Jessica Setnick Blog Interview

This is the second in my blog interview series. This time it is Jessica Setnick, MS, RD/LD, CSSD who was a guest professional on one of our tele-classes in November.

Jessica Setnick Blog Interview

1. Your website, http://www.understandingnutrition.com/ shows your passion for helping folks with eating disorders.  Where does this passion come from?

It is a combination of wanting to help others and wanting to understand the human condition in some way that would help me understand myself. I learn so much from my patients, and the continuing education that I have pursued has been as applicable to myself as it is to my work. The other aspect is that I feel that I have been given a gift, a gift that I may not have identified on my own, but that the incidents of my life brought to my attention. I am grateful to have found the intersection of what I like to do, that I am good at, that helps people, that I can do for a living. It is my mission and I wouldn’t feel complete if I didn’t act on it. Over time my mission has evolved into helping other professionals to help solve eating disorders, and most recently into helping build a treatment center, Ranch 2300, to do the same.

2. What is your philosophy on effective eating disorders treatment?

Ah, my philosophy. My philosophy on effective treatment starts with my philosophy on eating disorders themselves. I believe that the nomenclature we use for eating disorders stinks. I think it was developed to facilitate research and description but it does not describe the human experience. So we are not treating individuals with eating disorders as well as we could be because the research is based on artificial distinctions. Anyone who is familiar with the field realizes that two people with “anorexia” might have very different situations – different causes, different skill deficits, different needs – but yet we continue to look for the one “best” treatment. There might be two people whose eating disorders look very different, but they have a lot in common. The treatment must be individualized to what each person needs. But I think that if we did a better job of describing eating disorders, such as “Depression-related eating disorders” and “Anxiety Spectrum Eating Disorders” and “Post-traumatic eating disorders” instead of the way we do now, we could also do a better job of recommending treatments rather than the trial-and-error approach.

The most important factor in treatment that lasts is recovery protection, ie the systems and skills that someone needs in order to thrive outside of a treatment setting. That has been the most fun part of designing Ranch 2300 – thinking of all the skills that someone needs to “make it” in recovery, and figuring out ways to teach those skills in the safe environment of treatment.

3. What is your opinion on full recovery?

I prefer to use the word “remission,” since it seems to fit the paradigm of eating disorders better than recovery. I feel recovery can begin the very day someone realizes their eating disorder is killing them and they want to change, but that is no guarantee of a change in the parameters we tend to measure. On the other hand, an individual may be weight-restored and seem to be “in recovery” while internally they are not recovered at all.

Remission indicates that while bodies heal faster than minds, both the body and mind have recovered to the point that eating disorders stay in the thought stage only and do not transmit into behaviors that are problematic. In other words, I believe that I am in remission because when I have eating disorder thoughts, I am able to manage them before they lead to behaviors, and on occasion under extreme duress when I have an eating disorder behavior, it is no more severe nor lasting than the average American. It does not lead to guilt or shame, or a repetitive cycle, and I use it as a clue that life is not in balance and a cue to re-evaluate my situation.

My opinion on Remission is that it takes up to 7 years of compliance with treatment from the day an individual with an eating disorder enters treatment to advance to the stage of Remission, where the eating disorder is genuinely and for all practical purposes “in the past.”

4. How have people used your boot camp to treat their eating disorder?

Well I did not intend it for that purpose, it is a training program for professionals treating eating disorders. But after some of the workshops, professionals who attended would come forward and tell me that after attending the weekend they recognized their own eating disorder, or recognized that it was no longer congruent with their lives, and they asked me to help them find treatment in their area.

5. What do you tell people who care about someone with an eating disorder to say to encourage their loved one to seek treatment?

I care about you is a good start. I care about you and I would like to help you find treatment is even better. I care about you and I have made an appointment with a counselor to talk about how hard it is to watch someone I love hurt themself is the best way of all. Because then you are not only expressing yourself, expressing how deeply this is important to you, and how you are willing to stick by this person “in sickness and in health,” but you are also role-modeling self-care and reaching out for help, two things that everyone with an eating disorder needs to see more of.

Women over 50 and body image

Given that I am a proponent of the Health At Every Size (HAES)- size acceptance model, I was intrigued when I spoke with Thea Sheldon about women over 50 and their long and too often rugged relationships with their bodies.  I had recently written an article about women over 50 with eating disorders and we got talking about her work in helping women be happy with their bodies.  Wow, someone who cares about women over 50 and how we feel about these bodies that look so different from when we were younger!  I decided to do a blog interview with her to share her wisdom with you.

Thea started noticing when walking up a few stairs to her office she would be out of breath by the top.  All of her medical tests were fine.  Instead of prescribing fun movement or activity her doctor said she needed to lose about 30 pounds.  Thea hadn’t heard of HAES but she knew she wanted to be less winded and be able to do more fun physical activities—regardless of her size.

Thea began focusing not on dieting but on her health and reclaiming what brought her joy.  In the process of adding fun movement Thea’s body did shed some weight. More importantly she gained peace with her body as well as newfound fun and freedom in her life. As a coach she developed programs helping other women to find the peace with their bodies that she had found. 

Regular readers of my blog know that I do not promote losing weight – only gaining health.  Some people when they start making different health choices will gain weight, some will lose and some will stay the same.  Even though Thea has the words, “weight loss” in her materials I am sharing what she does because I see her helping women to “create a long-term, sustainable change in your relationship with your body.”  And when we love ourselves and our bodies that is when we can regain health.  I hope my HAES colleagues and fellow eating disorders advocates understand that she is using those words in her marketing because that is what women initially think they want.  Thea helps them find something so much better.

Here is my interview with Thea:

What shifted recently in how you treat your body?

Now I am better with boundaries in relationships with people and in my relationship with food.  I am able to draw boundaries with food and ask for what I really want, both in planning a menu and making choices in a restaurant. 

What has given you the ability to set these boundaries with food?

1. Knowing much more clearly what I want.  Health!  I want Radiant Vibrant Health.  I’m responsible for what I put into my body and there is a real correlation between that, and how I feel, and my health numbers.  It was making a commitment to my health. Realizing I have a choice.
2. I developed habits via steps.  Gradually I started making better choices. Trying to be perfect is no longer necessary. Now I feel much better and that keeps me motivated to keep making choices that are good for my body.
3. I was totally open to the idea of experimenting. I know there isn’t one RIGHT way for every woman.  I became intimately familiar with my own body. I observe and respect what feels good and what doesn’t for my body.

As a result of these changes, what is now present in your life that wasn’t there?  

For 18 months now I've been doing all kinds of fun activities I hadn’t been able to do so easily before. Now I can flow into yoga positions I just couldn’t do because of the bulk on my body.

Thanks to my newfound body respect and awareness I recently participated in a community modern dance performance, even though I’m not a trained dancer. I had confidence that I could learn the moves. I wasn’t concerned about how my body looked on stage. I didn’t compare myself to others. I had so much fun! I never would have done this before I started taking charge of my body.

Now when we go on extended canoe trips I am able to carry my food pack across the portages easily. I don’t have to stop every few yards and rest. Cross- country skiing is so much more fun. I can get up some speed and feel more fluid and graceful skiing. It’s easier to get in and out of the car. On a practical note, I can easily carry my groceries. I don’t feel weighted down. I am much more flexible.

What is no longer present?  

When I am walking down the street, I no longer sneak little peeks in the window reflections to see how “fat” I am.  Now if I see my reflection it is no longer negative. I smile and say, “Wow you look great!” 

How have you changed the way you respect your body?

Now, more than ninety per cent of the time I don’t criticize my body and am genuinely grateful for my body.  I notice I am gentle and soft even when washing my body – not critical but appreciating my strong arms for example.  This is a huge change.  Previously I was unkind and really abusive to my body – scrubbing it hard and not in a kind way.  Now I love this body!  Accepting the changes of aging makes life so much easier. 

My language has changed.  I no longer say, “I shouldn’t eat that.”  Now I will consciously ask myself, “Hum, do I want to eat that? Am I hungry for that?  Is this going to taste as good as it looks?”

What have you created in your business as a result?

Over the phone I offer Body Breakthrough: Wise Weight Loss, Management and Momentum. Locally in Ely, Minnesota my co-leader Kathy Cyriacks and I offer Choose to Lose, a support group for women. Both programs emphasize making lifelong changes in your relationship with food, your health and your body. I tell women, “You will come to appreciate and love your body for the amazing gift it is.”

Thank you Thea for doing this Blog Interview with me. 

Thea Sheldon can be found at True Voice Coaching of Ely, MN http://www.theasheldon.com/body-breakthrough.html

Eating Disorders and the Holidays Guest Post on Pathways to Wholeness

Happy Winter's Solistice to you!

Janet Nestor, MA, LPC, DCEP of Mindful Pathways asked me to be her guest blogger for December.  This is the blog post I shared on her site: http://mindfulpathways.com/  Her book is on special for the holidays for only $5.64!! 

Back to wrapping gifts for me.  Thanks for your comments and readership. 

Eating Disorders and the Holidays

Posted on December 19, 2011 by Janet

We are so lucky to have the opporutinity to welcome Becky Henry as our guest blogger. She is the Author of Just Tell Her to Stop, an award winning book for families who care for an member with an eating disorder.  She is the founder of Hope Network a wonderful support sommunity.  I recommend her book to clients with eating disorders and also to their family members as it is the only book of its kind on the market.
Families living with an eating disorder can find the holidays extra challenging with all the focus on food. There are so many different stresses and foods that can be frightening for people facing eating disorders.
Two years ago I got to have a conversation with Peter McClellan on his radio show 401k Latte about eating disorders at the holidays. We talked about the huge spreads of food that can be overwhelming and stress inducing. Take a listen:  http://www.kkmslive.com/MP3/PM_12_23_09.mp3
Peter asked some great questions to open up the conversation about how both parents and health care providers can support someone with an eating disorder. A few things we talked about were:

• As family member; put on your oxygen mask first-make a Top Ten list and do 1 self-care/fun thing each day.
• Family members can help by: Learning to let go with love (easier said than done).
• Don’t make comments about other people’s bodies.
• Low fat – Low Calorie diets backfire – they don’t work – 95% failure rate.
• Language from health care providers is important – telling patients to lose weight not only doesn’t help – it hurts.
• Health care providers can ask open ended questions about what a patient’s health care goals are can enroll the patient in the process of making healthy choices.
• The book: Just Tell Her to Stop can be ordered at:  JustTellHerToStop.com
• Weight-ism is alive and well –notice our judgments about sizes.
• People can be healthy at many different sizes.
• Focus on overall health to achieve your health goals.
• Insurance and eating disorders coverage – Academy for Eating Disorders works for mental health parity.
• College professors can add the book to their curriculum as required reading.
• Companies are invited to purchase the books to donate to eating disorders treatment centers.

What have you heard from your health care provider that has backfired for you? What comments have you found helpful while recovering from an eating disorder?
I hope you will focus on what you are grateful for this holiday season and have peace.
Hope Network:
http://www.hopenetwork.info/index.html
http://www.facebook.com/HopeNetworkBeck#!/hopenetwork.llc

What is "drunkorexia" all about?

When I was doing interviews for my book, Just Tell Her To Stop: Family Stories of Eating Disorders I heard an amazing story about a young woman with co-morbid eating disorders and alcoholism.  That is fancy lingo meaning she had both an eating disorder and alcoholism.  I chose not to use the story in the book because there was a lot of media attention about the outcome and legal proceedings.  I interviewed the former housemate of a college student who regularly skipped eating and drank instead.  Every day the young woman got so drunk that the housemates had to protect her from males who wanted to take advantage of her.  On what happened to be her 21st birthday this pattern caught up with her and she died as a direct result of what was being done to her body.  If a 2nd book happens I will write the whole story because it is so important to share the dangers of this combination that has come to be termed: Drunkorexia.  I'd like to share a blog post from the blog at www.onlinecollege.org addressing this dangerous phenomenon.  Please share your reactions in the comments section.

What Drunkorexia is Doing to College Students

At first, "drunkorexia" may sound like kind of a funny word, jokingly made up to describe a situation in which college students and others forgo food in order to be able to afford more alcohol and feel higher effects of alcohol on an empty stomach. But what some may brush off as crazy college-kid behavior is actually a serious problem that can have highly damaging consequences both in long- and short-term health. Of course, that hasn't stopped college students from engaging in this unhealthy trend, and a study at the University of Missouri-Columbia indicated that one in six students had practiced drunkorexia within the last year. Typically, drunkorexia is done by women; the study showed that three out of four drunkorexia respondents were female.
Students may not realize that drunkorexia is incredibly damaging to their health, but the fact remains that the practice puts them at risk for problems like sexually transmitted diseases, malnutrition, and even seizures and comas. Specifically, the University of Missouri study indicates that drunkorexia may lead to:

• sexually transmitted diseases
• HIV
• drunk driving
• alcohol poisoning
• injury risk
• perpetrating or being a victim of sexual assault
• passing out
• malnutrition
• heart problems
• cognitive disabilities
• seizure
• comas
• organ failure

All of the possible effects are disturbing, but perhaps the most worrisome are heart problems and cognitive disabilities that can stem from drunkorexia-induced malnutrition. STDs, injury, or sexual assault are without a doubt difficult to bounce back from, but malnutrition-induced heart problems and cognitive disabilities are something you just can't take back. Cognitive problems are especially disturbing for college students, as they can result in "difficulty concentrating, studying, and making decisions." These are long-term health issues brought on by drunkorexia that can follow a college student for the rest of her life. That is, assuming that the student survives past the possibility of seizures, comas, and organ failure.
So it seems that a practice that may be approached lightheartedly is in fact a very serious problem that doesn't just stop with fun (and possible weight loss) one night. Used as a regular practice, drunkorexia can scar you for life and even end in death. And although the long-term effects are certainly frightening, the short-term possibilities of drunkorexia aren't incredibly easy hurdles to get over, either. Just one night of drunkorexia can have serious consequences, with higher levels of intoxication and starvation putting students at risk for dangerous behavior. At high levels of intoxication, students lose the ability to make good decisions, which can lead to dangerous situations like having unprotected sex, or even being involved in a rape, driving drunk, and becoming injured as a result of stunts, fights, or simply an inability to function properly. In addition to these risks, just one night of intense drinking on an empty stomach can lead to blackouts, hospitalization, and death from alcohol poisoning. Clearly, drunkorexia has serious and lasting consequences, even for students who aren't repeat offenders.

Drunkorexia is a scary situation for any college student, but for women, the problem is compounded. Female students are not only more prone to engage in drunkorexia, but they are also at a higher risk of problems from its effects. Dr. Valerie Taylor, chief of psychiatry at Women's College Hospital in Toronto indicates that female college students are more likely to engage in drunkorexia due to social pressure to stay slim. Even worse, female students are more likely to experience higher effects (meaning: reach alcohol poisoning and organ damage faster) because women metabolize alcohol faster than men. These facts combined with a higher risk of sexual assault mean that girls in college are hit with an even scarier drunkorexia situation.
How did things get so bad? It's one thing to have an eating disorder, and another to have a substance abuse problem, but combined, they're an incredible problem to overcome. Dr. Bunnell, former president of the National Eating Disorders Association, says that college students often suffer from an obsession with being skinny, while at the same time noticing the social acceptance of alcohol and drug abuse. In a world where celebrities checking into rehab is a regular practice and can even be "downright chic," it's not hard to understand why college students, especially female students, might think that drunkorexia is OK. But on top of social pressures, psychologists share that eating disorders may also be rooted in deep emotional pain. Alcohol, binging, and purging can provide an outlet for mental anguish, including childhood traumas like sexual abuse and neglect.
Such deep problems don't often come with an easy cure, and in some cases, require hospitalization and rehab. Judy Van De Veen suffered from eating disorders for years, and also took up drinking in later years. Things got so bad, she had to join a 12-step program and spent two years in and out of rehab, which cost her $25,000 out of her own pocket. None of them helped, but after becoming pregnant and joining support groups to address her daughter's caloric needs, she found an "excuse to eat" and be happy about it. Although Van De Veen's case is an extreme one, it offers a cautionary tale for students who are engaging in drunkorexia. Without help, things can go too far, resulting in a problem that can haunt you for decades, cost thousands of dollars, and even put your future family at risk.
We hope it's clear by now that drunkorexia is not harmless and is actually quite dangerous to the lives and long-term health of college students. So what can you do to avoid it and stop the practice on campus? FastWeb points out that college is a great place to simply ask for help. There are resources on every college campus to deal with not only alcohol abuse, but also eating disorders. College counselors are there to help, and your student fees have already paid for the visits. If you or a friend are suffering from drunkorexia, don't hesitate to speak up and get help while you still can. Be supportive with friends who may have a drunkorexia problem, offering positive reinforcement as well as fun alternatives to drinking, like movies and going out to dinner. It's also a good idea to set a good example by making responsible decisions with alcohol or avoiding it completely.

November 21st, 2011 written by Site Administrator

What does it mean to live in a nation where one out of every three people is obese?

My response to this NPR query:
"My brief response to this question:
What does it mean to live in a nation where one out of every three people is obese?

It means that daily there are millions of people who are being subjected to bullying and harassment due to the stigma of obesity.  Due to lack of awareness it has now become acceptable to discriminate against an entire group of people.  This reminds me of when educated people thought it was perfectly acceptable to discriminate against people of color.

Another piece that is not understood is that there are healthy obese people and unhealthy thin people.  Yes, this is true.   Regan Chastain of www.danceswithfat.org says it so well: "The idea of "healthy weight" is a dangerous one. Health is multi-dimensional and includes past and current behaviors, genetics, environment, stress and access. There is no weight that someone can achieve that will make them healthy. If we want to have a real discussion about health, especially when dealing with the sensitive subject of eating disorders, we need to take weight out of the discussion completely and talk about health."

When we look at what the Health At Every Size community has learned it just does not make sense to make weight the goal in having good health but instead aim for creating health and let the weight land where it may. This took me a long time to understand but as I have read the work of many dedicated researchers I understand it now.  This takes compassion and not shaming fat people.

My biggest beef with this is that we have a worldwide epidemic of eating disorders and this anti-obesity war is only making that worse.  People with eating disorders have so much body shame and dysmorphia already and hearing this constant message that "FAT IS BAD" only adds fuel to the eating disorder.

The bottom line is that living in a nation where one out of every three people is obese means we must have compassion, work hard to find answers and learn from people who are actually helping people living with obesity.  We do have answers and bullying, shaming and war are not the answer. "

No More Stigma Around Eating Disorders

This is my dream - that one day people will freely talk about eating disorders as we NOW freely speak about breast cancer or autism.  There was a time (not very long ago) that people didn't say the words, "breast cancer" because it was embarrassing.  Parents were shamed for having a child with autism - so they hid it.  These families have broken the silence and we have all seen how powerful it has been. 

Every where we look we see pink as companies and organizations support the fight against breast cancer.  Big NFL players sporting pink towels, gloves, shoes, etc.  A bridge in Australia all lit up in pink.

It has been a long time coming and now, thanks to the F.E.A.S.T. organization, the families of those with eating disorders and the professionals who support us are coming out and speaking up!

I shared my thoughts on the F.E.A.S.T. Symposium website  http://www.feast-ed.org/Alexandria2011.aspx
 “For me this symposium is the historic moment in which the trumpets blare and the world gets to know more about these complex life threatening illnesses.  For years I have been looking forward to the moment when we as advocates can launch the awareness campaign that will make eating disorders a household word.  Families of those with breast cancer and autism for example, have done an impressive job of creating world wide awareness as well as raising funds for those illnesses. This time has come.  I hope you’ll join us and attend this historic event.”

My dream is coming true.  We are being given not only permission but it is being requested of us to speak up and speak out about these most deadly of all mental illnesses.


I'll be there and hope you will join us!  I will have the privilege of moderating a Q and A with Dr. James Lock of Stanford University.

Eating Disorders and Older Women

This article will appear on the Aging But Dangerous website shortly.  I wanted to share it with you here first.  Becky

Eating Disorders Consuming Older Women

Many of us, including health professionals think of an emaciated young girl with anorexia when we hear of an eating disorder. First of all, anorexia is the least common of all eating disorders. These deadly illnesses exist on a spectrum from anorexia (AN) and bulimia (BN) to Eating Disorder Not Otherwise Specified (EDNOS) which includes Binge Eating Disorder (BED).

I found out the hard way (when it took two years to get my daughter diagnosed) that health professionals often aren’t taught that people with eating disorders come in all shapes, sizes, colors, genders, nationalities, socioeconomic backgrounds and AGES.

Not all skinny people have eating disorders.

Not all fat people have eating disorders.

Some “normal” size people have eating disorders.

It is common for women over age 50 to feel dissatisfied with their bodies and report feeling “fat” to the point it is now “normal” to dislike our bodies.  An example is from a friend of mine who developed terminal cancer and began shrinking. Once she had reached a much smaller size she told me one good thing about cancer was that now she was thin.  Sad.

I have to wonder if a doctor was shown photos of my friend, one when large and one small-a year before she died, which they would believe is the “healthy” one.  I’m certain most would choose the smaller size.  Wouldn’t they be surprised to know she was very unhealthy—dying actually.

I can’t help but see the irony in our societal views.  A fond childhood memory is sitting on my great-grandmother’s cushy lap and feeling like I was on a soft fluffy cloud. To me she was perfect. To the rest of the world she was a fat old lady.

Books on the subject:
A Girl Called Tim - Escape from an Eating Disorder Hell by June Alexander – Australian author, international eating disorder advocate http://www.junealexander.com/

Healing Your Hungry Heart by Joanna Poppink, MFT http://eatingdisorderrecovery.com/

Lying in Weight: the Hidden Epidemic of Eating Disorders in Adult Women by Trisha Gura http://www.trishagura.com/gura-author-book.htm

When we as society stop looking at the outside and start looking at souls and what is on the inside we will all become stronger and better.

If you care about anyone with an eating disorder and want support please check out our fall tele-class series and our Date Without ED opportunities at  http://www.JustTellHerToStop.com

Becky Henry

President, Hope Network, LLC

National Award Winning Author of: Just Tell Her to Stop: Family Stories of Eating Disorders – Available at http://www.JustTellHerToStop.com
Coachbeckyhenry.blogspot.com
http://www.facebook.com/HopeNetworkBeck