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The Nutrition Blog Series will take an in-depth look at the nutrition programs of our three eating disorder programs, Oliver-Pyatt Centers, Monte Nido and Clementine adolescent treatment program. This week, we hope to give a brief introduction to the programs and in the coming weeks, will offer a deeper understanding of what nutrition philosophy looks like at each individual program. 

Oliver-Pyatt Centers, Monte Nido and Clementine are three eating disorder treatment programs that operate with the same intention: To support individuals healing from eating disorders and to help them realize their potential of full recovery. That being said, we understand treatment is not a one-size-fits-all formula. Our three directors of nutrition come from the same underlying dietary philosophy that combines medically based research in the treatment of eating disorders with practices that help individuals learn to confidently nourish themselves independently. By understanding the slight differentiators that are practiced in all three facilities, it becomes easy to see that though the day-to-day may differ for clients from facility to facility, the fundamental reasoning for these different practices come from the same place.

Oliver-Pyatt Centers in Miami offers comprehensive, day treatment, transitional living and intensive out-patient programs for women seeking eating disorder recovery. Our program uses thoughtfully planned, supported food exposures to challenge food rituals, beliefs and judgments while building skills and laying the foundational understanding of the role hunger, fullness and satiety play in self-nourishment.  We work with a variety of mindful eating techniques, paying particular attention to hunger and fullness cues, while implementing a medically indicated and individually structured meal plans. Our hope is that this combination lays the groundwork for a future of intuitive eating as our clients move toward full recovery after discharge.

Monte Nido treatment centers offers residential, day and intensive outpatient programming and transitional living for clients seeking eating disorder recovery. At Monte Nido treatment centers, we work with our clients to support their nutritional, physical, and emotional health and wellbeing.  With treatment of the whole person as our guide, our initial goal is to build rapport with our clients, to gain an understanding of an individual’s challenges and to formulate an individualized treatment plan that promotes movement away from eating disorder ideals and towards whole health. Using thoughtfully planned, supported exposures to a variety of food and eating environments, active challenging of eating disorder behaviors, and individualized, structured meal plans, we work with our clients to support the development of the skills required for a life of conscious eating.

Lastly, Clementine is strategically structured for the treatment of adolescents with philosophies that pull from both of its parent programs. Our dietary practices are no exception; nutritional practices are based on research that is aligned with adolescent growth and development. We practice mindful eating techniques before and during meals and reflect after mealtime. There is an emphasis placed on healing the whole family through education, family food exposures and individual work with the family.

While on paper all three programs appear somewhat different, our objectives remain the same. In the next few weeks we’ll dive into the specifics of each program to reveal some more key similarities and differences between the three programs. Our first in-depth look at nutrition will be focused on Monte Nido programs and can be found here.

 

For more information about Oliver-Pyatt Centers, please call 866.511.HEAL (4325), visit our websitesubscribe to our blog, and connect with us on FacebookLinkedInTwitter, and Instagram.


Oliver-Pyatt Centers Clinical Director of Intensive Outpatient and Transitional Living Programs Giulia Suro, PhD will present at OPC’s First Wednesdays Series for Clinical Professionals on Wednesday, February 1st. Dr. Suro will share her expertise on “Using Acceptance and Commitment Therapy to Drop the Rope in the Context of Challenging Therapy Cases”.

Acceptance and Commitment Therapy (ACT) challenges conventional wisdom and overturns the ground rules of most of Western psychology. Within the framework of ACT, quality of life is dependent on mindful, values-guided action, regardless of how many symptoms you have. Applying an ACT approach in the context of complex pathology (e.g. personality disorders, trauma, eating disorders) provides an opportunity  to address the numerous and multifaceted factors that maintain the symptom presentation. ACT encourages clients to examine the function of their symptomatology from an objective and compassionate stance. Additionally, ACT techniques teach clients and clinicians alike how to live a meaningful and valued life in the presence of the most painful and unrelenting thoughts and feelings. For our February edition of First Wednesdays at OPC, Dr. Giulia Suro will provide a general overview of the theoretical underpinnings of ACT as well as specific clinical techniques to use in challenging cases.

Through this presentation, participants will be able to identify and define the six core components of the ACT hexaflex. Participants will learn techniques to illustrate the skills of diffusion and experiential acceptance in the context of thoughts and feelings associated with the eating disorder and to define the difference between a value and a goal in the framework of working with clients toward behavioral change.

Lunch begins at 12:00pm and the presentation will be from 12:30-1:30pm. One CE hour will be offered for PhD, PsyD, LMFT, LMHC, LCSW, LPCC and RD. If you would like to join Oliver-Pyatt Center’s First Wednesdays on February 1st, please RSVP to Florida Outreach Manager Callie Chavoustie at CChavoustie@www.oliverpyattcenters.com or RSVP here by Montday, January 30th.

For more information about Oliver-Pyatt Centers, please call 866.511.HEAL (4325), visit our websitesubscribe to our blog, and connect with us on FacebookLinkedInTwitter, and Instagram.

Mary Dye_MPH RD CEDRD LDN_Director of Nutrition Services

Oliver-Pyatt Centers Director of Nutrition Services Mary Dye, MPH, RD, CDN, LD/N shares about the Intuitive Eating Model in this week’s blog post. Mary gives insight into how OPC supports clients to lay a foundation of intuitive eating so that they are able to improve their relationship with food on their recovery journey. 

Sometimes, when eating disorder professionals hear of intuitive eating, they aren’t sure how this method can be incorporated into treatment at higher levels of care. The concept of listening to the body’s internal cues sounds like an ideal long-term goal for a person who has imposed strict and maybe even aggressive dietary guidelines on themselves. However, the reality for an individual living with an eating disorder, requires nutritional structure to ensure adequate nourishment and re-engagement of cues while working through all aspects of treatment. Oliver-Pyatt Centers’ nutrition programming, often referred to as an Intuitive Eating model, utilizes individualized, structured meal plans while assisting clients in increasing their awareness, understanding and ability to appropriately respond to innate cues with increasing autonomy over time. Throughout treatment, mindful eating practices and participation in thoughtfully planned, supported food exposures serve as the basis of each client’s journey toward the goal of full recovery, freedom and flexibility with food.

An individual with an eating disorder typically has little to no awareness, connection or ability to appropriately respond to their bodily cues. A key characteristic of the eating disorder is disassociation- a person comes to disregard their body’s hunger and fullness cues for so long that they forget what it feels like to be comfortably hungry for a meal and what it feels like to be satiated after eating. Our work is to reorient our clients with their own body’s language. As they work towards making peace with food, movement, and their bodies, we continually draw their attention back to their own experience- we ask them over and over again to describe what is happening in their body in the present moment. We do this first by having them assess their hunger and fullness on a scale of 0-10; zero being empty, and ten being painfully full. We also ask them to explore how these cues equate to emotional hunger and fullness. On empty, a person is experiencing cognitive deterioration or numbness, while when painfully full, the sensation is profound and distracting. During the initial phases of nutritional restoration, a client’s hunger and fullness cues are all over the scale and this can be confusing and quite anxiety provoking for the individual. However, as the body is restored to health and becomes accustomed to the routine of the meal plan laid out by the nutritional team, these cues start to fall in a less extreme and more comfortable range where hunger and fullness are experienced more gently and predictably. By noticing hunger and fullness in more comfortable, and less distressing ranges of sensation, clients learn to better recognize their body’s physical needs and address them before they become unmanageable.

Another key aspect of nutritional philosophy at Oliver-Pyatt Centers is the way we incorporate the Principles of Exposure Response Prevention Therapy to guide our client’s supported interactions with food. Because of our intimate staff to client ratio, we are able to provide a high volume of exposure experiences in a controlled and safe setting. We remind clients that exposures must be repeated and while there is a peak in shame, anxiety, and disassociation, we find that overtime maladaptive responses decrease. To support our clients through daily exposures, meals are reported in a safe setting just prior to exposure experience and intentions for that specific meal are set in a focused and supported environment. These built in, habitual exposures are paired with individualized challenges to address specific eating disorder behaviors and beliefs. We work with clients to quell their anxieties in the moment to work through challenges early on as they continue towards the goal of mindful connection to their experience in the moment.

Throughout each client’s treatment stay, we work to lay a foundation of mindful, and eventually intuitive eating, with the goal of reconnecting mind and body. We believe that after following treatment recommendations and continuing to work toward full recovery, our clients are capable of making peace with food through intuitive eating.

For more information about Oliver-Pyatt Centers, please call 866.511.HEAL (4325), visit our websitesubscribe to our blog, and connect with us on FacebookLinkedInTwitter, and Instagram

Mindful & Intuitive Eating

Posted on September 08, 2016 by StayConnected

Mary Dye_MPH RD CEDRD LDN_Director of Nutrition ServicesOliver-Pyatt Centers Director of Nutrition Services Mary Dye, MPH, RD, CDN, LD/N shares about the complimentary relationship of Mindful and Intuitive Eating in this week’s blog post.  Mary explains the ten principles of intuitive eating and the ways in which you can practice mindful eating in your own life.

Mindful and Intuitive Eating often become confused and used interchangeably. While practicing mindfulness is a necessary step on the path to intuitive eating, the two are actually quite different.

Mindful eating is awareness of all of the components influencing your eating (i.e. emotions, physical cues, timing, access, preference, etc) without judgment. The “without judgment” piece is hugely important as it allows us to observe our eating behaviors without criticizing our patterns.

On the other hand, intuitive eating is a form of attunement of mind, body, and food guided by 10 principles, nicely outlined by Tribole and Resch in their book, “Intuitive Eating.” These principles include eating in response to physical cues (rather than for emotional reasons) along with unconditional permission to eat when cues are present. We are born as intuitive eaters, yet somewhere along the course of life – often we start toying with diets and/or attaching shame and judgment to eating and our bodies, many people lose touch with their internal cues and eat according to external cues such as calorie counts, body weight, rules regarding timing or judgments of “good” and “bad” foods. In intuitive eating we let these external forces go and rely on our internal cues.

10 Principles to Intuitive Eating:

Reject the Diet Mentality

Honor Your Hunger

Make Peace with Food

Challenge the Food Police

Respect Your Fullness

Discover the Satisfaction Factor

Honor Your Feelings Without Using Food

Respect Your Body 

Exercise–Feel the Difference

Honor Your Health

Our aim at OPC is to really dive into the work of mindfulness by noticing what impacts our food choices and responses to food both internally and externally. We discuss everything from what judgments might be held about the food itself, what emotions might be experienced that impact hunger and fullness cues, how the food feels in our bodies and what foods truly satiate us. For instance, when someone reports feeling a lack of hunger before a meal, we dig in and discuss if any emotions might be masking their hunger cue or if a long-held judgment over the food being served is impacting their readiness to have the meal. By acknowledging all of these facets to eating openly to seek support we can help women re-engage in their intuitive cues and learn to respond to them appropriately.

A part of our work that we take very seriously as a clinical team is our modeling of mindful eating behaviors to our clients. There’s something very powerful about women eating and acknowledging their need and desire for food. In our culture it is all too common to hear of women depriving themselves and striving to alter their bodies and deny their need and desire for food. Yes, we’re a busy group of clinicians, but we make time to nourish our bodies in a mindful manner. Our client’s see that and share in it – I believe it is a key to their healing process. I’d love to see more women promoting mindful and intuitive eating to one another. And don’t even get me started on the need for more positive body talk!

At the table we promote the entire mindful experience; considering every detail from a beautiful tablescape and relaxing environment without distractions to thoughtful conversation so clients can fully engage with the meal experience. These are details I find so important in the promotion of mindfulness, whether a person is recovering from an eating disorder or not. Learning to differentiate emotional and physical forms of hunger, fullness, and satiety are a preliminary step to intuitive eating in all of our lives. In doing this we find that sometimes what is needed to satiate us isn’t even food.

As a mother of a 3 year old, I understand how hard it can be to remain mindful on a daily basis. Often, dinner time in my house can feel rushed and distracted after a day of work, the need to start a bath, and complete a pre-schooler’s bedtime routine. It is so important to check in with cues and assess fullness and satiation to ensure intuitive cues are being honored. I sometimes find that what’s lacking for satiation is something as simple as the chance to sit outside after being inside all day or to have a deep conversation with an old friend. Other times, I just need some ice cream. It’s all about taking each eating experience one at a time and not judging what your body needs in that moment, but answering it and moving on. Really, how can any of us feel confident in our food choices and enjoy food if we have a constant feeling of shame and doubt when choosing food and eating it?

Ways you can practice mindful eating:

Sit down at the table to eat without added distractions (yes, I mean turn off the TV)

Step away from the package and take the time to put all foods on a dish

Schedule in breaks from meals and snacks rather than munching while working, driving, or studying

Take time before meals to appreciate the color, aroma, texture, and care taken in the meal prep

While eating, note the flavors and textures of your food

Keep food and body talk positive both at and away from the table

Remember: Food is food; it can nourish our bodies but it can’t solve our problems

 

For more information about Oliver-Pyatt Centers, please call 866.511.HEAL (4325), visit our websitesubscribe to our blog, and connect with us on FacebookLinkedInTwitter, and Instagram.

Article Inspiration

Posted on June 09, 2016 by StayConnected

Join us in reading inspirational and informative articles we have cultivated from across the web. If you have found an article you feel is inspirational, explores current research, or is a knowledgeable piece of literature and would like to share with us please send an e-mail here.

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Anxiety, Fears, and Things That Go Bump in the Night Psychology Today

How Weight Information Can Increase Overeating/Binge Eating Dr. Stacey Rosenfeld

Yoga May Be Good for the Brain The NY Times

If We Treated Ourselves The Way We Treat Our Children Kantor & Kantor Law

How Anorexia Causes a ‘Starved Brain’ Dr. Jen Gaudiani

Understanding Anorexia Nervosa in Males Psychology Today

Binge Eating and Binge Drinking: Same Origins  BEDA

For more information about Oliver-Pyatt Centers, please call 866.511.HEAL (4325), visit our websitesubscribe to our blog, and connect with us on FacebookLinkedIn, Twitter, and Instagram

We are so pleased to feature a guest post on the importance of leaving the diet mentality behind from registered dietitian nutritionist Jenna Hollenstein. You can see her first guest post, Loving your perfect self before improving it, here. To read more from Jenna, visit her blog Eat to Love: redefining fullness, or join her on Facebook, LinkedIn, and Twitter. 

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Letting go of the dieting mentality can feel like one of the hardest parts of embarking on the Intuitive Eating journey. Even as you learn to listen to your own internal signals of hunger, fullness, and satisfaction and to shift your allegiance in this direction, there is a lingering pull toward the seemingly never-ending barrage of eat this, not that; how to ensure that calories in are less than calories out; means of manipulating your metabolism; and whatever superfood or supplement will finally “fix” you.

Doing something that feels so far outside the mainstream can be disorienting at best, which is why one client’s straightforward approach to turning down the noise of dieting struck me as incredibly concrete and relatable. Here’s her 4-point plan with some commentary of my own:

1. “I choose not to consume”

One sure way to decrease the noise of dieting is to not engage with it. If you know that you are vulnerable to being drawn in by these things, reducing your exposure is important. This means not buying the diet books and dieting-focused magazines, not following weight-loss pins, Instagram accounts, Facebook pages, and tweets.

2. “I’m skeptical of what gets through”

No one can eliminate 100% of their exposure to the dieting and weight loss machine. But you can learn to recognize it when it gets through and to question its sources and intentions. Where do they get their information? Is it based in science or anecdote? What are their motives? To sell something? To create dependence on themselves, their program, or their product? To promote weight loss or to sustain health? Are they helping you to become the expert of you?

3. “I make decisions based on health, wellness, and pleasure rather than on what will make me skinny”

When you focus on your own internal signals of hunger, fullness, and satisfaction, you can start to make important connections. What works for you? What, when, and how much do you need to eat to feel content, vibrant, and sustained in your daily activities? What do you enjoy? And what makes you happy?

4. “I don’t participate in the dieting dialogue, food shaming, or fat shaming”

Not participating in diet speak in particular can make you feel like a salmon swimming upstream. At times it feels like everyone else is doing it! Many people, especially women, seem to bond over the commiseration about diet, weight, and their bodies. But taking the risk of doing something different will cut through these superficial connections and help to build real common ground: trust in yourself and a curiosity in others about this approach to true self-care!

For more information about Oliver-Pyatt Centers and newly introduced Embrace, a binge eating recovery program and Clementine, a residential program exclusively for adolescents girls please call 866.511.HEAL (4325), visit our websitesubscribe to our blog, and connect with us on Facebook, LinkedIn, Twitter, and Instagram

Eating in “Peace”

Posted on July 10, 2014 by StayConnected

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We are pleased to share a guest post from Laura Cipullo, RD, CDE, CEDRD, CDN on mindful, and silent, eating. To learn more and connect with Laura please see details at the end of the post. 

No matter our age, our education, or our past experiences, we are always able to learn more… especially new and different things. Two Fridays ago, alongside my peers, Andrea Gitter, MA, LCAT, and Jill Castle, RD, I delivered a presentation on Intuitive Eating and Diabetes to the New York City Nutrition Education Network (NYCNEN). After the presentation, NYCNEN offered the attendees a mindful lunch meal experience. I was super excited to partake with other registered dietitians and to share lunch with some former colleagues. However, when I arrived at the mindful lunch space, I was told we would be, believe it or not, eating in silence.

Ugh! I was not at an Ashram! I was definitely disappointed by this pronouncement. Of course, I wanted to chat and be mindful at the same time. After all, I live in NYC and by genetic make-up am a confirmed, card-carrying multitasker. This was precious time I could be using to write, work and/or run errands. But I quickly had to let this mind set go and embrace the “silent eating.” I listened to our mindful meal leader Rachel Knopf, RD who was wonderful and engaging.

I took out the meal I had brought with me for the occasion: Thai chicken salad over primitive kale salad with two rather small rolls from Hu Kitchen – one of my favorite lunch spots! Rachel handed each luncher a page from Discover Mindful Eating that posed “Five Simple Questions”…

  1. What am I seeing? (bright green, wet kale leaves; red, mush and chunks – Thai chicken salad; toasted brown and shiny lumps, perhaps millet in the little bread-like rolls)
  2. What am I hearing? (crunch of the kale, not much else)
  3. What am I smelling? (the bread has a hearth-like smell)
  4. What am I tasting? (sweet, yet tart while the mini rolls are earthy and hearth like)
  5. What am I touching or feeling? (the rough texture of the goji berries, the wet kale leaves, the cool temperature of the chicken salad)

I immediately thought to myself… I already know to use my five senses when eating! I just want to talk with these fascinating women. But then I reminded myself that I surely could learn from this “silent” experience… and I did. When we are truly quiet and have nothing to do but pay attention to our food and/or our body, the experience of eating becomes like no other. While I regularly lead mindful meal groups, this experience was truly different because there was absolutely no speaking – from start to finish. Although there were people around me, I sat totally immersed in my own thoughts. I observed how I would so easily and quickly move from concentrating on my five senses while eating to diverting to my to-do list and what I wanted to chat about with my colleagues. Back and forth. Back and forth. I chuckled at the idea that I was really not doing a very good job of being mindful. I thought this must be what it feels like for my clients when they can’t settle their thoughts or focus on their meals. But just then I noticed this ever so slight change seeming to indicate I was about full. I thought to myself: “Will this hold me for about three hours?” I wasn’t 100% percent sure… or 100% full. As I sat there, I noticed that I still had a physical need to eat more. So I took a few more bites. The experience reminded me of the very subtle feelings of fullness and the need to return to quiet at times during my own meals so that I can really check in with my internal cues. Note to self: I need to be more mindful than I have been of late.

So what else did this “quiet” experience teach me? Well, Rachel helped me understand that in the world of meditation, mindfulness is simply the act of observing our present thoughts. She helped me recognize that my thoughts about eating versus my thinking about my to-do list actually were the mindfulness. And switching back and forth between the two was 100% appropriate because I was both aware and observing. I also decided it may be helpful to engage in this “silent eating” experience with the women who work with me. There is something transcendent about eating in peace and quiet for an entire meal. I typically encourage people to start with the first few bites only. But if tolerable, it would be an extraordinary learning opportunity to eat a complete meal or snack in silence while observing personal thoughts. I am so thankful to Rachel and this experience because, quite honestly, I never would have sat down for a meal with a bunch of friends or colleagues and even dared to suggest being 100% mindful instead of talking. And by the way, I also realized that I didn’t care for the Thai chicken salad or the little bumps of bread, but I absolutely love Hu’s kale salad!

So now, I challenge all of you to arrange a meal or snack where you eat in peace and quiet at least once! We would love to hear what you learn!

Connect with Laura Cipullo, RD, CDE, CEDRD, CDN through her website and blog, Laura Cipullo Whole Nutrition Services, Facebook, Twitter, and YouTube. To contact Laura and the Whole Nutrition services team call 917-572-7137 or e-mail here.

 

How Do I Know When I’m Hungry?

Posted on June 10, 2014 by StayConnected

A big thank you to our guest contributor Dr. Jamie Long for her wisdom and insight in regards to emotional and intuitive eating. To read more from Dr. Long and to follow her on social media, please refer to the end of this post. 

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Imagine you’re sitting on the couch enjoying a cozy night at home when you see a commercial advertising scrumptious looking cookies. Suddenly you have a severe hankering for some chocolate chips. Where did that come from? Are you really hungry or just impacted by the power of suggestion and advertising? This all-too-familiar scenario has many of us questioning how to tell when we are truly hungry or dealing with an emotional craving.

Oftentimes food cravings caused by emotions are confused as physical hunger cues. Food is tangled with many emotions in our culture such as boredom, celebration, pleasure, reward, etc. Most people can relate to noshing on a little something when there’s nothing else to do and that’s okay. But if emotional eating is impacting your happiness or your health, it’s important to learn how to recognize the difference between emotional and physical hunger.

What is Emotional Eating?

The term emotional eating is often used interchangeably with compulsive overeating and food addiction. Regardless what you call it, emotional eating describes a behavioral pattern of ignoring physical cues of hunger and satiety and eating in response to an emotion. Emotional eaters may engage in frequent episodes of uncontrolled eating, or binge eating, during which he or she may feel out of control — often consuming food past the point of being comfortably full. Emotional eaters may also engage in grazing behavior (eating continuously throughout the day,) resulting in a high number of calories consumed even if the quantities eaten at any one time may be small.

How to tell the difference between emotional and physical hunger:

  • Emotional hunger comes on suddenly; physical hunger comes on gradually
  • Emotional eating tends to be more mindless (in front of the TV, computer, while playing on a gadget)
  • Physical hunger is usually felt in the gut, with a growling stomach or nausea. Emotional hunger comes more from the head (fantasizing about the taste of a particular food item)
  • Emotional food cravings are usually specific; physical hunger is open to various food options
  • Emotional eating passes the point of fullness (satiety) and often results in negative feelings (guilt, shame, etc.)

Tips to Combat Emotional Eating

Most people succumb to emotional eating from time-to-time, so don’t beat yourself up if this blog post describes your behaviors. However, if emotional eating has interfered with your quality of life in some way, it’s important to take steps to combat it.

  • Identify your triggers. Take notice of the times you tend to crave food. What time of day is it? How long has it been since you last ate? What are you feeling and what is going on around you?
  • Have a competing response ready before cravings begin. If you notice that you tend to feel hungry when you are bored, think of something pleasurable to do instead of going for another helping of food. Eating is a rewarding behavior and it can be overused when we feel deprived of life’s pleasures. Think of a handful of enjoyable things to do that don’t include food.
  • Add more tools for coping. Find ways to cope with feelings rather than using food as a way of soothing. Make peace with all foods and challenge negative internal/external messages about eating. Nurture yourself and strive for a balanced and rewarding life with breaks from stress. And as always, make sure you are getting enough rest & exercise.

What is Normal & Healthy Eating?

In short, normal eating is nourishing your body with nutrient-rich foods and enjoying treats free of guilt. Normal eating is honoring your hunger and your fullness. Normal eating is flexible (it’s okay to have cake!) and it is also responsible. Healthy eaters do not restrict or abuse food.

In counseling those who struggle with disordered eating patterns, several specialists ascribe to a non-diet nutrition philosophy called Intuitive Eating. I.E. is based on the belief that most people instinctually know how to eat. It emphasizes an adaptive relationship between food, mind, and body by making peace with food and normalizing eating patterns. Intuitive Eaters recognize and distinguish the difference between physical and emotional feelings and maintain a stable, healthy weight without depriving themselves or overindulging in food. Two dieticians — Evenly Tribole and Elyse Resch — coined the phrase Intuitive Eating in their 1995 book which is now in its third edition. Click here to learn more.

Have a question for Dr. Jamie or want to learn more about her services?  Visit DrJamieLong.com or email: dr.jamie@bayviewtherapy.com


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Copyright © Finding Cloud9, Dr. Jamie Long

A big thank you to our guest blogger Page Love, MS, RD, CSSD, LD, President of NutriFit Sport Therapy, for sharing her insight into compulsive exercise: how to spot it, the damage it can cause, and how to create a mindful and positive exercise experience. To learn more from Page and NutriFit, follow her on Facebook and Twitter.

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Many of us have been influenced by the diet and exercise obsessed culture and have been pushed to an extreme to over-exercise. But, for many, they are not aware that their exercise routines are abnormally excessive. For many of us, we choose exercise as a coping tool for stress and feeling overwhelmed. Many of my clients report decreases in anxiety when over-exercising, yet do not realize that they are hurting their bodies and creating imbalance in their lives in other ways.

You may be struggling with over-exercise if:

  • You have to exercise every day
  • You are consumed by the need to exercise and are upset when you miss a session
  • Depressed, irritable, and anxious when forced to stop
  • You are always thinking about calorie-burning from exercise
  • Your responsibilities and relationships suffer or friends, family, and work take a backseat to exercise
  • You develop physical problems such as muscle tension and soreness, decreased appetite, and constipation and you continue to train at the same intensity
  • You continue to exercise even when it is medically, vocationally, and socially contraindicated

Our society does not openly discuss the side effects of exercise obsession. Here are some physical and psychological consequences to compulsive exercise that are medically significant, may require medical attention, and can cause permanent damage if left untreated or unaddressed:

Physical

  • Stress fractures
  • Tendonitis
  • Damaged bones, joints, tendons and ligaments
  • Irregular menstruation/amenorrhea
  • Osteoporosis
  • Chronic fatigue
  • Malnutrition
  • Anemia
  • Dehydration
  • Fatigue
  • Insomnia

Psychological

  • Obsessive thoughts
  • Compulsive behaviors
  • Self-worth measured only in terms of performance
  • Abandoned relationships
  • Damaged career
  • Lower grades in school
  • Depression
  • Anxiety
  • Social isolation

What can you do to set reasonable limits on your exercise and develop and more normalized and balanced movement routine:

  • Allow at least 2 rest days per week
  • Do not exceed one hour cardio sessions
  • Consider alternating cardio and strengthening sessions on alternating days
  • Go to a smaller or different gym where less equipment is available or one where your exercise equipment of choice is not available
  • Slowly step down your program by decreasing duration and frequency and changing mode
  • Try cross training with varying activities
  • Consider a personal trainer to help you maintain healthy boundaries
  • Join classes that are led by exercise leaders – aerobic dance, stretching, jazz, yoga, Pilates, kickboxing, etc.
  • Ask a friend or family member to exercise with you to help with containment
  • Give your exercise shoes to someone else, even if it is just temporarily until ready to approach your routine more reasonably
  • Consider an alternative, less physically demanding sport or activity
  • Try a low-impact activity such as playing golf and using a cart or an exercise with natural conformity, such as yoga
  • Do not work in or spend extra time at or near a gym
  • Do not wake up early to allow time to exercise, but also set a limit on how much sleep you get every night
  • Vary your routine and include more “fun” activities as alternatives, such as biking,climbing , boating, canoeing, kayaking, rollerblading, camping, etc.
  • If you have chosen over-exercise as a way of dealing with stress, consider exploring why you are choosing to over-exercise, through journaling or therapy, and what other healthier ways you can choose to manage your stress

If you feel you struggle with over-exercise to an extreme, consider reaching out for guidance and support to a psychotherapist, registered dietitian, or certified strength trainer who have experience working with exercise addiction and over-exercise. The following organizations may be helpful in finding a certified professional that may be a good fit for you:

We are pleased to share a segment from Registered Dietician Kori Kostka that was recently published on The Association for Size Diversity and Health. For the full piece, please visit the Health At Every Size blog here.

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Sometimes we all need a little R&R (what I like to call rest and rejuvenation,) taking a break from the work we do so that we can come back with a fresh perspective. Over the last several months I have had the opportunity to attend conferences and visit people working towards a health approach. Currently, I work as a registered dietitian in a Family Health Team just outside of Toronto, Canada where I have been practicing Health At Every Size® (HAES®) for the last several years. A Family Health Team is a unique place to work because of the extended resources available and coverage offered by the Ontario Health Insurance Plan (OHIP) that go above and beyond the traditional family doctor’s office. Our Family Health Team is fortunate to have an amazing group of social workers, a pharmacist, doctors, nurse practitioners, and nurses.

Implementing a HAES approach at our Family Health Team has been exciting, challenging, energizing, exhausting, and everything in between. I am ever so thankful that I can reach out to the people who “get it”—like colleagues on various HAES networks, which fortunately seem to be plentiful these days! Recently I have had the pleasure of organizing one of these, a local Greater Toronto Area HAES Professionals Network, which includes a range of participants beyond registered dietitians, like social workers, nurses, teachers, moms, exercise physiologists, and personal trainers. So far, we have held three meetings to work on building and developing the network, and showcase various speakers and topics such as: the National Eating Disorder Information Centre (NEDIC), The Difference between Fitness and Fatness, Intuitive Exercising, Mindful Eating and Marketing a HAES Approach. We have also explored several challenges and gaps within our communities that would benefit from the development of local subcommittees, for example, on how to prevent and manage the increased prevalence of disordered eating and eating disorders in the youth population. […]

Our visit at OPC was packed with a full day of visiting the grounds, various buildings, residential apartments, eating yummy food (of course!) and meeting almost the whole OPC team who function very cohesively. Most impressively, they utilize and share common language and messaging no matter their role, and complement and reinforce each other’s work with the aim of coaching patients back to intuitive and mindful eating habits. Part of a patient’s treatment includes visiting restaurants and eating once “forbidden” foods with the accompaniment of the therapist and/or dietitian to provide extensive coaching and support. Together, the patient and team member work through the experience of dining in a social environment and overcoming the fear of food while addressing other emotions or anxiety that accompany the dining experience.

As a registered dietitian, I most enjoyed meeting with Mary Dye, the Director of Nutrition Services, and the other registered dietitians at the center. I asked Founder and Executive Director Wendy Oliver-Pyatt a question that I recall being asked at the ASDAH conference in 2013 on whether or not we should be so focused on a patient’s weight during treatment for an eating disorder. Her response involved the many side effects of patients who are not adequately nourished as evidenced by being severely underweight: the inability to concentrate and make conscious decisions, altered moods, increased anxiety, weakening of the cardiovascular system and the inability to respect hunger and fullness cues. The best tool we have to identify if a patient, particularly one with anorexia nervosa, has restored his/her nourishment is to compare current body weight to “ideal” body weight. The nutrition team added to this response later in the day by explaining how at the patient level, rather than focusing on calories and weight, they coach patients using intuitive and mindful eating practices, which works well regardless of an individual’s eating disorder type and degree of illness. Part of this coaching involves the use of beautiful laminated, colorful cards, which list hunger and fullness levels on one side and various emotions on the other. At each meal, patients sit with a team member to help identify their hunger and fullness levels and how they are feeling before and after. In the beginning, it can often be difficult to feel these cues and connect them to emotions, but patients are encouraged to take part in this exercise no matter where they are in the recovery process. Mary commented that often, as patients progress through their recovery journey, these cues change and become easier to sense, especially once detangled from the emotional component.

I went to OPC hoping to simply learn about the program, but I came away with a focus on how we could use a similar approach in primary care. Last month, I and one of our primary care physicians shared our experience of implementing HAES principles to the Peterborough Family Health Team. One of the physicians in the audience commented that dietitians need to be consistent with their messaging. He’s right, but not only do dietitians need to be consistent, there is a need for all of us working within nutrition to work intersectorally and to share the same language. It excites me to think that we are on the horizon of integrating Health in All Policies in Ontario, which may be the evidence-based solution to an intersectoral approach or perhaps a universal Canadian nutrition policy that just might parallel the Health At Every Size approach. We can always learn from the frameworks used in other practices, like how Oliver Pyatt Centers works collaboratively in healing eating disorders to ultimately promote a healthy lifestyle and minimize unintended consequences. Many of us encounter daily challenges of practicing HAES, whether it is resistance from our clients, our colleagues or society. Sometimes we need to take a step back from our individual HAES settings and look at the good that is going on in the world. If you were to look back a few years ago, would you have known as much about the HAES model as you do today? Would you have heard as many success stories? I sometimes watch Dr. Ivan Joseph’s TED talk on self-confidence and he recommends to write your own “brag sheet” so that you can look back and read all of your HAES successes, big or small. Maybe it does not have to be as much of a “brag sheet” as a way to show the HAES movement is growing and gaining momentum. And I am thankful to have each of you on my team!

Mindful and Intuitive Eating

Posted on April 22, 2014 by StayConnected

We are pleased to share a post from Director of Nutrition Services Mary Dye, MPH, RD, CDN, LD/N on the complimentary relationship of Mindful and Intuitive Eating, including the ten principles of intuitive eating and the ways in which you can practice mindful eating in your own life. 

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Mindful and Intuitive Eating often become confused and used interchangeably. While practicing mindfulness is a necessary step on the path to intuitive eating, the two are actually quite different.

Mindful eating is awareness of all of the components influencing your eating (i.e. emotions, physical cues, timing, access, preference, etc) without judgment. The “without judgment” piece is hugely important as it allows us to observe our eating behaviors without criticizing our patterns.

On the other hand, intuitive eating is a form of attunement of mind, body, and food guided by 10 principles, nicely outlined by Tribole and Resch in their book, “Intuitive Eating.” These principles include eating in response to physical cues (rather than for emotional reasons) along with unconditional permission to eat when cues are present. We are born as intuitive eaters, yet somewhere along the course of life – often we start toying with diets and/or attaching shame and judgment to eating and our bodies, many people lose touch with their internal cues and eat according to external cues such as calorie counts, body weight, rules regarding timing or judgments of “good” and “bad” foods. In intuitive eating we let these external forces go and rely on our internal cues.

10 Principles to Intuitive Eating:

  1. Reject the Diet Mentality
  2. Honor Your Hunger
  3. Make Peace with Food
  4. Challenge the Food Police
  5. Respect Your Fullness
  6. Discover the Satisfaction Factor
  7. Honor Your Feelings Without Using Food
  8. Respect Your Body
  9. Exercise–Feel the Difference
  10. Honor Your Health

Our aim at OPC is to really dive into the work of mindfulness by noticing what impacts our food choices and responses to food both internally and externally. We discuss everything from what judgments might be held about the food itself, what emotions might be experienced that impact hunger and fullness cues, how the food feels in our bodies and what foods truly satiate us. For instance, when someone reports feeling a lack of hunger before a meal, we dig in and discuss if any emotions might be masking their hunger cue or if a long-held judgment over the food being served is impacting their readiness to have the meal. By acknowledging all of these facets to eating openly to seek support we can help women re-engage in their intuitive cues and learn to respond to them appropriately.

A part of our work that we take very seriously as a clinical team is our modeling of mindful eating behaviors to our clients. There’s something very powerful about women eating and acknowledging their need and desire for food. In our culture it is all too common to hear of women depriving themselves and striving to alter their bodies and deny their need and desire for food. Yes, we’re a busy group of clinicians, but we make time to nourish our bodies in a mindful manner. Our client’s see that and share in it – I believe it is a key to their healing process. I’d love to see more women promoting mindful and intuitive eating to one another. And don’t even get me started on the need for more positive body talk!

At the table we promote the entire mindful experience; considering every detail from a beautiful tablescape and relaxing environment without distractions to thoughtful conversation so clients can fully engage with the meal experience. These are details I find so important in the promotion of mindfulness, whether a person is recovering from an eating disorder or not. Learning to differentiate emotional and physical forms of hunger, fullness, and satiety are a preliminary step to intuitive eating in all of our lives. In doing this we find that sometimes what is needed to satiate us isn’t even food.

As a mother of a 3 year old, I understand how hard it can be to remain mindful on a daily basis. Often, dinner time in my house can feel rushed and distracted after a day of work, the need to start a bath, and complete a pre-schooler’s bedtime routine. It is so important to check in with cues and assess fullness and satiation to ensure intuitive cues are being honored. I sometimes find that what’s lacking for satiation is something as simple as the chance to sit outside after being inside all day or to have a deep conversation with an old friend. Other times, I just need some ice cream. It’s all about taking each eating experience one at a time and not judging what your body needs in that moment, but answering it and moving on. Really, how can any of us feel confident in our food choices and enjoy food if we have a constant feeling of shame and doubt when choosing food and eating it?

Ways you can practice mindful eating:

  • Sit down at the table to eat without added distractions (yes, I mean turn off the TV)
  • Step away from the package and take the time to put all foods on a dish
  • Schedule in breaks from meals and snacks rather than munching while working, driving, or studying
  • Take time before meals to appreciate the color, aroma, texture, and care taken in the meal prep
  • While eating, note the flavors and textures of your food
  • Keep food and body talk positive both at and away from the table
  • Remember: Food is food; it can nourish our bodies but it can’t solve our problems

We are excited to feature a guest post from Marci Anderson. Marci is a  Certified Eating Disorder Specialist who manages a group practice in Cambrige, MA. To read more from Marci, please visit her blog or you can follow her on Twitter and Facebook.

When you have a healthy relationship with food then…

How would you finish this sentence? Kaleigh, from HugStronger asked me this question and given the culture of eating in the U.S. it’s a really important one. We live in a society that conflates health with morality, size with success, and appearance with identity. This takes a toll on our feelings of self-worth and ability (or lack thereof) to measure up. Our food landscape is over-processed and over-abundant while the sub-text speaks to the virtue of self-denial. How utterly confusing. The line between clinical eating disorders and culturally accepted dieting and body hating continues to blur. Many people feel as if they are living in a food and body prison with no way out. In short, I will never be out of a job.

So this brings us back to what a healthy relationship with food looks like. Here’s my top 10:

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1. Eating is often enjoyable- full of flavors and textures you truly love.

2. Eating doesn’t define you as a person. Your sense of self-worth doesn’t increase or decrease based on what you eat in a particular day.

3. Eating requires some forethought and planning but food does not pre-occupy the majority of your thoughts.

4. Eating is flexible in terms of timing and variety.

5. Eating does not result in feelings of guilt or shame.

6. Eating is motivated by internal cues of hunger and fullness most of the time.

7. When eating or thinking about eating you can feel relaxed and at ease.

8. Sometimes you eat food solely for the pleasure of eating, regardless of nutritional content.

9. Balanced, nutritious eating comes naturally because of your connection to how certain foods make you feel physically and the emotional tug of war is not present.

10. Eating is viewed as a way to take good care of yourself.

These are my top 10. What would you add to the list?

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Thank you to guest blogger, Dr. Matthew Lissak, MD. We are honored to share his thoughts on one of the commonly misunderstood myths of eating disorders. For more blog posts from Dr. Lissak, take some time to view his blog here

There’s a myth about eating disorders that people can’t really fully recover. I have encountered many clinicians in the community who may not state this directly but organize treatment as if these were incurable, chronic illnesses. Even people who know little about eating disorders often ask me if any of my patients get better, fully expecting the answer to be no. This commonly held myth is widely believed and leads many people seeking treatment to give up hope.

To be honest, I’ve thought a lot about why eating disorders are viewed this way. The body of medical and psychological literature reports that people can get well. There are many books of recovered people describing their painful, but ultimately successful, path to full recovery. There are many clinicians who have fully recovered themselves. So if all the easily found information doesn’t propagate a message of hopelessness, where does this myth come from?

I think the first culprit is the belief that having an eating disorder is a lifestyle choice, not a devastating illness. Although media outlets don’t state this directly, there are very regular headlines that infer that restricting food intake and increasing exercise to maintain very thin weights are the ideal lifestyle choices one can make, not the signs of an illness.

Accordingly, it can be difficult for many people to differentiate between these supposedly “healthy” goals and an eating disorder. In fact, many magazine articles imply that choosing to eat less and overexercise is simultaneously healthy and synonymous with eating disorders, an extremely confusing and contradictory message.

The truth is that people with eating disorders struggle to eat every meal, not because of vanity, but because it’s a symptom of an illness. To most people, it’s almost unthinkable to have trouble eating, so it only makes sense to view eating disorders as a lifestyle choice. When people cannot comprehend something, they will concoct a theory that makes sense to them, so explaining to people that not being able to eat is a symptom, rather than a choice, is very challenging.

The second likely cause for the myth has to do with how long people stay sick. Many patients are sick for a long time before seeking help and, once they take the first step, experience treatment with a clinician who isn’t knowledgeable about eating disorders. These initial forays into therapy imprint the idea that treatment won’t ever really make a difference. It also means that many patients are sick for years before starting a true path to recovery. That extended time without much change in the illness makes it appear to others that eating disorders are lifelong. For friends and family, it’s not surprising that they start to believe this will be a chronic curse, an inescapable maze the person is trapped in for life.

I have written much in this blog about family support. Bridging years of separation caused by the eating disorder is challenging but critical to recovery. I find that a significant part of recovery rests on being able to educate families and patients that eating disorders are curable. This step can invigorate all involved to muster enough energy and attention through the difficult process of getting better.

The raw, painful, emotional experience of nourishing oneself and re-entering life doesn’t look like getting better, at first. The person usually seems to have things more together when she was even sicker because the eating disorder symptoms numb any emotions. Starting to eat again instead unleashes these feelings. If family and friends work hard to understand that the painful process is necessary to lead to full recovery, the chance of really getting better goes up significantly. There’s one other reason our society has trouble seeing people with eating disorders get well. It has to do with how we glorify these illnesses. Idealizing thinness, even being clearly underweight, reflects our collective understanding about eating disorders. The process of getting sick with an eating disorder is encouraged by the outside world. There are too many stories of adolescent girls enjoying praise as they lose weight only to find that they cannot stop the descent into an eating disorder.

As long as we make extreme thinness a goal, we will conflate desire with disease. In this case, how can anyone see an eating disorder as curable? Part of shattering the myth that eating disorders are lifelong is convincing people that there is nothing desirable about being too thin or about being sick. No one would choose a lifestyle that strips so much of life away.

e=mc²

Posted on March 04, 2014 by StayConnected

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We are pleased to share a thought-provoking guest blog post from Jodi Rubin, a Certified Eating Disorder Specialist in private practice. To read more from Jodi please visit her blog

Energy = Mass x Speed of Light (in a vacuum) squared

What is energy? Intensity or vitality of action or expression.

All energy can be transformed or converted into different types of energy. Energy can also be refocused. The laws of physics state that total energy remains the same while only the type and focus changes.

It seems that people tend not to consider their energy until it is depleted. At that point, they feel frustrated that they can’t engage in things but think less about their relationship with their energy. So let’s think about it together…

Where do you direct your energy? Do you even think about it? Are you discerning? How do you decide where to invest your time and your energy?

How do you balance your energy? We live in a world that leans in the direction of multitasking. It is impossible to be fully engaged when you are multitasking. Energy is not well used and is often wasted when there is too much going on. Did you ever read an email in the flurry of your day and realize later that you misread it? I certainly have. Consider multitasking less than you do. Notice the difference in your efficiency when you carve out some time and focus on only one thing. Notice how much less energy this takes.

How do you conserve your energy? Conservation of energy is critical in order to not become depleted, overspent and crushed by exhaustion. Your energy is your currency so treat it respectfully and wisely. Manage it well and it will work better for you!

How do you restore your energy? What do you find to be restorative? What is nourishing to you? What helps you breathe deeper? How often do you make room for these things? Is it a priority for you? If not, why? How do you imagine things will change for you if you prioritize restoration in your life?

Remember, it’s your energy and if you stay conscious of it, then all of the above become your choice!

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Executive Director Dr. Wendy Oliver-Pyatt, M.D., FAED, CEDS and Clinical Director Stephanie Diamond, Ph.D. share an excerpt from an upcoming presentation, “Exposure, Refeeding, and the Development of Mindfulness in the residential treatment of Anorexia, Bulimia, and Binge Eating Disorders,” at the Eating Disorder Information Network in Atlanta, Georgia on February 21, 2014. Dr. Diamond’s clinical and research interests include women’s issues in general, and eating disorders in particular, as well as comorbidity and personality style. Prior to working at Oliver-Pyatt Centers, she had worked as part of an Eating Disorder Unit in Montreal, Canada; had facilitated various eating disorder support groups; and had treated women who struggled with eating disorders on an outpatient basis. Her clinical style can best be described as interpersonal, individualized, and strength-based. 

Would a person with an elevator phobia overcome their elevator fear by taking the stairs?  This is a question we pose on Family Friday at Oliver-Pyatt Centers to help families understand the phobic paralysis that their loved ones may experience around food.

Patients with eating disorders often lack an internal compass to guide them intrapersonally, interpersonally, and in their relationship with food. Without an internal compass, a person with an eating disorder is unable to navigate their relationship with food, clinging to their eating disorder thoughts as their only pathway. The person affected by the eating disorder is alone, ricocheting off of intrusive irrational and judgmental thoughts and emotions, resulting in fear-based living.  The decision to enter treatment is terrifying in that on some level the patient may recognize that treatment means facing these fears– entering the elevator.

Eating disorders are both phobias and disorders of the self. In residential treatment, we are working to address both aspects via exposure and the development of mindfulness. Humane treatment must encompass an understanding and sensitivity to the enormity of the food phobia, and the need to challenge these fears experientially through exposure. Mindfulness is an integral part of the gateway to a new paradigm and provides a foundation upon which the patient can develop trust in self and subsequently develop an internal compass. An attuned response from the provider is critical to the work. Without an attuned response, the provider can either under-expose/insufficiently challenge, or over-expose/flood the patient. The attuned response is also important in the development of mindfulness. It is often through the therapeutic relationship that the patient develops a self, and the capacity to tune into the developing self, creating a foundation for trust.

The refeeding process is where the rubber meets the road– it is the cross section of phobia, exposure, development of self, mindfulness, physical healing, and psychological healing. It is imperative that nutrition treatment takes into account the medical and psychological healing processes. Furthermore, in understanding the eating disorder as a phobia, and exposure as the treatment, the relationship with the provider is the conduit that will lead the person through the difficult process of exposure therapy.

When a patient asks us, how much weight they will gain, they are asking us to be careful with them as they enter the elevator and need comfort, security, reassurance, and an attuned guide who will find their “doable edge” as they ascend in their healing process.

To attend this presentation, and earn 2 CEU’s, please RSVP to Colleen Stephens by February 17, 2014. The event will be held on Friday, February 21, 2014, 8:30am at the Villa Christina Restaurant at Perimeter Summit, 4000 Summit Boulevard, Atlanta, Georgia.

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