A Reflection on BMI | Part 2 – BMI Report Cards

A Reflection on BMI: Part 2 BMI Report Cards
By Laura Cipullo Whole Nutrition Services Team

Screen shot 2014-06-07 at 11.59.22 PM

Just to recap what we learned in Part I, BMI is a measurement based on an individual’s height and weight. It is used on a scale to reflect one’s status as underweight, normal and underweight. While using measurements is essential for statistical reasons and diagnostic tools, BMI is being utilized as a marker of health rather than focusing on behaviors and a cluster of measurements. We have said it before and will say it again; BMI is only one measurement and it’s not always reflective of a person’s state of health.

 

After collecting all of this information on BMI, does this change how we look at it for our growing children and adolescents?

 

Adolescent bodies, the time of development just after childhood, are growing at a rapid pace. Mentally and physically. Teens deal with an increased level of hormones in their bodies, which contribute to the many different growth spurts they will endure. They struggle with self-identity and the desire for independence. This combination often causes teens to be deeply self-conscious, which can inhibit decision-making. It could cause them to become defiant and often times unresponsive to parental guidance.

 

Puberty arrives at different times, stages and intervals for every child but usually happens around age 11-14. On average, teens experience a 20-25% growth increase during this time—35 pounds for girls and 45 pounds for boys. In an average one-year spurt, girls grow roughly 3.5 inches and boys about 4 inches. Using a measurement such as BMI, which is already so marginalized to determine the health status of a rapidly changing youth seems counterproductive.

Screen shot 2014-06-07 at 11.53.57 PM

Over the past few years, you may have heard of BMI Report Cards or, as they are more harshly referred to, “Fat Letters.” They are letters sent home from schools reporting on a child’s BMI and suggesting to seek out a physician if results are above normal. Needless to say, parents did not respond well to this. It caused a national outrage. In 2004, Arkansas was the first state to send BMI report cards home to parents and/or guardians. Children and adolescents with a BMI indicating they were “overweight” were suggested to consult a health care professional. Today, the program is implemented in over a quarter of United States school districts.

 

A cover story from the New York Post last week chronicled (with pictures!) this same concern. Click here to read the article in full and see the letter that a young girl was sent home with from the NY Department of Education. Unfortunately, this is happening with more regularity in New York City schools than the article chronicled. It isn’t just front cover news; a friend of ours recently received “obese” range marks for two of her three children who are nowhere near overweight. Now it becomes clear that we cannot possible classify these kids as overweight or underweight without taking into consideration other factors such as fat distribution, family history and the child’s behavior. This leads us to a very important question—if BMI calculates the relationship between height and weight, in a time when height and weight are rapidly changing at different paces and intervals, how can we justify using this as a determinant of adolescent health?

 

Knowing everything that we know about BMI, is this really something that will be beneficial for children and adolescents? Shouldn’t we be focusing on their habits through this time to pave the way for a lifelong positive relationship with health and food?

 

Perhaps even more important, we should be considering how these letters impact the children receiving them. We know that adolescence is the time that individuals are molded into adults. So what happens when a child is told they are fat? A recent article published by the LA Times discusses a study at UCLA that researched this question. Their data reflects “10-year-old girls who are told they are too fat by people that are close to them are more likely to be obese at 19 than girls who were never told they were too fat.” (LA Times, Deborah Netburn) The research goes on to emphasize the danger of “Weight Labeling” at this age. With our understanding of adolescent development, it’s easy to see why.

 

The major flaw with BMI calculations continues to be that it cannot tell you an individual’s habits. Those high in muscle weight are considered overweight, petite individuals are underweight and normal range individuals could be harboring unhealthy eating habits. BMI is limiting. It doesn’t ask the big questions; have you started menstruating? Are you feeling pressure to experiment with drugs, alcohol, cigarettes, or sex? How often do you think about food? Are you eating a balanced diet? These are the thoughts and habits that, overtime, determine the health of an individual.

 

Has your child received a BMI report card known as a Fitness Gram? What are your feelings concerning weight stigmas and children?

 

For more information on this subject, check out the Academy of Eating Disorder’s stand on BMI reporting in schools and Examiner’s take on Fitnessgrams.

A Reflection on BMI

A Reflection on BMI
Part 1 – In The Media
By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team

Photo Credit: Barbara.K via Compfight cc
Photo Credit: Barbara.K via Compfight cc

We’ve been hearing a lot about BMI recently in news. Between The Biggest Loser controversy and a recent article recounting a Yale student’s struggle with her school’s perception of health, BMI seems to be the hottest new weight assessment. Mom Dishes it Out covered BMI in 2012 (the article can be accessed here) emphasizing the importance of good and healthy behaviors over the use of a flawed scale of measurement. Since then, we found that it continues to be used in the media as a fact determining obesity. But what does BMI really tell us about our bodies? Body Mass Index—or BMI—is a measurement of body fat based on an individual’s height and weight. To determine your own BMI, you can use this easy equation.

BMI = weight (kg)/ height (m)2 

Screen shot 2014-05-12 at 12.11.39 PM

Determining BMI is not specific; it’s general. An individual’s BMI is just one part of the puzzle when health care professionals work towards improving an individuals habits and it should not be used as the sole determinate to suggest that an individual is either under or overweight. It is merely a clue as part of a larger nutrition and health assessment.  In recent years, the parameters for BMI have changed, causing more people to fall into certain categories.

Consider this – muscle weighs more than fat. So are Tom Brady, Michael Phelps, and many of the female Olympic gymnasts overweight? Their BMI says yes, though we know this is not the case. Bodies come in all shapes, sizes, and masses and it is important to remember this.

The fueling argument behind The Biggest Loser contestant, Rachel Frederickson’s, weight controversy was her BMI of 18, a value considered just underweight and malnourished. Without considering her BMI, it’s easy to understand how and why a driven and competitive individual involved in a nationally televised weight-loss competition (who would win $250,000) would be so intent on dramatic weight loss. However, we don’t think her weight was healthy. But not because of her BMI, rather her report of exercising 6 hours a day while only consuming 1600 kcals daily in addition to losing 266 pounds in such a short period of time. This is not realistic to continue nor healthy for a lifestyle. If an Olympic athletic were in training, they may exercise for so many hours but they would also be likely consuming 4000 kcals/day. Since the final weigh-in, and after resuming her “normal lifestyle” with the tools she learned from the show, Rachel has a BMI of about 20.

What is more important to consider, is that she reports she is finding time to exercise everyday for about 60 minutes. She loves cooking and is enthusiastic about her meals. She has a renewed sense of her athleticism. She has invested in behavior modification and it is working for her. Instead of using her BMI as a tool to ask the larger questions, we used it’s against her stating that is was a fact that she was unhealthy and now that her BMI is in normal range it is a fact that she is healthy. When, in reality, none of us truly have access to that information. Particularly since none of us know the mental and physical impact that social scrutiny had on her—that’s certainly not information we can get from her BMI. We wonder, is she menstruating, is she thinking about food all of the time or some of the time? We don’t need Rachel to answer these questions, but rather, for us to understand that a mid-range BMI and decreased exercise still does not equate health. More questions need to be answered.

Photo Credit: -Paul H- via Compfight cc
Photo Credit: -Paul H- via Compfight cc

A similar scandal arose when Yale student, Frances Chan, reported in an article later picked up by the Huffington Post, that Yale was forcing her to gain weight, at risk of mandated medical leave from school, based on her BMI. Chan, 5’2” and 90 lbs has a BMI of 16.5. Says Chan;

The University blindly uses BMI as the primary means of diagnosis, it remains oblivious to students who truly need help but do not have low enough BMIs. Instead, it subjects students who have a personal and family history of low weight to treatment that harms our mental health. 

While we are given access to Chan’s height and weight and, therefore, her BMI—she is not our patient. We do not have her medical history or understanding of her body’s development overtime. Most importantly, we are not made aware of Chan’s habits and behaviors. With all of that said, her BMI is quiet low. This is a red flag to health professionals suggesting they dig deeper into one’s medical status and mental health to determine if there is an issue, perhaps behavioral, that needs addressing. Chan suggests that Yale used her BMI as the sole determinant during her nutrition intervention. Whether or not an intervention was required remains unclear to us, but we would hope that more than one’s BMI will be used in future assessments and they would take into account her medical status, her mental health and her behavior/habits.

The above scenario is particularly true when visually assessing others. The point here is size is not the only measurement of health especially that of BMI. Some people qualify as healthy with a BMI of 20 yet their behaviors say otherwise by implementing dietary restriction, smoking, over exercising and even purging. While others, with a BMI of 26 could be healthy, exercising, not smoking, and eating normally yet be considered overweight. The same holds true for someone in the extreme margins of BMI. There are many nutrition clients that we have counseled with BMI’s greater than 29 who have made dietary and lifestyle behavioral changes yet their weight does not reflect the media’s representation of health. And so the same goes for someone who is naturally thin and healthy. For women, regular menstruation, adequate nutrition intake and lack of food thoughts/obsessions along with a normal blood pressure, EKG and more, may be a better indicator of true health. So don’t judge a book by its cover.

Stay tuned; there is more information to come about BMI and how it is being used in our culture and society.

Aging Nutritionally and Gracefully

Aging Nutritionally and Gracefully
By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team

 

If there is one thing working against us when it comes to aging it’s..…TIME. It is true that as we get older, we age. While we can’t turn back time, we can try to keep our bodies as healthy as possible to help us feel better, stronger, and more energized. Here are three of our favorite books that discuss diet, health, and lifestyle recommendations that can help you feel younger by keeping your mind and body in a state of wellness:

 Screen shot 2014-03-23 at 12.49.31 PM

You Staying Young- by Dr. Roizen and Dr. Oz

This book describes the aging process in a fun, easy-to-read way. It does an excellent job of intertwining medicine and nutrition. It has tons of useful tools like the YOU Tool 2 “Ultimate Work Up”-a fantastic list of tests you should be sure to inquire about at your next doctor’s visit. You also offers a 14-day plan that includes dietary changes, exercise routines, meditation, and relaxation plans. This book reminds you that caring for the mind and body together are equally important. It also includes interesting little known facts. For example Roizen and Oz note that you should remove your dry-cleaned clothing from the plastic-wrap, as soon as you get home to prevent the chemicals from becoming trapped.  There is a great chapter on other toxins that you may find in your environment as well. I am going to head to my closet right now to remove the plastic from my dry-cleaning.

 Screen shot 2014-03-23 at 12.49.46 PM

Younger Next Week- Elisa Zied, MS, RD

In Younger Next Week , my colleague registered dietitian Elisa Zied points out that crash dieting is not the solution to aging. In fact she explains that crash dieting increases cortisol levels, leading to both weight gain and aging! Zied’s 7-day vitality plan offers manageable ways to make permanent lifestyle changes that can lead to improved health and wellness. This plan is supposed to be repeated weekly so that it eventually becomes a lifestyle. Elisa states “it’s about finding a sustainable balance in your food and food choices” (Page 189). Finding balance, not only in food choices, but also in our schedules is important. Elisa offers countless examples of structured meal plans, tasty recipes, and creative “stressipes” to get you started on living a more balanced life. I am really excited to try Strawberry-Walnut Cinnamon French toast (Page 216) for breakfast next weekend!

 Screen shot 2014-03-23 at 12.52.05 PM

Eat, Drink, and Be Healthy- Dr. Willett

This book may look intimidating at first, but when you crack it open it has some very practical advice. Eat, Drink, and Be Healthy: Harvard Medical School Guide to Healthy Eating is one of my favorites! Dr. Willett provides a review of some of the quick-fix diets and why they do not work. He also includes his own version of the USDA pyramid, which I find to be very useful. This is a great book if you want to learn about nutrition science. This book focuses more on the diet component of lifestyle changes and includes some really wonderful recipes, menus guides, and cooking tips to help you feel comfortable trying new ingredients. This book may be a little more of challenging read than our other two recommendations, but it is certainly worth it.

 

Ultimately these books can aid the work you are doing with your RD and/or MD. Remember to help yourself feel your best, make small daily changes in your life. Think balance not CONTROL! Aim for the middle ground – “The Grey Zone” – the healthy diet mentality should steer clear of black and white, all or nothing thinking. Healthy diets are learning which foods work for you. Try to think of these foods as  “everyday” foods and  “sometimes” foods, when meal and snack planning. Choose to exercise to help your bodies physically and mentally, not just to lose weight. Take time to relax  – again both physically and mentally!! Oftentimes quick fixes may be appealing when trying to become healthy, but this typically ends up backfiring. Instead, consider taking small manageable steps, such as meditating for one minute each night, to achieve permanent behavior change.

 

Want more information on nutrition and aging? Check out this recently published article by the Nutrition Society:

Jessica C. Kiefte-de Jong, John C. Mathers and Oscar H. Franco. Nutrition and healthy ageing: the key ingredients . Proceedings of the Nutrition Society, available on CJO2014. doi:10.1017/S0029665113003881.

What Eating Right Means to the Future of Nutrition!

In honor of the Academy of Nutrition and Dietetic’s National Nutrition Month, we wanted to share our views on eating right. Read what eating right means to the women who make up the team of dietetic interns at Laura Cipullo Whole Nutrition Services: 

IMG_0842

Courtney Darsa
Dietetic Intern at University of Delaware

When someone asks me how I define eating healthy, many different things come to mind.  Consuming a balanced diet that contains plenty of fruits and vegetables, whole grains, lean protein, and low fat dairy products, is only part of my definition.  The most important part of healthy eating is to have a positive relationship with food.  When a person enjoys the food they are eating, it can become a big surprise as to how much more satisfying eating can truly be.  Developing a positive relationship with food is not as easy as it sounds.  When you slow down to eat a meal, it becomes easier to savor and enjoy the flavors of the particular food you are eating.  This gives your body the time to recognize whether or not it is still hungry.  Another definition for this is Mindful Eating.

Mindful eating is defined as eating with awareness.  It is a great way to measure healthy eating because there is no right or wrong answer.   It is about realizing that each individual’s eating experiences are unique and cannot be compared to any other person’s experience.  Mindful eating is about listening to your body’s cravings and satisfying them.  It is about recognizing that there are no “good or bad foods”, eating food in moderation is important.  Yes, there are foods that contain more vitamins and minerals than others (these foods should be eaten more often) but it does not mean that foods that do not contain as many nutrients should be restricted.  Healthy eating is all about balance and listening to your body’s wants and needs.  By developing a healthy relationship with food, you will be come surprised as to how much more enjoyable your eating experiences can be!

banana walnut yogurt parfait MDIO

Laura Iu
Dietetic Intern at NewYork-Presbyterian Hospital
Instagram: @dowhatiulove

As an alumna of NYU and now a dietetic intern, I’ve realized that studying in the nutrition field by no means makes me perfect in the way I eat; but the way I eat is perfect for me. I’m at my happiest and healthiest when I’m able to cook my own meals, which I prefer to do instead of dining out. I love knowing exactly what ingredients are going into my food which helps me eat healthier, and being in the kitchen is my go-to de-stressor. With every new experience, my definition of “healthy” is evolves. To simplify what “healthy” means to me, I’ll begin by telling you what “healthy” is not. Healthy is not about eating only low-fat foods, low-calories, or feeling guilty after enjoying something tasty. In fact, healthy means not feeling hungry, guilty, or deprived. Being healthy does not mean one must follow a specific diet (i.e. vegetarian, vegan, paleo, etc.) and it also doesn’t mean it must be expensive or the food always organic.

Eating right and being healthy is a balancing act! It requires us to embrace all foods in an amount that makes us feel good, fitting in physical activities for enjoyment, setting aside time for yourself to de-stress, or simply sleep! It’s about nourishing our bodies with wholesome foods—so that we’re not just satisfied, but also energized to live to the fullest today and to another tomorrow—for the people we love, the things we love to do, and most importantly, for ourselves.

granola-640x480

 

Valery Kallen
MS Candidate at New York University

Eating “right” means nourishing both my body and my mind. When I think of food, I don’t just think of calories or nutrients – I think of the whole mind/body connection. So when I try to eat healthy, it’s not just to maintain a certain weight, it’s also because I know that I will feel stronger, more focused, and more at peace with my food choices. And that doesn’t mean depriving myself either; it means eating mostly whatever I want, in moderation. So if I feel like having a scoop of ice cream while watching a Saturday night movie, that’s eating “right” to me. Eating healthy means not feeling guilty about the foods you eat. There are no good foods versus bad foods – it’s not a superhero comic book! When you eat a wholesome, balanced diet the majority of the time, you’ll find that you no longer feel shame over eating the occasional cookie, or two. And there’s something very “right” about that.

IMG_0995

Lindsay Marr
BS Nutrition and Dietetics, New York University

In my opinion, eating right doesn’t have to mean deprivation or limitations. In fact, I believe it means the opposite. Eating right is striving to eat all foods in moderation. As both a nutrition graduate and a person with dietary restrictions, eating right is very important to me. Throughout my time as a nutrition student, I worked to maintain a healthy diet filled with wholesome ingredients and balanced meals. To this day, I continue to do so. My version of eating right means reading labels on the foods I buy to ensure the ingredients are safe for me and checking the quality of the products I eat to be sure I am eating the most nutritional items. I eat a diet rich in fresh foods and make sure to enjoy all foods. Eating right is more than aiming for a certain number on a scale or looking a certain way: it is important to maintaining our health. I eat right to fuel my body with the necessary nutrients it needs to thrive. I eat healthfully to feel good now and to continue to feel good later in life. Most importantly, I eat right to enjoy life.

IMG_1159

Alyssa Mitola
Dietetic Intern at New York University

Eating right is all about balance, a balance of flavors, tastes, culture, and nutrients. I believe it is essential to nourish your body with adequate nutrients. It is also important to enjoy your food and feel satisfied. When feasible, I love to eat fresh wholesome foods. We are lucky that nature is abundant with so many delicious choices. There is nothing like a fresh tomato in season or a ripe apple picked straight off the tree. But it is important to remember that no food should be off limits when “eating right.” I believe we should eat with intent and take time to enjoy the smells and flavors of the food we eat. Living in NYC, one of my favorite things to do is taste cuisines from all over the world. It amazes me how similar ingredients can be made into so many different dishes. I love discovering new foods and flavors each day. Food and eating not only fulfill essential biological needs, but also social, psychological, and cultural needs. For me, eating right is about understanding all aspects of food and cultivating a healthy relationship with food. Eating right means purposefully choosing foods to fuel one’s mind, body, and soul! Happy National Nutrition Month!

 

I'm Blogging National Nutrition MonthTo learn more about the Academy of Nutrition and Dietetic’s National Nutrition Month, please click here to be redirected to their NNM Page. 

A Look Back at 2013

We covered a number of topics this past year, from hangover remedies, hydration, gluten, and positive body image. 2013 was a great year and we can’t wait to see what 2014 has in store for EALM and our readers. To take a trip down memory lane, we compiled a Table Of Contents of our 2013 blog posts. We hope you enjoy this blast from the past and we wish you all a healthy and happy 2014!

Screen shot 2013-09-25 at 4.33.12 PMJANUARY

Hangover Remedies

The Pros and Cons of Being a Vegetarian Fitness Enthusiast

6 Nutrition Trends of 2013

What a Difference a Title Makes: Nutritionist vs. Dietitian

4 Smart Superbowl Swaps

Photo Credit: prideandvegudice via Compfight cc
Photo Credit: prideandvegudice via Compfight cc

FEBRUARY

The Feast on Fat Tuesday for those Who Don’t Cook

Boosting Positive Body Image

Love Your Heart with 8 Heart-Healthy Foods

Power Up with Phytochemicals!

MARCH

My Exercise Allergy

Protein, Fiber, and a Booty Barre Class? Sign Me Up!

All About Gluten: Your Questions Answered

Calcium and Vitamin D

Photo Credit: Alex E. Proimos via Compfight cc
Photo Credit: Alex E. Proimos via Compfight cc

APRIL

Spring Training…Let’s Head to the Races!

Genetically Modified Foods

Healthy in the Mind and the Body

Super Foods Super Expensive

Olive Oil, Extra Virgin, or Cold-Pressed…What’s the Difference?

Photo Credit: mischiru via Compfight cc
Photo Credit: mischiru via Compfight cc

MAY

How to Eat Your Water and Stay Hydrated

To Prevent Kidney Stones

Is Your Favorite Organic Restaurant Actually Organic?

JUNE

How To Choose Safer, Sustainable Seafood

Fun and Easy Outdoor Activities for Father’s Day

Sprouted Grain Bread vs Whole Wheat Bread

3 New Moves

Photo Credit: Admanchester via Compfight cc
Photo Credit: Admanchester via Compfight cc

JULY

Wheatgrass

Vitamins: The Basics

Fish Oil Linked to Prostate Cancer?

A Day at the Beach: So What’s for Lunch?

Join the Challenge on Food Waste

AUGUST

Nuts

Breakfast, the Most Important Meal of the Day

Is Greek Frozen Yogurt Everyone’s Answer to Dessert?

10 Foods to Help You Fuel Your Day

SEPTEMBER

Workout from Within

New FDA Ruling Making Waves in Gluten-Free Community

How to Feed a Fast!

National Celiac Awareness Day

Contrary to Popular Belief – Men, Also Suffer From Eating Disorders

OCTOBER

What’s the Story with GMOs?

“Shattered Image”: An Interview with Brian Cuban

The Latest Diet Recommendations for Breast Cancer

Healthy Snack Options for Diabetics

Prostate Cancer: News and Recommendations

Canola Oil: Is It Healthy?

NOVEMBER

Should Your Oil be Cold-Pressed?

What Exactly is Diabulimia?

5 Simple Tips for a Simply Healthier You This Holiday Season

The Art of the Bliss Point

DECEMBER

Out with ORAC

Eating in “Peace”

Eating Healthfully When Gluten-Free

Happy and Healthy Diabetes-Friendly Holiday Meals with Dessert!

Nutrition Trends: 2014 Edition

5 Simple Tips For A Simply Healthier You This Fall Holiday Season

5 Simple Tips For A Simply Healthier You This Fall Holiday Season

Laura Cipullo, RD, CDE, CEDRD

 

Autumn typically means cooler, darker days, busier schedules with school and work, oh, and we can’t forget about all of those holiday parties. When things get busy, to-do lists get longer, calendars fill up and our self-care can slip further and further down our priority list. Thankfully, there are some simple changes to re-prioritize and maintain or even improve your well being.

Photo Credit: AlphaTangoBravo / Adam Baker via Compfight cc
Photo Credit: AlphaTangoBravo / Adam Baker via Compfight cc

1. Connect Food and Mood: After eating a meal, think does this make me feel comfortable, give me energy and improve my mood?

    • If the answer is no, you need a new comfort food. A great resource is to reach for my Diabetes Comfort Food Cookbook, filled with 200 healthy and comforting recipes.
    • A good tip to remember is that comfort food is meant to make us feel well, not sick and lethargic. So choose a food that will make you feel content, and increase your energy levels. Be sure to be eating when you are hungry.

 

2. Think brown for fall: Switch to brown bread and brown grains to get less processed, more wholesome natural fiber in your diet. This is also great for those favorite holiday recipes. Consider swapping white bread for a whole-wheat variety in a stuffing recipe to add more Vitamin B and Vitamin E, plus natural fiber. Or swap all-purpose flour for whole-wheat flour in your homemade baked goods. Here are some tips to go brown this holiday season:

    • Buy grains in bulk to really save money.
    • Be weary of the sugar content: choose grains with no added sugar.
    • Hello comfort food: whole grains can make a great comfy side dish. Whole-wheat pasta, brown rice, and quinoa all make wonderful sides.

 

3. Warm up! Fat is essential for body temperature regulation. Keep warm this fall and replace saturated fat and trans fat like margarine with heart helpful fats known as MUFAs (monounsaturated fatty acids). Here are some suggestions to help you stay warm and healthy.

    • Choose canola oil or olive oil.
    • Spread natural peanut butter rather than butter. (Hint: opt for a brand with minimal ingredients, only peanuts and/or salt is ideal).
    • Skip the cheese, avocado please! Swapping avocado for cheese increases your intake of heart-healthy MUFAs, B vitamins and even potassium.
Photo Credit: Chris Blakeley via Compfight cc
Photo Credit: Chris Blakeley via Compfight cc

4. Say Goodbye to Calorie Counting: Log hunger and fullness cues in a food log, not calories! This is the best way to learn if you are eating the right amount for you.

    • Log food, feelings and behaviors to identify obstacles to self-care and healthy habits.
    • Identify if you are eating for physical, emotional or behavioral reasons. Ideally you want to aim to eat for physical reasons.
    • If you are always full or just not hungry but find yourself eating, seek alternative comfort or distractions – find a new hobby or fun workout class to distract you. Even better learn to sit with your feelings. They will pass.

 

5. Carpe Diem!! Last but not least, relish the happy moments this holiday season. We know that the holidays can be stressful and hectic, but they are also a great time to catch up with family and friends. So relax, find positive moments and take deep breaths. You deserve it!

“Shattered Image”: An Interview with Brian Cuban

“Shattered Image”: An Interview with Brian Cuban
By Laura Cipullo, RD, CDE, CEDRD and the Laura Cipullo Whole Nutrition Services Team

Screen shot 2013-10-06 at 4.09.10 PM

Weight Stigma Awareness week just passed and Laura joined her iaedp NY team at NEDA’s walk for eating disorder awareness this past Sunday. To continue raising awareness, here at EALM we are sharing a very honest and intimate interview with Brian Cuban, lawyer, author of Shattered Image, and brave individual who is sharing his own story of body dysmorphia.


1) How old were you when you realized that you suffered from BDD (Body Dysmorphic Disorder)? And could you describe what BDD is, from a patient’s perspective?

I was in my 40’s before I knew [BDD] had a name. While the disorder has been around for 100 years, BDD has really only been studied “mainstream” in the last decade. From my personal perspective, it was exaggerating the size of my stomach, love handles and the loss of hair on my head to the point where it affected my ability to function and caused me to engage in self-destructive behaviors.

2) The documented number of men with eating disorders is increasing. Why do you think this is? Do you think our society and the field is offering more resources for men to seek support?

I think it’s because more men are coming forward and being diagnosed because of increased awareness. The increase in awareness makes it easier for a guy to not be consumed by gender stereotypes and stigma and be honest with his treatment provider or other trusted person. There are absolutely more resources. When I first started going through it in the early eighties there was virtually no awareness nor were there resources. I didn’t even know the words anorexia or bulimia existed.

3) Where does bullying fit in the “eating disorder and BDD spectrum”? Would you say bullying was a trigger for your EDO and BDD? Or is there a way to describe to readers how all of these: EDO, BDD, and Poly-substance abuse are all likely to fall in the same bucket?

Bullying is definitely one of the things that played a major role in the development of my eating disorder, especially when that bullying was related to appearance.  It was certainly that way for me. Can I say it was the only reason? No. There was also fat shaming at home. I was also a very shy and withdrawn child genetically. It is possible there was a pre-disposition to such behavior for me.

I started with a distorted image in the mirror. In my mind, if I could change that image to what, I equated, as something that would cause me to be accepted, then everything would be ok. For me, that was being thin at first. When eating behaviors did not work to change the image, I cycled into alcohol and drug abuse, and, eventually, steroid addiction.  I call it a “BDD Behavior Wheel” -constantly spinning with no end game until I addressed the core issues of the fat shaming and bullying I experienced as a child.

4) As a man who has suffered from an eating disorder, in what ways could an eating disorder impact a man’s life that may differ from a woman? (If any).

Gender specific health issues aside, I think the impact is probably the same from a social and day-to-day standpoint. Shame, isolation, health, and impaired achievement affect both men and women with eating disorders. It is society that views them differently. From a male’s “going through it’ standpoint, I suspect much is the same for both sexes.

5) Do you have any advice for moms and dads raising boys or what to look for in terms of signs that their son may be developing a negative relationship with food and body?

I try not to take the role of a treatment provider since I am not one. I can only speak for my behaviors. These are the behaviors I engaged in: trips to the bathroom with water and/or the shower turned on to hide purging, evidence of purging in the bathroom, scraped/bruised finger joints from purging, and eating tiny portions. I was eating less, staying below a specific number of calories per day. Depression, isolation and social withdrawal are big ones. Children don’t isolate themselves without a reason, something is wrong.

6) In addition to genetics and other environmental stimuli, what role do you think nutrition played in the development of your eating disorder and BDD? Was there a message of health versus thin in your house and if so how do you think this affected the ED/BDD?

Nutrition played a role in that it was something I had no context for. Healthy eating was not really something that was a huge topic of discussion in the early 1970’s. I honestly can’t remember whether it was a topic of discussion in my home. I think my parents did the best they could to provide a healthy food environment within the constraints of awareness of that era. I can say that I tended to not eat healthy because it soothed my loneliness and depression in the moment. This typically occurred during lunch and during the day.

7) In terms of eating – do you now practice intuitive eating, mindful eating and/or how would you generally describe your nutrition intake?

Currently I would say that I practice intuitive eating but, I have to admit, I go through yo-yo phases like many others. I actually consulted a nutritionist about a year or so ago and did pretty well with it, but I have gotten away from healthy/balanced eating more than I would like recently. It’s nothing that ties into my disorder in itself, its just life although when I gain weight because of it that can have an effect on how my BDD thoughts play out.

8) Do you have any words of wisdom to share with adolescents who may be struggling with similar issues?

You are not alone and you are loved.  Find a trusted person you can confide in. There is an end game of recovery and a great life if you can drop the wall of shame and self protection for one second and take one tiny step forward by confiding in those who love and care about you.  Don’t wait 27 years like I did. Do it now.

Shattered Image - BCuban

One of our lucky subscribers will receive a free copy of Brian’s book, Shattered Image!

First be sure you have subscribed to EALM and then you can submit more than one entry by doing any of the following.  Be sure to leave an additional comment letting us know you subscribed and liked us! Good luck!

  • Leave a comment here and  “Like us” on our Facebook page
  • Follow @MomDishesItOut and tweet “@MomDishesItOut is having a #Giveaway”

Giveaway ends on Sunday, October 20th, 2013 at 6:00PM EST.

Contrary to Popular Belief – Men, Also Suffer From Eating Disorders

Contrary to Popular Belief – Men, Also Suffer From Eating Disorders
By: Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team

Many people believe that the majority of individuals with eating disorders are female. However, recent studies are showing that this is not the case. Males, also, suffer from eating disorders. In fact, the amount of men facing an eating disorder may surprise you.

The National Institute of Mental Health has determined that an estimated 1 million men struggle with eating disorders or roughly 1 in 10 eating disorder patients is a male1. Researchers believe this suggests, not only that the incidence of male eating disorders is increasing, but the amount of men seeking treatment is also rising2.

Screen shot 2013-09-23 at 12.13.31 PM

A recent report featured in the Journal of Men’s Health and Gender found that a frequent behavior among males with eating disorders is a term called “Anorexia Athleticism,” or extreme and frequent exercise3. It is typical to see male eating disorder patients use excessive exercise to make up for their eating habits or on the other hand, exercising without enough food intake, resulting in possible starvation or Anorexia. Andrew Walen, LCSW-C, a psychotherapist specializing in male eating disorders, states that eating disorders can also stem from childhood bullying (A. Walen, LCSW-C, phone communication, September 2013). For example, a young boy who is bullied because of his weight may be prone to dieting to feel accepted by his peers. This can be a slippery slope that could potentially lead to an eating disorder.

According to NEDA, boys’ and men’s body images are formed by the “attitudes and beliefs that culture attributes to the meaning of masculinity, including the traits of independence, competitiveness,
strength, and aggressiveness. Those who do not conform to the culture’s ideal image tend to have a
lower self-esteem than those who do conform. When males fail to live up to these masculine expectations,
they feel emotionally isolated, and this leads to problem behaviors. These problem behaviors may take
the form of eating disordered beliefs and behaviors”4.

John F. Morgan, the author of The Invisible Man: A Self Help Guide for Men with Eating Disorders, Compulsive Exercise, and Bigorexia, states that if left untreated, male eating disorders can affect aspects of the man’s life, such as “interference with their work, social activities, or just meeting day-to-day responsibilities”5. “While the effects of an eating disorder don’t differ dramatically between males and females,” Andrew Walen explains, “males typically experience a deeper feeling of shame.” The male psyche has an “I can handle it” mentality and admitting the need for help can be difficult for men. There is often a sense of isolation for men, even in recovery (phone communication, September 2013).The good news is that the amount of resources for males with eating disorders is beginning to change with the increasing level of awareness.

Study authors, Kearney-Cooke and Steichen-Asch, state that in our modern day culture “muscular build, overt physical aggression, competence at athletics, competitiveness, and independence” are desirable traits for males, while, “dependency passivity, inhibition of physical aggression, smallness, and neatness” are often viewed as more appropriate for females6. Here at EALM, we encourage families to be very cautious and not fall prey to furthering this type of categorizing and or stereotyping of boys and girls. We ask parents to educate yourselves on eating disorder warning signs that your sons may exhibit.

Possible Warning Signs of EDO Young Boys:

  • Experienced a negative reaction to their bodies from their peers at a young age6.
  • Tendency to share a closer relationship with their mothers, in comparison to their fathers.
  • Dieting in response to being overweight, (whereas females begin to diet because they may “feel” overweight).
  • Likely to manage their weight through exercise and calorie restriction.
  • Fixated on building a muscular “shape,” or a certain look. They are less likely to be fixated on their actual weight on the scale.
  • Participate in the following sports: gymnasts, runners, body builders, rowers, wrestlers, jockeys, dancers, and swimmers. Are particularly vulnerable to eating disorders because their sports necessitate weight restriction. It is important to note that weight loss in an attempt to improve athletic ability differs from an eating disorder when the central psychopathology is absent4.

 In addition to the above signs, there are psychological and biological factors that may also be associated with eating disorders including, but not limited to the following:

  • A lack of coping skills or a lack of control over one’s life
  • Experiencing anxiety, depression, anger, stress, or loneliness
  • Having a family member with an eating disorder

If you feel that you, or a family member, may be suffering from an eating disorder, we’ve provided some suggestions from Andrew Walen:

Screen shot 2013-09-23 at 12.11.15 PM

  • Visit The National Association for Males with Eating Disorders, Inc.
  • Find a male therapist or find a program that understands the male perspective.
  • Get help wherever you can, educate yourself, and be sure to include your family.
  • Lastly, don’t let shame or your eating disorder voice tell you that you aren’t worth it, because you are.


Here are our recommended resources:

National Eating Disorder Association, NEDA

The International Association of Eating Disorder Professionals Foundation, iaedp Foundation

The International Association of Eating Disorder Professionals Foundation of NY, iaedpNY Foundation

The Eating Disorder Referral and Information Center

Diet, Detox, or Disorder – An article featuring Laura Cipullo

Screen shot 2013-09-25 at 1.19.21 PMIf you live in the NYC area, come join us on Sunday, October 6th in a walk to raise awareness of eating disorders at the NYC NEDA Walk. Click here to learn more.

 

References:

1. Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. 2012. Eating Disorders in men: Underdiagnosed, undertreated, and Misunderstood. Eating Disorders, 20(5), 346-355.
2. Striegel R.H., Rosselli F., Perrin N., DeBar L., Wilson G.T., May A., and Kraemer, H.C. Gender Difference in the Prevalence of Eating Disorder Symptoms. Intnl J of Eat Dis. 2009; 42.5: 471-474. Available at: http://works.bepress.com/ruth_striegel/24
3. Weltzin, T. 2005. Eating disorders in men: Update. Journal of Men’s Health & Gender, 2: 186–193.
4. Shiltz T. Research on Males and Eating Disorders. NEDA. undefined. Available athttp://www.nationaleatingdisorders.org/research-males-and-eating-disorders. Accessed September 20, 2013
5. Morgan, J. 2008. The invisible man: A self-help guide for men with eating disorders, compulsive exercise, and bigorexia, New York, NY: Routledge.
6. Kearney-Cooke, A., Steichen-Asch, E. 1990. Men, body image, and eating disorders. Males and Eating Disorders. 54-74.

Workout from Within

Before you reach for a bottle of vitamins, look for a more holistic approach with nutrition expert, Registered Dietitian Laura Cipullo.  Along with Jeff Halevy, Laura reveals a few key foods that are high in fiber, heart healthy, and offer a great source of omega-3 fatty acids. And if you’re confused about omega-3 or omega-6 fatty acids, Laura will also clarify the confusion. From olives to collard greens, tune in to find out which foods will help your start living a happy, healthy lifestyle!

Screen Shot 2013-09-02 at 4.30.03 PM
If you have trouble viewing Workout from Within – Girl’s Night In, click here.

Healthy in the Mind and the Body

You want to be healthy in the mind as well as the body, right? So do you think a gym is a place of healthy attitudes and positive role models? Unfortunately, it’s not always the best place for our mind or bodies especially when we are moving for the wrong reasons. Many times, I encourage my clients to move but fear they will get caught up in over-working their bodies, or triggered when their trainer or instructor give unsolicited diet advice or encourages more than one spin class a day. Well my colleague had the brilliant idea to create a training program to educate fitness specialists/trainers at the gym how to work with health seekers in a way that honors both the mind and body. This amazing training helps the gym employees to identify individuals with eating disorders and gives them tools to work with clients in a healthy way rather than encouraging the disorder. Read on to learn about Jodi’s Destructively Fit and perhaps think about whether or not your health club needs a little bit of Jodi’s energy.

By Guest Blogger, Jodi Rubin

Eating disorders have always been my passion. They have been my specialty since I began my LCSW private practice more than a decade ago. Over the years, I’ve directed a program for eating disorders, currently teach a curriculum I created on eating disorders at NYU’s Graduate School of Social Work, and have done a few other things. Yet, I have not found a way to connect my love of healthy fitness and honoring one’s body with my passion for helping those struggling with eating disorders.

The issue of eating disorders within fitness centers is a ubiquitous one. I’ve seen people spending hours on the treadmill, heard countless patients recounting their obsessiveness with the gym, and others seeming as though their self-esteem became immediately deflated if they couldn’t work out hard enough, fast enough or long enough. The research I have done has revealed that the presence of eating disorders within fitness centers is “sticky” and “complicated” and gets very little attention. Through no fault of anyone in particular, if people aren’t given the education and tools, then how can anyone feel knowledgable and confident enough to address this sensitive issue?

I went directly to fitness professionals to see what they thought about eating disorders within the fitness industry. As I suspected, it was clear that there was not a lack of interest in this issue. Quite the contrary. Most, if not all, of those with whom I spoke were eager and excited to finally have a forum in which they could learn about eating disorders and how to approach the issue. That’s when DESTRUCTIVELY FIT™: demystifying eating disorders for fitness professionals™ was born. I created this 3-hour training with the goal of educating those within the fitness industry about what eating disorders are and what to do if they notice that someone may be struggling. It has since been endorsed for continuing education by both the National Academy of Sports Medicine (NASM) and The American Council on Exercise (ACE) and has sparked the interest of variety of fitness clubs. Check out Destructively Fit™ in the news here!

Some stats for you…
• 25 million American women are struggling with eating disorders
• 7 million American men are struggling with eating disorders
• 81% of 10 year old girls are afraid of being fat
• 51% of 9-10 year old girls feel better about themselves when they are dieting
• 45% of boys are unhappy with their bodies
• 67% of women 15-64 withdraw from life-engaging activities, like giving an opinion and going to the doctor, because they feel badly about their looks
• An estimated 90-95% of those diagnosed with eating disorders are members of fitness centers

 

Read more about Destructively Fit™ on destructivelyfit.com. You can also follow Destructively Fit™ on Facebook and Twitter. Help spread the word and be a part of affecting change!