Tag Archives: Eating Disorders

Digesting the connection between food and mood

By Lindsey Phillips December 31, 2019

For most of her life, the woman would not let herself eat cake. She feared that if she started, she would never be able to stop. The presence of cake at every birthday party she attended tormented her. She grew so preoccupied with thoughts of cake that she had food fantasies about eating it.

The woman’s unhealthy relationship with food eventually led her to Michele Smith, a licensed professional counselor who operates a private practice called The Runaway Fork in Westfield, New Jersey. With Smith’s guidance, the woman decided to conquer her fear by eating a sheet cake while she was alone.

The client took her first bite, but it wasn’t the experience she had fantasized about. It tasted artificial and waxy. She thought perhaps it was only the frosting that she didn’t like, so she took another bite, this time focusing more on the cake itself. It only confirmed the horrible taste from her first impression. The woman ended up throwing out the entire cake.

The client’s craving for cake had caused her years of suffering, yet when she finally ate it mindfully, she discovered that she didn’t even like it, says Smith, who is also a licensed mental health counselor in New York.

“There’s all this unnecessary suffering around food, weight and body,” Smith continues. At the same time, “there seems to be a lack of services available for everyday people who do not have eating disorders [but] who want to discuss and heal their relationship with food, body and weight.”

For this reason, Smith, a certified mind-body eating coach and a member of the American Counseling Association, created her private practice to help people who struggle in their relationship with food. She doesn’t have a precise phrase to explain this special niche she has carved out with her counseling practice, but she says it differs from nutritional counseling, which focuses on helping clients figure out what to eat. Instead, Smith attends to who clients are as “eaters.” This includes connecting their relationship with food to other life domains and psychosocial factors — such as anxiety, depression and trauma — that professional clinical counselors work with every day.

Researchers are not completely sure how food fits into the overall mental health equation, but recent studies suggest a strong connection. In general, food can promote wellness in three ways: 1) by providing the brain with nutrients it needs to grow and generate new connections, 2) by tamping down inflammation and 3) by promoting gut health.

In 2017, the world’s first study of dietary intervention for clinical depression, called the SMILES trial, found that a modified Mediterranean-style diet (which encourages whole grains, fruits, vegetables, legumes, low-fat/unsweetened dairy, raw unsalted nuts, lean red meat, chicken, fish, eggs and olive oil, while discouraging sweets, refined cereals, fried foods, fast foods and processed meat) resulted in a significant reduction in depression symptoms when compared with the typical modern diet loaded with fast food, processed foods and refined carbohydrates.

A randomized controlled trial published last year in PLOS ONE supports the findings of the SMILES trial. Researchers found that adults who followed a Mediterranean-style pattern of eating for three weeks reported lower levels of anxiety and stress and a significant decrease in their depression symptoms.

These and other findings suggest that counselors should no longer think of mental health in isolation but rather as part of a complex system that includes what people eat.

A missing piece of the mental health puzzle

Lisa Schmidt, a licensed associate counselor, certified whole foods dietitian nutritionist, and instructor in the School of Social Work at Arizona State University, points out that people seldom think about what they eat. “The act of eating is considered a nuisance. It’s something people don’t have time for until they’re just so hungry, they have to eat something, and when you get to that point, you often make very poor nutritional choices,” she says.

For instance, people may grab fast food and eat it in the car on the way to their next meeting or to pick up their kids. Then, when they have trouble sleeping later that evening, they assume it is related to their feelings of anxiety, thus overlooking any possible connection to food, Schmidt adds. 

“Most people don’t know that the kind of foods we choose [to eat] can help us regulate our nervous system and perhaps is the missing link in mental health care,” Schmidt notes.

Schmidt, an ACA member in private practice in Scottsdale, Arizona, says that mood-related disorders often have a food component to them because nutrition-poor diets affect mood. The standard American diet, often aptly referred to by its acronym SAD, frequently leads to people being hungry and tired and having dysregulated moods, she continues. People often alternate between periods of escalation, during which they fuel themselves with caffeine, processed sugar and refined carbs, and periods of starvation. This unhealthy pattern leads to dysregulated moods, Schmidt explains.

In addition, stress (which is common in fast-paced, disrupted lifestyles) dysregulates people’s nervous system responses. When people are stressed and in fight-or-flight mode, their bodies secrete glucose into the bloodstream, fueling them to run away from real or imagined danger. Then the pancreas secretes insulin as it tries to regulate blood sugar levels, Schmidt explains. These swings in blood sugar levels affect mood and can lead people to become “hangry” — hungry and angry, she adds.

Two researchers at the University of North Carolina at Chapel Hill recently set out to study the underlying mechanism behind the complicated “hangry” reaction, and their results challenge the theory that hanger is the result only of low blood sugar. They found that hunger-induced feelings can lead to tantrums and anger when people are in stressful situations and are unaware of their bodily state. In other words, hunger pangs might turn into other negative emotions in certain contexts.

This suggests that people should slow down and pay attention to both their physical and their emotional cues. Smith advises her clients to carefully set the scene before eating, telling them that eating should be stress free, relaxing and pleasant. To achieve this, they might consider using a candle or playing calming music. They shouldn’t be using their phones, watching television or walking around, she says. And although some families use dinner as a time to reprimand their children, there shouldn’t be any arguing while eating, Smith adds.

Because the quickest way to relax the body and mind is through breathing, Smith instructs clients to take as many deep breaths as they need to calm down before they begin eating. She also recommends that clients put their forks down between bites or use their nondominant hand to help them slow down and fully experience their food.

Mindful eating also involves approaching the meal with all of the senses, Smith says. She often illustrates this type of eating in session by having clients — especially those prone to eating quickly or eating distractedly as they work or stare at a screen — engage their senses while eating a Girl Scout Thin Mint cookie. During this activity, Smith asks clients to forget about their ingrained diet rules, negative self-talk, or whatever else might be in their heads and focus on their bodily experience of eating.

First, she has clients look at the cookie so the brain will register that food is present. Next, she has them touch the cookie and notice its texture. Then Smith asks them to smell the Thin Mint because scent affects our pleasure or displeasure with food. Once clients put the cookie in their mouths, they slowly roll it on all parts of their tongues without biting into it. When they finally bite the cookie, they listen to the sound it makes and notice how it tastes and when the taste starts to diminish. At the end of the exercise, Smith asks clients to rate their experience as pleasant, unpleasant or neutral. 

This simple exercise is an eye-opening experiment for most of Smith’s clients, who often admit they would normally just throw the cookie in their mouths and not think twice about it. When people learn to slow down and eat mindfully, they become better at noticing when they are full or if they are no longer tasting their food. Smith says one of her clients discovered through the exercise that she actually didn’t like Thin Mint cookies, even though she had eaten them all of her life.

It’s one thing to tell clients what mindful eating is; it’s another thing for them to experience and feel it for themselves, Smith says. “Mindful eating as a practice can be helpful at reawakening [our] appreciation for food,” notes Schmidt, author of Sustainable Living & Mindful Eating. “As we wake up to how we feel and what we experience, we have the possibility of change.”

The emotional toll of restrictive eating

“Every diet is some form of food restriction,” Smith asserts. “When you eliminate certain foods or when you deem certain foods bad or forbidden, you’re actually going to create the overeating through that sense of deprivation.” For example, the night before someone starts a no-carb diet, he or she might binge on bread as a “farewell” (often referred to as “Last Supper” eating). People on diets never reach habituation, so when they are exposed to restricted foods, they may overeat them, which only reinforces the idea that they can’t be trusted around a particular food, Smith adds.

Licensed clinical professional counselor Heather Shannon wrote a book chapter on nutritional stress management strategies for volume one of the book Stress in the Modern World: Understanding Science and Society. She says the all-or-nothing, judgmental thinking that is common with most diets often creeps over into character judgment: “I’m bad because I ate that carb” or “I feel horrible that I cheated on my diet by eating that cupcake,” for example.

Shannon, who offers coaching and teletherapy as a psychotherapist at Lotus Center in Chicago, had one client who was fit and healthy but fixated on losing three pounds. One morning, the client woke up feeling great, but the second she stepped on her scale and saw she had gained one pound, her mood changed. She went from feeling wonderful to feeling horrible in two seconds.

Fixating on an outcome, such as the number on the scale or the number of times a person has gone to the gym that week, is a big part of anxiety, Shannon says, and it opens up the possibility of good and bad labeling (e.g., “I’m bad because I went to the gym only once this week”). Instead, she helps clients focus more on their habits and which habits make them feel good, healthy and connected to their bodies. “If you’re treating your body really well, then whatever the results are is how your body is supposed to be,” she says.

Smith, a certified intuitive eating counselor, helps clients let go of the dieting mentality and reawaken their intuitive eater. In the intuitive eating model, there are no “good” and “bad” foods. Smith describes it as “a non-diet, flexible style of eating where you follow your internal sensations of hunger and satiety to gauge what, when and how much you eat.”

Smith points out that not every client will automatically be ready to put all foods back on the table. Under those circumstances, counselors can instead help raise awareness around dieting and how it may be interfering in clients’ lives. For instance, counselors might ask: How has your diet affected or changed your relationships with others? How much time and money have you spent on diets? How has it affected your social life and mental health? What in your life has changed because of dieting?

Schmidt also tries to help clients adjust their mindset around food. “Nourishment is not determined by one episode,” she says. “It’s an eating pattern over time.” For this reason, she advises clients to follow the 80-20 rule, in which 80% of the time people make choices that are whole foods (mostly plant-based), and then they don’t need to worry about the 20% of the time that they have a treat or indulge.

“We eat for reasons that are other than just to feed our bodies,” Schmidt says. “We eat as part of celebrations, and food is pleasurable. So, adopting a very restrictive, Spartan way of eating” — particularly one that demonizes any particular food group — “… can become disordered eating and cause problems for some people. … And research shows eating this way will fail 95% of the time.”

Instead of adopting the latest diet fad, people should find a way to eat that they can follow for the rest of their lives and that simultaneously supports their health and mood, Schmidt says.

Using foods to cope with moods 

If clients understand biological hunger and still reach for food without feeling hungry, then they are often engaging in emotional eating, Smith says. This may mean that a client eats because of unresolved trauma or grief. Maybe the client has perfectionist tendencies and uses food to manage his or her anxiety. Or perhaps food is the way a client copes with being in a marriage or job that makes them unhappy.

Smith works with clients to figure out what they are feeling — such as anxious or lonely, for example — when they experience emotional hunger. “This is where the mental health piece comes in,” she says. “You’re talking about eating, but the root cause of the eating is really psychological issues. … They’re people pleasing. They need boundaries. They need to be assertive. They need to say no to people and they can’t, so they use food to cope.”

Shannon, author of the ACA blog posts “Nutrition for Mental Health” and “How Does What You Eat Affect How You Feel?” finds the internal family systems approach effective for uncovering underlying issues associated with emotional eating, especially if clients have a playful side. She first helps clients identify the part of themselves that is overeating by asking what this eating part of them feels like in their bodies. One client might feel it in their stomach, whereas another client might sense it as a coach whispering in their ear.

Shannon also instructs clients to personify the part of them that is overeating by naming it (for example, the Snacking Part, Cake, or even a human name such as Maria). Then, both she and the client can easily address and reference this personified part.

Shannon might ask the part, “What is going on when you overeat?”

And the part almost always provides an answer. For example, “Well, I feel like I work too hard, and I need this because it’s my pressure release valve” or “I feel like I can’t count on people, so I’m counting on food.”

Smith and Shannon both caution against having clients keep a food journal that tracks food intake or weight. They say that activity takes clients out of themselves rather than tuning inward. In addition, they warn, it can promote obsessiveness. But they agree that clients can benefit from journaling about their emotions and feelings associated with food. For example, a client could write down what he or she feels right after overeating as a way of identifying what emotions are associated with the behavior. 

Schmidt has clients keep a food and mood journal, but not to track food intake or to promote weight loss. Instead, the goal is to help clients build an awareness of when they’re eating and how they feel before and after eating. This ultimately gives them a better understanding of how food affects their mood and how mood can affect their eating habits.

She provides an extreme but not unusual example: While journaling, a client noticed that they did not eat anything until 2 p.m. They felt terrible but only had 10 minutes to eat, so they ingested a protein bar and soda. Immediately afterward, they felt good, but an hour later, the client was starving, mad and stressed again.

“Most people … spend less than two minutes a day thinking about what they’re going to eat. They just react,” Schmidt says. “So, building awareness of all our habits, including our fueling habits, is really important.” 

In addition, if people are not fueling their bodies in a healthful way, it will create difficulties for them, Schmidt says. Chronic pain, substance abuse, anxiety and depression are all issues for which food is a huge component, she asserts. Schmidt had a client who would eat seven to nine bowls of Froot Loops for breakfast while in recovery from drug use. People recovering from substance use may often transfer their addiction to food, especially highly processed, sugary types of foods, she says.

Smith encourages her clients to approach their relationship to food with a compassionate curiosity. Clients can view nutritional changes as an experiment to figure out how their bodies react or what works best for them, she explains. Also, if clients haven’t fully mastered their new coping skills and continue to engage in emotional eating, then Smith advises them to be compassionate with themselves and say, “I’m reaching for food, and I know I’m not hungry. I look forward to the day when I can cope with my emotions without using food.”

Staying within scope

Smith has noticed that many counselors shy away from discussing any issue related to food with clients, reasoning that it falls outside their scope of practice and because becoming a certified eating disorder specialist or nutritionist requires specialized training. But she encourages counselors to rethink this mindset. “It’s not out of [counselors’] scope of practice to talk about people’s relationship with food. It’s such a critical part of everybody’s day. So, to not look at it is missing a big part,” Smith says.

“You don’t have to talk about the grams of protein per se, which is out of our scope … to really help somebody,” she continues. “Because [clients are] dying to talk about it, and they need that space. And it’s connected to so many other life domains [e.g., trauma, grief, anxiety, depression, stress] which counselors are more than equipped to talk about.” 

As a certified health coach, Shannon says she would never prescribe foods for clients or tell them what they should or shouldn’t eat, but that doesn’t prevent her from talking about food in session. In fact, on her intake form, she screens for potential issues with food by including general questions such as: What do you generally eat for breakfast, lunch and dinner? Do you snack or skip meals? Do you overeat or under eat? Then, in her first session with clients, she discusses this information and asks follow-up questions to gain a better understanding of clients’ relationship with food and the way this could be affecting their mental health.

“Even if you’re not a nutrition expert, we all know some basic stuff. We all know whole foods are better than processed foods. We all know excess sugar is not helpful,” Shannon says. For this reason, she recommends that counselors screen for basic nutritional information to see if food might be a piece of the client’s mental health puzzle. 

Rather than telling clients what to eat, Shannon takes a behavioral approach and asks, “What are you eating, and how is that working for you? What do you think might work better?” Sometimes, she will also provide clients with helpful resources and advise them to talk to their doctor or a nutritionist about other options they could pursue.

Schmidt finds that discussing alcohol use with clients can serve as a great segue into talking about their diet in general. In her experience, alcohol often comes up with clients who have mood disorders, and because alcohol is a nervous system depressant, it is not advised for these clients. While discussing their alcohol use, Schmidt will ask other questions about their diet, such as if they eat breakfast consistently or if they eat lots of processed, high-sugar foods. From there, she might suggest that clients try to limit the amount of food with added sugars that they eat and experiment with eating fresh fruit as a snack or dessert most days of the week. Schmidt will also use the Healthy Eating Plate (created by Harvard Health Publications and nutrition experts at the Harvard School of Public Health) as a way to help clients visualize how to build meals that support balanced moods.

Schmidt recommends that counselors interested in the food-mood connection experiment with their own eating habits to see how this affects their mood. “It is particularly difficult for a counselor who has a poor diet to talk about the food-mood connection with a client,” she says. Similar to how counselors practice meditation themselves before teaching it to clients, Schmidt believes counselors should first reorganize their own way of eating to include mostly foods derived from plants, to limit caffeine, and to limit or eliminate alcohol.

After counselors have experimented on their own with the food-mood connection, Schmidt says, then they can ask clients to do a chain analysis. For example, if a client is having panic attacks, the counselor might ask, “What do you remember doing just before the panic attack? Did you have anything to eat or drink? If so, what did you eat or drink?” Maybe the client will say that he or she remembers drinking coffee or alcohol before the panic attack happened. The counselor could follow up and ask whether the client noticed any change in how he or she felt after drinking three cups of coffee or drinking alcohol to excess before having a panic attack. This technique will help clients connect their dietary choices, which are ultimately under their control, to the way their mood is affected, Schmidt says.

Smith acknowledges that counselors’ scope of practice does limit just how far they can go in addressing food issues with clients. For instance, counselors cannot provide nutritional advice to clients. “That creates this barrier that is hard to get around,” she says. “So, then, you do have to reach out to other professionals like nutritionists and dietitians and really work as a team.” She says counselors can either work with a nutritionist to determine what nutritional treatments and approaches are best for the client, or work with clients to ensure they are advocating for their own dietary preferences (such as using plans that focus on well-being instead of weight loss) with the nutritionist or speaking up when they feel a certain nutritional approach is harming or not helping them.

But at what point should counselors refer to a nutritionist? Counselors have referred clients to Schmidt, in her role as a nutritionist, because they suspected their clients had an eating disorder or were binging on foods. Schmidt thinks it is a good idea to also refer to an eating specialist if clients talk about food or their bodies frequently in counseling, are extremely overweight or underweight and the condition is disruptive for them, or have suddenly lost a significant amount of weight.

When finding referral sources, Schmidt recommends that counselors look for professionals trained in the Health at Every Size approach, which promotes size acceptance and serves as an alternative to the weight-centered approach.

Smith agrees that “the focus always has to be on wellness, not weight loss.” She advises counselors against referring clients to dietitians, nutritionists or doctors who track calories, encourage weigh-ins, or engage in fat shaming. Instead, she suggests looking for health professionals who teach intuitive eating and operate from a weight-neutral model.

Adding in the nutritional piece

People routinely look for mental shortcuts or a magic bullet to solve their problems, and this tendency extends to food consumption. From research, we know that people will tend to eat 30% more of a food that they deem “healthy,” Schmidt notes. Researchers even have a name for this tendency to overestimate the overall healthfulness of an item based on a single claim such as being low calorie or low in fat: the health halo effect. This halo effect appears to encourage people to eat more than they otherwise would because they feel less guilty about consuming the food.

Clients often come to see Smith because they are confused and don’t know what to do. They have dieted for years with little or no success, and they are confounded by all the conflicting nutritional advice. For Smith, it comes down to a core question: “How does this [food] feel in your body?”

“You’re making peace with food,” she says. “This is your journey of one, and only you can know whether pizza feels good or depleting and when and under what circumstances.” Counseling can help clients tune in to their own unique nutritional needs and preferences and connect this piece to how their mood is affected, Smith says.

Schmidt advises counselors to focus on the big picture and not get caught up in one particular approach to eating. Instead, it is about helping clients make their own connections between what they are eating and how it affects their moods.

Also, because everyone is unique, the nutritional advice that has benefited a counselor personally may not help the counselor’s clients. However, the majority of clients (and all people) need to eat more fruits and vegetables, so if counselors encourage them to do that, it could have a huge impact on clients’ health and mood, Schmidt asserts.

“Having a personal connection to food and its life-giving properties is one of the most amazing gifts we can give ourselves, as well as elevating the status of food and eating for our clients,” Schmidt says. “Helping clients understand that the process of food and feeding is a central part of their recovery is a message that’s independent of what they should be eating.”

“Nutrition is always a piece of the puzzle,” Shannon adds. “So, by understanding the nutrition …
even a little bit, you’re going to be potentially twice as effective working with your clients.”

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Food for thought

By Laurie Meyers January 25, 2018

With January now behind us, the annual barrage of diet and fitness commercials has started to fade. Many people who made New Year’s resolutions to lose weight or “get fit” have already labeled themselves failures for indulging on leftover holiday chocolate and not making it to the gym more than twice per week. Other determined warriors in the fight to attain the perfect size and shape may stick to their resolutions and lose the desired amount of weight, only to find that they’ve gained it all back (and then some) within six months. This cycle of dieting and weight loss, followed by weight gain, is a process that many Americans go through over and over again, often in search of an unattainable or unsustainable ideal.

“The primary message we get from popular culture is that our worth is based on our appearance and the ability to achieve a thin and beautiful cultural ideal,” says Laura H. Choate, editor of the book Eating Disorders and Obesity: A Counselor´s Guide to Treatment and Prevention, published by the American Counseling Association. “When individuals internalize this message — that they are only worthwhile or acceptable if they are able to achieve this ideal — they develop a negative body image, which can lead to dieting and disordered eating behaviors.”

According to the National Eating Disorders Association, in the United States, approximately 20 million women and 10 million men will struggle with a clinically significant eating disorder at some point in their lives. Experts say that many millions more will engage in disordered eating — patterns of behavior that resemble those of eating disorders but which do not meet clinical criteria. Symptoms of disordered eating may include chronic dieting, frequent weight fluctuations, extremely rigid and unhealthy food and exercise regimens, emotional eating and a preoccupation with food, body and weight issues that causes distress.

Ashamed to eat?

Licensed mental health counselor Tamara Duarte, a private practitioner in the Vancouver, Washington, area who specializes in treating women with eating disorders and body and food issues, says that we live in a culture that has normalized chronic dieting. She refers to this phenomenon as the “dieting roller coaster.”

Women come to Duarte, an ACA member, having spent years pingponging back and forth between restrictive diets and binge eating. After attempting to limit their consumption only to “good” food, these clients have typically fallen off of their diet wagon and ended up in a binge cycle, during which they eat all of the foods they consider “bad,” Duarte explains. Feeling guilty, the women go back to dieting and start the cycle all over again.

Duarte also sees clients who have gained weight as they have aged and want to get their former bodies back — even if it is through unhealthy means. “People come in and tell me that they used to have a restrictive eating disorder and wish they could go back to that time so that they could be thin,” Duarte says.

What all of these clients have in common is a sense of shame about food and their bodies, Duarte says. Fear of being or becoming fat is so prevalent in our society that this shame has become normalized, she says. The irony is that much of the research has found that dieting ultimately leads to weight gain, Duarte notes. Chronic dieting (even at a subclinical level) may even be harmful to the body, and Duarte and other eating disorder experts say that the benefit of weight loss through dieting is unclear.

Like many who study or treat disordered eating and eating disorders, Duarte wants to remove the stigma attached to different-sized bodies. “Fat is just an adjective,” she says.

Part of breaking free of disordered eating — and eating disorders — is learning body acceptance, Duarte says. “Helping a person to accept their body as is can be a very slow, complex process,” she admits.

“I read something posted on Instagram once that said, ‘You cannot obtain recovery while actively trying to change the size and shape of your body,’” Duarte continues. “I really liked that, and I introduce that very early on in the counseling process. Throughout counseling, we look at the beliefs the client has about their body and where those stem from. Typically, thoughts like ‘I’m ugly and unlovable in this body’ stem from society or family members. It’s interesting because none of my clients so far have thought others are unlovable because of their body size, so I question what makes them different. We also look at how screwed up society is for picking one body size as being beautiful and acceptable. With a recovering mind, they are able to recognize how erroneous these thoughts are.”

Duarte also asks clients to get rid of their scales. “Not relying on an arbitrary number to tell them whether they are ‘good’ or ‘bad’ frees them up to connect in with themselves to figure out how they are feeling,” she explains.

Intuitive eating and Health at Every Size

Duarte has personal experience both with eating disorders and the power of that “arbitrary number.” She had been in recovery for more than 10 years when she happened to gain about 45 pounds because of some medication she was taking. Uncomfortable in her new body size, Duarte was ready to put herself on a diet and workout regimen. But then she attended some seminars on intuitive eating, an approach created by dietitian Evelyn Tribole and nutrition therapist Elyse Resch, both of whom specialize in eating disorders. Intuitive eating rejects dieting. Instead, it advocates listening to the body’s signals of hunger and fullness and getting rid of the idea of “good” and “bad” foods, among other principles.

Duarte also learned about Health at Every Size (HAES), a program and social movement inspired by the book written by Linda Bacon, a nutrition professor and researcher. HAES advocates the acceptance of bodies of all sizes, rejects dieting and calls for addressing health concerns directly with healthy behaviors. Both intuitive eating and HAES also encourage physical activity in whatever form a person naturally enjoys.

“I immediately recognized the power of teaching IE [intuitive eating] and HAES to clients,” Duarte says. “Both HAES and IE teach that when you listen to your body and feed it what it wants, when it wants, how much it wants, your body will naturally go to its set point range — the weight range where it works optimally. HAES tells me that I am OK no matter what my body looks like and that I can love and accept it right now.”

After learning about intuitive eating and HAES, Duarte started following the principles found in each approach. “At that point, I had a laundry list of good foods and bad foods, so I did the work to incorporate my ‘bad’ foods back into my diet,” she says. “An incredible thing happened: As I allowed myself to want and have these foods, the power they used to hold went away. Pizza was pizza. In the past, I would not allow myself pizza, and if I did decide to allow it, I would eat like five pieces because it tasted so good and I was telling myself I wouldn’t have it again. When pizza became accessible, I realized I only wanted one or two slices, and then I was able to step away because I knew that the next time I wanted pizza — in 10 minutes or 10 days — I would be able to eat it.”

Duarte also realized that although she enjoyed going to the gym, the activity she loved best was going on walks with her dog. So, instead of carving out time to devote to workouts, she started spending more time walking her dog.

“I really enjoy my walks when I go on them, and I am kind to myself when life gets busy and I can’t or don’t want to fit them in,” she says. “I no longer berate myself because the walks are for self-care, not to manipulate the size and shape of my body. I enjoy the array of foods I eat. I love opening a menu and deciding based on what I want instead of what I ‘should have.’ I never thought I would have this kind of relationship with food or my body.”

For those who might wonder whether Duarte lost weight, she responds that it doesn’t matter because her body shape and size have no bearing on her happiness or success.

Combating body hatred

Knowing from personal experience that intuitive eating and HAES can be very effective, Duarte now incorporates the approaches into her counseling work. “Every single client that calls my office for a free consultation ends up telling me that what they want most from counseling is freedom,” she says. “Freedom from the eating disorder, the never-ending thoughts about weight and food, freedom from self-hatred. I know that HAES and IE [are huge pieces] of the puzzle when it comes to freedom.”

“I don’t have to tell my clients about my experience with HAES and IE,” she continues. “I just have it with me when I am helping to guide them through it. It influences the way I feel and think about my clients’ bodies as well. I do not hold judgments about people’s bodies because of what I have learned in my journey, and my clients know I don’t judge them. When I tell my clients that their body is acceptable no matter what it looks like, I mean it, and they know it.”

Duarte discusses how HAES and intuitive eating helped guide her treatment of a teenage client she calls “Sara,” who was restricting her food intake and using exercise and vomiting to purge. “Sara believed that her body was wrong and ugly because it didn’t look like her family members, who were taller and built leaner than she was,” Duarte says. “One of the first things I had Sara do was put her scale away in a place that she wouldn’t have easy access to.”

Duarte introduced Sara to intuitive eating and its philosophy that foods should neither be demonized nor celebrated. Sara was particularly resistant to this concept, but Duarte successfully encouraged Sara to slowly add “forbidden foods” back into her diet.

Duarte also used mindfulness to help Sara with her purging behavior. “We worked on mindfulness, so she was able to identify when the urge to purge was coming on,” Duarte says. “She would write down for me everything that she was thinking — why she wanted to purge and why she didn’t.”

The urges would usually pass, and over time, Sara was able to get through them by using tools she had learned in session. Duarte teaches all of her clients distraction and self-soothing skills drawn from dialectical behavior therapy. Examples of distraction activities include dancing to a favorite song, writing or drawing, calling or texting a friend and going for a walk or a drive. Self-soothing might involve clients taking a shower, painting their fingernails (an activity that Duarte says is great for people with bulimia because they can’t induce vomiting with wet nails) or giving themselves a foot massage.

With time — and the help of the tools she had learned — Sara no longer experienced urges to purge. It took awhile for Sara to grow comfortable with her body, but she began to enjoy the increasing sense of physical strength that came from no longer restricting her food intake, Duarte says. Over time, that physical feeling of strength also became psychological.

“She struggles from time to time with not liking how she looks, but she’s able to identify what’s really going on at those times,” Duarte says. “Typically, Sara is stressed or scared, and instead of feeling [that], she focuses on her body and her need to change it. [But now] she uses the tools we have worked on in session, and she feels her feelings effectively, and most often, the body hatred goes away too.”

Alternatives to emotional eating

Licensed professional counselor Rachael Parkins is a practitioner at the Bucks Eating Support Collaborative in Bucks County, Pennsylvania, where she currently runs a support and therapy group for emotional eating. The group meets weekly and serves as a place for women to share their challenges, support one another and get professional guidance from Parkins. Group members may be struggling with a variety of concerns, but food is their common method of coping with emotions and issues such as stress, insecurity, self-esteem and body image, Parkins explains. Most of the women are working with a dietitian, and group members also have access to an intuitive eating coach.

The goal of the group is to learn how to handle emotions in a healthy way by working on methods such as distress tolerance. Group participants identify distressing emotions, such as loneliness, and Parkins helps them identify alternative ways to cope with what they’re feeling. Sometimes, this can be as simple as group members going out of their way to be kind to themselves and practice self-care, such as putting on lotion or taking a bubble bath. Other methods are more concrete, such as journaling or completing a decatastrophizing worksheet. In that case, participants write down their worst thoughts, evaluate the worst-case scenario and the likelihood of it happening, and identify other possible outcomes.

Parkins also encourages group members to acknowledge the small victories they experience in pursuit of their personal goals by recording them in a log. For example, a group member might state a goal of practicing better self-care. For this particular group member, an action such as getting out of bed and taking a shower might represent a small victory. Another participant might want to stop procrastinating. Calling to set up a doctor’s visit could be a small victory, even if the group member doesn’t keep the appointment.

Parkins also helps group members break free of comparisons, both with other people and themselves. She explains that participants regularly hold themselves and how they look up not only to the perceived “successes” of others in their lives, but also to their own past selves. Parkins says it is not uncommon for group members to express a desire to go back in time to when they were thinner, even if it was a miserable point in their lives.

“They have this idea in their head that if they get to this size or number on the scale, that’s going to bring happiness,” she says. “Losing weight might be desirable, but as an emotional focus, it’s never enough. I’m helping people accept that losing weight is not the answer.”

Signs of a problem

Although not every client who diets is engaging in disordered eating, counselors should regularly assess for eating and body issues, says Choate, a professor of counselor education at Louisiana State University.

“We know that a large proportion of the population experiences problems related to eating and negative body image, so it is reasonable for counselors to assess for these issues with all of their clients,” she says. “Because clients with eating-related problems might come to counseling with other issues — depression, anxiety, relational problems — asking questions specifically related to eating patterns and body image is a good way to explore to see if these problems are contributing in any way to the client’s presenting issues.”

Choate suggests asking the following questions:

  • Is the disordered eating pattern causing problems in the person’s life?
  • Does the disordered eating pattern interfere with the person’s relationships with others? With the enjoyment of life activities? With completing daily routines?
  • Does the client’s weight, shape or appearance unduly influence self-esteem?
  • Does the client believe that she or he is less acceptable if weighing a few pounds more than in the past or, conversely, that she or he is more acceptable if weighing a few pounds less?

When assessing clients for signs of an eating disorder, Duarte says, it is essential that counselors not be misled by the stereotypical presentation of extreme thinness. The stigma attached to larger bodies often can obscure the reality that eating disorders may occur in people of all sizes, she says. In part because our society generally expects that people who do not fit into an idealized size range want and need to lose weight, counselors may be less likely scrutinize dieting behavior and weight loss in larger clients. Like Choate, Duarte believes that counselors should assess all clients for signs of disordered eating.

Choate also offers one final caution for counselors. “While there are some eating-related problems that might respond well to counseling alone, it is important to be aware that eating disorders are chronic, and anorexia in particular has the highest mortality rate of any psychiatric disorder. Treatment of these disorders requires specialized knowledge and training, and because eating disorders all involve a medical component, the involvement of a multidisciplinary treatment team is required. This would include, at minimum, a physician or medical professional, a dietitian and the counselor.”

 

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Defining eating disorders: Changes in diagnosis

Laura H. Choate notes that in the past, most individuals with eating disorders fell into the diagnostic criteria of eating disorders not otherwise specified (EDNOS), which led to changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

The criteria for anorexia nervosa and bulimia nervosa were expanded to include more people. Binge eating disorder was added as a stand-alone disorder (rather than remaining as previously listed as a subcategory under EDNOS). EDNOS was renamed “other specified feeding or eating disorder” and includes issues such as:

  • Atypical anorexia nervosa: All criteria for anorexia nervosa are met; despite significant weight loss, the individual’s weight is within or above the normal range.
  • Bulimia nervosa of low frequency or limited duration
  • Binge eating disorder of low frequency or limited duration
  • Purging disorder
  • Night eating syndrome

 

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Multicultural considerations

Although often perceived as a “white” problem, eating disorders and disordered eating do occur among women and men of color, says Regine Talleyrand, an American Counseling Association member whose research focuses on eating disorders among women of color.

“Counselors should be aware that women of color do experience concerns regarding beauty and body esteem,” she says. “[However], the traditional methods of evaluating these factors — weight, body parts, preoccupation with thin body ideals — may not capture the real body appearance concerns of all women of color.” Talleyrand, an associate professor and coordinator of the counseling and development program at George Mason University in Virginia, says that characteristics such as hair, skin color and facial features may be more relevant when evaluating body image in women of color.

In addition, high rates of obesity and binge eating among Latina and African American women highlight the need to look beyond “traditional” eating disorders such as anorexia and bulimia when working with women of color who struggle with eating, weight or body issues, Talleyrand says. Because African American and Latina women are even more likely than white women to display eating disorder symptoms at any size, counselors who are evaluating clients of color for disordered eating should also look beyond the stereotypical underweight image, she emphasizes.

Of course, the factors influencing the risk of eating disorders in all populations go beyond appearance. These factors are often culturally specific. In particular, racism and oppression may play a significant part in eating disorder risk among Latina and African American women, Talleyrand says. In fact, the development of eating disorder symptoms — particularly binge eating — has been linked to racism and oppression experienced by African American women, she adds.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Eating Disorders and Obesity: A Counselor´s Guide to Treatment and Prevention, edited by Laura H. Choate

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Anorexia Nervosa” by Shannon L. Karl

Journal articles (counseling.org/publications/counseling-journals)

  • “Special Section: Assessment, Prevention and Treatment of Eating Disorders: The Role of Professional Counselors,” Journal of Counseling & Development, July 2012

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor:ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The powerful perspective of body satisfaction

By Juleen K. Buser and Rachael A. Parkins December 22, 2014

Every January, right as the new year begins, we are saturated by commercials for diets, advertisements for exercise machines and stories of people whose lives were transformed upon Branding-Box-body-satisfactionattaining the elusive goals of slimness and fitness. This message is an undercurrent throughout the entire year, of course; it just becomes especially blatant and constant in the days leading up to and immediately after New Year’s resolutions.

But the messages about being thinner, fitter, sleeker and more attractive are rarely absent — particularly for women. In fact, in a quite alarming example of the consistency and doggedness of this message, a few years ago I (Juleen Buser) watched a newscaster comment on National Eating Disorders Awareness week. This alert about the annual marking of a week to increase awareness of the agony and perils of eating disorders was almost immediately followed by a commercial on the latest weight loss tool promising to help women shed those extra pounds of flab and fat.

The problem of body dissatisfaction among women is pervasive and persistent. In a 2014 study published in the scientific journal Eating Behaviors, Elizabeth Fallon, Brandonn Harris and Paige Johnson reported that 13.4 percent to 31.8 percent of adult women experience body displeasure. Moreover, these authors noted that young, middle-aged and older women all reported body dissatisfaction.

A prominent strand in the literature is the role that the media play in fostering and maintaining this rampant, steadfast body dissatisfaction. A meta-analysis conducted by researchers Lisa Groesz, Michael Levine and Sarah Murnen in 2002 pointed clearly to the detrimental impact of the media as it relates to female body image.

As counselors, we are bound at some point to encounter a client who has dealt with the negative impact of the media’s obsession with body size and shape. Ruth Striegel-Moore, Lisa Silberstein and Judith Rodin wrote a seminal article in 1986 (“Toward an understanding of risk factors for bulimia”) that discussed how incredibly common it is for women in Western society to struggle with body dissatisfaction. The concern is so typical, in fact, that it may actually be unusual to identify a woman who expresses happiness and satisfaction with her body.

We, the authors of this article, wanted to hear the perspectives of women who expressed the uncharacteristic view of body satisfaction. We thought that much could be learned about mental Body image authorshealth from women in college who were able to assert satisfaction with their bodies despite the many media messages lauding the ideal of thinness. Thus, we embarked on a research project in which we interviewed nine college women about their experiences of body satisfaction.

We asked these women questions about their emotions and cognitions regarding their body size and shape, their history of body image attitudes and views, and how they cope with the external pressures for thinness. In what was often viewed as an unexpected inquiry, we also asked them questions about the connection between their spirituality and body image. We chose women who specifically expressed having both body satisfaction and a spiritual belief system because we were curious about the ways in which spiritual beliefs might play a role in body satisfaction. The full empirical findings of this study are available in an article we published in the April 2013 Adultspan Journal, “‘Made this way for a reason’: Body satisfaction and spirituality.” This Counseling Today article is an adaptation of that article; here, we focus more closely on the practical counseling implications of our findings.

The importance of the body

Our findings uncovered a striking contradiction. Many of the women we spoke with felt that their bodies were both more important and less important than the societal messages about female physical appearance.

They viewed their bodies as more important than the societal narratives in that the media images of thinness did not disrupt their core belief in personal beauty. Some women talked about Photoshopped images and the erroneousness of the media’s idea of beauty, explaining that they were able to distance themselves from the models by recognizing that their bodies were simply different than the ones in the media. To these women, their bodies and the bodies in the media were incomparable.

On the other hand, they also placed less importance on their bodies in that many of these women did not emphasize physical size and shape over other significant areas of life. Media narratives often would have us believe that a physically fit, attractive body should be a primary value for women. Some of the women we interviewed communicated aspects of their lives that they felt were more valuable than their physical bodies. For example, one participant said: “I mean, your weight compared to, like, the time you could spend with your family. … Why are you wasting your time staring in the mirror for an hour?” 

These findings around the importance of the body have potentially powerful implications for counseling. When working with women who express body dissatisfaction (that common, persistent displeasure counselors are bound to encounter in clients), the views of these women who were able to hold onto body happiness could be helpful. Counselors may be able to pair the beliefs that many of the participants of this study possessed with different therapeutic methodologies. For example, counselors might use cognitive therapy techniques that help clients alter distorted thoughts by replacing them with more rational beliefs. A client who found she was frequently comparing her body with the bodies often seen in the media may be able to use thought replacement, for instance. She could substitute thoughts that engender body comparison with a statement such as: “My body is incomparable to that image because it is falsified, making it unattainable.”   

Counselors can also work with clients to shift their focus and priorities. Clients may benefit from focusing less on their body shape and size and focusing more on other aspects of life. For example, clients might come to counseling with the identified problem of a distorted body image and a self-image closely tied to body size and shape. A counseling session may be the ideal opportunity for a counselor to help shift these common distortions by pointing out the dissimilarity between the client’s long-term goals and the value the client is placing on her body image. For example, counselors can draw from principles of acceptance and commitment therapy (ACT) when working with clients struggling with body dissatisfaction.

Adria Pearson, Michelle Heffner and Victoria Follette, authors of Acceptance and Commitment Therapy for Body Image Dissatisfaction, applied ACT to the treatment of body displeasure and noted the benefits of helping clients move beyond a focus on body size and shape to live a life in tune with personal values. For example, a counselor might ask a client to create a list of morals, values and attributes that she would like to work toward having or may currently see in herself. This would be a crucial opportunity to point out to the client the incongruence between her morals/values and the concentration she may be placing on her outward appearance.

Spirituality and the body

Initially, almost all of the participants in our research project were a bit staggered by the notion of a connection between their spirituality and their body image. Yet, despite early confusion over or even rejection of this connection, many were able to see and give examples of how their body image and spiritual beliefs could be correlated.

One way in which these two components were tied together for some participants involved the idea of spiritual control over one’s body. Specifically, these women accepted certain limitations concerning their ability to control their physical bodies. They gave ownership of these limitations to a higher power, noting that God “made me how I am” and “I just feel like maybe I am a certain way for a reason, and God wants me to be happy with myself.”

Again, these findings are rich with potential counseling implications. First of all, the participants’ initial surprise, confusion and hesitation concerning a potential connection between their spirituality and body image suggests that counselors may have to take the initiative in broaching these topics. Although such a connection may be relevant, clients simply may not think about the intersection of these two domains and, consequently, could miss a very salient and therapeutically beneficial exploration.

Counselors can begin the conversation with open questions that give the client a chance to think about (likely for the first time) possible connections between spirituality and body image. Potential questions and comments include:

  • “You mentioned having a spiritual faith a few sessions ago. I am curious about ways in which your spiritual beliefs might play a role in how you feel about your body.”
  • “Tell me about your spiritual practices (for example, prayer, meditation). What things do you focus on during those times? Do your feelings about your body relate to these spiritual practices?”
  • “Are there ways that God or a higher power influences the way you feel about your body? Tell me more about this connection.”
  • “What aspects of your spiritual faith are relevant to body image concerns? Are there certain [theological principles, sacred texts, underlying philosophies, etc.] that discuss the physical body?”

For certain clients, this connection between spirituality and body image may be personally meaningful and significant. In such instances, counseling can delve more fully into a discussion of the ways that a client’s spiritual beliefs could foster body satisfaction. When discussing the spiritual belief systems of clients, however, counselors will want to be cautious not to offer spiritual guidance or instruction to the client. Rather, counselors can remain in an encouraging role, asking open questions and fostering client exploration of spiritual and body beliefs.

For example, a client struggling with body displeasure may believe in her complete ability to control her body size and shape. Disordered eating behaviors may result in part from this belief in personal agency over weight and shape. Yet, this client may possess a spiritual belief system that contains theology about the sovereignty of a higher power.

In such a case, a counselor could help the client explore the ways in which her spiritual views (of little control) might relate to or inform her body image views (of complete control). A client may then begin to apply her spiritual beliefs about divine power to her body size and shape. She may ultimately see her physical body as created by a higher power and thus not fully within her control to manage through a strict diet and exercise regimen. This spiritual belief system may give her the relief of accepting her body.

Conclusion

Inundated by media images of thinness, many women are vulnerable to the ensuing effects of body dissatisfaction and unhappiness. Yet, for some women, attitudes of body satisfaction persist despite these external pressures and societal mores. As counselors, we can learn from these women. The factors that allow them to hold onto a belief in the beauty of their bodies can help us in our work with clients who are struggling with beliefs about the inadequacy and unattractiveness of their bodies.

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Juleen K. Buser is an assistant professor at Rider University in Lawrenceville, New Jersey, and a past president of the International Association of Addictions and Offender Counselors. Her research focuses on both adaptive and maladaptive coping strategies such as eating disorders, nonsuicidal self-injury and spiritual coping styles. Contact her at jbuser@rider.edu.

Rachael A. Parkins is a primary therapist at the Renfrew Center in Radnor, Pennsylvania. She received her master’s degree in clinical mental health counseling at Rider University. Her research includes emphases on eating disorders, body image, coping and spirituality.

Letters to the editor:  ct@counseling.org

Disordered eating and body bashing

By Kiphany Hof March 17, 2014

Today I ate a piece of chocolate cake, and I survived. This sounds silly, I know. But not too long ago, there were countless days in a row when I truly thought my life was measured by the number on the scale, the size of my jeans, the number of calories I ate or my ability to refuse chocolate cake.

Sadly, this is no exaggeration, and many of you know this because you too are dealing with or have dealt with living in a self-made prison where the bars are made of supermodel standards, fear of rejection, endless exercising, obsession with body image, overeating, undereating, laxatives, diuretics, self-induced vomiting and self-loathing. Would you be able to tell, just by knowing someone, if they are one of the inmates in this prison of torment that destroys both body and soul? Are you one of these people who secretly hope that your warden of self-criticism will unlock the door and free you?

eatingdisorder

I am writing this article because I am a former inmate in the jail of disordered eating and body bashing. I was stunned at the number of people I met, both men and women, who were cellmates of mine, although I did not know it at the time. You too might be surprised at the number of occupants.

This article is not a forum for me to tell my story, however, because my story is really the story of thousands of other men and women across the nation who are locked up and rotting in that same prison. Rather, I hope to catch your attention, even if for the briefest of moments, and remind you that freedom to live freely in a world made up of self-acceptance and contentment is possible, even when you eat chocolate cake.

The etymology of the word disorder is “dis” — meaning “not” — plus the verb, “order.” Translation: not ordered. Ironic, isn’t it, when we consider how much time and effort we expend to “order” ourselves around eating, exercising and the attainment of an acceptable and attractive body?

Even the term “body awareness” is somewhat ambiguous in interpretation. In its positive context, awareness of the way our bodies are uniquely created and the multiple miracles our bodies perform each day is cause for celebration. In its negative context, awareness of how much we hate our bodies and fantasize about them being different is awareness I am sure most people would rather not have.

Personally, I do not think the term “eating disorder” is an accurate description of what happens when someone’s behaviors become so ordered that she or he is more consumed with appearance than with consuming a required, life-sustaining substance: food. It is not about the eating, the calories, the fat grams or even about the food.

What is it about then? When and how did the detailed “order” of it all cross into the “disordered” spectrum?

There are many theories and possible explanations behind the hows and whys of eating disorders and negative body image. Some blame the media for saturating our visual world with unrealistic expectations about the perfect body. Others focus on the influence of societal pressures to look, behave or speak a certain way. Still others believe familial influences contribute to disordered eating and negative thinking.

All of the above may contribute to either a positive/negative, healthy/unhealthy or rational/irrational image of our bodies. Although the roots of our body perceptions may differ, we share a common thread of wanting to be accepted, recognized, admired and wanted by someone at some point in time. Sadly, everyone is painfully aware that physical appearance can either deliver or deny these desires. However, physical appearance is not the only route to fulfillment; it is just the most visible and advertised journey to get there. And that journey is oftentimes costly.

Take a few moments to venture on your own body image journey this week. Are you walking the path of freedom, or are you an inmate in the prison of body hate? Are you visiting someone who is locked up in his or her own fear, guilt and shame? Have you been a person who contributes to the building of those prison walls? Will you choose to celebrate your body this week, without judgment, as you become more aware of its impact on your life? Will you choose to help others unlock the cell door? Will you ask for help in being freed? Will you look beyond the body and see the simultaneous pain and beauty of a human soul? Will you question the meaning of “ideal” and expand your field of vision?

I encourage you to reflect on your own thoughts and feelings about your body and notice who defines them: Is it you or others? As you ponder, challenge yourself and others to find their own personal freedom; it is there, waiting for you to embrace it.

 

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Kiphany Hof, a provisionally licensed mental health practitioner, works as a counselor at University of Nebraska Kearney Counseling Care, a mental health clinic that offers personal counseling to students. Contact her at hofkj@unk.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Behind the Book: Eating Disorders and Obesity: A Counselor’s Guide to Prevention and Treatment

Heather Rudow March 11, 2013

78076Laura Choate, associate professor of counselor education at Louisiana State University, is the editor of Eating Disorders and Obesity: A Counselor’s Guide to Prevention and Treatment, a new book published by the American Counseling Association. Choate believes the book is a unique resource for counselors that sheds new light on how to treat and prevent eating and obesity-related disorders.

What inspired you to write Eating Disorders and Obesity: A Counselor’s Guide to Prevention and Treatment?

Rates of body dissatisfaction-disordered eating and problems with body weight and shape are increasing in populations across the life span. For example, young women are particularly at high risk for eating-related concerns such as binge eating, and obesity rates are increasing rapidly in the general population, putting individuals at risk for negative health outcomes. Furthermore, those individuals who experience body dissatisfaction and subthreshold eating disorders are at high risk for the development of potentially life-threatening, full-syndrome eating disorders such as anorexia nervosa and bulimia nervosa. The book provides insight into these problems and offers detailed information for the prevention and treatment of these concerns.

How does this book compare with similar books on market?

There is little information available in the field written primarily for a counseling audience. Many of the best-practice treatments are located in manuals that are hard to access. This resource provides essential foundational information for counselors such as sociocultural influences, gender differences, ethical issues, information on current assessment and diagnostic concerns, effective prevention programs for communities and schools, and best-practice treatments for a range of eating-related problems.

The book is distinct from others on the market due to the fact that it is written specifically for counselors. It contains both detailed prevention and treatment guidelines; it has a school and community focus; and it is accessible for practitioners who may not specialize in the area of eating disorders and obesity.

Some special features are as follows:

  • The book contains chapters from authors in the field who are well known among eating disorders professionals but who might not be known to counselors, such as Margo Maine, Linda Smolak, Douglas Bunnell, Diane Wilfley, Marian Tanofsky-Kraff, Eric Stice, Heather Shaw and Niva Piran. The book also contains chapters by authors from Canada and Australia. Counselors will benefit from an interdisciplinary perspective on eating disorders prevention and treatment that is tailored specifically toward their needs
  • The book contains information on sociocultural dynamics, assessment, diagnosis, conceptualization, prevention and treatment. Counselors will have information on a variety of topics located in one resource.
  • The book is written in an accessible format, with chapter highlights, case examples, and recommended online and print resources. Because it is reader friendly, counselors will be able to access and use the information.

How did you choose contributing authors, and how did this enhance the content? 

The idea for the book came from my experience as guest editor for the special section on eating disorders prevention and treatment published in the summer 2012 issue of the Journal of Counseling & Development. Based on the response to that collection of articles, I decided to compile a book on both eating disorders and obesity, and to address the areas of foundation, assessment and practice frameworks, prevention and evidence-based treatments. I invited some of the authors from the special section to contribute chapters based on their fit with one of these four areas, then sought out specific leading experts in the eating disorders/obesity prevention and treatment field to round out each section. The authors are practitioners as well as researchers and come from psychiatry, psychology and counseling disciplines, and all are doing important work in the U.S. as well as in Canada and Australia. I was honored to have a chance to work with each of them.

How did you get involved with subject?

The idea for this edited book originates from a variety of influences. First, my desire to compile this type of book stems from being a mother of elementary-age children who are exposed daily to harmful media images and messages regarding narrow cultural definitions of how they “should” look and act. Because I want my children and all others to be equipped with the skills they need to stay healthy and resilient in the face of cultural pressures around eating, weight and shape, this book is dedicated to assisting counselors and their clients to become empowered to effect positive change in this area within the multiple systems  —family, school, community — in which they are embedded.

The origins of this book are also grounded in my professional experience as a licensed professional counselor and counselor educator. I have been involved in the prevention and treatment field in a variety of roles. I have counseled clients, supervised and taught graduate students, published articles regarding body image resilience and eating disorders treatment, and presented at local schools to adolescent girls as well as to professionals at state and national conferences. I have observed that counselors are often unclear as to their role in preventing eating disorders and obesity and in providing early intervention and treatment, and they often lack training in best practices in this field. Therefore, the overarching purpose of this book is to provide a much-needed resource specifically targeted to counselors that provides accessible information practitioners can implement in their daily work with clients across the continuum of care. The book strategically includes chapters that address assessment, prevention and treatment, including information for working with children and adults as well as with clients from diverse cultural groups.

What are the most important take-away messages for the reader?

Readers will have access to current information on assessment, diagnosis, prevention and treatment of eating-related problems, eating disorders and obesity. Each chapter contains information to provide a knowledge base as well as essential resources for further education and training in that particular area of the field. 

Who is the best audience for the book?

This book is intended for all counselors, not just those who specialize in eating disorders and obesity treatment. Therefore, all school counselors, mental health counselors, counselors with interest in health and wellness — specifically eating disorders and obesity — child and adolescent counselors and counselor educators will benefit from this book.

Why is this book important to the counseling profession?

Both practical and comprehensive, this long-needed book provides a clear framework for the assessment, treatment, and prevention of eating disorders and obesity. Focusing on best practices and offering a range of current techniques, experts in the field examine these life-threatening disorders and propose treatment options for diverse clients experiencing problems related to eating, weight and body image.

Parts I and II of the text address risk factors in and sociocultural influences on the development of eating disorders, gender differences, the unique concerns of clients of color, ethical and legal issues, and assessment and diagnosis. Part II explores prevention and early intervention with high-risk groups in school, university and community settings. The final section of the book presents a variety of best-practice treatment interventions, such as cognitive behavioral, interpersonal, dialectical behavior and family-based therapy, which are empirically supported and have been used successfully in a variety of settings.

Click here to purchase a copy of Eating Disorders and Obesity: A Counselor’s Guide to Prevention and Treatment.

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.