And follow accounts that make you feel validated.” 3. Surround yourself with people with a variety of different body types. “This could be on social media or in your daily life,” England says. “This normalizes body diversity and can help with challenging the thin ideal.” 4. Make space for grief. “When we embark on body image work, we need to hold space for grieving: you may miss the experiences you had in a different sized body or grieve the image you always pictured for yourself—but that grief is another piece of healing,” Duvall says. “We often run from negative emotions. But in these moments of body grief, we can make space for the new relationship we’re building while holding space for what used to be.” 5. Try doing things your negative body image says you can’t do. “This could look like wearing a bikini to the beach or letting yourself have your picture taken,” England says. “It could really be anything that you struggle to allow yourself to do with your current body image.” 6. Seek professional help. “Negative body image is so common, but it can definitely lead to disordered eating,” Isenhower says. “Being able to talk it through with an objective third party can help you develop coping skills to combat negative self talk.” 7. Celebrate the joy. “This could be by following people that look more like you on social media and seeing them live full, authentic lives; making space to do an activity you used to love—I highly recommend singing your favorite childhood songs—or spending time with your friends and community,” Duvall says. “Finding pockets of joy throughout your body image journey can be so pivotal in feeling more true to yourself and remembering why you want to challenge the appearance ideals.”]]></content:encoded>
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            <title><![CDATA[New Research: What Family Factors Determine Success with FBT? ]]></title>
            <link>https://equip.health/articles/news-and-research/research-does-fbt-work-for-all-families</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/research-does-fbt-work-for-all-families</guid>
            <pubDate>Mon, 12 Dec 2022 01:21:00 GMT</pubDate>
            <content:encoded><![CDATA[We frequently mention that family-based treatment (FBT) is the only evidence-based eating disorder treatment for young people. But, as we all know, families vary drastically from one to the next, and no two eating disorders are the same. So do certain demographic or diagnostic factors determine whether FBT will work for a patient? According to new research, no. The study in question, “Predictors of family-based treatment for adolescent eating disorders: Do family or diagnostic factors matter?”, was co-authored by Equip’s VP of Clinical Programs, Cara Bohon, and appeared in the December 2022 issue of the International Journal of Eating Disorders. Researchers analyzed data from six clinical trials in both the U.S. and Canada, which included a combined 724 patients ages 12-18 with a diagnosis of either anorexia or bulimia who were receiving some form of treatment, either FBT or other approaches. Using this data, they compared outcomes with a variety of different familial and diagnostic factors, including socioeconomic status, feelings of self-efficacy (caregivers’ belief about their ability to take care of their loved one successfully), family configuration (i.e., married vs divorced), prior treatment, illness duration, and more. Their findings showed that the only factor that directly predicted the success of FBT was whether or not a patient had received prior eating disorder treatment (those with no prior treatment had better outcomes). No other demographic or clinical variables affected the outcome of FBT. These results have significant implications for future treatment. While providers may hesitate to refer certain patients and families to FBT because of misconceptions around who it works for, this initial analysis suggests that factors commonly assumed to impede FBT actually have no impact. Rather, FBT can be an equally effective approach for all families and patients. “Overall, it feels good to confirm what my clinical experience had suggested to be true,” says Bohon, who has almost 20 years of experience in clinical eating disorder research. “FBT is adaptable and can meet family and patient needs, whatever they may be.”]]></content:encoded>
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            <title><![CDATA[5 Warning Signs of Orthorexia: Red Flags to Look Out For]]></title>
            <link>https://equip.health/articles/understanding-eds/five-warning-signs-of-orthorexia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/five-warning-signs-of-orthorexia</guid>
            <pubDate>Thu, 31 Aug 2023 20:53:00 GMT</pubDate>
            <content:encoded><![CDATA[Many people assume that there’s no such thing as eating too “healthy.” But it’s possible for the desire to eat “clean” foods and stay healthy to escalate into a harmful obsession. When this happens, it’s known as orthorexia. Orhorexia is a disordered eating pattern that stems from an intensive and excessive commitment to a “healthy” diet, or “clean eating.” It's not always easy to pinpoint when “healthy” eating becomes disordered eating, because in a world steeped in diet culture, the behaviors are easy to justify or even celebrated. That’s why it’s important to be aware of the clear warning signs of orthorexia so that you can seek proper treatment. Read on to learn more about what orthorexia is, the warning signs to look out for, and the next steps to take if you're concerned. The basics of orthorexia Orthorexia, or orthorexia nervosa, refers to eating patterns that stem from a preoccupation with eating “healthy” foods or “clean eating.” This obsession with achieving optimum health can lead to restrictive eating behaviors that interfere with quality of life, relationships, and both mental and physical health. The definition of “healthy” or “clean” eating can vary from person to person (which is part of the reason that we put both words in quotes). But regardless of a person’s specific interpretation of those words, orthorexia refers to rigid eating patterns and a commitment to eating “pure” or high-quality foods. It’s important to note that orthorexia isn’t a diagnosable eating disorder. But many people with eating patterns characteristic of orthorexia fit the criteria of OSFED, or other specified feeding and eating disorder. It’s also possible that the eating behaviors can develop into a diagnosable eating disorder, such as binge eating disorder or anorexia. Orthorexia can cause issues such as: Malnourishment Mental health issues, including anxiety or depression Distrust in healthcare providers and medication Social isolation, due to an inability or unwillingness to eat in social settings or rigidity around exercise What are the warning signs of orthorexia? People of all shapes and sizes can struggle with orthorexia, and if you appear healthy or have a regular body mass index, you may not think you need help. But there are a variety of warning signs of orthorexia that can indicate when your desire to eat healthy has started to have negative mental, social, and physical effects. Here are the five warning signs of orthorexia to be on the lookout for: Intense fixation on food quality Eating only “pure” ingredients is paramount to a person with orthorexia. This can show up in a variety of different ways, including cutting out large food groups or types of food or adopting organic, vegan, or raw diets. Counting and measuring nutritional components There are many aspects of a food’s nutritional value, such as carbohydrates, calories, and protein. Closely tracking your intake of these nutrients could be a sign you have orthorexia. Fear of “impure” foods A common sign of orthorexia is feeling worried about contamination or disease from “impure” or “bad” foods. You may even feel anxious being around certain foods because you view them as “poison.” Stress about eating out or while traveling When you’re eating at a restaurant or traveling to new places, orthorexia can cause you to feel emotional and mental distress about the availability of “clean” foods. This stress may even lead you to avoid travel and miss out on these experiences completely. Emotional distress if eating patterns aren’t followed People with orthorexia tend to make rules for themselves—like always reading nutrition labels and ingredient lists before eating—as a way to stick to their rigid eating patterns. If these rules are broken, they can feel severe anxiety. What to do if you recognize warning signs of orthorexia If you’ve recognized warning signs of orthorexia in yourself or someone else in your life, you’ve already taken a huge first step. Once you acknowledge these warning signs, it may be time to explore treatment options that can help reduce the harmful behaviors of orthorexia. Working with a multidisciplinary care team can help you tackle every aspect of your orthorexia and reduce its impact on your overall quality of life. At Equip, patients struggling with orthorexia can be matched with a therapist, dietitian, medical provider, peer mentor, and family mentor to help address the nutritional, behavioral, psychological, and emotional aspects of orthorexia. Equip can help you address warning signs of orthorexia There’s no denying that eating nutritious foods is important. But an obsession with “clean eating” can start to take a toll on your physical and mental health, and rob you of much of the joy in life. While acknowledging the warning signs of orthorexia can be tough, it also means that you’ve taken the first step toward seeking help and healing your relationship with food, freeing up space to live a fulfilling life. Get in touch with our team today to learn more about Equip treatment or to schedule a free consultation. About Erin Reeves, RD Erin Reeves, Director of Nutrition at Equip, has 15 years of experience treating patients through all age ranges and levels of care. She received her Masters's Degree in Nutritional Science and completed her dietetic internship through California State University Long Beach. Erin is extremely passionate about helping people improve their relationship with food to live a full and happy life.]]></content:encoded>
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            <title><![CDATA[Tactical Steps to Help Someone with an Eating Disorder]]></title>
            <link>https://equip.health/articles/understanding-eds/how-to-help-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/how-to-help-eating-disorder</guid>
            <pubDate>Tue, 22 Aug 2023 02:06:00 GMT</pubDate>
            <content:encoded><![CDATA[It can be difficult to see someone you love struggle with their mental and physical health. It’s even harder when they don’t seem to initially want your help. Because eating disorders can be egosyntonic, meaning the person struggling may not actually want to get better, providing support can be complicated. But you can still play a vital role in getting your loved one the care they need to recover from an eating disorder. Read on to learn the warning signs of an eating disorder and the steps that you should take to help them get help and become a healthier and happier version of themselves. What to look for when you suspect that someone in your life has an eating disorder  Eating disorders are common mental health disorders, affecting more than 20 million Americans. So statistically, it’s likely that there’s someone in your life who may be struggling with one. If your friend skips a meal, or your significant other says, “I’m not hungry,” you probably don’t think much of it. But if things like that keep occurring, you might start to get worried. By understanding the behavioral patterns that may lead to or indicate an eating disorder, you’ll be better equipped to support your loved one and get them help if they need it. Here are some eating disorder symptoms to be aware of: Skipping meals Weighing food or counting calories Rigid exercise routines Hiding food Cutting out entire food groups Only eating “clean” foods Rapid weight gain or loss Fatigue Social withdrawal or isolation Always being cold Being highly critical of their body Even though there are some physical indicators of an eating disorder, it’s important to remember that eating disorders aren’t always reflected in a person’s physical appearance. Even someone who appears to look “healthy” or hasn’t had notable weight loss may be struggling with eating disorder symptoms. With eating disorders, there’s no such thing as “not sick enough” to get treatment. Steps for helping someone in your life with an eating disorder Recognizing the potential signs of an eating disorder in someone close to you is concerning, but it’s an important first step. So what comes next? It’s not easy for someone with an eating disorder to be open about their struggles. They may feel shame or embarrassment; they may even feel protective of their eating disorder and become defensive, lash out, or close themselves off. It’s important to recognize that eating disorders and malnourishment can change how a person’s brain works, which may cause them to act outside of their ordinary values. Oftentimes, you’re speaking to their eating disorder and not them; but that doesn’t mean you should stop trying to help. Here are actionable steps that you can take to help someone you love with an eating disorder: Make them feel included: Not only is social withdrawal or isolation common in people with eating disorders, so are body image struggles and self-criticism. To combat all of these feelings, include your loved one in conversations and social plans (even if they tend to say no) to support their self-esteem and help them feel less alone. Create a judgment-free zone: Any sort of mental health disorder can make people feel ashamed or guilty about their symptoms, often because they feel like the people in their life wouldn’t approve. Letting your loved one know that they can talk to you without fear of judgment can go a long way. By creating a safe space for them, you can help them feel supported and more likely to seek out professional help. Relay your observations: It’s important that you share your concerns about their behaviors without being accusatory. Using “I” statements can be helpful, as can leading with curiosity. Ask questions rather than making judgements or stating things as facts. Share your research: Educating yourself on the type of eating disorder that they may be struggling with, as well as potential treatment options, can prove to the person that you have their best interests at heart. By putting in the effort to learn about their struggles and how they can work toward recovery, you’re also showing that you believe in their ability to recover. Equip can help someone in your life work toward eating disorder recovery If you see the initial signs of an eating disorder in someone close to you, it’s normal to assume that you should wait until it becomes “more serious” before you step in. But eating disorders are serious—even deadly—and the earlier a person gets help, the more likely they are to achieve full recovery. That said, it’s never too late for someone to get treatment and heal. Regardless of how long your loved one has been struggling or how severe their symptoms seem, it’s important that they get help. And by taking the steps above, you can play a pivotal role in encouraging them to do that. Don’t forget that you need support throughout this journey too. At Equip, loved ones are invited into treatment and are matched with a family mentor, someone who has lived experience helping a loved one into recovery. You can also join support groups and connect with others who share your experience. You’re not alone in this process; our team of expert clinicians and people who’ve been there are here to help. Get in touch with our team today for more information or to schedule a free consultation. About Angela Celio Doyle, PhD Dr. Doyle has been a clinician and researcher in the eating disorder field for over 20 years. Passionate about early intervention and access to evidence-based care, she trains treatment providers internationally in providing family-based treatment for eating disorders and has a research background in internet-based eating disorder prevention programs. Dr. Doyle earned her Ph.D. in Clinical Psychology from the SDSU-UCSD Joint Doctoral Program and completed a postdoctoral fellowship at the University of Chicago. She holds an adjunct faculty position at the University of Washington's Department of Psychology and is Vice President of Behavioral Health Care at Equip.]]></content:encoded>
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            <title><![CDATA[Why Do Latinx Folks Fall Through The Cracks of Eating Disorder Care?]]></title>
            <link>https://equip.health/articles/understanding-eds/latinx-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/latinx-eating-disorders</guid>
            <pubDate>Mon, 16 Aug 2021 14:17:00 GMT</pubDate>
            <content:encoded><![CDATA[Born and raised in the Dominican Republic, Equip Medical Assistant Genesis Taveras says eating disorders were rarely—if ever—discussed. So when one of her friends developed anorexia, she and her peers were left in the dark about the diagnosis. “She would miss tons of days from school and withdraw from social occasions,” Taveras says. “Although her closest friends knew there was an illness affecting her, none of us were aware that it was an eating disorder. We were all told that it was heart disease.” Taveras’s story unfortunately has a tragic end.“After her unexpected passing, and after many years, we learned the reason,” Taveras says. “There were indeed heart issues, but they were linked to the eating disorder.” Unfortunately, this isn’t an uncommon outcome, as eating disorders are among the deadliest mental illnesses. Reflecting on her friend’s story, Taveras believes there were many cultural factors at play that kept the girl’s illness a secret. “The social stigma played a huge part in the lack of information available for the ones that cared for her and the lack of empathy and compassion toward her family,” she says. “The real issue and struggles were never discussed, which made her unable to seek the help she needed. The family was so afraid of the ‘shame’ or ‘failure as parents’ that it was almost impossible for other people to help in her recovery.” Because of the points Taveras raises—in addition to many other cultural and socioeconomic factors—eating disorders in the Latinx community are still very much under the radar. What research exists around eating disorders in Latinx culture? It’s important to first understand the language around identity when discussing eating disorders in the Latinx community. People sometimes erroneously use the terms “Hispanic” and “Latino” interchangeably, but they are in fact, two distinct things: “Hispanic” refers to people who speak Spanish and/or are descended from Spanish-speaking populations and “Latino” refers to people who are from or descended from people from Latin America. The term “Latinx,” which is used throughout this article, is an increasingly popular ​​gender-neutral or non-binary alternative to “Latino” or “Latina.” “When it comes to researching eating disorders in the Latinx community, the truth is that there is simply not enough research out there,” says registered dietitian, Isabel Vasquez, RD, LDN. “Therefore, we can't be sure that what we consider evidence-based care is truly effective for this population, since they are typically excluded from studies.” In the research that does exist, scientists have seen comparable rates of bulimia and binge eating disorder in Hispanic Latinos and white people, but Latinx individuals fall through the cracks in today’s treatment landscape. Vasquez believes there are a few potential reasons for that. “Obstacles faced by the Latinx population are mental health stigma in the community, financial barriers or lack of insurance coverage, language barriers, lack of diversity amongst providers and patients, and concerns related to immigration status.” According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), BIPOC individuals are significantly less likely than white people to have been asked by a doctor about eating disorder symptoms and as one study demonstrated, both Latinx and Native American participants were significantly less likely than white people to receive a recommendation or referral for further evaluation or care. In addition, BIPOC individuals with eating disorders are half as likely to be diagnosed or to receive treatment. “There is an expectation that eating disorders affect mostly white middle-class adolescents, when in fact Latinx and Asian American communities are impacted at similarly rampant rates—in particular when it comes to bulimia and binge eating disorder,” says Ioana Marcus, PhD, LPC, NCC, a Virginia-based therapist who has worked extensively with adolescents and adults coping with eating disorders and has authored several papers regarding cross-cultural approaches to ED treatment. To Marcus’s point, one study found that Hispanic girls reported significantly greater body dissatisfaction than white girls and researchers concluded that Hispanic girls may be at greater risk for adopting eating disorder behaviors than previously recognized. Eating disorders in general are complex and multilayered psychological illnesses, and while there’s no single reason they develop for anyone, people who identify as Latinx may face distinct and unique risk factors. “The Latinx community's vulnerability to developing an eating disorder could be impacted by a wide array of factors including facing racism and xenophobia in the U.S., assimilation into American culture, being bombarded by unattainable beauty ideals in the two cultures, and a pervasive feeling of not belonging,” Vasquez says. Why eating disorders can be so difficult to identify in the Latinx community According to the National Alliance on Mental Illness (NAMI), one Spanish phrase that’s common in the Latinx community is, “la ropa sucia se lava en casa,” which roughly translates to, “don’t air your dirty laundry in public.” Some people may avoid discussing their mental health issues for fear of being labeled as “locos” (crazy), and others may be concerned about “bringing shame or unwanted attention to their families.” Marcus agrees, adding, “there is a certain level of stigma associated with seeking therapy and treatment, and oftentimes, a need to do consistent psychoeducation with families and parents.” She believes that psychoeducation with family can help address communication surrounding food, appearance, expression of feelings and culturally ingrained patterns that may be negative. Why aren’t eating disorders being treated effectively in the Latinx community? Effective treatment is unfortunately tough to come by in the Latinx community. “The most significant factors preventing individuals from accessing treatment are individual and systemic racism and lack of awareness in the family system, communities, and amongst medical and mental health professionals,” Marcus says. “Additionally, the location of treatment facilities and access to mental health professionals/dietitians, potential language barriers and the prohibitive costs of treatment—particularly inpatient and residential.” Even when Latinx people are able to access care, the likelihood of receiving culturally competent treatment from a trained professional is rare. “Awareness of cross-cultural differences in terms of nutrition and dietary choices is really important,” Marcus says. “I would emphasize the importance of having professionals either immerse in the community or be willing to listen and adapt their recommendations appropriately.” The future of recognizing and treating eating disorders in the Latinx community While adequate research may not yet exist to support the need for nuanced, informed eating disorder care in the Latinx community, both experts and those with lived experience believe increased awareness is the first step in building a better future. “Eating disorders don't have a look,” Vasquez says. “Latinx individuals get eating disorders and deserve to be diagnosed and to receive evidence-based treatment. We need to expand research efforts to include all the communities affected by EDs. We need treatment environments to be more inclusive with a diverse range of providers working at facilities and practicing cultural humility.” Taveras is hopeful that increased awareness will dispel existing assumptions, stereotypes, and myths—both within the Latinx community and outside of it—so more individuals can receive the proper care her friend wasn’t granted. “Eating disorders can affect anybody, and they are mental and physical conditions that require both body and mind treatments to be able to get better,” she says.]]></content:encoded>
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            <title><![CDATA[What Does It Mean to Recover? Insights from Recent Equip Research]]></title>
            <link>https://equip.health/articles/news-and-research/equip-research-defining-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-research-defining-eating-disorder-recovery</guid>
            <pubDate>Mon, 17 Feb 2025 17:19:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders are one of the most complex mental health diagnoses, so it makes sense that coming up with a consistent definition of recovery is equally tricky. Equip’s newest research—featuring nearly 500 people either in recovery from or seeking treatment for an eating disorder—sheds light on the intricacies of the recovery process and what recovery means to different people. Below we’ll unpack some key learnings and insights, touching on the treatment experience, relapse factors, individual definitions of recovery, and more. Defining recovery: a spectrum of experiences Eating disorder recovery remains a deeply personal and evolving concept. But when we asked survey respondents what recovery meant to them, certain themes emerged. Most said that recovery means, among other things: Developing a positive relationship with food and body Freedom from disordered thoughts Physical health However, respondents also reported that challenges can persist even into recovery, and that they sometimes don’t feel “fully” recovered. Among this subset, 93% said they still struggled with disordered behaviors, 89% said they still had disordered thoughts, and 92% said they still have a challenging relationship with food.  Real people define recovery Below are some excerpts from an open-response question that asked respondents to define recovery. “I define recovery as existing without a constant cloud over my head. I know the thoughts will always be there, but recovery to me is making that voice as tiny and as far away as possible, being drowned out by better, healthier, more positive thoughts.” -30-39 year-old pansexual woman “Recovery, I hope, will be one through which I can take my life back and live not crippled by food and body image preoccupations, fostering health in both my body and my mind through good eating habits and self-care. I also do hope to develop self-compassion, build meaningful connections with people, and live a full and purpose-driven life filled with joy.” -18-29 year-old woman “I will feel fully recovered when my eating habits and routine no longer involve the so-called ‘binge/purge’ process. I still experience these encounters less than before. When I can go sustained periods of time—months/years—then I will feel confident of recovery” -40-49 year-old bisexual man  Treatment motivation and effectiveness We also asked people about their motivation for seeking treatment and what treatment they sought. Encouragingly, 64% of respondents cited desire for recovery as a motivating factor, which is contrary to the widespread idea that people with eating disorders don’t want to get better. Other motivating factors were mental health concerns (69%), and physical health risks (65%). Outpatient therapy was the most common treatment setting (67%), followed by inpatient care. Notably, treatment satisfaction was higher among those with strong support networks and access to evidence-based interventions. The most important aspects of treatment that came up again and again were: Multidisciplinary care: Therapists, dietitians, and psychiatrists were key members of treatment teams, with many respondents citing their empathy and personalized approaches as pivotal. Support from others. Nearly half (46%) of those discharged from treatment cited peer support and family involvement as aids in recovery, but the treatment team was the top contributor (78%). Therapeutic tools: Coping strategies, such as challenging negative thoughts and developing resilience, played a critical role in progress.  Barriers and relapse concerns Our research highlights widespread concerns about relapse, with 88% fearing it and 51% having relapsed multiple times. Stress, societal pressures, and co-occurring mental health issues are common triggers. Among those currently in treatment, 40% worry about post-discharge relapse, citing stress, body image struggles, and past relapses. While most (78%) respondents had a positive treatment experience, the high relapse concerns emphasize that recovery isn’t linear—and that treatment must include relapse planning to support lasting recovery. Relapse insights Every relapse is different, but some patterns emerged among respondents. Timing: Most relapses occurred within two to six months of discharging from treatment. Stigma and isolation: Marginalized groups, including LGBTQ+ and racial minorities, reported higher vulnerability to relapse due to systemic inequities and lack of affirming care. Gender differences. While men and women share similar relapse rates, women more frequently report disordered thoughts, mental health, stress, and social media as a concern. Body image. Body image concerns were more frequently mentioned by younger respondents (18–29 years) across all genders.  Real people speak about relapse “Looking at myself in the mirror or in unflattering photos makes me feel like completely relapsing. Plus, food costs cause me to think that eating is optional.” -18-29 y/o queer man “When I feel overwhelmed by stress, loneliness, or sadness, I notice those feelings can make me more vulnerable to old patterns. It's hard to resist the urge to cope in unhealthy ways during those moments.” -30-39 y/o Black woman “It feels unavoidable. A lot of the social media content I interact with serves as a huge trigger because they are all so thin and beautiful. Even the thought of shopping can trigger a relapse since I have to see how my sizes fluctuate (even though I know sizing isn't standard—at all).” - 18-29 y/o Asian woman  Spotlight on marginalized groups Our study highlighted disparities in treatment experiences among marginalized populations, like LGBTQIA+ individuals and racial minorities: LGBTQ+ community Stigma and lack of gender-affirming care were significant barriers to treatment, and family support emerged as a critical factor for recovery. Nearly half (44%) of survey respondents identified as LGBTQIA+, highlighting the disproportionate impact that eating disorders have on this community.  Racial minorities Black respondents were more likely to rely on intensive treatment, and reported positive outcomes linked to family involvement and community-based support. BIPOC individuals were twice as likely to cite pressure to recover fast and unrealistic goals as a barrier to treatment progress compared to white individuals (10% vs. 5%). Considering that +50% of LGBTQIA+ youth have an eating disorder, and that BIPOC individuals are half as likely to be diagnosed or receive treatment, there’s work to be done in supporting these communities better in treatment. Learn more about eating disorders in LGBTQIA+ and BIPOC populations. Looking ahead: a call to action The path to eating disorders recovery is challenging, but recovery is both possible and worth it for everyone affected by an eating disorder. The perspectives shared in our survey reveal these challenges, as well as the resilience and hope within so many people struggling. Sustainable recovery for everyone requires: Accessible care: Affordable, evidence-based treatments tailored to individual needs. Community support: Peer networks and family involvement are crucial for lasting change. Holistic approaches: Treatment that addresses mental, physical, and emotional health, as well as co-occurring conditions, is essential. This research is a powerful reminder of the ongoing work needed to support those on their recovery journeys. By amplifying diverse voices and addressing systemic barriers, we can build a future where it’s possible for everyone to not only achieve recovery, but maintain it long-term as well. Learn more about accessible, evidence-based eating disorder treatment at Equip.]]></content:encoded>
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            <title><![CDATA[Social Media and Eating Disorders: What Parents Should Know (and Do) to Protect their Kids]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/eating-disorders-social-media</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/eating-disorders-social-media</guid>
            <pubDate>Sun, 18 May 2025 18:21:00 GMT</pubDate>
            <content:encoded><![CDATA[It started when Equip Family Mentor Christa Marlow’s daughter began exploring “healthy” lifestyle ideas on Instagram at the age of 15. “Unfortunately, the algorithms quickly directed her towards content centered on weight loss, food restriction, intermittent fasting, and, eventually, explicit pro-anorexia material,” Marlow says. “These ‘pro-ana communities’ which idealize and promote eating disorders, had a devastating effect on her.” Marlow’s daughter soon developed severely restricted eating habits and became compulsively focused on exercise. Not long after, as Marlow puts it, anorexia firmly took hold. “Her social media feeds became dominated by pro-eating disorder posts, which unfortunately reinforced her illness and significantly complicated her recovery,” she says. Marlow’s story is heartbreaking, but not unique. Social media has a significant impact on the mental health of young people, and this includes heightened risk for developing body image issues, disordered eating, or eating disorders. Read on to learn everything you need to know about eating disorders and social media, including why it can be so harmful and expert-endorsed strategies for protecting your child from the risks. Social media, young people, and mental health It’s no secret that social media has a massive impact on young people. According to the U.S. Department of Health and Human Services, up to 95% of young people aged 13 to 17 report using a social media platform. Nearly two thirds of teenagers report using social media every day, and one third use social media “almost constantly.” That nonstop exposure to platforms like Instagram and TikTok can have serious consequences: according to that same report from DHHS, children and adolescents who spend more than three hours a day on social media face double the risk of mental health problems as those without such exposure. Considering that teens spend an average of 3.5 hours a day on social media, this is particularly concerning. Beyond raising risk of anxiety and depression, another way that social media impacts mental health is its effect on eating and body image concerns. A 2022 survey found that when asked about the impact of social media on their body image, 46% of adolescents aged 13 to 17 said social media makes them feel worse. And as a 2017 study found, there is “a strong and consistent association between social media use and eating concerns” in young adults between 19 and 32 years old. Research shows that most adolescents in the United States have been engaging with media in general (including TV, movies, podcasts, etc) on a daily basis throughout their youth, and social media in particular has both positive and negative effects. While nearly half of those surveyed reported that social media improved friendships and the majority felt it helped them feel more socially connected and emotionally supported by their peers, many reported that it had a negative impact on their grades and their body image.  How social media increases eating disorder risk It’s true that explicit “pro-ana” and “thinspiration” content has existed in corners of the internet for decades, but the landscape has changed dramatically over time. “Social media has been both subtly and actively promoting eating disorder-related content for a long while,” says Equip Therapy Lead Jonathan Levine, LCSW. “But one major shift now compared to 10 years ago is the power and prevalence of algorithms dictating people's feed, versus following people intentionally.” In other words, while pro-eating disorder content has been available for years, you generally had to actively seek it out—now it’s often served up, unsolicited. “There were a plethora of ‘pro-ana’ blogs on Tumblr and throughout the internet that required someone sending you a link or finding it on your own,” Levine says. “The shift towards algorithmic social media has increased damage by bringing people to eating disorder content without their direct intention or goal. This is certainly worse and more dangerous: what once required informed consent—or at least curiosity—now can be programmed to be brought to you, leading people to spiral down into dangerous beliefs that normalize disordered behaviors and increasing risk for the development of an eating disorder.” “Popular trends like ‘What I Eat in a Day’ and ‘Get Ready With Me’ videos can easily expose young users to dangerous content,” Marlow says. “A particularly alarming recent trend on TikTok, known as ‘SkinnyTok,’ openly promotes toxic diet culture. While movements promoting body positivity, body neutrality, and Health at Every Size have gained traction, the pressure for perfection is also amplified by advanced filters and editing tools.” It’s worth acknowledging that some social media platforms have implemented official policies against the promotion of eating disorders. For example, certain hashtags are blocked on these platforms, and the processes to report and block harmful content have become easier to navigate. However, Marlow points out that pro-eating disorder communities have adapted to the changes in order to avoid detection, by concealing themselves within seemingly harmless wellness, fitness, and diet communities and utilizing less regulated chat apps.  Tips for protecting your kids from harmful content To parents, all of the above can feel extremely scary—but while it may be unrealistic (if not impossible) to completely shelter your kids from social media, there are ways to reduce its risks. Marlow and Levine shared their insights on how parents can protect their children from harmful content and help them build a healthy relationship with food and their body during this vulnerable stage of life. Keep close watch Given the amount of negative or dangerous content online, it’s crucial for parents to remain involved in monitoring what their kids see, and being open to discussing it. “Regularly review your child's social media activity, ideally in a way that fosters open dialogue and trust,” Marlow says. “Talk to them directly about any concerning content you observe.” Levine agrees, noting that parents should also feel empowered to utilize safety measures and available tools whenever possible. “Use parental controls,” he says. “Watch your child's social media feed with them occasionally to gauge the type of content they're receiving and interacting with.” Among the options available, Marlow suggests tools like Bark or Qustodio, and features such as restricted modes on platforms like TikTok, Instagram, and YouTube, which can help filter out potentially harmful content. “Setting limits on screen time and implementing a ‘no-device’ policy overnight can also be beneficial,” she says. Encourage them to follow body positive and diverse accounts In addition to helping kids find and follow accounts dedicated to body diversity and Health at Every Size (HAES), Marlow suggests unfollowing or blocking accounts that promote dieting, extreme fitness, or “thinspo.” Doing so not only helps protect them from harmful content, but also provides an opportunity to highlight the ways in which social media is misleading. “Engage in regular, open, and honest conversations about the potential dangers of social media,” she says. “Help them understand that many online images are heavily filtered and edited and do not reflect reality. Discuss why certain types of content can be harmful, the impact of comparison culture, and how social media often promotes unrealistic appearance standards.” Monitor your own language While social media is full of potential hazards, don’t forget about the offline factors that could negatively impact your child too, like the use of derogatory, fatphobic, or otherwise diet culture-coded terminology. “Utilize neutral language around body types, food, and exercise, and avoid attaching your child's worth to their body,” Levine says. “Promoting a body-positive home environment is equally important,” Marlow adds. “Emphasize health and overall well-being rather than focusing solely on appearance. Model positive attitudes towards food and body image, and avoid negative self-talk or negative comments about anyone's body. Encourage a balanced lifestyle that includes a variety of foods and enjoyable physical activities, rather than focusing on restriction or exercise as a means to achieve a specific body type.” Stay vigilant for potential warning signs. “Be on the lookout for any changes in your child's eating habits, such as expressing a desire to eat ‘healthier’ or cutting out previously enjoyed foods, as well as an increasing obsession with weight, exercise routines, or appearance,” Marlow advises. “Stay alert for changes in mood, relationships, or signs of emotional withdrawal. Trust your instincts and seek professional help promptly if you have concerns about your child's behavior.” Marlow reiterates that while social media can offer some benefits for young people—like connecting with friends and family and fostering creative expression—it can also be extremely detrimental to their mental health. “The constant exposure to comparisons, unrealistic appearance standards, unhealthy diet advice, and eating disorder content poses significant risks,” she says. “Young minds are particularly vulnerable to the negative aspects of social media, as they are in the process of developing their sense of identity and self-worth.” The Equip takeaway on eating disorders and social media Despite the abundance of harmful content circulating on social media, there is good news here: parents have the authority and influence to truly make a difference and help protect their kids from these hazards in myriad ways. “Social media is prevalent and disordered eating is normalized—as are eating disorders in some parts of the internet,” Levine says. “Stay vigilant and model behaviors that value your own worth as related to your actions, not your body or what you eat. Social media is powerful, but role modeling is more powerful!” If you’re concerned that your child might have an eating disorder, take Equip’s eating disorder screener or schedule a call to talk through your concerns.]]></content:encoded>
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            <title><![CDATA[What Is Pediatric Feeding Disorder? What Parents Should Know]]></title>
            <link>https://equip.health/articles/understanding-eds/pediatric-feeding-disorder-parents-guide</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/pediatric-feeding-disorder-parents-guide</guid>
            <pubDate>Tue, 29 Apr 2025 23:23:00 GMT</pubDate>
            <content:encoded><![CDATA[Until I gave birth to my daughter last fall, I couldn’t have imagined just how complex, nuanced, and challenging it could be to feed a small child. Whether feeding by breast or bottle, I was amazed (and, frankly, overwhelmed) to learn how subtle a child’s hunger cues can be and how many strategies exist to ensure a baby receives the nourishment required to thrive. According to the nonprofit organization, Feeding Matters, there are 26 muscles and six cranial nerves involved in perfectly executing one single swallow. And when one or more of those necessary parts are missing or malfunctioning, eating and drinking can become extremely difficult if not impossible for a young child. When this happens, it results in a serious issue called pediatric feeding disorder, or PFD. While pediatric feeding disorder may not be a condition that many people are familiar with, it affects more than one in 37 children under the age of five in the United States each year. Infants and children with pediatric feeding disorder may experience pain, fear, or anxiety about eating, leading to compromised nutrition, growth, and general well-being. Pediatric feeding disorder is a feeding disorder, not an eating disorder, but it has many overlaps with eating disorders and can have similarly serious consequences. It’s important that parents are aware of the risks of pediatric feeding disorder, how it could potentially lead to an eating disorder, and what to do if you’re concerned about your child. Read on to learn more about pediatric feeding disorder, symptoms to look out for, treatment options, how to get help, and more. What is pediatric feeding disorder? While there’s not a universally accepted definition for pediatric feeding disorder, researchers have proposed defining it as “impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.” “Pediatric feeding disorder is a condition that reflects problems with the age-appropriate skills or processes needed to eat,” explains Equip’s Vice President of Program Development, Jessie Menzel, PhD. “Pediatric feeding disorder has always been around, although not necessarily captured by a single, unifying diagnostic classification system. In the past, different professional fields have referred to the feeding challenges captured by PFD using their own terminology.” According to Menzel, pediatric feeding disorder is associated with impairment in one of the following categories: Medical: this can include allergies, gastrointestinal conditions, or genetic disorders Nutritional: many children with PFD have a restricted quality, quantity, and/or variety of foods, increasing the risk of malnutrition, micronutrient deficiency, dehydration, and more Skills-based: when a child lacks the oral or motor skills needed to consume food Psychosocial: this can include developmental factors, mental and behavioral health problems, social influences, environmental factors, and more Menzel shares some specific examples of what those impairments could look like: An infant who experienced early medical trauma and developed an aversion to feeding A toddler who has never eaten foods with chewy or challenging textures and has a strong emotional response to being asked to try new foods at meal times A young child who lacks the fine motor skill coordination to feed themselves using utensils and requires assistance to eat. “Basically, PFD can be present any time feeding or eating is hard, scary, or painful for a child,” Menzel says. Pediatric feeding disorder, along with avoidant/restrictive food intake disorder (ARFID), is one of several feeding disorders, which are defined as “a range of eating activities and behaviors that may or may not include problems with swallowing.” There’s not one hard and fast line between feeding and eating disorders, but the latter tends to affect older children, teens, and adults, and involves a significant mental health component, whereas the former tends to affect young children and generally has a physiological root. ARFID is unique in that it can be considered both an eating disorder and a feeding disorder, whereas pediatric feeding disorder is strictly a feeding disorder. Symptoms of pediatric feeding disorder Because pediatric feeding disorder can be linked to difficulties in one of four domains, the signs and symptoms can vary widely and can affect kids at various developmental stages, from birth to school age and beyond. “There are a number of different symptoms that may indicate the presence of pediatric feeding disorder, and they vary based on whether PFD is associated with medical, skills-based, nutritional, or psychosocial impairments,” Menzel explains. Some potential symptoms of pediatric feeding disorder include: Vomiting Physical discomfort when eating or drinking Crying, gagging, coughing, grimacing while eating Weight loss or lack of growth Dependence on supplements Dependence on tube feeding Lack of dietary variety Avoidance of specific food textures Need for special equipment to eat or feed Failure to advance textures of foods Difficulty chewing Excessively long or short mealtimes Mealtime anxiety Inability to eat outside the home or with others Tantrums at meals Refusal to eat Note that while several of these symptoms overlap with the symptoms of ARFID, they are distinct conditions and require different treatment. Health risks of pediatric feeding disorder “Pediatric feeding disorder can have devastating consequences for a young child and their family,” Menzel says. “Because PFD can present so early in a child’s life, sometimes at infancy, there are significant and dangerous risks to a child’s ability to grow and develop.” In addition to failure to thrive (when a child’s weight or rate of weight gain is significantly below that of other similarly aged children of the same sex), PFD is associated with malnutrition, aspiration (when food accidentally enters the airways), dehydration, and allergic reactions. Beyond the immediate physical risks, Menzel adds that pediatric feeding disorder can have a profound impact on the family system. “Often, PFD causes significant stress in the relationship between child and caregiver,” she says. “Children may develop significant anxiety or aversion to food and mealtimes. PFD can also result in financial strain, as children with PFD may need to see multiple specialists and require in-home therapy or special equipment to feed.” Pediatric feeding disorder vs. ARFID Menzel notes that the delineation between pediatric feeding disorder and ARFID is currently a major topic of discussion in each respective field. “Generally, experts in these fields agree that there is a significant overlap between PFD and ARFID, particularly when PFD is associated with impairment in the nutritional and psychosocial domains,” she says. In fact, Menzel and several other experts in both ARFID and PFD recently published a consensus paper on the overlap between the two conditions, which underscored the need to both improve diagnostic criteria and educate more clinicians on how to identify and distinguish between PFD and ARFID. Both PFD and ARFID can result in the following symptoms: Mealtime anxiety Tantrums Food avoidance and restriction Weight loss or failure to grow Poor appetite or lack of interest in food Limited dietary variety Despite these similarities, Menzel says a key differentiator between pediatric feeding disorder and ARFID is the extent to which the eating or feeding problems are related to a child’s development of age-appropriate feeding skills. “The primary developmental window for acquiring feeding skills is between birth and five years of age, after which feeding skills continue to progress and be refined,” she says. “Any feeding or eating challenges that present before a child has met all of their developmental feeding milestones should be strongly considered for pediatric feeding disorder.” According to Menzel, experts in both fields agree that feeding or eating problems primarily associated with medical or skills-based impairments reflect pediatric feeding disorder and not ARFID— although these impairments have the potential to lead to ARFID over time. “In general, in young children, any feeding or eating challenges should be thoroughly assessed for PFD,” she says. How is pediatric feeding disorder treated? Because eating is such a complex process—especially during early development—Menzel explains that treatment of pediatric feeding disorder largely depends on which domain(s) a child is experiencing impairment in: Medical impairment: For those with medical conditions that contribute to feeding or eating problems, healthcare providers such as gastroenterologists, developmental pediatricians, cardiologists, or allergists may need to be involved in treatment. Nutritional impairment: Those who need help expanding dietary variety, resolving malnutrition, or addressing specialized dietary needs or challenges may benefit most from working with a dietitian. Skills-based impairment: “Speech language pathologists or occupational therapists can address any skills-related deficits that make eating challenging,” Menzel says. Psychosocial impairment: “Psychologists use behavioral and psychotherapeutic approaches to address difficult mealtime behaviors, anxiety or fear, and improve child-caregiver interactions,” Menzel says. What to do if you’re concerned your child has PFD Trying to discern whether your child has any type of feeding difficulty can be scary, but it’s important to stay calm and consult a medical expert. “Pediatricians are commonly the first point of contact for identifying PFD,” Menzel says. “They will be able to facilitate the appropriate referrals to the right specialist who will be able to evaluate your child further, depending on the domain where you are seeing problems.” Another great place to start is Feeding Matters. Originally known as Parent Organized Partnerships Supporting Infants and Children Learning to Eat (P.O.P.S.I.C.L.E.), Feeding Matters was founded in 2006 by Shannon and Bob Goldwater when their newborn triplets struggled to eat. Today, the organization continues to advocate for families affected by pediatric feeding disorder, as well as educating the public about the condition and researching treatment and support options. And as with all things parenting-related, it’s important to listen to your own intuition and trust your gut. If you suspect something is wrong or causing your child pain, fear, or anxiety around food, seek professional help immediately. “Parents shouldn’t hesitate to raise concerns about a child’s eating, growth, or development,” Menzel says.]]></content:encoded>
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            <title><![CDATA[How to Help a Friend with Bulimia: What to Do if You’re Worried]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/how-to-help-a-friend-with-bulimia</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/how-to-help-a-friend-with-bulimia</guid>
            <pubDate>Wed, 17 Apr 2024 15:27:00 GMT</pubDate>
            <content:encoded><![CDATA[When Equip Lead Peer Mentor Makailah (Mak) Dowell reflects back on her teenage years living with bulimia and binge eating disorder (BED), she vividly remembers the isolation and loneliness. “I didn’t tell anyone and I was barely diagnosed due to the biases at play in my own healthcare,” she says. “I learned how to suffer in silence really, really well.” Dowell’s one reliable source of comfort through the struggle was her best friend, Olivia. “She would always call me to leave the house, take me to the movies with her family, and include me in any type of plans she had,” she says. “As an only child being raised by my single-parent grandparent, her family took me and my grandma in.” Anyone who has ever witnessed a friend navigate the treacherous path of an eating disorder has likely wondered how to be a supportive and nonjudgmental ally, like Olivia was for Mak. And while all eating disorders tend to come with shame and secrecy, this can be especially true for bulimia—making it harder for the person struggling to ask for and receive support, and for loved ones to offer it. But that support is so important, and can even be life-saving. Read on for expert-approved guidance on how to help a friend with bulimia. Why it’s so hard to know if someone is a struggling with bulimia It can be particularly tough to know when and how to talk to a friend about their concerning behaviors if they haven’t confided in you about their disease. In some cases, they may not even be aware that they have a problem. The first step in determining whether or not someone is dealing with bulimia is knowing what, exactly, it is. As Equip Therapy Lead, Maddie Friedman, LCSW, defines it, bulimia is a disorder characterized by episodes of binge eating followed by compensatory behaviors to “get rid of” or “make up for” the food, known as purging. These behaviors and health risks can include everything from self-induced vomiting and laxative/diuretic use to over-exercising, fasting, and taking diet pills. While those unfamiliar with the disorder may assume the signs of bulimia are easy to spot, Friedman underscores just how hidden the issue can be. “Bulimia is often shrouded in shame and guilt, and thrives in secrecy,” she says. “Needless to say, these eating disorder behaviors can feel all-consuming and can result in people really dropping out of their lives: drifting away from close friends and family, disengaging from responsibilities and hobbies, and finding less joy in previously enjoyed activities.” Dowell knows from her own experience and from working with others that detachment from the outside world can be a red flag. “​​One of the biggest signs of bulimia is isolation,” she says. “If your friend is gone for long periods of time or canceling plans more consistently than before, then you should check in. Most people in recovery mention that isolation allowed the eating disorder to thrive.” Why friends are so important in the recovery process Research has shown that having a strong support network can make a world of difference in eating disorder recovery, so it’s important for friends and loved ones to know how impactful their words and actions can be. In fact, many people who have overcome eating disorders cite these supportive relationships as one of the key factors in their recovery. Since social isolation is such a common aspect of eating disorders like bulimia, actively supporting a friend who is struggling can help disrupt and dismantle problematic thoughts and behaviors that tend to be amplified in secrecy. “We know that bringing your village to treatment can enhance treatment outcomes, because it challenges the secrecy that often maintains eating disorder behaviors,” Friedman says. “When supports can rally around a loved one to promote treatment and recovery, they may be more likely to reconnect with their values and life worth living outside of the eating disorder, which can be motivating despite the hardship.”  How to help a friend with bulimia who isn’t in treatment If you’re worried that a friend is dealing with bulimia but they haven’t yet sought help, there are things you can do to help them get there. In some cases, a friend may not be aware of their concerning behaviors, or they may refuse treatment because they don't believe they’re “sick enough” to seek help. Here are some ways to gently guide them toward recovery: Call for backup if you need it. If you’re certain a friend is struggling with bulimia but they haven’t expressed interest in treatment, Friedman says this may be an opportunity to bring in reinforcements. “Depending on the circumstances, it may be helpful to offer to contact their loved ones or help connect a friend to bulimia treatment,” she says. Help with logistics. Another way to show solidarity and support a friend’s path toward recovery is to encourage or even supply food options, since simply deciding what to eat and making it can be a barrier. “You can offer to provide meal or snack support and help normalize regular eating, aka three meals and two snacks a day,” Friedman says. “Eating regularly is often one of the most helpful strategies to discourage binge eating because it disrupts the binge/restrict cycle. If folx are feeling nourished and energized, it may decrease the likelihood of engaging in binge behaviors that promote compensatory behaviors.” Just be there. Dowell says that simply being present and making yourself available can also go a long way in making a friend feel unconditionally supported. “Invite your friends out, come to them, and be there to help with distress tolerance,” she says. “My best friend would always take me out of the house and be there to enjoy food with me and watch a movie afterward. This didn’t allow the eating disorder to bully me into behaviors, and helped me to distract and enjoy a good show with my friend.” Friedman seconds this recommendation, noting that if a friend isn’t willing to seek care, “you can offer to partner with them during high vulnerability moments to resist eating disorder urges and behaviors like binging or purging.” Remember to care for yourself. While it’s commendable to want to make sacrifices to help a friend in need, Friedman also points out the importance of self-care and boundary-setting through the process. “Please also know that peer support and professional support for eating disorders exist!” she says. “You do not have to take it all on, even if your loved one isn’t willing to seek care. Boundaries are important and caregiver burnout is real.” How to help a friend with bulimia who is already in treatment The recovery process can be incredibly challenging, even with a team of experts guiding the way. Plus, having the support of loved ones outside of treatment can improve a person’s odds of achieving lasting recovery. Here are a few ways to continue supporting a friend as they navigate treatment for bulimia: Validate their hard work. “Offering validation and support to loved ones in treatment can be critical,” Friedman says. “Treatment is really hard, and tends to be very upsetting and draining initially. Normalizing that treatment is worth it, even when it feels hard, can be super helpful. People often feel very torn between their eating disorder and their sense of self when they begin treatment, and being a consistent source of support through the storm can promote treatment compliance.” Let them guide the conversation. Though it comes from a good place, it’s never helpful to force a conversation about how recovery is going. “Someone in treatment may want to compartmentalize their life in recovery or get done with treatment and move on,” Dowell says. “Depending on your friend, you may be talking about their recovery or never talk about it explicitly. Both ways are fine! As long as you both agree that the relationship is supportive.” What may not be helpful for a friend struggling with bulimia? While there are plenty of constructive ways to approach and support a friend, it can be beneficial to understand why some tactics and strategies—even when well-intentioned—may not be helpful. If you’re worried about a friend with bulimia, here’s what not to do: Express judgment. “If you suspect a friend is struggling with bulimia, it is always best to approach with curiosity,” Friedman says. “Refrain from confrontation or accusation, and give them space to come to you for support. Since eating disorders can be such powerful drivers of behavior, they can really disrupt relationships. It’s important to remember that your loved one is still there and is often fighting beneath the influence of the eating disorder. When we approach folx who are in the throes of an eating disorder forcefully, we’re more likely to trigger shame and guilt, and promote further isolation.” (Check out this guide on how to avoid triggers.) Offer unsolicited feedback. “I would start by respecting your friend’s agency and checking in with them first,” Dowell says. “If you suspect something, you can ask, ‘are you facing any challenges you want to let me know about?’ or ‘I noticed you haven’t been hanging out with me as much as before, has anything changed?’ Even asking, ‘how is your mental health?’ can open up a bigger conversation.” Shoulder all the responsibility yourself. If a friend doesn’t seem receptive to the conversation or chooses to avoid the subject, Dowell says this may be time to reach out to one of their loved ones for extra support. “It’s always important to respect your friend’s agency and start with curiosity,” she says. “Then once you understand that your friend needs support, reach out.” If you’re wondering how to help a friend with bulimia, you’re already on the right track. Supportive relationships can make a significant impact on a friend’s recovery, but it’s important to help out thoughtfully. By continuing to care for yourself and understanding how to approach a delicate issue like bulimia, you’ll be empowered to show up as a prepared, empathetic, and compassionate friend. “Olivia was a part of my recovery and still a part of my life,” Dowell says. “I’m grateful and privileged to say that I am the godmother to her first child born this year. These 15 years of friendship continue to be a place of support, love, and leaning on each other.”]]></content:encoded>
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            <title><![CDATA[Ask a Provider: What's the connection between food insecurity and eating disorders?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/food-insecurity-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/food-insecurity-and-eating-disorders</guid>
            <pubDate>Thu, 16 Nov 2023 19:53:00 GMT</pubDate>
            <content:encoded><![CDATA[Food insecurity is a growing issue in America: 12.8% of U.S. households, approximately 17 million people, had some form of experience with it in 2022. Food insecurity includes having unstable or inadequate access to food due to factors such as socio-economic status, geographical limitations, or climate-related displacement. With food prices rising, and food deserts limiting access to quality food, more people are facing the physical and mental health consequences of food insecurity. One of those issues is an increased risk for eating disorders. One study found that up to 17% of those who experience child hunger go on to report eating disorder symptoms in adulthood. In addition, 47% of adolescents who experience food insecurity report unsafe weight control behaviors. Other studies have found a distinct connection between food insecurity and an increased risk for bulimia and binge eating disorder. Both of these illnesses are perpetuated by the binge-restrict cycle: exhaustion and hunger leads to a period of bingeing due to your biological need to get out of a starvation state. A lack of sufficient food access in food insecurity can mimic the restriction that is present in dieting—and can ultimately also lead to binge eating (and in the case of bulimia, purging). To get a dietitian’s perspective on the link between food insecurity and eating disorders, we interviewed Amye O'Neal, RDN, LDN, Clinical Dietitian at Equip. Here’s what she advises providers to know about this topic. What’s the relationship between food insecurity and the development of eating disorders?  There is no single root cause to an eating disorder; it’s the culmination of a perfect storm of factors. Regular and safe access to food is one key factor for many patients. Put in simple terms, when someone lacks adequate food for a period of time, their body doesn’t understand why there’s no food and responds to the lack of food as if there is a famine. Their metabolism slows down to conserve energy. Their body shifts into survival mode. When the person then has access to food again, their brain can signal them to eat as much as possible (which often constitutes binge eating) in anticipation of another famine. While food insecurity can play a significant role, it’s important that a patient’s care team also address other key contributing factors, such as ongoing medical/health concerns, weight stigmatization, and racial discrimination. How would you work with a patient who’s experiencing food insecurity and also suffering from an eating disorder?  Often the most important thing for patients experiencing food insecurity is to help them eat enough calories. Using an “all foods fit” philosophy can help to first ensure a patient is meeting their caloric needs. Nutrition deficiencies are also common, and include iron, iodine, Vitamin A and Vitamin D. Generally under-eating and unintended restriction of food groups is the typical cause for these nutrition deficiencies. Of course, having access to the food to correct nutritional deficiencies or get enough calories isn’t a guarantee for individuals with food insecurity. That’s where the advocacy of a provider, especially a dietitian, can step in. They can help provide nutrition education, unpack common food myths, assist in cheap meal planning, and support efforts in finding free food programs, grocery store reward programs, coupons, and other strategies to reduce food costs or increase quantity. What are the ties between food insecurity and mental health? The socio-economic factors that contribute to food insecurity are complex and multifaceted. Financial hardships can make it difficult for individuals to meet their basic needs, including clothing, shelter, and food. Health insurance is another cost barrier that can prevent individuals from accessing the care they need to recover from eating disorders. These financial hardships can also lead to high levels of stress, which can negatively impact the body and make it difficult for individuals to focus on their recovery. In times of stress, it’s normal for humans to seek comfort, which can increase the risk of a relapse, or of maladaptive coping strategies such as substance use. 
 Anything else you’d like providers to know about diagnosing or treating eating disorder patients who experience food insecurity? Typically food insecurity doesn’t happen in isolation. There are usually other socio-economic factors at play that can also affect a patient’s recovery journey, such as challenges related to substance use, transportation, health care, or housing. They may have difficulty storing and preparing food due to lack of resources or facilities. Providers need to understand these complex factors that affect eating behaviors, and avoid blaming or judging a patient for their situation. Instead, a spirit of collaboration with patients can lead to realistic and flexible solutions that suit their needs and preferences. Eating disorder treatment has the power to help people transform their relationship to food, and that can include gaining support and tools for combating food insecurity. Equip supports families facing food by taking extra steps to assess their needs and connecting them with resources in their community such as SNAP benefit enrollment or local food banks. We can’t expect people to recover from their eating disorders if they don’t have the tools they need to live full, happy lives.]]></content:encoded>
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            <title><![CDATA[Eating Disorders in Men and Boys Can Look Different. Here’s How. ]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-in-males</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-in-males</guid>
            <pubDate>Wed, 25 Nov 2020 17:23:00 GMT</pubDate>
            <content:encoded><![CDATA[I was always the tallest kid in my class, a not-so-subtle feature of mine I liked quite a bit. I would look at my growth chart and projected adult height and feel on top of the world (almost literally). I had a bit of a belly, as many kids do, but it didn’t bother me much—until, suddenly, it began drawing unwanted attention. As I got older, kids started to comment about my weight in a rather malicious way. I tried not to let it bother me, but that became increasingly difficult. I continued to gain weight, and when the next-size-up pants didn’t fit, my mom suggested I try a “husky” fit (for those who didn’t live through it, “husky” was a sizing category for boys in bodies that were larger than “normal” sizing could accommodate). I couldn’t pretend to be unbothered anymore. Was I husky? What did that even mean? I wore the pants, begrudgingly, feeling self conscious and unhappy about the way I looked. I began trying to change my body: I dabbled in diets in middle school, then started working out more intensely in high school in an effort to lose weight. But nothing really stuck until college, when I became more diligent about dieting and exercise and lost a significant amount of weight. After losing the weight, I distinctly remember finishing some laps at our community pool and a neighbor commenting to me that I looked “athletic.” As a nerdy Jewish kid with poor hand-eye coordination, I couldn’t remember ever hearing my name and the word “athletic” in the same sentence. It felt great. I went back to the locker room and flexed in the mirror, noticing the tone of my muscles. That seemingly innocuous comment reinforced the efforts I’d been making, and I doubled down on my weight lifting, biking, and dieting. Although I never met formal criteria for an eating disorder, I could see my behaviors becoming unhealthy. And like so many men who remain undiagnosed or are diagnosed late, I couldn’t see the negative effects my behaviors were having. How eating disorders present in men and boys Although many people perceive eating disorders to overwhelmingly affect women, about one in three people with an eating disorder identify as male, and an estimated 10 million American men will have an eating disorder at some point during their lifetime. Men and boys are also nearly as likely as women to have disordered eating behaviors that don’t meet criteria for an eating disorder. Despite all this, men and boys are far less likely to seek treatment for eating disorders than women and girls. There are several reasons for this discrepancy including stigma and gender differences in presentation—meaning the way eating disorders tend to show up in men and boys vs the way they tend to show up in women and girls. Men with eating disorders generally have a later onset of illness than women, with eating disorders usually developing later in their teenage years. In terms of eating disorder behaviors, men are less likely to struggle with “emotional eating,” to report out-of-control binge eating, or to use laxatives or induce vomiting than women. Men and boys who seek treatment for eating disorders are less likely to say they have body dissatisfaction, and generally strive to be lean and muscular as opposed to thin. In the newest edition of the DSM (the handbook containing information detailing all psychiatric disorders), there’s a description of “muscle dysphoric disorder,” which is characterized by a preoccupation with the idea that one’s body isn’t sufficiently muscular and behaviors like dieting, weightlifting, and steroid use. Muscle dysphoric disorder isn’t considered an eating disorder, and there’s controversy over whether it should be; however, the fact is that men with muscle dysphoric disorder have similar rates of weight concerns and restrictive dieting as men with anorexia. Risk factors for eating disorders in men and boys First off, it’s important to note that eating disorders don’t discriminate: they affect people across gender, age, race, socioeconomic status, body size, and more. However, there are certain characteristics that are associated with an increased risk of developing an eating disorder in men and boys. Men with eating disorders often have a history of being “overweight” when they were younger. Interestingly, obesity in boyhood is associated with greater risk for development of an eating disorder later in life. And although many women with eating disorders have a perception that they were overweight, more typically they have a “normal” weight history. Another important consideration is history of sexual abuse, as an estimated 30% of people who struggle with an eating disorder experienced sexual abuse at some point in their lives. Men are less likely to report sexual abuse than women, most likely because of increased feelings of shame and stigmatization. Because most perpetrators of sexual assault are men, men and boys who are victims of sexual assault often experience conflicts related to their sexuality and sexual orientation They may cope with those conflicts by restricting what they eat in order to delay the development of secondary sex characteristics. Body image distress is also more common in men who were victims of sexual abuse. Sexual orientation and gender identity also come into play. Although an estimated 5% of the total population of men identify as gay, that number is 42% among men with eating disorders. Men who identify as gay or bisexual are also more likely to have eating disorder behaviors than heterosexual men. Interestingly, gay men who report feeling connected to the gay community are less likely to have eating disorders than those who do not. The relationship between gender identity and eating disorders is complex, and there are relatively few studies examining eating disorders in transgender individuals. However, the evidence that does exist reveals much higher rates of eating disorders in transgender people compared to those who identify as cisgender. One study found that gender non-binary individuals were over three times more likely to have a diagnosed eating disorder relative to those with a binary gender, while another found transgender college students had significantly higher rates of self-reported eating disorder diagnoses compared to heterosexual cisgender women. Some transgender folks report a desire for thinness as a way to alter their gender expression, and that gender reassignment procedures led to an improvement in some disordered eating behaviors. Overall, despite the fact that men and boys represent a significant proportion of people with eating disorders, many—perhaps the majority—go undiagnosed and even fewer seek treatment. One of the first steps toward changing this reality is educating both the public and healthcare providers about the different and unique ways that eating disorders show up in men and boys. The sooner we can throw out stereotypes and see eating disorders in the many different ways they show up in all populations, the sooner we can get treatment to everyone suffering.]]></content:encoded>
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            <title><![CDATA[Debunking 4 Common Myths about Bulimia]]></title>
            <link>https://equip.health/articles/understanding-eds/common-myths-about-bulimia</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/common-myths-about-bulimia</guid>
            <pubDate>Thu, 16 Mar 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[  Growing up, Equip Peer Mentor Makailah Dowell remembers learning about the dangers of just one type of eating disorder. “I was taught anorexia is an awful and deadly disease,” she says. “It seemed that bulimia was less dangerous than anorexia, a myth that made it easier for me to let it into my life.” Dowell says that because no one ever explained to her the dangers of bulimia, she wasn’t aware of the insidious aspects and potentially fatal consequences of the illness—and neither were her loved ones. “My grandmother thought it would be easy to tackle my bulimia and understand how to prevent and stop it,” she says. “But she didn't know my eating disorder could thrive in new ways. Like all eating disorders, bulimia is embedded in secrecy, and I got creative with my dishonesty.” Given her personal experience, Dowell believes that one of the biggest myths about bulimia is that it’s easy to identify s. The truth is, bulimia is a complex disorder and can manifest in a myriad of different ways. While people of any size can suffer from any eating disorder, individuals with bulimia are even less likely to exhibit weight-related symptoms than individuals with anorexia, which can make the illness harder to identify. According to one study, about 65% of people with bulimia are considered “normal weight” and only 3.5 percent are “underweight.” But that’s just one of the many myths that continues to keep bulimia a mystery to so many, and keeps so many struggling without treatment. Here, Dowell and two of Equip’s experts break down — and bust — the most common bulimia myths. Myth #1: If someone has bulimia, they’re by definition thin One of the most harmful and pervasive myths about bulimia is the belief that it only in affects one particular demographic, a myth that persists for a number of reasons including media representations and lack of research in diverse groups. “There’s a myth that bulimia only affects young, white girls, yet actually it’s equally prevalent in all races and ethnicities, with a slight increase in prevalence in Black and Hispanic adolescents,” says Equip Senior Vice President of Clinical Programs, Cara Bohon. “And although the onset of bulimia peaks in late adolescence, it can occur throughout a person’s lifespan.” Bohon also points out that although the rate of bulimia is three times higher in females than males, “a substantial number of males do suffer, and likely a greater number of transgender or gender non-conforming individuals, as data suggest rates of eating disorders are five times higher in that population.” Dowell says that when she was suffering with her disorder, few people would have suspected she had bulimia. “No one assumed that me, Makailah Dowell, who wears size large shirts and eats lunch at school everyday, would actually have an eating disorder,” she says. “No one would have assumed I was acting so intensely on my eating disorder behaviors that it hurt while also smiling everyday at school and eating normally in public. People tend to believe that you need to be relatively small to have bulimia.This was completely untrue for my story. Anyone can have this eating disorder.” Myth #2: Bulimia isn’t as serious an illness as anorexia “This myth is harmful because it creates a narrative that if someone is at least eating, then it's ‘not that bad,’” says Equip Director of Therapy, Reggie Ash. “This is false in so many ways. Someone diagnosed with bulimia has both physical and psychological concerns, both of which can lead to long-term health problems or even death—just the same as anorexia. To compare and say one is more severe than the other isn't true.” Bohon says that because people with bulimia may not appear visibly ill, it can be difficult for others to understand the severity of the health risks of bulimia. “However, there are many health consequences and risk of death in bulimia,” she says. “Electrolyte imbalances caused by purging can lead to heart or organ failure and death. Dehydration, throat damage, stomach damage, and other serious health consequences occur. Additionally, suicide risk is higher in those with bulimia compared to the general population.” Myth #3: Vomiting is the only form of purging in bulimia When most people think of bulimia, they think of episodes of binge eating followed by self-induced vomiting to purge the food. And while bulimia is characterized by episodes of binge eating followed by purging, that purging may or may not take the form of vomiting. Other versions of purging include use of laxatives, enemas, or diuretics in an effort to eliminate food they’ve eaten from their bodies. In other cases, people may not “purge” in any of these ways, but rather fast for prolonged periods of time or engage in excessive exercise to “compensate” for their binges. Ash says this misconception about bulimia can lead people to minimize the symptoms and severity of the disorder. “Someone may think everything is fine’ because the person isn't vomiting,” he says. “This thought then causes someone to overlook the overexercising someone may be doing, or their use of laxatives or diuretics.” Myth #4: Bulimia is all about an inability to control overeating While some people believe bulimia is rooted in the drive to overeat or the inability to stop eating when full, Bohon says there’s so much more to it than that—in fact, it often starts as the opposite. “One of the core symptoms of bulimia is an extreme valuation of shape or weight,” she says. “This results in food restriction or dieting as an initial behavior and precursor to the eating disorder. The drive to eat or loss of control around eating doesn’t indicate an overarching impulsivity problem, but instead is a natural response to insufficient nutrition.” Ash also notes that bulimia—as well as anorexia and other eating disorders—may indicate the presence of other emotional or psychological issues. According to the National Eating Disorder Association, people with anorexia and bulimia “more often than not” have an anxiety disorder that began before the onset of their eating disorder. People with bulimia also have significantly higher rates of post traumatic stress disorder (PTSD) than individuals without an eating disorder. How can you cut through the misconceptions and support those with bulimia? Given the abundance of misinformation about bulimia, how can families stay attuned to the actual signs and symptoms of trouble? Admittedly, it can be difficult, given the shame and secrecy that often accompanies the disorder. “Just like with any eating disorder or mental health diagnosis, a lot of symptoms happen in secret, so it might not be clear what a red flag looks like” Ash says. That said, the obvious signs of trouble are consistent with those of other eating disorders: significant mood shifts, feelings of inadequacy, body shame, increased anxiety and isolation, and more. There are also a number of red flags associated with bulimia specifically. “I recommend families pay attention to the timing of bathroom breaks or trips to the gym—are they always after eating or after eating certain foods?—skipping breakfast, large amounts of food missing from the kitchen, and frequent weighing,” Bohon says. If you’ve noticed some of these red flags and are concerned that someone you care about may be struggling, it’s important to broach the topic carefully. “Be sure to approach loved ones with compassion and curiosity rather than as an accusation or judgment about behaviors,” Bohon says. “The primary behaviors in bulimia of binge eating and compensatory behaviors are often shameful and secretive, so you may need to be more proactive in figuring out if someone is struggling and asking questions about how you can support them. This is not a ‘vanity issue’ to be ignored, or a phase that will pass. Bulimia treatment is available, and recovery is possible. But the first step to getting help is identifying the problem.” Citations: Hudson, James I et al. “The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.” Biological psychiatry vol. 61,3 (2007): 348-58. doi:10.1016/j.biopsych.2006.03.040 Nagata, Jason M et al. “Emerging trends in eating disorders among sexual and gender minorities.” Current opinion in psychiatry vol. 33,6 (2020): 562-567. doi:10.1097/YCO.0000000000000645]]></content:encoded>
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            <title><![CDATA[ARFID in Kids: What Does It Look Like and Why Is It Commonly Misdiagnosed?]]></title>
            <link>https://equip.health/articles/understanding-eds/ARFID-in-kids</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/ARFID-in-kids</guid>
            <pubDate>Wed, 18 Oct 2023 18:11:00 GMT</pubDate>
            <content:encoded><![CDATA[As parents, one of our constant daily tasks is feeding our kids. This is challenging enough on its own, but it can be extra difficult and complex for children struggling with an eating disorder known as avoidant restrictive food intake disorder, or ARFID. Picky eating is a common theme in childhood, but when that picky eating becomes progressively more and more restrictive, it’s cause for concern. ARFID can occur at any age, but ARFID in kids is particularly common. According to one recent study, ARFID can affect up to 3.2% of kids ages eight to 13 years old. ARFID is different from other eating disorders like anorexia nervosa or bulimia nervosa, in that the restrictive eating behaviors don’t stem from body image distress or a desire to lose weight. Children with ARFID eat a very limited amount of food and/or very limited types of foods, due to sensory issues, a lack of interest in eating, or a fear of something bad happening when they eat (like vomiting or choking). Kids with ARFID usually have a very short list of foods they will eat, and this can have serious physical consequences, leading to malnutrition and impairing development and growth. Signs and symptoms of ARFID in kids How do you know if your kid might be dealing with ARFID? Warning signs can include: Limited food variety. Your child might stick to a very small list of foods they’re comfortable with. This list often gets progressively shorter. To them, foods on this list are “safe” foods. Sensory sensitivity. Some kids with ARFID eat a very limited variety of food because they are particularly sensitive to textures, tastes, or smells. This might look like avoiding anything too mushy or too crunchy, foods that have a strong smell, or foods that aren’t the right brand. Fear of an adverse event. Your child could avoid eating due to a fear that something bad will happen if they do, like choking, vomiting, or becoming ill. This is often related to a past traumatic incident involving food, and can lead them to avoid specific foods as well as food in general. Lack of interest in eating. Some children with ARFID have a hard time eating simply out of a lack of interest. Eating doesn’t seem appealing to them and therefore it’s difficult for them to eat enough. Risks of untreated ARFID in kids ARFID isn’t just about being a picky eater. It’s a serious eating disorder that comes with serious long-term and short-term consequences for kids’ physical and mental health. Some of the issues ARFID can cause include: Nutritional deficiencies. By limiting their diet, your child may not be getting all the nutrients they need. This can lead to deficiencies that can impact their growth and health, as well as cognitive function. Weight loss or lack of expected growth. Limited eating can lead to weight loss or decreased growth, which can also have a negative impact on children’s physical development. Losing too much weight can lead to many other health side effects, like fatigue or a weakened immune system. Social isolation. ARFID can make social situations tricky for both kids and their family members. ARFID can cause your child to experience anxiety, and make them want to avoid gatherings that involve food. Going to parties or restaurants or eating meals with friends becomes impossible, leading to social isolation. Impaired cognitive function. Poor nutrition can hinder your child’s cognitive function, having a negative impact on their ability to concentrate and learn. Emotional distress. ARFID can take a toll on your child emotionally. Their ARFID may go hand in hand with anxiety, depression, or other mental health concerns, all of which can be addressed alongside ARFID. What can cause ARFID in kids? Like all eating disorders, ARFID doesn’t usually have one single cause. It can result from a mix of genetic, environmental, and psychological factors. Here are some possible contributors: Sensory sensitivities. Some kids are particularly sensitive to textures or smells. This can influence what they’re willing to eat. Traumatic events. Having a bad experience with food, like choking or food poisoning, can play a role in the development of ARFID in kids. Autism spectrum disorders. ARFID is common in kids who are on the autistic spectrum: up to 23% of people with autism also have a diagnosis of ARFID. How is ARFID in kids diagnosed? Drawing the line between developmentally normal picky eating and ARFID can be tricky. But by consulting with a team of eating disorder-informed providers, you’ll be able to get an accurate assessment for your child. The process of diagnosing ARFID in kids often goes as follows: Medical evaluation. Your pediatrician will check for any underlying health issues that may be causing your child to have eating difficulties. Psychological assessment. A mental health professional will assess your child’s mental health to understand whether or not they’re dealing with anxiety, trauma, or other factors that can have an impact on their eating. Nutritional evaluation. A dietitian can take an expert look at your child’s nutritional intake. This can help them determine any deficiencies and their potential impact on your child’s health. Parental input. As the parent, you’ll also play a vital role by providing the information about your child’s eating habits, behaviors, and possible triggers. ARFID can often be misdiagnosed or undiagnosed. It might be dismissed as mere picky eating, either by providers or by loved ones. It might also be mistaken for other eating disorders, like anorexia nervosa, due to a lack of awareness among health care professionals. Improved awareness, specialized training, and the development of targeted screening tools can help improve early identification and intervention in affected children. Our team are all well-versed in diagnosing and treating ARFID, and you can schedule a free assessment if you’re concerned about your child. How is ARFID in kids treated? Just like the diagnosis process, treating ARFID in kids is a team effort. Research shows that eating disorders are best treated through a multidisciplinary approach, so it’s important to support your child with a team that can help to address the physical, psychological, and nutritional aspects of the disorder on their road to recovery. Some aspects of ARFID treatment for kids include: Nutritional rehabilitation. Your child’s dietitian can help gradually broaden their food choices. They can help fill any nutrition gaps with supplements if needed. Exposure and response prevention (ERP). This form of exposure therapy is an effective and safe way to help your child expand the variety of food they’ll eat and face and conquer their fears about certain foods. Family-based treatment (FBT). FBT involves the whole family and can be a game changer by helping to create a supportive environment in which to try new foods. It also helps to deal with any family dynamics that may be tied to your child’s ARFID. FBT-AR is a specific form of FBT designed particularly for ARFID. Sensory integration therapy. If your child has sensory issues, this approach focuses on sensory integration to help ease their aversions. ARFID is a serious but treatable eating disorder. With the right expertise and resources alongside your love and support, your child can conquer these challenges and build a healthier relationship with food that allows for the full, joyful life they deserve. At Equip, our personalized and empathetic approach gives your child the tailored support they need. Our virtual, evidence-based treatment model ensures that your family has the tools you need to navigate and overcome this challenging journey. Every step of the way, you and your child will be supported by a multidisciplinary team that provides collaborative and comprehensive treatment. Get in touch with our team today for more information or to schedule a consultation. 
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            <title><![CDATA[Ask an Equip Provider: How Can I Best Support Larger-Bodied Patients?]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/supporting-larger-bodied-patients-ask-an-equip-provider</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/supporting-larger-bodied-patients-ask-an-equip-provider</guid>
            <pubDate>Thu, 23 Mar 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[People living in larger bodies face unique challenges when they seek out medical care. Weight stigma and fatphobia are widespread in our society: weight discrimination has increased by 66% in the past 30 years, and is now on par with racial discrimination. And while all medical providers want the best for all patients, they’re not immune to this phenomenon, with weight discrimination showing up even among doctors who specialize in the field of obesity. These biases can have a far-reaching impact on patient health. Research shows that weight bias can negatively affect patient care, leading patients to avoid or mistrust doctors and show low adherence with treatment plans. Weight stigma can also make people more vulnerable to anxiety, depression, and low self-esteem, as well as other mental health struggles that can, in turn, contribute to poor physical health. Given all this context, it’s important for healthcare providers to understand how to best support their larger-bodied patients. While you may already be providing inclusive, weight-neutral care (and kudos to you if so!) it’s always helpful to gain greater understanding of how weight stigma can manifest and how you can cultivate an environment that promotes health for people of all sizes. Angela Celio Doyle, PhD, Equip’s VP of Behavioral Health Care, answered some common questions healthcare providers may have on this important topic. What are some of the subtle, less obvious ways that weight discrimination might show up in a medical setting? I’ve seen weight discrimination in medical settings affect my patients in many harmful ways. It could be the medical provider saying something condescending or critical about eating habits or fitness when they know nothing about a patient’s lifestyle. It could show up as a patient bringing up physical problems and the provider automatically blaming body weight as the reason for the issue. For example, I had a patient who had terrible arthritis in her knees —a genetic problem in her family — and one medical provider automatically wrote off this pain as due to the patient’s weight. In actuality, she had osteoarthritis, and she suffered for a long time until she found a weight-neutral medical provider who did a more extensive assessment. More subtly, we know from research that weight discrimination can lead to medical providers spending less time connecting with patients in larger bodies, which means the provider is less likely to show concern and empathy and develop a rapport with the patient, making communication much less open. Finally, when medical offices do not have chairs, exam tables, or even toilets to accommodate people with larger bodies, that is weight discrimination. What should I say (and not say) when working with larger-bodied patients? First, be thoughtful about messages you send indirectly. Educate yourself by learning about Health at Every Size (HAES) and being intentional about size-inclusivity. If you have an office space, do you have magazines or other materials in the waiting room that elevate thin bodies over larger ones? Do you create comfortable spaces for people in all body sizes to sit and move? When meeting a patient in a larger body, listen to and use the words they feel comfortable using. If your patient describes their body as “fat”, take their lead: “fatness” is a morally neutral term and weight-inclusivity is reflected in your comfort using the terms that your patient chooses. Also, if you are not living in a larger body, be willing to openly acknowledge that fact when issues of weight arise. If you are in a smaller or thinner body, you will likely not have the experience of being discriminated against due to your size and it will be important to show interest and openness to learning from their experience. When, if ever, should a patient’s weight come into the conversation when addressing other health issues? In conversations about mental health, I would allow the patient to raise their own weight as a potential contributor to their well-being if they feel it is relevant, but also ask about experiences of discrimination related to weight, given how commonly it occurs. When it comes to physical health, medical providers should take a similar approach and allow the patient to raise the topic of weight before focusing on it themselves. There are many contributing factors to any health issue—genetics, lifestyle, undiagnosed conditions, and more—and you can’t tell much about a person’s well-being from how they look or the number on the scale. Remember that just because a patient is in a larger body, it doesn’t mean that weight, food, or exercise is one of their top concerns. Ask them what they would like to focus on in treatment. Are there any particular mental or physical health concerns I should be on the lookout for in larger-bodied patients? Should my care differ at all from the care I provide to patients in smaller bodies? When I am working with patients living in larger bodies, I start with asking all of the same questions I would of any other person. I thoroughly assess for depression and anxiety, staying aware of the impact weight discrimination could have on them. I am also careful to assess the full range of eating disorder behaviors and am mindful to avoid assumptions about binge eating, body image, and risk of anorexia nervosa. Only 5-15% of adults who live in larger bodies meet criteria for disorders involving binge eating, such as binge eating disorder. People in larger bodies can also have atypical anorexia nervosa, which is when they experience all the symptoms and health effects of anorexia while remaining at a higher weight. Also, body image is quite individual and questions about how patients feel about their body shape and weight are important. If you’re not a medical health provider, I also recommend that you make sure your patient has a medical provider they trust. It’s possible that they have not had medical care in a long time if they have experienced weight discrimination in a medical setting. That's why early intervention is even more critical. You can also offer to contact their medical provider to discuss the importance of weight neutrality prior to a visit or help patients find a weight neutral medical setting, which can be a crucial step to good mental and physical health. Citations: Andreyeva, Tatiana et al. “Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006.” Obesity (Silver Spring, Md.) vol. 16,5 (2008): 1129-34. doi:10.1038/oby.2008.35 Puhl, R M et al. “Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America.” International journal of obesity (2005) vol. 32,6 (2008): 992-1000. doi:10.1038/ijo.2008.22 Schwartz, Marlene B et al. “Weight bias among health professionals specializing in obesity.” Obesity research vol. 11,9 (2003): 1033-9. doi:10.1038/oby.2003.142 Phelan, S M et al. “Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.” Obesity reviews : an official journal of the International Association for the Study of Obesity vol. 16,4 (2015): 319-26. doi:10.1111/obr.12266 Puhl, Rebecca M, and Chelsea A Heuer. “Obesity stigma: important considerations for public health.” American journal of public health vol. 100,6 (2010): 1019-28. doi:10.2105/AJPH.2009.159491 McCuen-Wurst, Courtney et al. “Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities.” Annals of the New York Academy of Sciences vol. 1411,1 (2018): 96-105. doi:10.1111/nyas.13467]]></content:encoded>
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            <title><![CDATA[Victoria's Secret Commandeered the Term 'Sexy' and it Contributed to the Millions Who Develop an Eating Disorder]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/victoria-secret-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/victoria-secret-eating-disorder</guid>
            <pubDate>Wed, 16 Oct 2024 19:06:06 GMT</pubDate>
            <content:encoded><![CDATA[I was 17-years-old when I bought my first Victoria’s Secret bra. The year was 2001: Britney Spears and a python made pop culture history, Sex and the City swept the Emmys, and I dove head-first into an eating disorder that would claim the better part of my next two decades. But back to that bra. It was shiny, black, and padded to such a comically cushioned point, my quickly diminishing breasts almost created the illusion of cleavage. But the straps were really the main attraction with every millimeter bedazzled in gaudy, era-appropriate rhinestones. I was obsessed with it. It represented everything I wanted to be at that point of time: sparkling, seductive, and—as the retailer assured me I would be if I kept investing in their products—very sexy. No seriously, that was the name of the bra: the Victoria’s Secret Very Sexy™ Push-Up Bra. But even with that absurd level of in-your-face co-opting and marketing of female sexuality, I never connected any dots between my own lifelong struggle with body image to the largest lingerie retailer in the United States. That is, until Hulu released the three-part docuseries Victoria’s Secret: Angels and Demons in 2022. In all honesty, from the perspective of an obsessive pop culture analyst and women’s health advocate, the series was somewhat disappointing in that its main focus was on the misdeeds of the rich, white men behind the scenes—an important story to tell of course, but it felt like adding insult to injury to see the likes of Jeffrey Epstein stealing the spotlight from the victims in this re-telling. And while I’m referring to the literal victims of Epstein’s horrific crimes here, I’m also talking about others who suffered as a direct result of Victoria’s Secret's booming success: its female executives, its models, and the millions of consumers who bought into the dangerous fantasy it perpetuated. Even though the villainization of Victoria’s Secret is well-deserved in so many ways, it’s imperative to understand that the company was not the first to equate thinness, whiteness, and a very specific allowance of curves to the notion of beauty. It is true that the retailer has been hawking that extremely narrow definition of sexiness since it launched in 1977 (doubling and tripling down on these efforts in 1982 and onward when controversial businessman Les Wexner took the helm). But Playboy had been peddling a similar image since 1953, and Barbie’s unfathomable measurements debuted in 1959. And long before that, women had been bombarded with weight, size, and shape ideals that were largely unattainable for the majority of bodies. Victoria’s Secret is not solely responsible for the creation of an impossible-to-most ideal, but the company is without a doubt one of the main contributors to the proliferation of body dysmorphia that has afflicted generations of women in record numbers. And it’s the culmination of all those images and messages over time that has played a part in the unprecedented prevalence of eating disorders. There’s another important truth to keep in mind here, however: eating disorders are not the inevitable by-product of an adolescence spent absorbing unrealistic, altered, and airbrushed bodies in the media. These potentially fatal brain diseases are rooted in biological, psychological, and social risk factors and triggers. In other words, to point a finger at a corporation like Victoria’s Secret, suggesting that the images it perpetuated are the single cause of these potentially fatal illnesses is ridiculously simplistic and just plain wrong.  But media images and messages can and do contribute to the development of anorexia, bulimia, binge eating disorder, and more. The bodies we see glorified in movies, television shows, and advertisements inevitably serve as our default standard, whether we consciously make that choice or not. And as beneficial as observing body diversity in our real lives can be for our mental and emotional well-being, it’s impossible to ignore the profound impact repeated, daily exposure to media images portraying one specific body type can and does have. “Research shows that exposure to media images of ideal bodies is related to depression, stress, insecurity, and body dissatisfaction, which in turn is also related to eating disorder symptoms. While it's certainly not a direct and universal link that seeing these images will cause an eating disorder—if it were, everyone would have one—they are a clear part of a common cascade of risk factors setting someone on the path. If someone has genetic and brain-based risk factors, frequent media exposure to 'ideal' bodies can be the extra push,” says Cara Bohon, PhD, VP of clinical programs at Equip. Besides being a potential trigger to those vulnerable to eating disorders, the imagery put forth by Victoria's Secret is a prime example of the underrepresentation that leads so many people to feel unworthy. Forty-plus years of Victoria’s Secret marketing would suggest the only characteristics worth pursuing are six-pack abs, voluptuous breasts, and able-bodiedness. The fact that only a sliver of the human population will ever embody those attributes has allowed Victoria’s Secret and other retailers to maintain a customer base all these years; by feeding consumers an incredibly limited notion of “beauty” defined by features they’ve deemed beautiful (“they,” by the way, being mostly those aforementioned rich, white men who openly balked at hiring transgender or plus-size models), then they’ve ensured shoppers will keep coming back, shelling out money in hopes of getting a little closer to that seemingly successful supermodel smiling back at them from the pages of a magazine.  But an unknown, incalculable number of individuals won’t just pursue that beauty ideal through their credit card; those predisposed to developing eating disorders due to genetics, health history, stress, or any number of risk factors will sacrifice their lives in hopes of achieving that fantasy. "I spent countless hours planning what I would do with my life once I finally achieved the thinner version of me. ‘Thinner Ally’ would graduate college, get married, love her job and finally feel confident—all things I was told wouldn't be possible until I stopped eating and exercised constantly,” says Ally Duvall, senior program development lead at Equip. "Except, ‘thinner Ally’ was just a fantasy created by people in power hoping to make more of a profit from my body distress. I did graduate college, I am getting married and love my job—and none of that has anything to do with how my body looks or what brand of bra I wear,” she says. And that airbrushed, glossy image of the Victoria’s Secret “Angel” really was fantasy—so much so that even the supermodels themselves weren’t “perfect” enough to fulfill it. In 2011, Angel Adriana Lima told reporters she abstained from solid food in the nine days leading up to the brand’s annual fashion show. Last year, model Erin Heatherton opened up about using diet pills during her days as an Angel, and her former colleague Bridget Malcolm has been open about her recovery from anorexia. Add to all these extreme and life-threatening measures the fact that most catalog and advertising images are doctored anyway, and the result is a maddening, impossible-to-attain standard that no human could possibly meet—but many might die trying. Mercifully, the Victoria’s Secret “Angel” concept has been scrapped, and with new leadership in place, the company has finally evolved past its myopic vision of beauty and brought in a group of diverse women including inclusivity advocate Paloma Elsesser and gender equity campaigner and soccer star, Megan Rapinoe. It remains to be seen whether this rebranding effort can save the company’s tarnished reputation, but one thing’s for sure: it can’t undo the decades of damage it’s inflicted on countless women. Had I known at 17 what I know now, I may have reconsidered buying that bedazzled black bra circa 2001—or I would have at least known that abusing my body wasn’t a prerequisite to wear it and feel worthy. If you or a loved one are struggling with body image distress, disordered eating, or other eating disorder symptoms, it's important to get prompt help. Talk to your medical provider or schedule a consultation call with our team.  ]]></content:encoded>
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            <title><![CDATA[I’m an Eating Disorders Physician. Here’s What I Wish Everyone Knew About Eating Disorders]]></title>
            <link>https://equip.health/articles/understanding-eds/ED-facts-from-physician</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/ED-facts-from-physician</guid>
            <pubDate>Mon, 11 Apr 2022 14:56:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders run rampant in our society, yet nearly every day I encounter well-intentioned people, even medical professionals, with potentially harmful misconceptions about eating disorders and the people who get them. Eating disorders are deadly and pervasive: they are the second deadliest mental illness with a mortality rate of 4-5 percent, and about 5 million Americans will get an eating disorder every year - that’s more than the population of Los Angeles! The rate of eating disorders during the pandemic has surged, with inpatient hospitalizations more than doubling since the pandemic began. Our society is long overdue to dispel some common myths about eating disorders. Eating disorders don’t just affect thin, young, affluent white girls The number one misconception I encounter about eating disorders is they exclusively affect thin, white, upper-middle class girls and women . Eating disorders affect people of all ages, genders, ethnicities, body sizes, and socioeconomic statuses. Unfortunately, due to this pervasive myth, the diagnosis and opportunity for treatment is often missed in any people who don’t fit the stereotype, including men and those in larger bodies. This often means that by the time they do receive a proper diagnosis, these patients are sicker and harder to treat. People with eating disorders don’t “look” a certain way Repeat after me: You can’t tell by looking at someone if they have an eating disorder. Many believe that all people with eating disorders must be underweight But the vast majority of those struggling with eating disorders do not appear excessively thin. So it’s important to avoid commenting on anyone’s body or weight as you might inadvertently trigger someone who is struggling with eating or body image. Even commenting positively on someone’s weight loss or body might fuel the fire for someone predisposed to disordered eating. Anorexia nervosa and bulimia nervosa are not the most common eating disorders. While the most well-known eating disorders are anorexia nervosa and bulimia nervosa, the most common eating disorder in the US is binge eating disorder, affecting about 3 percent of Americans . Binge eating disorder is characterized by loss of control and consuming large amounts of food, which can have harmful medical and psychological consequences. Another common but lesser-known eating disorder is Avoidant and Restrictive Food Intake Disorder, or ARFID, which involves an apparent lack of interest in food and eating due to factors like the sensory characteristic of the food itself or fear of vomiting People with ARFID generally don’t have body image concerns, unlike in anorexia or bulimia, but can suffer from the same psychological or physical harm nonetheless. Eating disorders are rooted in many factors Stop blaming the parents, the soccer coach, or that reality TV show. Eating disorders are complex brain disorders that are largely genetic and rooted in biological, psychological, social, and environmental factors. No one person or event is responsible for an eating disorder.However, if someone is genetically predisposed, they might be more sensitive to certain conversations, such as “Fitspiration” on social media and diet talk. With prompt and proper treatment, eating disorders are very treatable Eating disorder treatment has traditionally been incredibly expensive, not evidence based, and inaccessible to most people. Only about 20 percent of folks with eating disorders will receive any treatment at all, and an even smaller number will have access to gold-standard treatment like Family-Based Treatment. But greater accessibility to affordable evidence-based treatment can help change that narrative and ensure that everyone is able to achieve lasting recovery.]]></content:encoded>
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            <title><![CDATA[Equip Raises $17 Million to Transform Eating Disorder Treatment]]></title>
            <link>https://equip.health/articles/news-and-research/equip-launch-announcement</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-launch-announcement</guid>
            <pubDate>Tue, 09 Feb 2021 18:22:00 GMT</pubDate>
            <content:encoded><![CDATA[Company brings reinvented care model to eating disorder patients in 2021, supported by investment from F-Prime, Optum Ventures, and .406 Ventures SAN DIEGO, February 10, 2021 –– Equip, a health tech company pioneering a program that virtually delivers evidence-based eating disorder treatment to families at home, today announced it has closed $13 million in Series A financing, bringing its total funds raised to date to $17 million. The Series A round was led by Optum Ventures, with participation from new investor .406 Ventures and existing investor F-Prime Capital, who led the company’s prior Seed round. Equip’s mission is to make gold-standard eating disorder treatment accessible to all people through Family-Based Treatment (FBT) – the standard of care which empowers families to help their loved ones through recovery. Equip builds upon this model of care by providing families with a five-person dedicated care team, including a peer and family mentor, a medical physician (psychiatrist, PCP, or pediatrician), a therapist and a dietician. Equip’s fully virtual platform allows families to arrange treatment to fit their schedules and needs, instead of upending their routines to send their child away from home to a residential facility. “Equip is poised to raise the bar for eating disorder treatment in ways we never thought possible,” said Patrick J. Kennedy, former U.S. Representative and an advisor to Equip. “Their focus on evidence-based approaches and commitment to working closely with health insurers sets them apart from the traditional treatment landscape, which is often opaque, ineffective, and far too expensive.” Equip was founded in 2019 by Kristina Saffran, who recovered from anorexia as a teenager and founded the nonprofit Project Heal at the age of 15, and Erin Parks, Ph.D, a clinical psychologist and researcher who spent the past decade at the renowned UC San Diego Eating Disorders Center. “Over the past 15 years, I’ve watched people cycle in and out of treatment centers before they’ve even heard of FBT,” said Saffran, co-founder and CEO of Equip. “We believe this model, which combines lived experience and clinical expertise, provides the hope that recovery is possible and worth the hard work.” Currently, 80 percent of the 30 million Americans who struggle with eating disorders never receive treatment, and less than one percent have access to FBT, which is widely recognized as the leading evidence-based treatment. “From those who have had access to FBT, we’ve heard loud and clear that they wanted mentorship, a coordinated care team, and treatment at home so they could build a life worth living to drown out the eating disorder voice,” said Parks, co-founder and CCO of Equip. “So after years of plugging holes, we decided to build this model that we knew we needed to exist.” The company has launched in California, New York and Texas, and intends to use the funding to expand its geographic reach and deliver care to additional patient populations in 2021. The company will also use the proceeds to continue building its clinical team, develop its technology platform, and help the business scale as they launch programs with several insurance partners. “The virtual approach to high-quality eating disorder treatment being pioneered by Equip has the opportunity to better enable families to support recovery,” said Laura Veroneau, partner at Optum Ventures. “We’ve never seen a team with this combination of lived experience and clinical expertise, and we believe Equip will be the much-needed change agent in eating disorder treatment.” About Equip Equip delivers modern eating disorder treatment through family-based care that promises lasting recovery at home. Created by experts in the field and people who’ve been there, Equip provides each patient with a five-person dedicated care team including a therapist, dietician, physician, and peer & family mentor. Our vision is to equip every family with effective tools to confidently overcome eating disorders in a way that is accessible and affordable. We believe Equip is a better alternative to the status quo treatment options and we eliminate the various obstacles families face in treatment today. For more information, visit www.equip.health. About Optum Ventures Optum Ventures is the independent venture fund of Optum, a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone, and part of UnitedHealth Group. Optum Ventures invests in digital health companies that use data and insights to help improve consumers' access to health care services and how care is delivered and paid for, and that make the health care system more reliable and easier to navigate. For more information, visit www.optumventures.com. About F-Prime Capital F-Prime Capital is a global venture capital firm investing in healthcare and technology. For the past 50 years, our independent venture capital group has had the privilege of backing great entrepreneurs building groundbreaking companies. With over two billion dollars under management and a global portfolio of nearly 200 companies, we champion those dedicated to creating positive change in the world. F-Prime is headquartered in Cambridge, MA, with offices in London, UK and San Francisco, CA. For more information, please visit www.fprimecapital.com ​and follow us on Twitter and LinkedIn. About .406 Ventures .406 Ventures is a Boston-based early stage venture capital firm investing in healthcare and enterprise technology companies founded by visionary entrepreneurs. The firm was founded in 2005 and has over $1 billion under management across four core and two opportunity funds. .406 Ventures typically leads, or co-leads, early stage investment rounds centered around a deep thesis. .406 Ventures’ healthcare theses focus on systems, technologies, and services that improve clinical delivery, with investments in companies such as Abacus Insights, AbleTo, AristaMD, Heartbeat Health, Hurdle Health, Iora Health, Nomad Health, Redox and WelbeHealth. Learn more at www.406ventures.com. Equip Leadership and Advisors Equip’s leadership and advisory team is made up of leading experts in eating disorder treatment, advocacy and policy, behavioral health, and company building. Martha Temple, Former CEO, Optum Behavioral Health Patrick J. Kennedy, Former Congressman + Founder, The Kennedy Forum Solome Tibebu, Founder + CEO, Cognific and The Upswing Foundation Susannah Fox, Researcher + Former CTO, HHS Daniel LeGrange, PhD, Director of Eating Disorders Program + Professor, UC San Francisco Evelyn Attia, MD, Director of the Center for Eating Disorders, New York-Presbyterian Hospital John Simon, Managing Director of Sigma Prime Ventures + Founder of Ventureforgood 
 Media Contact Lauren Gerber Director of Marketing, Equip lauren@equip.health 619-847-1850]]></content:encoded>
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            <title><![CDATA[Equip Works with Cigna to Broaden Access to Eating Disorder Care in CA, NY + TX]]></title>
            <link>https://equip.health/articles/news-and-research/in-network-with-cigna</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/in-network-with-cigna</guid>
            <pubDate>Wed, 16 Jun 2021 14:50:00 GMT</pubDate>
            <content:encoded><![CDATA[SAN DIEGO, June 2, 2021 –– Equip, a company that virtually delivers evidence-based eating disorder treatment to families at home, today announced that customers with Cigna in California, Texas and New York now have access to its network. “Families should not have to worry about seeking affordable care when they need it most,” said Kristina Saffran, CEO and co-founder of Equip. “By launching additional insurance partnership capabilities, we're taking a major step in our mission to make gold-standard eating disorder treatment accessible to all people.” Founded in 2019 by Kristina Saffran and Erin Parks, Ph.D., Equip builds upon Family-Based Treatment (FBT) - a model which empowers families to help their loved ones through recovery - with a five-person dedicated care team, including a peer and family mentor, a medical physician, a therapist and a dietitian. Equip’s fully virtual platform allows families to arrange treatment to fit their schedules and needs. “Diagnosing and treating an eating disorder can be challenging, even more so during a pandemic. Working with Equip allows our customers access to clinically-validated, virtual care with proven outcomes so they can address and treat the eating disorder head on with an interdisciplinary team,” said Doug Nemecek, MD, Cigna’s chief medical officer for behavioral health. The company, which raised $13mm earlier this year, currently serves families in California, New York, New Jersey and Texas, and plans to expand its geographic reach throughout 2021 to several states. Equip, which is currently covered by Optum, has seen remarkable outcomes in its first 6 months of treating patients. Members who have weight restoration goals are gaining an average of 1.2 pounds per week (existing treatment centers report 1 lb per week), and 68% of patients have experienced an improvement in EDE-QS scores, the clinically validated measure for eating disorders. About Equip Equip delivers modern eating disorder treatment through family-based care that promises lasting recovery at home. Created by experts in the field and people who’ve been there, Equip provides each patient with a five-person dedicated care team including a therapist, dietician, physician, and peer & family mentor. Our vision is to equip every family with effective tools to confidently overcome eating disorders in a way that is accessible and affordable. We believe Equip is a better alternative to the status quo treatment options and we eliminate the various obstacles families face in treatment today. For more information, visit www.equip.health. Media Contact Lauren Gerber Director of Marketing, Equip lauren@equip.health 619-847-1850]]></content:encoded>
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            <title><![CDATA[Equip Now Provides Eating Disorder Care to Half the US Population! ]]></title>
            <link>https://equip.health/articles/news-and-research/160mm-patients-families-announcement</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/160mm-patients-families-announcement</guid>
            <pubDate>Thu, 14 Oct 2021 13:59:18 GMT</pubDate>
            <content:encoded><![CDATA[Virtual eating disorder treatment provider nearly doubles footprint with launches in Colorado, Florida, Georgia, and Illinois SAN DIEGO, Calif. – October 14, 2021 – Equip, the leading provider of virtual, evidence-based eating disorder treatment in the U.S., today announced the expansion of its services into four major markets – Colorado, Florida, Georgia, and Illinois. With this growth, Equip is now able to serve half the country – over 160 million patients and their families – through Family-Based Treatment (FBT) delivered at home for lasting recovery. “We’ve long known how widespread and detrimental eating disorders can be – and the recent news from Facebook shows that younger generations are continuing to suffer,” said Kristina Saffran, CEO and co-founder of Equip. “Our mission at Equip is to ensure that every family has access to affordable eating disorder treatment that works. We’re making major strides toward that goal as we expand into these critical states, bringing the gold-standard of treatment to millions.” Eating disorders, which have the second highest mortality rate of all mental illnesses, will impact over 30 million Americans throughout their lifetime. A nationwide shortage of qualified behavioral health providers and the lack of cost-effective care means that less than 5 percent of eating disorder patients in the U.S. receive treatment that works. Equip’s FBT model – which empowers families to help their loved ones through recovery at home with a dedicated team of clinicians and mentors with lived experience – promises superior, lasting outcomes for patients. Close to 70 percent of Equip patients report reduction in eating disorder symptoms, and 98 percent of families are still in treatment after four weeks. Equip will be covered by Optum immediately in CO, FL, and IL, and in GA in November, with more insurance plans coming soon. While many status quo eating disorder treatment options – like residential treatment centers – cost upwards of $30k per month, insurance coverage is often spotty at best. It is estimated that Americans' total out-of-pocket payments for eating disorder treatment topped $363 million in 2019. Equip, in its mission to make quality care accessible to anyone with an eating disorder, is also in-network with Cigna, Horizon Blue Cross Blue Shield, Pacific Source, and Aetna in other states. “The access gap in eating disorder care is wide and deep,” said Susannah Fox, former Chief Technology Officer of the U.S. Department of Health and Human Services and advisor to Equip. “As someone dedicated to using technology to power healthcare innovation, I am energized by Equip’s model that is bringing this mental illness out of the shadows and providing critical care for those who need it most.” Equip was founded in 2019 by Kristina Saffran and Erin Parks, PhD, and raised $13 million in Series A funding earlier this year. The company aims to expand its geographic reach to all 50 states in the coming years. To learn more about Equip’s treatment model and virtual platform, visit equip.health. About Equip Equip delivers modern eating disorder treatment through family-based care that promises lasting recovery at home. Created by experts in the field and people who've been there, Equip provides each patient with a five-person dedicated care team including a therapist, dietician, physician, and peer & family mentor. Our vision is to equip every family with effective tools to confidently overcome eating disorders in a way that is accessible and affordable. We believe Equip is a better alternative to the status quo treatment options and we eliminate the various obstacles families face in treatment today. For more information, visit www.equip.health.]]></content:encoded>
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            <title><![CDATA[Equip Expands its Eating Disorder Care to Pacific Northwest ]]></title>
            <link>https://equip.health/articles/news-and-research/pacific-northwest-launch</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/pacific-northwest-launch</guid>
            <pubDate>Wed, 01 Sep 2021 01:21:00 GMT</pubDate>
            <content:encoded><![CDATA[Equip is now seeing patients in Washington and Oregon, expanding its current footprint to six states as it continues to transform eating disorder treatment SAN DIEGO, September 1, 2021 –– Equip, a company that delivers virtual, evidence-based eating disorder treatment to families at home, announced today that it is now seeing patients in Washington and Oregon. Equip is currently in-network with PacificSource and Optum in these two states, with additional insurance plans coming soon. “Washington and Oregon are suffering from the same crisis in eating disorder care as the rest of the nation since the emergence of COVID-19,” said Kristina Saffran, CEO and co-founder of Equip. “Only 20% of people who get diagnosed with eating disorders receive treatment, and merely 1% of them get treatment that works. In Washington and Oregon alone, this means nearly a million people with eating disorders never get treatment. Equip’s mission is to change this equation.” In Washington and Oregon, even when people seek treatment, they face a dearth of eating disorder providers, let alone providers trained in evidence-based care. In Washington, 3 million (or 50% of the state) people live in a Mental Health Professional Shortage Area (MHPSA), and in Oregon, nearly 2 million (40% of the state). “We are thrilled to work with Equip to support our members and their families with gold-standard telehealth eating disorder treatment,” said Dr. Mike Franz, PacificSource Medical Director-Behavioral Health. “As we continue to navigate the challenges of the pandemic, virtual care is now, more than ever, an essential and valuable tool in helping our members get the care they need.” Founded in 2019 by Kristina Saffran and Erin Parks, Ph.D., Equip builds upon Family-Based Treatment (FBT) – a model that empowers families to help their loved ones through recovery – with a dedicated five-person care team for each patient that includes a peer and family mentor, a medical physician, a therapist, and a dietitian. Equip’s fully virtual platform allows families to arrange treatment to fit their schedules and needs. The company, which raised $13mm earlier this year, currently serves families in California, New York, New Jersey, and Texas, and plans to expand its geographic reach to all 50 states over the next few years. Equip has seen remarkable outcomes in its first six months of patient care with 60% of patients meeting their weight restoration goals, a 98% retention rate of families opting to continue treatment after four weeks, and a 68% improvement in patients’ EDE-QS scores, the clinically validated measure for eating disorders. About Equip Equip delivers modern eating disorder treatment through family-based care that promises lasting recovery at home. Created by experts in the field and people who’ve been there, Equip provides each patient with a five-person dedicated care team including a therapist, dietician, physician, and peer & family mentor. Our vision is to equip every family with effective tools to confidently overcome eating disorders in a way that is accessible and affordable. We believe Equip is a better alternative to the status quo treatment options and we eliminate the various obstacles families face in treatment today.]]></content:encoded>
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            <title><![CDATA[Why Dietitians Are an Essential Ingredient in Treatment]]></title>
            <link>https://equip.health/articles/food-and-fitness/essential-ingredient-dietitians</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/essential-ingredient-dietitians</guid>
            <pubDate>Tue, 08 Sep 2020 20:50:00 GMT</pubDate>
            <content:encoded><![CDATA[  I have been a registered dietitian (RD), specializing in eating disorders, for nearly twenty years. Like most dietitians, I initially worked in patient-focused settings, rarely meeting the parents or family members. I loved the patients that I worked with, I loved my kind and thoughtful colleagues—but I didn’t love that the patients often struggled to find sustained recovery. For 10 years, I watched hundreds of patients experience initial success, only to relapse shortly after discharging to go home. My colleagues and I were eager to include families in treatment—but we were not sure how. In traditional treatment, parents often felt blamed for their child’s eating disorder and were routinely: 1. Excluded from conversations regarding treatment planning and goals 2. Told that their involvement would make things worse, not better 3. Asked to support the recommendations of the team, from a distance A decade into my career, I was introduced to Family Based Treatment (FBT) where services are family-centered, instead of patient-centered. FBT provided a sound alternative to conventional treatment, as parents were armed with the skills and tools to help their child sustain recovery. However, FBT as it was originally conceived, didn’t include dietitians as part of patient care. In FBT treatment, dietitians often felt dispensable and were routinely: 1. Excluded from conversations regarding treatment planning and goals 2. Told that their involvement would make things worse, not better 3. Asked to support the recommendations of the team, from a distance It may surprise you that Equip, whose foundation is built upon FBT, would then have a dietitian as their first clinical hire. We joke that it’s because one of our co-founders cooks exclusively with a toaster-oven, but the truth is, Equip knows that dietitians are essential ingredients! I have spent the past 10 years working as an FBT Dietitian, and I’m proud to lead the dietary team in bringing these essential dietary services to Equip families. Nutrition prescription Equip dietitians give families personalized Nutrition Prescriptions. For our patients on weight restoration, they may need 3k, 4k, or even 5k calories per day to gain 1# per week. Dietitians know how to safely increase calories and guide patients towards health. Recipes, meal plans, and snack menus While feeding your child may be intuitive, feeding your child 2-3x what a normal child eats, is not. Equip dietitians provide practical guidance including recipes, meal plans, and snack menus to help parents achieve the difficult task of feeding their child a high-calorie diet. Nutrition education While many people with eating disorders may have memorized the caloric content of everything in a grocery store, they tend to lack proper, fact-based, nutritional knowledge. Equip dietitians help patients and their families to differentiate between Diet Culture Pseudoscience and nutritional facts—helping the entire family to develop a healthy relationship with food. Activity prescription Parents are often fearful that physical activity will slow recovery or result in relapse. Adults in recovery report “not trusting their bodies” and being unsure of how to approach physical activity. Equip dietitians celebrate the many benefits of sports and exercise and help patients and their family return to healthy activity. Manage physiological side effects Stomach pain, reflux, low hunger cues, gas, constipation—dietitians help to manage many of the physiological issues that can occur on the road to recovery. Food variety and challenging fear foods Eating disorders have often robbed patients of their favorite foods, and resulted in the elimination of entire food groups. Dietitians know how to safely reintroduce foods and bring variety back into a family’s diet. Preparing to launch As teens recover from an eating disorder and prepare to leave their parents’ home for school and work, Equip dietitians give them real-world skills to independently feed themselves and stay in recovery. At Equip, dietitians are a critical component of our five-person care teams. Every patient/family gets their own dietitian, for unlimited sessions and between-session messaging, to help them on their journey to full health. Dietitians stay with you, long after you’ve reached your treatment goals, to continue to help you as you go through life transitions—returning to sports, going away to college, or studying abroad! Equip dietitians are an essential ingredient to sustained recovery.]]></content:encoded>
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            <title><![CDATA[Traditional Eating Disorder Treatment Doesn't Fit For Most People. Here's Why.]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/traditional-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/traditional-treatment</guid>
            <pubDate>Thu, 12 Oct 2023 16:31:00 GMT</pubDate>
            <content:encoded><![CDATA[When I initially sought treatment for my eating disorder, I had to get a crash course on the ABCs of options. Within a week of asking my doctor for guidance, I received a quick education on RTCs, PHPs, and IOPs (Residential Treatment Centers, Partial Hospitalization Programs, and Intensive Outpatient Programs, respectively) in addition to outpatient care. To say that flood of information was a lot to take in would be an understatement; I was totally lost and unsure which path to choose. What I learned the hard way is that while each of these traditional treatment options have their merit, all of them include significant financial, geographical, and logistical barriers. Not only can it be challenging to locate and access traditional treatment, but it can often prove fruitless as there is limited evidence to demonstrate their long-term effectiveness. I wished I knew earlier that these traditional forms of treatment are not the end-all be-all. Let’s break down what traditional treatment is, why it often fails its patients, and what alternatives can look like. What is “traditional” eating disorder treatment? Historically, eating disorder treatment has been divided into RTCs, PHPs, and IOPs, in addition to outpatient care. Here’s a quick guide to what those acronyms mean: Residential Treatment Center (RTC): An RTC requires patients to live at a center 24 hours a day for a set period of time (usually 30 days or more) and in addition to full-time housing, typically offers meal support, individual and group therapy, and some recreational activities. An RTC is usually appropriate for patients who require more intensive care than outpatient facilities can provide and may act as a bridge between hospital‐based inpatient treatment and traditional outpatient services. Partial Hospitalization Program (PHP): Sometimes known as Day Treatment, a PHP offers patients support for 6-10 hours a day, 5-6 days per week. Unlike patients in RTCs, those in PHPs usually live at home and may gradually decrease the hours they spend in treatment each day as they progress in recovery. Intensive Outpatient Program (IOP): A lower level of care than a PHP, IOPs usually provide about 3-4 hours of treatment per day for 3-5 days a week. Patients in IOPs can typically continue to go to school or work and participate in other activities while participating in treatment. Outpatient: Unlike the structured programs mentioned above, outpatient care involves a patient seeing a team of providers (including psychologists, psychiatrists, dietitians, etc.) on their own time, for approximately 1 hour each week. While costs of all these options can vary widely, including location, insurance coverage, and length of stay, the prices attached to traditional eating disorder treatment are quite high. According to Project HEAL, IOP treatment costs an average of $1,500 per week while RTC and inpatient treatment can cost an average of $2,000 per day. Overall, estimates put the average cost of a single eating disorder treatment episode around $80,000 and the cost of full healing to be around $250,000 over the span of two years. None of the traditional options were accessible for Equip Lead Peer Mentor Mak Dowell, who was raised by her grandmother who worked 60-hour weeks and had little time or money for conventional treatment. “Medicaid had a hard time approving any type of treatment for me so my recovery came together with a combination of support from my resilient grandmother, my best friends, and my therapist” Dowell says. “Money, time, and energy are all privileges we aren't equally afforded. It’s important to explore what treatment options are available to you and what would be not just effective, but also sustainable.” The potential shortcomings of traditional eating disorder treatment While traditional treatment options may offer real, long-lasting recovery to those who can afford them, the evidence supporting the success of these paths is mixed. As one 2020 systematic review on RTCs found, there’s significant variability in program characteristics and efficacy.” An earlier paper demonstrated that the long-term success rate (defined as 3-5 years or more of abstinence from disordered behaviors) of conventional treatments “is in the 40% to 50% range, at best.” And according to a 2016 report, eating disorders are not only “the least covered psychiatric conditions in the American health insurance system,” but “Fewer than 1 in 10 people with an eating disorder will access mental health care, and only half will fully recover.” Let’s explore some of the limits to traditional treatment that may be causing these mixed results. Creating geographical and financial barriers “The nearest eating disorder treatment was two and a half hours away from my town,” Dowell says. “These traditional treatments remain unattainable due to the fact they are expensive, located mostly in metropolitan cities, have long waitlists, and only accept commercial insurance or cash.” Removing patients from their motivation As Equip’s Director of Program Development, Tana Luo explains, “Traditional eating disorder treatment settings tend to take people out of their lives. They’re not able to connect with the things that are meaningful to them — friends, family, work, school, and activities. Those are often the very things that motivate people to recover, so it can be really challenging to hold on to that drive to recover if there isn’t access to motivators.” Using therapies that may work better at home While enhanced cognitive behavioral therapy (CBT-E) is considered the leading eating disorder treatment for treating adults, and family-based therapy (FBT) is the gold standard for adolescents, these treatments don’t always work as well when administered inpatient. “FBT and CBT-E were designed to be delivered on an outpatient basis,” Luo says. “Therefore, outpatient treatment with a modality that’s backed by research is a great alternative to traditional treatment.” Forming a “treatment bubble” The “treatment bubble” refers to the feeling of safety and escapism patients often feel in traditional treatment settings. “It’s so great that people sometimes have that experience of feeling safe in treatment, and the drawback is that there can then be a lack of motivation to recover and get out of treatment,” Luo says.  “It may be triggering to be around other people who are struggling with eating disorder behaviors, and it’s not uncommon for people with eating disorders to compete with each other.”   The evidence-based treatment alternatives you may not be aware of While the many forms of traditional treatment may be right for some people, others may benefit from support outside of typical treatment settings. There are virtual treatment programs, like Equip, that allow patients to receive evidence-based care from the comfort of their own home. “The best part of this type of treatment is that you have options,” Dowell says. “The eating disorder field and research has expanded in the last year and more studies indicate that virtual treatment programs are just as effective.” Dowell says that through her own recovery and her experience at Equip she’s seen the power of innovative treatment models in action. “What I can say is that non-traditional treatment is not only effective, but sustainable. Non-traditional treatment meets a patient where they are. They are able to meet providers in spaces they feel comfortable with, don’t have to worry about the time strain of treatment, and can maintain this modality for several months with effective outcomes.” Luo agrees, noting she’s seen many examples of families who have engaged in and benefited from outpatient FBT. “The beauty of FBT is that it combines the training and expertise of the provider with the wisdom and experience of the family,” she says. “So the efforts to work towards recovery are highly individualized and draw from what the family knows can be effective for their child.” While many people associate virtual or outpatient care as being less intensive, Equip can be an effective alternative for RTCs, PHPs, and IOPs alike, without the strain of driving to appointments or digging a financial hole. At Equip each patient is matched with a trained, comprehensive care team who build a specialized treatment plan to give you the best chance of achieving lasting recovery. Schedule a free consultation to learn more. ]]></content:encoded>
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            <title><![CDATA[To My Parents and All the Parents of Children with Eating Disorders]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/letter-to-my-parents</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/letter-to-my-parents</guid>
            <pubDate>Wed, 02 Feb 2022 15:37:37 GMT</pubDate>
            <content:encoded><![CDATA[Note: *This article originally appeared on F.E.A.S.T.'s blog. Dear Mom and Dad, Thank you for saving my life. Thank you for never giving up. Thank you for loving me enough to allow me to hate you. Thank you for fighting my battle when I couldn’t or just didn’t want to. Thank you for choosing recovery for me before I could chose it for myself. To all the parents out there who are in this fight with their child, don’t give up! Don’t wait for your child to choose or want their own recovery because let’s just be honest: it’s not going to happen, and if it eventually does, it might be too late. Don’t let the fear of losing or damaging your child’s love for you keep you from fighting—the love will come back deeper and stronger when they are healthy, alive, and in recovery. It is not your child that hates you; it is the illness that has taken them hostage. Think of their disorder as a person; when your child is yelling, screaming, throwing things, refusing to eat, negotiating meals, whatever it may be, you are not witnessing or dealing with your actual child, you are face-to-face with the personification of their disorder. This hate comes from a losing eating disorder so just remember that the more hate you feel, the better job you are doing. Be more worried when your child likes you because ED must be happy about something. Stand strong and unwavering when you are confronted with the demons and struggles you and your child face every day, every meal. It is so important to remember that your sick child is not your child. When I was sick, I was not me. Anorexia turned me into a lifeless, vacant, unpleasant, and unloving version of myself. It must be the scariest thing for a parent to look at their child but not actually see them; to just see them disappearing more and more each day, both mind and body. It’s crazy to hear people talk about the way they saw me slowly coming back to life through my weight restoration journey. They tell me how they could see it in my eyes, how they once appeared soulless and empty, but were finally full of the life and personality they always loved again. Keep fighting so you too can experience this with your child. I always say that my parents have probably put in just as much work for my recovery as I have, especially at the beginning. Recovery is one of the hardest things a person can do, and just simply choosing recovery is even harder. This is why Family-Based Treatment and parent involvement is so crucial in a successful recovery. Just as my parents did, you have to want their recovery before they can want it for themselves, you have to choose their recovery for them before they can choose it for themselves, and you have to be their motivation before they find their own. Recovery is not a simple, linear, or easy journey but it is worth it. Sincerely, Kinsey Ouellette Kinsey was 17 and a senior in high school when she developed anorexia. Thankfully, her family had access to cutting-edge, evidence-based care using family-based treatment and she lost relatively little of her life to the devastation of anorexia. Though the journey was incredibly tough, and required uncomfortable oversight for some time, complete weight restoration and adequate brain healing time gave her freedom and independence for life. Kinsey penned this letter as a recent college graduate about to embark on a several month travel adventure. She has found the most impactful way to pay forward the wonderful care she received is to assure other parents that FBT does not ruin relationships, it saves and strengthens them.]]></content:encoded>
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            <title><![CDATA[Do I Have an Eating Disorder? 7 Warning Signs You Shouldn't Ignore]]></title>
            <link>https://equip.health/articles/understanding-eds/do-i-have-an-eating-disorder-signs</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/do-i-have-an-eating-disorder-signs</guid>
            <pubDate>Wed, 16 Aug 2023 17:25:00 GMT</pubDate>
            <content:encoded><![CDATA[Given the world we live in, it’s normal to have a somewhat complicated relationship with food and your body. But if that complexity is leading to concerning habits or behaviors, you may have asked yourself, “do I have an eating disorder?” Assessing your routines and eating patterns is the first step to finding the answer and seeking help if you need it. Of course, doing so isn’t always easy. If you’re struggling, it can be hard to look at your condition from a neutral perspective; but by learning more about potential warning signs, you can view your behaviors in a more objective way and assess whether or not you may be struggling with an eating disorder. 7 warning signs that you may have an eating disorder 1. Persistent weight changes Have you experienced sudden and significant weight changes? Rapid weight gain or loss can be an indicator that you have an eating disorder. If there’s no clear external or medical cause for your weight change, an eating disorder could be the culprit. That said, it’s worth noting that someone without any perceivable weight changes can still be suffering from an eating disorder. 2. Preoccupation with food Are your thoughts dominated by food and dieting? Thinking about your next meal or grocery trip isn’t necessarily cause for alarm, but constant thoughts may signal an unhealthy relationship with eating. People who have an eating disorder may get distracted by pervasive food-related thoughts, like repetitive thoughts about calories and nutritional content or obsessive ruminations about what they’re going to eat or have eaten. 3. Disordered eating habits Disordered eating habits are, unsurprisingly, one of the biggest signs of an eating disorder. Such habits might include skipping meals, extreme portion control (weighing or measuring everything you eat), avoiding certain foods or food groups, or rigidity around what or when you eat. 4. Anxiety around meals Emotional changes around meals can be a major warning sign that you have an eating disorder. People with eating disorders may experience feelings of anxiety and distress around mealtimes. For example, you might get stressed out in anticipation of a meal or feel guilty after eating. Emotional turmoil connected to eating can contribute to a harmful cycle or using food to cope with negative emotions, which then tends to trigger more negative emotions. 5. Physical distress If you’re not properly nourishing your body, it will start to take a physical toll. Noticeable changes could include hair loss and brittle nails, gastrointestinal issues, a weakened immune system, increased risk of injury, and always being cold, among other issues. If you notice your relationship with eating and exercise is causing you frequent physical stress, that’s a good indication to seek support. 6. Secrecy and rituals Feelings of self-consciousness and shame can lead to secrecy around certain eating habits. You may hide food, eat in secret, or develop rituals around mealtimes. Starting to connect with others and shed secrecy around eating habits is a massive step in the recovery process. 7. Body dissatisfaction and body dysmorphia Constantly thinking about, criticizing, and observing your body (a habit known as body checking) are all common symptoms for people with eating disorders. Some people also experience body dysmorphia, where they have a distorted view of their body. What to do if you think you have an eating disorder Eating disorders show up in different ways in different people—there are other warning signs that aren’t included in the list above, and you don’t need to have all (or even most) of these warning signs to have an eating disorder. Listen to your gut: if you’re concerned about yourself or your loved one, your safest and smartest bet is to get a professional assessment. The longer an eating disorder goes untreated, the more challenging it is to treat (though full recovery is possible for everyone, regardless of how long they’ve been struggling). If you have an eating disorder, getting quality treatment is important. Finding a provider that offers innovative, evidence-based care can help you make lasting progress. At Equip, we believe in delivering personalized care tailored to the needs and priorities of each patient. Our team can provide a range of integrated interventions to help you succeed in finding lasting recovery. Our treatment is also fully virtual, meaning it fits into your life and around your schedule while still providing the intensive, wraparound care you need to begin to heal. Get in touch with our team today for more information or to schedule an initial consultation. About Tana Luo, PhD Dr. Tana Luo, Equip’s Director of Program Development, is a clinical psychologist with a Ph.D. from the University of Southern California. She completed her predoctoral and postdoctoral training at the UC San Diego Eating Disorders Center. She specializes in treating pediatric and adolescent eating disorders and has in-depth experience working with children, adolescents, and adults at different levels of care.]]></content:encoded>
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            <title><![CDATA[Kids and Eating Disorders: Common Signs and When to Seek Help]]></title>
            <link>https://equip.health/articles/understanding-eds/kids-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/kids-eating-disorder</guid>
            <pubDate>Wed, 25 Oct 2023 21:11:00 GMT</pubDate>
            <content:encoded><![CDATA[Navigating the challenges of childhood can be complex, for both kids and their parents. Sometimes, those challenges are a normal part of growing up and you just need to ride the wave. But sometimes, like if your child is struggling with a mental illness like an eating disorder, it's crucial to get professional help. So how can you know when it’s time to seek out a specialist? Here’s where knowing the signs of eating disorders in kids can make a big difference. While eating disorders look different from person to person, and different diagnoses can manifest in different ways (for instance, anorexia won’t look the same as ARFID), there are some general symptoms that are common to most eating disorders. By looking out for these signs, you can get your child the support they need as soon as they need it. Common eating disorder signs in kids 1. Rigidity around eating and meals It’s normal for kids to go through different phases in their eating habits: they may be more or less hungry, more or less picky, and their preferences will change. However, if your child’s pickiness has become extreme, they are severely restricting their diet, or they’ve become very rigid about food (including what, where, and how they eat) it could be the sign of an eating disorder. Try to pay attention to how much your child focuses on their diet. Kids with eating disorders tend to think and talk a lot about food and their diet. They may start stressing over calorie counts and how food is affecting the way they look. If your child has an intense preoccupation with their diet and body image, it’s important to seek help. 2. Major eating pattern changes In addition to how much they think and talk about food, notice their actual eating habits: have they changed? Changes might include refusals of certain food groups, cutting up food in a certain way, or binge eating. Changes in eating patterns are not always associated with quantity. Instead of simply eating more or less, your child might start to eat at odd times instead of at regular meals. Being aware of these pattern changes can help you get the right treatment for your child. Early intervention can be essential for preventing health issues caused by nutritional imbalances. 3. Weight loss or lack of growth Unexplained weight changes are a common indicator of eating disorders in kids. These weight changes are typically caused by drastic changes in the child’s diet and eating behaviors. For growing children, this could also mean falling off the growth curve even without weight loss (in this case, not meeting expected weight gain benchmarks is the equivalent to losing weight). If your child is malnourished due to their eating disorder, immediate treatment is necessary. Malnutrition can be particularly harmful in growing young people, who need those calories and nutrients for their brains and bodies to properly develop. With weight restoration-focused treatment, your family’s provider team can help your child return to a healthy weight. 4. Changes in clothing Has your child suddenly started dressing differently? Sudden changes in clothing style can be totally normal in young people, but it could also be a sign of an eating disorder. People with eating disorders often choose to wear layered or loose, oversized clothing to hide their body shape or conceal weight changes. And while many of us associate body image distress with teenagers and adults, research shows that these issues can emerge as early as age six. 5. GI or stomach troubles Disordered eating habits can have a serious impact on digestion, leading to issues like constipation, diarrhea, nausea, stomach pain, and others. If your child frequently complains of stomach aches or pain and there’s not another identifiable cause, it could be an eating disorder. 6. Lack of appetite  Often, a lack of appetite or interest in food can be an indication of an eating disorder in young children. If your child is rarely hungry or gets full too quickly and you have to push or force them to eat, an eating disorder could be the root cause. If your child never gets their appetite back after an illness, especially a stomach flu, it could also be a red flag. 7. Excessive exercise In addition to changing their diet, if your child has an eating disorder they may also have adopted disordered exercise habits. Rather than working out to feel good or for sports they enjoy, your child may be hyper-fixated on burning calories or obtaining a certain image through extreme exercises. If your child is exercising through pain, sickness, or poor weather; exercising in secret; or choosing exercise over other activities, like spending time with family and friends, it’s a sign that they may be struggling with an eating disorder. It’s also important to note that exercise in kids usually looks different than it does in adults. They may not hit the gym or go on long runs, but rather engage in compulsive movement around the house (constant standing, workout out in their room, doing exercises while watching TV), develop a new interest in exercise videos, or ask to tag along with parents when they work out. 8. Concentration issues  An eating disorder can make it hard to concentrate and stay focused, not only because malnutrition impairs brain function and causes fatigue, but also because eating disorders clutter the brain with food- and body-related thoughts, leaving little room for anything else. Eating disorders also tend to worsen or bring on anxiety or depression, which can make it even harder to focus on things like homework and lectures at school. These difficulties can lead to poor school performance, even for kids who usually do well in class. Treating kids with eating disorders at Equip The unfortunate reality is that kids get eating disorders. If you’ve noticed some of the above eating disorder signs in your child, it’s important to talk to your pediatrician. Early intervention is associated with better outcomes and makes recovery easier. At Equip, we use a variety of proven, evidence-based interventions to treat eating disorders in young people. Each family is matched with a dedicated five-person provider team who work with you to create a personalized treatment plan that you can follow at home. With wraparound support and individualized care, your child can recover at home, alongside your family, which makes recovery more sustainable and protects against relapse. It also means you don’t need to press pause on life so that they can get better. Reach out to our team today to learn more about eating disorder treatment for kids at Equip or to schedule a consultation.]]></content:encoded>
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            <title><![CDATA[Equip Treatment: How We Took the Best Eating Disorder Treatment Option For Young People—FBT—and Improved It]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/equip-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/equip-treatment</guid>
            <pubDate>Mon, 14 Sep 2020 17:00:00 GMT</pubDate>
            <content:encoded><![CDATA[  JD is Equip's Director of Mentorship. She is an educator turned Family Mentor whose youngest child developed anorexia in 2012; they received cutting edge, evidence-based treatment at UC San Diego, igniting JD’s passion to ensure all families have access to evidence-based care. She became active in online family support communities, writing, and began attending and speaking at conferences. She is a board member for FEAST. Your most pressing question is likely, “How do I help my loved one and my family beat this eating disorder—for good?”  Equip took the most effective treatment model available for eating disorders—Family Based Treatment (FBT)—and gathered experts in the field, including those with lived experience, to build upon it in order to help you do just that. Why do we need better treatment? Of patients who attend a residential treatment program, 50% need to be readmitted within a year—and only 35% of those with eating disorders fully recover in today’s current treatment landscape. (1) At Equip we believe we can change those numbers drastically by changing everything about the way eating disorders treatment is delivered. Those statistics reflect the lives of real people who deserve the chance to fulfill their potential and live lives free of the disruptive and often tragic impact of an eating disorder. Equip builds on fundamental principles of FBT and powerfully enhances it for better, longer-lasting results. FBT produces the best results because it prioritizes nutritional rehabilitation and includes and trains families to make consistent nutrition happen.(2) Where traditional treatments focus on talk therapy to encourage choosing to eat and cease behaviors, FBT recognizes that malnourished brains cannot (versus will not) make these choices (3), and that compassionate, insistent, and trained families are best equipped to renourish their loved one. In fact, given that a core feature of eating disorders is lack of awareness of how sick one is, and ambivalence about recovery (4) , and that a core feature of eating disorder treatment is facing your greatest fear every day, multiple times a day, Equip believes that individual treatment is setting our patients up to fail. Equip follows the principles of family-based treatment by: Empowering family caregivers. Families are willing and capable of doing hard work if it produces results. Beginning treatment by prioritizing nutritional rehabilitation and cessation of eating disorder behaviors Moving forward versus cataloguing patient history To address the needs of families and get patients into long-term recovery, the Equip model includes important additions: A multidisciplinary team of highly-trained professionals, as well as peer and family mentors. This team provides wraparound support for families—because eating disorders are complex and affect more than just patients. We also incorporate lived experience because nobody knows better what families need than those who have been there. Care at home on your schedule, to make it possible to involve everyone in your family’s support circle and because we believe the key to lasting recovery is doing it in your real life. Explicit skills-training for families to improve the treatment experience, build lifelong recovery skills, provide relapse prevention, and improve family function Tracked outcomes and proven care practices. We deliver treatment effectively—and capture and utilize data to improve patient outcomes. Let’s dive in deeper to what each of these four pillars of Equip’s Enhanced FBT look like. 1.) A multidisciplinary team of highly-trained professionals Traditional FBT is delivered by one provider. At Equip, you get five. In the community, only 6-25% of eating disorder “specialists” utilize evidence based techniques (4). At Equip, all providers are Equip employees, trained in the latest evidence based treatments, and supervised by Equip. Most importantly, teams are all on the same page, meeting weekly to discuss progress and changes to the treatment plan. MD/Psychiatrist: Order and interpret labs, monitor vital signs, prescribe medications, and collaborate with outside specialists on medically complicated cases. Registered dietitian (RD): Interpret growth charts and provide target weights, provide nutrition prescriptions and movement protocols, work with athletes, and educate families and patients on nutrition to separate fact from popular culture beliefs. Therapist: Work fluidly with families as individual therapists, couples therapists, or family therapists. The therapist delivers evidence-based treatments and is the Care Team Manager, making sure the treatment team is aligned on messages and education for families. Family mentor: A source of emotional and logistical support, normalizing common issues, providing context for treatment plan components, and brainstorming and coaching to develop and implement authentic solutions to create progress. Importantly, family and peer mentors both provide hope and confirmation that recovery is achievable. Peer mentor: A confidante who will understand, commiserate, teach skills, and support patients through challenges. Peer mentors are a living, breathing testament that full recovery is possible and worth it. Our care teams truly operate as a cohesive team and receive the time, space, and tools they need to enable coordination. No more mixed messages from providers, or quarterbacking your own care team. 2. Care at home on your schedule Equip’s virtual treatment delivery allows you to access your providers whenever works best for your family. Because multiple people can participate in care sessions regardless of location—you can define who is in your family support circle. No time is wasted driving to clinic appointments, and families don’t need to leave work or school for care. Your entire family has access to support, including siblings and your family’s needs are addressed holistically. Your loved one with an eating disorder will need to face their greatest challenge multiple times a day, and we know that for most people, that requires more support than a once a week therapy session. Families have unlimited access to their care team, can adjust the number of sessions with their providers, and message them between sessions. If you just need a quick check-in, we offer short appointments—as well as regular hour-long sessions. Finally, Equip believes that you can’t build a life worth living if you’re not living life. Our goal is to help you address challenges in real life, and rebuild your life worth living so that there are real consequences to relapsing. 3. Explicit skills-training for families to build lifelong recovery skills While FBT is the gold standard in getting adolescents to recovery, skills based training ensures that they remain in recovery long after treatment ends. Equip providers teach skills and deliver behavioral therapies drawing from Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBTP), Exposure and Response Prevention (ERP), and Emotion Focused Family Therapy (EFFT) from day one. Patients and families learn distress tolerance skills, communication skills, and tangible skills like how to deal with dieting peers. We expose patients to challenges (food and otherwise) from day one to build a well of resilience and coping skills. Finally, we know that eating disorders rarely occur in isolation. Equip providers are trained to treat comorbid anxiety, depression, trauma, substance use, and autism spectrum disorder concurrently with the eating disorder. As adolescents complete nutritional rehabilitation and gain back independence, we work with them to harness their unique temperament traits for good. 4. Tracked outcomes and proven care practices. We can’t know if treatment is working, nor how to improve upon it, unless we measure it. Equip was built on established research and is pioneering data-driven treatment. We collect and transparently share data with patients and families because they are our partners, and we use this information to drive our treatment plan and make adjustments to ensure consistent progress. Data collection, monitoring and evaluation include: Vitals Nutritional intake Weight Behaviors Scores on eating disorders evaluation instruments Other measures, including hope for recovery and parental self efficacy Equip treatment: the new gold standard Equip is built by professionals, peers, and families to create treatment that works for you—because that’s critical to what makes treatment successful. We supercharge FBT and utilize behavioral therapy models and lived experience because it provides the best chance for success. We built Equip to be the last treatment program families need—providing recovery that’s real, full, and sustained for life. While FBT is the most effective approach for young people with eating disorders, there are also evidence-based options for adults, like CBT-E (cognitive behavioral therapy for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention), among others. At Equip, we tailor treatment to each patient's individual needs, regardless of age, and pull from a variety of evidence-based modalities to create individualized treatment that leads to lasting recovery.]]></content:encoded>
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            <title><![CDATA[Binge Eating Disorder Specialist: What to Look For When Interviewing Providers]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/binge-eating-disorder-specialist</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/binge-eating-disorder-specialist</guid>
            <pubDate>Mon, 23 Oct 2023 21:03:00 GMT</pubDate>
            <content:encoded><![CDATA[Binge eating disorder (BED) is the most common eating disorder in the U.S. It involves recurrent episodes of bingeing, when a person eats an excessive amount of food over a short period of time with a feeling of being out of control. Binges are used to numb or cope with distressing emotions, but are inevitably followed by feelings of guilt and shame afterward. Binge eating disorder is not a lack of willpower or a matter of simply overeating: it is a serious eating disorder that requires specialized treatment by a binge eating disorder specialist or team of specialists. Read on to learn more about what a binge eating disorder specialist does and what to look for in one. Binge eating disorder specialists are healthcare providers who are specially trained in treating patients with binge eating disorder. The term could refer to a number of different provider types, including medical doctors, dietitians, therapists, psychiatrists, and nurses. A binge eating disorder specialist will help you stop the disordered behaviors associated with your BED—like binge eating and restricting—as well as address the emotional and psychological components of the eating disorder. What to look for in a binge eating disorder specialist Working with a binge eating disorder specialist is key to achieving lasting recovery, but it can be difficult to find a qualified provider or providers near you. Fortunately, research shows that virtual treatment for eating disorders is as effective as in-person care, which widens your pool of potential treatment options. Whether you pursue treatment online or in-person, there are some important factors you’ll want to consider to help you make an informed decision. Specialized training: A good binge eating disorder specialist will have advanced training beyond the training and experience required for their license (MD, RD, PhD, MFT, LMHC, etc). Look for clinicians with credentials in the field of eating disorders and experience working specifically with BED patients. A top-notch provider team will include a range of experts in their respective fields, which could include a specialized therapist, medical provider, and dietitian. Specialists may also have certifications relating to BED. Their expertise can help ensure a deep understanding of your condition and its nuances and how to best help you reach lasting recovery. Extensive experience: When it comes to choosing a specialist, hands-on experience is also important. Look for clinicians with experience treating other people with BED, as this experience means that they’re better equipped to manage the complexities of your eating disorder. Working with BED patients in the past means that they understand the unique nature of the illness and will be able to tailor treatment to your specific needs. Compassion: The best binge eating disorder specialists know that humanity is a core part of treatment. They’ll bring compassion to treatment, guiding you through the hard work of recovery with empathy and support. BED is often a misunderstood diagnosis—many uneducated providers may unintentionally worsen BED by prescribing weight loss—so it’s important to find a provider who understands the nuances of BED and follows a Health at Every Size approach. Customized treatment: Like all eating disorders, BED looks different from person to person, and so there’s no one-size-fits-all treatment. A good binge eating disorder specialist will offer personalized treatment, tailoring your treatment plan to your specific needs, challenges, and life circumstances. This includes considering factors such as co-occurring conditions, as well as your lifestyle, personal preferences, and emotional struggles. With a virtual care format, your treatment can also be highly flexible and tailored to your schedule. Collaboration: All eating disorders are best treated through a multidisciplinary approach, so look for a binge eating disorder specialist who works with other providers. The makeup of a provider team can vary, but you’ll usually want at least a registered dietitian, a licensed therapist, and a medical provider, all of whom have experience treating BED and communicate with one another. At Equip, all patients are matched with a dedicated 5-person care team that works together to address every facet of the illness. Evidence-based practices: Not all eating disorder treatment is based on evidence. Look for a binge eating disorder specialist who integrates proven therapeutic modalities for treating BED. Enhanced cognitive behavioral therapy (CBT-E) is one example of a strong evidence-driven BED treatment for adults. Providers might also turn to dialectical behavioral therapy (DBT) and family-based treatment (FBT), among other approaches. Accessibility: Consistency is key in BED treatment. To ensure adherence to your treatment plan, it helps to have treatment that’s accessible and integrated into your life. With virtual care, you don’t need to worry about planning transportation for each session or being in a specific physical place to receive treatment. Being able to work with binge eating disorder specialists from your home, work, or school can help you keep up with treatment that aligns with your personal schedule. Eating disorder specialists at Equip If you’re struggling with binge eating, it’s not due to a lack of willpower or personal failure. BED is a serious eating disorder that requires professional treatment from binge eating disorder specialists. At Equip, our providers have years of training and experience in treating a variety of eating disorders, including BED. Get in touch with our team today for more information about binge eating disorder treatment at Equip or to schedule a free consultation.]]></content:encoded>
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            <title><![CDATA[Should Your Child Go to a Certified Eating Disorder Specialist?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/certified-eating-disorder-specialist</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/certified-eating-disorder-specialist</guid>
            <pubDate>Wed, 18 Oct 2023 18:28:00 GMT</pubDate>
            <content:encoded><![CDATA[If you’re concerned that your child has an eating disorder, it’s natural to feel overwhelmed by questions and choices. Should you be worried? Do you need to seek help? If so, who is best qualified to help your child? It’s important to be informed when answering all of those questions, and consulting a certified eating disorder specialist could be a smart first step. But before you can make the decision about whether to get a professional assessment, you need to understand the signs and symptoms of an eating disorder. Read on to learn what a certified eating disorder specialist is and how to determine if your child could benefit from seeing one. What is a certified eating disorder specialist? The term “eating disorder specialist” isn’t regulated, so if someone calls themselves an eating disorder specialist, it can be hard to know what that means. Thankfully, there are other ways to determine if someone truly specializes in eating disorders, including their experience, training, awards, published papers, and more. One other signifier that someone specializes in eating disorders is the Certified Eating Disorder Specialist (CEDS) title. CEDS is a title issued by the International Association of Eating Disorder Professionals (iaedp), and it refers to a licensed therapist or medical provider who, according to iaedp, “has completed high-level training and exam assessment in the effective and collaborative treatment of feeding and eating disorders.” Someone with a CEDS certification is knowledgeable about medical, nutritional, and therapeutic treatment considerations for eating disorders, adheres to a high level of professional ethics, and commits to ongoing specialized education in the field of eating disorders. It’s important to note that someone can, indeed, specialize in treating eating disorders without a CEDS certification, and many of the leaders in the field do not have one. However, it can be a useful way to get a quick understanding of a provider’s qualifications. If you’re considering working with a provider who doesn’t have the CEDS title, you can get a similar sense of their qualifications by looking at their education, experience, reviews, published research, awards, and other information. Signs your child should see a certified eating disorder specialist So how can you determine whether your loved one needs to seek professional help for an eating disorder? The signs and symptoms below are a good place to start. Changes in eating patterns Have there been noticeable changes in your child’s eating habits? These changes could range from extreme dieting to avoiding certain food groups to skipping meals or eating in private and other unusual eating behaviors. Sudden changes in your child’s eating patterns are one of the primary signs that they might be struggling with an eating disorder. These changes often include eating significantly more or less food than usual. A certified eating disorder specialist can help assess the severity of your child’s diet changes and whether an eating disorder is at their root. Body image distress Listening to your child is essential for identifying the signs of an eating disorder. If they are expressing negative thoughts and feelings about their body, it may mean that they’re struggling with disordered thoughts. Some children will directly verbalize dissatisfaction with their body, while others may make more subtle comments about wanting to change the way they look. A certified eating disorder specialist can help your child address their negative thought patterns and improve the relationship with their body. Academic decline Changes in academic performance can be attributed to many factors, but when it occurs alongside other eating disorder symptoms, it can be a warning sign. Eating disorders make school harder in a lot of ways. Dietary changes caused by an eating disorder can have a major impact on cognitive function and concentration, while food-related anxiety and stressors can distract from schoolwork. If your child’s academic decline can’t be explained by other factors, an eating disorder could be the cause. With the help of a certified eating disorder specialist, your family can identify and address the source of your child’s struggles at school. Weight changes Has your child gained or lost a significant amount of weight without any clear medical reason? Unexplained weight changes—or falling off the growth curve for growing children—are often an early eating disorder warning sign of an eating disorder. A certified eating disorder specialist can help ensure that your child receives proper nutrition, restoring them to a stable weight. Secretive eating Secrecy around eating can signal an eating disorder. Your child might be hiding their eating habits due to feelings of shame and guilt. These feelings may even drive your child to avoid eating in social settings. In addition to eating in secret, people with eating disorders often hide food; these behaviors tend to be rooted in perceived judgment from others. A certified eating disorder specialist can create a safe space for your child to discuss their behaviors and feelings without judgment. Irritability While young people can be irritable for a variety of reasons, an eating disorder can be at the root of some mood swings and irritability. If your child seems to be more frustrated and emotionally unstable, alongside other concerning signs, their emotional volatility could be caused by an eating disorder. Irritability and mood swings may still occur, but they can improve over time with proper treatment by an eating disorder specialist. If you’re considering finding a certified eating disorder specialist for your child, we can help. At Equip, each patient is matched with a dedicated 5-person provider team that includes a therapist, medical provider, registered dietitian, peer mentor, and family mentor, and they’ll work with you and your child to develop a tailored treatment plan that meets their unique needs. Get in touch with our team today for more information or to schedule a consultation. 
]]></content:encoded>
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            <title><![CDATA[ED Recovery Is Possible—But It’s a Team Effort]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/ED-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/ED-recovery</guid>
            <pubDate>Wed, 18 Oct 2023 18:32:00 GMT</pubDate>
            <content:encoded><![CDATA[The journey back from an eating disorder isn’t an easy one, but ED recovery is possible and worth it for everyone struggling. To get there, it’s essential to have the right support from a team of multidisciplinary experts who are well-versed in evidence-based eating disorder treatment. Getting this kind of care used to be extremely difficult, but with the advent of virtual care, effective eating disorder treatment is now much more accessible. Read on to learn why it’s so important to work with a team of specialists to achieve lasting recovery, how virtual treatment makes this possible, and how to take your first step toward ED recovery today. The importance of accessibility Historically, accessibility has been a major issue in the field of eating disorder treatment. Patients have been unable to get the care they need due to geographic, financial, logistical, or other barriers. Virtual treatment eliminates most of those hurdles, allowing people to access evidence-based care no matter where they live, to fit treatment around their busy lives, and to get care that’s a fraction of the cost of in-person treatment and usually covered by insurance. Research also shows that virtual eating disorder treatment is as effective as in-person treatment. The benefits of virtual treatment include: Quick help when you need it: When you’re struggling with an eating disorder, it’s important to get help as soon as you can: early intervention is associated with better outcomes and makes recovery easier. With virtual treatment, you can usually get care right away (at Equip there is no waitlist), and your providers are available for virtual sessions when you need them most. Consistent care without the long commute: Consistency is key to a successful recovery. Regular check-ins, therapy sessions, and nutritional guidance work best when they’re consistent. Virtual treatment makes it easier to stay consistent with your treatment by making sessions extremely convenient: they can happen anywhere and they fit around your schedule.  Individualized care. No two eating disorders are alike, and when you meet individually with providers in a virtual setting, it allows them to truly tailor treatment to you. At Equip, we tailor treatment to each patient’s individual needs, creating a treatment plan that fits their diagnosis, lifestyle, preferences, and other factors. We treat you as a whole person, not as a diagnosis or particular symptoms. Meet your multidisciplinary provider team So if recovery is a team effort, who is on that team? The exact makeup of a treatment team will vary from treatment program to treatment program, but it should include at least a registered dietitian, a therapist, and a medical provider. At Equip, each patient is matched with a dedicated team of experts across different disciplines. This team includes: Therapist: You’ll work with a licensed therapist who specializes in treating eating disorders. They’ll help you unravel the psychological and emotional aspects of your eating disorders. Individual sessions can help you dig into the root causes and triggers of your disordered behaviors, and help you learn healthy coping strategies to turn to instead. Group or family sessions can help you work through complex dynamics and build a recovery-supporting environment at home. Dietitian: With the guidance of a registered dietitian, you’ll learn to normalize your eating patterns and establish food freedom. They’ll help you create a meal plan that works with your preferences, lifestyle, and nutritional needs, and provide accountability and support for sticking to that plan. They can help you debunk harmful nutrition myths, learn more about your body’s nutritional needs, and better listen to your intuitive hunger and fullness cues. Medical provider: Eating disorders can lead to a number of physical and medical complications. Your medical provider will monitor and address these, while tracking essential measures of health like weight and vital signs. They’ll address any health issues that arise during treatment, as well as manage medications and any co-occurring medical conditions. Peer mentor: Having walked the road to recovery themselves, your peer mentor can provide you with invaluable empathy, understanding, and shared experiences. They’re living proof that ED recovery is possible and worth it, providing a powerful source of inspiration during tough moments. Family mentor: The treatment journey can be tough on loved ones as well. Your family mentor is someone who has supported a loved one through eating disorder recovery, and can provide empathy, support, and actionable advice to your family, friends, and whoever else joins you in treatment. Why teamwork matters for eating disorder recovery One of the most important factors in making treatment work is the collaboration of your provider team. In many treatment settings, patients might work with a team of providers, but these providers don’t communicate openly with one another, putting the burden on the patient to be the middleman between providers and creating disjointed, ineffective care. At Equip, your provider team truly works as a team, with each member bringing their own unique perspective and expertise to build a treatment approach that leads to real results. Here’s what you can expect from collaborative, team-based treatment: All-in-one care: Eating disorders don’t affect just one part of a person—they touch every aspect of your life: emotional, physical, nutritional, psychological, and social. This means that achieving sustainable recovery requires working with multiple specialists. When you take a team-based approach to treatment, you get the holistic, wraparound support you need all in one place. Smooth communication: Seeing a variety of different outpatient specialists often means that patients have to act as the liaison between providers. When you work with a team, this burden is off your shoulders. Your team will be in constant communication, sharing insights and updates and ensuring that everyone is on the same page. This helps minimize gaps in your care, making recovery more seamless and more effective. Relapse prevention: Holistic care also means thinking about what happens after treatment. By addressing every aspect of your eating disorder—including triggers, root causes, body image, your home environment, and more—your team sets you up for success once formal care ends. Each team member brings their unique expertise and perspective to treatment, ensuring that we address every aspect of your eating disorder and leave it no place to hide. Equip treatment is built on a team-based approach. When you begin treatment at Equip, you’ll be matched with a dedicated multidisciplinary team that provides you and your loved ones the seamless, comprehensive support you need to achieve ED recovery. With an expert team by your side every step of the way, you’ll have the support you need to navigate the ups and downs of treatment and find a full, vibrant, eating disorder-free life on the other side. 
Get in touch with our team today for more information or to schedule a consultation.]]></content:encoded>
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            <title><![CDATA[Adolescent Eating Disorder Treatment: 7 Signs That You Should Seek Help]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/adolescent-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/adolescent-eating-disorder-treatment</guid>
            <pubDate>Wed, 18 Oct 2023 18:18:00 GMT</pubDate>
            <content:encoded><![CDATA[Adolescence is a period filled with lots of big changes, which can be both exciting and challenging. It’s also a high-risk time for the development of eating disorders: about 12% of adolescent girls have some form of eating disorder, and eating disorder rates are rising among adolescent boys. Given these risks, if you have an adolescent child, it’s important to be on the lookout for disordered eating behaviors and other signs that something might be amiss. If you’re concerned about your child, it’s important to seek adolescent eating disorder treatment options promptly. Early intervention is associated with better outcomes, and eating disorders don’t go away on their own. Read on to learn seven signs of eating disorders in adolescents. Signs you should seek treatment for an adolescent eating disorder 1. Physical signs Eating disorders can have a variety of different physical consequences, including: Dizziness and fainting. Inadequate nutrition is a leading cause of fainting spells and dizziness. Noticeable changes in your child’s skin and hair. If your child has brittle hair and dry skin, this could be caused by poor nutrition. Persistent dehydration. Dehydration can also lead to physical changes such as dry mouth and flushed skin. Frequent injuries. Excessive exercise, another common symptom of eating disorders, can lead to overuse injuries. 2. Dramatic weight changes Sudden changes in weight can be a strong indicator of an eating disorder. While weight fluctuations are normal as your child develops, extreme changes can suggest a deeper issue. Depending on the eating disorder, you may notice your child either rapidly gaining or losing weight. These weight changes tend to be a sign of disordered eating habits, like restricting or binge eating. If your child has fallen off their growth chart (even without weight loss), this is also a cause for concern. 3. Fear of weight changes People with eating disorders often experience intense fear of weight gain or changes in body shape. Physical changes are a natural part of adolescence, and it’s normal for young people to have insecurities about their developing bodies, but for someone struggling with an eating disorder, those insecurities will be more pronounced, and even debilitating. Anxieties relating to weight and body shape are often a driving force behind many eating disorder symptoms, like restrictive eating or purging. 4. Strict dieting Does your child have a newfound preoccupation with what they eat? This could signal the onset of an eating disorder. An obsession with calories, fat content, and other aspects of diet can lead to disordered eating behaviors, which can turn into a full-blown eating disorder. If your child has started scrutinizing nutrition labels, restricting how much they eat, or removing certain foods or food groups from their diet, these choices might be driven by a burgeoning eating disorder. Recognizing this kind of shift in eating habits is crucial for early detection and intervention. 5. Increased secrecy Eating disorders thrive in secrecy. If your child starts to act more secretive around food, exercise, or their body, it could signal an eating disorder. People with eating disorders tend to hide or obscure their disordered habits and changing bodies, often out of a sense of shame, but also because eating disorders protect themselves by remaining hidden from loved ones. If you notice that your child skips family meals, prefers to eat alone, hides or hoards food, disposes of food wrappers discreetly, exercises in secret, wears baggy clothes to hide their body, or other secretive behaviors, it could be a red flag. 6. Social withdrawal Social withdrawal can be a sign of several different issues in adolescents, including eating disorders. An eating disorder can make it stressful to eat around others, causing your child to avoid food-related outings, like going to restaurants with friends or parties where food will be served. Eating disorders can also lead people to lose interest in the things that once brought them joy, like spending time with friends. If you notice your adolescent detaching from their social life, check in with them to try to understand what’s behind it. 7. Mood swings It’s normal for adolescents to experience a lot of mood fluctuations as they grow and mature, which can make it difficult to determine if mood swings are a normal developmental phase or associated with an eating disorder. But if your child is exhibiting other signs of disordered eating, along with sudden changes in temperament, an eating disorder could be to blame. These mood changes can be brought on by the physiological effects of malnourishment and irregular eating patterns, as well as the increased anxiety and depressive symptoms that tend to come with eating disorders. What adolescent eating disorder treatment looks like Family-based therapy (FBT) is an evidence-based approach for treating eating disorders in adolescents and young adults. FBT is based on the idea that a patient’s healthy family members are the ones best suited to help them recover from their eating disorder. This means that recovery happens at home, and that family (or chosen family) is actively engaged in their loved one’s recovery. When you seek adolescent eating disorder treatment at Equip, each family is matched with a dedicated 5-person care team that includes a medical provider, dietitian, therapist, peer mentor, and family mentor. This care team guides you through FBT using evidence-based modalities, providing accountability, tools, and support to build a sustainable recovery at home. Our virtual treatment model is designed to provide accessible, effective care without having to uproot your life. 
Get in touch with our team today for more information about adolescent eating disorder treatment at Equip or to schedule a consultation.]]></content:encoded>
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            <title><![CDATA[Eating Disorders in Adolescents: How and When to Seek Treatment]]></title>
            <link>https://equip.health/articles/understanding-eds/seeking-treatment-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/seeking-treatment-eating-disorders</guid>
            <pubDate>Wed, 18 Nov 2020 17:50:00 GMT</pubDate>
            <content:encoded><![CDATA[If you suspect your child is struggling with an eating disorder, the path to seeking treatment may feel daunting and filled with uncertainty. I have been an eating disorders clinician at multiple levels of care, ranging from outpatient to day treatment, and I have worked with families just starting treatment for the first time, as well as families who have been in treatment for years.  A common thread across most, if not all, parents is the experience of coming to terms with their child’s eating disorder and making the decision to seek help. Many parents can distinctly recall the early days of picking up on red flags of disordered eating in their children and the challenges associated with seeking support from their networks. Parents have frequently described hearing any variation of the following messages from their well-meaning family, friends, and even their child’s medical providers: “Oh, but your child looks so healthy!” “Don’t worry. I’m sure he will grow out of this.” “She looks so great! We should all strive to look like her.” “This is just a phase. It’s completely normal for children to go through this.” “Just make them eat!” These types of messages may ultimately leave parents feeling confused, invalidated, and alone. To add to the uncertainty, children and teens with eating disorders may not be aware that they are struggling, a condition referred to as anosognosia. Concerned parents who try to talk to their child about what they’re observing may be met with vehement denial that anything is wrong, an assertion that, in fact, they feel great, and a desire to just be left alone. This is the ploy of an eating disorder trying to protect itself and to throw parents off of its tracks. And unfortunately, eating disorders are highly effective at getting loved ones to question their own intuitions. As a result, parents might be left with a slew of questions and unfair expectations of themselves -- Am I overreacting? My child says he’s fine, so am I making a mountain out of a molehill? I used to talk about eating healthy foods...did I bring about my child’s eating disorder? Is my child really sick enough to need treatment? I should be able to help my child on my own. There may also be an immense feeling of shame and an underlying belief that it is the parent who is at fault. The bottom line is that parents do not cause eating disorders, and yet, they do have the power to help their children recover. The first step is to trust your intuitions as a parent. Even if there are people around you assuring you that everything is fine, and your child’s eating disorder is doing everything it can to make you question yourself and back down, you know your child better than anyone else possibly could -- If you think something isn’t right, something isn’t right. Once parents have decided to pursue treatment, they are often met with a new set of challenges related to identifying appropriate and effective treatment for their child. Parents often describe seeking treatment as feeling like a leap of faith into the unknown, and this process can be accompanied by even more fear and uncertainty. With so many treatment options available, it is easy to feel overwhelmed and unsure of which treatment option would be the best fit for your child and family. Parents at this stage may find it helpful to turn to eating disorder resources in various formats, including books, podcasts, online parent groups, and websites. In particular, using resources that detail the latest research on eating disorder treatment may help orient parents to the types of treatment to pursue. At Equip, we work collaboratively with families to help them start the process of seeking treatment. Our approach is built on the following: Getting to know your child and family. We understand that each eating disorder and family is different. It is important to us that we get to know YOU. Providing families with information on the different options for treatment, as well as education on eating disorder treatment that is backed by research. Our goal is for families to feel confident in their own knowledge of what is considered to be the gold standard in eating disorders treatment and to be able to make informed decisions about their child’s care. Working collaboratively with your family to determine what the best treatment option is for your family right now. When you are ready to start treatment, we are here to support you and your family. We provide easily accessible wraparound support that focuses on arming your child and your family with the skills needed to recover. My work as an eating disorders clinician over the years has shown me the power of parental intuition in guiding parents to seek help for their children. Whether you are a parent looking for the next step in treatment for your child or a parent navigating the world of eating disorder treatment for the first time, listen to your instincts, and seek out resources that speak to the latest research on eating disorder treatment. Your experiences as a parent and your knowledge of your child are integral to the processes of accessing resources, starting treatment, and helping your child recover.]]></content:encoded>
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            <title><![CDATA[Do You Address Body Image Issues in Eating Disorder Treatment?]]></title>
            <link>https://equip.health/articles/body-image/addressing-body-image-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/addressing-body-image-eating-disorder-treatment</guid>
            <pubDate>Wed, 12 Jul 2023 14:02:00 GMT</pubDate>
            <content:encoded><![CDATA[Many eating disorder symptoms have to do with bodies: being preoccupied with your body, going to great lengths to change it, having a distorted sense of what it looks like. Given that, it would be reasonable to assume that eating disorder treatment would focus on body image issues right upfront—but this isn’t the case. In evidence-based eating disorder treatment, body image is actually one of the last areas to be addressed, if it’s addressed at all. This might seem counterintuitive, but there’s a reason behind it. Read on to learn more about why, how, and when body image should fit into treatment for the best shot at success. What’s the relationship between body image and eating disorders? Eating disorders and body image concerns often go hand in hand, but the Venn diagram isn’t a perfect circle. Why is this? Research shows that body dissatisfaction is a risk factor for eating disorders, body image disturbance is one of the diagnostic criteria for anorexia and bulimia, and body image issues help maintain an eating disorder. Research also shows that those with binge eating disorder tend to have body image distress. But it’s important to remember that not everyone with an eating disorder has body image issues; this is particularly true of ARFID, which manifests in significant food restriction but not out of a desire to lose weight or change one’s body. At the same time, not everyone with body image struggles has an eating disorder (and given how prevalent body image issues are today, the eating disorder rate would be extraordinarily high if this were the case. Learn more about the connection between body image and eating disorders. Where body image fits into eating disorder treatment No matter a person’s eating disorder diagnosis, the first focus in treatment is normalizing eating habits and gaining weight for those who need it. If a patient is actively engaging in eating disorder behaviors, their brain is likely malnourished—regardless of their weight—and a malnourished brain doesn’t think clearly or take in new information well. This means it’s tremendously difficult to make real progress in any other areas of treatment, including body image work, until patients have been able to reduce their eating disorder behaviors and achieve weight restoration. “The main rationale for addressing body image in later stages of treatment is because starvation or undereating is known to impact a person's thought processes and may be directly contributing to body image-related concerns,” explains Shannon Patterson, PhD, therapist and clinical instructor at Equip. “Additionally, body image work can require a fair amount of cognitive skills that may be affected by disrupted nutrition.” Those with lived experience have seen this play out in the real world. “I think addressing body image issues is important in recovery, but there’s a right time for it,” says Gabrielle Terzano, a peer mentor at Equip. “If I was forced to address body image issues in the beginning of recovery, I think I would have been more resistant to it. I think addressing the body image with a more nourished mind was important for me.” Equip’s Director of Lived Experience, J.D. Ouellette, who helped her daughter through anorexia recovery, echoes this sentiment. “Our experience was that it wasn’t possible to address body image until my daughter had restored all the weight she lost and then some. During the time that she was undergoing nutritional rehabilitation and weight gain, body image issues were handled in the same way that eating and exercise interruption were handled: by validating the pain she was in, confirming confidence in the recovery plan, and offering distraction.” The importance of body image work for long-term recovery This is not at all to say that body image work has no place in eating disorder treatment. In later stages of treatment, addressing body image issues can be crucial for strengthening recovery and helping protect against relapse. “For many people with eating disorders, the ability to control one’s shape or weight is one of the hallmark features that keeps the eating disorder going,” says Patterson. “If we ignore the maintaining factor of someone’s eating disorder, it will be difficult to see lasting changes, and they may be at a higher risk of relapsing. Indeed, unaddressed body image issues are associated with an increased risk of relapse after successful treatment. According to one study, patients who still overestimated their body size upon discharge were more likely to relapse, while another found that specifically targeting body image after initial eating disorder treatment can enhance treatment effects. Patterson also sees body image work as an avenue for a deeper connection between the patient and healthcare provider. “Addressing body image in treatment allows the therapist to develop a greater understanding of the patient,” she says. “We’re able to see them not as a set of symptoms, but as a whole person. We learn more about a person's family, cultural heritage, and core beliefs about themselves and the world when we can address this important issue in therapy.” However, for some, body image never becomes a focus of treatment. This is the case for patients without significant body image issues—like those with ARFID, for instance—but it can also be true for patients who do have body image distress. Patterson explains that this might happen due to a clinician’s lack of confidence in addressing body image concerns, or if a patient’s insurance coverage runs out before treatment providers have had a chance to shift the focus to body image. It also might just not be a part of a given treatment program. In an ideal world, all treatment programs would include a body image component to increase each patient’s chance of achieving lasting recovery. At Equip, we take an individualized approach to addressing body image issues. For patients who struggle with body image, our providers use a variety of different evidence-based modalities to help them overcome their struggles and protect against relapse. We also have a targeted body image program that’s available to all patients, as well as the general public, and led by subject matter experts.  How is body image addressed in treatment? There are a lot of different ways to tackle body image issues, but some are more research-backed than others. The primary evidence-based modalities include: Cognitive behavioral therapy (CBT). “Cognitive behavioral therapy approaches are often used to support people with body image changes, and this may include stopping body checking or avoidance behaviors,” Patterson says. “The therapist may work with someone on ‘body approaching,’ which is engaging in something that they may have previously avoided due to discomfort or fear about their body.” That might mean getting your photo taken by a friend or wearing a bathing suit at the pool, for instance. Dialectical behavioral therapy (DBT). DBT skills can be used to help people tolerate the distress or discomfort they may feel in their body and copy with body changes during treatment. For example, the DBT skill of radical acceptance can help a person move on when they don’t like what they see in the mirror, or the DBT skill of opposite action can push someone to go to a pool party when their instinct is to stay at home, showing them that their body doesn’t have to hold them back from enjoying life. Acceptance-based approaches. These approaches are used not to change a person’s thoughts about their body, but to help them change the relationship they have to those thoughts. For instance, rather than trying to change someone’s perception that their arms are too big, an acceptance-based approach would help that person challenge the idea that their arms being a certain size matters or means anything even if it is true. Body image work might also include intuitive eating, media literacy strategies (i.e., learning to view media and its messages through a critical lens, rather than internalizing diet culture values), having gratitude for what the body can do rather than how it looks, and learning to engage in mindful, joyful movement. No matter the approach used, she says, the provider’s philosophy toward body and weight matters. “It’s crucial that providers incorporate a Health at Every Size approach to their treatment, which means that they are—at minimum—not pathologizing a person's weight, or perpetuating weight bias in their body image interventions,” she says. Ouellette also points to the power of rejecting society’s thin ideal and weight bias. “Do the work of figuring out who benefits from you feeling terrible about yourself,” she says. “For my daughter, it was really helpful for her to become educated on the toxic forces at play designed to make people feel insecure about their bodies in order to control them and sell them things. Honestly, I highly recommend getting good and angry as the first step to shedding all the societal baloney around what constitutes a ‘good’ body and the idea it’s a mandate we strive for that and that if we can't achieve arbitrary, narrow, unattainable, standards, we are less than. Learn to value the true you; the you that is your heart and soul.” Will body image be “solved” after eating disorder recovery? Despite the many benefits of addressing body image distress, the truth is that it’s possible for people to complete treatment and find recovery without making peace with their body. “I think as a field we’re still trying to define ‘recovery,’” Patterson says. “Body image interventions can aid a person in coping with aspects of society that make recovery difficult—like weight bias, racism, accessing medical care, food insecurity—but it’s important to remember that recovery can’t exist in a vacuum. We have to acknowledge the impact that larger systemic issues have on our clients’ body image.” Indeed, these larger systemic issues can make it difficult for anyone, even those without an eating disorder, to feel fully comfortable and confident in their body all of the time. Patterson also highlights the nuance and individuality of each person’s relationship with their body; because of how differently we all relate to our physical selves, each patient’s body image journey will look different. “It’s important to realize that everyone has the right to discuss their body image to the extent that feels comfortable to them,” she says. “It's also important to remember that many people lead a happy and fulfilled life without loving their bodies. I think that for many, healing doesn't necessarily mean that they no longer have body image issues, or that they love—or even like—their bodies. Instead, they’re able to build a full life and exist regardless of their body image.” Terzano is living proof of this idea. “Something that really helped me is understanding that my perception of myself can change from day to day, even if my body hasn’t changed at all,” she says. “It was my attitude towards that perception that fueled my eating disorder behaviors. I started asking myself, ‘what do I really want to look like?’ Most of the time I didn’t have an answer. That’s when I knew that my body wasn’t the problem. It was my mindset.” “Body image is one of the most challenging parts of eating disorder recovery, partially because body image doesn’t go away, even if you’re recovered,” Terzano continues. “You need to learn to remember that what you weigh isn’t more important than who you are. Focus on a lot of self-care: do a face mask, paint your nails, meditate, journal, wear comfortable clothes. This will pass. Keep going.”]]></content:encoded>
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            <title><![CDATA[Experts Say Anorexia Treatment In The U.S. Is In A “Crisis.” Here’s Why.]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/anorexia-research-crisis</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/anorexia-research-crisis</guid>
            <pubDate>Fri, 30 Apr 2021 01:04:00 GMT</pubDate>
            <content:encoded><![CDATA[While recent media has focused on the spike in eating disorders among adolescents during the pandemic, a silent and equally devastating problem has been building: expensive, unproven, failing treatment models. A paper published earlier this year which evaluated the state of the anorexia treatment landscape in the U.S. described the conditions with one powerful word: “crisis.” According to the paper, titled, “Treatment of Patients With Anorexia Nervosa in the US—A Crisis in Care” published in JAMA Psychiatry, there are a long list of shortcomings around how this country addresses disordered eating. Eating disorders continue to cost the U.S. approximately $65 billion, and there are still no targeted treatments that address the neurobiology of illnesses like anorexia. private programs to offer untested, non evidence-based interventions in the wake of academic medical center closures. What are the problems with eating disorder treatment in the United States? “Treatment for eating disorders in the United States is the Wild West,” says study author, Cynthia M. Bulik, PhD, FAED, founding director of the University of North Carolina Center of Excellence for Eating Disorders. “In the absence of standards of care and outcome reporting, individuals with eating disorders and their families are confronted with a dizzying array of direct-to-consumer, and direct-to-physician marketing, with no way of accurately evaluating whether they are truly receiving high quality evidence-based care from adequately trained healthcare professionals.” As Bulik and co-author Walter H. Kaye, MD, outlined in the study, anorexia is a serious, potentially fatal illness that frequently requires “prolonged hospitalization for weight restoration and medical and psychiatric stabilization” in the current state of under-diagnoses and faulty treatment. Anorexia is one of the most lethal psychiatric disorders and has a relapse rate of almost 50%. While Family Based Treatment (FBT) has been found to be the gold-standard of treatment for young people, it is stuck in academic circles and has not been disseminated to the public. Another challenge in eating disorders treatment has been the shrinking pool of academic medical centers. According to the paper, eating disorders programs housed in academic medical centers have been closing or shrinking over the last decade because they simply can’t compete with the proliferation of private treatment centers—many of which may not offer evidence-based approaches. Fewer medical facilities treating eating disorders means fewer medical school students receiving any clinical eating disorder education, further perpetuating the problem—“fewer emerging clinicians may be prepared to care for these patients, and more lives could be lost,” the authors write. “A vicious cycle is emerging with many academic medical center-based programs shrinking or closing, which decreases the availability of treatment programs for the most critically ill and reduces opportunities for health professional trainees to receive training in evidence-based care of eating disorders,” Bulik says. “These closures also dry up the pipeline of future clinician-scientists who are academically and clinically prepared to design studies and develop interventions to improve eating disorders treatment and outcomes. In the absence of high quality research proposals, federal funding for eating disorders research may further dwindle below the current meagre rates.” The lack of regulation makes it hard to get effective help Another major issue with eating disorder treatment in the U.S. is the fact that treatments aren’t regulated in any way, making it easy for anyone to market their own direct-to-consumer programs — whether they work or not. And of course, many of these fee-for-service programs come at a high cost. Insurance reimbursement is severely lacking for anorexia, Medicaid coverage for eating disorders is highly variable, and Medicare doesn’t cover some key components of evidence-based treatment (like nutrition therapy). “Although research on the biology and genetics of eating disorders is making impressive advances, translating those findings into treatments is lagging woefully behind and will decelerate further with the shrinkage of the pool of next generation translational scientists in eating disorders,” Bulik says.  How we can rewrite the future of eating disorder treatment So where do we go from here? Bulik and Keyes offer some guiding principles that could help change the trajectory of anorexia treatment in the future: Early detection and referral. People with anorexia typically experience symptoms for years before they seek treatment. Training more front-line physicians (like pediatricians), as well as teachers, parents, and coaches, to spot the early signs of an eating disorder will lead to better outcomes. Development of care standards. Bulik and Keyes suggest that some kind of mandated standards of care must exist and be implemented and that these standards be rooted in evidence-based treatments. Servicing underserved populations. Access to care is a must for improved treatment outcomes and there have to be more academic centers that combine research and clinical care with evidence-based approaches. Multidisciplinary care is a must. Bulik and Keyes write that “successful eating disorder treatment necessitates integrated multidisciplinary care across development and levels of care and considers patients and their families.” Improved virtual therapy and real-time interventions need to become the norm for better outcomes. Improved funding. The fact remains that anorexia and eating disorders in general receive very little funding compared to other psychiatric disorders. While the estimated financial value of medical research for eating disorders in 2018 and 2019 was $49.8 million ($9 per person with an eating disorder), Alzheimer’s disease was $239 per individual, autism was $109 per individual, and schizophrenia was $69 per individual. Bulik and Keyes encourage stakeholders “including federal funding agencies, philanthropic organizations, patients and families, advocates, insurance companies, policy makers, and clinicians, to coordinate dialogue to set priorities for the field.” While these changes won’t happen overnight, experts in the field are continuing to seek out ways to improve early detection rates, accessibility, and of course, treatment protocols, for individuals with eating disorders. And while research and clinicians continue to develop more effective protocols, evidence-based programs like Equip are available to those seeking immediate, comprehensive support.]]></content:encoded>
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            <title><![CDATA[Fear Foods: How They Can Lead to ARFID]]></title>
            <link>https://equip.health/articles/understanding-eds/fear-of-food-ARFID</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/fear-of-food-ARFID</guid>
            <pubDate>Wed, 30 Aug 2023 18:17:00 GMT</pubDate>
            <content:encoded><![CDATA[Even though food is meant to nourish your body and bring joy, it can sometimes cause stress, anxiety, and even fear. Some people may find food in general to be stressful, while others may have certain “fear foods” that evoke negative strong emotions and impact their ability to eat. For people struggling with the latter, these fear foods can come to take on a great deal of power, and may even lead to a diagnosable eating disorder, specifically ARFID. “Fear foods” may not be something that many people are familiar with, but they can play a large role in the development of eating disorders. By understanding fear foods and how they can contribute to eating disorders, you can help yourself or your loved one confront any distress that might arise from certain foods and get the support you need to overcome disordered behaviors that have emerged as a result of this fear. Read on to learn what fear foods are, how they can lead to an eating disorder like ARFID, and how to overcome that fear. What are fear foods? Fear foods refer to specific foods that a person avoids due to anxiety. This anxiety may stem from fears about how a food will affect their body, or its association with a negative event, like vomiting or choking. Fear foods look different for everyone and can refer to specific foods, or entire categories of foods. The fear of certain foods can stem from anxiety or distress about: Certain textures. Textures such as slimy, mushy, or crunchy foods, or mixed textures, can cause fear for some people. Strong flavors. Foods that are particularly spicy, bitter, sour, or sweet can be common fear foods. Unfamiliar foods. If a food hasn’t been tried before someone may develop fear around its unknowns. Health risks. Some people can develop disproportionate fears around certain foods that they’re worried will make them sick or cause them pain, in particular gastrointestinal pain. They may also fear having an allergic reaction, even if they’re not allergic to a food. Negative memories. If someone experienced a traumatic event around food, such as choking or vomiting, they may develop a fear around eating that food again. Other food sensitivities. Food temperature and appearance can also be a cause of food fears. How fear foods can lead to ARFID While it’s normal to have food preferences, consistently avoiding certain foods due to severe distress may lead to an eating disorder known as avoidant restrictive food intake disorder, or ARFID. ARFID is an eating disorder that makes it difficult to eat certain foods, enough food for proper nourishment, or both. Common ARFID symptoms include: Severely limited quantity or types of food consumed Weight loss or lack of growth Lack of interest in food or eating Early fullness or lack of appetite Difficulty trying new foods Reliance on liquid nutritional supplements or meal replacements Anxiety around food and eating Eating habits and preferences that cause significant disruption to daily life
 This restrictive disorder can stem from a variety of reasons, including a lack of interest in eating and sensory sensitivities like resistance to a food’s appearance, taste, texture, or appearance. Another common cause of ARFID is a fear of getting sick or past trauma related to the food, such as choking or nausea. Having severe distress surrounding particular foods can lead a person to limit the variety or quantity of food they eat, which is a hallmark of ARFID. No matter what types of food groups someone has cut out from their diet, avoiding too many foods can prevent their body from getting the nutrients that it needs, which can lead to weight loss or malnutrition (also symptoms of ARFID). If left untreated, ARFID can lead to chronic medical issues and the development of other mental health problems, like anxiety and depression. How to overcome fear foods The key to reducing distress around certain foods—and thus reducing the risk of developing ARFID—is confronting and overcoming your fear of those foods. While it’s easier said than done, proper treatment can help you gradually face your fears and reduce unhealthy nutritional, behavioral, emotional, and thought patterns that may lead to ARFID. At Equip, we focus on your nutrition before anything else. If your avoidance of certain foods has led to malnutrition, then weight restoration is the first step in your treatment. After that, we’ll guide you through evidence-based therapies that are effective in treating eating disorder symptoms and their root causes. We use a variety of evidence-based modalities, including cognitive behavior therapy for avoidant restrictive food intake disorder (CBT-AR) for patients with ARFID.
 CBT-AR helps you become more comfortable with the distressing foods by encouraging curiosity and making strategic adjustments to your behavior. Exposure-based therapy slowly exposes you to your fear foods to alleviate the distress that they cause and help you learn that these foods are safe. It’s okay to not like certain foods. But if you or your loved one have severe distress surrounding particular foods or types of foods, and this distress is impacting other areas of your life, then it’s possible that you’re dealing with ARFID. This can be a distressing realization, but it’s important to understand that lasting recovery is possible for every person with an eating disorder. Get in touch with our team today for more information or to schedule a free consultation. About Jessie Menzel, Ph.D Dr. Jessie Menzel, Ph.D., is the Vice President of Program Development at Equip. A clinical psychologist with over 15 years of specialized experience in eating disorders, Dr. Menzel earned her Ph.D. in clinical psychology from the University of South Florida and is also the founder and former director of the Pediatric Program at the UCSD Eating Disorders Center. She has conducted national and international training on treating eating disorders and supervising graduate students, postdoctoral fellows, and psychiatry residents. Her research experience includes the study of body image disturbance, body awareness, and the development of disordered eating interventions. ]]></content:encoded>
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            <title><![CDATA[From Perfectionist to Peer Mentor: How I Built a Life Worth Living]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/life-worth-living</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/life-worth-living</guid>
            <pubDate>Mon, 17 May 2021 18:22:00 GMT</pubDate>
            <content:encoded><![CDATA[Peacekeeping. Introverted. Sensitive. Easygoing. People pleaser. Organized. Studious. The “perfect” one. These labels were assigned to me by well-intentioned family and friends from as early as I can remember. At times, though, they felt more like directives than descriptors—an identity I had to live up to. And I clung to that last directive for dear life. On my quest toward “perfection,” I happened upon a new identity, one consumed by calorie counting, body checking, restricting and secret exercise. I didn’t have to look far to see these behaviors in action; they were the same ones my older sister had practiced just a couple years prior - the ones that had landed her in the depths of anorexia nervosa. Before long, I too received a diagnosis of anorexia and clinical depression, and with each pound lost, the eating disorder’s grip became stronger until I had no identity except for it. Anorexia provided comfort, control, safety and a sense of accomplishment. Why would I ever want to give it up? Being good at something felt good. Reflecting on my experience 15 years later, I remember the illness mostly in snapshots. Refusing to attend my best friend’s birthday party out of anxiety about eating in front of other people. Spending an entire family road trip scheming my way out of meals and angrily writing in my journal from the back seat when forced to eat a Subway sandwich. Shivering from being too cold to swim with my friends on summer vacation. What should have been joyful moments of adolescence were taken away by the eating disorder. My parents, anorexia experts-by-experience, shuffled me around to various appointments where concerned doctors raised alarm about my low heart rate and insisted I be admitted to a residential treatment center for nutritional rehabilitation. My mom, hell-bent on keeping me at home, gave me an ultimatum: I could either stay home and do what she said to get better, or be sent hours away to inpatient treatment. At age thirteen, the prospect of being sent far away from home terrified me more than the alternative, so, much to my eating disorder’s chagrin, I (mostly) complied. What I didn’t see at the time was that my mother was saving my life. Let me pause here to acknowledge the enormous privilege in my story. I fit the anorexia stereotype of a white, middle-class, thin, cis-gender female, and I therefore received a formal diagnosis fairly quickly. I had parents who were familiar with eating disorders and could swiftly intervene. Food was not scarce, and I had a stay-at-home mom with the time and financial freedom to grocery shop, cook, sit with me at meals and book appointments with highly qualified clinicians in my Los Angeles-area hometown. I grew up in a loving household and had the luck and privilege so many with this disorder are not afforded. Even still, recovery was HARD. We know eating disorders are brain disorders and I was genetically predisposed to the temperament traits that can fuel them. I was (and still am) perfectionistic, achievement-oriented, harm-avoidant and attentive to detail with a tremendous capacity to feel. And my goodness, did I begin to feel in recovery. My restrictive behaviors had numbed the shame, fear, and loneliness deep inside me (if only temporarily), so changing the behaviors left me raw and vulnerable, unsure of how to process the full spectrum of emotions that came flooding in as a result. My therapist encouraged me to approach my emotions with curiosity and channel my academic drive to help me become a “student” of the eating disorder voice. I began to externalize the eating disorder and recognize its patterns. I learned how to “cope ahead,” challenge my black-and-white thinking, evaluate the utility of my own perfectionist rules, ask for help, and explore the concept of true self-care. Eventually, as my brain and body healed and became invested in life—through friendships and new hobbies—it became easier to drown out the eating disorder. Without its voice occupying my every thought and action, I began to realize the eating disorder’s values—control, manipulation, achievement at all costs —were not my own; in fact, they were in conflict with what I really believed. Some parents describe this time as “seeing the lights come back on” in their child. For me, it felt like someone slowly cracking open a window in a dark room to reveal the light on the other side. It was a bit blinding at times; but I was also curious enough to peer through the windowpane. It turned out that the light on the other side was life, and my eating disorder was keeping me from participating in mine. Armed with new skills, a greater awareness of myself, and medication that continues to help me manage my depression to this day, I began to step outside the dark room and into my life. From this vantage point, everything looked different. I learned that many of the temperament traits that contributed to the onset of my eating disorder were not inherently negative. They made me an excellent student, employee, friend, and listener, when channeled appropriately. I’ve remained strong in my recovery for several years, and even when moments of change (like my first year away from home at college) appeared to threaten my progress, I returned to the wise-minded Mackenzie I had come to know through my journey. Unlike the eating disorder, which incessantly whispered lies in my ear, this person revealed truths —beautiful truths that I might have never come to learn if not for my recovery experience. Some days, I have to fight a little harder to access them, but I know they’re there. Today, as a Peer Mentor at Equip and a Master of Social Work student, I channel my innate traits of empathetic listening, attention to detail and emotional awareness into helping people receive quality treatment like the kind that saved my life. My new identity is rooted in recovery-oriented values of body liberation, food freedom, and Health at Every Size, and most importantly, it feels authentic to me. This is the life I’ve built, and it’s absolutely worth living. ]]></content:encoded>
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            <title><![CDATA[What Is PHP Eating Disorder Treatment? Know Your Options]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/before-php-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/before-php-eating-disorder-treatment</guid>
            <pubDate>Tue, 29 Aug 2023 17:15:00 GMT</pubDate>
            <content:encoded><![CDATA[If you or a loved one are struggling with eating disorder symptoms, getting the right care is your top priority. There are many eating disorder treatment options, each with their unique benefits and downsides, and it can be an overwhelming maze to weave through. One option that you may have come across is a partial hospitalization program (PHP) — sometimes also referred to as “day treatment” — which is a common treatment format for people struggling with mental health disorders, including eating disorders. But what, exactly, is PHP for eating disorder treatment? In short, a partial hospitalization program is a treatment option for patients with mental health disorders that don’t require 24/7 supervision but do require a significant amount of structure and care. While PHPs can be the right choice for some patients, it’s important to know that if you are deemed medically stable (a requirement to begin PHP), there are other choices available, including virtual treatment. Deciding on a treatment program is an important choice, so it’s essential to understand all the ins and outs of each option and think carefully about which one is right for your needs. Read on to learn the basics of PHP for eating disorder treatment, whether or not virtual treatment is a viable alternative, and the signs that it’s time to seek professional help. What is PHP and how does it work for eating disorder treatment? A partial hospitalization program (PHP) is a treatment program for people struggling with a mental health disorder. PHP allows patients to receive care during the day in a safe, structured environment, then return to their own home at night. PHP for eating disorders is an outpatient treatment option for patients who are medically stable but still require a structured treatment plan as they move along their journey to recovery. PHP for eating disorders generally run five to seven days a week, and each day includes five to 10 hours of extensive, personalized care. The goal of a PHP is to provide consistent structure and accountability throughout eating disorder recovery with individual therapy sessions, supervised meals, group therapy, medical check-ins, and psychiatric medication management. It’s often an option for those who are transitioning out of residential care as a step down before returning full-time to their day-to-day routine or for those who haven’t made progress in a lower level of care, like traditional outpatient treatment. It’s important to note that, despite the name including “hospitalization,” PHP doesn’t always take place in a hospital setting, though it may. Can virtual outpatient care replace PHP for eating disorder treatment? When you’re trying to determine the best eating disorder treatment for yourself or a loved one, it’s important that you consider each option alongside your needs and the demands of your daily life. While PHP may be effective for some people, it’s not always the most accessible route: for one thing, jobs and school aren’t compatible with the hours of PHP, meaning you’d need to take time off from work or school. What’s more, PHPs have limits on the number of patients they can treat, meaning you may spend several weeks or even more on a waitlist before treatment can begin. It’s also entirely possible that there just isn’t a center in your area (25% of Equip patients living more than 20 miles away from a treatment facility). Financial barriers can also make PHP inaccessible. They can cost an average of $2,000 per day and may not be covered by insurance, or be covered only partially by insurance. If they are, that insurance authorization often runs out before a patient is fully ready for discharge. Eating disorder treatment is all about helping you work toward recovery by improving your nutritional, psychological, emotional, and behavioral patterns and learning how to integrate those changes into your own life. While it’s entirely possible to do that in PHP, it can be more difficult: when treatment and life exist in two distinct bubbles, translating your recovery-supporting habits to your day-to-day after discharge can be very challenging. When you’re able to recover at home, incorporating family and other supports into your treatment while still facing the challenges of everyday life, it provides a more sustainable framework to continue on the road to lasting recovery post-treatment. Equip is an effective alternative to PHP for eating disorders because we provide: Virtual outpatient treatment: Flexibility plays a huge role in someone’s ability to access eating disorder treatment. That’s why we offer virtual outpatient treatment, allowing you to get care that meets you where you are, working around your schedule and helping you prioritize your own health while continuing to manage your day-to-day responsibilities. Wraparound support: Eating disorders affect more than one part of a person: they have physical, psychological, emotional, and nutritional ramifications. That’s why we match each patient with a five-person multidisciplinary care team. The team includes a medical provider, therapist, dietitian, peer mentor, and family mentor. Loved ones are always included in treatment for our young patients; for our adult patients, we encourage your friends and family to be involved so that they can learn more about eating disorders and provide additional support. Proven results: At Equip, we use evidence-based therapy. Evidence-based therapy leads to long-lasting results for sustainable recovery: more than 80% of our patients experience an improvement in their eating disorder behaviors, 74% report reduced depression and/or anxiety, and the average patient sees their eating disorder symptoms decrease by half within their first four months of treatment. How to know it’s time to consider eating disorder treatment It’s not always easy to admit to yourself that you’re struggling, or that someone you love is struggling. Many people with eating disorders (especially anorexia) also struggle with anosognosia, meaning they don’t actually recognize that they’re sick. But if you’re able to notice disordered behavior and thought patterns related to food and body image in yourself or your loved one, that’s an important first step toward recovery. Here are a few signs that you or a your loved one would benefit from treatment: Your eating disorder symptoms are persistent or worsening You’ve experienced notable weight fluctuations and related medical issues You’re isolating yourself from loved ones Your eating disorder is interfering with your productivity and motivation While PHP works for some patients with eating disorders, virtual outpatient treatment provides a more accessible alternative. The program at Equip is evidence-based and specifically designed to work for patients with all levels of eating disorder severity or acuity, as long as they’re medically stable (making it a viable alternative to PHP). Treatment should fit into your life, not the other way around. Get in touch with our team today for more information or to schedule a free consultation. About Maria La Via, MD Dr. Maria La Via, a Supervising Child and Adolescent Psychiatrist at Equip, is an experienced child, adolescent and adult psychiatrist focusing on working with individuals struggling with an eating disorder. Dr. La Via has a demonstrated history of working across various healthcare settings, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient care, as well as in clinical research. Skilled in Clinical Supervision, Psychological Assessment, Psychopharmacology, Cognitive Behavioral Therapy (CBT), and Family Based Treatment, Dr. La Via is also an Adjunct Faculty member at the University of North Carolina at Chapel Hill.]]></content:encoded>
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            <title><![CDATA[5 Signs You May Have a History of Eating Disorders (Even if You Didn’t Know It) ]]></title>
            <link>https://equip.health/articles/understanding-eds/history-of-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/history-of-eating-disorders</guid>
            <pubDate>Mon, 14 Aug 2023 21:58:00 GMT</pubDate>
            <content:encoded><![CDATA[Eating disorders often go under the radar. Symptoms can range drastically in how they show up and how severe they are, and many are easy to justify or hide—even from yourself. This, in combination with a diet culture-obsessed society that normalizes many eating disorder behaviors, means that it’s possible to have gone through an eating disorder without even realizing it at the time. In fact, many people navigate eating disorder symptoms for years without ever getting a diagnosis or treatment. It’s not uncommon for adults with eating disorders to reflect back and realize they were unknowingly suffering earlier in their life as well. If you’re concerned about your current habits around food, weight, or your body, it can be helpful to reflect on the past to determine if you have a history of eating disorders. Doing so can help you prevent a relapse and better understand what drives your behaviors today. Read on to learn what it means to have a history of eating disorders, signs that you have experienced one in the past, and what to do if you have a relapse. Is it possible to not realize you have a history of eating disorders? It’s possible for people to not realize that they're struggling with an eating disorder or were in the past. For one thing, it can be hard to identify harmful eating patterns when they’re so normalized in society. There are also limiting stereotypes about who gets eating disorders, and many people feel like they don’t fit into that image or believe they’re not “sick enough” to qualify for a diagnosis. For example, it’s a common perception that you must be underweight to have an eating disorder, when in reality the majority of people with an eating disorder are at weights considered normal or above normal. However, hindsight is 20/2, as they say, so it’s sometimes easier to reflect back and see that behaviors from your past aligned with the nutritional, behavioral, psychological, or emotional symptoms of an eating disorder. While it may be a bit confusing or shocking to recognize that you have a history of eating disorders, it’s important that you use this insight to help you today. Seeing your past behaviors in a new light can help you distance yourself from any disordered habits you may still be holding onto and get any support that might help you now. 5 signs that you have a history of eating disorders Every type of eating disorder has its own symptoms, but there are some general patterns that can point to a potential eating disorder that was left untreated. By reflecting on your past and looking for these patterns, you may be able to recognize signs of a history with eating disorders. Acknowledging these signs will help you gain a better understanding of what you need in your life now to achieve lasting healing. Here are five signs that you may have a history of eating disorders: Restricted intake: Eating disorders such as anorexia and ARFID often result in restricting the quantity or types of food eaten. This can mean that you’ve gone through points in your life where you reduced your food intake significantly, or eliminated certain foods or food groups altogether. Consistently dieting: There isn’t just one type of diet. New ones pop up all the time, and many pretend they’re not diets by hiding behind terms like “lifestyle changes,” or “wellness.” If you realize that you’ve spent much of your life on one diet or another in the hopes of achieving a certain body ideal, that could be an indication of past disordered eating. Gastrointestinal issues: While it’s natural to feel an upset stomach every now and then, an eating disorder can cause recurring gastrointestinal issues that affect your quality of life, such as abdominal pain, nausea, and constipation. If you’ve experienced these issues for extended periods of time, it may indicate a past eating disorder. Skipping meals or frequently eating alone: A lack of appetite and struggling to eat in front of others are both common eating disorder symptoms that can lead to skipping meals. If you found that you were deliberately missing meals, and making excuses like “I’m not hungry” or “I already had a big meal earlier,” you may have been struggling with an eating disorder. In addition, eating additional meals in isolation can be a sign of binge eating disorder. Intense focus on weight and body shape: It can sometimes be difficult to not be critical of your own body, especially as you’re growing up and struggling to feel comfortable in your own skin. But being hyperfixated on losing weight, changing your body, or fixing your “flaws” are common signs of an eating disorder. What to do if you have a history of eating disorders and experience a relapse Due to the complex nature of eating disorders, which stem from a confluence of biological, psychological, and environmental factors, people can struggle with eating disorders for many years if they don’t get the right treatment. Relapse is also a relatively common part of the recovery journey, with the relapse rate for all eating disorders somewhere between 22% and 51%. If you recognize that you may have struggled with an eating disorder in the past and are still struggling today, it’s time to seek help. All eating disorders can be treated regardless of how long you’ve been dealing with them, and it’s never too late to take the first step toward recovery. Realizing that you have a history of eating disorders can be an emotional experience, but it can also be empowering to put symptoms you may have been quietly struggling with into the context of a diagnosable medical condition. If you didn’t get proper support in the past and are now experiencing a relapse (or if the symptoms never really went away), the good news is that there are evidence-based treatment options out there to help you achieve lasting recovery. Equip, for example, is a virtual treatment program that allows you to heal from home, with evidence-based treatment and wraparound support that fits into your life. Lasting healing is possible, and we’re here to help you get there. Get in touch with our team today for more information or to schedule a free consultation. About Tana Luo, PhD Dr. Tana Luo, Equip’s Director of Program Development, is a clinical psychologist with a Ph.D. from the University of Southern California. She completed her predoctoral and postdoctoral training at the UC San Diego Eating Disorders Center. She specializes in treating pediatric and adolescent eating disorders and has in-depth experience working with children, adolescents, and adults at different levels of care.  
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            <title><![CDATA[We Already Knew Social Media is Detrimental for Eating Disorders. Now Let's Get Everyone Access to Care]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/facebook-whistleblower-eating-disorders-op-ed</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/facebook-whistleblower-eating-disorders-op-ed</guid>
            <pubDate>Thu, 21 Oct 2021 01:46:57 GMT</pubDate>
            <content:encoded><![CDATA[In light of the Facebook whistleblower events that have taken our society by storm this month, I have simple words to share: we’ve known this all along. In the eating disorder field, we’ve known for over a decade that social media has harmful, harrowing, and preventable effects on young people. We’ve known that the mere act of holding a phone – which most young people do for more than 7 hours per day – exposes young people to toxic messages and images steeped in harmful diet practices that can lead to eating disorders. I should know because I developed anorexia at 10 years old after the experience of watching my babysitter diet. Frances Haugen’s testimony and whistleblowing is a gift that our society should never have needed to receive. Social platforms should have always been held accountable, since their inception, for keeping their users safe. We’ve known that while eating disorders have the second highest mortality rate of all mental illnesses and 30 million people will have one over their lifetime, less than 5% get treatment that works. The status quo treatment options (largely residential treatment centers) are cost-prohibitive for most, and we don’t know much about their clinical outcomes. Research shows that having an outpatient multidisciplinary care team measurably enhances recovery outcomes, but very few providers are trained in evidence-based treatments for eating disorders, and only a small fraction of them take insurance. Now that our cultural gaze is held on eating disorders and young people – and social platforms are being called to re-evaluate their policies – we must first and foremost turn our focus on ensuring that everyone with an eating disorder has access to affordable and effective eating disorder treatment. Barriers abound to making that a reality – from pervasive weight stigma and harmful stereotypes to lack of geographic access and affordability. While the trope of a white thin cis-gender woman with anorexia permeates our media and healthcare system, we know that eating disorders affect people equally across races, ethnicities, body sizes, genders, sexual orientation, socioeconomic status, and abilities. And we know what needs to be done to unwind these systemic challenges. Evidence-based care like Family-Based Treatment needs to continue to be pulled out of academic circles; telehealth needs to be accepted as a key solution to significantly closing access gaps; insurance companies need to continue taking note and reimbursing for innovative, effective care models; and historically marginalized folks need to receive culturally humble treatment. There’s sizable work that still needs to be done by our health system and by all of us, in bringing these conversations to bear. For now, a few simple but profound changes in your everyday life can make an impact: pay more attention to the children in your life and the cultural messages they consume; reach out with a loving hand and ear to a friend who makes self-deprecating comments about their body or image; challenge your healthcare provider’s unsolicited weight-related commentary; read up on weight stigma and fatphobia; and encourage loved ones in your community to learn about the evidence-based eating disorder care and to ask for the help they deserve. It’s what we have deserved all along.]]></content:encoded>
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            <title><![CDATA[What Is the Most Common Eating Disorder? (and What to Do If You Think You Have It)]]></title>
            <link>https://equip.health/articles/understanding-eds/most-common-eating-disorder</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/most-common-eating-disorder</guid>
            <pubDate>Wed, 23 Aug 2023 17:27:00 GMT</pubDate>
            <content:encoded><![CDATA[What Is the Most Common Eating Disorder? (and What to Do If You Think You Have It) 
 Eating disorders are tragically common: up to 10% of the U.S. population (some 30 million people) will be affected by an eating disorder in their lifetime. But among the different eating disorder diagnoses, some are more common than others. Read on to learn about the most common eating disorder and what steps you should take if you or someone you love is struggling with it. 
 The most common eating disorder 
 When many people hear the term “eating disorder,” they think immediately of anorexia or bulimia. But in fact, the most common eating disorder is binge eating disorder (BED). Binge eating disorder is defined by repeated episodes of binge eating, without purging afterward. A binge is when a person eats an unusually large amount of food very quickly, past the point of discomfort, while feeling a lack of control. Binges are generally followed by intense feelings of shame and guilt, and are generally preceded by periods of not eating enough. 
 Similar to other eating disorders, binge eating disorder behaviors can stem from restriction. However, unlike other eating disorders, BED doesn’t usually involve behaviors like vomiting or excessive exercising to “make up” for the amount of food consumed (behaviors that fall under the umbrella of “purging”). 
 Having the occasional big meal or snack doesn’t mean you have binge eating disorder. It becomes a concern when this happens frequently, and it starts to cause you distress and affect your daily life. 
 What to do if you think you have an eating disorder 
 If you suspect you might have disordered eating habits that may be becoming an eating disorder, it’s crucial to take action quickly. Prompt and early intervention is important for the best odds of recovery—though full recovery is possible for anyone struggling, regardless of when they get help. 
 Here’s what to do if you’re worried that you have binge eating disorder or another eating disorder: 
 Acknowledge your concerns: The first step is acknowledging that something might be going on. If you constantly worry about food, your weight, or your body, and are noticing disordered behaviors around food, it may be time to admit that these concerns need attention. 
 Reach out to someone you trust: You don’t have to go through this alone—in fact, it’s not possible. Talk to someone you trust: a friend, family member, teacher, or counselor. Opening up about what you’re going through can be tough, but it’s a necessary step toward getting the support you need. 
 Educate yourself: Knowledge is power. Taking the time to learn about binge eating disorder or eating disorders in general can be helpful. Understanding what you could be dealing with can empower you to make more informed decisions and realize that eating disorders are complex illnesses that need real treatment, not a lack of willpower. 
 Consult a professional: The next vital step is connecting with a medical professional. This could be your primary care doctor, a dietitian, or a mental health professional. They can help assess your situation, provide a diagnosis if needed, and help guide you toward suitable treatment options. You can also schedule a free consultation with our team at Equip. 
 Consider therapy: Therapy can be a game-changer. It can help you identify and change unhealthy thought patterns and behaviors around food. 
 Involve your support system: Friends and family can be your biggest supporters and allies. Involving them in your journey can provide you with a safety net when recovery gets hard, as well as help protect you against relapse when treatment is over. Whether they’re attending treatment sessions with you or simply listening to your concerns, having a solid support system is invaluable to your recovery. 
 Give yourself grace: Recovery is a marathon, not a sprint. Be patient and kind to yourself. There may be ups and downs, but every step forward is progress. 
 Binge eating disorder is a serious mental health condition, and it’s more common than many people realize. If you think you or someone you love is struggling with BED, get in touch with our team today for more information or to schedule a free consultation. 
 About Angela Celio Doyle, PhD Dr. Doyle has been a clinician and researcher in the eating disorder field for over 20 years. Passionate about early intervention and access to evidence-based care, she trains treatment providers internationally in providing family-based treatment for eating disorders and has a research background in internet-based eating disorder prevention programs. Dr. Doyle earned her Ph.D. in Clinical Psychology from the SDSU-UCSD Joint Doctoral Program and completed a postdoctoral fellowship at the University of Chicago. She holds an adjunct faculty position at the University of Washington's Department of Psychology and is Vice President of Behavioral Health Care at Equip. ]]></content:encoded>
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            <title><![CDATA[Ask An Equip Provider: Should I Recommend Family-Based Treatment (FBT) for My Patient?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/questions-about-family-based-treatment-ask-an-equip-provider</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/questions-about-family-based-treatment-ask-an-equip-provider</guid>
            <pubDate>Fri, 21 Apr 2023 07:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Family-Based Treatment (FBT) is the most effective, evidence-based approach for treating eating disorders in young people. It consistently shows better outcomes than individual treatment, and while residential treatment centers (RTCs) are often the default choice for care, 50% of those who attend an RTC need to be readmitted within a year. FBT is built on the radical idea that healthy family members are the ones best suited to help their loved one recover from an eating disorder. Whereas traditional treatment focuses on talk therapy or intensive treatment away from home, FBT recognizes that young people who are malnourished simply can’t make healthy choices, and tasks family members with first and foremost renourishing their loved one. At Equip, our treatment model is based on FBT and enhances the approach with a dedicated 5-person treatment team that’s delivered virtually—which our research shows to be just as effective as in-person treatment. FBT is a bold approach, which means that—despite a large body of evidence pointing to its effectiveness—clinicians may have hesitations about recommending it for their patients. This is understandable. Cara Bohon, PhD, Equip’s Senior Vice President of Clinical Programs, answered some common questions and concerns that healthcare providers have about Family-Based Treatment for eating disorders. Doesn’t FBT take away a patient’s agency? It seems misguided for adolescents and teens to lose control over their eating, movement, and other parts of daily life. Eating disorders are brain-based illnesses and not a choice. The eating disorder itself limits the agency of the patient before treatment begins. Their world revolves around food choices, body checking, or exercise, but not because they want to be thinking or doing those things—the eating disorder brain processes are driving these behaviors. I hear family and friends say “Why can’t they just eat?!” or “Why can’t they just stop binge eating or purging?!” about their loved one with an eating disorder. But it’s not that simple. It’s not a choice. I say all of this to illustrate that FBT is not taking away anything that the eating disorder did not take away first. Instead, FBT is creating an environment that takes away the eating disorder’s control over the patient and allows the patient to recover their own agency. It’s important to note that FBT is individualized and adaptive. Many patients begin treatment with the eating disorder almost fully eclipsing their true selves. We can often see that from loved ones’ assessment of behaviors, values, interests, and mood before and after the eating disorder began. When a patient is in a state where their eating disorder dictates their every move, FBT guides loved ones to make food choices that align with what the patient would have wanted if the eating disorder weren’t present. Family members monitor meal completion so that the eating disorder doesn’t have the opportunity to restrict, as well as bathroom usage and other post-meal behavior to prevent purging. As the eating disorder’s hold on the patient slips away, FBT guides loved ones to return independence around eating back to the patient in a safe and supportive way. This may mean restrictions on movement or limitations on social or physical activities, as these are instances in which the eating disorder is more likely to take control. But a key part of FBT is using the family’s knowledge of their loved one to guide choices and return independence as soon as they are able. FBT seems like a huge ask for parents and family members who have no training in treating eating disorders. Can they really take all of that on effectively? I won’t lie. FBT is a lot of work. Eating disorder recovery is not easy on anyone. But providers trained in FBT are positioned to support the family in succeeding. Families know their loved one and their family, and providers know eating disorders and the treatment strategies and skills that get people to recovery. Families and providers work together as a team, collaboratively determining what approaches will work best for each family. Despite common misconceptions, it’s not a one-size-fits-all set of solutions for a family to take on, but rather a collaborative and adaptable process. Families and providers talk together about what possible solutions will help them be successful in challenging the eating disorder’s hold on the patient. And despite the hard work of implementing FBT, families report reductions in their sense of burden and burnout once they’re in treatment. The eating disorder itself is more disruptive to families than treatment, where there can finally be a sense of hope. Won’t FBT harm the patient’s relationship with their family? In the midst of FBT, many families worry about their relationship with their loved one. The eating disorder creates a lot of distress as it weakens, as if in an attempt to sabotage treatment and remain present and strong. But while the treatment hurts in the moment, patients and families describe a sense of healing afterward. A patient’s father once told me, “I would never wish an eating disorder upon anyone, but this process has brought our family closer together than we ever were before.” Equip’s Director of Peer Mentorship has written about her experience hating treatment and fighting with her parents, but later being grateful for their choice to do a treatment that saved her life. She wrote, “If I could send one message to parents supporting their children in this journey, it’s that the disorder gets louder, meaner, and angrier when it feels threatened: and that can be a sign that you’re truly helping your child break free from its grasp.” And that life-saving gift is one that often brings families closer through recovery. Are there any types of families for whom you wouldn’t recommend FBT? I have learned over the years that we are pretty bad at predicting who would or would not do well in FBT. My initial instinct was that families with a stay-at-home parent who could be dedicated to meal support were the only ones who could truly make this treatment work. I was wrong. Then I thought that perhaps working parents could do it, but divorced parents would certainly struggle since they often couldn’t get along well. Wrong again. Then I thought, “Well, certainly single parents or those with multiple jobs wouldn’t be able to do FBT.” Families of all kinds have proven me wrong every time. I have had families with a stay-at-home parent struggle and families with a single parent achieve great success. The truth is that we do not have any good predictors of which families will do well or not. FBT is adaptable, and a well-trained provider will work with families to identify what resources they have available to support their loved one and meet their needs. Virtual treatment, which is as effective as in-person treatment, allows families to join treatment sessions from work breaks or between shifts of jobs, as well as bring extended family members who can provide additional support. The most important thing is a strong collaborative relationship between the family and provider team to create a plan that fits—and leads to lasting recovery. 
 Citations: Lock, J. An Update on Evidence-Based Psychosocial Treatments for Eating Disorders in Children and Adolescents, Journal of Clinical Child & Adolescent Psychology, 44:5, 707-721, 2015. DOI: 10.1080/15374416.2014.971458 Couturier, J., et al, Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. Int. J. Eat. Disord., 46: 3-11. 2013. https://doi.org/10.1002/eat.22042 Accurso, Erin C et al. “Attitudes Toward Family-Based Treatment Impact Therapists' Intent to Change Their Therapeutic Practice for Adolescent Anorexia Nervosa.” Frontiers in psychiatry vol. 11 305. 23 Apr. 2020, doi:10.3389/fpsyt.2020.00305 Steinberg, D. et al. (2023) Effectiveness of delivering evidence-based eating disorder treatment via telemedicine for children, adolescents, and youth, Eating Disorders, 31:1, 85-101, DOI: 10.1080/10640266.2022.2076334]]></content:encoded>
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            <title><![CDATA[Beyond the Food: Redefining the Meaning of Thanksgiving While in Eating Disorder Recovery]]></title>
            <link>https://equip.health/articles/food-and-fitness/thanksgiving-eating-disorder-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/thanksgiving-eating-disorder-recovery</guid>
            <pubDate>Fri, 17 Nov 2023 21:27:16 GMT</pubDate>
            <content:encoded><![CDATA[For many, Thanksgiving is a day centered around wholesome traits like family, friends, gratitude, and food. For those struggling with disordered eating, Thanksgiving to be a particularly challenging time. Here, several Equip team members share how they’ve found meaning in Thanksgiving that transcends beyond the meal and helps them reclaim the day for themselves and their loved ones. Kevin Dunn, Director of Family Mentorship Kevin Dunn, Equip's Director of Family Mentorship, acknowledges that Thanksgiving can be a tough day for some, due to everything from an out-of-ordinary meal to potential unsolicited body or weight commentary. But he says there are effective methods for reclaiming the day in the name of health and recovery. "We can effectively navigate and support our loved ones’ through Thanksgiving conversations focused on weight, food, shape, movement, or diet by flexing our validation and distraction skills,” he says. “As we reply to those delivering triggering content, our response might sound like, ‘I can hear that topic is a challenge for you. We’re thankful for so much today. In fact, we made a list. I’ll bet we share gratitude for some of the same people and things. Let’s take a look.’” Chita Gastelum, Family Mentor Lead Gastelum grew up in a marginalized, Indigenous and Hispanic community. “My grandparents lived about 40 mins outside of Nogales, Sonora Mexico,” Gastelum says. “Their ranch was located off to the left down a dirt road near the railroad tracks. They lived in a makeshift home my grandfather built made of adobe and metal roofing. Their small farm was surrounded by the desert, mountains, and a small river a few feet away that consistently flowed.” Gastelum and her family spent most of their time and holidays at her grandparents’ ranch. “As a child, I have a memory of my sister and I helping my grandfather collect vegetables from his garden. My nana and mother would roast corn outside, and they would cook the squash, potatoes, and green beans on the wooden stove. Afterwards, my sister, cousins, and I would help to make fry bread with piloncillo (pure brown sugar cane) syrup and the pumpkin empanadas (crescent shaped stuffed pastry) for dessert.” When the family sat down for dinner, Gastelum says her grandfather would say a prayer of gratitude for the meal which included a mixture of the cooked vegetables, freshly made semitas, chicken, and charro beans. As the evening neared and the sun began to go down, he would share stories about her family’s ancestors and Indigenous folktales. “I believe having this unique connection with my family, as well as being surrounded by nature created a safe space for me,” shares Gastelum. “It was moments like these shared in my culture where I felt nurtured and supported during my recovery from the eating disorder.” Elizabeth Moscoso, Equip Peer Mentor Equip peer mentor Elizabeth Moscoso says that growing up in a Central/South American family, she felt an underlying pressure to express gratitude for all the hard work it took to prepare the festive Thanksgiving meal by eating generous portions. “It can be tough for folks that want to please their loved ones and feel guilty if they aren't feeling that ‘clean-plate club’ honors their relationship with food,” she says. “By shifting the message to enjoying the holiday as a time to be with family and watch a movie, play a game, go on a gentle stroll in the neighborhood, and respect that this can be a tough holiday for people in eating disorder recovery can make the day feel inclusive. By taking focus off of the holiday food can be super helpful as recovery warriors heal their relationship with food and body." Amy E. Cunningham, Equip Community Advisor Equip community advisor Amy E. Cunningham acknowledges that separating the Thanksgiving holiday from food itself can be a tricky thing for those navigating recovery because “at the foundation of healing from an eating disorder is the need to eat food, and likely lots of it.” With that in mind, Cunningham has experience easing the difficulty that can often accompany this focus on food during the holiday and beyond. “To be very honest, when my daughter —then age 11 — was in the deepest throes of anorexia and I was re-feeding through Family-based treatment, I did not celebrate Thanksgiving in the traditional way,” she says. “Food was at the center of our lives simply because I needed to re-feed her to save her life (food is medicine) and that meant six meals a day with the aim to increase her weight fast and in that way, counter the eating disorder.” Cunningham says that instead of engaging in any mainstream traditions, she would treat Thanksgiving like any other day of recovery-focused meals and quality time and “just having a moment to quietly cuddle or watch a TV show would have been plenty for me.” These days, Cunningham says the holiday is a different story altogether. “Today Thanksgiving does mean a great deal of enjoyment around food and family — we look forward to all the yummy treats and traditional family foods, as well as time for all of us to gather together,” she says. “The message is: even if this year's Thanksgiving is tough, know that with recovery from the eating disorder, there are happier days ahead!”]]></content:encoded>
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            <title><![CDATA[Eating Disorders Are a Mental Illness. Here's What You Need to Know.]]></title>
            <link>https://equip.health/articles/understanding-eds/eating-disorders-are-a-mental-illness</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eating-disorders-are-a-mental-illness</guid>
            <pubDate>Mon, 08 May 2023 15:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Anyone who’s ever been diagnosed with an eating disorder or witnessed a loved one struggle knows one of the toughest parts of recovery is navigating the misunderstandings around the nature of eating disorders. No, eating disorders are not a vanity issue, a lifestyle choice, a diet gone wrong, or a “phase.” Eating disorders are serious brain diseases with high mortality rates. And it’s time we start recognizing them as such. “It’s important for folks to understand that eating disorders are a serious mental illness, because then we’ll treat them with the same urgency as any other mental illness, like depression, anxiety, or PTSD,” says Equip Lead Peer Mentor Zaynah Mahon. “The sooner we start accurately treating eating disorders as mental illnesses, the sooner treatments can be accessible to everyone.” Equip therapist Jonathan Levine points out that like all brain diseases, eating disorders do not give those suffering the ability to opt out or simply “decide” to get better. “Understanding that eating disorders are mental illnesses is critical for three main reasons: empathy, awareness, and recovery,” he says. “Assuming that eating disorders are a phase or strictly vanity-related is dangerous, because it neglects to factor in that you're dealing with a brain disease. And like with all brain diseases, you can't think yourself out of it. It takes action, support, and treatment for the majority of people with eating disorders to recover.” So, is an eating disorder a mental illness? As research has repeatedly demonstrated, eating disorders are complex illnesses that involve biological, psychological, and social risk factors. Studies have shown that eating disorders physically change the reward circuitry in the brain and alter gray matter and brain structure. “​​When you're dealing with an eating disorder, the brain is severely impacted,” Levine says. “What ‘makes sense’ to a nourished brain will not follow a malnourished brain's logic. The eating disorder brain is, by definition, irrational.. In order for the reward system to kick back online and the brain to heal, you need nourishment.” With a deeper understanding of the science behind eating disorders, it’s clear that writing these illnesses off as aesthetic pursuits is not only grossly misinformed and inaccurate—it’s also dangerous. “Eating disorders are among the deadliest mental illnesses, second only to opioid overdose,” Mahon, who is in recovery, says. “When I was still suffering from an eating disorder, I was mentally ill. The eating disorder didn’t want a certain body type or number on the scale. It would have kept me sick until I was dead. Whenever I did reach a ‘goal weight,’ my brain only desired more, which means that nothing would ever be truly good enough.” Underscoring Mahon’s point, Levine points to the severity and entrenched nature of eating disorders. “Let's look at the facts: if eating disorders are not ‘true’ mental illnesses, why are they historically treatment-resistant?” he asks. “Why doesn't simply telling someone to eat heal a restrictive eating disorder? Why does the average duration of an episode of anorexia last five to seven years? If eating disorders weren't a ‘real’ mental illness, none of this would be true.” To fully understand the experience of living with an eating disorder, Levine advises putting yourself in the shoes of someone suffering. “Try envisioning someone else's voice in your ear, telling you deeply harmful, shameful, and untrue things about yourself, your body, and what you need to do,” he says. “It can feel like a total eclipse of the self. Many people with eating disorders don't want to recover— eating disorders are “egosyntonic.”Someone may be at risk of dying from not eating and still think that it’s the only way forward, that eating is worse than organ failure. That's how loud an eating disorder can get by impacting the brain.” The role of culture and society in eating disorders It’s undeniable that we exist in a diet culture-driven society where disordered behaviors like food restriction, overexercise, and obsessive thinking about one’s body are normalized. Given this, it’s understandable that some people might think eating disorders are simply a reaction to cultural expectations—but this explanation oversimplifies eating disorders by ignoring the many other contributing factors. After all, if harmful diet culture messaging was the sole cause of eating disorders, wouldn’t everyone have one? “It’s true that media and diet culture can play a role in the development of eating disorders, but not on their own,” Mahon says. “ There are social factors that folks can’t opt out of that can contribute to the development of an eating disorder. For example, not having regular and secure access to food can absolutely contribute to disordered eating.” She also points to genetics, noting that anywhere from 28-74% of eating disorder risk is through genetic heritability. While society, culture, and media all play their own role in the development and proliferation of eating disorders, Levine is clear that these issues are “biopsychosocial” phenomena. “What I mean by that is, eating disorders are partly genetic (biology), partly mental health-related (psychological), and partly cultural (social)—rarely does just ‘one’ thing lead to an eating disorder,” he says. How to start shifting the perspective on eating disorders By learning more about the science of these illnesses and talking openly about their prevalence, we can start to chip away at some of the biggest myths about eating disorders—all of which are doing a disservice to those in need of healing. Anyone who suspects they or someone they love may be experiencing symptoms should be encouraged to take the issue as seriously as any other disease and seek help immediately. “Stay curious and be mindful,” Levine advises parents and other support figures. “Watch out for sudden or rapid shifts in eating habits, mood, sleep regulation, and how one talks about their body, as these could be warning signs. Most importantly, be consistent and supportive. Eating disorders are cunning and adept at pushing buttons to remain in power—don't be afraid to be firm and loving.” For those experiencing the very real, at times debilitating symptoms of an eating disorder, Mahon encourages swift action and deep self-compassion. “Regardless of what anyone says about your eating disorder or their feelings on the intensity of your suffering, you are in fact sick enough to get help,” she says. “You don’t have to wait until you’re sick like someone else. If you are even for a second thinking of skipping lunch because you want to fit into your outfit for prom, or you think you need to run just one more mile even though you haven’t eaten, you need to ask for help. Tell a friend, an adult you trust, a crisis text line, anyone. Don’t wait for it to feel like a more serious problem."  If your'e concerned that you or a loved one is struggling with an eating disorder, it's important to get prompt treatment. Talk with a trusted medical provider or schedule a consultation with an Equip team member.]]></content:encoded>
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            <title><![CDATA[Online Therapy for Eating Disorders: How Technology Can Benefit Eating Disorder Clients]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/benefits-virtual-therapy-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/benefits-virtual-therapy-eating-disorders</guid>
            <pubDate>Wed, 09 Dec 2020 17:35:00 GMT</pubDate>
            <content:encoded><![CDATA[Before the pandemic, the idea of conducting online eating therapy for eating disorders was off-putting—even incomprehensible—to some therapists. We had questions like “how can we ensure that patients are eating properly?” and “how can we weigh them without doing it in person?” Then 2020 happened, and many of us had no choice but to make the move to virtual treatment. And in doing so, we learned that online eating disorder therapy has a lot of advantages, and many of us saw clearly how technology can benefit eating disorder clients. Online therapy for eating disorders closes the treatment gap Beyond being safe during a pandemic, online eating disorder therapy can help close the treatment gap and provide greater opportunities for learning and psychosocial information gathering. If you've worked in the eating disorder field, you know that the vast majority patients do not have access to evidence-based treatment. With virtual care, being licensed in a particular state means that you can practice virtually anywhere in that state. This translates into a countless number of people now having access to care who didn’t at the start of the year. On top of that, virtual care cuts down on travel time and expenses for people who have limited free time and financial resources. Of all of the benefits of virtual care, improving access to evidence-based treatment is arguably the most important. Online therapy for eating disorders allows providers to work creatively with families While we're mostly focused on how technology can help eating disorder clients, it can also help eating disorder therapists. For instance, a patient can be eating with their family while the therapist provides real-time feedback through a headset on what skills to use to ensure the meal is completed. This can be much better than having the family eat a meal in your office. For one thing, the family is in the comfort of their own home. On top of that, only the person with the headset can hear your feedback, rather than the whole family. This makes things much less awkward! Plus, patients and families can also pre-record meals for the therapist to view later. As it turns out, the concern about not being able to see what a patient eats is rather unfounded. In fact, technology can add transparency, making the job of the therapist easier and more efficient. Technology make eating disorder treatment more seamless Technology can also make care more seamless. There are scales that patients can purchase that automatically send weights to their provider without the patient ever having the information. If, for whatever reason, using one of those scales isn't feasible, there are other non-technical workarounds. For instance, a family member involved in treatment can be trained on how to take a blind weight for their loved one. Technology allows online eating disorder therapy to be, in many ways, more seamless than in-person care—and the obstacles it does present can be creatively overcome. Virtual care allows providers to see how patients behave in their daily life Obtaining psychosocial information can also be easier in a virtual setting. In telehealth sessions, the therapist naturally sees the inside of the patient’s home. We can also, for instance, ask to see the decorations on the wall of an adolescent’s room. Not only does this allow for rapport building, but it can provide very rich psychosocial data above and beyond what we would see in a brick-and-mortar setting. With online therapy for eating disorders, therapists may also be privy to seeing real-life interactions between family members. For example, a patient and mother might get into an argument while the therapist is meeting with the father. Because family dynamics are particularly important to understand in when treating eating disorders (whether you're using family-based treatment or another modality), the type of psychosocial information-gathering that a virtual setting offers can really be an asset to treatment. Online eating disorder therapy leaves room for innovation Although many of us were hesitant to incorporate technology into eating disorder care, some of us were excited about its potential even prior to the pandemic. After all, there is nothing but room to innovate in this space! Equip is a digital-native virtual eating disorder clinic that did not have brick-and-mortar beginnings. We use a custom-built online platform for therapists, treatment team members, patients, and their families that includes secure video calls, messaging, scheduling, medical records, symptom-tracking, and more. We're constantly exploring how technology can benefit eating disorder clients, by staying on top of developments in the field while also closely monitoring patient outcomes and family satisfaction.  Along with having a digital-native online platform customized for the treatment of eating disorders, Equip is novel in other ways as well. At Equip, each patient and their family work with a multidisciplinary care team to treat every facet of the eating disorder: emotional, nutritional, physical, psychological. This includes a therapist, a medical doctor, and a dietitian, all of whom specialize in eating disorders, as well as mentors who have lived through recovery themselves or helped a loved one through recovery. By providing virtual, wraparound care in this way, we hope to leverage technology to close the treatment gap. Online therapy for eating disorders has a lot of benefits. In addition to allowing for a rich picture of family dynamics, home life, and meals, it can also help close the treatment gap in a meaningful way. As we continue to learn about how technology can benefit eating disorder clients, we're seeing more and more potential for increasing not only accessibility, but effectiveness of treatment. It will be exciting to see how far we can take it.]]></content:encoded>
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            <title><![CDATA[School's in Session: Supporting a Student with an Eating Disorder]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/school-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/school-and-eating-disorders</guid>
            <pubDate>Thu, 04 Aug 2022 14:28:29 GMT</pubDate>
            <content:encoded><![CDATA[A new school year is just around the corner which inherently means excitement and nervous jitters for kids and students. And for those in recovery from an eating disorder, the transition may be even more complicated for both the student and parents who may be at a loss for how to offer support for getting back on campus. “Transitions are hard for everyone,” says Equip therapist Jenna Zimmerman. “They can make us grasp at anything in our control to maintain a sense of security when we are not sure what is coming our way. This can present added vulnerability for children or adolescents that are at risk of developing eating disorder behaviors as they seek to control aspects as the change is happening around them.” Zimmerman says there are a few distinct ways a new school year may trigger challenges related to body image and eating. Kids may feel compelled to make an impression on their peers through their appearance, fixating on their body shape or how their clothes fit in comparison to others. Lunchtime anxiety may prompt them to eat (or not eat) in a certain way if they feel it may help them fit in. The stress that can accompany all this can also invoke appetite-suppressing tension, reducing a kid’s natural desire to eat. Because back-to-school season is often characterized by clothes shopping, reuniting with peers, and adapting to new teachers and workloads, stress can be rampant. “It’s not uncommon for eating disorders to develop from what was initially unintentional food restriction and then snowballs into something very different,” Zimmerman says. Equip therapist Maddie Friedman shares examples of how these seasonal changes can promote eating disorder behaviors. “For example, changes to clothing size, social comparison, and new stressors can activate underlying mental health conditions or predisposition to EDs and promote maladaptive coping,” she says. Tips for parents to help their loved ones prepare for a new school year While every child has unique needs, experts agree that there are some tactics that could help bolster a student’s confidence and support their eating disorder recovery during the particularly tumultuous time of transitioning into a new school year. Start talking early. A few weeks before the school year, initiate a frank conversation about the importance of moving from one life stage to the next. “Normalize changes to body shape and size!” Friedman says. “It is entirely appropriate (and expected) for children and adolescents to grow and gain from year to year. But our society feeds us unhealthy messaging about beauty ideals, so openly questioning and investigating these messages early and often can promote acceptance of all bodies.
 Follow your child’s lead on clothing selection. While back-to-school shopping has traditionally been considered an important rite of passage into the new school year, shifting the focus away from new clothes may be necessary as a child figures out what they feel comfortable wearing.

“Often parents make a big deal out of the ‘first day’ of school outfits and photos. Maybe downplay that a bit this year and/or follow your kid’s lead on this,” says Equip family mentor Laura Cohen. “If any clothes shopping is being done, do not discuss any sizes or how clothes ‘look’ on your kiddos. Parents have good intentions and may not realize that what they think is a compliment can really trigger their kiddos.”

Friedman adds that parents may want to actively find ways to neutralize the perceived importance of clothing size. “From store to store and brand to brand, sizes are entirely inconsistent and therefore, meaningless!” she says. “The best clothes are the ones that feel good on your body, no matter what the label says. And maybe we cut out those labels because we don't need to know that information anyway!”
 Call on your community. “Seek support from your community to ensure that your family has the necessary supervision and assistance to promote success” Friedman says. “No carer has endless resources, and tapping out can be an essential tool for countering caregiver burnout. Have a teenager at home who may need support with an afterschool snack? IPull in a neighbor or sitter to provide intermediary support.” Tips for parents to spark conversation with educators Parents can prepare as much as possible for potential school stressors, but teachers and other school staff will be on the front lines once school is in session. If your child is in recovery or you feel could benefit from an educator who is empathetic and educated on eating disorders and body image struggles, you may want to initiate a discussion with school staff. Here are some tips for starting those conversations: Communicate with teachers directly. “Talking to your child’s teacher is key in terms of arming your child with support during the school day,” Zimmerman says. “Having a dean or school nurse involved is great, but there's no replacement for that person who has eyes on your child all day in the classroom."
 Draft an email chock full of info. “Because the beginning of the school year is such a hectic time for educators, sending an email and then following up in person or by phone is a great way to present resources and updates about your child,” Zimmerman says. “Having information by email allows your child’s teacher to return to the information when it’s relevant and also when they are most poised to respond and share the information appropriately.”
 Talk to educators about the need for excused assignments. Talking with a child’s teachers ahead of the school year can help ensure a smooth transition back to the classroom, but in some cases, involving higher level administrators may be helpful as well. “For example, you may want to speak to your school’s administration about getting it in writing that your child will be excused from any assignment related to ‘health’ or ‘nutrition,’” Cohen suggests. “These tend to be common in gym and health classes, and often involve keeping a food/meal log or activity log.”
 Make sure the treatment team is in the loop. Even if a child is prepared to return to school or start a new year after treatment, it’s essential for members of the recovery team to remain in the know about ongoing developments. “Talk with your treatment team about your child returning to school and know that they are prepared to advocate on your behalf and support you in obtaining accommodations,” Friedman says.]]></content:encoded>
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            <title><![CDATA[How To Support Kids Facing Unwanted Back-to-School Comments About Their Appearance]]></title>
            <link>https://equip.health/articles/body-image/back-to-school</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/back-to-school</guid>
            <pubDate>Wed, 20 Jul 2022 21:00:00 GMT</pubDate>
            <content:encoded><![CDATA[The return to school is never seamless for kids. While there’s sure to be excitement about reuniting with friends and getting new clothes, the stress of new classmates, teachers, and changes in routine can actually be very emotionally taxing for young ones. And for students who’ve gone through puberty or experienced weight fluctuations over the course of the summer, the impending unsolicited commentary will leave them especially vulnerable. While anyone of any age can be a target for appearance-focused comments, Cynthia M. Bulik, Ph.D., FAED, distinguished professor of eating disorders in the Department of Psychiatry of the School of Medicine at the University of North Carolina at Chapel Hill, says pre-teens are in a particularly tough spot. “Sixth through eighth graders often experience summer growth and maturation spurts as a matter of course,” Dr. Bulik says. “But because kids may be out of practice when it comes to socializing with other children due to the pandemic, unfiltered comments and a lack of solidarity between students may be more likely.” In addition to the run-of-the-mill stress around these maturation spurts, some kids may also have to contend with returning to in-person schooling after a period of attending school in a hybrid format, during which growth, maturation, and potential weight changes are more likely to have occurred. All of this can amount to even more stress for returning students. “As is the case with so many other stressors in our lives, our culture perpetuates the myth that trying to ‘fix’ or ‘change’ our bodies might be the ticket to feeling better and more at ease in this world,” says Equip family mentor, Oona Hanson. Teachers and other adults can sometimes say the wrong things, too It’s certainly not just peers who might be delivering uninvited opinions about a student’s physical changes — adults can often be culprits. And even the most well-intentioned comments can leave a lasting mark. “Teachers need to stifle the urge to comment on how children have changed,” Dr. Bulik says. “There is really no good way to comment on a child or adolescent’s changed appearance. Just focus on how great it is to have them back in the classroom. If you comment on someone’s maturation, they will feel like their pubertal changes are on display. ” Hanson says she’s most concerned about messaging from academic leaders that may center on “the so-called ‘childhood ob*sity epidemic,’” which she says often dominates the cultural conversation around kids’ health. “Mandated health and nutrition curriculum, cafeteria signage, subtle messages during P.E. class, and even content in word problems or language arts passages can teach kids they should be restricting their foods and trying to control their body size,” she says. Hanson also points out that all of these real-life pressures only compound the triggering content children and teens are often exposed to on social media. “This is all on top of dangerous ‘what I eat in a day’ posts and weight-loss ‘tips’ from TikTokers and other social media influencers,” she says. “Panic about pandemic weight gain has only added fuel to the fire; these messages hurt all children, but for a child in recovery from an eating disorder, those well-intended recommendations can pose an immediate health risk.” What parents can do to educate and empower their kids as they return to school Equip co-founder and chief clinical officer Erin Parks, Ph.D., says there are plenty of ways to prepare kids who are returning to school. One strategy is to educate them about cultural norms they may encounter and talk openly with them about what they hear from others outside the home. “Tell your kids that in many cultures around the world, when you haven’t seen someone in a long time, it is culturally normal to comment on their body: ‘You’ve gotten so tall!’; ‘you got your braces off!’; your face has hair!’” Dr. Parks says. “Ask your kids where they’ve observed this; if your kids respond with silence and an eye-roll, have some answers prepared for them to better understand. Maybe you can point out they heard it from a grandparent they only see annually, or maybe they even heard you do it!” Dr. Bulik says providing kids with tools and a safe space are essential back-to-school strategies as well. “Unfortunately, kids can be mean and that is just a fact,” she says. “We can arm our children with words. For example, saying out loud, ‘that’s a very hurtful thing to say.’ Or saying, ‘I’m sorry, I didn’t hear you, could you please repeat that?’ But hurtful comments can still get under their skin and stick like velcro. Try to help your children feel comfortable sharing mean things other kids say with you, so you can help them process these comments.” It’s also important to acknowledge when your child may be perpetuating hurtful verbal exchanges, and help them to course-correct. “It’s really hard for us to realize when our kids are the bullies or the ones making the hurtful comments,” Dr. Bulik says. “Of course, you also should be watching how you’re commenting on people you haven’t seen for a long time. Watch out for comments like, ‘wow, she gained/lost weight’ or ‘did you see how gray her hair is?’ If you are making comments or judgments about other people, that becomes a model for your children.” Hanson says that while it may be tempting for parents to rush in and remedy any (intentional or accidental) bullying that does occur, it may be best to take a less direct approach. “When your child is expressing body dissatisfaction, it’s very tempting to rush in with reassurances, such as ‘no, honey, you’re beautiful,’” she says. This natural and well-meaning response can have unintended consequences: It risks invalidating the child’s experience, it shuts down conversation that might have revealed the emotions underneath the body image concerns, and it ultimately reinforces that physical appearance is of high importance. What should parents do instead? Hanson suggests taking a breath and leaning into the child’s discomfort. She explains, “You could try saying something like, ‘That sounds like a really painful feeling to have. Can you tell me more?’” Dr. Bulik agrees and says letting kids experience their feelings is an important part of the growing process. “Sometimes parents want to rush in and fix the negative experiences that their children have had, but sometimes kids don’t want that,” she says. “They just want the opportunity to share what happened and lighten the load a little.” Dr. Parks suggests asking kids if they’ve ever felt embarrassed or hurt when someone has commented on how their appearance changed. “If you get a shrug and an ‘I don’t know,’ from your child, be ready with an anecdote from your own life when you felt self-conscious, sad, or uncomfortable when someone commented on your appearance,” she says. “Sometimes the more recent anecdotes actually have more impact; kids still have a hard time imagining us as teenagers! It can also be helpful to tell them about how you have commented on others’ appearances, and while it was well-intentioned, you can see how you may have made the person uncomfortable, and you’re trying to stop making unsolicited comments on other people’s bodies.” Dr. Parks offers an example from her own life that drives home the importance of why parents might want to consider preparing their children for unsolicited physical commentary: “My 9-year-old son, in a rare moment of vulnerability, told me that he didn’t like his stomach fat, and shared that he’d heard that cold showers may burn fat,” she says. “In a household where a parent preaches body neutrality, that all foods are good foods, and health at every size, children can and will still have negative inner commentary about their physical appearance. I asked my son, ‘has anyone ever said anything about your body that made you feel bad?’ He shook his head no. Then I asked, ‘have you ever said anything about your body that made you feel bad?’ And this time he nodded and said, ‘sometimes.’” In light of this anecdote, Dr. Parks notes that kids don’t necessarily need outside voices to amplify an already-thriving inner bully. “As you send your children back to school, acknowledge to them that you too have an inner critic that tells you that other parents are cleaner, more organized, and never late, and also tells you that you need to lose weight, you have too many wrinkles, and your lips get too thin when you smile. Show your children that everyone has an inner critic and that they can and should fight back, just like you do,” she says. How to model body acceptance at home “As with so many things in parenting, what we do is sometimes more powerful than what we say,” Hanson says. “Modeling body acceptance can be a powerful protective factor for our kids. We can do this in a number of ways: Not weighing ourselves, nourishing ourselves, and moving our bodies in ways that feel good, matter-of-factly getting clothes in a larger size if our body has changed, and not letting appearance concerns prevent us from engaging in activities.” There is also immense power in helping children reappraise what merits value in this world. “Make sure you praise them for who they are and the values and skills they have rather than how they look,” Bulik says. “Teach them how to value and compliment those things in others. Talking about both positive and negative experiences of the day is still an important touchstone of family life.”]]></content:encoded>
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            <title><![CDATA[The Limitations of AI: The Role of (Real) Human Interaction in Eating Disorder Care]]></title>
            <link>https://equip.health/articles/news-and-research/ai-chatbots-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/ai-chatbots-eating-disorder-treatment</guid>
            <pubDate>Tue, 01 Aug 2023 19:58:00 GMT</pubDate>
            <content:encoded><![CDATA[It’s impossible to read the news these days without encountering one (or several) headlines about AI. Seemingly every industry is exploring ways to leverage AI-powered tech, and these applications have the potential to transform the way we interact with the world and each other. This is understandable: AI capabilities are advancing at an exponential rate, and the possibilities feel endless. But it’s vital to recognize not only the possibilities, but also the limitations—and eating disorder treatment is one place where this comes vividly to life. The proliferation of AI Most AI news has centered around highly advanced chatbots, most notably those that use GPT, or Generative Pre-training Transformers. GPT is, essentially, a large language model that uses natural language processing technology to understand user input and generate helpful, relevant responses. The technology pulls from a huge dataset of existing (human-created) language to learn about language, grammar, the meaning of words, and more, and informs how it both interprets and responds to human input. It would be an understatement to say that both consumers and industry leaders are enthusiastic about the potential of AI. About three-quarters of internet users prefer using chatbots to people when looking for answers to simple questions, 65% of consumers feel comfortable handling an issue without a human agent, and 57% of executives say that chatbots bring in significant ROI with minimal effort. A striking 84% of companies believe that AI chatbots will become more important for communication between customers and businesses. The healthcare industry isn’t exempt from these seismic shifts despite the more fragile nature of the industry’s work. Experts estimate that up to 73% of healthcare admin tasks could be automated by AI within the next year, and chatbots are starting to take over more “human” roles as well. A 2021 survey found that 22% of adults had used a mental health chatbot, and 47% were interested in using one. When asked why they sought out a chatbot over a human, most respondents cited affordability, ease of use, and ability to connect with a chatbot at any time. At first glance, it makes sense that chatbots could serve as quick, low-cost alternatives to trained mental health professionals. After all, GPT technology is adept at responding to questions, synthesizing research, and having human-like conversations. But AI-powered chatbots also have points of failure, and in the realm of mental health—and eating disorders in particular—these can come at a serious, high cost. Where AI fails eating disorder patients Eating disorders are complex and highly nuanced mental illnesses; their signs and symptoms may be hidden or counterintuitive, and treatment needs to be highly individualized in order to be effective. What’s more, up to 90% of people with eating disorders have co-occurring illnesses, which makes their treatment even more complex. This murky landscape is not one in which chatbots thrive. Because the language models look for rules and patterns in their dataset, they’re likely to miss eating disorders that don’t fit a certain mold, or to misdiagnose someone whose symptoms correspond to more than one pattern. There’s also the reality that while bots themselves don’t have biases, the data they learn from does. GPT chatbots are trained on massive sets of human-created language, and much human-created content around food, weight, bodies, and eating disorders is shaped by the powerful force of diet culture. This means that their interpretation of and response to questions may reflect weight bias, fatphobia, and the thin ideal. As Dr. Angela Celio Doyle, Equip’s VP of Behavioral Health, put it in a recent article: “Our society endorses many unhealthy attitudes toward weight and shape, pushing thinness over physical or mental health. This means AI will automatically pull information that’s directly unhelpful or harmful to someone struggling with an eating disorder.” This potential risk was brought to life recently, when the National Association for Eating Disorders replaced its human helpline staff with a chatbot named Tessa. Within a week, it was reported that Tessa gave harmful advice that promoted dieting and weight loss behaviors to callers who struggled with an eating disorder, and the bot was shut down. With chatbots, there’s also the risk of providing false information, which can be extremely detrimental in the case of eating disorder patients. While chatbots are designed to provide only information validated through their  training data, they can be prone to what are called “hallucinations,” which is essentially when bots make things up and deliver them as facts. For a parent who is trying to assess their child for eating disorder risk, a patient researching treatment options, or a provider looking up the medical criteria to admit a patient to the hospital, this sort of false information can have dire consequences. Lastly, chatbots simply can’t deliver the support that has been proven to help people recover from eating disorders. Though eating disorders are mental illnesses, the most important initial focus of treatment is behavioral modifications. This means helping patients normalize their eating habits, stop eating disorder behaviors (like restricting, binge eating, purging, or compulsive exercise), and restore their weight if necessary. While a chatbot might be able to advise someone to do all these things, they cannot supervise or support them in doing so; and without that accountability and wraparound support, someone in the throes of an eating disorder is unlikely to simply stop their disordered behaviors cold turkey. Human connection is another vital part of eating disorder recovery. Research shows that the support of loved ones greatly increases a person’s likelihood of recovery, and clinical guidelines recommend that family members be involved in care. Mentorship—connecting with someone who has been through recovery themselves—has also been shown to increase a person’s likelihood of achieving full recovery. Chatbots, no matter how intelligent, simply can’t provide this sort of emotional, human element, and likely won’t be able to for a long time, if ever. Eating disorder care without empathy will always fall short. Exploring the potential of AI in eating disorder care This isn’t to say that AI has no place in the eating disorder treatment field. The technology is powerful and expansive, and we’re only just beginning to scratch the surface of what it might be able to do. And even in its current state, it’s easy to see use cases for it. For instance, AI could be programmed to send “nudges” to people in treatment, using patterns and other input to sense when they may be in a high-risk situation (at a restaurant, for instance, or at the gym) and suggesting healthy coping techniques. AI could help direct patients and loved ones to the most relevant resources, giving people timely and tailored information. AI could be used to synthesize and summarize a patient’s different treatment options, comparing and contrasting them across an endless list of variables, like cost, efficacy, time-intensiveness, and more. Dietitians could leverage AI to put together individualized meal plans. Researchers could use AI to summarize large amounts of academic papers and determine new areas of research. Physicians could use AI-powered algorithms to generate highly individualized weight goals for patients. So on and on. In the United States alone, some 30 million people will be affected by an eating disorder in their lifetime, and there’s a nationwide shortage of mental health professionals (not to mention mental health professionals who are also trained in treating eating disorders). This is to say: there’s a great deal of work to be done, and AI offers a promising way to lighten the load of both eating disorder treatment providers and the patients they serve. AI isn’t bad. It is likely to be a powerful tool as companies like Equip and our colleagues in the field work to transform the eating disorder treatment landscape and deliver effective care to everyone who needs it. But in order to ensure we do more good than harm, it’s essential to always be aware of the limitations of GPT and similar technology innovations. We need to apply thoughtful scrutiny, to honestly acknowledge their mistakes and failures, and to adjust course accordingly. At Equip, our treatment is data-driven and built on technology — we know that in order to tackle a problem as massive as the eating disorder crisis, we need technology — but it’s powered by humans. Learn more about what Equip’s evidence-based care looks like, and how we balance the human and the automated to deliver eating disorder care that works.]]></content:encoded>
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            <title><![CDATA[Why Community is Not Only Helpful in Eating Disorder Recovery, It's Essential]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/community-in-ed-recovery</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/community-in-ed-recovery</guid>
            <pubDate>Fri, 22 Jul 2022 13:03:00 GMT</pubDate>
            <content:encoded><![CDATA[When we talk about what makes eating disorder treatment successful, we often focus on weight restoration, skill development, and identity formation—all building blocks of evidence-based treatments like family-based treatment (FBT). But there is an additional, more subtle defining factor: culture and community. “Our culture is a primary dimension of our identity, and we cannot treat the ‘whole person’ without accounting for the customs, beliefs, and behaviors a person holds. Incorporating a patient's culture into treatment presents opportunities to better understand potential motivating factors for recovery which providers may otherwise be unaware of if adhering to Westernized treatment paradigms,” says Equip’s Senior Manager of Diversity, Equity, Inclusion, and Belonging, Scout Silverstein. Experts also believe that incorporating community aspects into treatment—which is inherently built into FBT—can greatly impact a patient’s chances for recovery. “It takes a village to overcome an eating disorder,” says Equip dietitian Isabel Vasquez, RD, LDN. “Incorporating a patient's community empowers the patient to know they do not have to fight the eating disorder alone. Eating disorders can be tough to overcome and thrive in isolation, so having a whole community backing a patient in their recovery gives the eating disorder less opportunity to survive.” Equip Lead Family Mentor Chita Gastelum knows first-hand how incredibly important both culture and community can be in the recovery process. “My ancestors were Indigenous healers and in our culture we practice Curanderismo [a holistic form of traditional healing],” she says. “Curanderismo was a huge part of my ED recovery. Having this spiritual guidance allowed me to connect with something greater than myself and it gave me the faith and courage to face the beast—the eating disorder. The ED spends most of its time creating fear and anxiety to continue staying in control; incorporating the patient’s community into ED treatment creates more safe spaces for the patient to feel supported.” Why culture has to play a role There’s no single way to define “culture,” but in most cases, the term can encompass everything from a person’s religion and systems of belief to the languages they speak, their manner of dress, behavioral norms, rituals, and more. “When we think of the ways culture impacts someone, it is impossible to fully separate who someone is from the cultures to which they belong,” says Equip Research Intern Bek Urban, MA. “When providers ignore culture, they cannot see the client as a whole individual. Cultural ideals around food and body vary, and when conversations around culture are left out of treatment it results in treatment providers assuming everyone has the same ideals related to food and body. This assumption causes further harm as patients are often forced to conform to the dominant cultural narrative in the United States.” Urban also notes that this narrative has often resulted in things like diet culture and anti-fat attitudes, so by opening the door to other ways of being, providers can help deconstruct these ideals and offer treatment that is individualized and effective. “Given that certain cultural foods are put on a pedestal over others, individuals from marginalized communities often become disconnected from their cultural foods,” Vasquez says. “Incorporating a patient's culture helps a patient connect with their authentic self and develop a more positive relationship with food. Part of the beauty of recovery is being able to rediscover the various ways food nourishes us. And in many cultures, such as my Latin culture, food is not just nutrition, it's love! Incorporating the cultural component into treatment can help a patient reclaim their relationship with food in a way that resonates with their cultural values.” To ensure all patients receive adequate and effective treatment, it’s also important that providers practice “cultural humility,” which means being open to genuinely understanding a patient’s cultural identity and how it influences them, as well as shifting the dynamics of the clinician-patient relationship by being self-reflective and building partnerships with communities. “Cultural humility is an appreciation of someone else's culture and an acknowledgement that you are not the expert in their cultural norms,” Vasquez says. “It entails being curious and open-minded. It means doing the work to understand someone's cultural traditions while understanding that individuals from the same cultural background may have different levels of connection to their culture. Cultural humility is key to successful treatment because if we don't fully understand the nuances of their experience in their body and their relationship to food,we may mistakenly stereotype someone or offer suggestions that don't fit within their cultural norms or values.” But getting to know a person’s culture is only part of the equation — taking action is also critical. “It’s important for people to know that cultural humility isn’t just about getting to know someone,” Gastelum says. “It’s about creating accessibility and equity in eating disorder treatments for diverse cultures.” Why community has to play a role One of the primary perks of community is social support — something Silverstein says is essential to the recovery process. “For many, eating disorders can be all-consuming — impairing relationships, increasing hypervigilance, and at times leading to the false belief that one does not have a life worth living,” Silverstein says. “Incorporating community can help to remind patients that they are unconditionally loved, that they are more than their eating disorder, and that they have a safe place to turn to in a world that may feel unsafe. It is incredibly difficult, if not impossible, to heal in isolation.” Urban agrees, adding that as social creatures, humans crave connection — something that can be lacking in traditional care. “When people are in traditional modes of treatment, they often have to leave their community behind to heal, which can feel isolating and alienating,” Urban says. “Our communities and the social networks we rely on are one of our greatest assets as humans. When we can use these assets, we are truly able to heal and see change throughout a whole family and community, something that can help foster lasting change for individuals.” How community and culture impacted these real-life Equip patients When 15-year-old Arya began eating disorder treatment, her East Asian culture played an integral role in her recovery. BBC Writer Ritu Agurwal described in her essay, Why India is a Nation of Foodies, “for many Indians, ‘sitting down’ with their family for a meal is one of the most important activities of the day,” a concept that resonated with Arya’s family who felt “the family that eats together stays together, and meal time is a strong source of family bonding, talking, and sharing.” Through FBT’s focus on meals and family inclusion, Arya’s siblings were able to join in sessions and learn how best to support their sibling and their parents at the table and beyond. Arya’s mother was able to feed her recovering child familiar, nutrient-dense foods that made meal times less stressful for everyone. For 18-year-old Talia, food has always been central to her family’s faith. Coming from a Hasidic Jewish background, her family keeps kosher, carefully maintaining the separation of meat and milk products, and engaging in the labor-intensive preparation necessary to abide by their religious rules. In FBT, Talia and her family could access effective treatment while staying aligned with their faith, and use the support of their team to navigate cultural challenges like fasting holidays. Practical tips for parents and providers to incorporate community and culture into eating disorder treatment Equip’s team members offer their top tips for parents and providers to successfully incorporate community and culture into ED treatment: Be mindful of one’s cultural languages, communication differences, beliefs, and behaviors Talk to your patient or loved one about who they would like involved in their treatment as a support or advocate – a friend, partner, teacher, religious leader, etc. Ask them: “Are there aspects of your identity you feel are important for your provider care team to know about? What do you want me to know about you and your experiences and who you are that might impact this process?” Inquire about cultural norms related to foods, eating patterns, and family dynamics]]></content:encoded>
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            <title><![CDATA[Equip Publishes Study Showing Virtual Treatment Is Highly Effective for Eating Disorders as Company Expands to 50 States]]></title>
            <link>https://equip.health/articles/news-and-research/virtual-treatment-50-states</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/virtual-treatment-50-states</guid>
            <pubDate>Wed, 22 Jun 2022 13:07:00 GMT</pubDate>
            <content:encoded><![CDATA[Published in Eating Disorders: The Journal of Treatment & Prevention, Study Finds FBT via Telemedicine Leads to Positive Patient Outcomes in Young People San Diego, Calif. (June 22, 2022) – Equip, the only provider of virtual, evidence-based eating disorder treatment in the U.S., today published data from its groundbreaking study proving the efficacy of virtual Family-Based Treatment (FBT) for eating disorders amongst children, adolescents, and young adults. The study, which was published in Eating Disorders: The Journal of Treatment & Prevention, confirms that FBT delivered via telemedicine leads to meaningful reduction in eating disorder symptoms and improvement in mood for patients and their families. The study closely evaluated Equip’s FBT model, in which each eating disorder patients received care from a five-person coordinated team including a therapist, dietitian, medical provider, peer mentor, and family mentor for up to 12 months. Key findings include: 80 percent of patients achieved their weight restoration goals; Patients’ eating disorder symptoms were reduced by half*; Symptoms of depression and anxiety lessened by one-third*; Family members felt more confident and reported a reduced burden in taking care of their loved one. *after 16 weeks of treatment Eating disorders surged 70 percent during the pandemic, and we already knew only 80 percent of Americans receive treatment, with a small fraction receiving evidence-based care. With access to eating disorder treatment proving more critical than ever, Equip has scaled its treatment to patients in all 50 U.S. states and Washington, D.C., a pivotal step in closing the treatment gap. “The lack of access to eating disorder care is a critical, urgent issue,” said Dori Steinberg, Vice President of Research at Equip and lead author of the study. “When we talk about evidence-based treatment, it means that it needs to be studied and measured in a robust way. We did that here. Virtual FBT is an effective model and it works just as well, if not better, than in-person treatment for eating disorders. This research will allow people to receive the help they need and make lasting recovery possible for more Americans.” Over 30 million Americans will be affected by an eating disorder in their lifetime. As the mental illness with the second highest mortality rate after opioid addiction, the ability to access evidence-based care could be life-saving. To deliver on its mission, Equip, which launched in 2020, has forged in-network partnerships with major commercial health insurance payors including Aetna, Anthem, Cigna, United Healthcare, and several Medicaid health plans to ensure that everyone can get access to quality, affordable care. “Recovering from an eating disorder is an extremely taxing process that comes with immense emotional, financial, and social burdens,” said Dr. Erin Parks, co-founder and COO of Equip. “When families are able to access treatment from their home—with the support of their entire village of extended family, siblings, coaches, teachers, and more—true lasting recovery is possible for young people.” The study can be found via PDF here and at Eating Disorders: The Journal of Treatment & Prevention. To learn more about Equip, visit www.equip.health. About Equip Equip is the leading provider of virtual, evidence-based eating disorder treatment in the U.S. Founded in 2019, Equip is built upon a combination of clinical expertise and lived experience to transform eating disorder care and make it accessible to all patients and families. Built on the Family-Based Treatment (FBT) model, Equip uses a five-person dedicated care team – including a therapist, dietitian, physician, and peer & family mentor – to support patients in their recovery journey. The company operates in all U.S. states and is partnered with nearly every major health insurance plan. For more information, visit www.equip.health. Contact: LaunchSquad for Equip equip@launchsquad.com]]></content:encoded>
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            <title><![CDATA[Kim Kardashian’s Weight Loss Comments Could Be Deadly. It’s Not Her Fault.]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/kim-kardashian-met-gala</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/kim-kardashian-met-gala</guid>
            <pubDate>Mon, 09 May 2022 13:44:31 GMT</pubDate>
            <content:encoded><![CDATA[Kim Kardashian holds the gaze of hundreds of millions of girls and teenagers across the world. Everything she says or does inspires action in young women everywhere: Buy this! Make your brows thicker! Now thinner! Dream about a 5-carat ring! Now just a gold band! When Kim arrived at this year’s Met Gala in the iconic “Happy Birthday, Mr. President” dress worn by Marilyn Monroe at JFK’s birthday in 1962, every article about the sparkly gold number had this Kim quote affixed to it: “I tried it on and it didn't fit me. I had three weeks and I had to lose 16 pounds.” These words—most startlingly “I had three weeks and I had to lose 16 pounds”—are now imprinted in the minds and hearts of millions of young people, not to mention the 600+ million who struggle with an eating disorder. We know that a moment like this one can be the trigger that sets off an eating disorder in someone who is genetically predisposed – it’s not so dissimilar to what happened to me when I copied my babysitter and started a diet that led to anorexia at the age of ten. “No one changes their eating or exercise habits with the intent to develop an eating disorder,” says Jennifer Derenne MD, Equip’s VP of Clinical Care Delivery and former Stanford psychiatrist. “But, for a young person who is already vulnerable, prom or graduation may be their version of the Met Gala.” And with eating disorders having the second highest mortality rate of any mental illness, these seemingly small moments can create the highest possible stakes. We know that no one person, experience, or event causes an eating disorder, and we also know that icons like Kim Kardashian shape the unattainable, harmful ideals that can send young people into a tailspin that leads to an eating disorder. This will happen to 5 million Americans, including kids as young as 7, this year alone. In America, our narrow idea of beauty asks our younger generation to place value on certain body ideals, and the famous women who embody them. Our culture tells us that you must get there at any cost — even if that includes your mental health, your self-worth, or tragically, your life itself. ​​ This isn’t Kim’s fault. It’s society’s fault. She, too, is a victim of our culture and its praise of behaviors that are also the symptoms of an eating disorder—rapid weight loss, restriction of food, excessive exercise, and fixation on the thin ideal. But this is not about blame, it’s about change. Kim has the power to fundamentally shift the conversation from teaching young people that “I am valuable because of how I look” to “I am valuable because of who I am.”]]></content:encoded>
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            <title><![CDATA[Winter Blues: The Complex Relationship Between Seasonal Affective Disorder (SAD) and Eating Disorders]]></title>
            <link>https://equip.health/articles/understanding-eds/SAD-and-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/SAD-and-eating-disorders</guid>
            <pubDate>Fri, 17 Dec 2021 21:16:03 GMT</pubDate>
            <content:encoded><![CDATA[For a long time, Equip Peer Mentor Kelsey Gilchriest didn't understand why her mood would dip so low around the winter holidays. At times, the seasonal shift made it difficult to spend time with family and find joy in her usual hobbies. The sadness also made her relationship with eating even more challenging — a feeling known far too-well for many people with eating disorders. “This only worsened after treatment, when I felt isolated because of my eating disorder diagnosis and lonely in a new city,” Gilchriest says. “When my doctor finally diagnosed me with seasonal affective disorder (SAD), some things finally made a lot more sense.” What is SAD and how can it affect individuals with eating disorders? Gilchriest’s diagnosis, commonly referred to as SAD, or seasonal affective disorder, is a form of depression associated with seasonal changes. For many, SAD often starts and ends at approximately the same times each year, usually with symptoms beginning in the fall and continuing through winter. While some people experience the signature symptoms of SAD (depressed mood, low energy, trouble sleeping, etc.) in the spring and early summer, most people feel its effects in the latter half of the year. According to the National Institute of Mental Health, millions of adults suffer from SAD, although many may not know they have it. The condition is much more common in women than in men, and for those who live farther north (like in Alaska or New England), where winter days are shorter and there are fewer daylight hours, anyone can develop SAD. Experts still don’t fully understand what causes it, but research suggests SAD may be related to reduced activity of serotonin, a neurotransmitter that helps regulate mood. Other research indicates that people with the condition produce an excess of melatonin, an important hormone involved in maintaining the sleep-wake cycle. While anyone can develop SAD — or any form of depression — there is some evidence that individuals with eating disorders may be more likely to experience symptoms of SADA 2000 study found that eating disorders and mood disorders both include serotonin disruptions, and that bulimia in particular seems to share certain symptoms with SAD. A 2014 study found that the symptoms of SAD also overlap with many of the symptoms of binge eating disorder (BED), which are associated with atypical depression symptoms. Gilchriest says that while an official diagnosis was helpful, the label itself wasn’t enough to alleviate the pain she felt. “It didn't change the fact that in the winter months, I could suddenly change into someone I didn't recognize,” she explains. “Even following moments of joy, like opening Christmas presents with my family.” “The holiday season can be difficult for so many due to the various activities we encounter,” says Equip therapist Sara Quint. “From food-centric family gatherings that we may not necessarily enjoy to financial crises and fears, the season of joy can turn dark quickly. Loneliness, disappointment, past traumas, and grief and loss are all sore spots that may flare up for folks during this time.” Gilchriest says that one of her biggest challenges each year was knowing that she would have to navigate an entire season of internal turmoil that could affect her desire to eat, be in community with others, or participate in joyful movement — activities she struggled to participate in despite recognizing their potential to boost her mood. Finding a solution for SAD and other forms of depression Experts use a variety of treatments to reduce the symptoms of SAD, including light therapy, which involves sitting in front of a very bright light box for about 30 to 45 minutes a day to help boost vitamin D, a nutrient believed to promote serotonin activity. For some people, talk therapy and medication may also be helpful in addressing the full scope of symptoms. “The ways I've learned to overcome these challenges is by creating a plan, both with myself and with my partner, for those moments when my depression overwhelms my ability to stay recovery-focused,” Gilchriest says. “I use a light box starting around Labor Day, which has greatly improved my symptoms overall. I go for regular walks even when I'm feeling willful, and I always keep Boost [a nutritional supplement] in the house during the holiday season. It's these things that I plan ahead for that keep my head above water and remind me that the depression won't last forever.” Quint agrees that some of the most important tools to cultivate during bouts of seasonal (or longer-term) depression are kindness to oneself and a commitment to planning. “I would encourage practicing self-compassion, giving yourself a break (or several) when needed, and finding ways to have support on tougher days,” she says. “Creating a ‘Cope Ahead’ plan (taken from DBT) with your family, therapist, or peer mentor may be just what is needed to find a way to enjoy your holiday; if we have a plan, sometimes we can walk in to the festivities feeling more confident and capable, which leads to lower anxiety and less stress, knowing someone has your back (or, knowing that you’ve got your own back in setting up self-care for after the party is over!).” All forms of depression — seasonal, acute, chronic, etc. — are serious and should be addressed as soon as possible. For those with eating disorders, treating the ED is often an indispensable part of long-term mood treatment as well. A 2019 study found that those who had recovered from an eating disorder were significantly less likely to be diagnosed with depression. According to the researchers, these findings provide evidence that long-term recovery from EDs is associated with recovery from or absence of these common major comorbidities.” “This season can certainly be stressful,” Quint says. “But walking in with a plan of attack can help protect you and your family from the ED and lead to a more pleasant, enjoyable, and bright time!” Gilchriest agrees, adding that her biggest piece of advice to others struggling during the holidays is to “create a plan when you're feeling well to use when you're not,” which can prevent bigger blowouts in times of crisis. “Let loved ones or friends you trust know that you tend to struggle during this time, and create a plan together of ways that they can support you and ways you can support yourself,” she suggests. “Most importantly, be gentle with yourself. The holiday season is tough, and you are still enough and deserving of love and life, even when you're feeling depressed or lonely.”]]></content:encoded>
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            <title><![CDATA[What Happens After Eating Disorder Treatment?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/after-eating-disorder-treatment-ends</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/after-eating-disorder-treatment-ends</guid>
            <pubDate>Wed, 12 Oct 2022 12:05:00 GMT</pubDate>
            <content:encoded><![CDATA[Getting an eating disorder diagnosis and finding the right treatment can be a long and winding road. Depending on the treatment approach and the severity of the illness, treatment may last from months to several years. But what happens after eating disorder treatment ends? So much of the answer to this question depends on where someone is in their recovery when treatment ends and the nature of their support system. Staying in recovery after treatment can look different for everyone. How Do You Know When Your Loved One Is Ready To Leave Treatment? Being fully nourished and weight restored if necessary — to the right recovery weight range for one’s body — is the foundation of a solid recovery. In addition, eliminating eating disorder behaviors (such as restricting, purging, or overexercising) is an important part of the recovery process. While weight restoration is necessary for many patients, it’s not always sufficient for recovery from an eating disorder. Developing effective coping strategies, self-care practices, and emotion regulation skills is often crucial. Some patients also need support for processing trauma and treatment for co-occurring mental health conditions, such as depression or anxiety. Every patient benefits from building a life worth living outside of their eating disorder; having authentic interests and relationships to explore is another signal of readiness to move beyond treatment and into relapse prevention. For patients with ARFID, there may be some treatment targets that remain a focus even after formal treatment is done, such as trying new foods. In general, the goal of treatment is to ensure that any ARFID symptoms are no longer causing significant problems in a person's life: they have no nutritional deficiencies, are not reliant on supplements, and can fully enjoy the activities and relationships that are meaningful to them. It’s worth noting that too many people lose access to treatment prematurely because of limitations in their health insurance coverage. An abrupt discharge from a higher level of care can be a frightening and confusing time, especially if there aren’t plans for ongoing support. This can also aggravate existing beliefs about not being “sick enough” to deserve treatment. Having family involvement during eating disorder treatment can help foster a smoother and more supportive transition into and through recovery. With the support of loved ones who understand eating disorders, patients have a better chance of maintaining recovery, and a safety net in the event they struggle with a return of symptoms. How Do Treatment Teams Prepare Patients To Stay in Recovery? To give patients the best chance at long-term recovery, treatment teams focus on helping to heal the whole person and arming them with the tools needed to stay in recovery. Treatment usually involves the following key areas: Prioritizing weight restoration when applicable Normalizing eating patterns Addressing any co-occurring conditions, including but not limited to depression, anxiety, and/or obsessive-compulsive disorder Developing body image resilience when needed Teaching coping skills Empowering family or friends to support their loved one Stress-testing recovery by engaging in real-life challenges Exploring passions and goals outside of recovery Developing a concrete relapse prevention plan How Can You Stay in Recovery in a Diet-Obsessed World? In a culture that prizes thinness, praises weight loss, and demonizes certain ways of eating, staying in recovery after treatment isn’t easy. For patients in large bodies, these challenges can be even more difficult because the outside world’s fatphobic tendencies collude with the eating disorder’s thoughts at nearly every turn. Here are some common approaches to maintaining and even strengthening recovery: Relapse Prevention Plan. Having a relapse prevention plan that includes the continued support of family and friends is often a critical final step of treatment. The plan should provide clear strategies for monitoring and bolstering recovery and addressing any struggles that arise. Advocacy at the Doctor’s Office. Someone in recovery from an eating disorder may need to advocate for themselves — or have a loved one do so for them — with doctors they encounter after treatment. Disclosing an eating disorder history and articulating individual needs can help patients get the appropriate medical care they deserve. For instance, a patient may ask not to be told their weight or request that they not receive weight-loss recommendations or be prescribed restrictive diets. Recovery Weight Range or Weight Minimum. With the guidance of their treatment team, some patients and families may identify and continue monitoring a recovery weight range or minimum. For children and adolescents who are still growing, the recovery weight range will be an upwardly moving target. Body Image Resilience. Maintaining healthy body image is an important way to protect recovery, and doing so in our society requires resilience. Healing the relationship with the body can take different forms and may evolve over time. Concepts such as body positivity, body neutrality, body acceptance, and body liberation are just some of the frameworks people in recovery can explore to develop a sense of empowerment in their bodies. Fat activism offers a social justice framework that can be especially powerful for patients in large bodies. Anti-Diet Mentality. By adopting a flexible, all-foods-fit approach to eating, someone with an eating disorder can help protect their hard-earned recovery. Any kind of restrictive diet — even if it’s not specifically focused on weight loss — can increase the risk of relapse. This includes eating behaviors that have become normalized in our culture, like eliminating certain food groups (gluten or dairy, for instance), or intermittent fasting. Support Groups. Attending support groups after treatment can be an important component. Being surrounded by other recovery-minded individuals and getting guidance during stressful times can offer essential support while navigating life’s inevitable ups and downs. What Does Eating Look Like After Treatment? Recovery looks different for everyone, and there isn’t one “right” way to approach eating after treatment. Many patients and families in recovery are eager to adopt intuitive eating — an eating approach in which you trust and listen to your body in order to make food choices that feel good for you, free of any internal judgments shaped by diet culture — and there can be a lot of pressure to cross an imagined finish line and “get there.” Intuitive eating, by definition, is individualized, and many eating disorder dietitians recommend that patients start slowly and incorporate only certain elements of intuitive eating early in recovery. Some patients find they need some level of ongoing meal support with a family member or friend, especially during stressful times. Other patients find they stay in recovery by following a meal plan or eating “by the clock,” especially if hunger and fullness cues aren’t always accessible or reliable. As mentioned above, eating disorder experts caution patients about the risks of engaging in restrictive diets, even if they are described as “healthy eating.” In fact, the idea of “healthy eating” itself can be damaging, as this vague phrase implies the existence of good and bad foods and almost always involves eating less. Eating disorders tend to fixate on numbers and rules, often making diets more rigid or more extreme than even intended. Unless truly medically necessary, someone in eating disorder recovery should avoid eliminating foods from their diet or following an eating plan from anyone other than a dietitian who specializes in eating disorders. What Is the Role of Family After Treatment Ends? The end of a loved one’s treatment can be a time of celebration or an extended exhale, but also a time of uncertainty. For the family of a loved one who’s been in treatment, it’s common to wonder when or if you can ever stop worrying. Some may even find themselves surprised by the emergence of delayed feelings of distress after their loved one is in recovery. After months or years of treatment, many families are understandably eager to return to “normal.” It’s tempting to assume your loved one is recovered enough not to need your support. In most cases, however, patients benefit from an ongoing support system that can continue to monitor recovery progress. For decades, there was a pervasive and harmful myth that relapse was inevitable or that someone could never fully recover from an eating disorder. While recovery looks different for everyone, we now know that true healing is possible. Families can benefit from continuing to participate in recovery communities and ongoing virtual support groups, such as those hosted by FEAST, FEDUP, and Equip.]]></content:encoded>
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            <title><![CDATA[I'm a Latina Dietitian. Here's What I Wish People Knew About Eating Disorders in My Community]]></title>
            <link>https://equip.health/articles/understanding-eds/latina-dietitian</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/latina-dietitian</guid>
            <pubDate>Mon, 24 May 2021 18:54:00 GMT</pubDate>
            <content:encoded><![CDATA[When most people think of someone with an eating disorder, they probably picture a young, thin middle-class white woman. There’s a reason for that: we have a long way to go in debunking the mythology around who actually gets eating disorders. The reality is that eating disorders affect people across all body sizes, ages, genders, sexual orientations, socioeconomic statuses, races, and ethnicities. And as a Latina registered dietitian, I’m especially passionate about increasing awareness of the prevalence and treatment of eating disorders among Latinas. Eating disorders: a white issue? Unfortunately, eating disorders are stereotypically viewed as a white, middle to upper class issue. This generalization is not only false, but it’s damaging and dangerous – it contributes to people of color being under-reported and undiagnosed. That means plenty of people in desperate need of care either don’t believe they fit the criteria for an eating disorder (and therefore don’t believe that they merit help), or those in their communities — including medical professionals — don’t consider them to be the “type” of people to have eating disorders. In either case, these individuals aren’t getting the support and treatment they need. Although there is a lot more research to be done on eating disorders in marginalized communities, existing studies have shown that eating disorders occur at similar rates in Latinas compared to non-hispanic whites, specifically bulimia nervosa and binge-eating disorder. There are a lot of reasons why these rates are what they are, and researchers are still trying to make sense of the numbers. But everything from exposure to mainstream American culture and its emphasis on thinness to socioeconomic disparities could play a role. Diving into the possible factors that drive these numbers can help illuminate the work that needs to be done in the research field, treatment settings, and in the community. Conflicting beauty ideals Being Latina and living in the U.S. means living between two cultures and trying to constantly navigate between and balance different types of food, music, and family cultures. Latinas are also often confronted with the tough reality of existing between varying — and sometimes conflicting — beauty ideals. That means that the physical traits that may be coveted or considered “beautiful” in Latin American culture are at odds with the Eurocentric beauty ideal that’s often celebrated in America. In most cases, neither type of “ideal” is attainable, and trying to fit the impossible standards of both can be triggering to someone at risk for an eating disorder. Conflicting food messages Another often overlooked area that may predispose Latinas to eating disorders is actually more obvious than many people realize: the kitchen. Within Latin American culture itself, food messages can be conflicting and confusing: on the one hand, our families often encourage us to “eat, eat, eat!” and we’re raised to interpret food as a symbol of love that’s central to our culture and family time. In fact, many Latinas may be familiar with the scenario of politely refusing seconds, only to endure their abuela’s pained reaction, as if the refusal is a sign of rejection or an offensive display of bad manners.  But, on the flip side of all that food celebration is a stigma around weight gain. Many Latinas are familiar with the humiliation of being labeled “gorda” (meaning “fat” in Spanish) if they’ve gained any weight at all. And unfortunately, setting boundaries around this language can be tough since we are taught to respect our mamás and abuelas. That means many have had to endure the embarrassment silently. Mental health: estas loca!? Another major factor to consider when analyzing the prevalence of eating disorders among Latinas is the fact that mental health is often still a taboo topic in the Latin American community. Our grandparents and even our parents might not be familiar with mental health issues and may label people as “loco” (i.e. “crazy”) if they admit to struggling with a mental health issue. They may be more inclined to recommend a home remedy (“vivaporu” anyone?) because physical ailments may be easier to accept and understand than mental ones. That mentality makes it tough or even impossible to advocate for oneself, meaning many Latinas may be hiding their mental health challenges for fear of facing the cultural sigma head on. The Underlying Issues Although eating disorders manifest as food and body issues, they are mental health issues. In fact, they are among the deadliest of mental illnesses. There are underlying psychological issues that spark this serious disordered behavior that we’re still learning about. Among Latinas specifically, the internal conflict of being a member of a marginalized community in the U.S. may be a contributing factor in the development of an eating disorder. The lack of feeling understood and valued as someone from a marginalized group may be one of many triggers, as it can cause feelings of isolation and inadequacy; the disordered behaviors may be an attempt to blend in with the white majority. At Equip, we are committed to making care more accessible. Having providers with various lived and professional experiences as well as various identities is key in being able to address a diverse range of patients’ needs. This is one of the main reasons why I decided to get into this field. I knew that in order to provide the best care to patients from diverse cultural backgrounds, we needed more representation in the field. We need more providers who can understand marginalized patients’ lived experiences, and who can bring cultural humility into treatment. If you or someone you know is having a hard time addressing their eating disorder for any number of reasons, Equip is here to offer support.]]></content:encoded>
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            <title><![CDATA[Distress Tolerance for Caregivers]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/distress-tolerance-for-caregivers</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/distress-tolerance-for-caregivers</guid>
            <pubDate>Sat, 06 Feb 2021 01:23:00 GMT</pubDate>
            <content:encoded><![CDATA[During their recovery, your loved one may be learning a specific set of skills called “distress tolerance” skills to manage the emotions and feelings that arise during their journey. Distress tolerance skills are often used to tolerate negative emotions, sit through difficult sensations that may arise in the body, and distract from certain eating disorder urges until they pass. Distress tolerance, however, is not just a set of skills for your loved one to use. It’s not even just for anyone going through a mental health crisis. Ultimately, distress tolerance is a helpful skill to learn for all of us, especially for those dealing with a loved one in recovery. It can be hard to see your loved one in pain. It can be hard to see them struggling. Often, you may be tempted to let things go — just once. To give your loved one a break from the difficult process of recovery for a few days. After all, it’s so hard for all of you. In other words, recovery can be distressing for everyone involved. This is where you need to use your own distress tolerance skills — to realize that you need to sit through the discomfort and stress and anxiety of seeing your loved one in pain. Allowing them to deal with their stress is what leads them to realize how competent they really are. It is only by going through their own discomfort that they will learn they can do hard things — like pushing back against their ED and survive. Practicing distress tolerance skills can help you come to the understanding that you and your loved ones can sit through the darkness of pain together and emerge into the light. You cannot save your loved one from that experience and you don’t want to do that, either — allowing them to traverse their own path is an essential part of recovery. Equip’s interdisciplinary care team includes a family mentor specifically to emotionally support family members as they increase their distress tolerance, and to help parents and caregivers develop specific skills to manage frustration and emotionally regulate as a means to decrease distress for everyone involved in the recovery journey. This article by Julie O’Toole on tolerating your child’s distress is a great explanation of this topic. Distress tolerance is a vital piece of the recovery journey, and it’s one that you can’t escape — it can only be conquered by moving forward together.]]></content:encoded>
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            <title><![CDATA[Is It Normal for Athletes Not to Get a Period? Understanding Eating Disorders, Periods, and Athletics]]></title>
            <link>https://equip.health/articles/food-and-fitness/ED-myth-athlete-period</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/ED-myth-athlete-period</guid>
            <pubDate>Wed, 06 Jan 2021 14:45:00 GMT</pubDate>
            <content:encoded><![CDATA[When I was a teenager, I was a competitive swimmer, training up to 4 hours a day. Irregular periods were the norm on my swim team and nobody thought much of it. I can recall when a teammate told our coach she was worried she hadn’t had a period in many months. The coach said, “That’s a good thing! That just means you’re training hard enough.” Now, years of research shows it’s generally NOT normal for a teen to have absent or irregular periods. Despite the medical evidence, I have had many cisgender female patients who have been told by well-intentioned adults, and sometimes even healthcare providers, that their absent periods just mean they’re working hard enough in their sport, it’s nothing to worry about, or even that it’s a good thing. But missing periods can indicate a dangerous physiological problem that can lead to permanent damage to bone health and affect virtually every organ in the body. First, let’s focus on what’s normal Having a first period (menarche) after the age of 9 and before the age of 15 (average age of menarche is about 12 and a half) Having some irregular periods in the first 1-2 years after menarche A cycle between 21 and 35 days, and maybe a bit longer in the first 2 years after menarche A period lasting 3 to 7 days Potential causes of irregular or absent periods  Caloric deficit*. This will be the focus of today’s blog. Underlying medical condition, like Polycystic Ovarian Syndrome (PCOS) or thyroid disease Structural or anatomical abnormality of the genitalia Pregnancy Understanding energy imbalance and how it relates to menstruation When someone expends a lot of energy in the form of exercise, or restricts their dietary intake (as with many eating disorders, this often results in an energy imbalance. This means caloric intake is less than caloric expenditure/output. When a body is in caloric deficit, virtually every organ system can be affected. Also, injuries, illnesses, and poor athletic performance are more likely. This syndrome of energy imbalance is called RED-S, which stands for “Relative Energy Deficiency in Sport”. FAQ’s about RED-S: I’m a 17-year-old cisgender female softball player. Why should I care that I’m not getting a period? Getting my period sucks! You’re right. Getting your period can be an inconvenience. And for some, downright painful and horrible! But if you’re not getting regular periods due to inadequate caloric intake, your body isn’t producing enough estrogen. Estrogen is a hormone that’s crucial to keeping your bones strong. You can only build bone until your 20’s, so your teen and young adult years are very important for building up peak bone mass for life! P.S. If your period is especially painful or heavy, see your medical provider as there are some great treatments for this. No need to suffer! But I’m a guy and I don’t get periods. This doesn’t apply to me, right? It sure does! Even though males and those without uteruses aren’t capable of having periods, the impact on the body when not getting enough nutrition is virtually the same. You can have all the same consequences of RED-S, even the decreased bone density (testosterone decreases and bones cannot sufficiently strengthen with suppressed hormones!). In fact, it’s best to be on high alert if you’re a male or don’t have a uterus, as it can be harder to tell when you’re not meeting your energy needs when there’s no glaring sign like missing periods in females/people with uteruses. I was told I have the Female Athlete Triad. How does that relate to RED-S? The Female Athlete Triad is a very similar and related condition that similarly describes a low energy state like RED-S (3). The Female Athlete Triad refers to a syndrome of 3 interrelated conditions: Decreased energy availability Irregular or absent menstrual cycles Decreased bone mineral density We know now low energy states affect all humans, regardless of whether or not they have a uterus. Low energy states affect many parts of the body—not just bone health.. You can have both Female Athlete Triad and RED-S, but RED-S is a broader framework. When to get help If your teen is not having regular periods (and it’s been more than 2 years since their first period), if periods haven’t started by the age of 15, or if your teen has very painful periods, please seek guidance from her pediatrician or other medical professional. Sometimes, RED-S can be the result of an eating disorder, in which case our team at Equip is here to help with our virtual 5-person care team. Related reading for patients and families: ED-S Information The Female Athlete Triad: Info for Patients and Families Mary Cain's New York Times Video Lauren Fleshman's Op-Ed in New York Times]]></content:encoded>
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            <title><![CDATA[Can You Tell if Someone Has an Eating Disorder Just by Looking at Them?]]></title>
            <link>https://equip.health/articles/understanding-eds/edmyth1</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/edmyth1</guid>
            <pubDate>Mon, 28 Sep 2020 16:51:00 GMT</pubDate>
            <content:encoded><![CDATA[Francisco* (not a real patient) is a 17-year-old larger bodied male who recently learned he was “overweight” at a recent visit with his primary care doctor. His doctor, with good intentions, recommends that he start “eating better and exercising”. For his health, Francisco cuts out sugar and processed food, starts exercising 30 minutes a day, and begins losing weight.  Soon, Francisco’s friends and parents are complimenting him on his weight loss. So Francisco decides to cut out dairy, gluten, and meat, and increases his exercise to 2 hours a day. Within two months, he has lost 50 pounds and is down to a “normal” weight. But he feels terrible. He has no energy, is dizzy when he stands up, and his mental health is suffering. All he seems to be able to think about is food, weight, or exercise, but he keeps hearing, “Wow, you look great!” from all the people who love him, including his doctor.  Francisco’s weight loss stalls, so he resorts to purging after meals. In a gym class at school, he passes out and has to go to the emergency room. He is found to have a heart rate in the 30s (about half of what a normal heart rate is), and dangerously low levels of potassium in his blood. He is admitted to the hospital, and told that if he doesn’t gain weight, he might die. When he shares with his best friend that he is hospitalized with malnutrition and an eating disorder, his best friend asks, “How can you have an eating disorder? Don’t you have to be a thin white girl to have an eating disorder?” Understandably, Francisco is very confused and has many questions. Didn’t I do what my doctor suggested? How can my best friend be thinner than me and not have to be hospitalized? Why do my doctors just want to make me gain weight again when I was told my body wasn’t “right” before? And how can I have an eating disorder if I’m not a thin white girl? Unfortunately, though this is a fictional patient, Francisco’s scenario is all too common. What started with good intentions at the recommendation of a physician, ended in a near-death situation. Francisco will need an experienced and compassionate team of providers, like the ones we offer here at Equip, to help his body and mind stabilize and recover from his eating disorder. In honor of Weight Stigma Awareness Week and people like Francisco, I wanted to focus on a very common misconception about eating disorders: that one must be thin to have one. Unfortunately, this myth runs rampant, even amongst the medical community. The truth is, you can’t tell by looking at someone if they have an eating disorder. Eating disorders are more likely to be missed in larger-bodied individuals. The longer a diagnosis is missed and treatment is delayed, the more likely they are to end up sicker and higher risk when they do finally present to care. Regardless of the starting weight, if patients lose too much weight too quickly, then they can have serious medical and psychological consequences. Compared to their thinner counterparts, larger-bodied individuals frequently lose huge amounts of weight before presenting to care. And studies show that the bigger the difference between starting and ending weight after weight loss, the more severe the eating disorder symptoms tend to be. Like with Fransisco, too-rapid weight loss not only leads to dangerous physical changes affecting virtually every organ system, but also is associated with worsening of disordered eating behaviors and obsessive thoughts surrounding food, exercise, and weight. A malnourished body and brain tend to behave this way no matter what the individual’s body size. In the past, a patient had to be low weight to receive a diagnosis of anorexia nervosa. Thankfully, that is no longer the case, as the latest medical research and clinical experience show that people of all sizes can suffer the exact same deleterious consequences of eating disorders. Another related myth is that all eating disorders lead to weight loss. In fact, binge eating disorder, which is not associated with weight loss, is the most common eating disorder in the US. During tough times like these, it is also important to recognize that lower income individuals facing food insecurity may be at increased risk of disordered eating behaviors, yet much less likely to have access to quality treatment. Eating disorders, it turns out, aren’t limited to thin, rich, white, straight teen females. People struggling with eating disorders come in virtually every shape, size, body type, socioeconomic status, ethnicity, gender, age, and sexuality. At Equip, we aim to increase access to evidence-based eating disorder treatment to all individuals, no matter which categories they fall into. And we owe it to patients like Francisco to raise awareness that (repeat after me) you can’t tell by looking at someone if they have an eating disorder. ]]></content:encoded>
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            <title><![CDATA[Which Dietary Intervention Is Best for Eating Disorder Treatment?]]></title>
            <link>https://equip.health/articles/news-and-research/research-virtual-dietary-interventions-eating-disorder-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/research-virtual-dietary-interventions-eating-disorder-treatment</guid>
            <pubDate>Thu, 26 Jan 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[Consider these four facts: Eating disorders affect 9% of the U.S. population (30 million people) Eating disorders are the second deadliest mental illness, behind only opioid addiction Weight gain early in treatment is considered a primary predictor of success with FBT, which is the gold-standard treatment for young people Nutrient needs of patients are complex and non-intuitive 
 Taken together, these facts make it clear just how important weight gain is to lasting recovery. And yet, there is no data on dietary interventions used in eating disorder treatment. A variety of different approaches are used in practice, and research is sparse on which may be the most effective. This gap was the impetus behind Equip’s latest “Renourish” study. The Renourish study, which began in the spring of 2022, is Equip’s first randomized trial, and the first study (to our knowledge) to compare virtually delivered dietary interventions commonly used in eating disorder treatment. We enrolled 100 patients aged 6-24 with a diagnosis of either anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID), and had self-selected for virtual eating disorder treatment. Upon admission, patients were assigned to receive one of two dietary interventions: Calorie-based: Caregivers are provided a daily calorie goal by their registered dietitian. . Plate-by-Plate™: This is a visual approach, designed for FBT, whereby caregivers are asked to follow a series of simple steps to assemble a plate that is “normal,” with representation of most/all food groups and emphasis on variety. Counting calories and weighing are discouraged. 
 The primary objective of the study is to examine any potential differences in weight changes across the two groups during the first sixteen weeks of treatment. We’re also looking at other outcomes, such as eating disorder symptoms, anxiety, depression, and caregiver burden. Interviews were conducted with both caregivers and clinicians (RDs) to assess their experience with each approach. Data analysis is not yet complete (but will be soon—stay tuned for our Renourish Outcomes paper, which will follow in a few months!), but you can read more about the Renourish study through our protocol paper here. The findings will help us better understand (1) effectiveness and acceptability of dietary interventions commonly used in FBT, and (2) the needs of the families we’re serving here at Equip. 
 Citations: Hellner M, Steinberg D, Baker JH, Blanton C. Digitally Delivered Dietary Interventions for Patients with Eating Disorders Undergoing Family-Based Treatment: Protocol for a Randomized Feasibility Trial. JMIR Res Protoc 2023;12:e41837. doi: 10.2196/41837]]></content:encoded>
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            <title><![CDATA[When Exercise Is Unhealthy]]></title>
            <link>https://equip.health/articles/food-and-fitness/when-exercise-is-unhealthy</link>
            <guid isPermaLink="false">https://equip.health/articles/food-and-fitness/when-exercise-is-unhealthy</guid>
            <pubDate>Wed, 10 Feb 2021 03:41:37 GMT</pubDate>
            <content:encoded><![CDATA[If you don’t like the way your body looks, you should get off your butt and change it...right? Wrong. If a person has an eating disorder, what can look like a healthy attitude toward exercising is usually part of the problem. Because fear of weight gain is at the heart of eating disorders, people are driven to exercise in order to get rid of this fear and regulate their emotions. In the context of eating disorders, and in an effort to control this fear, people can exercise to an unhealthy extent. Let’s explore the difference between unhealthy and healthy types of exercise. Read through the following two lists, and then read through them again, checking all the items that apply to you. Notice which of the two lists has more check marks. Exercise is physically and mentally unhealthy when… A person is exercising specifically to decrease intense fears of “fatness” A person is exercising in response to feelings of guilt and disgust after eating A person feels as if they have to exercise or else they will immediately gain weight A person feels intense anxiety if they do not exercise A person’s overall mental health is impaired by exercise A person’s physical health is negatively impacted by the exercise A person’s physician has recommended a decrease in exercise A person is unwilling to accept their physical appearance A person is actively attempting to change their physical appearance It is a form of self-punishment Exercise is physically and mentally healthy when... A person engages in a mild to moderate amount of exercise for fun or for health A person is not exercising specifically to decrease intense fears of “fatness” A person is not exercising in response to feelings of guilt and disgust after eating A person does not feel as if they have to exercise or else they will immediately gain weight A person does not feel intense anxiety if they do not exercise A person’s physician approves of the exercise Exercise: not so healthy with an eating disorder A person is not attempting to actively change their physical appearance at the cost of their mental and physical health A person generally accepts their physical appearance A person’s physical health is improved by exercise A person’s mental health is improved by exercise An eating disorder is not triggered by exercise Why exercise is tricky Almost everyone says that exercise is healthy, so it can be confusing to suddenly learn that exercise is unhealthy for you. Until the eating disorder is under control, exercise is a tricky business. For reasons involving your physical health, and to break the eating disorder habit of exercising in response to distress, it is important for you to disconnect from exercise during treatment. Once you are able to tolerate your fear of weight gain and feelings of guilt and disgust after eating, and to do so without engaging in eating disorder behaviors, relearning how to engage in physical activity for fun and health, without the eating disorder, will be a very important part of your recovery. But a focus on restoring your mental health will be primary until you’ve reached the stage of recovery where you can reintegrate physical activity into your routine. Some questions to consider about exercise: What types of exercise are you currently engaging in? How often are you currently engaging in exercise? On a scale of 0 to 10, with 0 representing no negative emotion at all and 10 representing the highest degree of negative emotion, how much are negative emotions (such as anxiety) driving you to exercise? How much do you think exercise is negatively impacting your health? In what ways will it be or has it been hard for you to scale back on exercising? How can you overcome barriers to scaling back? Whenever you have the urge to exercise but you resist that urge, list the date and the time as well as any other relevant details. (Example: “Thursday, 5:00 p.m., spent time with my sister instead of going to the gym”).]]></content:encoded>
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            <title><![CDATA[Why Do New Year's Resolutions Revolve Around Weight, Anyway?]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/new-years-resolutions-and-weight</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/new-years-resolutions-and-weight</guid>
            <pubDate>Mon, 28 Dec 2020 14:51:05 GMT</pubDate>
            <content:encoded><![CDATA[A “resolution” on its own is not inherently good or bad, but somehow New Year's Resolutions have turned into a focus on getting into a gym routine or starting a new fad diet. At some point, this was likely a reaction to perceived (or real) weight gain during the holidays. But who said we need to do anything about that weight change? The truth is that weight can fluctuate throughout the year naturally, and changes in weight don’t hold moral value. Gaining weight does not reflect poorly on our self-worth or moral attributes such as “self-discipline,” despite the messages we may receive from diet culture. Focusing on a major overhaul to “correct” weight gain can mean setting yourself up for frustration or failure to maintain whatever strict regimen you set up in that resolution. In fact, less than 25% of people actually stay committed to their resolutions after just 30 days! (1) So instead of trying to have some major amazing breakthrough, many people end up feeling disappointed with themselves, or worse, getting into unhealthy weight control behaviors because they are still so focused on that holiday weight gain that they were taught to view as “bad.” Instead, this year, I recommend this: focus on acceptance; focus on finding passions in life outside of your appearance; identify activities that will fill your days with pleasure or a sense of achievement or connection with others. As Equip’s Chief Clinical Officer, Dr. Erin Parks said, “The diet industry would like us to focus on how we want to LOOK in 2021; we urge you to focus on how you want to FEEL.” Shifting your focus in this way can still bring growth into your new year, separate from your physical appearance. This can also be a rich opportunity to practice embracing change in all forms: not just on the scale or in the mirror. In fact, some of that holiday body change may very well have been a misperception based on a hyper-focus on your body. And the re-focus to other fulfilling things in life can be the much needed solution. Do you need to set a resolution or a goal? Nope. But if you do, consider choosing one that builds on your strengths rather than one that assumes you have something that needs to be fixed.]]></content:encoded>
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            <title><![CDATA[The Power of Family Mentorship: The Power of YOU]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/power-of-family-mentorship</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/power-of-family-mentorship</guid>
            <pubDate>Wed, 04 Nov 2020 19:30:00 GMT</pubDate>
            <content:encoded><![CDATA[JD is Equip's Director of Mentorship. She is an educator turned Family Mentor whose youngest child developed anorexia in 2012; they received cutting edge, evidence-based treatment at UC San Diego, igniting JD’s passion to ensure all families have access to evidence-based care. She became active in online family support communities, writing, and began attending and speaking at conferences. She is a board member for FEAST. I credit UC San Diego Eating Disorders Center for Treatment and Research, including their use of family mentorship as part of care, with saving my daughter’s life and enabling our family to emerge from the terrifying darkness of an eating disorder—and to walk into the light of recovery even stronger as individuals and a family. Multi-family groups were invaluable in normalizing the experience, learning (then teaching) the tricks of the trade, and forming strong bonds we’ve relied on in the years since then. Likewise our children were able to process, share, and receive support with their peers in the program. Patients and families participate in a variety of groups and involve siblings. My daughter has maintained her recovery for over ten years-as well as some friendships from that time and they have been positive influences; it’s beautiful to see.. Anorexia nervosa became central to my life in 2012, when my youngest daughter became suddenly and dangerously ill. I could never have predicted where this journey would take her, our family, and my career. In fact, I wouldn’t have been able to predict a single thing, so overwhelmed and terrified was I. As a San Diego family with good insurance, we were also lucky our pediatrician was extremely knowledgeable about eating disorders and insisted we access gold standard, evidence-based FBT through UCSD. She advocated for Aetna to cover it via a single case agreement. Our almost immediate access to excellent treatment is very unusual; the eating disorder field widely practices outdated treatment, with a 17-year delay utilizing the latest research. . This gap between research and treatment is why families in the eating disorder community have long acted as first responders and envelop worried newcomers with information, support, wisdom and caring immediately from the first contact. We fill in gaps in professional access and knowledge that are sometimes more akin to chasms. Equip is professionalizing the labor of supporters who have done this work, unpaid, by Facebook post, by forum, by email, by phone, by Zoom, in person, and across the globe. Equip includes Family and Peer Mentors as core Equip Treatment Team members, alongside medical practitioners, dietitians, and therapists. The (evidence-based) inclusion of mentors in FBT is transformative. If you are a person who has helped your loved one battle an eating disorder, you are already an Expert by Experience. Equip training, support and supervision give you the tools to take what you have been through and use it as the basis to become an effective, professional mentor. At Equip, we value all your experiences in all aspects of your life, and building a diverse, inclusive provider team is a priority. We have no educational requirement for mentors; it is your ability to connect with others, to be trained and coached, and your belief in our mission and alignment with our values, that matter. It is a passion for recovery that drives us and that we want to drive you. Interested in helping other families recover from eating disorders? Equip is seeking peer and family mentors. 
 What does work as a mentor for Equip look like? You are paid a salary (rather than hourly) wage with generous benefits. You work from home with technology we supply you (including an allowance for workspace function and comfort.) You will complete comprehensive training before meeting with families, and get to know your team members. You will see patients/families via our HIPAA-compliant portant and participate in planning, and support execution of, the treatment plan. Your insights and expertise will be valued as you work collaboratively with the MD, Psychiatrist, Registered Dietitian, Therapist and the Peer Mentor. An added bonus is the ability to have input on research directions as Equip begins to analyze and share valuable data. If you have already been considering this work, or if this idea is new to you, please think about applying to become part of our pipeline of Family Mentors—the work is fulfilling, the company culture is incredible, and the work-life balance of a remote job is a huge plus. Being a pioneer in this field and impacting so many recoveries is not something I imagined eight years ago, and here we are. It, and Equip, is a great place to be—join me?]]></content:encoded>
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            <title><![CDATA[What the Facebook Whistleblower Taught Us About Social Media and Eating Disorders]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/social-media-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/social-media-eating-disorders</guid>
            <pubDate>Mon, 06 Dec 2021 15:30:00 GMT</pubDate>
            <content:encoded><![CDATA[Anyone who’s ever scrolled through social media (approximately 3.5 billion people) is likely aware that much of the content on platforms like Facebook, Instagram, and TikTok can be problematic or triggering to anyone struggling with body image let alone an eating disorder. But it wasn’t until this October of this year that the public confronted the fact that not only are these platforms failing to crack down on accounts with harmful, often extreme dieting and body image content — they’re actively promoting them, according to insiders. Frances Haugen, a former product manager at Facebook who has become known as the “Facebook whistleblower” gathered internal documents from the company that indicate 13.5% of teen girls said Instagram makes thoughts of suicide worse, and 17% said Instagram makes eating disorders worse. "What's super tragic is Facebook's own research says as these young women begin to consume this eating disorder content, they get more and more depressed. It actually makes them use the app more," Haugen said. "They end up in this feedback cycle where they hate their bodies more and more." The revelations were harrowing, but the findings aren’t exactly new — researchers have long-known that social media has a harmful, negative, and preventable impact on young people. In a 2006 paper titled “Body Image, Media, and Eating Disorders,” researchers examined changes in the “ideal” female body type over time and concluded that “throughout history, the ideal of beauty has been difficult to achieve and has been shaped by social context. Current mass media is ubiquitous and powerful, leading to increased body dissatisfaction”. Jennifer Derenne MD, the study’s lead author and Equip’s senior psychiatric medical director, says she was interested in how current events shape ideal standards of beauty throughout time, and the first paper she wrote on the topic went on to become one of Academic Psychiatry’s most downloaded articles, so she was asked to update it ten years later. “It was really eye-opening to see the ways in which things had changed in that time — particularly with the widespread availability of social media platforms.” As Derenne details in her updated paper, “the Internet remains the major source of health information for the vast majority of people, yet the information is not always accurate or regulated.” In addition to “self-proclaimed gurus touting the latest weight loss and exercise gimmicks,” social media users may also encounter “more blatantly pro-eating disorder messages and communities” that are difficult to moderate or shut down, despite efforts by Facebook and Instagram to filter and flag pro-eating disorder content. “It is infuriating for me to learn that these companies know that the algorithms steer people to misleading and unhealthy content,” Derenne says. “At the same time, I appreciate the dilemma of not wanting to censor content. I’m hopeful that they’ll pivot and approach body image, eating disorders, and dieting content in the same manner that they use to approach suicidality and self-harm.” Gillian Klein knows that social media is made up of many “split second depictions” of peoples’ lives — depictions that are often posed and edited. ”Given the time spent scrolling on these mass communication platforms, the underlying messages these images transmit manifest into our reality. Layer on the addition of likes and comments, which only feed our ideas of what’s ‘in’ or ‘accepted’ and suddenly the voice of an eating disorder is being hand-fed ‘facts’ to fight your voice of reason.” Klein says social media — specifically Pinterest — is initially what piqued her interest in dieting. “I recall coming across colorful displays of low-sugar, no-carb diets claiming they were the solution,” she says. “Solution to what? That I did not know, but apparently they were the solution to a problem I’d not known existed.” As a result of social media scrolling, Klein says weight loss practices and overexercise became integral habit’s in her daily life -“habits that were only further ingrained and encouraged with the posts I saw on my feed,” she adds. “I unintentionally created through my feed a world in which my ED could thrive”. Dr. Derenne says she believes it’s important to consider subtlety and nuance when evaluating the effects of social media on eating disorders. “We are all exposed to media on a daily basis, but we don’t all develop eating disorders,” she says. “There really seems to be a ‘perfect storm’ of factors, including temperament, genetic vulnerability, co-occurring mental health conditions, and environmental or societal factors that contribute.” But even with that ‘perfect storm’ in mind, Derenne says the media plays an undeniable role in the development of body image ideals and self perception. “I love the Becker Fiji study that illustrates the qualitative differences in body image resulted from television being introduced to the island between 1995 and 1998. It is really compelling — many of the people she spoke to did not have body image concerns until they were confronted with images of thin (usually white) television stars.” All of this, however, came before the advent and proliferation of social media and the landscape of influence we know today. Derenne says the revelations are fascinating and has heard multiple people refer to this as social media’s ‘Big Tobacco’ moment, meaning many of the industry’s nefarious truths are coming to light in a major way. “Most people were in agreement that smoking is not good for you and can lead to lung cancer, so it should not be marketed to young people and should be regulated,” Derenne says. “Social media is ubiquitous, and the outages on Facebook [in October] illustrate how dependent many people are on these platforms for communication and commerce. Honestly, being connected this way has many health benefits — personally, I’ve loved keeping up with people I had lost touch with over the years and enjoy seeing photos of kids and vacations and life events. There have been studies showing that social media groups can actually be supportive and beneficial to recovery.” Derenne believes that to move forward in the fight against problematic content, it’s important to recognize that social media isn’t going anywhere. “We will need to find ways to help young people hone their skills as savvy consumers of digital content,” she says. “My opinion is that it is ideal for parents to be curious about what their children are watching or scrolling from an early age, and that they watch things together and encourage open conversation about difficult topics. While restricting access to social media may be necessary when an individual is in the throes of an eating disorder, most people will interact in the digital space at some point in their lives and benefit from learning to do that in a safe and gradual manner.” Through the lens of her own experience, Klein says she hopes increased awareness of the potential pitfalls and risks of social media may help mitigate some of its risks. “These mass communication platforms tell us about our values as we continue taking and editing pictures to fit what we believe will perform well,” she says. “For those of us suffering from, or in recovery from, disordered eating behaviors, such platforms become a tool in which we may subconsciously construct worlds that uphold the values ED tells us are important. Reflecting upon and altering how important certain values are to social acceptance isn’t going to eliminate eating disorders; however, it will ease the pressures that often influence the relationships we, as a society, have to body image, exercise, and food.”]]></content:encoded>
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            <title><![CDATA[Why I’m Now Grateful for Family-Based Treatment...Even Though I Hated It]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/grateful-family-based-treatment</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/grateful-family-based-treatment</guid>
            <pubDate>Tue, 20 Oct 2020 16:55:00 GMT</pubDate>
            <content:encoded><![CDATA[I remember my life immediately after my diagnosis of anorexia nervosa as a time filled with challenging emotions: fear, shame, frustration, and even grief. As a fourteen-year-old, I felt unprepared to have my life turned upside down by a diagnosis that I didn’t even fully understand. Anorexia? Wasn’t that something ballerinas and models got? Did that mean I was vain? Did I do something wrong? More challenging than untangling myself from the untrue and unfair stereotypes and stigma associated with eating disorders, though, was coming to terms with what needed to be done for me to heal. My parents, still working through their own confusion and shame around my sudden diagnosis, took me home from the Stanford Eating Disorders Program with a plan to do everything they could to support my recovery. Neither of them had undergone any kind of mental health education before my hospitalization, but they were willing to embark on a crash course in it in order to help their daughter. At the time, still present in a persistent eating disorder, I focused mostly on their slips along the way: the times they didn’t say exactly the right thing, the times they repeated stereotypes about eating disorders unknowingly, the times they snapped at me out of frustration and fear. But today, as a recovered adult supporting others in their recovery journeys, I feel immense gratitude for their willingness to learn, adapt, and help me fight an eating disorder when I simply couldn’t do it alone. To be fully honest, I hated Family Based Treatment (or, more accurately, my eating disorder hated it). I was asked, if not commanded, to relinquish all of the control my eating disorder demanded. No more choosing my own meals. No more choosing when or how I ate. No more eating unsupervised. No more exercise. No more freedom. At first, I was fully consumed by the fear-response this evoked: the eating disorder voice grew louder and angrier, resulting in outbursts, food thrown, and mean words tossed at my parents. The eating disorder knew exactly what to say to hurt my parents and hopefully wear them down enough to surrender power back to the disorder that raged at them. There were many times that I told my parents I hated them, that if they loved me, they would let me go back to living the life I thought I wanted, alone with the eating disorder. And yet, as challenging as it must have been for them, they pressed on. They sat with me at the kitchen table until each bite was taken. They took me to each and every therapy session and doctor’s appointment. They sacrificed much of their lives to spend time with their child who, gripped by an eating disorder, hurled insults and hateful words their way. All the while they held onto the hope that someday, things would improve. As challenging as this process was, a tiny part of me slowly began to surrender to the relief I felt inside. At first it was a small voice that my eating disorder labeled as a “weakness” or “lack of self-discipline.” But over time, this tiny voice grew louder and delivered a message of comfort: the battle against my eating disorder was no longer a burden I had to carry on my own. Each meal wasn’t a fight with the rules and restrictions of the disorder, because I had no power to decide what was on my plate. As much as the eating disorder hated Family Based Treatment, the wise-minded Maris that was always within me found relief in no longer feeling fully responsible for challenging the disorder at every meal. Having no freedom, in a way, meant feeling more freedom from the disorder. Many parents struggle with the challenges of family-based treatment. Eating disorders are invested in sticking around and will say and do very hurtful things to try and do so. Watching your child gripped by an illness that demands full control react to the changes of you taking back control can be heartbreaking, frustrating, and confusing. There are many parents who tell me they’ve had many moments of saying: “Is this really the best thing I can do for my child? Is this really worth it?” As someone who now reaps the benefits of Family Based Treatment, I can say whole-heartedly that every challenging meal and fight over food was worth it. We didn’t do everything “perfectly,” but that’s not what’s expected of anyone in recovery. My parents sometimes said hurtful things back or doubted themselves in the process, but we still learned from these instances and moved forward. In doing so, I was able to begin my healing process and get my body back to a stable state, strong enough to support me as I navigated all the deep-digging and personal exploration that comes with recovery. Today, I see myself as proof that full recovery is possible, and that it’s entirely worth the challenges that arise along the way. If I could send one message to parents supporting their children in this journey, it’s that the disorder gets louder, meaner, and angrier when it feels threatened: and that can be a sign that you’re truly helping your child break free from its grasp. Despite all the hurtful things I said and did at the hands of my eating disorder, I still love my parents. And yes, I am grateful for the time they took control away from the disorder to give me space to breathe and heal - even if I couldn’t express it at the time.]]></content:encoded>
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            <title><![CDATA[What One Parent Learned from Supporting a Child in Recovery]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/frank</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/frank</guid>
            <pubDate>Wed, 16 Sep 2020 16:34:00 GMT</pubDate>
            <content:encoded><![CDATA[Frank Brockmann lives and works as an education consultant near Sacramento, California. In early 2019, he and his wife temporarily relocated to San Diego for four months while their 12-year-old daughter was treated at UCSD’s Eating Disorder Center. Like many parents, he found tremendous value in becoming ED-ucated and set about the task of learning through online support forums, TED talks, research presentations, and independent study in addition to the support and educational tools provided as part of the PHP and IOP programs at UCSD. Until last year, most of what I thought I knew about anorexia came straight from The Karen Carpenter Story. Later, shows like Heathers and Glee further contributed to my ill-informed perspective: like many, I was convinced anorexia was about the desperation of teen girls who try to "get thin to fit in." I would imagine that visual we've all seen by now--that image of an emaciated girl looking at a distorted “fat” image in the mirror. To me, that's what anorexia was about. But our daughter wasn't like that at all. For one thing, she was just 11 years old when she stumbled into her eating disorder. It started with a secret crash diet on New Years Day, and a few weeks later we knew there was a problem. Because she wasn't really even a teenager yet, I thought I could just show her a spreadsheet and some articles from the internet to convince her to eat. And because she was so bright and thoughtful at such a young age, and because she wasn't much of an attention-seeker, I thought she would gladly choose to give up what I thought was just a new set of very bad habits. Wrong. 
In fact, I soon learned almost everything I thought I ever knew about anorexia was wrong. But that's another story.
 The first barrier to recovery appeared immediately. I realized right away that entering "eating disorders" into those find-a-therapist-type websites was a hit-or-miss proposition. And it only took a few phone conversations to learn most therapists who are willing to work with kids who have eating disorders are not specialists at all.
 The second barrier was the lack of expertise among the initial treatment team itself. Our daughter had a pediatrician, a therapist, and a dietitian. We assembled that team in less than 2 weeks--but our problems didn't end there. It was actually our dietitian--not the therapist or pediatrician--who alerted us to the severity of our daughter's medical condition within one hour of her first meeting. (That dietitian, as it turned out, had had anorexia herself as a teen.) Within 3 days our daughter was hospitalized for inpatient treatment. The long road to recovery began soon afterward, and we relocated to San Diego for 4 months and underwent family-based treatment for Anorexia / ARFID.
 My wish for all parents and caregivers is to have rapid, direct, and fully-engaged access to a highly-qualified team of ED specialists. There are far too many people who have ZERO access to care at all simply because of where they live. Or they face insurmountable odds against building a truly knowledgeable team. That needs to change.
 There are also far too many well-meaning providers who truly do not understand the most up-to-date treatments for eating disorders. They may not know how to be part of a team approach to treating eating disorders, or they may be unwilling to modify a treatment approach that requires everyone to view a single person as "the expert." That definitely needs to change, too.
 EQUIP can address these barriers by tackling these problems head-on. A tele-health model does so much to level the playing field! (We spent weeks just trying to get to the point where we could get off a plane and walk through the doors of a top-notch treatment facility). And by "pre-assembling" a team of ED specialists, parents and caregivers can focus on what matters most and spend a lot less time trying to perform "administrative acrobatics."
 Parents are so fortunate to have EQUIP as an emerging entity right now. I can only imagine the amount of heartache that might be spared using the EQUIP model.]]></content:encoded>
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            <title><![CDATA[An Eating Disorder Therapist on Appropriate Treatment for All Bodies]]></title>
            <link>https://equip.health/articles/body-image/eating-disorder-treatment-all-bodies</link>
            <guid isPermaLink="false">https://equip.health/articles/body-image/eating-disorder-treatment-all-bodies</guid>
            <pubDate>Wed, 02 Sep 2020 17:05:53 GMT</pubDate>
            <content:encoded><![CDATA[Shira Rose, LCSW Knowing the trauma of weight stigmatizing treatment, Shira promotes weight-neutral clinical support as vital. Shira is an eating disorder therapist based in New York City. I struggled with an eating disorder from the age of 10 and then spent years cycling in and out of treatment. I felt so much shame about the fact that I must be weak or broken because I couldn’t seem to recover. But there was a significant delay in my receiving treatment as no one believed I could have an eating disorder because I didn’t “look” the part. And when I finally received treatment, I was harmed by fatphobic clinicians again and again. All of this wasn’t particularly conducive to my recovery because the treatment I received was often further traumatizing. While my peers in smaller bodies received appropriate nourishment and support in their healing process, my restriction was encouraged and my weight loss was praised. I was told to eat kid size portions of certain foods while my peers were given normal portions. I was made to measure and weigh every last ounce of food I consumed in treatment. All of this further drove home what I had learned from the age of 5; that my body was broken, my body was different, and I shouldn’t dare eat like other people. Many people continue to believe that eating disorders only happen to thin, white girls. That stereotype is incredibly dangerous. Treatment is rarely safe for the millions that don’t fit that stereotype and things really need to change. My experiences made me really passionate about going into the eating disorder field myself and offering safe and fat-positive care to my clients in all size bodies. I am a licensed clinical social worker and I treat eating disorders, disordered eating, and body image concerns from a strong Health At Every Size ® framework. I often see clients, particularly children and teens, enter the treatment world and then spend decades cycling in and out of higher levels of care. Children and teens often learn new behaviors from the other clients and often the eating disorder identity takes a strong hold and treatment becomes their whole life. Community and family based treatment is rarely offered as the first option and I find that devastating and detrimental. Of course higher levels of care have its place but when family based treatment is appropriate, I believe it should be the first option. I’m excited that Equip is now offering family based treatment that will be covered by insurance. I am hopeful that as Equip grows, increased accessibility will continue to be a priority because there are so many people struggling right now with no ability to afford the care they desperately need and deserve. I also hope that Equip continues to work on being anti-racist and fat-affirming as current treatment is built for the thin, white woman and that leaves out so many people who often can’t even get properly diagnosed, let alone access appropriate treatment. There is so much work that needs to be done in the eating disorder field and I hope Equip can start filling in some of the gaps.]]></content:encoded>
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            <title><![CDATA[New Research Reveals the Devastating Realities of Eating Disorders — Here’s What Families Need to Know ]]></title>
            <link>https://equip.health/articles/news-and-research/mortality-research</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/mortality-research</guid>
            <pubDate>Thu, 09 Sep 2021 13:27:22 GMT</pubDate>
            <content:encoded><![CDATA[Long before Anne* became an Equip family mentor—and decades before her own daughter was diagnosed with anorexia—she experienced the harsh realities of an eating disorder first-hand. When Anne read a new research paper on eating disorders and mortality, the findings resonated deeply: people with current or former EDs have up to a 5x higher mortality rate, a reduced quality of life, 50% increased healthcare costs, and heightened fertility struggles. “I’m not surprised by the high mortality rates associated with anorexia (and other eating disorders), especially via suicide—I myself had attempted four times between the ages of 14 and 22, twice coming very close to completing,” Anne says. “I didn’t connect these attempts and my ongoing depression and anxiety to my anorexia but looking back, I can see the complicated interconnectedness.” The recent study, Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden, found that patients with anorexia nervosa and atypical anorexia nervosa (when a person may exhibit many of the same symptoms of anorexia without extreme weight loss or low body weight) were five times more likely to have premature mortality compared to similar individuals matched on age and sex without an eating disorder. “Put differently, having AN or AAN means you are five times more likely to die early compared to not having that diagnosis,” explains Equip’s director of research, Dori Steinberg, PhD, RD. “If we compare those with AN and AAN to various other mental health disorders, the odds of dying early are still two times higher. Eating disorders, and in particular AN and AAN, lead to a much higher risk of premature mortality.” The current research on eating disorders, mortality, and more According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), eating disorders are the second deadliest mental illness after opioid overdose. Approximately one death occurs every 52 minutes due to an eating disorder and about 26 percent of people with eating disorders attempt suicide. And while mortality rates are critical to the understanding of eating disorders and the trauma they cause, there are other tremendous consequences of anorexia, bulimia, binge eating disorder, and other EDs. Steinberg feels this study is distinctive from earlier research because it goes beyond examining the devastating consequence of eating disorders — death — and evaluates the myriad ways these diseases can cause life-altering devastation, including quality of life impairment, disability, family burden, cost, and more. “This study is important because it highlights all the ways that an eating disorder can wreak havoc and cause tremendous burden,” she says. “This study is a great comprehensive review of the burden and costs of eating disorders, highlighting a few things that are often overlooked,” says Equip’s VP of clinical programs, Cara Bohon, PhD. “One of these often overlooked aspects is their inclusion and recognition of the burden on the family. They report that studies have shown caregiver burden (worry, tension, etc.) to be higher for carers of patients with eating disorders than those with depression or schizophrenia.” Anne, who was the primary caregiver for her daughter, says that even with the benefit of early intervention and competent treatment, the cost in quality of life and impact on the family is still quite high. “I don’t regret being the primary caretaker for our four years of FBT (Family-Based Treatment), but it revealed the toll it can take on caretakers,” she says. “My career basically had to be put on hold, tens of thousands were spent out of pocket on treatment, my marriage was strained (or existing cracks revealed), and the PTSD I still experience as we begin to emerge on the other side is very real.” How Equip’s treatment model addresses the real impact of eating disorders A key finding of the study is that the mortality risk for patients with anorexia who are studied after receiving outpatient care is lower than those who are studied after inpatient care. “This is in-line with our goal at Equip to support people in recovery at home, helping them avoid inpatient or residential treatment as much as possible,” Bohon says. “Additionally, Equip's inclusion of family mentors is key in increasing support for families when we know they face such a great burden in the fight against the eating disorder.” Anne says anorexia impacted approximately 40 years of her life and the only “treatment” she received for her own eating disorder was a one-week stay at a residential facility in her mid 20s. She wishes she and her daughter had access to more comprehensive recovery programs like Equip. “Looking back, with the hindsight of using family-based therapy (FBT) for my daughter’s anorexia, I imagine a much different trajectory for myself had I been offered care early on — perhaps less suicide attempts, more stability in college, jobs and relationships, and more than an only quasi-recovery up until my early 50s.” Reflecting on the research and her own experience, Anne is all too aware of the seriousness of eating disorders and through her work as a family mentor, hopes to help support other families navigating the recovery journey. “I cannot speak for my daughter as to what the anorexia has cost her personally; that story is hers to tell or not,” she says. “As her mother, I remain vigilant for the possibility of suicide, knowing statistically and personally how high the odds are.” *A pseudonym has been used.]]></content:encoded>
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            <title><![CDATA[My Kid Is Getting Better, So Why Do I Feel Worse?]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/getting-better</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/getting-better</guid>
            <pubDate>Wed, 18 Aug 2021 16:46:00 GMT</pubDate>
            <content:encoded><![CDATA[When caring for a loved one with an eating disorder, you have to develop all kinds of new skills and coping strategies. One of the ways to survive the grueling treatment process is to adopt an unflappable, almost robotic approach in the face of unpredictable outbursts, cruel insults, and terrifying threats. Wearing a kind of emotional armor not only protects you from this painful onslaught but also helps you stand up more firmly to the manipulative bully living in your house (the eating disorder, that is, not your child). Taking a matter-of-fact approach has other benefits, too, as it can help your anxious or angry child find equilibrium. Through the process of co-regulation, your relative state of calm allows them to feel calmer, too. Sometimes this firm stance can feel a little bit like going numb–and that makes sense as a survival strategy when you’re in a painful battle with an eating disorder. Helping your child heal forces you to find deep reserves of toughness, often drawing on strength you didn’t even know you had. It’s like the stories of mothers who have literally lifted a car off their child. In that moment of rescue, no one would ask a parent, “But aren’t you worried? How are you feeling about this terrible situation?” No, you don’t have time for feelings, let alone time for processing those feelings. You are busy trying to save someone’s life. As your child starts to recover and you see glimpses of hope, there is a shift that can, at first, make you feel worse. Why? Because you are starting to feel again. You’ve begun to shed some of that heavy armor and can now tend to your war wounds. The muscles that lifted the car are sore, and you can look back and acknowledge just how frightening and devastating the experience was. Through sheer force of will and love for your child, you endured something harrowing. You didn’t have the luxury to experience all the feelings earlier, and here they come, welling up in uncomfortable ways. If you’ll entertain another analogy, it’s a bit like the pain from dental surgery after the novocaine wears off. The pain was always there–you just couldn’t feel it. Crisis mode provides a certain level of pain-blocking, but it’s temporary. What makes this transition even more challenging is that it tends to come when the outside world sees your child starting to look well, even if there is a long road of recovery ahead. You might start getting comments like, “You must be so relieved!” or even, “I bet you’re glad that’s over!” The outside world might assume life is already back to normal in your family and expect you to be back to your old self, too. When your loved one starts to re-enter their life–school, activities, socializing–it’s often a vulnerable time, as the child may be at risk for set-backs and even relapse. This is a terrifying stage for families, and it’s often when parents need the most support. You are exhausted, raw, sad, angry, and scared just when most people expect you to be grateful and carefree. Even if your child is in really strong recovery, you may be hit by waves of feelings that seem to come out of nowhere. Remember you’re probably making up for lost time. If you can, feel what you’re feeling without judgement. Try to make space for the sadness and anger in whatever way works for you–attending support groups, seeing a therapist, journaling, talking to friends who “get it,” watching tearjerkers, listening to sad songs. It hurts, but as with many things in eating disorder treatment, the only way out is through. And before long, you’ll start crying tears of joy again, too. *This article originally appeared on feast-ed.org]]></content:encoded>
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            <title><![CDATA[In the Name of Access: From Academia to Equip ]]></title>
            <link>https://equip.health/articles/treatment-and-recovery/jennifer-derenne</link>
            <guid isPermaLink="false">https://equip.health/articles/treatment-and-recovery/jennifer-derenne</guid>
            <pubDate>Wed, 28 Jul 2021 02:18:00 GMT</pubDate>
            <content:encoded><![CDATA[It seemed as though I had some version of the following conversation a million times over the course of the pandemic: “I’m not really sure what happened. I just wanted to stay healthy during shelter-in place. I started by cutting out junk food and exercising more, but then it took on a life of its own, and I ended up really sick.” All young people were impacted by the sudden shutdowns that prevented them from their normal lives. School attendance, time with friends, and participation in sports and other activities were all affected. Social media provided important connection to friends and also ample opportunity for social comparison as well as access to nutrition and fitness “tips”. For the last ten years, a large part of my job has consisted of evaluating and treating hospitalized patients with eating disorders who have become medically unstable secondary to malnutrition. Even in a well-resourced place like Silicon Valley, access to evidence-based treatment is difficult. At baseline, there are serious inequities in the ways in which people can access care. Owing to the frustrations of red tape and low reimbursement, many qualified clinicians don’t work with commercial insurance, and instead serve patients who can pay privately. Families covered by government payors don’t have access to certain levels of care. With the pandemic, we saw a spike in demand for eating disorder treatment, without a corresponding increase in resources. All the mental health providers in the area were tapped by a sharp increase in mental health acuity. Our reality became what seemed a never-ending revolving door of patients. We could get them medically stable enough to safely send home, but we didn’t have a lot of options for ongoing treatment, and that meant that many did poorly on discharge and needed to be readmitted. Academic centers and community providers were completely full. Day treatment and residential centers were dealing with COVID precautions and limits to their census in addition to unprecedented acuity, and many had months-long waiting lists. It was (and is) a very difficult time. Eating disorders have the dubious distinction of having the highest mortality rate of any mental illness other than opiate dependence. Sudden death can result from any of the many medical complications of malnutrition, such as cardiac arrhythmia. Half of patients who succumb to an eating disorder die by suicide. It is a terrible illness in the best of times, and especially in the worst of times, it felt overwhelming to tell families over and over again that I knew what they needed, but was limited in helping them find it. I’ve worked in academia my entire career, and have absolutely loved it. I’ve had the honor of working alongside clinicians and scholars who have developed the innovative treatments we deliver in real world settings. Striving to provide excellent clinical care while also training the next generation of physicians and psychologists keeps me on my toes and feeds my soul. At the same time, I’ve struggled with the limitations in the current treatment landscape. When I was approached with the opportunity to join Equip, I knew that I needed to be involved in some way. At Equip, I’m afforded with the opportunity to provide high-quality care, teach and train in a wide range of settings, and be involved in helping solve the seemingly daunting access and scalability issues. At the same time, I’m still able to stay involved in the academic tasks that have been such a large part of my professional identity. I will always be grateful to academia, and the many wonderful colleagues I continue to work alongside, for preparing me to pivot into this new role. Providing everyone who needs it access to evidence-based eating disorder treatment is at the heart of our mission, and I can attest to the fact that this is reinforced often at Equip. It is truly our north star.]]></content:encoded>
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            <title><![CDATA[Project HEAL and Equip Announce "Equipped to Heal" Scholarship Program]]></title>
            <link>https://equip.health/articles/news-and-research/equipped-to-heal</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equipped-to-heal</guid>
            <pubDate>Mon, 12 Jul 2021 19:42:00 GMT</pubDate>
            <content:encoded><![CDATA[SAN DIEGO, July 13th, 2021 –– Equip, a company that virtually delivers evidence-based eating disorder treatment to families at home, and Project HEAL, the only major direct service nonprofit in the U.S. focused on equitable healthcare access for people with eating disorders, announced a new scholarship program, Equipped to HEAL, which grants scholarships to five patients for one year of Equip treatment. “While I started Equip to improve access to eating disorder care within the existing healthcare system, we still see people fall through the cracks every day, and that's why we're partnering with Project HEAL – to make sure we provide treatment to patients and families who otherwise wouldn’t receive it,” said Kristina Saffran, CEO and co-founder of Equip. Founded in 2019 by Kristina Saffran and Erin Parks, Ph.D., Equip builds upon Family-Based Treatment (FBT) - a model which empowers families to help their loved ones through recovery - with a five-person dedicated care team, including a peer and family mentor, a medical physician, a therapist and a dietitian. Equip’s fully virtual platform allows families to arrange treatment to fit their schedules and needs. Through Equipped to HEAL, Equip will be providing free treatment to at least five Project HEAL beneficiaries per year whose family is low-income or facing extenuating financial circumstances; experiencing medical or social discrimination related to their identity or appearance; and don’t currently have quality eating disorder treatment options through an insurance provider. "We're so grateful to have committed, passionate, values-aligned partners like Equip to help us finally make eating disorder treatment accessible to those who the system is otherwise likely to fail. Mental health support and healing should not be a luxury of the privileged few," said Rebecca Eyre, CEO of Project HEAL. Equip currently serves families in California, New York, New Jersey and Texas, and is in-network with Optum and Cigna with plans to expand its geographic and health plan reach throughout 2021. The company has seen remarkable outcomes in its first 6 months of treating patients. Nearly 60% of patients have reached their weight restoration goals and have experienced an improvement in EDE-QS scores, the clinically validated measure for eating disorders. Of the 30 million Americans who will be diagnosed with an eating disorder in their lifetime, only 20% will access treatment. The reasons for this are complex, but a vast majority are related to systemic, healthcare, and financial barriers. Project HEAL is on a mission to change this - breaking down barriers to eating disorder treatment one patient at a time - so that recovery is accessible for all. With one person dying of an eating disorder every 52 minutes, we cannot afford to deny care to anyone who is ready and willing to heal. About Equip Equip delivers modern eating disorder treatment through family-based care that promises lasting recovery at home. Created by experts in the field and people who’ve been there, Equip provides each patient with a five-person dedicated care team including a therapist, dietician, physician, and peer & family mentor. Our vision is to equip every family with effective tools to confidently overcome eating disorders in a way that is accessible and affordable. We believe Equip is a better alternative to the status quo treatment options and we eliminate the various obstacles families face in treatment today. For more information, visit www.equip.health. About Project HEAL Project HEAL is the leading nonprofit in the U.S. focused on equitable access to eating disorder treatment. Founded in 2008, Project HEAL has since expanded to include three direct service programs, innovative research, and advocacy work. Through cash assistance grants, a national network of treatment providers donating their services, and a national network of volunteers providing expert insurance navigation support, Project HEAL helps over 200 low-income and often marginalized individuals per year access life-saving treatment - for free. Project HEAL’s mission is to break down systemic, healthcare, and financial barriers to eating disorder treatment, and our vision is that everyone with an eating disorder has the resources and opportunities they need to recover. Media Contact Lauren Gerber Director of Marketing, Equip lauren@equip.health 619-847-1850]]></content:encoded>
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            <title><![CDATA[Research Shows Equip’s Family-Based Treatment Model Works. Here’s Why.]]></title>
            <link>https://equip.health/articles/news-and-research/research-study</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/research-study</guid>
            <pubDate>Mon, 28 Jun 2021 17:53:00 GMT</pubDate>
            <content:encoded><![CDATA[When it comes to eating disorder treatment, the reality is not all therapeutic approaches are created equal. In fact, the type of therapy at the center of the Equip model—Family-Based Treatment (FBT)—is the only well-established treatment for adolescent eating disorders. While methods like cognitive behavioral therapy (CBT), which is built on skills like thought retraining, and dialectical behavioral therapy (DBT), which involves self-soothing and mindfulness techniques, play important roles in the array of treatment options, FBT has proven time and time again to be the most effective method for adolescents—so why isn’t every child and teen with an eating disorder getting it? That’s the question Equip team members Megan Hellner, Cara Bohon, Samuel Kolander, and Erin Parks set out to answer in their new paper, “Virtually delivered family-based eating disorder treatment using an enhanced multidisciplinary care team: A case study,” published earlier this month. The team chronicled the outcomes of two patients treated virtually through a modified four-week version of Equip’s model. Not only did both patients experience significant improvement in weight and clinical assessment scores, but both said they would “definitely recommend” the treatment to a friend or family member. If FBT works, why isn’t everyone getting it? So why isn’t FBT, the gold-standard treatment for eating disorders in adolescents, more common? According to the researchers, there are a few major obstacles — both on the provider side and the patient side. For one thing, a surprisingly small number of eating disorder “experts” are actually trained in delivering FBT or any evidence-based treatments, for that matter. According to the report, the majority (57%) of psychotherapy providers receive no clinical training or supervision on eating disorders. “There is a tension in the field between evidence-based treatment and real-world experience,” says one of the study’s authors, Cara Bohon, PhD, Equip’s VP of Clinical Programs. “Academically-trained clinicians and clinician-scientists tend to favor pure evidence-based protocols that they can have confidence in based on controlled trials. Others who see the limitations in both the data from those trials and the experience of their patients or themselves tend to push back on the pressure to follow protocols that don't feel flexible. Further, even the best evidence-based treatments we have—FBT at the moment—are still only successful less than 50% of the time.” But looking at treatment as an “either/or” situation is a paradigm experts say only ends up failing patients and impedes growth in the research field. “Sticking purely with the protocols can limit us from innovation, but straying too far from the research risks ending up with worse outcomes,” Bohon says. “I hope that this work pushes people on both sides of this research-practice divide to come together and see how we can use the research evidence and enhance it with lived experience to meet patients and families where they are, while not falling into a pattern of providing treatment that feels good, but doesn't work.” FBT as it exists in the traditional clinical setting can also be challenging from a patient perspective, which may make it a less appealing option for those who manage to have access to it. “Many people quit FBT (if they are able to find it in the first place) when they realize how much work it is,” Bohon says. “It can feel overwhelming, and as the eating disorder is challenged by the family and treatment team, distress often rises initially. This is normal and gets better by sticking with treatment, but that is hard for families and patients to believe when they are in the thick of it in the first few weeks.” How can Equip help FBT evolve? Experts are advocating for FBT because it has the potential to be improved upon through platforms like Equip, which can deliver multidisciplinary care virtually, eliminating many of the existing obstacles on all sides of care. “This case study highlights the potential for mentorship to support families through those early weeks,” Bohon says. “Having someone who has been there (both for the patient and the family) has a great impact and can hopefully support the family, not only in successfully making progress against the eating disorder, but sticking with the treatment at all.” Bohon says that even she was taken aback by some of the case study’s findings, and sees this research as a launching pad for further investigation. “I was honestly a little surprised to see such decreases in the self-report measures of eating disorder symptoms,” Bohon says. “Clinical lore about eating disorder recovery is generally that attitudinal or cognitive symptoms of eating disorders (thinking about shape or weight, food, fear of weight gain, etc.) are slower to recover than behaviors.” Although the self-report measure used in the case study included both cognitive and behavioral symptoms, patients experienced reductions in both those categories of symptoms within just four weeks. “Although we don't know why and I don't have benchmarks from other trials at the four-week mark of treatment, I'm curious about the impact of peer mentors during this very challenging period of treatment when parents are taking over control of meals and snacks,” she says. “I could imagine that their support could lead to relief of those cognitive symptoms.” As far as how this type of study may impact the direction of research, studies like this could pave the way for more focused efforts in the future and Equip is excited to design more controlled trials of FBT to study the effect of this team-based program compared to more standard approaches.]]></content:encoded>
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            <title><![CDATA[Why We Need to Stop Thinking All People with Eating Disorders are Underweight]]></title>
            <link>https://equip.health/articles/understanding-eds/eds-underweight</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/eds-underweight</guid>
            <pubDate>Mon, 14 Jun 2021 17:14:00 GMT</pubDate>
            <content:encoded><![CDATA[When plus-size supermodel Tess Holliday recently revealed that she is in recovery from anorexia, she was met with a barrage of misinformed responses. “I’ve had a lot of messages from folks that have anorexia that are livid and angry because they feel like I’m lying,” Holiday told Good Morning America. “I am plus-size but advocating for diversity in larger bodies so I think for people hearing me say I’m anorexic was really jarring.” Holliday’s experience reveals an unfortunate, pervasive issue with the public perception of eating disorders—namely the myth that any person with an eating disorder must be underweight. That notion isn’t just false; it’s dangerous. And it’s part of the reason so many people fail to receive the diagnoses and care they deserve to overcome their eating disorders. “Eating disorders can affect anyone. People of all shapes and sizes,” says clinical psychologist, Elizabeth Gordon, PsyD, who is a therapist at Equip. “In fact, most people with eating disorders are not actually underweight.” Gordon’s point is underscored by a 2017 study that found that only 5.6% of women and 0% of men with eating disorders are considered "underweight.” According to the National Eating Disorder Association (NEDA), despite decades of media representations exclusively portraying people with eating disorders as emaciated, it’s impossible to tell whether someone has an eating disorder based on appearance alone. And as a University of California San Francisco (UCSF) study revealed in 2019, despite the fact that “lower weight has historically been equated with more severe illness in anorexia,” not everyone at risk for the devastating potential side effects of the disorder (like slow heart rate, menstrual dysfunction, and electrolyte imbalance) can be classified as “underweight.” Unfortunately, the stereotype only serves to perpetuate the problem. “The belief that all people with eating disorders are underweight leads many people with severe eating disorders who are not underweight to not seek treatment or even acknowledge they have a problem,” Gordon says. “Medical doctors, therapists, and other helping professionals who believe these harmful stereotypes might believe that someone with a serious eating disorder is ‘fine’ if they are not underweight. This belief perpetuates so much suffering among people with eating disorders who are not underweight, who can be equally sick and deserve treatment and help.” The experience Gordon describes is similar to the one of Equip Peer Mentor, Ally Duvall. “I spent my childhood and teenage years with an undiagnosed eating disorder because I was fat,” Duvall says. “Every doctor, dietitian, and weight loss program missed the signs and symptoms — not because I didn't share them, but because my fatness was the only thing they wanted to solve. I didn't even know I had an eating disorder because I too had only heard of the underweight, white, cis-woman stereotype. Even after receiving my diagnosis in 2017, I didn't see my body represented in eating disorder conversations so it was extremely tough to feel validated about the very real disorder I was fighting." The importance of the Health At Every Size® (HAES®) approach One crucial way we can start chipping away at the myths about weight and eating disorders is by embracing the Health At Every Size® (HAES®) approach. HAES® isn’t new — it started in the 1960s — but it’s still a revolutionary concept to many people, including those in the medical field. The basic premise is this: your well-being has nothing to do with a number on the scale. You can’t tell how “healthy” or “ill” someone is by assessing their appearance or weight, and HAES® advocates believe in promoting size-acceptance, ending weight discrimination, and lessening the cultural obsession with weight loss and thinness. The approach is all about “balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes.” As Dr. Lindo Bacon wrote in the book, Health at Every Size: The Surprising Truth About Your Weight, “We’re losing the war on obesity. Fighting fat has not made the fat go away. However, extensive ‘collateral damage’ has resulted: Food and body preoccupation, self-hatred, eating disorders, weight cycling, weight discrimination, poor health...Few of us are at peace with our bodies, whether because we’re fat or because we fear becoming fat. It’s time to withdraw the troops.” In the context of eating disorder recovery, a HAES® approach can go a long way in getting people the care they need and deserve, regardless of whether they fit the physical stereotype of what society thinks an eating disorder looks like. The principles of HAES®, which was trademarked by The Association for Size Diversity and Health (ASDAH), advocate for weight inclusivity, accessible health information, respectful care, flexible and individualized eating, and physical activities that allow people of all sizes, abilities, and interests to enjoy movement — all those aspects and more are essential in supporting eating disorder recovery. What to do if you think you need help For people who don’t feel they fit the physical criteria of what they assume an eating disorder “should” look like, based on false media representations and outdated assumptions, getting help can be scary. But the bottom line is this: everyone deserves compassionate, effective care if they need it — period. So what can a person do if they feel they don’t “look the part” of someone with an eating disorder but suspect their thoughts and behaviors are problematic? “Seek help anyway, from a treatment team (therapist, dietitian, medical doctor) informed about HAES®,” Gordon says. “If you think you need help for an eating disorder, you do! Your weight has no bearing on how sick you are or how much you need help.” Duvall agrees with Gordon’s sentiments and encourages anyone to seek the help of sensitive, trained experts if they feel they need support. "No one deserves to have their eating disorder overlooked because of myths rooted in anti-fatness,” she says. “Excluding fat folks from the eating disorder community further reinforces the stigma around who can develop an eating disorder and creates even more barriers for seeking and receiving treatment. We can all help shift the conversation away from how an eating disorder 'should' look and focus on what really matters: getting individuals who are fighting an eating disorder the treatment they need to begin their healing journey, regardless of their weight and body size."]]></content:encoded>
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            <title><![CDATA[Equip's New Chief of Staff: Why I Left VC to Help Transform Eating Disorder Care]]></title>
            <link>https://equip.health/articles/news-and-research/equip-new-chief-of-staff</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/equip-new-chief-of-staff</guid>
            <pubDate>Fri, 12 Feb 2021 02:09:00 GMT</pubDate>
            <content:encoded><![CDATA[There’s a story that I’ve told over the past decade in countless graduate school applications and job interviews. It goes something like this: “I am passionate about improving the healthcare system. I had a personal experience as a teenager that made clear just how broken and disconnected the system is. As a patient, I was forced to be the conduit of information between a multidisciplinary care team and my family, coordinate my own care as I moved between cities multiple times a year as a college student, and tell and re-tell my story and medical history with each new start, all while being sick myself.”  It’s at this point in the story that I always stop short of sharing what the medical experience was. I had an eating disorder. My story is not particularly unique: my eating disorder came on slowly and then all at once in the spring of my senior year of high school. My parents pieced together a care team—a doctor, a therapist, a dietitian—in Boston, repeated that in Nashville, and then repeated it again in Ithaca when I transferred schools. I was simultaneously terrified by the gravity of my medical condition and terrified to let go of my eating disorder. My parents were scared and frustrated that they couldn’t be more involved in my treatment. It was disjointed, exhausting, taxing, and isolating - but I recovered. I thought I had recovered when the doctors were satisfied with my weight gain and I was eating meals that balanced all the food groups. I knew I had recovered when I lost track of how many days in the week I had worked out or eaten out, when I cared more about the conversation I was having over the meal than the meal itself, and when I noticed that the real estate in my brain that used to be reserved for planning meals and recalling portion sizes had been taken over by to-do lists for work and learning new Excel formulas. I heard Kristina and Erin describe their vision for Equip for the first time during a meeting with F-Prime Capital nearly a year and a half ago, and I immediately knew that the world was long overdue for Equip. I recalled how my first primary care doctor said to me: “You’re lucky you haven’t been sick that long and were totally healthy before. You should make a full recovery.” I clung so tightly to those words—and often doubted them.  Revisiting those feelings, I knew how powerful it would be to have a peer mentor who can model that recovery is possible and worth the hard work. I recalled how badly I wished my parents had been a part of my treatment so that they weren’t left to their own coping mechanisms and healing while arming me with so many resources, and so that we’d have the vocabulary to talk about the eating disorder and recovery. In hearing about Equip, I recalled how the absolute best thing for my recovery had been the steady takeover of non-food and non-health activities, events, and thoughts—slowly restoring energy back to the life I was living because I had never been removed from it. I was lucky that my treatment worked, and it is such a privilege to be part of a team building a world where every person with an eating disorder has access to the treatment that we know works, that makes a very tough journey as bearable as possible, and that focuses on making the patient and family whole. I am thrilled to be joining the Equip team as Chief of Staff to help transform eating disorder care.]]></content:encoded>
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            <title><![CDATA[When Being “Unproductive” Can Be the Most Productive Thing You Can Do]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/unproductive</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/unproductive</guid>
            <pubDate>Wed, 10 Feb 2021 03:38:22 GMT</pubDate>
            <content:encoded><![CDATA[We live in a society that measures worth by productivity. Whether that productivity is measured in grades, accomplishments, or goals achieved often doesn’t seem to matter. What matters is doing something — anything, even. For those in recovery from eating disorders, this constant quest for productivity can become even more complicated due to the fact that eating disorders often feel like an accomplishment in and of themselves. Achieving the goals your eating disorder sets for you and following its self-imposed rules can often feel like progress, too, even though the goalposts are forever moving and shifting. In recovery, it is common to struggle with the feeling that in order to be worthy, you must still be productive. However, if you can’t do all the things your eating disorder used to order you to do, what is productivity then? How can you still feel worthy if your carers and treatment team are constantly telling you to rest and recover? Often, the things you’re supposed to do in recovery (rest, relax, distract yourself, etc.) seem like the direct opposite of what you used to think of as productive tasks. Many patients have identified some of the following activities as feeling “unproductive”: Self-care (such as resting, calling a friend, or making art) Necessary elements of recovery (including time off from movement, exercise, or sports) Resting (getting enough sleep) Having fun! (watching a movie or playing a board game) Taking time away from schoolwork or a job when necessary While it may seem like engaging in any of the above actions is unproductive (that is, you are not doing them to achieve a goal and aren’t graded on them), doing these things actually is productive. They do have a purpose, too — a very important one. Self-care, rest, and having fun are important to our lives in another way: they fill up our cup when we have depleted it with stress or exhaustion. They give us energy, recharge us, and bring us joy. They also promote recovery. Why might you feel this way? Human beings aren’t made to be constantly moving — physically or emotionally. Constantly working and achieving can lead to exhaustion and burnout, which can negatively affect you in various ways. This is why it’s important to rest, especially when you need to maintain forward momentum in your recovery goals. One thing that many overachievers have in common is this tendency to always be productive. And despite the previous paragraphs, this actually is a positive temperament trait in life. It’s great to be highly motivated and to have a strong work ethic. But the pendulum can swing too far in the other direction — this shift can lead to immense pressure to always be “busy” or “working,” lest you feel unworthy. The answer to this predicament, as in the case with so many things, is balance and moderation. It’s okay to try to achieve things. But you also need to rest, especially in recovery, where learning to rest is part of your journey. Can you learn to love rest? Depending on your personality, you may not always love rest, but you can learn to appreciate it and enjoy it. You can learn to fight back against the urge to always be productive. It can be helpful to use affirmations when you brush up against these feelings, such as: I am caring for myself and my needs. Self-care isn’t selfish. I can’t pour from an empty cup. I deserve rest. Productivity and unproductivity can live in balance, as long as unproductivity is acknowledged as a crucial part of both recovery and life itself.]]></content:encoded>
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            <title><![CDATA[Why Eating Disorders Are Like Velociraptors]]></title>
            <link>https://equip.health/articles/understanding-eds/velociraptors</link>
            <guid isPermaLink="false">https://equip.health/articles/understanding-eds/velociraptors</guid>
            <pubDate>Wed, 10 Feb 2021 03:44:03 GMT</pubDate>
            <content:encoded><![CDATA[When you think of the movie Jurassic Park, you might picture an island in the middle of nowhere. You might picture a group of scientists and kids running for their lives. Or maybe you think of the classic scene where the velociraptor is being fed — it strains against the electric fence holding it in and systematically checks the barrier for any weakness. In many ways, eating disorders are a lot like that velociraptor. Eating disorders are predators; they take away the lives and mental health of those suffering. But eating disorders are also smart, and instead of listening to logic, they actively try to work against those trying to defeat them. In Jurassic Park, the velociraptor is furiously searching for any place where it can break through the electric fence and it won’t relax until it finds an escape. With an eating disorder, the illness is furiously searching for any opportunity to work through your loved one’s defenses. The difference is that the eating disorder already knows all the vulnerabilities that it can target. Unlike the velociraptor, the eating disorder doesn’t have to search for weaknesses at all. Instead, it’s already aware of the times when someone may be more susceptible to worries about weight or when they are more likely to act upon the urges it puts into their heads. The important thing for your loved one — and for you, as a support — to realize is that getting angry at this dinosaur of an eating disorder is not always the easiest course of action. You do need to continue fighting, of course. When dealing with an eating disorder, you will always need to keep fighting. However, it is also necessary to have compassion for the effort your loved one is putting into recovery. Even if the eating disorder does make its way past their defenses at times, even if they sometimes give into urges and get caught up in the worries in their heads, it is important to remember that they are still trying and that the eating disorder is pernicious — “letting it through the fence” is not their fault. Ultimately, the compulsion to restrict or binge or purge is driven by the voice of the eating disorder, and your loved one can’t control that. What they can control is their reaction to those compulsions and how they can work to strengthen their electric fence. You will work with them, too, by always meeting their urges and worries with recovery-supporting behaviors (ensuring eating compliance, behavior extinction, etc.). Through your compassion and support, you and your loved one can strengthen their electric fence together. Unlike with most velociraptors, an eating disorder can be recaptured. Boundaries and fences can be put back up again and strengthened. Having compassion for your loved ones’ slips will make future battles against the eating disorder easier and will make sure your loved one knows that you are fully on their team and that fighting against you will just delay the inevitability of what they need to do. With all of you working together, the eating disorder will now know that there are no more weak spots in the electric fence. Boundaries have been tested and have proven to be strong and impenetrable. When the eating disorder knows that it can’t convince your loved one to engage in behaviors anymore, it will stop searching. Consistency in your response to your loved one’s behaviors and urges will strengthen that fence, inch by once-electrified inch. Together, you will work to stop the velociraptor from escaping again and get closer to a future filled with full recovery (and no dinosaurs at all).]]></content:encoded>
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            <title><![CDATA[What Really IS Self-Care?]]></title>
            <link>https://equip.health/articles/diet-culture-and-society/self-care</link>
            <guid isPermaLink="false">https://equip.health/articles/diet-culture-and-society/self-care</guid>
            <pubDate>Sat, 24 Jul 2021 13:39:00 GMT</pubDate>
            <content:encoded><![CDATA[Since 2011, July 24 has been known as International Self-Care Day, a 24-hour period that’s meant to encourage all of us to make room for activities and practices that enhance our well-being or happiness. But for many people, the term “self-care” has connotations that may not resonate with their own desires to feel healthy or fulfilled. If you search the #selfcare hashtag on Instagram, you’ll find hundreds of thousands of influencers promoting high-end skin serums or even companies rooted in diet culture co-opting the phrase to sell products. But “self-care” isn’t a product and it doesn’t have a price tag. In fact, according to the World Health Organization (WHO), self-care is a critical practice that has serious implications for the health of ourselves, our families, and our communities: “self-care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc), environmental factors (living conditions, social habits, etc.) socio-economic factors (income level, cultural beliefs, etc.) and self-medication.” The International Self-Care Foundation — the creators of Self-Care Day — break the concept of self-care down into seven pillars: Health literacy (which means obtaining, processing, and understanding basic health information and services needed to make appropriate health decisions) Mental wellbeing Physical activity (practiced in a moderate and appropriate way that’s healthy for you) Healthy eating (having a nutritious, balanced diet with appropriate caloric levels) Risk avoidance or mitigation (which means quitting tobacco, limiting alcohol use, getting vaccinated, practicing safe sex, using sunscreen, etc) Good hygiene Rational and responsible use of products, services, diagnostics, and medicines You may notice that that comprehensive list doesn’t include the use of high-priced skin care products. “We're often exposed to a very narrow depiction of what self-care looks like: something luxurious like a face mask or spa day,” says Equip’s lead peer mentor, Maris Degener. “In reality, we all have different resources, needs, and interests that affect how we care for ourselves.” Degener points out that for many people, certain acts of “self-care” may not look particularly luxurious or fancy — or even be particularly “pleasurable” in the moment. What constitutes “self-care” is really the underlying drive and action for improved overall health and happiness. “For many, self-care is taking medications, setting boundaries with the people in our lives, or taking a few minutes to tidy up our workspace in the morning,” Degener says. “While I wouldn't want anyone to feel bad for taking bubble baths or getting a massage for self-care (I know I'm lucky enough to engage in these from time to time), I wouldn't want anyone to feel that they are not practicing self-care ‘correctly’ if their unique practices don't look like this.” “There are a lot of people promoting an idea of ‘self-care’ that focuses on things that are calming or relaxing, so the go-to image is a massage, a bath, a spa day, etc.,” says Equip’s VP of Clinical Programs, Cara Bohon, PhD. “Maybe mindful practices of yoga or self-reflection exercise of journaling come to mind. And those are all well and good options for people if their basic needs are already met.” While there’s definitely nothing wrong with finding serenity or peace in a manicure or face mask moment, prioritizing those momentary feel-good moments over the fundamental building blocks of proper physical and mental health isn’t true self-care — and may actually mask any issues that need to be resolved. “If you’re struggling to get a solid night of sleep on a regular basis, a bath or a yoga class are only going to go so far,” Bohon says. “I like to think of it as a recipe for cake: you aren’t going to get very far with icing alone, although, of course, icing is delicious. But to actually make a cake, you need a solid base before you even start with the icing.” Riffing on that baking analogy, Bohon says there are several non-negotiable ingredients that are really at the core of a strong self-care practice: “Balanced nutrition — remember that all foods are good foods, including cake! — hydration, joyful movement that feels good, and the key ingredient that many are lacking: sleep,” she says. “For people who are not able to have those basic needs met, then self-care should start there.” That means that although an hours-long Netflix marathon may feel like a restful way to spend an evening, if all that TV time actually cuts into your sleep — a required ingredient in your proverbial self-care cake — then your attempt at self-care may actually backfire and leave you feeling drained and under-resourced. “If your sleep is solid and you are eating a variety of foods throughout the day, then maybe adding on extra strategies to manage stress may be the right next step,” Bohon says. “Those strategies may very well include the bath, journaling, yoga, or more, but could also include meeting other needs like creative ones via art or music.” “First of all, self care isn't ‘selfish,’ ‘lazy,’ or ‘self-indulgent’ — I hear variations of this a lot,” says Alyssa Mass, M.A., M.F.T. a marital and family therapist based in La Jolla, California. “We're all familiar with the concept of recharging a phone battery — think of self-care as a way to recharge or gain balance.” One crucial aspect of self-care that often goes unmentioned is its open-ended definition; yes, self-care should be rooted in the pursuit of enriching your overall wellness, but that can mean a lot of different things, and those things can change depending on the circumstances. “Somewhere along the line, it seems like the term evolved to mean a bubble bath, lighting candles, soft music,” Mass says. “Those things are all great if they work for you, but there is no set prescription to taking care of oneself.” But what if you don’t know what actually works for you in terms of self-care beyond the basics of proper nutrition, rest, and daily feel-good experiences? What do you do if all your basic needs are met but you still feel like you need some extra TLC? According to Mass, experimentation is key. “Try different things, develop a variety of options,” she says. “Think of those old crayon boxes with 56 colors —you open it up and can pick anything for the mood you're in and what you want to create.” In order to access your own Crayola set, Mass recommends asking yourself some starter questions to figure out which action (or color in this metaphorical case) will make the most sense in your current scenario: “An important question to ask yourself — or to work with your therapist on together — is ‘what are you recharging from?’” she says. “Now think about creating counter-balance. For example, if you're somebody who has been staring at a screen all day, the counter-balance would be turning off the screen and engaging your senses in a meaningful way. On another day, perhaps you've been outside all day and just want to play some video games when you get home — that's still a counter-balance.” Once you settle on an activity (or non-activity if that’s what feels appropriate), take stock of how you’re feeling as you experience it. “Check in with yourself — how do you feel before, during, and after?” Mass says. “Write down what works so that you remember! The same things may not work every single day.” If you’re struggling to figure out how to integrate intentional self-care into an already jam-packed schedule (and the thought of packing more into that schedule is more stress-inducing than relaxing), you may want to consider calendaring appointments with yourself, just as you would calendar meetings or events with others. “Be specific about time — as much as you can — just like you schedule other things in your life, it's okay to schedule time for you!” Mass says. “It doesn't need to be hours, even just a few minutes. “Maintaining balance throughout the day is a beautiful thing, rather than having to swing in extremes. If you check in with yourself and what you're doing isn't working, pick something else off the menu. Creating a menu takes time, patience, and experimentation — have fun with it!” In the end, “self-care” is a highly individualized practice that can look different for every single person — and may even look different for the same person on different days. It turns out that trying new things and getting to know what makes you feel your best is actually the highest form of self-care you can practice. “Self-care is different for everyone and very much depends on what individual needs are,” Bohon says. “For people in recovery from an eating disorder, one of the best self-care steps they can take is getting support for treatment, as it can be vital for any of the other self-care concepts to have positive effects. If your nutrition is suffering, other self-care efforts will only go so far.”]]></content:encoded>
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            <title><![CDATA[Equip's New Media Guidelines for Writing About Food, Bodies, and Eating Disorders ]]></title>
            <link>https://equip.health/articles/news-and-research/media-guidelines-for-eating-disorders</link>
            <guid isPermaLink="false">https://equip.health/articles/news-and-research/media-guidelines-for-eating-disorders</guid>
            <pubDate>Wed, 15 Feb 2023 08:00:00 GMT</pubDate>
            <content:encoded><![CDATA[The media doesn’t “cause” eating disorders, just as they aren’t caused by Instagram, or parenting, or any single event. Eating disorders are complex issues with a multitude of different causes—neurobiological, emotional, sociocultural, genetic—and no one factor fully holds all the responsibility. Still, each of these factors can play a role in setting off an eating disorder in someone who’s already vulnerable, and it’s important to acknowledge that the language used and messages spread by the media can be a powerful influence. Words hold power, and the words of journalists reach wide audiences. Images and videos, too, increasingly captivate us. When members of the media cover topics related to food, bodies, eating, and eating disorders, the way they address these topics shapes how we think about them. They have great power to shift the cultural conversation around body image, diet culture, and eating disorders—and that conversation is in desperate need of shifting. Because of this, we recently created and released a set of guidelines that asks members of the media and other content creators to thoughtfully choose language and imagery that avoids harmful stereotypes. While these guidelines were put together with the media in mind, many of them can be applied to your daily life. We hope you’ll find these guidelines thought-provoking and helpful in your own conversations, and that we all begin to see some of these changes made in the articles we read and the content we consume. Follow the link below to read our full Media Guidelines. 
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